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Feldmann HJ, Grosu AL, Weber W, Bartenstein P, Gross M, Schwaiger M, Molls M. The value of iodine-123-alpha-methyl-L-tyrosine single-photon emission tomography for the treatment planning of malignant gliomas. FRONTIERS OF RADIATION THERAPY AND ONCOLOGY 1999; 33:37-42. [PMID: 10549474 DOI: 10.1159/000061212] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
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127
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Huber R, Braselmann H, Kulka U, Schumacher-Georgiadou V, Bayerl A, Molls M, Bauchinger M. Follow-up analysis of translocation and dicentric frequencies, measured by FISH-chromosome painting in breast cancer patients after partial-body radiotherapy with little bone marrow exposure. Mutat Res 1999; 446:103-9. [PMID: 10613190 DOI: 10.1016/s1383-5718(99)00153-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Follow-up translocation and dicentric measurements in blood lymphocytes of five breast cancer patients were performed by FISH using painting probes for chromosomes 1, 4, and 12 simultaneously with a pancentromeric DNA probe, during 14 months after fractionated photon therapy affecting only small areas of the bone marrow (about 5%). The analysis of individual time-courses for translocations and dicentrics revealed a significant temporal decline of the yields with comparable half-times, both for these stable and unstable aberration types in two patients. In three patients, the aberration yields remained fairly unchanged during the observation period. Regarding retrospective biodosimetry for cases with partial-body exposures or large dose inhomogeneity, it follows that even FISH chromosome painting is limited in assessing initial doses correctly in terms of stable translocations.
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Adam M, Gabalski E, Pinto H, Brown J, Molls M, Terris D. Head and neck cancer: pretreatment and midtreatment PO2 levels. Eur J Cancer 1999. [DOI: 10.1016/s0959-8049(99)81080-6] [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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129
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Stadler P, Feldmann H, Creighton C, Molls M. Changes of tumor oxygenation during radiotherapy. Eur J Cancer 1999. [DOI: 10.1016/s0959-8049(99)81118-6] [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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130
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Greulich K, Rhein A, Gilbertz K, Brueckner M, van Beuningen D, Molls M. Effect of genomic instability on radiation response of leukemic cells. Eur J Cancer 1999. [DOI: 10.1016/s0959-8049(99)81129-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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131
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Becker A, Stadler P, Lavey R, Hènsgen G, Feldmann H, Molls M, Dunst J. Influence of severe anemia on tumor oxygenation in squamous cell carcinoma of the head & neck (SCCHN). Eur J Cancer 1999. [DOI: 10.1016/s0959-8049(99)81040-5] [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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132
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Stadler P, Becker A, Feldmann HJ, Hänsgen G, Dunst J, Würschmidt F, Molls M. Influence of the hypoxic subvolume on the survival of patients with head and neck cancer. Int J Radiat Oncol Biol Phys 1999; 44:749-54. [PMID: 10386631 DOI: 10.1016/s0360-3016(99)00115-7] [Citation(s) in RCA: 203] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE Tumor hypoxia is regarded as an important factor influencing radiation response, disease-free, and overall survival of patients with squamous cell carcinoma of the head and neck (SCCHN). This study was performed to reevaluate the prognostic significance of the "classical oxygenation parameters" hypoxic fraction (percentage of pO2 values < 5 mmHg or < 2.5 mmHg, respectively) and median pO2, and to determine the influence of a new radiobiological factor. This factor was termed the "hypoxic subvolume" (HSV) and was defined as percentage of pO2-values below 5 mmHg multiplied by the total tumor volume. The rationale of this parameter was to quantify approximately the amount of hypoxic tissue which should be correlated to the number of hypoxic cells in the tumor. It is obvious that a tumor of 100 cm3 with a hypoxic fraction of 20% (HSV = 20 cm3) contains more hypoxic cells than a tumor of 1 cm3 with a hypoxic fraction of 50% (HSV = 0.5 cm3). METHODS AND MATERIALS Pretreatment pO2 was assessed in 59 patients with SCCHN with the Eppendorf histograph, and pretreatment volume was determined by ultrasonography (lymphnode metastases) and computer tomography (primaries). All patients were referred to our departments for radiotherapy (n = 27, median dose 70 Gy) or radiochemotherapy (n = 32; 5-FU, mitomycin C, median dose 70 Gy), respectively. All parameters were evaluated using the Kaplan-Meier analysis, and significance was assumed at a p-value of < 0.05 (log-rank test, Cox-Mantel). A multivariate analysis was performed to control for confounding factors. The median follow-up was 233 days. At the time of the evaluation, 34 of the 59 patients were dead. RESULTS In univariate analyses, the hypoxic fraction (pO2 < 5 mmHg, PO2 < 2.5 mmHg [p < 0.05]), the hemoglobin concentration (p < 0.05), and the hypoxic subvolume (p < 0.01) were of prognostic significance for overall survival. In multivariate analysis, the hemoglobin concentration and the hypoxic subvolume (p = 0.01) were significant prognosticators. We found no significant correlation between tumor volume or median pO2 and overall survival. No clear correlation was found between tumor volume and hypoxic fraction. CONCLUSION These data suggest that the total amount of hypoxic tissue, as determined by the hypoxic subvolume, influences the prognosis of patients suffering from SCCHN. In addition, our data confirm the statements of previous studies that low pretherapy pO2-values indicate a worse prognosis.
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Auberger T, Thürriegl B, Freude T, Weissfloch L, Senekowitsch-Schmidke R, Kneschaurek P, Wagner FM, Molls M. Oxygen tension in transplanted mouse osteosarcomas during fractionated high-LET- and low-LET radiotherapy--predictive aspects for choosing beam quality? Strahlenther Onkol 1999; 175 Suppl 2:52-6. [PMID: 10394398 DOI: 10.1007/bf03038889] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE The lower OER of high-LET radiations, compared to conventional (low-LET) radiations, has often been put forward as an argument for using high-LET radiotherapy in the management of hypoxic tumours. Among the different neutron beams used in therapy, the reactor fission neutrons have the lowest OER. The aim of the present study is to follow the variations of tumour oxygenation status during fractionated irradiation with different radiation qualities. Little information is available so far after fractionated high-LET irradiation. In addition, the RBE of reactor fission neutrons for effects on tumours and on normal tissues are compared. MATERIAL AND METHODS Murine OTS 64-osteosarcomas were transplanted in 102 balb-C mice and irradiated by 36 Gy of photons in fractions of 3 Gy five times a week (group P-36/3) or by 12 Gy of reactor fission neutrons in fractions of 2 Gy two times a week (group N-12/2). Irradiations started at a tumor volume of 500 to 600 mm3. A third group received no radiotherapy, but all investigations (group CG). Tumor volume and tumor oxygenation were measured once a week under therapy and during three weeks after therapy. For in vivo-evaluation of oxygen status a computerized polarographic needle electrode system (KIMOC pO2 histograph, Eppendorf) was used. The median pO2 and the hypoxic fraction (pO2 values < 5 mm Hg) of single tumors and of total groups were calculated from pooled histograms and from row data as well. RESULTS In correlation with the increase of tumor volume, from day 1 to day 42 of follow-up the median pO2 decreased from 20 mm to 8 mm Hg and the hypoxic fraction increased from 7% to 31%. After fractionated photon therapy a growth delay of three weeks was observed. Six weeks after beginning of the irradiation the median tumor volume had been doubled again. After fission neutron therapy growth delay continued until the end of the follow-up period. In both of the irradiated groups a significant decrease of median pO2 values and an increase of the hypoxic fraction were observed under radiotherapy. Hypoxia was more intensive after neutrons with a decrease of the median pO2 from 20 mm Hg to 1 mm Hg vs. 10 mm Hg after photon therapy and with an increase of the hypoxic fraction from 7% to 78% vs. 36% respectively. Two weeks after the end of therapy the median pO2 and the hypoxic fraction of both treated groups reached the levels prior to irradiation indicating a complete reoxygenation. CONCLUSION During fractionated irradiation of murine osteosarcomas with photons and reactor fission neutrons, a marked hypoxia was observed for both radiation qualities, but hypoxia was more intense during fractionated neutron irradiation. After irradiation, a complete reoxygenation occurred in both groups independently of the degree of hypoxia observed during the treatment. The RBE of reactor fission neutrons, after fractionated irradiation, was much higher for effects on murine osteosarcomas compared to their RBE observed for normal tissues in previous experiments. Present data are in agreement with our clinical observations on more than 300 patients treated with reactor fission neutrons for advanced and hypoxic tumours with various histologies.
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Weissfloch L, Bremer M, Lemmen P, Probst T, Wagner M, Peller M, Auberger T, Senekowitsch-Schmidtke R, Tempel K, Molls M. New drugs for BNCT: an experimental approach. Strahlenther Onkol 1999; 175 Suppl 2:118-20. [PMID: 10394418 DOI: 10.1007/bf03038909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
New kinds of boron-containing drugs were developed and tested in several murine tumor models. The boron-containing ether lipid B-Et-11-OMe was injected in mammary carcinoma (AT17) and osteosarcoma (OTS-64) bearing mice. Furthermore boron-substituted ferrocenium derivatives were tested. Two were excessively toxic; the third could be investigated. Boron accumulation and time-dependent biodistribution were determined using alpha-particle sensitive films and inductively coupled plasma-atomic emission pectrometry (ICP-AES) and -mass spectrometry (ICP-MS) of tumors, organs and tissues. Additionally, a new method of boron detection by NMR is in preparation.
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Bremer M, Neuhofer C, Auberger T, Zimmermann FB, Kneschaurek P, Reuschel W, Molls M. Palliative radiotherapy of malignant melanoma with reactor fission neutron therapy (RENT): a prospective study. RADIATION ONCOLOGY INVESTIGATIONS 1999; 7:118-24. [PMID: 10333253 DOI: 10.1002/(sici)1520-6823(1999)7:2<118::aid-roi8>3.0.co;2-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
To study the efficacy and safety of relatively low-dosed reactor fission neutron therapy (RENT) at the research reactor of the Technical University Munich, we treated 33 superficial lesions of 20 patients with advanced malignant melanoma by neutron beam alone (n = 22), mixed neutron/electron beam (n = 5), or by neutron beam after incomplete surgery (n = 6). Median tumor volume was 17.0 cm3. Median dose for neutron beam alone was 8.0 Gy and for mixed beam 3.0 Gy n + 45.3 Gy e-. Local tumor response, local control time, survival and treatment related toxicity were followed prospectively over a time period of 52 months. Overall response rate (CR;PR) after neutron beam alone and mixed beam therapy was 64% (CR: 36%) and 100% (CR: 60%), respectively. Observed differences between complete (CR) and incomplete (PR, NC) responding lesions were as follows: median tumor volume: 2.0 vs. 51.5 cm3, local control time: 13.3 vs. 3.7 months, median survival: 19.8 vs. 9.0 months. No severe acute or late sequelae could be observed. In conclusion, low-dosed RENT is an effective and well tolerated palliative treatment of superficial malignant melanoma utilizing the biologic advantage of diminished cellular repair capacity. Because melanoma lesions of small size (< or = 6 cm3) tend to respond completely, neutron beam should be performed at an early stage.
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Geinitz H, Zimmermann FB, Molls M. [Radiotherapy of the elderly patient. Radiotherapy tolerance and results in older patients]. Strahlenther Onkol 1999; 175:119-27. [PMID: 10093614 DOI: 10.1007/bf02742345] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Despite a growing number of elderly patients receiving radiation therapy little is known about side effects and outcome of irradiation in this section of the population. METHODS In a review article epidemiologic data, aspects of radiation-biology as well as side effects and outcome of radiation therapy of elderly patients are discussed. RESULTS Cancer incidence rises with age (Figure 1) and is exceeding 3.5% for males older than 85 years. With a life expectancy of more than 4 years, curative therapy is indicated even at this age. Furthermore several retrospective studies indicate that local control and disease-Specific survival after radiation therapy of elderly patients is comparable with that of younger persons (Tables 3 and 4). The exception contains elderly patients with Grade-III to IV gliomas or with rectal carcinoma who show a reduced survival which is perhaps caused by less aggressive combined treatment (tumor resection). Although some biological and molecular data indicate a rise in radiation sensitivity with growing age like the reduction of the capacity of some DNA-repair enzymes, there is no convincing evidence in animal studies or in retrospective clinical studies that radiation therapy is generally less well tolerated by older individuals (Tables 1 and 2). Some age-depending differences in organ toxicities are described in 3 large studies, which evaluate the data of patients who were enrolled in different EORTC-trials: Older patients suffer more of functional mucositis in case of radiation therapy to the head and neck, they have an increased weight loss and a higher frequency of late esophageal damage when irradiated in the thorax, and they show a higher prevalence of sexual dysfunction when treated with radiation therapy to the pelvis. On the other hand younger patients suffer more from acute toxicity like skin damage, nausea, and deterioration of the performance status during pelvic radiotherapy. When discussing the dose intensity of radiation therapy concomitant disease which leads to extensive atherosclerotic vessel damage should be kept in mind. Old patients should be monitored closely during therapy, since the loss of electrolytes or fluid is often not very well tolerated. CONCLUSION The indication to radiation therapy of elderly cancer patients should take into account their performance status as well as the extent and the severity of comorbidity. Age per se is seldom a contraindication for radiation therapy. Regarding the available data in literature there is no indication for a dose reduction in radiation therapy only because of age, especially in the curative setting.
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Zimmermann F, Molls M. Three-Dimensional Radiation Treatment Planning: Principles and Practice. Oncol Res Treat 1999. [DOI: 10.1159/000026890] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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138
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Becker A, Stadler P, Kuhnt T, Feldmann H, Molls M, Dunst J. 2017 Experience with continuous polarographic pO2-measurements in advanced squamous cell carcinoma of the head and neck during hyperbaric oxygenation. Int J Radiat Oncol Biol Phys 1999. [DOI: 10.1016/s0360-3016(99)90287-0] [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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Grosu A, Feldmann H, Weber W, Schwaiger M, Molls M. 129 The impact of I-123-alpha-methyl-tyrosine spect in the planning of 3-D radiation treatment of brain gliomas. Int J Radiat Oncol Biol Phys 1999. [DOI: 10.1016/s0360-3016(99)90147-5] [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]
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Jund R, Feldmann HJ, Wollenberg B, Stadler P, Molls M. Changes in head and neck tumor hypoxic fraction during split-course radiochemotherapy. Ann Otol Rhinol Laryngol 1999; 108:73-8. [PMID: 9930544 DOI: 10.1177/000348949910800111] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study explored patterns of oxygen distribution in human tumors during primary radiochemotherapy. Patients with positive nodes from head and neck squamous cell carcinoma (n = 15) were investigated before therapy, before and after a 2-week respite, and at the end of the treatment. Intratumoral tissue oxygen tension (pO2) was measured with sterile polarographic needle electrodes and a computerized histography system. The 2 lowest pO2 classes, ie, 0 and 5 mm Hg, were designated the hypoxic fraction, and the mean and median pO2 were evaluated for each tumor. In the beginning, a marked variability in tissue pO2 was found. The initial size of the hypoxic fraction ranged from 0% to 61% of measured values. At the end of treatment, 4 tumors showed an increase in mean pO2, and 7 tumors a lower mean pO2 in comparison to the initial values. However, an impressive finding was that the hypoxic fraction of 9 tumors became smaller during the pause, 1 tumor showed no change, and 1 showed an increase in hypoxic fraction. The results show that there is a widely distributed tissue oxygenation with marked hypoxic zones in human neck nodes. During radiochemotherapy, tissue oxygenation changed, with great intertumor variability. A tendency toward a decrease of the hypoxic fraction after the respite could be seen. This change in tumor oxygenation during therapy needs further evaluation.
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Feldmann HJ, Molls M, Vaupel P. Blood flow and oxygenation status of human tumors. Clinical investigations. Strahlenther Onkol 1999; 175:1-9. [PMID: 9951511 DOI: 10.1007/bf02743452] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE There is a large body of evidence suggesting that blood flow and oxygenation of human tumors are important research topics which may explain, in particular, resistance to radiation and to many antineoplastic drugs, which can limit the curability of solid tumors by radiotherapy and chemotherapy. MATERIALS AND METHODS This manuscript reviews the clinical investigations which have been performed regarding blood flow and oxygenation status of human tumors in radiation oncology. RESULTS The possible uses and limitations of the prognostic significance and the changes under therapy measuring blood flow and oxygenation in human tumors were discussed. In addition, several approaches were summarized, which can improve the microvascular O2 availability and perfusion-limited O2 delivery. CONCLUSION The clinical data concerning the prognostic significance of blood flow, vascular function and oxygenation of human tumors are relevant for patient selection in clinical oncology. Strategies to improve traditional cancer therapy by modulation of the oxygenation status remain quite promising but more critical research and sophisticated clinical studies are necessary before its true potential is known.
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Molls M, Stadler P, Becker A, Feldmann HJ, Dunst J. Relevance of oxygen in radiation oncology. Mechanisms of action, correlation to low hemoglobin levels. Strahlenther Onkol 1998; 174 Suppl 4:13-6. [PMID: 9879341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
At the beginning of this century Schwarz (1909) and Holthusen (1921) observed the influence of oxygen on the radiosensitivity of cells. In 1951 Hollaender et al. described that E. coli needed 3-fold higher radiation doses when treated under anoxic conditions compared to normoxic conditions. This led to the evaluation of the oxygen enhancement ratio (OER) for photons (X-rays), neutrons and heavy ions. It was found that the OER for conventional radiation therapy (RT) with photons is much higher (about 3) than the OER for neutron-RT (only 1.5) or heavy ions. According to a hypothesis free radicals which are produced by radiation are fixed in the presence of oxygen. Radicals are interacting with DNA, macromolecules and membranes. The DNA lesion can be followed by cell death. There is some evidence that tumor cells respond to hypoxia with the expression of a variety of genes coding for oxygen regulated proteins such as c-jun, VEGF or p53. Hypoxia also enhances the genetic instability of tumor cells. Oxygen tensions in malignant tumors can be determined under clinical routine conditions by using a computerized polarographic needle electrode system (Eppendorf, Hamburg, Germany). Several studies in the past years showed that tumors are in general more hypoxic than the surrounding normal tissue and that a marked variability of intra- as well as intertumoral pO2 values exist (for review see Vaupel and Höckel 1998). Moreover, it has been shown in different tumor entities that the oxygenation status influences the local control rate and overall survival. Furthermore, the oxygenation status obtained at one site (primary) is significantly related at other sites (lymph node metastases) in patients with squamous cell carcinoma of the head and neck (SCCHN). In addition, there is a significant correlation between hemoglobin level and tumor oxygenation in patients with SCCHN. There is some evidence that the oxygenation status can be improved by the correction of a low hemoglobin level and consequently, the curative chance might rise.
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Bartzsch O, Riepl M, Busch M, Michael G, Allgäuer M, Voss AC, Sauer R, Dühmke E, Gademann G, Molls M. [Use of G-CSF (Neupogen) in multimodal treatment in radiotherapy]. Strahlenther Onkol 1998; 174:551-5. [PMID: 9830435 DOI: 10.1007/bf03038291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Therapy-induced leukopenias with corresponding consequences repeatedly occur in radiotherapy using combined modalities treatment. In radiotherapy, where G-CSF (granulocyte-colony-stimulating-factor) is not licensed, G-CSF has been used successfully under individual circumstances. These results were confirmed in several studies with small patient groups. The aim of this study was to check former results in a larger patient group, to verify postulated side effects and specially to define a cost-effective schedule in the treatment with G-CSF (Neupogen). PATIENTS AND METHODS In this surveillance trial 50, partially previously treated patients with different malignant tumors were treated with G-CSF. According to the probability of a leucocytosis lower than 1000/mm3, G-CSF (Neuropogen) was already given at leukocyte values lower than 2500/mm3 (500/mm3 bis 2450/mm3). It administered subcutaneously every other day, based on body weight until reaching normal leucocyte levels. RESULTS In 92% of the patients the increase of leucocytes occurred in the first 24 hours. On average G-CSF was given 4.9 times per patient. Patients without prior therapies or less complex therapies needed less G-CSF applications (3.5 to 5.8 applications). Due to individually varying leucocyte courses the G-CSF therapy was started with leucocyte values between 500/mm3 and 2450/mm3. Patients who were treated with up to 3 G-CSF applications had higher leucocyte levels than those with 4 or more applications (1620/mm3 to 1250/mm3). Leucopenia related infections, therapy interruptions or break-offs did not occur. Besides light "flu like" symptoms in 14% of the patients, no side effects were observed. CONCLUSIONS When a decrease of leucocyte values lower than 1000/mm3 is expected, the most cost-effective treatment is given when starting the interventional G-CSF administration already at leucocyte values around 1600/mm3. Leucopenias can be treated effectively, with little side effects and in a cost-effective way when G-CSF is given on time.
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Peller M, Weissfloch L, Stehling MK, Weber J, Bruening R, Senekowitsch-Schmidtke R, Molls M, Reiser M. Oxygen-induced MR signal changes in murine tumors. Magn Reson Imaging 1998; 16:799-809. [PMID: 9811145 DOI: 10.1016/s0730-725x(98)00076-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Breathing of 100% oxygen was used to challenge vascular autoregulation in 14 mice with either osteosarcomas (n = 6) or mammary carcinomas (n = 8). Reproducible and statistically significant signal intensity changes of -29 +/- 6% to +35 +/- 3% were observed on heavily T2*-weighted images in the tumors during the oxygen challenge. No significant changes were observed in muscle. For the mammary carcinomas a higher percentage of tumor voxels showed significant signal-intensity decrease (31 +/- 8%) compared to the percentage of voxels showing a signal-intensity increase (22 +/- 3%). In contrast, for the osteosarcomas, a higher percentage of tumor voxels showed signal-intensity increase (52 +/- 9%) compared to the percentage of voxels showing signal-intensity decrease (27 +/- 9%). The regional distribution of these signal intensity changes did not correlate with the signal pattern on T1-, T2-,and T2*-weighted and Gd-DTPA enhanced images acquired without breathing 100% oxygen. Most likely, the signal intensity changes represented the inability of the tumor's neovascularization for autoregulation during the oxygen challenge, particularly in hypoxic regions. Although further investigation is needed, the findings that malignant tumor tissue showed signal intensity changes, whereas normal muscle tissue did not, suggests that this technique may prove useful in distinguishing benign from malignant tissue.
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Stadler P, Feldmann HJ, Creighton C, Kau R, Molls M. Changes in tumor oxygenation during combined treatment with split-course radiotherapy and chemotherapy in patients with head and neck cancer. Radiother Oncol 1998; 48:157-64. [PMID: 9783887 DOI: 10.1016/s0167-8140(98)00032-2] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate the changes in tumor oxygenation during definitive split-course radiochemotherapy in locally advanced head and neck cancer (lymph nodes and primaries). MATERIALS AND METHODS Twenty-four patients with locally advanced head and neck cancer were investigated pretherapeutically and during a defined course of radiochemotherapy (RCTh) with a total dose of 70 Gy given in 35 fractions over 9 weeks (2-week break after 30 Gy). In weeks 1 and 6, the patients received chemotherapy (5 FU and mitomycin C) concomitant with irradiation. The oxygen partial pressure measurements were carried out using polarographic needle probes in combination with a microprocessor-controlled device (pO2 histograph/KIMOC). Times of measurements were before therapy, at the end of week 3 (30 Gy), after a 2-week break (30 Gy) and at the end of therapy if measurable lesion was found (70 Gy). RESULTS There was a significant reduction in the median pO2 (P < 0.005, n = 18) and an increase in the hypoxic fraction (defined as the percentage of pO2 values of <5 mm Hg) after application of 30 Gy (P < 0.05, n = 18). This effect was partially reversed at the end of the 2-week break. During the break an increase in the median PO2 (P = 0.05, n = 12) and a decrease in the hypoxic fraction could be observed. Towards the end of therapy (70 Gy) a significant decrease (P = 0.02, n = 13) in the median pO2 occurred. Corresponding to this, the hypoxic fraction increased during the last 4 weeks of therapy (P = 0.06, n = 13). CONCLUSION Statistically significant changes in oxygenation in locally advanced head and neck cancer were found during a split-course radiochemotherapy. This information was obtained in a homogenous group of patients under well-defined therapeutic conditions. The decrease in the tumor oxygenation status at doses of 30 and 70 Gy are important findings because they are in contrast to the concept of continuous improvement of the oxygenation status during fractionated radiotherapy.
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Gross MW, Weber WA, Feldmann HJ, Bartenstein P, Schwaiger M, Molls M. The value of F-18-fluorodeoxyglucose PET for the 3-D radiation treatment planning of malignant gliomas. Int J Radiat Oncol Biol Phys 1998; 41:989-95. [PMID: 9719107 DOI: 10.1016/s0360-3016(98)00183-7] [Citation(s) in RCA: 80] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE The aim of the study was to determine the impact of positron emission tomography using the glucose analogue fluorine-18-fluorodeoxyglucose (FDG-PET) on the delineation of the target volume in three-dimensional radiation treatment planning of primary brain tumors. METHODS AND MATERIALS In 18 patients with histologically proven (8x biopsy, 10x subtotal resection) primary brain tumors (8 astrocytomas grade III, one mixed glioma grade III, and 9 glioblastomas), magnetic resonance imaging (MRI) with gadolinium-DTPA and FDG-PET were performed in radiation treatment position within the same week. A computer program was developed for fusion of the PET and MR images. On corresponding axial slices, FDG uptake was compared to contrast enhancement in T1-weighted and to signal hyperintensity in T2-weighted MR images. Based on PET and MRI data, three-dimensional treatment planning was performed. All patients underwent linear accelerator (LINAC) radiotherapy. RESULTS In MRI, all tumors and the surrounding edema were visible as hyperintense lesions in the T2-weighted images. 17/18 tumors showed contrast enhancement. In FDG-PET, 16 tumors showed hypermetabolism compared to normal white matter, whereas only 8/18 tumors showed hypermetabolism compared to normal gray matter. White matter edema was associated with decreased FDG uptake in all patients. The area of increased FDG uptake correlated closely with contrast enhancement, only in one case the volume of increased FDG uptake was larger than the area of contrast enhancement. Mean tumor volumes obtained by MRI T1 + Gd, T2, and PET were 30, 106, and 10 ml, respectively. Survival was comparable to data in the literature with a 1-year survival of 39% and a median survival of 310 days. CONCLUSION Only in a minority of patients did FDG-PET provide additional information for radiation treatment planning. This is mainly caused by the high intensity of FDG uptake in normal brain tissue. PET may be of greater value in the definition of regions that should obtain a radiation dose boost.
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Schiessl W, Borojevic N, Pietzsch C, Bayerl A, Molls M, Kneschaurek P. [Dose-volume histograms and 3-D planning in breast-saving therapy of breast carcinoma]. Strahlenther Onkol 1998; 174:329-32. [PMID: 9645215 DOI: 10.1007/bf03038548] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM Improvement of the dose homogeneity in radiation treatment of the intact breast using 3D-planning and dose volume histograms. PATIENTS AND METHOD 3D-planning, including the calculation of dose volume histograms of the planning target volume, was performed on 15 patients, who underwent radiation therapy with tangential photon beams. A standard plan and 2 modified or optimized plans were evaluated. Different dosimetric parameters like maximum dose, mean dose, standard deviation and the fractional volume which receives doses from 95 to 105% of the reference dose were compared and correlated with breast size. RESULTS With increasing breast size standard planning leads to increased overdosage, both in magnitude and volume. Individual optimization by modifying weights and wedges gives no improvement in dose homogeneity, whereas a photon energy of 10 MV results in a more homogeneous dose distribution. The drawback of the higher energy is the increased underdosage of the skin. CONCLUSION Using the standard geometry of tangential fields the dose homogeneity cannot be improved significantly by 3D-planning, compared to our standard technique.
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148
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Stärk S, Grosu AL, Molls M, Kneschaurek P. [Mask technique of the BrainLab Company. Noninvasive fixation in stereotaxic radiotherapy]. BIOMED ENG-BIOMED TE 1998; 42 Suppl:352-3. [PMID: 9517187 DOI: 10.1515/bmte.1997.42.s2.352] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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149
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Grosu AL, Stärk S, Feldmann HJ, Kneschaurek P, Leonardi M, Lumenta C, Molls M. [Stereotactic convergence irradiation with linear accelerator. Imaging,technique and clinical indications]. RONTGENPRAXIS; ZEITSCHRIFT FUR RADIOLOGISCHE TECHNIK 1998; 51:9-15. [PMID: 9594633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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150
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Gofferjé M, Roesen B, Feldmann H, Scheider A, Grosu A, Molls M. One-year-results after fractionated radiotherapy in choroidal neovascularisation in age-related macula degeneration. Int J Radiat Oncol Biol Phys 1998. [DOI: 10.1016/s0360-3016(98)80228-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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