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Introduction
Current institution
Current position
- Leitung Pädiatrische Onkologie und Hämatologie UKSH Lübeck, Studienleitung Late Effects Surveillance System, LESS
Additional affiliations
November 1994 - July 2013
Universitätsklinikum Erlangen, Kinder- und Jugendklinik
Position
- Oberarzt
Publications
Publications (240)
This study examines the organization of long-term follow-up care for pediatric cancer survivors through the lens of Bronfenbrenners’ Ecological Systems Theory (EST). Using focus group discussions with survivors and healthcare professionals across Germany, we aimed to identify challenges and facilitators in care provision. Data were gathered during...
Purpose
The shift from child‐centered to adult‐focused healthcare presents social and psychological challenges for adolescents and young adults with chronic conditions, which can affect their participation in follow‐up care. This study aims to investigate the factors that influence patient‐driven motivations for adhering to follow‐up recommendation...
Background
In Germany, around 2.250 children and adolescents are diagnosed with cancer each year. Despite generally positive long-term survival rates, many patients must cope with late effects of the disease and its treatment. This highlights the need for a well-structured, long-term approach addressing both physical and mental health issues. Curre...
Background
To overcome knowledge gaps and optimize long-term follow-up (LTFU) care for childhood cancer survivors, the concept of the Survivorship Passport (SurPass) has been invented. Within the European PanCareSurPass project, the semiautomated and interoperable SurPass (version 2.0) will be optimized, implemented, and evaluated at 6 LTFU care ce...
BACKGROUND
Many childhood cancer survivors (CCS) develop treatment-related late effects, including increased risk of obesity and metabolic syndrome. A healthy lifestyle can reduce the risk of associated comorbidities. Therefore, at-risk CCS could benefit from lifestyle counseling during regular long term follow up (LTFU).
OBJECTIVE
We implemented...
Background
Many childhood cancer survivors (CCS) develop treatment-related late effects, including an increased risk of obesity and metabolic syndrome. A healthy lifestyle can reduce the risk of associated comorbidities. Therefore, at-risk CCS could benefit from lifestyle counseling during regular long-term follow-up (LTFU).
Objective
We implement...
Die Zahl der Menschen, die von einer Krebserkrankung im Kindesalter geheilt worden sind, wächst beständig. Sie leiden jedoch an den Therapiefolgen, zudem drohen Zweittumoren. Diese Patientinnen und Patienten sind hierzulande unzureichend versorgt. Eine Studie soll das ändern.
Introduction
This article presents the study design of the qualitative part of the VersKiK study (Long-term care, care needs and wellbeing of individuals after cancer in childhood or adolescence: study protocol of a large scale multi-methods non-interventional study) aiming to explore actual follow-up needs of childhood and adolescence cancer survi...
Purpose
Childhood, adolescent and young adult (CAYA) cancer survivors require ongoing surveillance for health problems from the end of cancer treatment throughout their lives. There is a lack of evidence-based guidelines on optimal surveillance strategies for the period from the end of treatment to 5 years after diagnosis. We aimed to address this...
Purpose
To identify barriers and facilitators for implementing the Survivorship Passport (SurPass) v2.0 in six long-term follow-up (LTFU) care centres in Europe.
Methods
Stakeholders including childhood cancer survivors (CCSs), healthcare providers (HCPs), managers, information and technology (IT) specialists, and others, participated in six onlin...
To prospectively assess the incidence of Dropped Head Syndrome (DHS) in childhood cancer survivors (CCS) and to develop and evaluate a diagnostic algorithm for DHS.
A systematic literature search for DHS in combination with neck radiotherapy (RT) exposure was performed. Analyses and a combination of the most common examination methods were integrat...
Purpose
Auditory complications are potential side effects from childhood cancer treatment. Yet, limited evidence exists about the impact of auditory complications—particularly tinnitus—on health-related quality of life (HRQoL) among childhood cancer survivors (CCS). We determined the prevalence of hearing loss and tinnitus in the European PanCareLI...
Purpose: Due to large medical achievements in the field of pediatric oncology, more and more children as well as adolescents now reach adulthood. The literature suggests that one in 640 young adults can be considered a pediatric cancer survivor. Structured aftercare programs for the early detection of cancer recurrence and/or negative therapy assoc...
The impact of the temporal sequence by which cranial radiotherapy (CRT) and platin‐based chemotherapy (PCth) are administered on sensorineural hearing loss (SNHL) in pediatric and adolescent central nervous system (CNS) and head‐and‐neck (HN) cancer patients has not yet been studied in detail. We examined the ototoxic effects of sequentially applie...
Zusammenfassung
Kinder und Jugendliche überleben eine Krebsdiagnose und erfolgreiche Krebstherapie länger als Erwachsene. Damit gewinnen Spätfolgen der Behandlung, wie kardiotoxische Langzeitwirkungen, zunehmend an Relevanz. Häufig werden im Rahmen der onkologischen Therapie Anthrazykline eingesetzt, deren akute und chronische Kardiotoxizität bekan...
Purpose
To prospectively assess incidence of Dropped Head Syndrome (DHS) in childhood cancer survivors (CCS) and to develop and evaluate a diagnostic algorithm for DHS
Methods
A systematic literature search for DHS in combination with neck radiotherapy (RT) exposure was performed. Analyses and combination of the most common examination methods wer...
Background:
Timely diagnosis of treatment-related chronic health conditions in childhood cancer survivors (CCS) may result in reduced long-term morbidity and mortality. Evidence-based guidelines serve as a tool to implement risk-adapted screening examinations in long-term follow-up (LTFU) of CCS.
Summary:
New international LTFU guidelines from t...
Purpose
Childhood cancer survivors (CCS) are at risk for increased morbidity and reduced quality of life associated with treatment-related late effects. In Germany, however, only a few of the more than 40,000 CCS registered in the German Childhood Cancer Registry (GCCR) currently benefit from adequate clinical long-term follow-up (LTFU) structures....
Purpose: Childhood cancer survivors (CCS) are at risk for increased morbidity and reduced quality of life associated with treatment-related late effects. In Germany, however, only a few of the more than 40,000 CCS registered in the German Childhood Cancer Registry (GCCR) currently benefit from adequate clinical long-term follow-up (LTFU) structures...
BACKGROUND
To overcome knowledge gaps and optimize long-term follow-up (LTFU) care for childhood cancer survivors, the concept of the Survivorship Passport (SurPass) has been invented. Within the European PanCareSurPass project, the semiautomated and interoperable SurPass (version 2.0) will be optimized, implemented, and evaluated at 6 LTFU care ce...
Approximately 2200 children and adolescents below the age of 18 years are diagnosed with cancer in Germany every year. Due to the continuous further development and standardization of treatment, nowadays over 80% of those affected survive their disease in the long term. Due to the improved long-term survival, late sequelae are becoming increasingly...
Background
Many childhood cancer survivors (CCS) develop treatment-related late effects years after the end of treatment, including increased risk of obesity, metabolic syndrome and related diseases. A healthy lifestyle can reduce the risk of associated comorbidities. Lifestyle counseling during regular long term follow up (LTFU) care could benefit...
Auditory complications are potential side effects from childhood cancer treatment. Yet, limited evidence exists about the impact of auditory complications—particularly tinnitus—on health–related quality of life (HRQoL) among childhood cancer survivors (CCS). We determined the prevalence of hearing loss and tinnitus in the large European PanCareLIFE...
Background:
Epidemiological research on late effects of therapy shows the necessity to aggregate chemotherapy agents to substance classes. This requires using conversion factors by substance classes.
Aims:
The aim of this study was to identify previously used conversion factors from the literature, to present a novel approach for additional fact...
Introduction:
Osteosarcoma treatment has benefitted greatly from collaborative research. This paper describes the history and accomplishments of the Cooperative Osteosarcoma Study Group (COSS), mainly dedicated to clinical questions, as well as remaining challenges.
Materials and methods:
Narrative review of over four decades of uninterrupted co...
Purpose:
Long-term follow-up (LTFU) care for childhood cancer survivors (CCSs) is essential to improve and maintain their quality of life. The Survivorship Passport (SurPass) is a digital tool which can aid in the delivery of adequate LTFU care. During the European PanCareSurPass (PCSP) project, the SurPass v2.0 will be implemented and evaluated a...
Ewing sarcoma (EwS) represents highly aggressive bone and soft tissue tumors that require intensive treatment by multi-chemotherapy, surgery and/or radiotherapy. While therapeutic regimens have increased survival rates, EwS survivors face long-term sequelae that include secondary malignant neoplasms (SMNs). Consequently, more knowledge about EwS pa...
Approximately 2200 children and adolescents below the age of 18 years are diagnosed with cancer in Germany every year. Due to the continuous further development and standardization of treatment, nowadays over 80% of those affected survive their disease in the long term. Due to the improved long-term survival, late sequelae are becoming increasingly...
BACKGROUND AND PURPOSE: Diffuse glioneuronal tumor with oligodendroglioma-like features and nuclear clusters (DGONC) is a new, molecularly defined glioneuronal CNS tumor type. The objective of the present study was to describe MR imaging and clinical characteristics of patients with DGONC.
MATERIALS AND METHODS: Preoperative MR images of 9 patient...
Background
It has been shown previously that a relevant proportion of childhood cancer survivors suffers from late effects, which are often directly related to the cancer itself or its therapy, resulting in particular follow-up needs, additionally burdening healthcare systems. Being diagnosed with cancer at a vulnerable stage of development, this g...
Many long-term childhood cancer survivors suffer from treatment-related late effects, which may occur in any organ and include a wide spectrum of conditions. Long-term follow up (LTFU) is recommended to facilitate early diagnosis and to ensure better health outcomes. Due to the heterogeneity of these sequelae, different specialists work together in...
Compared to the general population, childhood cancer survivors represent a vulnerable population as they are at increased risk of developing health problems, known as late effects, resulting in excess morbidity and mortality. The Survivorship Passport aims to capture key health data about the survivors and their treatment, as well as personalized r...
Zusammenfassung
Aufgrund von diagnostischen und therapeutischen Fortschritten in der Hämatologie und Onkologie und entsprechend steigenden Überlebensaussichten ist ein stetiger Zuwachs der Gruppe von Langzeitüberlebenden mit und nach Krebs (Cancer Survivor) in Deutschland zu verzeichnen. Obwohl das bereits vorhandene deutsche Gesundheitswesen vielf...
PurposeLong-term follow-up (LTFU) care is essential to optimise health outcomes in childhood cancer survivors (CCS). We aimed to assess the impact of the COVID-19 pandemic on LTFU services and providers.MethodsA COVID-19 working group within the International Late Effects of Childhood Cancer Guideline Harmonization Group (IGHG) distributed a questi...
Advances in cancer therapy during the past four decades have resulted in remarkable increases in survival for most cancers of childhood and adolescence. Data from the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) Program show that the overall 5-year survival rate for childhood cancer has increased from 45% in 1970 t...
With ever increasing long-term, disease free survival rates, long-term toxicities of otherwise successful therapy have gained increasing importance. They can be grouped into potentially life-threatening, especially secondary malignancies and anthracycline cardiomyopathies, potentially disabling, particularly severe hearing loss and renal insufficie...
Major advances in the treatment of paediatric malignancies have resulted in significant and impressive results, with the overall 5-year survival rate exceeding 80%. Childhood cancer survivors (CCSs), though being cured of cancer, often experience late effects, both physical and psychological, secondary to their cancer or its treatment. Many survivo...
Introduction
Radiation-induced cavernomas (RIC) after cranial radiotherapy have an unknown risk of hemorrhage. Zabramski magnetic resonance imaging (MRI) classification is touted as being able to indicate non-radiation-induced cavernomas hemorrhage risk. The aim of our study was to assess the hemorrhage risk of RIC during long-term follow-up of chi...
In children with cancer, the heterogeneity in ototoxicity occurrence after similar treatment suggests a role for genetic susceptibility. Using a genome-wide association study (GWAS) approach, we identified a genetic variant in TCERG1L (rs893507) to be associated with hearing loss in 390 non-cranial irradiated, cisplatin-treated children with cancer...
Array technology to genotype single-nucleotide variants (SNVs) is widely used in genome-wide association studies (GWAS), clinical diagnostics, and linkage studies. Arrays have undergone a tremendous growth in both number and content over recent years making a comprehensive comparison all the more important. We have compared 28 genotyping arrays on...
Anti-Hu syndrome is a rare autoantibody associated paraneoplastic disease of the central and peripheral nervous system resulting in a variety of neurological symptoms. In pediatric patients it is described in the context of (ganglio) neuroblastoma associated Opsoclonus-Myoclonus Syndrome (OMS) and other paraneoplastic syndromes. The timely diagnosi...
b> Background and Summary: Thanks to increasing cure rates to currently >80%, children, adolescents, and young adults (CAYA) survive their cancer much more frequently today than decades ago. Due to their long life expectancy, CAYA cancer survivors are at a particular risk of long-term sequelae from the cancer itself or the therapy applied; this req...
BACKGROUND
Cardiac toxicity is the most common non-malignant cause of death in childhood cancer survivors attributed to treatment-related consequences. Identifying patients at risk of developing late cardiac toxicity is therefore crucial to improving treatment outcomes. Genetic markers have been proposed to be used together with clinical risk facto...
Background:
In childhood cancer survivors (survival of 5 years or more after diagnosis), cardiac toxicity is the most common nonmalignant cause of death attributed to treatment-related consequences. Identifying patients at risk of developing late cardiac toxicity is therefore crucial to improving treatment outcomes. The use of genetic markers has...
Patients with childhood, adolescent, and young adult cancer who will be treated with gonadotoxic therapies are at increased risk for infertility. Many patients and their families desire biological children but effective communication about treatment-related infertility risk and procedures for fertility preservation does not always happen. The PanCa...
Female patients with childhood, adolescent, and young adult cancer are at increased risk for fertility impairment when treatment adversely affects the function of reproductive organs. Patients and their families desire biological children but substantial variations in clinical practice guidelines reduce consistent and timely implementation of effec...
Forty-two chapters have been structured according to the toxicities in cancer entities, and the late effects and follow-up proposals have been discussed by European and American authors. Cancer diseases in children, adolescents and young adults are treated within specific treatment protocols and can produce different late effects that will have to...
Long-term survival rates of childhood and young adult cancer patients improved significantly during the last decades. However, treatment used to cure cancer can cause secondary diseases, which can occur even many years after the end of therapy (late effects), resulting in high morbidity and reduced health-related quality of life. These sequelae are...
Non-Hodgkin’s lymphoma (NHL) in childhood was a deadly diagnosis in most cases until the early 1970s. At that point of time, the Berlin-Frankfurt-Muenster study group ran their first NHL study very similar to the BFM treatment for acute lymphoblastic leukemia (ALL). The first study reached an event-free survival of 75% for none-B-NHL but only 34% f...
Isolated CNS relapse after stage IV neuroblastoma is a rare event and
prognosis is very poor. We report about a girl with stage IV neuroblastoma at
the age of 13 months, who developed isolated CNS relapse at age of 5 years
after primary treatment according to the GPOH-NB2004 protocol. The girl was
successfully treated with complete resection of the...
The treatment of children with posterior fossa brain tumours (PFBT) impacts their long term functional and imaging outcomes. This study aimed to evaluate academic achievement correlated with long-term sequelae after different PFBT treatment modalities. The study cohort consisted of 110 survivors (median age at diagnosis 10.1 years and median time o...
Solide Tumoren im Kindesalter sind selten und vielfältig. Sie stellen sowohl in der Diagnostik als auch in der Therapie erhebliche Herausforderungen an die behandelnden Disziplinen. Nur eine multidisziplinäre Herangehensweise und eine Diskussion eines jeden Patienten in einer entsprechend besetzten Tumorkonferenz werden den Betroffenen gerecht.
Childhood, adolescent, and young adult (CAYA) cancer survivors may be at risk for a severe course of COVID-19. Little is known about the clinical course of COVID-19 in CAYA cancer survivors, or if additional preventive measures are warranted. We established a working group within the International Late Effects of Childhood Cancer Guideline Harmoniz...
Background:
Irreversible sensorineural hearing loss is a common side effect of platinum treatment with the potential to significantly impair the neurocognitive, social and educational development of childhood cancer survivors. Genetic association studies suggest a genetic predisposition for cisplatin-induced ototoxicity. Among other candidate gene...
Genetic association studies suggest a genetic predisposition for cisplatin-induced ototoxicity. Among other candidate genes, thiopurine methyltransferase (TPMT) is considered a critical gene for susceptibility to cisplatin-induced hearing loss in a pharmacogenetic guideline. The PanCareLIFE cross-sectional cohort study evaluated the genetic associa...
Objective
As adolescent cancer patients may suffer from infertility following treatment, fertility counselling is essential. Our aim was to explore the current situation in four European countries in terms of (I) education about the risk for infertility, (II) counselling on fertility preservation, (III) patients' knowledge on fertility, (IV) suffic...
Ototoxicity is a common side effect of platinum treatment and manifests as irreversible, high-frequency sensorineural hearing loss. Genetic association studies have suggested a role for SNPs in genes related to the disposition of cisplatin or deafness. In this study, 429 pediatric patients that were treated with cisplatin were genotyped for 10 cand...
Background:
Many childhood cancer survivors develop treatment-associated late effects emerging years or even decades after the end of treatment. Evidence-based guidelines recommend risk-adapted screening, facilitating early diagnosis and management of these sequelae. Long-term follow-up (LTFU) in specialized late effects clinics is devised to impl...
Background:
Improved, multimodal treatment strategies have been shown to increase cure rates in cancer patients. Those who survive cancer as a child, adolescent or young adult (CAYA), are at a higher risk for therapy-, or disease-related, late or long-term effects. The CARE for CAYA-Program has been developed to comprehensively assess any potentia...
Infertility is a relevant late-effect following cancer treatment; yet, a large proportion of survivors cannot recall having been informed of this risk. In an intervention study, we examined if and how supportive patient information material on fertility/fertility-preserving measures influences utilization of cryopreservation in adolescent cancer pa...
Erkrankungen des endokrinen Systems gehören zu den häufigsten Folgen onkologischer Erkrankungen im Kindes- und Jugendalter. Große Langzeitnachsorgestudien zeigen, dass jeder zweite Überlebende einer Krebserkrankung im Kindesalter im Verlauf des Lebens von mindestens einer endokrinologischen Störung erkrankt, die als direkte Spätfolge auf die antine...
After the definition of hearing loss, audiological grading scales defining the presence and severity of hearing loss are presented. An overview is provided of epidemiological estimates of childhood hearing loss and issues involved in their calculation. After specification of the stages of hearing development, the different types of behavioural resp...
Junge Menschen, die im Kindes-, Jugend- oder jungen Erwachsenenalter
eine Krebserkrankung überstanden haben, sind häufig von
krankheits- oder therapiebedingten Langzeit- und Spätfolgen betroffen.
Hierzu können neben körperlichen und psychischen Beschwerden
auch soziale Probleme gehören.
URL: https://www.kinderkrebsstiftung.de/fileadmin/Redaktion/Z...
Purpose:
Within a multicenter European study, we explored fertility-related wishes, concerns, and decision-making of adolescent cancer patients and their parents.
Patients and Methods:
Patients and parents were each asked to complete a fertility-related questionnaire 3 months after initial diagnosis. In total, 113 of 142 (79.6%) eligible patients...
Introduction/objectives:
Fertility preservation is a major concern for adolescent cancer patients; yet, educational gaps remain. Our intervention study examined whether specially designed educational materials regarding fertility preservation increase knowledge and empowerment of patients and parents.
Methods:
Eleven paediatric-oncological centr...
Dank verbesserter Therapiemöglichkeiten haben sich die Langzeitüberlebensraten der Patienten mit einer Krebserkrankung im Kindes- und Jugendalter in den letzten Jahrzehnten deutlich verbessert. Durch die zur Heilung der Krebserkrankung eingesetzten Therapien können jedoch Folgeerkrankungen bestehen bleiben oder auch viele Jahre nach Therapieende no...
Background:
With rising numbers of childhood cancer survivors, somatic and socio-economic outcome as well as the health-related quality of life (QoL) gain increasing relevance. Based on the first nationwide German Survey on Life Situation, State of Health and Quality of Life of Childhood Cancer Survivors, the VIVE-survey, we report the outcome of...
Background
About 80% of children and adolescents with cancer are nowadays cured. However, depending on the type of cancer and its treatment, many of these patients are at risk of developing chronic health conditions. If these late effects occur decades after the end of therapy, these patients are already adults and no longer in regular pediatric on...
Childhood, adolescent, and young adult (CAYA) cancer survivors treated with platinum-based drugs, head or brain radiotherapy, or both have an increased risk of ototoxicity (hearing loss, tinnitus, or both). To ensure optimal care and reduce consequent problems—such as speech and language, social–emotional development, and learning difficulties—for...
The number of patients surviving five or more years after initial cancer diagnosis has significantly increased over the last decades due to considerable improvements in the treatment of many cancer entities. A negative consequence of this is the emergence of long-term sequelae and endocrine disorders account for a high proportion of these. These la...
Zusammenfassung
Krebskranke Kinder und Jugendliche überleben heute dank Heilungsraten von über 80% viel häufiger ihre Krebserkrankung als vor 40 Jahren. Etwa 33 000 geheilte ehemalige krebskranke Kinder und Jugendliche sind in der Langzeitbeobachtung über das Deutsche Kinderkrebsregister (DKKR) bundesweit erfasst. Heißt geheilt aber auch gesund? Be...
Aims:
Survival after cancer diagnosed during childhood or adolescence continues to improve with new treatments and supportive therapies. Optimal long-term care requires that risks to vulnerable organs are clearly defined and translated into guidelines that are implemented into practice. PanCareLIFE is a pan-European consortium that addresses survi...
Background
Childhood cancer survivors are at risk of cancer- and treatment-related chronic health conditions. Since these sequelae may occur years after the end of treatment, many patients are already adults and have completed pediatric oncological care. Thus, successful transition is essential in order to ensure long-term surveillance.
Objectives...
Überlebende nach Krebs im Kindes- u. Jugendalter können in hohem Ausmaß an körperlichen Spätfolgen der Erkrankung und der onkologischen Behandlung leiden. Diese gehen oft mit psychosozialen Belastungen einher. Das Konstrukt der gesundheitsbezogenen Lebensqualität (HRQoL) ergänzt die Erhebung psychischer Belastungen um deskriptive und weniger defizi...
Background
As survival rates of childhood cancer have continuously increased over the last few decades, the number of long-term survivors is also steadily growing. Many of these patients are at risk of developing late effects as a consequence of cancer therapy. The occurrence of late effects depends on the treatment regime and may affect different...
BACKGROUND
Survival rates after childhood cancer now reach nearly 80% in developed countries. However, the treatment leading to this improved survival can cause serious adverse effects that have life-long negative impacts on survivor’s quality of life. Hearing impairment is a common adverse effect in children treated with cisplatin-based chemothera...
Background
Survival rates after childhood cancer now reach nearly 80% in developed countries. However, treatments that lead to survival and cure can cause serious adverse effects with lifelong negative impacts on survivor quality of life. Hearing impairment is a common adverse effect in children treated with cisplatin-based chemotherapy or cranial...
Background:
Childhood cancer survivors are at risk for therapy-related sequelae and, therefore, require long-term follow-up. At 2 university hospitals in Germany collaborative multidisciplinary late effects clinics were installed to provide specialized care and to evaluate the current health status of these patients in a clinical setting. Patients...
Introduction
The variability in late toxicities among childhood cancer survivors (CCS) is only partially explained by treatment and baseline patient characteristics. Inter-individual variability in the association between treatment exposure and risk of late toxicity suggests that genetic variation possibly modifies this association. We reviewed the...
Background:
The Cooperative Ewing Sarcoma Study and the Late Effects Surveillance System of the Society for Paediatric Oncology and Haematology recommend a structured follow-up imaging protocol (FUIP) for patients with Ewing sarcoma (EwS) with decreasing frequency of imaging over the first 5 years. The present study aims to assess the effectivenes...
Da bei krebskranken Kindern und Jugendlichen heute Heilungsraten von >80 % erzielt werden, leben in Deutschland mittlerweile mehr als 30.000 Geheilte. Aber heißt geheilt auch gesund? Beim Vergleich mit der Normalbevölkerung stellt man fest, dass die Morbidität und Mortalität bei den ehemaligen Patienten deutlich erhöht sind. Die Krebserkrankungen u...
Ob Folgeerkrankungen oder Spätfolgen auftreten, ist von der Krebserkrankung und der Krebstherapie abhängig. Nachfolgend werden ausgewählte somatische, aber auch psychische Spätfolgen aufgeführt und Empfehlungen für die Langzeitnachbeobachtung gegeben.
Today, 80% of children and adolescents with cancer survive their disease. From the results of aftercare research arises the question: Are the survivors also healthy? Many late effects depend on the type of cancer and its treatment. Patients with brain tumors and with malignant sarcomas are very often affected by secondary diseases. Data from the US...
