Radioonkologische Aspekte des Zervixkarzinoms

Chemoradiotherapy is an integral component of cervical cancer treatment in cases where surgery alone is not sufficient to achieve an optimal oncological outcome. The present German interdisciplinary guidelines on treatment of cervical cancer recommend performing either radical hysterectomy or primary chemoradiotherapy. The frequently used practice of trimodal therapy (i.e. radical hysterectomy, radiation and chemotherapy) doubles the risk for treatment-related delayed toxicity and should be avoided whenever possible. If risk factors are known prior to therapy, e.?g. lymph node metastases, parametrial infiltration or a combination of tumor size >4 cm, grade 3, lymphovascular space invasion (LVSI) or deep stromal infiltration, primary chemoradiotherapy should be recommended. The purely clinical FIGO classification does not consider lymph node involvement. This leads to a high rate of adjuvant chemoradiotherapy after radical surgery due to lymph node involvement. This could have been avoided in 90?% of patients, if surgical (laparoscopic) lymph node staging would have been used routinely. Whether this can result in advantages for patients with respect to the prognosis, was one of the aims of the Uterus-11 study of the working group for gynecological oncology (AGO) and the working group on radiological oncology (ARO).Mature data are expected to be available in 2018. For chemoradiotherapy sophisticated irradiation techniques should be used, which are available in all German treatment facilities. This is the only way to reduce acute and delayed side effects. Although ovarian preservation by ovarian transposition and organ sparing can be provided to premenopausal patients, a pregnancy after full-dose chemoradiotherapy is unlikely because of the resulting atrophy of the endometrium and fibrosis of the myometrium. Oncological results depend on treatment quality, full-dose external beam radiation, the use of brachytherapy and the administration of concomittant chemotherapy. The experience of the treatment facility is a predictor for patient outcome. The value of neoadjuvant chemotherapy in locally advanced cervical cancer is unclear and still under discussion.     

Aktuelle Aspekte zur Therapie des Nierenzellkarzinoms

A definitive curative treatment exists only for localized renal cell carcinoma (RCC) by surgical resection. The prognosis for metastatic renal cell carcinoma (mRCC) is still comparatively limited. With the introduction of the targeted therapy in 2006, a significant improvement in overall survival (OS) and progression-free survival (PFS) was achieved. In 2016 the approval of the PD-1 inhibitor nivolumab enhanced the therapy spectrum of second-line treatment with a new class of active substances. For first-line treatment there is still a high therapeutic need for additional treatment options to achieve a relevant survival benefit and a sustained and improved response to treatment. The systemic therapy of mRCC currently comprises a total of 11 different targeted drugs from 4 different substance classes.     

Neue Aspekte der Pathologie des Nierenzellkarzinoms

New treatment options for renal cell cancer have increased the interest in the histogenesis and in molecular alterations of renal tumors. The current WHO classification of renal cancer is based on specific molecular alterations and characteristic biologic behavior. During recent years novel tumor types have been identified with immediate impact for the selection of new treatment modalities. In this review the current classification of renal cancer with special emphasis on novel renal tumor types will be discussed. Knowledge of Xp11 translocation carcinomas and renal tumors with characteristic cyst formation is diagnostically relevant. In addition this review focuses on reassessing the current TNM staging system for renal cell cancer. Retrospective studies have shown the relevance of renal sinus invasion for stage evaluation.     

Pathologisch-diagnostische Aspekte neuroendokriner Tumoren des Gastrointestinaltrakts

Gastroenteropankreatische neuroendokrine Tumoren (NET) sind bezüglich ihres Differenzierungsgrads, der Lokalisation, Hormonproduktion und Prognose heterogen. Sie treten überwiegend sporadisch, aber auch famili?r z. B. bei der multiplen endokrinen Neoplasie Typ 1 und dem von-Hippel-Lindau-Syndrom auf. Die komplexen Manifestationsformen spiegeln sich in den differenten bisher verwendeten Definitionen, Terminologien und Gradierungen von NET wider. Die allgemeinen Bezeichnungen “Karzinoid” bzw. “endokriner Pankreastumor” oder die funktions- bzw. funktionalit?tsbezogenen Termini “Insulinom, Gastrinom, Somatostatinom” vermitteln nicht, ob die Neoplasien als benigne, potenziell maligne oder eindeutig maligne einzustufen sind. Neue molekular- und zellbiologische Entwicklungen auf dem Gebiet der Neurobiologie leisteten einen entscheidenden Beitrag zur Identifizierung und Charakterisierung von NET und bilden heute auch die Grundlage der aktuellen pathologisch-diagnostischen Beurteilung, auf deren Aspekte der folgende Beitrag eingeht.     

Strahlentherapeutische Aspekte bei der Behandlung des Kolonkarzinoms

Radiotherapy is an integral part of the multimodality treatment for locally advanced rectal cancer. Conversely, for patients with colon cancer there is generally no indication for radiotherapy after R0 resection due to the lower risk of locoregional failure. Randomized trials could not show a benefit of postoperative radiochemotherapy (of the tumor bed or the liver) even in subgroups with an increased risk of recurrence. Preoperative radiochemotherapy can be considered for patients with T4 colon cancer when R0 resection is jeopardized. For liver metastases, stereotactic radiotherapy is an effective non-invasive treatment approach.     

Neue technologische Aspekte bei der Bestrahlung des Prostatakarzinoms

Radiotherapy is a well accepted treatment modality for patients with localised prostate cancer. Nevertheless, a variety of new technological developments will further increase the value of this treatment approach. In this regard, a wider use of intensity-modulated radiotherapy (IMRT) will result in even lower toxicity rates with increased coverage of tumor tissue. However, the use of IMRT with reduced margins mandates a more precise visualisation of treatment positioning. In this regard several new technologies including cone beam CT, implanted gold markers or radio transponders as well as ultrasound-based positioning systems have entered clinical practice. In addition, it becomes increasingly clear that the integration of various imaging modalities (MRI, MR spectroscopy, PET CT, SPECT sentinel imaging) into the process of treatment planning results in a more precise definition of target volumes. However, for most of the putative applications, only trials documenting the clinical feasibility are available. Nevertheless it is obvious that many of the new technological approaches will become part of the clinical routine for prostate cancer in the course of time.     

Wichtige Studien vom ESMO

best practice onkologie -     

Verschiedene Aspekte des onkologischen Qualitätsmanagements in der Pathologie

Quality control as one part of quality management has a long tradition in pathology, and has been revitalized in recent years by a variety of factors. In the process of quality management several aspects of quality in the field of oncological pathology are considered. Laboratory quality assurance practices have been used to track error rates and laboratories are starting to use these data for error reduction initiatives. Attempts to optimize the results of outcome quality are beginning to pave their way. The development has been stimulated by the necessity to thoroughly control molecular pathology techniques in the form of blind trials resulting in continuing quality assurance procedures.     

Wichtige Studien vom ASH 2021

best practice onkologie -     

Wichtige Studien vom ASH 2022

best practice onkologie -     

Wichtige Studien vom ASH 2021

best practice onkologie -     

Wichtige Studien vom ASH 2021

best practice onkologie -     

Rechtliche Aspekte der Teleradiologie

Ohne Zusammenfassung     

Pathohistologische Aspekte der Sentinel-Lymphknoten-Biopsie

Das Konzept des Schildwächterlymphknotens (im Folgenden soll der englische Ausdruck Sentinel-Lymphknoten gebraucht werden) ist eine der wichtigsten Entwicklungen in der klinischen Onkologie der letzten Zeit. Eine besondere Bedeutung beim Sentinel-Lymphknoten-Konzept fällt der Pathologie zu, sowohl bezüglich der Aufarbeitung des Sentinel-Lymphknotens als auch bei der Klassifikation der Befunde. Es ist in den letzten Jahren deutlich geworden, dass die Wertigkeit der Methode entscheidend vom Zusammenspiel zwischen nuklearmedizinischer Diagnostik, chirurgischer Expertise und pathohistologischer Untersuchungstechnik geprägt wird. Es soll daher nachfolgend eine Übersicht über die wichtigsten pathohistologischen Aspekte der Sentinel-Lymphknoten-Biopsie und ihre diagnostische und prognostische Relevanz gegeben werden.     

Palliativmedizinische Aspekte beim kleinzelligen Lungenkarzinom

Context

Small-cell lung cancer (SCLC) is an aggressive tumor with an unfavorable prognosis. There are only very limited data on the effectiveness of palliative care interventions for this disease.

Method

Selective review of the literature.

Results

Compared to other tumor types there is a more frequent and more severe symptom burden. Paraneoplastic syndromes, for instance, are seen more frequently compared to other tumor types. Given the high rate of cerebral metastases and the indications for prophylactic cranial irradiation there is a substantial risk of developing cognitive impairment. Therefore, SCLC appears to be a disease with a high need for early palliative care interventions.

Conclusions

Early palliative care can improve the quality of life of cancer patients. Furthermore it helps reduce the aggressiveness of cancer treatment near the end of life. The higher number of advance directives achieved in patients with early palliative care helps in the planning of critical situations during the course of the disease.     

Urologische Aspekte in der Palliativmedizin

Several abdominal and pelvic tumors cause external compression of the ureters. Hydronephrosis resulting in renal insufficiency is the most common urological complication in the palliative situation. Although it is always possible to insert a ureteral catheter or, if this is not successful, to perform a nephrostomy, the indications for this in a palliative setting should be strongly considered. This is also true for the indications for definitive supravesical urinary diversion. Other tumor or therapeutically caused complications are macrohematuria and urinary fistula. Besides urological aspects within palliative care in general, the treatment of nearly all advanced urological tumors is of palliative character. Most important are sufficient pain medication and supportive care for complications such as supra- or infravesical urinary obstruction, incontinence, hematuria, urinary fistula, fractures and exulceration of the tumor. In patients with a supravesical urinary diversion, special aspects of the diversion have to be taken into account, e.g. metabolic acidosis.     

Psychologische Aspekte in der Tumorschmerzbehandlung

Background

Psychological aspects (e.g., illness perception or behaviour) and psychological reactions (e.g., anxiety and depressive reactions) that are possible as a result of a cancer can influence the perception of acute and chronic pain and, thus, the quality of life significantly.

Objective

The goal of this work is to describe important diagnostic aspects of pain-related psychosocial history, possible and necessary counseling and psychotherapy and pain-related interventions involving family members, taking into account the current status in diagnosis and therapy.

Material and methods

Analysis and review of relevant publications based on a selective literature research in PubMed and current guidelines.

Results

For cancer patients with pain the earliest possible diagnosis taking into account the biopsychosocial perspective is considered essential. The identification of potential chronicity factors but also resources helps to initiate the best possible counseling and treatment offer to increase quality of life.