J Treuner

University of Tuebingen, Tübingen, Baden-Württemberg, Germany

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Publications (179)539.07 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: In this retrospective study of 62 children with ALL and 10 children with AML, data are compiled on the special aspects of a guarded indication for platelet transfusions; in Tubingen this indication is usually based solely on clinical signs of incipient or manifest bleeding at platelet counts below 11,000/mm3. This is in contrast to the practice most often used to transfuse platelets at counts below 20,000/mm3 for prophylactic reasons irrespective of therapeutic need. The guarded indication aims at keeping the rate of allosensitization by platelet transfusions as low as possible. Of all patients in remission induction of ALL and of AML, platelet transfusions were needed by 53% and 80% respectively; the mean platelet support was 2.9 units in ALL and 19.0 units in AML. In relapse, the need increased considerably. Of all patients with ALL, 11% were sensitized by platelet transfusions; lethal complications related to this guarded indication could not be seen.
    07/2009; 1(1):51-58.
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    ABSTRACT: Ifosfamide is widely used in paediatric oncology, but its use is limited by nephrotoxic side effects. The aim of this study was to evaluate the incidence and risk factors of tubulopathy, with special emphasis on the influence of age, where different findings have been published so far. Five hundred ninety three children and adolescents treated for Ewing, osteo- or soft-tissue sarcoma (median age at diagnosis: 11.7 years) were prospectively investigated for nephrotoxicity in the Late Effects Surveillance System (LESS) study. Tubulopathy was diagnosed in case of continuing hypophosphatemia and proteinuria. After a median follow up of 19 months, 27 patients (4.6%; 95% CI: 3.0-6.6%) had newly developed tubulopathy. This incidence was 0.4% (95% CI: 0-2.4%) in patients treated with a cumulative ifosfamide dose of < or =24 g/m2, 6.5% (95% CI: 3.6-10.7%) after 24-60 g/m2, and 8.0% (95% CI: 4.2-13.6%) after > or = 60 g/m2. In multivariate analysis, children younger than 4 years at time of diagnosis had an 8.7-fold (95% CI: 3.5-21.8) higher risk for tubulopathy than older patients. Neither carboplatin treatment nor abdominal irradiation showed any significant influence. Ifosfamide-induced nephrotoxicity was found in 4.6% of patients. Risk factors were the cumulative ifosfamide dose and young age at treatment.
    Pediatric Blood & Cancer 04/2007; 48(4):447-52. · 2.35 Impact Factor
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    ABSTRACT: Prospective longitudinal examinations of anthracycline-induced cardiomyopathy in a homogeneous cohort are rare in pediatric oncology. We herein report the results of observations on the frequency of cardiomyopathy in doxorubicin-treated sarcoma patients in Germany, Austria, and Switzerland. The Late Effects Surveillance System (LESS) prospectively collects longitudinal data on late sequelae of antineoplastic therapy in Ewing-, soft tissue-, and osteosarcoma patients treated within the therapy trial protocols of the German Society of Pediatric Oncology and Hematology. Two hundred sixty-five relapse-free patients who had received doxorubicin for the treatment within the EICESS-92/EURO-E.W.I.N.G.-99, COSS-96, and CWS-96 therapy trials were serially examined by echocardiography. The analyzed population consisted of 142 males and 123 females. Their mean age at the end of therapy was 13 +/- 5 years. The mean follow-up time was 34 +/- 12 months. The mean cumulative doxorubicin dose was 290 +/- 91 mg/m(2). In this cohort, the total cumulative incidence of doxorubicin-induced cardiomyopathy was 7.5%. Four patients (1.5%) suffered from a symptomatic cardiomyopathy and 16 (6%) from a subclinical cardiomyopathy. Cardiomyopathy manifested in 11 cases already under antineoplastic therapy and in the remaining nine cases at a median of 26 days (range: 17-174 days) after stopping antineoplastic therapy. Univariate and multivariable analysis did not confirm any of the known risk factors for developing anthracycline-induced cardiomyopathy in our patient group within the described time interval. After a mean follow-up of 34 +/- 12 months, cumulative incidence of doxorubicin-induced cardiomyopathy in our pediatric sarcoma patients was at the lower end of that reported by other groups.
    Pediatric Blood & Cancer 05/2006; 46(4):489-95. · 2.35 Impact Factor
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    ABSTRACT: Up to now, cardiotoxicity of epirubicin has been studied almost exclusively in adult cancer patients. The aim of this study was to investigate epirubicin in children and adolescents, in comparison with doxorubicin. About 172 soft tissue sarcoma patients (mean age at diagnosis: 8.3 years), treated with epirubicin (median cumulative dose: 450 mg/m2) or doxorubicin (median cumulative dose: 240 mg/m2) within the high-risk group of the CWS-96 study, were examined in a prospective multicentre study. Heart function was analysed by echocardiography, measuring left-ventricular fractional shortening (FS). The median follow up was 27.7 months. Incidence of clinically manifest cardiomyopathy was 0% (0/60; 95% CI: 0-6.0%) in patients treated with epirubicin, and 0.9% (1/108; 95% CI: 0-5.1%) in patients treated with doxorubicin. A further three patients showed subclinical cardiomyopathy. There was no difference in FS between the two treatment arms. Cardiotoxicity was low in our study. For the short term, cardiotoxicity seems to be only a minor problem in patients treated with epirubicin as applied in this cohort.
    Journal of Cancer Research and Clinical Oncology 02/2006; 132(1):35-40. · 2.91 Impact Factor
  • Biology of Blood and Marrow Transplantation - BIOL BLOOD MARROW TRANSPLANT. 01/2006; 12(2):10-10.
  • Treuner J, Brecht IB
    Pädiatrische Hämatologie und Onkologie., Edited by Gadner H, Gaedicke G, Niemeyer Ch, Ritter J, 01/2006: chapter Weichteilsarkome.; Springer.
  • J. Treuner, I. B. Brecht
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    ABSTRACT: Die Stadieneinteilung der Weichteilsarkome im Kindes- und Jugendalter erfolgt nach der prächirurgischen RNM-Klassifikation der SIOP (International Society of Paediatric Oncology), dem „grouping system“ der IRS (Intergroup Rhabdomyosarkomstudie) und der postchirurgischen histopathologischen Klassifikation der SIOP
    12/2005: pages 5514-5550;
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    ABSTRACT: We investigated whether polymorphonuclear leukocytes (PMN) are able to kill human neuroblastoma cells either directly or if coated with antibody MAb 14.18 that recognizes ganglioside GD2 present on the cell surface of most neuroblastoma cells. Neuroblastoma cells could not be destroyed directly, whereas in the antibody-dependent reaction (ADCC-reaction) they were easily eliminated. In order to answer the question whether reactive oxygen intermediates are involved in this process, chemiluminescence measurements were performed. Compared to the signals that could be measured using opsonized zymosan as stimulus, only weak CL-signals could be registered during the ADCC reaction. Pretreatment of PMN with granulocyte-macrophage colony stimulating factor (GM-CSF) enhanced the CL-signals, catalase and SOD reduced it; however, cell killing was only slightly influenced in the presence of catalase and superoxide dismutase. These data suggested that reactive oxygen compounds do not play a prominent role in the killing process. Definitive evidence for this suggestion could be obtained using PMN from a patient with chronic granulomatous disease (CGD): MAb 14.18 coated neuroblastoma cells could be killed effectively, but no CL-signal could be registered, either in the ADCC-reaction or using opsonized zymosan as stimulus.
    Journal of Bioluminescence and Chemiluminescence 03/2005; 3(2):93-6.
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    ABSTRACT: Final results are presented from two consecutive European studies for patients with metastatic rhabdomyosarcoma (RMS) to identify prognostic variables and determine the value of high-dose chemotherapy (HDCT) in complete remission. A total of 174 patients aged 3 months to 18 years participated. From 1989 to 1991, patients received four cycles of intensive multiagent chemotherapy. From 1991 to 1995, patients achieving complete remission received consolidation with HDCT. All received local therapy (surgery, radiation therapy) according to response. At a median follow-up of 8 years, 5-year overall survival (OS) and event-free survival (EFS) for the whole group were 24% and 20%, respectively. No statistical difference was found between HDCT and standard chemotherapy (5-year OS, 36% v 27%; EFS 29% v 23%). Univariate analysis identified primary tumor in parameningeal, extremity, or other sites; age younger than 1 year and older than 10 years; bone or bone marrow metastases; multiple metastases; and multiple sites of metastases as unfavorable prognostic factors for OS and EFS. Multivariate analysis identified unfavorable site, bone or bone marrow involvement, and unfavorable age as independently unfavorable factors. Two subgroups were identified. Those with fewer than two unfavorable factors had 5-year EFS and OS of 40% and 47%, respectively. Patients with > or = two unfavorable factors had 5-year EFS and OS of 7.5% and 9%, respectively. A minority of patients with metastatic RMS have better survival than overall results for this population suggest. Those in the highest risk group have such poor survival that they are candidates for first-line novel therapies. There is no evidence that consolidation with HDCT improves outcome.
    Journal of Clinical Oncology 12/2004; 22(23):4787-94. · 18.04 Impact Factor
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    ABSTRACT: The aim of this study was to analyse carboplatin-induced ototoxicity in a recent study trial. Twenty patients who had received carboplatin for the treatment of soft tissue sarcoma were investigated prospectively for ototoxicity in a multi-centre trial. Hearing function was tested by audiometry. All patients but one were treated with a cumulative dose of 1500 mg/m(2), the remaining with 500 mg/m(2). We evaluated the incidence and dependencies of hearing loss, and compared hearing thresholds to those of an untreated control group (n=60). Hearing thresholds in the carboplatin treated group were only marginally poorer compared with those of the control group. After carboplatin therapy no patient (0%; 95%-KI: 0-17%) had a hearing loss >20 dB. Hearing thresholds were not dependent on age, sex or cranial irradiation. We conclude that ototoxicity after carboplatin was low in our group of patients.
    Oncology Reports 11/2004; 12(4):767-71. · 2.30 Impact Factor
  • I B Brecht, J Treuner
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    ABSTRACT: The very heterogeneous group of paediatric soft tissue sarcomas account for approximately 7 % of all malignant childhood tumours. More than one half of all cases are rhabdomyosarcomas, some of the over 20 entities are very rare. The prognosis and biology of soft tissue sarcomas in children and adolescents vary greatly depending on histological subtype, the age of the patient, the primary site, the tumour size, tumour invasiveness and the extent of disease at diagnosis. Since 1981, 2918 children and adolescents with soft tissue sarcomas were treated prospectively according to the common treatment protocols of the Cooperative Soft Tissue Sarcoma Study Group (CWS-81 - 96). The known prognostic factors were used to develop a more and more detailed risk stratification. The multimodal treatment includes the use of surgery, chemotherapy and radiotherapy and should be planned by a multidisciplinary team. That way, an overall survival of nearly 70 % over all risk groups could be achieved.
    Handchirurgie · Mikrochirurgie · Plastische Chirurgie 11/2004; 36(5):275-81. · 0.86 Impact Factor
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    ABSTRACT: To ascertain whether alveolar histology retains its adverse prognostic role in the subset of paratesticular rhabdomyosarcoma (RMS) patients, generally characterized by a very good outcome. Twenty pediatric patients were treated over a 25-year period using the protocols of the Italian and German Soft Tissue Sarcoma Cooperative Groups. Clinical characteristics at presentation were much the same as in non-alveolar patients. The proportion of patients with alveolar histotype (8%) in paratesticular site was lower than in the general RMS population (20-30%). With a median follow-up of 122 months, 5-year EFS and OS were 78 and 89%, respectively. Our data suggest a distinctly better clinical behavior of paratesticular alveolar RMS than when the disease occurs at other sites. These patients were more intensively treated than the embryonal cases, however, so-although a treatment intensity reduction may be desiderable-the idea of eliminating the alkylating agents (as in low-risk embryonal paratesticular RMS) must be considered with great caution.
    Pediatric Blood & Cancer 03/2004; 42(2):134-8. · 2.35 Impact Factor
  • I. B. Brecht, J. Treuner
    Handchirurgie Mikrochirurgie Plastische Chirurgie - HANDCHIR MIKROCHIR PLAST CHIR. 01/2004; 36(5):275-281.
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    ABSTRACT: Chromosomal translocations t(11;22) (q24;q12) are characteristic of about 80-90 % of Ewing's sarcoma family of tumors [bone and soft tissue Ewing's sarcoma and peripheral neuroectodermal tumors (PNET)]. They generate ews/fli1 rearrangements showing great diversity in breakpoint exon combination. In about 5 % of Ewing's tumors, ews is fused to the erg gene at 21q22. The various chimeric proteins encoded may function as aberrant oncogenic transcription factors. These specific translocations can be used for exact molecular diagnosis in these poorly differentiated small round-cell tumors. Moreover, the prognostic relevance of different translocational variants has been previously suggested. Furthermore, the sensitive molecular detection of minimal metastatic and residual disease and its clinical significance can be evaluated. To address these questions more definitively in the large number of patients registered in multicenter studies, it is often necessary to access archival paraffin-embedded tumor tissue if no fresh or frozen tumor material is available for analysis by RT (reverse transcription)-PCR. Specific problems arise from formalin-fixed and paraffin-embedded tissue due to the degradation of RNA and insufficient extraction efficiency. Therefore, primer distance and product size are limited for successful PCR amplification. This conflicts with the requirement for identification of various possible exon combinations by PCR simultaneously using one single primer pair with larger distance. We examined paraffin embedded soft part tumor tissue samples from 47 Ewing's tumor patients. Patients were treated according to either CWS (Cooperative Weichteilsarkomstudie, CWS-91 or CWS-96) or Euro-E.W.I.N.G. 99 therapy protocols. We established a novel RT-PCR method, using 3 different exon specific sets of PCR primer pairs, selected according to the coding ews and fli1 nucleotide sequences (NCBI database), suitable for RT-PCR identification of variant ews/fli1 fusion transcripts in RNA isolated from formalin-fixed, paraffin-embedded tissue. For use in combination with ews -primer, an erg specific primer was selected to alternatively test for ews/erg fusion transcripts. As positive control for the integrity of isolated mRNA, we used the ubiquitously expressed gapdh transcript for RT-PCR amplification in each sample. In 31 cases (= 66 %) of 47 paraffin samples of Ewing's tumors analysed, gapdh control indicated adequate quality of RNA. In 16 cases no gapdh control fragment was amplifiable, nevertheless in 2 of these 16 samples distinct ews fusion products could be detected. In 23 cases we identified ews fusion transcripts. Thereof in 65 % ews exon 7 being fused to fli1 exon 6 (fusion type I), in 22 % to fli1 exon 5 (fusion type II). In 4 % each ews exon 10 being juxtaposed to fli1 either exon 6 or exon 5, respectively. An ews/erg fusion was detected in 4 % ( ews exon 7 fused to erg exon 6). In 10 samples, a gapdh fragment was amplified, but no ews/fli1 or - erg fusion transcript could be identified. The reference pathological review (I. L., Kiel, Germany) disproved the primary histopathology in 5 cases. Using our different sets of exon specific primer pairs, it was possible to detect 4 different breakpoints of ews/fli1 fusion transcripts and the ews/erg fusion by RT-PCR in RNA isolates from formalin-fixed, paraffin-embedded Ewing's tumor tissue. This method can be a very useful alternative in clinical situations (to ensure diagnosis and perform minimal metastatic and residual disease investigations) and in order to assess prognostic significance of translocation subtypes when no fresh tumor tissue is available.
    Klinische Pädiatrie 01/2004; 216(6):315-22. · 1.90 Impact Factor
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    ABSTRACT: In the current study, the authors aim to evaluate clinical features and treatment results observed in patients from the German and Italian studies who had nonmetastatic abdominal rhabdomyosarcomas (RMS). One hundred sixty-one patients were observed; 78 registered in the German studies between October 1980 and August 1995, and 83 registered in the Italian studies between April 1975 and December 1995. The age range of the patients was 0-18 years (median, 4 yrs). The distribution of tumor sites was as follows: 32 intraperitoneal, 42 retroperitoneal, 75 pelvic, and 12 not otherwise specified (NOS). Most patients had a large and invasive primary mass (26 T1b, 114 T2b). The breakdown in histology was as follows: 116 embryonal, 34 alveolar, and 11 other (leiomyomatous, pleomorphic, and NOS); all cases were staged according to the Intergroup Rhabdomyosarcoma Studies (IRS) system. Nine Group I patients were treated after surgery with chemotherapy (CT) (radiotherapy [RT] was delivered to treat alveolar RMS in the 1991 German and 1988 Italian studies); 19 Group II patients received CT + RT (40-44 Gy); 133 Group III patients underwent neoadjuvant CT +/- surgery and/or RT (54 Gy) + CT. Different CT regimens (based primarily on the administration of vincristine, dactinomycin, doxorubicin, and cyclophosphamide or ifosfamide) were adopted. RT was not recommended for patients age < 3 years. The 10-year overall survival (OS) and progression-free survival (PFS) were 47.2% and 43.9%, respectively. The OS was related significantly to the following variables: histology (alveolar, 29.4% vs. nonalveolar, 52.1% [P = 0.0156]), tumor size (> 5 cm, 42.1% vs. < 5 cm, 81% [P = 0.005]), age (< 10 yrs, 51.4% vs. >or= 10 yrs, 27.8% [P = 0.02]), complete surgery at diagnosis or after CT (+/-RT) (70.4% vs. 34.4% without it [P = 0.0015]). Most patients who achieved the delayed local control had responded well to neoadjuvant CT. Tumor size, histology, age, and initial or delayed achievement of local control were important prognostic factors. Most relapsed patients had unfavorable outcomes.
    Cancer 04/2003; 97(8):1974-80. · 5.20 Impact Factor
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    ABSTRACT: The MMT4 study was designed to explore an intensive chemotherapy regimen (MMT4-89) and the role of high-dose melphalan (MMT4-91) in children with metastatic soft tissue sarcoma, including extraosseous peripheral neuroectodermal tumor (PNET). Thirty-one patients with PNET were treated between 1989 and 1995 (11 according to MMT4-89 and 20 according to MMT4-91). Chemotherapy consisted of four CEVAIE cycles, each including three 3-week courses: CEV (carboplatin 500 mg/m(2), epirubicin 150 mg/m(2), vincristine 1.5 mg/m(2)), IVA ifosfamide 9 g/m(2), actinomycin 1.5 mg/m(2), vincristine 1.5 mg/m(2)), IVE (ifosfamide 9 g/m(2), etoposide 600 mg/m(2), vincristine 1.5 mg/m(2)). In MMT4-91 the fourth CEVAIE was replaced with melphalan 200 mg/m(2) with stem cell rescue. The CEV combination was evaluated as a window study. Surgery followed the second cycle. Radiotherapy was administered to post-surgical residual disease. The response rate was 55% after CEV, rising to 80% after the first CEVAIE. Twenty-five patients achieved complete remission (CR). Overall, the 5-year EFS was 22.6%: 36.4% and 15% for patients treated according to MMT4-89 and MMT4-91, respectively (P = 0.3). Local control was achieved in 77% of irradiated patients vs 45% of non-irradiated. Age >10 years was associated with significantly poorer outcome (P = 0.04). In conclusion, despite the high CR rate, intensive chemotherapy with or without high-dose melphalan appeared to have little impact on the survival of patients with metastatic extraosseus PNET.
    Bone Marrow Transplantation 10/2002; 30(5):297-302. · 3.54 Impact Factor
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    ABSTRACT: Die Frage, ob eine Neuroblastomscreening im Alter von 1 Jahr die Inzidenz der metastasierten Neuroblastome bzw. die krankheitsbedingte Sterblichkeit senken kann, war bisher unbeantwortet. Ein einfacher Windeltest auf Neuroblastom wurde 2.581.188 Kindern im Alter von 1 Jahr in 6 von 16 Bundesländern von 1995–2000 angeboten (Screeningregion). Im gleichen Zeitraum dienten 2.117.600 Kinder in den anderen 10 Ländern als Kontrollgruppe. Es wurden anschließend die Inzidenz von metastasierten Neuroblastomen und die Rate von Neuroblastomsterbefällen in Screening- und Kontrollregion verglichen. Insgesamt nahmen 1.475.773 Kinder an der Untersuchung teil. Die Screening- und die Kontrollgruppe zeigten keinen relevanten Unterschied bei der Stadium-4-Inzidenz und der Sterblichkeitsrate. Ein epidemipologischer Vergleich der beiden Gruppen zeigte eine erhebliche “Überdiagnose” in der Screeninggruppe. Diese “Überdiagnose” beinhaltet Neuroblastomfälle, bei denen durch die Screeninguntersuchung ein Neuroblastom entdeckt wurde, das sonst nie klinisch auffällig geworden wäre. Das bedeutet, die Kinder profitieren von dieser Früherkennung nicht. Die Ergebnisse zeigen, dass die Einführung einer generellen Neuroblastomfrüherkennungsuntersuchung im Alter von 1 Jahr nicht empfehlenswert ist.
    Der Onkologe 09/2002; 8(10):1103-1108. · 0.13 Impact Factor
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    ABSTRACT: Malignant vascular tumors are extremely rare in childhood and few data on their clinical management are available. We report on a series of 18 children who had malignant vascular tumors, treated from 1980 to 2000 by the Italian and German Soft Tissue Sarcoma Cooperative Group. Twelve patients had angiosarcoma, four had malignant hemangioendothelioma, and two had Kaposi's sarcoma. Surgical resection was completed in six cases; radiotherapy was administered to 6 children, and chemotherapy to 14. After a median follow-up of 208 months, the 5-year survival and event-free survival rates were 30.9 and 20.8%. Six patients were alive, four in first remission (three had tumor < 5 cm, grossly completely resected), and two in second remission. Response to chemotherapy was evaluable in nine cases and was: six no response, two partial remission, one complete remission. Angiosarcoma and related malignant vascular tumors are aggressive neoplasms with a poor prognosis; their behavior in children seems no different from their adult counterparts. Complete surgical resection remains the mainstay of treatment, but is probably sufficient in only a minority of cases. Postoperative radiotherapy may have a role and could be added to improve local control. The role of chemotherapy is uncertain, but the high rate of metastatic spread prompts investigation into new chemotherapeutic approaches.
    Medical and Pediatric Oncology 08/2002; 39(2):109-14.
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    ABSTRACT: Die Frage, ob ein Neuroblastomscreening im Alter von einem Jahr die Inzidenz der metastasierten Neuroblastome beziehungsweise die krankheitsbedingte Sterblichkeit senken kann, war bisher unbeantwortet. Von 1995–2000 wurde in 6 von 16 Bundesländern (Screeningregion) 2.581.188 Kindern im Alter von einem Jahr ein einfacher Windeltest auf Neuroblastom angeboten. Im gleichen Zeitraum dienten 2.117.600 Kinder in den anderen 10 Ländern als Kontrollgruppe. Anschließend wurden die Inzidenz von metastasierten Neuroblastomen und die Rate von Neuroblastomsterbefällen in Screening- und Kontrollregion verglichen. Insgesamt nahmen 1.475.773 Kinder an der Untersuchung teil. Die Screening- und die Kontrollgruppe zeigten keinen relevanten Unterschied bei der Stadium 4-Inzidenz und der Sterblichkeitsrate. Ein epidemipologischer Vergleich der beiden Gruppen zeigte eine erhebliche “Überdiagnose” in der Screeninggruppe. Diese “Überdiagnose” beinhaltet Neuroblastomfälle, bei denen durch die Screeninguntersuchung ein Neuroblastom entdeckt wurde, das sonst nie klinisch auffällig geworden wäre, d.h.die Kinder profitieren von dieser Früherkennung nicht. Die Ergebnisse zeigen, dass die Einführung einer generellen Neuroblastom-Früherkennungsuntersuchung im Alter von einem Jahr nicht empfehlenswert ist. The question whether neuroblastoma screening at one year of age reduces either incidence of stage 4 disease and/or mortality was open. We offered 2,581,188 children at one year of age a urine test in six of 16 German states from 1995 to 2000, the 2,117,600 children in the remaining states acted as contemporary controls. We compared the incidence of metastasized neuroblastoma and neuroblastoma related mortality. 1,475,773 children participated in the screening area. The screening and control areas showed neither a difference of stage 4 incidence nor of mortality. Substantial “overdiagnosis” was observed in the screened group. These cases are children whose tumor was detected by screening but who would not benefit from early detection or early treatment. The findings do not support a recommendation to implement neuroblastoma screening at one year of age.
    Monatsschrift Kinderheilkunde 07/2002; 150(8):934-941. · 0.19 Impact Factor
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    ABSTRACT: Clear cell sarcoma (CCS) of tendons and aponeuroses is extremely rare in childhood and little information is available on its clinical management. Originally believed to be a type of melanoma of soft tissue origin, CCS is now considered a distinct clinicopathologic entity that behaves like a high-grade soft tissue sarcoma. We report on a series of 28 pediatric patients treated from 1980 to 2000 by the Soft Tissue Sarcoma Italian Cooperative Group and the German Cooperative Group. Patients were treated with a multimodality therapeutic approach. Surgical resection was complete in 17 patients (mutilating in 3), radiotherapy was administered to 8 patients, and 20 patients received chemotherapy. After a median follow-up of 102 months (range, 19-238 months), the 5-year and event-free survival rates were 66.4% and 63.3%, respectively. Seventeen patients were alive in first remission, two were alive in second remission, and nine had died of disease. The response to chemotherapy in the 7 evaluable patients included one partial remission, one minor response, and five no responses. Radiotherapy contributed to achieving local control in four of six Intergroup Rhabdomyosarcoma Study (IRS) Group II patients. Statistically significant differences in outcome were evident according to IRS group, tumor size, and site. Our study confirms the aggressive behavior of CCS. Complete surgical resection represents the mainstay of treatment, and even the only treatment for patients with small tumors. Radiotherapy may control microscopic residual disease after surgery. Chemotherapy is ineffective and the prognosis is unfavorable for patients with unresectable and large tumors.
    Cancer 07/2002; 94(12):3269-76. · 5.20 Impact Factor

Publication Stats

2k Citations
539.07 Total Impact Points


  • 1981–2009
    • University of Tuebingen
      • Department of Radiology
      Tübingen, Baden-Württemberg, Germany
  • 2004–2007
    • Universitätsklinikum Erlangen
      Erlangen, Bavaria, Germany
    • Gesellschaft für Pädiatrische Onkologie und Hämatologie
      Stuttgart, Baden-Württemberg, Germany
  • 2001–2004
    • Fondazione IRCCS Istituto Nazionale dei Tumori di Milano
      • s.c. Pediatria Oncologica
      Milano, Lombardy, Italy
  • 2002–2003
    • University of Padova
      • • Department of Women’s and Children’s Health - SDB
      • • Department of Pediatrics
      Padova, Veneto, Italy
  • 1989–2001
    • Christian-Albrechts-Universität zu Kiel
      • Institute of Phytopathology
      Kiel, Schleswig-Holstein, Germany
    • Hannover Medical School
      • Clinic for Paediatric Surgery
      Hannover, Lower Saxony, Germany
  • 1996
    • University of Texas MD Anderson Cancer Center
      Houston, Texas, United States
    • University of Hamburg
      • Department of Paediatric Haematology and Oncology
      Hamburg, Hamburg, Germany
  • 1994
    • Universität Regensburg
      Ratisbon, Bavaria, Germany
  • 1989–1992
    • University of Iowa Children's Hospital
      Iowa City, Iowa, United States
  • 1986–1991
    • Universitätsklinikum Tübingen
      Tübingen, Baden-Württemberg, Germany
  • 1988–1989
    • Universitätsklinikum Düsseldorf
      Düsseldorf, North Rhine-Westphalia, Germany