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Mücke R, Heim G, Gosenheimer R, Schmitz V, Schulz C, Knoeß P, Fakhrian K, Harvey C, Mücke C, Lochhas G, Metzmann U, Bussmann M, Paschold M. Radiation therapy of breast cancer in the Nahe Breast Center: first results of an analysis in the context of health services research. Strahlenther Onkol 2024; 200:314-319. [PMID: 37947805 DOI: 10.1007/s00066-023-02157-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 09/10/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND The first evaluation of radiotherapy results in patients with breast cancer treated as part of a multimodal oncologic therapy in the Nahe Breast Center is presented. Analysis of the results was performed using an in-practice registry. PATIENTS AND METHODS From September 2016 to December 2017, 138 patients (median age 62.5 years; range 36-94 years) with breast cancer (right side, n = 67; left side, n = 71) received adjuvant radiation therapy. Of these, 103 patients received gyneco-oncologic care at the Nahe Breast Center, and 35 were referred from outside breast centers. The distribution into stages was as follows: stage I, n = 48; stage II, n = 68; stage III, n = 19; stage IV, n = 3. Neoadjuvant chemotherapy was given to 19 and adjuvant chemotherapy to 50 patients. Endocrine treatment was given to 120 patients. Both 3D conformal (n = 103) and intensity-modulated (n = 35) radiotherapy were performed with a modern linear accelerator. RESULTS With a median follow-up of 60 months (1-67), local recurrence occurred in 4/138 (2.9%) and distant metastasis in 8/138 (5.8%) patients; 7/138 (5.1%) patients died of their tumors during the follow-up period. The actuarial 5‑year local recurrence-free survival of all patients was 97.1%, and the actuarial 5‑year overall survival of all patients was 94.9%. We observed no grade 3 or 4 radiogenic side effects. CONCLUSION The results of radiotherapy for breast carcinoma at the Nahe Breast Center are comparable to published national and international results. In particular, the local recurrence rates in our study, determined absolutely and actuarially, are excellent, and demonstrate the usefulness of radiotherapy.
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Affiliation(s)
- Ralph Mücke
- Radiotherapy RheinMainNahe, Mainz-Ruesselsheim-Bad Kreuznach, Mühlenstraße 39a, 55543, Bad Kreuznach, Germany.
- Department of Radiotherapy and Radiation Oncology, Marien Hospital Herne, Ruhr University Bochum, Bochum, Germany.
| | - Gabor Heim
- Department of Gynecology, Hospital Sankt Marienwoerth, Bad Kreuznach, Germany
| | - Robert Gosenheimer
- Department of Internal Medicine, Hospital Sankt Marienwoerth, Bad Kreuznach, Germany
| | - Volker Schmitz
- Department of Internal Medicine, Hospital Sankt Marienwoerth, Bad Kreuznach, Germany
| | | | - Per Knoeß
- Institute of Pathology, Bad Kreuznach, Germany
| | | | - Christina Harvey
- Department of Internal Medicine, Hospital Sankt Marienwoerth, Bad Kreuznach, Germany
| | - Christiane Mücke
- Radiotherapy RheinMainNahe, Mainz-Ruesselsheim-Bad Kreuznach, Mühlenstraße 39a, 55543, Bad Kreuznach, Germany
| | - Gabriele Lochhas
- Radiotherapy RheinMainNahe, Mainz-Ruesselsheim-Bad Kreuznach, Mühlenstraße 39a, 55543, Bad Kreuznach, Germany
| | - Ute Metzmann
- Radiotherapy RheinMainNahe, Mainz-Ruesselsheim-Bad Kreuznach, Mühlenstraße 39a, 55543, Bad Kreuznach, Germany
| | - Matthias Bussmann
- Medical Management Board, Hospital Sankt Marienwoerth, Bad Kreuznach, Germany
| | - Markus Paschold
- Department of Surgery, Hospital Sankt Marienwoerth, Bad Kreuznach, Germany
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Micke O, Ugrak E, Bartmann S, Adamietz IA, Schaefer U, Bueker R, Kisters K, Heinrich Seegenschmiedt M, Fakhrian K, Muecke R. Radiotherapy for calcaneodynia, achillodynia, painful gonarthrosis, bursitis trochanterica, and painful shoulder syndrome - Early and late results of a prospective clinical quality assessment. Radiat Oncol 2018; 13:71. [PMID: 29673383 PMCID: PMC5907721 DOI: 10.1186/s13014-018-1025-y] [Citation(s) in RCA: 16] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 04/12/2018] [Indexed: 11/13/2022] Open
Abstract
Background The aim of this prospective clinical quality assessment was to evaluate the short-term and long-term efficacy of low dose radiotherapy (RT) for calcaneodynia, achillodynia, painful gonarthrosis, painful bursitis trochanterica, and painful shoulder syndrome. Methods Between October 2011 and October 2013, patients with calcaneodynia, achillodynia, painful gonarthrosis, painful bursitis trochanterica, and painful shoulder syndrome were recruited for this prospective clinical quality assessment. Single doses of 0.5-1.0 Gy and a total dose of 6.0 Gy per series were used. Pain was measured before and directly after RT (early response) with a visual analogue scale (VAS). Additionally, pain relief was measured with the four-scale pain score according to “von Pannewitz” (VPS) immediately at the end of RT and during follow-up. Within this context we defined a good response as complete pain relief and markedly improved. The assessment of the long-term efficacy was carried out by a telephone survey. Results 703 evaluable patients (461 female, 242 male) with a mean age of 63.2 years (28-96) were recruited for this prospective clinical quality assessment. In 254 patients RT was performed with the linear accelerator, 449 patients received orthovoltage radiotherapy. After a median follow-up of 33 months (3-60) 437 patients could be reached for evaluation of follow up results. The mean VAS value before treatment was 6.63 (1.9-10) and immediately on completion of RT 4.51 (0-10) (p < 0,001). Concerning the VPS immediately on completion of RT, a good response could be achieved in 264/703 patients (37.6%), and with the follow up in 255/437 patients (58.4%) (p < 0.001). Only in patients with gonarthrosis we could not observe a significantly improved long-term success in comparison to the results immediately after RT (30.2% versus 29.9%). Conclusion Low dose RT is a very effective treatment for the management of calcaneodynia, achillodynia, painful gonarthrosis, painful bursitis trochanterica, and painful shoulder syndrome. Due to the delayed onset of analgesic effects low dose RT results in a significantly improved long-term efficacy in comparison to the results immediately after RT particularly in patients with calcaneodynia, achillodynia, bursitis trochanterica, and shoulder syndrome.
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Affiliation(s)
- Oliver Micke
- Department of Radiotherapy and Radiation Oncology, Franziskus Hospital Bielefeld, Kiskerstrasse 26, D-33615, Bielefeld, Germany.
| | - Eyup Ugrak
- Department of Internal Medicine, St. Anna Hospital, Herne, Germany
| | | | - Irenaeus A Adamietz
- Department of Radiotherapy and Radiation Oncology, Marien Hospital Herne, Ruhr University Bochum, Bochum, Germany
| | | | - Rebecca Bueker
- Department of Radiotherapy, Lippe Hospital, Lemgo, Germany
| | - Klaus Kisters
- Department of Internal Medicine, St. Anna Hospital, Herne, Germany
| | | | - Khashayar Fakhrian
- Department of Radiotherapy and Radiation Oncology, Marien Hospital Herne, Ruhr University Bochum, Bochum, Germany
| | - Ralph Muecke
- Department of Radiotherapy and Radiation Oncology, Marien Hospital Herne, Ruhr University Bochum, Bochum, Germany.,Radiotherapy RheinMainNahe, Bad Kreuznach, Germany
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Micke O, Seegenschmiedt MH, Adamietz IA, Kundt G, Fakhrian K, Schaefer U, Muecke R. Low-Dose Radiation Therapy for Benign Painful Skeletal Disorders: The Typical Treatment for the Elderly Patient? Int J Radiat Oncol Biol Phys 2017; 98:958-963. [DOI: 10.1016/j.ijrobp.2016.12.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 11/30/2016] [Accepted: 12/07/2016] [Indexed: 11/25/2022]
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Khosrawipour V, Khosrawipour T, Hedayat-Pour Y, Diaz-Carballo D, Bellendorf A, Böse-Ribeiro H, Mücke R, Mohanaraja N, Adamietz IA, Fakhrian K. Effect of Whole-abdominal Irradiation on Penetration Depth of Doxorubicin in Normal Tissue After Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC) in a Post-mortem Swine Model. Anticancer Res 2017; 37:1677-1680. [PMID: 28373428 DOI: 10.21873/anticanres.11498] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [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: 02/05/2017] [Revised: 03/19/2017] [Accepted: 03/20/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND This study was performed to evaluate the impact of whole-abdominal irradiation on local penetration of doxorubicin into the peritoneum and the abdominal organs in a post-mortem swine model. MATERIALS AND METHODS Doxorubicin was aerosolized into the abdominal cavity of swine at a pressure of 12 mmHg CO2 at room temperature (25°). One swine was subjected to pressurized intraperitoneal aerosol chemotherapy (PIPAC) using Micropump© without irradiation; the second one received 2 Gy and the third one 7 Gy whole-abdominal irradiation, 15 min prior to PIPAC application. Samples of the peritoneal surface were extracted at different positions from within the abdominal cavity. In-tissue doxorubicin penetration was measured using fluorescence microscopy on frozen thin sections. RESULTS The depth of penetration of doxorubicin was found to be wide-ranging, between 17 μm on the surface of the stomach and 348 μm in the small intestine. The penetration depth into the small intestine was 348 μm, 312 μm and 265 μm for PIPAC alone, PIPAC with 2 Gy irradiation and PIPAC with 7 Gy irradiation, respectively (p<0.05). The penetration into the liver was 64 μm, 55 μm and 40 μm, respectively (p=0.05). CONCLUSION Irradiation was not found to increase the depth of doxorubicin penetration into normal tissue in the post-mortem swine model. A reduction of doxorubicin penetration was observed after application of higher irradiation doses. Further studies are warranted to determine if irradiation can be used safely as chemopotentiating agent for patients with peritoneal metastases treated with PIPAC.
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Affiliation(s)
| | - Tanja Khosrawipour
- Department of General Surgery, Marien Hospital Herne, Ruhr University, Bochum, Germany
| | - Yousef Hedayat-Pour
- Department of Radiation Oncology, Marien Hospital Herne, Ruhr University, Bochum, Germany
| | - David Diaz-Carballo
- Department of Hematology & Medical Oncology, Marien Hospital Herne, Ruhr University, Bochum, Germany
| | | | - Hugo Böse-Ribeiro
- Department of Radiation Oncology, Marien Hospital Herne, Ruhr University, Bochum, Germany
| | - Ralph Mücke
- Department of Radiation Oncology, Marien Hospital Herne, Ruhr University, Bochum, Germany
| | | | - Irenäus Anton Adamietz
- Department of Radiation Oncology, Marien Hospital Herne, Ruhr University, Bochum, Germany
| | - Khashayar Fakhrian
- Department of Radiation Oncology, Marien Hospital Herne, Ruhr University, Bochum, Germany
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Khosrawipour V, Khosrawipour T, Falkenstein TA, Diaz-Carballo D, Förster E, Osma A, Adamietz IA, Zieren J, Fakhrian K. Evaluating the Effect of Micropump© Position, Internal Pressure and Doxorubicin Dosage on Efficacy of Pressurized Intra-peritoneal Aerosol Chemotherapy (PIPAC) in an Ex Vivo Model. Anticancer Res 2017; 36:4595-600. [PMID: 27630300 DOI: 10.21873/anticanres.11008] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2016] [Accepted: 07/12/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Pressurized intraperitoneal aerosol chemotherapy (PIPAC) is a novel clinical approach to the treatment of peritoneal carcinomatosis. A well-established, not anatomic ex vivo PIPAC model was used to investigate the influence of changes in internal pressure, distance of the Micropump(©) (MIP) to the distributing surface and the drug concentration on the penetration depth of doxorubicin in the target tissue. MATERIALS AND METHODS Doxorubicin was aerosolized in an ex vivo PIPAC model using a hermetic container system mimicking the abdominal cavity. Fresh post-mortem swine peritoneum was cut into proportional samples. Tissue specimens were spatially placed at 4 different spots within the box: P1, on the distributing surface of the box, directly opposite to MIP; P2, on the side wall of the box; P3, on the ceiling of the box; P4, on the distributing surface with a partial cover. Impact of changes in the following parameters were analyzed and compared with clinically established values (CEVs) at our center: pressure (CEV=12 mmHg), distance of the MIP from the distributing surface (CEV=8 cm) and doxorubicin concentration (CEV=3 mg/50 ml). In-tissue doxorubicin penetration depth was measured using fluorescence microscopy on frozen thin sections. RESULTS Tissue positioning in the box had a significant impact on drug penetration after PIPAC with CEV. Under CEV conditions, the highest drug penetration depth was observed in the tissue placed on the distributing surface directly opposite to the MIP (P1: 351 μm, P2: 77 μm, P3: 66 μm, P4: 34 μm). A closer positioning of the MIP lead to a significantly higher mean depth penetration of doxorubicin in the P1 in contrast to other samples in which a reduced drug penetration was observed (1 cm vs. 8 cm distance from MIP to the distributing surface, P1 at 1 cm: 469 μm vs. P1 at 8 cm: 351 μm, p<0.0001; P2 at 1 cm: 25 μm vs. P2 at 8 cm: 77 μm, p<0.0001; P3 at 1 cm: 21 μm vs. P3 at 8 cm: 66 μm, p<0.001; P4 at 1 cm: 13 μm vs. P4 at 8 cm: 39 μm, p=0.021). Higher doxorubicin concentrations led to a highly significant increase of drug penetration in P1 (1 cm vs. 8 cm, p<0.0001), but only a little significant increase in other samples. An increase of internal pressure did not show a significant increase in penetration depth of doxorubicin. CONCLUSION Our ex vivo data suggest that a higher pressure does not increase the penetration deepness of doxorubicin. Higher drug dosage and a closer positioning of the MIP toward the target lead to a higher penetration of doxorubicin within the samples. A more homogeneous penetration within all targets cannot be achieved by changing drug concentration, position of the nozzle or pressure increase.
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Affiliation(s)
- Veria Khosrawipour
- Department of General Surgery and Therapy Center for Peritoneal Carcinomatosis, Marien Hospital Herne, Ruhr University Bochum, Herne, Germany Basic Research Laboratory, Department of Surgery, Marien Hospital Herne, Ruhr University Bochum, Herne, Germany
| | - Tanja Khosrawipour
- Basic Research Laboratory, Department of Surgery, Marien Hospital Herne, Ruhr University Bochum, Herne, Germany
| | - Thomas Albert Falkenstein
- Basic Research Laboratory, Department of Surgery, Marien Hospital Herne, Ruhr University Bochum, Herne, Germany
| | - David Diaz-Carballo
- Department of Hematology and Medical Oncology, Marien Hospital Herne, Ruhr University Bochum, Herne, Germany
| | - Eckart Förster
- Department of Neuroanatomy and Molecular Brain Research, Ruhr University Bochum, Herne, Germany
| | - Aras Osma
- Basic Research Laboratory, Department of Surgery, Marien Hospital Herne, Ruhr University Bochum, Herne, Germany
| | - Irenäus Anton Adamietz
- Department of Radiation Oncology, Marien Hospital Herne, Ruhr University Bochum, Herne, Germany
| | - Jürgen Zieren
- Department of General Surgery and Therapy Center for Peritoneal Carcinomatosis, Marien Hospital Herne, Ruhr University Bochum, Herne, Germany Basic Research Laboratory, Department of Surgery, Marien Hospital Herne, Ruhr University Bochum, Herne, Germany
| | - Khashayar Fakhrian
- Basic Research Laboratory, Department of Surgery, Marien Hospital Herne, Ruhr University Bochum, Herne, Germany Department of Radiation Oncology, Marien Hospital Herne, Ruhr University Bochum, Herne, Germany
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Hoberg C, Kochanneck A, Nguemgo-Kouam P, Fakhrian K, Adamietz IA, Bühler H. Zoledronat hemmt die Motilität von Progenitorzellen des Mammakarzinoms über eine Inaktivierung der Focal Adhesion Kinase (FAK). Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1592729] [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] Open
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Khosrawipour V, Bellendorf A, Khosrawipour C, Hedayat-Pour Y, Diaz-Carballo D, Förster E, Mücke R, Kabakci B, Adamietz IA, Fakhrian K. Irradiation Does Not Increase the Penetration Depth of Doxorubicin in Normal Tissue After Pressurized Intra-peritoneal Aerosol Chemotherapy (PIPAC) in an Ex Vivo Model. In Vivo 2016; 30:593-597. [PMID: 27566077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 07/07/2016] [Indexed: 06/06/2023]
Abstract
AIM To compare the impact of single fractional with bi-fractional irradiation on the depth of doxorubicin penetration into the normal tissue after pressurized intra-peritoneal aerosol chemotherapy (PIPAC) in our ex vivo model. MATERIALS AND METHODS Fresh post mortem swine peritoneum was cut into 12 proportional sections. Two control samples were treated with PIPAC only (no irradiation), one sample on day 1, the other on day 2. Five samples were irradiated with 1, 2, 4, 7 or 14 Gy followed by PIPAC. Four samples were treated on day one with 0.5, 1, 2, 3.5 or 7 Gy and with the same radiation dose 24 h later followed by PIPAC. Doxorubicin was aerosolized in an ex vivo PIPAC model at 12 mmHg/36°C. In-tissue doxorubicin penetration was measured using fluorescence microscopy on frozen thin sections. RESULTS Doxorubicin penetration (DP) after PIPAC for the control samples was 407 μm and 373 μm, respectively. DP for samples with single fraction irradiation was 396 μm after 1 Gy, 384 μm after 2 Gy, 327 μm after 4 Gy, 280 μm after 7 Gy and 243 μm after 14 Gy. DP for samples with 2 fractions of irradiation was 376 μm after 0.5+0.5 Gy, 363 μm after 1+1 Gy, 372 μm after 2+2 Gy, 341 μm after 3.5+3.5 and 301 μm after 7+7 Gy irradiation. Fractionating of the irradiation did not significantly change DP into normal tissue. CONCLUSION Irradiation does not increase the penetration depth of doxorubicin into the normal tissue but might have a limiting impact on penetration and distribution of doxorubicin. Further studies are warranted to investigate the impact of addition of irradiation to PIPAC of tumor cells and to find out if irradiation can be used safely as chemopotenting agent for patients with peritoneal metastases treated with PIPAC.
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Affiliation(s)
- Veria Khosrawipour
- Department of General Surgery and Therapy Center for Peritonealcarcinomatosis, Marien Hospital Herne, Ruhr University Bochum, Herne, Germany Basic Research Laboratory, Department of Surgery, Marien Hospital Herne, Ruhr University Bochum, Herne, Germany
| | | | - Carolina Khosrawipour
- Basic Research Laboratory, Department of Surgery, Marien Hospital Herne, Ruhr University Bochum, Herne, Germany
| | - Yousef Hedayat-Pour
- Department of Radiation Oncology, Marien Hospital Herne, Ruhr University Bochum, Herne, Germany
| | - David Diaz-Carballo
- Department of Hematology and Medical Oncology, Marien Hospital Herne, Ruhr University Bochum, Herne, Germany
| | - Eckart Förster
- Department of Neuroanatomy and Molecular Brain Research, Ruhr University Bochum, Herne, Germany
| | - Ralph Mücke
- Department of Radiation Oncology, Marien Hospital Herne, Ruhr University Bochum, Herne, Germany
| | - Burak Kabakci
- Basic Research Laboratory, Department of Surgery, Marien Hospital Herne, Ruhr University Bochum, Herne, Germany
| | - Irenäus Anton Adamietz
- Department of Radiation Oncology, Marien Hospital Herne, Ruhr University Bochum, Herne, Germany
| | - Khashayar Fakhrian
- Basic Research Laboratory, Department of Surgery, Marien Hospital Herne, Ruhr University Bochum, Herne, Germany Department of Radiation Oncology, Marien Hospital Herne, Ruhr University Bochum, Herne, Germany
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Khosrawipour V, Khosrawipour T, Kern AJP, Osma A, Kabakci B, Diaz-Carballo D, Förster E, Zieren J, Fakhrian K. Distribution pattern and penetration depth of doxorubicin after pressurized intraperitoneal aerosol chemotherapy (PIPAC) in a postmortem swine model. J Cancer Res Clin Oncol 2016; 142:2275-80. [PMID: 27590613 DOI: 10.1007/s00432-016-2234-0] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 08/30/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Pressurized intraperitoneal aerosol chemotherapy (PIPAC) is a novel approach delivering intraperitoneal chemotherapy by means of a pressurized aerosol. This study was conducted to evaluate the distribution pattern of doxorubicin in the abdominal cavity after PIPAC in a postmortem swine model. METHODS Doxorubicin was aerosolized through a Micropump© (MIP) into the peritoneal cavity of two swines at a pressure of 12 mm Hg CO2 and 32 °C. To measure the distribution of the drug, 9 different positions within the abdominal cavity were sampled. In-tissue doxorubicin penetration was evaluated using fluorescence microscopy on frozen thin sections. RESULTS A maximum of drug penetration was observed in the area around the MIP. The penetration in the small intestine reached a depth of 349 ± 65 µm. Penetration depth in the right upper abdomen and left upper abdomen were 349 ± 65 and 140 µm ± 26 µm, respectively. Distant areas to the MIP showed variable penetration rates between 50 and 150 µm. CONCLUSIONS Doxorubicin reached all areas within the peritoneum. Highest penetration rates were measured in the area around the Micropump. Further studies are warranted to evaluate and optimize the distribution and penetration of cytotoxic agent into the tissue after PIPAC.
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Affiliation(s)
- Veria Khosrawipour
- Department of General Surgery and Therapy Center for Peritonealcarcinomatosis, Marien Hospital Herne, Ruhr University Bochum, Hölkeskampring 40, 44625, Herne, Germany. .,Basic Research Laboratory, Department of General Surgery, Marien Hospital Herne, Ruhr University Bochum, Herne, Germany.
| | - Tanja Khosrawipour
- Department of General Surgery and Therapy Center for Peritonealcarcinomatosis, Marien Hospital Herne, Ruhr University Bochum, Hölkeskampring 40, 44625, Herne, Germany.,Basic Research Laboratory, Department of General Surgery, Marien Hospital Herne, Ruhr University Bochum, Herne, Germany
| | - Alexander Jens Peter Kern
- Basic Research Laboratory, Department of General Surgery, Marien Hospital Herne, Ruhr University Bochum, Herne, Germany
| | - Aras Osma
- Basic Research Laboratory, Department of General Surgery, Marien Hospital Herne, Ruhr University Bochum, Herne, Germany
| | - Burak Kabakci
- Basic Research Laboratory, Department of General Surgery, Marien Hospital Herne, Ruhr University Bochum, Herne, Germany
| | - David Diaz-Carballo
- Basic Research Laboratory, Department of General Surgery, Marien Hospital Herne, Ruhr University Bochum, Herne, Germany
| | - Eckart Förster
- Department of Neuroanatomy and Molecular Brain Research, Ruhr University Bochum, Bochum, Germany
| | - Jürgen Zieren
- Department of General Surgery and Therapy Center for Peritonealcarcinomatosis, Marien Hospital Herne, Ruhr University Bochum, Hölkeskampring 40, 44625, Herne, Germany
| | - Khashayar Fakhrian
- Department of Radiation Oncology, Marien Hospital Herne, Ruhr University Bochum, Herne, Germany
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Kup PG, Nieder C, Winnekendonk G, Adamietz IA, Fakhrian K. Extracranial oral cavity metastasis from glioblastoma multiforme: A case report. Mol Clin Oncol 2016; 5:437-439. [PMID: 27699039 DOI: 10.3892/mco.2016.991] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 06/01/2016] [Indexed: 11/06/2022] Open
Abstract
Glioblastoma multiforme is the most common primary malignant brain tumor. The clinical outcome following diagnosis remains extremely poor. The treatment of choice is wide surgical resection of the visible tumor, frequently followed by adjuvant combined radiochemotherapy (RCTx) with temozolomide as the chemotherapeutic agent. Extracranial metastases are extremely rare, with <200 cases of extracranial metastases from glioblastoma multiforme reported in the literature to date. We herein present a case of a patient suffering from a fast-growing metastasis to the oral cavity, completely filling the buccal cavity within 2 weeks, as the only manifestation of recurrent glioblastoma multiforme following initial surgical resection and adjuvant RCTx.
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Affiliation(s)
- Philipp Günther Kup
- Department of Radiation Oncology, Marien Hospital Herne, Ruhr University Bochum, D-44625 Herne, Germany; Department of Radiation Oncology, St. Josef Hospital Bochum, Ruhr University Bochum, D-44791 Bochum, Germany
| | - Carsten Nieder
- Department of Oncology and Palliative Medicine, Nordland Hospital, 8005 Bodø, Norway
| | - Guido Winnekendonk
- Department of Radiology, Marien Hospital Herne, Ruhr University Bochum, D-44625 Herne, Germany
| | - Irenäus Anton Adamietz
- Department of Radiation Oncology, Marien Hospital Herne, Ruhr University Bochum, D-44625 Herne, Germany; Department of Radiation Oncology, St. Josef Hospital Bochum, Ruhr University Bochum, D-44791 Bochum, Germany
| | - Khashayar Fakhrian
- Department of Radiation Oncology, Marien Hospital Herne, Ruhr University Bochum, D-44625 Herne, Germany; Department of Radiation Oncology, St. Josef Hospital Bochum, Ruhr University Bochum, D-44791 Bochum, Germany
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Khosrawipour V, Giger-Pabst U, Khosrawipour T, Pour YH, Diaz-Carballo D, Förster E, Böse-Ribeiro H, Adamietz IA, Zieren J, Fakhrian K. Effect of Irradiation on Tissue Penetration Depth of Doxorubicin after Pressurized Intra-Peritoneal Aerosol Chemotherapy (PIPAC) in a Novel Ex-Vivo Model. J Cancer 2016; 7:910-4. [PMID: 27313780 PMCID: PMC4910582 DOI: 10.7150/jca.14714] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [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: 12/16/2015] [Accepted: 03/15/2016] [Indexed: 01/20/2023] Open
Abstract
Background: This study was performed to assess the impact of irradiation on the tissue penetration depth of doxorubicin delivered during Pressurized Intra-Peritoneal Aerosol Chemotherapy (PIPAC). Methods: Fresh post mortem swine peritoneum was cut into 10 proportional sections. Except for 2 control samples, all received irradiation with 1, 2, 7 and 14 Gy, respectively. Four samples received PIPAC 15 minutes after irradiation and 4 other after 24 hours. Doxorubicin was aerosolized in an ex-vivo PIPAC model at 12 mmHg/36°C. In-tissue doxorubicin penetration was measured using fluorescence microscopy on frozen thin sections. Results: Doxorubicin penetration after PIPAC (15 minutes after irradiation) was 476 ± 74 µm for the control sample, 450 ± 45µm after 1 Gy (p > 0.05), 438 ± 29 µm after 2 Gy (p > 0.05), 396 ± 32 µm after 7 Gy (p = 0.005) and 284 ± 57 after 14 Gy irradiation (p < 0.001). The doxorubicin penetration after PIPAC (24 hours after irradiation) was 428 ± 77 µm for the control sample, 393 ± 41 µm after 1 Gy (p > 0.05), 379 ± 56 µm after 2 Gy (p > 0.05), 352 ± 53 µm after 7 Gy (p = 0.008) and 345 ± 53 after 14 Gy irradiation (p = 0.001). Conclusions: Higher (fractional) radiation dose might reduce the tissue penetration depth of doxorubicin in our ex-vivo model. However, irradiation with lower (fractional) radiation dose does not affect the tissue penetration negatively. Further studies are warranted to investigate if irradiation can be used safely as chemopotenting agent for patients with peritoneal metastases treated with PIPAC.
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Affiliation(s)
- Veria Khosrawipour
- 1. Department of General Surgery & Therapy Center for Peritonealcarcinomatosis, Marien Hospital Herne, Ruhr University Bochum, Germany.; 2. Basic Research Laboratory, Department of Surgery, Marien Hospital Herne, Ruhr University Bochum, Germany
| | - Urs Giger-Pabst
- 1. Department of General Surgery & Therapy Center for Peritonealcarcinomatosis, Marien Hospital Herne, Ruhr University Bochum, Germany.; 2. Basic Research Laboratory, Department of Surgery, Marien Hospital Herne, Ruhr University Bochum, Germany
| | - Tanja Khosrawipour
- 2. Basic Research Laboratory, Department of Surgery, Marien Hospital Herne, Ruhr University Bochum, Germany
| | - Yousef Hedayat Pour
- 3. Department of Radiation Oncology, Marien Hospital Herne, Ruhr University Bochum, Germany
| | - David Diaz-Carballo
- 4. Department of Hematology & Medical Oncology, Marien Hospital Herne, Ruhr University Bochum, Germany
| | - Eckart Förster
- 5. Department of Neuroanatomy and Molecular Brain Research, Ruhr University Bochum, Germany
| | - Hugo Böse-Ribeiro
- 3. Department of Radiation Oncology, Marien Hospital Herne, Ruhr University Bochum, Germany
| | - Irenäus Anton Adamietz
- 3. Department of Radiation Oncology, Marien Hospital Herne, Ruhr University Bochum, Germany
| | - Jürgen Zieren
- 1. Department of General Surgery & Therapy Center for Peritonealcarcinomatosis, Marien Hospital Herne, Ruhr University Bochum, Germany
| | - Khashayar Fakhrian
- 3. Department of Radiation Oncology, Marien Hospital Herne, Ruhr University Bochum, Germany
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Gitt A, Böse-Ribeiro H, Nieder C, Kup P, Hermani H, Bühler H, Ergönenç H, Drüppel D, Adamietz I, Fakhrian K. EP-1958: Treatment results of Mammosite catheter in combination with whole breastirradiation. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)33209-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Bühler H, Nguemgo-Kouam P, Kochanneck A, Hermani H, Fakhrian K, Adamietz I. PO-0998: The Robo1-receptor is involved in the migration of irradiated glioblastoma cells. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)32248-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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13
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Kup P, Rubin J, Adamietz I, Fakhrian K. EP-2107: Work satisfaction and motivation of radiation therapists. A qualitative study. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)33358-8] [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: 10/21/2022]
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14
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Kup P, Welsch J, Bühler H, Hermani H, Adamietz I, Fakhrian K. EP-1263: Survival and symptom relief after palliative radiotherapy for esophageal cancer. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)32513-0] [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: 11/29/2022]
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Gitt A, Böse-Ribeiro H, Nieder C, Kup PG, Hermani H, Bühler H, Ergönenç HY, Drüppel D, Adamietz IA, Fakhrian K. Treatment Results of MammoSite Catheter in Combination with Whole-breast Irradiation. Anticancer Res 2016; 36:355-360. [PMID: 26722065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
AIM To report the initial outcomes of patients treated with the MammoSite brachytherapy device (MSBT) as a boost followed by external whole-breast irradiation (WBI). PATIENTS AND METHODS From June 2011 to March 2014, 107 patients (typically with pT1-2, pN0-1, M0 disease) were treated with breast-conserving therapy and adjuvant radiotherapy with MSBT (15 Gy in 2.5-Gy fractions) followed by WBI (median=50.4 Gy). Toxicity was classified according to the Common Terminology Criteria for Adverse Events v3.0. The median follow-up was 21 months. RESULTS To date, no ipsilateral breast-tumor recurrences have been observed; 102 patients (95%) were alive at last follow-up. Two patients (2%) developed distant metastases. Five patients (5%) died during follow-up, only one as a result of breast cancer. The 2-year disease-free survival was 95±3%. The incidence of asymptomatic and symptomatic seroma in 90 days after MSBT was 28% and 10%, respectively. Infectious mastitis was observed in three patients (3%), who were treated successfully with antibiotics. Only three patients (3%) developed RT-induced dermatitis greater than grade 2 after WBI. CONCLUSION The boost technique used in this study seems to provide excellent local control with acceptable toxicity, similar to the results observed with other forms of interstitial accelerated partial-breast irradiation as a boost. Long-term follow-up is necessary to refine the patient selection criteria and to assess efficacy and late toxicities.
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Affiliation(s)
- Alexander Gitt
- Department of Radiation Oncology, Marien Hospital Herne, Ruhr University Bochum, Bochum, Germany
| | - Hugo Böse-Ribeiro
- Department of Radiation Oncology, Marien Hospital Herne, Ruhr University Bochum, Bochum, Germany
| | - Carsten Nieder
- Department of Oncology and Palliative Medicine, Nordland Hospital Bodø, Bodø, Norway Department of Clinical Medicine, Faculty of Health Sciences, University of Tromsø, Tromsø, Norway
| | - Philipp Günther Kup
- Department of Radiation Oncology, Marien Hospital Herne, Ruhr University Bochum, Bochum, Germany
| | - Horst Hermani
- Department of Radiation Oncology, Marien Hospital Herne, Ruhr University Bochum, Bochum, Germany
| | - Helmut Bühler
- Department of Radiation Oncology, Marien Hospital Herne, Ruhr University Bochum, Bochum, Germany
| | | | | | - Irenäus Anton Adamietz
- Department of Radiation Oncology, Marien Hospital Herne, Ruhr University Bochum, Bochum, Germany Department of Radiation Oncology, Saint Josef Hospital Bochum, Ruhr University Bochum, Bochum, Germany
| | - Khashayar Fakhrian
- Department of Radiation Oncology, Marien Hospital Herne, Ruhr University Bochum, Bochum, Germany Department of Radiation Oncology, Saint Josef Hospital Bochum, Ruhr University Bochum, Bochum, Germany
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Wolanczyk MJ, Fakhrian K, Adamietz IA. Radiotherapy, Bisphosphonates and Surgical Stabilization of Complete or Impending Pathologic Fractures in Patients with Metastatic Bone Disease. J Cancer 2016; 7:121-4. [PMID: 26722368 PMCID: PMC4679389 DOI: 10.7150/jca.13377] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 11/01/2015] [Indexed: 01/30/2023] Open
Abstract
Purpose: To report the treatment outcomes of patients with metastatic bone disease with complete or impending pathologic fractures, who were treated with postoperative radiotherapy (RT), bisphosphonates or both after orthopedic stabilization. Material and Methods: We retrospectively evaluated the results of RT, bisphosphonates or both after orthopedic stabilization for complete or impending pathologic fractures in 72 patients with skeletal metastases. After surgery, 32 patients (44%) were treated with RT alone (group 1), 31 patients (43%) were treated with RT and bisphosphonates (group 2) and 9 (13%) patients were treated with bisphosphonates (group 3), respectively. Patients were treated with a median dose of 30Gy (30-40 Gy/2-3Gy per fraction).The local tumor progression, pain progression and need for re-operation or re-radiotherapy were assessed from patients' medical records. Median follow-up time was 9 months. Results: Median overall survival time was 14 months (95% CI: 12-17). Secondary surgical intervention at the same location was necessary in 1 patient of group 1 (2%), 2 patients of group 2(5%) and 2 patients of group 3 (15%), respectively (p=0.097). Local tumor progress was observed in 3 patients of group 1 (9%), 2 patients of group 2 (7%) and 4 patients in group 3 (44%), respectively (p=0.021). Local pain progress was observed in 19%, 16% and 67% of the same groups (p=0.011). Conclusion: Our data confirm the efficacy and necessity of postoperative RT after orthopedic stabilization for metastatic bone disease to control the local disease. Bisphosphonates do not obviate the need for RT in the management of bone metastases after surgical stabilization. The combined treatment might lead to a better local tumor and pain control.
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Affiliation(s)
- Michal J Wolanczyk
- 1. Department of General and Interventional Radiology and Neuroradiology, Wroclaw Medical University, Poland
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Welsch J, Kup PG, Nieder C, Khosrawipour V, Bühler H, Adamietz IA, Fakhrian K. Survival and Symptom Relief after Palliative Radiotherapy for Esophageal Cancer. J Cancer 2016; 7:125-30. [PMID: 26819634 PMCID: PMC4716843 DOI: 10.7150/jca.13655] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 11/01/2015] [Indexed: 12/17/2022] Open
Abstract
Purpose: The aim of this study was to assess the 6-months dysphagia-free survival, improvement in swallowing function, complication rate, and overall survival in patients with incurable esophageal cancer treated with palliative radiotherapy. Methods: We retrospectively reviewed data from 139 patients (median age 72 years) with advanced/recurrent incurable esophageal cancer, who were referred to 3 German radiation oncology centers for palliative radiotherapy between 1994 and 2014. Radiotherapy consisted of external beam radiotherapy (EBRT) with 30 - 40.5 Gy/2.5 - 3 Gy per fraction, brachytherapy alone (BT) with 15 - 25 Gy/5 - 7Gy per fraction/weekly and EBRT + BT (30 - 40.5 Gy plus 10 - 14 Gy with BT) in 65, 46, and 28 patients, respectively. Dysphagia-free survival (Dy-PFS) was defined as the time to worsening of dysphagia for at least one point, a new loco-regional failure or death of any cause. Results: Median follow-up time was 6 months (range 1-6 months). Subjective symptom relief was achieved in 72 % of patients with median response duration of 5 months. The 1-year survival rate was 30%. The 6-months Dy-PFS time for the whole group was 73 ± 4%. The 6-months Dy-PFS was 90 ± 4% after EBRT, 92 ± 5% after EBRT + BT and 37 ± 7% after BT, respectively (p<0.001). Five patients lived for more than 2 years, all of them were treated with EBRT ± BT. Ulceration, fistula and stricture developed in 3, 6 and 7 patients, respectively. Conclusions: Radiotherapy leads to symptom improvement in the majority of patients with advanced incurable esophageal cancer. The present results favor EBRT ± BT over BT alone. Due to the retrospective nature of this study, imbalances in baseline characteristics might have contributed to this finding, and further trials appear necessary.
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Affiliation(s)
- Julia Welsch
- 1. Department of Radiation Oncology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany
| | - Philipp Günther Kup
- 1. Department of Radiation Oncology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany
| | - Carsten Nieder
- 2. Department of Oncology and Palliative Medicine, Nordland Hospital Bodø, Norway; 3. Department of Clinical Medicine, Faculty of Health Sciences, University of Tromsø, Norway
| | - Veria Khosrawipour
- 4. Department of Surgery, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany
| | - Helmut Bühler
- 1. Department of Radiation Oncology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany
| | - Irenäus A Adamietz
- 1. Department of Radiation Oncology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany.; 5. Department of Radiation Oncology, Sankt Josef Hospital Bochum, Ruhr-University Bochum, Bochum, Germany.; 6. Department of Radiation Oncology, Ev-Krankenhaus Witten, Academic Hospital of the Witten/Herdecke University, Witten, Germany
| | - Khashayar Fakhrian
- 1. Department of Radiation Oncology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany.; 5. Department of Radiation Oncology, Sankt Josef Hospital Bochum, Ruhr-University Bochum, Bochum, Germany
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Bühler H, Nguemgo-Kouam P, Fakhrian K, Sahinbas H, Adamietz I. 610 Clonogenic survival as well as motility of malignant cells is reduced by hyperthermia alone or in combination with irradiation. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)30346-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: 11/26/2022]
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Bühler H, Strohm GL, Nguemgo-Kouam P, Lamm H, Fakhrian K, Adamietz IA. The therapeutic effect of photon irradiation on viable glioblastoma cells is reinforced by hyperbaric oxygen. Anticancer Res 2015; 35:1977-1983. [PMID: 25862850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Hyperbaric oxygen (HBO) seems to intensify the effect of ionising radiation. We investigated whether HBO combined with irradiation decreases the capability of U251 glioblastoma cells for relapse and metastasis. MATERIALS AND METHODS Cells were treated with O2 at 1.3 bar and then irradiated with 2 Gy photons. Clonogenic survival was tested with colony formation. Motility is an important feature of metastasis and was measured with time-lapse videography. RESULTS The clonogenic survival diminished by 22% through HBO, by 49% through irradiation, and by 70% through the combination of both. The accumulated distance travelled by cells fell by 3% with HBO, rose by 17% with irradiation, but was reduced by 11% with their combination. The respective values for the Euclidean distance travelled were +8%, +47% and -14%. Compared to normoxic irradiation, additional HBO lowered travel by 41%. CONCLUSION HBO strengthens the effect of irradiation on clonogenic survival and reverses radiation-induced increase in the mobility of cells.
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Affiliation(s)
- Helmut Bühler
- Institute for Molecular Oncology, Radio-Biology and Experimental Radiotherapy, University Medical Centre Marienhospital, Ruhr-University Bochum, Herne, Germany
| | - Gerfried L Strohm
- Department of Radiotherapy and Radio-Oncology, University Medical Centre Marienhospital, Ruhr-University Bochum, Herne, Germany
| | - Pascaline Nguemgo-Kouam
- Institute for Molecular Oncology, Radio-Biology and Experimental Radiotherapy, University Medical Centre Marienhospital, Ruhr-University Bochum, Herne, Germany
| | - Hans Lamm
- Druckkammerzentrum Hannover, Hannover, Germany
| | - Khashayar Fakhrian
- Department of Radiotherapy and Radio-Oncology, University Medical Centre Marienhospital, Ruhr-University Bochum, Herne, Germany
| | - Irenäus A Adamietz
- Department of Radiotherapy and Radio-Oncology, University Medical Centre Marienhospital, Ruhr-University Bochum, Herne, Germany
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Kup PG, Nieder C, Geinitz H, Henkenberens C, Besserer A, Oechsner M, Schill S, Mücke R, Scherer V, Combs SE, Adamietz IA, Fakhrian K. The prognostic value of irradiated lung volumes on the prediction of intra-/ post-operative mortality in patients after neoadjuvant radiochemotherapy for esophageal cancer. A retrospective multicenter study. J Cancer 2015; 6:254-60. [PMID: 25663943 PMCID: PMC4317761 DOI: 10.7150/jca.10796] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 12/06/2014] [Indexed: 12/25/2022] Open
Abstract
PURPOSE To assess the association between dosimetric factors of the lung and incidence of intra- and postoperative mortality among esophageal cancer (EC) patients treated with neoadjuvant radiochemotherapy (N-RCT) followed by surgery (S). METHODS AND MATERIALS Inclusion criteria were: age < 85 years, no distant metastases at the time of diagnosis, no induction chemotherapy, conformal radiotherapy, total dose ≤ 50.4 Gy, and available dose volume histogram (DVH) data. One-hundred thirty-five patients met our inclusion criteria. Median age was 62 years. N-RCT consisted of 36 - 50.4 Gy (median 45 Gy), 1.8 - 2 Gy per fraction. Concomitant chemotherapy consisted of 5-Fluoruracil (5-FU) and cisplatin in 113 patients and cisplatin and taxan-derivates in 15 patients. Seven patients received a single cytotoxic agent. In 130 patients an abdominothoracal and in 5 patients a transhiatal resection was performed. The following dosimetric parameters were generated from the total lung DVH: mean dose, V5, V10, V15, V20, V30, V40, V45 and V50. The primary endpoint was the rate of intra- and postoperative mortality (from the start of N-RCT to 60 days after surgical resection). RESULTS A total of ten postoperative deaths (7%) were observed: 3 within 30 days (2%) and 7 between 30 and 60 days after surgical intervention (5%); no patient died during the operation. In the univariate analysis, weight loss (≥10% in 6 months prior to diagnosis, risk ratio: 1.60, 95%CI: 0.856-2.992, p=0.043), Eastern Cooperative Oncology Group-performance status (ECOG 2 vs. 1, risk ratio: 1.931, 95%CI: 0.898-4.150, p=0.018) and postoperative pulmonary plus non-pulmonary complications (risk ratio: 2.533, 95%CI: 0.978-6.563, p=0.004) were significantly associated with postoperative mortality. There was no significant association between postoperative mortality and irradiated lung volumes. Lung V45 was the only variable which was significantly associated with higher incidence of postoperative pulmonary plus non-pulmonary complications (Exp(B): 1.285, 95%CI 1.029-1.606, p=0.027), but not with the postoperative pulmonary complications (Exp(B): 1.249, 95%CI 0.999-1.561, p=0.051). CONCLUSIONS Irradiated lung volumes did not show relevant associations with intra- and postoperative mortality of patients treated with moderate dose (36 - 50.4 Gy) conventionally fractionated conformal radiotherapy combined with widely used radiosensitizers. Postoperative mortality was significantly associated with greater weight loss, poor performance status and development of postoperative complications, but not with treatment-related factors. Limiting the volume of lung receiving higher radiation doses appears prudent because of the observed association with risk of postoperative complications.
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Affiliation(s)
- Philipp Günther Kup
- 1. Department of Radiation Oncology, Marien Hospital Herne, Clinic of Ruhr-Universität Bochum, Herne, Germany
| | - Carsten Nieder
- 2. Department of Oncology and Palliative Medicine, Nordland Hospital Bodø, Norway
| | - Hans Geinitz
- 3. Department of Radiation Oncology, Krankenhaus der Barmherzigen Schwestern Linz, Linz, Austria. ; 4. Department of Radiation Oncology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Christoph Henkenberens
- 5. Department of Radiation Oncology, Medizinische Hochschule Hannover, Hannover, Germany
| | - Angela Besserer
- 6. Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Markus Oechsner
- 4. Department of Radiation Oncology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Sabine Schill
- 4. Department of Radiation Oncology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Ralph Mücke
- 1. Department of Radiation Oncology, Marien Hospital Herne, Clinic of Ruhr-Universität Bochum, Herne, Germany. ; 7. Department of Radiation Oncology, Lippe Hospital, Lemgo, Germany
| | - Vera Scherer
- 4. Department of Radiation Oncology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Stephanie E Combs
- 4. Department of Radiation Oncology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Irenäus A Adamietz
- 1. Department of Radiation Oncology, Marien Hospital Herne, Clinic of Ruhr-Universität Bochum, Herne, Germany. ; 8. Department of Radiation Oncology, Sankt Josef Hospital Bochum, Clinic of Ruhr-University Bochum, Bochum, Germany
| | - Khashayar Fakhrian
- 1. Department of Radiation Oncology, Marien Hospital Herne, Clinic of Ruhr-Universität Bochum, Herne, Germany. ; 4. Department of Radiation Oncology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany ; 8. Department of Radiation Oncology, Sankt Josef Hospital Bochum, Clinic of Ruhr-University Bochum, Bochum, Germany
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Ordu AD, Nieder C, Geinitz H, Scherer V, Kup PG, Schuster T, Combs SE, Fakhrian K. Association between radiation dose and pathological complete response after preoperative radiochemotherapy in esophageal squamous cell cancer. Anticancer Res 2014; 34:7255-7261. [PMID: 25503157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
AIM This study was undertaken to examine the impact of radiation dose on pathological complete response (pCR) rates following neoadjuvant radiochemotherapy (N-RCT) for squamous cell esophageal cancer (ESCC). PATIENTS AND METHODS From 1988 to 2011, 218 patients were treated with 30-30.6 Gy (1.8-2 Gy per fraction), 39.6-40 Gy (1.8-2 Gy per fraction) or 44-45 Gy (1.8-2 Gy per fraction) and concomitant cisplatin ± 5-fluorouracil (5-FU), oxaliplatin + 5-FU or 5-FU alone. The most commonly used concomitant chemotherapy was continuous infusion of 5-FU-alone with a dose of 300 mg/m(2)/day during the whole course of treatment (n=111). To eliminate the dispersing effect of potentially different efficacy levels of these drug regimens on pCR, we excluded patients with regimens other than 5-FU-alone. RESULTS Histomorphological regression grade 1a (0% residual tumor), 1b (<10% residual tumor), 2 (10-50% residual tumor) and 3 (>50% residual tumor) was observed in 26 (23%), 24 (22%), 36 (32%) and 25 (23%) patients, respectively. pCR was observed in 9 out of 71 (13%) patients treated with 30 Gy-30.6 Gy, 13 of 34 (38%) patients treated with 39.6-40 Gy and 4 of 6 (67%) patients treated with 44-45 Gy (p=0.001). Median follow-up time from the start of N-RCT was 191 months (range=2-262 months). The estimated 5-year overall survival (OS) was 33% for the whole cohort. OS at 5 years was 58% for patients with pCR compared to 25% for patients with less favorable response to N-RCT (p=0.009), respectively. CONCLUSION The dose of radiation correlates significantly with the likelihood of achieving a pCR in stage II/III squamous cell esophageal cancer patients. Prospective randomized trials are required to definitively evaluate the impact of application of higher radiation doses on efficacy and safety/tolerability in the context of N-RCT on the clinical outcomes.
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Affiliation(s)
- Arif Deniz Ordu
- Department of Radiation Oncology, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - Carsten Nieder
- Department of Oncology and Palliative Medicine, Nordland Hospital Trust, Bodø, and Institute of Clinical Medicine, Faculty of Health Sciences, University of Tromsø, Tromsø, Norway
| | - Hans Geinitz
- Department of Radiation Oncology, Klinikum rechts der Isar, Technische Universität München, München, Germany Department of Radiation Oncology, Krankenhaus der Barmherzigen Schwestern Linz, Linz, Austria
| | - Vera Scherer
- Department of Radiation Oncology, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - Philipp Günther Kup
- Department of Radiation Oncology, Marien Hospital Herne, Ruhr-University Bochum, Bochum, Germany
| | - Tibor Schuster
- Lady Davis Institute for Medical Research, Centre for Clinical Epidemiology, Montreal, Canada
| | - Stephanie E Combs
- Department of Radiation Oncology, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - Khashayar Fakhrian
- Department of Radiation Oncology, Klinikum rechts der Isar, Technische Universität München, München, Germany Department of Radiation Oncology, Krankenhaus der Barmherzigen Schwestern Linz, Linz, Austria Department of Radiation Oncology, Sankt Josef Hospital Bochum, Ruhr-University, Bochum, Germany
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Ordu AD, Nieder C, Geinitz H, Kup PG, Deymann LF, Scherer V, Combs SE, Fakhrian K. Radio(chemo)therapy for locally advanced squamous cell carcinoma of the esophagus: long-term outcome. Strahlenther Onkol 2014; 191:153-60. [PMID: 25404062 DOI: 10.1007/s00066-014-0779-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Accepted: 10/30/2014] [Indexed: 12/23/2022]
Abstract
PURPOSE The purpose of this work is to report the long-term outcomes of three-dimensional conformal radio(chemo)therapy in the curative management of esophageal squamous cell carcinoma (ESCC). PATIENTS AND METHODS A retrospective analysis of patients treated with radio(chemo)therapy between 1988 and 2011 at Klinikum rechts der Isar, Technische Universität München was performed. In all, 168 patients received radio(chemo)therapy for ESCC in curative intention. The median follow-up time was 91 months (range 1-212 months). There were 128 men and 40 women with a median age of 63 years. Selection criteria for radio(chemo)therapy were unfit for surgery and/or unresectable primary tumor (n = 146, 87 %) or patients' choice (n = 22, 13 %). The majority of the patients received a combination of cisplatin and 5-fluorouracil chemotherapy with 54 Gy in 30 fractions of radiotherapy. RESULTS The median overall survival (OS) was 20 months (95 % confidence interval 17-23 months). The OS at 2 and 5 years for the whole cohort was 41 ± 4 % and 22 ± 3 %, respectively. Forty patients (24 %) suffered an in-field recurrence. The most common acute nonhematologic toxicity >grade 2 was dysphagia in 35 % of the patients. Acute hematologic toxicity > grade 2 was recorded in 14 % of the patients. There was no grade 5 toxicity observed during the study. Poor ECOG performance status (0-1 vs. 2-3, HR = 1.70, p = 0.002) and weight loss ≥ 10 % before the start of therapy (HR = 1.99, p = 0.001) were among the factors significantly associated with poor OS in multivariate analysis. CONCLUSION Three-dimensional conformal definitive radio(chemo)therapy is well tolerated and leads to long-term survival in more than 20 % of patients with advanced disease and/or contraindication to surgery. However, 24 % in-field recurrence remains a major concern. Prospective trials are warranted to assess if a well-tailored conformal radiochemotherapy can improve the local control and obviate the need for surgical resection in patients with good general condition and potentially resectable tumors.
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Affiliation(s)
- Arif Deniz Ordu
- Department of Radiation Oncology, Klinikum rechts der Isar, Technische Universität München, München, Germany
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Muecke R, Micke O, Schomburg L, Glatzel M, Reichl B, Kisters K, Schaefer U, Huebner J, Eich HT, Fakhrian K, Adamietz IA, Buentzel J. Multicenter, phase III trial comparing selenium supplementation with observation in gynecologic radiation oncology: follow-up analysis of the survival data 6 years after cessation of randomization. Integr Cancer Ther 2014; 13:463-7. [PMID: 25015649 DOI: 10.1177/1534735414541963] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE In 2010, we reported that selenium (Se) supplementation during radiation therapy (RT) is effective for increasing blood Se levels in Se-deficient cervical and uterine cancer patients, and reduced the number of episodes and severity of RT-induced diarrhea. In the current study, we examine whether of Se supplementation during adjuvant RT affects long-term survival of these patients. PATIENTS AND METHODS Former patients were identified and questioned with respect to their health and well-being. RESULTS A total of 81 patients were randomized in the initial supplementation study, 39 of whom received Se (selenium group, SeG) and 42 of whom served as controls (control group, CG). When former patients were reidentified after a median follow-up of 70 months (range = 0-136), the actuarial 10-year disease-free survival rate in the SeG was 80.1% compared to 83.2% in the CG (P = .65), and the actuarial 10-year overall survival rate of patients in the SeG was 55.3% compared to 42.7% in the CG (P = .09). CONCLUSIONS Our extended follow-up analysis demonstrates that Se supplementation had no influence on the effectiveness of the anticancer irradiation therapy and did not negatively affect patients' long-term survival. In view of its positive effects on RT-induced diarrhea, we consider Se supplementation to be a meaningful and beneficial adjuvant treatment in Se-deficient cervical and uterine cancer patients while undergoing pelvic radiation therapy.
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Affiliation(s)
- Ralph Muecke
- Lippe Hospital, Lemgo, Germany Marien Hospital Herne, Ruhr University, Bochum, Germany
| | | | | | | | | | | | | | - Jutta Huebner
- Working Group Integrative Oncology, German Cancer Society, Berlin, Germany
| | | | - K Fakhrian
- Marien Hospital Herne, Ruhr University, Bochum, Germany
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Bühler H, Priesch-Grzeszkowiak B, Nguemgo-Kouam P, Fakhrian K, Adamietz I. PO-0949: The efficiency of radiotherapy in the treatment of glioblastoma is enhanced by chloroquine. Radiother Oncol 2014. [DOI: 10.1016/s0167-8140(15)31067-7] [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: 10/23/2022]
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Fakhrian K, Gitt A, Hermani H, Böse-Ribeiro H, Drüppel D, Ergönenç H, Adamietz I. EP-1189: Acute toxicity after boost with MammoSite technique. Radiother Oncol 2014. [DOI: 10.1016/s0167-8140(15)31307-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Fakhrian K, Sauer T, Dinkel A, Klemm S, Schuster T, Molls M, Geinitz H. Chronic adverse events and quality of life after radiochemotherapy in anal cancer patients. A single institution experience and review of the literature. Strahlenther Onkol 2013; 189:486-94. [PMID: 23636349 DOI: 10.1007/s00066-013-0314-5] [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: 09/13/2012] [Accepted: 01/16/2013] [Indexed: 12/28/2022]
Abstract
PURPOSE To report on chronic adverse events (CAE) and quality of life (QOL) after radiochemotherapy (RCT) in patients with anal cancer (AC). PATIENTS AND METHODS Of 83 patients who had received RCT at our department between 1988 and 2011, 51 accepted the invitation to participate in this QOL study. CAE were evaluated using the Common Terminology Criteria for Adverse Events (CTCAE) v. 4.0 and QOL was assessed with the Functional Assessment of Cancer Therapy-Colorectal (FACT-C) questionnaire. RESULTS CAE could be evaluated in 49 patients. There was a tendency toward a higher rate of grade 3 CAE in female patients, i.e. 18 out of 37 (49 %) vs. 2 out of 12 (17 %) male patients (p = 0.089). The most common grade 3 CAE were dyspareunia and vaginal symptoms (itching, burning and dryness) in 35 and 22 % of female patients, respectively, followed by stool incontinence in 13 % of all patients (6 out of 49). Both FACT-C and CAE information were available for 42 patients, allowing evaluation of the impact of CAE on QOL. The median total FACT-C score was 110 (40-132) out of a possible maximum of 136. The absence of grade 3 CAE (115 vs. 94, p = 0.001); an interval of ≥ 67 months after the end of the treatment (111 vs. 107, p = 0.010), no stool incontinence vs. grade 3 stool incontinence (111 vs. 74, p = 0.009), higher education (114 vs. 107, p = 0.013) and no dyspareunia vs. grade 3 dyspareunia (116 vs. 93, p = 0.012) were significantly associated with a higher median FACT-C score. CONCLUSION The majority of AC patients treated with RCT have acceptable overall QOL scores, which are comparable to those of the normal population. Patients with grade 3 CAE-particularly dyspareunia and fecal incontinence-have a poorer QOL compared to patients without CAE. In order to improve long-term QOL, future strategies might aim at a reduction in dose to the genitalia and more intensive patient support measures.
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Affiliation(s)
- K Fakhrian
- Department of Radiation Oncology, Marienhospital Herne, Universitätsklinikum der Ruhr-Universität Bochum, Hölkeskampring 40, Herne, Germany.
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Fakhrian K, Oechsner M, Kampfer S, Schuster T, Molls M, Geinitz H. Advanced techniques in neoadjuvant radiotherapy allow dose escalation without increased dose to the organs at risk : Planning study in esophageal carcinoma. Strahlenther Onkol 2013; 189:293-300. [PMID: 23443611 DOI: 10.1007/s00066-012-0297-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2012] [Accepted: 12/06/2012] [Indexed: 12/25/2022]
Abstract
PURPOSE The goal of this work was to investigate the potential of advanced radiation techniques in dose escalation in the radiotherapy (RT) for the treatment of esophageal carcinoma. METHODS A total of 15 locally advanced esophageal cancer (LAEC) patients were selected for the present study. For all 15 patients, we created a 3D conformal RT plan (3D-45) with 45 Gy in fractions of 1.8 Gy to the planning target volume (PTV1), which we usually use to employ in the neoadjuvant treatment of LAEC. Additionally, a 3D boost (as in the primary RT of LAEC) was calculated with 9 Gy in fractions of 1.8 Gy to the boost volume (PTV2) (Dmean) to a total dose of 54 Gy (3D-54 Gy), which we routinely use for the definitive treatment of LAEC. Three plans with a simultaneous integrated boost (SIB) were then calculated for each patient: sliding window intensity-modulated radiotherapy (IMRT-SIB), volumetric modulated arc therapy (VMAT-SIB), and helical tomotherapy (HT-SIB). For the SIB plans, the requirement was that 95 % of the PTV1 receive ≥ 100 % of the prescription dose (45 Gy in fractions of 1.8 Gy, D95) and the PTV2 was dose escalated to 52.5 Gy in fractions of 2.1 Gy (D95). RESULTS The median PTV2 dose for 3D-45, 3D-54, HT-SIB, VMAT-SIB, and IMRT-SIB was 45, 55, 54, 56, and 55 Gy, respectively. Therefore, the dose to PTV2 in the SIB plans was comparable to the 3D-54 plan. The lung dose in the SIB plans was in the range of the standard 3D-45, which is applied for neoadjuvant radiotherapy. The mean lung dose for the same plans was 13, 15, 12, 12, and 13 Gy, respectively. The V5 lung volumes were 71, 74, 79, 75, and 73 %, respectively. The V20 lung volumes were 20, 25, 16, 18, and 19 %, respectively. CONCLUSION New treatment planning techniques enable higher doses to be delivered for neoadjuvant radiotherapy of LAEC without a significant increase in the delivered dose to the organs at risk. Clinical investigations are warranted to study the clinical safety and feasibility of applying higher doses through advanced techniques in the neoadjuvant treatment of LAEC.
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Affiliation(s)
- K Fakhrian
- Department of Radiation Oncology, Klinikum rechts der Isar, Technische Universität München, Ismaninger St. 22, Munich, Germany.
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Abstract
Purpose To evaluate the efficacy of radiotherapy (RT) for early-stage nodal and extranodal marginal zone lymphoma (MZL). Materials and methods Patients with stage I (n = 22) and stage II (n = 8) MZL, who were treated with RT were reviewed. The primary tumor localisation was in the orbita (n = 12), stomach (n = 8), head and neck other than the orbita (n = 8), breast (n = 1) and one case of marginal zone lymphoma of the skin (n = 1). The median radiotherapy dose was 40 Gy (5 to 45 Gy). Results The median follow-up time was 103 months. The 5-year overall survival and event-free survival rates were 85 ± 7% and 71 ± 9%, respectively. There was no infield recurrence. Recurrence occurred outside of the radiation field in six patients. The relapses were treated with salvage RT and had excellent local control (100%) at five years after salvage RT. Conclusions Localized extranodal MZL have an excellent prognosis following moderate-dose RT. RT is also an effective salvage therapy in cases of localized recurrence. Further clinical studies should evaluate the optimal dose for MZL.
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Affiliation(s)
- Kristin Deinbeck
- Department of Radiation Oncology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
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Fakhrian K, Klemm S, Keller U, Bayer C, Riedl W, Molls M, Geinitz H. Erratum to: Radiotherapy in stage I-III follicular non-Hodgkin lymphoma. Retrospective analysis of a series of 50 patients. Strahlenther Onkol 2012. [DOI: 10.1007/s00066-012-0279-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Fakhrian K, Öchsner K, Kampfer S, Hammami H, Omrcen T, Bisof V, Geinitz H. EP-1070 DOES ADVANCED TECHNIQUE ALLOW A DOSE ESCALATION IN NEOADJUVANT RADIOTHERAPY OF ESOPHAGEAL CARCINOMA? Radiother Oncol 2012. [DOI: 10.1016/s0167-8140(12)71403-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Fakhrian K, Heilmann J, Schuster T, Thamm R, Reuschel W, Molls M, Geinitz H. Primary radiotherapy with or without chemotherapy in non-metastatic esophageal squamous cell carcinoma: a retrospective study. Dis Esophagus 2012; 25:256-62. [PMID: 21899651 DOI: 10.1111/j.1442-2050.2011.01244.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The purpose of this study was to report the outcome of radio(chemo)therapy in the curative management of esophageal squamous cell carcinoma (ESCC). We retrospectively analyzed 163 patients with T1-T4, N0-1, M0 ESCC who were treated between January 1988 and December 2006 at the Technische Universität München. One hundred sixty patients were inoperable due to a poor performance status, comorbidities or locally advanced unresectable disease. External beam radiation therapy (EBRT) was performed with (n= 146) or without (n= 17) systemic chemotherapy. Fifty-four patients received an additional boost with intraluminal brachytherapy (IBT). Surviving patients were followed for a median of 72 months (range 10-173 months). The estimated overall survival (OS) at 2 and 5 years was 27 ± 4% and 11 ± 3%, respectively. Loco-regional recurrence at the primary site was observed in 29% of patients (n= 47). The recurrence-free survival (RFS) at 2 and 5 years was 24 ± 3% and 9 ± 2%, respectively. In multivariate analyses, the ECOG performance status (P= 0.004), 3D conformal (vs conventional) radiotherapy (P= 0.031) and continuous standard fractionation (vs split-course radiotherapy, P= 0.048) were associated with a better OS. Simultaneous chemotherapy (P= 0.49) or IBT (P= 0.31) had no significant impact on survival. Outcome for patients with ESCC is poor. Despite the very unfavorable patient selection (poor performance status, high rate of comorbidities, and advanced disease), long-term survival with radio(chemo)therapy was achieved in about 10% of patients. The introduction of modern treatment techniques/modalities (3D conformal planning/ continuous standard fractionation) might be associated with better outcomes.
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Affiliation(s)
- K Fakhrian
- Department of Radiation Oncology, Klinikum rechts der Isar, Technische Universitaet Muenchen.
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Fakhrian K, Klemm S, Keller U, Bayer C, Riedl W, Molls M, Geinitz H. Radiotherapy in stage I-III follicular non-Hodgkin lymphoma. Retrospective analysis of a series of 50 patients. Strahlenther Onkol 2012; 188:464-70. [PMID: 22349634 DOI: 10.1007/s00066-011-0057-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2011] [Accepted: 11/23/2011] [Indexed: 11/27/2022]
Abstract
PURPOSE The goal of this work was to analyze the response rate and outcome of patients with stage I-III follicular lymphoma (FL) treated with radiotherapy (RT) alone. PATIENTS AND METHODS The records of 50 consecutive patients with stage I-III FL treated with RT alone at our department from 1988-2009 were analyzed. The median age was 60 years (range 32-80 years) with a median follow-up duration of 8 years (range 4-11 years). Clinical staging was performed according to the Ann Arbor system. Stage I: 30 patients (60%), stage II: 15 patients (30%), stage III: 5 patients (10%). Thirty-two patients (64%) presented with nodal disease, 14 patients (28%) presented with disease in extranodal sites, and 4 patients (8%) had nodal and extranodal involvement. The RT field encompassed only the involved Ann Arbor nodal regions (involved-field RT) in 26 patients (52%), mantle and whole abdominopelvic fields in 6 patients (12%), mantle field in 10 patients (20%), whole abdominopelvic fields in 5 patients (10%), and a so-called mini-mantle in 3 patients (6%). The total RT dose ranged from 26-56 Gy (median 40 Gy) in daily fractions of 1.2-2.5 Gy. RESULTS Complete remission (CR) and partial remission (PR) were observed in 39 (76%) and 9 (20%) patients, respectively. Only 2 of 8 patients (25%) with tumor bulk > 5 cm reached CR, whereas 37 of 42 patients (88%) with a maximum lymphoma diameter < 5 cm achieved CR (p = 0.0001). The median overall survival (OS) and median event-free survival (EFS) were 18 years (CI 95% 10-26 years) and 7 years (6-8 years), respectively. The 2-, 5-, and 10-year OS were 96 ± 3%, 90 ± 5%, and 70 ± 9%, respectively. The 2-, 5-, and 10-year EFS were 90 ± 5%, 70 ± 7%, and 38 ± 9%, respectively. Fifteen patients developed a recurrence outside the radiation field (30%) and 4 patients developed an in-field recurrence (8%). All in-field recurrences were observed in regions without clinical (macroscopic) involvement, which were irradiated with a dose of ≤ 26 Gy. Pretreatment maximum lymphoma diameter < 5 cm (p = 0.039) and complete remission after RT (p = 0.021) were significantly associated with a better OS in the univariate analysis. CONCLUSION RT is a curative option in the treatment of limited stage FL. If RT of microscopically uninvolved area is necessary, a reduction in the radiation dose should be carefully weighed against the risk of in-field recurrences.
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Affiliation(s)
- K Fakhrian
- Department of Radiation Oncology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
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Fakhrian K, Gamisch N, Schuster T, Thamm R, Molls M, Geinitz H. Salvage radiotherapy in patients with recurrent esophageal carcinoma. Strahlenther Onkol 2012; 188:136-42. [PMID: 22218502 DOI: 10.1007/s00066-011-0023-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2011] [Accepted: 06/27/2011] [Indexed: 12/14/2022]
Abstract
PURPOSE The feasibility and effectiveness of radiotherapy in the management of recurrent esophageal carcinoma (REC) is reported. PATIENTS AND METHODS A consecutive cohort of 54 patients with rcT1-4, rcN0-1, or cM0 recurrent esophageal carcinoma (69% squamous cell carcinoma, 31% adenocarcinoma) was treated between 1988 and 2010. The initial treatment for these patients was definitive radiochemotherapy, surgery alone, or neoadjuvant radiochemotherapy + surgical resection in 8 (15%), 33 (61%), and 13 (24%) patients, respectively. The median time to recurrence from initial treatment was 19 months (range 4-79 months). The site of the recurrence was anastomotic or local, nodal, or both in 63%, 30%, and 7% of patients, respectively. Salvage radio(chemo)therapy was carried out with a median dose of 45 Gy (range 30-68 Gy). RESULTS Median follow-up time for surviving patients from the start of R(C)T was 38 months (range 10-105 months). Relief of symptoms was achieved in 19 of 28 symptomatic patients (68%). The median survival time was 12 months (95% confidence interval (CI) 7-17 months) and the median recurrence-free interval was 8 months (95% CI 4-12 months). The survival rates at 1, 2, and 3 years were 55 ± 7%, 29 ± 6%, and 19 ± 5%, respectively. The recurrence-free survival rates at 1, 2, and 3 years were 44 ± 7%, 22 ± 6%, and 15 ± 5%, respectively. A radiation dose ≥ 45 Gy and conformal RT were associated with a better prognosis. CONCLUSION RT is feasible and effective in the management of recurrent esophageal carcinoma, especially for relief of symptoms. Toxicity is in an acceptable range. The outcome of REC is poor; however, long-term survival of patients with recurrent esophageal carcinoma after radiochemotherapy might be possible, even with a previous history of radiotherapy in the initial treatment. If re-irradiation of esophageal carcinoma is contemplated, three-dimensional conformal techniques and a minimum total dose of 45 Gy are recommended.
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Affiliation(s)
- K Fakhrian
- Radiation Oncology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Strasse 22, Munich, Germany.
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