Wann ist welche ökonomische Analyse sinnvoll?

Seit die Limitierung der verfügbaren Ressourcen auch im Gesundheitssystem wahrgenommen wird, nimmt die Forderung nach der Durchführung gesundheits?konomischer Analysen kontinuierlich zu. Diese Entwicklung findet auch Ausdruck in der wachsenden Zahl gesundheits?konomischer Berichte auf wissenschaftlichen Tagungen und in der anhaltenden Gründung neuer pharmako-?konomischer Arbeitskreise in Vereinigungen und Verb?nden. Jüngere Beispiele dafür sind die Gründung solcher Arbeitsgruppen innerhalb der Paul-Ehrlich-Gesellschaft und in der Arbeitsgemeinschaft Internistische Onkologie der Deutschen Krebsgesellschaft. Für den Beobachter der Szene stellt sich die Frage, durch welche Form der ?konomischen Analysen oder in welcher dieser gesundheits?konomischen Studien tats?chlich bedeutende Erkenntnisse für die Leistungserbringer und/oder Leistungsnehmer im Gesundheitssystem gewonnen werden. Diese Frage ist für ?rzte nicht unbedeutend, weil die Anforderungen an die Erhebung von Daten kontinuierlich zunehmen und vor allem die verfügbare man-power wie auch die Bereitschaft der Patienten an Studien teilzunehmen und letztlich die Mittel zur Finanzierung dieser Projekte, limitiert sind. Der Arzt wird deshalb ebenso wie die Industrie zunehmend die Frage stellen, ob durch die Teilnahme an bzw. durch die Finanzierung von Studien handlungsrelevante Informationen gewonnen werden k?nnen.     

Wo ist die molekulare Pathologie sinnvoll?

Background

The increasing importance of molecular pathology in routine oncological diagnostics.

Objective

Current recommendations, developments and future applications of molecular pathology in the clinical course of malignant melanoma, colorectal cancer and non-small cell lung cancer (NSCLC).

Material and methods

The article is based on a literature review investigating clinically relevant aspects of molecular diagnostics in various databases, e.g. PubMed, the European Society of Medical Oncology (ESMO) and the World Health Organization (WHO).

Results and conclusion

The translation of preclinical research and the application in clinical practice are characterized by an increasing speed. The advanced classification of malignant diseases is of high relevance in current therapeutic approaches.

     

Was ist eine “Sentinel Node-Biopsy”?

Onkologie im Internet

Was ist eine Sentinel Node-Biopsy?     

Krebspr?vention durch Lebensstil – was ist evidenzbasiert?

Thousands of epidemiologic studies, in addition to clinical trials and basic scientific research create a convincing picture of the current potential for cancer prevention: at least 50% of all cancers could be prevented through a healthy lifestyle. The most important risk factors are smoking, incorrect nutrition and overweight or obesity, as well as lack of physical activity. Cancer risk can be reduced by quitting smoking and sunscreen use, higher intake of plant-based foods, regular physical activity, aspirin use, HPV immunization and use of cancer screening. It is noteworthy to consider that for each type of cancer different risk and preventive factors exist; thus, data need to be interpreted appropriately to develop sound public health recommendations.     

Was ist die optimale Therapie des primären Mammakarzinoms?

Vom 12.–15.März 2003 fand in St. Gallen das 8. internationale Brustkrebs-Symposium zur Optimierung der interdiziplinären Primärtherapie des Mammakarzinoms statt. Ziel der mittlerweile alle zwei Jahre abgehaltenen Tagung ist eine Diskussion und Standortbestimmung über die neuesten wissenschaftlichen Erkenntnisse zur Biologie, Diagnostik und Primärtherapie des Mammakarzinoms im Austausch von internationalen Experten. Das traditionelle Live-Fazit der Tagung, die eigentliche Konsensuskonferenz, war in diesem Jahr zum Bedauern vieler Teilnehmer weitgehend auf die Formulierung der offenen Fragen reduziert. Die Publikation des Konsensus ist erst im Sommer zu erwarten. Es wurden neue Daten präsentiert, offene Fragen formuliert, ein Konsens aber vertagt.     

Waldenström's macroglobulinemia

Waldenstr?m's macroglobulinemia is an unusual low-grade lymphoplasmacytic lymphoma characterized by the production of monoclonal IgM. The clinical manifestations associated with WM can be classified as those related to direct tumor infiltration, by the amount and specific properties of circulating IgM, and by the deposition of IgM in various tissues. Asymptomatic patients should be followed without treatment. The management of the disease relies on the administration of systemic chemotherapy to reduce tumor load and on the application of plasmapheresis to remove circulating IgM. Standard treatment consists of oral chlorambucil, which induces response in at least 50% of patients, resulting in a median survival of approximately 5 years. Nucleoside analogues (cladribine, fludarabine) are effective in most previously untreated patients. These agents are the treatment of choice for patients with disease resistant to alkylating agents. New treatment approaches include high-dose therapy with stem-cell support and administration of monoclonal anti-CD20 antibodies.     

Waldenström macroglobulinemia

Waldenstr?m macroglobulinemia (WM) is a low-grade lymphoproliferative disorder characterized by the presence of an immunoglobulin M monoclonal protein in the blood and monoclonal small lymphocytes and lymphoplasmacytoid cells in the marrow. The disease is uncommon and there is a lack of clear diagnostic criteria. WM is treatable but not curable and long-term survival is possible. Therefore, the treating physician needs to carefully balance the risks and benefits of treatment. Treatments are aimed at relieving symptoms resulting from marrow infiltration and the hyperviscosity syndrome. Therapies available for initiation of treatment include alkylating agents, purine nucleoside analogs, and rituximab. Chlorambucil has been the mainstay of treatment for many years and remains useful, especially in older patients. Rituximab has become an important new therapy for this disease because of its positive treatment responses, acceptable toxicity, and lack of therapy-associated myelosuppression and myelodysplasia. Currently, rituximab is being combined with chemotherapy. Other options of treatment include interferon and corticosteroids. Emerging therapies include stem cell transplantation (autologous and allogeneic) for younger patients. Currently, there are few comparative data on which to state an absolute opinion concerning the best available treatment for patients with WM.     

Waldenström's macroglobulinemia

Waldenstr?m's macroglobulinemia (WM) is a clinical syndrome with diverse prognoses, and not all patients require therapy at diagnosis. Serum beta2 microglobulin is a major prognostic determinant, and asymptomatic patients with low beta2 microglobulin levels and preserved hemoglobin can be observed over long periods without therapy. Low-dose alkylating agents and purine analogs are commonly employed as initial therapy but rarely yield complete remissions. Patients who are refractory to or have relapse after alkylator or purine analogue therapy can be salvaged with purine analogs. Improvement in outcome demands a comprehensive approach aimed at increasing and sustaining complete remissions. Such an approach should probably employ Rituxan (IDEX Pharmaceuticals, La Jolla, CA) in conjunction with induction therapy, peripheral stem cell procurement before purine analog therapy, and high-dose therapy followed by maintenance therapy with interferon.     

Waldenström macroglobulinaemia

Waldenstr?m macroglobulinemia (WM) is a lymphoid neoplasm characterised by a monoclonal lymphoplasmacytic expansion accompanied by a serum monoclonal immunoglobulin M (IgM). In some patients, the monoclonal protein will lead to a characteristic hyperviscosity syndrome. Although indolent, WM is incurable and most patients eventually succumb to disease progression. Thus, we need to better understand the natural history and biology of the disease. Recent work has shown that half of patients with WM harbour deletions in the long arm of chromosome 6. Increasing evidence suggests the disease is a defined pathological entity and not purely a clinical syndrome. Current therapeutic modalities include alkylator agents, purine nucleoside analogues, and rituximab. The optimum initial therapeutic strategy is not yet defined, and current clinical trials are addressing the role of combination therapy. In this review, we summarise the current understanding of the pathogenesis, clinical and laboratory features, prognostic factors, and therapeutic options for patients with WM. We also discuss current knowledge of WM and available therapies.     

Waldenström's macroglobulinemia

Waldenstr?m's macroglobulinemia is a low-grade lymphoplasmacytic lymphoma. It has an overall incidence of 2.5/million/year. The median age at diagnosis is 63 years. The clinical manifestations are hepatomegaly (20%), splenomegaly (15%), and lymphadenopathy (15%). The most common symptom is fatigue related to a normochromic, normocytic anemia, and the median hemoglobin value at diagnosis is 10 gm/dl. All patients with Waldenstr?m's macroglobulinemia have a circulating tumor marker, the monoclonal IgM protein. Occasionally high levels of the IgM monoclonal protein can produce a hyperviscosity syndrome manifested by oronasal bleeding. Occasionally retinal hemorrhage or serious neurologic complications, such as somnolence or coma, may occur. The most important prognostic factors are hemoglobin, age, weight loss, and a cryoglobulin. Therapy has included alkylating agents, particularly chlorambucil, purine nucleoside analogs such as fludarabine or cladribine, and most recently the use of rituximab. The median survival of symptomatic patients is 65 months. Patients without symptoms should not be treated.     

Paraneoplastische Gerinnungsstörungen

Background

Cancer-related coagulation disorders are common complications of patients with solid or hematological neoplasms.

Methods

This article gives an overview of paraneoplastic thromboembolic and hemorrhagic complications and therapy of patients with solid or hematological neoplasms under consideration of pathogenetic insights into the interaction of tumor cells and hemostasis. Special attention will be paid to routine clinical laboratory coagulation parameters in terms of their importance for the manifestation of a clinical event (thrombosis or hemorrhage).

Results/Conclusion

Knowledge of thromboembolic or hemorrhagic syndromes in underlying malignancies allows early diagnosis and targeted therapy and helps to reduce morbidity and mortality.

Conclusion

Of particular importance is the implementation of existing guidelines in the clinical treatment of patients with malignancies, e.g. prophylaxis and treatment of venous thromboembolism.     

Translationale Melanomforschung ist nach wie vor schwer in praktische Erfolge umzumünzen

Ohne Zusammenfassung

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Pathologie des ösophagogastralen Adenokarzinoms

Context

Adenocarcinomas of the esophagogastric junction and the stomach share similar preneoplastic lesions and genetic alterations but are different according to their risk profiles and epidemiological characteristics.

Objective

The aim of the review was the comparison of pathohistological, molecular and therapeutic similarities and differences of these tumor entities.

Material and methods

The following review relied on a literature database search comprising the pathohistological, molecular and clinical characteristics of adenocarcinomas of the esophagogastric junction and the stomach.

Results

For both entities comparable alterations have been published even correlating with the pathohistological subtypes.

Conclusions

Despite many similarities concerning pathogenesis, the TNM classification for both tumor entities recommended by the WHO depends on the localization and is of particular importance for the clinical practice. Molecular targets for therapy optimization include Her2/neu and in the future, perhaps also c-Met.     

Erhöhung von Dosis und biologischen Wirkungen durch rückgestreute Elektronen aus röntgenbestrahlten Materialien höherer Ordnungszahl

Near the interfaces between tissues and materials of higher atomic number, the dose distribution caused by X-ray exposure is strongly influenced by backscattered photo and Auger electrons. This dose enhancement, dependent on the material of the inhomogeneity and the quality of the primary radiation, typically reaches the order of 10 to 100 and is effective over distances of the order of 10 μm. The cytobiological effects of this dose enhancement have been demonstrated with V79 hamster cells and C3H10T1/2 mouse fibroblasts exposed near such surfaces. In addition to significantly enhanced cell killing, oncogenic cell transformation was found to be significantly enhanced. These results are pointing to a possible radiobiologic relevance of dose enhancements caused by implants and contrast agents in X-ray diagnostics.