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Bel A, Azzarouali S, Goudschaal K, den Boer D, Daniels L, Visser J, Hulshof M. Clinical Feasibility of Daily Online Adaptive Bladder Cancer Radiotherapy with Cone Beam CT, Using Fiducial Makers. Int J Radiat Oncol Biol Phys 2023; 117:e643. [PMID: 37785915 DOI: 10.1016/j.ijrobp.2023.06.2055] [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) Radiotherapy (RT) for muscle invasive bladder cancer is challenging due to varying bladder filling. We assessed the efficacy and feasibility of online adaptive RT (oART), applying a focal boost to the tumor, in terms of dose and workflow. MATERIALS/METHODS Bladder cancer patients (N = 15) were treated with oART on a ring-shaped Linac. This system integrates imaging (CBCT) with AI-based organ and tumor segmentation, adaptive treatment planning and delivery. Before treatment the GTV was demarcated with liquid markers. On the planning CT organs-at-risk and the GTV were contoured. The reference treatment plan was optimized with total dose for PTV (elective bladder, lymph nodes) 40Gy/20 fractions and an integrated focal boost to the GTV (15Gy). Margins were 3mm (GTV-CTV) and 5mm (CTV-PTV). Before each daily treatment, a CBCT was acquired. Bladder, rectum and GTV were determined by the AI. Planning CT and CBCT were registered to generate other organs at risk. Subsequently, the dose of the reference plan was calculated for this anatomy (scheduled plan). An adaptive plan was generated by reoptimization. Subsequently, a second pretreatment CBCT (CBCT2) was made to verify and correct the position, when necessary. Target coverage for PTV and GTV (V95%) and dose outside the target were evaluated on CBCT2. Radiation therapists (RTTs) executed the oART workflow with medical physicists (MPs) and radiation oncologists (ROs) on call. The time (median [range]) and personnel involvement were monitored. RESULTS For all adaptive plans V95%>98% for CTV and GTV (boost) volumes. For scheduled plans this was 53.5% (CTV boost) and 98.5% (bladder+lymph nodes). For adaptive vs scheduled plans, the volume of dose (40Gy) to tissue outside the PTV reduced with 150cm3(p<0. 01). Median session time (patient entering-leaving) was 32 [25-45] min for the first 5 patients and reduced to 27 [20-61] min for subsequent patients. About 30% of this time was reoptimization. AI-generated GTVs were corrected in 75% for the first 5 patients and 40% for subsequent patients (taking 5min). Fiducial markers were clearly visible on CBCTs supporting GTV localization. ROs and MPs were consulted during each first fraction (5% of total) and 12% of the remaining fractions. CONCLUSION The adaptive procedure is well feasible in clinical practice with an RTT-only workflow. The procedure takes longer than conventional RT, with reoptimization as a main factor. Dosimetric result are clearly favorable compared to delivery of non-adaptive plans.
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Affiliation(s)
- A Bel
- Department of Radiation Oncology, Amsterdam UMC - location University of Amsterdam, Amsterdam, The Netherlands
| | - S Azzarouali
- Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - K Goudschaal
- Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - D den Boer
- Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - L Daniels
- Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - J Visser
- Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - M Hulshof
- Amsterdam University Medical Centers, Amsterdam, The Netherlands
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Feldman E, Pos FJ, Smeenk RJ, van der Poel H, van Leeuwen P, de Feijter JM, Hulshof M, Budiharto T, Hermens R, de Ligt KM, Walraven I. Selecting a PRO-CTCAE-based subset for patient-reported symptom monitoring in prostate cancer patients: a modified Delphi procedure. ESMO Open 2023; 8:100775. [PMID: 36652781 PMCID: PMC10024147 DOI: 10.1016/j.esmoop.2022.100775] [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: 06/15/2022] [Revised: 12/09/2022] [Accepted: 12/10/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Clinician-based reporting of adverse events leads to underreporting and underestimation of the impact of adverse events on prostate cancer patients. Therefore, interest has grown in capturing adverse events directly from patients using the Patient-Reported Outcomes (PROs) version of the Common Terminology Criteria for Adverse Events (CTCAE). We aimed to develop a standardized PRO-CTCAE subset tailored to adverse event monitoring in prostate cancer patients. MATERIALS AND METHODS We used a mixed-method approach based on the 'phase I guideline for developing questionnaire modules' by the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life group, including a literature review, and interviews with patients (n = 30) and health care providers (HCPs, n = 16). A modified Delphi procedure was carried out to reach consensus on the final subset selected from the complete PRO-CTCAE item library. RESULTS Fourteen multidisciplinary HCPs and 12 patients participated in the Delphi rounds. Ninety percent agreed on the final subset, consisting of: 'ability to achieve and maintain erection', 'decreased libido', 'inability to reach orgasm', 'urinary frequency', 'urinary urgency', 'urinary incontinence', 'painful urination', 'fecal incontinence', 'fatigue', 'hot flashes', 'feeling discouraged', 'sadness', and 'concentration'. From 16 articles identified in the literature review, the following adverse events for which no PRO-CTCAE items are available, were included to the recommendation section: 'nocturia', 'blood and/or mucus in stool', 'hemorrhoids', 'hematuria', 'cystitis', 'neuropathy', and 'proctitis'. CONCLUSIONS The obtained PRO-CTCAE-subset can be used for multidisciplinary adverse event monitoring in prostate cancer care. The described method may guide development of future PRO-CTCAE subsets.
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Affiliation(s)
- E Feldman
- Department for Health Evidence, Radboud University Medical Center, Nijmegen
| | - F J Pos
- Department of Radiation Oncology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek, Amsterdam
| | - R J Smeenk
- Department of Radiation Oncology, Radboud University Medical Center, Nijmegen
| | - H van der Poel
- Department of Urology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek, Amsterdam; Department of Urology, Amsterdam University Medical Centers, Amsterdam
| | - P van Leeuwen
- Department of Urology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek, Amsterdam
| | - J M de Feijter
- Department of Internal Medicine, The Netherlands Cancer Institute, Antoni van Leeuwenhoek, Amsterdam
| | - M Hulshof
- Department of Radiation Oncology, Academical Medical Center, University of Amsterdam, Amsterdam
| | - T Budiharto
- Department of Radiation Oncology, Catharina Hospital, Eindhoven
| | - R Hermens
- Scientific Institute for Quality in Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Radboud University Nijmegen, Nijmegen
| | - K M de Ligt
- Department of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek, Amsterdam, the Netherlands
| | - I Walraven
- Department for Health Evidence, Radboud University Medical Center, Nijmegen.
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Azzarouali S, Goudschaal K, den Boer D, Visser J, Hulshof M, Bel A. PD-0235 AI-based online adaptive CBCT-guided radiotherapy for bladder cancer using SIB and fiducial markers. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02790-6] [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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Stroes C, Creemers A, Bennink R, Schokker S, Verhoeven R, Meijer S, Krisnadath K, van Oijen M, Creemers GJ, van der Sangen M, Beerepoot L, Heisterkamp J, Los M, Slingerland M, Cats A, Hospers G, Bijlsma M, van Berge Henegouwen M, Hulshof M, van Laarhoven H. Trastuzumab and pertuzumab added to neoadjuvant chemoradiotherapy in resectable HER2+ esophageal adenocarcinoma patients: An update on survival and predictive biomarkers in the TRAP study. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz247.101] [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: 11/12/2022] Open
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Creemers A, Meijer S, Holtzer L, Stoffels M, van Ooijen H, van Brussel A, Aussems-Custers E, van Berge Henegouwen M, Hulshof M, Krishnadath S, van de Stolpe A, Bijlsma M, van Laarhoven H. Exploring candidate signal transduction pathways for targeted therapy in esophageal cancer. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz247.150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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de Vos-Geelen J, Hoebers F, Geurts S, Hoeben A, de Greef B, Voncken F, Bogers J, Braam P, Muijs C, de Jong M, Kasperts N, Rozema T, Jeene P, Blom G, Hulshof M, van Laarhoven H, Grabsch H, Lemmens VEPP, Tjan-Heijnen V, Nieuwenhuijzen G. A national comparative effectiveness study to assess definitive chemoradiation regimens in proximal oesophageal squamous cell cancer. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz247.087] [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: 11/12/2022] Open
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Creemers A, Ebbing E, Hooijer G, Van Berge Henegouwen M, Hulshof M, Krishnadath K, Oijen MV, Bijlsma M, Meijer S, Laarhoven H. PO-506 The dynamics of HER2 status in esophageal adenocarcinoma. ESMO Open 2018. [DOI: 10.1136/esmoopen-2018-eacr25.1007] [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: 11/04/2022] Open
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Creemers A, Meijer S, Hooijer G, Grieken NV, Soeratram T, Ylstra B, Van Berge Henegouwen M, Hulshof M, Bijlsma M, Laarhoven H. PO-373 Dynamics of the esophageal tumour immune micro-environment after neoadjuvant chemoradiation (nCRT). ESMO Open 2018. [DOI: 10.1136/esmoopen-2018-eacr25.884] [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: 11/03/2022] Open
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Hulshof M. SP-0469: Radio(chemo)therapy in oesophageal cancer: can we do better? Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)30909-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: 11/29/2022]
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Van Putten M, Koëter M, Van Laarhoven H, Lemmens V, Siersema P, Hulshof M, Verhoeven R, Nieuwenhuijzen G. 63. Hospital of diagnosis influences the probability to receive curative treatment for oesophageal cancer. Eur J Surg Oncol 2016. [DOI: 10.1016/j.ejso.2016.06.069] [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: 11/24/2022] Open
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Gwynne S, Wijnhoven B, Hulshof M, Bateman A. Role of Chemoradiotherapy in Oesophageal Cancer — Adjuvant and Neoadjuvant Therapy. Clin Oncol (R Coll Radiol) 2014; 26:522-32. [DOI: 10.1016/j.clon.2014.05.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Revised: 02/28/2014] [Accepted: 05/27/2014] [Indexed: 02/07/2023]
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van den Hoek A, Kamphuis M, de Jong R, van Wieringen N, Hulshof M. OC-0445: Evaluation of soft tissue changes using ConeBeam CT scans during treatment of esophageal cancer. Radiother Oncol 2013. [DOI: 10.1016/s0167-8140(15)32751-1] [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: 10/23/2022]
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Sauer R, Creeze H, Hulshof M, Issels R, Ott O. Concerning the final report “Hyperthermia: a systematic review” of the Ludwig Boltzmann Institute for Health Technology Assessment, Vienna, March 2010. Strahlenther Onkol 2012; 188:209-13. [DOI: 10.1007/s00066-012-0072-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Chai X, van Herk M, Hulshof M, Remeijer P, Bel A. SU-F-BRA-04: Automatic Bladder Segmentation on CBCT for Online ART of Bladder Cancer. Med Phys 2011. [DOI: 10.1118/1.3612871] [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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Chai X, van Herk M, van de Kamer J, Hulshof M, Remeijer P, Bel A. 531 oral AUTOMATIC BLADDER SEGMENTATION ON CBCT FOR ONLINE ART OF BLADDER CANCER. Radiother Oncol 2011. [DOI: 10.1016/s0167-8140(11)70653-3] [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: 11/16/2022]
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Kamphuis M, van Wieringen N, Elfering L, Bel A, Hulshof M. 328 oral INTERFRACTION DISPLACEMENT OF PELVIC LYMPH NODES DURING RADIOTHERAPY FOR BLADDER CANCER. Radiother Oncol 2011. [DOI: 10.1016/s0167-8140(11)70450-9] [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: 10/18/2022]
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Gaast AV, van Hagen P, Hulshof M, Richel D, van Berge Henegouwen MI, Nieuwenhuijzen GA, Plukker JT, Bonenkamp JJ, Steyerberg EW, Tilanus HW. Effect of preoperative concurrent chemoradiotherapy on survival of patients with resectable esophageal or esophagogastric junction cancer: Results from a multicenter randomized phase III study. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.4004] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Meerten EV, van Rij C, Tesselaar ME, Neelis K, Richel D, Hulshof M, Gaast AV. Definitive concurrent chemoradiation (CRT) with weekly paclitaxel and carboplatin for patients (pts) with irresectable esophageal cancer: A phase II study. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e14508] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Kamphuis M, van Maurik L, Bel A, Hulshof M. USING CONE BEAM CT FOR ONE STOP SIMULATION AND TREATMENT IN PALLIATIVE SETTINGS. Radiother Oncol 2009. [DOI: 10.1016/s0167-8140(12)72802-5] [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: 10/27/2022]
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Dees-Ribbers H, van Herk M, Hulshof M, Bex A, de Reijke T, Pos F. IMPROVED BLADDER TUMOR DELINEATION THROUGH REGISTRATION OF PLANNING CT AND CYSTOSCOPY IMAGES. Radiother Oncol 2009. [DOI: 10.1016/s0167-8140(12)72899-2] [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: 11/27/2022]
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Pos F, Hulshof M, Lebesque J, Lotz H, van Tienhoven G, Moonen L, Remeijer P. Adaptive Radiotherapy for Invasive Bladder Cancer, a Feasibility Study. Int J Radiat Oncol Biol Phys 2005. [DOI: 10.1016/j.ijrobp.2005.07.527] [Citation(s) in RCA: 2] [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: 10/25/2022]
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Kok H, Van Haaren P, Van de Kamer J, Zum Vörde Sive Vörding P, Oldenborg S, Wiersma J, Hulshof M, Geijsen E, Bel A, Crezee J. 523 Improvement of locoregional hyperthermia treatments of oesophageal cancer using treatment planning. Radiother Oncol 2005. [DOI: 10.1016/s0167-8140(05)81499-9] [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: 11/24/2022]
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Lotz H, Pos F, Hulshof M, van Herk M, Lebesque J, Remeijer P. SU-FF-J-74: Tumor Motion and Tumor Shape Changes During Radiotherapy of Bladder Cancer. Med Phys 2005. [DOI: 10.1118/1.1997620] [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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Goedegebure A, Hulshof M, Maas RJ, Dreschler WA, Verschuure H. Effects of single-channel phonemic compression schemes on the understanding of speech by hearing-impaired listeners. Audiology 2001; 40:10-25. [PMID: 11296937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Abstract
The effect of digital processing on speech intelligibility was studied in hearing-impaired listeners with moderate to severe high-frequency losses. The amount of smoothed phonemic compression in a high-frequency channel was varied using wide-band control. Two alternative systems were tested to compensate for upward spread of masking (USOM) and to reduce modulations in the high-frequency channel effectively. Consonant-vowel-consonant tests were conducted in a group of 14 subjects using eight different speech-processing settings. Speech intelligibility improved significantly with compression, mainly due to positive effects on the initial-consonant score. Surprisingly, listeners with a smaller residual dynamic range tended to profit less from compression. Compensation for USOM gave an additional improvement of vowel intelligibility. In background noise, consistently negative effects of speech processing were found. The combined use of phonemic compression and USOM compensation is promising in conditions without background noise.
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Affiliation(s)
- A Goedegebure
- Department of Audiology--ENT, Erasmus Medical University Centre Rotterdam, The Netherlands
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Miralbell R, Mornex F, Greiner R, Bolla M, Storme G, Hulshof M, Bernier J, Denekamp J, Rojas AM, Pierart M, van Glabbeke M, Mirimanoff RO. Accelerated radiotherapy, carbogen, and nicotinamide in glioblastoma multiforme: report of European Organization for Research and Treatment of Cancer trial 22933. J Clin Oncol 1999; 17:3143-9. [PMID: 10506611 DOI: 10.1200/jco.1999.17.10.3143] [Citation(s) in RCA: 69] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE A three-step phase I/II trial associating accelerated radiotherapy with carbogen (step 1, ARCO), with nicotinamide (step 2, ARN), or with both (step 3, ARCON) was conducted, the aim of which was to overcome the effects of proliferation and hypoxia as potential causes of tumor radioresistance in glioblastoma multiforme. PATIENTS AND METHODS Radiotherapy consisted of 60 Gy delivered over 4 weeks in 1.5-Gy fractions twice daily, 5 days a week. Carbogen breathing was started 5 minutes before each fraction and continued until the end of each treatment session. Nicotinamide was given daily as a single oral dose of 85 mg/kg. RESULTS A total of 115 patients with a median age of 55 years were registered. Of 107 eligible patients, 23 were registered in step 1, 28 in step 2, and 56 in step 3. The planned treatment was administered without any interruption in 72% of patients (86% in ARCO but 68% in ARN and ARCON). The incidence and severity of acute skin and mucous membrane toxicity were higher in patients who received nicotinamide (ie, the ARN and ARCON groups). Grade 1 to 2 gastrointestinal toxicity was observed in 44% of patients in the ARN group and 32% of patients in the ARCON group, but only in 8% of patients in the ARCO group. Eight percent of evaluated patients presented with abnormal liver test results at treatment completion. The dose of corticosteroids had to be increased in 44% of patients. Late neurologic side effects were similar in all treatment steps and were observed mostly in patients with disease progression. Median survival times for patients treated with ARCO, ARN, and ARCON were 10.1, 9.7, and 11.1 months, respectively. CONCLUSION Feasibility of ARCO treatment was good but that of ARN and ARCON was only fair. This probably reflected the higher acute toxicity rate, particularly gastrointestinal, for patients receiving nicotinamide. The dose of corticosteroids had to be increased frequently during treatment, suggesting a higher than expected acute neurologic toxicity. Overall survival was similar in the three treatment steps and not different when compared with results of other series that used radiotherapy alone.
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Affiliation(s)
- R Miralbell
- Hôpital Cantonal Universitaire, Geneva, Switzerland.
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Journée HL, Hulshof M, de Jonge AB. ESTRACE--1: a stethoscope for functional checking of electrostimulators and low cost body surface mapping system. Med Eng Phys 1994; 16:492-5. [PMID: 7858781 DOI: 10.1016/1350-4533(94)90074-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
In a project on the mapping of body surface potentials evoked by implanted spinal cord stimulators and transcutaneous electrostimulators, a simple device was developed for use in polyclinical practice for easy checking of the function of these stimulators. The device is an electrical stethoscope and consists of an instrumentation amplifier, bandpass filter, a distortion circuit and a headphone. In vivo measurements demonstrate the generation of an amplitude-dependent tone by the distortion circuit. The apparatus is in many aspects similar to a stethoscope: simple to understand and a practical tool for a fast Go/No-Go test. The device can be optionally connected with a PC and enables body surface mapping documentation within a few minutes.
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Affiliation(s)
- H L Journée
- JS Centre of Biomedical Engineering and Medical Research, Bedum, The Netherlands
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Abstract
The frequency and magnitude of localization errors detected by verification films, during mantle-field irradiation for Hodgkin's disease, were assessed. A total of 216 treatment set-ups was studied. The first verification film, at the start of treatment, showed a localization error of over 1 cm in 13% of cases, leading to a critical margin between the shielding block and the tumor bearing area in 9% of the treatment set-ups. After the first correction, an adequate treatment set-up was obtained in 60% of cases, whereas after two corrections the adequacy rate was 84%. Verification films are therefore very useful in detecting clinically important localization errors and in monitoring and checking subsequent corrections. An additional advantage exists because the first verification film can be used as a final check of the simulation plan itself.
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Affiliation(s)
- M Hulshof
- Department of Radiotherapy, University Hospital St. Rafael, Leuven, Belgium
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