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  • 1
  • 2
    Abstract: Primäre ZNS-Lymphome (PZNSL) gehören zu den seltenen Gehirntumoren. Sie machen etwa 3% aller primären intrakraniellen Neubildungen aus; das mediane Erkrankungsalter liegt zwischen 60 und 65 Jahren. PZNSL führen häufig zu einem rasch progredienten Psychosyndrom und zeigen sich in der Magnetresonanztomographie (MRT) oft als multifokale oder unifokale, intensiv kontrastmittelaufnehmende Läsionen, häufig in der Nachbarschaft zu den Ventrikeln. Die diagnostische Maßnahme der Wahl ist die stereotaktische Biopsie, die bei mehr als 90% der Patienten ein hoch malignes Non-Hodgkin-Lymphom (NHL) der B-Zell-Reihe vom diffus-großzelligen Typ zeigt. Da weiterhin eine Therapieoptimierung der PZNSL angestrebt wird, sollten Patienten innerhalb klinischer Studien behandelt werden. Bei Patienten unter 60 Jahren ist das Therapieziel kurativ. Jungen Patienten sollte eine Polychemotherapie unter Einschluss von systemischem hochdosiertem Methotrexat (MTX) angeboten werden. Der Stellenwert einer myeloablativen Hochdosischemotherapie mit autologer Stammzelltransplantation in der Primärtherapie ist noch nicht abschließend geklärt. Für Patienten über 60 Jahre ist noch keine kurative Therapie etabliert. Außerdem spielt die Toxizität eine noch größere Rolle. Bei diesen Patienten kann eine MTX-basierte Chemotherapie, z. B. in Kombination mit Ifosfamid oder Temozolomid, eingesetzt werden. Die alleinige Radiotherapie in der Primärbehandlung wird nicht empfohlen. Ihr Stellenwert in Kombination mit einer MTX-basierten Chemotherapie ist ebenfalls nicht etabliert, sie ist jedoch insbesondere bei älteren Patienten mit einer hohen Rate neurotoxischer Spätfolgen verbunden. Im Rezidiv gibt es in der Regel gute Behandlungsmöglichkeiten, deren Auswahl von der Primärtherapie abhängt. In Deutschland gibt es mehrere Studienkonsortien, die wesentliche Arbeiten zur Optimierung der Therapie dieser Tumoren geleistet haben und die sich in enger Diskussion austauschen.
    Type of Publication: Journal article published
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  • 3
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    German Medical Science; Düsseldorf, Köln
    In:  27. Deutscher Krebskongress; 20060322-20060326; Berlin; DOCIS020 /20060320/
    Publication Date: 2006-04-21
    Keywords: ddc: 610
    Language: English
    Type: conferenceObject
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  • 4
    ISSN: 1433-0350
    Keywords: Key words Intraspinal glioma ; High-grade astrocytoma ; Radiation therapy ; Multidrug chemotherapy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Intraspinal high-grade astrocytoma in children is an extremely rare tumor entity with disappointingly short survival times despite multimodality treatment. We report on a girl with anaplastic astrocytoma at level T9–11, who was treated with tumor resection, multidrug chemotherapy and irradiation. Local recurrence was diagnosed after 16 months. With reference to other cases reported in the literature, the course of disease, achievements and limitations of currently available therapeutic options, and potential future strategies are discussed.
    Type of Medium: Electronic Resource
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  • 5
    Electronic Resource
    Electronic Resource
    Springer
    Der Onkologe 4 (1998), S. 608-617 
    ISSN: 1433-0415
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Die Astrozytome hohen Malignitätsgrades (Grad III, IV) sind mit etwa 30% die häufigsten und zugleich aggressivsten Hirntumoren gliösen Ursprungs und führen unbehandelt innerhalb weniger Wochen zum Tode. Neben der primär einzusetzenden Operation ist der Stellenwert der postoperativen perkutanen Strahlentherapie in der Behandlung der malignen Gliome unbestritten. Derzeit gibt es keinen gesicherten Hinweis, daß eine Chemotherapie Operation und Strahlentherapie ersetzen kann, so daß die malignen Gliome wegen ihres aggressiven Wachstums und der damit verbundenen schlechten Prognose unverändert eine Herausforderung an den Radioonkologen stellen.
    Type of Medium: Electronic Resource
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  • 6
    ISSN: 1432-0533
    Keywords: Key words Hodgkin’s lymphoma ; Primary central ¶nervous system lymphoma ; Immunosuppression ; Epstein-Barr virus ; Immunoglobulin rearrangement
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract A 66-year-old woman treated for ocular myasthenia gravis with azathioprine for 12 years presented with a left fronto-parietal mass. Histology revealed primary Hodgkin’s lymphoma of the central nervous system with CD30, Epstein-Barr virus (EBV) latent membrane protein and CD20-positive, CD45 (LCA)-negative Reed-Sternberg cells surrounded by T cells. Moreover, EBV-encoded RNA-1 (EBER-1) sequences and a monoclonal rearrangement of the immunoglobulin heavy chain CDR2 locus were detected.
    Type of Medium: Electronic Resource
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  • 7
    ISSN: 0942-0940
    Keywords: Atypical meningioma ; anaplastic meningioma ; postoperative radiotherapy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary We retrospectively analysed 13 patients (pts.) treated at the University of Tübingen from 1985 to 1993 to evaluate the results of radiation therapy (XRT) given as an adjuvant to totally or subtotally resected meningiomas. The overall survival was 38% at five years with a probability of relapse of 50% at this time. Reclassification of the tumours according to the new WHO-classification of brain tumours [14] revealed 10 grade-II-tumours (atypical meningioma) and 3 grade-III-tumours (anaplastic meningioma). Radiotherapy failed in all 3 pts. with macroscopically incomplete resection (Simpson's grade IV), who died with relapse between 4 and 51 months after radiotherapy. 5 out of 10 pts. with grade-II-tumours relapsed. All 3 pts. with grade-III-tumours died with relapse between 6 and 21 months after XRT. Morbidity was seen in 2 pts. after irradiation with 60 GY (ICRU dose specification). Complete surgical exstirpation offers the best possibility of tumour control. Grade-III-tumours should be irradiated whatever the extent of the primary surgery was. Our results might indicate a possible indication for XRT in pts. with atypical grade-II-tumours especially when radical surgery must be in doubt. Prospective multicentre trials are warranted to prove the prognostic value of the new WHO-classification for atypical and anaplastic meningiomas and to define the ultimate role of radiotherapy in this setting.
    Type of Medium: Electronic Resource
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  • 8
    ISSN: 1432-2102
    Keywords: Schlüsselwörter Gamma-Knife ; Radiochirurgie ; Linearbeschleuniger ; Konvergenzbestrahlung ; Konformationsbestrahlung ; Key words Gamma knife ; Radiosurgery ; Linear accelerator ; Convergent beam irradiation ; Conformation radiotherapy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Introduction: The principles of radiosurgery were developed in 1951 by Leksell. Their technical realization led to the development of the gamma knife and stereotactically modified linear accelerator. Methods: In addition to the gamma knife, we present the different principles of convergent beam irradiation (radiosurgery with linear accelerator), the further development to fractionated stereotactic conformal radiotherapy, and the necessary quality-assurance steps. Results: The greatest uncertainties in the precision of radiosurgery result from medical imaging (CT 0.7 × 0.7 × 1 mm; DSA 1–5 mm; MR angiography 〈 2 mm). The focusing accuracy of the gamma knife (± 0.3 mm) can also be achieved today by linear accelerators using a stereotactic floorstand. For the same indication and the same dosage for the target volume, there are no clinical differences between the gamma knife and the linear accelerator (AVM: 80 % complete obliteration; metastases: 85 % local tumor control; AN: 90 % tumor control). However, there are greater differences in costs. There is no constellation where the gamma knife is just as expensive or more cost-effective than the linear accelerator treatment. The most cost-effective solution is modification of an available linear accelerator, resulting in treatment costs per patient of 9,201.25 DM (50 patients/year). Conclusion: There seem to be no methodological, physical, clinical or cost reasons for using a gamma knife, especially because the trend is going towards fractionated conformation radiotherapy instead of the application of high single doses.
    Notes: Zusammenfassung Einführung: Die Prinzipien der Radiochirurgie wurden 1951 von Leksell entwickelt. Die technische Realisierung führte zur Entwicklung von Gamma-Knife und stereotaktisch umgerüstetem Linearbeschleuniger. Methode: Neben dem Gamma-Knife werden die unterschiedlichen Prinzipien der Konvergenzbestrahlung (Radiochirurgie mit Linearbeschleuniger), deren Weiterentwicklung zur fraktionierten stereotaktischen Konformationsbestrahlung und die notwendigen Qualitätssicherungsmaßnahmen dargestellt. Ergebnisse: Die größten Unsicherheiten in der Präzision der Radiochirurgie ergeben sich aus den bildgebenden Verfahren (CT 0,7 × 0,7 × 1 mm, DSA 1–5 mm, MR-Angiographie 〈 2 mm). Die Fokussiergenauigkeit des Gamma-Knife von ± 0,3 mm kann heutzutage auch von Linearbeschleunigern bei Verwendung eines Stereotaxiestativs erreicht werden. Bei gleicher Indikationsstellung und gleicher zielvolumenumschließender Dosierung ergeben sich keine klinischen Unterschiede zwischen Gamma-Knife und Linearbeschleuniger (AVM: 80 % vollständige Obliteration; Metastasen: 85 % lokale Tumorkontrolle; AN: 90 % Tumorkontrolle). Um so größer sind die Unterschiede bei den Kosten. Es gibt keine Konstellation, bei der das Gamma-Knife gleich teuer oder billiger ist als eine Linearbeschleunigerbehandlung. Die kostengünstigste Lösung ist die Umrüstung eines bestehenden Linearbeschleunigers, wobei Behandlungskosten von 9201,25 DM pro Patient (bei 50 Patienten/Jahr) entstehen. Zusammenfassung: Es lassen sich keine methodisch-physikalischen, klinischen oder Kostengründe finden, die für die Verwendung eines Gamma-Knife sprechen, insbesondere da die Entwicklung sich von der Applikation hoher Einzeitdosen zur fraktionierten Konformationsbestrahlung hinwendet.
    Type of Medium: Electronic Resource
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  • 9
    ISSN: 1573-5117
    Keywords: phosphorus ; nutrient cycling ; stratification ; epilimnion
    Source: Springer Online Journal Archives 1860-2000
    Topics: Biology
    Notes: Abstract Phosphorus regeneration from lake sediments, and subsequent migration to trophogenic surface water, significantly contributes to the lake nutrient budgets and algal bloom conditions in some lake types. Decomposition of organic matter in deep water and sediments results in the accumulation of regenerated nutrients, alternate electron acceptors (reduced products of anaerobic respiration = COD), carbon dioxide, and depletion of dissolved oxygen (electron acceptor in aerobic respiration). Thermal stratification creates spatial segregation of trophogenic and tropholytic environments in the lake, resulting in gradients between sediments, hypolimnion, and the epilimnion. Exchange of oxygen, nutrients, and reduced alternate electron acceptors between the hypolimnion and epilimnion affects the productivity of a lake. Secchi depth, temperature, and dissolved oxygen profiles were determined twice each week from May 1980 to October 1980 at each of five lake stations. Nutrient concentration profiles, including total soluble and total phosphorus, ammonium-N, nitrate, soluble Kjeldahl, and total Kjeldahl nitrogen were determined twice each month. Epilimnetic algal samples were collected twice each week using Kemmerer and water column ‘straw’ amplers. Cell counts of total, green, bluegreen, and diatom algae groups were made. Three methods were used to describe hypolimnetic-epilimnetic exchange, including coefficients of eddy diffusion (based on lake heat budget), a graphical method of defining thermocline location, and relative thermal resistance to mixing (RTRM, based on density differences). All three methods yeilded comparable estimates of net seasonal transport. The graphical and RTRM methods described events occurring at shorter intervals (greater resolution). We find general agreement between the three methods of describing hypolimnetic-epilimnetic transport. The frequency of sampling resulted in increased resolution of thermal profiles (in time), allowing accurate estimation of short-term nutrient flux into epilimnetic waters. An algal bloom event occurred 5 to 12 days following erosion of the top of the metalimnion to below the aerobic-anaerobic interface. The lag time to peak algal concentration, following such events, decreased through the summer (June = 12 days, September = 5 days)
    Type of Medium: Electronic Resource
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  • 10
    ISSN: 1573-5117
    Keywords: phosphorus ; nutrient cycling ; stratification ; epilimnion
    Source: Springer Online Journal Archives 1860-2000
    Topics: Biology
    Notes: Abstract Phosphorus regeneration from lake sediments, and subsequent migration to trophogenic surface water, significantly contributes to the lake nutrient budgets and algal bloom conditions in some lake types. Decomposition of organic matter in deep water and sediments results in the accumulation of regenerated nutrients, alternate electron acceptors (reduced products of anaerobic respiration = COD), carbon dioxide, and depletion of dissolved oxygen (electron acceptor in aerobic respiration). Thermal stratification creates spatial segregation of trophogenic and tropholytic environments in the lake, resulting in gradients between sediments, hypolimnion, and the epilimnion. Exchange of oxygen, nutrients, and reduced alternate electron acceptors between the hypolimnion and epilimnion affects the productivity of a lake. Secchi depth, temperature, and dissolved oxygen profiles were determined twice each week from May 1980 to October 1980 at each of five lake stations. Nutrient concentration profiles, including total soluble and total phosphorus, ammonium-N, nitrate, soluble Kjeldahl, and total Kjeldahl nitrogen were determined twice each month. Epilimnetic algal samples were collected twice each week using Kemmerer and water column ‘straw’ amplers. Cell counts of total, green, bluegreen, and diatom algae groups were made. Three methods were used to describe hypolimnetic-epilimnetic exchange, including coefficients of eddy diffusion (based on lake heat budget), a graphical method of defining thermocline location, and relative thermal resistance to mixing (RTRM, based on density differences). All three methods yeilded comparable estimates of net seasonal transport. The graphical and RTRM methods described events occurring at shorter intervals (greater resolution). We find general agreement between the three methods of describing hypolimnetic-epilimnetic transport. The frequency of sampling resulted in increased resolution of thermal profiles (in time), allowing accurate estimation of short-term nutrient flux into epilimnetic waters. An algal bloom event occurred 5 to 12 days following erosion of the top of the metalimnion to below the aerobic-anaerobic interface. The lag time to peak algal concentration, following such events, decreased through the summer (June = 12 days, September = 5 days)
    Type of Medium: Electronic Resource
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