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Rades D, Seibold N, Hoffmann A, Gebhard M, Noack F, Thorns C, Schild S. Erratum to: Impact of the HPV-positivity definition on the prognostic value of HPV status in patients with locally advanced squamous cell carcinoma of the head and neck. Strahlenther Onkol 2014. [DOI: 10.1007/s00066-013-0545-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Rades D, Segedin B, Nagy V, Schild SE, Trang NT, Khoa MT. Predicting the presence of extracranial metastases in patients with brain metastases upon first diagnosis of cancer. Strahlenther Onkol 2014; 190:405-7. [PMID: 24429480 DOI: 10.1007/s00066-013-0516-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Accepted: 11/11/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND AND PURPOSE This study aimed to determine factors allowing the prediction of extracranial metastases in patients presenting with brain metastases at the first diagnosis of cancer. MATERIALS AND METHODS Data from 659 patients with brain metastases upon first diagnosis of cancer were retrospectively analyzed. The parameters age, gender, Karnofsky performance score (KPS), primary tumor type and number of brain metastases were compared between 359 patients with extracranial metastases and 300 patients without extracranial metastases. Additional analyses were performed for patients with the most unfavorable and those with the most favorable characteristics. RESULTS The comparison of patients with versus without extracranial metastases revealed significant differences between the groups in terms of KPS (p < 0.001) and number of brain metastases (p < 0.001). Of the study patients, 113 had both most unfavorable characteristics, i.e. KPS ≤ 50 and ≥ 4 brain metastases. The sensitivity for identifying patients with extracranial metastases was 82 %; specificity was 51 %. A total of 50 patients had KPS ≥ 90 and only one brain metastasis. The sensitivity for identifying patients without extracranial metastases was 86 %; specificity was 58 %. CONCLUSION The combination of KPS and the number of brain metastases can help to predict the presence or absence of extracranial metastases.
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Rades D, Seibold ND, Schild SE, Bruchhage KL, Gebhard MP, Noack F. Androgen receptor expression: prognostic value in locally advanced squamous cell carcinoma of the head and neck. Strahlenther Onkol 2014; 189:849-55. [PMID: 23959264 DOI: 10.1007/s00066-013-0389-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Accepted: 05/22/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE This study investigated the prognostic value of androgen receptor (AR) expression of tumor cells in patients treated with surgery and subsequent radio(chemo)therapy for locally advanced squamous cell carcinoma of the head and neck (SCCHN). MATERIAL AND METHODS The impact of AR and 11 additional factors on locoregional control (LRC), metastases-free survival (MFS), and overall survival (OS) was retrospectively studied in 163 patients with nonmetastatic stage III/IV SCCHN. Additional factors included age, gender, ECOG performance status, pre-radiotherapy (pre-RT) hemoglobin levels, tumor site, histologic grade, T category, N category, HPV status, extent of resection, and concurrent chemotherapy. RESULTS On multivariate analysis, improved LRC was significantly associated with pre-RT hemoglobin levels≥12 g/dl (risk ratio [RR] 2.22; 95% confidence interval [CI] 1.19–4.13; p=0.013), tumor site (RR 1.39; 95% CI 1.14–1.70; p=0.001), lower T category (RR 1.67; 95% CI 1.18–2.44; p=0.003), and lower N category (RR 4.18; 95% CI 1.90–10.55; p<0.001). Improved MFS was associated with AR expression (RR 2.21; 95% CI 1.01–5.41; p=0.048), better ECOG performance status (RR 3.19; 95% CI 1.50–7.14; p=0.003), lower T category (RR 2.24; 95% CI 1.47–3.65; p<0.001), and lower N category (RR 5.33; 95% CI 2.07–16.63; p<0.001). OS was positively associated with AR expression (RR 1.99; 95% CI 1.06–4.00; p=0.032), better ECOG performance status (RR 2.20; 95% CI 1.20–4.09; p=0.010), pre-RT hemoglobin levels≥12 g/dl (RR 2.13; 95% CI 1.19–3.82; p=0.012), lower T category (RR 1.81; 95% CI 1.30–2.62; p<0.001), and lower N category (RR 3.41; 95% CI: 1.65–7.80; p<0.001). CONCLUSION Tumor cell expression of AR was an independent prognostic factor for MFS and OS and should be considered in future prospective trials.
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Werner R, Bode F, Bruder R, Gebhard M, Dunst J, Rades D, Blanck O. OC-0503: Impact of cardiac and respiratory motion during cardiac radiosurgery: a dose accumulation study in a porcine model. Radiother Oncol 2014. [DOI: 10.1016/s0167-8140(15)30608-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Rades D. SP-0116: Advances in radiotherapy of spinal metastases. Radiother Oncol 2014. [DOI: 10.1016/s0167-8140(15)30221-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Rades D, Gerdan L, Segedin B, Nagy V, Khoa MT, Trang NT, Schild SE. Brain metastasis. Prognostic value of the number of involved extracranial organs. Strahlenther Onkol 2013; 189:996-1000. [PMID: 24104872 DOI: 10.1007/s00066-013-0442-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Accepted: 07/31/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE This study was performed to evaluate the prognostic role for survival of the number and the type of involved extracranial organs in patients with brain metastasis. MATERIAL AND METHODS The data of 1146 patients who received whole-brain radiotherapy (WBRT) alone for brain metastasis have been retrospectively analyzed. In addition to the number of involved extra cranial organs, seven potential prognostic factors were investigated including WBRT regimen, age, gender, Karnofsky Performance Score (KPS), primary tumor type, number of brain metastases, and the interval from cancer diagnosis to WBRT. Additionally, subgroup analyses were performed for patients with involvement of one (lung vs. bone vs. liver vs. other metastasis) and two (lung + lymph nodes vs. lung + bone vs. lung + liver vs. liver + bone vs. other combinations) extracranial organs. RESULTS The 6-month survival rates for the involvement of 0, 1, 2, 3, and ≥4 extracranial organs were 51, 30, 16, 13, and 10%, respectively (p<0.001). On multivariate analysis, the number of involved extracranial organs maintained significance (risk ratio 1.26; 95% confidence interval 1.18-1.34; p<0.001). According to the multivariate analysis, age (p<0.001), gender (p=0.002), and KPS (p<0.001) were also independent prognostic factors for survival. In the subgroup analyses of patients with involvement of one and two extracranial organs, survival was not significantly different based on the extracranial organ involved. CONCLUSION The number of involved extracranial organs proved to be an independent prognostic factor in patients with brain metastasis, regardless of the organs involved. The number of involved extracranial organs should be considered in future trials designed for patients with brain metastasis.
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Gerdan L, Segedin B, Nagy V, Khoa MT, Trang NT, Schild SE, Rades D. Brain metastasis from non-small cell lung cancer (NSCLC): prognostic importance of the number of involved extracranial organs. Strahlenther Onkol 2013; 190:64-7. [PMID: 24104871 DOI: 10.1007/s00066-013-0439-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Accepted: 07/25/2013] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE This study investigated the potential prognostic value of the number of involved extracranial organs in patients with brain metastasis from non-small cell lung cancer (NSCLC). MATERIAL AND METHODS A total of 472 patients who received whole-brain radiotherapy (WBRT) alone with 5 × 4 Gy or 10 × 3 Gy for brain metastasis from NSCLC were included in this retrospective study. In addition to the number of involved extracranial organs, 6 further potential prognostic factors were investigated including WBRT regimen, age, gender, Karnofsky Performance Score (KPS), number of brain metastases, and the interval from cancer diagnosis to WBRT. Subgroup analyses were performed for patients with metastatic involvement of one (lung vs. bone vs. other metastasis) and two (lung + bone vs. lung+lymph nodes vs. other combinations) extracranial organs. RESULTS The survival rates at 6 months of the patients with involvement of 0, 1, 2, 3, and ≥ 4 extracranial organs were 52, 27, 17, 4, and 14%, respectively (p<0.001). On multivariate analysis, the number of involved extracranial organs remained significant (risk ratio 1.32; 95% confidence interval 1.19-1.46; p<0.001). Age <65 years (p=0.004), KPS ≥ 70 (p<0.001), and only 1-3 brain metastases (p=0.022) were also significantly associated with survival in the multivariate analysis. In the separate analyses of patients with involvement of one and two extracranial organs, survival was not significantly different based on the pattern of extracranial organ involvement. CONCLUSION The number of involved extracranial organs is an independent prognostic factor of survival in patients with brain metastasis from NSCLC, irrespective of the pattern of extracranial organ involvement.
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Blanck O, Bode F, Gebhard M, Hunold P, Brandt S, Bruder R, Schweikard A, Grossherr M, Rades D, Dunst J. Cardiac Radiosurgery: Preliminary Results in a Porcine Model and Possible Implications for the Treatment of Atrial Fibrillation. Int J Radiat Oncol Biol Phys 2013. [DOI: 10.1016/j.ijrobp.2013.06.1482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Rades D, Seibold ND, Hoffmann A, Gebhard MP, Noack F, Thorns C, Schild SE. Impact of the HPV-positivity definition on the prognostic value of HPV status in patients with locally advanced squamous cell carcinoma of the head and neck. Strahlenther Onkol 2013; 189:856-60. [PMID: 23868550 DOI: 10.1007/s00066-013-0377-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Accepted: 05/06/2013] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND PURPOSE This study re-evaluated the prognostic value of HPV status for loco-regional control (LRC), metastases-free survival (MFS), and survival (OS) in patients with locally advanced squamous cell carcinoma of the head and neck (SCCHN). A modified definition of HPV positivity was used in the current study compared to the authors' previous study. PATIENTS AND METHODS In the previous study of the same 170 patients, a tumor was defined as HPV-positive if it showed a positive in situ hybridization result in ≥10% of tumor cells and/or positive p16 immunostaining. In the current analysis, tumors were considered HPV-positive only if they showed positive results for both in situ hybridization and p16 immunostaining. In addition to HPV status, the same 11 potential prognostic factors were investigated for treatment outcomes as in the preceding study. RESULTS In the multivariate analysis of the current study, HPV positivity was significantly associated with improved LRC [risk ratio (RR) 9.78; p<0.001], MFS (RR 7.17; p=0.008), and OS (RR 6.61; p<0.001). In the previous study, HPV positivity was associated with LRC (RR 2.34; p=0.014) and OS (RR 2.19; p=0.019), but not with MFS (RR 2.04; p=0.11). CONCLUSIONS Applying the new definition of HPV positivity, the impact of HPV status on the prognosis of patients irradiated for locally advanced SCCHN was more prominent than in our previous study and associated with all three investigated endpoints.
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Seibold ND, Schild SE, Bruchhage KL, Gebhard MP, Noack F, Rades D. Prognostic impact of VEGF and FLT-1 receptor expression in patients with locally advanced squamous cell carcinoma of the head and neck. Strahlenther Onkol 2013; 189:639-46. [PMID: 23748230 DOI: 10.1007/s00066-013-0341-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Accepted: 03/06/2013] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND PURPOSE This study investigated the prognostic value of tumor cell expression of vascular endothelial growth factor (VEGF) and its receptor fms-related tyrosine kinase 1 (FLT-1) in patients with locally advanced squamous cell carcinoma of the head and neck (SCCHN) who had been treated with adjuvant radiotherapy or radiochemotherapy. MATERIAL AND METHODS The impact of tumor cell VEGF and FLT-1 expression plus 11 additional factors on loco-regional control (LRC), metastases-free survival (MFS) and overall survival (OS) was retrospectively evaluated in 157 patients. The additional factors were age, gender, performance status, pre-radiotherapy (pre-RT) hemoglobin levels, tumor site, histologic grade, T-category, N-category, human papillomavirus (HPV) status, extent of resection and chemotherapy. RESULTS On multivariate analysis, improved LRC was significantly associated with an absence of VEGF expression (risk ratio, RR: 5.02; p = 0.009), lower T-category (RR: 2.00; p < 0.001), lower N-category (RR: 3.75; p < 0.001) and pre-RT hemoglobin levels ≥ 12 g/dl (RR: 2.20; p = 0.029). Improved MFS was significantly associated with an absence of VEGF expression (RR: 7.46; p = 0.002), lower T-category (RR: 1.97; p = 0.002), lower N-category (RR: 3.29; p = 0.005) and a favorable tumor location (RR: 1.34; p = 0.033); HPV positivity showed a trend towards improved MFS (RR: 1.43; p = 0.09). Improved OS was significantly associated with an absence of VEFG expression (RR: 3.22; p = 0.041), pre-RT hemoglobin levels ≥ 12 g/dl (RR: 2.47; p = 0.009), lower T-category (RR: 1.92; p < 0.001) and lower N-category (RR: 3.39; p < 0.001). FLT-1 expression was significantly associated with LRC and OS in the univariate but not in the multivariate analysis. CONCLUSION VEGF expression proved to be an independent negative predictor for LRC, MFS and OS in patients treated for locally advanced SCCHN with adjuvant radiotherapy or radiochemotherapy. FLT-1 expression was not significant in multivariate analyses.
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Rades D, Dziggel L, Segedin B, Oblak I, Nagy V, Marita A, Schild SE, Trang NT, Khoa MT. A simple survival score for patients with brain metastases from breast cancer. Strahlenther Onkol 2013; 189:664-7. [PMID: 23740157 DOI: 10.1007/s00066-013-0367-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Accepted: 04/22/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND AND PURPOSE Personalized cancer treatment considers the patient's survival prognosis. Therefore, it is important to be able to estimate the patient's survival time, particularly in a palliative situation such as brain metastasis. This study aimed to create and validate a survival score for patients with brain metastasis from breast cancer, which is the second most common primary tumor in these patients. PATIENTS AND METHODS Data of 230 patients treated with whole-brain radiotherapy (WBRT) alone for brain metastasis from breast cancer were retrospectively analyzed. Patients were assigned to a test (n = 115) or a validation group (n = 115). According to the results of the multivariate analysis of the test group, Karnofsky Performance Score and extracranial metastases were included in the scoring system. The score for each factor was obtained from the 6-month survival rate (in %) divided by 10. Total scores represented the sum of these scores and were 4, 7, 9, or 12 points. Three prognostic groups were formed. RESULTS The 6-month survival rates in the test group were 10 % for 4-7 points, 55 % for 9 points, and 78 % for 15 points (p < 0.001). In the validation group the corresponding 6-month survival rates were 11, 54, and 75 %, respectively (p < 0.001). The comparisons between the prognostic groups of the test and the validation group did not show significant differences. CONCLUSION This simple survival score appears valid and reproducible. It can be used to estimate the survival time of patients with brain metastasis from breast cancer receiving WBRT alone.
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Rades D, Veninga T, Bajrovic A, Karstens JH, Schild SE. A validated scoring system to identify long-term survivors after radiotherapy for metastatic spinal cord compression. Strahlenther Onkol 2013; 189:462-6. [PMID: 23604188 DOI: 10.1007/s00066-013-0342-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Accepted: 03/06/2013] [Indexed: 12/25/2022]
Abstract
PURPOSE This study aimed to develop and validate a scoring system to identify long-term survivors after conventional radiotherapy (RT) for metastatic spinal cord compression (MSCC). PATIENTS AND METHODS Data from 1,125 patients who had received long-course RT for MSCC were included in this study. Of these patients, 344 survived for over 12 months and 781 died within a year following RT. Based on differences between the distributions of patient characteristics in the two groups, a scoring system was developed. Scores ranged from 0 to 18 points and 15 points was selected as the cutoff for identifying long-term survivors. Data from the 1,125 long-course RT patients (test group) were compared to data from 773 patients receiving short-course RT (validation group). RESULTS A score of ≥ 15 points was associated with a 94 % proportion of long-term survivors. The 15-point cutoff resulted in a specificity of 98 % and a positive predictive value of 94 % for identification of long-term surviving patients. The proportions of long-term survivors for each scoring point in the validation group were very similar to those in the test group. CONCLUSION This new scoring system enabled identification of long-term survivors after RT for MSCC with very high specificity and positive predictive value. The score proved to be valid and reproducible.
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Rades D. Vorteile der stereotaktischen gegenüber der konventionellen Bestrahlung von Wirbelkörpermetastasen. Strahlenther Onkol 2013; 189:342-3. [DOI: 10.1007/s00066-012-0287-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Dziggel L, Segedin B, Podvrsnik NH, Oblak I, Schild SE, Rades D. Validation of a survival score for patients treated with whole-brain radiotherapy for brain metastases. Strahlenther Onkol 2013; 189:364-6. [PMID: 23519358 DOI: 10.1007/s00066-013-0308-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2012] [Accepted: 01/16/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND This study was performed to validate a scoring system published in 2008 to predict the survival of patients receiving whole-brain radiotherapy (WBRT) alone for brain metastases. METHODS The scoring system included four independent prognostic factors: age, performance status, extracranial metastases, and interval between first diagnosis of cancer and WBRT. The score for each prognostic factor was determined by dividing the 6-month survival rate (in %) by 10. The total score represented the sum of the scores for each prognostic factor. Total scores ranged from 9-18 points, and patients were divided into four groups. In the present study, 350 new patients were evaluated in order to validate the previously developed score. RESULTS In the present validation study, the 6-month survival rates were 8 % for patients with a score of 9-10 points (group A), 24 % for those with a score of 11-13 points (group B), 51 % for those with a score of 14-16 points (group C), and 82 % for those with scores of 17-18 points (group D), respectively (p < 0.001). In our previous study published in 2008, the 6-month survival rates were 6 %, 15 %, 43 %, and 76 %, respectively (p < 0.001). The comparisons between each of the four prognostic groups of both series did not reveal a significant difference. CONCLUSION In this study, the 6-month survival rates of the four prognostic groups were not significantly different from those of the preceding study. This demonstrates the validity and reproducibility of this score. The score can help select the appropriate treatment for the individual patient and help design prospective trials.
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Rades D, Douglas S, Schild SE. A validated survival score for breast cancer patients with metastatic spinal cord compression. Strahlenther Onkol 2012; 189:41-6. [PMID: 23138773 DOI: 10.1007/s00066-012-0230-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2012] [Accepted: 08/27/2012] [Indexed: 01/01/2023]
Abstract
BACKGROUND To create a validated scoring system predicting survival of breast cancer patients with metastatic spinal cord compression (MSCC). PATIENTS AND METHODS Of 510 patients, one half were assigned to either the test or the validation group. In the test group, eight pretreatment factors (age, performance status, number of involved vertebrae, ambulatory status, other bone metastases, visceral metastases, interval from cancer diagnosis to radiotherapy of MSCC, time of developing motor deficits) plus the radiation regimen were retrospectively investigated. Factors significantly associated with survival in the multivariate analysis were included in the scoring system. The score for each factor was determined by dividing the 6-month survival rate (%) by ten. The total score was the sum of the scores for each factor. RESULTS In the multivariate analysis of the test group, performance status, ambulatory status, other bone metastases, visceral metastases, interval from cancer diagnosis to radiotherapy of MSCC, and time of developing motor deficits were significant for survival and included in the score. Total scores ranged from 30 to 50 points. In the test group, the 6-month survival rates were 12% for 30-35 points, 41% for 36-40 points, 74% for 41-45 points, and 98% for 46-50 points (p < 0.0001). In the validation group, the 6-month survival rates were 14%, 46%, 77%, and 99%, respectively (p < 0.0001). CONCLUSION The survival rates of the validation group were similar to the test group. Therefore, this score was reproducible and can help when selecting the appropriate radiotherapy regimen for each patient taking into account her survival prognosis.
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Rades D, Hakim SG, Bajrovic A, Karstens JH, Veninga T, Rudat V, Schild SE. Impact of zoledronic acid on control of metastatic spinal cord compression. Strahlenther Onkol 2012; 188:910-6. [PMID: 22903395 DOI: 10.1007/s00066-012-0158-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2012] [Accepted: 05/30/2012] [Indexed: 11/25/2022]
Abstract
BACKGROUND Zoledronic acid was demonstrated to reduce the rate of skeletal-related events, a hypernym including various outcomes, in patients with bone metastases. In contrast to other studies, this matched-pair analysis focused solely on the impact of zoledronic acid on metastatic spinal cord compression (MSCC). PATIENTS AND METHODS Data from 98 patients with MSCC receiving radiotherapy plus zoledronic acid were matched 1:2 to 196 patients receiving radiotherapy alone for ten potential prognostic factors. Both groups were compared for local control of MSCC within the irradiated region, overall control of MSCC (local and distant MSCC control), and survival. RESULTS The 1-year local control rates were 90% after radiotherapy plus zoledronic acid and 81%, after radiotherapy alone (p = 0.042). The 1-year overall control rates were 87% and 75%, respectively (p = 0.016), and the 1-year survival rates were 60% and 52%, respectively (p = 0.17). Results were significant in the Cox proportional hazards model regarding local control (p = 0.024) and overall control (p = 0.008). CONCLUSION According to the results of this study, zoledronic acid was associated with improved control of MSCC in irradiated patients.
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Tsao MN, Rades D, Wirth A, Lo SS, Danielson BL, Vichare A, Hahn C, Chang EL. International Practice Survey on the Management of Brain Metastases: Third International Consensus Workshop on Palliative Radiotherapy and Symptom Control. Clin Oncol (R Coll Radiol) 2012; 24:e81-92. [PMID: 22794327 DOI: 10.1016/j.clon.2012.03.008] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2011] [Revised: 01/27/2012] [Accepted: 03/22/2012] [Indexed: 11/30/2022]
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Krause J, Blanck O, Duerichen R, Wurster S, Andratschke N, Rades D, Hildebrandt G, Dunst J, Schweikard A, Schlaefer A. TH-A-BRA-08: Retrospective Accuracy Estimation for Motion Compensated Robotic Radiosurgery of the Liver. Med Phys 2012. [DOI: 10.1118/1.4736257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Blanck O, Dürichen R, Ernst F, Dunst J, Rades D, Hildebrandt G, Schweikard A. OC-0022 EVALUATION OF A WAVELET-BASED LEAST MEAN SQUARE MOTION PREDICTION ALGORITHM FOR LUNG AND LIVER PATIENTS. Radiother Oncol 2012. [DOI: 10.1016/s0167-8140(12)70361-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Rades D. SP-0010 EXTRACRANIAL STEREOTACTIC RADIOSURGERY FOR SPINAL AND PARASPINAL METASTASIS. Radiother Oncol 2012. [DOI: 10.1016/s0167-8140(12)70349-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Blanck O, Dunst J, Rades D, Hildebrandt G. EP-1395 FILM BASED DELIVERY QUALITY ASSURANCE FOR ROBOTIC RADIOSURGERY. Radiother Oncol 2012. [DOI: 10.1016/s0167-8140(12)71728-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Rades D, Douglas S, Veninga T, Bajrovic A, Stalpers LJA, Hoskin PJ, Rudat V, Schild SE. A survival score for patients with metastatic spinal cord compression from prostate cancer. Strahlenther Onkol 2012; 188:802-6. [PMID: 22526228 DOI: 10.1007/s00066-012-0106-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2012] [Accepted: 03/14/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND This study aimed to develop and validate a survival scoring system for patients with metastatic spinal cord compression (MSCC) from prostate cancer. PATIENTS AND METHODS Of 436 patients, 218 patients were assigned to the test group and 218 patients to the validation group. Eight potential prognostic factors (age, performance status, number of involved vertebrae, ambulatory status, other bone metastases, visceral metastases, interval from cancer diagnosis to radiotherapy of MSCC, time developing motor deficits) plus the fractionation regimen were retrospectively investigated for associations with survival. Factors significant in the multivariate analysis were included in the survival score. The score for each significant prognostic factor was determined by dividing the 6-month survival rate (%) by 10. The total score represented the sum of the scores for each factor. The prognostic groups of the test group were compared to the validation group. RESULTS In the multivariate analysis of the test group, performance status, ambulatory status, other bone metastases, visceral metastases, and interval from cancer diagnosis to radiotherapy were significantly associated with survival. Total scores including these factors were 20, 21, 22, 24, 26, 28, 29, 30, 31, 32, 33, 35, 37, or 39 points. In the test group, the 6-month survival rates were 6.5% for 20-24 points, 44.6% for 26-33 points, and 95.8% for 35-39 points (p < 0.0001). In the validation group, the 6-month survival rates were 7.4%, 45.4%, and 94.7%, respectively (p < 0.0001). CONCLUSIONS Because the survival rates of the validation group were almost identical to the test group, this score can be considered valid and reproducible.
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Rades D, Schild SE. Do patients with a limited number of brain metastases need whole-brain radiotherapy in addition to radiosurgery? Strahlenther Onkol 2012; 188:702-6. [PMID: 22418589 DOI: 10.1007/s00066-012-0093-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2011] [Accepted: 02/02/2012] [Indexed: 11/28/2022]
Abstract
BACKGROUND About 40% of patients with brain metastases have a very limited number of lesions and may be candidates for radiosurgery. Radiosurgery alone is superior to whole-brain radiotherapy (WBRT) alone for control of treated and new brain metastases. In patients with a good performance status, radiosurgery also resulted in better survival. However, the question is whether the results of radiosurgery alone can be further improved with additional WBRT. METHODS Information for this review was compiled by searching the PubMed and MEDLINE databases. Very important published meeting abstracts were also considered. RESULTS Based on both retrospective and prospective studies, the addition of WBRT to radiosurgery improved control of treated and new brain metastases but not survival. However, because a recurrence within the brain has a negative impact on neurocognitive function, it is important to achieve long-term control of brain metastases. CONCLUSION The addition of WBRT provides significant benefits. Further randomized studies including adequate assessment of neurocognitive function and a follow-up period of at least 2 years are needed to help customize the treatment for individual patients.
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Rades D, Douglas S, Veninga T, Bajrovic A, Stalpers L, Hoskin P, Rudat V, Schild S. Metastatic spinal cord compression in non-small cell lung cancer patients. Strahlenther Onkol 2012; 188:472-6. [DOI: 10.1007/s00066-012-0086-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2011] [Accepted: 01/25/2012] [Indexed: 01/16/2023]
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Rades D, Douglas S, Veninga T, Stalpers LJA, Bajrovic A, Rudat V, Schild SE. Prognostic factors in a series of 504 breast cancer patients with metastatic spinal cord compression. Strahlenther Onkol 2012; 188:340-5. [PMID: 22354333 DOI: 10.1007/s00066-011-0061-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2011] [Accepted: 10/20/2011] [Indexed: 11/28/2022]
Abstract
BACKGROUND This study was performed to identify new significant prognostic factors in breast cancer patients irradiated for metastatic spinal cord compression (MSCC). PATIENTS AND METHODS The data of 504 patients with breast cancer patients with MSCC were retrospectively analyzed with respect to posttreatment motor function, local control of MSCC, and survival. The investigated potential prognostic factors included age, Eastern Cooperative Oncology Group (ECOG) performance score, number of involved vertebrae, other bone metastases, visceral metastases, pretreatment ambulatory status, interval from cancer diagnosis to radiotherapy of MSCC, time developing motor deficits before radiotherapy, and the radiation schedule. RESULTS On multivariate analysis, better functional outcome was associated with ambulatory status prior to RT (estimate - 1.29, p < 0.001), no visceral metastases (estimate - 0.52, p = 0.020), and slower development of motor deficits (estimate + 2.47, p < 0.001). Improved local control was significantly associated with no other bone metastases (risk ratio (RR) 4.33, 95% confidence interval (CI) 1.36-14.02, p = 0.013) and no visceral metastases (RR 3.02, 95% CI 1.42-6.40, p = 0.005). Improved survival was significantly associated with involvement of only 1-2 vertebrae (RR 1.27, 95% CI 1.01-1.60, p = 0.044), ambulatory status before radiotherapy (RR 1.75, 95% CI 1.23-2.50, p = 0.002), no other bone metastases (RR 1.93, 95% CI 1.18-3.13, p = 0.009), no visceral metastases (RR 7.60, 95% CI 5.39-10.84, p < 0.001), and time developing motor deficits before radiotherapy (RR 1.55, 95% CI 1.30-1.86, p < 0.001). CONCLUSION Several new independent prognostic factors were identified for treatment outcomes. These prognostic factors should be considered in future trials and may be used to develop prognostic scores for breast cancer patients with MSCC.
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