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Background
Due to the lifetime prevalence, patients with previous a psychological illness represent a significant group of oncologic patients. They have numerous particularities.Results
These special aspects include altered pain perception, a significantly increased risk of suicide, a sometimes drastically altered ability to communicate, and, finally the necessity of ongoing psychopharmacological treatment in patients with severe and chronic mental illness.Conclusion
This situation requires the oncologist to take special care during the anamnestic evaluation and necessitates close collaboration with the treating colleagues in psychiatry. Special attention is needed to prevent a deterioration or triggering of psychiatric symptomatology through the interaction of different (pain) medications.3.
Background
External beam radiotherapy (EBRT) is a curative therapeutic option in prostate cancer.Percutaneous radiotherapy with curative intent
Patients with low risk can be cured with EBRT. For patients at intermediate risk, EBRT may be combined with androgen deprivation therapy (ADT) for 4 months. For patients at high risk, ADT should be administered for 2–3 years and the EBRT dose should be escalated. Hypofractionation is currently under intensive clinical investigation, but is currently not a clinical standard.Recurrence
A recurrence after EBRT is defined as two prostate-specific antigen (PSA) values higher than nadir +2 ng/ml.Adjuvant radiotherapy
Adjuvant EBRT is recommended after pT3 and/or R1 resection. In patients with lower stages or with more comorbidities, a PSA follow-up can be recommended with initiation of salvage EBRT only after increase of PSA (but preferably < 0.5 ng/ml).4.
Susanne Krege 《Der Onkologe》2016,22(11):889-902
Background
Testicular cancer is a disease of young adult men, and it is curable in most cases. Even in advanced disease, cure rates reach 80?% nowadays. This was achieved by consistently performing studies concerning the different stages of disease.Treatment and follow-up care
The concept of treatment is interdisciplinary. After removal of the affected testis, histology and stage determine further therapy, which can be active surveillance, polychemotherapy, radiotherapy, surgery, or a combination of these. Curability also has consequences for the long-term follow-up. We speak about long-term survivorship. Besides looking for recurrences, it is also necessary to observe and treat long-term toxicities caused by the different therapeutic procedures.Conclusion
Because testicular cancer is rare with about 4500 cases annually, treatment—especially for advanced disease—should be performed at centers. In addition, it is possible to obtain a second opinion using the Interdisciplinary German Testicular Study Group website.5.
Background
Primary malignant sarcomas in children, adolescents and young adults are rare and represent a major challenge for the treating physician.Aim
The aim of this article is to provide a comprehensive overview on sarcomas in children, adolescents and young adults. This article provides an overview of the epidemiology, clinical presentation, diagnoses, tumor biology, international therapy strategies and currently active phase I, II and III clinical trials.Material and methods
The article is based on a selective literature search and also provides data from the authors’ own national and international clinical trials.Results
The treatment must follow a multimodal concept, which ultimately requires close cooperation between many disciplines. As a result of modern interdisciplinary treatment approaches consisting of chemotherapy, surgery and/or radiotherapy, two thirds of patients can be cured if they undergo early and appropriate therapy. This requires a precise and early diagnosis and treatment in selected medical centers with an interdisciplinary team of specialized oncologists, surgeons and radiotherapists is highly recommended.6.
Martin C. Koch Grit Mehlhorn Matthias W. Beckmann Mitglieder der Leitliniengruppe und der Fachgesellschaften 《Der Onkologe》2016,22(10):763-772
Background
The problems of uncertain treatment, mortality and morbidity rates that have not declined over the last 15 years, and the current wide variations in treatment, made necessary an upgrade from the existing Level 2k consensus-based guideline from 2008 to a Level 3 guideline. These factors also induced the current Level 3 guideline on diagnosis, treatment, and follow-up of patients with cervical carcinoma (AWMF register no. 032-033OL) since 2014.Objectives
This overview describes the current standard of cervical cancer treatment. Therefore, it focusses on the drug therapy of patients suffering from cervical cancer. This is in line with the focus of the journal. A further topic is the diagnostic chain that is essential for therapeutic decision-making.Materials and methods
Based on the recommendations of the S3 guideline, the current algorithms for treating cervical cancer are shown and discussed.Results
Surgical procedures are mainly carried out in the early stages. From stage IIB, a simultaneous cisplatin-containing radiochemotherapy is recommended. The therapy of choice for non-operable local recurrence or metastasic situation consists of palliative chemotherapy regimens. Since 2014 the addition of a targeted therapy with bevacizumab has been integrated to the treatment approach.Conclusion
Therapy for patients with cervical cancer has changed significantly over the last decades. There are various new therapeutic options, which are applied according to tumour stage and on an individual basis. The decision of which therapeutic method has to be applied is based on the interdisciplinary consultation and is individualized. The patient has to be involved in the decision process. Age and life situation have to be considered as well as the stage of the disease, risk factors and the side effects of the different therapies. The aim is to provide the best quality of life and the best outcome.7.
Background
Pain is a frequent and highly distressing burden in cancer patients. Resource-oriented use of hypnotherapeutic subjective trance phenomena lends itself well to treatment.Objective
This work aims to describe hypnotherapeutic treatment options for pain in cancer patients, illustrate the basic procedures, and provide for evidence on their effectivity.Materials and methods
A literature search on the different treatment aspects was performed and clinical experiences were procured.Results
Hypnosis and hypnotherapy enable treatment and effective control of a wide spectrum of acute and chronic pain. There are a number of evidence-based interventions from which the majority of patients may benefit. Education in the use of self-hypnosis is considered a basic skill for regaining control over pain and enhancing self-efficacy, which should therefore be provided at an early stage of therapy. The various available techniques should be used in combination as much as possible, paying particular respect to the patients’ individual subjective resource experiences. Neuroscientific evidence on the central neurocognitive hubs involved in pain regulation imply use of processing-specific hypnotic suggestions that specifically address the different pain components.Conclusion
Hypnotherapeutic interventions are ideally suited for the treatment of acute and chronic pain in tumor patients due to both their rapid effectivity and the indirect permissive course of action. A particular advantage of these interventions is resource-oriented use of subjective trance phenomena and simultaneous treatment of different components of the pain complex.8.
Tobias Kampfenkel Anna Arning Oliver Heidinger Heribert Jürgens Raphael Koch 《Der Onkologe》2016,22(12):984-991
Background
In 2014, 41?% of all colorectal cancer patients in North Rhine-Westphalia (NRW) were treated in a certified cancer center, with rising tendency. While positive outcomes have been shown for surrogate parameters in certified bowel cancer centers, the influence of center certification on patient-relevant outcomes has so far remained unclear. In general, the classic endpoint with the highest patient relevance in oncology is overall survival.Objective
The present study investigated whether there is a difference in overall survival between colorectal cancer patients who have been treated in a certified cancer center versus those treated in a non-certified center.Methods
A non-interventional retrospective observational study using routine data from a statutory health insurance fund (AOK Nordwest) supplemented by data from the Epidemiological Cancer Register NRW was performed. Statistical analyses of overall survival were performed using multivariate methods.Results
Tumor stage, age at initial diagnosis, care level, end-stage renal disease, and dementia were associated with statistically noticeable effects on overall survival. However, no significant difference in overall survival could be observed between patients treated in certified cancer centers versus patients treated in non-certified centers (hazard ratio = 1.043, 95?% CI 0.893–1.219; p = 0.592).Conclusion
This analysis revealed no statistically noticeable difference in overall survival between patients treated in a certified cancer center versus patients treated in a non-certified cancer center. However, due to study limitations, this outcome must be interpreted with caution. The applied methodology cannot replace comprehensive evaluations based on data generated from clinical cancer registries.9.
B. Seekatz E. Jentschke M. Lukasczik S. Neuderth M. Schuler B. van Oorschot 《Der Onkologe》2016,22(11):870-877
Background
The German S3 guideline on palliative care requires that symptoms and needs of patients with incurable cancerous diseases should be regularly assessed, irrespective of the tumor-specific treatment. Self-report questionnaires for palliative medicine are available for screening, such as the Edmonton Symptom Assessment Scale (ESAS), which is used in oncology centers in Canada in the context of a quality management initiative.Aims and method
Implemention of the ESAS as a screening method for patients with metastases in lung cancer centers, colorectal cancer centers, in centers for neuro-oncological cancer and in the skin cancer center at the Mainfranken Comprehensive Cancer Center.Results
From a total of 839 patient sceened, 79.6?% patients reported at least 1 out of 10 symptoms with moderate or severe intensity (ESAS item score ≥4), which indicates the need for a more detailed clinical assessment or intervention. The most prevalent symptoms were impairment of general well-being, fatigue and exhaustion, loss of appetite and dyspnea. Of the patients 40.4?% showed at least 1 symptom with severe intensity (ESAS score ≥7) with an ensuing need for an intervention.Conclusions
A large proportion of patients reported a significant symptom burden. It should be further discussed whether clinical assessment and subsequent interventions can be provided by general palliative care teams and at what stage the inclusion of specialized teams is necessary.10.
Rachel Sommer Jörg Dirmaier Dennis Fechtelpeter Klaus Koch Martin Härter Corinna Bergelt 《Der Onkologe》2016,22(8):578-585
Background
Women between the ages of 50 and 69 are invited in Germany every two years to participate in the mammography screening program. The German Institute for Quality and Efficiency in Health Care (IQWiG), together with experts, was assigned by the Federal Joint Committee (G-BA) to modify the existing informational material into a new decision aid.Objective
The new decision aid was qualitatively tested with regard to comprehensibility and acceptance of users.Material and methods
Testing of the decision aid was done through a multi-step procedure with 37 women in six focus groups. The results were qualitatively analyzed.Results
The results show that the new material was regarded as helpful information on mammography screening. Many women were surprised about the information regarding overdiagnosis. All women had difficulties understanding the concept of overdiagnosis. In their understanding, most did not differentiate between overdiagnosis and false-positive results.The newly developed value clarification tool was helpful for 18 women with regard to their personal decision-making. Those who experienced no further benefit by the value clarification tool (n = 15), reasoned that they had already made their decision and did not need further support.Discussion
Communicating the existence of overdiagnosis is a challenge when developing decision aids on screening decisions. The new value clarification tool was considered to be helpful for coming to an individual decision for or against screening participation. Health literacy plays an important role regarding the comprehensiveness of the material and should be considered in the development of decision aids.11.
Background
Bone metastases are the most common cause of pain in oncologic patients.Objective
This article aims to describe the use of external-beam radiotherapy for pain control in patients with bone metastases.Materials and methods
The relevant literature in PubMed was reviewed.Results
Pain in patients with bone metastases can be effectively and safely treated by modern radiotherapy. Partial response rates range between 50 and 90%, while 10 to 50% of patients achieve total response. For analgesic effects single, hypo-, and normofractionated concepts are described. Current meta-analyses show that a single fraction of 8?Gy results in similar pain relief as fractionated regimes. Better remineralization is achieved 3–6 months after conventional fractionated radiotherapy with 2–3 Gy than after single-fraction radiation; furthermore, less pain relapses occur, thus re-irradiation is required less frequently after multifraction radiation. A single fraction of 8?Gy is recommended as the standard of care for uncomplicated symptomatic bone metastases without fractures or spinal cord compression worldwide. Patients with a good performance status and a survival prognosis of at least 3 months should receive normofractionated radiotherapy. Since a temporary increase in pain can occur several days after the first fraction (“pain flare”), patients require adequate pain management before starting radiotherapy and, potentially, antiedematous prophylaxis.Conclusion
Since different radiotherapeutic options for alleviating pain in patients with bone metastases exist, the optimal regimen for radiotherapy should be determined in an interdisciplinary approach together with the patient (“shared decision making”).12.
Holger S. Willenberg 《Der Onkologe》2016,22(6):431-446
Aim
Adrenocortical carcinoma is a rare disease. This article intends to inform the reader on its genesis, clinical, and hormonal characteristics, as well as on diagnostic and therapeutic strategies in this malignant entity.Contents
Recent years have seen advancements in terms of our understanding of disease genesis, as well as the development of new diagnostic methods and treatment options. Hormonal, nuclear medicine, histopathologic, and genetic studies are underlying these advancements. In order to achieve a good quality of life and good life expectancy, therapeutic approaches target local control, metastasis, and the hormonal alterations that are provoked by the tumor or the individual treatments and which are, in addition to tumor biology and age, important for prognosis. Also in this regard, it has been possible to gather data on the mechanisms and efficacy of drugs.Conclusions/recommendations
Specialized interdisciplinary diagnosis and patient management – from disease onset and continuing during its further course – is a prerequisite for optimal outcomes. The combination of different therapeutic options and early adjuvant treatment often affords the patient the best chance of survival and the optimal quality of life. In order to increase the data available on this disease and improve patient care, national and international networks have been formed.13.
Background
The concept of sentinel removal is a safe procedure in the field of gynecological oncology and is an integral part of staging in early vulvar and cervical cancer. Moreover resent studies have shown that this type of nodal staging has promising results even in endometrial cancer. Only in ovarian cancer is this concept still far from clinical routine.Diagnosis
There are at least three different tracers for staining the lymph nodes: blue dye, indocyanine green, and radioactive technetium. The blue tracer is visualized with conventional cameras, while indocyanine green needs a special fluorescent camera. Technetium is detectable only with a special probe and an acoustic signal in the proximity of a stained lymph node.Conclusion
The increasing data available in the field of sentinel node technology shows that this concept will be used in an ever broader area in the future—with the same oncological safety but with lower peri- and postoperative morbidity.14.
Background
Despite modern diagnostics and multimodal treatment strategies, overall survival of lung cancer could not be significantly improved in recent decades. The majority of patients with non-small cell lung cancer (NSCLC) have distant metastases at the time of diagnosis (57%) and only approximately 40% of patients are in a potentially curable tumor stage.Material and methods
A systematic literature search concerning original research and review articles on surgery of NSCLC in stages I and II was carried out in the PubMed database.Results
For patients in an early tumor stage, stages I and II tumors according to the 8th edition of the Union for International Cancer Control (UICC) tumor stage classification, surgical removal of the tumor remains the therapeutic gold standard. By complete anatomical resection (lobectomy, bilobectomy or pneumonectomy) combined with a systematic mediastinal and hilar lymphadenectomy, 5?year survival rates of more than 80% in early stage IA and 48% in stage II can be achieved. In addition to open surgical resection, video-assisted, minimally invasive thoracoscopic (VATS) resection was successfully implemented worldwide for the treatment of NSCLC patients in stages I and II. For patients with stage II NSCLC, adjuvant chemotherapy was shown to improve the overall survival.Discussion
Whether targeted therapies or immunotherapy in a neoadjuvant or adjuvant treatment modality further improve the survival of NSCLC patients in the multimodal treatment of early stage NSCLC, is currently under investigation in randomized studies.15.
Background
Non-small cell lung cancer (NSCLC) accounts for ca. 75% of malignant epithelial neoplasms of the lungs. In recent years profound insight has been gained regarding the molecular mechanisms of lung carcinogenesis and subsequently new targeted therapies as well as immunotherapies have been developed. These advances have had a significant impact on routine diagnostics in pathology.Objective
The article aims to give an overview of the most common histological subtypes of NSCLC as well as the morphological, immunohistochemical and molecular characteristics.Material and methods
Selective search of the PubMed database.Results and discussion
Adenocarcinomas, squamous cell carcinomas and large cell carcinomas are the most common histological subtypes. With the ancillary methods available in routine pathology even poorly differentiated tumors can be assigned to these entities. The NSCLC show numerous genetic changes of which alterations of EGFR, MET, ALK1 and ROS1 are target structures for personalized therapy.16.
B.-Ole Juhnke Brigitte Bison Michael C. Frühwald Rolf-D. Kortmann Hendrik Witt Stefan Rutkowski 《Der Onkologe》2016,22(12):908-922
Background
In recent years, new insights into many disciplines of pediatric neuro-oncology have been generated. These include important progress in understanding the biology of medulloblastoma, pontine glioma, low and high-grade glioma, ependymoma, embryonal tumor with multilayered rosettes (ETMR) and atypical teratoid/rhabdoid tumor (AT/RT). This ushered in a new era of clinical and molecular diagnostics and therapy.Methods
This study is based on the research results of the German treatment network HIT as well as a selective literature review of studies published over the last 40 years.Results
Modern therapy concepts are gradually becoming integrated into clinical treatment recommendations based on the expanded understanding of tumor biology. Current therapeutic approaches are modified according to the clinical and biological risk in order to reduce the long-term toxicity in patients with a good prognosis and to improve the poor cure rates in high-risk groups. Novel imaging techniques, such as the availability of intraoperative magnetic resonance imaging (MRI) have facilitated neurosurgery. Improvements in radiotherapy planning and the increasing availability of proton beam therapy raise hopes for a long-term decrease in morbidity after irradiation. A better understanding of the pathophysiology of damage to the developing brain and other treatment-related complications are increasingly becoming the focus of research, with the aim of mitigating damage and providing children with coping mechanisms.Conclusions
The validation and further development of the biological and clinical aspects described are required in future prospective studies within the HIT treatment network.17.
Michael Ried Michael Rechenmacher Barbara Dietl Alexander Marx Okka W. Hamer Berthold Schalke Lukas Kirzinger Hans-Stefan Hofmann 《Best Practice Onkologie》2017,12(5):206-214
Background
Thymoma and thymic carcinoma (TC) are the most common primary malignancies in the anterior mediastinum.Objectives
In this review article, modern diagnostic tools and innovative treatments are described.Materials and methods
Selective literature research in Medline (key words: thymoma, thymic carcinoma, advanced thymoma) and interdisciplinary, clinical experience.Results
Treatment decisions and the prognosis of thymomas and TCs depend on tumor stage (currently described in parallel by the Masaoka-Koga and the new TNM system), histological subtype (according to the World Health Organization [WHO] classification) and resection status. R0 resection (that traditionally includes thymectomy) counts among the most important prognostic factors and is the standard therapeutic approach for resectable tumors. A multimodality treatment regime consisting of chemotherapy, surgical resection and in some cases radiotherapy is recommended for advanced or primarily unresectable tumors. Clinical trials evaluating immune checkpoint inhibitors in refractory thymomas and TCs are underway.Discussion
Modern diagnostics comprise computertomography scans, magnetic resonance imaging and precise histological investigation. An interdisciplinary evaluation and a multimodal treatment regime might improve the prognosis of locoregional and pleural advanced thymoma and thymic carcinoma as well as the prognosis of recurrent thymoma.18.
Background
The surgical treatment of cervical cancer is dependent on the stage and should follow complex but accurately defined algorithms and also consider the general condition of the patient, tumor type, tumor biology (and additional risk factors) as well as personal and family planning of patients.Material and methods
Selective literature and guideline search in PubMed.Results
At present only surgical staging can provide exact information regarding potential tumor spread throughout the abdominal cavity, detection or exclusion of lymph node involvement and involvement of neighboring organs. Patients with early cervical cancer should if possible always undergo minimally invasive surgical procedures because in experienced hands the surgical and oncological outcomes of minimally invasive surgery are at least equal to those of laparotomy and with a clearly lower perioperative and postoperative morbidity. The sentinel lymphadenectomy concept provides the possibility of an adequate staging by omission of radical lymphadenectomy and leads to a significant reduction of associated complications.Conclusion
The complex surgical interventions for cervical cancer should not be carried out sporadically but only in specialized centers, which are equipped with a complete, interdisciplinary infrastructure.19.
Background
Ethical dilemmas that arise during the treatment of patients in oncology are self-evident to any clinician or lay person who has cared for individuals battling cancer. Issues related to autonomy, advance directives, surrogate decision making, communication barriers, goals of care, treatment decisions, end of life decisions and admission to the intensive care unit of advanced cancer patients are emotionally laden and complex; therefore, circumstances can arise in which moral dilemmas or conflicting values are not so easily resolved. Clinical ethics consultation is a structured approach to assist in mitigating ethical questions and conflicts through careful deliberation and guidance among the parties involved, particularly in a setting of standardized team or family conferences.Method
Research and analysis of the current literature.Objective and conclusion
The resolution process involves a reasoned approach to the ethical or moral dilemma or conflict in which multiple perspectives and points of view are integrated into an ethically justifiable and workable solution that is driven by a shared decision-making process. In respect to emergency conflict interventions by an ethics consultation it is hoped that advance care planning will be able to minimize requested ethics consultations.20.
Haryana M. Dhillon Ian F. Tannock Gregory R. Pond Corrinne Renton Sean B. Rourke Janette L. Vardy 《Journal of cancer survivorship》2018,12(2):178-185