Preventive medicine of von Hippel-Lindau disease-associated pancreatic neuroendocrine tumors

Pancreatic neuroendocrine tumors (PanNETs) are rare in von Hippel-Lindau disease (VHL) but cause serious morbidity and mortality. Management guidelines for VHL-PanNETs continue to be based on limited evidence, and survival data to guide surgical management are lacking. We established the European-American-Asian-VHL-PanNET-Registry to assess data for risks for metastases, survival and long-term outcomes to provide best management recommendations. Of 2330 VHL patients, 273 had a total of 484 PanNETs. Median age at diagnosis of PanNET was 35 years (range 10-75). Fifty-five (20%) patients had metastatic PanNETs. Metastatic PanNETs were significantly larger (median size 5 vs 2\u2009cm; P\u20091.5\u2009cm in diameter were operated. Ten-year survival was significantly longer in operated vs non-operated patients, in particular for PanNETs <2.8\u2009cm vs 652.8\u2009cm (94% vs 85% by 10 years; P\u2009=\u20090.020; 80% vs 50% at 10 years; P\u2009=\u20090.030). This study demonstrates that patients with PanNET approaching the cut-off diameter of 2.8\u2009cm should be operated. Mutations in exon 3, especially of codons 161/167 are at enhanced risk for metastatic PanNETs. Survival is significantly longer in operated non-metastatic VHL-PanNETs

D. Caroli Ludovici Willdenow Bot. et Hist. Natur. Prof. Publ. Ord. Hortus Berolinensis, Sive Icones Et Descriptiones, Plantarum Rariorum Vel Minus Cognitarum, Quae In Horto Regio Botanico Berolinensi Excoluntur : Cum Tabulis CX Aeneis Coloratis

D. CAROLI LUDOVICI WILLDENOW BOT. ET HIST. NATUR. PROF. PUBL. ORD. HORTUS BEROLINENSIS, SIVE ICONES ET DESCRIPTIONES, PLANTARUM RARIORUM VEL MINUS COGNITARUM, QUAE IN HORTO REGIO BOTANICO BEROLINENSI EXCOLUNTUR : CUM TABULIS CX AENEIS COLORATIS D. Caroli Ludovici Willdenow Bot. et Hist. Natur. Prof. Publ. Ord. Hortus Berolinensis, Sive Icones Et Descriptiones, Plantarum Rariorum Vel Minus Cognitarum, Quae In Horto Regio Botanico Berolinensi Excoluntur : Cum Tabulis CX Aeneis Coloratis (1) Einband (1) Titelblatt (10) Widmung (12) Praefatio (14) Epilogus (18) Tab. A. (20) Tab. B. (22) Index plantarum in opere descriptarum depictarumque (24) Kupfertafeln und Beschreibungen (27

Handbuch zur Erkennung der nutzbarsten und am häufigsten vorkommenden Gewächse /

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Handbuch zur Erkennung der nutzbarsten und am häufigsten vorkommenden Gewächse /

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Cost Effectiveness of Adding Folinic Acid to Fluorouracil Plus Levamisole as Adjuvant Chemotherapy in Patients with Colon Cancer in Germany

Objective: To assess the cost effectiveness of the addition of folinic acid to fluorouracil plus levamisole in patients with colon cancer from the perspective of the German Social Health Insurance. Study Design and Methods: Patients with International Union Against Cancer (Union International Contre Cancer; UICC) II/T4 or UICC III colon cancer enrolled in an open-label randomised clinical trial in Germany (Forschungsgruppe Onkologie Gastrointestinaler Tumoren-1 [FOGT-1]) received either fluorouracil plus levamisole (A, standard) or fluorouracil plus levamisole and folinic acid (B) for 12 months as adjuvant chemotherapy after curative intended surgery. Outcome measures for economic evaluation were disease-free life-years gained (df-LYG) and overall life-years gained (LYG) derived from the respective Kaplan-Meier survival curves. Direct medical costs from the perspective of the German Social Health Insurance were estimated retrospectively (2000 values) and incremental cost-effectiveness ratios (ICERs) were calculated. A Markov model was used to project the trial results beyond 5 years for the patients Results: Adding folinic acid to the fluorouracil/levamisole regimen results in an increase in time to progression and survival in patients with locally advanced colon cancer. Within the trial period of 5 years ICERs (B versus A) were Conclusions: Results of this cost-effectiveness analysis suggest that the addition of folinic acid offers clinical benefits at additional costs which are likely to be acceptable for decision makers in the long term. Cost-effectiveness ratios calculated within the clinical trial period were just aboveAntineoplastics, Colorectal-cancer, Cost-effectiveness, Fluorouracil, Folinic-acid, Levamisole, Pharmacoeconomics