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Umezawa R, Takase K, Jingu K, Takanami K, Ota H, Kaneta T, Takeda K, Matsushita H, Ariga H, Takahashi S, Yamada S. Evaluation of radiation-induced myocardial damage using iodine-123 β-methyl-iodophenyl pentadecanoic acid scintigraphy. JOURNAL OF RADIATION RESEARCH 2013; 54:880-9. [PMID: 23412468 PMCID: PMC3766284 DOI: 10.1093/jrr/rrt011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
We evaluated radiation-induced myocardial damage using iodine-123 β-methyl-iodophenyl pentadecanoic acid (I-123 BMIPP) scintigraphy. Between May 2010 and April 2011 we performed I-123 BMIPP scintigraphy for patients who had maintained complete response to curative radiotherapy (RT) for esophageal cancer for more than six months. We compared the area of the myocardium in the RT fields with that of reduced I-123 BMIPP uptake using a 15-segment model that is based on axial computed tomography (CT) images. We classified the segments into three categories: segments receiving 40 Gy (Segment 40 Gy), segments receiving 60 Gy (Segment 60 Gy) and segments out of the radiation fields (Segment 0 Gy). A segment with reduced uptake in the RT fields was defined as positive. A total of 510 segments in 34 patients were used for analysis. The median interval from completion of RT to I-123 BMIPP scintigraphy was 22 months (range, 6-103 months). The numbers of Segment 0 Gy, Segment 40 Gy and Segment 60 Gy were 324, 133 and 53, respectively. Reduced uptake was detected in 42.9% (57/133) of Segment 40 Gy, 67.9% (36/53) of Segment 60 Gy and 13.3% (43/324) of Segment 0 Gy. The odds ratios of 40 Gy and 60 Gy compared with regions out of the RT fields were 5.2 (95% confidence interval [CI]: 3.7-7.4) and 15.4 (95% CI: 6.9-34.6), respectively. Reduced myocardial I-123 BMIPP uptake in RT fields, suggesting RT-induced myocardial damage, was frequently observed. I-123 BMIPP myocardial scintigraphy may be useful for identifying RT-induced myocardial damage.
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Affiliation(s)
- Rei Umezawa
- Department of Radiation Oncology, Tohoku University School of Medicine, Seiryou-machi 1-1, Aobaku, Sendai 980-8574, Japan
- Corresponding author. Department of Radiation Oncology, Tohoku University School of Medicine, Seiryou-machi 1-1, Aobaku, Sendai 980-8574, Japan. Tel: +81-22-717-7312; Fax: +81-22-717-7316;
| | - Kei Takase
- Department of Diagnostic Radiology, Tohoku University School of Medicine, Seiryou-machi 1-1, Aobaku, Sendai 980-8574, Japan
| | - Keiichi Jingu
- Department of Radiation Oncology, Tohoku University School of Medicine, Seiryou-machi 1-1, Aobaku, Sendai 980-8574, Japan
| | - Kentaro Takanami
- Department of Diagnostic Radiology, Tohoku University School of Medicine, Seiryou-machi 1-1, Aobaku, Sendai 980-8574, Japan
| | - Hideki Ota
- Department of Diagnostic Radiology, Tohoku University School of Medicine, Seiryou-machi 1-1, Aobaku, Sendai 980-8574, Japan
| | - Tomohiro Kaneta
- Department of Diagnostic Radiology, Tohoku University School of Medicine, Seiryou-machi 1-1, Aobaku, Sendai 980-8574, Japan
| | - Ken Takeda
- Department of Radiation Oncology, Tohoku University School of Medicine, Seiryou-machi 1-1, Aobaku, Sendai 980-8574, Japan
| | - Haruo Matsushita
- Department of Radiation Oncology, Tohoku University School of Medicine, Seiryou-machi 1-1, Aobaku, Sendai 980-8574, Japan
| | - Hisanori Ariga
- Department of Radiation Oncology, Tohoku University School of Medicine, Seiryou-machi 1-1, Aobaku, Sendai 980-8574, Japan
| | - Shoki Takahashi
- Department of Diagnostic Radiology, Tohoku University School of Medicine, Seiryou-machi 1-1, Aobaku, Sendai 980-8574, Japan
| | - Shogo Yamada
- Department of Radiation Oncology, Tohoku University School of Medicine, Seiryou-machi 1-1, Aobaku, Sendai 980-8574, Japan
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Dörffel W, Rühl U, Lüders H, Claviez A, Albrecht M, Bökkerink J, Holte H, Karlen J, Mann G, Marciniak H, Niggli F, Schmiegelow K, Schwarze EW, Pötter R, Wickmann L, Schellong G. Treatment of Children and Adolescents With Hodgkin Lymphoma Without Radiotherapy for Patients in Complete Remission After Chemotherapy: Final Results of the Multinational Trial GPOH-HD95. J Clin Oncol 2013; 31:1562-8. [DOI: 10.1200/jco.2012.45.3266] [Citation(s) in RCA: 107] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose To minimize the risk of late effects in pediatric Hodgkin lymphoma (HL) by omitting radiotherapy (RT) in patients in complete remission (CR) after chemotherapy and reducing the standard radiation dose to 20 Gy in patients in incomplete remission. Patients and Methods Between 1995 and 2001, 925 patients with classical HL (cHL) were registered from seven European countries in German Society of Pediatric Oncology and Hematology Hodgkin Lymphoma Trial 95. Patients in treatment group 1 (TG1; early stages) received two cycles of vincristine, prednisone, procarbazine, and doxorubicin or vincristine, prednisone, etoposide, and doxorubicin chemotherapy; additional two or four cycles of cyclophosphamide, vincristine, prednisone, and procarbazine were added in TG2 (intermediate stages) or TG3 (advanced stages), respectively. Patients in CR (assessed by computed tomography or magnetic resonance imaging) did not undergo RT. Those with tumor volume reduction more than 75% received reduced involved-field RT with 20 Gy and an additional 10- or 15-Gy boost only for larger residuals. Results Rates of overall survival, progression-free survival (PFS), and event-free survival at 10 years were (± SE) 96.3% ± 0.6%, 88.2% ± 1.1%, and 85.4% ± 1.3%, respectively. PFS for TG1 patients without or with RT was 97.0% ± 2.1% versus 92.2% ± 1.7% (P = .214) but was unsatisfactory for nonirradiated patients in TG2 (68.5% ± 7.4% v 91.4% ± 1.9%; P < .0001), with similar but not significant results in TG3 (82.6% ± 5.4% v 88.7% ± 2.0%, P = .259). Reduction of the standard radiation dose from 25 to 20 Gy did not increase failure rate. Conclusion RT can be omitted in early stage HL in so defined CR following this chemotherapy. RT with 20(−35) Gy proved to be sufficient in patients with incomplete remission following chemotherapy.
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Affiliation(s)
- Wolfgang Dörffel
- Wolfgang Dörffel, Heike Lüders, Heinz Marciniak, and Lutz Wickmann, HELIOS Hospital Berlin-Buch, Berlin-Buch; Ursula Rühl and Marion Albrecht, VIVANTES Hospital Berlin-Moabit, Berlin-Moabit; Alexander Claviez, University of Schleswig-Holstein, Kiel; Ernst-Wilhelm Schwarze, Municipal Clinic Dortmund, Dortmund; Günther Schellong, University Hospital of Münster, Münster, Germany; Jos Bökkerink, Academisch Ziekenhuis Nijmegen, the Netherlands; Harald Holte, Oslo University Hospital, Oslo, Norway; Jonas
| | - Ursula Rühl
- Wolfgang Dörffel, Heike Lüders, Heinz Marciniak, and Lutz Wickmann, HELIOS Hospital Berlin-Buch, Berlin-Buch; Ursula Rühl and Marion Albrecht, VIVANTES Hospital Berlin-Moabit, Berlin-Moabit; Alexander Claviez, University of Schleswig-Holstein, Kiel; Ernst-Wilhelm Schwarze, Municipal Clinic Dortmund, Dortmund; Günther Schellong, University Hospital of Münster, Münster, Germany; Jos Bökkerink, Academisch Ziekenhuis Nijmegen, the Netherlands; Harald Holte, Oslo University Hospital, Oslo, Norway; Jonas
| | - Heike Lüders
- Wolfgang Dörffel, Heike Lüders, Heinz Marciniak, and Lutz Wickmann, HELIOS Hospital Berlin-Buch, Berlin-Buch; Ursula Rühl and Marion Albrecht, VIVANTES Hospital Berlin-Moabit, Berlin-Moabit; Alexander Claviez, University of Schleswig-Holstein, Kiel; Ernst-Wilhelm Schwarze, Municipal Clinic Dortmund, Dortmund; Günther Schellong, University Hospital of Münster, Münster, Germany; Jos Bökkerink, Academisch Ziekenhuis Nijmegen, the Netherlands; Harald Holte, Oslo University Hospital, Oslo, Norway; Jonas
| | - Alexander Claviez
- Wolfgang Dörffel, Heike Lüders, Heinz Marciniak, and Lutz Wickmann, HELIOS Hospital Berlin-Buch, Berlin-Buch; Ursula Rühl and Marion Albrecht, VIVANTES Hospital Berlin-Moabit, Berlin-Moabit; Alexander Claviez, University of Schleswig-Holstein, Kiel; Ernst-Wilhelm Schwarze, Municipal Clinic Dortmund, Dortmund; Günther Schellong, University Hospital of Münster, Münster, Germany; Jos Bökkerink, Academisch Ziekenhuis Nijmegen, the Netherlands; Harald Holte, Oslo University Hospital, Oslo, Norway; Jonas
| | - Marion Albrecht
- Wolfgang Dörffel, Heike Lüders, Heinz Marciniak, and Lutz Wickmann, HELIOS Hospital Berlin-Buch, Berlin-Buch; Ursula Rühl and Marion Albrecht, VIVANTES Hospital Berlin-Moabit, Berlin-Moabit; Alexander Claviez, University of Schleswig-Holstein, Kiel; Ernst-Wilhelm Schwarze, Municipal Clinic Dortmund, Dortmund; Günther Schellong, University Hospital of Münster, Münster, Germany; Jos Bökkerink, Academisch Ziekenhuis Nijmegen, the Netherlands; Harald Holte, Oslo University Hospital, Oslo, Norway; Jonas
| | - Jos Bökkerink
- Wolfgang Dörffel, Heike Lüders, Heinz Marciniak, and Lutz Wickmann, HELIOS Hospital Berlin-Buch, Berlin-Buch; Ursula Rühl and Marion Albrecht, VIVANTES Hospital Berlin-Moabit, Berlin-Moabit; Alexander Claviez, University of Schleswig-Holstein, Kiel; Ernst-Wilhelm Schwarze, Municipal Clinic Dortmund, Dortmund; Günther Schellong, University Hospital of Münster, Münster, Germany; Jos Bökkerink, Academisch Ziekenhuis Nijmegen, the Netherlands; Harald Holte, Oslo University Hospital, Oslo, Norway; Jonas
| | - Harald Holte
- Wolfgang Dörffel, Heike Lüders, Heinz Marciniak, and Lutz Wickmann, HELIOS Hospital Berlin-Buch, Berlin-Buch; Ursula Rühl and Marion Albrecht, VIVANTES Hospital Berlin-Moabit, Berlin-Moabit; Alexander Claviez, University of Schleswig-Holstein, Kiel; Ernst-Wilhelm Schwarze, Municipal Clinic Dortmund, Dortmund; Günther Schellong, University Hospital of Münster, Münster, Germany; Jos Bökkerink, Academisch Ziekenhuis Nijmegen, the Netherlands; Harald Holte, Oslo University Hospital, Oslo, Norway; Jonas
| | - Jonas Karlen
- Wolfgang Dörffel, Heike Lüders, Heinz Marciniak, and Lutz Wickmann, HELIOS Hospital Berlin-Buch, Berlin-Buch; Ursula Rühl and Marion Albrecht, VIVANTES Hospital Berlin-Moabit, Berlin-Moabit; Alexander Claviez, University of Schleswig-Holstein, Kiel; Ernst-Wilhelm Schwarze, Municipal Clinic Dortmund, Dortmund; Günther Schellong, University Hospital of Münster, Münster, Germany; Jos Bökkerink, Academisch Ziekenhuis Nijmegen, the Netherlands; Harald Holte, Oslo University Hospital, Oslo, Norway; Jonas
| | - Georg Mann
- Wolfgang Dörffel, Heike Lüders, Heinz Marciniak, and Lutz Wickmann, HELIOS Hospital Berlin-Buch, Berlin-Buch; Ursula Rühl and Marion Albrecht, VIVANTES Hospital Berlin-Moabit, Berlin-Moabit; Alexander Claviez, University of Schleswig-Holstein, Kiel; Ernst-Wilhelm Schwarze, Municipal Clinic Dortmund, Dortmund; Günther Schellong, University Hospital of Münster, Münster, Germany; Jos Bökkerink, Academisch Ziekenhuis Nijmegen, the Netherlands; Harald Holte, Oslo University Hospital, Oslo, Norway; Jonas
| | - Heinz Marciniak
- Wolfgang Dörffel, Heike Lüders, Heinz Marciniak, and Lutz Wickmann, HELIOS Hospital Berlin-Buch, Berlin-Buch; Ursula Rühl and Marion Albrecht, VIVANTES Hospital Berlin-Moabit, Berlin-Moabit; Alexander Claviez, University of Schleswig-Holstein, Kiel; Ernst-Wilhelm Schwarze, Municipal Clinic Dortmund, Dortmund; Günther Schellong, University Hospital of Münster, Münster, Germany; Jos Bökkerink, Academisch Ziekenhuis Nijmegen, the Netherlands; Harald Holte, Oslo University Hospital, Oslo, Norway; Jonas
| | - Felix Niggli
- Wolfgang Dörffel, Heike Lüders, Heinz Marciniak, and Lutz Wickmann, HELIOS Hospital Berlin-Buch, Berlin-Buch; Ursula Rühl and Marion Albrecht, VIVANTES Hospital Berlin-Moabit, Berlin-Moabit; Alexander Claviez, University of Schleswig-Holstein, Kiel; Ernst-Wilhelm Schwarze, Municipal Clinic Dortmund, Dortmund; Günther Schellong, University Hospital of Münster, Münster, Germany; Jos Bökkerink, Academisch Ziekenhuis Nijmegen, the Netherlands; Harald Holte, Oslo University Hospital, Oslo, Norway; Jonas
| | - Kjeld Schmiegelow
- Wolfgang Dörffel, Heike Lüders, Heinz Marciniak, and Lutz Wickmann, HELIOS Hospital Berlin-Buch, Berlin-Buch; Ursula Rühl and Marion Albrecht, VIVANTES Hospital Berlin-Moabit, Berlin-Moabit; Alexander Claviez, University of Schleswig-Holstein, Kiel; Ernst-Wilhelm Schwarze, Municipal Clinic Dortmund, Dortmund; Günther Schellong, University Hospital of Münster, Münster, Germany; Jos Bökkerink, Academisch Ziekenhuis Nijmegen, the Netherlands; Harald Holte, Oslo University Hospital, Oslo, Norway; Jonas
| | - Ernst-Wilhelm Schwarze
- Wolfgang Dörffel, Heike Lüders, Heinz Marciniak, and Lutz Wickmann, HELIOS Hospital Berlin-Buch, Berlin-Buch; Ursula Rühl and Marion Albrecht, VIVANTES Hospital Berlin-Moabit, Berlin-Moabit; Alexander Claviez, University of Schleswig-Holstein, Kiel; Ernst-Wilhelm Schwarze, Municipal Clinic Dortmund, Dortmund; Günther Schellong, University Hospital of Münster, Münster, Germany; Jos Bökkerink, Academisch Ziekenhuis Nijmegen, the Netherlands; Harald Holte, Oslo University Hospital, Oslo, Norway; Jonas
| | - Richard Pötter
- Wolfgang Dörffel, Heike Lüders, Heinz Marciniak, and Lutz Wickmann, HELIOS Hospital Berlin-Buch, Berlin-Buch; Ursula Rühl and Marion Albrecht, VIVANTES Hospital Berlin-Moabit, Berlin-Moabit; Alexander Claviez, University of Schleswig-Holstein, Kiel; Ernst-Wilhelm Schwarze, Municipal Clinic Dortmund, Dortmund; Günther Schellong, University Hospital of Münster, Münster, Germany; Jos Bökkerink, Academisch Ziekenhuis Nijmegen, the Netherlands; Harald Holte, Oslo University Hospital, Oslo, Norway; Jonas
| | - Lutz Wickmann
- Wolfgang Dörffel, Heike Lüders, Heinz Marciniak, and Lutz Wickmann, HELIOS Hospital Berlin-Buch, Berlin-Buch; Ursula Rühl and Marion Albrecht, VIVANTES Hospital Berlin-Moabit, Berlin-Moabit; Alexander Claviez, University of Schleswig-Holstein, Kiel; Ernst-Wilhelm Schwarze, Municipal Clinic Dortmund, Dortmund; Günther Schellong, University Hospital of Münster, Münster, Germany; Jos Bökkerink, Academisch Ziekenhuis Nijmegen, the Netherlands; Harald Holte, Oslo University Hospital, Oslo, Norway; Jonas
| | - Günther Schellong
- Wolfgang Dörffel, Heike Lüders, Heinz Marciniak, and Lutz Wickmann, HELIOS Hospital Berlin-Buch, Berlin-Buch; Ursula Rühl and Marion Albrecht, VIVANTES Hospital Berlin-Moabit, Berlin-Moabit; Alexander Claviez, University of Schleswig-Holstein, Kiel; Ernst-Wilhelm Schwarze, Municipal Clinic Dortmund, Dortmund; Günther Schellong, University Hospital of Münster, Münster, Germany; Jos Bökkerink, Academisch Ziekenhuis Nijmegen, the Netherlands; Harald Holte, Oslo University Hospital, Oslo, Norway; Jonas
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