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  • 1
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    Online Resource
    Comparison of cisplatin and mitomycin C/5-FU as radiosensitisers in the treatment of locally advanced vulvar cancer: results of a retrospective, observational, single-institutional cohort study
    Springer Science and Business Media LLC ; 2023
    In:  Journal of Cancer Research and Clinical Oncology Vol. 149, No. 4 ( 2023-04), p. 1391-1399
    Details
    In: Journal of Cancer Research and Clinical Oncology, Springer Science and Business Media LLC, Vol. 149, No. 4 ( 2023-04), p. 1391-1399
    Abstract: We retrospectively investigated the widely used radiosensitisers cisplatin and mitomycin C/5-fluorouracil (5-FU) in patients with locally advanced vulvar cancer for outcome and toxicity. Methods We screened the archive for patients treated with chemoradiation for vulvar cancer diagnosed between 01/2010 and 08/2021 at our institution. The impact of both radiosensitisers on prognosis was compared using Kaplan–Meier method and Cox-regression analysis. Results One hundred and forty-three patients with vulvar cancer were screened. Twenty-nine patients received chemoradiation (mitomycin C/5-FU n  = 14; cisplatin n  = 12; others n  = 3) as a primary, neoadjuvant or adjuvant treatment. Median follow-up was 15.5 months. Patients in the cisplatin group were older (mean age 54.4 vs. 70.7; p  = 0.004). However, the mitomycin C/5-FU group had more advanced tumour stages. The 2-year recurrence-free survival (RFS) was comparable (44.5% vs. 33.3%; p  = 0.932). The 2-year overall survival (OS) showed a numerical but not statistically significant difference in favour of the mitomycin C/5-FU group (59.7% vs. 31.7%; p  = 0.37). 64.3% (9 out of 14) patients, who received mitomycin C/5-FU achieved clinical complete response (cCR) compared to 41.7% (5 out of 12) who received cisplatin ( p  = 0.505). Radiodermatitis was the most common adverse event in both groups (81%) and more severe in the mitomycin C/5-FU cohort. Myelotoxicity was frequently observed in both groups. Eighteen patients received an additional radiation boost with 10.0 (9–16) Gy and showed a significantly prolonged RFS ( p  = 0.027) and OS ( p  = 0.003). Conclusion Mitomycin C/5-FU may be considered in the treatment of young and healthy patients with locally advanced vulvar cancer.
    Type of Medium: Online Resource
    ISSN: 0171-5216 , 1432-1335
    URL: Article
    DOI: 10.1007/s00432-022-04006-0
    RVK:
    XA 52301
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2023
    detail.hit.zdb_id: 1459285-X
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  • 2
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    Prognostic Impact of Immunoglobulin Kappa C (IGKC) in Early Breast Cancer
    MDPI AG ; 2021
    In:  Cancers Vol. 13, No. 14 ( 2021-07-20), p. 3626-
    Details
    In: Cancers, MDPI AG, Vol. 13, No. 14 ( 2021-07-20), p. 3626-
    Abstract: We studied the prognostic impact of tumor immunoglobulin kappa C (IGKC) mRNA expression as a marker of the humoral immune system in the FinHer trial patient population, where 1010 patients with early breast cancer were randomly allocated to either docetaxel-containing or vinorelbine-containing adjuvant chemotherapy. HER2-positive patients were additionally allocated to either trastuzumab or no trastuzumab. Hormone receptor-positive patients received tamoxifen. IGKC was evaluated in 909 tumors using quantitative real-time polymerase chain reaction, and the influence on distant disease-free survival (DDFS) was examined using univariable and multivariable Cox regression and Kaplan–Meier estimates. Interactions were analyzed using Cox regression. IGKC expression, included as continuous variable, was independently associated with DDFS in a multivariable analysis also including age, molecular subtype, grade, and pT and pN stage (HR 0.930, 95% CI 0.870–0.995, p = 0.034). An independent association with DDFS was also found in a subset analysis of triple-negative breast cancers (TNBC) (HR 0.843, 95% CI 0.724–0.983, p = 0.029), but not in luminal (HR 0.957, 95% CI 0.867–1.056, p = 0.383) or HER2-positive (HR 0.933, 95% CI 0.826–1.055, p = 0.271) cancers. No significant interaction between IGKC and chemotherapy or trastuzumab administration was detected (Pinteraction = 0.855 and 0.684, respectively). These results show that humoral immunity beneficially influences the DDFS of patients with early TNBC.
    Type of Medium: Online Resource
    ISSN: 2072-6694
    URL: Article
    DOI: 10.3390/cancers13143626
    Language: English
    Publisher: MDPI AG
    Publication Date: 2021
    detail.hit.zdb_id: 2527080-1
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  • 3
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    New therapeutic approaches in recurrent cervical cancer
    Springer Science and Business Media LLC ; 2020
    In:  Der Onkologe Vol. 26, No. 7 ( 2020-07), p. 623-629
    Details
    In: Der Onkologe, Springer Science and Business Media LLC, Vol. 26, No. 7 ( 2020-07), p. 623-629
    Type of Medium: Online Resource
    ISSN: 0947-8965 , 1433-0415
    URL: Article
    DOI: 10.1007/s00761-020-00776-9
    Language: German
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2020
    detail.hit.zdb_id: 3120761-3
    detail.hit.zdb_id: 1462966-5
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  • 4
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    Role of integrins in the metastatic spread of high-grade serous ovarian cancer
    Springer Science and Business Media LLC ; 2022
    In:  Archives of Gynecology and Obstetrics Vol. 305, No. 5 ( 2022-05), p. 1291-1298
    Details
    In: Archives of Gynecology and Obstetrics, Springer Science and Business Media LLC, Vol. 305, No. 5 ( 2022-05), p. 1291-1298
    Abstract: Integrins may be involved in the metastatic spread of high-grade serous ovarian cancer (HGSOC) which determines the therapeutical approach and prognosis. We investigated the integrin expression in primary tumor and metastases of advanced HGSOC. Methods The expression of integrin α2, α4, α5, α6, and β1 was assessed by immunostaining in tumor samples of the ovary, omentum, and peritoneum of each patient. Differences in integrin expression among tumor localizations and their association with clinicopathological parameters were examined by Fisher’s exact test. The impact of integrin expression on progression-free survival (PFS) and overall survival (OS) was examined by Cox regression and Kaplan–Meier analyses. Results Hundred and thirteen tumor samples of 40 HGSOC patients were examined. The expression of the integrins did not differ between the three tumor localizations (all p values  〉  0.05) with the exception of high expression of integrin α4 in primary tumor and omentum (52.5% versus 47.5%, p  = 0.008) and primary tumor and peritoneum (52.5% versus 47.5%, p  = 0.050). High expression of integrin α4 in peritoneum was associated with poorer PFS (HR 2.02 95% CI 1.01–4.05, p  = 0.047), younger age ( p  = 0.047), and death ( p  = 0.046). Median PFS in patients with high expression of integrin α4 was 13.00 months, whereas median PFS in patients without high expression of integrin α4 was 21.00 months ( p  = 0.040). Expression of other integrins did not correlate with PFS or OS. Conclusion Expression of integrin α4 may be altered during the metastatic spread of HGSOC and affect prognosis, whereas expression of integrin α2, α5, α6, and β1 did not reveal any prognostic value.
    Type of Medium: Online Resource
    ISSN: 1432-0711
    URL: Article
    DOI: 10.1007/s00404-021-06281-7
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2022
    detail.hit.zdb_id: 1458450-5
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  • 5
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    The preoperative G8 geriatric screening tool independently predicts survival in older patients with endometrial cancer: results of a retrospective single-institution cohort study
    Springer Science and Business Media LLC ; 2023
    In:  Journal of Cancer Research and Clinical Oncology Vol. 149, No. 2 ( 2023-02), p. 851-863
    Details
    In: Journal of Cancer Research and Clinical Oncology, Springer Science and Business Media LLC, Vol. 149, No. 2 ( 2023-02), p. 851-863
    Abstract: The aim of this retrospective study was to evaluate the prognostic impact of global health status assessment tools in elderly patients with endometrial cancer (EC) on survival. Methods Preoperative frailty status was assessed by the G8 geriatric screening tool (G8 Score), Lee Schonberg prognostic index, Charlson Comorbidity index and American Society of Anesthesiologists Physical Status System in women older than 60 years with EC. Univariable and multivariable Cox-regression analyses, as well as Kaplan–Meier survival analyses were performed to determine the prognostic impact. Statistical analyses were adjusted for cancer entity-specific risk factors such as conventional histopathological tumor characteristics and relevant anamnestic life style parameters. Results 153 patients with all stages of EC who were operated at the University Medical Center Mainz between 2008 and 2019 were included . In multivariable analyses, only the G8 Score retained independent significance as a prognostic factor for disease-specific survival (DSS) (HR:4.58; 95% CI [1.35–15.51]) and overall survival (OS) (HR:2.89; 95% CI [1.31–6.39] . 92 patients (61.3%) were classified as G8-non-frail with a significantly increased DSS and OS rate compared to the 58 G8-frail patients (DSS:93.8% vs. 60.8%; p   〈  0.001 and OS:88.2% vs. 49.7%; p   〈  0.001; respectively). Conclusions This is the first study demonstrates the substantial clinical and prognostic impact of the G8 Score on survival in elderly women with EC. Assessing the frailty status to estimate the individual vulnerability of elderly cancer patients could be useful in preoperative decision-making to individualize treatment plans such as the surgical radicality and to improve pre- and postoperative morbidity.
    Type of Medium: Online Resource
    ISSN: 0171-5216 , 1432-1335
    URL: Article
    DOI: 10.1007/s00432-022-03934-1
    RVK:
    XA 52301
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2023
    detail.hit.zdb_id: 1459285-X
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  • 6
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    Prognostic impact of metabolic syndrome in patients with primary endometrial cancer: a retrospective bicentric study
    Springer Science and Business Media LLC ; 2024
    In:  Journal of Cancer Research and Clinical Oncology Vol. 150, No. 4 ( 2024-04-03)
    Details
    In: Journal of Cancer Research and Clinical Oncology, Springer Science and Business Media LLC, Vol. 150, No. 4 ( 2024-04-03)
    Abstract: Endometrial cancer (EC) is the most common gynaecological cancer. Its incidence has been rising over the years with ageing and increased obesity of the high-income countries’ populations. Metabolic syndrome (MetS) has been suggested to be associated with EC. The aim of this study was to assess whether MetS has a significant impact on oncological outcome in patients with EC. Methods This retrospective study included patients treated for EC between January 2010 and December 2020 in two referral oncological centers. Obesity, arterial hypertension (AH) and diabetes mellitus (DM) were criteria for the definition of MetS. The impact of MetS on progression free survival (PFS) and overall survival (OS) was assessed with log-rank test and Cox regression analyses. Results Among the 415 patients with a median age of 64, 38 (9.2%) fulfilled the criteria for MetS. The median follow-up time was 43 months. Patients suffering from MetS did not show any significant differences regarding PFS (36.0 vs. 40.0 months, HR: 1.49, 95% CI 0.79–2.80 P = 0.210) and OS (38.0 vs. 43.0 months, HR: 1.66, 95% CI 0.97–2.87, P = 0.063) compared to patients without MetS. Patients with obesity alone had a significantly shorter median PFS compared to patients without obesity (34.5 vs. 44.0 months, P = 0.029). AH and DM separately had no significant impact on PFS or OS (p 〉 0.05). Conclusion In our analysis, MetS in patients with EC was not associated with impaired oncological outcome. However, our findings show that obesity itself is an important comorbidity associated with significantly reduced PFS.
    Type of Medium: Online Resource
    ISSN: 1432-1335
    URL: Article
    DOI: 10.1007/s00432-024-05699-1
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2024
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  • 7
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    Risk Factors for Chemotherapy-Associated Venous Thromboses in Gynaecological Oncology Patients
    Georg Thieme Verlag KG ; 2019
    In:  Geburtshilfe und Frauenheilkunde Vol. 79, No. 10 ( 2019-10), p. 1100-1109
    Details
    In: Geburtshilfe und Frauenheilkunde, Georg Thieme Verlag KG, Vol. 79, No. 10 ( 2019-10), p. 1100-1109
    Abstract: Einleitung Venöse Thrombosen und deren Folgen zählen zu den Haupttodesursachen bei Patienten mit Tumorerkrankungen. Ziel dieser Studie ist die Analyse von Risikofaktoren sowie die Evaluation der Anwendbarkeit zweier Risikoscores an einem rein gynäkoonkologischen Patientinnenkollektiv. Mit der Identifikation von Hochrisikopatientinnen für das Auftreten von venösen Thrombosen könnte die Durchführung einer gezielten medikamentösen Thromboseprophylaxe mit hohem Nutzen bei gleichzeitig geringem Risiko ermöglicht werden. Material und Methoden In einer retrospektiven Fallkontrollstudie an 152 Patientinnen, die sich zwischen 2006 und 2013 in onkologischer Behandlung an der Frauenklinik der Universitätsmedizin Mainz befanden, wurden die Daten von 104 Patientinnen mit Mamma-, 26 mit Ovarial- und 22 mit Zervixkarzinom untersucht. 76 Probandinnen der Fallgruppe, die während der Chemotherapie eine venöse Thrombose erlitten haben, wurde eine Kontrolle zugeordnet, die in den Punkten Tumorlokalisation, Alter, Lymphknotenbefall, Metastasierung und Zeitpunkt der Erstdiagnose übereinstimmt. Mittels χ2-Test, t-Test, Mann-Whitney-U-Test und einer logistischen Regressionsanalyse wurden die Gruppenunterschiede analysiert. Ergebnisse Für eine fehlende stationäre Thromboseprophylaxe (p = 0,014), erhöhte Leukozytenzahlen (p = 0,018) vor Beginn der Chemotherapie und Portsysteme (p = 0,032) zeigten sich deutliche Gruppenunterschiede. Operative Eingriffe wurden als unabhängiger Risikofaktor bestätigt (p ≤ 0,001). Khorana- und Protecht-Score gingen nicht als unabhängige Prädiktoren für eine Thrombose aus der Analyse hervor. In der Fallgruppe sind mehr Patientinnen verstorben als in der Kontrollgruppe (p = 0,028; OR: 8,1; KI: 1,254 – 52,162). Fazit Operationen stellen in diesem Patientenkollektiv einen unabhängigen Risikofaktor für venöse Thrombosen dar. Daneben zeigte sich ein Zusammenhang zwischen einer stationären Thromboseprophylaxe, Leukozytose sowie Portsystemen und einem erhöhten Thromboserisiko. Weder Khorana- noch Protecht-Score waren unabhängige Risikofaktoren für venöse Thrombosen. Deutlich mehr Thrombosepatientinnen sind im Beobachtungszeitraum verstorben.
    Type of Medium: Online Resource
    ISSN: 0016-5751 , 1438-8804
    URL: Article
    DOI: 10.1055/a-0834-6468
    Language: English
    Publisher: Georg Thieme Verlag KG
    Publication Date: 2019
    detail.hit.zdb_id: 2026496-3
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  • 8
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    Risikofaktoren für Chemotherapie-assoziierte venöse Thrombosen bei gynäkoonkologischen Patientinnen
    Georg Thieme Verlag KG ; 2020
    In:  Phlebologie Vol. 49, No. 02 ( 2020-04), p. 98-107
    Details
    In: Phlebologie, Georg Thieme Verlag KG, Vol. 49, No. 02 ( 2020-04), p. 98-107
    Abstract: Einleitung Venöse Thrombosen und deren Folgen zählen zu den Haupttodesursachen bei Patienten mit Tumorerkrankungen. Ziel dieser Studie ist die Analyse von Risikofaktoren sowie die Evaluation der Anwendbarkeit zweier Risikoscores an einem rein gynäkoonkologischen Patientinnenkollektiv. Mit der Identifikation von Hochrisikopatientinnen für das Auftreten von venösen Thrombosen könnte die Durchführung einer gezielten medikamentösen Thromboseprophylaxe mit hohem Nutzen bei gleichzeitig geringem Risiko ermöglicht werden. Material und Methoden In einer retrospektiven Fallkontrollstudie an 152 Patientinnen, die sich zwischen 2006 und 2013 in onkologischer Behandlung an der Frauenklinik der Universitätsmedizin Mainz befanden, wurden die Daten von 104 Patientinnen mit Mamma-, 26 mit Ovarial- und 22 mit Zervixkarzinom untersucht. 76 Probandinnen der Fallgruppe, die während der Chemotherapie eine venöse Thrombose erlitten hatten, wurde eine Kontrolle zugeordnet, die in den Punkten Tumorlokalisation, Alter, Lymphknotenbefall, Metastasierung und Zeitpunkt der Erstdiagnose übereinstimmte. Mittels χ2-Test, t-Test, Mann-Whitney-U-Test und einer logistischen Regressionsanalyse wurden die Gruppenunterschiede analysiert. Ergebnisse Für eine fehlende stationäre Thromboseprophylaxe (p = 0,014), erhöhte Leukozytenzahlen (p = 0,018) vor Beginn der Chemotherapie und Portsysteme (p = 0,032) zeigten sich deutliche Gruppenunterschiede. Operative Eingriffe wurden als unabhängiger Risikofaktor bestätigt (p≤ 0,001). Khorana- und Protecht-Score gingen nicht als unabhängige Prädiktoren für eine Thrombose aus der Analyse hervor. In der Fallgruppe sind mehr Patientinnen verstorben als in der Kontrollgruppe (p = 0,028; OR: 8,1; 95 %-KI: 1,254–52,162). Fazit Operationen stellen in diesem Patientenkollektiv einen unabhängigen Risikofaktor für venöse Thrombosen dar. Daneben zeigte sich ein Zusammenhang zwischen einer stationären Thromboseprophylaxe, Leukozytose sowie Portsystemen und einem erhöhten Thromboserisiko. Weder Khorana- noch Protecht-Score waren unabhängige Risikofaktoren für venöse Thrombosen. Deutlich mehr Thrombosepatientinnen sind im Beobachtungszeitraum verstorben.
    Type of Medium: Online Resource
    ISSN: 0939-978X , 2567-5826
    URL: Article
    DOI: 10.1055/a-1099-4832
    Language: German
    Publisher: Georg Thieme Verlag KG
    Publication Date: 2020
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  • 9
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    Pain experience and social support of endometriosis patients during the COVID-19 pandemic in Germany – results of a web-based cross-sectional survey
    Public Library of Science (PLoS) ; 2021
    In:  PLOS ONE Vol. 16, No. 8 ( 2021-8-25), p. e0256433-
    Details
    In: PLOS ONE, Public Library of Science (PLoS), Vol. 16, No. 8 ( 2021-8-25), p. e0256433-
    Abstract: Endometriosis is a chronic pain condition in premenopausal women. Pain is mainly characterized by pain intensity and may induce disability in all areas of daily life. Nevertheless, pain is influenced by emotional and social factors as well. Social distancing measures or quarantine, as reaction to rapidly rising infections with the COVID-19 virus due to the SARS-CoV-2 pandemic, were implemented across Europe to prevent the spread of the virus and social distancing measures were imposed by the German government by beginning of March 2020 with initiation of the lockdown by the end of March 2020. The objective of this study was to assess, how social distancing measures during the lockdown impacted the various aspects of pain perception in a group of chronic pain patients, such as women suffering from endometriosis. Methods Between 6 th to 27 th April 2020, an online questionnaire was activated at internet platforms of endometriosis patients support groups. Participants were asked retrospectively at one time point about their visual pain intensity measured by the visual analogue scale (VAS) and pain disability via pain disability index (PDI) prior to initiation of social distancing measures in Germany (VAS P , PDI P ), as well as the pain intensity and pain disability since implementation of social distancing measures (VAS I , PDI I ). Differences of VAS and PDI previous and after implementation of social distancing measures were displayed as ΔVAS and ΔPDI. Pain experience and social support were assessed by a 5-point Likert scale. Results 285 participants completed at least one question regarding pain intensity, disability, pain experience or social support. Dysmenorrhea, the symptom with the highest level of pain assessed by VAS, decreased significantly during the SARS-CoV-2 pandemic compared to the time period prior to social isolation (45.30% respondents experienced improvemenet vs 40.50% who experienced worsening; p = 0.025). The global physical impairment improved significantly (improvement of pain induced disability in 48.20% vs 40.90% with worsening of pain symptoms; p = 0.032) after the implementation of social distancing measures. Pain experience was negatively affected by social distancing measures, since frequency of pain awareness increased in 43.6% (p 〈 0.001) of participants and 30.0% (p 〈 0.001) more participants experienced pain as a threat. Verbalization of pain experience was reduced in 36.6% (p = 0.001) of participants and 14.6% (p = 0.91), 21.9% (p 〈 0.001) and 31.5% (p 〈 0.001) of participants reported less social support from their partner, family and friends. Conclusions Physical pain and disability on one hand and emotional and social pain experience on the other were differentially affected by the emerged emotional, social and health care constraints related to the SARS-CoV-2 pandemic.
    Type of Medium: Online Resource
    ISSN: 1932-6203
    URL: Article
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    DOI: 10.1371/journal.pone.0256433
    DOI: 10.1371/journal.pone.0256433.g001
    DOI: 10.1371/journal.pone.0256433.g002
    DOI: 10.1371/journal.pone.0256433.t001
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    DOI: 10.1371/journal.pone.0256433.s001
    Language: English
    Publisher: Public Library of Science (PLoS)
    Publication Date: 2021
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  • 10
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    Real-World Experience of Metronomic Chemotherapy in Metastatic Breast Cancer: Results of a Retrospective Unicenter Study
    S. Karger AG ; 2023
    In:  Breast Care Vol. 18, No. 2 ( 2023), p. 97-105
    Details
    In: Breast Care, S. Karger AG, Vol. 18, No. 2 ( 2023), p. 97-105
    Abstract: 〈 b 〉 〈 i 〉 Introduction: 〈 /i 〉 〈 /b 〉 Metronomic chemotherapy (MCT) is increasingly used in oncology due to its favorable therapeutic index. There is still a lack of evidence for MCT in metastatic breast cancer (MBC). In this retrospective unicenter study, we demonstrated real-word data on MCT in MBC. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 MBC patients who received metronomic oral cyclophosphamide (CTX) (50 mg daily) and methotrexate (MTX) (2.5 mg every other day), CTX and capecitabine (CAPE) (500 mg thrice daily), CTX, or vinorelbine (VRL) (30 mg daily) alone for at least 4 weeks between 2009 and 2021 were included. The primary endpoint was disease control rate (DCR) ≥24 weeks. Secondary endpoints were progression-free survival (PFS) and overall survival (OS). Patient characteristics and therapy response were analyzed using χ 〈 sup 〉 2 〈 /sup 〉 test. For survival analyses, Kaplan-Meier estimator and log-rank test were used. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 Seventy-two patients were identified. Sixty-two patients received CTX/MTX, three CTX/CAPE, two CTX, and five VRL. Median age at diagnosis MBC and at start of MCT was 59.0 years and 64.5 years, respectively. 72.2% tumors were hormone receptor positive and 27.8% were triple-negative. 54.2% patients had more than two different metastases. 80.6% patients showed visceral involvement. 31.9% patients achieved DCR ≥24 weeks. Median PFS was 17.0 weeks (95% CI 14.5–19.5) and median OS was 58.0 weeks (95% CI 29.0–87.0). MCT showed similar DCR ≥24 weeks and clinically meaningful but not statistically significant shorter median PFS compared to prior therapy (31.9% versus 32.8% [ 〈 i 〉 p 〈 /i 〉 = 0.570] and 17.0 weeks versus 20.0 weeks [ 〈 i 〉 p 〈 /i 〉 = 0.093], respectively) and statistically significant higher DCR ≥24 weeks and longer median PFS compared to subsequent therapy (31.9% versus 17.4% [ 〈 i 〉 p 〈 /i 〉 = 0.038] and 17.0 weeks versus 12.0 weeks [ 〈 i 〉 p 〈 /i 〉 = 0.006], respectively). Three (4.2%) patients terminated MCT because of toxicity. 〈 b 〉 〈 i 〉 Conclusion: 〈 /i 〉 〈 /b 〉 In this real-world retrospective study, MCT was effective and well tolerated and may thus represent a valuable treatment option in selected MBC patients.
    Type of Medium: Online Resource
    ISSN: 1661-3791 , 1661-3805
    URL: Article
    DOI: 10.1159/000528042
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2023
    detail.hit.zdb_id: 2205941-6
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