Background: Having demonstrated in a previous report that the response of circulating epithelial tumor cells (CETC) during the first cycles of primary (neoadjuvant) chemotherapy perfectly reflects the response of the tumor, in the present study the changes in cell numbers during subsequent cycles and their possible impact on the therapy's outcome were examined. Patients and methods:In 58 breast cancer patients CETC were quantified during therapy with either EC (epirubicin/ cyclophosphamid) or dose intensified E (epirubicin) followed by taxane, with or without trastuzumab, and subsequent CMF (cyclophosphamid/methorexate/ fluorouracil).Results: CETC numbers declined more than 10-fold (good response) in 65% (her2/neu-negative) and 55% (her2/neu-positive) of patients during EC, and in 60% during dose intensified E, respectively, followed by an increase of CETC in all patients. CETC remained increased, decreasing only when adding CMF. A good initial response correlated with estrogen-receptor negativity, a poor response with early distant relapse (P < 0,0001, hazard ratio = 11.91). Conclusion:Response of CETC already during the first cycles of neoadjuvant treatment predicts the final response of the tumor. Hitherto unknown effects of the release of tumor cells during therapy further our understanding of tumor-blood interaction and may improve access of agents like antibodies to cells. The impact on the further course of disease remains to be evaluated.

Background In breast cancers, the gene for the growth factor receptor HER2 can be ampliWed leading to increased aggressiveness and metastasis formation. The monoclonal antibody trastuzumab prolongs relapse-free survival highly signiWcantly but eventually many patients relapse. Method In this study, CETC were monitored using the Maintrac ® method during adjuvant trastuzumab treatment and during subsequent treatment with capecitabine/lapatinib.

Our technique circumvents a larger abdominal incision. This combined laparoscopic-transvaginal approach, avoiding the extension of port-site incisions, represents a viable option for the treatment of bowel endometriosis.

ZusammenfassungDer Artikel stellt das typische Präsentationssymptom des gynäkologischen Notfalls – das unklare Abdomen der Frau – anhand von Szenarien aus dem prä- und innerklinischen Bereich vor. Die genaue Notfallanamnese und -untersuchung werden für die gynäkologische Patientin modifiziert. Wichtige Differenzialdiagnosen des unklaren Abdomens sowie weitere gynäkologische Notfallszenarien, wie z.B. genitales Trauma, werden in den kommenden Ausgaben erläutert.

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