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Rades D, Cremers F, Janssen S, Bartscht T, Kristiansen C, Timke C, Duma MN, Yu NY, Bohnet S. Associations Between Mean Lung Dose and Prevalence of Radiation Pneumonitis in Elderly Lung Cancer Patients. Anticancer Res 2024; 44:2073-2079. [PMID: 38677766 DOI: 10.21873/anticanres.17011] [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: 02/14/2024] [Revised: 03/01/2024] [Accepted: 03/04/2024] [Indexed: 04/29/2024]
Abstract
BACKGROUND/AIM Pneumonitis is a serious radiotherapy complication. This study, which is a prerequisite for a prospective trial, aimed to identify the prevalence of pneumonitis and risk factors in elderly patients with lung cancer. PATIENTS AND METHODS Ninety-eight lung cancer patients aged ≥65 years were included. Seventeen factors were investigated regarding grade ≥2 pneumonitis at 24 weeks following radiotherapy. RESULTS The prevalence of grade ≥2 pneumonitis at 24 weeks was 27.3%. On univariate analysis, a significant association was observed for mean (ipsilateral) lung dose (MLD; ≤13.0 vs. 13.1-20.0 vs. >20.0 Gy; 0% vs. 24.9% vs. 48.7%). Results were significant also for ≤13.0 vs. >13.0 Gy (0% vs. 37.1%) or ≤20.0 vs. >20.0 Gy (13.4% vs. 48.7%). MLD achieved significance on multivariate analysis. CONCLUSION Elderly patients receiving MLDs >13.0 Gy, particularly >20.0 Gy, have a high risk of grade ≥2 pneumonitis. These results are important for designing a prospective trial.
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Affiliation(s)
- Dirk Rades
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany;
- Department of Radiation Oncology, University Medical Center Schleswig-Holstein, Lübeck, Germany
| | - Florian Cremers
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
- Department of Radiation Oncology, University Medical Center Schleswig-Holstein, Lübeck, Germany
| | - Stefan Janssen
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
- Department of Radiation Oncology, University Medical Center Schleswig-Holstein, Lübeck, Germany
| | - Tobias Bartscht
- Department of Hematology, Oncology and Stem Cell Transplantation, Medical School Hamburg, Schwerin, Germany
- Department for Human Medicine, MSH Medical School Hamburg, Hamburg, Germany
| | - Charlotte Kristiansen
- Department of Oncology, Vejle Hospital, University Hospital of Southern Denmark, Vejle, Denmark
| | - Carmen Timke
- Department of Radiotherapy, Malteser Hospital St. Franziskus, Flensburg, Germany
| | - Marciana N Duma
- Department for Human Medicine, MSH Medical School Hamburg, Hamburg, Germany
- Department of Radiotherapy, Medical School Hamburg, Schwerin, Germany
| | - Nathan Y Yu
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, U.S.A
| | - Sabine Bohnet
- Department of Pulmonology, University of Lübeck, Lübeck, Germany
- Department of Pulmonology, University Medical Center Schleswig-Holstein, Lübeck, Germany
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Gkika E, Kostyszyn D, Fechter T, Moustakis C, Ernst F, Boda-Heggemann J, Sarria G, Dieckmann K, Dobiasch S, Duma MN, Eberle F, Kroeger K, Häussler B, Izaguirre V, Jazmati D, Lautenschläger S, Lohaus F, Mantel F, Menzel J, Pachmann S, Pavic M, Radlanski K, Riesterer O, Gerum S, Röder F, Willner J, Barczyk S, Imhoff D, Blanck O, Wittig A, Guckenberger M, Grosu AL, Brunner TB. Interobserver agreement on definition of the target volume in stereotactic radiotherapy for pancreatic adenocarcinoma using different imaging modalities. Strahlenther Onkol 2023; 199:973-981. [PMID: 37268767 PMCID: PMC10598103 DOI: 10.1007/s00066-023-02085-7] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 04/11/2023] [Indexed: 06/04/2023]
Abstract
PURPOSE The aim of this study was to evaluate interobserver agreement (IOA) on target volume definition for pancreatic cancer (PACA) within the Radiosurgery and Stereotactic Radiotherapy Working Group of the German Society of Radiation Oncology (DEGRO) and to identify the influence of imaging modalities on the definition of the target volumes. METHODS Two cases of locally advanced PACA and one local recurrence were selected from a large SBRT database. Delineation was based on either a planning 4D CT with or without (w/wo) IV contrast, w/wo PET/CT, and w/wo diagnostic MRI. Novel compared to other studies, a combination of four metrics was used to integrate several aspects of target volume segmentation: the Dice coefficient (DSC), the Hausdorff distance (HD), the probabilistic distance (PBD), and the volumetric similarity (VS). RESULTS For all three GTVs, the median DSC was 0.75 (range 0.17-0.95), the median HD 15 (range 3.22-67.11) mm, the median PBD 0.33 (range 0.06-4.86), and the median VS was 0.88 (range 0.31-1). For ITVs and PTVs the results were similar. When comparing the imaging modalities for delineation, the best agreement for the GTV was achieved using PET/CT, and for the ITV and PTV using 4D PET/CT, in treatment position with abdominal compression. CONCLUSION Overall, there was good GTV agreement (DSC). Combined metrics appeared to allow a more valid detection of interobserver variation. For SBRT, either 4D PET/CT or 3D PET/CT in treatment position with abdominal compression leads to better agreement and should be considered as a very useful imaging modality for the definition of treatment volumes in pancreatic SBRT. Contouring does not appear to be the weakest link in the treatment planning chain of SBRT for PACA.
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Affiliation(s)
- E Gkika
- Department of Radiation Oncology, University Medical Center Freiburg, Robert Koch Str 3, Freiburg, Germany.
| | - D Kostyszyn
- Department of Radiation Oncology, University Medical Center Freiburg, Robert Koch Str 3, Freiburg, Germany
| | - T Fechter
- Department of Radiation Oncology, University Medical Center Freiburg, Robert Koch Str 3, Freiburg, Germany
| | - C Moustakis
- Department of Radiation Oncology, University Medical Center Muenster, Muenster, Germany
| | - F Ernst
- Institute for Robotics and Cognitive Systems, University of Luebeck, Luebeck, Germany
| | - J Boda-Heggemann
- Department of Radiation Oncology, Faculty of Medicine Mannheim, Department of Radiation Oncology, University of Heidelberg, Mannheim, Germany
| | - G Sarria
- Department of Radiation Oncology, University Hospital Bonn, Bonn, Germany
| | - K Dieckmann
- Department of Radiation Oncology, University Departments of the MedUni Vienna, Vienna General Hospital, Vienna, Austria
| | - S Dobiasch
- Department of Radiation Oncology, Klinikum Rechts der Isar, TU Munich, Munich, Germany
| | - M N Duma
- Department of Radiotherapy and Radiation Oncology, University Hospital Jena, Friedrich-Schiller University, Jena, Germany
| | - F Eberle
- Department of Radiation Oncology, University Hospital Marburg, Marburg, Germany
| | - K Kroeger
- Department of Radiation Oncology, University Medical Center Muenster, Muenster, Germany
| | - B Häussler
- Radiation Oncology Dr. Häussler/Dr. Schorer, Munich, Germany
| | - V Izaguirre
- Department of Radiation Oncology, University Hospital Halle, Halle, Germany
| | - D Jazmati
- Proton Therapy Centre, University Hospital Essen, Essen, Germany
| | - S Lautenschläger
- Department of Radiation Oncology, University Hospital, Marburg, Germany
| | - F Lohaus
- Department of Radiation Oncology, University Hospital Dresden, Dresden, Germany
| | - F Mantel
- Department of Radiation Oncology, University Hospital Würzburg, Würzburg, Germany
| | - J Menzel
- Department of Radiation Oncology, University Hospital Hannover, Hannover, Germany
| | - S Pachmann
- Department of Radiation Oncology, Weilheim Clinic, Weilheim, Germany
| | - M Pavic
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - K Radlanski
- Department of Radiation Oncology, Charite, University Hospital Berlin, Berlin, Germany
| | - O Riesterer
- Centre for Radiation Oncology KSA-KSB, Kantonsspital Aarau, Aarau, Switzerland
| | - S Gerum
- Department of Radiation Oncology, University Clinic, Paracelsus Medical University (PMU), Salzburg, Austria
| | - F Röder
- Department of Radiation Oncology, University Clinic, Paracelsus Medical University (PMU), Salzburg, Austria
| | - J Willner
- Department of Radiation Oncology, University Hospital Bayreuth, Bayreuth, Germany
| | - S Barczyk
- Center for Radiation Oncology, Belegklinik am St. Agnes-Hospital, Bocholt, Germany
| | - D Imhoff
- Department of Radiation Oncology, Saphir Radiosurgery, University Hospital Frankfurt, Frankfurt, Germany
| | - O Blanck
- Saphir Radiosurgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - A Wittig
- Department of Radiotherapy and Radiation Oncology, University Hospital Jena, Friedrich-Schiller University, Jena, Germany
| | - M Guckenberger
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Anca-L Grosu
- Department of Radiation Oncology, University Medical Center Freiburg, Robert Koch Str 3, Freiburg, Germany
| | - T B Brunner
- Department of Therapeutic Radiology and Oncology, Comprehensive Cancer Center, Medical University of Graz, Graz, Austria
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Borm KJ, Ernst L, Voppichler J, Oechsner M, Düsberg M, Buschner G, Weber W, Combs SE, Duma MN. Comparison of the distribution of lymph node metastases compared to healthy lymph nodes in breast cancer. Radiat Oncol 2022; 17:27. [PMID: 35123538 PMCID: PMC8818136 DOI: 10.1186/s13014-021-01964-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 12/07/2021] [Indexed: 12/02/2022] Open
Abstract
Background Current literature lacks a comparison of lymph node metastases and non-pathological lymph nodes distribution in breast cancer patients. The aim of the current retrospective study was to generate a comprehensive atlas of the lymph node system. Methods 143 breast cancer patients underwent F-18-FDG-PET/CT (PET/CT) imaging for staging purposes and were diagnosed with regional lymph node metastases. Based on the PET/CT data set a total of 326 lymph node metastases and 1826 non-pathological lymph nodes were detected and contoured manually in the patient collective. Using rigid and deformable registration algorithms all structures were transferred to a template planning CT of a standard patient. Subsequently, a 3D-atlas of the distribution of lymph node metastases and non-pathological lymph nodes were generated and compared to each other. Results Both, lymph node metastases and non-pathological lymph nodes, accumulated in certain areas (“hot-spots”) within the lymphatic drainage system. However large differences regarding the distribution patterns were detected: lymph node metastases hot spots occurred in close proximity to the subclavian vein in level I-III, whereas the non-pathological lymph nodes accumulated mostly (within a wider range) in level I. In level II and III lymph node metastases exceeded clearly the areas in which non-pathological lymph nodes occurred. Conclusion Lymph node metastases and non-pathological lymph node distribution within the lymph node system differ clearly. Based on our results, an individual adjustment of the CTV in order to include visible lymph nodes in level II and III should be discussed.
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Reibelt A, Mayinger M, Borm KJ, Combs SE, Duma MN. Neuroanatomical changes seen in MRI in patients with cerebral metastasized breast cancer after radiotherapy. Tumori 2021; 108:486-494. [PMID: 34256653 PMCID: PMC9500168 DOI: 10.1177/03008916211031301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Purpose: To quantify neuroanatomical changes using magnetic resonance imaging (MRI) in patients with cerebral metastasized breast cancer after brain radiotherapy (RT). Methods: Fifteen patients with breast cancer with brain metastases who underwent whole brain RT (WBR), radiosurgery (RS), and/or hypofractionated stereotactic treatment (STX) were examined at four time points (TPs). A total of 48 MRIs were available: prior to RT (TP1), 5–8 months after RT (TP2), 9–11 months after RT (TP3), and >20 months after RT (TP4). Using automatic segmentation, 25 subcortical structures were analyzed. Patients were split into three groups: STX (receiving STX and RS), RS (receiving RS only), and WBR (receiving WBR at least once). After testing for a normal distribution for all values using the Kolmogorov-Smirnov test, a two-sided paired t test was used to analyze volumetric changes. For those values that were not normally distributed, the nonparametric Mann-Whitney test was employed. Results: The left cerebellum white matter (p = 0.028), the right pallidum (p = 0.038), and the left thalamus (p = 0.039) significantly increased at TP2 compared to TP1. The third ventricle increased at all TPs (p = 0.034–0.046). The left choroid plexus increased at TP3 (p = 0.037) compared to TP1. The left lateral ventricle increased at TP3 (p = 0.012) and TP4 (p = 0.027). Total gray matter showed a trend of volume decline in STX and WBR groups. Conclusions: These findings indicate that alterations in the volume of subcortical structures may act as a sensitive parameter when evaluating neuroanatomical changes and brain atrophy due to radiotherapy. Differences observed for patients who received STX and WBR, but not those treated with RS, need to be validated further.
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Affiliation(s)
- Antonia Reibelt
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich, Munich, Bayern, Germany
| | - Michael Mayinger
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich, Munich, Bayern, Germany
- Department of Radiation Oncology, University of Zurich, Zurich, Switzerland
- Michael Mayinger, Department of Radiation Oncology, Technical University Munich, Ismaninger Str. 22, München, 81675, Germany.
| | - Kai J. Borm
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich, Munich, Bayern, Germany
| | - Stephanie E. Combs
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich, Munich, Bayern, Germany
- Deutsches Konsortium für Translationale Krebsforschung (DKTK)–Partner Site Munich, Munich, Germany
- Institute of Radiation Medicine (IRM), Department of Radiation Sciences (DRS), Helmholtz Zentrum München, Neuherberg, Germany
| | - Marciana N. Duma
- Department of Radiation Oncology, University of Jena, Jena, Germany
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5
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Mayinger M, Straube C, Habermehl D, Duma MN, Combs SE. Hypo- vs. normofractionated radiation therapy in breast cancer: A patterns of care analysis in German speaking countries. Rep Pract Oncol Radiother 2020; 25:775-779. [PMID: 32904392 DOI: 10.1016/j.rpor.2020.07.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 05/31/2020] [Accepted: 07/24/2020] [Indexed: 10/24/2022] Open
Abstract
Aim and background To assess the use of hypofractionated (HG-RT) versus normofractionated radiation therapy (NF-RT) in Breast Cancer in German speaking countries. Materials and methods Between July 2017 and August 2017, an email-based survey was sent to all 1408 physicians that are members of the German Society of Radiation Oncology (DEGRO). The survey was completed by 180 physicians including 10 private practice owners and 52 heads of departments. The majority (82.1%) of the participants had >15 years of experience in radiation therapy (RT). Results The majority (83.9%) of the heads of the departments agreed on using the normofractionated regimen of RT as standard treatment for breast cancer. Several physicians were skeptical about HF-RT with 6.5% of the heads refusing to use HF-RT. 40.3% of the departments had not seen the new German guidelines suggesting HF-RT as the standard treatment for all patients as positive or merely adopted a neutral position toward the guidelines (33.9%). The main points of criticism were increased side effects, an impaired toxicity profile and insufficient data. Most departments (46.8%) that perform HF-RT do so in an individual based manner. Conclusions HF-RT remains controversial in German speaking countries. Our data shows that NF-RT remains the predominant method of treatment. HF-RT is only used in a defined group of patients as most German physicians agree that particular patients, especially those at higher risk of RT late effects, may benefit from a less intense, extended fractionation schedule.
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Affiliation(s)
- M Mayinger
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany.,Radiation Oncology, University Hospital Zurich, University of Zurich, Switzerland
| | - C Straube
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany.,Institute of Innovative Radiotherapy (iRT), Department of Radiation Sciences (DRS), Helmholtz Zentrum München, Munich, Germany.,Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partnerstandort München, Munich, Germany
| | - D Habermehl
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany.,Institute of Innovative Radiotherapy (iRT), Department of Radiation Sciences (DRS), Helmholtz Zentrum München, Munich, Germany.,Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partnerstandort München, Munich, Germany
| | - M N Duma
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany.,Institute of Innovative Radiotherapy (iRT), Department of Radiation Sciences (DRS), Helmholtz Zentrum München, Munich, Germany.,Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partnerstandort München, Munich, Germany
| | - S E Combs
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany.,Institute of Innovative Radiotherapy (iRT), Department of Radiation Sciences (DRS), Helmholtz Zentrum München, Munich, Germany.,Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partnerstandort München, Munich, Germany
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6
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Arend F, Oechsner M, Weidenbächer CB, Combs SE, Borm KJ, Duma MN. Correlations of UICC tumor stage and tumor regression on T2-weighted MRI sequences during definitive radiotherapy of cervical cancer. Tumori 2020; 107:139-144. [PMID: 32701045 DOI: 10.1177/0300891620940024] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The purpose of this study is to detect a correlation between the preradiation tumor staging and the relative volumetric regression of the primary tumor through external beam radiation therapy (EBRT). METHODS Clinical data of 32 patients with a mean age of 60±12 years treated with primary radiation therapy (RT) of cervical carcinoma were analyzed. Union Internationale Contre le Cancer (UICC) stages were T1 = 4 patients, T2 = 15 patients, T3 = 8 patients, T4 = 5 patients; N1 = 26 patients, N0 = 6 patients; and M0 = 25 patients, M1 = 7 patients. All patients received pelvic magnetic resonance imaging (MRI) before RT as well as during RT. The cervical primary tumor was delineated as gross tumor volume (ptGTV) in T2-weighted MRI sequences. We compared ptGTV reduction by stage, lymph node status, metastatic status, and grading. RESULTS Mean ptGTV reduction during RT was 61.4±28.9%. T1 tumors shrank by 88.2±13.4%, T2 by 67.6±28.7%, T3 by 50.8±23.6%, and T4 by 38.7±27.2%. The difference in tumor shrinkage was statistically significant between the lower T stages and the higher T stages (p < 0.05). There was no statistical difference in the mean ptGTV before treatment in the group with lymph node metastases (LNM) (54.1±47.7 cm3) as compared to the group without LNM (76.6±52.2 cm3). Nonetheless, ptGTV shrank significantly differently: by 68.9±25.7% (N1 patients) and by 29.0±17.7% (N0 patients). No significant differences in ptGTV shrinkage were observed in M0 versus M1 and G2 versus G3 tumors. CONCLUSION There is a correlation between mean ptGTV reduction during EBRT and tumor stages. Tumors with higher T stages shrank less under radiation treatment, and the ptGTV of N1 patients responded better than that of N0 patients.
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Affiliation(s)
- Florian Arend
- Department of Radiotherapy, Klinikum Rechts der Isar, Technical University Munich, München, Bayern, Germany.,Faculty of Medicine, Technical University Munich, München, Bayern, Germany
| | - Markus Oechsner
- Department of Radiotherapy, Klinikum Rechts der Isar, Technical University Munich, München, Bayern, Germany
| | - Clara B Weidenbächer
- Department of Radiotherapy, Klinikum Rechts der Isar, Technical University Munich, München, Bayern, Germany
| | - Stephanie E Combs
- Department of Radiotherapy, Klinikum Rechts der Isar, Technical University Munich, München, Bayern, Germany.,Institute of Innovative Radiotherapy, Helmholtz Zentrum München, München, Germany.,Deutsches Konsortium für Translationale Krebsforschung (DKTK)-Partner Site Munich, München, Germany
| | - Kai J Borm
- Department of Radiotherapy, Klinikum Rechts der Isar, Technical University Munich, München, Bayern, Germany
| | - Marciana N Duma
- Department of Radiotherapy, Klinikum Rechts der Isar, Technical University Munich, München, Bayern, Germany.,Department of Radiotherapy and Radiation Oncology, University Hospital of the Friedrich Schiller University, Jena, Germany
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7
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Borm KJ, Oechsner M, Düsberg M, Buschner G, Wolfgang W, Combs SE, Duma MN. Effect of hypofractionation on the incidental axilla dose during tangential field radiotherapy in breast cancer. Strahlenther Onkol 2020; 196:771-778. [PMID: 32488292 PMCID: PMC7450000 DOI: 10.1007/s00066-020-01636-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 05/09/2020] [Indexed: 11/30/2022]
Abstract
Objective Tangential field irradiation in breast cancer potentially treats residual tumor cells in the axilla after sentinel lymph node biopsy (SLNB). In recent years, hypofractionated radiotherapy has gained importance and currently represents the recommended standard in adjuvant breast cancer treatment for many patients. So far, the impact of hypofractionation on the effect of incidental lymph node irradiation has not be addressed. Materials and methods Biological effective dose (BED) and tumor control probability (TCP) were estimated for four different hypofractionated radiation schemes (42.50 Gy in 16 fractions [Fx]; 40.05 Gy in 15 Fx; 27 Gy in 5 Fx; and 26 in 5 Fx) and compared to conventional fractionation (50 Gy in 25 Fx). For calculation of BED and TCP, a previously published radiobiological model with an α/β ratio of 4 Gy was used. The theoretical BED and TCP for incidental irradiation between 0 and 100% of the prescribed dose were evaluated. Subsequently, we assessed BED and TCP in 431 axillary lymph node metastases. Results The extent of incidental lymph node irradiation and the fractionation scheme have a direct impact on BED and TCP. The estimated mean TCP in the axillary nodes ranged from 1.5 ± 6.4% to 57.5 ± 22.9%, depending on the patient’s anatomy and the fractionation scheme. Hypofractionation led to a significant reduction of mean TCP of lymph node metastases for all schedules. Conclusion Our data indicate that hypofractionation might affect the effectiveness of incidental radiotherapy in the axilla. This is particularly relevant for patients with positive sentinel lymph nodes who receive SLNB only.
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Affiliation(s)
- Kai J Borm
- Department of RadiationOncology, Technical University Munich, Medical School, Klinikum rechts der Isar, Munich, Germany
| | - Markus Oechsner
- Department of RadiationOncology, Technical University Munich, Medical School, Klinikum rechts der Isar, Munich, Germany
| | - Mathias Düsberg
- Department of RadiationOncology, Technical University Munich, Medical School, Klinikum rechts der Isar, Munich, Germany
| | - Gabriel Buschner
- Department of Nuclear Medicine, Technical University Munich, Medical School, Klinikum rechts der Isar, Munich, Germany
| | - Weber Wolfgang
- Department of Nuclear Medicine, Technical University Munich, Medical School, Klinikum rechts der Isar, Munich, Germany
| | - Stephanie E Combs
- Department of RadiationOncology, Technical University Munich, Medical School, Klinikum rechts der Isar, Munich, Germany.,Deutsches Konsortium für Translationale Krebsforschung (DKTK)-Partner Site Munich, Munich, Germany.,Institute of Radiation Medicine, Helmholtzzentrum München, Ingolstaedter Landstr. 1, 85764, Neuherberg, Germany
| | - Marciana N Duma
- Department of RadiationOncology, Technical University Munich, Medical School, Klinikum rechts der Isar, Munich, Germany. .,Department of Radiotherapy and Radiation Oncology, Friedrich Schiller University Hospital, Bachstraße 18, 07743, Jena, Germany.
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8
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Strnad V, Krug D, Sedlmayer F, Piroth MD, Budach W, Baumann R, Feyer P, Duma MN, Haase W, Harms W, Hehr T, Fietkau R, Dunst J, Sauer R. DEGRO practical guideline for partial-breast irradiation. Strahlenther Onkol 2020; 196:749-763. [PMID: 32350554 PMCID: PMC7449998 DOI: 10.1007/s00066-020-01613-z] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 03/19/2020] [Indexed: 12/24/2022]
Abstract
Purpose This consensus statement from the Breast Cancer Working Group of the German Society for Radiation Oncology (DEGRO) aims to define practical guidelines for accelerated partial-breast irradiation (APBI). Methods Recent recommendations for relevant aspects of APBI were summarized and a panel of experts reviewed all the relevant literature. Panel members of the DEGRO experts participated in a series of conferences, supplemented their clinical experience, performed a literature review, and formulated recommendations for implementing APBI in clinical routine, focusing on patient selection, target definition, and treatment technique. Results Appropriate patient selection, target definition for different APBI techniques, and basic rules for appropriate APBI techniques for clinical routine outside of clinical trials are described. Detailed recommendations for APBI in daily practice, including dose constraints, are given. Conclusion Guidelines are mandatory to assure optimal results of APBI using different techniques.
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Affiliation(s)
- V Strnad
- University Hospital Erlangen, Erlangen, Germany.
| | - D Krug
- University Hospital Schleswig-Holstein, Kiel, Germany
| | - F Sedlmayer
- Paracelsus Medical University Hospital Salzburg, Salzburg, Austria
| | - M D Piroth
- Helios University Hospital Wuppertal, Witten/Herdecke University, Wuppertal, Germany
| | - W Budach
- Heinrich-Heine-University Hospital Düsseldorf, Düsseldorf, Germany
| | - R Baumann
- St. Marien-Krankenhaus Siegen, Siegen, Germany
| | - P Feyer
- Vivantes Hospital Neukoelln, Berlin, Germany
| | - M N Duma
- University Hospital, Jena, Germany
| | - W Haase
- St.-Vincentius-Hospital Karlsruhe, Karlsruhe, Germany
| | - W Harms
- St. Claraspital Basel, Basel, Switzerland
| | - T Hehr
- Marienhospital Stuttgart, Stuttgart, Germany
| | - R Fietkau
- University Hospital Erlangen, Erlangen, Germany
| | - J Dunst
- University Hospital Schleswig-Holstein, Kiel, Germany
| | - R Sauer
- University Hospital Erlangen, Erlangen, Germany
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Duma MN, Oszfolk NI, Boeckh-Behrens T, Oechsner M, Zimmer C, Meyer B, Pfluger PT, Combs SE. Positive correlation between blood glucose and radiotherapy doses to the central gustatory system in Glioblastoma Multiforme patients. Radiat Oncol 2019; 14:97. [PMID: 31174561 PMCID: PMC6555968 DOI: 10.1186/s13014-019-1311-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 01/04/2019] [Accepted: 05/29/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The aim of this study was to assess the correlations between the levels of blood glucose (BG) and the dose of radiation therapy (RT) to the central gustatory system (GS) in glioblastoma multiforme (GBM) patients. METHODS Thirty-seven GBM patients with regular blood glucose measurements were investigated retrospectively. 59.5% were female and 40.5% male with a median age of 64.3 years (range 27.4-85.6). Diabetes mellitus type 2 (DM2) history, BG levels and dexamethasone (DEXA) medication were assessed. The analyzed central gustatory structures were: solitary tract and nucleus, ventral posteromedial nucleus of the thalamus, sensory tongue area of the postcentral gyrus, anterior part of the insula, frontal operculum, amygdala, hypothalamus. These structures were delineated on magnetic resonance tomographies (MRIs) registered to planning-CTs. All GS doses were transformed in equivalent doses in 2 Gy fraction (EQD2). RESULTS Twenty one patients (56.8%) had at least one BG values over 200 mg/dl during RT. There was a difference between average BG in DM2: 192.8 mg/dl (±24.4) and non-DM2 patients: 145.7 mg/dl (±39.5; p = 0.01) but no significant difference in daily DEXA medication - DM2 patients: 7.9 mg/d (±1.9) vs. non-DM2: 9.3 mg/dl (±5.7; p = 0.29). The EQD2 Dmean to the total GS was 36.0Gy (±8.6 Gy). There was a tendency for a higher increase in maximum BG values with more radiation dose to the total GS (b = 1.9, R2 = 0.103, p = 0.06). CONCLUSION BG levels in GBM patients are in direct correlation to the dose of RT applied to the central GS. GBM patients that undergo RT should thus be closely monitored for changes in BG levels during and after the radiation.
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Affiliation(s)
- Marciana N Duma
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University, Munich, Germany. .,Faculty of Medicine, Technical University, Munich, Germany. .,Department of Radiotherapy and Radiation Oncology, University Hospital Jena, Bachstr. 18, 07743, Jena, Germany.
| | | | - Tobias Boeckh-Behrens
- Department of Neuroradiology, Klinikum rechts der Isar, Technical University, Munich, Germany
| | - Markus Oechsner
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University, Munich, Germany
| | - Claus Zimmer
- Department of Neuroradiology, Klinikum rechts der Isar, Technical University, Munich, Germany
| | - Bernhard Meyer
- Department of Neurosurgery, Klinikum rechts der Isar, Technical University, Munich, Germany
| | - Paul T Pfluger
- Research Unit NeuroBiology of Diabetes, Helmholtz Diabetes Center, Helmholtz Zentrum München (HMGU), Oberschleißheim, Germany
| | - Stephanie E Combs
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University, Munich, Germany.,Department of Radiation Sciences (DRS), Institute of Innovative Radiotherapy (iRT), Helmholtz Zentrum München (HMGU), Oberschleißheim, Germany.,Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partner Site Munich, Munich, Germany
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Borm KJ, Loos M, Oechsner M, Mayinger MC, Paepke D, Kiechle MB, Combs SE, Duma MN. Acute radiodermatitis in modern adjuvant 3D conformal radiotherapy for breast cancer - the impact of dose distribution and patient related factors. Radiat Oncol 2018; 13:218. [PMID: 30404664 PMCID: PMC6223003 DOI: 10.1186/s13014-018-1160-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [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: 04/12/2018] [Accepted: 10/22/2018] [Indexed: 12/20/2022] Open
Abstract
Purpose This study was performed to evaluate skin toxicity during modern three-dimensional conformal radiotherapy (3D-CRT) and to evaluate the importance of dose distribution and patient related factors. Material and methods This study comprises 255 patients with breast cancer treated with tangential three-dimensional conformal radiotherapy (3D-CRT) after breast conserving surgery between 03/2012 and 05/2017. The median prescribed dose was 50.4 Gy (range 50–50.4) and 92.2% of the patients received a sequential boost of 10–16 Gy. Adverse skin toxicities (according to CTCAE v. 4.03 and the occurrence of moist desquamations) were assessed at the end of treatment. The dose distribution in the skin (5 mm strip from the patient outline) and in the CTV was evaluated and correlated to the CTCAE scores and the occurrence of moist desquamation. Results 42.4% of the patients developed grade I, 55.7% grade II and 2% grade III skin toxicities. Moist desquamation was observed in 59 cases (23.1%). Dose distribution within the CTV and skin was homogenous with only small areas receiving 107% of the prescribed dose (median: 0.7 cm3) in the CTV and 105% (median 0.5 cm3) in the skin. On univariate analysis breast size as well as V107%(CTV), V105%(skin) and V80%(skin) correlated significantly (p < 0.05) with the incidence of skin toxicity. On multivariate analysis only V80%(skin) was confirmed as independent risk factor. Conclusion Modern tangential multi-field 3D-CRT allows a homogeneous dose distribution with similar skin toxicity as compared to studies performing IMRT. Dose distribution within the skin (V80%) might have a relevant impact on the severity of skin toxicity and the occurrence of moist desquamation.
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Affiliation(s)
- Kai J Borm
- Department of Radiotherapy, Klinikum Rechts der Isar, Technical University, Munich, Germany
| | | | - Markus Oechsner
- Department of Radiotherapy, Klinikum Rechts der Isar, Technical University, Munich, Germany
| | - Michael C Mayinger
- Department of Radiotherapy, Klinikum Rechts der Isar, Technical University, Munich, Germany
| | - Daniela Paepke
- Department of Gynecology and Obstetrics, Klinikum Rechts der Isar, Technical University, Munich, Germany
| | - Marion B Kiechle
- Department of Gynecology and Obstetrics, Klinikum Rechts der Isar, Technical University, Munich, Germany
| | - Stephanie E Combs
- Department of Radiotherapy, Klinikum Rechts der Isar, Technical University, Munich, Germany.,Deutsches Konsortium für Translationale Krebsforschung (DKTK)-Partner Site Munich, 81675, Munich, Germany.,Institute of Innovative Radiohterapy, Helmholtzzentrum München, Munich, Germany
| | - Marciana N Duma
- Department of Radiotherapy, Klinikum Rechts der Isar, Technical University, Munich, Germany. .,Institute of Innovative Radiohterapy, Helmholtzzentrum München, Munich, Germany. .,Department of Radiation Oncology, Klinikum rechts der Isar/ TU Munchen, Ismaninger Strasse 22, 81675, Munchen, Germany.
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Sage EK, Schmid TE, Geinitz H, Gehrmann M, Sedelmayr M, Duma MN, Combs SE, Multhoff G. Effects of definitive and salvage radiotherapy on the distribution of lymphocyte subpopulations in prostate cancer patients. Strahlenther Onkol 2017; 193:648-655. [PMID: 28500490 DOI: 10.1007/s00066-017-1144-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [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: 02/02/2017] [Accepted: 04/20/2017] [Indexed: 01/27/2023]
Abstract
BACKGROUND Radiotherapy (RT) is an established treatment for patients with primary and recurrent prostate cancer. Herein, the effects of definitive and salvage RT on the composition of lymphocyte subpopulations were investigated in patients with prostate cancer to study potential immune effects. PATIENTS AND METHODS A total of 33 prostate cancer patients were treated with definitive (n = 10) or salvage RT (n = 23) after biochemical relapse. The absolute number of lymphocytes and the distribution of lymphocyte subpopulations were analyzed by multiparameter flow cytometry before RT, at the end of RT, and in the follow-up period. RESULTS Absolute lymphocyte counts decreased significantly after RT in both patient groups and a significant drop was observed in the percentage of B cells directly after RT from 10.1 ± 1.3 to 6.0 ± 0.7% in patients with definitive RT and from 9.2 ± 0.8 to 5.8 ± 0.7% in patients with salvage RT. In contrast, the percentages of T and natural killer (NK) cells remained unaltered directly after RT in both patient groups. However, 1 year after RT, the percentage of CD3+ T cells was significantly lower in patients with definitive and salvage RT. The percentage of regulatory T cells was slightly upregulated in primary prostate cancer patients after definitive RT, but not after salvage RT. CONCLUSION Definitive and salvage RT exert similar effects on the composition of lymphocyte subpopulations in prostate cancer patients. Total lymphocyte counts are lower in both patient groups compared to healthy controls and further decreased after RT. B cells are more sensitive to definitive and salvage RT than T and NK cells.
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Affiliation(s)
- Eva K Sage
- Department of Radiation Oncology, Klinikum rechts der Isar, Technische Universität München (TUM), Munich, Germany
| | - Thomas E Schmid
- Department of Radiation Oncology, Klinikum rechts der Isar, Technische Universität München (TUM), Munich, Germany
- Department of Radiation Sciences (DRS), Institute of Innovate Radiotherapy (iRT), HelmholtzZentrum München, Munich, Germany
- Partner Site Munich, Deutsches Konsortium für Translationale Krebsforschung (DKTK), Munich, Germany
| | - Hans Geinitz
- Department of Radiation Oncology, Ordensklinikum Linz, Krankenhaus der Barmherzigen Schwestern and Medical Faculty, Johannes Kepler University, Linz, Austria
| | - Mathias Gehrmann
- Department of Radiation Oncology, Klinikum rechts der Isar, Technische Universität München (TUM), Munich, Germany
| | - Michael Sedelmayr
- Department of Radiation Oncology, Klinikum rechts der Isar, Technische Universität München (TUM), Munich, Germany
| | - Marciana N Duma
- Department of Radiation Oncology, Klinikum rechts der Isar, Technische Universität München (TUM), Munich, Germany
- Department of Radiation Sciences (DRS), Institute of Innovate Radiotherapy (iRT), HelmholtzZentrum München, Munich, Germany
| | - Stephanie E Combs
- Department of Radiation Oncology, Klinikum rechts der Isar, Technische Universität München (TUM), Munich, Germany
- Department of Radiation Sciences (DRS), Institute of Innovate Radiotherapy (iRT), HelmholtzZentrum München, Munich, Germany
- Partner Site Munich, Deutsches Konsortium für Translationale Krebsforschung (DKTK), Munich, Germany
| | - Gabriele Multhoff
- Department of Radiation Oncology, Klinikum rechts der Isar, Technische Universität München (TUM), Munich, Germany.
- Department of Radiation Sciences (DRS), Institute of Innovate Radiotherapy (iRT), HelmholtzZentrum München, Munich, Germany.
- Partner Site Munich, Deutsches Konsortium für Translationale Krebsforschung (DKTK), Munich, Germany.
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Duma MN, Heinrich C, Schönknecht C, Chizzali B, Mayinger M, Devecka M, Kampfer S, Combs SE. Helical TomoTherapy for locally advanced or recurrent breast cancer. Radiat Oncol 2017; 12:31. [PMID: 28129767 PMCID: PMC5273793 DOI: 10.1186/s13014-016-0736-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [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: 02/19/2016] [Accepted: 12/01/2016] [Indexed: 12/25/2022] Open
Abstract
Purpose We report our experience of using helical tomotherapy (HT) to treat large and irregular shaped loco-regional advanced breast cancer target volumes embracing various organs at risk. Patients and methods We retrospectively analyzed 26 patients treated for very large, irregular shaped breast cancers. Patients were treated either with the intent to achieve local control in a primary setting (n = 14) or in a reirradiation setting (n = 12). The recurrence group was heavily pretreated with systemic therapy. Tumors were characterized by wide infiltration of the skin, encompassing mostly a complete hemithorax. The primary group underwent irradiation of supraclavicular, infraclavicular, axillary and parasternal lymphonodal region. Radiotherapy was combined with chemotherapy (n = 11). We assessed the PTV volume and its craniocaudal extension, the dose to the organs at risk, acute toxicity and survival. Results Median PTV was 2276 cm3 (1476–6837 cm3) with a median cranio-caudal extension of 28 cm (15–52 cm). The median dose to PTV was 40 Gy (32–60Gy). HT could be carried out in all patients without interruption. The acute toxicities were mild to moderate. The median LRFS and OS after radiotherapy was 21 and 57 months for the primary group versus 10 and 11 months for the recurrence group. Median PFS was 18 months (primary group) and 7 months (recurrence group). Conclusions HT is feasible for advanced thorax embracing target volumes with acceptable acute toxicity. Both curative and palliative indications can be considered good indications based on treatment volume and anatomical constellation.
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Affiliation(s)
- M N Duma
- Department of Radiation Oncology, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Str. 22, 81675, München, Germany. .,Institute of Innovative Radiotherapy (iRT), Helmholtz Zentrum München, München, Germany.
| | - C Heinrich
- Department of Radiation Oncology, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Str. 22, 81675, München, Germany.,Praxis für Strahlentherapie, Hausham, Germany
| | - C Schönknecht
- Department of Radiation Oncology, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Str. 22, 81675, München, Germany
| | - B Chizzali
- Department of Radiation Oncology, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Str. 22, 81675, München, Germany
| | - M Mayinger
- Department of Radiation Oncology, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Str. 22, 81675, München, Germany
| | - M Devecka
- Department of Radiation Oncology, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Str. 22, 81675, München, Germany
| | - S Kampfer
- Department of Radiation Oncology, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Str. 22, 81675, München, Germany
| | - S E Combs
- Department of Radiation Oncology, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Str. 22, 81675, München, Germany.,Institute of Innovative Radiotherapy (iRT), Helmholtz Zentrum München, München, Germany
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13
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Sage EK, Schmid TE, Sedelmayr M, Gehrmann M, Geinitz H, Duma MN, Combs SE, Multhoff G. Comparative analysis of the effects of radiotherapy versus radiotherapy after adjuvant chemotherapy on the composition of lymphocyte subpopulations in breast cancer patients. Radiother Oncol 2015; 118:176-80. [PMID: 26683801 DOI: 10.1016/j.radonc.2015.11.016] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 11/11/2015] [Accepted: 11/16/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Breast cancer is the most common cancer in women worldwide and surgery, radiotherapy (RT) and chemotherapy (ChT) are frequently used to treat this cancer. Adjuvant RT has been shown to cause long-term changes in lymphocyte counts in the peripheral blood. Herein, the time course of changes in lymphocyte subpopulations upon RT was studied in patients with and without adjuvant ChT in order to explore its potential clinical impact. MATERIALS AND METHODS Total lymphocyte counts and the composition of lymphocyte subpopulations before RT (t0), after 30 Gy (t1), at the end of RT (t2), and 6 weeks (t3), 6 months (t4), and 1 year (t5) after RT were studied by flow cytometry. RESULTS Absolute lymphocyte counts were significantly lower in all breast cancer patients (n=40) before and also 1 year after RT compared to healthy controls. The percentage of CD3(+)/CD4(+) helper T cells and FoxP3(+) regulatory T cells increased significantly in patients without adjuvant ChT. Different NK cell subpopulations dropped during RT in patients with and without ChT, but recovered to initial levels 6months after RT (t4). During RT (t0-t2) the percentage of CD19(+) B cells significantly dropped in patients without ChT, but gradually increased in patients with adjuvant ChT. Both patient groups reached initial levels 6 months after RT (t4). CONCLUSION Different lymphocyte subpopulations respond differently to RT with and without adjuvant ChT. CD4(+) T cells increase during RT, whereas NK cells and B cells decrease in patients without ChT, but recover within 6 months after RT. Treg cells gradually increase in patients without ChT from t0 to t5, but not in patients with adjuvant ChT.
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Affiliation(s)
- Eva K Sage
- Department of Radiation Oncology, Klinikum rechts der Isar, Technische Universität München (TUM), Germany
| | - Thomas E Schmid
- Department of Radiation Oncology, Klinikum rechts der Isar, Technische Universität München (TUM), Germany; HelmholtzZentrum München, Department of Radiation Sciences (DRS), Institute of Innovative Radiotherapy (iRT), Germany; Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partner Site Munich, Germany
| | - Michael Sedelmayr
- Department of Radiation Oncology, Klinikum rechts der Isar, Technische Universität München (TUM), Germany
| | - Mathias Gehrmann
- Department of Radiation Oncology, Klinikum rechts der Isar, Technische Universität München (TUM), Germany
| | - Hans Geinitz
- Department of Radiation Oncology, Krankenhaus der Barmherzigen Schwestern and Medical Faculty, Johannes Kepler University Linz, Austria
| | - Marciana N Duma
- Department of Radiation Oncology, Klinikum rechts der Isar, Technische Universität München (TUM), Germany; HelmholtzZentrum München, Department of Radiation Sciences (DRS), Institute of Innovative Radiotherapy (iRT), Germany
| | - Stephanie E Combs
- Department of Radiation Oncology, Klinikum rechts der Isar, Technische Universität München (TUM), Germany; HelmholtzZentrum München, Department of Radiation Sciences (DRS), Institute of Innovative Radiotherapy (iRT), Germany; Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partner Site Munich, Germany
| | - Gabriele Multhoff
- Department of Radiation Oncology, Klinikum rechts der Isar, Technische Universität München (TUM), Germany; HelmholtzZentrum München, Department of Radiation Sciences (DRS), Institute of Innovative Radiotherapy (iRT), Germany; Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partner Site Munich, Germany.
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Duma MN, Molls M, Trott KR. From heart to heart for breast cancer patients - cardiovascular toxicities in breast cancer radiotherapy. Strahlenther Onkol 2013; 190:5-7. [PMID: 24253182 DOI: 10.1007/s00066-013-0465-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Accepted: 09/11/2013] [Indexed: 12/25/2022]
Affiliation(s)
- M N Duma
- Department of Radiation Oncology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 , München, Germany,
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Bundschuh RA, Andratschke N, Dinges J, Duma MN, Astner ST, Brügel M, Ziegler SI, Molls M, Schwaiger M, Essler M. Respiratory gated [18F]FDG PET/CT for target volume delineation in stereotactic radiation treatment of liver metastases. Strahlenther Onkol 2012; 188:592-8. [PMID: 22441441 DOI: 10.1007/s00066-012-0094-3] [Citation(s) in RCA: 32] [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: 11/29/2011] [Accepted: 02/02/2012] [Indexed: 11/28/2022]
Abstract
PURPOSE The use of 4D-[(18)F]fluorodeoxyglucose (FDG) PET/CT in combination with respiratory gated magnet resonance imaging (MRI) in target volume definition for stereotactic radiation of liver metastases was investigated. METHODS AND MATERIALS A total of 18 patients received respiration gated FDG-PET/CT and MRI. Data were fused using a rigid co-registration algorithm. The quality of the co-registration was rated on a scale from 1 (excellent) to 5 (poor) for co-registration of MRI with gated PET and ungated PET. Gross tumor volume (GTV) was delineated in CT (GTV (CT)), MRI (GTV(MRI)), and PET (GTV(PET)). MRI- and PET-based GTVs were defined by three observers each. Interobserver variability was calculated for all patients as well as for subgroups with and without previous treatment of liver metastases. All GTVs were compared for all patients and separately for patients with previous local therapy. In addition, a semiautomatic segmentation algorithm was applied on the PET images. RESULTS Co-registration between MR and PET images was rated with 3.3 in average when non-gated PET was used and improved significantly (p < 0.01) to 2.1 using gated PET. The average GTV(CT) was 51.5 ml, GTV(MRI) 51.8 ml, and the average GTV(PET) 48.1 ml. Volumes delineated in MRI were 9.9% larger compared to those delineated in CT. Volumes delineated in PET were 13.8% larger than in MRI. The differences between the GTVs were more pronounced in patients with previous treatment. The GTVs defined in MRI showed an interobserver variability of 47.9% (84.1% with previous treatment and 26.2% without previous treatment). The PET-defined GTVs showed an interobserver variability of 21% regardless of previous treatment. Semiautomatic segmentation did not provide satisfying results. CONCLUSION FDG-PET can distinguish vital tumor tissue and scar tissue, and therefore alters the GTV especially in patients with previous local treatment. In addition, it reduces the interobserver variability significantly compared to MRI. However, respiratory gated PET is necessary for good co-registration of PET and MRI.
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Affiliation(s)
- R A Bundschuh
- Nuklearmedizinische Klinik und Poliklinik, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Str. 22, 81675, Munich, Germany.
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Geier M, Astner ST, Duma MN, Jacob V, Nieder C, Putzhammer J, Winkler C, Molls M, Geinitz H. Dose-escalated simultaneous integrated-boost treatment of prostate cancer patients via helical tomotherapy. Strahlenther Onkol 2012; 188:410-6. [PMID: 22367410 DOI: 10.1007/s00066-012-0081-8] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2011] [Accepted: 01/20/2012] [Indexed: 11/28/2022]
Abstract
PURPOSE The goal of this work was to assess the feasibility of moderately hypofractionated simultaneous integrated-boost intensity-modulated radiotherapy (SIB-IMRT) with helical tomotherapy in patients with localized prostate cancer regarding acute side effects and dose-volume histogram data (DVH data). METHODS Acute side effects and DVH data were evaluated of the first 40 intermediate risk prostate cancer patients treated with a definitive daily image-guided SIB-IMRT protocol via helical tomotherapy in our department. The planning target volume including the prostate and the base of the seminal vesicles with safety margins was treated with 70 Gy in 35 fractions. The boost volume containing the prostate and 3 mm safety margins (5 mm craniocaudal) was treated as SIB to a total dose of 76 Gy (2.17 Gy per fraction). Planning constraints for the anterior rectal wall were set in order not to exceed the dose of 76 Gy prescribed to the boost volume. Acute toxicity was evaluated prospectively using a modified CTCAE (Common Terminology Criteria for Adverse Events) score. RESULTS SIB-IMRT allowed good rectal sparing, although the full boost dose was permitted to the anterior rectal wall. Median rectum dose was 38 Gy in all patients and the median volumes receiving at least 65 Gy (V65), 70 Gy (V70), and 75 Gy (V75) were 13.5%, 9%, and 3%, respectively. No grade 4 toxicity was observed. Acute grade 3 toxicity was observed in 20% of patients involving nocturia only. Grade 2 acute intestinal and urological side effects occurred in 25% and 57.5%, respectively. No correlation was found between acute toxicity and the DVH data. CONCLUSION This institutional SIB-IMRT protocol using daily image guidance as a precondition for smaller safety margins allows dose escalation to the prostate without increasing acute toxicity.
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Affiliation(s)
- M Geier
- Klinik und Poliklinik für Strahlentherapie und Radiologische Onkologie, Technische Universität München, Ismaninger Str. 22, 81675, München, Germany
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Kampfer S, Schell S, Duma MN, Wilkens JJ, Kneschaurek P. Measurements to predict the time of target replacement of a helical tomotherapy. J Appl Clin Med Phys 2011; 12:3596. [PMID: 22089018 PMCID: PMC5718742 DOI: 10.1120/jacmp.v12i4.3596] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2011] [Revised: 05/23/2011] [Accepted: 06/27/2011] [Indexed: 11/30/2022] Open
Abstract
Intensity‐modulated radiation therapy (IMRT) requires more beam‐on time than normal open field treatment. Consequently, the machines wear out and need more spare parts. A helical tomotherapy treatment unit needs a periodical tungsten target replacement, which is a time consuming event. To be able to predict the next replacement would be quite valuable. We observed unexpected variations towards the end of the target lifetime in the performed pretreatment measurements for patient plan verification. Thus, we retrospectively analyze the measurements of our quality assurance program. The time dependence of the quotient of two simultaneous dose measurements at different depths within a phantom for a fixed open field irradiation is evaluated. We also assess the time‐dependent changes of an IMRT plan measurement and of a relative depth dose curve measurement. Additionally, we performed a Monte Carlo simulation with Geant4 to understand the physical reasons for the measured values. Our measurements show that the dose at a specified depth compared to the dose in shallower regions of the phantom declines towards the end of the target lifetime. This reproducible effect can be due to the lowering of the mean energy of the X‐ray spectrum. These results are supported by the measurements of the IMRT plan, as well as the study of the relative depth dose curve. Furthermore, the simulation is consistent with these findings since it provides a possible explanation for the reduction of the mean energy for thinner targets. It could be due to the lowering of low energy photon self‐absorption in a worn out and therefore thinner target. We state a threshold value for our measurement at which a target replacement should be initiated. Measurements to observe a change in the energy are good predictors of the need for a target replacement. However, since all results support the softening of the spectrum hypothesis, all depth‐dependent setups are viable for analyzing the deterioration of the tungsten target. The suggested measurements and criteria to replace the target can be very helpful for every user of a TomoTherapy machine. PACS numbers: 87.55.N‐, 87.55.Qr, 87.55.T‐, 87.56.bd
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Affiliation(s)
- Severin Kampfer
- Department of Radiation Oncology, Technische Universität München, Klinikum rechts der Isar, München, Germany.
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Sension MG, Quinn TC, Markowitz LE, Linnan MJ, Jones TS, Francis HL, Nzilambi N, Duma MN, Ryder RW. Measles in hospitalized African children with human immunodeficiency virus. Am J Dis Child 1988; 142:1271-2. [PMID: 3195521 DOI: 10.1001/archpedi.1988.02150120025021] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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