首页 > 最新文献

Deutsches Arzteblatt international最新文献

英文 中文
The Ross Operation in Young Patients—A Single-Center, Long-Term Follow-Up Study. 年轻患者的罗斯手术--一项单中心长期随访研究。
IF 6.5 2区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-11-15 DOI: 10.3238/arztebl.m2024.0195
Markus Liebrich, Christoph Dingemann, Detlef Roser, Hartwig Schrimm, You-Shan Feng, Wolfgang Hemmer, Joerg Seeburger, Vladimir Voth

Background: The standard aortic valve replacement operations in young patients are bioprosthetic or mechanical aortic valve replacement. In this study, we present the long-term results of the Ross operation in young patients.

Methods: The Ross operation with root replacement was performed on 795 patients between 1995 and 2020. The endpoints were overall survival, re-operation/reintervention rates on the autograft and homograft/RV-PA conduit (RV, right ventricle; PA, pulmonary artery), and the occurrence of serious adverse events.

Results: 795 patients (75% male, 25% female; mean age 43 ± 14 years) underwent the Ross operation with root replacement. The 30-day mortality was 1% (8 patients) with a 95% confidence interval of [0.48; 1.9]. The follow-up was 96 % complete and covered 9540 patient-years, with a mean follow-up time of 12 ± 7 years. The survival rates at 5, 10, 15 and 20 years were 97% [96; 98], 96% [93; 96], 92% [89; 94] and 86% [83; 90]. The rate of autograft survival without reoperation was 94% [92; 96] at 10 years and 80% [76; 85] at 20 years. The rate of homograft/RV-PA conduit survival without reoperation was 95% [93; 97] at 10 years and 85% [81; 90] at 20 years. There were 5 cases of hemorrhage, 14 of thromboembolic complications or apoplexy, and 19 of endocarditis.

Conclusion: The Ross operation with root replacement was associated with high survival rates over 25 years of follow-up. The rates of reoperation and reintervention, the morbidity and mortality, and the rate of endocarditis are low. The Ross operation is thus an effective surgical treatment option for young patients with aortic valve disease.

背景:年轻患者的标准主动脉瓣置换手术是生物人工主动脉瓣置换术或机械主动脉瓣置换术。在这项研究中,我们介绍了年轻患者接受罗斯手术的长期结果:方法:1995 年至 2020 年间,我们为 795 名患者实施了带根部置换的罗斯手术。研究终点为总生存率、自体移植和同种移植/RV-PA 导管(RV:右心室;PA:肺动脉)的再手术/再介入率以及严重不良事件的发生率:795名患者(75%为男性,25%为女性;平均年龄为43±14岁)接受了根部置换的Ross手术。30 天死亡率为 1%(8 名患者),95% 置信区间为 [0.48; 1.9]。96%的患者完成了随访,随访时间为 9540 年,平均随访时间为 12 ± 7 年。5年、10年、15年和20年的存活率分别为97% [96; 98]、96% [93; 96]、92% [89; 94]和86% [83; 90]。自体移植物无需再次手术的存活率在10年为94% [92; 96],20年为80% [76; 85]。同种移植物/RV-PA导管存活率在10年和20年分别为95% [93; 97]和85% [81; 90],无须再次手术。有5例大出血,14例血栓栓塞并发症或心肌梗塞,19例心内膜炎:结论:在25年的随访中,Ross手术根部置换术的存活率较高。再次手术和再次介入的比例、发病率和死亡率以及心内膜炎的发生率都很低。因此,对于患有主动脉瓣疾病的年轻患者来说,罗斯手术是一种有效的外科治疗选择。
{"title":"The Ross Operation in Young Patients—A Single-Center, Long-Term Follow-Up Study.","authors":"Markus Liebrich, Christoph Dingemann, Detlef Roser, Hartwig Schrimm, You-Shan Feng, Wolfgang Hemmer, Joerg Seeburger, Vladimir Voth","doi":"10.3238/arztebl.m2024.0195","DOIUrl":"10.3238/arztebl.m2024.0195","url":null,"abstract":"<p><strong>Background: </strong>The standard aortic valve replacement operations in young patients are bioprosthetic or mechanical aortic valve replacement. In this study, we present the long-term results of the Ross operation in young patients.</p><p><strong>Methods: </strong>The Ross operation with root replacement was performed on 795 patients between 1995 and 2020. The endpoints were overall survival, re-operation/reintervention rates on the autograft and homograft/RV-PA conduit (RV, right ventricle; PA, pulmonary artery), and the occurrence of serious adverse events.</p><p><strong>Results: </strong>795 patients (75% male, 25% female; mean age 43 ± 14 years) underwent the Ross operation with root replacement. The 30-day mortality was 1% (8 patients) with a 95% confidence interval of [0.48; 1.9]. The follow-up was 96 % complete and covered 9540 patient-years, with a mean follow-up time of 12 ± 7 years. The survival rates at 5, 10, 15 and 20 years were 97% [96; 98], 96% [93; 96], 92% [89; 94] and 86% [83; 90]. The rate of autograft survival without reoperation was 94% [92; 96] at 10 years and 80% [76; 85] at 20 years. The rate of homograft/RV-PA conduit survival without reoperation was 95% [93; 97] at 10 years and 85% [81; 90] at 20 years. There were 5 cases of hemorrhage, 14 of thromboembolic complications or apoplexy, and 19 of endocarditis.</p><p><strong>Conclusion: </strong>The Ross operation with root replacement was associated with high survival rates over 25 years of follow-up. The rates of reoperation and reintervention, the morbidity and mortality, and the rate of endocarditis are low. The Ross operation is thus an effective surgical treatment option for young patients with aortic valve disease.</p>","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":" Forthcoming","pages":"766-772"},"PeriodicalIF":6.5,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142388836","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The Ross Operation—A Demanding Cardiac Surgical Procedure That Yields Excellent Results for Young Patients.
IF 6.5 2区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-11-15 DOI: 10.3238/arztebl.m2024.0229
Sebastian Michel, Christian Hagl
{"title":"The Ross Operation—A Demanding Cardiac Surgical Procedure That Yields Excellent Results for Young Patients.","authors":"Sebastian Michel, Christian Hagl","doi":"10.3238/arztebl.m2024.0229","DOIUrl":"https://doi.org/10.3238/arztebl.m2024.0229","url":null,"abstract":"","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":"121 23","pages":"764-765"},"PeriodicalIF":6.5,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143122416","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The Incidence and Risk Factors of Persis tent Opioid Use After Surgery—A Retrospective Secondary Data Analysis. 手术后持续使用阿片类药物的发生率和风险因素--一项回顾性二次数据分析。
IF 6.5 2区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-11-15 DOI: 10.3238/arztebl.m2024.0200
Johannes Dreiling, Norman Rose, Christin Arnold, Philipp Baumbach, Carolin Fleischmann-Struzek, Christine Kubulus, Marcus Komann, Ursula Marschall, Heike Lydia Rittner, Thomas Volk, Winfried Meißner, Daniel Schwarzkopf

Background: The risk of persistent postoperative opioid use (PPOU) and its association with the type of surgery are still unclear in Germany.

Methods: We conducted a nationwide retrospective cohort study on the basis of claims data from BARMER, a statutory health insurance carrier in Germany. Opioid-naive adults who did not have cancer and who underwent inpatient surgery in 2018 were included in the study. The operations were divided into 103 categories. PPOU was defined as the prescribing of opioids between post - operative days 1 and 90 and also between postoperative days 91 and 180 after hospital discharge. Patient-associated risk factors in the 12 months before surgery were investigated.

Results: 203 327 patients were included. 1.4% had PPOU (95% confidence interval [1.4; 1.5]). There were major differences between operation groups: major amputations and orthopedic procedures carried the greatest risk for the development of PPOU. The type of surgery had a larger effect on the risk of PPOU than preexisting risk factors (explained variance 22.3% vs. 14.3%). Among such factors, alcohol abuse and preexisting treatment with antidepressant drugs were associated with the highest risk for PPOU (odds ratios [OR] 1.515 [1.277; 1.797] and 2.131 [1.943; 2.336]).

Conclusion: The incidence of PPOU in Germany is low (1.4%). The type of surgery plays an important role in its development.

背景:在德国,术后持续使用阿片类药物(PPOU)的风险及其与手术类型的关系尚不清楚:在德国,术后持续使用阿片类药物(PPOU)的风险及其与手术类型的关系尚不清楚:我们以德国法定医疗保险公司 BARMER 的理赔数据为基础,在全国范围内开展了一项回顾性队列研究。研究纳入了 2018 年接受住院手术的未患癌症且未服用阿片类药物的成年人。手术分为 103 个类别。PPOU 被定义为术后第 1 天至第 90 天以及出院后术后第 91 天至第 180 天期间的阿片类药物处方。研究还调查了患者在手术前 12 个月内的相关风险因素。1.4% 的患者患有 PPOU(95% 置信区间 [1.4; 1.5])。不同手术组之间存在重大差异:大截肢手术和矫形手术发生 PPOU 的风险最大。手术类型对 PPOU 风险的影响大于原有风险因素(解释方差为 22.3% 对 14.3%)。在这些因素中,酗酒和预先接受抗抑郁药物治疗与 PPOU 的最高风险相关(几率比 [OR] 1.515 [1.277; 1.797] 和 2.131 [1.943; 2.336]):结论:PPOU 在德国的发病率较低(1.4%)。结论:PPOU 在德国的发病率较低(1.4%),手术类型对其发展起着重要作用。
{"title":"The Incidence and Risk Factors of Persis tent Opioid Use After Surgery—A Retrospective Secondary Data Analysis.","authors":"Johannes Dreiling, Norman Rose, Christin Arnold, Philipp Baumbach, Carolin Fleischmann-Struzek, Christine Kubulus, Marcus Komann, Ursula Marschall, Heike Lydia Rittner, Thomas Volk, Winfried Meißner, Daniel Schwarzkopf","doi":"10.3238/arztebl.m2024.0200","DOIUrl":"10.3238/arztebl.m2024.0200","url":null,"abstract":"<p><strong>Background: </strong>The risk of persistent postoperative opioid use (PPOU) and its association with the type of surgery are still unclear in Germany.</p><p><strong>Methods: </strong>We conducted a nationwide retrospective cohort study on the basis of claims data from BARMER, a statutory health insurance carrier in Germany. Opioid-naive adults who did not have cancer and who underwent inpatient surgery in 2018 were included in the study. The operations were divided into 103 categories. PPOU was defined as the prescribing of opioids between post - operative days 1 and 90 and also between postoperative days 91 and 180 after hospital discharge. Patient-associated risk factors in the 12 months before surgery were investigated.</p><p><strong>Results: </strong>203 327 patients were included. 1.4% had PPOU (95% confidence interval [1.4; 1.5]). There were major differences between operation groups: major amputations and orthopedic procedures carried the greatest risk for the development of PPOU. The type of surgery had a larger effect on the risk of PPOU than preexisting risk factors (explained variance 22.3% vs. 14.3%). Among such factors, alcohol abuse and preexisting treatment with antidepressant drugs were associated with the highest risk for PPOU (odds ratios [OR] 1.515 [1.277; 1.797] and 2.131 [1.943; 2.336]).</p><p><strong>Conclusion: </strong>The incidence of PPOU in Germany is low (1.4%). The type of surgery plays an important role in its development.</p>","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":" Forthcoming","pages":"757-763"},"PeriodicalIF":6.5,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142361312","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Hallucinations While Using Guanfacine in ADHD. 使用胍法辛治疗ADHD时的幻觉。
IF 6.5 2区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-11-01 DOI: 10.3238/arztebl.m2024.0088
Judith U Harrer-Haag, Anette Voran
{"title":"Hallucinations While Using Guanfacine in ADHD.","authors":"Judith U Harrer-Haag, Anette Voran","doi":"10.3238/arztebl.m2024.0088","DOIUrl":"https://doi.org/10.3238/arztebl.m2024.0088","url":null,"abstract":"","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":"121 22","pages":"739"},"PeriodicalIF":6.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143001861","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
One Question, Many Results—Why Epidemiological Studies Yield Heterogeneous Findings. Part 34 of a Series on Evaluation of Scientific Publications. 一个问题,多种结果--为什么流行病学研究得出的结果各不相同?
IF 6.5 2区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-11-01 DOI: 10.3238/arztebl.m2024.0135
Bernd Kowall, Susanne Stolpe, Wolfgang Galetzka, Michael Nonnemacher, Andreas Stang

Background: Observational epidemiological studies often yield different results on the same research question. In this article, we explain how this comes about.

Methods: In this review, which is based on publications retrieved by a selective search in PubMed and the Web of Science, we use information from international publications, simulation studies on sampling error, and a quantitative bias analysis on fictitious data to demonstrate why the results of epidemiological studies are often uncertain, and why it is, therefore, generally necessary to perform more than one study on any particular question.

Results: Sampling errors, imprecise measurements, alternative but equally appropriate methods of data analysis, and features of the populations being studied are common reasons why studies on the same question can yield different results. Simulation studies are used to illustrate the fact that effect estimates such as relative risks or odds ratios can deviate markedly from the true value because of sampling error, i.e., by chance alone. Quantitative bias analysis is used to show how strongly effect estimates can be distorted by misclassification of exposures or outcomes. Finally, it is shown through illustrative examples that different but equally appropriate methods of data analysis can lead to divergent study results.

Conclusion: The above reasons why epidemiological study results can be heterogeneous are explained in this review. Quantitative bias analyses and sensitivity analyses with alternative data evaluation strategies can help explain divergent results on one and the same question.

背景:观察性流行病学研究往往会对同一问题得出不同的结果。在本文中,我们将解释这种情况是如何产生的:这篇综述基于在 PubMed 和 Web of Science 上有选择性地搜索到的出版物,我们利用国际出版物中的信息、对抽样误差的模拟研究以及对虚构数据的定量偏差分析,来说明为什么流行病学研究的结果常常是不确定的,以及为什么通常有必要对任何特定问题进行不止一项研究:结果:抽样误差、不精确的测量、其他同样合适的数据分析方法以及被研究人群的特征,都是对同一问题进行研究得出不同结果的常见原因。模拟研究用来说明,相对风险或几率比率等效应估计值可能会因为抽样误差(即仅仅是偶然因素)而明显偏离真实值。定量偏差分析用于说明暴露或结果的错误分类会如何强烈地扭曲效果估计值。最后,通过举例说明不同但同样适当的数据分析方法会导致不同的研究结果:本综述解释了上述流行病学研究结果可能存在差异的原因。定量偏倚分析和采用其他数据评估策略的敏感性分析有助于解释同一问题的不同结果。
{"title":"One Question, Many Results—Why Epidemiological Studies Yield Heterogeneous Findings. Part 34 of a Series on Evaluation of Scientific Publications.","authors":"Bernd Kowall, Susanne Stolpe, Wolfgang Galetzka, Michael Nonnemacher, Andreas Stang","doi":"10.3238/arztebl.m2024.0135","DOIUrl":"10.3238/arztebl.m2024.0135","url":null,"abstract":"<p><strong>Background: </strong>Observational epidemiological studies often yield different results on the same research question. In this article, we explain how this comes about.</p><p><strong>Methods: </strong>In this review, which is based on publications retrieved by a selective search in PubMed and the Web of Science, we use information from international publications, simulation studies on sampling error, and a quantitative bias analysis on fictitious data to demonstrate why the results of epidemiological studies are often uncertain, and why it is, therefore, generally necessary to perform more than one study on any particular question.</p><p><strong>Results: </strong>Sampling errors, imprecise measurements, alternative but equally appropriate methods of data analysis, and features of the populations being studied are common reasons why studies on the same question can yield different results. Simulation studies are used to illustrate the fact that effect estimates such as relative risks or odds ratios can deviate markedly from the true value because of sampling error, i.e., by chance alone. Quantitative bias analysis is used to show how strongly effect estimates can be distorted by misclassification of exposures or outcomes. Finally, it is shown through illustrative examples that different but equally appropriate methods of data analysis can lead to divergent study results.</p><p><strong>Conclusion: </strong>The above reasons why epidemiological study results can be heterogeneous are explained in this review. Quantitative bias analyses and sensitivity analyses with alternative data evaluation strategies can help explain divergent results on one and the same question.</p>","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":" Forthcoming","pages":"740-745"},"PeriodicalIF":6.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141893139","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Care Models for Psychosocial Problems in Primary Care—A Survey on Awareness and Health Policy Assessment. 初级保健中心理社会问题的护理模式——关于意识和卫生政策评估的调查。
IF 6.5 2区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-11-01 DOI: 10.3238/arztebl.m2024.0116
Wolfram J Herrmann, Hendrik Napierala
{"title":"Care Models for Psychosocial Problems in Primary Care—A Survey on Awareness and Health Policy Assessment.","authors":"Wolfram J Herrmann, Hendrik Napierala","doi":"10.3238/arztebl.m2024.0116","DOIUrl":"https://doi.org/10.3238/arztebl.m2024.0116","url":null,"abstract":"","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":"121 22","pages":"748-749"},"PeriodicalIF":6.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143001860","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Better Health Strategies for Men. 更好的男性健康战略。
IF 6.5 2区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-11-01 DOI: 10.3238/arztebl.m2024.0084
Doris Bardehle
{"title":"Better Health Strategies for Men.","authors":"Doris Bardehle","doi":"10.3238/arztebl.m2024.0084","DOIUrl":"https://doi.org/10.3238/arztebl.m2024.0084","url":null,"abstract":"","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":"121 22","pages":"752"},"PeriodicalIF":6.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143001859","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
In Reply. 在回答。
IF 6.5 2区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-11-01 DOI: 10.3238/arztebl.m2024.0141
Michael J Stein
{"title":"In Reply.","authors":"Michael J Stein","doi":"10.3238/arztebl.m2024.0141","DOIUrl":"https://doi.org/10.3238/arztebl.m2024.0141","url":null,"abstract":"","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":"121 22","pages":"754-755"},"PeriodicalIF":6.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143001863","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Criteria for Re-Irradiation. 再次照射的标准。
IF 6.5 2区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-11-01 DOI: 10.3238/arztebl.m2024.0156
Jonas Willmann, Nicolaus Andratschke, Jens Peter Klußmann, Jürgen E Gschwend, Ghazaleh Tabatabai, Maximilian Niyazi

Background: The treatment options for patients with progressive malignant tumors despite primary radiotherapy are often limited. In selected cases, re-irradiation can be offered. This article concerns the selection criteria and results of re-irradiation for certain types of cancer.

Methods: This review is based on pertinent publications retrieved by a selective search in PubMed, with particular attention to glio - blastoma, head and neck tumors, and prostatic carcinoma.

Results: The published studies of re-irradiation are few in number and often of limited methodological quality. For glioblastoma, a randomized controlled trial (RCT) found that adding re-irradiation to treatment with bevacizumab yielded no significant improvement in either median progression-free survival or median overall survival (hazard ratio [HR] 0.73; p = 0.05 and HR 0.98; p = 0.46, respec - tively). Re-irradiation is a treatment option for locoregional recurrences of head and neck tumors after primary radiotherapy, but it carries a risk of serious side effects. For unresectable recurrences of nasopharyngeal carcinoma, an RCT has shown that hyperfractionated re-irradiation is more effective than normofractionated re-irradiation (overall survival: HR 0.54, p = 0.014). For locally recurrent prostatic carcinoma after radiotherapy, re-irradiation can yield good oncologic outcomes with an acceptable level of urogenital and gastrointestinal side effects (5-year recurrence-free survival: stereotactic body radiation therapy (SBRT), 58%; high dose rate (HDR) brachytherapy, 77%; versus salvage prostatectomy, 72%). RCTs on this topic are lacking.

Conclusion: Re-irradiation is a treatment option for selected cancer patients. As the available scientific evidence is limited, multidisciplinary collaboration and participatory decision-making are particularly important.

背景:尽管进行了原发性放疗,但恶性肿瘤仍在进展的患者的治疗方案往往很有限。在某些情况下,可以进行再照射。本文涉及某些类型癌症再照射的选择标准和结果:方法:本综述基于在PubMed上选择性检索到的相关文献,尤其关注胶质母细胞瘤、头颈部肿瘤和前列腺癌:已发表的关于再照射的研究数量很少,而且方法质量往往有限。就胶质母细胞瘤而言,一项随机对照试验(RCT)发现,在贝伐单抗治疗的基础上加用再照射,中位无进展生存期或中位总生存期均无明显改善(危险比[HR]分别为0.73;P = 0.05和HR 0.98;P = 0.46)。再次放疗是头颈部肿瘤原发性放疗后局部复发的一种治疗选择,但有可能产生严重的副作用。对于无法切除的鼻咽癌复发,一项研究表明,超分次再照射比普通分次再照射更有效(总生存率:HR 0.54,P = 0.014)。对于放疗后局部复发的前列腺癌,再次照射可产生良好的肿瘤治疗效果,且泌尿生殖系统和胃肠道副作用水平可接受(5 年无复发生存率:立体定向体放射治疗(SBRT)58%;高剂量率近距离放射治疗(HDR)77%;与挽救性前列腺切除术相比,72%)。目前尚缺乏相关的研究数据:结论:再次照射是特定癌症患者的一种治疗选择。由于现有的科学证据有限,多学科合作和参与式决策尤为重要。
{"title":"Criteria for Re-Irradiation.","authors":"Jonas Willmann, Nicolaus Andratschke, Jens Peter Klußmann, Jürgen E Gschwend, Ghazaleh Tabatabai, Maximilian Niyazi","doi":"10.3238/arztebl.m2024.0156","DOIUrl":"10.3238/arztebl.m2024.0156","url":null,"abstract":"<p><strong>Background: </strong>The treatment options for patients with progressive malignant tumors despite primary radiotherapy are often limited. In selected cases, re-irradiation can be offered. This article concerns the selection criteria and results of re-irradiation for certain types of cancer.</p><p><strong>Methods: </strong>This review is based on pertinent publications retrieved by a selective search in PubMed, with particular attention to glio - blastoma, head and neck tumors, and prostatic carcinoma.</p><p><strong>Results: </strong>The published studies of re-irradiation are few in number and often of limited methodological quality. For glioblastoma, a randomized controlled trial (RCT) found that adding re-irradiation to treatment with bevacizumab yielded no significant improvement in either median progression-free survival or median overall survival (hazard ratio [HR] 0.73; p = 0.05 and HR 0.98; p = 0.46, respec - tively). Re-irradiation is a treatment option for locoregional recurrences of head and neck tumors after primary radiotherapy, but it carries a risk of serious side effects. For unresectable recurrences of nasopharyngeal carcinoma, an RCT has shown that hyperfractionated re-irradiation is more effective than normofractionated re-irradiation (overall survival: HR 0.54, p = 0.014). For locally recurrent prostatic carcinoma after radiotherapy, re-irradiation can yield good oncologic outcomes with an acceptable level of urogenital and gastrointestinal side effects (5-year recurrence-free survival: stereotactic body radiation therapy (SBRT), 58%; high dose rate (HDR) brachytherapy, 77%; versus salvage prostatectomy, 72%). RCTs on this topic are lacking.</p><p><strong>Conclusion: </strong>Re-irradiation is a treatment option for selected cancer patients. As the available scientific evidence is limited, multidisciplinary collaboration and participatory decision-making are particularly important.</p>","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":" Forthcoming","pages":"725-732"},"PeriodicalIF":6.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142079657","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The Understanding and Emotional State of Patients About to Undergo Visceral Surgery for Cancer. 癌症内脏手术患者的认知和情绪状态。
IF 6.5 2区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-11-01 DOI: 10.3238/arztebl.m2024.0119
Tina Gürlich, Peter Szatmary, Ulrich Ronellenfitsch, Heike Schmidt, Jörg Kleeff
{"title":"The Understanding and Emotional State of Patients About to Undergo Visceral Surgery for Cancer.","authors":"Tina Gürlich, Peter Szatmary, Ulrich Ronellenfitsch, Heike Schmidt, Jörg Kleeff","doi":"10.3238/arztebl.m2024.0119","DOIUrl":"https://doi.org/10.3238/arztebl.m2024.0119","url":null,"abstract":"","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":"121 22","pages":"750-751"},"PeriodicalIF":6.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143001870","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
期刊
Deutsches Arzteblatt international
全部 Acc. Chem. Res. ACS Applied Bio Materials ACS Appl. Electron. Mater. ACS Appl. Energy Mater. ACS Appl. Mater. Interfaces ACS Appl. Nano Mater. ACS Appl. Polym. Mater. ACS BIOMATER-SCI ENG ACS Catal. ACS Cent. Sci. ACS Chem. Biol. ACS Chemical Health & Safety ACS Chem. Neurosci. ACS Comb. Sci. ACS Earth Space Chem. ACS Energy Lett. ACS Infect. Dis. ACS Macro Lett. ACS Mater. Lett. ACS Med. Chem. Lett. ACS Nano ACS Omega ACS Photonics ACS Sens. ACS Sustainable Chem. Eng. ACS Synth. Biol. Anal. Chem. BIOCHEMISTRY-US Bioconjugate Chem. BIOMACROMOLECULES Chem. Res. Toxicol. Chem. Rev. Chem. Mater. CRYST GROWTH DES ENERG FUEL Environ. Sci. Technol. Environ. Sci. Technol. Lett. Eur. J. Inorg. Chem. IND ENG CHEM RES Inorg. Chem. J. Agric. Food. Chem. J. Chem. Eng. Data J. Chem. Educ. J. Chem. Inf. Model. J. Chem. Theory Comput. J. Med. Chem. J. Nat. Prod. J PROTEOME RES J. Am. Chem. Soc. LANGMUIR MACROMOLECULES Mol. Pharmaceutics Nano Lett. Org. Lett. ORG PROCESS RES DEV ORGANOMETALLICS J. Org. Chem. J. Phys. Chem. J. Phys. Chem. A J. Phys. Chem. B J. Phys. Chem. C J. Phys. Chem. Lett. Analyst Anal. Methods Biomater. Sci. Catal. Sci. Technol. Chem. Commun. Chem. Soc. Rev. CHEM EDUC RES PRACT CRYSTENGCOMM Dalton Trans. Energy Environ. Sci. ENVIRON SCI-NANO ENVIRON SCI-PROC IMP ENVIRON SCI-WAT RES Faraday Discuss. Food Funct. Green Chem. Inorg. Chem. Front. Integr. Biol. J. Anal. At. Spectrom. J. Mater. Chem. A J. Mater. Chem. B J. Mater. Chem. C Lab Chip Mater. Chem. Front. Mater. Horiz. MEDCHEMCOMM Metallomics Mol. Biosyst. Mol. Syst. Des. Eng. Nanoscale Nanoscale Horiz. Nat. Prod. Rep. New J. Chem. Org. Biomol. Chem. Org. Chem. Front. PHOTOCH PHOTOBIO SCI PCCP Polym. Chem.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1