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Mangesius J, Seppi T, Arnold CR, Mangesius S, Kerschbaumer J, Demetz M, Minasch D, Vorbach SM, Sarcletti M, Lukas P, Nevinny-Stickel M, Ganswindt U. Prognosis versus Actual Outcomes in Stereotactic Radiosurgery of Brain Metastases: Reliability of Common Prognostic Parameters and Indices. Curr Oncol 2024; 31:1739-1751. [PMID: 38668035 PMCID: PMC11049204 DOI: 10.3390/curroncol31040132] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 03/11/2024] [Accepted: 03/21/2024] [Indexed: 04/28/2024] Open
Abstract
This study aims to evaluate the clinical outcome of stereotactic radiosurgery as the sole treatment for brain metastases and to assess prognostic factors influencing survival. A total of 108 consecutive patients with 213 metastases were retrospectively analyzed. Treatment was determined with close-meshed MRI follow-up. Various prognostic factors were assessed, and several prognostic indices were compared regarding their reliability to estimate overall survival. Median overall survival was 15 months; one-year overall survival was 50.5%. Both one- and two-year local controls were 90.9%. The rate of new metastases after SRS was 49.1%. Multivariate analysis of prognostic factors revealed that the presence of extracranial metastases, male sex, lower KPI, and progressive extracranial disease were significant risk factors for decreased survival. Of all evaluated prognostic indices, the Basic Score for Brain Metastases (BSBMs) showed the best correlation with overall survival. A substantial survival advantage was found for female patients after SRS when compared to male patients (18 versus 9 months, p = 0.003). SRS of brain metastasis is a safe and effective treatment option when frequent monitoring for new metastases with MRI is performed. Common prognostic scores lack reliable estimation of survival times. Female sex should be considered as an additional independent positive prognostic factor influencing survival.
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Affiliation(s)
- Julian Mangesius
- Department of Radiation Oncology, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Thomas Seppi
- Department of Radiation Oncology, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | | | - Stephanie Mangesius
- Department of Neuroradiology, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Johannes Kerschbaumer
- Department of Neurosurgery, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Matthias Demetz
- Department of Neurosurgery, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Danijela Minasch
- Department of Radiation Oncology, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Samuel Moritz Vorbach
- Department of Radiation Oncology, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Manuel Sarcletti
- Department of Radiation Oncology, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Peter Lukas
- Department of Radiation Oncology, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | | | - Ute Ganswindt
- Department of Radiation Oncology, Medical University of Innsbruck, 6020 Innsbruck, Austria
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Mangesius J, Arnold CR, Seppi T, Mangesius S, Brüggl M, Eichberger P, Ganswindt U. Impact of COVID-19 on Radiation Oncology, an Austrian Experience. Curr Oncol 2021; 28:4776-4785. [PMID: 34898552 PMCID: PMC8628691 DOI: 10.3390/curroncol28060404] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 10/29/2021] [Accepted: 11/11/2021] [Indexed: 11/25/2022] Open
Abstract
The COVID-19 pandemic has an unprecedented impact on cancer treatment worldwide. We aimed to evaluate the effects of the pandemic on the radiation treatment of patients in order to provide data for future management of such crises. We compared the number of performed radiotherapy sessions of the pandemic period from February 2020 until May 2021 with those of 2018 and 2019 for reference. At our department, no referred patients had to be rejected or postponed, nor any significant changes in fractionation schedules implemented. Nevertheless, there was a substantial drop in overall radiotherapy sessions in 2020 following the first incidence wave of up to −25% (in June) in comparison to previous years. For breast cancer, a maximum decline of sessions of −45% (July) was recorded. Only a short drop of prostate cancer sessions (max −35%, May) followed by a rebound (+42%, July) was observed. Over the investigated period, a loss of 4.4% of expected patients never recovered. The severe impact of COVID-19 on cancer treatment, likely caused by retarded diagnosis and delayed interdisciplinary co-treatment, is reflected in a lower count of radiotherapy sessions. Radiation oncology is a crucial cornerstone in upholding both curative treatment options and treatment capacity during a pandemic.
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Affiliation(s)
- Julian Mangesius
- Department of Radiation Oncology, Medical University of Innsbruck, 6020 Innsbruck, Austria; (C.R.A.); (T.S.); (M.B.); (P.E.); (U.G.)
- Correspondence:
| | - Christoph Reinhold Arnold
- Department of Radiation Oncology, Medical University of Innsbruck, 6020 Innsbruck, Austria; (C.R.A.); (T.S.); (M.B.); (P.E.); (U.G.)
| | - Thomas Seppi
- Department of Radiation Oncology, Medical University of Innsbruck, 6020 Innsbruck, Austria; (C.R.A.); (T.S.); (M.B.); (P.E.); (U.G.)
| | - Stephanie Mangesius
- Department of Neuroradiology, Medical University of Innsbruck, 6020 Innsbruck, Austria;
| | - Mario Brüggl
- Department of Radiation Oncology, Medical University of Innsbruck, 6020 Innsbruck, Austria; (C.R.A.); (T.S.); (M.B.); (P.E.); (U.G.)
| | - Paul Eichberger
- Department of Radiation Oncology, Medical University of Innsbruck, 6020 Innsbruck, Austria; (C.R.A.); (T.S.); (M.B.); (P.E.); (U.G.)
| | - Ute Ganswindt
- Department of Radiation Oncology, Medical University of Innsbruck, 6020 Innsbruck, Austria; (C.R.A.); (T.S.); (M.B.); (P.E.); (U.G.)
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3
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Arnold CR, Lindner AK, Schachtner G, Tulchiner G, Tulchiner N, Mangesius J, Maffei M, Horninger W, Kouvaiou O, Lukas P, Ganswindt U, Pichler R, Skvortsov S. Vinorelbine in bladder-preserving multimodality treatment for muscle-invasive bladder cancer-a valid option for cisplatin-unfit patients? Strahlenther Onkol 2021; 198:25-32. [PMID: 34414475 PMCID: PMC8760228 DOI: 10.1007/s00066-021-01837-7] [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: 02/10/2021] [Accepted: 06/13/2021] [Indexed: 11/17/2022]
Abstract
Purpose Treatment of muscle-invasive bladder cancer (MIBC) remains challenging, especially for elderly and/or comorbid patients. Patients who are unfit for or refuse surgery should receive bladder-preserving multimodality treatment (BPMT), consisting of transurethral resection of the bladder tumor (TURB) followed by combined chemoradiotherapy (CRT). We aimed to investigate the effectiveness of vinorelbine, a chemotherapeutic agent not routinely used for MIBC, in patients referred to CRT who are unfit for standard chemotherapy and would thus rely solely on radiotherapy (RT). Methods We retrospectively analyzed 52 consecutive patients with MIBC who received standard CRT with cisplatin (n = 14), CRT with vinorelbine (n = 26), or RT alone (n = 12). Primary endpoints were median overall survival (OS) and median cancer-specific survival (CSS). Secondary endpoints were median local control (LC), median distant control (DC), and OS, CSS, LC, and DC after 1, 2, and 3 years, respectively. Results Median OS and CSS were significantly higher for patients who received vinorelbine as compared to RT alone (OS 8 vs. 22 months, p = 0.003; CSS 11 months vs. not reached, p = 0.001). Median LC and DC did not differ significantly between groups. Vinorelbine was well tolerated with no reported side effects >grade II. Conclusion Our results suggest that CRT with vinorelbine is well tolerated and superior to RT alone in terms of OS and CSS. Therefore, this treatment regime might constitute a new treatment option for patients with MIBC who are unfit for or refuse surgery or standard chemotherapy. This study encourages a randomized controlled trial to compare this new regime to current standard therapies.
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Affiliation(s)
- C R Arnold
- Department of Therapeutic Radiology and Oncology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - A K Lindner
- Department of Urology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - G Schachtner
- Department of Urology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - G Tulchiner
- Department of Urology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - N Tulchiner
- Department of Urology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - J Mangesius
- Department of Therapeutic Radiology and Oncology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - M Maffei
- Department of Radiation Oncology, General Hospital Bolzano, Lorenz Böhler Straße 5, 39100, Bolzano, Italy
| | - W Horninger
- Department of Urology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - O Kouvaiou
- Department of Therapeutic Radiology and Oncology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - P Lukas
- Department of Therapeutic Radiology and Oncology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - U Ganswindt
- Department of Therapeutic Radiology and Oncology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - R Pichler
- Department of Urology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria.
| | - S Skvortsov
- Department of Therapeutic Radiology and Oncology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria.
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Ostheimer C, Mäurer M, Ebert N, Schmitt D, Krug D, Baumann R, Henkenberens C, Giordano FA, Sautter L, López G, Fleischmann DF, Niyazi M, Käsmann L, Kaul D, Thieme AH, Billiet C, Dobiasch S, Arnold CR, Oertel M, Haussmann J, Gauer T, Goy Y, Suess C, Ziegler S, Panje CM, Baues C, Trommer M, Skripcak T, Medenwald D. Correction to: Prognostic impact of gross tumor volume during radical radiochemotherapy of locally advanced non-small cell lung cancer-results from the NCT03055715 multicenter cohort study of the Young DEGRO Trial Group. Strahlenther Onkol 2021; 197:560-561. [PMID: 33674905 PMCID: PMC8154766 DOI: 10.1007/s00066-021-01750-z] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- C Ostheimer
- Department of Radiation Oncology, Faculty of Medicine, Martin Luther University Halle-Wittenberg, Ernst-Grube-Straße 40, 06110, Halle (Saale), Germany.
| | - M Mäurer
- Department of Radiation Oncology, University Medical Center Jena, Jena, Germany
| | - N Ebert
- Department of Radiation Oncology, University Medical Center Dresden, Dresden, Germany.,OncoRay-National Center for Radiation Research in Oncology, Dresden, Germany
| | - D Schmitt
- Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany.,National Center for Radiation Research in Oncology (NCRO), Heidelberg, Germany.,Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg, Germany
| | - D Krug
- Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany
| | - R Baumann
- Department of Radiation Oncology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - C Henkenberens
- Department of Radiation and Special Oncology, Hannover Medical School, Hannover, Germany
| | - F A Giordano
- Department of Radiation Oncology, University Medical Center Mannheim, Mannheim, Germany
| | - L Sautter
- Department of Radiation Oncology, University Medical Center Mannheim, Mannheim, Germany
| | - Guerra López
- Department of Radiation Oncology, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - D F Fleischmann
- Department of Radiation Oncology, LMU Munich, Munich, Germany.,partner site Munich, German Cancer Consortium (DKTK), Munich, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - M Niyazi
- Department of Radiation Oncology, LMU Munich, Munich, Germany.,partner site Munich, German Cancer Consortium (DKTK), Munich, Germany
| | - L Käsmann
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
| | - D Kaul
- Department of Radiation Oncology, Charité School of Medicine, Berlin, Germany.,Campus Virchow-Klinikum, University Hospital, Berlin, Germany
| | - A H Thieme
- Department of Radiation Oncology, Charité School of Medicine, Berlin, Germany
| | - C Billiet
- Department of Radiation Oncology, Iridium Kankernetwerk, Antwerp, Belgium
| | - S Dobiasch
- Department of Radiation Oncology, Technische Universität München, Munich, Germany
| | - C R Arnold
- Department of Therapeutic Radiology and Oncology, Medical University of Innsbruck, Innsbruck, Austria
| | - M Oertel
- Department of Radiation Oncology, University Medical Center Muenster, Muenster, Germany
| | - J Haussmann
- Department of Radiation Oncology, University Medical Center Düsseldorf, Dusseldorf, Germany
| | - T Gauer
- Department of Radiotherapy and Radio-Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Y Goy
- Department of Radiotherapy and Radio-Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - C Suess
- Department of Radiation Oncology, University Medical Center Regensburg, Regensburg, Germany
| | - S Ziegler
- Department of Radiation Oncology, University Medical Center Erlangen, Erlangen, Germany
| | - C M Panje
- Department of Radiation Oncology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - C Baues
- Department of Radiation Oncology and Cyberknife Center, University of Cologne, Cologne, Germany
| | - M Trommer
- Department of Radiation Oncology and Cyberknife Center, University of Cologne, Cologne, Germany
| | - T Skripcak
- German Cancer Research Center (DKFZ), Heidelberg, Germany.,German Cancer Consortium (DKTK), Dresden, Germany
| | - D Medenwald
- Department of Radiation Oncology, Faculty of Medicine, Martin Luther University Halle-Wittenberg, Ernst-Grube-Straße 40, 06110, Halle (Saale), Germany
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5
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Ostheimer C, Mäurer M, Ebert N, Schmitt D, Krug D, Baumann R, Henkenberens C, Giordano FA, Sautter L, López G, Fleischmann DF, Niyazi M, Käsmann L, Kaul D, Thieme AH, Billiet C, Dobiasch S, Arnold CR, Oertel M, Haussmann J, Gauer T, Goy Y, Suess C, Ziegler S, Panje CM, Baues C, Trommer M, Skripcak T, Medenwald D. Prognostic impact of gross tumor volume during radical radiochemotherapy of locally advanced non-small cell lung cancer-results from the NCT03055715 multicenter cohort study of the Young DEGRO Trial Group. Strahlenther Onkol 2021; 197:385-395. [PMID: 33410959 PMCID: PMC8062351 DOI: 10.1007/s00066-020-01727-4] [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: 06/17/2020] [Accepted: 11/30/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND In radical radiochemotherapy (RCT) of inoperable non-small-cell lung cancer (NSCLC) typical prognostic factors include T- and N-stage, while there are still conflicting data on the prognostic relevance of gross tumor volume (GTV) and particularly its changes during RCT. The NCT03055715 study of the Young DEGRO working group of the German Society of Radiation Oncology (DEGRO) evaluated the prognostic impact of GTV and its changes during RCT. METHODS A total of 21 university centers for radiation oncology from five different European countries (Germany, Switzerland, Spain, Belgium, and Austria) participated in the study which evaluated n = 347 patients with confirmed (biopsy) inoperable NSCLC in UICC stage III A/B who received radical curative-intent RCT between 2010 and 2013. Patient and disease data were collected anonymously via electronic case report forms and entered into the multi-institutional RadPlanBio platform for central data analysis. GTV before RCT (initial planning CT, GTV1) and at 40-50 Gy (re-planning CT for radiation boost, GTV2) was delineated. Absolute GTV before/during RCT and relative GTV changes were correlated with overall survival as the primary endpoint. Hazard ratios (HR) of survival analysis were estimated by means of adjusted Cox regression models. RESULTS GTV1 was found to have a mean of 154.4 ml (95%CI: 1.5-877) and GTV2 of 106.2 ml (95% CI: 0.5-589.5), resulting in an estimated reduction of 48.2 ml (p < 0.001). Median overall survival (OS) was 18.8 months with a median of 22.1, 20.9, and 12.6 months for patients with high, intermediate, and low GTV before RT. Considering all patients, in one survival model of overall mortality, GTV2 (2.75 (1.12-6.75, p = 0.03) was found to be a stronger survival predictor than GTV1 (1.34 (0.9-2, p > 0.05). In patients with available data on both GTV1 and GTV2, absolute GTV1 before RT was not significantly associated with survival (HR 0-69, 0.32-1.49, p > 0.05) but GTV2 significantly predicted OS in a model adjusted for age, T stage, and chemotherapy, with an HR of 3.7 (1.01-13.53, p = 0.04) per 300 ml. The absolute decrease from GTV1 to GTV2 was correlated to survival, where every decrease by 50 ml reduced the HR by 0.8 (CI 0.64-0.99, p = 0.04). There was no evidence for a survival effect of the relative change between GTV1 and GTV2. CONCLUSION Our results indicate that independently of T stage, the re-planning GTV during RCT is a significant and superior survival predictor compared to baseline GTV before RT. Patients with a high absolute (rather than relative) change in GTV during RT show a superior survival outcome after RCT.
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Affiliation(s)
- C Ostheimer
- Department of Radiation Oncology, Faculty of Medicine, Martin Luther University Halle-Wittenberg, Ernst-Grube-Straße 40, 06110, Halle (Saale), Germany.
| | - M Mäurer
- Department of Radiation Oncology, University Medical Center Jena, Jena, Germany
| | - N Ebert
- Department of Radiation Oncology, University Medical Center Dresden, Dresden, Germany.,OncoRay-National Center for Radiation Research in Oncology, Dresden, Germany
| | - D Schmitt
- Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany.,National Center for Radiation Research in Oncology (NCRO), Heidelberg, Germany.,Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg, Germany
| | - D Krug
- Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany
| | - R Baumann
- Department of Radiation Oncology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - C Henkenberens
- Department of Radiation and Special Oncology, Hannover Medical School, Hannover, Germany
| | - F A Giordano
- Department of Radiation Oncology, University Medical Center Mannheim, Mannheim, Germany
| | - L Sautter
- Department of Radiation Oncology, University Medical Center Mannheim, Mannheim, Germany
| | - Guerra López
- Department of Radiation Oncology, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - D F Fleischmann
- Department of Radiation Oncology, LMU Munich, Munich, Germany.,partner site Munich, German Cancer Consortium (DKTK), Munich, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - M Niyazi
- Department of Radiation Oncology, LMU Munich, Munich, Germany.,partner site Munich, German Cancer Consortium (DKTK), Munich, Germany
| | - L Käsmann
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
| | - D Kaul
- Department of Radiation Oncology, Charité School of Medicine, Berlin, Germany.,Campus Virchow-Klinikum, University Hospital, Berlin, Germany
| | - A H Thieme
- Department of Radiation Oncology, Charité School of Medicine, Berlin, Germany
| | - C Billiet
- Department of Radiation Oncology, Iridium Kankernetwerk, Antwerp, Belgium
| | - S Dobiasch
- Department of Radiation Oncology, Technische Universität München, Munich, Germany
| | - C R Arnold
- Department of Therapeutic Radiology and Oncology, Medical University of Innsbruck, Innsbruck, Austria
| | - M Oertel
- Department of Radiation Oncology, University Medical Center Muenster, Muenster, Germany
| | - J Haussmann
- Department of Radiation Oncology, University Medical Center Düsseldorf, Dusseldorf, Germany
| | - T Gauer
- Department of Radiotherapy and Radio-Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Y Goy
- Department of Radiotherapy and Radio-Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - C Suess
- Department of Radiation Oncology, University Medical Center Regensburg, Regensburg, Germany
| | - S Ziegler
- Department of Radiation Oncology, University Medical Center Erlangen, Erlangen, Germany
| | - C M Panje
- Department of Radiation Oncology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - C Baues
- Department of Radiation Oncology and Cyberknife Center, University of Cologne, Cologne, Germany
| | - M Trommer
- Department of Radiation Oncology and Cyberknife Center, University of Cologne, Cologne, Germany
| | - T Skripcak
- German Cancer Research Center (DKFZ), Heidelberg, Germany.,German Cancer Consortium (DKTK), Dresden, Germany
| | - D Medenwald
- Department of Radiation Oncology, Faculty of Medicine, Martin Luther University Halle-Wittenberg, Ernst-Grube-Straße 40, 06110, Halle (Saale), Germany
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Abstract
Cancer stem cells (CSC) are a distinct subpopulation within a tumor. They are able to self-renew and differentiate and possess a high capability to repair DNA damage, exhibit low levels of reactive oxygen species (ROS), and proliferate slowly. These features render CSC resistant to various therapies, including radiation therapy (RT). Eradication of all CSC is a requirement for an effective antineoplastic treatment and is therefore of utmost importance for the patient. This makes CSC the prime targets for any therapeutic approach. Albeit clinical data is still scarce, experimental data and first clinical trials give hope that CSC-targeted treatment has the potential to improve antineoplastic therapies, especially for tumors that are known to be treatment resistant, such as glioblastoma. In this review, we will discuss CSC in the context of RT, describe known mechanisms of resistance, examine the possibilities of CSC as biomarkers, and discuss possible new treatment approaches.
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Affiliation(s)
- Christoph Reinhold Arnold
- Department of Therapeutic Radiology and Oncology, Medical University of Innsbruck, Innsbruck, Austria
| | - Julian Mangesius
- Department of Therapeutic Radiology and Oncology, Medical University of Innsbruck, Innsbruck, Austria
| | - Ira-Ida Skvortsova
- Department of Therapeutic Radiology and Oncology, Medical University of Innsbruck, Innsbruck, Austria.,EXTRO-Lab, Tyrolean Cancer Research Institute, Innsbruck, Austria
| | - Ute Ganswindt
- Department of Therapeutic Radiology and Oncology, Medical University of Innsbruck, Innsbruck, Austria
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7
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Mangesius J, Seppi T, Weigel R, Arnold CR, Vasiljevic D, Goebel G, Lukas P, Ganswindt U, Nevinny-Stickel M. Intrafractional 6D head movement increases with time of mask fixation during stereotactic intracranial RT-sessions. Radiat Oncol 2019; 14:231. [PMID: 31852497 PMCID: PMC6921566 DOI: 10.1186/s13014-019-1425-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 06/21/2019] [Accepted: 11/22/2019] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND The present study investigates the intrafractional accuracy of a frameless thermoplastic mask used for head immobilization during stereotactic radiotherapy. Non-invasive masks cannot completely prohibit head movements. Previous studies attempted to estimate the magnitude of intrafractional inaccuracy by means of pre- and postfractional measurements only. However, this might not be sufficient to accurately map also intrafractional head movements. MATERIALS AND METHODS Intrafractional deviation of mask-fixed head positions was measured in five patients during a total of 94 fractions by means of close-meshed repeated ExacTrac measurements (every 1.4 min) conducted during the entire treatment session. A median of six (range: 4 to 11) measurements were recorded per fraction, delivering a dataset of 453 measurements. RESULTS Random errors (SD) for the x, y and z axes were 0.27 mm, 0.29 mm and 0.29 mm, respectively. Median 3D deviation was 0.29 mm. Of all 3D intrafractional motions, 5.5 and 0.4% exceeded 1 mm and 2 mm, respectively. A moderate correlation between treatment duration and mean 3D displacement was determined (rs = 0.45). Mean 3D deviation increased from 0.21 mm (SD = 0.26 mm) in the first 2 min to a maximum of 0.53 mm (SD = 0.31 mm) after 10 min of treatment time. CONCLUSION Pre- and post-treatment measurement is not sufficient to adequately determine the range of intrafractional head motion. Thermoplastic masks provide both reliable interfractional and intrafractional immobilization for image-guided stereotactic hypofractionated radiotherapy. Greater positioning accuracy may be obtained by reducing treatment duration (< 6 min) and applying intrafractional correction. TRIAL REGISTRATION Clinicaltrials.gov, NCT03896555, Registered 01 April 2019 - retrospectively registered.
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Affiliation(s)
- Julian Mangesius
- Department of Therapeutic Radiology and Oncology, Medical University of Innsbruck, Anichstraße 35, A-6020 Innsbruck, Austria
| | - Thomas Seppi
- Department of Therapeutic Radiology and Oncology, Medical University of Innsbruck, Anichstraße 35, A-6020 Innsbruck, Austria
| | - Rocco Weigel
- Department of Therapeutic Radiology and Oncology, Medical University of Innsbruck, Anichstraße 35, A-6020 Innsbruck, Austria
| | - Christoph Reinhold Arnold
- Department of Therapeutic Radiology and Oncology, Medical University of Innsbruck, Anichstraße 35, A-6020 Innsbruck, Austria
| | - Danijela Vasiljevic
- Department of Therapeutic Radiology and Oncology, Medical University of Innsbruck, Anichstraße 35, A-6020 Innsbruck, Austria
| | - Georg Goebel
- Department of Medical Statistics, Informatics and Health Economics, Medical University of Innsbruck, Innsbruck, Austria
| | - Peter Lukas
- Department of Therapeutic Radiology and Oncology, Medical University of Innsbruck, Anichstraße 35, A-6020 Innsbruck, Austria
| | - Ute Ganswindt
- Department of Therapeutic Radiology and Oncology, Medical University of Innsbruck, Anichstraße 35, A-6020 Innsbruck, Austria
| | - Meinhard Nevinny-Stickel
- Department of Therapeutic Radiology and Oncology, Medical University of Innsbruck, Anichstraße 35, A-6020 Innsbruck, Austria
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Cocuzza AJ, Hobbs FW, Arnold CR, Chidester DR, Yarem JA, Culp S, Fitzgerald L, Gilligan PJ. 4-Aryl-2-anilinopyrimidines as corticotropin-releasing hormone (CRH) antagonists. Bioorg Med Chem Lett 1999; 9:1057-62. [PMID: 10230640 DOI: 10.1016/s0960-894x(99)00132-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A series of 4-aryl-2-(N-ethylanilino)pyrimidines has been synthesized as corticotropin-releasing hormone (CRH) inhibitors. The effect of substitution on each aromatic ring on receptor binding was investigated.
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Affiliation(s)
- A J Cocuzza
- DuPont Pharmaceuticals Company, Chemical and Physical Sciences Department, Experimental Station, Wilmington, DE 19880-0500, USA
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Gwo JC, Strawn K, Arnold CR. Changes in mechanical tolerance and chilling sensitivity of red drum () embryos during development. Theriogenology 1995; 43:1155-61. [PMID: 16727701 DOI: 10.1016/0093-691x(95)00087-o] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/1994] [Accepted: 12/01/1994] [Indexed: 11/28/2022]
Abstract
The effects of mechanical shock and thermal stress on red drum (Sciaenopus ocellatus) embryos at specific developmental stages were studied. The tolerance of red drum embryos to mechanical and chilling shocks depended on the embryo's stage of development. Gastrulae stage was more susceptible to mechanical shock than the other developmental stages. However, a different ontogenetic tolerance pattern for chilling shock was observed. It is suggested that the embryonic developmental stage needs be considered in future studies on the cryopreservation of fish embryos.
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Affiliation(s)
- J C Gwo
- Department of Aquaculture, National Taiwan Ocean University, Keelung 20224, Taiwan
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Gwo JC, Strawn K, Arnold CR. Induced ovulation in Atlantic croaker (Sciaenidae) using hCG and an LHRH analog: A preliminary study. Theriogenology 1993; 39:353-61. [PMID: 16727215 DOI: 10.1016/0093-691x(93)90378-i] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/1992] [Accepted: 10/22/1992] [Indexed: 11/18/2022]
Abstract
A single dose of LHRHa (D-Ala(6), des Gly(10)- LHRH-ethylamide; 100 mug/kg body weight); administered by intramuscular injection, effectively induced ovulation in the Atlantic croaker (Micropogonias undulatus ); 37 of 40 (92%) females were successfully hand-stripped and there was no mortality. A single dose of human chorionic gonadotropin (hCG; 500 IU/kg body weight) was successful in inducing oocyte hydration. However, only 16 of 30 (53%) females ovulated successfully and could be hand-stripped. Another 8 females became extremely bloated and died. Thus LHRHa was shown to be the more reliable method of inducing ovulation in the Atlantic croaker. The response interval between hormone treatment and ovulation at different water temperatures was also determined.
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Affiliation(s)
- J C Gwo
- Department of Aquaculture National Taiwan Ocean University Keelung 20224, Taiwan
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Abstract
The spermatozoon of the Atlantic croaker (Micropogonias undulatus) is a primitive type in that it lacks an acrosome. The kidney-shaped head has a diameter of about 1.5 microns and is occupied by a granular and electron-dense nucleus. The short midpiece contains 3 spherical mitochondria and encircles the basal body of the flagellum but is separated from it. The flagellum consists of the typical 9 + 2 axoneme and surrounding plasma membrane but lacks a lateral ridge. Spermatozoa of Atlantic croaker diluted in either NaCl or sodium citrate solutions with or without DMSO were examined with the electron microscope before freezing in liquid nitrogen and after thawing. Damage following cryopreservation appeared to be greater to the mitochondria, plasma membrane, and 9 + 2 axoneme than to the nucleus. The incidence of postthaw damage in spermatozoa diluted with NaCl solutions containing DMSO was remarkably lower than that with either pure NaCl solutions, pure sodium citrate solutions, or sodium citrate solutions containing DMSO.
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Affiliation(s)
- J C Gwo
- Marine Science Institute, University of Texas, Austin 78373-1267
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Morrison ST, Arnold CR. Patients with common communicable diseases. Preventive measures, treatment, and rehabilitation. Nurs Clin North Am 1970; 5:143-55. [PMID: 5197967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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13
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