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Pixberg MK, Riemann B, Schuck A, Heinecke A, Schmid KW, Willich N, Dralle H, Schober O, Biermann M. Clinical outcomes of adjuvant external-beam radiotherapy for differentiated thyroid cancer. Nuklearmedizin 2018; 48:89-98; quiz N15. [DOI: 10.3413/nukmed-0221] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2008] [Accepted: 11/26/2008] [Indexed: 11/20/2022]
Abstract
Summary
Aim: Evaluate the clinical benefit of external beam radiotherapy (RTx) for locally invasive thyroid carcinoma with follicular cell differentiation (DTC). Patients, methods: The Multicentre Study on Differentiated Thyroid Cancer (MSDS) was planned as a prospective multicenter trial on the benefit of adjuvant RTx in locally invasive DTC (pT4; UICC 1997) with or without lymph node metastases and no known distant metastases. All patients were treated with thyroidectomy, 131I-therapy, and TSH-suppression and were randomized to receive additional RTx or not. In 4/2003 the trial became a prospective cohort study after only 45 of then 311 patients had consented to randomization. 351 of 422 patients met the trial's inclusion criteria. Age was 48 ± 12 years (mean ± SD). 25% were men. Tumours were papillary in 90% and follicular in 10%. Of 47 patients randomized or allocated to RTx, 26 actually received RTx. Results: Mean followup was 930 days. In an actual treatment analysis, 96% (25/26) of the RTx-patients reached complete remission (CR) vs. 86% in the non-RTx patients. Recurrences occurred in 0 vs. 3 % of patients: 6 reoperated for regional lymph node metastases, 1 tracheal invasion treated with tracheoplasty, 1 local invasion necessitating laryngectomy, 2 distant metastases (1 lung, 1 lung + bone). Serious chronic RTx toxicity occurred in 1/26 patients. Conclusion: The MSDS trial showed low mortality and recurrence rates and a weak benefit of RTx in terms of local control that did however not reach statistical significance. Routine RTx in locally invasive DTC can no longer be recommended .
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Pixberg MK, Dörr U, Dietlein M, Schlemmer H, Grimm J, Zajic T, Nestle U, Ladner S, Sepehr-Rezai S, Rosenbaum S, Puskás C, Fostitsch P, Heinecke A, Schuck A, Willich N, Schmid KW, Dralle H, Schober O, Biermann M. Guidelines on radioiodine therapy for differentiated thyroid carcinoma. Nuklearmedizin 2018. [DOI: 10.1055/s-0038-1625319] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
SummaryAim: For the examination of the impact on clinical practice of the guidelines for differentiated thyroid carcinoma (DTC), treatment data from the ongoing Multicenter Study Differentiated Thyroid Carcinoma (MSDS) were analyzed. Patients, methods: Patients were randomized to adjuvant external beam radiotherapy (RTx) or no RTx in addition to standard therapy in TNM stages pT4 pN0/1/x M0/x (UICC, 5th ed. 1997). All patients were to receive the same treatment regimen consisting of thyroidectomy, ablative radioiodine therapy (RIT), and a diagnostic 131I whole-body scintigraphy (WBS) 3-4 months after RIT. Results: Of 339 eligible patients enrolled between January 2000 and March 2004, 273 could be analyzed. Guideline recommendations by the German Society for Nuclear Medicine from 1999 and 1992 were complied with within 28% and 82% with regard to the interval between surgery and RIT (4 vs. 4–6 weeks), in 33% and 84% with regard to 131I activity for RIT (1-3 vs. 1-4 GBq; ± 10%), and in 16% and 60% with regard to 131I activity for WBS (15319-300 vs. 15319-400 MBq; ± 10%). Conclusions: The 1999 guideline revision appears to have had little impact on clinical practice. Further follow-up will reveal if guideline compliance had an effect on outcomes.
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Pixberg MK, Schuck A, Heinecke A, Köpcke W, Schmid KW, Dralle H, Willich N, Schober O, Biermann M. Multicenter Study Differentiated Thyroid Carcinoma (MSDS). Nuklearmedizin 2018. [DOI: 10.1055/s-0038-1625735] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Summary
Aim: The Multicenter Study Differentiated Thyroid Carcinoma (MSDS) is an ongoing study in Germany, Austria, and Switzerland on the clinical benefit of adjuvant external beam radiotherapy (RTx) for locally invasive differentiated thyroid carcinoma (DTC) in TNM stages pT4 pN0/1/x M0/x (5th ed. 1997). Methods: MSDS was designed as a prospective randomized trial. Patients receive thyroidectomy, radioiodine therapy (RIT) to ablate the thyroid remnant, and TSH-suppressive L-thyroxine therapy with or without RTx after documented elimination of cervical iodine-131 uptake (http://msdsstudie.uni-muenster.de). Results: 311 patients were enrolled between January 2000 and March 2003. 279 patients met the trial’s inclusion criteria. 45 consented to randomization, of whom 17 were randomized into treatment arm A (RTx) and 18 into arm B (no RTx).Advised by the trial’s independent Data Monitoring and Safety Committee, the MSDS steering committee decided to terminate randomization in April 2003 and continue MSDS as a prospective cohort study. 23 of the 234 patients in the observation arm of the trial were prescribed RTx by their physicians. Thus, 14% of the trial cohort were randomized or assigned to receive RTx (intention-to-treat analysis). In contrast, at least 44% of all patients with pT4 papillary DTC in Germany in the nationwide PCES study underwent RTx in 1996 (p <0.001, χ2-test). Conclusions: Acceptance of external beam RTx as a treatment modality for DTC has receded to a degree that accrual of a sufficient number of patients for a randomized trial has been impossible. Observation of the trial cohort is continued in order to assess clinical event rates with and without RTx and chronic RTx toxicity.
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Bölling T, Braun-Munzinger G, Burdach S, Calaminus G, Craft A, Delattre O, Deley MCL, Dirksen U, Dockhorn-Dworniczak B, Dunst J, Engel S, Faldum A, Fröhlich B, Gadner H, Göbel U, Gosheger G, Hardes J, Hawkins DS, Hjorth L, Hoffmann C, Kovar H, Kruseova J, Ladenstein R, Leuschner I, Lewis IJ, Oberlin O, Paulussen M, Potratz J, Ranft A, Rössig C, Rübe C, Sauer R, Schober O, Schuck A, Timmermann B, Tirode F, van den Berg H, van Valen F, Vieth V, Willich N, Winkelmann W, Whelan J, Womer RB. Development of curative therapies for Ewing sarcomas by interdisciplinary cooperative groups in Europe. Klin Padiatr 2015; 227:108-15. [PMID: 25985445 DOI: 10.1055/s-0035-1545263] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Curative therapies for Ewing sarcoma have been developed within cooperative groups. Consecutive clinical trials have systematically assessed the impact and timing of local therapy and the activity of cytotoxic drugs and their combinations. They have led to an increase of long-term disease-free survival to around 70% in patients with localized disease. Translational research in ES remains an area in which interdisciplinary and international cooperation is essential for future progress. This article reviews current state-of-the art therapy, with a focus on trials performed in Europe, and summarizes novel strategies to further advance both the cure rates and quality of survival.
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Affiliation(s)
- T Bölling
- Department Osnabrueck, Center for Radiotherapy Rheine-Osnabrueck, Osnabrueck, Germany
| | - G Braun-Munzinger
- Pediatric Hematology and Oncology Muenster, University Children's Hospital Muenster, Germany
| | - S Burdach
- Department of Pediatrics, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - G Calaminus
- Pediatric Hematology and Oncology Muenster, University Children's Hospital Muenster, Germany
| | - A Craft
- Royal Victoria Infirmary, Newcastle, United Kingdom
| | - O Delattre
- Inserm U830, Laboratory of Genetics and Biology of Cancers, Institut Curie, Paris, France
| | - M-C L Deley
- Université Paris-Sud, Le Kremlin-Bicêtre, and Gustave Roussy Institute, Villejuif, France
| | - U Dirksen
- Pediatric Hematology and Oncology Muenster, University Children's Hospital Muenster, Germany
| | | | - J Dunst
- Department of Radiation Oncology, University of Luebeck and University Medical Center Schleswig-Holstein, Campus Luebeck, Germany
| | - S Engel
- Pediatric Hematology and Oncology Muenster, University Children's Hospital Muenster, Germany
| | - A Faldum
- Institute of Biostatistics and Clinical Research, University of Muenster, Muenster, Germany
| | - B Fröhlich
- Pediatric Hematology and Oncology Muenster, University Children's Hospital Muenster, Germany
| | - H Gadner
- St. Anna Kinderkrebsforschung e.V., Children's Cancer Research Institute, and Department of Pediatrics, Medical University Vienna
| | - U Göbel
- Clinic of Pediatric Oncology, Hematology and Clinical Immunology, Heinrich-Heine-University, Duesseldorf, Germany
| | - G Gosheger
- Department of Orthopedic Surgery, University Hospital Muenster, Muenster, Germany
| | - J Hardes
- Department of Orthopedic Surgery, University Hospital Muenster, Muenster, Germany
| | - D S Hawkins
- Seattle Children's Hospital and Fred Hutchinson Cancer Research Center, University of Washington, Seattle, Washington, USA
| | - L Hjorth
- Skåne University Hospital, Lund University, Lund, Sweden
| | - C Hoffmann
- Pediatric Hematology and Oncology Muenster, University Children's Hospital Muenster, Germany
| | - H Kovar
- St. Anna Kinderkrebsforschung e.V., Children's Cancer Research Institute, and Department of Pediatrics, Medical University Vienna
| | - J Kruseova
- Department of Paediatric Haematology and Oncology Charles University, 2nd School of Medicine, Prague, Czech Republic
| | - R Ladenstein
- St. Anna Kinderkrebsforschung e.V., Children's Cancer Research Institute, and Department of Pediatrics, Medical University Vienna
| | - I Leuschner
- Kiel Paediatric Tumor Registry, Department of Paediatric Pathology, Christian-Albrechts-University Kiel, Kiel, Germany
| | - I J Lewis
- Alder Hey Children's National Health Service Foundation Trust, Liverpool, UK
| | - O Oberlin
- Gustave Roussy Institute, Villejuif, France
| | - M Paulussen
- Vestische Kinder-und Jugendklinik Datteln, Witten/Herdecke University, Datteln, Germany
| | - J Potratz
- Pediatric Hematology and Oncology Muenster, University Children's Hospital Muenster, Germany
| | - A Ranft
- Pediatric Hematology and Oncology Muenster, University Children's Hospital Muenster, Germany
| | - C Rössig
- Pediatric Hematology and Oncology Muenster, University Children's Hospital Muenster, Germany
| | - C Rübe
- Department of Radiotherapy and Radiation Oncology, Saarland University Medical Center, Homburg, Germany
| | - R Sauer
- Department of Radiation Therapy, University of Erlangen, Erlangen, Germany
| | - O Schober
- Department of Nuclear Medicine, University of Münster, Münster, Germany
| | - A Schuck
- Department of Radiotherapy, University Hospital Muenster, Muenster, Germany
| | - B Timmermann
- Clinic for Particle Therapy, West German Proton Therapy Center Essen, West German Cancer Center, University Hospital Essen
| | - F Tirode
- Inserm U830, Laboratory of Genetics and Biology of Cancers, Institut Curie, Paris, France
| | - H van den Berg
- Emma Children Hospital AMC, University of Amsterdam, Amsterdam, the Netherlands
| | - F van Valen
- Institute of Experimental Musculoskeletal Medicine, University Hospital Muenster, Muenster, Germany
| | - V Vieth
- Department of Clinical Radiology, University Hospital Muenster, Muenster, Germany
| | - N Willich
- Department of Radiotherapy, University Hospital Muenster, Muenster, Germany
| | - W Winkelmann
- Department of Orthopedic Surgery, University Hospital Muenster, Muenster, Germany
| | - J Whelan
- NIHR University College London Hospitals Biomedical Research Centre, London, UK
| | - R B Womer
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine and Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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Schuck A, Lemke C, Suvichakorn A, Antoine JP. Analysis of Magnetic Resonance Spectroscopic signals with data-based autocorrelation wavelets. Annu Int Conf IEEE Eng Med Biol Soc 2010; 2010:855-858. [PMID: 21097194 DOI: 10.1109/iembs.2010.5628034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
A new class of wavelet functions called data-based autocorrelation wavelets is developed for analyzing Magnetic Resonance Spectroscopic (MRS) signals by means of the continuous wavelet transform (CWT), instead of the traditional wavelet like Morlet wavelet. These new wavelets are derived from the normalized autocorrelation function from metabolite data and then used for detecting the presence of a given metabolite in a signal with a presence of many different components and finally for quantifying some of its parameters.
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Affiliation(s)
- A Schuck
- Electrical Eng. Dept. (DELET), Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.
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Bölling T, Schuck A, Pape H, Rübe C, Meyer FM, Martini C, Timmermann B, Asadpour B, Kortmann RD, Beck JD, Langer T, Paulides M, Könemann S, Willich N. [Register for the evaluation of side effects after radiation in childhood and adolescence--first results]. Klin Padiatr 2007; 219:139-45. [PMID: 17525907 DOI: 10.1055/s-2007-973848] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Late effects after radiotherapy in childhood and adolescence have mainly been characterized retrospectively with small patient numbers. Therefore the German Group of Pediatric Radiation Oncology (APRO) established the "RegIster for the evaluation of late Side effects after radiation in childhood and adolescence" (RiSK). After a pilot phase starting in 2001 documentation has been performed all over Germany since 2004. This analysis shows the first results of "RiSK". PATIENTS AND METHODS Radiation parameters including detailed organ doses as well as toxicity evaluations were collected prospectively from centers all over Germany in the study center. Standardized documentation forms were used. Documentation is planned for all children who receive radiotherapy in one of the German pediatric therapy trials. RESULTS Until December 31st 2006, 696 documentations of radiotherapy and 526 acute as well as 836 late follow-up documentation forms have been collected. Altogether, 41 patients with late grade 3 and 16 patients with late grade 4-side effects were identified. Side effects mainly concerned joints with functional impairment (after combined radiotherapy and surgery), the bowel, skin and subcutis as well as blood parameters under continued chemotherapy. Patients with late side effects of a higher grade were mainly treated for Ewing's or soft tissue sarcomas (n=235 patients), representing 33.8% of all patients in this study. CONCLUSION Fortunately, up to now only a few late grade 3 or 4 side effects of radiotherapy are shown for almost 700 documented patients. For further results, especially for the characterization of dose-effect-relationships, this study has to be continued with a higher patient number and a longer follow-up.
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Affiliation(s)
- T Bölling
- Klinik und Poliklinik für Strahlentherapie der Universitätsklinik Münster, Albert-Schweitzer-Strasse 33, 48129 Münster.
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Timmermann B, Schuck A, Lomax A, Niggli F, Goitein G. 116 Proton therapy at PSI for soft tissue tumours in childhood. Radiother Oncol 2006. [DOI: 10.1016/s0167-8140(06)80595-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Könemann S, Bölling T, Kolkmeyer A, Riesenbeck D, Hesselmann S, Vormoor J, Willich N, Schuck A. Heterogeneity of radiation induced apoptosis in Ewing Tumor cell lines characterized on a single cell level. Apoptosis 2005; 10:177-84. [PMID: 15711933 DOI: 10.1007/s10495-005-6072-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The objective of this study was to investigate heterogeneity of radiation induced apoptosis on a single cell level. Two Ewing tumor cell lines were characterized in vitro before and 24 and 72 h after radiation with 5 Gy by multiparametric flow cytometry. Annexin V, 7-AAD and fluorescence conjugated antibodies that were directed against HLA-ABC, CD11a and CD62L were used. Based on these markers radiation induced apoptosis was quantified, multiple apoptotic subpopulations were identified and a characteristic individual apoptotic profile was characterized. The characterization of HLA-ABC, CD11a and CD62L was informative to detect subpopulations of apoptotic cells. The observed heterogeneity and the identification of multiple apoptotic subpopulations reflect the complexity and diversity of biology of radiation induced cell death. This might be an indication for co-existing apoptotic pathways or it might represent sequential steps of the apoptotic cascade.
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Affiliation(s)
- S Könemann
- Department of Radiotherapy, University Hospital Münster, 48149, Münster, Germany.
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10
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Biermann M, Pixberg MK, Dörr U, Dietlein M, Schlemmer H, Grimm J, Zajic T, Nestle U, Ladner S, Sepehr-Rezai S, Rosenbaum S, Puskás C, Fostitsch P, Heinecke A, Schuck A, Willich N, Schmid KW, Dralle H, Schober O. Guidelines on radioiodine therapy for differentiated thyroid carcinoma: impact on clinical practice. Nuklearmedizin 2005; 44:229-34, 236-7. [PMID: 16400382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
AIM For the examination of the impact on clinical practice of the guidelines for differentiated thyroid carcinoma (DTC), treatment data from the ongoing Multicenter Study Differentiated Thyroid Carcinoma (MSDS) were analyzed. PATIENTS, METHODS Patients were randomized to adjuvant external beam radiotherapy (RTx) or no RTx in addition to standard therapy in TNM stages pT4 pN0/1/x M0/x (UICC, 5th ed. 1997). All patients were to receive the same treatment regimen consisting of thyroidectomy, ablative radioiodine therapy (RIT), and a diagnostic 131I whole-body scintigraphy (WBS) 3-4 months after RIT. RESULTS Of 339 eligible patients enrolled between January 2000 and March 2004, 273 could be analyzed. Guideline recommendations by the German Society for Nuclear Medicine from 1999 and 1992 were complied with within 28% and 82% with regard to the interval between surgery and RIT (4 vs. 4-6 weeks), in 33% and 84% with regard to 131I activity for RIT (1-3 vs. 1-4 GBq; +/- 10%), and in 16% and 60% with regard to 131I activity for WBS (100-300 vs. 100-400 MBq; +/- 10%). CONCLUSIONS The 1999 guideline revision appears to have had little impact on clinical practice. Further follow-up will reveal if guideline compliance had an effect on outcomes.
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Affiliation(s)
- M Biermann
- Department of Nuclear Medicine, Münster University, Albert-Schweitzer-Str. 30-33, 48129 Münster, Germany.
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Winter B, Lanvers-Kaminsky C, Koling S, Frodermann B, Braun Y, Schäfer KL, Diallo RI, Könemann S, Boos J, Willich N, Poremba C, Schuck A. Doxorubicin reduces telomerase activity in a human Ewing-Xenograft tumor. Klin Padiatr 2004. [DOI: 10.1055/s-2004-828601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Dullat J, Lanvers-Kaminsky C, Möllers T, Koling S, Schuck A, Poremba C, Boos J. Preclinical investigation of combination from the telomerase-inhibitor BRACO 20 with cisplatin and the effects of sole BRACO 20 treatment on neuroblastoma cells. Klin Padiatr 2004. [DOI: 10.1055/s-2004-828558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Braun Y, Schäfer KL, Lanvers-Kaminsky C, Schuck A, Brachwitz K, Diallo R, Gödde D, Gabbert H, Poremba C. Effects of telomerase inhibition and activation in neuroblastoma cell lines SKNSH and CHLA90. Pathol Res Pract 2004. [DOI: 10.1016/s0344-0338(04)80696-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Biermann M, Pixberg MK, Schuck A, Heinecke A, Köpcke W, Schmid KW, Dralle H, Willich N, Schober O. Multicenter study differentiated thyroid carcinoma (MSDS). Diminished acceptance of adjuvant external beam radiotherapy. Nuklearmedizin 2003; 42:244-50. [PMID: 14668957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
AIM The Multicenter Study Differentiated Thyroid Carcinoma (MSDS) is an ongoing study in Germany, Austria, and Switzerland on the clinical benefit of adjuvant external beam radiotherapy (RTx) for locally invasive differentiated thyroid carcinoma (DTC) in TNM stages pT4 pN0/1/x M0/x (5th ed. 1997). METHODS MSDS was designed as a prospective randomized trial. Patients receive thyroidectomy, radioiodine therapy (RIT) to ablate the thyroid remnant, and TSH-suppressive L-thyroxine therapy with or without RTx after documented elimination of cervical iodine-131 uptake (http://msds-studie.uni-muenster.de). RESULTS 311 patients were enrolled between January 2000 and March 2003. 279 patients met the trial's inclusion criteria. 45 consented to randomization, of whom 17 were randomized into treatment arm A (RTx) and 18 into arm B (no RTx). Advised by the trial's independent Data Monitoring and Safety Committee, the MSDS steering committee decided to terminate randomization in April 2003 and continue MSDS as a prospective cohort study. 23 of the 234 patients in the observation arm of the trial were prescribed RTx by their physicians. Thus, 14% of the trial cohort were randomized or assigned to receive RTx (in-tention-to-treat analysis). In contrast, at least 44% of all patients with pT4 papillary DTC in Germany in the nation-wide PCES study underwent RTx in 1996 (p <0.001, chi(2)-test). CONCLUSIONS Acceptance of external beam RTx as a treatment modality for DTC has receded to a degree that accrual of a sufficient number of patients for a randomized trial has been impossible. Observation of the trial cohort is continued in order to assess clinical event rates with and without RTx and chronic RTx toxicity.
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Affiliation(s)
- M Biermann
- Department of Nuclear Medicine, Münster University, 48129 Münster, Germany.
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Könemann S, Bölling T, Malath J, Kolkmeyer A, Janke K, Riesenbeck D, Hesselmann S, Diallo R, Vormoor J, Willich N, Schuck A. Time- and dose-dependent changes of intracellular cytokine and cytokine receptor profile of Ewing tumour subpopulations under the influence of ionizing radiation. Int J Radiat Biol 2003; 79:897-909. [PMID: 14698958 DOI: 10.1080/09553000310001626126] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE Cytokines and their corresponding cell surface receptors are involved in intercellular signalling pathways and in the radioresistance of normal and malignant cells. The aim was the characterization of the expression of intracellular cytokines, their receptors and apoptosis-associated markers under the influence of radiation. MATERIAL AND METHODS Two Ewing tumours were characterized in vitro before and 4, 24 and 72 h after radiation with 5 and 10 Gy, and in vivo 4, 6 and 15 days after radiation with 5 and 30 Gy by five parameter flow cytometry. Direct fluorescence-conjugated antibodies directed against intracellular cytokines (interferon-gamma, tumour necrosis factor [TNF]-alpha, interleukin 1) and their receptors (CD119, CD120a, CD121a) were used. Annexin V and 7-amino-actinomycin D were used to identify radiation-induced apoptosis. RESULTS Inter- and intra-individual heterogeneities were identified by the expression of cytokine receptors and the intracellular cytokine profile before radiation. Time- and dose-dependent up-regulation of the cytokines TNF-alpha and interleukin 1 were found in vitro. In vivo, an up-regulation of CD120a and CD121a was detectable on tumour cell subpopulations. For interferon-gamma and CD119, no changes were seen. CONCLUSIONS The observed radiation-induced changes of cytokine and receptor profile are an indication for complex intercellular interactions in view of radioresistance-associated mechanisms between cell populations within one individual tumour. The observed heterogeneous response on radiation might have therapeutic implications for an individualized therapy based on combined radiation and cytokine modulation, defined by flow cytometric characterization of markers potentially informative for radioresistance.
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MESH Headings
- Animals
- Annexin A5/pharmacology
- Antigens, CD/biosynthesis
- Apoptosis
- CD11 Antigens/biosynthesis
- Cell Division
- Cell Line, Tumor
- Cytokines/biosynthesis
- Cytokines/metabolism
- DNA/metabolism
- Dactinomycin/pharmacology
- Dose-Response Relationship, Drug
- Dose-Response Relationship, Radiation
- Enzyme Inhibitors/pharmacology
- Flow Cytometry
- Fluorescent Dyes/pharmacology
- Humans
- Immunophenotyping
- Interferon-gamma/metabolism
- Interleukin-1/metabolism
- Mice
- Mice, Nude
- Microscopy, Fluorescence
- Neoplasm Transplantation
- Radiation, Ionizing
- Receptors, Cytokine/biosynthesis
- Receptors, Interferon/biosynthesis
- Receptors, Interleukin-1/biosynthesis
- Receptors, Tumor Necrosis Factor/biosynthesis
- Receptors, Tumor Necrosis Factor, Type I
- Sarcoma, Ewing/metabolism
- Time Factors
- Tumor Necrosis Factor-alpha/metabolism
- Up-Regulation
- Interferon gamma Receptor
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Affiliation(s)
- S Könemann
- Department of Radiotherapy University Hospital Münster Albert-Schweitzer-Str. 33 48 129 Münster Germany.
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Könemann S, Bölling T, Schuck A, Malath J, Kolkmeyer A, Horn K, Riesenbeck D, Hesselmann S, Diallo R, Vormoor J, Willich NA. Effect of radiation on Ewing tumour subpopulations characterized on a single-cell level: intracellular cytokine, immunophenotypic, DNA and apoptotic profile. Int J Radiat Biol 2003; 79:181-92. [PMID: 12745883 DOI: 10.1080/0955300031000073400] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE Adhesion molecules, cytokines and their corresponding cell-surface receptors are involved in intercellular signalling pathways, radioresistance and metastasis-mediating mechanisms of malignant cells. The aim was the characterization of changes in the marker profile of Ewing tumour cell subpopulations under the influence of radiation. MATERIALS AND METHODS Three Ewing tumours were characterized in vitro and in vivo in a xenograft model before and after radiation by five-parameter flow cytometry. Antibodies directed against cell surface and intracellular antigens, apoptosis-associated markers and the DNA dye 7-aminoactinomycin D were used. RESULTS Tumour cell subpopulations were identified by expression of adhesion molecules and cytokine receptors, intracellular cytokines, apoptotic markers and DNA content. Heterogeneous changes of flow cytometric profile were identified on tumour cell subpopulations after radiation. CONCLUSIONS The changed profile of tumour cells under radiation might be associated with biological changes of tumour subpopulations in view of radioresistance and metastatic potential and might be useful to identify intercellular regulation mechanisms and to define parameters being predictive for a response to therapy.
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Affiliation(s)
- S Könemann
- University Hospital Münster, Department of Radiotherapy, Albert-Schweitzer-Str 33, D-48129 Münster, Germany.
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Ruebe C, van Valen F, Wilfert F, Palm J, Schuck A, Ruebe C. Ewing’s sarcoma and peripheral primitive neuroectodermal tumor cells produce extremely large quantities of bioactive tumor necrosis factor-α following irradiation exposure. Int J Radiat Oncol Biol Phys 2002. [DOI: 10.1016/s0360-3016(02)03431-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Schuck A, Könemann S, Matthees B, Rübe CE, Reinartz G, Hesselmann S, Micke O, Schäfer U, Willich N. Radiotherapy in the treatment of locoregional relapses of breast cancer. Br J Radiol 2002; 75:663-9. [PMID: 12153940 DOI: 10.1259/bjr.75.896.750663] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Locoregional recurrences of breast cancer are associated with considerable morbidity and frequently present with concurrent metastatic disease. Yet patients without systemic spread can be treated with curative intent. In a retrospective analysis, the results of treatment of these patients have been evaluated at our institution. Between 1987 and 1996, 113 patients with locoregional breast cancer relapse, without systemic manifestation, received irradiation after local tumour excision. 13 patients (11.5%) had already received radiotherapy as part of their primary treatment. In these cases, only the area involved was treated. In all other patients, the chest wall and the ipsilateral lymph nodes were irradiated. Median dose was 50 Gy (range 20-65 Gy). Median follow-up was 4.4 years. 76 patients (67.3%) presented with chest wall recurrence only, 25 patients (22.1%) with nodal relapse only and 12 patients (10.6%) with combined relapses. 93% of patients had local control of disease after treatment. Local control rate after 5 years was 59%. 63 patients (55.8%) died within the follow-up interval, 45 patients (39.8%) owing to metastases, 4 patients (3.5%) owing to local failure and 8 patients (7%) owing to causes unrelated to tumour. Overall survival after 5 years was 43%. In multivariate analysis, positive hormone receptor status, small tumours on relapse and chest wall relapses alone were associated with improved survival. Radical local therapy is necessary in order to achieve and maintain local control and to prevent secondary dissemination in patients with only local recurrence of breast cancer.
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Affiliation(s)
- A Schuck
- Radiotherapy Department, University of Muenster, Albert-Schweitzer-Str. 33, D-48129 Muenster, Germany
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Könemann S, Deppe K, Schuck A, Micke O, Schäfer U, Lindner N, Hillmann A, Dietl KH, Kronholz HL, Annweiler H, Willich NA. Fractionated perioperative high dose rate brachytherapy using a tissue equivalent bendy applicator. Br J Radiol 2002; 75:453-9. [PMID: 12036840 DOI: 10.1259/bjr.75.893.750453] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Intraoperative radiation techniques allow an additional local dose in areas at high-risk for local failure. With brachytherapy techniques, perioperative radiation can be fractionated. Fractionated treatment might offer an interesting alternative to a single dose, both to increase the therapeutic ratio and to protect late reacting tissues at risk. The dose distribution for brachytherapy applicators can be optimized using spacer materials. In this prospective study a new tissue equivalent bendy applicator (TEBA) that can remain in situ for several days is introduced, and the feasibility of fractionated perioperative high dose rate (HDR) brachytherapy is examined. 31 patients with different tumours (soft tissue sarcoma, Ewings sarcoma, rectal cancer, and locally infiltrating diseases) were treated. The TEBA was applied, depending on resection status and intraoperative findings. Planning was based on digitized radiographs and CT scans. Perioperative HDR brachytherapy was performed using an individual treatment schedule. In 29 patients perioperative radiation was given and in 26 cases fractionated brachytherapy application was possible. TEBA application time varied from 1 day to 11 days. During this time between 1 and 8 fractions were given with total doses from 10 Gy to 25 Gy. Fractionated perioperative brachytherapy with this technique is feasible and adequate. Further studies will show whether fractionated perioperative treatment using the TEBA technique fulfils its theoretical advantages over single dose intraoperative radiotherapy by decreased late toxicity and increased local tumour control.
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Affiliation(s)
- S Könemann
- Department of Radiotherapy, University Hospital, Münster, Germany
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Li D, Turi TG, Schuck A, Freedberg IM, Khitrov G, Blumenberg M. Rays and arrays: the transcriptional program in the response of human epidermal keratinocytes to UVB illumination. FASEB J 2001; 15:2533-5. [PMID: 11641260 DOI: 10.1096/fj.01-0172fje] [Citation(s) in RCA: 110] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
The epidermis, our first line of defense from ultraviolet (UV) light, bears the majority of photodamage, which results in skin thinning, wrinkling, keratosis, and malignancy. Hypothesizing that skin has specific mechanisms to protect itself and the organism from UV damage, we used DNA arrays to follow UV-caused gene expression changes in epidermal keratinocytes. Of the 6,800 genes examined, UV regulates the expression of at least 198. Three waves of changes in gene expression can be distinguished, 0.5-2, 4-8, and 16-24 h after illumination. The first contains transcription factors, signal transducing, and cytoskeletal proteins that change cell phenotype from a normal, fast-growing cell to an activated, paused cell. The second contains secreted growth factors, cytokines, and chemokines; keratinocytes, having changed their own physiology, alert the surrounding tissues to the UV damage. The third wave contains components of the cornified envelope, as keratinocytes enhance the epidermal protective covering and, simultaneously, terminally differentiate and die, removing a carcinogenic threat. UV also induces the expression of mitochondrial proteins that provide additional energy, and the enzymes that synthesize raw materials for DNA repair. Using a novel skin organ culture model, we demonstrated that the UV-induced changes detected in keratinocyte cultures also occur in human epidermis in vivo.
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Affiliation(s)
- D Li
- R. O. Perelman Department of Dermatology, The Kaplan Cancer Research Center, New York University School of Medicine, New York, New York 10016, USA
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Horst E, Micke O, Moustakis C, Schuck A, Schaefer U, Willich N. Conformal therapy of pancreatic cancer: variation of organ position due to differential gastrointestinal distension and implications for treatment planning. Int J Radiat Oncol Biol Phys 2001. [DOI: 10.1016/s0360-3016(01)02208-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Abstract
BACKGROUND A variety of solutions are used to match tangential fields and opposed lymph node fields in irradiation of nodal positive breast cancer. The choice is depending on the technical equipment which is available and the clinical situation. The CT simulation of a non-monoisocentric technique was evaluated in terms of accuracy and reproducibility. PATIENTS, MATERIAL AND METHODS The field match parameters were adjusted virtually at CT simulation and were compared with parameters derived mathematically. The coordinate transfer from the CT simulator to the conventional simulator was analyzed in 25 consecutive patients. RESULTS The angles adjusted virtually for a geometrically exact coplanar field match corresponded with the angles calculated for each set-up. The mean isocenter displacement was 5.7 mm and the total uncertainty of the coordinate transfer was 6.7 mm (1 SD). Limitations in the patient set-up became obvious because of the steep arm abduction necessary to fit the 70 cm CT gantry aperture. Required modifications of the arm position and coordinate transfer errors led to a significant shift of the marked matchline of > 1.0 cm in eight of 25 patients (32%). CONCLUSION The virtual CT simulation allows a precise and graphic definition of the field match parameters. However, modifications of the virtual set-up basically due to technical limitations were required in a total of 32% of cases, so that a hybrid technique was adapted at present that combines virtual adjustment of the ideal field alignment parameters with conventional simulation.
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Affiliation(s)
- E Horst
- Department of Radiation Oncology, University of Münster, Germany.
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Schuck A, Ahrens S, Paulussen M, Konaszewska A, Fröhlich B, Rübe C, Rübe C, Dunst J, Willich N, Jürgens H. Hemithorax irradition in Ewing tumors of the chest wall. Eur J Cancer 2001. [DOI: 10.1016/s0959-8049(01)81738-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Schuck A, Mueller S, Koehler A, Koenemann S, Ruebe C, Wassmann H, Willich N. Radiochemotherapy with paclitaxel in malignant glioma: results of a phase II study. Eur J Cancer 2001. [DOI: 10.1016/s0959-8049(01)81762-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Schuck A, Biermann M, Poremba C, Boecker W, Heinecke A, Koepcke W, Senninger N, Dralle H, Willich N, Schober O. Prospective randomized multicenter trial on adjuvant percutaneous radiotherapy in locally advanced differentiated thyroid cell carcinoma. Eur J Cancer 2001. [DOI: 10.1016/s0959-8049(01)80885-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Ruebe C, Wilfert F, Uthe D, Schuck A, Willich N, Ruebe C. Modulation of radiation-induced tumor necrosis factor alpha expression in the lung tissue by pentoxifyline. Eur J Cancer 2001. [DOI: 10.1016/s0959-8049(01)81018-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Schubert E, Schuck A, Jung K, Geltman S. Triple differential cross sections for the electron impact ionisation of helium at 35 eV collision energy. ACTA ACUST UNITED AC 2001. [DOI: 10.1088/0022-3700/12/6/015] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Könemann S, Schuck A, Malath J, Rupek T, Horn K, Baumann M, Vormoor J, Rübe C, Willich N. Cell heterogeneity and subpopulations in solid tumors characterized by simultaneous immunophenotyping and DNA content analysis. Cytometry 2000; 41:172-7. [PMID: 11042613 DOI: 10.1002/1097-0320(20001101)41:3<172::aid-cyto3>3.0.co;2-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Heterogeneity in human malignant tumors is a well-described phenomenon and of interest with regard to subpopulations with differences in clonality, metastatic potential, and response to therapy under different treatment regimes. The aim of this study was the simultaneous characterization of surface markers and DNA content of solid tumors to identify tumor cell subpopulations and to study the association between the expression of antigens and DNA content. METHODS In the present study, six different malignant tumors grown as xenografts in nude mice were characterized by five-parameter flow cytometry. Immunophenotyping was performed using a variety of direct fluorescence-conjugated antibodies. In all cases, simultaneous detection of DNA content was done after staining with 7-aminoactinomycin D. RESULTS Tumor cells were characterized by light scatter properties, antigen expression, and DNA content. Tumor cell heterogeneity, subpopulations, and DNA content-dependent antigen expression were identified. CONCLUSIONS This method offers the possibility of characterizing solid tumors according to their immunophenotype and DNA content. The results obtained can be used to identify changes in immunophenotypic and DNA profiles of tumor cell populations before and after therapy and might be useful to define parameters predictive for response to therapy.
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Affiliation(s)
- S Könemann
- Department of Radiation Oncology, University of Münster, Münster, Germany.
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Rube CE, Uthe D, Schmid KW, Richter KD, Wessel J, Schuck A, Willich N, Rube C. Dose-dependent induction of transforming growth factor beta (TGF-beta) in the lung tissue of fibrosis-prone mice after thoracic irradiation. Int J Radiat Oncol Biol Phys 2000; 47:1033-42. [PMID: 10863076 DOI: 10.1016/s0360-3016(00)00482-x] [Citation(s) in RCA: 220] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
PURPOSE The lung is the major dose-limiting organ for radiotherapy of cancer in the thoracic region. The pathogenesis of radiation-induced lung injury at the molecular level is still unclear. Immediate cellular damage after irradiation is supposed to result in cytokine-mediated multicellular interactions with induction and progression of fibrotic tissue reactions. The purpose of this investigation was to evaluate the acute and long-term effects of radiation on the gene expression of transforming growth factor beta (TGF-beta) in a model of lung injury using fibrosis-sensitive C57BL/6 mice. METHODS AND MATERIALS The thoraces of C57BL/6 mice were irradiated with 6 and 12 Gy, respectively. Treated and sham-irradiated control mice were sacrificed at times corresponding to the latent period (1, 3, 6, 12, 24, 48, 72 hours and 1 week postirradiation), the pneumonic phase (2, 4, 8, and 16 weeks postirradiation), and the beginning of the fibrotic phase (24 weeks postirradiation). The lung tissue from three different mice per dosage and time point was analyzed by a combination of polymerase chain reaction (PCR), immunohistochemistry, and light microscopy. The mRNA expression of TGF-beta was quantified by competitive reverse transcriptase/polymerase chain reaction (RT-PCR); the cellular origin of the TGF-beta protein was identified by immunohistochemical staining (alkaline phosphatase-anti-alkaline phosphatase [APAAP]). The cytokine expression on mRNA and protein level was correlated with the histopathological alterations. RESULTS Following thoracic irradiation with a single dose of 12 Gy, radiation-induced TGF-beta release in lung tissue was appreciable already within the first hours (1, 3, and 6 hours postirradiation) and reached a significant increase after 12 hours; subsequently (48 hours, 72 hours, and 1 week postirradiation) the TGF-beta expression declined to basal levels. At the beginning of the pneumonic phase, irradiation-mediated stimulation of TGF-beta release reached maximal values at 2 and 4 weeks. The elevated levels of TGF-beta mRNA during the latent phase have been found to correlate with immunohistochemical staining of alveolar macrophages. The most striking increase in TGF-beta immunoreactivity was seen during the acute phase of pneumonitis. Throughout this observation period, type II pneumocytes and fibroblasts (apart from inflammatory cells) served as important sources of TGF-beta expression. Increased TGF-beta expression was detected prominently in regions of histopathologic radiation injury. After exposure to a single radiation dose of 6 Gy, the lung tissue revealed only a minor radiation-mediated TGF-beta mRNA response. The modest upregulation ranged from 6 hours to 48 hours after irradiation. Corresponding to the only minor histopathologic changes after thoracic irradiation with 6 Gy, measurement of TGF-beta mRNA levels during the later time points revealed no significant alterations in comparison to untreated control mice. CONCLUSIONS This study demonstrates an acute and long-lasting increase in the expression of TGF-beta in lung tissue following thoracic irradiation with 12 Gy. The predominant localization of TGF-beta in areas of inflammatory cell infiltrates and fibrosis suggests involvement of this cytokine in the pathogenesis of radiation-induced pulmonal fibrosis. Further studies should be performed to explore the role of other cytokines in the development of radiation injury. An improved understanding of the underlying mechanisms of pulmonary fibrosis may eventually lead to modulatory intervention at the molecular level to modify the fibrotic process.
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Affiliation(s)
- C E Rube
- Department of Radiooncology, University of Munster, Munster, Germany.
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Daugey N, Bergeat A, Loison JC, Schuck A, Caubet P, Dorthe G. CN(A2Πi→X2Σ+) chemiluminescence from the N+C2N, N+CCl, and N+C2 reactions under low-pressure fast-flow conditions. Chem Phys Lett 2000. [DOI: 10.1016/s0009-2614(00)00588-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Borrosch D, Micke O, Papke K, Schaefer U, Schuck A, Schueller P, Willich N. Functional MRI in the treatment planning of conformal radiotherapy for reirradiation of malignant brain tumors. Int J Radiat Oncol Biol Phys 2000. [DOI: 10.1016/s0360-3016(00)80314-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Schuck A, Hofmann J, Rübe C, Hillmann A, Ahrens S, Paulussen M, Jürgens H, Dunst J, Willich N. Radiotherapy in Ewing's sarcoma and PNET of the chest wall: results of the trials CESS 81, CESS 86 and EICESS 92. Int J Radiat Oncol Biol Phys 1998; 42:1001-6. [PMID: 9869222 DOI: 10.1016/s0360-3016(98)00294-6] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE Treatment results and the pattern of relapse were evaluated in the multimodal treatment of Ewing's sarcomas of the chest wall. METHODS AND MATERIALS In a retrospective analysis, 114 patients with non-metastatic Ewing's sarcoma of the chest wall were evaluated. They were treated in the CESS 81, CESS 86, or EICESS 92 studies between January 1981 and December 1993. The treatment consisted of polychemotherapy (VACA, VAIA, or EVAIA) and local therapy, either surgery alone (14 patients), radiotherapy alone (28 patients) or a combination of both (71 patients). The median follow-up was 46.6 months (range 5-170). A relapse analysis for all patients with local or combined relapses was performed. RESULTS Overall survival was 60% after 5 years, event-free survival was 50%. Thirty-seven patients had a systemic relapse (32.4%), 11 patients had a local relapse alone (9.6%), and 3 patients had a combined local and systemic relapse (2.6%). The risk to relapse locally after 5 years was 0% after surgery alone, 19% after radiation alone, and 19% after postoperative irradiation. None of the 8 patients with preoperative irradiation have failed locally so far. With the introduction of central radiotherapy planning in CESS 86, local control of irradiated patients improved. Ten of 14 patients with local failure could be evaluated in the relapse analysis: 3 patients had an in-field relapse, 4 patients had a marginal relapse, 2 patients had a relapse outside the radiation fields, and 1 patient failed with pleural dissemination. Six treatment deviations were observed. CONCLUSION Local control was best after surgery alone in a positively selected group of patients. Local control after radiation or combined radiation and surgery was good. With diligent performance of radiotherapy, it will be possible to further improve the results in the radiotherapy group.
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MESH Headings
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Bone Neoplasms/drug therapy
- Bone Neoplasms/radiotherapy
- Bone Neoplasms/surgery
- Combined Modality Therapy
- Cyclophosphamide/administration & dosage
- Dactinomycin/administration & dosage
- Doxorubicin/administration & dosage
- Etoposide/administration & dosage
- Humans
- Ifosfamide/administration & dosage
- Neuroectodermal Tumors, Primitive, Peripheral/drug therapy
- Neuroectodermal Tumors, Primitive, Peripheral/radiotherapy
- Neuroectodermal Tumors, Primitive, Peripheral/surgery
- Neuroectodermal Tumors, Primitive, Peripheral/therapy
- Retrospective Studies
- Sarcoma, Ewing/drug therapy
- Sarcoma, Ewing/radiotherapy
- Sarcoma, Ewing/surgery
- Sarcoma, Ewing/therapy
- Thorax
- Vincristine/administration & dosage
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Affiliation(s)
- A Schuck
- Department of Radiotherapy, University of Muenster, Germany
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Dunst J, Paulussen M, Ahrens S, Craft A, Rübe C, Winkelmann W, Schuck A, Zoubek A, Jürgens H. Bilateral lung irradiation improves survival in Ewing's sarcoma patients with lung metastases at diagnosis: An analysis of 114 consecutive patients in the (EI) CESS-studies. Int J Radiat Oncol Biol Phys 1998. [DOI: 10.1016/s0360-3016(98)80218-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Schuck A, Rűbe C, Hillmann A, Paulussen M, Jűrgens H, Willich N. Intraoperative HDR brachytherapy of Ewing's sarcoma. Eur J Cancer 1997. [DOI: 10.1016/s0959-8049(97)84924-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Schuck A, Rübe C, Hofmann J, Paulussen M, Dunst J, Jürgens H, Willich N. Radiotherapy in treatment of Ewing's sarcoma of the chest wall (Askin tumors). Eur J Cancer 1997. [DOI: 10.1016/s0959-8049(97)85087-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Hillmann A, Ozaki T, Rübe C, Hoffmann C, Schuck A, Blasius S, Haas A, Jürgens H, Winkelmann W. Surgical complications after preoperative irradiation of Ewing's sarcoma. J Cancer Res Clin Oncol 1997; 123:57-62. [PMID: 8996542 DOI: 10.1007/bf01212616] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The influence of preoperative irradiation on surgical complications in 42 patients with Ewing's sarcoma was analysed. After preoperative irradiation and chemotherapy, 35 of 40 patients showed a good histological response and 25 of 40 patients had no viable tumour cells in the resected specimen. Local relapse alone did not develop, local relapse and metastasis developed in 2 patients and metastasis alone in 15 patients. Surgical complications appeared in 12 of 42 patients: 9 of 19 central tumours (19 pelvic lesions), 1 of 13 proximal and 2 of 10 distal tumours. Surgical complications after preoperative irradiation are distributed as follows: delayed wound healing 8, hematoma 2, thrombosis 2, skin infection 1, and abscess 1. On the other hand, complications appeared in 2 of 28 patients without preoperative irradiation: none in 9 patients having central tumours including 2 pelvic lesions, 1 in 12 patients with proximal tumours, and 1 in 7 patients with distal tumours. The multivariate regression test showed that the tumour site (central) is an influencing factor in the appearance of surgical complications. In central tumours, the surgical complication rate increases after preoperative irradiation; however, it is affected by the increase of the ratio of patients with pelvic tumours.
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Affiliation(s)
- A Hillmann
- Department of Orthopaedics, Westfalische Wilhelms-University, Müster, Germany
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Schuck A, Willich N, Rübe C, Hillmann A, Winkelmann W, Jürgens H. Intraoperative high-dose-rate brachytherapy after preoperative radiochemotherapy in the treatment of Ewing's sarcoma. Front Radiat Ther Oncol 1997; 31:153-6. [PMID: 9263811 DOI: 10.1159/000061183] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- A Schuck
- Department of Radiotherapy, University of Münster, Germany
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Rübe C, Hampel G, Schuck A, Willich N. [Combined effect of Paclitaxel and ionizing radiation. Experimental data of in-vitro and in-vivo models]. Strahlenther Onkol 1996; 172 Suppl 1:2-5. [PMID: 8633269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- C Rübe
- Klinik für Strahlentherapie Radioonkologie der Westfälischen Wilhelms-Universität Münster
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Schuck A, Rübe C, Hofmann J, Hoffmann C, Dunst J, Pötter R, Jürgens H, Willich N. 311The role of radiotherapy in the multimodal treatment of Ewing's sarcoma of the chest walk (Askin tumors). Radiother Oncol 1996. [DOI: 10.1016/s0167-8140(96)80320-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Rübe C, Schuck A, Hillmann A, Paulussen M, Jürgens H, Willich N. 710Intraoperative HDR brachytherapy of Ewing's sarcoma. Radiother Oncol 1996. [DOI: 10.1016/s0167-8140(96)80719-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Rüber C, Schuck A, Hillmann A, Dunst J, Jürgens H, Willich N. 679Preoperative simultaneous radiochemotherapy in the treatment of Ewing's sarcoma. Radiother Oncol 1996. [DOI: 10.1016/s0167-8140(96)80688-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Abstract
We report on a case of secondary syphilis that became clinically manifest as partially erosive, almost asymptomatic lesions of the oral mucosa. Dark-field microscopy, typical serological parameters and the presence of spirochetes in the biopsy material promptly led to the diagnosis. Depending on the clinical picture, the possibility of syphilis should not be overlooked in the differential diagnosis of disease of the oral mucosa.
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Affiliation(s)
- P Thomas
- Dermatologische Klinik und Poliklinik, Ludwig-Maximilians-Universität, München
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