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Ferdinandus J, Müller H, Damaschin C, Jacob AS, Meissner J, Krasniqi F, Mey U, Schöndube D, Thiemer J, Mathas S, Zijlstra J, Greil R, Feuring-Buske M, Markova J, Rüffer JU, Kobe C, Eich HT, Baues C, Fuchs M, Borchmann P, Behringer K. Impact of individualized treatment on recovery from fatigue and return to work in survivors of advanced-stage Hodgkin's lymphoma: results from the randomized international GHSG HD18 trial. Ann Oncol 2024; 35:276-284. [PMID: 38061428 DOI: 10.1016/j.annonc.2023.11.014] [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: 09/18/2023] [Revised: 11/01/2023] [Accepted: 11/29/2023] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND Persisting cancer-related fatigue impairs health-related quality of life (HRQoL) and social reintegration in patients with Hodgkin's lymphoma (HL). The GHSG HD18 trial established treatment de-escalation for advanced-stage HL guided by positron emission tomography after two cycles (PET-2) as new standard. Here, we investigate the impact of treatment de-escalation on long-term HRQoL, time to recovery from fatigue (TTR-F), and time to return to work (TTR-W). PATIENTS AND METHODS Patients received European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire C30 (EORTC QLQ-C30) and life situation questionnaires at baseline, interim, end of treatment, and yearly follow-up. TTR-F was defined as time from the end of chemotherapy until the first fatigue score <30. TTR-W was analyzed in previously working or studying patients and measured from the end of treatment until the first documented work or education. We compared duration of treatment on TTR-F and TTR-W using Cox proportional hazards regression adjusted for confounding variables. RESULTS HRQoL questionnaires at baseline were available in 1632 (83.9%) of all randomized patients. Overall, higher baseline fatigue and age were significantly associated with longer TTR-F and TTR-W and male sex with shorter TTR-W. Treatment reduction from eight to four chemotherapy cycles led to a significantly shorter TTR-F [hazard ratio (HR) 1.41, P = 0.008] and descriptively shorter TTR-W (HR 1.24, P = 0.084) in PET-2-negative patients. Reduction from six to four cycles led to non-significant but plausible intermediate accelerations. The addition of rituximab caused significantly slower TTR-F (HR 0.70, P = 0.0163) and TTR-W (HR 0.64, P = 0.0017) in PET-2-positive patients. HRQoL at baseline and age were the main determinants of 2-year HRQoL. CONCLUSIONS Individualized first-line treatment in patients with advanced-stage HL considerably shortens TTR-F and TTR-W in PET-2-negative patients. Our results support the use of response-adapted shortened treatment duration for patients with HL.
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Affiliation(s)
- J Ferdinandus
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Medical Faculty and University Hospital Cologne, Cologne; German Hodgkin Study Group (GHSG), Cologne.
| | - H Müller
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Medical Faculty and University Hospital Cologne, Cologne; German Hodgkin Study Group (GHSG), Cologne
| | - C Damaschin
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Medical Faculty and University Hospital Cologne, Cologne; German Hodgkin Study Group (GHSG), Cologne
| | - A S Jacob
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Medical Faculty and University Hospital Cologne, Cologne; German Hodgkin Study Group (GHSG), Cologne
| | - J Meissner
- Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany
| | - F Krasniqi
- Medical Oncology, University Hospital of Basel, Basel; Swiss Group for Clinical Cancer Research, Bern
| | - U Mey
- Swiss Group for Clinical Cancer Research, Bern; Oncology and Hematology, Kantonsspital Graubuenden, Chur, Switzerland
| | - D Schöndube
- Department of Oncology and Hematology, Helios Klinikum Bad Saarow, Bad Saarow
| | - J Thiemer
- Department of Hematology and Oncology, Klinikum der Philipps-Universität Marburg, Marburg
| | - S Mathas
- Charité-Universitätsmedizin Berlin, Hematology, Oncology and Tumor Immunology, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin; Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association (MDC), Group Biology of Malignant Lymphomas, Berlin; Experimental and Clinical Research Center (ECRC), a cooperation between the MDC and the Charité, Berlin, Germany
| | - J Zijlstra
- Department of Hematology, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - R Greil
- Illrd Medical Department, Paracelsus Medical University, Salzburg; Salzburg Cancer Research Institute and AGMT, Salzburg, Austria
| | - M Feuring-Buske
- Department of Internal Medicine III, University Hospital of Ulm, Ulm, Germany
| | - J Markova
- Department of Internal Medicine-Hematology, University Hospital Kralovske Vinohrady, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | | | - C Kobe
- German Hodgkin Study Group (GHSG), Cologne; Department of Nuclear Medicine, University Hospital of Cologne, Cologne
| | - H-T Eich
- German Hodgkin Study Group (GHSG), Cologne; Department of Radiotherapy, University Hospital of Muenster, Muenster
| | - C Baues
- German Hodgkin Study Group (GHSG), Cologne; Department of Radiooncology, Marienhospital Herne, Ruhr University Bochum, Bochum, Germany
| | - M Fuchs
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Medical Faculty and University Hospital Cologne, Cologne; German Hodgkin Study Group (GHSG), Cologne
| | - P Borchmann
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Medical Faculty and University Hospital Cologne, Cologne; German Hodgkin Study Group (GHSG), Cologne
| | - K Behringer
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Medical Faculty and University Hospital Cologne, Cologne; German Hodgkin Study Group (GHSG), Cologne
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Nguyen CB, Kobe C, Kumbier KE, Bauman J, Burns JA, Tsao PA, Sparks JB, Skolarus TA, Caram ME. Determinants of Bone-Modifying Agent Prescribing for Metastatic Castration-Resistant Prostate Cancer in a National Health Care Delivery System. JCO Oncol Pract 2024; 20:59-68. [PMID: 38085028 PMCID: PMC10827294 DOI: 10.1200/op.23.00258] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 09/07/2023] [Accepted: 09/27/2023] [Indexed: 01/13/2024] Open
Abstract
PURPOSE Despite guidelines recommending bone-modifying agents (BMAs) to decrease skeletal-related events (SREs) in men with metastatic castration-resistant prostate cancer (mCRPC), BMAs are underutilized. In this retrospective cohort study, we report the factors associated with BMA use in a national health care delivery system. METHODS We used the Veterans Affairs Corporate Data Warehouse to identify men with mCRPC between 2010 and 2017. BMA prescribing frequency was evaluated, and the association between patient- and disease-specific factors with BMA use was assessed using multivariable logistic regression. RESULTS Among 3,980 men identified with mCRPC (mean age 73.5 years, 29% Black), 47% received a BMA; median time to BMA from start of mCRPC treatment was 102 days. Factors associated with BMA use included previous BMA use (adjusted odds ratio [aOR], 7.81 [95% CI, 6.48 to 9.47]), diagnosis code for bone metastases (aOR, 1.26 [95% CI, 1.08 to 1.46]), and concomitant corticosteroid use (aOR, 1.53 [95% CI, 1.29 to 1.82]). Decreased BMA use was associated with advancing age (aOR, 0.85 per 10 years [95% CI, 0.78 to 0.92]), Charlson comorbidity index ≥2 (aOR, 0.76 [95% CI, 0.63 to 0.93]), Black race (aOR, 0.83 [95% CI, 0.70 to 0.98]), and decreased estimated glomerular filtration rate (eGFR; aOR, 0.19 [95% CI, 0.11 to 0.32] for eGFR 0-29 mL/minutes; aOR, 0.76 [95% CI, 0.64 to 0.91] for 30-59 mL/minutes). CONCLUSION Patients who are older, Black, or have more comorbidities are less likely to receive guideline concordant care to prevent SREs. These observations highlight the unique challenges of caring for patients with mCRPC and the need for future studies to increase BMA use in these populations.
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Affiliation(s)
- Charles B. Nguyen
- Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | - Christopher Kobe
- Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | - Kyle E. Kumbier
- VA Health Services Research & Development, Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI
| | - Jordan Bauman
- Division of Geriatric & Palliative Medicine, Department of Internal Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Jennifer A. Burns
- VA Health Services Research & Development, Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI
| | - Phoebe A. Tsao
- Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
- VA Health Services Research & Development, Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI
| | - Jordan B. Sparks
- VA Health Services Research & Development, Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI
| | - Ted A. Skolarus
- VA Health Services Research & Development, Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI
- Department of Surgery, Section of Urology, University of Chicago Pritzker School of Medicine, Chicago, IL
| | - Megan E.V. Caram
- Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
- VA Health Services Research & Development, Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI
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Wiesweg M, Hense J, Darwiche K, Michels S, Hautzel H, Kobe C, Metzenmacher M, Herold T, Zaun G, Laue K, Drzezga A, Schildhaus HU, Wolf J, Herrmann K, Schuler M. 1171P A phase II theranostic study with osimertinib in patients with EGFR-mutated non-small cell lung cancer (NSCLC) progressing on EGFR tyrosine kinase inhibitors (TKI) and undetectable EGFR T790M (THEROS). Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1294] [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: 11/01/2022] Open
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4
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Eichenauer DA, Kreissl S, Bühnen I, Baues C, Kobe C, van Heek L, Goergen H, Fuchs M, Hartmann S, von Tresckow B, Engert A, Borchmann P. PET-2-guided escalated BEACOPP for advanced nodular lymphocyte-predominant Hodgkin lymphoma: a subgroup analysis of the randomized German Hodgkin Study Group HD18 study. Ann Oncol 2021; 32:807-810. [PMID: 33667668 DOI: 10.1016/j.annonc.2021.02.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/10/2021] [Accepted: 02/16/2021] [Indexed: 11/25/2022] Open
Affiliation(s)
- D A Eichenauer
- First Department of Internal Medicine, Center for Integrated Oncology Aachen, Bonn, Cologne and Dusseldorf, University of Cologne, Cologne, Germany; German Hodgkin Study Group (GHSG), University Hospital Cologne, Cologne, Germany.
| | - S Kreissl
- First Department of Internal Medicine, Center for Integrated Oncology Aachen, Bonn, Cologne and Dusseldorf, University of Cologne, Cologne, Germany; German Hodgkin Study Group (GHSG), University Hospital Cologne, Cologne, Germany
| | - I Bühnen
- First Department of Internal Medicine, Center for Integrated Oncology Aachen, Bonn, Cologne and Dusseldorf, University of Cologne, Cologne, Germany; German Hodgkin Study Group (GHSG), University Hospital Cologne, Cologne, Germany
| | - C Baues
- German Hodgkin Study Group (GHSG), University Hospital Cologne, Cologne, Germany; Department of Radiation Oncology, University of Cologne, Cologne, Germany
| | - C Kobe
- German Hodgkin Study Group (GHSG), University Hospital Cologne, Cologne, Germany; Department of Nuclear Medicine, University of Cologne, Cologne, Germany
| | - L van Heek
- German Hodgkin Study Group (GHSG), University Hospital Cologne, Cologne, Germany; Department of Nuclear Medicine, University of Cologne, Cologne, Germany
| | - H Goergen
- First Department of Internal Medicine, Center for Integrated Oncology Aachen, Bonn, Cologne and Dusseldorf, University of Cologne, Cologne, Germany; German Hodgkin Study Group (GHSG), University Hospital Cologne, Cologne, Germany
| | - M Fuchs
- First Department of Internal Medicine, Center for Integrated Oncology Aachen, Bonn, Cologne and Dusseldorf, University of Cologne, Cologne, Germany; German Hodgkin Study Group (GHSG), University Hospital Cologne, Cologne, Germany
| | - S Hartmann
- Senckenberg Institute of Pathology, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - B von Tresckow
- First Department of Internal Medicine, Center for Integrated Oncology Aachen, Bonn, Cologne and Dusseldorf, University of Cologne, Cologne, Germany; German Hodgkin Study Group (GHSG), University Hospital Cologne, Cologne, Germany; Clinic for Hematology and Stem Cell Transplantation, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - A Engert
- First Department of Internal Medicine, Center for Integrated Oncology Aachen, Bonn, Cologne and Dusseldorf, University of Cologne, Cologne, Germany; German Hodgkin Study Group (GHSG), University Hospital Cologne, Cologne, Germany
| | - P Borchmann
- First Department of Internal Medicine, Center for Integrated Oncology Aachen, Bonn, Cologne and Dusseldorf, University of Cologne, Cologne, Germany; German Hodgkin Study Group (GHSG), University Hospital Cologne, Cologne, Germany
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5
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Christakopoulos GE, Kobe C, Flesch S, Lee J, Parsons HM, Sadak KT. Personalized Clinical Research: Childhood Cancer Survivor and Parent Preferences for Research Participation. JCO Oncol Pract 2020; 16:779-782. [PMID: 33006912 DOI: 10.1200/op.20.00307] [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: 11/20/2022] Open
Affiliation(s)
- Georgios E Christakopoulos
- University of Minnesota Medical School, Department of Pediatrics, Minneapolis, MN.,Department of Hematology, Department of Oncology, St Jude Children's Research Hospital, Memphis, TN
| | - Christopher Kobe
- University of Minnesota Medical School, Department of Pediatrics, Minneapolis, MN.,University of Minnesota Masonic Children's Hospital, Minneapolis, MN.,University of Minnesota Masonic Cancer Center, Minneapolis, MN
| | - Sue Flesch
- University of Minnesota Medical School, Department of Pediatrics, Minneapolis, MN.,University of Minnesota Masonic Children's Hospital, Minneapolis, MN.,University of Minnesota Masonic Cancer Center, Minneapolis, MN
| | - Jill Lee
- University of Minnesota Medical School, Department of Pediatrics, Minneapolis, MN.,University of Minnesota Masonic Children's Hospital, Minneapolis, MN.,University of Minnesota Masonic Cancer Center, Minneapolis, MN
| | - Helen M Parsons
- University of Minnesota Masonic Cancer Center, Minneapolis, MN.,University of Minnesota School of Public Health, Division of Health Policy and Management, Minneapolis, MN
| | - Karim T Sadak
- University of Minnesota Medical School, Department of Pediatrics, Minneapolis, MN.,University of Minnesota Masonic Children's Hospital, Minneapolis, MN.,University of Minnesota Masonic Cancer Center, Minneapolis, MN
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6
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Voltin CA, Goergen H, Baues C, Fuchs M, Mettler J, Kreissl S, Oertl J, Klaeser B, Moccia A, Drzezga A, Engert A, Borchmann P, Dietlein M, Kobe C. Value of bone marrow biopsy in Hodgkin lymphoma patients staged by FDG PET: results from the German Hodgkin Study Group trials HD16, HD17, and HD18. Ann Oncol 2019; 29:1926-1931. [PMID: 30010775 DOI: 10.1093/annonc/mdy250] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Bone marrow (BM) involvement defines advanced-stage Hodgkin lymphoma and thus has impact on the assignment to treatment. Our aim was to evaluate whether the established BM biopsy may be omitted in patients if 18F-fluorodeoxyglucose positron emission tomography (PET) scanning is carried out during staging. Patients and methods Our analysis set consisted of 832 Hodgkin lymphoma patients from the German Hodgkin Study Group trials HD16, HD17, and HD18 who underwent both PET scanning and BM biopsy before treatment. All PET studies were centrally reviewed and BM was categorized as showing focal involvement or not. Results Taking BM biopsy as reference standard, baseline PET showed a negative predictive value of 99.9% [95% confidence interval (CI) 99.2% to 100%] with true-negative results in 702 of 703 cases. The sensitivity of PET for detecting BM involvement was 95.0% (95% CI 75.1% to 99.9%) as it could identify 19 out of 20 patients with positive BM biopsy. Moreover, PET found 110 additional subjects with focal BM lesions who would have been considered negative by biopsy. Conclusions When compared with BM biopsy, PET was able to detect focal BM lesions in a large number of additional patients. This indicates that conventional BM biopsy may substantially underestimate the actual incidence of BM involvement. Given the high negative predictive value, baseline PET scanning can safely be used to exclude BM involvement in Hodgkin lymphoma. BM biopsy should be considered only in such patients in whom PET-detected lesions lead to a change of treatment protocol. Registered trials The trials included in this analysis were registered at ClinicalTrials.gov: HD16-NCT00736320, HD17-NCT01356680, and HD18-NCT00515554.
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Affiliation(s)
- C-A Voltin
- Department of Nuclear Medicine, University Hospital of Cologne, Cologne, Germany
| | - H Goergen
- German Hodgkin Study Group (GHSG), Department of Internal Medicine I, University Hospital of Cologne, Cologne, Germany
| | - C Baues
- Departments of Radiation Oncology, University Hospital of Cologne, Cologne, Germany
| | - M Fuchs
- German Hodgkin Study Group (GHSG), Department of Internal Medicine I, University Hospital of Cologne, Cologne, Germany
| | - J Mettler
- Department of Nuclear Medicine, University Hospital of Cologne, Cologne, Germany
| | - S Kreissl
- Departments of Internal Medicine I, University Hospital of Cologne, Cologne, Germany
| | - J Oertl
- Department of Nuclear Medicine, University Hospital of Cologne, Cologne, Germany
| | - B Klaeser
- Department of Nuclear Medicine, Inselspital, Bern University Hospital and University of Bern, Bern; Swiss Group for Clinical Cancer Research (SAKK), Bern
| | - A Moccia
- Swiss Group for Clinical Cancer Research (SAKK), Bern; Department of Medical Oncology, Oncology Institute of Southern Switzerland (IOSI), Bellinzona, Switzerland
| | - A Drzezga
- Department of Nuclear Medicine, University Hospital of Cologne, Cologne, Germany
| | - A Engert
- Departments of Internal Medicine I, University Hospital of Cologne, Cologne, Germany
| | - P Borchmann
- Departments of Internal Medicine I, University Hospital of Cologne, Cologne, Germany
| | - M Dietlein
- Department of Nuclear Medicine, University Hospital of Cologne, Cologne, Germany
| | - C Kobe
- Department of Nuclear Medicine, University Hospital of Cologne, Cologne, Germany.
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7
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Eich H, Baues C, Fuchs M, Kobe C, Greil R, Sasse S, Zijlstra J, Lohri A, Rosenwald A, Tresckow B, Diehl V, Kuhnert G, Dietlein M, Borchmann P, Engert A. PET-Guided Treatment of Early-Stage Favorable Hodgkin Lymphoma: Final Results of the International, Randomized Phase 3 Trial HD16 by the GHSG. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.380] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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8
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Baues C, Goergen H, Fuchs M, Kobe C, Dietlein M, Rosenbrock J, Celik E, Eich H, Kriz J, Semrau R, Borchmann P, Engert A, Marnitz S. Consolidating Involved Field Radiotherapy Prevents Early and Local Recurrences in Early Stage Hodgkin Lymphoma. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.445] [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: 11/25/2022]
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9
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Abdulla D, Ruge M, Scheffler M, Nogova L, Koleczko S, Persigehl T, Grau S, Drzezga A, Kobe C, Buettner R, Galldiks N, Wolf J. Feasibility of O-(2-[18F]fluoroethyl)-L-tyrosine (FET) PET for treatment monitoring of brain metastases in lung cancer patients. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz063.076] [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: 11/13/2022] Open
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10
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Busemeyer S, Kobe C, Schmidt M, Theissen P, Schicha H, Dietlein M. Recombinant human TSH versus hypo thyroidism. Nuklearmedizin 2018; 49:216-24. [DOI: 10.3413/nukmed-0321-1005] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2010] [Accepted: 09/13/2010] [Indexed: 11/20/2022]
Abstract
SummaryThe primary aim of this study was to compare pharmacoeconomic effects of hypothyroidism secondary to hormone withdrawal (THW) and recombinant human TSH (rhTSH) for followup WBS in patients with differentiated thyroid cancer (DTC). The second aim was to determine patients' preference for one procedure or the other. Patients, methods: This retrospective survey included 327 patients with DTC who underwent at least one in-hospital WBS with rhTSH between 1999 and 2006. They had also undergone THW for WBS. Patients received a two-page questionnaire via mail addressing five symptoms and ten items regarding managing their daily life which was answered by 61.6%. The responder group did not differ from the entire group. The medical and societal cost of both procedures for diagnostic WBS was calculated including direct and all ascertainable indirect cost for the reference year 2005. A sensitivity analysis included the German DRG system of 2007 and 2010. Results: After THW, 94% of patients reported hypothyroid symptoms. Using rhTSH, symptoms occurred significantly less. As a result, 97% of patients favored rhTSH over THW. Mean absence from salaried work was 12.3 days after THW compared to 4 days with rhTSH. Family members of salaried employees missed 3 and 0.7 workdays after THW and rhTSH, respectively. Almost twice as often, medical attention was sought after THW (36%) compared to rhTSH (19 %). Undergoing THW, 48% of patients still used their car while hypothyroid. Our cost calculation revealed a slight benefit of about 89.00 Euro in favour of rhTSH stimulation. Conclusion: Hypothyroidism after THW causes significant morbidity and safety risks. The clinical and societal benefits associated with rhTSH are roughly gained at equivalent overall cost to that of THW.
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Börner SM, Fischer T, Hansen H, Schnell R, Zimmermanns B, Tawadros S, Engert A, Staak O, Pogge von Strandmann E, Kobe C, Schicha H, Schomäcker K, Dietlein M. Development of anti-CD30 radioimmunoconstructs (RICs) for treatment of Hodgkin's lymphoma. Nuklearmedizin 2018; 49:97-105. [DOI: 10.3413/nukmed-0258] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2009] [Accepted: 01/22/2010] [Indexed: 11/20/2022]
Abstract
Summary
Objectives: Comparison of the binding affinity to a CD30-positive Hodgkin lymphoma (HL) cell line and biodistribution in HL bearing mice of new anti-CD30 radioimmunoconjugates (RICs) of varying structure and labelling nuclides. Methods: The antibodies Ki-4 and 5F11 were radioiodinated by the chloramine T method or labelled with 111In via p-NCSBenzyl- DOTA. In addition, the Ki-4-dimer was investigated in the iodinated form. The RICs were analyzed for retained immunoreactivity by immunochromatography. In-vitro binding studies were performed on CD30-positive L540 cell lines. For in-vivo biodistribution studies, SCID mice bearing human HL xenografts were injected with the various radioimmunoconjugates. After 24 h, activities in the organs and tumour were measured for all 5 RICs. Tumour-free animals were studied in the same way with 131I- Ki-4 24 h p. i. The three RICs with the highest tumour/background ratios 24 h p.i. (131I-Ki-4, 131I–5F11, 111In-bz- DOTA-Ki-4) were analysed further at 48 h and 72 h. Results: All the RICs were successfully labelled with high specific activities (28–47 TBq/ mmol) and sufficient radiochemical yields (> 80%). Scatchard plot analysis proved high tumour affinity (KD = 20–220 nmol/l). In-vivo tumour accumulation in % of injected dose per g tissue (%ID/g) lay between 2.6 (131I-5F11) and 12.3 % ID/g (131I-Ki-4) with permanently high background in blood. Tumour/blood-ratios of all RICs were below one at all time points. Conclusions: In-vitro tumour cell affinities of all RICs were promising. However, in-vivo biokinetics tested in the mouse model did not meet expectations. This highlights the importance of developing and testing further new anti-CD30 conjugates.
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12
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Hellmich M, Lehmacher W, Eschner W, Schmidt M, Kobe C, Schober O, Dietlein M, Schicha H. Should all patients with thyroid nodules ≥ 1 cm undergo fine-needle aspiration biopsy? Nuklearmedizin 2018; 48:79-83. [DOI: 10.3413/nukmed-0313] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2009] [Indexed: 11/20/2022]
Abstract
SummaryThe prevalence of thyroid nodules . 1 cm is high in a previously iodine-deficient area. Under the hypothesis, that all patients with such nodules undergo fine-needle aspiration biopsy (FNAB) and that sensitivity and specificity of cytology are calculated with 85%, the positive predictive value of pathologic cytologic finding will reach 1.5% only according to Bayes-theorem. This is clinically unacceptable, as resection will be the consequence in all cases with suspect cytology. Even implementation of a second, independent test (e. g. moleculargenetic testing of thyreocytes, sensitivity to detect mutation 50%, specificity 95%) and application of sequential Bayestheorem the positive predictive value of combined pathologic findings will increase to 13% only. Nevertheless, 58% out of all thyroid cancer remain undetected by such a sequential algorithm.As a consequence, pre-selection of thyroid nodules for FNAB is required to increase the pretest-probability to at least 5.10%. A combination of sonographic criteria and scintigraphy, even in patients with normal TSHlevels, is suited to selected thyroid nodules for FNAB.
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Boldt F, Kobe C, Hammes J, Eschner W, Schicha H, Sudbrock F. Radiation exposure in the environment of patients after application of radiopharmaceuticals. Nuklearmedizin 2018. [DOI: 10.3413/nukmed-0193] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Summary
Aim: After therapeutical application of radionuclides the patient has to be regarded as a radioactive source. The radiation exposure differs from diagnostic nuclear medicine due to the amount of radioactivity and due to β-radiation. Measurements of photon dose rates were carried out and estimates of β-radiation outside the patient using Monte-Carlo methods. Calculations of maximum β-ranges in tissue were also performed. Detailed knowledge of the radiation exposure close to the patient is of major importance with respect to radiation protection of the staff. Method: Photon dose rates for 32 patients were determined after treatment with [131I]NaI and [131I]meta-iodobenzylguanidin, [32P]Na2HPO4, [90Y]Zevalin and [153Sm]EDTMP. Readings were taken immediately after application at eight distances. Results: For therapies with 131I photon dose rates amount to 2 mSv·h-1·GBq-1 close to the patient. Taking the typical activities of 3.7 GBq for thyroid carcinoma and up to 11 GBq for mIBG therapies into account this leads to a considerable radiation exposure of approximately 7.5 mSv/h and 20 mSv/h, respectively. At a distance of 2 m the dose rates fall to 1/100 compared to the vicinity. For 153Sm the maximum of 100 μSv·h-1·GBq-1 is significantly lower compared to therapies using radioiodine. After application of 32P or 90Y all photon dose rates are lower (>10 μSv·h-1·GBq-1) but in both cases high energy β-particles associated with high maximum ranges exceeding 1 cm in tissue have to be considered. Conclusion: The remarkable difference of the dose rates in the vicinity of the radioactive patient compared to readings at 2 m distance underlines the major importance of the distance for radiation protection. After application of nuclides emitting high energy β-particles their contribution outside the patient should be considered. For typical procedures in the patient's vicinty the radiation exposure of the personnel remains below the annual limit of 20 mSv.
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Abstract
SummaryThe need for therapy for nodular goiter results from the growth of thyroid nodules over decades and from the possibility of tracheal compression and worsening of respiratory function. Given the high prevalence of non-toxic goiter, the epidemiologically low incidence of clinically apparent thyroid cancer justifies non-surgical strategies. Randomised studies have shown that levothyroxine offers limited therapeutic effects and is inferior to radioiodine therapy regarding goiter shrinkage. When indication for a definitive therapy is given, the choice between resection and radioiodine therapy should consider volume of goiter, severity of clinical symptoms, thyroid uptake, patient’s age, co-morbidity, previous resection of goiter, patient’s profession and patient’s wish. Even in large goiters between 100 and 300 ml radioiodine therapy showed consistent results with goiter size reduction from 35-40% one year and 40-60% two years after radioiodine therapy. Thyroid hormones to prevent recurrence of goiter are not necessary. Recurrent goiters were seldom observed after radioiodine therapy and resulted from initially very large goiters or uptake in dominante nodules or from low 131I activities. Recombinant human TSH (rhTSH) offers the opportunity to enhance the effect of radioiodine therapy. Observational studies have shown that rhTSH increases low 131I uptake in case of high alimentary iodine-supply by the factor 4, causes a more homogenous 131I distribution within the goiter and improves goiter reduction. A phase I study for dose finding is running in the USA. Conclusion: Radioiodine therapy for shrinkage of large non-toxic goiter should not be restricted to elderly patients, or to patients with co-morbidity or high operative risk, but is an attractive alternative to surgery in patients with special professions (singer, teacher, speaker) or with the wish for a non-invasive treatment modality.
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Dietlein M, Mauz-Körholz C, Engert A, Borchmann P, Sabri O, Schober O, Schicha H, Kluge R, Kobe C. FDG-PET in Hodgkin lymphoma. Nuklearmedizin 2018; 47:235-8; quiz N75-6. [DOI: 10.3413/nukmed-0216] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
SummaryThe high negative predictive value of FDG-PET in therapy control of Hodgkin lymphoma is proven by the data acquired up to now. Thus, the analysis of the HD15 trial has shown that consolidation radiotherapy might be omitted in PET negative patients after effective chemotherapy. Further response adapted therapy guided by PET seems to be a promising approach in reducing the toxicity for patients undergoing chemotherapy. The criteria used for the PET interpretation have been standardized by the German study groups for Hodgkin lymphoma patients and will be reevaluated in the current studies.
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Abstract
SummaryInteractions between brain, psyche and thyroid are known from historical descriptions of thyroidectomy (Kocher) and hyperthyroidism. However, their importance is often underscored in clinical routine. Thyroid hormone deficiency during pregnancy may result in irreversible mental retardation and requires levothyroxine substitution. TSH screening after delivery must identify newborns with congenital hypothyroidism: An early levothyroxine substitution and long term therapy control are required.Hypothyroidism and depression have many symptoms in common. Cognitive deficits and depressive states are often found in overt hypothyroidism, psychotic derangements are rare. Levothyroxine improves hypothyroid symptoms and mental performance, mood and motivation. Psychic symptoms of hyperthyroidism include agitation, irritability, mood disturbances, hyperactivity, anxiousness and even panic attacks. Manic and delusional states are rare. In geriatric patients hyperthyroidism may be oligosymptomatic. In psychiatric patients more frequent but unspecific disturbances of thyroid laboratory values being reversible without specific therapy have to be distinguished from rather rare but causative organic thyroid diseases with therapeutic consequences. Some psychiatric drugs influence thyroid laboratory results. Hypothyroidism in depressive patients is a negative prognostic parameter and requires therapy. Psychiatric symptoms associated with hypothyroidism are usually reversible under levothyroxine within 4–8 weeks. The standard for hypothyroidism is mono-levothyroxine therapy.
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Boldt F, Kobe C, Eschner W, Schicha H, Sudbrock F. Radiation exposure in the environment of patients after application of radiopharmaceuticals. Nuklearmedizin 2018. [DOI: 10.3413/nukmed-0184] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Summary
Aim: After application of radiopharmaceuticals the patient becomes a radioactive source which leads to radiation exposure in the proximity. The photon dose rates after administration of different radiopharmaceuticals used in diagnostic nuclear medicine were measured at several distances and different time intervals. These data are of importance for estimating the exposure of technologists and members of the public. Patients, method: In this study dose rates were measured for 67 patients after application of the following radiopharmaceuticals: 99mTc-HDP as well as 99mTcpertechnetate, 18F-fluorodeoxyglucose, 111In-Octreotid and Zevalin® and 123I-mIBG in addition to 123I-NaI. The dose rates were measured immediately following application at six different distances to the patient. After two hours the measurements were repeated and – whenever possible – after 24 hours and seven days. Results: Immediately following application the highest dose rates were below 1 mSv / h: with a maximum at 780 μSv/h for 18F (370 MBq), 250 μSv/h for 99mTc (700 MBq), 150 μSv/h for 111In (185 MBq) and 132 μSv/ h for 123I (370 MBq). At a distance of 0.5 m the values decrease significantly by an order of magnitude. Two hours after application the values are diminished to 1/3 (99mTc, 18F), to nearly ½ (123I) but remain in the same order of magnitude for the longer-lived 111In radiopharmaceuticals. Conclusion: For greater distances the doses remain below the limits outlined in the national legislation.
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Abstract
SummarySeveral population-based studies have shown a significant association between TSH-level and BMI (body mass index). About 30% of the rest energy expenditure are regulated by thyroid hormones, which generated the hypothesis that thyroid hormone substitution with TSH-titration into the lower reference levels may prevent body weight gain. The opposite effect of thyroid hormones is appetite stimulation, which may be responsible for body weight gain in case of substitutive medication.The association between TSH and BMI has become a complex topic in the light of the endocrine activity of adipocytes. Adipocytes are not a silent fat mass, but increase the hormone level of leptin, which influences neurones in the hypothalamus, the thyreotropic axis and TSH secretion. BMI is positively correlated with serum leptin. Elevated leptin levels, endogenous in individuals with high BMI or exogenous after leptin injection for treatment of hypothalamic amenorrhoea, shift TSH in the upper reference level. Borderline elevated TSH levels are reversible in case of body weight reduction in obese persons. It remains unclear whether high TSH levels or high leptin level are responsible for obesity or represent secondary phenomenon.
Recommendation for daily practice: Borderline elevated TSH-levels in obese patients will decrease in case of body weight reduction without hormone medication. After definitive treatment of hyperthyroidism patient's history for use of carbohydrates (increased during hyperthyroidism) should be noticed and substitution with thyroid hormones aims at TSH in the lower reference level. As body weight gain is observed in all TSH groups, a special concept for prevention and therapy of obesity (diet, daily exercise, behaviour training) should be initiated early and additionally to medication.
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Abstract
SummaryAim: This study was performed to analyse the impact of the choice of antithyroid drugs (ATD) on the outcome of ablative radioiodine therapy (RIT) in patients with Graves' disease. Patients, material, methods: A total of 571 consecutive patients were observed for 12 months after RIT between July 2001 and June 2004. Inclusion criteria were the confirmed diagnosis of Graves' disease, compensation of hyperthyroidism and withdrawal of ATD two days before preliminary radioiodine-testing and RIT. The intended dose of 250 Gy was calculated from the results of the radioiodine test and the therapeutically achieved dose was measured by serial uptake measurements. The end-point measure was thyroid function 12 months after RIT; success was defined as elimination of hyperthyroidism. The pretreatment ATD was retrospectively correlated with the results achieved. Results: Relief from hyperthyroidism was achieved in 96 % of patients. 472 patients were treated with carbimazole or methimazole (CMI) and 61 with propylthiouracil (PTU). 38 patients had no thyrostatic drugs (ND) prior to RIT. The success rate was equal in all groups (CMI 451/472; PTU 61/61; ND 37/38; p=0.22). Conclusion: Thyrostatic treatment with PTU achieves excellent results in ablative RIT, using an accurate dosimetric approach with an achieved post-therapeutic dose of more than 200 Gy.
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Abstract
SummaryAim: This study was performed to determine the results of ablative radioiodine therapy (RIT) when the achieved dose in the thyroid was above 200 Gy and to characterize predictive factors for treatment outcome. Patients, methods: A total of 571 consecutive patients were observed for 12 months between July 2001 and June 2004. Inclusion criteria were a confirmed diagnosis Graves' disease, compensation of hyperthyroidism and withdrawal of antithyroid drugs two days before preliminary radioiodine-testing and RIT. The intended dose was 250 Gy and the therapeutically achieved dose was calculated from serial uptake measurements. The end-point measure was thyroid function 12 months after RIT; success was defined as elimination of hyperthyroidism. The relation between success rate and the achieved dose, thyroid volume, age and sex of patients, TSH- and TRAb-values and presence of ophthalmopathy was analysed. Results: Relief from hyperthyroidism was achieved in 96% of patients who received more than 200 Gy, even for thyroid volumes >40 ml. The success of ablative RIT was not influenced by age or sex of patients, or by TSH- or TRAb values or concomitant ophthalmopathy. The mean achieved dose in the thyroid was 298 Gy with a standard deviation of 74.6 Gy. Conclusion: To achieve a dose of over 200 Gy with the above standard deviation, we recommend calculating an intended dose of 250 Gy and using a dosimetric approach with early and late uptake values in the radioiodine test, to allow early therapeutic intervention should the posttherapeutic thyroid dose fall unexpectedly below 200 Gy.
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Meixner M, Hellmich M, Dietlein M, Kobe C, Schicha H, Schmidt M. Disease-free survival in papillary and follicular thyroid carcinoma. Nuklearmedizin 2017; 52:71-80. [DOI: 10.3413/nukmed-0530-12-09] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Accepted: 01/21/2013] [Indexed: 12/16/2022]
Abstract
SummaryT stage was redefined for patients with differentiated thyroid carcinoma (DTC) between the 5th and 7th versions of the UICC tumour classification system. Patients, methods: 636 patients (486 women, 150 men; mean age 49.1 ± 15.6 years, mean follow-up 4.6 years) who had been treated with ablative radioiodine therapy after thyroidectomy for papillary (PTC) or follicular thyroid carcinomas (FTC) were retrospectively assessed on occurrence of locoregional recurrent disease, or cervical lymph node or distant metastases. Disease-free survival was calculated from initial T stage, classified according to both versions of the UICC staging system and compared with the prognostic value of primary tumour size. Kaplan-Meier method and two measures of explained variation, (1) R2 based on the (partial) likelihood ratio statistic of the Cox proportional hazards model and (2) a model-free variant of a distance measure proposed by Schemper had the aim to detect the most advantageous classification. Results: Of the 508 patients with PTC, 11 (2.2%) developed a local recurrence, 37 (7.3%) cervical lymph node and 23 (4.5%) distant metastases, 3 (2.3%), 8 (6.3%), and 18 (14.1%) were the numbers for the 128 FTC patients respectively. The two classification systems yielded an equal count of statistically significant differences regarding disease-free survival in patients with PTC while UICC 7th classification appeared slightly advantageous in patients with FTC. Regarding explained variation the UICC 7th classification tended to be superior to the UICC 5th classification, both in PTC and FTC, however statistical significance was not reached. Conclusion: The primary tumour size significantly added to the prognosis regarding local cervical and distant metastases.
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Eggers C, Holstein A, Schneider C, Pedrosa DJ, Dietlein M, Kobe C, Timmermann L, Schmidt M, Kahraman D. 123I-FP-CIT SPECT imaging of the dopaminergic state. Nuklearmedizin 2017; 51:244-51. [DOI: 10.3413/nukmed-0449-11-12] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2011] [Accepted: 04/17/2012] [Indexed: 11/20/2022]
Abstract
Summary123I-N-ω-fluoropropyl-2β-carbomethoxy-3β- (4-iodophenyl)nortropan (123I-FP-CIT) single photon emission computed tomography (SPECT) can be evaluated by both visual assessment and quantitative analysis to assess the striatal dopamine state in vivo. The aim of our study was to investigate if visual assessment according to a predefined image grading scale reflects the results of quantitative assessment techniques. Patients, methods: 195 patients with a clinical diagnosis of idiopathic Parkinson's disease (n = 134), atypical parkinsonian syndrome (n = 47) or essential tremor (n = 14) were examined with 123I-FP-CIT SPECT and included in this retrospective study. Results were analysed according to predefined visual patterns of dopaminergic degeneration and graded as normal (grade 5) or abnormal (grade 1–4) independently by three raters. Quantitative two-dimensional (2D) operator-dependent, manual and three-dimensional (3D) operator- independent, automated approaches were used for quantitative analysis of the specific 123I-FP-CIT tracer binding ratio (SBR) for caudate and putamen. Results: Sensitivity, specificity, PPV, NPV and diagnostic accuracy of visual assessment of 123I-FP-CIT SPECT for the diagnosis of a neuro degenerative Parkinson's syndrome were 99%, 86%, 99%, 86% and 98%, respectively. Visual assessment and quantitative analysis agreed well in evaluating the degree of dopaminergic degeneration. Significant differences (p < 0.001) were found between degeneration patterns. Only between the so-called eagle wing degeneration and the normal pattern no significant differences in SBR caudate and putamen were found, neither by the quantitative manual (p = 1.00; p = 0.196) nor by the quantitative automated method (p = 1.0; p = 0.785). Inter-rater agreement for visual assessment was substantial for all possible pairs of the three raters (κ = 0.70 to 0.74). Strong correlations were observed between the quantitative manual and quantitative automated methods for quantification of SBR caudatum (r = 0.920, r2 = 0.846, p < 0.001) and SBR putamen (r = 0.908, r2 = 0.824, p < 0.001). Conclusion: Visual assessment was highly consistent with the results obtained by quantitative analysis and showed a substantial inter-rater agreement between experienced and inexperienced raters. Our findings indicate that visual assessment might be a reliable analysis approach for clinical routine.
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Borchmann P, Goergen H, Kobe C, Eichenauer D, Greil R, Lohri A, Novak U, Markova J, Beck H, Meissner J, Zijlstra J, Ostermann H, Feuring-Buske M, Dierlamm J, Eich H, Baues C, Rosenwald A, Fuchs M, Diehl V, Kuhnert G, Dietlein M, Engert A. EBEACOPP WITH OR WITHOUT RITUXIMAB IN INTERIM-PET-POSITIVE ADVANCED-STAGE HODGKIN LYMPHOMA: UPDATED RESULTS OF THE INTERNATIONAL, RANDOMIZED PHASE 3 GHSG HD18 TRIAL. Hematol Oncol 2017. [DOI: 10.1002/hon.2437_52] [Citation(s) in RCA: 5] [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] [Indexed: 11/10/2022]
Affiliation(s)
- P. Borchmann
- Department I of Internal Medicine, German Hodgkin Study Group (GHSG); University Hospital of Cologne; Cologne Germany
| | - H. Goergen
- Department I of Internal Medicine, German Hodgkin Study Group (GHSG); University Hospital of Cologne; Cologne Germany
| | - C. Kobe
- Department of Nuclear Medicine; University Hospital of Cologne; Cologne Germany
| | - D. Eichenauer
- Department I of Internal Medicine, German Hodgkin Study Group (GHSG); University Hospital of Cologne; Cologne Germany
| | - R. Greil
- IIIrd Medical Department; Paracelsus Medical University and Salzburg Cancer Research Institute and AGMT (Arbeitsgemeinschaft Medikamentöse Tumortherapie); Salzburg Austria
| | - A. Lohri
- Oncology; Cantonal Hospital Baselland; Liestal Switzerland
| | - U. Novak
- Swiss Group for Clinical Cancer Research (SAKK); Inselspital Bern; Bern Switzerland
| | - J. Markova
- Third Faculty of Medicine; Charles University, University Hospital Kralovske Vinohrady; Prague Czech Republic
| | - H. Beck
- IIIrd Medical Department; University Hospital Mainz; Mainz Germany
| | - J. Meissner
- Center for Internal Medicine; University of Heidelberg; Heidelberg Germany
| | - J.M. Zijlstra
- Oncology; VU University Medical Center; Amsterdam The Netherlands
| | - H. Ostermann
- Department of Internal Medicine III; University Hospital of Munich; Munich Germany
| | - M. Feuring-Buske
- Department of Internal Medicine III; University Hospital of Ulm; Ulm Germany
| | - J. Dierlamm
- Department II; University Hospital Hamburg-Eppendorf; Hamburg Germany
| | - H. Eich
- Department of Radiotherapy; University Hospital of Muenster; Muenster Germany
| | - C. Baues
- Department of Radiotherapy, Germany x Berlin Reference Center for Lymphoma and 17 Berlin; University Hospital of Cologne; Cologne Germany
| | - A. Rosenwald
- 1Institute of Pathology; University of Wuerzburg; Wuerzburg Germany
| | - M. Fuchs
- Department I of Internal Medicine, German Hodgkin Study Group (GHSG); University Hospital of Cologne; Cologne Germany
| | - V. Diehl
- Department I of Internal Medicine, German Hodgkin Study Group (GHSG); University Hospital of Cologne; Cologne Germany
| | - G. Kuhnert
- Department of Nuclear Medicine; University Hospital of Cologne; Cologne Germany
| | - M. Dietlein
- Department of Nuclear Medicine; University Hospital of Cologne; Cologne Germany
| | - A. Engert
- Department I of Internal Medicine, German Hodgkin Study Group (GHSG); University Hospital of Cologne; Cologne Germany
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Fowler E, Kobe C, Roberts KJ, Collins CL, McKenzie LB. Injuries Associated With Strollers and Carriers Among Children in the United States, 1990 to 2010. Acad Pediatr 2016; 16:726-733. [PMID: 27402353 DOI: 10.1016/j.acap.2016.07.002] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 06/30/2016] [Accepted: 07/03/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To describe the incidence, rate, and characteristics of injuries associated with strollers and carriers among young children in the United States. METHODS A retrospective analysis was conducted using data from the National Electronic Injury Surveillance System for children 5 years of age and younger treated in emergency departments (1990-2010), who sustained an injury associated with a stroller or carrier. RESULTS An estimated 360,937 (95% confidence interval: 294,279-427,594) children aged 5 years or younger were treated in emergency departments for stroller- or carrier-related injuries, an average of 17,187 annually. Overall, the rate of stroller- and carrier-related injuries decreased significantly during the study period. Regarding stroller-related injuries, patients were most commonly male (52.4%) and younger than 1 year of age (42.0%); the head (43.0%) and face (31.0%) were most commonly injured. The most common diagnoses were soft tissue injuries (39.4%) and traumatic brain injuries/concussions (24.6%). Similarly, for carrier-related injuries, patients were most commonly male (52.5%) and younger than 1 year of age (89.0%); the head (61.5%) and face (24.7%) were most commonly injured. The most common diagnoses were soft tissue injuries (48.1%) and traumatic brain injuries/concussions (34.9%). Carrier-related injuries resulted in more hospitalizations (6.5%) than stroller-related injuries (2.4%). CONCLUSIONS Stroller- and carrier-related injuries, specifically those resulting from falls from the product or tip-overs, are important sources of injury for children 5 years of age and younger. Although injuries over the 21-year study period decreased overall, the considerable number of injuries annually shows the need to further reduce the potential for injury associated with these ubiquitous products.
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Affiliation(s)
- Erica Fowler
- Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
| | - Christopher Kobe
- Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
| | - Kristin J Roberts
- Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
| | | | - Lara B McKenzie
- Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio; Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, Ohio; Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, Ohio.
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Bose-Brill S, Kobe C, Kretovics M, Pressler-Vyrda T, Belanger L, Ballenger T, Taylor R. Factors Associated with Age Affect Willingness to Engage in Early End-of-Life Communication Using Electronic Health Record-Tethered Patient Portals. J Am Geriatr Soc 2016; 64:e88-e90. [PMID: 27551955 DOI: 10.1111/jgs.14362] [Citation(s) in RCA: 2] [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] [Indexed: 11/26/2022]
Affiliation(s)
- Seuli Bose-Brill
- Division of General Internal Medicine, College of Medicine, The Ohio State University, Columbus, Ohio
| | - Christopher Kobe
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Matthew Kretovics
- Division of General Internal Medicine, College of Medicine, The Ohio State University, Columbus, Ohio
| | | | - Lindsay Belanger
- Oregon Clinical and Translational Research Institute, Oregon Health & Science University, Portland, Oregon
| | | | - Robert Taylor
- Center for Palliative Care, Division of Palliative Medicine, College of Medicine, The Ohio State University, Columbus, Ohio
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Kobe C, Kuhnert G, Haverkamp H, Fuchs M, Kahraman D, Eich HT, Kriz J, Baues C, Nast-Kolb B, Bröckelmann PJ, Borchmann P, Drzezga A, Engert A, Dietlein M. Concordance in the interpretation of PET after chemotherapy in advanced stage Hodgkin lymphoma. Nuklearmedizin 2015; 54:241-6. [PMID: 26388152 DOI: 10.3413/nukmed-0746-15-06] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 06/01/2015] [Accepted: 09/16/2015] [Indexed: 01/27/2023]
Abstract
UNLABELLED The aim was to analyze the degree of agreement between the central review panel and the local PET interpretation within the HD15 trial and its impact on subsequent treatment and progression free survival. PATIENTS, METHODS The analysis set consisted of 739 patients with residues ≥ 2.5 cm after 6 or 8 cycles of BEACOPPesc from the HD15 trial performed by the German Hodgkin Study Group. The recommendation for or against further radiotherapy was based on the central [(18)F]FDG-PET interpretation. Central PET interpretation was compared to the local PET interpretation and concordance was measured using Cohen's Kappa coefficient. Prognostic impact of the analysis of concordance between local and central PET interpretations was evaluated using progression free survival (PFS); groups were compared with the log rank test. RESULTS The central panel rated 548 of 739 patients (74%) as PET negative. Of these, 513 were also rated as PET negative in the local PET interpretation. PET positivity was seen by central reviewers in the remaining 191 patients (26%), in concordance with local reviewers in 155 cases. Even though substantial agreement was found (Cohen's Kappa 0.81), the interpretation of the central PET review panel led to a different therapeutic recommendation in 71/739 (10%) patients. PFS was equally high in groups in which the therapeutic regime had been changed on the basis of the central panel decision. CONCLUSION High concordance is found between local and central reviewers with regard to PET interpretation in residual tissue after intense chemotherapy. The existence of the central PET review panel allows the identification of additional patients as PET negative so that radiotherapy can be safely omitted (35 of 548 patients = 4.7%).
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Affiliation(s)
- C Kobe
- Carsten Kobe, Department of Nuclear Medicine, University Hospital of Cologne, Kerpener Str. 62, 50937 Cologne, Germany, Tel. +49/(0)221/478-50 24, Fax -67 77,
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Eich H, Kriz J, Reinartz G, Kobe C, Kuhnert G, Haverkamp U, Haverkamp H, Hegerfeld K, Baues C, Engert A. Relapse Analysis After Radiation Therapy of PET-Positive Residual Tumors of Patients With Advanced Stage Hodgkin Lymphoma Treated in the HD15 Trial of the German Hodgkin Study Group (GHSG). Int J Radiat Oncol Biol Phys 2013. [DOI: 10.1016/j.ijrobp.2013.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Furth C, Erdrich AS, Steffen IG, Ruf J, Stiebler M, Kahraman D, Kobe C, Schönberger S, Grandt R, Hundsdoerfer P, Hauptmann K, Amthauer H, Hautzel H. Interim PET response criteria in paediatric non-Hodgkin's lymphoma. Results from a retrospective multicenter reading. Nuklearmedizin 2013; 52:148-56. [PMID: 23928982 DOI: 10.3413/nukmed-0546-12-12] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Accepted: 03/10/2013] [Indexed: 12/22/2022]
Abstract
AIM To evaluate the use and reliability of the PET-based response criteria for interim PET (iPET) in terms of interobserver variability in pediatric and adolescent patients suffering from non-Hodgkin´s lymphoma (NHL). Particular attention was given to the identification of visual cutoff to separate patients with a favourable outcome. PATIENTS, METHODS Retrospective analysis of PET-datasets of 18 children and adolescents suffering from NHL who underwent iPET after two cycles of chemotherapy for response assessment. Datasets were evaluated and rated in three independent review centers (RC) (blinded-read, intra-center consensus) using a visual 5-point response scale. Ratings were compared to clinical outcome. Pairwise interobserver agreement was analysed with Cohen's kappa-test (κ). Overall agreement (between attended RCs) was assessed with Fleiss' κ-test. RESULTS Four patients suffered relapse (early, n = 2; late, n = 2). Per region analyses on interobserver variability revealed a "substantial" agreement (Fleiss' κ = 0.618). Per patient analyses revealed concordant iPET-ratings in eight patients: iPET-negative (iPET-), n = 5; iPET-positive (iPET+), n = 2; iPET-inconclusive (iPET±), n = 1. Discordant ratings were found in the remaining patients. Patients with early relapse were concordantly identified using mediastinal blood pool structures (MBPS, score ≥ 3) as visual cutoff between iPET+ or iPET-, respectively. However, patients with late relapse were not concordantly identified taking the MBPS as visual cutoff. CONCLUSION The iPET interpretation using a dedicated PET-based response scale assured a low interobserver variability in per-region but not in per-patient analyses in a multicenter read. Using a sensitive read out (iPET+, score ≥ 3) a reliable identification of patients suffering relapse was limited to those with early relapse.
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Affiliation(s)
- C Furth
- Department of Radiology and Nuclear Medicine, Medical School, Otto-von-Guericke University Magdeburg A.ö.R., Magdeburg, Germany.
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Bos M, Gardizi M, Schildhaus HU, Heukamp LC, Geist T, Kaminsky B, Zander T, Nogova L, Scheffler M, Dietlein M, Kobe C, Holstein A, Maintz D, Büttner R, Wolf J. Complete metabolic response in a patient with repeatedly relapsed non-small cell lung cancer harboring ROS1 gene rearrangement after treatment with crizotinib. Lung Cancer 2013; 81:142-3. [PMID: 23558310 DOI: 10.1016/j.lungcan.2013.02.018] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Accepted: 02/19/2013] [Indexed: 11/30/2022]
Abstract
A 55-year-old Caucasian woman with lung adenocarcinoma stage IV presented with repeated relapse after treatment with cytotoxic chemotherapy (carboplatin, gemcitabine, docetaxel, pemetrexed) and targeted agents (erlotinib, cetuximab, sunitinib). Comprehensive molecular diagnostics (EGFR-, ALK-, RAS-, BRAF-, PIK3CA-, HER2- and DDR2-aberrations) were performed and failed initially to detect any driver mutation. While the patient suffered from rapid deterioration of her general condition, in particular from progressive dyspnea due to lung metastases, we implemented screening for RET- and ROS1 translocations into our molecular diagnostic program based on recent reports of these new molecular subgroups in lung adenocarcinoma. On retesting the patient's tumor sample was found to harbor a ROS1-translocation. The patient was subsequently treated with crizotinib and experienced a pronounced clinical improvement corresponding to a complete metabolic response in (18)F-FDG-PET and a good and confirmed partial response in CT (RECIST 1.1). Our case exemplifies the need for rapid implementation of newly discovered rare genetic lung cancer subtypes in routine molecular diagnostics.
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Affiliation(s)
- M Bos
- Department I of Internal Medicine, Center for Integrated Oncology Köln-Bonn, University Hospital Cologne, Cologne, Germany
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Kriz J, Mueller RP, Mueller H, Kuhnert G, Engert A, Kobe C, Haverkamp U, Eich H. Large mediastinal tumor mass as a prognostic factor in Hodgkin’s lymphoma. Strahlenther Onkol 2012; 188:1020-4. [DOI: 10.1007/s00066-012-0163-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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31
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Heath DE, Kobe C, Jones D, Moldovan NI, Cooper SL. In vitro endothelialization of electrospun terpolymer scaffolds: evaluation of scaffold type and cell source. Tissue Eng Part A 2012; 19:79-90. [PMID: 22834688 DOI: 10.1089/ten.tea.2011.0655] [Citation(s) in RCA: 7] [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] [Indexed: 01/10/2023] Open
Abstract
A family of methacrylic terpolymer biomaterials was electrospun into three-dimensional scaffolds. The glass transition temperature of the polymer correlates with the morphology of the resulting scaffold. Glassy materials produce scaffolds with discrete fibers and large pore areas (1531±1365 μm(2)), while rubbery materials produce scaffolds with fused fibers and smaller pore areas (154±110 μm(2)). Three different endothelial-like cell populations were seeded onto these scaffolds under static conditions: human umbilical vein endothelial cells (HUVECs), adult human peripheral blood-derived outgrowth endothelial cells, and umbilical cord blood-derived human blood outgrowth endothelial cells. Cellular behavior depended on both cell type and scaffold topography. Specifically, cord blood-derived outgrowth endothelial cells showed more robust adhesion and growth on all scaffolds in comparison to other cell types as measured by the density of adherent cells, the number of proliferative cells, and the enzymatic activity of the adherent cells. Peripheral blood-derived outgrowth cells exhibited less ability to inhabit the terpolymer interfaces in comparison to their cord blood-derived counterparts. HUVECs also exhibited less of a capacity to colonize the terpolymer interfaces in comparison to the cord blood-derived cells. However, the mature endothelial cells did show scaffold-dependent behavior. Specifically, we observed an increase in their ability to populate the low-porosity scaffolds. All cells maintained an endothelial phenotype after 1 week of culture on the electrospun scaffolds.
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Affiliation(s)
- Daniel E Heath
- Department of Chemical and Biomolecular Engineering, The Ohio State University, Columbus, Ohio, USA
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32
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Schneider C, Kobe C, Schmidt M, Kahraman D, Malchau G, Faust M, Schicha H, Dietlein M. Calcitonin screening in patients with thyroid nodules. Diagnostic value. Nuklearmedizin 2012; 51:228-33. [PMID: 22940904 DOI: 10.3413/nukmed-0494-12-04] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2011] [Accepted: 08/27/2012] [Indexed: 11/20/2022]
Abstract
AIM The positive predictive value (PPV) of a slightly elevated basal calcitonin (CT) for the diagnosis of medullary thyroid cancer (MTC) is still under debate. PATIENTS, METHODS A total of 11270 patients with thyroid nodules underwent calcitonin screening. Patients with known elevation of CT, renal insufficiency, bacterial infection, alcohol abuse, proton-pump inhibitor therapy or autoimmune thyroid disease were excluded from further analysis. Serum CT was determined by the solid-phase, enzyme-labeled, two-site chemiluminescent immunoassay Immulite 2000. If possible, a pentagastrin test was done to differentiate cases of hypercalcitoninaemia. RESULTS Hypercalcitoninsemia was found in 32 patients. 20 patients underwent surgery. In 10 patients a MTC was found. The PPV of hypercalcitoninaemia for MTC was 31%. The PPV increased to 50% for those patients who underwent surgery (10/20). A subgroup of 26 patients presented with basal CT between 13 and 50 pg/ml, 14 of them underwent surgery, in 4 cases evidence of MTC was revealed. This resulted in a PPV of 15% (4/26), although the value increased to 28% when only surgically treated patients were considered (4/14). CONCLUSION Taking all clinical data into account, calcitonin screening has an acceptable PPV for medullary thyroid cancer in patients with thyroid nodules. Therefore, we recommend calcitonin screening in centers for thyroid disorders.
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Affiliation(s)
- C Schneider
- Department of Nuclear Medicine, University Hospital of Cologne, Kerpener Str. 62, 50937 Cologne, Germany.
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33
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Bose-Brill S, Kobe C, Pressler T, Wills C. Patient and provider perceptions of advance care planning using electronic health record patient portals. BMJ Support Palliat Care 2012. [DOI: 10.1136/bmjspcare-2012-000250.20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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34
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Kahraman D, Scheffler M, Zander T, Holstein A, Kuhnert G, Wolf J, Dietlein M, Kobe C. Quantitative Analysis of Response to treatment with Erlotinib in advanced Non-Small Cell Lung Cancer using FDG and FLT PET. ROFO-FORTSCHR RONTG 2012. [DOI: 10.1055/s-0032-1311112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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35
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Kobe C, Engert A, Markova J, Haverkamp H, Eich HT, Müller RP, Holstein A, Kahraman D, Dietlein M, Borchmann P, Diehl V. Assessment of residual bulky tumor using FDG-PET in patients with advanced stages after completion of chemotherapy. Final report of the GHSG HD15 trial. ROFO-FORTSCHR RONTG 2012. [DOI: 10.1055/s-0032-1311119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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36
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Schneider C, Dietlein M, Eschner W, Schmidt M, Kahraman D, Kobe C. Recombinant Human TSH Increases Uptake and Effective Half-life of Radioiodine in Thyroid Hormone Secreting Metastases of Follicular Thyroid Cancer. Exp Clin Endocrinol Diabetes 2012; 120:160-3. [DOI: 10.1055/s-0031-1299710] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
AbstractFollicular thyroid cancer with thyroid hormone secreting metastases is an extremely rare condition, with only a few cases reported world-wide.We here present the case of a 64-year-old female patient affected by follicular thyroid cancer with extensive thyroid hormone secreting metastases leading to TSH-suppression.We have also summarized the relevant diagnostic and therapeutic approaches and describe, for the first time, the effects of rhTSH-application in this rare tumor entity.In this patient, we found that rhTSH increased 131I-uptake into the thyroid hormone secreting metastases and prolonged the effective half-life of 131I. These effects of rhTSH should be considered when fixed activities of 131I are prescribed.
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Affiliation(s)
- C. Schneider
- University Hospital of Cologne, Department of Nuclear Medicine, Cologne, Germany
| | - M. Dietlein
- University Hospital of Cologne, Department of Nuclear Medicine, Cologne, Germany
| | - W. Eschner
- University of Cologne, Department of Nuclear Medicine, Cologne, Germany
| | - M. Schmidt
- University Hospital of Cologne, Department of Nuclear Medicine, Cologne, Germany
| | - D. Kahraman
- University Hospital of Cologne, Department of Nuclear Medicine, Cologne, Germany
| | - C. Kobe
- University Hospital of Cologne, Department of Nuclear Medicine, Cologne, Germany
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37
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Eich H, Kobe C, Dietlein M, Kriz J, Haverkamp H, Fuchs M, Borchmann P, Engert A, Mueller R. Role of Radiotherapy after Assessment of Residual Bulky Tumor using FDG-PET in Patients with Advanced-stage Hodgkin Lymphoma: Final Report of the GHSG HD15 Trial. Int J Radiat Oncol Biol Phys 2011. [DOI: 10.1016/j.ijrobp.2011.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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38
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Kobe C, Dietlein M, Borchmann P, Engert A, Kuhnert G, Fuchs M, Haverkamp H, Eich H, Kriz J, Diehl V. 57 INVITED PET-Response Adapted Therapy in Hodgkin Lymphoma. Eur J Cancer 2011. [DOI: 10.1016/s0959-8049(11)70272-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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39
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Nogova L, Mattonet C, Scheffler M, Papachristou I, Muthen N, Sos M, Hacker UT, Elter T, Backes H, Kobe C, Rhiem K, Mallmann P, Fuhr U, Schnell R, Katay I, Toepelt K, Reiser M, Harbeck N, Dietlein M, Wolf J. The combination of sorafenib and everolimus in patients with solid tumors: Results of a phase I study. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e13613] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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40
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Scheffler M, Zander T, Nogova L, Kobe C, Kahraman D, Dietlein M, Papachristou I, Querings S, Stoelben E, Engel-Riedel W, Neumaier B, Wolf J. [ 18F]fluoro-L-thymidine (FLT) uptake in baseline positron emission tomography (PET) as a prognostic marker in patients with advanced non-small cell lung cancer (NSCLC) treated first-line with erlotinib. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.7591] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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41
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Kahraman D, Goretzki PE, Szangolies M, Schade H, Schmidt M, Kobe C. Extra-adrenal pheochromocytoma in the organ of Zuckerkandl: diagnosis and treatment strategies. Exp Clin Endocrinol Diabetes 2011; 119:436-9. [PMID: 21374546 DOI: 10.1055/s-0030-1270511] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Pheochromocytoma (PHEO) and paraganglioma (PGL) are rare catecholamine-secreting neuroendocrine tumors arising from chromaffin tissue and can occur within the adrenal medulla (PHEO) or extra-adrenal sites (PGL). The most common site for PGL is the organ of Zuckerkandl, extra-adrenal chromaffin tissue near the origin of the inferior mesenteric artery.We here present 2 patients with extra-adrenal PGL in the organ of Zuckerkandl, located by iodine-123-metaiodobenzylguanadine ( (123)I-MIBG) scintigraphy and thereafter treated surgically or with iodine-131-metaiodobenzylguanadine ( (131)I-MIBG). First, in a 15-year-old boy with clinical suspicion of PHEO, the diagnosis was established by biochemical evaluation and confirmed by further imaging studies, including CT and (123)I-MIBG, as PGL in the Zuckerkandl organ. The tumor was completely resected by laparotomy. Second, in a 70-year-old woman presenting with progressive hypertension and palpitations, MR and (123)I-MIBG revealed a singular tumor lesion with abnormal (123)I-MIBG uptake in the Zuckerkandl organ. Due to severe general vascular disease, surgery was not performed and instead the patient underwent (131)I-MIBG therapy. The patient showed a good symptomatic response with improvement of symptoms and no relevant side-effects of therapy.
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Affiliation(s)
- D Kahraman
- Department of Nuclear Medicine, University of Cologne, Germany.
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42
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Furth C, Amthauer H, Hautzel H, Steffen IG, Ruf J, Schiefer J, Schönberger S, Henze G, Grandt R, Hundsdoerfer P, Dietlein M, Kobe C. Evaluation of interim PET response criteria in paediatric Hodgkin's lymphoma--results for dedicated assessment criteria in a blinded dual-centre read. Ann Oncol 2010; 22:1198-1203. [PMID: 20966182 DOI: 10.1093/annonc/mdq557] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The aim of this study was to evaluate the use and reliability of the new positron emission tomography (PET)-based response criteria for interim positron emission tomography (iPET) in patients with paediatric Hodgkin's lymphoma (pHL). Particular emphasis was put on interobserver variability and on identification of a visual cut-off defining patients with very low risk for relapse. PATIENTS AND METHODS The iPET scans of 39 pHL patients were evaluated in two independent centres by two PET-experienced specialists in nuclear medicine (blinded read, centre consensus) each. The iPET scans were interpreted using a 5-point scale and were compared with the outcome. Cohen's kappa-test (κ) was used to analyse the interobserver agreement. RESULTS Concordant ratings were assessed in 19 patients with iPET-negative findings, in 11 patients with iPET-positive findings and in 2 patients with inconclusive ratings. A 'substantial agreement' between attended centres was achieved (κ = 0.748). All patients suffering relapse were concordantly identified, taking mediastinal blood pool structures (MBPS) as visual cut-off between PET-positive and PET-negative findings, respectively. All pHL patients with uptake lower than or equal to MBPS remained in complete remission. CONCLUSION(S) The iPET interpretation assured low interobserver variability. High sensitivity for identification of pHL patients suffering relapse is achieved if [18F]-fluorodeoxyglucose uptake above the MBPS value is rated as a PET-positive finding.
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Affiliation(s)
- C Furth
- Department of Radiology and Nuclear Medicine, Medical School, Otto-von-Guericke University, Magdeburg.
| | - H Amthauer
- Department of Radiology and Nuclear Medicine, Medical School, Otto-von-Guericke University, Magdeburg; Department of Radiology and Nuclear Medicine, Charité Campus Virchow, Humboldt-University Berlin, Berlin
| | - H Hautzel
- Department of Nuclear Medicine (KME) at the Research Center Juelich, Heinrich-Heine-University Duesseldorf, Juelich
| | - I G Steffen
- Department of Radiology and Nuclear Medicine, Medical School, Otto-von-Guericke University, Magdeburg; Department of Radiology and Nuclear Medicine, Charité Campus Virchow, Humboldt-University Berlin, Berlin
| | - J Ruf
- Department of Radiology and Nuclear Medicine, Medical School, Otto-von-Guericke University, Magdeburg
| | - J Schiefer
- Department of Radiology and Nuclear Medicine, Medical School, Otto-von-Guericke University, Magdeburg
| | - S Schönberger
- Department of Paediatric Oncology, Haematology and Clinical Immunology, University Children's Hospital, Heinrich-Heine-University, Duesseldorf
| | - G Henze
- Department of Paediatric Oncology/Haematology, Charité Campus Virchow, Humboldt-University Berlin, Berlin
| | - R Grandt
- Department of Nuclear Medicine (KME) at the Research Center Juelich, Heinrich-Heine-University Duesseldorf, Juelich
| | - P Hundsdoerfer
- Department of Paediatric Oncology/Haematology, Charité Campus Virchow, Humboldt-University Berlin, Berlin
| | - M Dietlein
- Department of Nuclear Medicine, University Hospital of Cologne, Cologne, Germany
| | - C Kobe
- Department of Nuclear Medicine, University Hospital of Cologne, Cologne, Germany
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Zander T, Scheffler M, Nogova L, Querings S, Dietlein M, Neumaier B, Kobe C, Stoelben E, Thomas RK, Wolf J. Early PET analysis to identify responders to erlotinib treatment of advanced NSCLC. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e18092] [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: 11/20/2022] Open
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44
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Furth C, Hundsdoerfer P, Ruf J, Schiefer J, Schönberger S, Dietlein M, Kobe C, Grandt R, Ricke J, Henze G, Amthauer H. Evaluation PET-basierter Bewertungskriterien bei pädiatrischen Patienten mit M. Hodgkin (HL). ROFO-FORTSCHR RONTG 2010. [DOI: 10.1055/s-0030-1252699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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45
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Markova J, Kobe C, Skopalova M, Klaskova K, Dedeckova K, Plütschow A, Eich HT, Dietlein M, Engert A, Kozak T. FDG-PET for assessment of early treatment response after four cycles of chemotherapy in patients with advanced-stage Hodgkin's lymphoma has a high negative predictive value. Ann Oncol 2009; 20:1270-4. [PMID: 19228806 DOI: 10.1093/annonc/mdn768] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND As positron emission tomography (PET) seems to be a powerful prognostic marker in the treatment of Hodgkin's lymphoma (HL), we analysed the prognostic value of PET after four cycles of combination therapy with bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine and prednisone (BEACOPP) in patients with advanced-stage HL. PATIENTS AND METHODS From January 2004 to March 2007, 50 patients with newly diagnosed HL in clinical stages IIB with large mediastinal mass or extranodal disease, III and IV were treated according to the HD15 protocol of the German Hodgkin Study Group. All patients received a PET scan after four cycles of BEACOPP (PET-4). RESULTS Of the overall group, 14 of 50 patients had a positive PET-4 while 36 had a negative PET-4. At a median observation time of 25 months, 2 of the 14 patients with a positive PET-4 had progressed or relapsed, while there was no progression or relapse in PET-4-negative patients. CONCLUSION Our results indicate a very good negative predictive value of PET-4 in advanced-stage HL patients treated with BEACOPP.
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Affiliation(s)
- J Markova
- Department of Clinical Hematology, University Hospital Kralovske Vinohrady, Third Faculty of Medicine, Charles University, Prague, Czech Republic.
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46
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Sudbrock F, Boldt F, Kobe C, Hammes J, Eschner W, Schicha H. [Radiation exposure in the environment of patients after application of radiopharmaceuticals. Part 2: Therapeutic procedures]. Nuklearmedizin 2009; 48:17-25. [PMID: 19212607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
AIM After therapeutical application of radionuclides the patient has to be regarded as a radioactive source. The radiation exposure differs from diagnostic nuclear medicine due to the amount of radioactivity and due to beta-radiation. Measurements of photon dose rates were carried out and estimates of beta-radiation outside the patient using Monte-Carlo methods. Calculations of maximum beta-ranges in tissue were also performed. Detailed knowledge of the radiation exposure close to the patient is of major importance with respect to radiation protection of the staff. METHOD Photon dose rates for 32 patients were determined after treatment with [131I]NaI and [131I]meta-iodobenzylguanidin, [32P]Na2HPO4, [90Y]Zevalin and [153Sm]EDTMP. Readings were taken immediately after application at eight distances. RESULTS For therapies with 131I photon dose rates amount to 2 mSv.h(-1).GBq(-1) close to the patient. Taking the typical activities of 3.7 GBq for thyroid carcinoma and up to 11 GBq for mIBG therapies into account this leads to a considerable radiation exposure of approximately 7.5 mSv/h and 20 mSv/h, respectively. At a distance of 2 m the dose rates fall to 1/100 compared to the vicinity. For 153Sm the maximum of 100 microSv.h(-1).GBq(-1) is significantly lower compared to therapies using radioiodine. After application of 32P or 90Y all photon dose rates are lower (<10 microSv.h(-1).GBq(-1)) but in both cases high energy beta-particles associated with high maximum ranges exceeding 1 cm in tissue have to be considered. CONCLUSION The remarkable difference of the dose rates in the vicinity of the radioactive patient compared to readings at 2 m distance underlines the major importance of the distance for radiation protection. After application of nuclides emitting high energy beta-particles their contribution outside the patient should be considered. For typical procedures in the patient's vicinity the radiation exposure of the personnel remains below the annual limit of 20 mSv.
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Affiliation(s)
- F Sudbrock
- Klinik und Poliklinik für Nuklearmedizin, Universität zu Köln, Kerpener Str. 62, 50937 Köln.
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47
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Dietlein M, Kahaly G, Kobe C, Schmidt M, Derwahl KM, Schicha H. [Obesity, energy regulation and thyroid function: is borderline elevated TSH-level the cause or secondary phenomenon of obesity]. Nuklearmedizin 2008; 47:181-187. [PMID: 18852923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Several population-based studies have shown a significant association between TSH-level and BMI (body mass index). About 30% of the rest energy expenditure are regulated by thyroid hormones, which generated the hypothesis that thyroid hormone substitution with TSH-titration into the lower reference levels may prevent body weight gain. The opposite effect of thyroid hormones is appetite stimulation, which may be responsible for body weight gain in case of substitutive medication. The association between TSH and BMI has become a complex topic in the light of the endocrine activity of adipocytes. Adipocytes are not a silent fat mass, but increase the hormone level of leptin, which influences neurones in the hypothalamus, the thyreotropic axis and TSH secretion. BMI is positively correlated with serum leptin. Elevated leptin levels, endogenous in individuals with high BMI or exogenous after leptin injection for treatment of hypothalamic amenorrhoea, shift TSH in the upper reference level. Borderline elevated TSH levels are reversible in case of body weight reduction in obese persons. It remains unclear whether high TSH levels or high leptin level are responsible for obesity or represent secondary phenomenon. Recommendation for daily practice: Borderline elevated TSH-levels in obese patients will decrease in case of body weight reduction without hormone medication. After definitive treatment of hyperthyroidism patient's history for use of carbohydrates (increased during hyperthyroidism) should be noticed and substitution with thyroid hormones aims at TSH in the lower reference level. As body weight gain is observed in all TSH groups, a special concept for prevention and therapy of obesity (diet, daily exercise, behaviour training) should be initiated early and additionally to medication.
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Affiliation(s)
- M Dietlein
- Klinik und Poliklinik für Nuklearmedizin der Universität zu Köln, Köln.
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48
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Kobe C, Weber I, Eschner W, Sudbrock F, Schmidt M, Dietlein M, Schicha H. Graves' disease and radioiodine therapy. Is success of ablation dependent on the choice of thyreostatic medication? Nuklearmedizin 2008; 47:153-156. [PMID: 18690374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
AIM This study was performed to analyse the impact of the choice of antithyroid drugs (ATD) on the outcome of ablative radioiodine therapy (RIT) in patients with Graves' disease. PATIENTS, MATERIAL, METHODS A total of 571 consecutive patients were observed for 12 months after RIT between July 2001 and June 2004. Inclusion criteria were the confirmed diagnosis of Graves' disease, compensation of hyperthyroidism and withdrawal of ATD two days before preliminary radioiodine-testing and RIT. The intended dose of 250 Gy was calculated from the results of the radioiodine test and the therapeutically achieved dose was measured by serial uptake measurements. The end-point measure was thyroid function 12 months after RIT; success was defined as elimination of hyperthyroidism. The pretreatment ATD was retrospectively correlated with the results achieved. RESULTS Relief from hyperthyroidism was achieved in 96% of patients. 472 patients were treated with carbimazole or methimazole (CMI) and 61 with propylthiouracil (PTU). 38 patients had no thyrostatic drugs (ND) prior to RIT. The success rate was equal in all groups (CMI 451/472; PTU 61/61; ND 37/38; p = 0.22). CONCLUSION Thyrostatic treatment with PTU achieves excellent results in ablative RIT, using an accurate dosimetric approach with an achieved post-therapeutic dose of more than 200 Gy.
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Affiliation(s)
- C Kobe
- Department of Nuclear Medicine, University of Cologne, Kerpener Strasse 62, Cologne, Germany
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49
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Sudbrock F, Boldt F, Kobe C, Eschner W, Schicha H. [Radiation exposure in the environment of patients after application of radiopharmaceuticals. Part 1: Diagnostic procedures]. Nuklearmedizin 2008; 47:267-274. [PMID: 19057801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
AIM After application of radiopharmaceuticals the patient becomes a radioactive source which leads to radiation exposure in the proximity. The photon dose rates after administration of different radiopharmaceuticals used in diagnostic nuclear medicine were measured at several distances and different time intervals. These data are of importance for estimating the exposure of technologists and members of the public. PATIENTS, METHOD In this study dose rates were measured for 67 patients after application of the following radiopharmaceuticals: 99mTc-HDP as well as 99mTc-pertechnetate, 18F-fluorodeoxyglucose, 111In-Octreotid and Zevalin and 123I-mIBG in addition to 123I-NaI. The dose rates were measured immediately following application at six different distances to the patient. After two hours the measurements were repeated and--whenever possible--after 24 hours and seven days. RESULTS Immediately following application the highest dose rates were below 1 mSv/h: with a maximum at 780 microSv/h for 18F (370 MBq), 250 microSv/h for 99mTc (700 MBq), 150 microSv/h for 111In (185 MBq) and 132 microSv/h for 123I (370 MBq). At a distance of 0.5 m the values decrease significantly by an order of magnitude. Two hours after application the values are diminished to 1/3 (99mTc, 18F), to nearly (1/2) (123I) but remain in the same order of magnitude for the longer-lived 111In radiopharmaceuticals. CONCLUSION For greater distances the doses remain below the limits outlined in the national legislation.
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Affiliation(s)
- F Sudbrock
- Klinik und Poliklinik für Nuklearmedizin, Universität zu Köln, Kerpener Str. 62, 50937 Köln.
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Kobe C, Eschner W, Sudbrock F, Weber I, Marx K, Dietlein M, Schicha H. Graves' disease and radioiodine therapy. Is success of ablation dependent on the achieved dose above 200 Gy? Nuklearmedizin 2008; 47:13-17. [PMID: 18278207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
AIM This study was performed to determine the results of ablative radioiodine therapy (RIT) when the achieved dose in the thyroid was above 200 Gy and to characterize predictive factors for treatment outcome. PATIENTS, METHODS A total of 571 consecutive patients were observed for 12 months between July 2001 and June 2004. Inclusion criteria were a confirmed diagnosis Graves' disease, compensation of hyperthyroidism and withdrawal of antithyroid drugs two days before preliminary radioiodine-testing and RIT. The intended dose was 250 Gy and the therapeutically achieved dose was calculated from serial uptake measurements. The end-point measure was thyroid function 12 months after RIT; success was defined as elimination of hyperthyroidism. The relation between success rate and the achieved dose, thyroid volume, age and sex of patients, TSH- and TRAb-values and presence of ophthalmopathy was analysed. RESULTS Relief from hyperthyroidism was achieved in 96% of patients who received more than 200 Gy, even for thyroid volumes >40 ml. The success of ablative RIT was not influenced by age or sex of patients, or by TSH- or TRAb values or concomitant ophthalmopathy. The mean achieved dose in the thyroid was 298 Gy with a standard deviation of 74.6 Gy. CONCLUSION To achieve a dose of over 200 Gy with the above standard deviation, we recommend calculating an intended dose of 250 Gy and using a dosimetric approach with early and late uptake values in the radioiodine test, to allow early therapeutic intervention should the posttherapeutic thyroid dose fall unexpectedly below 200 Gy.
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Affiliation(s)
- C Kobe
- Department of Nuclear Medicine, University of Cologne, Kerpener Str. 62, 50924 Cologne, Germany.
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