A Dietz

University of Leipzig, Leipzig, Saxony, Germany

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Publications (350)417.67 Total impact

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    ABSTRACT: Based on level I evidence, postoperative platinum-based radiochemotherapy (PORCT) is the recommended standard of care in defined risk situations after resection of squamous cell carcinomas of the larynx and hypopharynx (LHSCC). The value of the addition of chemotherapy to adjuvant radiation in intermediate and high risk situations other than extracapsular spread or R1-/R2 resection is still debated. From 1993 to 2009, 555 patients (median follow-up: 24.4 months) with advanced LHSCC (UICC stages III-IVB) were treated in a curative intent. Patient data were continuously documented in the county of Leipzig cancer registry and were retrospectively analyzed as mono institutional survey. PORCT was introduced into the standard procedures in 2004, but also applied before in selected cases. Based on this paradigm shift, the patient population was divided into two comparative groups treated before and after 2004. 361 patients were treated before 2004. 43.8 % received primary surgery (OP) + postoperative radiotherapy (PORT) and 20.2 % OP + PORCT. 194 patients were treated after 2004: 21.1 % received OP + PORT and 35.6 % OP + PORCT. Regarding the PORCT groups, 20.6 % received cisplatin plus 5FU before 2004 which shifted to 59.4 % after 2004. The 3-year tumor-specific-survival rate of the whole cohort was improved from 47 to 60 % (p = 0.006). The subgroup treated with OP + PORT or PORCT improved from 56.1 to 68.5 % (p = 0.028). Localization proved to be a significant and independent factor. Only patients with advanced laryngeal cancer had significant improved survival (p < 0.01), while the improvement for hypopharyngeal cancer patients was not significant (p < 0.2). After 2004, there was a slight increase (+10.2 %) of primary radiochemotherapy (pRCT) due to stronger selection if R0 > 5 mm-resectability is unlikely. Standardised use of PORCT and pRCT considering clear indications showed to be significantly involved in improved survival in advanced LHSCC.
    06/2014;
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    ABSTRACT: BACKGROUND The authors investigated whether cancer patients who have comorbid mental health disorders (MD) are at greater risk of early retirement compared with those who do not have MD.METHODS Individuals ages 18 to 55 years from a consecutive sample of patients who were admitted for inpatient oncologic treatment were interviewed using structured clinical interviews to ascertain MD. The patients were followed for 15 months, and the date of early retirement was documented. Rates of early retirement per 100 person-years (py) in patients with and without MD were compared using multivariate Poisson regression models.RESULTSAt baseline, 491 patients were interviewed, and 150 of those patients (30.6%) were diagnosed with MD. Forty-one patients began full early retirement during follow-up. In patients with MD, the incidence of early retirement was 9.3 per 100 py compared with 6.1 per 100 py in mentally healthy patients. The crude rate ratio (RR) was 1.5 (95% confidence interval [CI], 0.8-2.8). The effect of MD on early retirement was modified in part by income: in patients with low income, the adjusted RR was 11.7, whereas no effect was observed in higher income groups. Patients with depression were at greater risk of retirement when they had higher income (RR, 3.4; P = .05). The effects of anxiety (RR, 2.4; P = .05), adjustment disorders (RR, 1.7; P = .21), and alcohol dependence (RR, 1.8; P = .40) on early retirement were equal across income groups.CONCLUSIONS Mental health conditions are risk factors for early retirement in cancer patients, although this effect differs according to the type of disorder and the patient's income level. Cancer 2014. © 2014 American Cancer Society.
    Cancer 04/2014; · 5.20 Impact Factor
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    ABSTRACT: Children with certain risk factors, such as comorbidities or severe obstructive sleep apnea syndrome (OSAS) are known to require extended postoperative monitoring after adenotonsillectomy. However, there are no recommendations available for diode-laser-assisted tonsillotomy. A retrospective chart review of 96 children who underwent diode-laser-assisted tonsillotomy (07/2011-06/2013) was performed. Data for general and sleep apnea history, power of the applied diode-laser (λ = 940 nm), anesthesia parameters, the presence of postoperative respiratory complications and postoperative healing were evaluated. After initially uncomplicated diode-laser-assisted tonsillotomy, an adjustment of post-anesthesia care was necessary in 16 of 96 patients due to respiratory failure. Respiratory complications were more frequent in younger children (3.1 vs. 4.0 years, p = 0.049, 95 % CI -1.7952 to -0.0048) and in children who suffered from nocturnal apneas (OR = 5.00, p < 0.01, 95 % CI 1.4780-16.9152) or who suffered from relevant comorbidities (OR = 4.84, p < 0.01, 95 % CI 1.5202-15.4091). Moreover, a diode-laser power higher than 13 W could be identified as a risk factor for the occurrence of a postoperative oropharyngeal edema (OR = 3.45, p < 0.01, 95 % CI 1.3924-8.5602). Postoperative respiratory complications should not be underestimated in children with sleep-disordered breathing (SDB). Therefore, children with SDB, children with comorbidities or children younger than 3 years should be considered "at risk" and children with confirmed moderate to severe OSAS should be referred to a PICU following diode-laser-assisted tonsillotomy. We recommend a reduced diode-laser power (<13 W) to reduce oropharyngeal edema.
    Archives of Oto-Rhino-Laryngology 03/2014; · 1.29 Impact Factor
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    ABSTRACT: The management of patient-specific information is a challenging task for surgeons and physicians because existing clinical information systems are insufficiently integrated into daily clinical routine and contained information entities are distributed across different proprietary databases. Thus, existing information is hardly usable for further electronic processing, workflow support or clinical studies. A Web-based clinical information system has been developed that automatically imports patient-specific information from different information systems. The system is tailored to the existing workflow for the treatment of patients with head and neck cancer. In this paper, the clinical assistance functions and a quantitative as well as a qualitative system evaluation are presented. The information system has been deployed at a clinical site and is in use in daily clinical routine. Two evaluation studies show that the information integration, the structured information presentation in the Web browser and the assistance functions improve the physician's workflow. The studies also show that the usage of the new information system does not impair the time physicians need for a process step compared with the usage of the existing information system. Information integration is crucial for efficient workflow support in the clinic. The central access to information within a modern and structured user interface saves valuable time for the physician. The comprehensive database allows an instant usage of the existing information clinical workflow support or the conduction of trial studies.
    International Journal of Computer Assisted Radiology and Surgery 02/2014; · 1.36 Impact Factor
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    ABSTRACT: Simvastatin (Sim) is approved as lipid-controlling drug in patients with cardiovascular risk to reduce hypercholesterolemia. Recent publications indicate possible inhibitory effects of Sim on tumor cell lines, and epidemiological data suggest activity in cancer patients. Still, its therapeutic efficacy, particularly in head and neck squamous cell carcinoma (HNSCC), remains to be elucidated. This study analyzes the effects of Sim on HNSCC cell lines (KB, HN5, FaDu) and on a larger set of primary HNSCC cells by employing a short-time ex vivo colony formation test (FLAVINO assay). Possible additive or synergistic effects of Sim combinations with established chemotherapeutics are determined as well. Biopsies of 49 HNSCC were tested in the FLAVINO assay with Sim alone or in combination with cisplatin (Cis) or docetaxel (DTX). Cell lines were studied for reference. Epithelial HNSCC cells were stained by Cy2-labeled anti-cytokeratin antibodies facilitating the detection of colony formation (CF) by immunofluorescence. Drug combinations were analyzed regarding their interaction. Sim alone acted suppressive on tested cell lines and increased the cytostatic efficacy of Cis and DTX. 18/49 HNSCC qualified for FLAVINO-based dose-response analyses, and Sim significantly suppressed CF in 18/18 primary HNSCC. Moreover, Sim increased cytotoxic effects of Cis and DTX, primarily in an additive mode of action. The ex vivo tumor cell inhibition of Sim and its additive effects upon combination with established cytostatics provide the basis for epidemiological and clinical studies on statins, potentially directed toward co-medication in future treatment regimens.
    Cancer Chemotherapy and Pharmacology 02/2014; · 2.80 Impact Factor
  • A. Dietz, M. Knödler, F. Lordick
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    ABSTRACT: In dem Beitrag werden die wesentlichen aktuellen Betrachtungen zur Primärtherapie von Plattenepithelkarzinomen des Kopf-Hals-Bereichs dargestellt und kommentiert. Der Leser soll weniger in die operativen Details als in den konzeptuellen Hintergrund aktuell propagierter Therapieempfehlungen eingeführt werden. Hierbei werden die Grundzüge der chirurgischen und postoperativen adjuvanten Therapie dargestellt. Schließlich wird die aktuelle Entwicklung und Zielrichtung neuer klinischer Studien diskutiert.Darstellung der aktuellen Diskussionspunkte in der Therapie von Kopf-Hals-Tumoren.Sichtung und Zusammenstellung der aktuellen Literatur aus den Jahren 2011 bis 2013 mit Fokus auf Therapiekonzepte.Die europaweite Fünfjahresüberlebensrate von Plattenepithelkarzinomen der Kopf-Hals-Region (HNSCC) liegt derzeit bei 42 %. Insbesondere in den letzten 3 Jahren haben sich verschiedenen Leitlinien durchgesetzt, die den Versuch bei eingeschränkter Evidenzlage einer Standardisierung von Therapiekonzepten anstreben. Hierbei wird im europäischen Raum überwiegend festgestellt, dass bei funktionaler Operabilität primär chirurgischen Ansätzen der Vorzug gegeben werden sollte. Die postoperative adjuvante Therapie unterliegt klaren Indikationslinien, die sich aus Risikoeinschätzungen aufgrund der Beurteilung der Resektionsränder, der Halslymphknotenmetastasen und des extrakapsulären Tumorwachstums dieser Metastasen definieren. Ablativ chirurgische Verfahren konkurrieren mit sog. Organerhaltungsprogrammen, die sich derzeit im Stadium klinischer Studien befinden und als Standard nicht empfohlen werden. Bei nicht sinnvoller Resektabilität wird weltweit unstrittig die platinbasierte simultane Radiochemotherapie empfohlen. Die aktuellen Bemühungen der weiteren Optimierung der Strahlentherapie beziehen sich auf bessere Schonung von funktionell wichtigen Strukturen, um die bislang zu hohe Spättoxizität (überwiegend Spätdysphagie) ohne Effektivitätseinbußen zu senken.
    Der Onkologe 01/2014; 20(2). · 0.13 Impact Factor
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    ABSTRACT: The Head and Neck Cancer Tumor Board is a multispeciality comprehensive conference that brings together experts with different backgrounds to make group decisions about the appropriate treatment. Due to the complexity of the patient cases and the collaboration of different medical disciplines most of these decisions have to be made under uncertainty, i. e., with-out knowing all relevant factors and without being quite sure about the outcome.To develop effective team decision making under uncertainty, it is necessary to understand how medical experts perceive and handle uncertainties. The aim of this field study was to develop a knowledge base by exploring additionally the factors that influence group decision making processes. A structured nonparticipant observational study was employed to address the research goal. Video data were analyzed by 2 independent observers using an observation checklist. A total of 20 videotaped case discussions were studied. Observations were complemented by a questionnaire gathering subjective evaluations of board members about the process and quality of their decisions (N=15).The results show that uncertainty is recognized by board members. Reasons for uncertainty may stem from the complexity of the cases (e. g. therapy options) or the assessment from different disciplines coming together at the board.With respect to handling uncertainty and guaranteeing an optimal decision making process potential for improvement could be defined. This pertains to the handling of different levels of competence, the promotion of a positive discussion culture as well as structuring of the decision making process.
    Laryngo-Rhino-Otologie 12/2013; · 0.82 Impact Factor
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    ABSTRACT: Background:Human head and neck squamous cell carcinoma (HNSCC) fundamentally vary in their susceptibility to different cytotoxic drugs and treatment modalities. There is at present no clinically accepted test system to predict the most effective therapy for an individual patient.Methods:Therefore, we established tumour-derived slice cultures which can be kept in vitro for at least 6 days. Upon treatment with cisplatin, docetaxel and cetuximab, slices were fixed and paraffin sections were cut for histopathological analysis.Results:Apoptotic fragmentation, activation of caspase 3, and cell loss were observed in treated tumour slices. Counts of nuclei per field in untreated compared with treated slices deriving from the same tumour allowed estimation of the anti-neoplastic activity of individual drugs on an individual tumour.Conclusion:HNSCC-derived slice cultures survive well in vitro and may serve not only to improve personalised therapies but also to detect mechanisms of tumour resistance by harvesting surviving tumour cells after treatment.British Journal of Cancer advance online publication, 21 November 2013; doi:10.1038/bjc.2013.700 www.bjcancer.com.
    British Journal of Cancer 11/2013; · 5.08 Impact Factor
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    ABSTRACT: Previous studies tried to assess the association between socioeconomic status and laryngeal cancer. Alcohol and tobacco consumption explain already a large part of the social inequalities. Occupational exposures might explain a part of the remaining but the components and pathways of the socioeconomic contribution have yet to be fully disentangled. The aim of this study was to evaluate the role of occupation using different occupational indices, differentiating between physical, psycho-social and toxic exposures and trying to summarize the occupational burden into one variable. A population-based case--control study conducted in Germany in 1998--2000 included 208 male cases and 702 controls. Information on occupational history, smoking, alcohol consumption and education was collected with face-to-face interviews. A recently developed job-classification index was used to account for the occupational burden. A sub-index focussed on jobs involving potentially carcinogenic agents (CAI) for the upper aero digestive tract. When adjusted for smoking and alcohol consumption, higher odds ratios (ORs) were found for lower education. This OR decreased after further adjustment using the physical and psycho-social job indices (OR = 3.2, 95%-CI: 1.5-6.8), similar to the OR using the sub-index CAI (OR = 3.0, 95%-CI: 1.4-6.5). The use of an easily applicable control variable, simply constructed on standard occupational job classifications, provides the possibility to differentiate between educational and occupational contributions. Such an index might indirectly reflect the effect of carcinogenic agents, which are not collected in many studies.
    BMC Public Health 11/2013; 13(1):1080. · 2.08 Impact Factor
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    ABSTRACT: The aim of this study was to measure the extent to which the association between socioeconomic status and laryngeal cancer among males is mediated by smoking, alcohol consumption, and occupational exposure. We used Karlson et al's decomposition method for logit models, which returns the percentage of change in odds ratios (OR) due to confounding. This population-based, case-control study on laryngeal cancer was conducted in Germany in 1998-2000 and included 208 male cases and 702 controls. Information on occupational history, smoking, alcohol consumption, and education was collected through face-to-face interviews. Jobs coded according to ISCO-68 were linked to a recently developed job-classification index covering physical and psychosocial dimensions. A sub-index focused on jobs involving potentially carcinogenic agents (CAI) for the upper-aero digestive tract. When adjusted for smoking and alcohol consumption, higher OR were found for lower education. This OR decreased after further adjustment using the overall job index [2.9, 95% confidence interval (95% CI) 1.4-6.2], similar to the OR using the sub-index CAI (OR 2.7, 95% CI 1.3-5.8). Applying the Karlson et al method, 25.4% (95% CI 22.6-28.2%) of the reduction in these OR was due to occupational exposure (CAI), while smoking and alcohol consumption contributed to around 26.1% (95% CI 23.2-28.9%) and 2.7% (95% CI 1.7-3.8%), respectively. Occupational aspects, in particular the exposure to carcinogenic agents, explain a large portion of the association between low educational level and laryngeal cancer risk among males. Occupational effects are now easier to quantify using this recently developed and easily applicable index.
    Scandinavian journal of work, environment & health 11/2013; · 3.78 Impact Factor
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    ABSTRACT: Dacryocystorhinostomy (DCR) is performed in patients with saccal or postsaccal lacrimal duct obstruction. Focusing on the endonasal approach, we compared success rates, clinical outcome, complications and patient satisfaction of endoscopic vs. non-endoscopic techniques in endonasal DCR. We analyzed the results of 173 patients who underwent an endonasal DCR either utilizing a non-endoscopic (Group I) or an endoscopic technique (Group II) between 2006 and 2011. Irrigation tests followed the first day and at least 3 months after surgery. Postoperative patients' satisfaction and the occurrence of symptoms were documented and evaluated in a follow-up questionnaire. The minor complication rates of both endonasal DCR techniques were similarly low (10 %) without severe adverse events. The use of the endoscope prolonged the operating time significantly (28 ± 9 min Group I vs. 34 ± 14 min Group II, p = 0.003). The success rate was 90.2 % in Group II compared to only 57.9 % in Group I (p < 0.000). Further, we determined the absence of reflux during the irrigation test 1 day after surgery as a significant predictor for the later outcome (R = 1.598, p = 0.005). The follow-up questionnaire revealed a significant improvement in subjectively perceived symptoms by the surgical intervention for both endonasal techniques (p < 0.000). The endoscopically assisted DCR is a safe and successful endonasal technique for patients with saccal or postsaccal lacrimal duct obstructions. The use of the endoscope led to significant higher success rates compared to non-endoscopic techniques in our collective.
    Archives of Oto-Rhino-Laryngology 11/2013; · 1.29 Impact Factor
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    ABSTRACT: To assess the frequency of mental disorders and the use of psychosocial services in laryngectomized patients during the first year after surgery. Multi-center prospective study including 6 interviews. Data regarding psychiatric comorbidity, 3 months (3m) and 1 year (12m) after total laryngectomy (TLE) is reported in this paper. Structured interviews were conducted at 9 hospitals and 3 rehabilitation centers in Germany. 171 patients were interviewed at both time points. Structured clinical interview for DSM-IV (SCID). Mental disorders were diagnosed in 25% of the patients (3m) and in 22% of the patients (12m) respectively. 6% of the patients developed a mental disorder during the first year after TLE. In general male and female patients suffered from mental disorders with equal frequency (3m: 23% vs. 37%; p=0.26; 12m: 22% vs. 21%; p=1.00). Women suffered more often than men from posttraumatic stress disorder (3m) (p=0.01) and generalized anxiety disorder (12m) (p=0.01). Of the patients who had acquired no voice 80% suffered from alcohol dependence (p=0.01). There were no differences between men and women in receiving any kind of counselling (p=0.79) or psychotherapy/psychiatric treatment (p=0.47). Of those patients diagnosed with any mental disorder 3 months after TLE, 7% had received psychotherapy 1 year after TLE. None of the patients diagnosed with alcohol dependence received psychotherapy or psychiatric treatment. Mental disorders occur in laryngectomees as frequently in men as they do in women. TLE patients who were mentally ill did not receive enough psychotherapeutic or psychiatric support. Since mental health seems to be related to successful voice restoration, future research should develop and evaluate special psychosocial supportive programs for laryngeal cancer patients, especially regarding alcohol dependence treatment. This article is protected by copyright. All rights reserved.
    Clinical otolaryngology: official journal of ENT-UK; official journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery 11/2013; · 1.87 Impact Factor
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    ABSTRACT: Navigated control (NC) is an advanced image-guided navigation system that provides an additional control function to enhance patient safety. It automatically stops the surgical instrument if it comes close to critical anatomical structures that need to be protected during surgery. The purpose of this study was to explore the human performance consequences of computer-based navigated control assistance. Seven experienced surgeons conducted a simulated mastoidectomy manually and with support of the NC system. The impact on surgical performance, workload and situation awareness was analysed. NC support led to a better quality of surgical outcome and a lower level of physiological effort during surgery. Cost effects were reflected in reduced time efficiency and an increased subjectively experienced workload. The results demonstrate the potential of NC support in terms of lower workload and enhanced patient safety. Cost effects might be reduced by remodelling the control function. Copyright © 2013 John Wiley & Sons, Ltd.
    International Journal of Medical Robotics and Computer Assisted Surgery 08/2013; · 1.49 Impact Factor
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    ABSTRACT: Background: CCPA was proven to be a protective factor in ischemic reperfusion injury. The purpose was to determine how CCPA would affect the single tissue layers of the adipocutaneous flap. Methods: Seventy male WISTAR rats were divided into five experimental groups. Samples were taken of the area of flap necrosis and the wound margin after classical or pharmacological preconditioning on the fifth postoperative day. All samples were fixed in formaldehyde, embedded in paraplast and analyzed in 3-4 µm sections (haemalaun and eosin stain, light microscopy). Results: In general wound healing was alike and remained unaffected by the experimental design. Most sensitive part of the flap during preconditioning is the subcutis. Number of neutrophils and of plasma cells is reduced significantly (p<0.05). Conclusion: CCPA has an effect on each tissue layer of the flap. Subcutis became apparent as the most sensitive layer. CCPA influences complement pathway and neutrophils directly and indirectly. Head Neck, 2013.
    Head & Neck 07/2013; · 2.83 Impact Factor
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    ABSTRACT: High-risk types of human papilloma virus (HPV) are increasingly associated with oropharyngeal squamous cell carcinoma (OPSCC). Strikingly, patients with HPV-positive OPSCC are highly curable with ionizing radiation and have better survival compared with HPV-negative patients, but the underlying molecular mechanisms remain poorly understood. We applied an array-based approach to monitor global changes in CpG island hypermethylation between HPV-negative and HPV-positive OPSCCs and identified a specific pattern of differentially methylated regions that critically depends on the presence of viral transcripts. HPV-related alterations were confirmed for the majority of candidate gene promoters by mass spectrometric, quantitative methylation analysis. There was a significant inverse correlation between promoter hypermethylation of ALDH1A2, OSR2, GATA4, GRIA4, and IRX4 and transcript levels. Interestingly, Kaplan-Meier analysis revealed that a combined promoter methylation pattern of low methylation levels in ALDH1A2 and OSR2 promoters and high methylation levels in GATA4, GRIA4, and IRX4 promoters was significantly correlated with improved survival in 3 independent patient cohorts. ALDH1A2 protein levels, determined by immunohistochemistry on tissue microarrays, confirmed the association with clinical outcome. In summary, our study highlights specific alterations in global gene promoter methylation in HPV-driven OPSCCs and identifies a signature that predicts the clinical outcome in OPSCCs.
    Journal of Clinical Investigation 06/2013; 123(6):2488-501. · 12.81 Impact Factor
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    ABSTRACT: BACKGROUND: The purpose of this study was to determine what quality of life (QOL) areas improve and deteriorate during the first year after total laryngectomy and to identify predictors of these changes. METHODS: One hundred seventy-four patients completed the European Organization for Research and Treatment of Cancer (EORTC) QOL questionnaires before laryngectomy, n = 133 before discharge from hospital, n = 110 at the end of rehabilitation, and n = 86 1 year after laryngectomy. Multivariate regression analysis was performed to estimate the effect of potential predictors on QOL. RESULTS: Areas that did not recover to baseline level were physical functioning, role functioning, social functioning, fatigue, dyspnea, appetite loss, financial difficulties, senses, speech, and social contact, whereas global health status, coughing, and weight improved. There was no evidence for predicting effects of age, sex, education, and tumor site. Tumor stage, recurrent disease, radiotherapy, and mental health did display predicting effects. Smoking status before the treatment had marginally significant effects. CONCLUSION: QOL decreases initially after laryngectomy; some QOL areas recover slowly over the course of the year after surgery, and some remain significantly worse than at baseline. © 2013 Wiley Periodicals, Inc. Head Neck, 2013.
    Head & Neck 06/2013; · 2.83 Impact Factor
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    ABSTRACT: The hedgehog signaling pathway (HH) is involved in tumorigenesis in a variety of human malignancies. In head and neck squamous cell carcinomas (HNSCC), Hh overexpression was associated with poor prognosis. Therefore, we analyzed the effect of Hh signaling blockade with cyclopamine on colony formation of cells from HNSCC samples. HNSCC biopsies were cultured alone for reference or with serial dilutions of cyclopamine (5-5,000 nM), docetaxel (137.5-550 nM), or cisplatin (1,667-6,667 nM) and their binary combinations. Cytokeratin-positive colonies were counted after fluorescent staining. Cyclopamine concentration-dependently inhibited HNSCC ex vivo [(IC50) at about 500 nM]. In binary combinations, cyclopamine additively enhanced the suppressive effects of cisplatin and docetaxel on HNSCC colony formation. Our findings define SMO - a Hh component- as a potential target in HNSCC and suggest the utility of Hh targeting in future multimodal treatment regimens for HNSCC.
    Anticancer research 06/2013; 33(6):2415-24. · 1.71 Impact Factor
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    ABSTRACT: PURPOSE: Platinum/5-fluorouracil plus cetuximab is a standard systemic treatment for recurrent or metastatic squamous cell carcinoma of the head and neck (SCCHN). Pemetrexed has shown activity in SCCHN. This phase II study evaluated pemetrexed with cisplatin and cetuximab in recurrent/metastatic SCCHN. METHODS: Patients received cetuximab 250mg/m(2) (loading dose: 400mg/m(2))days 1, 8 and 15; pemetrexed 500mg/m(2)+cisplatin 75mg/m(2) on day 1, q3w up to six cycles and folic acid, vitamin B12 and prophylactic medications. After a minimum of four cycles, responding patients were eligible for maintenance with pemetrexed and cetuximab, or either as monotherapy, until progression or toxicity. Efficacy (primary end-point: progression-free survival [PFS]) and toxicity were evaluated. RESULTS: Sixty-six patients received ⩾1 cycle of the triplet. Most patients were male (80.3%), with a median age of 62years and Eastern Cooperative Oncology Group (ECOG) performance status of 1 (71.2%). Diagnoses included oropharynx (45.5%) and larynx (24.2%) cancers, with locoregional disease (51.5%) alone, or combined with distant metastases (48.5%). Median (m) PFS was 4.4months (95% confidence interval [CI]: 3.6, 5.4); median overall survival was 9.7months (95% CI: 6.5, 13.1). Objective response rate was 29.3%; 23 patients had stable disease (39.7%). Drug-related grade 3/4 toxicities included neutropaenia (33.3%), fatigue (24.2%), anorexia (12.1%) and infection (10.6%). Five treatment-related deaths (7.6%) occurred. CONCLUSIONS: Efficacy results were consistent with current standard treatment for this patient population, but the pre-specified mPFS of 5.5months was not achieved. Grade 3/4 toxicities were also consistent with standard treatment, although treatment-related deaths were higher than expected.
    European journal of cancer (Oxford, England: 1990) 05/2013; · 4.12 Impact Factor
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    ABSTRACT: Aim of this study was to find out how many patients after a total laryngectomy (TLE) return to work successfully and what factors support vocational rehabilitation.Laryngectomees (n=231) aged up to 60 years completed questionnaires and structured interviews before TLE (t1), before rehabilitation (t2), at the end of rehabilitation (t3), 1 year after TLE (t4), 2 years after TLE (t5), and 3 years after TLE (t6).Prior to TLE, 38% of all respondents were employed, 34% were unemployed, 23% received disability-related and 3% age-related pension retirement. One year after TLE, 13% were employed, 15% 2 years and 14% 3 years after TLE. Unemployed were 10% (t4), 5% (t5), and 7% (t6) of the patients. For 59% of all respondents it was very important to have a job. Predictors of successful vocational rehabilitation were employment prior to TLE, age <50 years, being self-employed or clerical employee, good physical functioning, good speech intelligibility, high motivation to go back to work, and support from colleagues.Only few laryngectomees return to work. However, even before TLE only a third of the patients was employed, another third was unemployed. Most of the patients receive pension retirement after TLE. As return to work is important for many patients, patient consultations should consider possibilities to support vocational rehabilitation before offering to apply for retirement.
    Laryngo-Rhino-Otologie 05/2013; · 0.82 Impact Factor

Publication Stats

2k Citations
417.67 Total Impact Points

Institutions

  • 2005–2014
    • University of Leipzig
      • • Innovationszentrum für Computerassistierte Chirurgie
      • • Klinik und Poliklinik für Hals-, Nasen- und Ohrenheilkunde
      Leipzig, Saxony, Germany
  • 2013
    • Charité Universitätsmedizin Berlin
      • Medical Department, Division of Oncology and Hematology
      Berlin, Land Berlin, Germany
  • 2006–2013
    • Technische Universität Berlin
      • Department of Psychology and Ergonomics
      Berlin, Land Berlin, Germany
  • 1990–2013
    • Universität Heidelberg
      • • Institute of Public Health
      • • Department of Radiation Oncology
      • • Department of Molecular Biology
      • • Institute of Anatomy and Cell Biology
      • • University Hospital of Otolaryngology
      Heidelburg, Baden-Württemberg, Germany
  • 2012
    • University of Groningen
      • Department of Otorhinolaryngology
      Groningen, Province of Groningen, Netherlands
    • McGill University
      • Department of Educational and Counselling Psychology (ECP)
      Montréal, Quebec, Canada
  • 2009–2012
    • Katholische Kliniken Ruhrhalbinsel gGmbH
      Essen, North Rhine-Westphalia, Germany
  • 2011
    • Philipps University of Marburg
      Marburg, Hesse, Germany
    • Paul-Flechsig-Institut für Hirnforschung
      Leipzig, Saxony, Germany
  • 2010
    • Helmholtz-Zentrum für Umweltforschung
      • Department Umweltimmunologie
      Leipzig, Saxony, Germany
  • 2006–2010
    • Technische Universität München
      • Lehrstuhl für Mikrotechnik und Medizingerätetechnik
      München, Bavaria, Germany
  • 2008
    • Saad Specialist Hospital
      Khobar, Eastern Province, Saudi Arabia
  • 2004
    • University of Hamburg
      Hamburg, Hamburg, Germany
  • 1991–2004
    • Deutsche Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie e.V.
      Heidelburg, Baden-Württemberg, Germany
  • 2003
    • German Cancer Research Center
      Heidelburg, Baden-Württemberg, Germany
  • 1992–2003
    • ATOS Klinik Heidelberg
      Heidelburg, Baden-Württemberg, Germany
    • Heidelberg University
      Tiffin, Ohio, United States
  • 1997
    • Bundeswehrkrankenhaus Ulm
      Ulm, Baden-Württemberg, Germany