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Djuzenova CS, Mühl B, Fehn M, Oppitz U, Müller B, Flentje M. Radiosensitivity in breast cancer assessed by the Comet and micronucleus assays. Br J Cancer 2006; 94:1194-203. [PMID: 16538220 PMCID: PMC2361251 DOI: 10.1038/sj.bjc.6603005] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Spontaneous and radiation-induced genetic instability of peripheral blood mononuclear cells derived from unselected breast cancer (BC) patients (n=50) was examined using the single-cell gel electrophoresis (Comet) assay and a modified G2 micronucleus (MN) test. Cells from apparently healthy donors (n=16) and from cancer patients (n=9) with an adverse early skin reaction to radiotherapy (RT) served as references. Nonirradiated cells from the three tested groups exhibited similar baseline levels of DNA fragmentation assessed by the Comet assay. Likewise, the Comet analysis of in vitro irradiated (5 Gy) cells did not reveal any significant differences among the three groups with respect to the initial and residual DNA fragmentation, as well as the DNA repair kinetics. The G2 MN test showed that cells from cancer patients with an adverse skin reaction to RT displayed increased frequencies of both spontaneous and radiation-induced MN compared to healthy control or the group of unselected BC patients. Two patients from the latter group developed an increased early skin reaction to RT, which was associated with an increased initial DNA fragmentation in vitro only in one of them. Cells from the other BC patient exhibited a striking slope in the dose–response curve detected by the G2 MN test. We also found that previous RT strongly increased both spontaneous and in vitro radiation-induced MN levels, and to a lesser extent, the radiation-induced DNA damage assessed by the Comet assay. These data suggest that clinical radiation may provoke genetic instability and/or induce persistent DNA damage in normal cells of cancer patients, thus leading to increased levels of MN induction and DNA fragmentation after irradiation in vitro. Therefore, care has to be taken when blood samples collected postradiotherapeutically are used to assess the radiosensitivity of cancer patients.
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77
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Schmitt P, Griswold MA, Gulani V, Haase A, Flentje M, Jakob PM. A simple geometrical description of the TrueFISP ideal transient and steady-state signal. Magn Reson Med 2006; 55:177-86. [PMID: 16323155 DOI: 10.1002/mrm.20738] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
An intuitive approach is presented for assessment of the TrueFISP signal behavior in the transient phase and the steady state, based on geometrical considerations in combination with the Bloch equations. Short formulations are derived for the zenith and phase angle determining the direction of the magnetization vector for which a smooth monoexponential decay is obtained even at considerable off-resonance frequencies, thus compactly defining the target of various preparation schemes proposed in literature. A pictorial explanation is provided to illustrate how the interplay between RF excitation and relaxation governs the TrueFISP transient phase and steady state. Closed form expressions are developed that describe the signal evolution, accounting for the influence of T(1), T(2), flip angle, and resonance frequency offset in agreement with recently published studies. These results are obtained directly from basic assumptions, without the need for abstract mathematical treatment or further approximations. The validity of the conceptual framework and the analytical description is verified by simulations based on the Bloch equations as well as with MR phantom experiments. The theory may be used for contrast calculations and has the potential to facilitate improved parameter quantification with magnetization prepared TrueFISP experiments accounting for off-resonance effects.
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78
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Fassnacht M, Hahner S, Polat B, Koschker AC, Kenn W, Flentje M, Allolio B. Adjuvant radiation therapy of the tumor bed prevents local recurrences in adrenocortical carcinoma. Exp Clin Endocrinol Diabetes 2006. [DOI: 10.1055/s-2006-932889] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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79
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Guckenberger M, Baier K, Meyer J, Flentje M. Influence of Delineation of the Proximal and Distal Rectum as Separated Organ-at-Risks on IMRT Treatment Planning for the Prostate. Int J Radiat Oncol Biol Phys 2005. [DOI: 10.1016/j.ijrobp.2005.07.848] [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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80
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Arnold J, Kotas M, Pracht D, Flentje M, Jakob P. Could Functional MRI Improve Radiation Therapy Planning in Non-Small Cell Lung Cancer? Int J Radiat Oncol Biol Phys 2005. [DOI: 10.1016/j.ijrobp.2005.07.384] [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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81
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Meyer J, Baier K, Richter A, Flentje M. 345 Analysis of different algorithms for tracking moving organs by means of megavoltage imaging. Radiother Oncol 2005. [DOI: 10.1016/s0167-8140(05)81321-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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82
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Flentje M, Fietkau R, Huber R, Beckmann G, Poellinger B, Aubert D, Fittipaldo A. Oral vinorelbine (NVBo) + CDDP and radiotherapy (RT) in stage III non small cell lung cancer (NSCLC) patients (pts). J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.7302] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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83
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Semrau R, Mueller RP, Stuetzer H, Staar S, Schroeder U, Rudat V, Dietz A, Volling P, Schroeder M, Flentje M, Eckel HE. High pretherapeutic Hb- levels tend to decrease SLC: Updated results of a randomized multicentric trial of hf-acc radiotherapy and concurrent chemotherapy in advanced HNC. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.5525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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84
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Huber RM, Hüsch T, Flentje M, Schmidt M, Borgmeier A, Kirschner J, Gosse H, Pöllinger B, Ulm K. Lebensqualität in der Therapie von Patienten mit lokal fortgeschrittenem inoperablen nichtkleinzelligen Lungenkarzinom (NSCLC). Ergebnisse aus der BROCAT-Studie CTRT 99/97. Pneumologie 2005. [DOI: 10.1055/s-2005-864314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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85
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Meyer K, Guckenberger M, Möller A, Flentje M, Schmidt M, Kolb M. Beeinflussung der Strahlenfibrose unter Verwendung von Decorin und TGFbeta-Antikörpern. Pneumologie 2005. [DOI: 10.1055/s-2005-864250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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86
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Vordermark D, Katzer A, Kaffer A, Riedel S, Flentje M. 96 Characterization of carbonic anhydrase 9 (CA9) overexpression: endogenous hypoxia marker and potential tumor-specific target. EJC Suppl 2004. [DOI: 10.1016/s1359-6349(04)80104-6] [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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87
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Pohl F, Knaus P, Hassel S, Nohe A, Sebald W, Flentje M, Koelbl O. Radio-induced membrane alteration as rationale of prevention of heterotopic ossification by radiotherapy: An in vitro study. Int J Radiat Oncol Biol Phys 2004. [DOI: 10.1016/j.ijrobp.2004.07.519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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88
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Semrau R, Mueller R, Stuetzer H, Schroeder U, Staar S, Rudat V, Dietz A, Volling P, Schroeder M, Flentje M, Eckel H. Ceiling effect of hemoglobin (Hb)-levels increasing efficacy of intensified hyperfractionated (HF) and accelerated (ACC) radiotherapy (RT) and concurrent chemotherapy with carboplatin and 5-FU - updated results of a randomized multicentric German trial in advanced head and neck cancer. Int J Radiat Oncol Biol Phys 2004. [DOI: 10.1016/j.ijrobp.2004.06.127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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89
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Wulf J, Meyer J, Flentje M, Baier K. Adaptive radiotherapy in stereotactic radiotherapy of extracranial targets: Integration of CT-verification on the treatment couch using a dedicated software to calculate the current stereotactic coordinate including evaluation of breathing mobility. Int J Radiat Oncol Biol Phys 2004. [DOI: 10.1016/j.ijrobp.2004.07.161] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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90
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Huber RM, Flentje M, Gosse H, Poellinger B, Schmidt M, Willner J, Ulm K. Induction chemotherapy and following simultaneous radiochemotherapy versus induction chemotherapy and radiotherapy alone in inoperable NSCLC (Stage IIIA/IIIB): Update of CT/RT 99/97. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.7075] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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91
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Borgmeier A, Huber R, Flentje M, Willner J, Schmidt M, Manegold C, Debus J. A phase I study of concurrent chemoradiotherapy with docetaxel-cisplatin followed by docetaxel consolidation therapy in inoperable stage IIIA/B non-small cell lung cancer (NSCLC). J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.7350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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92
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Djuzenova C, Mühl B, Schakowski R, Oppitz U, Flentje M. Normal expression of DNA repair proteins, hMre11, Rad50 and Rad51 but protracted formation of Rad50 containing foci in X-irradiated skin fibroblasts from radiosensitive cancer patients. Br J Cancer 2004; 90:2356-63. [PMID: 15150571 PMCID: PMC2409526 DOI: 10.1038/sj.bjc.6601878] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2003] [Revised: 03/17/2004] [Accepted: 03/25/2004] [Indexed: 12/04/2022] Open
Abstract
About 5% of oncology patients treated by radiation therapy develop acute or late radiotoxic effects whose molecular mechanisms remain poorly understood. In this study, we evaluated the potential role of DNA repair proteins in the hypersensitivity of cancer patients to radiation therapy. The expression levels and focal nuclear distribution of DNA repair proteins, hMre11, Rad50 and Rad51 were investigated in skin fibroblasts strains derived from cancer patients with adverse early skin reaction to radiotherapy using Western blot and foci immunofluorescence techniques, respectively. Cells from cancer patients with normal reaction to radiotherapy as well as cells from apparently healthy subjects served as controls. Cellular radiosensitivity after in vitro irradiation was assessed by the clonogenic survival assay. The clonogenic survival assay and Western blot analysis of the DNA repair proteins did not reveal any abnormalities in cellular radiosensitivity in vitro and in protein expression levels or their migration patterns in the fibroblasts derived from cancer patients with hypersensitive reaction to radiotherapy. In contrast, in vitro irradiated cells from radiosensitive patients exhibited a significantly higher number of nuclei with focally concentrated Rad50 protein than in both control groups. The observed alteration of the distribution of radiation-induced Rad50 foci in cells derived from cancer patients with acute side reactions to radiotherapy might contribute to their radiation therapy outcome. These data suggest the usefulness of the Rad50 foci analysis for predicting clinical response of cancer patients to radiotherapy.
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93
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Huber RM, Gamarra F, Flentje M, Willner J, Borgmeier A, Schmidt M, Manegold C, Debus J, Pöllinger B. Simultane Radiochemotherapie (SRCHT) mit Docetaxel und Cisplatin, gefolgt von einer Konsolidierungschemotherapie mit Docetaxel bei Patienten mit inoperablem, nicht kleinzelligem Bronchialkarzinom im Stadium IIIA/B: eine Phase-I-Studie. Pneumologie 2004. [DOI: 10.1055/s-2004-819733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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94
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Reinhard H, Semler O, Bürger D, Bode U, Flentje M, Göbel U, Gutjahr P, Leuschner I, Maass E, Niggli F, Scheel-Walter HG, Stöckle M, Thüroff JW, Tröger J, Weirich A, von Schweinitz D, Zoubek A, Graf N. Results of the SIOP 93-01/GPOH Trial and Study for the Treatment of Patients with Unilateral Nonmetastatic Wilms Tumor. KLINISCHE PADIATRIE 2004; 216:132-40. [PMID: 15175957 DOI: 10.1055/s-2004-822625] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND The treatment of Wilms Tumor is integrated into clinical trials since the 1970's. In contrast to the National Wilms Tumor Study Group (NWTSG) the SIOP trials and studies largely focus on the issue of preoperative therapy to facilitate surgery of a shrunken tumor and to treat metastasis as early as possible. PATIENTS AND METHODS In the SIOP 93-01/GPOH trial and study 1 020 patients with a newly diagnosed renal tumor were registered. 847 of them had a histological proven Wilms Tumor, of whom 637 were unilateral localized, and 173 tumors had an other histology [40 congenital mesoblastic nephroma (CMN), 51 clear cell sarcoma (CCSK), 24 rhabdoid tumor (RTK) and 58 other tumors]. Preoperative chemotherapy in benign tumors was given to 1.3 % of the patients. The main objective of the trial was the randomized question, if the postoperative two drug chemotherapy for stage I in intermediate risk or anaplasia can be reduced from conventional 3 courses to an experimental 1 course without loss of efficacy. RESULTS 519 patients with unilateral nonmetastatic Wilms did receive preoperative chemotherapy. The histology in this group of patients was of intermediate risk in 469 (90 %) patients, 14 (3 %) tumors were low risk and 36 (7 %) high risk. The stage distribution of the tumors was stage I in 315 (61 %), stage II N- in 126 (24 %), stage II N+ in 25 (5 %) and stage III in 36 (7 %) patients. In 17 (3 %) patients the tumor stage remained unclear. Tumor volume was measured in 487 patients before and in 402 after preoperative chemotherapy. The median tumor volume did shrink from 353 to 126 ml. The amount of volume reduction depends on the histological subtype. The event free survival (EFS) after 5 years was 91 % for all patients with unilateral Wilms tumor without distant metastasis. Randomisation was done in 43.7 % for stage I patients and there was no difference in EFS for both treatment arms (90 versus 91 %). The EFS is identical for patients with stage I and II N- (0.92), as well as for stage II N+ and III (0.82). The tumor volume after chemotherapy is a prognostic factor for intermediate risk tumors with the exception of epithelial and stromal predominant tumors. These two subtypes often present as large tumors, they do not shrink during preoperative chemotherapy but they still have an excellent prognosis. On the other hand the prognosis of patients with blastemal predominant subtype after preoperative chemotherapy is worse than in any other patient group of intermediate risk tumors. There are less blastemal predominant tumors compared to primary surgery, but they are chemotherapeutic resistant selected by the preoperative chemotherapy. CONCLUSION Patients with unilateral Wilms tumor without metastasis have an excellent prognosis. The post-operative chemotherapy in stage I can be reduced to 4 weeks without worsening treatment outcome. The reduction of the tumor volume could be identified as a helpful marker for stratification of post-operative treatment. Post-chemotherapy blastemal predominant subtype of Wilms tumor has to be classified as high risk tumor. Focal anaplasia has a better prognosis than diffuse anaplasia and will be classified as intermediate risk tumor.
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MESH Headings
- Adolescent
- Antineoplastic Combined Chemotherapy Protocols/adverse effects
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Chemotherapy, Adjuvant
- Child
- Child, Preschool
- Combined Modality Therapy
- Disease-Free Survival
- Female
- Follow-Up Studies
- Humans
- Infant
- Kidney Neoplasms/drug therapy
- Kidney Neoplasms/mortality
- Kidney Neoplasms/pathology
- Kidney Neoplasms/surgery
- Male
- Neoadjuvant Therapy
- Neoplasm Staging
- Nephrectomy
- Nephroma, Mesoblastic/drug therapy
- Nephroma, Mesoblastic/mortality
- Nephroma, Mesoblastic/pathology
- Nephroma, Mesoblastic/surgery
- Prognosis
- Rhabdoid Tumor/drug therapy
- Rhabdoid Tumor/mortality
- Rhabdoid Tumor/pathology
- Rhabdoid Tumor/surgery
- Sarcoma, Clear Cell/drug therapy
- Sarcoma, Clear Cell/mortality
- Sarcoma, Clear Cell/pathology
- Sarcoma, Clear Cell/surgery
- Wilms Tumor/drug therapy
- Wilms Tumor/mortality
- Wilms Tumor/pathology
- Wilms Tumor/surgery
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95
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Höcht S, Hammad R, Thiel H, Wiegel T, Siegmann A, Willner J, Wust P, Herrmann T, Eble M, Carstens D, Flentje M, Neumann P, Hinkelbein W. A multicenter analysis of 123 patients with recurrent rectal cancer within the pelvis. FRONTIERS OF RADIATION THERAPY AND ONCOLOGY 2004; 38:41-51. [PMID: 15458186 DOI: 10.1159/000078263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
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96
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M�ller HL, Kaatsch P, Warmuth-Metz M, Flentje M, S�rensen N. Kraniopharyngeom im Kindes- und Jugendalter. Monatsschr Kinderheilkd 2003. [DOI: 10.1007/s00112-003-0711-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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97
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Pohl F, Hassel S, Nohe A, Flentje M, Knaus P, Sebald W, Koelbl O. Radiation-induced suppression of the Bmp2 signal transduction pathway in the pluripotent mesenchymal cell line C2C12: an in vitro model for prevention of heterotopic ossification by radiotherapy. Radiat Res 2003; 159:345-50. [PMID: 12600237 DOI: 10.1667/0033-7587(2003)159[0345:risotb]2.0.co;2] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Heterotopic ossification is a common complication after total hip replacement. Clinical studies showed the effectiveness of radiation for prevention of heterotopic ossification. The mechanism of radiotherapy responsible for the reduction of heterotopic ossification is unclear. The purpose of this study was to study an analogue model showing a time- and dose-dependent effect of radiation. Using cells of the defined embryonic mouse cell line C2C12, the influence of ionizing radiation on the Bmp-induced signal cascade leading to osteogenic differentiation was analyzed. Binding of iodinated Bmp2 to the receptors, Smad1 activation, and alkaline phosphatase (ALP) activity were determined in cells with or without irradiation. The cytotoxic effect of radiotherapy was evaluated using viability tests. Radiotherapy reduced formation of the Bmp2/Bmp receptor complex. This effect was dependent on dose. The phosphorylation (activation) of Smad1 decreased after irradiation in a time-dependent manner, whereas the level of total Smads was not influenced by radiotherapy. The ALP activity decreased after radiotherapy. A dose of 7 Gy delivered 6 h before or after incubation with Bmp resulted in about a 30% decrease in ALP activity. No signs of cytotoxic effects were observed within the time window studied using doses of 0 to 20 Gy. The time- and dose-dependent effect of radiotherapy for prevention of heterotopic ossification known from the results of clinical studies has an analogue in the C2C12 cell model. The primary mechanism of radiotherapy seems to be an influence on cellular responsiveness to the Bmp2-induced osteoblastic differentiation. The results suggest a down-regulation of the Bmp2/receptor complex.
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98
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Vordermark D, Flentje M. Planning target volume definition in dose-escalation studies. FRONTIERS OF RADIATION THERAPY AND ONCOLOGY 2002; 36:16-24. [PMID: 11842747 DOI: 10.1159/000061324] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
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99
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Oppitz U, Schulte S, Stopper H, Baier K, Müller M, Wulf J, Schakowski R, Flentje M. In vitro radiosensitivity measured in lymphocytes and fibroblasts by colony formation and comet assay: comparison with clinical acute reactions to radiotherapy in breast cancer patients. Int J Radiat Biol 2002; 78:611-6. [PMID: 12079540 DOI: 10.1080/09553000210126466] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
PURPOSE To compare colony-forming and comet assays on fibroblasts and lymphocytes of 32 breast cancer patients irradiated after breast-conserving operations and to correlate the results with acute clinical radiation reactions in the skin. MATERIAL AND METHODS Skin fibroblasts were isolated and cultivated before radiotherapy and lymphocytes were drawn prior to the first and directly after the final external irradiation. The colony-forming assay was performed with fibroblasts and the comet assay with lymphocytes and fibroblasts of breast cancer patients according to standard protocols. The clinical radiation reactions of the patients were graded according to the RTOG system. RESULTS No significant correlation (p =0.09) was detected between clinical acute skin reactions and the in vitro clonogenic data in fibroblasts. Results of the comet assay in lymphocytes, however, showed a significant correlation (p <0.05) with the clinical data when patients were divided into two groups with average and elevated acute reactions. Apart from initial damage, fibroblasts did not show significant differences between the two patient groups. Repeated comet assays in lymphocytes of the same patient drawn before treatment and before and after external radiotherapy demonstrated good reproducibility of the test and no significant impact of preceding radiation treatment. There was a good correlation (r =0.65) between the comet assay results in fibroblasts and lymphocytes of the same individual. CONCLUSIONS In this cohort of patients, a significant correlation between the in vitro results of the comet assay in lymphocytes and clinical acute reactions was detected. The results of the comet assay and of fibroblast colony formation did not correlate with in vitro radiosensitivity.
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100
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Wulf J, Hädinger U, Oppitz U, Thiele W, Ness-Dourdoumas R, Flentje M. Stereotactic radiotherapy of targets in the lung and liver. Strahlenther Onkol 2001; 177:645-55. [PMID: 11789403 DOI: 10.1007/pl00002379] [Citation(s) in RCA: 240] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Stereotactic irradiation of extracranial targets offers a non-invasive treatment modality for patients with localized tumors, which are not amenable for surgery or other invasive approaches because of age or impaired medical condition. The purpose of the study was the evaluation of the method to achieve local control of irradiated targets in relation to treatment toxicity. PATIENTS AND METHODS Irradiation was performed as hypofractionated treatment in three fractions of 10 Gy each, normalized to the PTV enclosing 65% isodose with patient fixation in a stereotactic body frame. The isocenter was localized by stereotactic coordinates. Targets were circumscribed tumors in the lung (n = 27) and liver (n = 24) not amenable for other treatment modalities: primary lung cancer (n = 12), local recurrences of lung cancer (n = 4), lung metastases (n = 11), liver metastases (n = 23) and one cholangiocellular carcinoma. Median CTV/PTV for targets in the lung was 57/113 cm3 (min/max 5-277 cm3/17-343 cm3) and for targets in the liver 50/102 cm3 (min/max 9-516 cm3/42-772 cm3). Median follow-up for targets in the lung was 8 months (2-33) and 9 months (2-28) for liver targets. Local control was defined as complete or partial remission and stable disease, measured by repeated CT scans after 6 weeks and in 3 months intervals. Treatment toxicity was evaluated according to the WHO score. RESULTS Crude local control was 85% for pulmonary targets and 83% for hepatic targets. Actuarial local control after 1 and 2 years was 76% and 76% for lung tumors and 76% and 61% for liver tumors. Actuarial overall patient survival was 48% after 1 year and 21% after 2 years for targets in the lung and 71% and 43% for targets in the liver. No acute grade 3-5 side effects were observed. Serious late toxicity occurred in two patients: a chronic ulceration of the esophagus at a target close to the mediastinum after 3 months (grade 3) and fatal bleeding from the pulmonary artery after 9 months (grade 5) in a previously irradiated patient. It remained unclear, whether the bleeding was a side effect of irradiation or due to tumor infiltration. CONCLUSION Hypofractionated stereotactic irradiation of targets in the lung and liver is a locally effective treatment with actuarial local control rates of 76% after 1 year and 61-76% after 2 years without relevant acute toxicity. Severe late toxicity did not occur, if targets close to the mediastinum were avoided.
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