Krankenhaus der Barmherzigen Brüder Trier

Since 2016, >21000 patients with prostate cancer (PC) used our personalized online decision aid in routine care in Germany. We analyzed the effects of this online decision aid for men with nonmetastatic PC in a randomized controlled trial. In the randomized controlled EvEnt-PCA trial, 116 centers performed 1:1 allocation of 1115 patients with nonmetastatic PC to use an online decision aid (intervention=I) or a printed brochure (control=C). The primary outcome was treatment decision after 14 mo. The secondary endpoints were knowledge, acceptance, decisional conflict, physician-patient communication, anxiety and depression, decision regret, and quality of life. With complete data from 1000 patients, there was no difference between the two groups in terms of primary or secondary endpoints. In the intervention group, consultation time was shorter (I: 61 min vs C: 70 min, p=0.02), and more patients provided a summary of their preparation (I: 76% vs C: 56%, p<0.001). Life expectancy (I: 53% vs C: 47%, p=0.03), radiotherapy (I: 90% vs C: 84%, p=0.005), rehabilitation (I: 69% vs C: 62%, p=0.02), and psycho-oncology (I: 21% vs C: 16%, p=0.07) were discussed more frequently in the intervention group. Additionally, more counseling sessions with general practitioners (I: 43% vs C: 35%, p=0.01) and radiotherapists (I: 24% vs C: 18%, p=0.03) were held in the intervention group. The use of the online decision aid was associated with structural improvements, for example, significantly shorter doctor-patient consultation time. Our findings suggest stronger guideline adherence in the counseling process and promotion of health literacy. Successful implementation of our online decision aid in routine care can provide an example for solving this key obstacle for shared decision-making.

We conducted a prospective observational study that included 27 patients (25 HeartMate3 and 2 HeartMateII) with a median follow-up of 30 months. We measured preoperative FGF23 plasma levels and computed the HeartMateII risk score (HMRS), the HeartMate3 risk score (HM3RS) and the EuroSCOREII with respect to postoperative mortality, as well as the Michigan right heart failure risk score (MRHFS), the Euromacs RHF risk score (EURORHFS), the CRITT score with respect to RHF prediction and the kidney failure risk equation (KFRE) with respect to kidney failure. Multivariate logistic regression and receiver operating characteristic (ROC) analyses were performed. In the multivariate logistic regression, preoperative FGF23 level was found to be a predictor of postoperative RHF (OR: 1.37, 95-CI: 0.78-2.38; p = 0.031), mortality (OR: 1.10, 95%-CI: 0.90-1.60; p = 0.025) and the need for postoperative dialysis (OR: 1.09, 95%-CI: 0.91-1.44; p = 0.032). In the ROC analysis, FGF23 as a predictor of post-LVAD RHF had an area under the curve (AUC) of 0.81. FGF23 improves the prediction of clinically significant patient outcomes-such as need for dialysis, RHF and mortality-after HM3 and HMII implantation, as adding FGF23 to established risk scores increased their predictive value.

In the event of adisaster, compliance with basic hygiene measures is crucial. These measures are carried out regardless of the colonization or infection status of the patient in order to prevent the transmission of pathogens to other patients and personnel and to minimize the risk of a nosocomial distribution of (potential) infectious pathogens. This primarily includes hygienic hand disinfection and the use of special barrier precautions and personal protective equipement depending on the situation as well as safe injection and infusion techniques, proper processing of medical products and full vaccination protection of the personnel. When consistently applied basic hygiene measures also protect against the transmission of multidrug-resistant pathogens in undetected colonized patients and many viral infections. Due to amassive increase in demand (e.g., during the pandemic), disruptions in supply chains or breakdowns in facility-specific structures, prolonged shortages of materials that are important for implementing basic hygiene can occur. In these situations, substitution strategies are required, e.g., for the in-house production of hand and surface disinfectants, the handling of drinking water, alternative ways of processing medical products, wound care and the use of antibiotics.

Introduction: Mantle Cell Lymphoma (MCL) is a rare subtype of Non-Hodgkin lymphoma with heterogenous clinical course and treatment typically involves chemotherapy with immunotherapy (CIT), use of targeted agents (i.e., Bruton tyrosine kinase inhibitors, BTKi) and cellular therapies (CAR-T-cells). In contrast, the role of radiotherapy (RT) remains yet to be defined and until now is rather limited to specific situations and not integrated in current treatment algorithms. However, in light of novel treatment options, the potential of radiotherapy might not yet be fully determined. Small, frequently uncontrolled series have shown positive effects of RT in limited disease or in palliative situations. To add on the current knowledge and eventually prepare for prospective investigation, we conducted a real-world analysis using data from the European Mantle Cell Lymphoma Registry (EMCL-Registry), focusing on the duration of local tumor control (LTC). Methods: Out of 1422 patients enrolled in the registry from Germany, Switzerland, Austria and Portugal at data cut-off March 2025, all patients who received radiotherapy were included in this analysis. Patient factors, tumor biology, site, dose and disease status at the time of RT were analyzed for each radiation. Kaplan Meier estimates were calculated for the duration of LTC and overall survival. Radiation sites were analyzed separately. If distant progression occurred, observations for the respective sites were censored. Results: 100 patients were identified with a total of 123 radiotherapies applied between June 2002 and November 2024. Treated sites included: lymphnodes (n = 43), extremities (n = 20), oropharyngeal site (n = 14), spine (n = 4) and orbita (n = 11). Median follow-up post radiation was 39 months (range, 0–235 months). Response to treatment was complete in 34 sites (30,1%), partial in 40 sites (32,5%), stable in 11 sites (8,9%) and progressive in 28 sites (24,8%). Median duration of LTC was 14 months. 80% of RT were performed out for non-curative disease control. Tumor biology (TP53 mutation, Ki67 ≥ 30% and blastoid morphology), bulky disease and progression of disease within 12 months (POD12) prior radiation correlated with poorer LTC whereas orbital and oropharyngeal radiation showed longer duration of LTC (median duration of LTC not reached). Combination of RT and systemic treatment (CIT, targeted agents) had no effect on the duration of LTC. Achievement of LTC was associated with longer overall survival (p = 0.0016). Conclusions: Our data support evidence that MCL is a radio-sensitive disease and radiation can achieve durable local responses, even in pretreated patients and unfavorable tumor biology or disease course. Local tumor control can serve as bridging strategy and ultimately results in longer overall survival. If, like in large B-cell lymphoma, an abscopal effect in combination with targeted agents or a positive effect on CAR-T-cell efficiency exists, needs further systematic evaluation. Research funding declaration: This research received no external funding Keywords: radiation therapy; indolent non-Hodgkin lymphoma No potential sources of conflict of interest.