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Harnblasenkarzinom beim alten und geriatrischen Patienten

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Geriatrische Onkologie

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Zusammenfassung

Das Harnblasenkarzinom ist nach dem Prostatakarzinom das zweithäufigste Malignom des Urogenitaltraktes. Die Erkrankungshäufigkeit steigt mit zunehmendem Lebensalter. Aufgrund der demographischen Entwicklung wird daher eine Zunahme von alten und hochaltrigen Patienten mit Harnblasenkarzinom erwartet. Eine Herausforderung für die geriatrische Onkologie stellt dabei die Identifikation derjenigen Patienten dar, für die durch aggressive Therapien unter Einschluss von radikaler Zystektomie, Radiochemotherapie sowie Kombinationschemotherapien im neoadjuvanten, adjuvanten oder palliativen Konzept eine Verbesserung der Prognose erreicht werden kann.

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Literatur

  • Advanced Bladder Cancer (ABC) Meta-analysis Collaboration (2005) Neoadjuvant chemotherapy in invasive bladder cancer: update of a systematic review and meta-analysis of individual patient data advanced bladder cancer (ABC) meta-analysis collaboration. Eur Urol 48:202–205; discussion 205–206

    Article  Google Scholar 

  • Alfred Witjes J, Lebret T, Comperat EM, Cowan NC, De Santis M, Bruins HM, Hernandez V, Espinos EL, Dunn J, Rouanne M et al (2016) Updated 2016 EAU guidelines on muscle-invasive and metastatic bladder cancer. Eur Urol 71:462–475

    Article  PubMed  Google Scholar 

  • Ali AS, Hayes MC, Birch B, Dudderidge T, Somani BK (2015) Health related quality of life (HRQoL) after cystectomy: comparison between orthotopic neobladder and ileal conduit diversion. Eur J Surg Oncol 41:295–299

    Article  CAS  PubMed  Google Scholar 

  • Babjuk M, Bohle A, Burger M, Capoun O, Cohen D, Comperat EM, Hernandez V, Kaasinen E, Palou J, Roupret M et al (2017) EAU guidelines on non-muscle-invasive urothelial carcinoma of the bladder: update 2016. Eur Urol 71:447–461

    Article  PubMed  Google Scholar 

  • Bellmunt J, Fougeray R, Rosenberg JE, von der Maase H, Schutz FA, Salhi Y, Culine S, Choueiri TK (2013) Long-term survival results of a randomized phase III trial of vinflunine plus best supportive care versus best supportive care alone in advanced urothelial carcinoma patients after failure of platinum-based chemotherapy. Ann Oncol 24:1466–1472

    Article  CAS  PubMed  Google Scholar 

  • Bohle A, Bock PR (2004) Intravesical bacille Calmette-Guerin versus mitomycin C in superficial bladder cancer: formal meta-analysis of comparative studies on tumor progression. Urology 63:682–686; discussion 686–687

    Article  CAS  PubMed  Google Scholar 

  • Bohle A, Suttmann H, Brandau S (2006) Effect mechanism of intravesical BCG immunotherapy of superficial bladder cancer. Urologe A 45:629–633, 635–636

    Article  CAS  PubMed  Google Scholar 

  • Bostrom PJ, Kossi J, Laato M, Nurmi M (2009) Risk factors for mortality and morbidity related to radical cystectomy. BJU Int 103:191–196

    Article  PubMed  Google Scholar 

  • Burger M, Catto JW, Dalbagni G, Grossman HB, Herr H, Karakiewicz P, Kassouf W, Kiemeney LA, La Vecchia C, Shariat S et al (2013) Epidemiology and risk factors of urothelial bladder cancer. Eur Urol 63:234–241

    Article  PubMed  Google Scholar 

  • Castagneto B, Zai S, Marenco D, Bertetto O, Repetto L, Scaltriti L, Mencoboni M, Ferraris V, Botta M (2004) Single-agent gemcitabine in previously untreated elderly patients with advanced bladder carcinoma: response to treatment and correlation with the comprehensive geriatric assessment. Oncology 67:27–32

    Article  CAS  PubMed  Google Scholar 

  • Cerruto MA, D’Elia C, Siracusano S, Gedeshi X, Mariotto A, Iafrate M, Niero M, Lonardi C, Bassi P, Belgrano E et al (2016) Systematic review and meta-analysis of non RCT’s on health related quality of life after radical cystectomy using validated questionnaires: better results with orthotopic neobladder versus ileal conduit. Eur J Surg Oncol 42:343–360

    Article  CAS  PubMed  Google Scholar 

  • Chang SS, Hassan JM, Cookson MS, Wells N, Smith JA Jr (2003) Delaying radical cystectomy for muscle invasive bladder cancer results in worse pathological stage. J Urol 170:1085–1087

    Article  PubMed  Google Scholar 

  • Cho KS, Hwang TK, Kim BW, Yoon DK, Chang SG, Kim SJ, Park JY, Cheon J, Sung GT, Hong SJ (2009) Differences in tumor characteristics and prognosis in newly diagnosed Ta, T1 urothelial carcinoma of bladder according to patient age. Urology 73:828–832, 832.e821

    Article  PubMed  Google Scholar 

  • Clark PE, Stein JP, Groshen SG, Cai J, Miranda G, Lieskovsky G, Skinner DG (2005) Radical cystectomy in the elderly: comparison of survival between younger and older patients. Cancer 103:546–552

    Article  PubMed  Google Scholar 

  • Collado A, Chechile GE, Salvador J, Vicente J (2000) Early complications of endoscopic treatment for superficial bladder tumors. J Urol 164:1529–1532

    Article  CAS  PubMed  Google Scholar 

  • Dash A, Galsky MD, Vickers AJ, Serio AM, Koppie TM, Dalbagni G, Bochner BH (2006) Impact of renal impairment on eligibility for adjuvant cisplatin-based chemotherapy in patients with urothelial carcinoma of the bladder. Cancer 107:506–513

    Article  CAS  PubMed  Google Scholar 

  • De Groote R, Gandaglia G, Geurts N, Goossens M, Pauwels E, D’Hondt F, Gratzke C, Fossati N, De Naeyer G, Schatteman P et al (2016) Robot-assisted radical cystectomy for bladder cancer in octogenarians. J Endourol 30:792–798

    Article  PubMed  Google Scholar 

  • De Nunzio C, Franco G, Cindolo L, Autorino R, Cicione A, Perdona S, Falsaperla M, Gacci M, Leonardo C, Damiano R et al (2014) Transuretral resection of the bladder (TURB): analysis of complications using a modified Clavien system in an Italian real life cohort. Eur J Surg Oncol 40:90–95

    Article  PubMed  Google Scholar 

  • Donat SM, Siegrist T, Cronin A, Savage C, Milowsky MI, Herr HW (2010) Radical cystectomy in octogenarians – does morbidity outweigh the potential survival benefits? J Urol 183:2171–2177

    Article  PubMed  Google Scholar 

  • Erlich A, Zlotta AR (2016) Treatment of bladder cancer in the elderly. Investig Clin Urol 57(Suppl 1):S26–S35

    Article  PubMed  PubMed Central  Google Scholar 

  • Froehner M, Brausi MA, Herr HW, Muto G, Studer UE (2009) Complications following radical cystectomy for bladder cancer in the elderly. Eur Urol 56:443–454

    Article  PubMed  Google Scholar 

  • Galsky MD, Hahn NM, Rosenberg J, Sonpavde G, Hutson T, Oh WK, Dreicer R, Vogelzang N, Sternberg C, Bajorin DF et al (2011) A consensus definition of patients with metastatic urothelial carcinoma who are unfit for cisplatin-based chemotherapy. Lancet Oncol 12:211–214

    Article  PubMed  Google Scholar 

  • Galsky MD, Krege S, Lin CC, Hahn N, Ecke TH, Moshier E, Sonpavde G, Godbold J, Oh WK, Bamias A (2014) Cisplatin-based combination chemotherapy in septuagenarians with metastatic urothelial cancer. Urol Oncol 32(30):e15–e21

    Google Scholar 

  • Gofrit ON, Pode D, Lazar A, Katz R, Shapiro A (2006) Watchful waiting policy in recurrent Ta G1 bladder tumors. Eur Urol 49:303–306; discussion 306–307

    Article  PubMed  Google Scholar 

  • Gore JL, Litwin MS (2009) Quality of care in bladder cancer: trends in urinary diversion following radical cystectomy. World J Urol 27:45–50

    Article  PubMed  Google Scholar 

  • Gore JL, Litwin MS, Lai J, Yano EM, Madison R, Setodji C, Adams JL, Saigal CS (2010) Use of radical cystectomy for patients with invasive bladder cancer. J Natl Cancer Inst 102:802–811

    Article  PubMed  PubMed Central  Google Scholar 

  • Gray PJ, Fedewa SA, Shipley WU, Efstathiou JA, Lin CC, Zietman AL, Virgo KS (2013) Use of potentially curative therapies for muscle-invasive bladder cancer in the United States: results from the National Cancer Data Base. Eur Urol 63:823–829

    Article  PubMed  Google Scholar 

  • Gschwend JE (2010) Indications and oncologic outcome of radical cystectomy for urothelial bladder cancer. Eur Urol 9:10–18

    Article  Google Scholar 

  • Heiner JG, Terris MK (2008) Effect of advanced age on the development of complications from intravesical bacillus Calmette-Guerin therapy. Urol Oncol 26:137–140

    Article  PubMed  Google Scholar 

  • Herr HW (2007) Age and outcome of superficial bladder cancer treated with bacille Calmette-Guerin therapy. Urology 70:65–68

    Article  PubMed  Google Scholar 

  • Herr HW, Donat SM, Reuter VE (2007) Management of low grade papillary bladder tumors. J Urol 178:1201–1205; discussion 1205

    Article  PubMed  Google Scholar 

  • Hollenbeck BK, Miller DC, Taub D, Dunn RL, Underwood W 3rd, Montie JE, Wei JT (2004) Aggressive treatment for bladder cancer is associated with improved overall survival among patients 80 years old or older. Urology 64:292–297

    Article  PubMed  Google Scholar 

  • Hugonnet CL, Danuser H, Springer JP, Studer UE (1999) Decreased sensitivity in the membranous urethra after orthotopic ileal bladder substitute. J Urol 161:418–421

    Article  CAS  PubMed  Google Scholar 

  • Huncharek M, Kupelnick B (2003) Impact of intravesical chemotherapy versus BCG immunotherapy on recurrence of superficial transitional cell carcinoma of the bladder: metaanalytic reevaluation. Am J Clin Oncol 26:402–407

    CAS  PubMed  Google Scholar 

  • Joudi FN, Smith BJ, O’Donnell MA, Konety BR (2006) The impact of age on the response of patients with superficial bladder cancer to intravesical immunotherapy. J Urol 175:1634–1639; discussion 1639–1640

    Article  PubMed  Google Scholar 

  • Kassouf W, Swanson D, Kamat AM, Leibovici D, Siefker-Radtke A, Munsell MF, Grossman HB, Dinney CP (2006) Partial cystectomy for muscle invasive urothelial carcinoma of the bladder: a contemporary review of the M. D. Anderson Cancer Center experience. J Urol 175:2058–2062

    Article  PubMed  Google Scholar 

  • Kenipkensteffen (2016) Alternative Verfahren beim Urothelkarzinom. Springer, Berlin

    Google Scholar 

  • Kohjimoto Y, Iba A, Shintani Y, Inagaki T, Uekado Y, Hara I (2010) Impact of patient age on outcome following bladder-preserving treatment for non-muscle-invasive bladder cancer. World J Urol 28:425–430

    Article  PubMed  Google Scholar 

  • Kouloulias V, Tolia M, Kolliarakis N, Siatelis A, Kelekis N (2013) Evaluation of acute toxicity and symptoms palliation in a hypofractionated weekly schedule of external radiotherapy for elderly patients with muscular invasive bladder cancer. Int Braz J Urol 39:77–82

    Article  PubMed  Google Scholar 

  • Leitlinienprogramm Onkologie (Deutsche Krebsgesellschaft, D.K., AWMF): Früherkennung, Diagnose, Therapie und Nachsorge des Harnblasenkarzinoms, Konsultationsfassung Langversion, Februar 2016, AWMF-Registrierungsnummer 032/038OL, http://leitlinienprogramm-onkologie.de/Leitlinien.7.0.html

  • Lee SS, Holzbeierlein JM (2014) Bladder cancer. Springer, New York

    Book  Google Scholar 

  • Leow JJ, Martin-Doyle W, Rajagopal PS, Patel CG, Anderson EM, Rothman AT, Cote RJ, Urun Y, Chang SL, Choueiri TK et al (2014) Adjuvant chemotherapy for invasive bladder cancer: a 2013 updated systematic review and meta-analysis of randomized trials. Eur Urol 66:42–54

    Article  CAS  PubMed  Google Scholar 

  • Lutkenhaus LJ, van Os RM, Bel A, Hulshof MC (2016) Clinical results of conformal versus intensity-modulated radiotherapy using a focal simultaneous boost for muscle-invasive bladder cancer in elderly or medically unfit patients. Radiat Oncol 11:45

    Article  PubMed  PubMed Central  Google Scholar 

  • Madersbacher S, Mohrle K, Burkhard F, Studer UE (2002) Long-term voiding pattern of patients with ileal orthotopic bladder substitutes. J Urol 167:2052–2057

    Article  PubMed  Google Scholar 

  • Madersbacher S, Bauer W, Willinger M, Wehrberger C, Berger I, Brossner C (2010) Radical cystectomy for bladder cancer in the 70+ population: a nation-wide registry analysis of 845 patients. Urol Int 85:287–290

    Article  PubMed  Google Scholar 

  • Maffezini M (2013) Radical cystectomy in miscle-infiltrative bladder cancer and conservative treatment in localized disease. Springer, London

    Google Scholar 

  • Mak RH, Hunt D, Shipley WU, Efstathiou JA, Tester WJ, Hagan MP, Kaufman DS, Heney NM, Zietman AL (2014) Long-term outcomes in patients with muscle-invasive bladder cancer after selective bladder-preserving combined-modality therapy: a pooled analysis of Radiation Therapy Oncology Group protocols 8802, 8903, 9506, 9706, 9906, and 0233. J Clin Oncol 32:3801–3809

    Article  PubMed  PubMed Central  Google Scholar 

  • Margel D, Alkhateeb SS, Finelli A, Fleshner N (2011) Diminished efficacy of bacille Calmette-Guerin among elderly patients with nonmuscle invasive bladder cancer. Urology 78:848–854

    Article  PubMed  Google Scholar 

  • Marsit CJ, Houseman EA, Schned AR, Karagas MR, Kelsey KT (2007) Promoter hypermethylation is associated with current smoking, age, gender and survival in bladder cancer. Carcinogenesis 28:1745–1751

    Article  CAS  PubMed  Google Scholar 

  • Mayr R, May M, Martini T, Lodde M, Comploj E, Pycha A, Strobel J, Denzinger S, Otto W, Wieland W et al (2012) Comorbidity and performance indices as predictors of cancer-independent mortality but not of cancer-specific mortality after radical cystectomy for urothelial carcinoma of the bladder. Eur Urol 62:662–670

    Article  PubMed  Google Scholar 

  • Messing E (2008) Urothelial tumors of the bladder (chapter 75), 9. Aufl. Saunders Elsevier, Philadelphia

    Google Scholar 

  • Morgan TM, Keegan KA, Barocas DA, Ruhotina N, Phillips SE, Chang SS, Penson DF, Clark PE, Smith JA Jr, Cookson MS (2011) Predicting the probability of 90-day survival of elderly patients with bladder cancer treated with radical cystectomy. J Urol 186:829–834

    Article  PubMed  Google Scholar 

  • Necchi A, Pond GR, Raggi D, Giannatempo P, Vogelzang NJ, Grivas P, Galsky MD, Bellmunt J, Sonpavde G (2017) Efficacy and safety of gemcitabine plus either taxane or carboplatin in the first-line setting of metastatic urothelial carcinoma: a systematic review and meta-analysis. Clin Genitourin Cancer 15:23

    Article  PubMed  Google Scholar 

  • Nguyen DP, Al Hussein Al Awamlh B, Charles Osterberg E, Chrystal J, Flynn T, Lee DJ, Scherr DS (2015) Postoperative complications and short-term oncological outcomes of patients aged >/=80 years undergoing robot-assisted radical cystectomy. World J Urol 33:1315–1321

    Article  PubMed  Google Scholar 

  • Nielsen ME, Shariat SF, Karakiewicz PI, Lotan Y, Rogers CG, Amiel GE, Bastian PJ, Vazina A, Gupta A, Lerner SP et al (2007) Advanced age is associated with poorer bladder cancer-specific survival in patients treated with radical cystectomy. Eur Urol 51:699–706; discussion 706–698

    Article  PubMed  Google Scholar 

  • Noon AP, Albertsen PC, Thomas F, Rosario DJ, Catto JW (2013) Competing mortality in patients diagnosed with bladder cancer: evidence of undertreatment in the elderly and female patients. Br J Cancer 108:1534–1540

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Oderda M (2013) Management of superficial bladder cancer in elderly patients. Springer, London

    Book  Google Scholar 

  • Ploussard G, Daneshmand S, Efstathiou JA, Herr HW, James ND, Rodel CM, Shariat SF, Shipley WU, Sternberg CN, Thalmann GN et al (2014) Critical analysis of bladder sparing with trimodal therapy in muscle-invasive bladder cancer: a systematic review. Eur Urol 66:120–137

    Article  CAS  PubMed  Google Scholar 

  • Prout GR Jr, Wesley MN, Yancik R, Ries LA, Havlik RJ, Edwards BK (2005) Age and comorbidity impact surgical therapy in older bladder carcinoma patients: a population-based study. Cancer 104:1638–1647

    Article  PubMed  Google Scholar 

  • Raj GV, Karavadia S, Schlomer B, Arriaga Y, Lotan Y, Sagalowsky A, Frenkel E (2011) Contemporary use of perioperative cisplatin-based chemotherapy in patients with muscle-invasive bladder cancer. Cancer 117:276–282

    Article  CAS  PubMed  Google Scholar 

  • Resorlu B, Beduk Y, Baltaci S, Ergun G, Talas H (2009) The prognostic significance of advanced age in patients with bladder cancer treated with radical cystectomy. BJU Int 103:480–483

    Article  PubMed  Google Scholar 

  • Rose TL, Milowsky MI (2015) Management of muscle-invasive bladder cancer in the elderly. Curr Opin Urol 25:459–467

    Article  PubMed  Google Scholar 

  • Rosenberg JE, Hoffman-Censits J, Powles T, van der Heijden MS, Balar AV, Necchi A, Dawson N, O’Donnell PH, Balmanoukian A, Loriot Y et al (2016) Atezolizumab in patients with locally advanced and metastatic urothelial carcinoma who have progressed following treatment with platinum-based chemotherapy: a single-arm, multicentre, phase 2 trial. Lancet 387:1909–1920

    Article  CAS  PubMed  Google Scholar 

  • Schiffmann J, Gandaglia G, Larcher A, Sun M, Tian Z, Shariat SF, McCormack M, Valiquette L, Montorsi F, Graefen M et al (2014) Contemporary 90-day mortality rates after radical cystectomy in the elderly. Eur J Surg Oncol 40:1738–1745

    Article  CAS  PubMed  Google Scholar 

  • Schultzel M, Saltzstein SL, Downs TM, Shimasaki S, Sanders C, Sadler GR (2008) Late age (85 years or older) peak incidence of bladder cancer. J Urol 179:1302–1305; discussion 1305–1306

    Article  PubMed  PubMed Central  Google Scholar 

  • Shariat SF, Milowsky M, Droller MJ (2009) Bladder cancer in the elderly. Urol Oncol 27:653–667

    Article  PubMed  PubMed Central  Google Scholar 

  • Sogni F, Brausi M, Frea B, Martinengo C, Faggiano F, Tizzani A, Gontero P (2008) Morbidity and quality of life in elderly patients receiving ileal conduit or orthotopic neobladder after radical cystectomy for invasive bladder cancer. Urology 71:919–923

    Article  PubMed  Google Scholar 

  • Solana R, Pawelec G, Tarazona R (2006) Aging and innate immunity. Immunity 24:491–494

    Article  CAS  PubMed  Google Scholar 

  • Soloway MS (2006) Expectant treatment of small, recurrent, low-grade, noninvasive tumors of the urinary bladder. Urol Oncol 24:58–61

    Article  PubMed  Google Scholar 

  • Spencer BA, McBride RB, Hershman DL, Buono D, Herr HW, Benson MC, Gupta-Mohile S, Neugut AI (2013) Adjuvant intravesical bacillus calmette-guerin therapy and survival among elderly patients with non-muscle-invasive bladder cancer. J Oncol Pract 9:92–98

    Article  PubMed  Google Scholar 

  • Stein JP, Lieskovsky G, Cote R, Groshen S, Feng AC, Boyd S, Skinner E, Bochner B, Thangathurai D, Mikhail M et al (2001) Radical cystectomy in the treatment of invasive bladder cancer: long-term results in 1,054 patients. J Clin Oncol 19:666–675

    Article  CAS  PubMed  Google Scholar 

  • Sylvester RJ, Brausi MA, Kirkels WJ, Hoeltl W, Calais Da Silva F, Powell PH, Prescott S, Kirkali Z, van de Beek C, Gorlia T et al (2010) Long-term efficacy results of EORTC genito-urinary group randomized phase 3 study 30911 comparing intravesical instillations of epirubicin, bacillus Calmette-Guerin, and bacillus Calmette-Guerin plus isoniazid in patients with intermediate- and high-risk stage Ta T1 urothelial carcinoma of the bladder. Eur Urol 57:766–773

    Article  PubMed  Google Scholar 

  • Sylvester RJ, Oosterlinck W, Holmang S, Sydes MR, Birtle A, Gudjonsson S, De Nunzio C, Okamura K, Kaasinen E, Solsona E et al (2016) Systematic review and individual patient data meta-analysis of randomized trials comparing a single immediate instillation of chemotherapy after transurethral resection with transurethral resection alone in patients with stage pTa-pT1 urothelial carcinoma of the bladder: which patients benefit from the instillation? Eur Urol 69:231–244

    Article  PubMed  Google Scholar 

  • Tourani J (2012) Influence of age on the pharmacokinetics of i. v. vinflunine: results of a phase I trial in elderly cancer patients. J Geriatr Oncol 3:41–48

    Article  Google Scholar 

  • Weizer AZ, Joshi D, Daignault S, Kinnaman M, Hussain M, Montie JE, Zhang Y, Lee CT (2007) Performance status is a predictor of overall survival of elderly patients with muscle invasive bladder cancer. J Urol 177:1287–1293

    Article  PubMed  Google Scholar 

  • Zebic N, Weinknecht S, Kroepfl D (2005) Radical cystectomy in patients aged > or = 75 years: an updated review of patients treated with curative and palliative intent. BJU Int 95:1211–1214

    Article  PubMed  Google Scholar 

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  1. Nationales Centrum für Tumorerkrankungen (NCT), Abt. Medizinische Onkologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 460, 69120, Heidelberg, Deutschland

    Dirk Jäger & Stefanie Zschäbitz

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  1. Dirk Jäger
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  2. Stefanie Zschäbitz
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Correspondence to Dirk Jäger .

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  1. II. Medizinische Klinik, Universitätsmedizin Mannheim, Mannheim, Germany

    Matthias Ebert

  2. II. Medizinische Klinik, Universitätsmedizin Mannheim, Mannheim, Germany

    Nicolai Härtel

  3. Klinik für Innere Medizin II, Universitätsklinikum Jena, Jena, Thüringen, Germany

    Ulrich Wedding

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  1. Interdisziplinäres Tumorzentrum, Universitätsmedizin Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland

    Nicolai Härtel

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Jäger, D., Zschäbitz, S. (2017). Harnblasenkarzinom beim alten und geriatrischen Patienten. In: Ebert, M., Härtel, N., Wedding, U. (eds) Geriatrische Onkologie. Springer Reference Medizin. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-49083-9_36-1

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