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Biomedical subjects

F Willgeroth

Publications and source records attributed to F Willgeroth.

At least 19 recordsLinked to original sources
PubMed2005

[Bavarian mammography screening program].

In Bavaria since the 1st April 2003 we have been conducting a high quality mammography-screening carried out in individual practises (BMS). We have used the European and the S 3 guidelines. The best diagnosis is an early diagnosis of the breast carcinoma to save human life. Because of this and the high mortality rate due to this disease it is essential to have a mammogram screening program. There is no single one ideal way of constructing a screening program, it is always based on compromise within the particular health care-systems. Arising problems cannot be avoided, it is only possible when all parties work closely together that the BMS works properly.

Breast Neoplasms↗
PubMed2000

Lack of effect of adjuvant chemotherapy on the elimination of single dormant tumor cells in bone marrow of high-risk breast cancer patients.

PURPOSE: There is an urgent need for markers that can predict the efficacy of adjuvant chemotherapy in patients with solid tumors. This study was designed to evaluate whether monitoring of micrometastases in bone marrow can predict the response to systemic chemotherapy in breast cancer. PATIENTS AND METHODS: Bone marrow aspirates of 59 newly diagnosed breast cancer patients with either inflammatory (n = 23) or advanced (> four nodes involved) disease (n = 36) were examined immunocytochemically with the monoclonal anticytokeratin (CK) antibody A45-B/B3 (murine immunoglobulin G(1); Micromet, Munich, Germany) before and after chemotherapy with taxanes and anthracyclines. RESULTS: Of 59 patients, 29 (49.2%) and 26 (44.1%) presented with CK-positive tumor cells in bone marrow before and after chemotherapy, respectively. After chemotherapy, less than half of the previously CK-positive patients (14 of 29 patients; 48.3%) had a CK-negative bone marrow finding, and 11 (36. 7%) of 30 previously CK-negative patients were CK-positive. At a median follow-up of 19 months (range, 6 to 39 months), Kaplan-Meier analysis of 55 assessable patients revealed a significantly reduced overall survival (P =.011; log-rank test) if CK-positive cells were detected after chemotherapy. In multivariate analysis, the presence of CK-positive tumor cells in bone marrow after chemotherapy was an independent predictor for reduced overall survival (relative risk = 5.0; P =.016). CONCLUSION: The cytotoxic agents currently used for chemotherapy in high-risk breast cancer patients do not completely eliminate CK-positive tumor cells in bone marrow. The presence of these tumor cells after chemotherapy is associated with poor prognosis. Thus, bone marrow monitoring might help predict the response to systemic chemotherapy.

Analysis of Variance↗
PubMed1999

Monoclonal antibody therapy with edrecolomab in breast cancer patients: monitoring of elimination of disseminated cytokeratin-positive tumor cells in bone marrow.

Despite current advances in antibody-based immunotherapy of breast and colorectal cancer, we have recently shown that the actual target cells (e.g., tumor cells disseminated to bone marrow) may express a heterogeneous pattern of the potential target antigens. Tumor antigen heterogeneity may therefore represent an important limitation of the efficacy of monospecific antibody therapy. To measure the efficacy of such a monospecific approach, we analyzed the elimination of tumor cells coexpressing the epithelial cell adhesion molecule (EpCAM) under therapy with murine monoclonal antibody 17-1A (Edrecolomab) directed against EpCAM. In bone marrow aspirates from 10 breast cancer patients with metastatic (n = 8) and locoregional recurrence (n = 2), tumor cells were identified with the antibody A45-B/B3 directed against the epithelial differentiation marker cytokeratin (CK) and simultaneously typed for EpCAM expression using the antibody 17-1A. Patients were treated with a single dose of 500 mg of Edrecolomab and monitored by bone marrow analyses before and at days 5-7 after antibody treatment. In all 10 patients, we assessed a marked reduction in the mean numbers of both CK+ cells (73 versus 15; P = 0.003, t test) and EpCAM+/CK+ cells (17 versus 1; P = 0.003, t test) per 10(6) bone marrow cells. Complete elimination of EpCAM+ cells was possible in four patients. We conclude that Edrecolomab can be used in breast cancer patients to target isolated EpCAM+/CK+ cancer cells. Using CK-based immunoassays, we reliably detected residual tumor cells in bone marrow and typed EpCAM expression. This allowed us to monitor the cytotoxic elimination of such cells after Edrecolomab application. Selection of EpCAM-/ CK+ tumor clones showed that further antibodies directed against tumor-associated antigens are warranted to improve the efficacy of monospecific approaches.

Antibodies, Monoclonal↗
PubMed1991

[Diagnostic problems in local recurrence after breast saving therapy of breast cancer].

From 1970 to 1987, 331 breast cancer patients of the Department of Gynaecology of the University of Erlangen were treated by conservative breast surgery. Adjuvant radiotherapy of the remaining breast was applied to only one-third of the patients. 30 patients (9.8%) had a local recurrence. This study analyses the 21 patients with local recurrence after breast conserving therapy, treated afterwards again in our hospital. 60% of the recurrences occurred within 2 years after the primary treatment. In 18 cases, the recurrences were located in the vicinity of the segmental resection area, in 3 cases the recurrences were diagnosed as new second primaries in the ipsilateral breast. 19 of the 21 recurrences were diagnosed by palpation, 2 cases were detected by mammography examination only. The palpable recurrences could only be shown in the mammography in 14 cases. We conclude, that for patients with breast conserving therapy, a mammographic examination need not be increased in frequency, but a quarterly examination by palpation should be extended over more than 2 years.

Adult↗
PubMed1990

[Functional changes in the lower urinary tract after irradiation of cervix carcinoma].

104 patients submitted to primary irradiation for cervix carcinoma were examined by means of urodynamic methods of diagnosis in order to investigate the functional changes of the lower urinary tract induced by therapy. 34 patients could be examined prior to therapy, 19 and 12 patients, respectively, were examined six and 18 months on an average after the treatment. Another group of 70 patients had retrospective check-up examinations with average intervals of five and ten years. Hydronephrosis occurred only as a late result after more than six years in 12% of the irradiated women. The incidence of residual urine, significant bacteriuria, and disturbed sensory function of the bladder was not important. All patients were incontinent two years after the irradiation; 60% of the cases of incontinence were due to the bladder and 40% to the urethra. The increase of urgency incontinence is possibly caused by a radiofibrotic reaction of the bladder, as is shown by correspondent cystometric alterations: the bladder tonicity increased, whereas the bladder capacity decreased. These alterations were only partially reversible. The stress incontinence, however, was found already before the treatment. The maximum urethral closing pressure, which often indicates incontinence due to the urethra, was not modified by the irradiation. An increased stress incontinence, probably caused by advanced age, was found only after six years or later. The problems resulting from functional changes should be taken into consideration in the course of post-therapeutic care, i.e. the patients concerned should be given instructions for a regular bladder training.

Brachytherapy↗
PubMed1988

[The role of mammography in the diagnosis of simultaneous second cancers in the contralateral breast].

In 1048 breast cancer patients, operated in the period 1969-1985 at the University of Erlangen Clinic of Obstetrics and Gynecology, estimations were made to determine the relative contribution of mammography and meticulous histology to the diagnosis of simultaneous contralateral cancer. The incidence of a bilateral simultaneous disease was 17% (6.1% invasive forms, 10.6% in situ). Complete histological examination of the extirpated tissue as well as the occurrence of discrete radiological signs could account for the detection of 41% of all invasive and 39% of all in situ forms respectively. Those contralateral breast cancer cases detected just by means of mammography, but without any presence of clinical signs, recorded an average diameter of 9 mm and in 20% had metastacised to the axillary lymph nodes. Comparatively, clinically and radiologically diagnosed cases were 17 mm on average and the occurrence of axillary lymph node involvement was 41%. The conclusion is drawn, that a meticulous diagnostic effort is necessary in view of the high incidence of occurrence of simultaneous cancer on the other breast and the prognostic importance of an early diagnosis for many patients. Every minute radiologically detected sign in the other breast of patients with mammary carcinoma requires careful diagnostic clarification. However, it should be considered that the data presented were gathered in a situation in which the radiologist performed the X-ray examination, knowing that an excision would have been carried out in 85 percent of all cases even without his specific localisation. The presence of additional risk factors (lobular cancer, multicentricity and family history of breast cancer) make such an effort justified and obligatory as well.

Biopsy↗
PubMed1985

A contribution to the natural history of breast cancer. V. Bilateral primary breast cancer: incidence, risks and diagnosis of simultaneous primary cancer in the opposite breast.

Tissue from contralateral breast was taken from 505 patients with invasive breast cancer. Every 5th patient had simultaneous carcinoma in the opposite breast, 7.7% (39/505) had invasive cancer, and 13.1% (66/505) had carcinoma in situ. Invasive cancers in the opposite breast were diagnosed at an earlier stage as compared with the neoplasm of the primary breast. However, 26% of the patients already had positive axillary nodes. The following risk indicators of the bilateral disease were found: age at time of diagnosis, histologic type of tumours, familial breast cancer, suspicious mammography, P2/DY-breast parenchymal pattern (Wolfe) and multicentric cancer of primary breast. Our findings support the proposal to consider bilaterality of breast cancer as a sign of systemic disease of the breasts, involving the ductal and lobular system within eight quadrants of a paired organ (Ober).

Age Factors↗
PubMed1983

[More than 1500 radiologically indicated breast biopsies. Microcalcifications and the pathologic galactogram, 1964-1982].

In the last 19 years 47,518 women had mammographies at the Department of Gynaecology of the University of Erlangen. 1653 patients had 2215 galactograms. Biopsies of the breast indicated by mammography were done in 1521 cases. 955 cases showed micro-calcifications in groups. 566 showed abnormal galactograms. The microscopic examination in the 955 cases with microcalcifications showed invasive carcinoma, carcinoma in situ or atypical epithelial proliferations in 1/3 of the cases In 10% of the cases small calcified fibroadenomata, papillomas or granulomas were found. In 60% of the biopsies mammary dysplasia partly with nonatypical epithelial proliferations were found. When the galactogram showed pathological contours the breast tissue was excised in a segment. In over 40% of 566 segmental excisions papillomata were the cause of pathological secretions from the breast. Ductal carcinomas, carcinoma in situ and extensive intraductal solid papillary or adenomatous epithelial proliferations were found in 27% of the cases. Approximately the same number of cases did not show atypical epithelial proliferations. Delay in the early diagnosis of changes which may be the first sign of malignant breast disease can be avoided by good cooperations between the physicians treating the cases.

Adenofibroma↗
PubMed1982

A contribution to the natural history of breast cancer. IV. Lobular carcinoma in situ and its relation to breast cancer.

We studied 52 patients with lobular carcinoma in situ (LCIS) of the breast, tissue being available from both breasts in 46 patients. Detailed histological examination of the tissue was combined with specimen radiography. By this technique, six invasive cancers were detected within 2 years of the primary diagnosis. five of these six carcinomas were clinically occult and were not suspected at specimen radiography. Three other invasive cancers were discovered 4 years, 7 years, and 10 years after diagnosing LCIS. The extent of the LCIS in the primary biopsy was the only feature which gave a guide to the possible presence and location of an occult invasive lesion.

Biopsy↗