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Loeser A, Finger A, Greinert F, Krause L, Grohmann M, Thieme A, Kruell A, Rades D, Petersen C. Irradiation Dose to the Swallowing Muscles Impacts Nutritional Status in Head and Neck Cancer Patients: The Prospective Randomized HEADNUT Trial. Int J Radiat Oncol Biol Phys 2023; 117:e601. [PMID: 37785815 DOI: 10.1016/j.ijrobp.2023.06.1964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) To evaluate the influence of radiation dose on swallowing muscles and associated side effects as well as on nutritional status in patients with head and neck cancer undergoing primary or adjuvant (chemo)radiotherapy. MATERIALS/METHODS Between 2018 and 2020, sixty-one patients were prospectively randomized into the so-called HEADNUT-trial (HEAD and neck cancer patients undergoing NUTritional intervention). Follow-up was continued until 2022. Contouring of the swallowing apparatus included and the swallowing muscles with the superior (scm), middle (mcm), and inferior constrictor muscle (icm), the cricopharyngeal muscle and the inlet of the esophagus. Nutritional status was assessed by bioelectrical impedance analysis (BIA) at the beginning and the end of radiotherapy. The post-therapeutic nutritional status was evaluated by the BIA-derived FFMI (fat-free mass index; kg/m²). Malnutrition was assumed at FFMI values of <15 (♀) and <17 (♂) kg/m². To find differences between dosimetric parameters in well- and malnourished patients, Mann-Whitney-U-test was used. To estimate the relationship between malnutrition and its influencing variables a logistic regression model was built. RESULTS The following structures differed between well- and malnourished patients at the end of therapy: icm (Dmean, V40Gy (%), V50Gy (%), V60Gy (%)) and cricopharyngeal muscle (V40Gy (%)). After entering these parameters into a multivariable logistic regression model icm Dmean (b = -0.12; Exp(b) = 0.88; 95%-CI: 0.78-1.0; p = 0.06) and icm V40Gy (%) (b = 0.06; Exp(b) = 1.07; 95%-CI: 1-1.13; p = 0.04) proved to be independent predictors of malnutrition. We only determined the cut-off value for icm V40Gy (%) since it was the only parameter which met p<0.05. The optimal cut-off value for the predictor V40Gy (%) based on the Youden Index was 85.6%. CONCLUSION Adherence to dose constraints for the swallowing apparatus may prevent malnutrition in head and neck cancer patients at the end of therapy. Specifically, we suggest an icm V40Gy (%) of more than 86% being predictive for nutritional complications.
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Affiliation(s)
- A Loeser
- Department of Radiotherapy, University Medical Center Schleswig-Holstein / Lübeck, Luebeck, Germany
| | - A Finger
- Outpatient Center of the UKE GmbH, Department of Radiotherapy and Radiation Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - F Greinert
- Outpatient Center of the University Medical Center Hamburg-Eppendorf, Department of Radiotherapy and Radiation Oncology, Hamburg, Germany
| | - L Krause
- University Medical Center Hamburg-Eppendorf, Institute of Medical Biometry and Epidemiology, Hamburg, Germany
| | - M Grohmann
- Department of Radiotherapy and Radio-oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - A Thieme
- Department of Medicine & Department of Biomedical Data Science, Stanford, CA
| | - A Kruell
- Outpatient Center of the UKE GmbH, Department of Radiotherapy and Radiation Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - D Rades
- Department of Radiation Oncology, University Medical Center Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - C Petersen
- Department of Radiotherapy and Radiooncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Rades D, Staackmann C, Lomidze D, Jankarashvili N, Lopez F, Navarro A, Segedin B, Groselj B, Kristiansen C, Dennis K, Schild SE, Fernandez JC. Radiotherapy for Metastatic Spinal Cord Compression with Increased Doses: Final Results of the RAMSES-01 Trial. Int J Radiat Oncol Biol Phys 2023; 117:S74. [PMID: 37784567 DOI: 10.1016/j.ijrobp.2023.06.386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) To investigate the outcomes of precision-radiotherapy (RT) with 15 × 2.633 Gy (EQD2 = 41.6 Gy for tumor cell kill, α/β = 10 Gy) or 18 × 2.333 Gy (EQD2 = 43.2 Gy) in patients with metastatic spinal cord compression (MSCC) and favorable survival prognoses (>35 points on a validated survival score). In addition, these patients were compared to a historical control group of patients with favorable prognoses treated with 10 × 3 Gy (EQD2 = 32.5 Gy). MATERIALS/METHODS In a multi-center phase 2 study (RAMSES-01), patients with MSCC and favorable survival prognoses receiving 15 × 2.633 Gy or 18 × 2.333 Gy of precision-RT alone (no upfront surgery) were mainly evaluated for local progression-free survival (LPFS), defined as no deterioration of motor function during RT and no in-field recurrence of MSCC following RT, at 12 months (primary endpoint). Secondary endpoints included improvement of motor and sensory functions, post-RT ambulatory status, relief of pain and distress, toxicity, and survival (OS). The maximum relative doses allowed to the spinal cord were 101.5 % of the prescribed dose for 18 × 2.333 Gy and 101.2% for 15 × 2.633 Gy, respectively (both representing an EQD2 of 46.6 Gy for myelopathy, α/β = 2 Gy). In addition, the RAMSES-cohort was compared to a historical control group (N = 266) irradiated with 10 × 3 Gy (propensity score adjusted Cox regression). RESULTS In the RAMSES-cohort, 50 (of 62 planned) patients were evaluable for LPFS and included in the analyses. Since OS was worse than expected, a new survival score was developed, which was more precise in predicting OS than a previous tool. As a consequence, the RAMSES-trial, which was based on the previous score, was terminated. In the 50 patients included so far, 12-month rates of LPFS and OS were 97.6% and 69.9%, respectively. Improvement of motor function occurred in 28 patients (56.0%), and 47 patients (94.0%) were ambulatory following RT. Within 3 months following RT, 12 of 21 patients (57.2%) with pre-RT sensory deficits improved, 38 of 45 patients (84.4%) with pre-RT pain experienced at least partial relief, and 39 of 50 patients (78.0%) reported relief of distress. Ten of 50 patients (20.0%) experienced grade 2 toxicities (mainly esophagitis/dysphagia) and another two patients (4.0%) grade 3 toxicities (1 diarrhea, 1 esophagitis). After propensity score adjustment, the RAMSES-cohort showed significantly better LPFS than the control group (hazard ratio = 0.125, 95% confidence interval = 0.016 - 0.962, p = 0.046) and a strong trend regarding improvement of motor function (hazard ratio = 1.943, 95% confidence interval = 0.981 - 3.850, p = 0.057). Post-RT ambulatory rates (p = 0.56) and OS rates (p = 0.62) were not significantly different. CONCLUSION Precision-RT with 15 × 2.633 Gy or 18 × 2.333 Gy was sufficiently well tolerated and resulted in significantly better long-term LPFS than 10 × 3 Gy in patients with MSCC and favorable survival prognoses. Thus, the dose-fractionation regimens of the RAMSES-01 trial appear preferable for these patients.
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Affiliation(s)
- D Rades
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
| | - C Staackmann
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
| | - D Lomidze
- Radiation Oncology Department, Tbilisi State Medical University and Ingorokva High Medical Technology University Clinic, Tbilisi, Georgia
| | - N Jankarashvili
- Department of Radiation Oncology, Acad. F. Todua Medical Center - Research Institute of Clinical Medicine, Tbilisi, Georgia
| | - F Lopez
- Department of Radiation Oncology, University Hospital Ramón y Cajal, Madrid, Spain
| | - A Navarro
- Department of Radiation Oncology, Instituto Catalán de Oncología, Barcelona, Spain
| | - B Segedin
- Department of Radiotherapy and Faculty of Medicine, Institute of Oncology Ljubljana and University of Ljubljana, Ljubljana, Slovenia
| | - B Groselj
- Department of Radiotherapy, Institute of Oncology Ljubljana and University of Ljubljana, Ljubljana, Slovenia
| | - C Kristiansen
- Department of Oncology, Vejle Hospital, University Hospital of Southern Denmark, Veijle, Denmark
| | - K Dennis
- Division of Radiation Oncology, The Ottawa Hospital and the University of Ottawa, Ottawa, ON, Canada
| | - S E Schild
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ
| | - J Cacicedo Fernandez
- Department of Radiation Oncology, Cruces University Hospital/Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
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Cremers F, Johannwerner L, Werner EM, Yu NY, Rades D. A Survival Score for Patients Treated with Whole-Brain Radiotherapy plus Simultaneous Integrated Boost for Brain Metastases. Int J Radiat Oncol Biol Phys 2023; 117:e95-e96. [PMID: 37786221 DOI: 10.1016/j.ijrobp.2023.06.859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Different types of radiotherapy (RT) are used for brain metastases including whole-brain RT (WBRT) and local therapies (radiosurgery, fractionated stereotactic RT). WBRT plus simultaneous integrated boost (WBRT+SIB) is another treatment option that was reported to improve intracranial control and overall survival (OS) when compared to WBRT alone. This study aimed to create a score to identify patients who may not benefit from this approach due to poor OS. MATERIALS/METHODS In 128 patients treated with WBRT+SIB for brain metastases (2014-2021), year of RT, interval from tumor diagnosis to RT, WBRT+SIB regimen [(14 x (2.5 + 0.5) Gy vs. 18 x (2.0 + 0.5) Gy], pre-RT systemic treatment, age, gender, performance score, primary tumor type, N lesions, and extracranial metastases were retrospectively evaluated for OS. Univariate analyses (UVA) were performed with Kaplan-Meier method and log-rank test. Factors that showed significant (p<0.05), a strong trend (p<0.07) or a trend (p<0.14) in UVA were included in a Cox proportional hazards model (MVA). To create the appropriate OS score, three models were created, one including factors significant on MVA, a second including factors with p<0.07 on UVA, and a third one including factors with p<0.14 on UVA. For each factor, 6-month OS rates (%) were divided by 10 and resulting points were added for each patient. Based on patient scores, three prognostic groups were designed for each model. Positive predictive values (PPV) of correct prediction of death ≤6 and OS ≥6 months were calculated. RESULTS On UVA, KPS >80 (p<0.001) and ≤3 lesions (p = 0.006) were associated with OS, age ≤64 years (p = 0.061) showed a strong trend, and no extracranial metastases (p = 0.128) a trend. On MVA, KPS (HR: 0.40, 95% CI: 0.27-0.61, p<0.001) and N lesions (HR: 1.81, 95% CI: 1.23-2.65, p = 0.002) were significant; age (HR: 1.12, 05% CI: 0-76-1.66, p = 0.57) and extracranial metastases (HR: 1.19, 95% CI: 0.79-1.78, p = 0.40) were not significant. In Model 1 (including only KPS and N lesions), groups were 5, 6-8 and 9 points with 6-month OS rates of 15%, 38% and 57%, respectively. PPVs to predict death and OS were 85% and 57%, respectively. In Model 2 (KPS, N lesions, age), groups were 8, 9-12 and 13 points with 6-month OS rates of 17%, 33% and 75%, respectively. PPVs were 83% and 75%, respectively. In Model 3 (KPS, N lesions, age, extracranial metastases), groups were 11, 12-16 and 17 points with 6-month OS rates of 14%, 34% and 78%, respectively. PPVs were 86% and 78%, respectively. CONCLUSION All three models achieved high accuracy regarding prediction of death ≤6 months and can help identify patients who may not be ideal candidates for WBRT+SIB. For prediction of OS ≥6 months, Models 2 and 3 were superior. Since differences between Models 2 and 3 were marginal and correct identification of extracranial metastases (Model 3) may require extensive staging, Model 2 appears preferable.
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Affiliation(s)
- F Cremers
- Department of Radiation Oncology, University Medical Center Schleswig-Holstein, Campus Lübeck, Lübeck, Germany; Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
| | - L Johannwerner
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
| | - E M Werner
- Department of Radiation Oncology, University Medical Center Schleswig-Holstein, Campus Lübeck, Lübeck, Germany; Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
| | - N Y Yu
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ
| | - D Rades
- Department of Radiation Oncology, University Medical Center Schleswig-Holstein, Campus Lübeck, Lübeck, Germany; Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
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Keit E, Lee SF, Woodward M, Shiue K, Desideri I, Oldenburger E, Beinz M, Agyeman MB, Theodorou M, Froid M, Simone CB, Yu HHM, Yarney J, Rembielak A, Rades D, Hoskin P, Johnstone PAS. Palliative Whole Brain Radiotherapy: International State of Practice 2022. Int J Radiat Oncol Biol Phys 2023; 117:e114-e115. [PMID: 37784656 DOI: 10.1016/j.ijrobp.2023.06.897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Increasing technology of radiation treatment planning and delivery, better systemic therapies, and randomized trials in the population of patients (pts) with brain metastases have provided robust targeted options. This has resulted in palliative whole brain radiation therapy (WBRT) being used far less frequently than previously. Most centers preferentially use stereotactic radiation surgery (SRS) for pts with several lesions and may reserve WBRT for those with poor performance, with rapidly progressive disease, or with leptomeningeal presentation. We hypothesize that different trends in current WBRT regimens exist across different continents with varying rates of use of hippocampal avoidance (HA) and memantine. Despite differences in dose, fractionation, and treatment technique, we predict that survival post-WBRT will remain poor-indicating appropriate application of whole brain treatment in this era of SRS and improved systemic therapies. MATERIALS/METHODS A multi-center international analysis of pts receiving WBRT in 2022 was performed. Primary end point was survival after WBRT. Participating centers were located in Belgium, the United Kingdom, Hong Kong, Cyprus, Italy, Germany, Ghana, and the United States. De-identified data were collected and analyzed centrally. Pts receiving WBRT as part of a curative regimen (e.g., medulloblastoma, primary CNS lymphomas), prophylactically in small cell lung cancer, or as bridging prior to CAR-T were excluded. The collected data consisted of pt parameters including prior stereotactic radiosurgery (SRS), prescription dose and fractionation, use of HA technique with or without memantine, and survival after WBRT. Survival was calculated via the Kaplan-Meier method. RESULTS Of 23,332 RT prescriptions written at these centers in 2022, 399 (1.7%) were for palliative WBRT. Most frequent primary cancers were lung (42%) and breast (28%). Twenty-seven different dose regimens were used. The most common prescriptions were for 3 Gy daily fractions for 10 fractions (45%) and 4 Gy daily for 5 fractions (37%). Prior CNS SRS was delivered in 32 pts (7%). HA technique was used in 44 pts (10%); this technique was almost exclusively used in the United States. Memantine was prescribed in 93 pts (20%). Survival ranged from zero days to still surviving. The global median overall survival was 84 days after completion of treatment (95% CI: 68.0-104.0). Cumulative 3-month and 6-month actuarial survivals were 48% and 32%. CONCLUSION This "moment in time" analysis confirms that pts with poor expected survival are being appropriately selected for WBRT and demonstrates the variance in global practice. Since poor survival precludes these pts from deriving much benefit, memantine and HA may be best suited only for carefully selected cases; use of these is not Standard of Care in the participating European, Asian, and African centers.
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Affiliation(s)
- E Keit
- H. Lee Moffitt Cancer Center and Research Institute, Department of Radiation Oncology, Tampa, FL
| | - S F Lee
- National University Cancer Institute Singapore, Singapore, Singapore
| | - M Woodward
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - K Shiue
- Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, IN
| | - I Desideri
- Department of Experimental Clinical and Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | | | - M Beinz
- Mount Vernon Hospital, Northwood, United Kingdom
| | | | - M Theodorou
- Bank of Cyprus Oncology Center, Nicosia, Cyprus
| | - M Froid
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | | | - H H M Yu
- H. Lee Moffitt Cancer Center and Research Institute, Department of Radiation Oncology, Tampa, FL
| | - J Yarney
- National Centre for Radiotherapy and Nuclear Medicine, Accra, Ghana
| | - A Rembielak
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - D Rades
- Department of Radiation Oncology, University Medical Center Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - P Hoskin
- Mount Vernon Cancer Centre, Northwood, United Kingdom
| | - P A S Johnstone
- H. Lee Moffitt Cancer Center and Research Institute, Department of Radiation Oncology, Tampa, FL
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Werner EM, Johannwerner L, Blanck O, Janssen S, Cremers F, Yu NY, Rades D. Radiation Necrosis following SRS or FSRT with Higher BED for Brain Metastases >20 mm. Int J Radiat Oncol Biol Phys 2023; 117:e155. [PMID: 37784744 DOI: 10.1016/j.ijrobp.2023.06.980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) In the RTOG 90-05 study, the maximum tolerated dose of single-fraction radiosurgery (SRS) for lesions 21-30 mm was 18 Gy (BED 45 Gy12). However, patients of the RTOG study were previously irradiated with median 60 Gy (brain tumors) or 30 Gy (brain metastasis). Thus, the max. tolerated BED for lesions not irradiated before may be >45 Gy12. This study investigated safety and efficacy of SRS or fractionated stereotactic radiotherapy (FSRT) with BED >49 Gy12 for radiotherapy-naive brain metastases >20 mm. MATERIALS/METHODS Data of 169 patients who received SRS or FSRT alone with BED >49 Gy12 for 1-4 brain metastases (2011-2022) were retrospectively analyzed. Thirty-two patients had lesions >20 mm (21-30 mm, n = 27; 21-40 mm, n = 4; >40 mm, n = 1). SRS was performed with 20 Gy (n = 9; 53.3 Gy12) or 19 Gy (n = 2; 49.1 Gy12), prescribed to the 60-80% isodose line (PTV = GTV). FSRT was Linac-based delivering 3 x 10 Gy (n = 3; 55 Gy12), 3 x 11 Gy (n = 4; 63.3 Gy12), 7 x 6 Gy (n = 1; 63 Gy12), 9 x 5 Gy (n = 1; 63.8 Gy12), 10 x 4 Gy (n = 11; 53.3 Gy12), or 12 x 4 Gy (n = 1; 64 Gy12), prescribed to the 80% isodose line (PTV = GTV+1-2 mm). SRS and FSRT were compared for grade ≥2 radiation necrosis (RN), local control (LC) and survival (OS). Fractionation [SRS (n = 89) vs FSRT (n = 48)] and lesion size (≤20 vs >20 mm) were studied in terms of RN rates. Kaplan-Meier method and log-rank test were used for univariate analyses and the Cox proportional hazards model for multivariate analyses. In patients with lesions >20 mm, SRS and FSRT were compared (Fisher's exact/Chi square test) for age, gender, KPS, year of SRS/FSRT, primary tumor, number/site of lesions, systemic treatment, and extracranial metastases. RESULTS In patients with lesions >20 mm, significantly more patients receiving SRS had a KPS >80 than patients treated with FSRT (91% vs 29%, p = 0.002); otherwise, distributions of patient characteristics were balanced. In patients with lesions >20 mm, SRS was associated with significantly higher RN rates at 1 year (50% vs 9%) and 2 years (50% vs 9%) on univariate analysis (p = 0.012), which remained on multivariate analysis (HR: 0.10; 95% CI: 0.01-0.94, p = 0.044). No significant differences were found for LC (p = 0.21) at 1 year (75% vs 70%) and 2 years (75% vs 53%), and OS (p = 0.09) at 1 year (36% vs 59%) and 2 years (27% vs 46%). In patients with lesions ≤20 mm, 1- and 2-year RN rates following SRS were both 4%, compared to 0% and 15% respectively after FSRT (p = 0.60). In the SRS group, RN rates were significantly higher with lesions >20 mm (vs ≤20 mm) on univariate (p<0.001) and multivariate (HR: 3.82, 95% CI: 1.70-8.58, p = 0.001) analyses. In the FSRT group, max. diameter had no significant impact on RN rates (p = 0.93). CONCLUSION Given the limitations of this study, FSRT with BED >49 Gy12 appears associated with a low risk of RN when used for brain metastases >20 mm. SRS with 1x19-20 Gy may not be optimal for metastases >20 mm but appears safe for lesions ≤20 mm. Prospective trials are warranted.
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Affiliation(s)
- E M Werner
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany; Department of Radiation Oncology, University Medical Center Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - L Johannwerner
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
| | - O Blanck
- Department of Radiation Oncology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany; Saphir Radiosurgery Center Northern Germany, Kiel, Germany
| | - S Janssen
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany; Medical Practice for Radiotherapy and Radiation Oncology, Hannover, Germany
| | - F Cremers
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany; Department of Radiation Oncology, University Medical Center Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - N Y Yu
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ
| | - D Rades
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany; Department of Radiation Oncology, University Medical Center Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
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Rades D, Al-Salool A, Cremers F, Staackmann C, Cacicedo J, Lomidze D, Segedin B, Groselj B, Jankarashvili N, Moreno AC, Ciervide R, Kristiansen C, Schild S. A New Scoring Tool to Estimate Post-Treatment Ambulatory Status after Radiotherapy of Metastatic Spinal Cord Compression. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.872] [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: 10/31/2022]
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Rades D, Staackmann C, Lomidze D, Lomidze D, Jankarashvili N, Navarro A, Lopez F, Šegedin B, Groselj B, Conde-Moreno A, Holländer N, Schild S, Cacicedo J. OC-0408 Higher-dose radiotherapy for metastatic spinal cord compression: First results of a phase II trial. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)06895-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Cañón V, Gómez-Iturriaga A, Casquero F, Rades D, Navarro A, del Hoyo O, Morillo V, Willisch P, López-Guerra J, Illescas-Vacas A, Ciervide R, Martinez-Indart L, Cacicedo J. PD-0885 Quality of Life improvement in patients with bone metastases undergoing palliative radiotherapy. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07164-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Mehta P, Janssen S, Fahlbusch FB, Schmid SM, Gebauer J, Cremers F, Ziemann C, Tartz M, Rades D. Sparing the hippocampus and the hypothalamic- pituitary region during whole brain radiotherapy: a volumetric modulated arc therapy planning study. BMC Cancer 2020; 20:610. [PMID: 32605648 PMCID: PMC7325372 DOI: 10.1186/s12885-020-07091-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 06/18/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Feasibility testing of a simultaneous sparing approach of hippocampus, hypothalamus and pituitary gland in patients undergoing whole-brain radiotherapy (WBRT) with and without a concomitant boost to metastatic sites. INTRODUCTION Cognitive impairment and hormonal dysfunction are common side effects of cranial radiotherapy. A reduced dose application to the patho-physiologically involved functional brain areas, i.e. hippocampus, hypothalamus and pituitary gland, could reduce these common side effects. While hippocampal sparing is already a common practice to improve cognitive outcome, technical experience of additional combined sparing of the hypothalamus/pituitary gland (HT-P) is insufficient. METHODS Twenty patients were included in the planning study. In 11 patients, a total dose of 36 Gy of WBRT (2 Gy per fraction) plus a simultaneous integrated boost (SIB) of 9 Gy (0.5 Gy per fraction, total dose: 45 Gy) to the brain metastases was applied. In 9 patients, prophylactic cranial irradiation (PCI) was simulated with a total dose of 30 Gy (2 Gy per fraction). In both patient cohorts, a sparing approach of the hippocampus and the HT-P area was simulated during WBRT. For all treatment plans, volumetric modulated arc therapy (VMAT) was used. Quality assurance included assessment of homogeneity, conformality and target coverage. RESULTS The mean dose to the hippocampus and HT-P region was limited to less than 50% of the prescribed dose to the planning target volume (PTV) in all treatment plans. Dose homogeneity (HI) of the target volume was satisfying (median HI = 0.16 for WBRT+SIB and 0.1 for PCI) and target coverage (conformation number, CN) was not compromised (median CN = 0.82 for SIB and 0.86 for PCI). CONCLUSION Simultaneous dose reduction to the hippocampus and the HT-P area did not compromise the PTV coverage in patients undergoing WBRT+SIB or PCI using VMAT. While the feasibility of the presented approach is promising, prospective neurologic, endocrine outcome and safety studies are required.
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Affiliation(s)
- P Mehta
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
| | - S Janssen
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany. .,Private Practice of Radiation Oncology, Hannover, Germany.
| | - F B Fahlbusch
- Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander-University of Erlangen-Nürnberg, Erlangen, Germany
| | - S M Schmid
- Institute for Endocrinology and Diabetes, University of Lübeck, Lübeck, Germany.,German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - J Gebauer
- Institute for Endocrinology and Diabetes, University of Lübeck, Lübeck, Germany
| | - F Cremers
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
| | - C Ziemann
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
| | - M Tartz
- Private Practice of Radiation Oncology, Hannover, Germany
| | - D Rades
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
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Mehta P, Fahlbusch FB, Rades D, Schmid SM, Gebauer J, Janssen S. Are hypothalamic- pituitary (HP) axis deficiencies after whole brain radiotherapy (WBRT) of relevance for adult cancer patients? - a systematic review of the literature. BMC Cancer 2019; 19:1213. [PMID: 31830931 PMCID: PMC6909600 DOI: 10.1186/s12885-019-6431-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 12/03/2019] [Indexed: 12/16/2022] Open
Abstract
Background Cranial radiotherapy (cRT) can induce hormonal deficiencies as a consequence of significant doses to the hypothalamic-pituitary (HP) axis. In contrast to profound endocrinological follow-up data from survivors of childhood cancer treated with cRT, little knowledge exists for adult cancer patients. Methods A systematic search of the literature was conducted using the PubMed database and the Cochrane library offering the basis for our debate of the relevance of HP axis impairment after cRT in adult cancer patients. Against the background of potential relevance for patients receiving whole brain radiotherapy (WBRT), a particular focus was set on the temporal onset of hypopituitarism and the radiation dose to the HP axis. Results Twenty-eight original papers with a total of 1728 patients met the inclusion criteria. Radiation doses to the HP area ranged from 4 to 97 Gray (Gy). Hypopituitarism incidences ranged from 20 to 93% for adult patients with nasopharyngeal cancer or non-pituitary brain tumors. No study focused particularly on hypopituitarism after WBRT. The onset of hypopituitarism occurred as early as within the first year following cRT (range: 3 months to 25.6 years). However, since most studies started follow-up evaluation only several years after cRT, early onset of hypopituitarism might have gone unnoticed. Conclusion Hypopituitarism occurs frequently after cRT in adult cancer patients. Despite the general conception that it develops only after several years, onset of endocrine sequelae can occur within the first year after cRT without a clear threshold. This finding is worth debating particularly in respect of treatment options for patients with brain metastases and favorable survival prognoses.
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Affiliation(s)
- P Mehta
- Department of Radiation Oncology, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - F B Fahlbusch
- Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander-University of Erlangen-Nürnberg, Erlangen, Germany
| | - D Rades
- Department of Radiation Oncology, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - S M Schmid
- Department of Endocrinology, University of Lübeck, Lübeck, Germany.,German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - J Gebauer
- Department of Endocrinology, University of Lübeck, Lübeck, Germany
| | - S Janssen
- Department of Radiation Oncology, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany. .,Private Practice of Radiation Oncology, Hannover, Germany.
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Moustakis C, Chan M, Kim J, Nilsson J, Bergman A, Bichay T, Cilla S, Deodato F, Doro R, Eich H, Fau P, Fong M, Haverkamp U, Heinze S, Köhn J, de Klerck E, Lambrecht U, Masi L, Mayville A, Morganti A, Milder M, Rades D, Ramm U, Ryu S, Soltys S, Tazeh Maha FE, Toom WD, Wang L, Blanck O. A Multi-Platform Treatment Planning Benchmark Study for Spinal Radiosurgery. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.810] [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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12
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Käsmann L, Janssen S, Fahlbusch F, Vordermark D, Rades D. EP-1565 Quality of online information about radiotherapy for prostate cancer. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31985-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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13
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Oria VO, Bronsert P, Thomsen AR, Föll MC, Zamboglou C, Hannibal L, Behringer S, Biniossek ML, Schreiber C, Grosu AL, Bolm L, Rades D, Keck T, Werner M, Wellner UF, Schilling O. Proteome Profiling of Primary Pancreatic Ductal Adenocarcinomas Undergoing Additive Chemoradiation Link ALDH1A1 to Early Local Recurrence and Chemoradiation Resistance. Transl Oncol 2018; 11:1307-1322. [PMID: 30172883 PMCID: PMC6121830 DOI: 10.1016/j.tranon.2018.08.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 08/02/2018] [Accepted: 08/03/2018] [Indexed: 12/13/2022] Open
Abstract
Pancreatic ductal adenocarcinoma (PDAC) has a poor prognosis with frequent post-surgical local recurrence. The combination of adjuvant chemotherapy with radiotherapy is under consideration to achieve a prolonged progression-free survival (PFS). To date, few studies have determined the proteome profiles associated with response to adjuvant chemoradiation. We herein analyzed the proteomes of primary PDAC tumors subjected to additive chemoradiation after surgical resection and achieving short PFS (median 6 months) versus prolonged PFS (median 28 months). Proteomic analysis revealed the overexpression of Aldehyde Dehydrogenase 1 Family Member A1 (ALDH1A1) and Monoamine Oxidase A (MAOA) in the short PFS cohort, which were corroborated by immunohistochemistry. In vitro, specific inhibition of ALDH1A1 by A37 in combination with gemcitabine, radiation, and chemoradiation lowered cell viability and augmented cell death in MiaPaCa-2 and Panc 05.04 cells. ALDH1A1 silencing in both cell lines dampened cell proliferation, cell metabolism, and colony formation. In MiaPaCa-2 cells, ALDH1A1 silencing sensitized cells towards treatment with gemcitabine, radiation or chemoradiation. In Panc 05.04, increased cell death was observed upon gemcitabine treatment only. These findings are in line with previous studies that have suggested a role of ALDH1A1 chemoradiation resistance, e.g., in esophageal cancer. In summary, we present one of the first proteome studies to investigate the responsiveness of PDAC to chemoradiation and provide further evidence for a role of ALDH1A1 in therapy resistance.
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Affiliation(s)
- V O Oria
- Institute of Molecular Medicine and Cell Research, Freiburg, Germany; Faculty of Biology, University of Freiburg, Freiburg, Germany; Spemann Graduate School of Biology and Medicine, Freiburg, Germany
| | - P Bronsert
- Institute of Surgical Pathology, University Medical Center, Freiburg, Germany; German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ) Heidelberg, Germany; Tumorbank Comprehensive Cancer Center Freiburg, Medical Center- University of Freiburg, Germany; Faculty of Medicine, University of Freiburg, Germany
| | - A R Thomsen
- German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ) Heidelberg, Germany; Faculty of Medicine, University of Freiburg, Germany; Department of Radiation Oncology, Medical Center - University of Freiburg, Germany
| | - M C Föll
- Institute of Molecular Medicine and Cell Research, Freiburg, Germany; Faculty of Biology, University of Freiburg, Freiburg, Germany
| | - C Zamboglou
- German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ) Heidelberg, Germany; Faculty of Medicine, University of Freiburg, Germany; Department of Radiation Oncology, Medical Center - University of Freiburg, Germany
| | - Luciana Hannibal
- Laboratory of Clinical Biochemistry and Metabolism, Department for Pediatrics, Medical Center, University of Freiburg, Freiburg, Germany
| | - S Behringer
- Laboratory of Clinical Biochemistry and Metabolism, Department for Pediatrics, Medical Center, University of Freiburg, Freiburg, Germany
| | - M L Biniossek
- Institute of Molecular Medicine and Cell Research, Freiburg, Germany
| | - C Schreiber
- Institute of Pathology, UKSH Campus Lübeck, Lübeck, Germany
| | - A L Grosu
- German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ) Heidelberg, Germany; Faculty of Medicine, University of Freiburg, Germany; Department of Radiation Oncology, Medical Center - University of Freiburg, Germany
| | - L Bolm
- Clinic of Surgery, UKSH Campus Lübeck, Lübeck, Germany
| | - D Rades
- Department of Radiation Oncology, UKSH Campus Lübeck, Lübeck, Germany
| | - T Keck
- Clinic of Surgery, UKSH Campus Lübeck, Lübeck, Germany
| | - M Werner
- Institute of Surgical Pathology, University Medical Center, Freiburg, Germany; German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ) Heidelberg, Germany; Tumorbank Comprehensive Cancer Center Freiburg, Medical Center- University of Freiburg, Germany; Faculty of Medicine, University of Freiburg, Germany
| | - U F Wellner
- Clinic of Surgery, UKSH Campus Lübeck, Lübeck, Germany
| | - O Schilling
- Institute of Molecular Medicine and Cell Research, Freiburg, Germany; Institute of Surgical Pathology, University Medical Center, Freiburg, Germany; German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ) Heidelberg, Germany; BIOSS Centre for Biological Signaling Studies, University of Freiburg, Freiburg, Germany.
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Janssen S, Rades D, Meyer A, Fahlbusch FB, Wildfang I, Meier A, Schild S, Christiansen H, Henkenberens C. Local recurrence of breast cancer: conventionally fractionated partial external beam re-irradiation with curative intention. Strahlenther Onkol 2018; 194:806-814. [DOI: 10.1007/s00066-018-1315-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 05/08/2018] [Indexed: 11/22/2022]
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15
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Käsmann L, Li A, Rades D, Fu C. EP-1658: A scoring system to predict bone metastasis after radical resection of colorectal cancer. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)31967-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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16
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Janssen S, Käsmann L, Fahlbusch FB, Rades D, Vordermark D. Side effects of radiotherapy in breast cancer patients. Strahlenther Onkol 2017; 194:136-142. [DOI: 10.1007/s00066-017-1197-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 08/08/2017] [Indexed: 12/01/2022]
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17
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Cacicedo J, Fernandez I, Del Hoyo O, Navarro A, Gomez-Iturriaga A, Pijoan JI, Martinez-Indart L, Escudero J, Gomez-Suarez J, de Zarate RO, Perez JF, Bilbao P, Rades D. Prognostic value of maximum standardized uptake value measured by pretreatment 18F-FDG PET/CT in locally advanced head and neck squamous cell carcinoma. Clin Transl Oncol 2017; 19:1337-1349. [PMID: 28540535 DOI: 10.1007/s12094-017-1674-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 05/12/2017] [Indexed: 11/24/2022]
Abstract
PURPOSE/OBJECTIVES To evaluate the prognostic impact of maximum standardized uptake value (SUVmax) in patients with locally advanced head and neck squamous cell carcinoma (HNSCC) undergoing pretreatment [F-18] fluoro-D-glucose-positron emission tomography/computed tomography (FDG PET/CT) imaging. MATERIALS/METHODS Fifty-eight patients undergoing FDG PET/CT before radical treatment with definitive radiotherapy (±concomitant chemotherapy) or surgery + postoperative (chemo)radiation were analyzed. The effects of clinicopathological factors (age, gender, tumor location, stage, Karnofsky Performance Status (KPS), and treatment strategy) including primary tumor SUVmax and nodal SUVmax on overall survival (OS), disease-free survival (DFS), locoregional control (LRC), and distant metastasis-free survival (DMFS) were evaluated. Kaplan-Meier survival curves were generated and compared with the log-rank test. RESULTS Median follow-up for the whole population was 31 months (range 2.3-53.5). Two-year OS, LRC, DFS and DMFS, for the entire cohort were 62.1, 78.3, 55.2 and 67.2%, respectively. Median pretreatment SUVmax for the primary tumor and lymph nodes was 11.85 and 5.4, respectively. According to univariate analysis, patients with KPS < 80% (p < 0.001), AJCC stage IVa or IVb vs III (p = 0.037) and patients undergoing radiotherapy vs surgery (p = 0.042) were significantly associated with worse OS. Patients with KPS < 80% (p = 0.003) or age ≥65 years (p = 0.007) had worse LRC. The KPS < 80% was the only factor associated with decreased DFS (p = 0.001). SUVmax of the primary tumor or the lymph nodes were not associated with OS, DFS or LRC. The KPS < 80% (p = 0.002), tumor location (p = 0.047) and AJCC stage (p = 0.025) were associated with worse cancer-specific survival (CSS). According to Cox regression analysis, on multivariate analysis KPS < 80% was the only independent parameter determining worse OS, DFS, CSS. Regarding LRC only patients with IK < 80% (p = 0.01) and ≥65 years (p = 0.01) remained statistically significant. Nodal SUVmax was the only factor associated with decreased DMFS. Patients with a nodal SUVmax > 5.4 presented an increased risk for distant metastases (HR, 3.3; 95% CI 1.17-9.25; p = 0.023). CONCLUSIONS The pretreatment nodal SUVmax in patients with locally advanced HNSCC is prognostic for DMFS. However, according to our results primary tumor SUVmax and nodal SUVmax were not significantly related to OS, DFS or LRC. Patients presenting KPS < 80% had worse OS, DFS, CSS and LRC.
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Affiliation(s)
- J Cacicedo
- Radiation Oncology Department, Cruces University Hospital (University of the Basque Country)/Biocruces Health Research Institute, c/Plaza de Cruces s/n, 48903, Barakaldo, Bizkaia (Basque Country), Spain.
| | - I Fernandez
- Nuclear Medicine Department, Cruces University Hospital, Barakaldo, Spain
| | - O Del Hoyo
- Radiation Oncology Department, Cruces University Hospital (University of the Basque Country)/Biocruces Health Research Institute, c/Plaza de Cruces s/n, 48903, Barakaldo, Bizkaia (Basque Country), Spain
| | - A Navarro
- Radiation Oncology Department, Hospital Duran i Reynals (ICO) Avda, Gran Via de L´Hospitalet, 199-203, Hospitalet de Llobregat, 08908, Barcelona, Spain
| | - A Gomez-Iturriaga
- Radiation Oncology Department, Cruces University Hospital (University of the Basque Country)/Biocruces Health Research Institute, c/Plaza de Cruces s/n, 48903, Barakaldo, Bizkaia (Basque Country), Spain
| | - J Ignacio Pijoan
- Clinical Epidemiology Unit, Cruces University Hospital/Biocruces Health Research Institute, Barakaldo, Spain.,CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - L Martinez-Indart
- Clinical Epidemiology Unit, Cruces University Hospital/Biocruces Health Research Institute, Barakaldo, Spain
| | - J Escudero
- Clinical Epidemiology Unit, Cruces University Hospital/Biocruces Health Research Institute, Barakaldo, Spain
| | - J Gomez-Suarez
- Otolaryngology Department, Cruces University Hospital, c/Plaza de Cruces s/n, 48903, Barakaldo, Vizcaya (Basque Country), Spain
| | - R Ortiz de Zarate
- Medical Physics and Radioprotection Department, Cruces University Hospital/Biocruces Health Research Institute, Vizcaya, Spain
| | - J Fernando Perez
- Medical Physics and Radioprotection Department, Cruces University Hospital/Biocruces Health Research Institute, Vizcaya, Spain
| | - P Bilbao
- Radiation Oncology Department, Cruces University Hospital (University of the Basque Country)/Biocruces Health Research Institute, c/Plaza de Cruces s/n, 48903, Barakaldo, Bizkaia (Basque Country), Spain
| | - D Rades
- Department of Radiation Oncology, University of Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany
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Bolm L, Oria V, Kaesmann L, Bronsert P, Wellner U, Schilling O, Rades D. PO-0953: Proteome profiles in PDAC patients with local recurrence after postoperative radiochemotherapy. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)31390-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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19
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Käsmann L, Bolm L, Motisi L, Janssen S, Schild S, Rades D. EP-1205: The prognostic role of Neutrophil-tolymphocyte ratio in limited disease small-cell lung cancer. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)31641-9] [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: 11/30/2022]
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Abstract
This study aims to identify predictors of survival and contribute to treatment personalization in patients with brain metastases from gastric cancer. Twelve patients received whole-brain radiotherapy (WBRT), four stereotactic radiosurgery and six neurosurgery plus WBRT. Treatment regimen, age, gender, Eastern Cooperative Oncology Group (ECOG) performance score, tumor site, number of brain metastases, extra-cranial metastases and interval between cancer diagnosis and brain metastases were evaluated for survival. On univariate analyses, more intensive treatment (p=0.003), ECOG-score 0-1 (p<0.001), cardiac location (p=0.025) and single brain metastasis (p=0.023) were associated with better survival. On multivariate analysis, ECOG-score maintained significance (p<0.001). Patients with all three positive factors on univariate analysis had a 12-month survival rate of 100%, patients with three negative factors a 3-month survival rate of 0%. Predictors of survival were identified that can guide physicians selecting personalized treatment approaches for patients with brain metastases from gastric cancer.
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Ipsen S, Blanck O, Oborn B, Bode F, Liney G, Hunold P, Rades D, Schweikard A, Keall PJ. Radiotherapy beyond cancer: target localization in real-time MRI and treatment planning for cardiac radiosurgery. Med Phys 2015; 41:120702. [PMID: 25471947 DOI: 10.1118/1.4901414] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE Atrial fibrillation (AFib) is the most common cardiac arrhythmia that affects millions of patients world-wide. AFib is usually treated with minimally invasive, time consuming catheter ablation techniques. While recently noninvasive radiosurgery to the pulmonary vein antrum (PVA) in the left atrium has been proposed for AFib treatment, precise target location during treatment is challenging due to complex respiratory and cardiac motion. A MRI linear accelerator (MRI-Linac) could solve the problems of motion tracking and compensation using real-time image guidance. In this study, the authors quantified target motion ranges on cardiac magnetic resonance imaging (MRI) and analyzed the dosimetric benefits of margin reduction assuming real-time motion compensation was applied. METHODS For the imaging study, six human subjects underwent real-time cardiac MRI under free breathing. The target motion was analyzed retrospectively using a template matching algorithm. The planning study was conducted on a CT of an AFib patient with a centrally located esophagus undergoing catheter ablation, representing an ideal case for cardiac radiosurgery. The target definition was similar to the ablation lesions at the PVA created during catheter treatment. Safety margins of 0 mm (perfect tracking) to 8 mm (untracked respiratory motion) were added to the target, defining the planning target volume (PTV). For each margin, a 30 Gy single fraction IMRT plan was generated. Additionally, the influence of 1 and 3 T magnetic fields on the treatment beam delivery was simulated using Monte Carlo calculations to determine the dosimetric impact of MRI guidance for two different Linac positions. RESULTS Real-time cardiac MRI showed mean respiratory target motion of 10.2 mm (superior-inferior), 2.4 mm (anterior-posterior), and 2 mm (left-right). The planning study showed that increasing safety margins to encompass untracked respiratory motion leads to overlapping structures even in the ideal scenario, compromising either normal tissue dose constraints or PTV coverage. The magnetic field caused a slight increase in the PTV dose with the in-line MRI-Linac configuration. CONCLUSIONS The authors' results indicate that real-time tracking and motion compensation are mandatory for cardiac radiosurgery and MRI-guidance is feasible, opening the possibility of treating cardiac arrhythmia patients completely noninvasively.
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Affiliation(s)
- S Ipsen
- Radiation Physics Laboratory, Sydney Medical School, The University of Sydney, Sydney, New South Wales 2006, Australia and Institute for Robotics and Cognitive Systems, University of Luebeck, Luebeck 23562, Germany
| | - O Blanck
- Department of Radiation Oncology, University of Luebeck and University Medical Center Schleswig-Holstein, Campus Luebeck, Luebeck 23562, Germany
| | - B Oborn
- Illawarra Cancer Care Centre (ICCC), Wollongong, New South Wales 2500, Australia and Centre for Medical Radiation Physics (CMRP), University of Wollongong, Wollongong, New South Wales 2500, Australia
| | - F Bode
- Medical Department II, University of Luebeck and University Medical Center Schleswig-Holstein, Campus Luebeck, Luebeck 23562, Germany
| | - G Liney
- Ingham Institute for Applied Medical Research, Liverpool Hospital, Liverpool, New South Wales 2170, Australia
| | - P Hunold
- Department of Radiology and Nuclear Medicine, University of Luebeck and University Medical Center Schleswig-Holstein, Campus Luebeck, Luebeck 23562, Germany
| | - D Rades
- Department of Radiation Oncology, University of Luebeck and University Medical Center Schleswig-Holstein, Campus Luebeck, Luebeck 23562, Germany
| | - A Schweikard
- Institute for Robotics and Cognitive Systems, University of Luebeck, Luebeck 23562, Germany
| | - P J Keall
- Radiation Physics Laboratory, Sydney Medical School, The University of Sydney, Sydney, New South Wales 2006, Australia
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Knief J, Gebauer N, Bernard V, Schemme J, Reddemann K, Gebauer J, Rades D, Brabant G, Lehnert H, Feller AC, Thorns C. Oncogenic mutations and chromosomal aberrations in primary extranodal diffuse large b-cell lymphomas of the thyroid – A study of 21 cases. Exp Clin Endocrinol Diabetes 2015. [DOI: 10.1055/s-0035-1547636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Gebauer N, Schmidt-Werthern C, Bernard V, Schemme J, Feller AC, Keck T, Begum N, Rades D, Lehnert H, Brabant G, Thorns C. Genomic landscape of pancreatic neuroendocrine tumors. Exp Clin Endocrinol Diabetes 2015. [DOI: 10.1055/s-0035-1547614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Rades D, Seibold N, Schild S, Bruchhage K, Gebhard M, Noack F. Erratum to: Androgen receptor expression. Strahlenther Onkol 2014. [DOI: 10.1007/s00066-013-0544-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Rades D, Seibold N, Hoffmann A, Gebhard M, Noack F, Thorns C, Schild S. Erratum to: Impact of the HPV-positivity definition on the prognostic value of HPV status in patients with locally advanced squamous cell carcinoma of the head and neck. Strahlenther Onkol 2014. [DOI: 10.1007/s00066-013-0545-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Rades D, Segedin B, Nagy V, Schild SE, Trang NT, Khoa MT. Predicting the presence of extracranial metastases in patients with brain metastases upon first diagnosis of cancer. Strahlenther Onkol 2014; 190:405-7. [PMID: 24429480 DOI: 10.1007/s00066-013-0516-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Accepted: 11/11/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND AND PURPOSE This study aimed to determine factors allowing the prediction of extracranial metastases in patients presenting with brain metastases at the first diagnosis of cancer. MATERIALS AND METHODS Data from 659 patients with brain metastases upon first diagnosis of cancer were retrospectively analyzed. The parameters age, gender, Karnofsky performance score (KPS), primary tumor type and number of brain metastases were compared between 359 patients with extracranial metastases and 300 patients without extracranial metastases. Additional analyses were performed for patients with the most unfavorable and those with the most favorable characteristics. RESULTS The comparison of patients with versus without extracranial metastases revealed significant differences between the groups in terms of KPS (p < 0.001) and number of brain metastases (p < 0.001). Of the study patients, 113 had both most unfavorable characteristics, i.e. KPS ≤ 50 and ≥ 4 brain metastases. The sensitivity for identifying patients with extracranial metastases was 82 %; specificity was 51 %. A total of 50 patients had KPS ≥ 90 and only one brain metastasis. The sensitivity for identifying patients without extracranial metastases was 86 %; specificity was 58 %. CONCLUSION The combination of KPS and the number of brain metastases can help to predict the presence or absence of extracranial metastases.
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Affiliation(s)
- D Rades
- Department of Radiation Oncology, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany,
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Rades D, Seibold ND, Schild SE, Bruchhage KL, Gebhard MP, Noack F. Androgen receptor expression: prognostic value in locally advanced squamous cell carcinoma of the head and neck. Strahlenther Onkol 2014; 189:849-55. [PMID: 23959264 DOI: 10.1007/s00066-013-0389-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Accepted: 05/22/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE This study investigated the prognostic value of androgen receptor (AR) expression of tumor cells in patients treated with surgery and subsequent radio(chemo)therapy for locally advanced squamous cell carcinoma of the head and neck (SCCHN). MATERIAL AND METHODS The impact of AR and 11 additional factors on locoregional control (LRC), metastases-free survival (MFS), and overall survival (OS) was retrospectively studied in 163 patients with nonmetastatic stage III/IV SCCHN. Additional factors included age, gender, ECOG performance status, pre-radiotherapy (pre-RT) hemoglobin levels, tumor site, histologic grade, T category, N category, HPV status, extent of resection, and concurrent chemotherapy. RESULTS On multivariate analysis, improved LRC was significantly associated with pre-RT hemoglobin levels≥12 g/dl (risk ratio [RR] 2.22; 95% confidence interval [CI] 1.19–4.13; p=0.013), tumor site (RR 1.39; 95% CI 1.14–1.70; p=0.001), lower T category (RR 1.67; 95% CI 1.18–2.44; p=0.003), and lower N category (RR 4.18; 95% CI 1.90–10.55; p<0.001). Improved MFS was associated with AR expression (RR 2.21; 95% CI 1.01–5.41; p=0.048), better ECOG performance status (RR 3.19; 95% CI 1.50–7.14; p=0.003), lower T category (RR 2.24; 95% CI 1.47–3.65; p<0.001), and lower N category (RR 5.33; 95% CI 2.07–16.63; p<0.001). OS was positively associated with AR expression (RR 1.99; 95% CI 1.06–4.00; p=0.032), better ECOG performance status (RR 2.20; 95% CI 1.20–4.09; p=0.010), pre-RT hemoglobin levels≥12 g/dl (RR 2.13; 95% CI 1.19–3.82; p=0.012), lower T category (RR 1.81; 95% CI 1.30–2.62; p<0.001), and lower N category (RR 3.41; 95% CI: 1.65–7.80; p<0.001). CONCLUSION Tumor cell expression of AR was an independent prognostic factor for MFS and OS and should be considered in future prospective trials.
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Werner R, Bode F, Bruder R, Gebhard M, Dunst J, Rades D, Blanck O. OC-0503: Impact of cardiac and respiratory motion during cardiac radiosurgery: a dose accumulation study in a porcine model. Radiother Oncol 2014. [DOI: 10.1016/s0167-8140(15)30608-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Rades D. SP-0116: Advances in radiotherapy of spinal metastases. Radiother Oncol 2014. [DOI: 10.1016/s0167-8140(15)30221-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Rades D, Gerdan L, Segedin B, Nagy V, Khoa MT, Trang NT, Schild SE. Brain metastasis. Prognostic value of the number of involved extracranial organs. Strahlenther Onkol 2013; 189:996-1000. [PMID: 24104872 DOI: 10.1007/s00066-013-0442-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Accepted: 07/31/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE This study was performed to evaluate the prognostic role for survival of the number and the type of involved extracranial organs in patients with brain metastasis. MATERIAL AND METHODS The data of 1146 patients who received whole-brain radiotherapy (WBRT) alone for brain metastasis have been retrospectively analyzed. In addition to the number of involved extra cranial organs, seven potential prognostic factors were investigated including WBRT regimen, age, gender, Karnofsky Performance Score (KPS), primary tumor type, number of brain metastases, and the interval from cancer diagnosis to WBRT. Additionally, subgroup analyses were performed for patients with involvement of one (lung vs. bone vs. liver vs. other metastasis) and two (lung + lymph nodes vs. lung + bone vs. lung + liver vs. liver + bone vs. other combinations) extracranial organs. RESULTS The 6-month survival rates for the involvement of 0, 1, 2, 3, and ≥4 extracranial organs were 51, 30, 16, 13, and 10%, respectively (p<0.001). On multivariate analysis, the number of involved extracranial organs maintained significance (risk ratio 1.26; 95% confidence interval 1.18-1.34; p<0.001). According to the multivariate analysis, age (p<0.001), gender (p=0.002), and KPS (p<0.001) were also independent prognostic factors for survival. In the subgroup analyses of patients with involvement of one and two extracranial organs, survival was not significantly different based on the extracranial organ involved. CONCLUSION The number of involved extracranial organs proved to be an independent prognostic factor in patients with brain metastasis, regardless of the organs involved. The number of involved extracranial organs should be considered in future trials designed for patients with brain metastasis.
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Affiliation(s)
- D Rades
- Department of Radiation Oncology, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany,
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Gerdan L, Segedin B, Nagy V, Khoa MT, Trang NT, Schild SE, Rades D. Brain metastasis from non-small cell lung cancer (NSCLC): prognostic importance of the number of involved extracranial organs. Strahlenther Onkol 2013; 190:64-7. [PMID: 24104871 DOI: 10.1007/s00066-013-0439-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Accepted: 07/25/2013] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE This study investigated the potential prognostic value of the number of involved extracranial organs in patients with brain metastasis from non-small cell lung cancer (NSCLC). MATERIAL AND METHODS A total of 472 patients who received whole-brain radiotherapy (WBRT) alone with 5 × 4 Gy or 10 × 3 Gy for brain metastasis from NSCLC were included in this retrospective study. In addition to the number of involved extracranial organs, 6 further potential prognostic factors were investigated including WBRT regimen, age, gender, Karnofsky Performance Score (KPS), number of brain metastases, and the interval from cancer diagnosis to WBRT. Subgroup analyses were performed for patients with metastatic involvement of one (lung vs. bone vs. other metastasis) and two (lung + bone vs. lung+lymph nodes vs. other combinations) extracranial organs. RESULTS The survival rates at 6 months of the patients with involvement of 0, 1, 2, 3, and ≥ 4 extracranial organs were 52, 27, 17, 4, and 14%, respectively (p<0.001). On multivariate analysis, the number of involved extracranial organs remained significant (risk ratio 1.32; 95% confidence interval 1.19-1.46; p<0.001). Age <65 years (p=0.004), KPS ≥ 70 (p<0.001), and only 1-3 brain metastases (p=0.022) were also significantly associated with survival in the multivariate analysis. In the separate analyses of patients with involvement of one and two extracranial organs, survival was not significantly different based on the pattern of extracranial organ involvement. CONCLUSION The number of involved extracranial organs is an independent prognostic factor of survival in patients with brain metastasis from NSCLC, irrespective of the pattern of extracranial organ involvement.
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Affiliation(s)
- L Gerdan
- Department of Radiation Oncology, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
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Blanck O, Bode F, Gebhard M, Hunold P, Brandt S, Bruder R, Schweikard A, Grossherr M, Rades D, Dunst J. Cardiac Radiosurgery: Preliminary Results in a Porcine Model and Possible Implications for the Treatment of Atrial Fibrillation. Int J Radiat Oncol Biol Phys 2013. [DOI: 10.1016/j.ijrobp.2013.06.1482] [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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Rades D, Seibold ND, Hoffmann A, Gebhard MP, Noack F, Thorns C, Schild SE. Impact of the HPV-positivity definition on the prognostic value of HPV status in patients with locally advanced squamous cell carcinoma of the head and neck. Strahlenther Onkol 2013; 189:856-60. [PMID: 23868550 DOI: 10.1007/s00066-013-0377-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Accepted: 05/06/2013] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND PURPOSE This study re-evaluated the prognostic value of HPV status for loco-regional control (LRC), metastases-free survival (MFS), and survival (OS) in patients with locally advanced squamous cell carcinoma of the head and neck (SCCHN). A modified definition of HPV positivity was used in the current study compared to the authors' previous study. PATIENTS AND METHODS In the previous study of the same 170 patients, a tumor was defined as HPV-positive if it showed a positive in situ hybridization result in ≥10% of tumor cells and/or positive p16 immunostaining. In the current analysis, tumors were considered HPV-positive only if they showed positive results for both in situ hybridization and p16 immunostaining. In addition to HPV status, the same 11 potential prognostic factors were investigated for treatment outcomes as in the preceding study. RESULTS In the multivariate analysis of the current study, HPV positivity was significantly associated with improved LRC [risk ratio (RR) 9.78; p<0.001], MFS (RR 7.17; p=0.008), and OS (RR 6.61; p<0.001). In the previous study, HPV positivity was associated with LRC (RR 2.34; p=0.014) and OS (RR 2.19; p=0.019), but not with MFS (RR 2.04; p=0.11). CONCLUSIONS Applying the new definition of HPV positivity, the impact of HPV status on the prognosis of patients irradiated for locally advanced SCCHN was more prominent than in our previous study and associated with all three investigated endpoints.
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Affiliation(s)
- D Rades
- Department of Radiation Oncology, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany,
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Seibold ND, Schild SE, Bruchhage KL, Gebhard MP, Noack F, Rades D. Prognostic impact of VEGF and FLT-1 receptor expression in patients with locally advanced squamous cell carcinoma of the head and neck. Strahlenther Onkol 2013; 189:639-46. [PMID: 23748230 DOI: 10.1007/s00066-013-0341-2] [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] [Received: 03/01/2013] [Accepted: 03/06/2013] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND PURPOSE This study investigated the prognostic value of tumor cell expression of vascular endothelial growth factor (VEGF) and its receptor fms-related tyrosine kinase 1 (FLT-1) in patients with locally advanced squamous cell carcinoma of the head and neck (SCCHN) who had been treated with adjuvant radiotherapy or radiochemotherapy. MATERIAL AND METHODS The impact of tumor cell VEGF and FLT-1 expression plus 11 additional factors on loco-regional control (LRC), metastases-free survival (MFS) and overall survival (OS) was retrospectively evaluated in 157 patients. The additional factors were age, gender, performance status, pre-radiotherapy (pre-RT) hemoglobin levels, tumor site, histologic grade, T-category, N-category, human papillomavirus (HPV) status, extent of resection and chemotherapy. RESULTS On multivariate analysis, improved LRC was significantly associated with an absence of VEGF expression (risk ratio, RR: 5.02; p = 0.009), lower T-category (RR: 2.00; p < 0.001), lower N-category (RR: 3.75; p < 0.001) and pre-RT hemoglobin levels ≥ 12 g/dl (RR: 2.20; p = 0.029). Improved MFS was significantly associated with an absence of VEGF expression (RR: 7.46; p = 0.002), lower T-category (RR: 1.97; p = 0.002), lower N-category (RR: 3.29; p = 0.005) and a favorable tumor location (RR: 1.34; p = 0.033); HPV positivity showed a trend towards improved MFS (RR: 1.43; p = 0.09). Improved OS was significantly associated with an absence of VEFG expression (RR: 3.22; p = 0.041), pre-RT hemoglobin levels ≥ 12 g/dl (RR: 2.47; p = 0.009), lower T-category (RR: 1.92; p < 0.001) and lower N-category (RR: 3.39; p < 0.001). FLT-1 expression was significantly associated with LRC and OS in the univariate but not in the multivariate analysis. CONCLUSION VEGF expression proved to be an independent negative predictor for LRC, MFS and OS in patients treated for locally advanced SCCHN with adjuvant radiotherapy or radiochemotherapy. FLT-1 expression was not significant in multivariate analyses.
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Affiliation(s)
- N D Seibold
- Department of Radiation Oncology, University of Lubeck, Ratzeburger Allee 160, 23538, Lubeck, Germany
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Rades D, Dziggel L, Segedin B, Oblak I, Nagy V, Marita A, Schild SE, Trang NT, Khoa MT. A simple survival score for patients with brain metastases from breast cancer. Strahlenther Onkol 2013; 189:664-7. [PMID: 23740157 DOI: 10.1007/s00066-013-0367-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Accepted: 04/22/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND AND PURPOSE Personalized cancer treatment considers the patient's survival prognosis. Therefore, it is important to be able to estimate the patient's survival time, particularly in a palliative situation such as brain metastasis. This study aimed to create and validate a survival score for patients with brain metastasis from breast cancer, which is the second most common primary tumor in these patients. PATIENTS AND METHODS Data of 230 patients treated with whole-brain radiotherapy (WBRT) alone for brain metastasis from breast cancer were retrospectively analyzed. Patients were assigned to a test (n = 115) or a validation group (n = 115). According to the results of the multivariate analysis of the test group, Karnofsky Performance Score and extracranial metastases were included in the scoring system. The score for each factor was obtained from the 6-month survival rate (in %) divided by 10. Total scores represented the sum of these scores and were 4, 7, 9, or 12 points. Three prognostic groups were formed. RESULTS The 6-month survival rates in the test group were 10 % for 4-7 points, 55 % for 9 points, and 78 % for 15 points (p < 0.001). In the validation group the corresponding 6-month survival rates were 11, 54, and 75 %, respectively (p < 0.001). The comparisons between the prognostic groups of the test and the validation group did not show significant differences. CONCLUSION This simple survival score appears valid and reproducible. It can be used to estimate the survival time of patients with brain metastasis from breast cancer receiving WBRT alone.
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Affiliation(s)
- D Rades
- Department of Radiation Oncology, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23538, Luebeck, Germany.
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Rades D, Veninga T, Bajrovic A, Karstens JH, Schild SE. A validated scoring system to identify long-term survivors after radiotherapy for metastatic spinal cord compression. Strahlenther Onkol 2013; 189:462-6. [PMID: 23604188 DOI: 10.1007/s00066-013-0342-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Accepted: 03/06/2013] [Indexed: 12/25/2022]
Abstract
PURPOSE This study aimed to develop and validate a scoring system to identify long-term survivors after conventional radiotherapy (RT) for metastatic spinal cord compression (MSCC). PATIENTS AND METHODS Data from 1,125 patients who had received long-course RT for MSCC were included in this study. Of these patients, 344 survived for over 12 months and 781 died within a year following RT. Based on differences between the distributions of patient characteristics in the two groups, a scoring system was developed. Scores ranged from 0 to 18 points and 15 points was selected as the cutoff for identifying long-term survivors. Data from the 1,125 long-course RT patients (test group) were compared to data from 773 patients receiving short-course RT (validation group). RESULTS A score of ≥ 15 points was associated with a 94 % proportion of long-term survivors. The 15-point cutoff resulted in a specificity of 98 % and a positive predictive value of 94 % for identification of long-term surviving patients. The proportions of long-term survivors for each scoring point in the validation group were very similar to those in the test group. CONCLUSION This new scoring system enabled identification of long-term survivors after RT for MSCC with very high specificity and positive predictive value. The score proved to be valid and reproducible.
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Affiliation(s)
- D Rades
- Department of Radiation Oncology, University of Lubeck, Ratzeburger Allee 160, Lubeck, Germany.
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Rades D. Vorteile der stereotaktischen gegenüber der konventionellen Bestrahlung von Wirbelkörpermetastasen. Strahlenther Onkol 2013; 189:342-3. [DOI: 10.1007/s00066-012-0287-9] [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: 10/27/2022]
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Dziggel L, Segedin B, Podvrsnik NH, Oblak I, Schild SE, Rades D. Validation of a survival score for patients treated with whole-brain radiotherapy for brain metastases. Strahlenther Onkol 2013; 189:364-6. [PMID: 23519358 DOI: 10.1007/s00066-013-0308-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2012] [Accepted: 01/16/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND This study was performed to validate a scoring system published in 2008 to predict the survival of patients receiving whole-brain radiotherapy (WBRT) alone for brain metastases. METHODS The scoring system included four independent prognostic factors: age, performance status, extracranial metastases, and interval between first diagnosis of cancer and WBRT. The score for each prognostic factor was determined by dividing the 6-month survival rate (in %) by 10. The total score represented the sum of the scores for each prognostic factor. Total scores ranged from 9-18 points, and patients were divided into four groups. In the present study, 350 new patients were evaluated in order to validate the previously developed score. RESULTS In the present validation study, the 6-month survival rates were 8 % for patients with a score of 9-10 points (group A), 24 % for those with a score of 11-13 points (group B), 51 % for those with a score of 14-16 points (group C), and 82 % for those with scores of 17-18 points (group D), respectively (p < 0.001). In our previous study published in 2008, the 6-month survival rates were 6 %, 15 %, 43 %, and 76 %, respectively (p < 0.001). The comparisons between each of the four prognostic groups of both series did not reveal a significant difference. CONCLUSION In this study, the 6-month survival rates of the four prognostic groups were not significantly different from those of the preceding study. This demonstrates the validity and reproducibility of this score. The score can help select the appropriate treatment for the individual patient and help design prospective trials.
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Affiliation(s)
- L Dziggel
- Department of Radiation Oncology, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
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Rades D, Douglas S, Schild SE. A validated survival score for breast cancer patients with metastatic spinal cord compression. Strahlenther Onkol 2012; 189:41-6. [PMID: 23138773 DOI: 10.1007/s00066-012-0230-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2012] [Accepted: 08/27/2012] [Indexed: 01/01/2023]
Abstract
BACKGROUND To create a validated scoring system predicting survival of breast cancer patients with metastatic spinal cord compression (MSCC). PATIENTS AND METHODS Of 510 patients, one half were assigned to either the test or the validation group. In the test group, eight pretreatment factors (age, performance status, number of involved vertebrae, ambulatory status, other bone metastases, visceral metastases, interval from cancer diagnosis to radiotherapy of MSCC, time of developing motor deficits) plus the radiation regimen were retrospectively investigated. Factors significantly associated with survival in the multivariate analysis were included in the scoring system. The score for each factor was determined by dividing the 6-month survival rate (%) by ten. The total score was the sum of the scores for each factor. RESULTS In the multivariate analysis of the test group, performance status, ambulatory status, other bone metastases, visceral metastases, interval from cancer diagnosis to radiotherapy of MSCC, and time of developing motor deficits were significant for survival and included in the score. Total scores ranged from 30 to 50 points. In the test group, the 6-month survival rates were 12% for 30-35 points, 41% for 36-40 points, 74% for 41-45 points, and 98% for 46-50 points (p < 0.0001). In the validation group, the 6-month survival rates were 14%, 46%, 77%, and 99%, respectively (p < 0.0001). CONCLUSION The survival rates of the validation group were similar to the test group. Therefore, this score was reproducible and can help when selecting the appropriate radiotherapy regimen for each patient taking into account her survival prognosis.
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Affiliation(s)
- D Rades
- Department of Radiation Oncology, University Hospital Schleswig-Holstein, Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany.
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Rades D, Hakim SG, Bajrovic A, Karstens JH, Veninga T, Rudat V, Schild SE. Impact of zoledronic acid on control of metastatic spinal cord compression. Strahlenther Onkol 2012; 188:910-6. [PMID: 22903395 DOI: 10.1007/s00066-012-0158-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2012] [Accepted: 05/30/2012] [Indexed: 11/25/2022]
Abstract
BACKGROUND Zoledronic acid was demonstrated to reduce the rate of skeletal-related events, a hypernym including various outcomes, in patients with bone metastases. In contrast to other studies, this matched-pair analysis focused solely on the impact of zoledronic acid on metastatic spinal cord compression (MSCC). PATIENTS AND METHODS Data from 98 patients with MSCC receiving radiotherapy plus zoledronic acid were matched 1:2 to 196 patients receiving radiotherapy alone for ten potential prognostic factors. Both groups were compared for local control of MSCC within the irradiated region, overall control of MSCC (local and distant MSCC control), and survival. RESULTS The 1-year local control rates were 90% after radiotherapy plus zoledronic acid and 81%, after radiotherapy alone (p = 0.042). The 1-year overall control rates were 87% and 75%, respectively (p = 0.016), and the 1-year survival rates were 60% and 52%, respectively (p = 0.17). Results were significant in the Cox proportional hazards model regarding local control (p = 0.024) and overall control (p = 0.008). CONCLUSION According to the results of this study, zoledronic acid was associated with improved control of MSCC in irradiated patients.
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Affiliation(s)
- D Rades
- Department of Radiation Oncology, University of Lubeck, Ratzeburger Allee 160, 23538 Lubeck, Germany.
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Tsao MN, Rades D, Wirth A, Lo SS, Danielson BL, Vichare A, Hahn C, Chang EL. International Practice Survey on the Management of Brain Metastases: Third International Consensus Workshop on Palliative Radiotherapy and Symptom Control. Clin Oncol (R Coll Radiol) 2012; 24:e81-92. [PMID: 22794327 DOI: 10.1016/j.clon.2012.03.008] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2011] [Revised: 01/27/2012] [Accepted: 03/22/2012] [Indexed: 11/30/2022]
Affiliation(s)
- M N Tsao
- Department of Radiation Oncology, University of Toronto, Odette Cancer Centre, Toronto, Ontario, Canada.
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Krause J, Blanck O, Duerichen R, Wurster S, Andratschke N, Rades D, Hildebrandt G, Dunst J, Schweikard A, Schlaefer A. TH-A-BRA-08: Retrospective Accuracy Estimation for Motion Compensated Robotic Radiosurgery of the Liver. Med Phys 2012. [DOI: 10.1118/1.4736257] [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: 11/07/2022] Open
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Blanck O, Dürichen R, Ernst F, Dunst J, Rades D, Hildebrandt G, Schweikard A. OC-0022 EVALUATION OF A WAVELET-BASED LEAST MEAN SQUARE MOTION PREDICTION ALGORITHM FOR LUNG AND LIVER PATIENTS. Radiother Oncol 2012. [DOI: 10.1016/s0167-8140(12)70361-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Rades D. SP-0010 EXTRACRANIAL STEREOTACTIC RADIOSURGERY FOR SPINAL AND PARASPINAL METASTASIS. Radiother Oncol 2012. [DOI: 10.1016/s0167-8140(12)70349-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Blanck O, Dunst J, Rades D, Hildebrandt G. EP-1395 FILM BASED DELIVERY QUALITY ASSURANCE FOR ROBOTIC RADIOSURGERY. Radiother Oncol 2012. [DOI: 10.1016/s0167-8140(12)71728-0] [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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Rades D, Douglas S, Veninga T, Bajrovic A, Stalpers LJA, Hoskin PJ, Rudat V, Schild SE. A survival score for patients with metastatic spinal cord compression from prostate cancer. Strahlenther Onkol 2012; 188:802-6. [PMID: 22526228 DOI: 10.1007/s00066-012-0106-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2012] [Accepted: 03/14/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND This study aimed to develop and validate a survival scoring system for patients with metastatic spinal cord compression (MSCC) from prostate cancer. PATIENTS AND METHODS Of 436 patients, 218 patients were assigned to the test group and 218 patients to the validation group. Eight potential prognostic factors (age, performance status, number of involved vertebrae, ambulatory status, other bone metastases, visceral metastases, interval from cancer diagnosis to radiotherapy of MSCC, time developing motor deficits) plus the fractionation regimen were retrospectively investigated for associations with survival. Factors significant in the multivariate analysis were included in the survival score. The score for each significant prognostic factor was determined by dividing the 6-month survival rate (%) by 10. The total score represented the sum of the scores for each factor. The prognostic groups of the test group were compared to the validation group. RESULTS In the multivariate analysis of the test group, performance status, ambulatory status, other bone metastases, visceral metastases, and interval from cancer diagnosis to radiotherapy were significantly associated with survival. Total scores including these factors were 20, 21, 22, 24, 26, 28, 29, 30, 31, 32, 33, 35, 37, or 39 points. In the test group, the 6-month survival rates were 6.5% for 20-24 points, 44.6% for 26-33 points, and 95.8% for 35-39 points (p < 0.0001). In the validation group, the 6-month survival rates were 7.4%, 45.4%, and 94.7%, respectively (p < 0.0001). CONCLUSIONS Because the survival rates of the validation group were almost identical to the test group, this score can be considered valid and reproducible.
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Affiliation(s)
- D Rades
- Department of Radiation Oncology, University of Lubeck, Germany.
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Rades D, Schild SE. Do patients with a limited number of brain metastases need whole-brain radiotherapy in addition to radiosurgery? Strahlenther Onkol 2012; 188:702-6. [PMID: 22418589 DOI: 10.1007/s00066-012-0093-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2011] [Accepted: 02/02/2012] [Indexed: 11/28/2022]
Abstract
BACKGROUND About 40% of patients with brain metastases have a very limited number of lesions and may be candidates for radiosurgery. Radiosurgery alone is superior to whole-brain radiotherapy (WBRT) alone for control of treated and new brain metastases. In patients with a good performance status, radiosurgery also resulted in better survival. However, the question is whether the results of radiosurgery alone can be further improved with additional WBRT. METHODS Information for this review was compiled by searching the PubMed and MEDLINE databases. Very important published meeting abstracts were also considered. RESULTS Based on both retrospective and prospective studies, the addition of WBRT to radiosurgery improved control of treated and new brain metastases but not survival. However, because a recurrence within the brain has a negative impact on neurocognitive function, it is important to achieve long-term control of brain metastases. CONCLUSION The addition of WBRT provides significant benefits. Further randomized studies including adequate assessment of neurocognitive function and a follow-up period of at least 2 years are needed to help customize the treatment for individual patients.
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Affiliation(s)
- D Rades
- Department of Radiation Oncology, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23538, Luebeck, Germany.
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Rades D, Douglas S, Veninga T, Bajrovic A, Stalpers L, Hoskin P, Rudat V, Schild S. Metastatic spinal cord compression in non-small cell lung cancer patients. Strahlenther Onkol 2012; 188:472-6. [DOI: 10.1007/s00066-012-0086-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2011] [Accepted: 01/25/2012] [Indexed: 01/16/2023]
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Rades D, Douglas S, Veninga T, Stalpers LJA, Bajrovic A, Rudat V, Schild SE. Prognostic factors in a series of 504 breast cancer patients with metastatic spinal cord compression. Strahlenther Onkol 2012; 188:340-5. [PMID: 22354333 DOI: 10.1007/s00066-011-0061-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2011] [Accepted: 10/20/2011] [Indexed: 11/28/2022]
Abstract
BACKGROUND This study was performed to identify new significant prognostic factors in breast cancer patients irradiated for metastatic spinal cord compression (MSCC). PATIENTS AND METHODS The data of 504 patients with breast cancer patients with MSCC were retrospectively analyzed with respect to posttreatment motor function, local control of MSCC, and survival. The investigated potential prognostic factors included age, Eastern Cooperative Oncology Group (ECOG) performance score, number of involved vertebrae, other bone metastases, visceral metastases, pretreatment ambulatory status, interval from cancer diagnosis to radiotherapy of MSCC, time developing motor deficits before radiotherapy, and the radiation schedule. RESULTS On multivariate analysis, better functional outcome was associated with ambulatory status prior to RT (estimate - 1.29, p < 0.001), no visceral metastases (estimate - 0.52, p = 0.020), and slower development of motor deficits (estimate + 2.47, p < 0.001). Improved local control was significantly associated with no other bone metastases (risk ratio (RR) 4.33, 95% confidence interval (CI) 1.36-14.02, p = 0.013) and no visceral metastases (RR 3.02, 95% CI 1.42-6.40, p = 0.005). Improved survival was significantly associated with involvement of only 1-2 vertebrae (RR 1.27, 95% CI 1.01-1.60, p = 0.044), ambulatory status before radiotherapy (RR 1.75, 95% CI 1.23-2.50, p = 0.002), no other bone metastases (RR 1.93, 95% CI 1.18-3.13, p = 0.009), no visceral metastases (RR 7.60, 95% CI 5.39-10.84, p < 0.001), and time developing motor deficits before radiotherapy (RR 1.55, 95% CI 1.30-1.86, p < 0.001). CONCLUSION Several new independent prognostic factors were identified for treatment outcomes. These prognostic factors should be considered in future trials and may be used to develop prognostic scores for breast cancer patients with MSCC.
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Affiliation(s)
- D Rades
- Department of Radiation Oncology, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, 23538, Lubeck, Germany.
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