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Klinische Implikationen der PORTEC-3-Studie zur Behandlung des Hochrisikoendometriumkarzinoms

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Title: Klinische Implikationen der PORTEC-3-Studie zur Behandlung des Hochrisikoendometriumkarzinoms
Authors: Waltar, Till, Marnitz, Simone
Source: Strahlentherapie und Onkologie. 196:410-413
Publisher Information: Springer Science and Business Media LLC, 2020.
Publication Year: 2020
Subject Terms: 03 medical and health sciences, 0302 clinical medicine, Chemoradiotherapy, Adjuvant [MeSH], Paclitaxel/administration, Female [MeSH], Area Under Curve [MeSH], Disease Progression [MeSH], Hysterectomy [MeSH], Cisplatin/administration, Brachytherapy [MeSH], Humans [MeSH], Literatur Kommentiert, Risk Factors [MeSH], Endometrial Neoplasms/mortality [MeSH], Oncology, Lymph Node Excision [MeSH], Neoplasm Staging [MeSH], Survival Rate [MeSH], Chemotherapy, Adjuvant [MeSH], Endometrial Neoplasms/pathology [MeSH], Neoplasm Recurrence, Local/radiotherapy [MeSH], Endometrial Neoplasms/radiotherapy [MeSH], Combined Modality Therapy [MeSH], Radiotherapy, Neoplasm Recurrence, Local/mortality [MeSH], 3. Good health
Description: Background!#!Patients with severe COVID-19 develop hyperferritinemic inflammation, a rare sepsis-like immune dysregulation syndrome.!##!Methods!#!Stratified treatment decisions in a cross-location telemedical interdisciplinary case conference were assessed in this retrospective cohort study. A standardized treatment algorithm including continuous positive airway pressure and noninvasive ventilation was implemented. A locally developed COVID inflammation score (CIS) defined patients at risk for severe disease. Patients with life-threatening inflammation were offered off-label treatment with the immune modulator ruxolitinib.!##!Results!#!Between 4 March 2020 and 26 June 2020 COVID-19 patients (n = 196) were treated. Median patient age (70 years) and comorbidity were high in interstudy comparison. Mortality in all patients was 17.3%. However, advance care planning statements and physician directives limited treatment intensity in 50% of the deceased patients. CIS monitoring of ruxolitinib-treated high-risk patients (n = 20) on days 5, 7, and15 resulted in suppression of inflammation by 42% (15-70), 54% (15-77) and 60% (15-80). Here, mortality was 20% (4/20). Adjusted for patients with a maximum care directive including ICU, total mortality was 8.7% (17/196).!##!Conclusion!#!Severe COVID-19 pneumonia with hyperferritinemic inflammation is related to macrophage activation syndrome-like sepsis. An interdisciplinary intensive care teleconference as a quality tool for ICUs is proposed to detect patients with rare sepsis-like syndromes.
Document Type: Article
Language: German
ISSN: 1439-099X
0179-7158
DOI: 10.1007/s00066-020-01592-1
Access URL: https://link.springer.com/content/pdf/10.1007/s00066-020-01592-1.pdf
https://pubmed.ncbi.nlm.nih.gov/32072198/
https://www.ncbi.nlm.nih.gov/pubmed/32072198
https://link.springer.com/content/pdf/10.1007%2Fs00066-020-01592-1.pdf
https://link.springer.com/article/10.1007/s00066-020-01592-1
https://paperity.org/p/233545483/klinische-implikationen-der-portec-3-studie-zur-behandlung-des
https://repository.publisso.de/resource/frl:6441856
Rights: CC BY
Accession Number: edsair.doi.dedup.....884e544df53a71d5e67ce6c7a89a4b00
Database: OpenAIRE
Description
Abstract:Background!#!Patients with severe COVID-19 develop hyperferritinemic inflammation, a rare sepsis-like immune dysregulation syndrome.!##!Methods!#!Stratified treatment decisions in a cross-location telemedical interdisciplinary case conference were assessed in this retrospective cohort study. A standardized treatment algorithm including continuous positive airway pressure and noninvasive ventilation was implemented. A locally developed COVID inflammation score (CIS) defined patients at risk for severe disease. Patients with life-threatening inflammation were offered off-label treatment with the immune modulator ruxolitinib.!##!Results!#!Between 4 March 2020 and 26 June 2020 COVID-19 patients (n = 196) were treated. Median patient age (70 years) and comorbidity were high in interstudy comparison. Mortality in all patients was 17.3%. However, advance care planning statements and physician directives limited treatment intensity in 50% of the deceased patients. CIS monitoring of ruxolitinib-treated high-risk patients (n = 20) on days 5, 7, and15 resulted in suppression of inflammation by 42% (15-70), 54% (15-77) and 60% (15-80). Here, mortality was 20% (4/20). Adjusted for patients with a maximum care directive including ICU, total mortality was 8.7% (17/196).!##!Conclusion!#!Severe COVID-19 pneumonia with hyperferritinemic inflammation is related to macrophage activation syndrome-like sepsis. An interdisciplinary intensive care teleconference as a quality tool for ICUs is proposed to detect patients with rare sepsis-like syndromes.
ISSN:1439099X
01797158
DOI:10.1007/s00066-020-01592-1