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Moser T, Biederer J, Nill S, Remmert G, Bendl R. Detection of respiratory motion in fluoroscopic images for adaptive radiotherapy. Phys Med Biol 2008; 53:3129-45. [PMID: 18495978 DOI: 10.1088/0031-9155/53/12/004] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Respiratory motion limits the potential of modern high-precision radiotherapy techniques such as IMRT and particle therapy. Due to the uncertainty of tumour localization, the ability of achieving dose conformation often cannot be exploited sufficiently, especially in the case of lung tumours. Various methods have been proposed to track the position of tumours using external signals, e.g. with the help of a respiratory belt or by observing external markers. Retrospectively gated time-resolved x-ray computed tomography (4D CT) studies prior to therapy can be used to register the external signals with the tumour motion. However, during treatment the actual motion of internal structures may be different. Direct control of tissue motion by online imaging during treatment promises more precise information. On the other hand, it is more complex, since a larger amount of data must be processed in order to determine the motion. Three major questions arise from this issue. Firstly, can the motion that has occurred be precisely determined in the images? Secondly, how large must, respectively how small can, the observed region be chosen to get a reliable signal? Finally, is it possible to predict the proximate tumour location within sufficiently short acquisition times to make this information available for gating irradiation? Based on multiple studies on a porcine lung phantom, we have tried to examine these questions carefully. We found a basic characteristic of the breathing cycle in images using the image similarity method normalized mutual information. Moreover, we examined the performance of the calculations and proposed an image-based gating technique. In this paper, we present the results and validation performed with a real patient data set. This allows for the conclusion that it is possible to build up a gating system based on image data, solely, or (at least in avoidance of an exceeding exposure dose) to verify gates proposed by the various external systems.
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Dinkel J, Biederer J, Thierfelder C, Jetter S, Nill S, Oelfke U, Schlegel W, Debus J, Kauczor H. 1017 POSTER 4D-CT, 4D-MRI and Linac-integrated 4D Cone Beam CT of the Lung: reproducibility of tumour size and displacement in a respirated ex-vivo system. EJC Suppl 2007. [DOI: 10.1016/s1359-6349(07)70612-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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103
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Haering P, Nill S, Janisch E, Klemm S, Rhein B. SU-FF-T-327: Online IMRT Verification by Flat Panel Measured Entrance Doses. Med Phys 2007. [DOI: 10.1118/1.2760990] [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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104
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Taheri-Kadkhoda Z, Nill S, Wilkens J, Oelfke U, Björk-Eriksson T, Huber P, Munter M. Comparison of intensity-modulated proton therapy and intensity-modulated photon therapy in treatment of nasopharyngeal carcinoma. Radiother Oncol 2007. [DOI: 10.1016/s0167-8140(07)80144-7] [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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105
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Münter MW, Schulz-Ertner D, Hof H, Nikoghosyan A, Jensen A, Nill S, Huber P, Debus J. Inverse planned stereotactic intensity modulated radiotherapy (IMRT) in the treatment of incompletely and completely resected adenoid cystic carcinomas of the head and neck: initial clinical results and toxicity of treatment. Radiat Oncol 2006; 1:17. [PMID: 16756669 PMCID: PMC1550720 DOI: 10.1186/1748-717x-1-17] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2006] [Accepted: 06/06/2006] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Presenting the initial clinical results in the treatment of complex shaped adenoid cystic carcinomas (ACC) of the head and neck region by inverse planned stereotactic IMRT. MATERIALS 25 patients with huge ACC in different areas of the head and neck were treated. At the time of radiotherapy two patients already suffered from distant metastases. A complete resection of the tumor was possible in only 4 patients. The remaining patients were incompletely resected (R2: 20; R1: 1). 21 patients received an integrated boost IMRT (IBRT), which allow the use of different single doses for different target volumes in one fraction. All patients were treated after inverse treatment planning and stereotactic target point localization. RESULTS The mean follow-up was 22.8 months (91-1490 days). According to Kaplan Meier the three year overall survival rate was 72%. 4 patients died caused by a systemic progression of the disease. The three-year recurrence free survival was according to Kaplan Meier in this group of patients 38%. 3 patients developed an in-field recurrence and 3 patient showed a metastasis in an adjacent lymph node of the head and neck region. One patient with an in-field recurrence and a patient with the lymph node recurrence could be re-treated by radiotherapy. Both patients are now controlled. Acute side effects >Grade II did only appear so far in a small number of patients. CONCLUSION The inverse planned stereotactic IMRT is feasible in the treatment of ACC. By using IMRT, high control rates and low side effects could by achieved. Further evaluation concerning the long term follow-up is needed. Due to the technical advantage of IMRT this treatment modality should be used if a particle therapy is not available.
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106
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Hesse BM, Nill S, Tücking T, Oelfke U. SU-FF-J-50: Dose Guidance in Radio Therapy by Means of Entrance Dosimetry. Med Phys 2006. [DOI: 10.1118/1.2240828] [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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107
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Jensen AD, Münter MW, Bischoff H, Haselmann R, Timke C, Krempien R, Sterzing F, Nill S, Heeger S, Hoess A, Haberkorn U, Huber PE, Steins M, Thomas M, Debus J, Herfarth KK. Treatment of non-small cell lung cancer with intensity-modulated radiation therapy in combination with cetuximab: the NEAR protocol (NCT00115518). BMC Cancer 2006; 6:122. [PMID: 16681848 PMCID: PMC1524801 DOI: 10.1186/1471-2407-6-122] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2006] [Accepted: 05/08/2006] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Even today, treatment of Stage III NSCLC still poses a serious challenge. So far, surgical resection is the treatment of choice. Patients whose tumour is not resectable or who are unfit to undergo surgery are usually referred to a combined radio-chemotherapy. However, combined radio-chemotherapeutic treatment is also associated with sometimes marked side effects but has been shown to be more efficient than radiation therapy alone. Nevertheless, there is a significant subset of patients whose overall condition does not permit administration of chemotherapy in a combined-modality treatment. It could be demonstrated though, that NSCLCs often exhibit over-expression of EGF-receptors hence providing an excellent target for the monoclonal EGFR-antagonist cetuximab (Erbitux) which has already been shown to be effective in colorectal as well as head-and-neck tumours with comparatively mild side-effects. METHODS/DESIGN The NEAR trial is a prospective phase II feasibility study combining a monoclonal EGF-receptor antibody with loco-regional irradiation in patients with stage III NSCLC. This trial aims at testing the combination's efficacy and rate of development of distant metastases with an accrual of 30 patients. Patients receive weekly infusions of cetuximab (Erbitux) plus loco-regional radiation therapy as intensity-modulated radiation therapy. After conclusion of radiation treatment patients continue to receive weekly cetuximab for 13 more cycles. DISCUSSION The primary objective of the NEAR trial is to evaluate toxicities and feasibility of the combined treatment with cetuximab (Erbitux) and IMRT loco-regional irradiation. Secondary objectives are remission rates, 3-year-survival and local/systemic progression-free survival.
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108
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Krempien R, Muenter MW, Huber PE, Nill S, Friess H, Timke C, Didinger B, Buechler P, Heeger S, Herfarth KK, Abdollahi A, Buchler MW, Debus J. Randomized phase II--study evaluating EGFR targeting therapy with cetuximab in combination with radiotherapy and chemotherapy for patients with locally advanced pancreatic cancer--PARC: study protocol [ISRCTN56652283]. BMC Cancer 2005; 5:131. [PMID: 16219105 PMCID: PMC1266352 DOI: 10.1186/1471-2407-5-131] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2005] [Accepted: 10/11/2005] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Pancreatic cancer is the fourth commonest cause of death from cancer in men and women. Advantages in surgical techniques, radiation therapy techniques, chemotherapeutic regimes, and different combined-modality approaches have yielded only a modest impact on the prognosis of patients with pancreatic cancer. Thus there is clearly a need for additional strategies. One approach involves using the identification of a number of molecular targets that may be responsible for the resistance of cancer cells to radiation or to other cytotoxic agents. As such, these molecular determinants may serve as targets for augmentation of the radiotherapy or chemotherapy response. Of these, the epidermal growth factor receptor (EGFR) has been a molecular target of considerable interest and investigation, and there has been a tremendous surge of interest in pursuing targeted therapy of cancers via inhibition of the EGFR. METHODS/DESIGN The PARC study is designed as an open, controlled, prospective, randomized phase II trial. Patients in study arm A will be treated with chemoradiation using intensity modulated radiation therapy (IMRT) combined with gemcitabine and simultaneous cetuximab infusions. After chemoradiation the patients receive gemcitabine infusions weekly over 4 weeks. Patients in study arm B will be treated with chemoradiation using intensity modulated radiation therapy (IMRT) combined with gemcitabine and simultaneous cetuximab infusions. After chemoradiation the patients receive gemcitabine weekly over 4 weeks and cetuximab infusions over 12 weeks. A total of 66 patients with locally advanced adenocarcinoma of the pancreas will be enrolled. An interim analysis for patient safety reasons will be done one year after start of recruitment. Evaluation of the primary endpoint will be performed two years after the last patient's enrollment. DISCUSSION The primary objective of this study is to evaluate the feasibility and the toxicity profile of trimodal therapy in pancreatic adenocarcinoma with chemoradiation therapy with gemcitabine and intensity modulated radiation therapy (IMRT) and EGFR-targeted therapy using cetuximab and to compare between two different methods of cetuximab treatment schedules (concomitant versus concomitant and sequential cetuximab treatment). Secondary objectives are to determine the role and the mechanism of cetuximab in patient's chemoradiation regimen, the response rate, the potential of this combined modality treatment to concert locally advanced lesions to potentially resectable lesions, the time to progression interval and the quality of life.
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109
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Dietrich L, Tucking T, Nill S, Hesse B, Thilmann C, Huber P, Debus J, Oelfke U. Respiration Gated Cone Beam Imaging Reconstruction at a Dedicated Linear Accelerator. Int J Radiat Oncol Biol Phys 2005. [DOI: 10.1016/j.ijrobp.2005.07.865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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110
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Szymanowski H, Pflugfelder D, Nill S, Oelfke U. 104 Practical implementation of an improved proton dose algorithm for heterogeneous media. Radiother Oncol 2005. [DOI: 10.1016/s0167-8140(05)81081-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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111
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Hesse B, Nill S, Tücking T, Oelfke U. 207 First clincal experiments with image and dose guided radiotherapy. Radiother Oncol 2005. [DOI: 10.1016/s0167-8140(05)81184-3] [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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112
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Nill S, Unkelbach J, Dietrich L, Oelfke U. SU-FF-J-61: Evaluation of Two Fluoroscopic Imaging Setups for Online Dose Delivery Adaptation. Med Phys 2005. [DOI: 10.1118/1.1997607] [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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113
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Seeber A, Nill S, Tücking T, Oelfke U. SU-FF-J-87: Linac Based KV Cone-Beam CT for Extended Field of Views: Evaluation of An Approximate Reconstruction Strategy. Med Phys 2005. [DOI: 10.1118/1.1997633] [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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114
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Tücking T, Nill S, Oelfke U. TU-EE-A2-03: Evaluation of Dose Calculation in KV-Cone Beam CT Data Sets. Med Phys 2005. [DOI: 10.1118/1.1998450] [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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115
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Szymanowski H, Nill S, Oelfke U. SU-FF-T-280: Verification of Monte Carlo Simulations of Proton Dose Distributions in Biological Media. Med Phys 2005. [DOI: 10.1118/1.1998009] [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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116
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Newhauser WD, Ding X, Giragosian D, Nill S, Titt U. Neutron radiation area monitoring system for proton therapy facilities. RADIATION PROTECTION DOSIMETRY 2005; 115:149-53. [PMID: 16381703 DOI: 10.1093/rpd/nci127] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
A neutron radiation area monitoring system has been developed for proton accelerator facilities dedicated to cancer therapy. The system comprises commercial measurement equipment, computer hardware and a suite of software applications that were developed specifically for use in a medical accelerator environment. The system is designed to record and display the neutron dose-equivalent readings from 16 to 24 locations (depending on the size of the proton therapy centre) throughout the facility. Additional software applications provide for convenient data analysis, plotting, radiation protection reporting, and system maintenance and administration tasks. The system performs with a mean time between failures of >6 months. Required data storage capabilities and application execution times are met with inexpensive off-the-shelf computer hardware.
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117
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Münter M, Hof H, Thilmann C, Nikoghosyan A, Didinger B, Haering P, Hoess A, Nill S, Debus J. 308 Inverse planned stereotactic intensity modulated radiation therapy (IMRT) in the treatment of complex shaped benign meningiomas of the skull base: Acute-, late toxicity and preliminary results. EJC Suppl 2003. [DOI: 10.1016/s1359-6349(03)90341-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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118
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Bortfeld T, Oelfke U, Nill S. What is the optimum leaf width of a multileaf collimator? Med Phys 2000; 27:2494-502. [PMID: 11128300 DOI: 10.1118/1.1319524] [Citation(s) in RCA: 92] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
UNLABELLED The following question is investigated: How narrow do the leaves of a multileaf collimator have to be such that further reduction of the leaf width does not lead to physical improvements of the dose distribution. Because of the physical principles of interaction between radiation and matter, dose distributions in radiotherapy are generally relatively smooth. According to the theory of sampling, the dose distribution can therefore be represented by a set of evenly spaced samples. The distance between the samples is identified with the distance between the leaf centers of a multileaf collimator. The optimum sampling distance is derived from the 20% to 80% field edge penumbra through the concept of the dose deposition kernel, which is approximated by a Gaussian. The leaf width of the multileaf collimator is considered to be independent from the sampling distance. Two cases are studied in detail: (i) the leaf width equals the sampling distance, which is the regular case, and (ii) the leaf width is twice the sampling distance. The practical delivery of the latter treatment geometry requires a couch movement or a collimator rotation. The optimum sampling distance equals the 20%-80% penumbra divided by 1.7 and is on the order of 1.5-2 mm for a typical 6 MV beam in soft tissue. The optimum leaf width equals this sampling distance in the regular case. A relatively small deterioration results if the leaf width is doubled, while the sampling distance remains the same. The deterioration can be corrected for by deconvolving the fluence profile with an inverse filter. CONCLUSIONS With the help of the sampling theory and, more generally, the theory of linear systems, one can find a general answer to the question about the optimum leaf width of a multileaf collimator from a physical point of view. It is important to distinguish between the sampling distance and the leaf width. The sampling distance is more critical than the leaf width. The leaf width can be up to twice as large as the sampling width. Furthermore, the derived sampling distance can be used to select the optimum resolution of both the fluence and the dose grid in dose calculation and inverse planning algorithms.
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Ziegler-Skylakakis K, Nill S, Pan JF, Andrae U. S-oxygenation of thiourea results in the formation of genotoxic products. ENVIRONMENTAL AND MOLECULAR MUTAGENESIS 1998; 31:362-373. [PMID: 9654246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Thiourea (TU) is a thyroid carcinogen which has previously been shown to cause genotoxicity in various test systems in vitro and in vivo. The mechanism underlying these effects has not yet been elucidated. The present study addressed the question of whether the formation of oxidized products of TU might be involved in genotoxicity. Chemical oxidation of [14C]TU with hydrogen peroxide in the presence of calf thymus DNA resulted in the formation of [14C]formamidine sulfinate ([14C]FASA), [14C]cyanomide, and [14C]urea and in covalent binding of radioactivity to the DNA. Incubation of V79 Chinese hamster cells with 10-20 mM TU for 18 hr but not for 3 hr, increased the frequency of micronuclei to a slight extent. In cells depleted of glutathione, which can prevent the oxidation of TU, micronucleus induction by TU was more pronounced and detectable both after 3 and 18 hr of incubation. Exposure of the cells to 1.25 to 10 mM FASA for 3-5 hr induced micronuclei, DNA repair synthesis, and gene mutations in the cells. Flavin-containing monooxygenase (FMO], an enzyme known to catalyze the S-oxygenation of TU in liver, could not be detected in the postmitochondrial supernatant (S-9) of the V79 cells. There is evidence, however, that TU can easily autoxidize to S-oxygenated products. Both FASA and TU caused a slight induction of DNA repair synthesis in cultured rat hepatocytes, but FASA was active at lower concentrations than TU. Cyanamide did not elicit repair. The finding that FASA, a product of both the nonenzymatic and the enzymatic S-oxygenation of TU, is genotoxic in cultured mammalian cells provides for the first time a hypothesis to explain the genotoxicity of TU.
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