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Niewald M, Moumeniahangar S, Müller LN, Hautmann MG, Dzierma Y, Fleckenstein J, Gräber S, Rübe C, Hecht M, Melchior P. ArthroRad trial: randomized multicenter single-blinded trial on the effect of low-dose radiotherapy for painful osteoarthritis-final results after 12-month follow-up. Strahlenther Onkol 2024; 200:134-142. [PMID: 37815599 PMCID: PMC10806033 DOI: 10.1007/s00066-023-02152-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 09/01/2023] [Indexed: 10/11/2023]
Abstract
OBJECTIVE Updated report about the randomized comparison of the effect of radiotherapy on painful osteoarthritis (OA) applying a standard dose vs. a very low dose regime after a follow-up of 1 year. PATIENTS AND METHODS Patients presenting with OA of the hand/finger and knee joints were included. After randomization (every joint region was randomized separately) the following protocols were applied: (a) standard arm: total dose 3.0 Gy, single fractions of 0.5 Gy twice a week; (b) experimental arm: total dose 0.3 Gy, single fractions of 0.05 Gy twice a week. The dosage was blinded for the patients. For evaluation the scores after 1‑year visual analog scale (VAS), Knee Injury and Osteoarthritis Outcome Score-Short Form (KOOS-PS), Short Form Score for the Assessment and Quantification of Chronic Rheumatic Affections of the Hands (SF-SACRAH) and 12-item Short-Form Health Survey (SF-12) were used (for further details: see [1]). RESULTS The standard dose was applied to 77 hands and 33 knees, the experimental dose was given to 81 hands and 30 knees. After 12 months, the data of 128 hands and 45 knees were available for evaluation. Even after this long time, we observed a favorable response of pain to radiotherapy in both trial arms; however, there were no reasonable statistically significant differences between both arms concerning pain, functional, and quality of life scores. Side effects did not occur. The only prognostic factor was the pain level before radiotherapy. CONCLUSIONS We found a favorable pain relief and a limited response in the functional and quality of life scores in both treatment arms. The possible effect of low doses such as 0.3 Gy on pain is widely unknown.
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Affiliation(s)
- Marcus Niewald
- Department of Radiotherapy and Radiooncology, Saarland University Medical Center Homburg/Saar, Homburg/Saar, Germany.
- , Mühlstraße 28, 66894, Bechhofen, Germany.
| | - Sobhan Moumeniahangar
- Department of Radiotherapy and Radiooncology, Saarland University Medical Center Homburg/Saar, Homburg/Saar, Germany
| | - Lara N Müller
- Department of Radiotherapy and Radiooncology, Saarland University Medical Center Homburg/Saar, Homburg/Saar, Germany
| | - Matthias G Hautmann
- Department of Radiotherapy and Radiooncology, Clinics of South-East Bavaria, Traunstein, Germany
| | - Yvonne Dzierma
- Department of Radiotherapy and Radiooncology, Saarland University Medical Center Homburg/Saar, Homburg/Saar, Germany
| | - Jochen Fleckenstein
- Department of Radiotherapy and Radiooncology, Saarland University Medical Center Homburg/Saar, Homburg/Saar, Germany
| | - Stefan Gräber
- Institute for Medical Biometry, Epidemiology and Medical Informatics, Saarland University Medical Center, Homburg/Saar, Germany
| | - Christian Rübe
- Department of Radiotherapy and Radiooncology, Saarland University Medical Center Homburg/Saar, Homburg/Saar, Germany
| | - Markus Hecht
- Department of Radiotherapy and Radiooncology, Saarland University Medical Center Homburg/Saar, Homburg/Saar, Germany
| | - Patrick Melchior
- Department of Radiotherapy and Radiooncology, Saarland University Medical Center Homburg/Saar, Homburg/Saar, Germany
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Schütte W, Gütz S, Nehls W, Blum TG, Brückl W, Buttmann-Schweiger N, Büttner R, Christopoulos P, Delis S, Deppermann KM, Dickgreber N, Eberhardt W, Eggeling S, Fleckenstein J, Flentje M, Frost N, Griesinger F, Grohé C, Gröschel A, Guckenberger M, Hecker E, Hoffmann H, Huber RM, Junker K, Kauczor HU, Kollmeier J, Kraywinkel K, Krüger M, Kugler C, Möller M, Nestle U, Passlick B, Pfannschmidt J, Reck M, Reinmuth N, Rübe C, Scheubel R, Schumann C, Sebastian M, Serke M, Stoelben E, Stuschke M, Thomas M, Tufman A, Vordermark D, Waller C, Wolf J, Wolf M, Wormanns D. [Prevention, Diagnosis, Therapy, and Follow-up of Lung Cancer - Interdisciplinary Guideline of the German Respiratory Society and the German Cancer Society - Abridged Version]. Pneumologie 2023; 77:671-813. [PMID: 37884003 DOI: 10.1055/a-2029-0134] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
The current S3 Lung Cancer Guidelines are edited with fundamental changes to the previous edition based on the dynamic influx of information to this field:The recommendations include de novo a mandatory case presentation for all patients with lung cancer in a multidisciplinary tumor board before initiation of treatment, furthermore CT-Screening for asymptomatic patients at risk (after federal approval), recommendations for incidental lung nodule management , molecular testing of all NSCLC independent of subtypes, EGFR-mutations in resectable early stage lung cancer in relapsed or recurrent disease, adjuvant TKI-therapy in the presence of common EGFR-mutations, adjuvant consolidation treatment with checkpoint inhibitors in resected lung cancer with PD-L1 ≥ 50%, obligatory evaluation of PD-L1-status, consolidation treatment with checkpoint inhibition after radiochemotherapy in patients with PD-L1-pos. tumor, adjuvant consolidation treatment with checkpoint inhibition in patients withPD-L1 ≥ 50% stage IIIA and treatment options in PD-L1 ≥ 50% tumors independent of PD-L1status and targeted therapy and treatment option immune chemotherapy in first line SCLC patients.Based on the current dynamic status of information in this field and the turnaround time required to implement new options, a transformation to a "living guideline" was proposed.
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Affiliation(s)
- Wolfgang Schütte
- Klinik für Innere Medizin II, Krankenhaus Martha Maria Halle-Dölau, Halle (Saale)
| | - Sylvia Gütz
- St. Elisabeth-Krankenhaus Leipzig, Abteilung für Innere Medizin I, Leipzig
| | - Wiebke Nehls
- Klinik für Palliativmedizin und Geriatrie, Helios Klinikum Emil von Behring
| | - Torsten Gerriet Blum
- Helios Klinikum Emil von Behring, Klinik für Pneumologie, Lungenklinik Heckeshorn, Berlin
| | - Wolfgang Brückl
- Klinik für Innere Medizin 3, Schwerpunkt Pneumologie, Klinikum Nürnberg Nord
| | | | - Reinhard Büttner
- Institut für Allgemeine Pathologie und Pathologische Anatomie, Uniklinik Köln, Berlin
| | | | - Sandra Delis
- Helios Klinikum Emil von Behring, Klinik für Pneumologie, Lungenklinik Heckeshorn, Berlin
| | | | - Nikolas Dickgreber
- Klinik für Pneumologie, Thoraxonkologie und Beatmungsmedizin, Klinikum Rheine
| | | | - Stephan Eggeling
- Vivantes Netzwerk für Gesundheit, Klinikum Neukölln, Klinik für Thoraxchirurgie, Berlin
| | - Jochen Fleckenstein
- Klinik für Strahlentherapie und Radioonkologie, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Homburg
| | - Michael Flentje
- Klinik und Poliklinik für Strahlentherapie, Universitätsklinikum Würzburg, Würzburg
| | - Nikolaj Frost
- Medizinische Klinik mit Schwerpunkt Infektiologie/Pneumologie, Charite Universitätsmedizin Berlin, Berlin
| | - Frank Griesinger
- Klinik für Hämatologie und Onkologie, Pius-Hospital Oldenburg, Oldenburg
| | | | - Andreas Gröschel
- Klinik für Pneumologie und Beatmungsmedizin, Clemenshospital, Münster
| | | | | | - Hans Hoffmann
- Klinikum Rechts der Isar, TU München, Sektion für Thoraxchirurgie, München
| | - Rudolf M Huber
- Medizinische Klinik und Poliklinik V, Thorakale Onkologie, LMU Klinikum Munchen
| | - Klaus Junker
- Klinikum Oststadt Bremen, Institut für Pathologie, Bremen
| | - Hans-Ulrich Kauczor
- Klinikum der Universität Heidelberg, Abteilung Diagnostische Radiologie, Heidelberg
| | - Jens Kollmeier
- Helios Klinikum Emil von Behring, Klinik für Pneumologie, Lungenklinik Heckeshorn, Berlin
| | | | - Marcus Krüger
- Klinik für Thoraxchirurgie, Krankenhaus Martha-Maria Halle-Dölau, Halle-Dölau
| | | | - Miriam Möller
- Krankenhaus Martha-Maria Halle-Dölau, Klinik für Innere Medizin II, Halle-Dölau
| | - Ursula Nestle
- Kliniken Maria Hilf, Klinik für Strahlentherapie, Mönchengladbach
| | | | - Joachim Pfannschmidt
- Klinik für Thoraxchirurgie, Lungenklinik Heckeshorn, Helios Klinikum Emil von Behring, Berlin
| | - Martin Reck
- Lungeclinic Grosshansdorf, Pneumologisch-onkologische Abteilung, Grosshansdorf
| | - Niels Reinmuth
- Klinik für Pneumologie, Thorakale Onkologie, Asklepios Lungenklinik Gauting, Gauting
| | - Christian Rübe
- Klinik für Strahlentherapie und Radioonkologie, Universitätsklinikum des Saarlandes, Homburg/Saar, Homburg
| | | | | | - Martin Sebastian
- Medizinische Klinik II, Universitätsklinikum Frankfurt, Frankfurt
| | - Monika Serke
- Zentrum für Pneumologie und Thoraxchirurgie, Lungenklinik Hemer, Hemer
| | | | - Martin Stuschke
- Klinik und Poliklinik für Strahlentherapie, Universitätsklinikum Essen, Essen
| | - Michael Thomas
- Thoraxklinik am Univ.-Klinikum Heidelberg, Thorakale Onkologie, Heidelberg
| | - Amanda Tufman
- Medizinische Klinik und Poliklinik V, Thorakale Onkologie, LMU Klinikum München
| | - Dirk Vordermark
- Universitätsklinik und Poliklinik für Strahlentherapie, Universitätsklinikum Halle, Halle
| | - Cornelius Waller
- Klinik für Innere Medizin I, Universitätsklinikum Freiburg, Freiburg
| | | | - Martin Wolf
- Klinikum Kassel, Klinik für Onkologie und Hämatologie, Kassel
| | - Dag Wormanns
- Evangelische Lungenklinik, Radiologisches Institut, Berlin
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Rübe CE, Raid S, Palm J, Rübe C. Radiation-Induced Brain Injury: Age Dependency of Neurocognitive Dysfunction Following Radiotherapy. Cancers (Basel) 2023; 15:cancers15112999. [PMID: 37296960 DOI: 10.3390/cancers15112999] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 05/18/2023] [Accepted: 05/20/2023] [Indexed: 06/12/2023] Open
Abstract
Cranial radiotherapy is a known risk factor for neurocognitive impairment in cancer survivors. Although radiation-induced cognitive dysfunction is observed in patients of all ages, children seem to be more vulnerable than adults to suffering age-related deficits in neurocognitive skills. So far, the underlying mechanisms by which IR negatively influences brain functions as well as the reasons for the profound age dependency are still insufficiently known. We performed a comprehensive Pubmed-based literature search to identify original research articles that reported on age dependency of neurocognitive dysfunction following cranial IR exposure. Numerous clinical trials in childhood cancer survivors indicate that the severity of radiation-induced cognitive dysfunction is clearly dependent on age at IR exposure. These clinical findings were related to the current state of experimental research providing important insights into the age dependency of radiation-induced brain injury and the development of neurocognitive impairment. Research in pre-clinical rodent models demonstrates age-dependent effects of IR exposure on hippocampal neurogenesis, radiation-induced neurovascular damage and neuroinflammation.
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Affiliation(s)
- Claudia E Rübe
- Department of Radiation Oncology, Saarland University Medical Center, Kirrbergerstrasse Building 6.5, 66421 Homburg, Germany
| | - Silvia Raid
- Department of Radiation Oncology, Saarland University Medical Center, Kirrbergerstrasse Building 6.5, 66421 Homburg, Germany
| | - Jan Palm
- Department of Radiation Oncology, Saarland University Medical Center, Kirrbergerstrasse Building 6.5, 66421 Homburg, Germany
| | - Christian Rübe
- Department of Radiation Oncology, Saarland University Medical Center, Kirrbergerstrasse Building 6.5, 66421 Homburg, Germany
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Altergot A, Schürmann M, Jungert T, Auerbach H, Nüsken F, Palm J, Rübe C, Rübe CE, Dzierma Y. Imaging doses for different CBCT protocols on the Halcyon 3.0 linear accelerator - TLD measurements in an anthropomorphic phantom. Z Med Phys 2023:S0939-3889(23)00039-9. [PMID: 37088675 DOI: 10.1016/j.zemedi.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 02/28/2023] [Accepted: 03/07/2023] [Indexed: 04/25/2023]
Abstract
INTRODUCTION Image guided radiotherapy allows for particularly conformal tumour irradiation through precise patient positioning. Becoming the standard for radiotherapy, this increases imaging doses to the patient. The Halcyon 3.0 linear accelerator (Varian Medical Systems, Palo Alto, CA) requires daily imaging due to its geometry. For this reason, the accelerator is equipped with on-line kV and MV imaging. However, daily CBCT images required for irradiation apply additional radiation, which increases the dose to normal tissue and therefore can affect the patient's secondary cancer risk. In this study, actual organ doses were measured for the kV system, and a comparison of normal tissue doses for all available kV CBCT protocols was presented to demonstrate differences in imaging doses across entities and protocols. In addition, effective dose and secondary cancer risk from imaging are evaluated. MATERIAL AND METHODS Measurements were performed with thermoluminescent dosimeters in an anthropomorphic phantom positioned according to each entity (brain, head and neck, breast, lung, pelvis). CBCT images were obtained, using all available pre-set protocols without further adjustment of the parameters. Measured doses for each position and each protocol were then compared and secondary cancer risk of relevant and specifically radiosensitive organs was calculated. RESULTS It was found that imaging doses for protocols such as Pelvis and Head could be reduced by up to half using the corresponding Fast and Low Dose modes, respectively. On the other hand, larger field sizes or the Large mode yielded higher doses than their initial protocols. Image Gently was found to spare normal tissue best, however it is not suitable for certain entities due to low image quality or insufficient projection data. DISCUSSION By using appropriate kV-CBCT protocols, it is possible to reduce imaging doses to a significant extent and therefore spare healthy tissue. Combined with studies of image quality, the results of this study could lead to adjustments in workflow regarding the choice of protocols used in daily routine. This could prevent unnecessary radiation exposure and reduce secondary cancer risk.
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Affiliation(s)
- Angelika Altergot
- Department of Radiotherapy and Radiation Oncology, Saarland University Medical Centre, Homburg/Saar, Germany.
| | - Michaela Schürmann
- Department of Radiotherapy and Radiation Oncology, Saarland University Medical Centre, Homburg/Saar, Germany
| | - Tanja Jungert
- Department of Radiotherapy and Radiation Oncology, Saarland University Medical Centre, Homburg/Saar, Germany
| | - Hendrik Auerbach
- Department of Radiotherapy and Radiation Oncology, Saarland University Medical Centre, Homburg/Saar, Germany
| | - Frank Nüsken
- Department of Radiotherapy and Radiation Oncology, Saarland University Medical Centre, Homburg/Saar, Germany
| | - Jan Palm
- Department of Radiotherapy and Radiation Oncology, Saarland University Medical Centre, Homburg/Saar, Germany
| | - Christian Rübe
- Department of Radiotherapy and Radiation Oncology, Saarland University Medical Centre, Homburg/Saar, Germany
| | - Claudia E Rübe
- Department of Radiotherapy and Radiation Oncology, Saarland University Medical Centre, Homburg/Saar, Germany
| | - Yvonne Dzierma
- Department of Radiotherapy and Radiation Oncology, Saarland University Medical Centre, Homburg/Saar, Germany
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Auerbach H, Dzierma Y, Schürmann M, Rübe C, Rübe CE. Measuring out-of-field dose to the hippocampus in common radiotherapy indications. Radiat Oncol 2023; 18:64. [PMID: 37029409 PMCID: PMC10080875 DOI: 10.1186/s13014-023-02242-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 03/06/2023] [Indexed: 04/09/2023] Open
Abstract
BACKGROUND The high susceptibility of the hippocampus region to radiation injury is likely the causal factor of neurocognitive dysfunctions after exposure to ionizing radiation. Repetitive exposures with even low doses have been shown to impact adult neurogenesis and induce neuroinflammation. We address the question whether the out-of-field doses during radiotherapy of common tumour entities may pose a risk for the neuronal stem cell compartment in the hippocampus. METHODS The dose to the hippocampus was determined for a single fraction according to different treatment plans for the selected tumor entities: Point dose measurements were performed in an anthropomorphic Alderson phantom and the out-of-field dose to the hippocampus was measured using thermoluminescence dosimeters. RESULTS For carcinomas in the head and neck region the dose exposure to the hippocampal region for a single fraction ranged from to 37.4 to 154.8 mGy. The hippocampal dose was clearly different for naso-, oro- and hypopharynx, with maximal values for nasopharynx carcinoma. In contrast, hippocampal dose levels for breast and prostate cancer ranged between 2.7 and 4.1 mGy, and therefore significantly exceeded the background irradiation level. CONCLUSION The mean dose to hippocampus for treatment of carcinomas in the head and neck region is high enough to reduce neurocognitive functions. In addition, care must be taken regarding the out of field doses. The mean dose is mainly related to scattering effects, as is confirmed by the data from breast or prostate treatments, with a very different geometrical set-up but similar dosimetric results.
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Affiliation(s)
- Hendrik Auerbach
- Department of Radiation Oncology, Saarland University Medical Center, Homburg, Saar, Germany.
| | - Yvonne Dzierma
- Department of Radiation Oncology, Saarland University Medical Center, Homburg, Saar, Germany
| | - Michaela Schürmann
- Department of Radiation Oncology, Saarland University Medical Center, Homburg, Saar, Germany
| | - Christian Rübe
- Department of Radiation Oncology, Saarland University Medical Center, Homburg, Saar, Germany
| | - Claudia E Rübe
- Department of Radiation Oncology, Saarland University Medical Center, Homburg, Saar, Germany
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McAleer MF, Melchior P, Parkes J, Pater L, Rübe C, Saunders D, Paulino AC, Janssens GO, Kalapurakal J. Harmonica consensus, controversies, and future directions in radiotherapy for pediatric Wilms tumors. Pediatr Blood Cancer 2022; 70 Suppl 2:e30090. [PMID: 36482883 DOI: 10.1002/pbc.30090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 10/16/2022] [Accepted: 10/18/2022] [Indexed: 12/13/2022]
Abstract
Radiotherapy (RT) is essential for multimodality treatment of pediatric renal tumors, particularly in higher-risk and metastatic disease. Despite decades of use, particularly for Wilms tumor, there remain controversies regarding RT indications, timing, dose, and targets. To align global management, we address these issues in this international HARMONIsation and CollAboration (HARMONICA) project. There are multiple knowledge gaps and opportunities for future research including: (1) utilization of advanced RT technologies, including intensity-modulated RT, proton beam therapy, combined with image-guided RT to reduce target volumes; (2) impact of molecular biomarkers including loss of heterozygosity at 1p, 16q, and 1q gain on RT indications; (3) mitigation of reproductive toxicity following RT; (4) promotion of RT late effects research; and (5) support to overcome challenges in RT utilization in low- and middle-income countries where 90% of the world's children reside. Here, we outline current status and future directions for RT in pediatric renal tumors.
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Affiliation(s)
- Mary Frances McAleer
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Patrick Melchior
- Department of Radiation Oncology, Saarland University Hospital, Homburg, Germany
| | - Jeannette Parkes
- Department of Radiation Oncology, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa.,Low- and Middle-Income Countries Committee Co-Chair, Paediatric Radiation Oncology Society, Cape Town, South Africa
| | - Luke Pater
- Department of Radiation Oncology, University of Cincinnati, Cincinnati, Ohio, USA
| | - Christian Rübe
- Department of Radiation Oncology, Saarland University Hospital, Homburg, Germany
| | | | - Arnold C Paulino
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Geert O Janssens
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - John Kalapurakal
- Department of Radiation Oncology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
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Vogel M, Gade J, Timm B, Schürmann M, Auerbach H, Nüsken F, Rübe C, Melchior P, Dzierma Y. Comparison of Breast Cancer Radiotherapy Techniques Regarding Secondary Cancer Risk and Normal Tissue Complication Probability - Modelling and Measurements Using a 3D-Printed Phantom. Front Oncol 2022; 12:892923. [PMID: 35965556 PMCID: PMC9365503 DOI: 10.3389/fonc.2022.892923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 06/15/2022] [Indexed: 11/13/2022] Open
Abstract
Background Radiotherapy after breast-conserving therapy is a standard postoperative treatment of breast cancer, which can be carried out with a variety of irradiation techniques. The treatment planning must take into consideration detrimental effects on the neighbouring organs at risk-the lung, the heart, and the contralateral breast, which can include both short- and long-term effects represented by the normal tissue complication probability and secondary cancer risk. Patients and Methods In this planning study, we investigate intensity-modulated (IMRT) and three-dimensional conformal (3D-CRT) radiotherapy techniques including sequential or simultaneously integrated boosts as well as interstitial multicatheter brachytherapy boost techniques of 38 patients with breast-conserving surgery retrospectively. We furthermore develop a 3D-printed breast phantom add-on to allow for catheter placement and to measure the out-of-field dose using thermoluminescent dosimeters placed inside an anthropomorphic phantom. Finally, we estimate normal tissue complication probabilities using the Lyman-Kutcher-Burman model and secondary cancer risks using the linear non-threshold model (out-of-field) and the model by Schneider et al. (in-field). Results The results depend on the combination of primary whole-breast irradiation and boost technique. The normal tissue complication probabilities for various endpoints are of the following order: 1%-2% (symptomatic pneumonitis, ipsilateral lung), 2%-3% (symptomatic pneumonitis, whole lung), and 1%-2% (radiation pneumonitis grade ≥ 2, whole lung). The additional relative risk of ischemic heart disease ranges from +25% to +35%. In-field secondary cancer risk of the ipsilateral lung in left-sided treatment is around 50 per 10,000 person-years for 20 years after exposure at age 55. Out-of-field estimation of secondary cancer risk results in approximately 5 per 10,000 person-years each for the contralateral lung and breast. Conclusions In general, 3D-CRT shows the best risk reduction in contrast to IMRT. Regarding the boost concepts, brachytherapy is the most effective method in order to minimise normal tissue complication probability and secondary cancer risk compared to teletherapy boost concepts. Hence, the 3D-CRT technique in combination with an interstitial multicatheter brachytherapy boost is most suitable in terms of risk avoidance for treating breast cancer with techniques including boost concepts.
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Affiliation(s)
- Marc Vogel
- Department of Radiotherapy and Radiation Oncology, Saarland University Medical Centre, Homburg, Germany
| | - Jonas Gade
- Department of Radiotherapy and Radiation Oncology, Saarland University Medical Centre, Homburg, Germany
| | - Bernd Timm
- Siemens Healthcare GmbH, Technical Service, Erlangen, Germany
| | - Michaela Schürmann
- Department of Radiotherapy and Radiation Oncology, Saarland University Medical Centre, Homburg, Germany
| | - Hendrik Auerbach
- Department of Radiotherapy and Radiation Oncology, Saarland University Medical Centre, Homburg, Germany
| | - Frank Nüsken
- Department of Radiotherapy and Radiation Oncology, Saarland University Medical Centre, Homburg, Germany
| | - Christian Rübe
- Department of Radiotherapy and Radiation Oncology, Saarland University Medical Centre, Homburg, Germany
| | - Patrick Melchior
- Department of Radiotherapy and Radiation Oncology, Saarland University Medical Centre, Homburg, Germany
| | - Yvonne Dzierma
- Department of Radiotherapy and Radiation Oncology, Saarland University Medical Centre, Homburg, Germany
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Groenendijk A, van Tinteren H, Jiang Y, de Krijger RR, Vujanic GM, Godzinski J, Rübe C, Schenk JP, Morosi C, Pritchard-Jones K, Al-Saadi R, Vaidya SJ, Verschuur AC, Ramírez-Villar GL, Graf N, de Camargo B, Drost J, Perotti D, van den Heuvel-Eibrink MM, Brok J, Spreafico F, Mavinkurve-Groothuis AMC. Outcome of SIOP patients with low- or intermediate-risk Wilms tumour relapsing after initial vincristine and actinomycin-D therapy only - the SIOP 93-01 and 2001 protocols. Eur J Cancer 2022; 163:88-97. [PMID: 35042071 DOI: 10.1016/j.ejca.2021.12.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 11/25/2021] [Accepted: 12/07/2021] [Indexed: 11/03/2022]
Abstract
PURPOSE Society of International Pediatric Oncology - Renal Tumor Study Group (SIOP-RTSG) treatment recommendations for relapsed Wilms tumour (WT) are stratified by the intensity of first-line treatment. To explore the evidence for the treatment of patients relapsing after vincristine and actinomycin-D (VA) treatment for primary WT, we retrospectively evaluated rescue treatment and survival of this patient group. PATIENTS AND METHODS We included 109 patients with relapse after VA therapy (no radiotherapy) for stage I-II primary low- or intermediate-risk WT from the SIOP 93-01 and SIOP 2001 studies. Univariate Cox regression analysis was performed to study the effect of relapse treatment intensity on event-free survival (EFS) and overall survival (OS). Relapse treatment intensity was classified into vincristine, actinomycin-D, and either doxorubicin or epirubicin (VAD), and more intensive therapies (ifosfamide/carboplatin/etoposide [ICE]/≥ 4 drugs/high-dose chemotherapy with haematopoietic stem cell transplantation [HD HSCT]). RESULTS Relapse treatment regimens included either VAD, or cyclophosphamide/carboplatin/etoposide/doxorubicin (CyCED), or ICE backbones. Radiotherapy was administered in 62 patients and HD HSCT in 15 patients. Overall, 5-year EFS and OS after relapse were 72.3% (95% confidence interval [CI]: 64.0-81.6%) and 79.3% (95% CI: 71.5-88.0%), respectively. Patients treated with VAD did not fare worse when compared with patients treated with more intensive therapies (hazard ratio EFS: 0.611 [95% CI: 0.228-1.638] [p-value = 0.327] and hazard ratio OS: 0.438 [95% CI: 0.126-1.700] [p-value = 0.193]). CONCLUSION Patients with relapsed WT after initial VA-only treatment showed no inferior EFS and OS when treated with VAD regimens compared with more intensive rescue regimens. A subset of patients relapsing after VA may benefit from less intensive rescue treatment than ICE/CyCED-based regimens and deserve to be pinpointed by identifying additional (molecular) prognostic factors in future studies.
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Affiliation(s)
- Alissa Groenendijk
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands.
| | - Harm van Tinteren
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Yilin Jiang
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Ronald R de Krijger
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands; Department of Pathology, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | - Jan Godzinski
- Department of Pediatric Surgery, Marciniak Hospital, Wroclaw, Poland; Department of Pediatric Traumatology and Emergency Medicine, Medical University Wroclaw, Poland
| | - Christian Rübe
- Department of Radiation Oncology, Saarland University Medical Center, Saarland University Faculty of Medicine, Homburg, Germany
| | - Jens-Peter Schenk
- Department of Diagnostic and Interventional Radiology, Division of Pediatric Radiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Carlo Morosi
- Department of Radiology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Kathy Pritchard-Jones
- Developmental Biology and Cancer Research and Teaching Department, University College London Great Ormond Street Institute of Child Health, London, UK
| | - Reem Al-Saadi
- Developmental Biology and Cancer Research and Teaching Department, University College London Great Ormond Street Institute of Child Health, London, UK; Department of Histopathology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Sucheta J Vaidya
- Children and Young People's Unit, The Royal Marsden Hospital, Sutton, UK
| | - Arnauld C Verschuur
- Department of Pediatric Oncology, Hôpital d'Enfants de la Timone, Marseille, France
| | - Gema L Ramírez-Villar
- Department of Pediatric Oncology, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Norbert Graf
- Department of Pediatric Oncology and Hematology, Saarland University Medical Center, Saarland University Faculty of Medicine, Homburg, Germany
| | - Beatriz de Camargo
- Pediatric Hematology and Oncology Program, Research Center, Instituto Nacional de Cancer, Rio de Janeiro, Brazil
| | - Jarno Drost
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands; Oncode Institute, Utrecht, the Netherlands
| | - Daniela Perotti
- Molecular Bases of Genetic Risk and Genetic Testing Unit, Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Jesper Brok
- Developmental Biology and Cancer Research and Teaching Department, University College London Great Ormond Street Institute of Child Health, London, UK; Department of Pediatric Oncology and Hematology, Rigshospitalet, Copenhagen, Denmark
| | - Filippo Spreafico
- Department of Medical Oncology and Hematology, Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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9
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Schuermann M, Dzierma Y, Nuesken F, Oertel J, Rübe C, Melchior P. Automatic Radiotherapy Planning for Glioblastoma Radiotherapy With Sparing of the Hippocampus and nTMS-Defined Motor Cortex. Front Neurol 2022; 12:787140. [PMID: 35095732 PMCID: PMC8795623 DOI: 10.3389/fneur.2021.787140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 12/06/2021] [Indexed: 11/13/2022] Open
Abstract
BackgroundNavigated transcranial magnetic stimulation (nTMS) of the motor cortex has been successfully implemented into radiotherapy planning by a number of studies. Furthermore, the hippocampus has been identified as a radiation-sensitive structure meriting particular sparing in radiotherapy. This study assesses the joint protection of these two eloquent brain regions for the treatment of glioblastoma (GBM), with particular emphasis on the use of automatic planning.Patients and MethodsPatients with motor-eloquent brain glioblastoma who underwent surgical resection after nTMS mapping of the motor cortex and adjuvant radiotherapy were retrospectively evaluated. The radiotherapy treatment plans were retrieved, and the nTMS-defined motor cortex and hippocampus contours were added. Four additional treatment plans were created for each patient: two manual plans aimed to reduce the dose to the motor cortex and hippocampus by manual inverse planning. The second pair of re-optimized plans was created by the Auto-Planning algorithm. The optimized plans were compared with the “Original” plan regarding plan quality, planning target volume (PTV) coverage, and sparing of organs at risk (OAR).ResultsA total of 50 plans were analyzed. All plans were clinically acceptable with no differences in the PTV coverage and plan quality metrics. The OARs were preserved in all plans; however, overall the sparing was significantly improved by Auto-Planning. Motor cortex protection was feasible and significant, amounting to a reduction in the mean dose by >6 Gy. The dose to the motor cortex outside the PTV was reduced by >12 Gy (mean dose) and >5 Gy (maximum dose). The hippocampi were significantly improved (reduction in mean dose: ipsilateral >6 Gy, contralateral >4.6 Gy; reduction in maximum dose: ipsilateral >5 Gy, contralateral >5 Gy). While the dose reduction using Auto-Planning was generally better than by manual optimization, the radiated total monitor units were significantly increased.ConclusionConsiderable dose sparing of the nTMS-motor cortex and hippocampus could be achieved with no disadvantages in plan quality. Auto-Planning could further contribute to better protection of OAR. Whether the improved dosimetric protection of functional areas can translate into improved quality of life and motor or cognitive performance of the patients can only be decided by future studies.
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Affiliation(s)
- Michaela Schuermann
- Department of Radiotherapy and Radiation Oncology, Saarland University Hospital, Homburg, Germany
- *Correspondence: Michaela Schuermann
| | - Yvonne Dzierma
- Department of Radiotherapy and Radiation Oncology, Saarland University Hospital, Homburg, Germany
| | - Frank Nuesken
- Department of Radiotherapy and Radiation Oncology, Saarland University Hospital, Homburg, Germany
| | - Joachim Oertel
- Faculty of Medicine, Saarland University, Saarbrücken, Germany
- Department of Neurosurgery, Saarland University Hospital, Homburg, Germany
| | - Christian Rübe
- Department of Radiotherapy and Radiation Oncology, Saarland University Hospital, Homburg, Germany
| | - Patrick Melchior
- Department of Radiotherapy and Radiation Oncology, Saarland University Hospital, Homburg, Germany
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10
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Vogt T, Melchior P, Rübe C, Ugurel S, Schimming TT, Utikal J, Esser S, Helbig D, Hadaschik E, Kasper B, Grabbe S, Müller CSL. S1‐Leitlinie kutane Angiosarkome – Update 2021. J Dtsch Dermatol Ges 2021; 19:1801-1813. [PMID: 34894182 DOI: 10.1111/ddg.14524_g] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 03/22/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Thomas Vogt
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum des Saarlandes, Homburg
| | - Patrick Melchior
- Klinik und Poliklinik für Strahlentherapie, Universitätsklinikum des Saarlandes, Homburg
| | - Christian Rübe
- Klinik und Poliklinik für Strahlentherapie, Universitätsklinikum des Saarlandes, Homburg
| | - Selma Ugurel
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Essen
| | | | - Jochen Utikal
- Klinische Kooperationseinheit Dermatoonkologie des Deutschen Krebsforschungszentrum Heidelberg (DKFZ) und der Klinik für Dermatologie, Venerologie und Allergologie, Medizinische Fakultät Mannheim, Ruprecht-Karls-Universität Heidelberg
| | - Stefan Esser
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Essen
| | - Doris Helbig
- Klinik und Poliklinik für Dermatologie und Venerologie, Uniklinik Köln
| | - Eva Hadaschik
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Essen
| | - Bernd Kasper
- Sarkomzentrum, Universität Heidelberg, Universitätsmedizin Mannheim
| | - Stephan Grabbe
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Mainz
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11
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Vogt T, Müller CSL, Melchior P, Rübe C, Ugurel S, Schimming TT, Utikal J, Esser S, Helbig D, Hadaschik E, Kasper B, Grabbe S. S1-Guideline Cutaneous Angiosarcomas - Update 2021. J Dtsch Dermatol Ges 2021; 19:1801-1812. [PMID: 34821470 DOI: 10.1111/ddg.14524] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 03/22/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Thomas Vogt
- Department and Clinic for Dermatology, Venereology and Allergology, University Hospital Saarland, Homburg
| | - Cornelia S L Müller
- Department and Clinic for Dermatology, Venereology and Allergology, University Hospital Saarland, Homburg
| | - Patrick Melchior
- Department and Clinic for Radiation Therapy, University Hospital Saarland, Homburg
| | - Christian Rübe
- Department and Clinic for Radiation Therapy, University Hospital Saarland, Homburg
| | - Selma Ugurel
- Department of Dermatology, Venereology and Allergology, University Hospital Essen
| | | | - Jochen Utikal
- Cooperative Unit Dermato-Oncology at the German Cancer Research Center Heidelberg (DKFZ) and the Department of Dermatology, Venereology and Allergology, Medical Faculty Mannheim, Ruprecht-Karls University Heidelberg
| | - Stefan Esser
- Department of Dermatology, Venereology and Allergology, University Hospital Essen
| | - Doris Helbig
- Department and Clinif for Dermatology and Venereology, University Hospital Cologne
| | - Eva Hadaschik
- Department of Dermatology, Venereology and Allergology, University Hospital Essen
| | - Bernd Kasper
- Sarcoma Center, University of Heidelberg, University Hospital Mannheim
| | - Stephan Grabbe
- Department of Dermatology, Venereology and Allergology, University Mainz
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12
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Dapper H, Belka C, Bock F, Budach V, Budach W, Christiansen H, Debus J, Distel L, Dunst J, Eckert F, Eich H, Eicheler W, Engenhart-Cabillic R, Fietkau R, Fleischmann DF, Frerker B, Giordano FA, Grosu AL, Herfarth K, Hildebrandt G, Kaul D, Kölbl O, Krause M, Krug D, Martin D, Matuschek C, Medenwald D, Nicolay NH, Niewald M, Oertel M, Petersen C, Pohl F, Raabe A, Rödel C, Rübe C, Schmalz C, Schmeel LC, Steinmann D, Stüben G, Thamm R, Vordermark D, Vorwerk H, Wiegel T, Zips D, Combs SE. Integration of radiation oncology teaching in medical studies by German medical faculties due to the new licensing regulations : An overview and recommendations of the consortium academic radiation oncology of the German Society for Radiation Oncology (DEGRO). Strahlenther Onkol 2021; 198:1-11. [PMID: 34786605 PMCID: PMC8594460 DOI: 10.1007/s00066-021-01861-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 09/19/2021] [Indexed: 11/30/2022]
Abstract
The new Medical Licensing Regulations 2025 (Ärztliche Approbationsordnung, ÄApprO) will soon be passed by the Federal Council (Bundesrat) and will be implemented step by step by the individual faculties in the coming months. The further development of medical studies essentially involves an orientation from fact-based to competence-based learning and focuses on practical, longitudinal and interdisciplinary training. Radiation oncology and radiation therapy are important components of therapeutic oncology and are of great importance for public health, both clinically and epidemiologically, and therefore should be given appropriate attention in medical education. This report is based on a recent survey on the current state of radiation therapy teaching at university hospitals in Germany as well as the contents of the National Competence Based Learning Objectives Catalogue for Medicine 2.0 (Nationaler Kompetenzbasierter Lernzielkatalog Medizin 2.0, NKLM) and the closely related Subject Catalogue (Gegenstandskatalog, GK) of the Institute for Medical and Pharmaceutical Examination Questions (Institut für Medizinische und Pharmazeutische Prüfungsfragen, IMPP). The current recommendations of the German Society for Radiation Oncology (Deutsche Gesellschaft für Radioonkologie, DEGRO) regarding topics, scope and rationale for the establishment of radiation oncology teaching at the respective faculties are also included.
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Affiliation(s)
- H Dapper
- Department of Radiation Oncology, Technical University of Munich, Munich, Germany. .,German Cancer Consortium (DKTK) Partner Site (DKTK), Munich, Germany.
| | - C Belka
- Department of Radiation Oncology, LMU University Hospital, Munich, Germany.,German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Heidelberg, Germany
| | - F Bock
- Department of Radiation Oncology, Rostock University Medical Center, Rostock, Germany
| | - V Budach
- Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Radiation Oncology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - W Budach
- Department of Radiation Oncology, Medical Faculty, Heinrich Heine University, Duesseldorf, Germany
| | - H Christiansen
- Department of Radiation Oncology, Hannover Medical School (MHH), Hannover, Germany
| | - J Debus
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,Heidelberg Ion-Beam Therapy Center, Heidelberg, Germany
| | - L Distel
- Department of Radiation Oncology, University Hospital Erlangen, Erlangen, Germany
| | - J Dunst
- Department of Radiation Oncology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - F Eckert
- Department of Radiation Oncology, University of Tübingen, Tübingen, Germany.,German Cancer Consortium (DKTK) Partner Site (DKTK), Tübingen, Germany
| | - H Eich
- Department of Radiation Oncology, University of Münster, Münster, Germany
| | - W Eicheler
- OncoRay-National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany
| | - R Engenhart-Cabillic
- Department of Radiotherapy and Radiation Oncology, University of Marburg, Marburg, Germany
| | - R Fietkau
- Department of Radiation Oncology, University Hospital Erlangen, Erlangen, Germany
| | - D F Fleischmann
- Department of Radiation Oncology, LMU University Hospital, Munich, Germany.,German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Heidelberg, Germany
| | - B Frerker
- Department of Radiation Oncology, Rostock University Medical Center, Rostock, Germany
| | - F A Giordano
- Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Bonn, Germany
| | - A L Grosu
- Department of Radiation Oncology, University Medical Center Freiburg, Freiburg, Germany.,German Cancer Consortium (DKTK) Partner Site (DKTK), Freiburg, Germany
| | - K Herfarth
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,Heidelberg Ion-Beam Therapy Center, Heidelberg, Germany
| | - G Hildebrandt
- Department of Radiation Oncology, Rostock University Medical Center, Rostock, Germany
| | - D Kaul
- Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Radiation Oncology, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Partner Site Berlin, German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Heidelberg, Germany
| | - O Kölbl
- Department of Radiotherapy, University of Regensburg, Regensburg, Germany
| | - M Krause
- Department of Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.,OncoRay-National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden and Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany.,Partner Site Dresden, German Cancer Research Center (DKFZ), National Center for Tumor Diseases (NCT), Heidelberg, Germany.,Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany.,Heidelberg and German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Dresden, Germany
| | - D Krug
- Department of Radiation Oncology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - D Martin
- Department of Radiotherapy and Oncology, University Hospital, Goethe University, Frankfurt, Germany.,German Cancer Consortium (DKTK) Partner Site (DKTK), Frankfurt, Germany
| | - C Matuschek
- Department of Radiation Oncology, Medical Faculty, Heinrich Heine University, Duesseldorf, Germany
| | - D Medenwald
- Deptartment of Radiation Oncology, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - N H Nicolay
- Department of Radiation Oncology, University Medical Center Freiburg, Freiburg, Germany.,German Cancer Consortium (DKTK) Partner Site (DKTK), Freiburg, Germany
| | - M Niewald
- Department of Radiotherapy and Radiooncology, Saarland University Medical Center, Homburg, Germany
| | - M Oertel
- Department of Radiation Oncology, University of Münster, Münster, Germany
| | - C Petersen
- Department of Radiotherapy and Radio-Oncology, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - F Pohl
- Department of Radiotherapy, University of Regensburg, Regensburg, Germany
| | - A Raabe
- Department of Radiotherapy and Radio-Oncology, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - C Rödel
- Department of Radiotherapy and Oncology, University Hospital, Goethe University, Frankfurt, Germany.,German Cancer Consortium (DKTK) Partner Site (DKTK), Frankfurt, Germany
| | - C Rübe
- Department of Radiotherapy and Radiooncology, Saarland University Medical Center, Homburg, Germany
| | - C Schmalz
- Department of Radiation Oncology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - L C Schmeel
- Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Bonn, Germany
| | - D Steinmann
- Department of Radiation Oncology, Hannover Medical School (MHH), Hannover, Germany
| | - G Stüben
- Department of Radiation Oncology, University of Augsburg, Augsburg, Germany
| | - R Thamm
- Department of Radiation Oncology and Radiotherapy, University Hospital Ulm, Ulm, Germany
| | - D Vordermark
- Deptartment of Radiation Oncology, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - H Vorwerk
- Department of Radiotherapy and Radiation Oncology, University of Marburg, Marburg, Germany
| | - T Wiegel
- Department of Radiation Oncology and Radiotherapy, University Hospital Ulm, Ulm, Germany
| | - D Zips
- Department of Radiation Oncology, University of Tübingen, Tübingen, Germany.,German Cancer Consortium (DKTK) Partner Site (DKTK), Tübingen, Germany
| | - S E Combs
- Department of Radiation Oncology, Technical University of Munich, Munich, Germany.,Institute of Radiation Medicine, Department of Radiation Sciences, Helmholtz Zentrum München, Munich, Germany.,German Cancer Consortium (DKTK) Partner Site (DKTK), Munich, Germany
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13
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Niewald M, Müller LN, Hautmann MG, Dzierma Y, Melchior P, Gräber S, Rübe C, Fleckenstein J. ArthroRad trial: multicentric prospective and randomized single-blinded trial on the effect of low-dose radiotherapy for painful osteoarthritis depending on the dose-results after 3 months' follow-up. Strahlenther Onkol 2021; 198:370-377. [PMID: 34724085 PMCID: PMC8940782 DOI: 10.1007/s00066-021-01866-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 10/03/2021] [Indexed: 12/03/2022]
Abstract
Purpose Randomized comparison of the effect of radiotherapy on painful osteoarthritis (OA) applying a standard-dose vs. a very-low-dose regime Patients and methods Patients with OA of the hand and knee joints were included. Further inclusion criteria: symptoms for more than 3 months, favorable general health status, age above 40 years. Patients with prior local radiotherapy, trauma, rheumatoid arthritis, or vascular diseases were excluded. After randomization (every joint was randomized separately), the following protocols were applied: standard arm: total dose 3.0 Gy, single fractions of 0.5 Gy twice weekly; experimental arm: total dose 0.3 Gy, single fractions of 0.05 Gy twice weekly. The dosage was not known to the patients. The patients were examined 3 and 12 months after radiotherapy. Scores like VAS (visual analogue scale), KOOS-SF (the knee injugy and osteoarthritis outcome score), SF-SACRAH (short form score for the assessment and quantification of chronic rheumatic affections of the hands), and SF-12 (short form 12) were used. Results A total of 64 knees and 172 hands were randomized. 3.0 Gy was applied to 87 hands and 34 knees, 0.3 Gy was given to 85 hands and 30 knees. After 3 months, we observed good pain relief after 3 Gy and after 0.3 Gy, there was no statistically significant difference. Side effects were not recorded. The trial was closed prematurely due to slow recruitment. Conclusion We found favorable pain relief and a limited response in the functional and quality of life scores in both arms. The effect of low doses such as 0.3 Gy on pain is widely unknown. Further trials are necessary to compare a conventional dose to placebo and to further explore the effect of low doses on inflammatory disorders.
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Affiliation(s)
- Marcus Niewald
- Dept. of Radiotherapy and Radiooncology, Saarland University Medial Center, Kirrberger Str. 100, Building. 6.5, 66424, Homburg/Saar, Germany.
| | - Lara Natalie Müller
- Dept. of Radiotherapy and Radiooncology, Saarland University Medial Center, Kirrberger Str. 100, Building. 6.5, 66424, Homburg/Saar, Germany
| | | | - Yvonne Dzierma
- Dept. of Radiotherapy and Radiooncology, Saarland University Medial Center, Kirrberger Str. 100, Building. 6.5, 66424, Homburg/Saar, Germany
| | - Patrick Melchior
- Dept. of Radiotherapy and Radiooncology, Saarland University Medial Center, Kirrberger Str. 100, Building. 6.5, 66424, Homburg/Saar, Germany
| | - Stefan Gräber
- Institute for Medical Biometry, Epidemiology and Medical Informatics, Saarland University Medical Center, Homburg/Saar, Germany
| | - Christian Rübe
- Dept. of Radiotherapy and Radiooncology, Saarland University Medial Center, Kirrberger Str. 100, Building. 6.5, 66424, Homburg/Saar, Germany
| | - Jochen Fleckenstein
- Dept. of Radiotherapy and Radiooncology, Saarland University Medial Center, Kirrberger Str. 100, Building. 6.5, 66424, Homburg/Saar, Germany
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14
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Graf N, Bergeron C, Brok J, de Camargo B, Chowdhury T, Furtwängler R, Gessler M, Godzinski J, Pritchard-Jones K, Ramirez-Villar GL, Rübe C, Sandstedt B, Schenk JP, Spreafico F, Sudour-Bonnange H, van Tinteren H, Verschuur A, Vujanic G, van den Heuvel-Eibrink MM. Fifty years of clinical and research studies for childhood renal tumors within the International Society of Pediatric Oncology (SIOP). Ann Oncol 2021; 32:1327-1331. [PMID: 34416363 DOI: 10.1016/j.annonc.2021.08.1749] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 08/08/2021] [Indexed: 01/01/2023] Open
Affiliation(s)
- N Graf
- Department of Pediatric Oncology and Hematology, Saarland University, Homburg, Germany.
| | - C Bergeron
- Department of Paediatric Haemato-Oncology, Centre Léon Bérard, Lyon, France
| | - J Brok
- Department of Pediatric Oncology and Hematology, Rigshospitalet, Copenhagen, Denmark
| | - B de Camargo
- Research Center, Instituto Nacional do Cancer, Rio de Janeiro, Brazil
| | - T Chowdhury
- Department of Haematology and Oncology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - R Furtwängler
- Department of Pediatric Oncology and Hematology, Saarland University, Homburg, Germany
| | - M Gessler
- Theodor-Boveri-Institute/Biocenter and Comprehensive Cancer Center Mainfranken, University of Würzburg, Würzburg, Germany
| | - J Godzinski
- Department of Pediatric Surgery, Marciniak Hospital, Fieldorfa 2, Poland; Department of Paediatric Traumatology and Emergency Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - K Pritchard-Jones
- Developmental Biology and Cancer Research and Teaching Department, University College London Great Ormond Street Institute of Child Health, University College London, London, UK
| | - G L Ramirez-Villar
- Department of Paediatric Oncology, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - C Rübe
- Department of Radiation Oncology, Saarland University, Homburg, Germany
| | - B Sandstedt
- Childhood Cancer Research Unit, Karolinska Institutet, Stockholm, Sweden
| | - J-P Schenk
- Pediatric Radiology Section, Department for Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
| | - F Spreafico
- Department of Medical Oncology and Hematology, Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - H Sudour-Bonnange
- Centre Oscar Lambret, Department of Children and AJA Oncology, Lille, France
| | - H van Tinteren
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - A Verschuur
- Department of Pediatric Oncology, Hôpital d'Enfants de la Timone, Marseille, France
| | - G Vujanic
- Department of Pathology, Sidra Medicine and Weill Cornell Medicine - Qatar, Doha, Qatar
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15
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Theobald L, Stroeder R, Melchior P, Iordache II, Tänzer T, Port M, Glombitza B, Marx S, Schub D, Herr C, Hart M, Ludwig N, Meese E, Kim YJ, Bohle RM, Smola S, Rübe C, Solomayer EF, Walch-Rückheim B. Chemoradiotherapy-induced increase in Th17 cell frequency in cervical cancer patients is associated with therapy resistance and early relapse. Mol Oncol 2021; 15:3559-3577. [PMID: 34469022 PMCID: PMC8637579 DOI: 10.1002/1878-0261.13095] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 07/22/2021] [Accepted: 08/31/2021] [Indexed: 12/19/2022] Open
Abstract
Cervical cancer therapy is still a major clinical challenge, as patients substantially differ in their response to standard treatments, including chemoradiotherapy (CRT). During cervical carcinogenesis, T-helper (Th)-17 cells accumulate in the peripheral blood and tumor tissues of cancer patients and are associated with poor prognosis. In this prospective study, we find increased Th17 frequencies in the blood of patients after chemoradiotherapy and a post-therapeutic ratio of Th17/CD4+ T cells > 8% was associated with early recurrence. Furthermore, Th17 cells promote resistance of cervical cancer cells toward CRT, which was dependent on the AKT signaling pathway. Consistently, patients with high Th17 frequencies in pretherapeutic biopsies exhibit lower response to primary CRT. This work reveals a key role of Th17 cells in CRT resistance and elevated Th17 frequencies in the blood after CRT correspond with early recurrence. Our results may help to explain individual treatment responses of cervical cancer patients and suggest evaluation of Th17 cells as a novel predictive biomarker for chemoradiotherapy responses and as a potential target for immunotherapy in cervical cancer.
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Affiliation(s)
- Laura Theobald
- Institute of Virology and Center of Human and Molecular Biology, Saarland University, Homburg/Saar, Germany
| | - Russalina Stroeder
- Department of Obstetrics and Gynecology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Patrick Melchior
- Department of Radiation Oncology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Ioan Iulian Iordache
- Department of Obstetrics and Gynecology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Tanja Tänzer
- Institute of Virology and Center of Human and Molecular Biology, Saarland University, Homburg/Saar, Germany
| | - Meike Port
- Institute of Virology and Center of Human and Molecular Biology, Saarland University, Homburg/Saar, Germany
| | - Birgit Glombitza
- Institute of Virology and Center of Human and Molecular Biology, Saarland University, Homburg/Saar, Germany
| | - Stefanie Marx
- Department of Transplant and Infection Immunology, Saarland University, Homburg/Saar, Germany
| | - David Schub
- Department of Transplant and Infection Immunology, Saarland University, Homburg/Saar, Germany
| | - Christian Herr
- Department of Internal Medicine V - Pulmonology, Allergology and Critical Care Medicine, Saarland University Medical Center, Homburg/Saar, Germany
| | - Martin Hart
- Institute of Human Genetics, Saarland University, Homburg/Saar, Germany
| | - Nicole Ludwig
- Institute of Human Genetics and Center of Human and Molecular Biology, Saarland University, Homburg/Saar, Germany
| | - Eckart Meese
- Institute of Human Genetics, Saarland University, Homburg/Saar, Germany
| | - Yoo-Jin Kim
- Institute of Pathology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Rainer Maria Bohle
- Institute of Pathology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Sigrun Smola
- Institute of Virology and Center of Human and Molecular Biology, Saarland University, Homburg/Saar, Germany
| | - Christian Rübe
- Department of Radiation Oncology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Erich Franz Solomayer
- Department of Obstetrics and Gynecology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Barbara Walch-Rückheim
- Institute of Virology and Center of Human and Molecular Biology, Saarland University, Homburg/Saar, Germany
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16
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Lorat Y, Reindl J, Isermann A, Rübe C, Friedl AA, Rübe CE. Focused Ion Microbeam Irradiation Induces Clustering of DNA Double-Strand Breaks in Heterochromatin Visualized by Nanoscale-Resolution Electron Microscopy. Int J Mol Sci 2021; 22:ijms22147638. [PMID: 34299263 PMCID: PMC8306362 DOI: 10.3390/ijms22147638] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 07/06/2021] [Accepted: 07/15/2021] [Indexed: 12/14/2022] Open
Abstract
Background: Charged-particle radiotherapy is an emerging treatment modality for radioresistant tumors. The enhanced effectiveness of high-energy particles (such as heavy ions) has been related to the spatial clustering of DNA lesions due to highly localized energy deposition. Here, DNA damage patterns induced by single and multiple carbon ions were analyzed in the nuclear chromatin environment by different high-resolution microscopy approaches. Material and Methods: Using the heavy-ion microbeam SNAKE, fibroblast monolayers were irradiated with defined numbers of carbon ions (1/10/100 ions per pulse, ipp) focused to micrometer-sized stripes or spots. Radiation-induced lesions were visualized as DNA damage foci (γH2AX, 53BP1) by conventional fluorescence and stimulated emission depletion (STED) microscopy. At micro- and nanoscale level, DNA double-strand breaks (DSBs) were visualized within their chromatin context by labeling the Ku heterodimer. Single and clustered pKu70-labeled DSBs were quantified in euchromatic and heterochromatic regions at 0.1 h, 5 h and 24 h post-IR by transmission electron microscopy (TEM). Results: Increasing numbers of carbon ions per beam spot enhanced spatial clustering of DNA lesions and increased damage complexity with two or more DSBs in close proximity. This effect was detectable in euchromatin, but was much more pronounced in heterochromatin. Analyzing the dynamics of damage processing, our findings indicate that euchromatic DSBs were processed efficiently and repaired in a timely manner. In heterochromatin, by contrast, the number of clustered DSBs continuously increased further over the first hours following IR exposure, indicating the challenging task for the cell to process highly clustered DSBs appropriately. Conclusion: Increasing numbers of carbon ions applied to sub-nuclear chromatin regions enhanced the spatial clustering of DSBs and increased damage complexity, this being more pronounced in heterochromatic regions. Inefficient processing of clustered DSBs may explain the enhanced therapeutic efficacy of particle-based radiotherapy in cancer treatment.
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Affiliation(s)
- Yvonne Lorat
- Department of Radiation Oncology, Saarland University Hospital, 66421 Homburg, Germany; (Y.L.); (A.I.); (C.R.)
| | - Judith Reindl
- Institute for Applied Physic and Metrology, Universität der Bundeswehr München, 85577 Neubiberg, Germany;
| | - Anna Isermann
- Department of Radiation Oncology, Saarland University Hospital, 66421 Homburg, Germany; (Y.L.); (A.I.); (C.R.)
| | - Christian Rübe
- Department of Radiation Oncology, Saarland University Hospital, 66421 Homburg, Germany; (Y.L.); (A.I.); (C.R.)
| | - Anna A. Friedl
- Department of Radiation Oncology, University Hospital, Ludwig-Maximilian University, 80539 Munich, Germany;
| | - Claudia E. Rübe
- Department of Radiation Oncology, Saarland University Hospital, 66421 Homburg, Germany; (Y.L.); (A.I.); (C.R.)
- Correspondence: ; Tel.: +49-6841-1634614
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Groenendijk A, Spreafico F, de Krijger RR, Drost J, Brok J, Perotti D, van Tinteren H, Venkatramani R, Godziński J, Rübe C, Geller JI, Graf N, van den Heuvel-Eibrink MM, Mavinkurve-Groothuis AMC. Prognostic Factors for Wilms Tumor Recurrence: A Review of the Literature. Cancers (Basel) 2021; 13:cancers13133142. [PMID: 34201787 PMCID: PMC8268923 DOI: 10.3390/cancers13133142] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 06/08/2021] [Accepted: 06/18/2021] [Indexed: 01/10/2023] Open
Abstract
Simple Summary A Wilms tumor is a childhood kidney tumor. In high-income countries, 90% of patients with this tumor survive. However, the tumor recurs in 15% of patients. It is important to identify the patients at risk of recurrence in order to adjust treatment in such a way that recurrence may potentially be prevented. However, we are currently unable to determine precisely which patients are at risk of recurrence. Therefore, we present an overview of factors that influence the risk of recurrence, also known as prognostic factors. These factors range from patient-, tumor- and treatment-related characteristics to geographic and socioeconomic factors. In addition to these factors, biological markers, such as genetic alterations, should be studied more intensively as these markers may be able to better identify patients at risk of tumor recurrence. Abstract In high-income countries, the overall survival of children with Wilms tumors (WT) is ~90%. However, overall, 15% of patients experience tumor recurrence. The adverse prognostic factors currently used for risk stratification (advanced stage, high risk histology, and combined loss of heterozygosity at 1p and 16q in chemotherapy-naïve WTs) are present in only one third of these cases, and the significance of these factors is prone to change with advancing knowledge and improved treatment regimens. Therefore, we present a comprehensive, updated overview of the published prognostic variables for WT recurrence, ranging from patient-, tumor- and treatment-related characteristics to geographic and socioeconomic factors. Improved first-line treatment regimens based on clinicopathological characteristics and advancing knowledge on copy number variations unveil the importance of further investigating the significance of biological markers for WT recurrence in international collaborations.
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Affiliation(s)
- Alissa Groenendijk
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, The Netherlands; (R.R.d.K.); (J.D.); (H.v.T.); (M.M.v.d.H.-E.); (A.M.C.M.-G.)
- Correspondence:
| | - Filippo Spreafico
- Department of Medical Oncology and Hematology, Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy;
| | - Ronald R. de Krijger
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, The Netherlands; (R.R.d.K.); (J.D.); (H.v.T.); (M.M.v.d.H.-E.); (A.M.C.M.-G.)
- Department of Pathology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Jarno Drost
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, The Netherlands; (R.R.d.K.); (J.D.); (H.v.T.); (M.M.v.d.H.-E.); (A.M.C.M.-G.)
- Oncode Institute, 3584 CS Utrecht, The Netherlands
| | - Jesper Brok
- Department of Pediatric Oncology and Hematology, Rigshospitalet, 2100 Copenhagen, Denmark;
- Developmental Biology and Cancer Research and Teaching Department, University College London Great Ormond Street Institute of Child Health, London WC1N 1EH, UK
| | - Daniela Perotti
- Molecular Bases of Genetic Risk and Genetic Testing Unit, Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy;
| | - Harm van Tinteren
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, The Netherlands; (R.R.d.K.); (J.D.); (H.v.T.); (M.M.v.d.H.-E.); (A.M.C.M.-G.)
| | | | - Jan Godziński
- Department of Pediatric Surgery, Marciniak Hospital, Fieldorfa 2, 54-049 Wroclaw, Poland;
- Department of Pediatric Traumatology and Emergency Medicine, Wroclaw Medical University, Bujwida 44a, 50-345 Wroclaw, Poland
| | - Christian Rübe
- Department of Radiation Oncology, Saarland University Medical Center and Saarland University Faculty of Medicine, D-66421 Homburg, Germany;
| | - James I. Geller
- Division of Oncology, Cincinnati Children’s Hospital Medical Center, University of Cincinnati, Cincinnati, OH 45229, USA;
| | - Norbert Graf
- Department of Pediatric Oncology and Hematology, Saarland University Medical Center and Saarland University Faculty of Medicine, D-66421 Homburg, Germany;
| | - Marry M. van den Heuvel-Eibrink
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, The Netherlands; (R.R.d.K.); (J.D.); (H.v.T.); (M.M.v.d.H.-E.); (A.M.C.M.-G.)
| | - Annelies M. C. Mavinkurve-Groothuis
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, The Netherlands; (R.R.d.K.); (J.D.); (H.v.T.); (M.M.v.d.H.-E.); (A.M.C.M.-G.)
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18
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Albrecht F, Wolters H, Ziert Y, Timmermann B, Kortmann RD, Matuschek C, Rübe C, Martini C, Christiansen H, Eich HT, Willich N, Steinmann D. Evaluation of treatment-associated eye toxicity after irradiation in childhood and adolescence-results from the Registry of the Evaluation of Side Effects after Radiotherapy in Childhood and Adolescence (RiSK). Strahlenther Onkol 2021; 197:700-710. [PMID: 34100093 PMCID: PMC8292243 DOI: 10.1007/s00066-021-01793-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 04/23/2021] [Indexed: 11/06/2022]
Abstract
Purpose The aim of the study is to evaluate treatment-related acute and late eye toxicity associated with radiation therapy in childhood and adolescence as correlated with RT (radiotherapy) doses. Methods From 2001 to 2016, a total of 1725 children and adolescents undergoing radiation therapy were prospectively documented in the Registry of the Evaluation of Side Effects after Radiotherapy in Childhood and Adolescence (RiSK). The RTOG/EORTC criteria were used to classify ocular acute and late effects. Uni- and multivariate analyses were carried out to evaluate the impact of patient age, pre-existing impairments, and radiation dose on ocular toxicity. Results Of all documented patients, 593 received dose to the eye and formed the basis of this analysis. In 435 patients, information on acute reaction was available and graded 1, 2, 3, and 4 in 49, 17, 0, and 2 patients, respectively. Information on late toxicity was available in 268 patients and graded 1, 2, 3, and 4 in 15, 11, 11, and 5 patients, respectively. The acute toxicity rate was significantly higher in children who received a maximum dose > 50 Gy to the eye (p < 0.001) and who had a pre-existing eye impairment (p < 0.001 in multivariate analysis). The development of late toxicity was significantly higher for patients experiencing acute toxicity and having received a radiation dose > 50 Gy. Conclusion Acute and late toxicity both correlate with high radiation dose to the eye (> 50 Gy) and acute toxicity additionally with pre-existing eye impairments.
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Affiliation(s)
- Fenja Albrecht
- Department of Radiotherapy, Medical School Hannover, Hannover, Germany.
| | - Heidi Wolters
- Department of Radiotherapy, University Hospital of Münster, Münster, Germany
| | - Yvonne Ziert
- Institute of biometrics, Medical School Hannover, Hannover, Germany
| | - Beate Timmermann
- Center for Proton Radiation Therapy, Paul-Scherrer-Institute, Villigen, Switzerland.,Department of Particle Therapy, West German Proton Therapy Centre Essen (WPE), West German Cancer Center (WTZ), German Cancer Consortium (DKTK), University Hospital Essen, Essen, Germany
| | | | - Christiane Matuschek
- Department of Radiation Oncology, Heinrich Heine University Hospital of Düsseldorf, Düsseldorf, Germany
| | - Christian Rübe
- Department of Radiotherapy and Radiation Oncology, Saarland University, Homburg/Saar, Germany
| | - Carmen Martini
- Department of Radiotherapy, University Hospital of Freiburg, Freiburg, Germany
| | - Hans Christiansen
- Department of Radiotherapy, Medical School Hannover, Hannover, Germany
| | - Hans Theodor Eich
- Department of Radiotherapy, University Hospital of Münster, Münster, Germany
| | - Normann Willich
- Department of Radiotherapy, University Hospital of Münster, Münster, Germany
| | - Diana Steinmann
- Department of Radiotherapy, Medical School Hannover, Hannover, Germany
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Knobe S, Dzierma Y, Wenske M, Berdel C, Fleckenstein J, Melchior P, Palm J, Nuesken FG, Hunt A, Engwer C, Surulescu C, Yilmaz U, Reith W, Rübe C. Feasibility and clinical usefulness of modelling glioblastoma migration in adjuvant radiotherapy. Z Med Phys 2021; 32:149-158. [PMID: 33966944 PMCID: PMC9948823 DOI: 10.1016/j.zemedi.2021.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 03/01/2021] [Accepted: 03/18/2021] [Indexed: 11/16/2022]
Abstract
Glioblastoma (GBM) is one of the most common primary brain tumours in adults, with a dismal prognosis despite aggressive multimodality treatment by a combination of surgery and adjuvant radiochemotherapy. A detailed knowledge of the spreading of glioma cells in the brain might allow for more targeted escalated radiotherapy, aiming to reduce locoregional relapse. Recent years have seen the development of a large variety of mathematical modelling approaches to predict glioma migration. The aim of this study is hence to evaluate the clinical applicability of a detailed micro- and meso-scale mathematical model in radiotherapy. First and foremost, a clinical workflow is established, in which the tumour is automatically segmented as input data and then followed in time mathematically based on the diffusion tensor imaging data. The influence of several free model parameters is individually evaluated, then the full model is retrospectively validated for a collective of 3 GBM patients treated at our institution by varying the most important model parameters to achieve optimum agreement with the tumour development during follow-up. Agreement of the model predictions with the real tumour growth as defined by manual contouring based on the follow-up MRI images is analyzed using the dice coefficient. The tumour evolution over 103-212 days follow-up could be predicted by the model with a dice coefficient better than 60% for all three patients. In all cases, the final tumour volume was overestimated by the model by a factor between 1.05 and 1.47. To evaluate the quality of the agreement between the model predictions and the ground truth, we must keep in mind that our gold standard relies on a single observer's (CB) manually-delineated tumour contours. We therefore decided to add a short validation of the stability and reliability of these contours by an inter-observer analysis including three other experienced radiation oncologists from our department. In total, a dice coefficient between 63% and 89% is achieved between the four different observers. Compared with this value, the model predictions (62-66%) perform reasonably well, given the fact that these tumour volumes were created based on the pre-operative segmentation and DTI.
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Affiliation(s)
- Sven Knobe
- Department of Radiotherapy and Radiation Oncology, Saarland University Medical Center, Homburg/Saar, Germany.
| | - Yvonne Dzierma
- Department of Radiotherapy and Radiation Oncology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Michael Wenske
- Institute for Analysis and Numerics, University of Muenster, Muenster, Germany
| | - Christian Berdel
- Department of Radiotherapy and Radiation Oncology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Jochen Fleckenstein
- Department of Radiotherapy and Radiation Oncology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Patrick Melchior
- Department of Radiotherapy and Radiation Oncology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Jan Palm
- Department of Radiotherapy and Radiation Oncology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Frank G. Nuesken
- Department of Radiotherapy and Radiation Oncology, Saarland University Medical Center, Homburg/Saar, Germany
| | | | - Christian Engwer
- Institute for Analysis and Numerics, University of Muenster, Muenster, Germany
| | - Christina Surulescu
- Felix Klein Centre for Mathematics, University of Kaiserslautern, Kaiserslautern, Germany
| | - Umut Yilmaz
- Department of Diagnostic and Interventional Radiology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Wolfgang Reith
- Department of Diagnostic and Interventional Radiology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Christian Rübe
- Department of Radiotherapy and Radiation Oncology, Saarland University Medical Center, Homburg/Saar, Germany
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Mul J, Melchior P, Seravalli E, Saunders D, Bolle S, Cameron AL, Gurtner K, Harrabi S, Lassen-Ramshad Y, Lavan N, Magelssen H, Mandeville H, Boterberg T, Kroon PS, Kotte AN, Hoeben BA, van Rossum PS, van Grotel M, Graf N, van den Heuvel-Eibrink MM, Rübe C, Janssens GO. Inter-clinician delineation variation for a new highly-conformal flank target volume in children with renal tumors: A SIOP-Renal Tumor Study Group international multicenter exercise. Clin Transl Radiat Oncol 2021; 28:39-47. [PMID: 33796796 PMCID: PMC7995478 DOI: 10.1016/j.ctro.2021.03.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 03/02/2021] [Accepted: 03/03/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND AND PURPOSE Recently, the SIOP-RTSG developed a highly-conformal flank target volume definition for children with renal tumors. The aims of this study were to evaluate the inter-clinician delineation variation of this new target volume definition in an international multicenter setting and to explore the necessity of quality assurance. MATERIALS AND METHODS Six pediatric renal cancer cases were transferred to ten radiation oncologists from seven European countries ('participants'). These participants delineated the pre- and postoperative Gross Tumor Volume (GTVpre/post), and Clinical Target Volume (CTV) during two test phases (case 1-2 and 3-4), followed by guideline refinement and a quality assurance phase (case 5-6). Reference target volumes (TVref) were established by three experienced radiation oncologists. The Dice Similarity Coefficient between the reference and participants (DSCref/part) was calculated per case. Delineations of case 5-6 were graded by four independent reviewers as 'per protocol' (0-4 mm), 'minor deviation' (5-9 mm) or 'major deviation' (≥10 mm) from the delineation guideline using 18 standardized criteria. Also, a major deviation resulting in underestimation of the CTVref was regarded as an unacceptable variation. RESULTS A total of 57/60 delineation sets were completed. The median DSCref/part for the CTV was 0.55 without improvement after sequential cases (case 3-4 vs. case 5-6: p = 0.15). For case 5-6, a major deviation was found for 5/18, 12/17, 18/18 and 4/9 collected delineations of the GTVpre, GTVpost, CTV-T and CTV-N, respectively. An unacceptable variation from the CTVref was found for 7/9 participants for case 5 and 6/9 participants for case 6. CONCLUSION This international multicenter delineation exercise demonstrates that the new consensus for highly-conformal postoperative flank target volume delineation leads to geometrical variation among participants. Moreover, standardized review showed an unacceptable delineation variation in the majority of the participants. These findings strongly suggest the need for additional training and centralized pre-treatment review when this target volume delineation approach is implemented on a larger scale.
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Key Words
- AA, abdominal aorta
- AP/PA, Anterior-Posterior/Posterior-Anterior
- CT, Computed Tomography
- CTV-N, Clinical Target Volume of the lymph node area
- CTV-T, Clinical Target Volume of the primary Tumor
- DICOM, Digital Imaging and Communications in Medicine
- DSC, Dice Similarity Coefficient
- Flank target volume
- GTVpre/post, pre- and postoperative Gross Tumor Volume respectively
- HR, High-Risk
- Highly-conformal radiotherapy
- IGRT, Image-Guided Radiotherapy
- IMRT, Intensity-Modulated Radiotherapy
- IR, Intermediate-Risk
- IVC, inferior vena cava
- Inter-clinician variation
- MRI, Magnetic Resonance Imaging
- OAR, organs at risk
- Pediatric renal tumors
- Quality assurance
- RT, radiotherapy
- RTOG, Radiation Oncology Group
- RTSG, Renal Tumor Study Group
- SIOP, International Society for Pediatric Oncology
- TVintersect, intersect target volume
- TVref, reference target volumes
- WT, Wilms’ tumor
- Wilms tumor
- n.a., not applicable
- part, participant
- ref, reference
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Affiliation(s)
- Joeri Mul
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Patrick Melchior
- Dept. of Radiation Oncology, Saarland University Hospital, Homburg, Germany
| | - Enrica Seravalli
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Daniel Saunders
- Dept. of Clinical Oncology, The Christie Hospital, Manchester, United Kingdom
| | - Stephanie Bolle
- Dept. of Radiation Oncology, Gustave Roussy, Villejuif, France
| | - Alison L. Cameron
- Bristol Cancer Institute, University Hospitals, Bristol, United Kingdom
| | - Kristin Gurtner
- Dept. of Radiation Oncology, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Semi Harrabi
- Dept. of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Naomi Lavan
- St. Luke’s Radiation Oncology Network, Dublin, Ireland
| | | | - Henry Mandeville
- Dept. of Clinical Oncology, The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - Tom Boterberg
- Dept. of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | - Petra S. Kroon
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Alexis N.T.J. Kotte
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Bianca A.W. Hoeben
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Peter S.N. van Rossum
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | - Norbert Graf
- Dept. of Pediatric Oncology, Saarland University Hospital, Homburg, Germany
| | | | - Christian Rübe
- Dept. of Radiation Oncology, Saarland University Hospital, Homburg, Germany
| | - Geert O. Janssens
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
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Pater L, Melchior P, Rübe C, Cooper BT, McAleer MF, Kalapurakal JA, Paulino AC. Wilms tumor. Pediatr Blood Cancer 2021; 68 Suppl 2:e28257. [PMID: 32893998 DOI: 10.1002/pbc.28257] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 02/24/2020] [Accepted: 02/25/2020] [Indexed: 01/03/2023]
Abstract
The objectives for the treatment of Wilms tumor in both the Children's Oncology Group (COG) and the International Society of Paediatric Oncology (SIOP) have focused on improving cure rates and minimizing toxicity by limiting the use of radiation and doxorubicin. Although the timing of surgery is different in COG (upfront surgery) and SIOP (upfront chemotherapy with delayed surgery), both are effective strategies and have the same survival. Fewer patients are treated with radiotherapy in the SIOP trials but with higher doses. The prognostic significance of biological markers such as 1q gain and clinical outcomes with novel radiation techniques such as intensity modulated radiation therapy will be determined in upcoming clinical trials. A closer collaboration between COG and SIOP could help promote research and improve the clinical outcomes of children with Wilms tumor.
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Affiliation(s)
- Luke Pater
- Department of Radiation Oncology, University of Cincinnati, Cincinnati, Ohio
| | - Patrick Melchior
- Department of Radiation Oncology, Saarland University Hospital, Homburg, Germany
| | - Christian Rübe
- Department of Radiation Oncology, Saarland University Hospital, Homburg, Germany
| | - Benjamin T Cooper
- Department of Radiation Oncology, Perlmutter Cancer Center, New York University School of Medicine, New York, New York
| | - Mary Fran McAleer
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - John A Kalapurakal
- Department of Radiation Oncology, Northwestern University, Chicago, Illinois
| | - Arnold C Paulino
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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22
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Dzierma Y, Schuermann M, Melchior P, Nuesken F, Oertel J, Rübe C, Hendrix P. Optimizing Adjuvant Stereotactic Radiotherapy of Motor-Eloquent Brain Metastases: Sparing the nTMS-Defined Motor Cortex and the Hippocampus. Front Oncol 2021; 11:628007. [PMID: 33718201 PMCID: PMC7953904 DOI: 10.3389/fonc.2021.628007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 01/06/2021] [Indexed: 12/25/2022] Open
Abstract
Brain metastases can effectively be treated with surgical resection and adjuvant stereotactic radiotherapy (SRT). Navigated transcranial magnetic stimulation (nTMS) has been used to non-invasively map the motor cortex prior to surgery of motor eloquent brain lesions. To date, few studies have reported the integration of such motor maps into radiotherapy planning. The hippocampus has been identified as an additional critical structure of radiation-induced deficits. The aim of this study is to assess the feasibility of selective dose reduction to both the nTMS-based motor cortex and the hippocampi in SRT of motor-eloquent brain metastases. Patients with motor-eloquent brain metastases undergoing surgical resection and adjuvant SRT between 07/2014 and 12/2018 were retrospectively analyzed. The radiotherapy treatment plans were retrieved from the treatment planning system (“original” plan). For each case, two intensity-modulated treatment plans were created: the “motor” plan aimed to reduce the dose to the motor cortex, the “motor & hipp” plan additionally reduce the dose to the hippocampus. The optimized plans were compared with the “original” plan regarding plan quality, planning target volume (PTV) coverage, and sparing of organs at risk (OAR). 69 plans were analyzed, all of which were clinically acceptable with no significant differences for PTV coverage. All OAR were protected according to standard protocols. Sparing of the nTMS motor map was feasible: mean dose 9.66 ± 5.97 Gy (original) to 6.32 ± 3.60 Gy (motor) and 6.49 ± 3.78 Gy (motor & hipp), p<0.001. In the “motor & hipp” plan, dose to the ipsilateral hippocampi could be significantly reduced (max 1.78 ± 1.44 Gy vs 2.49 ± 1.87 Gy in “original”, p = 0.003; mean 1.01 ± 0.92 Gy vs. 1.32 ± 1.07 Gy in “original”, p = 0.007). The study confirms the results from previous studies that inclusion of nTMS motor information into radiotherapy treatment planning is possible with a relatively straightforward workflow and can achieve reduced doses to the nTMS-defined motor area without compromising PTV coverage. Furthermore, we demonstrate the feasibility of selective dose reduction to the hippocampus at the same time. The clinical significance of these optimized plans yet remains to be determined. However, with no apparent disadvantages these optimized plans call for further and broader exploration.
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Affiliation(s)
- Yvonne Dzierma
- Department of Radiotherapy and Radiation Oncology, Saarland University Medical Centre, Homburg, Germany
| | - Michaela Schuermann
- Department of Radiotherapy and Radiation Oncology, Saarland University Medical Centre, Homburg, Germany
| | - Patrick Melchior
- Department of Radiotherapy and Radiation Oncology, Saarland University Medical Centre, Homburg, Germany
| | - Frank Nuesken
- Department of Radiotherapy and Radiation Oncology, Saarland University Medical Centre, Homburg, Germany
| | - Joachim Oertel
- Department of Neurosurgery, Saarland University Medical Centre and Saarland University Faculty of Medicine, Homburg, Germany
| | - Christian Rübe
- Department of Radiotherapy and Radiation Oncology, Saarland University Medical Centre, Homburg, Germany
| | - Philipp Hendrix
- Department of Neurosurgery, Saarland University Medical Centre and Saarland University Faculty of Medicine, Homburg, Germany
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Dávila Fajardo R, Furtwängler R, van Grotel M, van Tinteren H, Pasqualini C, Pritchard-Jones K, Al-Saadi R, de Camargo B, Ramírez Villar GL, Graf N, Muracciole X, Melchior P, Saunders D, Rübe C, van den Heuvel-Eibrink MM, Janssens GO, Verschuur AC. Outcome of Stage IV Completely Necrotic Wilms Tumour and Local Stage III Treated According to the SIOP 2001 Protocol. Cancers (Basel) 2021; 13:cancers13050976. [PMID: 33652659 PMCID: PMC7956604 DOI: 10.3390/cancers13050976] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 02/15/2021] [Accepted: 02/22/2021] [Indexed: 01/02/2023] Open
Abstract
Simple Summary Around 15–20% of all Wilms tumour (WT) patients present with metastatic disease. Approximately 10% of these patients achieve complete necrosis after preoperative chemotherapy, which is associated with a favourable prognosis. The aim of this observational study is to describe the outcome of metastatic patients with completely necrotic (low-risk histology), local stage III WT treated according to the SIOP 2001 protocol, whether or not postoperative radiotherapy was applied. Abstract Objective: Wilms tumour (WT) patients with a localised completely necrotic nephroblastoma after preoperative chemotherapy are a favourable outcome group. Since the introduction of the SIOP 2001 protocol, the SIOP– Renal Tumour Study Group (SIOP–RTSG) has omitted radiotherapy for such patients with low-risk, local stage III in an attempt to reduce treatment burden. However, for metastatic patients with local stage III, completely necrotic WT, the recommendations led to ambiguous use. The purpose of this descriptive study is to demonstrate the outcomes of patients with metastatic, completely necrotic and local stage III WT in relation to the application of radiotherapy or not. Methods and materials: all metastatic patients with local stage III, completely necrotic WT after 6 weeks of preoperative chemotherapy who were registered in the SIOP 2001 study were included in this analysis. The pattern of recurrence according to the usage of radiation treatment and 5 year event-free survival (EFS) and overall survival (OS) was analysed. Results: seven hundred and three metastatic WT patients were registered in the SIOP 2001 database. Of them, 47 patients had a completely necrotic, local stage III WT: 45 lung metastases (11 combined localisations), 1 liver/peritoneal, and 1 tumour thrombus in the renal vein and the inferior vena cava with bilateral pulmonary arterial embolism. Abdominal radiotherapy was administered in 29 patients (62%; 29 flank/abdominal irradiation and 9 combined with lung irradiation). Eighteen patients did not receive radiotherapy. Median follow-up was 6.6 years (range 1–151 months). Two of the 47 patients (4%) developed disease recurrence in the lung (one combined with abdominal relapse) and eventually died of the disease. Both patients had received abdominal radiotherapy, one of them combined with lung irradiation. Five-year EFS and OS were 95% and 95%, respectively. Conclusions: the outcome of patients with stage IV, local stage III, completely necrotic Wilms tumours is excellent. Our results suggest that abdominal irradiation in this patient category may not be of added value in first-line treatment, consistent with the current recommendation in the SIOP–RTSG 2016 UMBRELLA protocol.
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Affiliation(s)
- Raquel Dávila Fajardo
- Department of Radiation Oncology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands;
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (M.v.G.); (M.M.v.d.H.-E.)
- Correspondence: ; Tel.: +31-(0)88-756-7898
| | - Rhoikos Furtwängler
- Department of Paediatric Oncology and Haematology, University Hospital of Saarland, 66421 Homburg, Germany; (R.F.); (N.G.)
| | - Martine van Grotel
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (M.v.G.); (M.M.v.d.H.-E.)
| | - Harm van Tinteren
- Trial and Data Center, Princess Maxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands;
| | - Claudia Pasqualini
- Department of Paediatric Oncology, Institute Gustave Roussy, CEDEX, 94805 Villejuif, France;
| | - Kathy Pritchard-Jones
- Developmental Biology & Cancer Research & Teaching Department, UCL Great Ormond Street Institute of Child Health, London WC1N 1EH, UK; (K.P.-J.); (R.A.-S.)
| | - Reem Al-Saadi
- Developmental Biology & Cancer Research & Teaching Department, UCL Great Ormond Street Institute of Child Health, London WC1N 1EH, UK; (K.P.-J.); (R.A.-S.)
| | - Beatriz de Camargo
- Research Center, Brazilian National Cancer Institute, Rio de Janeiro 20230-240, Brazil;
| | - Gema L. Ramírez Villar
- Department of Paediatric Oncology, Hospital Universitario Virgen del Rocío, 41013 Seville, Spain;
| | - Norbert Graf
- Department of Paediatric Oncology and Haematology, University Hospital of Saarland, 66421 Homburg, Germany; (R.F.); (N.G.)
| | - Xavier Muracciole
- Department of Radiation Oncology, Assistance Publique Hôpitaux de Marseille, 13005 Marseille, France;
| | - Patrick Melchior
- Department of Radiation Oncology, University Hospital of Saarland, 66421 Homburg, Germany; (P.M.); (C.R.)
| | | | - Christian Rübe
- Department of Radiation Oncology, University Hospital of Saarland, 66421 Homburg, Germany; (P.M.); (C.R.)
| | | | - Geert O. Janssens
- Department of Radiation Oncology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands;
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (M.v.G.); (M.M.v.d.H.-E.)
| | - Arnauld C. Verschuur
- Department of Paediatric Oncology, La Timone Children’s Hospital, Assistance Publique Hôpitaux de Marseille, 13005 Marseille, France;
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24
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Melchior P, Dzierma Y, Rübe C, Graf N, Kager L, Dieckmann K, Kroiss S, Hubertus J, Warmann S, Schenk JP, Leuschner I, Nemes K, Meier CM, Vokuhl C, Frühwald M, Furtwängler R. Local Stage Dependent Necessity of Radiation Therapy in Rhabdoid Tumors of the Kidney (RTK). Int J Radiat Oncol Biol Phys 2020; 108:667-675. [PMID: 32407933 DOI: 10.1016/j.ijrobp.2020.04.046] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 03/15/2020] [Accepted: 04/30/2020] [Indexed: 12/22/2022]
Abstract
PURPOSE Rhabdoid tumor of the kidney (RTK) is one of the most aggressive childhood renal tumors. Overall survival ranges from 22% to 47%. The indication for radiation therapy (RT) in usually very young patients is an ongoing discussion. Recent protocols recommend RT independent of local stage, the latter being a good discriminator in other childhood kidney tumors. In this study, we analyze the evidence for RT in regard to risk factors, including tumor stage. METHODS AND MATERIALS This study analyzed 58 patients with RTK from Austria, Switzerland, and Germany treated in the framework of 4 consecutive, prospective renal/rhabdoid tumor studies from 1991 to 2014. All treatment protocols included multimodality treatment, including high-intensity chemotherapy, surgery, and RT. RESULTS Local stage distribution was not applicable, I, II, and III in 1, 6, 11, and 40, respectively. Twenty-nine (50%) patients had stage IV disease at diagnosis. Thirty-seven patients (64%) achieved complete remission, and 49% (18/37) relapsed. Thirty-four patients (60%) patients had progressive disease and died, 17 had local disease, 10 had combined disease, and 7 had distant disease; 2 treatment-related deaths were reported (3%). Twenty-one patients received RT during first-line treatment, 18 of them to all involved sites. Eight of the 34 cases of progressive disease occurred in irradiated patients. The local failure rate of treated patients with local stage II or III disease was 29% (6/18) in patients irradiated to all sites compared with 68% (15/22) in nonirradiated patients. One of 6 stage I patients received RT, and 1 patient experienced distant relapse (2-year progression-free and overall survival both 83% ± 15%). Progression-free survival for local stage II and III disease treated with RT, adjusted for early relapse or treatment abandonment, was 67% ± 11%, compared with 15% ± 7% without RT (P < .0001). CONCLUSION The 68% local failure rate in nonirradiated patients underlines the importance of local treatment. Our experience supports the use of RT for local control in higher stage disease. In contrast, no local relapse in 6 local stage I patients, including 5 nonirradiated patients, suggests omission of RT in this favorable subset of usually infant patients with RTK.
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Affiliation(s)
- Patrick Melchior
- Department of Radiation Oncology, Saarland University Hospital, Homburg, Germany.
| | - Yvonne Dzierma
- Department of Radiation Oncology, Saarland University Hospital, Homburg, Germany
| | - Christian Rübe
- Department of Radiation Oncology, Saarland University Hospital, Homburg, Germany
| | - Norbert Graf
- Department of Pediatric Hematology and Oncology, Saarland University Hospital, Homburg/Saar, Germany
| | - Leo Kager
- St. Anna Children's Hospital, Department of Pediatrics, Medical University Vienna, Vienna, Austria
| | - Karin Dieckmann
- Department of Radiation Oncology, Medical University Vienna, Vienna, Austria
| | - Sabine Kroiss
- Department of Pediatric Hematology and Oncology, Children's Hospital, Zurich University, Zurich, Switzerland
| | - Jochen Hubertus
- Department of Pediatric Surgery, von Haunersches Kinderspital, Ludwigs-Maximilians University, Munich, Germany
| | - Steven Warmann
- Department of Pediatric Surgery, Tübingen University Hospital, Tübingen, Germany
| | - Jens-Peter Schenk
- Department of Radiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Ivo Leuschner
- Department of Paidopathology, Schleswig-Holstein-University Hospital, Campus Kiel, Kiel, Germany; Section of Pediatric Pathology, Department of Pathology, University Hospital Bonn, Bonn, Germany
| | - Karolina Nemes
- Swabian Children's Cancer Center, University Children's Hospital Augsburg, Augsburg, Germany
| | | | - Christian Vokuhl
- Department of Paidopathology, Schleswig-Holstein-University Hospital, Campus Kiel, Kiel, Germany; Deceased
| | - Michael Frühwald
- Swabian Children's Cancer Center, University Children's Hospital Augsburg, Augsburg, Germany
| | - Rhoikos Furtwängler
- Department of Pediatric Hematology and Oncology, Saarland University Hospital, Homburg/Saar, Germany
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25
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Fajardo RD, van den Heuvel-Eibrink MM, van Tinteren H, Spreafico F, Acha T, Bergeron C, de Camargo B, Oldenburger F, Rübe C, Oue T, Vokuhl C, de Krijger RR, Vujanic G, Sebire N, Coulomb-L'Hermine A, Collini P, Gandola L, Pritchard-Jones K, Graf N, Janssens GO, van Grotel M. Is radiotherapy required in first-line treatment of stage I diffuse anaplastic Wilms tumor? A report of SIOP-RTSG, AIEOP, JWiTS, and UKCCSG. Pediatr Blood Cancer 2020; 67:e28039. [PMID: 31625685 DOI: 10.1002/pbc.28039] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Revised: 09/05/2019] [Accepted: 09/23/2019] [Indexed: 12/23/2022]
Abstract
BACKGROUND As a significant proportion of relapses occurred in the tumor bed or abdomen on patients with the fifth National Wilms Tumor Study stage I anaplastic Wilms tumor (WT), flank radiotherapy was added for stage I anaplastic WT in the subsequent study of the Children's Oncology Group (AREN0321). Preliminary results revealed reduction of relapse rate and improved survival. In cases treated with preoperative chemotherapy, such as in International Society of Pediatric Oncology (SIOP), the value of radiotherapy has never been studied. The aim of this observational study is to describe the pattern of recurrence and survival of patients with stage I diffuse anaplastic WT (DAWT) after induction chemotherapy. METHODS Retrospective data analysis of the pattern of relapse and survival of all patients with stage I DAWT were included in recent SIOP, L'Associazone Italiana Ematologica Oncologia Pediatrica (AIEOP), Japan Wilms Tumor Study Group (JWiTS), United Kingdom Children's Cancer Study Group (UKCCSG) renal tumor registries. Postoperative treatment consisted of actinomycin D, vincristine, and doxorubicin for 28 weeks without local irradiation. RESULTS One hundred nine cases with stage I DAWT were identified, of which 95 cases received preoperative chemotherapy. Of these, seven patients underwent preoperative true-cut biopsy. Sixteen of the 95 patients relapsed (17%), six locally, four at distant site, and six combined, and all treated according to SIOP 2001 relapse protocol, which resulted in a 5-year overall survival of 93%. CONCLUSION Despite 13% locoregional relapse rate, an excellent rescue rate was achieved after salvage treatment, in patients with stage I DAWT whose first-line treatment comprised three-drug chemotherapy (including doxorubicin), without flank irradiation. Therefore, we continue not to advocate the use of radiotherapy in first-line treatment after preoperative chemotherapy in stage I DAWT in the next SIOP protocol.
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Affiliation(s)
- Raquel Dávila Fajardo
- Department of Radiation Oncology, University Medical Centre Utrecht, Utrecht, The Netherlands
- Department of Pediatric Oncology, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | | | - Harm van Tinteren
- Department of Statistics, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Filippo Spreafico
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Thomas Acha
- Department of Pediatric Oncology, Hospital Materno-Infantil, Málaga, Spain
| | | | - Beatriz de Camargo
- Department of Pediatric Hematology and Oncology, Instituto Nacional Do Cancer (INCA), Rio de Janeiro, Brazil
| | - Foppe Oldenburger
- Department of Radiation Oncology, Academic Medical Center, Amsterdam, The Netherlands
| | - Christian Rübe
- Department of Radio-Oncology, University Hospital of Saarland, Homburg, Germany
| | - Takaharu Oue
- Department of Pediatric Surgery, Hyogo College of Medicine, Nishinomiya City, Hyogo Prefecture, Osaka, Japan
| | - Christian Vokuhl
- Institute of Pediatric Pathology, University of Kiel, Kiel, Germany
| | - Ronald R de Krijger
- Department of Pediatric Oncology, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | | | - Neil Sebire
- Department of Histopathology, Great Ormond Street Hospital, London, UK
| | | | - Paola Collini
- Department of Pathology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Lorenza Gandola
- Department of Radiation Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Norbert Graf
- Department of Pediatric Oncology, University Hospital of Saarland, Homburg, Germany
| | - Geert O Janssens
- Department of Radiation Oncology, University Medical Centre Utrecht, Utrecht, The Netherlands
- Department of Pediatric Oncology, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Martine van Grotel
- Department of Pediatric Oncology, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
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Lorat Y, Fleckenstein J, Görlinger P, Rübe C, Rübe CE. Assessment of DNA damage by 53PB1 and pKu70 detection in peripheral blood lymphocytes by immunofluorescence and high-resolution transmission electron microscopy. Strahlenther Onkol 2020; 196:821-833. [PMID: 32006067 PMCID: PMC7449954 DOI: 10.1007/s00066-020-01576-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 01/07/2020] [Indexed: 11/29/2022]
Abstract
Purpose 53BP1 foci detection in peripheral blood lymphocytes (PBLs) by immunofluorescence microscopy (IFM) is a sensitive and quantifiable DNA double-strand break (DSB) marker. In addition, high-resolution transmission electron microscopy (TEM) with immunogold labeling of 53BP1 and DSB-bound phosphorylated Ku70 (pKu70) can be used to determine the progression of the DNA repair process. To establish this TEM method in the PBLs of patients with cancer, we analyzed and characterized whether different modes of irradiation influence the formation of DSBs, and whether accompanying chemotherapy influences DSB formation. Methods We obtained 86 blood samples before and 0.1, 0.5, and 24 h after irradiation from patients (n = 9) with head and neck or rectal cancers receiving radiotherapy (RT; n = 4) or radiochemotherapy (RCT; n = 5). 53BP1 foci were quantified by IFM. In addition, TEM was used to quantify gold-labelled pKu70 dimers and 53BP1 clusters within euchromatin and heterochromatin of PBLs. Results IFM analyses showed that during radiation therapy, persistent 53BP1 foci in PBLs accumulated with increasing numbers of administered RT fractions. This 53BP1 foci accumulation was not influenced by the irradiation technique applied (3D conformal radiotherapy versus intensity-modulated radiotherapy), dose intensity per fraction, number of irradiation fields, or isodose volume. However, more 53BP1 foci were detected in PBLs of patients treated with accompanying chemotherapy. TEM analyses showed that DSBs, indicated by pKu70, were present for longer periods in PBLs of RCT patients than in PBLs of RT only patients. Moreover, not every residual 53BP1 focus was equivalent to a remaining DSB, since pKu70 was not present at every damage site. Persistent 53BP1 clusters, visualized by TEM, without colocalizing pKu70 likely indicate chromatin alterations after repair completion or, possibly, defective repair. Conclusion IFM 53BP1 foci analyses alone are not adequate to determine individual repair capacity after irradiation of PBLs, as a DSB may be indicated by a 53BP1 focus but not every 53BP1 focus represents a DSB. Electronic supplementary material The online version of this article (10.1007/s00066-020-01576-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yvonne Lorat
- Department of Radiotherapy and Radiation Oncology, Medical Center, Saarland University, Homburg/Saar, Germany.
| | - Jochen Fleckenstein
- Department of Radiotherapy and Radiation Oncology, Medical Center, Saarland University, Homburg/Saar, Germany
| | - Patric Görlinger
- Department of Radiotherapy and Radiation Oncology, Medical Center, Saarland University, Homburg/Saar, Germany.,Department of Anesthesiology, DRK Hospitals Berlin Westend, Berlin, Germany
| | - Christian Rübe
- Department of Radiotherapy and Radiation Oncology, Medical Center, Saarland University, Homburg/Saar, Germany
| | - Claudia E Rübe
- Department of Radiotherapy and Radiation Oncology, Medical Center, Saarland University, Homburg/Saar, Germany
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27
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Fietkau R, Hecht M, Hofner B, Iro H, Gefeller O, Rödel C, Hautmann M, Kölbl O, Salay A, Rübe C, Breinl P, Krings W, Gripp S, Wollenberg B, Keerl R, Schreck U, Siekmeyer B, Grabenbauer G, Balermpas P. OC-0387 radiotherapy with paclitaxel/cisplatin vs. fluorouracil/cisplatin for head and neck cancer. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)30807-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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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28
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Reinartz G, Pyra RP, Lenz G, Liersch R, Stüben G, Micke O, Willborn K, Hess CF, Probst A, Fietkau R, Jany R, Schultze J, Rübe C, Hirt C, Fischbach W, Bentz M, Daum S, Pott C, Tiemann M, Möller P, Neubauer A, Wilhelm M, Willich N, Berdel WE, Eich HT. Favorable radiation field decrease in gastric marginal zone lymphoma : Experience of the German Study Group on Gastrointestinal Lymphoma (DSGL). Strahlenther Onkol 2019; 195:544-557. [PMID: 30859254 DOI: 10.1007/s00066-019-01446-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 02/15/2019] [Indexed: 12/12/2022]
Abstract
PURPOSE Long-term impact of stage-adapted field reduction in a large cohort of gastric marginal zone lymphoma (gMZL) patients treated conservatively with curative radiation therapy (RT). PATIENTS AND METHODS Prospective analysis of paper records of 290 patients with stage IE-IIE gMZL, treated in 78 radiotherapeutic institutions in Germany from 1992-2013. Stage-adapted radiation fields decreased from extended field (EF) to involved field (IF) over the course of three consecutive prospective trials of the German Study Group on Gastrointestinal Lymphoma (DSGL). Treatment results were compared between the three cohorts. RESULTS Overall collective with median age of 60 years, slight male predominance (m:f = 1.1:1) and ratio of disease stage I:stage II = 2.1:1. Median follow-up 6.4 years in total: 13.0 years in the first gastrointestinal study (GIT 1992), 8.2 years in the second (GIT 1996) and 4.7 years in the third study (DSGL 01/2003). Stage-adapted radiation field decrease together with further technological development led to reduced relative frequencies of acute/chronic adverse effects and until now was accompanied by lower disease recurrence. The third study design with smallest field size (IF in stage I, locoregional EF in stage II) achieved the best survival outcome at the 5‑year follow-up (overall survival 92.7%, event-free survival 89.5% and lymphoma-specific survival 100.0%). Disease relapse observed in 10 patients. Cumulative incidence of disease-specific death was 1.7% of the followed patients. Primary disease stage associated with lymphoma-specific survival. CONCLUSION Stage-adapted reduction towards IF in gMZL resulted in favorable adverse effects, local control and survival rates. These results support further decreases in modern RT of gMZL.
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Affiliation(s)
- Gabriele Reinartz
- Department of Radiation Oncology, University Hospital of Münster, Building A1, Albert Schweitzer Campus 1, 48149, Münster, Germany.
| | - Regina P Pyra
- Department of Radiation Oncology, University Hospital of Münster, Building A1, Albert Schweitzer Campus 1, 48149, Münster, Germany
| | - Georg Lenz
- Department of Medicine A, Hematology, Oncology and Pneumology, University Hospital of Münster, Münster, Germany
| | - Rüdiger Liersch
- Department of Medicine A, Hematology, Oncology and Pneumology, University Hospital of Münster, Münster, Germany
| | - Georg Stüben
- Department of Radiation Oncology, Hospital Augsburg, Augsburg, Germany
| | - Oliver Micke
- Department of Radiotherapy and Radiation Oncology, Franziskus Hospital Bielefeld, Bielefeld, Germany
| | - Kay Willborn
- Department of Radiotherapy and Radiation Oncology, Pius Hospital Oldenburg, Oldenburg, Germany
| | - Clemens F Hess
- Department of Radiation Oncology, University Hospital of Göttingen, Göttingen, Germany
| | - Andreas Probst
- Department of Gastroenterology, Central Hospital, Augsburg, Germany
| | - Rainer Fietkau
- Department of Radiation Oncology, University of Erlangen, Erlangen, Germany
| | - Ralf Jany
- Department of Radiation Oncology, Saint Marien Hospital, Hamm, Germany
| | - Jürgen Schultze
- Department of Radiation Oncology, University of Schleswig-Holstein, Kiel, Germany
| | - Christian Rübe
- Department of Radiation Oncology, University of Saarland, Homburg, Germany
| | - Carsten Hirt
- Department of Medical Oncology, University of Greifswald, Greifswald, Germany
| | - Wolfgang Fischbach
- Department of Gastroenterology and Oncology, Hospital of Aschaffenburg, Aschaffenburg, Germany
| | - Martin Bentz
- Department of Medical Oncology, Municipal Hospital of Karlsruhe, Karlsruhe, Germany
| | - Severin Daum
- Department of Gastroenterology, University Charité, Berlin, Germany
| | - Christiane Pott
- Department of Medical Oncology, University of Schleswig-Holstein, Kiel, Germany
| | | | - Peter Möller
- Department of Pathology, University of Ulm, Ulm, Germany
| | - Andreas Neubauer
- Department of Medical Oncology, University of Marburg, Marburg, Germany
| | - Martin Wilhelm
- Department of Medical Oncology, Klinikum Nürnberg, Paracelsus Medical University, Nürnberg, Germany
| | - Normann Willich
- Department of Radiation Oncology, University Hospital of Münster, Building A1, Albert Schweitzer Campus 1, 48149, Münster, Germany
| | - Wolfgang E Berdel
- Department of Medicine A, Hematology, Oncology and Pneumology, University Hospital of Münster, Münster, Germany
| | - Hans T Eich
- Department of Radiation Oncology, University Hospital of Münster, Building A1, Albert Schweitzer Campus 1, 48149, Münster, Germany
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Sadrollahi A, Nuesken F, Licht N, Rübe C, Dzierma Y. Monte-Carlo simulation of the Siemens Artiste linear accelerator flat 6 MV and flattening-filter-free 7 MV beam line. PLoS One 2019; 14:e0210069. [PMID: 30620742 PMCID: PMC6324801 DOI: 10.1371/journal.pone.0210069] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 12/17/2018] [Indexed: 11/18/2022] Open
Abstract
The aim of our work is to provide the up-to-now missing information on the Siemens Artiste FFF 7 MV beam line using a Monte-Carlo model fit to the realistic dosimetric measurements at the linear accelerator in clinical use at our department. The main Siemens Artiste 6MV and FFF 7MV beams were simulated using the Geant4 toolkit. The simulations were compared with the measurements with an ionization chamber in a water phantom to verify the validation of simulation and tuning the primary electron parameters. Hereafter, other parameters such as surface dose, spectrum, electron contamination, symmetry, flatness/unflatness, slope, and characteristic off-axis changes were discussed for both Flat and FFF mode. The mean electron energy for the FFF beam was 8.8 MeV and 7.5 MeV for Flat 6 MV, the spread energy and spot size of the selected Gaussian distribution source were 0.4 MeV and 1mm, respectively. The dose rate of the FFF beam was 2.8 (2.96) times higher than for the flattened beam for a field size of 10×10 (20×20) cm2. The electron contamination has significant contribution to the surface dose especially for the flattened beam. The penumbra, surface dose and the mean energy of photons decrease by removing the flattening filter. Finally, the results show that off-axis changes have no strong effect on the mean energy of FFF beams, while this effect was more considerable for the flattened beam.
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Affiliation(s)
- Alemeh Sadrollahi
- Department of Radiotherapy and Radiation Oncology, Saarland University Medical Center, Homburg, Saarland, Germany
- * E-mail:
| | - Frank Nuesken
- Department of Radiotherapy and Radiation Oncology, Saarland University Medical Center, Homburg, Saarland, Germany
| | - Norbert Licht
- Department of Radiotherapy and Radiation Oncology, Saarland University Medical Center, Homburg, Saarland, Germany
| | - Christian Rübe
- Department of Radiotherapy and Radiation Oncology, Saarland University Medical Center, Homburg, Saarland, Germany
| | - Yvonne Dzierma
- Department of Radiotherapy and Radiation Oncology, Saarland University Medical Center, Homburg, Saarland, Germany
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Bell K, Licht N, Rübe C, Dzierma Y. Image guidance and positioning accuracy in clinical practice: influence of positioning errors and imaging dose on the real dose distribution for head and neck cancer treatment. Radiat Oncol 2018; 13:190. [PMID: 30285806 PMCID: PMC6167812 DOI: 10.1186/s13014-018-1141-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 09/24/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Modern radiotherapy offers the possibility of highly accurate tumor treatment. To benefit from this precision at its best, regular positioning verification is necessary. By the use of image-guided radiotherapy and the application of safety margins the influence of positioning inaccuracies can be counteracted. In this study the effect of additional imaging dose by set-up verification is compared with the effect of dose smearing by positioning inaccuracies for a collective of head-and-neck cancer patients. METHODS This study is based on treatment plans of 40 head-and-neck cancer patients. To evaluate the imaging dose several image guidance scenarios with different energies, techniques and frequencies were simulated and added to the original plan. The influence of the positioning inaccuracies was assessed by the use of real applied table shifts for positioning. The isocenters were shifted back appropriately to these values to simulate that no positioning correction had been performed. For the single fractions the shifted plans were summed considering three different scenarios: The summation of only shifted plans, the consideration of the original plan for the fractions with set-up verification, and the addition of the extra imaging dose to the latter. For both effects (additional imaging dose and dose smearing), plans were analyzed and compared considering target coverage, sparing of organs at risk (OAR) and normal tissue complication probability (NTCP). RESULTS Daily verification of the patient positioning using 3D imaging with MV energies result in non-negligible high doses. kV imaging has only marginal influence on plan quality, primarily related to sparing of organs at risk, even with daily 3D imaging. For this collective, sparing of organs at risk and NTCP are worse due to potential positioning errors. CONCLUSION Regular set-up verification is essential for precise radiation treatment. Relating to the additional dose, the use of kV modalities is uncritical for any frequency and technique. Dose smearing due to positioning errors for this collective mainly resulted in a decrease of OAR sparing. Target coverage also suffered from the positioning inaccuracies, especially for individual patients. Taking into account both examined effects the relevance of an extensive IGRT is clearly present, even at the expense of additional imaging dose and time expenditure.
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Affiliation(s)
- Katharina Bell
- Department of Radiotherapy and Radiation Oncology, Saarland University Medical Centre, Kirrberger Str. Geb. 6.5/Saar, D-66421 Homburg, Germany
| | - Norbert Licht
- Department of Radiotherapy and Radiation Oncology, Saarland University Medical Centre, Kirrberger Str. Geb. 6.5/Saar, D-66421 Homburg, Germany
| | - Christian Rübe
- Department of Radiotherapy and Radiation Oncology, Saarland University Medical Centre, Kirrberger Str. Geb. 6.5/Saar, D-66421 Homburg, Germany
| | - Yvonne Dzierma
- Department of Radiotherapy and Radiation Oncology, Saarland University Medical Centre, Kirrberger Str. Geb. 6.5/Saar, D-66421 Homburg, Germany
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Dzierma Y, Mikulla K, Richter P, Bell K, Melchior P, Nuesken F, Rübe C. Imaging dose and secondary cancer risk in image-guided radiotherapy of pediatric patients. Radiat Oncol 2018; 13:168. [PMID: 30185206 PMCID: PMC6125956 DOI: 10.1186/s13014-018-1109-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 08/21/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Daily image-guided radiotherapy (IGRT) can contribute to cover extended body volumes with low radiation dose. The effect of additional imaging dose on secondary cancer development is modelled for a collective of children with Morbus Hodgkin. METHODS Eleven radiotherapy treatment plans from pediatric patients with Hodgkin's lymphoma were retrospectively analyzed, including imaging dose from scenarios using different energies (kV/MV) and planar/cone-beam computed tomography (CBCT) techniques. In addition to assessing the effect of imaging dose on organs at risk, the excess average risk (EAR) for developing a secondary carcinoma of the lung or breast was modelled. RESULTS Although the variability between the patients is relatively large due to the different target volumes, the additional EAR due to imaging can be consistently determined. For daily 6MV CBCT, the EAR for developing a secondary cancer at age 50 is over 3 cases per 104 PY (patient-years) for the female breast and 0.7-0.8 per 104 PY for the lungs. This can be decreased by using only planar images (< 1 per 104 PY for the breast and 0.1 for the lungs). Similar values are achieved by daily 360° kV CBCT (0.44-0.57 per 104 PY for the breast and 0.08 per 104 PY for the lungs), which is again reduced for daily 200° kV CBCT (0.02 per 104 PY for the lungs and 0.07-0.08 per 104 PY for the breast). These values increase if an older attained age is considered (e.g., for 70 years, by a factor of four for the lungs). CONCLUSIONS Daily imaging can be performed with an additional secondary cancer risk of less than 1 per 104 PY if kV CBCT is applied. If MV modalities must be chosen, a similar EAR can be achieved with planar images. A further reduction in risk is possible if the imaging geometry allows for sparing of the breast by a partial rotation underneath the patient.
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Affiliation(s)
- Yvonne Dzierma
- Department of Radiotherapy and Radiation Oncology, Saarland University Medical Centre, Kirrberger Str. Geb. 6.5, 66421 Homburg, Saar Germany
| | - Katharina Mikulla
- Department of Radiotherapy and Radiation Oncology, Saarland University Medical Centre, Kirrberger Str. Geb. 6.5, 66421 Homburg, Saar Germany
| | - Patrick Richter
- Department of Radiotherapy and Radiation Oncology, Saarland University Medical Centre, Kirrberger Str. Geb. 6.5, 66421 Homburg, Saar Germany
| | - Katharina Bell
- Department of Radiotherapy and Radiation Oncology, Saarland University Medical Centre, Kirrberger Str. Geb. 6.5, 66421 Homburg, Saar Germany
| | - Patrick Melchior
- Department of Radiotherapy and Radiation Oncology, Saarland University Medical Centre, Kirrberger Str. Geb. 6.5, 66421 Homburg, Saar Germany
| | - Frank Nuesken
- Department of Radiotherapy and Radiation Oncology, Saarland University Medical Centre, Kirrberger Str. Geb. 6.5, 66421 Homburg, Saar Germany
| | - Christian Rübe
- Department of Radiotherapy and Radiation Oncology, Saarland University Medical Centre, Kirrberger Str. Geb. 6.5, 66421 Homburg, Saar Germany
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Dávila Fajardo R, Oldenburger E, Rübe C, López-Yurda M, Pritchard-Jones K, Bergeron C, Graf N, van Grotel M, van Tinteren H, Saunders D, van den Heuvel-Eibrink MM, Janssens GO, Oldenburger F. Evaluation of boost irradiation in patients with intermediate-risk stage III Wilms tumour with positive lymph nodes only: Results from the SIOP-WT-2001 Registry. Pediatr Blood Cancer 2018; 65:e27085. [PMID: 29693799 DOI: 10.1002/pbc.27085] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 02/22/2018] [Accepted: 03/13/2018] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To evaluate the value of radiotherapy boost omission in patients with intermediate-risk, stage III Wilms tumours (WT) with positive lymph nodes (LN). METHODS AND MATERIALS All patients with intermediate-risk, stage III (LN positive) WT consecutively registered in the SIOP-WT-2001 study were included in this analysis. Endpoints were 5-year event-free survival (EFS), loco-regional control (LRC) and overall survival (OS). RESULTS Between June 2001 and May 2015, 2,569 patients with stage I to III WT after preoperative chemotherapy were registered in the SIOP-WT-2001 study. Five hundred and twenty-three (20%) had stage III disease, of which 113 patients had stage III due to positive LN only. Of those, 101 (89%) received radiotherapy, 36 of which (36%) received, apart from flank irradiation, a boost dose to the LN positive area. Four patients (4%) did not receive any adjuvant radiotherapy. In eight patients information on radiotherapy was not available. With a median follow-up of 71 months, no difference in 5-year EFS (84% vs. 83%, P = 0.77) and LRC (96% vs. 97%, P = 0.91) was observed between patients receiving a radiotherapy boost and those without boost, respectively. Five-year OS, including salvage therapy, was excellent (boost vs. no boost: 97% vs. 95%, P = 0.58). CONCLUSIONS Outcome data demonstrate that omission of the radiotherapy boost to the loco-regional positive lymph nodes in patients with intermediate-risk, stage III WT who receive preoperative chemotherapy and postoperative flank irradiation (14.4 Gy) can be considered a safe approach for future SIOP protocols.
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Affiliation(s)
- Raquel Dávila Fajardo
- Department of Radiation Oncology, University Medical Center Utrecht and Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Eva Oldenburger
- Radiation Oncology Department, Leuven Cancer Center, Leuven, Belgium
| | - Christian Rübe
- Department of Radio-Oncology, University Hospital of Saarland, Homburg, Germany
| | - Marta López-Yurda
- Department of Statistics, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | | | - Norbert Graf
- Department of Paediatric Oncology, University Hospital of Saarland, Homburg, Germany
| | - Martine van Grotel
- Princess Máxima Center for Paediatric Oncology, Utrecht, The Netherlands
| | - Harm van Tinteren
- Department of Statistics, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Daniel Saunders
- Department of Radiation Oncology. The Christie NHS Foundation Trust, The Christie NHS Foundation Trust, Manchester, UK
| | | | - Geert O Janssens
- Department of Radiation Oncology, University Medical Center Utrecht and Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Foppe Oldenburger
- Department of Radiation Oncology, Academic Medical Center, Amsterdam, The Netherlands
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Stroeder R, Walch-Rückheim B, Fischbach J, Juhasz-Böss I, Rübe C, Solomayer EF, Smola S. Oncostatin M treatment increases the responsiveness toward cisplatin-based chemoradiotherapy in cervical cancer cells in a STAT3-dependent manner. Oncol Lett 2018; 16:3351-3358. [PMID: 30127934 DOI: 10.3892/ol.2018.8987] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 05/22/2018] [Indexed: 01/01/2023] Open
Abstract
Cervical cancer stage-dependent therapies include surgery, chemotherapy, radiotherapy and chemoradiotherapy. Concurrent cisplatin-based chemoradiotherapy (CCRT) is the standard therapy for locally advanced cervical carcinoma (FIGO>IIB), however therapy resistance in a subset of patients is still a major clinical challenge. The present study aimed to analyze the impact of Oncostatin M (OSM) stimulation on CCRT-induced cell death. The present study used cells derived from cervical squamous cell carcinomas (SW756, 808, CaSki and 879) and adenocarcinoma (HeLa). The cervical carcinoma cells were HPV18-positive (HeLa, SW756, 808) or HPV16-positive (CaSki, 879). In addition to the established cell lines HeLa, SW756 and CaSki, the more recently generated cervical cancer cells 808 and 879 were also used. To analyze their radiosensitivity, cells were treated with increasing doses of irradiation (0-8 Gy). To mimic chemotherapy, radiotherapy or CCRT in vitro, the cells were challenged with 0.975 µg/ml cisplatin, irradiated with 6 Gy or a combination. A total of 10 ng/ml OSM was applied for 2 h prior to the respective therapy. The responsiveness toward radiation alone varied among the cervical carcinoma cells. CaSki, 808 and 879 cells were resistant to irradiation up to 8 Gy. OSM pre-treatment sensitized two out of five cell lines (HeLa and 879) to irradiation. Notably, all tested cells were sensitized by OSM for CCRT-treatment, particularly in the less radiosensitive cells. Cell death enhancement was dependent on phosphorylated signal transducer and activator of transcription 3 (STAT3; Tyr705) signaling activation as demonstrated with a dominant-negative version of STAT3 interfering with phosphorylation at Tyr705 (dnSTAT3-Y705F). In conclusion, OSM pre-treatment was able to override resistance to CCRT via the STAT3 signaling pathway.
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Affiliation(s)
- Russalina Stroeder
- Department of Gynecology and Obstetrics, Saarland University, D-66421 Homburg/Saar, Germany
| | | | - Jil Fischbach
- Institute of Virology, Saarland University, D-66421 Homburg/Saar, Germany
| | - Ingolf Juhasz-Böss
- Department of Gynecology and Obstetrics, Saarland University, D-66421 Homburg/Saar, Germany
| | - Christian Rübe
- Department of Radiotherapy and Radiation Oncology, Saarland University, D-66421 Homburg/Saar, Germany
| | - Erich-Franz Solomayer
- Department of Gynecology and Obstetrics, Saarland University, D-66421 Homburg/Saar, Germany
| | - Sigrun Smola
- Institute of Virology, Saarland University, D-66421 Homburg/Saar, Germany
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Gooskens SL, Graf N, Furtwängler R, Spreafico F, Bergeron C, Ramírez-Villar GL, Godzinski J, Rübe C, Janssens GO, Vujanic GM, Leuschner I, Coulomb-L'Hermine A, Smets AM, de Camargo B, Stoneham S, van Tinteren H, Pritchard-Jones K, van den Heuvel-Eibrink MM. Position paper: Rationale for the treatment of children with CCSK in the UMBRELLA SIOP-RTSG 2016 protocol. Nat Rev Urol 2018; 15:309-319. [PMID: 29485128 DOI: 10.1038/nrurol.2018.14] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
The International Society of Paediatric Oncology-Renal Tumour Study Group (SIOP-RTSG) has developed a new protocol for the diagnosis, treatment, and follow-up monitoring of childhood renal tumours - the UMBRELLA SIOP-RTSG 2016 protocol (the UMBRELLA protocol). This protocol has been designed to continue international collaboration in the treatment of childhood renal tumours and will be implemented in over 50 different countries. Clear cell sarcoma of the kidney, which is a rare paediatric renal tumour that most commonly occurs in children between 2 and 4 years of age, is specifically addressed in the UMBRELLA protocol.
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Affiliation(s)
- Saskia L Gooskens
- Department of Paediatric Oncology, Princess Máxima Center for Paediatric Oncology, Utrecht, Netherlands.,Department of Paediatric Haematology and Oncology, Erasmus MC - Sophia Children's Hospital, Rotterdam, Netherlands
| | - Norbert Graf
- Department of Paediatric Haematology and Oncology, Saarland University, Homburg, Germany
| | - Rhoikos Furtwängler
- Department of Paediatric Haematology and Oncology, Saarland University, Homburg, Germany
| | - Filippo Spreafico
- Department of Haematology and Paediatric Onco-Haematology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Gema L Ramírez-Villar
- Department of Paediatric Oncology, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Jan Godzinski
- Department of Emergency Medicine, Medical University of Wroclaw and Department of Paediatric Surgery, Marciniak Hospital, Wroclaw, Poland
| | - Christian Rübe
- Department of Radiotherapy and Radiation Oncology, Saarland University, Homburg, Germany
| | - Geert O Janssens
- Department of Paediatric Oncology, Princess Máxima Center for Paediatric Oncology, Utrecht, Netherlands.,Department of Radiation Oncology, Utrecht University Medical Center, Utrecht, Netherlands
| | - Gordan M Vujanic
- Department of Pathology, Sidra Medicine, Sidra Hospital, Qatar Foundation, Doha, Qatar
| | - Ivo Leuschner
- Kiel Paediatric Tumour Registry, Department of Paediatric Pathology, University Schleswig-Holstein, Kiel, Germany
| | - Aurore Coulomb-L'Hermine
- Department of Pathology, Hopitaux Universitaires Est Parisien, Trousseau La Roche-Guyon, Paris, France
| | - Anne M Smets
- Department of Radiology, Academic Medical Center (AMC), Amsterdam, Netherlands
| | - Beatriz de Camargo
- Instituto Nacional do Cancer, Paediatric Haematology and Oncology Program, Rio de Janeiro, Brazil
| | - Sara Stoneham
- Department of Paediatric and Adolescent Oncology, University College Hospital, Bloomsbury, London, UK
| | - Harm van Tinteren
- Department of Statistics, Netherlands Cancer Institute (NKI-AvL), Amsterdam, Netherlands
| | - Kathy Pritchard-Jones
- Developmental Biology and Cancer Programme, UCL Great Ormond Street Institute of Child Health, University College, London, UK
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Bell K, Dzierma Y, Morlo M, Nüsken F, Licht N, Rübe C. Image guidance in clinical practice – Influence of positioning inaccuracy on the dose distribution for prostate cancer. Phys Med 2018. [DOI: 10.1016/j.ejmp.2018.01.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Furtwängler R, Kager L, Melchior P, Rübe C, Ebinger M, Nourkami-Tutdibi N, Niggli F, Warmann S, Hubertus J, Amman G, Leuschner I, Vokuhl C, Graf N, Frühwald MC. High-dose treatment for malignant rhabdoid tumor of the kidney: No evidence for improved survival-The Gesellschaft für Pädiatrische Onkologie und Hämatologie (GPOH) experience. Pediatr Blood Cancer 2018; 65. [PMID: 28843054 DOI: 10.1002/pbc.26746] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 06/19/2017] [Accepted: 07/07/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Malignant rhabdoid tumor of the kidney (MRTK) is the most aggressive childhood renal tumor with overall survival (OS) rates ranging from 22% to 42%. Whether high-dose chemotherapy with autologous stem-cell transplantation (HDSCT) in an intensive first-line treatment offers additional benefit is an ongoing discussion. METHODS A retrospective analysis of all 58 patients with MRTK from Austria, Switzerland, and Germany treated in the framework of consecutive, prospective renal/rhabdoid tumor studies SIOP9/GPO, SIOP93-01/GPOH (where SIOP is International Society of Pediatric Oncology and GPOH is German Society of Pediatric Oncology and Hematology), SIOP2001/GPOH, and European Rhabdoid Tumor Registry from 1991 to 2014. RESULTS Median age at diagnosis was 11 months. Fifty percent of patients had metastases or multifocal disease at diagnosis (Stage IV). Local stage distribution was as follows: not done/I/II/III-1/6/11/40. Fifteen (26%) patients underwent upfront surgery. Thirty-seven (64%) patients achieved a complete remission, 17 (29%) relapsed, 34 (59%) died of disease progression, and two (3%) died of treatment-related complication. Mean time to the first event was 3.5 months. Two-year EFS/OS (where EFS is event-free survival) for the whole group was 37 ± 6%/38 ± 6%. Metastases/multifocal disease, younger age, and local stage III were associated with significantly inferior survival. Eleven (19%) patients underwent HDSCT (carboplatin + thiotepa, n = 6; carboplatin + etoposide + melphalan, n = 4; others, n = 1); 2-year OS in this group was 60 ± 15% compared to 34 ± 8% in the non-HDSCT group (P = 0.064). However, the time needed from radiologic to histologic diagnosis, stem-cell harvest, and HDSCT must also be taken into account to avoid selection bias by excluding the highest risk group with early progression (<90 days). Thus, 2-year EFS only for patients without progression until day 90 was 60 ± 16% consolidated by HDSCT compared to 62 ± 11% without (P = 0.8). CONCLUSION Our retrospective analysis suggests comparable outcomes for patients with and without HDSCT, if adjusted for early disease progression.
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Affiliation(s)
- Rhoikos Furtwängler
- Department of Pediatric Hematology and Oncology, Saarland University Hospital, Homburg/Saar, Germany
| | - Leo Kager
- Department of Pediatrics, St. Anna Children's Hospital, Medical University Vienna, Vienna, Austria
| | - Patrick Melchior
- Department of Radiation Oncology, Saarland University Hospital, Homburg, Germany
| | - Christian Rübe
- Department of Radiation Oncology, Saarland University Hospital, Homburg, Germany
| | - Martin Ebinger
- Department of Pediatric Hematology and Oncology, Tübingen University Hospital, Tübingen, Germany
| | - Nasenien Nourkami-Tutdibi
- Department of Pediatric Hematology and Oncology, Saarland University Hospital, Homburg/Saar, Germany
| | - Felix Niggli
- Department of Pediatric Oncology, Children's Hospital, Zurich University, Switzerland
| | - Steven Warmann
- Department of Pediatric Surgery, Tübingen University Hospital, Tübingen, Germany
| | - Jochen Hubertus
- Department of Pediatric Surgery, von Haunersches Kinderspital, Ludwigs-Maximilian-University, Munich, Germany
| | - Gabriele Amman
- Department of Clinical Pathology, Medical University Vienna, Vienna, Austria
| | - Ivo Leuschner
- Department of Paidopathology, Schleswig-Holstein-University Hospital, Campus Kiel, Kiel, Germany
| | - Christian Vokuhl
- Department of Paidopathology, Schleswig-Holstein-University Hospital, Campus Kiel, Kiel, Germany
| | - Norbert Graf
- Department of Pediatric Hematology and Oncology, Saarland University Hospital, Homburg/Saar, Germany
| | - Michael C Frühwald
- Swabian Children's Center, Children's Hospital Augsburg, Augsburg, Germany
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van den Heuvel-Eibrink MM, Hol JA, Pritchard-Jones K, van Tinteren H, Furtwängler R, Verschuur AC, Vujanic GM, Leuschner I, Brok J, Rübe C, Smets AM, Janssens GO, Godzinski J, Ramírez-Villar GL, de Camargo B, Segers H, Collini P, Gessler M, Bergeron C, Spreafico F, Graf N. Position paper: Rationale for the treatment of Wilms tumour in the UMBRELLA SIOP-RTSG 2016 protocol. Nat Rev Urol 2017; 14:743-752. [PMID: 29089605 DOI: 10.1038/nrurol.2017.163] [Citation(s) in RCA: 180] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The Renal Tumour Study Group of the International Society of Paediatric Oncology (SIOP-RTSG) has developed a new protocol for the diagnosis and treatment of childhood renal tumours, the UMBRELLA SIOP-RTSG 2016 (the UMBRELLA protocol), to continue international collaboration in the treatment of childhood renal tumours. This protocol will support integrated biomarker and imaging research, focussing on assessing the independent prognostic value of genomic changes within the tumour and the volume of the blastemal component that survives preoperative chemotherapy. Treatment guidelines for Wilms tumours in the UMBRELLA protocol include recommendations for localized, metastatic, and bilateral disease, for all age groups, and for relapsed disease. These recommendations have been established by a multidisciplinary panel of leading experts on renal tumours within the SIOP-RTSG. The UMBRELLA protocol should promote international collaboration and research and serve as the SIOP-RTSG best available treatment standard.
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Affiliation(s)
- Marry M van den Heuvel-Eibrink
- Department of Paediatric Oncology, Princess Máxima Center for Paediatric Oncology, Lundlaan 6, 3584EA Utrecht, The Netherlands
| | - Janna A Hol
- Department of Paediatric Oncology, Princess Máxima Center for Paediatric Oncology, Lundlaan 6, 3584EA Utrecht, The Netherlands
| | - Kathy Pritchard-Jones
- Great Ormond Street Institute of Child Health, University College London, 30 Guilford St, London, WC1N 1EH, United Kingdom
| | - Harm van Tinteren
- Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Rhoikos Furtwängler
- Department of Paediatric Oncology & Haematology, Saarland University, Kirrberger Str. 100, 66421, Homburg, Germany
| | - Arnauld C Verschuur
- Department of Paediatric Oncology & Haematology, La Timone Children's Hospital, 264 Rue Saint-Pierre, 13385, Marseille, France
| | - Gordan M Vujanic
- Department of Cellular Pathology, University Hospital of Wales, Cardiff University School of Medicine, Heath Park, Eastern Ave, Cardiff, CF14 4XW, United Kingdom
| | - Ivo Leuschner
- Kiel Paediatric Tumour Registry, Department of Paediatric Pathology, University Hospital of Kiel, Christian-Albrechts-Platz 4, 24118, Kiel, Germany
| | - Jesper Brok
- Great Ormond Street Institute of Child Health, University College London, 30 Guilford St, London, WC1N 1EH, United Kingdom
| | - Christian Rübe
- Department of Radiotherapy, University Hospital of the Saarland, Kirrberger Str. 100, 66421, Homburg, Germany
| | - Anne M Smets
- Department of Radiology, Academic Medical Center Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Geert O Janssens
- Department of Paediatric Oncology, Princess Máxima Center for Paediatric Oncology, Lundlaan 6, 3584EA Utrecht, The Netherlands
- Department of Radiation Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Jan Godzinski
- Department of Paediatric Surgery, Marciniak Hospital, Fieldorfa 2, 54-049, Wroclaw, Poland
- Department of Paediatric Traumatology and Emergency Medicine, Medical University, Wybrzeze Ludwika Pasteura 1, 50-367, Wroclaw, Poland
| | - Gema L Ramírez-Villar
- Department of Paediatric Oncology, Hospital Universitario Virgen del Rocío, Av. Manuel Siurot, S/N, 41013 Seville, Spain
| | - Beatriz de Camargo
- Paediatric Haematology-Oncology Program, Instituto Nacional de Cancer (INCA), Praça Cruz Vermelha, 23, Rio de Janeiro, 20230-130, Brazil
| | - Heidi Segers
- Department of Paediatric Oncology, University Hospital Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Paola Collini
- Department of Diagnostic Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Giacomo Venezian, 1, 20133, Milan, Italy
| | - Manfred Gessler
- Biocenter of the University of Wuerzburg, Developmental Biochemistry, and Comprehensive Cancer Center Mainfranken, Josef-Schneider-Straße 6, 97080, Wuerzburg, Germany
| | - Christophe Bergeron
- Institut d'Hématologie et d'Oncologie Pédiatrique, Centre Léon Bérard, 28 Prom. Léa et Napoléon Bullukian, 69008, Lyon, France
| | - Filippo Spreafico
- Department of Diagnostic Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Giacomo Venezian, 1, 20133, Milan, Italy
| | - Norbert Graf
- Department of Paediatric Oncology & Haematology, Saarland University, Kirrberger Str. 100, 66421, Homburg, Germany
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Dzierma Y, Minko P, Ziegenhain F, Bell K, Buecker A, Rübe C, Jagoda P. Abdominal imaging dose in radiology and radiotherapy - Phantom point dose measurements, effective dose and secondary cancer risk. Phys Med 2017; 43:49-56. [PMID: 29195562 DOI: 10.1016/j.ejmp.2017.10.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 10/20/2017] [Accepted: 10/21/2017] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To compare abdominal imaging dose from 3D imaging in radiology (standard/low-dose/dual-energy CT) and radiotherapy (planning CT, kV cone-beam CT (CBCT)). METHODS Dose was measured by thermoluminescent dosimeters (TLD's) placed at 86 positions in an anthropomorphic phantom. Point, organ and effective dose were assessed, and secondary cancer risk from imaging was estimated. RESULTS Overall dose and mean organ dose comparisons yield significantly lower dose for the optimized radiology protocols (dual-source and care kV), with an average dose of 0.34±0.01 mGy and 0.54±0.01 mGy (average ± standard deviation), respectively. Standard abdominal CT and planning CT involve considerably higher dose (13.58 ± 0.18 mGy and 18.78±0.27 mGy, respectively). The CBCT dose show a dose fall-off near the field edges. On average, dose is reduced as compared with the planning or standard CT (3.79 ± 0.21 mGy for 220° rotation and 7.76 ± 0.37 mGy for 360°), unless the high-quality setting is chosen (20.30 ± 0.96 mGy). The mean organ doses show a similar behavior, which translates to the estimated secondary cancer risk. The modelled risk is in the range between 0.4 cases per million patient years (PY) for the radiological scans dual-energy and care kV, and 300 cases per million PY for the high-quality CBCT setting. CONCLUSIONS Modern radiotherapy imaging techniques (while much lower in dose than radiotherapy), involve considerably more dose to the patient than modern radiology techniques. Given the frequency of radiotherapy imaging, a further reduction in radiotherapy imaging dose appears to be both desirable and technically feasible.
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Affiliation(s)
- Yvonne Dzierma
- Department of Radiotherapy and Radiation Oncology, Saarland University Medical Center, Kirrberger Str. Geb. 6.5, D-66421 Homburg/Saar, Germany.
| | - Peter Minko
- Department of Diagnostic and Interventional Radiology, Saarland University Medical Center, Kirrberger Str. Geb. 50.1, D-66421 Homburg/Saar, Germany
| | - Franziska Ziegenhain
- Department of Radiotherapy and Radiation Oncology, Saarland University Medical Center, Kirrberger Str. Geb. 6.5, D-66421 Homburg/Saar, Germany
| | - Katharina Bell
- Department of Radiotherapy and Radiation Oncology, Saarland University Medical Center, Kirrberger Str. Geb. 6.5, D-66421 Homburg/Saar, Germany
| | - Arno Buecker
- Department of Diagnostic and Interventional Radiology, Saarland University Medical Center, Kirrberger Str. Geb. 50.1, D-66421 Homburg/Saar, Germany
| | - Christian Rübe
- Department of Radiotherapy and Radiation Oncology, Saarland University Medical Center, Kirrberger Str. Geb. 6.5, D-66421 Homburg/Saar, Germany
| | - Philippe Jagoda
- Department of Diagnostic and Interventional Radiology, Saarland University Medical Center, Kirrberger Str. Geb. 50.1, D-66421 Homburg/Saar, Germany
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Pfreundschuh M, Murawski N, Zeynalova S, Ziepert M, Loeffler M, Hänel M, Dierlamm J, Keller U, Dreyling M, Truemper L, Frickhofen N, Hünerlitürkoglu AN, Schmitz N, Pöschel V, Rixecker T, Berdel C, Rübe C, Held G, Zwick C. Optimization of rituximab for the treatment of DLBCL: increasing the dose for elderly male patients. Br J Haematol 2017; 179:410-420. [DOI: 10.1111/bjh.14860] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 05/15/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Michael Pfreundschuh
- Klinik für Innere Medizin I; Universitätsklinikum des Saarlandes; Homburg Germany
| | - Niels Murawski
- Klinik für Innere Medizin I; Universitätsklinikum des Saarlandes; Homburg Germany
| | | | | | | | | | | | - Ulrich Keller
- Medizinische Klinik III; Klinikum rechts der Isar; Technische Universität; Munich Germany
| | | | - Lorenz Truemper
- Abteilung Hämatologie; Universitätsmedizin Göttingen; Göttingen Germany
| | | | | | | | - Viola Pöschel
- Klinik für Innere Medizin I; Universitätsklinikum des Saarlandes; Homburg Germany
| | - Tanja Rixecker
- Klinik für Innere Medizin I; Universitätsklinikum des Saarlandes; Homburg Germany
| | | | - Christian Rübe
- Klinik für Strahlentherapie; Universitätsklinikum des Saarlandes; Homburg Germany
| | - Gerhard Held
- Klinik für Innere Medizin I; Universitätsklinikum des Saarlandes; Homburg Germany
| | - Carsten Zwick
- Klinik für Innere Medizin I; Universitätsklinikum des Saarlandes; Homburg Germany
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Al Kadah B, Papaspyrou G, Linxweiler M, Schick B, Rübe C, Büchler BS, Niewald M. Cancer of unknown primary (CUP) of the head and neck: retrospective analysis of 81 patients. Eur Arch Otorhinolaryngol 2017; 274:2557-2566. [PMID: 28314959 DOI: 10.1007/s00405-017-4525-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 03/01/2017] [Indexed: 11/28/2022]
Abstract
The treatment of patients with cervical lymph node metastases without detectable primary tumor remains an important challenge, until today, no standard therapy is available. The present study investigated the multimodal treatment of patients with head and neck CUP syndrome (HNCUP) and their follow-up retrospectively. 81 patients with cervical lymph node metastases without a primary tumor were treated at the Departments of Otorhinolaryngology as well as Radiotherapy and Radiation Oncology at the University of Saarland in Homburg, Germany in the period between 1991 and 2013. All patients received routine work-up consisting of CUP panendoscopy and imaging. Neck dissection was then performed in 77% of the patients. The most common histology was squamous cell carcinoma (80%). Ten percent of the patients had distant metastases. All patients underwent primary or adjuvant radiation therapy, or simultaneous radiochemotherapy. After a median follow-up of 3.5 years, the 5-year survival rate was 30%. There was a local recurrence that was known in 20/63 patients (31%) and distant metastases were documented in 19/61 M0 patients (31%). Higher grade late toxicity (grade 3-4) was observed in 12% of patients. Neck dissection and radiation therapy remains an integral part of HNCUP therapy, while the use of chemotherapy could be considered in selected cases. Prospective multicenter randomized trials would be necessary to identify the best target volume and to clarify the role of chemotherapy.
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Affiliation(s)
- Basel Al Kadah
- Department of Otorhinolaryngology, Saarland University Medical Center, Kirrberger Straße 100, 66421, Homburg/saar, Germany.
| | - Giorgos Papaspyrou
- Department of Otorhinolaryngology, Saarland University Medical Center, Kirrberger Straße 100, 66421, Homburg/saar, Germany
| | - Maximilian Linxweiler
- Department of Otorhinolaryngology, Saarland University Medical Center, Kirrberger Straße 100, 66421, Homburg/saar, Germany
| | - Bernhard Schick
- Department of Otorhinolaryngology, Saarland University Medical Center, Kirrberger Straße 100, 66421, Homburg/saar, Germany
| | - Christian Rübe
- Department of Radiotherapy and Radiation Oncology, Saarland University Medical Center, Homburg/saar, Germany
| | - Benjamin Simeon Büchler
- Department of Radiotherapy and Radiation Oncology, Saarland University Medical Center, Homburg/saar, Germany
| | - Marcus Niewald
- Department of Radiotherapy and Radiation Oncology, Saarland University Medical Center, Homburg/saar, Germany
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Oskan F, Dzierma Y, Wagenpfeil S, Rübe C, Fleckenstein J. Retrospective analysis of stereotactic ablative radiotherapy (SABR) for metastatic lung lesions (MLLs) in comparison with a contemporaneous cohort of primary lung lesions (PLLs). J Thorac Dis 2017; 9:742-756. [PMID: 28449482 DOI: 10.21037/jtd.2017.03.07] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND The net benefit from local ablative therapy for pulmonary oligometastases remains unknown. The outcomes of stereotactic ablative radiotherapy (SABR) for metastatic lung lesions (MLLs) were analyzed retrospectively and compared with those of SABR for primary lung lesions (PLLs). METHODS Medical records of patients treated with lung SABR between 2011 and 2014 were retrospectively reviewed. Basic patient, lesion and treatment characteristics were compared using the Pearson chi-square test for categorical and Mann-Whitney U test for continuous variables. To estimate the rates of local control (LC), progression-free survival (PFS), survival after the first progression post-SABR (SAPF) and overall survival (OS), the Kaplan-Meier method was used, and the differences between groups were assessed by means of the log rank test. The uni- and multivariate Cox proportional hazards regression model was used to identify predictive factors for these endpoints. RESULTS Twenty-nine MLLs in 18 consecutive patients and 51 PLLs in 42 patients were treated stereotactically and included in the study. Median follow-up was 14 months (range, 4-40 months). Although patients with MLLs had a significantly better cardiopulmonary function (P=0.0001), more conservative dose-fractionation schedules were prescribed (P=0.0001), but this did not result in a significant difference in LC (P=0.98), PFS (P=0.06) and OS (P=0.14). Multivariate analysis revealed that the dose per fraction (≥ or <12 Gy) was an independent predictor for LC (P=0.02) and PFS (P=0.01) for the whole population, and for PFS (P=0.02) in the PLLs group. Late toxicities ≥ G2 occurred in six patients with PLLs, compared with none in the metastatic group. CONCLUSIONS SABR for MLLs was as successful as for PLLs with respect to LC and OS with lower long-term toxicity in patients with MLLs. Dose per fraction ≥12 Gy turned out to be an independent, favorable prognostic factor.
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Affiliation(s)
- Feras Oskan
- Department of Radiotherapy and Radiation Oncology, Saarland University Medical Center, 66421 Homburg, Saarland, Germany.,Department of Radiation Oncology, Alb-Fils Kliniken GmbH, Eichertstr. 3, 73035 Goeppingen, Germany
| | - Yvonne Dzierma
- Department of Radiotherapy and Radiation Oncology, Saarland University Medical Center, 66421 Homburg, Saarland, Germany
| | - Stefan Wagenpfeil
- Institute of Medical Biometry, Epidemiology and Medical Informatics, Saarland University, Campus Homburg, 66421 Homburg, Saarland, Germany
| | - Christian Rübe
- Department of Radiotherapy and Radiation Oncology, Saarland University Medical Center, 66421 Homburg, Saarland, Germany
| | - Jochen Fleckenstein
- Department of Radiotherapy and Radiation Oncology, Saarland University Medical Center, 66421 Homburg, Saarland, Germany
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Bell K, Heitfeld M, Licht N, Rübe C, Dzierma Y. Influence of daily imaging on plan quality and normal tissue toxicity for prostate cancer radiotherapy. Radiat Oncol 2017; 12:7. [PMID: 28069053 PMCID: PMC5223448 DOI: 10.1186/s13014-016-0757-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 12/28/2016] [Indexed: 11/10/2022] Open
Abstract
Background Modern radiotherapy offers various possibilities for image guided verification of patient positioning. Different clinically relevant IGRT (image guided radiotherapy) scenarios were considered with regard to their influence on dosimetric plan quality and normal tissue complication probability (NTCP). Methods This study is based on treatment plans of 50 prostate patients. We evaluate the clinically performed IGRT and simulate the influence of different daily IGRT scenarios on plan quality. Imaging doses of planar and cone-beam-CT (CBCT) images for three different energies (6 MV, 1 MV and 121 kV) were added to the treatment plans. The plan quality of the different scenarios was assessed by a visual inspection of the dose distribution and dose-volume-histogram (DVH) and a statistical analysis of DVH criteria. In addition, an assessment of the normal tissue complication probability was performed. Results Daily 1MV-CBCTs result in undesirable high dose regions in the target volume. The DVH shows that the scenarios with actual imaging performed, daily kV-CBCT and daily 6MV imaging (1x CBCT, 4x planar images per week) do not differ exceedingly from the original plan; especially imaging with daily kV-CBCT has little influence to the sparing of organs at risk. In contrast, daily 1MV- CBCT entails an additional dose of up to two fraction doses. Due to the additional dose amount some DVH constraints for plan acceptability could no longer be satisfied, especially for the daily 1MV-CBCT scenario. This scenario also shows increased NTCP for the rectum. Conclusion Daily kV-CBCT has negligible influence on plan quality and is commendable for the clinical routine. If no kV-modality is available, a daily IGRT scenario with one CBCT per week and planar axial images on the other days should be preferred over daily MV-CBCT.
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Affiliation(s)
- Katharina Bell
- Department of Radiotherapy and Radiation Oncology, Saarland University Medical Centre, Kirrberger Str. Geb. 6.5, D-66421, Homburg/Saar, Germany.
| | - Marina Heitfeld
- Department of Radiotherapy and Radiation Oncology, Saarland University Medical Centre, Kirrberger Str. Geb. 6.5, D-66421, Homburg/Saar, Germany
| | - Norbert Licht
- Department of Radiotherapy and Radiation Oncology, Saarland University Medical Centre, Kirrberger Str. Geb. 6.5, D-66421, Homburg/Saar, Germany
| | - Christian Rübe
- Department of Radiotherapy and Radiation Oncology, Saarland University Medical Centre, Kirrberger Str. Geb. 6.5, D-66421, Homburg/Saar, Germany
| | - Yvonne Dzierma
- Department of Radiotherapy and Radiation Oncology, Saarland University Medical Centre, Kirrberger Str. Geb. 6.5, D-66421, Homburg/Saar, Germany
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Dzierma Y, Nuesken F, Licht N, Rübe C. Benchmarking the mARC performance – treatment time and dosimetric linearity. Z Med Phys 2016; 26:339-348. [PMID: 26947444 DOI: 10.1016/j.zemedi.2016.02.001] [Citation(s) in RCA: 2] [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] [Received: 08/07/2015] [Revised: 01/07/2016] [Accepted: 02/01/2016] [Indexed: 10/22/2022]
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Fleckenstein J, Jelden M, Kremp S, Jagoda P, Stroeder J, Khreish F, Ezziddin S, Buecker A, Rübe C, Schneider GK. The Impact of Diffusion-Weighted MRI on the Definition of Gross Tumor Volume in Radiotherapy of Non-Small-Cell Lung Cancer. PLoS One 2016; 11:e0162816. [PMID: 27612171 PMCID: PMC5017760 DOI: 10.1371/journal.pone.0162816] [Citation(s) in RCA: 12] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 08/29/2016] [Indexed: 12/25/2022] Open
Abstract
Objective The study was designed to evaluate diffusion-weighted magnetic resonance imaging (DWI) vs. PET-CT of the thorax in the determination of gross tumor volume (GTV) in radiotherapy planning of non-small-cell lung cancer (NSCLC). Materials and Methods Eligible patients with NSCLC who were supposed to receive definitive radio(chemo)therapy were prospectively recruited. For MRI, a respiratory gated T2-weighted sequence in axial orientation and non-gated DWI (b = 0, 800, 1,400 and apparent diffusion coefficient map [ADC]) were acquired on a 1.5 Tesla scanner. Primary tumors were delineated on FDG-PET/CT (stGTV) and DWI images (dwGTV). The definition of stGTV was based on the CT and visually adapted to the FDG-PET component if indicated (e.g., in atelectasis). For DWI, dwGTV was visually determined and adjusted for anatomical plausibility on T2w sequences. Beside a statistical comparison of stGTV and dwGTB, spatial agreement was determined with the “Hausdorff-Distance” (HD) and the “Dice Similarity Coefficient” (DSC). Results Fifteen patients (one patient with two synchronous NSCLC) were evaluated. For 16 primary tumors with UICC stages I (n = 4), II (n = 3), IIIA (n = 2) and IIIB (n = 7) mean values for dwGTV were significantly larger than those of stGTV (76.6 ± 84.5 ml vs. 66.6 ± 75.2 ml, p<0.01). The correlation of stGTV and dwGTV was highly significant (r = 0.995, p<0.001). Yet, some considerable volume deviations between these two methods were observed (median 27.5%, range 0.4–52.1%). An acceptable agreement between dwGTV and stGTV regarding the spatial extent of primary tumors was found (average HD: 2.25 ± 0.7 mm; DC 0.68 ± 0.09). Conclusion The overall level of agreement between PET-CT and MRI based GTV definition is acceptable. Tumor volumes may differ considerably in single cases. DWI-derived GTVs are significantly, yet modestly, larger than their PET-CT based counterparts. Prospective studies to assess the safety and efficacy of DWI-based radiotherapy planning in NSCLC are warranted.
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Affiliation(s)
- Jochen Fleckenstein
- Department of Radiotherapy and Radiation Oncology, Saarland University Medical Center, Homburg, Germany
- * E-mail:
| | - Michael Jelden
- Department of Radiotherapy and Radiation Oncology, Saarland University Medical Center, Homburg, Germany
| | - Stephanie Kremp
- Department of Radiotherapy and Radiation Oncology, Saarland University Medical Center, Homburg, Germany
| | - Philippe Jagoda
- Department of Diagnostic and Interventional Radiology, Saarland University Medical Center, Homburg, Germany
| | - Jonas Stroeder
- Department of Diagnostic and Interventional Radiology, Saarland University Medical Center, Homburg, Germany
| | - Fadi Khreish
- Department of Nuclear Medicine, Saarland University Medical Center, Homburg, Germany
| | - Samer Ezziddin
- Department of Nuclear Medicine, Saarland University Medical Center, Homburg, Germany
| | - Arno Buecker
- Department of Nuclear Medicine, Saarland University Medical Center, Homburg, Germany
| | - Christian Rübe
- Department of Radiotherapy and Radiation Oncology, Saarland University Medical Center, Homburg, Germany
| | - Guenther K. Schneider
- Department of Diagnostic and Interventional Radiology, Saarland University Medical Center, Homburg, Germany
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Fleckenstein J, Petroff A, Schäfers HJ, Wehler T, Schöpe J, Rübe C. Long-term outcomes in radically treated synchronous vs. metachronous oligometastatic non-small-cell lung cancer. BMC Cancer 2016; 16:348. [PMID: 27255302 PMCID: PMC4890277 DOI: 10.1186/s12885-016-2379-x] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 05/23/2016] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Radical treatment for oligometastatic non-small-cell lung cancer (NSCLC) has a curative potential for selected patients. The present retrospective study was designed to examine the relevance of synchronous vs. metachronous manifestations as a potential prognostic factor when ablative treatments are performed in oligometastatic disease. METHODS Seventy-five patients with radically treated oligometastatic NSCLC were identified, of whom 39 presented with synchronous and 36 with metachronous metastatic manifestations. For patients with synchronous metastases, an additional therapy of the thoracic locoregional disease with a curative intent (either surgery or radiochemotherapy) was required. All patients with metachronous metastases had a documented remission of the primary tumor. Ablative treatment of the complete extent of oligometastatic disease consisted (as a minimum requirement) of either complete surgical resection or definitive ablative stereotactic radiotherapy. A comparative survival analysis of two groups of patients with oligometastatic NSCLC (synchronous vs. metachronous) and a complementary analysis of prognostic factors for the whole group of patients (by means of Cox regression analysis) was performed. Endpoints were median overall and progression-free survival (OS, PFS, respectively). RESULTS Of the 75 patients, 57 presented with a solitary metastasis, in only 7 patients metastastatic lesions were present in ≥2 organs and 66 patients had a Karnofsky performance score (KPS) of 80 % or 90 %. The median follow-up was 54.0 months (95 % CI 28-81), the median OS 21.8 months (16.1-27.6) and the median PFS 13.7 months (9.7-17.6). In univariable Cox regression analysis, no single clinical factor was significantly associated with OS. For PFS both 'metastatic involvement of ≥2 organs vs. 1 organ' (hazard ratio (HR) 0.43, 0.23-0.83, p = 0.012) and a 'KPS of 90 % vs. 70-80 %' (HR 4.32, 1.73-10.89, p = 0.02) were significant prognostic factors as calculated by multivariable analysis. Comparing the cohorts with synchronous (n = 39) vs. metachronous oligometastases (n = 36), no differences in median OS and PFS were found. Both cohorts were well-balanced except for the KPS, which was significantly superior in patients with synchronous oligometastases. CONCLUSIONS Radical treatment of oligometastatic NSCLC was associated with acceptable long-term survival rates in patients with good KPS and it was equally effective for synchronous and metachronous manifestations.
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Affiliation(s)
- Jochen Fleckenstein
- Department of Radiotherapy and Radiation Oncology, Saarland University Medical Center, Homburg, Germany.
| | - Alev Petroff
- Department of Radiotherapy and Radiation Oncology, Saarland University Medical Center, Homburg, Germany
| | - Hans-Joachim Schäfers
- Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg, Germany
| | - Thomas Wehler
- Department of Respiratory and Critical Care Medicine, Saarland University Medical Center, Homburg, Germany
| | - Jakob Schöpe
- Institute for Medical Biometry, Epidemiology and Medical Informatics, Saarland University, Campus Homburg, Saarbrücken, Germany
| | - Christian Rübe
- Department of Radiotherapy and Radiation Oncology, Saarland University Medical Center, Homburg, Germany
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Walch-Rückheim B, Pahne-Zeppenfeld J, Fischbach J, Wickenhauser C, Horn LC, Tharun L, Büttner R, Mallmann P, Stern P, Kim YJ, Bohle RM, Rübe C, Ströder R, Juhasz-Böss I, Solomayer EF, Smola S. STAT3/IRF1 Pathway Activation Sensitizes Cervical Cancer Cells to Chemotherapeutic Drugs. Cancer Res 2016; 76:3872-83. [DOI: 10.1158/0008-5472.can-14-1306] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Accepted: 03/21/2016] [Indexed: 11/16/2022]
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Müller CSL, Jungmann J, Pföhler C, Mohammad F, Rübe C, Vogt T. Bericht über die sofortige Bestrahlung eines schnell wachsenden Sarkoms der Kopfhaut vor dem Wundverschluss. J Dtsch Dermatol Ges 2016; 14:539-42. [DOI: 10.1111/ddg.12786_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Cornelia Sigrid Lissi Müller
- Klinik für Dermatologie, Venerologie und Allergologie; Universitätsklinikum des Saarlandes; Homburg/Saar Deutschland
| | - Janina Jungmann
- Klinik für Dermatologie, Venerologie und Allergologie; Universitätsklinikum des Saarlandes; Homburg/Saar Deutschland
| | - Claudia Pföhler
- Klinik für Dermatologie, Venerologie und Allergologie; Universitätsklinikum des Saarlandes; Homburg/Saar Deutschland
| | - Farid Mohammad
- Klinik für Strahlentherapie und Radioonkologie; Universitätsklinikum des Saarlandes; Homburg/Saar Deutschland
| | - Christian Rübe
- Klinik für Strahlentherapie und Radioonkologie; Universitätsklinikum des Saarlandes; Homburg/Saar Deutschland
| | - Thomas Vogt
- Klinik für Dermatologie, Venerologie und Allergologie; Universitätsklinikum des Saarlandes; Homburg/Saar Deutschland
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Müller CSL, Jungmann J, Pföhler C, Mohammad F, Rübe C, Vogt T. Report on immediate irradiation of a rapidly growing sarcoma of the scalp prior to wound closure. J Dtsch Dermatol Ges 2016; 14:539-42. [PMID: 27119488 DOI: 10.1111/ddg.12786] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Cutaneous sarcomas are primarily treated with extensive surgery, and occasionally require adjuvant radiation therapy following complete wound healing. Thus, sarcoma surgery leads to large and deep wounds, and the initiation of adjuvant radiation therapy depends on the time required for defect closure. We present the case of a male patient with pleomorphic sarcoma of the temporal skin, which was treated with multiple wide and deep excisions, instant application of an Integra(®) bilayer, and immediate radiation therapy prior to wound closure. The objective was to investigate the usefulness of a dermal substitute (Integra(®) ) in accelerating the effect of adjuvant radiation therapy on scalp defects after tumor surgery. A ring-shaped skin area - at risk for recurrence - around the Integra(®) bilayer was irradiated with a total of 59.4 Gy. No necrosis, infection, or major radiotoxicity was observed, and a subsequent split skin graft following radiation therapy remained fully vital until complete healing. In conclusion, a combined procedure consisting of sequential tumor surgery and subsequent application of a dermal substitute in conjunction with immediate initiation of adjuvant radiation therapy is, in principle, possible, and may permit innovative therapeutic options in dermatooncology and dermatosurgery.
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Affiliation(s)
| | - Janina Jungmann
- Department of Dermatology, Saarland University Hospital Homburg/Saar, Germany
| | - Claudia Pföhler
- Department of Dermatology, Saarland University Hospital Homburg/Saar, Germany
| | - Farid Mohammad
- Department of Radiotherapy and Radiation Oncology, Saarland University Hospital Homburg/Saar, Germany
| | - Christian Rübe
- Department of Radiotherapy and Radiation Oncology, Saarland University Hospital Homburg/Saar, Germany
| | - Thomas Vogt
- Department of Dermatology, Saarland University Hospital Homburg/Saar, Germany
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Dzierma Y, Licht N, Norton I, Nuesken F, Rübe C. EP-1631: mARC treatment planning in non-dedicated systems: two conversion approaches using IMRT and SmartArc. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)32882-1] [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: 12/01/2022]
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Dzierma Y, Bell K, Nuesken F, Palm J, Fleckenstein J, Licht N, Rübe C. EP-1672: mARC vs. IMRT treatment of prostate and head-and-neck cancer with flat and FFF energies. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)32923-1] [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: 11/15/2022]
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