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Biomedical subjects

M Hünerbein

Publications and source records attributed to M Hünerbein.

At least 55 records · Page 3Linked to original sources
PubMed1998

The value of tumor markers in colorectal cancer.

Currently CEA is the most accurate tumor marker for colorectal cancer. Preoperative determination of this marker can assist staging, treatment planning and in particular postoperative follow-up of colorectal cancer. Postoperative CEA monitoring should be performed every 3 months. Further evaluation for local recurrence or metastatic disease is mandatory if elevated or increasing CEA levels occur after radical surgery. However, present data do not justify using CEA alone for postoperative follow-up and monitoring of adjuvant therapy. Molecular genetic techniques are now increasingly performed to detect genetic alterations that can be used as prognostic markers. In the future, identification and quantification of these genes may even be valuable in defining the susceptibility of healthy individuals for colorectal cancer.

Biomarkers, Tumor↗
PubMed1998

[Phase II study on preoperative radio-chemo-thermotherapy in locally advanced rectal carcinoma].

BACKGROUND: Recent studies show that preoperative radio-chemotherapy can increase resectability and local control of locally advanced rectal carcinomas. Additional regional hyperthermia might increase remission rates and tumor response. We therefore tested regional hyperthermia together with radio-chemotherapy in a phase-II study on locally advanced rectal carcinomas. PATIENTS AND METHODS: Thirty-seven patients with primary advanced stage uT3/T4 rectal carcinomas were treated with preoperative radio-chemo-thermo-therapy. The initial tumor depth was determined using endosonography, CT, and MRI. Radiotherapy was carried out in prone position (on a belly board) using standard techniques, with 5 x 1.8 Gy per week up to 45 Gy at the reference point. 5-Fluorouracil (300 to 500 mg/m2) was administered with low doses of leucovorin (50 mg) on days 1 to 5 and 22 to 28. The patients were treated with regional hyperthermia each week prior to radiotherapy and simultaneously with chemotherapy, using the Sigma 60 ring from the BSD-2000 system. Temperature/position curves and temperature/time curves were recorded in endocavitary (endorectal) catheters in tumor contact and as well in bladder and vagina. Following endosonographic restaging, the operation was carried out 4 to 6 weeks after the end of preoperative therapy and adjuvant chemotherapy continued in four cycles. In cases where tumors were non-resectable, a boost up to 64 Gy was aimed. RESULTS: Thirty-one of the 37 patients (84%) with primary carcinoma proved locally R0-resectable. In addition we had 1 R1-resection (3%) and 5 non-resectable tumors (13%). Among the resected tumors, 53% experienced a reduction of depth infiltration from the initial endosonographic stage during preoperative therapy. The actuarial survival rate after 4 years is 65% (free of progression 57%). The actuarial 4-year survival rate was particularly favorable for the group of responders. Overall, the preoperative multimodal therapy was well tolerated, and premature termination was only necessary in 1 case (3%). Grade III/IV toxicities in the intestine and skin were reduced as far as possible by field blockings and cooling of the perineal region. They occurred only in 5/37 patients (13%) at the intestine and in 6/37 patients (16%) at the skin. The thermal data were subjected to a statistical analysis. The quality of temperature distribution (T90, cum min T90 > or = 40.5 degrees C) depends on the power level and relative power density. The response (reduction of tumor size or depth infiltration) correlated significantly with quality parameters of the temperature distributions. This dependency is found as a trend for progression-free survival, too. CONCLUSIONS: Preoperative radio-chemo-thermo-therapy proved to be practical and effective, with encouraging remission rates and excellent local control rates. For this reason, a phase-III study to test regional hyperthermia has been initiated. At the same time, certain technical improvements are still under development for regional hyperthermia.

Adult↗
PubMed1998

Video-assisted thoracic surgery. Staging and management of thoracic tumors.

BACKGROUND: This prospective study was conducted to investigate the value of video-assisted thoracic surgery (VATS) for staging and therapy of thoracic tumors. METHODS: VATS was performed in 86 patients presenting peripheral pulmonary nodules. Indications for thoracoscopy included diagnosis of indeterminated pulmonary lesions (n = 55), staging of disseminated disease (n = 24), and therapeutic interventions (n = 7). Previous or simultaneous tumors belonged to gastrointestinal tract (n = 27), sarcoma (n = 19), breast (n = 12), and miscellaneous. VATS was carried out under general anesthesia using double lumen intubation. RESULTS: VATS was successfully performed in 78% of patients. It was converted in 19 patients (22%) because of adhesions (n = 12), technical problems (n = 3), and lesions not to be found (n = 4). VATS revealed malignancy in 81% and benign lesions in 19%. Additional information compared to conventional staging was obtained in 48%, resulting in therapeutic consequences in 34% of the patients. Postoperative complications related to VATS were observed in nine patients. CONCLUSIONS: In this study, VATS proved to be a sensitive technique for staging of pulmonary lesions. Thoracoscopic wedge resection may have significant impact on the operative management of carefully selected patients with peripheral pulmonary lesions.

Adolescent↗
PubMed1998

The role of staging laparoscopy for multimodal therapy of gastrointestinal cancer.

BACKGROUND: This prospective study was conducted to evaluate the accuracy and the therapeutic relevance of staging laparoscopy. METHODS: Between June 1993 and February 1997 staging laparoscopy was performed in 389 patients with various neoplasms. Additionally, 144 selected patients of this group were examined with laparoscopic ultrasound using a semiflexible ultrasound probe (7.5 MHz). RESULTS: Compared to conventional imaging methods, laparoscopy and laparoscopic ultrasound improved the accuracy of staging in 158 of 389 patients (41%). Statistical subgroup analysis of 131 patients with gastric cancer showed that the accuracy of staging laparoscopy in the detection of distant metastases (68%) was significantly higher (p < 0.01) than that of ultrasound (63%) or computed tomography (58%). In the whole group, laparoscopy alone disclosed intraabdominal tumor dissemination or nonresectable disease in 111 patients. Laparoscopic ultrasound displayed additional metastases-i. e., liver metastases (n = 9), M1 lymph nodes (n = 15), or nonresectable tumors (n = 6) in 30 patients. Although metastastic disease was suggested by preoperative imaging, benign lesions were found in five patients with laparoscopy and in a further 12 patients with ultrasonography. The findings of staging laparoscopy changed the treatment strategy in 45% of the patients. Conversion to open surgery was necessary in 5% of the cases, and complications related to laparoscopy occured in 4% of the patients. CONCLUSIONS: Laparoscopy with laparoscopic ultrasound improves the staging of gastrointestinal tumors and has a significant impact on a stage-adapted surgical therapy.

Adolescent↗
PubMed1998

Transendoscopic ultrasound of esophageal and gastric cancer using miniaturized ultrasound catheter probes.

BACKGROUND: The aim of this study was to investigate the value of miniaturized ultrasound catheter probes (miniprobes) for preoperative staging of esophageal and gastric cancer. METHODS: Fifty-one patients with esophageal (n = 21) and gastric cancer (n = 30) underwent endoscopic ultrasound (EUS). All examinations were carried out using mechanical miniprobes (diameter 6F, 12.5 MHz) that were introduced through the instrument channel of the endoscope. RESULTS: EUS with miniprobes was successfully performed in all patients, although stenotic tumors, which could not be traversed with the endoscope, were found in 6 of 21 patients (29%) with esophageal cancer. Miniprobe scanning provided high-resolution images of the gastrointestinal tract. The overall accuracy in the assessment of tumor infiltration depth for esophageal and gastric cancer was 90% and 82%, respectively. However, the value of miniprobe scanning in the assessment of advanced tumors was limited by the imaging depth of the probe (approximately 3 cm). Lymph node involvement was accurately diagnosed in 78% of the patients with esophageal cancer (sensitivity 75%, specificity 80%) and in 80% of the patients with gastric cancer (sensitivity 73%, specificity 89%). CONCLUSIONS: EUS with miniprobes can be performed as single-step procedure during diagnostic endoscopy. The 12.5 MHz transducer provides high-resolution imaging and enables accurate staging of tumors with limited infiltration depth.

Endosonography↗
PubMed1998

Transesophageal biopsy of mediastinal and pulmonary tumors by means of endoscopic ultrasound guidance.

OBJECTIVE: The aim of this study was to investigate the value of endoscopic ultrasound-guided biopsy for the diagnosis of thoracic lesions. METHODS: Transesophageal ultrasound-guided biopsy was performed in 29 patients with mediastinal (n = 25) or pulmonary tumors (n = 4). A flexible echoendoscope with a 7.5 MHz curved array transducer (Pentax FG 32 UA, Hamburg, Germany) and a biopsy device with a fine needle (diameter 0.8 mm) were used for all examinations. Three patients were excluded from the analysis of the data because a definite diagnosis based on surgery or follow-up was not available. RESULTS: Real-time visualization of the biopsy procedure with endoscopic ultrasound enabled accurate tissue sampling even of small mediastinal lesions with a diameter of less than 1 cm. Diagnostic material was obtained in 23 of the 26 patients (88%). In 3 cases (12%) non-representative biopsy material was found in the specimen. The sensitivity and specificity of transesophageal biopsy in the diagnosis of malignancy were 89% and 83%, respectively. Histologic analysis of the biopsy specimens established malignancy in 17 of 23 patients, whereas benign lesions were diagnosed in 6 patients. Endoscopic ultrasound-guided biopsy confirmed the diagnosis suggested by conventional diagnostic methods in 15 of 23 patients (65%), whereas an unsuspected diagnosis was disclosed in 8 patients (35%). The results of the biopsy had considerable impact on the therapeutic strategy. None of the patients had complications related to the procedure. CONCLUSIONS: Endoscopic ultrasound-guided biopsy provides a new minimally invasive approach to the biopsy of lesions in the posterior mediastinum and may complement surgical staging procedures.

Adult↗
PubMed1998

Endosonography-guided biopsy of mediastinal and pancreatic tumors.

BACKGROUND: Although endoscopic ultrasound (EUS) allows sensitive imaging of the upper gastrointestinal (GI) tract, it remains difficult to differentiate between benign and malignant lesions on the basis of ultrasound morphology. The purpose of this study was to determine the value of EUS-guided biopsy for the diagnosis of submucosal and extraluminal tumors. METHODS: EUS-guided biopsy was carried out in 50 patients with upper GI-tract lesions. All patients were examined using a flexible echoendoscope with a 5/7.5 MHz curved array transducer. A specially designed biopsy device (type Vilmann) with a fine needle (diameter 0.8 mm) was used for EUS-guided biopsy. RESULTS: EUS-guided biopsy was performed for evaluation of mediastinal lesions (n = 15), pancreatic tumors (n = 26) and submucosal (n = 5) or stenotic tumors of the esophagus (n = 4). Fine-needle aspiration yielded diagnostic tissue samples in 44 of 50 patients (88%). Histology demonstrated benign lesions in 20 of 44 patients and malignant tumors in the other 24 patients. EUS-guided biopsy failed in only six patients (12%): in four patients it was impossible to advance the needle into very hard pancreatic tumors; non-representative biopsy material was obtained in two further cases. The results of EUS-guided biopsy were validated by surgery (n = 21), autopsy (n = 3) or clinical follow-up (n = 20). After a mean follow-up of 16 months there is no evidence of malignancy in any of the patients with benign histology. The sensitivity and specificity of EUS-guided biopsy in the diagnosis of malignancy were 88% and 100%, respectively. None of the patients experienced complications related to endosonographic biopsy. CONCLUSIONS: EUS-guided biopsy with the Vilmann needle device is a safe and accurate method for tissue sampling of extraluminal lesions. This technique considerably improves the diagnostic value of endosonography.

Adenocarcinoma↗
PubMed1998

Preoperative hyperthermia combined with radiochemotherapy in locally advanced rectal cancer: a phase II clinical trial.

OBJECTIVE: A prospective phase II study was performed to determine the feasibility and efficacy in terms of response rate, resectability, and morbidity in patients with locally advanced rectal cancer who received preoperative regional hyperthermia combined with radiochemotherapy (HRCT). SUMMARY BACKGROUND DATA: Recent studies suggest that preoperative radiochemotherapy in locally advanced rectal cancer can induce downstaging, but after resection the incidence of local recurrences remains high. Hyperthermia (HT) may add tumoricidal effects and improve the efficacy of radiochemotherapy in a trimodal approach. PATIENTS AND METHODS: Thirty-seven patients with histologically proven rectal cancer and T3 or T4 lesions, as determined by endorectal ultrasound and computed tomography, entered the trial. 5-Fluorouracil (300-350 mg/m2) and leucovorin (50 mg) were administered on days 1 to 5 and 22 to 26. Regional HT using the SIGMA 60 applicator (BSD-2000) was given once a week before radiotherapy (45 Gy with 1.8-Gy fractions for 5 weeks). Surgery followed 4 to 6 weeks after completion of HRCT. RESULTS: Preoperative treatment was generally well tolerated, with 16% of patients developing grade III toxicity. No grade IV complications were observed. The overall resectability rate was 32 of 36 patients (89%), and 31 resection specimens had negative margins (R0). One patient refused surgery. In 5 patients (14%), the histopathologic report confirmed no evidence of residual tumor (pCR). A partial remission (PR) was observed in 17 patients (46%). The survival rate after 38 months was 86%. In none of the patients was local recurrence detected after R0(L), but five patients developed distant metastases. CONCLUSION: Preoperative HRCT is feasible and effective and may contribute to locoregional tumor control of advanced rectal cancer, which is to be proven in an ongoing phase III trial.

Adenocarcinoma↗
PubMed1998

[Thoracoscopic diagnosis and therapy of lung metastases].

INTRODUCTION: The purpose of this study was to evaluate the impact of thoracoscopy on staging and therapy of peripheral pulmonary nodules in patients with a cancer history. PATIENTS AND METHODS: Videothoracoscopy (VATS) was performed in patients presenting peripheral pulmonary nodules (< 3cm) in CT-scan. 65 patients (63%) presented less than 3 nodules and 39 patients (37%) had multiple lesions in the lungs. History revealed a primary gastro-intestinal cancer in 35 patients (34%), a sarcoma in 26 patients (25%), breast cancer in 13 patients (13%) and miscellaneous primary cancer in 22 patients (21%). VATS was performed under general anesthesia using a standard equipment (Olympus). Double lumen endotracheal intubation was carried out. Thoracoscopic pulmonary resection was accomplished with endoscopic stapler (Autosuture Multi-Fire Endo GIA 30). The specimens were removed in a retrieval bag and a tube was inserted into the thoracic cavity. RESULTS: In 24 patients (23%) conversion to thoracotomy was performed, because of adhesions (n = 12), technical reasons (n = 8), no tumor detectable (n = 4). Thoracoscopic wedge resection for coin lesions was performed in 61 of the 80 patients (76%). Three patients underwent decortication and in 16 patients biopsy was sufficient for therapeutical considerations. Additional informations in comparison to conventional diagnostic were found in 39 patients (49%). The treatment regimen altered in 32 patients (40%). CONCLUSIONS: In this study VATS proved to be a sensitive technique for staging of pulmonary coin lesions. Additional informations were achieved in 49% and therapeutic strategy was changed in 40% of the patients due to the distant spread of malignancy or detection of benign lesions obtained by thoracoscopic staging.

Adult↗
PubMed1998

[Obligatory and facultative measures in diagnosis and staging of stomach carcinoma].

A differential therapeutic regimen in gastric cancer requires exact staging. Criteria for accurate staging include exact localization of the tumor, the tumor depth, as well as the definition of local spread (lymph node metastases) and distant metastases (liver metastases, peritoneal carcinosis). Endoscopy, endoscopic ultrasound (EUS), laparoscopy and laparoscopic ultrasound provide the most precise information concerning T-, N- and M-categories in preoperative staging.

Diagnostic Imaging↗
PubMed1998

[Comparative diagnosis of locally advanced rectal carcinoma after preoperative therapy].

Locally advanced rectal carcinomas were increasingly treated by preoperative combined radiochemotherapy. Alterations of the rectal wall and the lymph nodes that were caused by the treatment make the assessment of the success of the therapy during the preoperative staging extremely difficult. Methods such as endorectal ultrasound, CT and MRI used for the estimation of the depth infiltration of the tumor achieved an exactness of only approximately 50%. It is thus essential to develop new criteria for the assessment of the success of the therapy.

Adult↗
PubMed1997

Application of rectal stents for palliation of obstructing rectosigmoid cancer.

BACKGROUND: The rationale of palliative endoscopic treatment is to avoid a colostomy in patients with advanced disease and limited life expectancy. This study was conducted to evaluate the role of endoscopic stent implantation for palliation of obstructing rectal cancer. METHODS: Overall, 19 patients (aged 47-87 years) with nonresectable or metastatic rectal cancer were treated by stent insertion after laser recanalization or dilation. Three types of stents, i.e., plastic tubes (n = 8), self-expanding mesh stents (n = 6), and endocoil stents (n = 5), were used to maintain luminal patency. RESULTS: Endoscopic stent implantation was successfully performed in all 19 patients. Long-term luminal patency and satisfactory bowel function were achieved in 16 of 19 patients (84%). After a median follow-up of 6 months, eight of the patients have died and eight are still alive without evidence of recurrent obstruction. Dislocation of the endoprosthesis occurred in two of eight plastic tubes and one of five mesh stents. Recurrent obstruction due to tumor ingrowth was only observed in patients treated with self-expanding mesh stents (n = 2). In spite of reinsertion and laser therapy a colostomy was required in three of 19 patients. There was no evidence of treatment failure in five patients who received endocoil stents. None of the patients experienced serious complications related to the endoscopic procedure. CONCLUSIONS: Endoscopic stent implantation seems to be a safe and efficient palliative approach to selected patients with obstructing rectal cancer. Currently, self-expanding coil stents are superior to other devices because of lower risk of dislocation and tumor ingrowth.

Aged↗
PubMed1997

Three-dimensional endoscopic ultrasound of the esophagus. Preliminary experience.

BACKGROUND: The aim of this study was to develop a technique for three-dimensional endoscopic ultrasound of the esophagus based on standard ultrasonic images. METHODS: Endoscopic ultrasound was performed in five esophageal cancer patients using a high-resolution miniprobe (360 degrees, 12.5 MHz). For acquisition of three-dimensional data sets, the miniprobe was attached to a stepping motor that enabled ECG-triggered withdrawal of the transducer. Three-dimensional images were reconstructed from serial transverse sections on a PC-based 3D work station. RESULTS: Twelve volume scans were obtained in five patients with esophageal cancer. The system enabled the acquisition of accurate three-dimensional ultrasound data within 30-50 s. Computed image processing allowed us to display the data in transverse, longitudinal, and oblique sections, or as a 3D reconstruction. Three-dimensional imaging provided accurate visualization of the tumor and surrounding structures in all cases. The tumor stage was determined correctly in four of five patients. Longitudinal scan planes and 3D views improved the assessment of longitudinal tumor infiltration and the spatial relation of the tumor to relevant mediastinal structures. CONCLUSION: This study shows that three-dimensional endoscopic ultrasound of the esophagus is technically feasible. The technique allows the assessment of local tumor spread in previously unattainable scan planes and 3D views. This promising preliminary experience should encourage further exploration of this method.

Endosonography↗
PubMed1997

[Magnetic resonance tomography and endosonography in the preoperative staging of advanced rectal carcinomas after hyperthermoradiochemotherapy].

PURPOSE: Comparison of diagnostic accuracy of staging of endorectal sonography (ES) and body coil MRI after preoperative hyperthermoradiochemotherapy in patients with advanced rectal cancer. METHODS: Prospective analysis of MRI and ES in 30 patients after hyperthermoradiochemotherapy and correlation with histopathological patterns. RESULTS: T-staging by MRI was correct in 47% and by ES in 53% of the cases. Despite similar accuracy of staging in T0- and T1-tumours, we found different accuracies concerning T2-tumour staging about 63% versus 73% (MRI/ES), concerning perirectal infiltration 70% for both techniques, concerning invasion of adjacent organs 90% versus 87%, and concerning lymph node metastases without respect to the N-stage 63% versus 63%. CONCLUSION: Both imaging modalities provide useful information for operation planning despite limited accuracy after hyperthermoradiochemotherapy. The body coil MRI does not seem to be severely inferior to ES in post-therapeutic staging, despite better contour line imaging by ES. With respect to the determination of invasion of other organs, MRI seems to be more useful.

Adult↗
PubMed1997

Three-dimensional endosonography for staging of rectal cancer.

OBJECTIVE: This prospective study was conducted to investigate the value of three-dimensional (3D) endosonography for staging of rectal cancer. SUMMARY BACKGROUND DATA: Transrectal ultrasound is the most sensitive technique for peroperative staging and follow-up of rectal cancer. Major limitations of this technique include the complexity of image interpretation and the inability to examine stenotic tumors or to identify recurrent rectal cancer. METHODS: Three-dimensional endosonography was performed in 100 patients with rectal tumors. Transrectal volume scans were obtained using a 3D multiplane transducer (7.5/10.0 MHz). Stenotic tumors were examined with a 3D frontfire transducer (5.0/7.5 MHz). The volume scans were processed and analyzed on a Combison 530 workstation (Kretztechnik, Zipf, Austria). RESULTS: The 3D endosonography and conventional endosonography were performed in 49 patients with nonstenotic rectal cancer. Display of volume data in three perpendicular planes or as 3D view facilitated the interpretation of ultrasound images and enhanced the diagnostic information of the data. The accuracy of 3D endosonography in the assessment of infiltration depth was 88% compared to 82% with the conventional technique. In the determination of lymph node involvement, 3D and two-dimensional endosonography provided accuracy rates of 79% and 74%, respectively. The 3D scanning allowed the visualization of obstructing tumors using reconstructed planes in front of the transducer. Correct assessment of the infiltration depth was possible in 15 of 21 patients with obstructing tumors (accuracy, 76%). Three-dimensional endosonography displayed suspicious pararectal lesions in 30 patients. Transrectal ultrasound-guided biopsy was extremely precise (accuracy, 98%) and showed malignancy in 10 of 30 patients. Histologic analysis changed the endosonographic diagnosis in 8 (27%) of the patients. CONCLUSIONS: The 3D endosonography permits examination of rectal cancer using previously unattainable planes and 3D views. The 3D imaging and ultrasound-guided biopsy seem capable to improve staging of rectal cancer and should be evaluated in further studies.

Endosonography↗
PubMed1997

Accuracy of staging rectal tumors with contrast-enhanced transrectal MR imaging.

OBJECTIVE: Our objective was to evaluate the accuracy of contrast-enhanced transrectal MR imaging in staging rectal adenoma and carcinoma by correlating with histopathologic findings. SUBJECTS AND METHODS: Thirty-five patients underwent transrectal MR imaging on a 1.5-T superconducting unit using unenhanced T1-weighted and T2-weighted spin-echo and turbo spin-echo sequences, a dynamic gadopentetate dimeglumine-enhanced turbo fast low-angle shot sequence, and enhanced T1-weighted spin-echo sequences. For all patients, histopathologic correlation was available from biopsy (n = 15) or surgical resection (n = 20). Two radiologists unaware of each other's interpretations of the scans interpreted each case from which we evaluated qualitative and quantitative data. RESULTS: Rectal adenomas (n = 15) were identified when imaging revealed an intact muscularis mucosae, a homogeneous internal structure, and high contrast enhancement of the lesion. Carcinomas staged as T1 by TNM criteria (n = 6) were best revealed by dynamic turbo fast low-angle shot sequences, in which an intact muscularis propria could be seen. Visualization of enhancing tumor tissue in the muscularis propria indicated T2 carcinoma (n = 5). All T3 (n = 5) and T4 (n = 4) carcinomas were correctly staged with dynamic and static MR imaging. The stage revealed by MR imaging correlated well with histologic staging results in 89% (observer 1) and 86% (observer 2) of interpretations. However, when interpreting MR imaging, observers tended to overstage and never understaged. CONCLUSION: Transrectal surface-coil MR imaging provided reliable information in staging patients before surgery and in evaluating rectal adenoma and carcinoma.

Adenoma, Villous↗
PubMed1997

[Value of endosonography in tumors of the upper GI tract in comparison with different scanners (Radial 360 degrees and Sector Scanner 120 degrees].

This comparative study was performed to determine the value of two endosonography devices, i.e, the radial and the longitudinal transducer, for staging upper GI tract cancer. The accuracy of both methods was comparable in esophageal cancer, whereas radial scanning was superior in gastric cancer. Generally radial scanning provided better spatial orientation and was easier to assess. An advantage of the longitudinal curved array scanner is the feasibility of EUS-guided biopsy.

Biopsy, Needle↗