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Klement RJ, Abbasi-Senger N, Adebahr S, Alheid H, Allgaeuer M, Becker G, Blanck O, Boda-Heggemann J, Brunner T, Duma M, Eble MJ, Ernst I, Gerum S, Habermehl D, Hass P, Henkenberens C, Hildebrandt G, Imhoff D, Kahl H, Klass ND, Krempien R, Lewitzki V, Lohaus F, Ostheimer C, Papachristofilou A, Petersen C, Rieber J, Schneider T, Schrade E, Semrau R, Wachter S, Wittig A, Guckenberger M, Andratschke N. The impact of local control on overall survival after stereotactic body radiotherapy for liver and lung metastases from colorectal cancer: a combined analysis of 388 patients with 500 metastases. BMC Cancer 2019; 19:173. [PMID: 30808323 PMCID: PMC6390357 DOI: 10.1186/s12885-019-5362-5] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [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: 06/10/2018] [Accepted: 02/11/2019] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND The aim of this analysis was to model the effect of local control (LC) on overall survival (OS) in patients treated with stereotactic body radiotherapy (SBRT) for liver or lung metastases from colorectal cancer. METHODS The analysis is based on pooled data from two retrospective SBRT databases for pulmonary and hepatic metastases from 27 centers from Germany and Switzerland. Only patients with metastases from colorectal cancer were considered to avoid histology as a confounding factor. An illness-death model was employed to model the relationship between LC and OS. RESULTS Three hundred eighty-eight patients with 500 metastatic lesions (lung n = 209, liver n = 291) were included and analyzed. Median follow-up time for local recurrence assessment was 12.1 months. Ninety-nine patients with 112 lesions experienced local failure. Seventy-one of these patients died after local failure. Median survival time was 27.9 months in all patients and 25.4 months versus 30.6 months in patients with and without local failure after SBRT. The baseline risk of death after local failure exceeds the baseline risk of death without local failure at 10 months indicating better survival with LC. CONCLUSION In CRC patients with lung or liver metastases, our findings suggest improved long-term OS by achieving metastatic disease control using SBRT in patients with a projected OS estimate of > 12 months.
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Affiliation(s)
- Rainer J Klement
- Department of Radiation Oncology, Leopoldina Hospital Schweinfurt, Schweinfurt, Germany
| | - N Abbasi-Senger
- Department of Radiation Oncology, University Hospital Jena, Jena, Germany
| | - S Adebahr
- Department of Radiation Oncology, University Hospital Freiburg, Freiburg, Germany
| | - H Alheid
- Strahlentherapie Bautzen, Bautzen, Germany
| | - M Allgaeuer
- Department of Radiation Oncology, Hospital Barmherzige Brueder, Regensburg, Germany
| | - G Becker
- RadioChirurgicum CyberKnife Suedwest, Goeppingen, Germany
| | - O Blanck
- Department of Radiation Oncology Universitaetsklinikum Schleswig-Holstein, Luebeck, Germany
| | - J Boda-Heggemann
- Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - T Brunner
- Department of Radiation Oncology, University Hospital Freiburg, Freiburg, Germany
| | - M Duma
- Department of Radiation Oncology, Klinikum rechts der Isar- Technische Universitaet Muenchen, Munich, Germany
| | - M J Eble
- Department of Radiation Oncology, University Hospital Aachen, Aachen, Germany
| | - I Ernst
- Department of Radiation Oncology, University Hospital Muenster, Muenster, Germany
| | - S Gerum
- Department of Radiation Oncology, Ludwig Maximilians University Munich, Munich, Germany
| | - D Habermehl
- Department of Radiation Oncology, Klinikum rechts der Isar- Technische Universitaet Muenchen, Munich, Germany.,Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany
| | - P Hass
- Department of Radiation Oncology, University Hospital Magdeburg, Magdeburg, Germany
| | - C Henkenberens
- Department of Radiotherapy and Special Oncology, Medical School Hannover, Hanover, Germany
| | - G Hildebrandt
- Department of Radiation Oncology, University of Rostock, Rostock, Germany
| | - D Imhoff
- Department of Radiation Oncology, University Hospital Frankfurt, Frankfurt, Germany
| | - H Kahl
- Department of Radiation Oncology, Hospital Augsburg, Augsburg, Germany
| | - N D Klass
- Department of Radiation Oncology, University Hospital Bern, Bern, Switzerland
| | - R Krempien
- Department of Radiation Oncology, Helios Klinikum Berlin Buch, Berlin, Germany
| | - V Lewitzki
- Department of Radiation Oncology, University Hospital Wuerzburg, Wuerzburg, Germany
| | - F Lohaus
- Department of Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - C Ostheimer
- Department of Radiation Oncology, University Hospital Halle, Halle, Germany
| | - A Papachristofilou
- Department of Radiation Oncology, University Hospital Hamburg, Hamburg, Germany
| | - C Petersen
- Department of Radiation Oncology, University Hospital Basel, Basel, Switzerland
| | - J Rieber
- Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany
| | | | - E Schrade
- Department of Radiation Oncology, Hospital Heidenheim, Heidenheim, Germany
| | - R Semrau
- Department of Radiation Oncology, University Hospital of Cologne, Cologne, Germany
| | - S Wachter
- Department of Radiation Oncology, Klinikum Passau, Passau, Germany
| | - A Wittig
- Department of Radiation Oncology, University Hospital Jena, Jena, Germany.,Department of Radiotherapy and Radiation Oncology, Philipps-University Marburg, University Hospital Giessen and Marburg, Marburg, Germany
| | - M Guckenberger
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - N Andratschke
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland.
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Klement R, Hoerner-Rieber J, Adebahr S, Andratschke N, Blanck O, Boda-Heggemann J, Duma M, Eble M, Eich H, Flentje M, Gerum S, Hass P, Henkenberens C, Hildebrandt G, Imhoff D, Kahl K, Klass N, Krempien R, Lohaus F, Petersen C, Schrade E, Wendt T, Wittig A, Guckenberger M. Stereotactic body radiotherapy (SBRT) for multiple pulmonary oligometastases: Analysis of number and timing of repeat SBRT as impact factors on treatment safety and efficacy. Radiother Oncol 2018; 127:246-252. [DOI: 10.1016/j.radonc.2018.02.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 02/14/2018] [Accepted: 02/15/2018] [Indexed: 12/25/2022]
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Roeder F, Alldinger I, Uhl M, Saleh-Ebrahimi L, Schimmack S, Mechtersheimer G, Büchler M, Debus J, Krempien R, Ulrich A. EP-1633: IOERT in primary retroperitoneal sarcoma: a retrospective single center analysis of 69 cases. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)31942-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Hörner-Rieber J, Abbasi-Senger N, Blanck O, Boda-Heggemann J, Duma M, Eble M, Eich H, Flentje M, Gerum S, Haas P, Henkenberens C, Imhoff D, Kahl H, Klass N, Krempien R, Lohaus F, Petersen C, Sackerer I, Schrade E, Uhlmann L, Wittig A, Guckenberger M. PV-0043: Histology as predictor for outcome following SBRT in NSCLC patients with lung oligo-metastases. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)30353-0] [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: 11/26/2022]
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Saleh-Ebrahimi L, Alldinger I, Uhl M, Schimmack S, Mechtersheimer G, Büchler M, Debus J, Krempien R, Ulrich A, Roeder F. EP-1634: IOERT in locally recurrent high grade RPS: a retrospective single center analysis of 83 cases. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)31943-1] [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: 11/25/2022]
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Guckenberger M, Klement R, Rieber J, Adebahr S, Andratschke N, Blanck O, Boda-Heggemann J, Duma M, Eble M, Eich H, Flentje M, Gerum S, Haas P, Henkenberens C, Hildebrandt G, Imhoff D, Kahl H, Klass N, Krempien R, Lohaus F, Petersen C, Schrade E, Wendt T, Wittig A. PV-0044: Repeat sbrt for pulmonary oligo-metastases. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)30354-2] [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: 10/14/2022]
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Roeder F, De Paoli A, Alldinger I, Bertola G, Boz G, Garcia-Sabrido J, Uhl M, Alvarez A, Lehner B, Calvo F, Krempien R. EP-1376: IOERT combined with EBRT in R1-resected soft tissue sarcomas of the extremities: a pooled analysis. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)31811-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: 10/19/2022]
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Tanadini-Lang S, Rieber J, Filippi AR, Fode MM, Streblow J, Adebahr S, Andratschke N, Blanck O, Boda-Heggemann J, Duma M, Eble MJ, Ernst I, Flentje M, Gerum S, Hass P, Henkenberens C, Hildebrandt G, Imhoff D, Kahl H, Klass ND, Krempien R, Lohaus F, Petersen C, Schrade E, Wendt TG, Wittig A, Høyer M, Ricardi U, Sterzing F, Guckenberger M. Nomogram based overall survival prediction in stereotactic body radiotherapy for oligo-metastatic lung disease. Radiother Oncol 2017; 123:182-188. [PMID: 28169042 DOI: 10.1016/j.radonc.2017.01.003] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [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: 08/06/2016] [Revised: 12/28/2016] [Accepted: 01/03/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND Radical local treatment of pulmonary metastases is practiced with increasing frequency due to acknowledgment and better understanding of oligo-metastatic disease. This study aimed to develop a nomogram predicting overall survival (OS) after stereotactic body radiotherapy (SBRT) for pulmonary metastases. PATIENTS AND METHODS A multi-institutional database of 670 patients treated with SBRT for pulmonary metastases was used as training cohort. Cox regression analysis with bidirectional variable elimination was performed to identify factors to be included into the nomogram model to predict 2-year OS. The calibration rate of the nomogram was assessed by plotting the actual Kaplan-Meier 2-year OS against the nomogram predicted survival. The nomogram was externally validated using two separate monocentric databases of 145 and 92 patients treated with SBRT for pulmonary metastases. RESULTS The median follow up of the trainings cohort was 14.3months, the 2-year and 5-year OS was 52.6% and 23.7%, respectively. Karnofsky performance index, type of the primary tumor, control of the primary tumor, maximum diameter of the largest treated metastasis and number of metastases (1 versus >1) were significant prognostic factors in the Cox model (all p<0.05). The calculated concordance-index for the nomogram was 0.73 (concordance indexes of all prognostic factors between 0.54 and 0.6). Based on the nomogram the training cohort was divided into 4 groups and 2-year OS ranged between 24.2% and 76.1% (predicted OS between 30.2% and 78.4%). The nomogram discriminated between risk groups in the two validation cohorts (concordance index 0.68 and 0.67). CONCLUSIONS A nomogram for prediction of OS after SBRT for pulmonary metastases was generated and externally validated. This tool might be helpful for interdisciplinary discussion and evaluation of local and systemic treatment options in the oligo-metastatic setting. KEY MESSAGE A nomogram for prediction of overall survival after stereotactic body radiotherapy (SBRT) for pulmonary metastases was developed and externally validated. This tool might be helpful for interdisciplinary discussion and evaluation of local and systemic treatment options in the oligo-metastatic setting.
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Affiliation(s)
- S Tanadini-Lang
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Switzerland
| | - J Rieber
- Department of Radiation Oncology, University Hospital Heidelberg, Germany; Heidelberg Institute of Radiation Oncology, Germany
| | - A R Filippi
- Department of Oncology, University of Torino, Torino, Italy
| | - M M Fode
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - J Streblow
- Department of Radiation Oncology, University Hospital Heidelberg, Germany; Heidelberg Institute of Radiation Oncology, Germany
| | - S Adebahr
- Department of Radiation Oncology, University Hospital Freiburg, Germany
| | - N Andratschke
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Switzerland; Department of Radiation Oncology, University of Rostock, Germany
| | - O Blanck
- Department of Radiation Oncology, UKSH Universitätsklinikum Schleswig Holstein, Kiel, Germany
| | - J Boda-Heggemann
- Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Germany
| | - M Duma
- Department of Radiation Oncology, Technical University Munich, Germany
| | - M J Eble
- Department of Radiation Oncology, University Hospital Aachen, Germany
| | - I Ernst
- Department of Radiation Oncology, University Hospital Münster, Germany
| | - M Flentje
- Department of Radiation Oncology, University Hospital Wuerzburg, Germany
| | - S Gerum
- Department of Radiation Oncology, 11 Ludwig Maximilians University Munich, Germany
| | - P Hass
- Department of Radiation Oncology, University Hospital Magdeburg, Germany
| | - C Henkenberens
- Department of Radiotherapy and Special Oncology, Medical School Hannover, Germany
| | - G Hildebrandt
- Department of Radiation Oncology, University of Rostock, Germany
| | - D Imhoff
- Department of Radiation Oncology, University Hospital Frankfurt, Germany
| | - H Kahl
- Department of Radiation Oncology, Hospital Augsburg, Germany
| | - N D Klass
- Department of Radiation Oncology, Bern University Hospital, Bern, Switzerland
| | - R Krempien
- Department of Radiation Oncology, Helios Klinikum Berlin Buch, Germany
| | - F Lohaus
- Department of Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany; German Cancer Research Center (DKFZ), Heidelberg Germany and German Cancer Consortium (DKTK), Dresden, Germany; OncoRay - National Center for Radiation Research in Oncology (NCRO), Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany
| | - C Petersen
- Department of Radiation Oncology, University Hospital Hamburg, Germany
| | - E Schrade
- Department of Radiation Oncology, Hospital Heidenheim, Germany
| | - T G Wendt
- Department of Radiation Oncology, University Hospital Jena, Germany
| | - A Wittig
- Department of Radiotherapy and Radiation Oncology, Philipps-University Marburg, University Hospital Giessen and Marburg, Germany
| | - M Høyer
- Danish Center for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - U Ricardi
- Department of Oncology, University of Torino, Torino, Italy
| | - F Sterzing
- Department of Radiation Oncology, University Hospital Heidelberg, Germany; Heidelberg Institute of Radiation Oncology, Germany; German Cancer Research Center, Clinical Cooperation Unit Radiation Oncology, Heidelberg, Germany
| | - M Guckenberger
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Switzerland.
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Roeder F, De Paoli A, Alldinger I, Bertola G, Boz G, Garcia-Sabredo J, Uhl M, Alvarez A, Lehner B, Calvo F, Krempien R. OC-0521: IORT after gross total resection combined with EBRT in extremity soft tissue sarcoma: a pooled analysis. Radiother Oncol 2015. [DOI: 10.1016/s0167-8140(15)40516-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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10
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Kurz S, Tessmer A, Krempien R, Lüders H, Bauer TT, Grohé C, Kollmeier J. Sequentielle Chemo – IM Radiotherapie zur Behandlung des malignen Pleuramesotheliom. Pneumologie 2015. [DOI: 10.1055/s-0035-1544663] [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: 10/24/2022]
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11
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Roeder F, Ulrich A, Habl G, Uhl M, Saleh-Ebrahimi L, Huber P, Schulz-Ertner D, Nikoghosyan A, Alldinger I, Krempien R, Mechtersheimer G, Hensley F, Debus J, Bischof M. Prospective Phase I/II Trial to Investigate Preoperative IMRT, Surgery and IOERT in Retroperitoneal Soft Tissue Sarcoma: Interim Analysis. Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2014.05.547] [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: 10/24/2022]
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Krempien R. [Surgical extirpation. The therapy of choice for chondrosarcoma of the larynx]. HNO 2011; 59:350-1. [PMID: 21647831 DOI: 10.1007/s00106-011-2287-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- R Krempien
- Klinik für Strahlentherapie, Sarkomzentrum Berlin-Brandenburg, Helios-Klinik Berlin-Buch, Berlin.
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Roeder F, Timke C, Habl MUG, Krautter U, Hensley F, Buechler M, Werner J, Debus J, Huber P, Krempien R. 33 poster AGGRESSIVE LOCAL TREATMENT CONTAINING INTRAOPERATIVE RADIATION THERAPY (IORT) FOR PATIENTS WITH ISOLATED LOCAL RECURRENCES OF PANCREATIC CANCER. Radiother Oncol 2011. [DOI: 10.1016/s0167-8140(11)70156-6] [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: 10/18/2022]
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Roeder F, Schramm O, Schwahofer A, Timke C, Habl G, Tanner M, Huber P, Debus J, Krempien R, Hensley F. 600 poster POSTPLANNING OF A THREE-DIMENSIONAL DOSE DISTRIBUTION FOR INTRAOPERATIVE ELECTRON RADIATION THERAPY (IOERT) USING INTRAOPERATIVE C-ARM BASED 3D-IMAGING : A PHANTOM STUDY. Radiother Oncol 2011. [DOI: 10.1016/s0167-8140(11)70722-8] [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: 10/18/2022]
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Hirche C, Dresel S, Krempien R, Hünerbein M. Sentinel Node Biopsy by Indocyanine Green Retention Fluorescence Detection for Inguinal Lymph Node Staging of Anal Cancer: Preliminary Experience. Ann Surg Oncol 2010. [DOI: 10.1245/s10434-010-1278-7] [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: 11/18/2022]
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16
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Kusters M, Valentini V, Calvo F, Krempien R, Nieuwenhuijzen G, Martijn H, Doglietto G, del Valle E, Roeder F, Buchler M, van de Velde C, Rutten H. Results of European pooled analysis of IORT-containing multimodality treatment for locally advanced rectal cancer: adjuvant chemotherapy prevents local recurrence rather than distant metastases. Ann Oncol 2010; 21:1279-1284. [DOI: 10.1093/annonc/mdp501] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
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Hirche C, Dresel S, Krempien R, Hünerbein M. Sentinel node biopsy by indocyanine green retention fluorescence detection for inguinal lymph node staging of anal cancer: preliminary experience. Ann Surg Oncol 2010; 17:2357-62. [PMID: 20217256 DOI: 10.1245/s10434-010-1010-7] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2009] [Indexed: 12/24/2022]
Abstract
BACKGROUND There is some evidence that sentinel lymph node (SLN) biopsy guided by dye injection and/or radioisotopes can improve staging of inguinal lymph nodes (LNs) in anal cancer. This study was performed to investigate the feasibility of fluorescence detection of SLN and lymphatic mapping in anal cancer. METHODS Twelve patients with anal cancer without evidence for inguinal LN involvement were included in the study. Intraoperatively, all patients received a peritumorous injection of 25 mg indocyanine green (ICG) for fluorescence imaging of the SLN with a near-infrared camera. For comparison, conventional SLN detection by technetium-(99)m-sulfur radiocolloid injection in combination with blue dye was also performed in all patients. The results of both techniques and the effect on the therapeutic regimen were analyzed. RESULTS Overall, ICG fluorescence imaging identified at least one SLN in 10 of 12 patients (detection rate, 83%). With the combination of radionuclide and blue dye, SLN were detected in 9 of 12 patients (detection rate, 75%). Metastatic involvement of the SLN was found in 2 of 10 patients versus 2 of 9 patients. Patients with metastatic involvement of the SLN received extended radiation field with inguinal boost. CONCLUSIONS ICG fluorescence imaging allows intraoperative lymphatic mapping and transcutaneous SLN detection for selective biopsy of inguinal SLN in anal cancer. This technique should be further evaluated in comparative studies with larger patient numbers.
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Affiliation(s)
- C Hirche
- Department of General Surgery and Surgical Oncology, Robert Rössle Hospital, Helios Hospital Berlin-Buch, Berlin, Germany
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Brief J, Hassfeld S, Däuber S, Pernozzoli A, Münchenberg J, Redlich T, Walz M, Krempien R, Weisser H, Poeckler C, Raczkowsky J, Burgert O, Salb T, Kotrikova B, Rembold U, Wörn H, Dillmann R, Mühling J. 3D Norm Data: The First Step towards Semiautomatic Virtual Craniofacial Surgery. ACTA ACUST UNITED AC 2010. [DOI: 10.3109/10929080009149853] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Timke C, Abdollahi A, Roeder F, Krempien R, Wagner M, Friess H, Werner J, Debus J, Huber P. Concurrent IMRT and Gemcitabine ± Cetuximab in Primarily Inoperable Adenocarcinomas of the Pancreas: Clinical Outcome and Serum Proteomics. Int J Radiat Oncol Biol Phys 2009. [DOI: 10.1016/j.ijrobp.2009.07.386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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20
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Huber P, Timke C, Wagner M, Schwager C, Zabel-du Bois A, Friess H, Debus J, Krempien R, Muenter M, Abdollahi A. Blood Transcriptomics Based Biomarker for Prediction of Clinical Outcome in Locally Advanced Pancreatic Cancer Patients Treated with Concurrent IMRT, Gemcitabine and Cetuximab. Int J Radiat Oncol Biol Phys 2008. [DOI: 10.1016/j.ijrobp.2008.06.798] [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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Roeder F, Oertel S, Timke C, Weitz J, Buchler M, Lehner B, Hensley F, Muenter M, Krempien R, Debus J. Intraoperative Electron Radiation Therapy (IOERT) as Part of a Multimodal Treatment Approach in Liposarcomas. Int J Radiat Oncol Biol Phys 2008. [DOI: 10.1016/j.ijrobp.2008.06.1481] [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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Abstract
There is a wide variety of conjunctival tumors. A good diagnosis can be reached by discussing the case history with the patient in conjunction with a slit-lamp examination. Presented here is the case of a 39-year-old patient with a rapidly growing conjunctival tumor on his left eye. After tumor resection and histological analysis, a plasmacytoma was found. The completed hemato-oncological analysis gave no further suspicious pathological results, leading to the diagnosis of a solitary extramedullary plasmacytoma. Percutaneous radiotherapy was carried out.
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Affiliation(s)
- B Schulze
- Augenklinik, Helios Klinikum Berlin Buch, Schwanebecker Chaussee 50, 13125 Berlin, Deutschland.
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Munter M, Timke C, Abdollahi A, Friess H, Jaeger D, Heeger S, Buchler M, Debus J, Huber P, Krempien R. Final results of a phase II trial [PARC-Study ISRCTN56652283] for patients with primary inoperable locally advanced pancreatic cancer combining intensity modulated radiotherapy (IMRT) with cetuximab and gemcitabine. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.4613] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [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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Welzel T, Niethammer A, Mende U, Heiland S, Wenz F, Debus J, Krempien R. Diffusion tensor imaging screening of radiation-induced changes in the white matter after prophylactic cranial irradiation of patients with small cell lung cancer: first results of a prospective study. AJNR Am J Neuroradiol 2008; 29:379-83. [PMID: 17974610 DOI: 10.3174/ajnr.a0797] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.3] [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: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Diffusion tensor imaging (DTI) will show abnormal fractional anisotropy (FA) in the normal-appearing brain after prophylactic cranial irradiation (PCI). These abnormalities will be more accentuated in patients with underlying vascular risk factors. MATERIALS AND METHODS A prospective study by use of DTI and conventional T2-weighted MR images was performed with a 1.5T unit with 16 patients with small cell lung cancer and undergoing PCI. All of the T2-weighted images were evaluated with respect to abnormalities in signal intensity of white matter as markers of radiation damage. Measurements of FA were performed before, at the end of, and 6 weeks after radiation therapy. On the FA maps, the bifrontal white matter, the corona radiata, the cerebellum, and the brain stem were evaluated. FA values were compared with respect to age, demographic, and vascular risk factors. Statistical analyses (Friedman test, Wilcoxon test, and Mann-Whitney U test) were performed. RESULTS Fractional anisotropy decreased significantly in supratentorial and infratentorial normal-appearing white matter from the beginning to the end of PCI (P < .01). A further decline in FA occurred 6 weeks after irradiation (P < .05). A stronger reduction in FA was observed in patients with more than 1 vascular risk factor. There was an age-related reduction of white matter FA. Patients 65 years and older showed a trend toward a stronger reduction in FA. CONCLUSION During the acute phase, after PCI, patients with many vascular risk factors showed stronger damage in the white matter compared with patients with only 1 risk factor.
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Affiliation(s)
- T Welzel
- Department of Radiooncology, University of Heidelberg, Heidelberg, Germany.
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Roeder F, Treiber M, Funk A, Timke C, Krautter U, Buchler M, Lehner B, Debus J, Krempien R. Intraoperative Electron Radiotherapy (IOERT) in the Management of Aggressive Fibromatosis. Int J Radiat Oncol Biol Phys 2007. [DOI: 10.1016/j.ijrobp.2007.07.229] [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: 10/22/2022]
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26
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Combs SE, Schulz-Ertner D, Herfarth KK, Krempien R, Debus J. [Advances in radio-oncology. From precision radiotherapy with photons to ion therapy with protons and carbon ions]. Chirurg 2007; 77:1126-32. [PMID: 17119885 DOI: 10.1007/s00104-006-1268-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [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: 12/25/2022]
Abstract
Modern techniques in radiation oncology, such as fractionated stereotactic radiotherapy (FSRT), stereotactic radiosurgery (SRS) or intensity modulated radiotherapy (IMRT) allow the application of high local doses to defined treatment volumes, while normal structures in close vicinity can be spared; high local control rates can be achieved, while treatment-related toxicity can be minimized. Innovative Hi-Art tomotherapy systems offer an alternative, combining a 6 MV photon accelerator with a CT scanner. Ion beams, such as protons and carbon ions, have been shown to be beneficial for distinct tumor entities. Both offer a characteristic physical dose distribution with an inverse dose profile contributing to beneficial dose conformality. Carbon ions also offer the advantage of increased relative biological effectiveness. For certain tumor types, a significant increase in local control and survival rates could be obtained with carbon ions.
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Affiliation(s)
- S E Combs
- Klinik für Radioonkologie und Strahlentherapie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Deutschland.
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27
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Bischof M, Zierhut D, Neuhof D, Karagiozidis M, Treiber M, Roeder F, Debus J, Krempien R. Indolent Stage IE Non-Hodgkin’s Lymphoma of the Orbit: Results after Primary Radiotherapy. Ophthalmologica 2007; 221:348-52. [PMID: 17728558 DOI: 10.1159/000104766] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2006] [Accepted: 12/15/2006] [Indexed: 11/19/2022]
Abstract
AIMS Primary non-Hodgkin's lymphoma (NHL) of the orbit is uncommon, representing approximately 8% of extranodal NHLs. Twenty-two patients with indolent stage IE NHL were reviewed retrospectively to analyze the outcome and late effects of primary local radiotherapy. MATERIALS AND METHODS The median age at first diagnosis was 63.5 years (range 24-82 years). Extranodal mucosa-associated lymphoid tissue lymphoma (n = 15) was the most common histological subtype of NHL, followed by follicular (n = 6) and lymphoplasmacytic lymphoma (n = 1). Radiotherapy was performed using a linear accelerator. The median radiation dose was 40 Gy (range 30-46 Gy). None of the patients received chemotherapy before irradiation. The follow-up period was 62 months (range 8-136 months). RESULTS A complete response was achieved in all patients. The 5-year local control rate was 100%. Distant relapse occurred in 2 patients, resulting in a 5-year distant relapse-free survival rate of 88%. The 5-year overall survival rate was 89%; there were no lymphoma-related deaths. No serious acute complications (grade 3/4) were observed. Grade 1/2 late effects were documented in 44% of patients. Grade 3 complications (cataract: 2, dryness: 2) were observed in 4 patients (18%). CONCLUSIONS Indolent early stage orbital NHL can be controlled with local radiotherapy. Morbidity is low. Regular follow-up examinations are necessary to detect rare cases of distant relapse.
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Affiliation(s)
- M Bischof
- Department of Radio-Oncology, University of Heidelberg, Heidelberg, Germany.
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Krempien R, Munter MW, Timke C, Friess H, Hartung G, Herfarth KK, Abdollahi A, Buchler MW, Huber PE, Debus J. Cetuximab in combination with intensity modulated radiotherapy (IMRT) and gemcitabine for patients with locally advanced pancreatic cancer: A prospective phase II trial [PARC-Study ISRCTN56652283]. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.4573] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4573 Background: The induction of EGFR targeting with cetuximab in radiation based therapy of solid tumors has yielded promising results. Thus, we initiated a prospective phase II trial designed to analyze the feasibility and effectivity of trimodal therapy with gemcitabine-based chemoradiation and cetuximab in locally advanced inoperable pancreatic cancer. Methods: In this phase 2 study, pts with locally advanced pancreatic cancer without prior cytotoxic therapy were treated with radiotherapy (RT), gemcitabine weekly (300mg/m2), and cetuximab weekly (loading dose 400mg/m2 day 1, and concomitant with radiation day 8,15,22,29,36 250mg/m2). RT was delivered by using an integrated IMRT boost concept (54 Gy GTV, 45 Gy CTV) over 5 weeks. RT was followed by gemcitabine (1,000mg/m2) weekly x 3 in 4 weeks. Response evaluation using CT followed at week 12. All pts were intended for surgical treatment between week 12–15. Pts were followed for adverse events and response. Results: 55 pts were enrolled. Preliminary results are presented on 36 pts with the following characteristics: pancreatic adenocarcinoma c2 T4 N1 36/36, median age = 61.5 (range 48–79); M/F = 24/12; ECOG PS 0/1/2 = 6/26/4; median days on treatment: 90 (range 70–100). Treatment-related toxicities were observed in 22 pts. Grade 3 toxicities included diarrhea (n=5), fatigue (n=4), nausea (n=6), neutropenia (n=10), thrombocytopenia (n=4), and vomiting (n=4). 34/36 pts developed some acneiforme rush during therapy. No omittance of cetuximab was necessary in any of the pts. 1 patient died during treatment due to tumor bleeding. Median follow-up at present is 13 month, 1-year survival was 57%, median survival has not been reached. Partial remissions 12/36, stable disease 20/36, progressive disease 4/36 (RECIST). 21/36 pts were amenable for secondary potentially curative resection. 9 pts could be resected, while 8 pts were found to have abdominal metastatic spread. Conclusions: Early data from trimodal therapy in pancreatic adenocarcinoma with chemoradiation (IMRT), gemcitabine, and cetuximab indicate feasibility without increased toxicity profile. The local response appears to be very promising in pancreatic cancer. [Table: see text]
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Affiliation(s)
- R. Krempien
- University of Heidelberg, Heidelberg, Germany; German Cancer Research Center, Heidelberg, Germany
| | - M. W. Munter
- University of Heidelberg, Heidelberg, Germany; German Cancer Research Center, Heidelberg, Germany
| | - C. Timke
- University of Heidelberg, Heidelberg, Germany; German Cancer Research Center, Heidelberg, Germany
| | - H. Friess
- University of Heidelberg, Heidelberg, Germany; German Cancer Research Center, Heidelberg, Germany
| | - G. Hartung
- University of Heidelberg, Heidelberg, Germany; German Cancer Research Center, Heidelberg, Germany
| | - K. K. Herfarth
- University of Heidelberg, Heidelberg, Germany; German Cancer Research Center, Heidelberg, Germany
| | - A. Abdollahi
- University of Heidelberg, Heidelberg, Germany; German Cancer Research Center, Heidelberg, Germany
| | - M. W. Buchler
- University of Heidelberg, Heidelberg, Germany; German Cancer Research Center, Heidelberg, Germany
| | - P. E. Huber
- University of Heidelberg, Heidelberg, Germany; German Cancer Research Center, Heidelberg, Germany
| | - J. Debus
- University of Heidelberg, Heidelberg, Germany; German Cancer Research Center, Heidelberg, Germany
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Schmitz-Winnenthal FH, Galindo-Escobedo LV, Rimoldi D, Geng W, Romero P, Koch M, Weitz J, Krempien R, Niethammer AG, Beckhove P, Buchler MW, Z'graggen K. Potential target antigens for immunotherapy in human pancreatic cancer. Cancer Lett 2007; 252:290-8. [PMID: 17320278 DOI: 10.1016/j.canlet.2007.01.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2006] [Revised: 01/02/2007] [Accepted: 01/05/2007] [Indexed: 11/24/2022]
Abstract
BACKGROUND To be effective and selective, immunotherapy ideally targets specifically tumor cells and spares normal tissues. Identification of tumor specific antigens is a prerequisite to establish an effective immunotherapy. Still very little is known about the expression of tumor-related antigens in pancreatic neoplasms. Cancer Testis antigens (CT) are antigens shared by a variety of malignant tumors, but not by normal tissues with the exception of germ cells in testis. Restricted expression in neoplastic tissues and inherent immunogenic features make CT antigens ideal for use in immunotherapy. We analyzed the expression of a selected panel of nine CT antigens that have been proven to elicit an efficient immunogenic response in other malignancies. In addition we analyzed the expression of HERV-K-MEL, an immunogenic antigen of viral origin. METHODS Pancreatic adenocarcinoma tumor samples (n=130) were obtained intraoperatively, control tissues (n=23) were collected from cadaveric donor and from patients with chronic pancreatitis. Tumor-associated antigen expression of MAGE-A1, MAGE-A3, MAGE-A4, MAGE-A10, LAGE-1, NY-ESO-1, SCP-1, SSX-2, SSX-4 and HERV-K-MEL was assessed by PCR. Sequencing of PCR products were performed to assess the expression of SSX-4 in neoplastic and normal pancreatic tissues. RESULTS Three of 10 tested antigens were expressed in over 10% of malignant pancreatic tissue samples. SSX-4 was found positive in 30% of cases, SCP-1 in 19% and HERV-K-MEL in 23% of cases. No expression of CT antigens was found in non-malignant pancreatic tissue with the exception of SSX-4 and and SSX-2. CONCLUSIONS Fifty two percentage of the analyzed tissues expressed at least one CT antigen. The concomitant expression of SSX-4 in both malignant and non-malignant pancreatic tissue is a new finding which may raise concerns for immunotherapy. However, HERV-K-MEL is expressed with a relatively high prevalence and may be a candidate for specific immunotherapy in a large subgroup of pancreatic cancer patients. This study advocates the analysis of patients with regard to their immunogenic profile before the onset of antigen-specific immunotherapy.
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Untch M, Keil E, Kettritz U, Mairinger T, Fleige B, Dresel S, Krempien R, Kretzschmar A, Preussker P, Loll H, Lüders H, Wildberger J, Schuler E. Das Interdisziplinäre Brustzentrum im HELIOS Klinikum Berlin-Buch. Breast Care (Basel) 2007. [DOI: 10.1159/000109748] [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: 11/19/2022] Open
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32
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Jensen AD, Münter MW, Bischoff H, Haselmann R, Timke C, Krempien R, Sterzing F, Nill S, Heeger S, Hoess A, Haberkorn U, Huber PE, Steins M, Thomas M, Debus J, Herfarth KK. Treatment of non-small cell lung cancer with intensity-modulated radiation therapy in combination with cetuximab: the NEAR protocol (NCT00115518). BMC Cancer 2006; 6:122. [PMID: 16681848 PMCID: PMC1524801 DOI: 10.1186/1471-2407-6-122] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2006] [Accepted: 05/08/2006] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Even today, treatment of Stage III NSCLC still poses a serious challenge. So far, surgical resection is the treatment of choice. Patients whose tumour is not resectable or who are unfit to undergo surgery are usually referred to a combined radio-chemotherapy. However, combined radio-chemotherapeutic treatment is also associated with sometimes marked side effects but has been shown to be more efficient than radiation therapy alone. Nevertheless, there is a significant subset of patients whose overall condition does not permit administration of chemotherapy in a combined-modality treatment. It could be demonstrated though, that NSCLCs often exhibit over-expression of EGF-receptors hence providing an excellent target for the monoclonal EGFR-antagonist cetuximab (Erbitux) which has already been shown to be effective in colorectal as well as head-and-neck tumours with comparatively mild side-effects. METHODS/DESIGN The NEAR trial is a prospective phase II feasibility study combining a monoclonal EGF-receptor antibody with loco-regional irradiation in patients with stage III NSCLC. This trial aims at testing the combination's efficacy and rate of development of distant metastases with an accrual of 30 patients. Patients receive weekly infusions of cetuximab (Erbitux) plus loco-regional radiation therapy as intensity-modulated radiation therapy. After conclusion of radiation treatment patients continue to receive weekly cetuximab for 13 more cycles. DISCUSSION The primary objective of the NEAR trial is to evaluate toxicities and feasibility of the combined treatment with cetuximab (Erbitux) and IMRT loco-regional irradiation. Secondary objectives are remission rates, 3-year-survival and local/systemic progression-free survival.
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Affiliation(s)
- AD Jensen
- Dept. of Radiation Oncology, Clinical Radiology, University of Heidelberg Medical School, INF 400, 69120 Heidelberg, Germany
- Clinical Co-operation Unit Radiation Oncology, German Cancer Research Centre (DKFZ), INF 280, 69120 Heidelberg, Germany
| | - MW Münter
- Dept. of Radiation Oncology, Clinical Radiology, University of Heidelberg Medical School, INF 400, 69120 Heidelberg, Germany
- Clinical Co-operation Unit Radiation Oncology, German Cancer Research Centre (DKFZ), INF 280, 69120 Heidelberg, Germany
| | - H Bischoff
- Dept. of Medical Oncology, Thoraxklinik Heidelberg, Amalienstr. 5, 69126 Heidelberg, Germany
| | - R Haselmann
- Dept. of Radiation Oncology, Clinical Radiology, University of Heidelberg Medical School, INF 400, 69120 Heidelberg, Germany
| | - C Timke
- Dept. of Radiation Oncology, Clinical Radiology, University of Heidelberg Medical School, INF 400, 69120 Heidelberg, Germany
| | - R Krempien
- Dept. of Radiation Oncology, Clinical Radiology, University of Heidelberg Medical School, INF 400, 69120 Heidelberg, Germany
| | - F Sterzing
- Dept. of Radiation Oncology, Clinical Radiology, University of Heidelberg Medical School, INF 400, 69120 Heidelberg, Germany
| | - S Nill
- Dept. of Medical Physics, German Cancer Research Centre (DKFZ), INF 280, 69120 Heidelberg, Germany
| | | | - A Hoess
- Dept. of Medical Physics, German Cancer Research Centre (DKFZ), INF 280, 69120 Heidelberg, Germany
| | - U Haberkorn
- Dept. of Nuclear Medicine, University of Heidelberg Medical School, INF 400, 69120 Heidelberg, Germany
| | - PE Huber
- Clinical Co-operation Unit Radiation Oncology, German Cancer Research Centre (DKFZ), INF 280, 69120 Heidelberg, Germany
| | - M Steins
- Dept. of Medical Oncology, Thoraxklinik Heidelberg, Amalienstr. 5, 69126 Heidelberg, Germany
| | - M Thomas
- Dept. of Medical Oncology, Thoraxklinik Heidelberg, Amalienstr. 5, 69126 Heidelberg, Germany
| | - J Debus
- Dept. of Radiation Oncology, Clinical Radiology, University of Heidelberg Medical School, INF 400, 69120 Heidelberg, Germany
| | - KK Herfarth
- Dept. of Radiation Oncology, Clinical Radiology, University of Heidelberg Medical School, INF 400, 69120 Heidelberg, Germany
- Clinical Co-operation Unit Radiation Oncology, German Cancer Research Centre (DKFZ), INF 280, 69120 Heidelberg, Germany
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Kotrikova B, Wirtz R, Krempien R, Blank J, Eggers G, Samiotis A, Mühling J. Piezosurgery—a new safe technique in cranial osteoplasty? Int J Oral Maxillofac Surg 2006; 35:461-5. [PMID: 16503118 DOI: 10.1016/j.ijom.2005.12.006] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2005] [Revised: 12/15/2005] [Accepted: 12/19/2005] [Indexed: 11/28/2022]
Abstract
All surgical interventions on the neurocranium bear the risk of injury of the dura mater and development of a cerebrospinal fluid fistula. Therefore, despite careful preparation, damage to the dura mater cannot always be omitted. Especially after surgery and in patients with increased intracranial pressure (craniosynostoses) there is a high risk of perforating the dura. In this article a new surgical technique for osteotomy (Piezosurgery) that avoids perforation of the dura is presented. Ultrasonic microvibrations allow a selective cut of only mineralized structures without damage to the soft tissue. Even in case of accidental contact the dura remains undamaged. This advantage is also useful for bone splitting, to separate the tabula externa from the tabula interna in situ, without any risk of dura perforation even in case of the very thin bones in an infantile skull. The present work shows the applicability of piezoelectric surgery in high-risk patients after osteotomy, avoiding perforation of the dura mater.
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Affiliation(s)
- B Kotrikova
- Department of Oral and Maxillofacial Surgery, University of Heidelberg, Im Neuenheimer Feld 400, D-69120 Heidelberg, Germany.
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Wörtche R, Hassfeld S, Lux CJ, Müssig E, Hensley FW, Krempien R, Hofele C. Clinical application of cone beam digital volume tomography in children with cleft lip and palate. Dentomaxillofac Radiol 2006; 35:88-94. [PMID: 16549435 DOI: 10.1259/dmfr/27536604] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [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: 11/05/2022] Open
Abstract
OBJECTIVES The diagnostic advantages of digital volume tomography (DVT) over conventional imaging and computed tomography are demonstrated in terms of the respective radiation exposure. The potential role for three-dimensional imaging in cleft lip and palate patients is illustrated on the basis of clinical examples. METHODS The radiation exposure resulting from scans using a cone beam DVT (NEW TOM QR-DVT 9000, Marburg, Germany) was measured with an Alderson-Rando-Phantom (The Phantom Laboratory, New York, NY) and compared with that resulting from other standard imaging modalities. The patient sample consisted of young children with cleft lip and palate on whom orthodontic and surgical treatment was planned on an interdisciplinary basis at the University-Hospital of Heidelberg. RESULTS Digital volume tomography allows high-quality three-dimensional imaging of the premaxilla region, with an effective equivalent investigation dose of (110 kV, 5.4 mA) 0.342 mSv based on ICRP recommendations. While the effective equivalent investigation dose for DVT is higher than that for standard imaging techniques (for example digital panoramic radiograph Orthophos Plus DS Ceph (66 kV, 8 mA) 0.016 mSv), it is much lower than that for a normal CT scan (e.g. Picker International Inc., Highland Heights, OH) adjusted at (spiral 130 kV, 125 mA, and 30 mA, 1.5 s) 2.27 mSv. Digital volume tomography provides extensive data important in clinical decision making. CONCLUSIONS The clinical examples show the good applicability of DVT with a reduced radiation dose.
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Affiliation(s)
- R Wörtche
- Department of Oral and Maxillofacial Surgery, University of Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany.
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Abstract
In spite of the high mortality in pancreatic cancer, significant progress is being made. This review discusses multimodality therapy for patients with pancreatic cancer. Surgical therapy currently offers the only potential monomodal cure for pancreatic adenocarcinoma. However, only 10-20% of patients present with tumors that are amenable to resection, and even after resection of localized cancers, long-term survival is rare. The addition of chemoradiation therapy significantly increases median survival. To achieve long-term success in treating this disease it is therefore increasingly important to identify effective neoadjuvant/adjuvant multimodality therapies. Preoperative chemoradiation for potentially resectable pancreatic cancer has the following advantages: (1) neoadjuvant treatment would eliminate the delay of adjuvant treatment due to postoperative complications; (2) neoadjuvant treatment could avoid unnecessary surgery for patients with metastatic disease evident on restaging after neoadjuvant therapy; (3) down-staging after neoadjuvant therapy may increase the likelihood of negative surgical margins; and (4) neoadjuvant treatment could prevent peritoneal tumor cell implantation and dissemination caused during surgery. This review systematically summarizes the current status, controversies, and prospects of neoadjuvant treatment of pancreatic cancer.
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Affiliation(s)
- R Krempien
- Department of Radiation Oncology, University of Heidelberg, Heidelberg, Germany.
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Mair-Walther J, Fuhr D, Welzel G, Krempien R, Wenz F, Hacke W, Debus J. Kognitive Beeiträchtigungen bei Meningeom-Patienten nach fraktionierter Strahlentherapie – Follow-up nach 5 Jahren. Akt Neurol 2006. [DOI: 10.1055/s-2006-953129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Krempien R, Muenter MW, Huber PE, Nill S, Friess H, Timke C, Didinger B, Buechler P, Heeger S, Herfarth KK, Abdollahi A, Buchler MW, Debus J. Randomized phase II--study evaluating EGFR targeting therapy with cetuximab in combination with radiotherapy and chemotherapy for patients with locally advanced pancreatic cancer--PARC: study protocol [ISRCTN56652283]. BMC Cancer 2005; 5:131. [PMID: 16219105 PMCID: PMC1266352 DOI: 10.1186/1471-2407-5-131] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2005] [Accepted: 10/11/2005] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Pancreatic cancer is the fourth commonest cause of death from cancer in men and women. Advantages in surgical techniques, radiation therapy techniques, chemotherapeutic regimes, and different combined-modality approaches have yielded only a modest impact on the prognosis of patients with pancreatic cancer. Thus there is clearly a need for additional strategies. One approach involves using the identification of a number of molecular targets that may be responsible for the resistance of cancer cells to radiation or to other cytotoxic agents. As such, these molecular determinants may serve as targets for augmentation of the radiotherapy or chemotherapy response. Of these, the epidermal growth factor receptor (EGFR) has been a molecular target of considerable interest and investigation, and there has been a tremendous surge of interest in pursuing targeted therapy of cancers via inhibition of the EGFR. METHODS/DESIGN The PARC study is designed as an open, controlled, prospective, randomized phase II trial. Patients in study arm A will be treated with chemoradiation using intensity modulated radiation therapy (IMRT) combined with gemcitabine and simultaneous cetuximab infusions. After chemoradiation the patients receive gemcitabine infusions weekly over 4 weeks. Patients in study arm B will be treated with chemoradiation using intensity modulated radiation therapy (IMRT) combined with gemcitabine and simultaneous cetuximab infusions. After chemoradiation the patients receive gemcitabine weekly over 4 weeks and cetuximab infusions over 12 weeks. A total of 66 patients with locally advanced adenocarcinoma of the pancreas will be enrolled. An interim analysis for patient safety reasons will be done one year after start of recruitment. Evaluation of the primary endpoint will be performed two years after the last patient's enrollment. DISCUSSION The primary objective of this study is to evaluate the feasibility and the toxicity profile of trimodal therapy in pancreatic adenocarcinoma with chemoradiation therapy with gemcitabine and intensity modulated radiation therapy (IMRT) and EGFR-targeted therapy using cetuximab and to compare between two different methods of cetuximab treatment schedules (concomitant versus concomitant and sequential cetuximab treatment). Secondary objectives are to determine the role and the mechanism of cetuximab in patient's chemoradiation regimen, the response rate, the potential of this combined modality treatment to concert locally advanced lesions to potentially resectable lesions, the time to progression interval and the quality of life.
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Affiliation(s)
- R Krempien
- Department of Radiation Oncology, University of Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
| | - MW Muenter
- Department of Radiation Oncology, University of Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
| | - PE Huber
- Department of Radiation Oncology, German Cancer Research Center (dkfz), 69120 Heidelberg, Germany
| | - S Nill
- Department of Medical Physics, German Cancer Research Center (dkfz), 69120 Heidelberg, Germany
| | - H Friess
- Department of Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
| | - C Timke
- Department of Radiation Oncology, University of Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
| | - B Didinger
- Department of Radiation Oncology, University of Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
| | - P Buechler
- Department of Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
| | - S Heeger
- Merck KGaA, Frankfurter Str. 250, 64293 Darmstadt, Germany
| | - KK Herfarth
- Department of Radiation Oncology, University of Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
| | - A Abdollahi
- Department of Radiation Oncology, German Cancer Research Center (dkfz), 69120 Heidelberg, Germany
| | - MW Buchler
- Department of Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
| | - J Debus
- Department of Radiation Oncology, University of Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
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Roeder F, Oertel S, Treiber M, Funk A, Buechler M, Debus J, Krempien R. Intraoperative Electron Beam Therapy (IEORT) Combined with EBRT in the Treatment of Retroperitoneal Sarcomas. Int J Radiat Oncol Biol Phys 2005. [DOI: 10.1016/j.ijrobp.2005.07.772] [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: 10/25/2022]
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Harms W, Krempien R, Grehn C, Berns C, Hensley FW, Debus J. Daytime pulsed dose rate brachytherapy as a new treatment option for previously irradiated patients with recurrent oesophageal cancer. Br J Radiol 2005; 78:236-41. [PMID: 15730988 DOI: 10.1259/bjr/51982166] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The aim of this study was to evaluate the feasibility, effects, and toxicity of pulsed dose rate (PDR) brachytherapy for re-irradiation of oesophageal carcinoma. A total of 16 patients (median age 67 years) with inoperable recurrences from oesophageal cancer after primary radio-(chemo)-therapy (median 50 Gy) were re-irradiated using PDR brachytherapy ((192)Ir, 37 GBq). Treatment was carried out on an outpatient basis applying a weekly 5 Gy daytime schedule (0.5 Gy pulse(-1) h(-1), total dose 15-20 Gy). The dose was prescribed 10 mm from the mid-dwell position and encompassed the clipped tumour extension with 2 cm margins. The use of clips for delineation of tumour extent and catheter movement during irradiations was evaluated. All 61 PDR treatments were applied safely. The median catheter movement was 5 mm, range 2-12 mm. After a median follow-up of 8 months, three patients had a complete and five a partial remission. Body weight increased in 5 of 16 (31%) and was stable in 4 of 16 (25%) patients, respectively. The median grade 2 (RTOG/EORTC) dysphagia-free survival was 17 months. Seven patients experienced grade 1, five grade 2, and one grade 3 late toxicity. Three patients with uncontrolled locoregional disease showed grade 4 complications (oesophago-tracheal fistulae (n=2), fatal arterial bleeding (n=1). Daytime PDR brachytherapy proved to be feasible and provided effective palliation. Toxicity remains a major problem. Thus, total dose should be restricted to <15 Gy in this palliative situation.
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Affiliation(s)
- W Harms
- Department of Radiooncology, University of Heidelberg, INF 400, 69120 Heidelberg, Germany
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Kayhan N, Günther F, Steinitz A, Krempien R, Vahl C. Is there evidence for acute damage of the myocardium when radiation is applied? Thorac Cardiovasc Surg 2005. [DOI: 10.1055/s-2005-862185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Treiber M, Oertel S, Weitz J, Krempien R, Bischof M, Wannenmacher M, Büchler M, Debus J. Intraoperative radiotherapy for rectal carcinoma. Recent Results Cancer Res 2005; 165:238-44. [PMID: 15865039 DOI: 10.1007/3-540-27449-9_26] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Affiliation(s)
- Martina Treiber
- Department of Radiotherapy, University of Heidelberg, INF 400, 69120 Heidelberg, Germany.
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Treiber M, Krempien R, Knaebel HP, Debus J. Adjuvant radiochemotherapy for rectal cancer. Recent Results Cancer Res 2005; 165:231-7. [PMID: 15865038 DOI: 10.1007/3-540-27449-9_25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Affiliation(s)
- Martina Treiber
- Department of Radiotherapy, University of Heidelberg, INF 400, 69120 Heidelberg, Germany.
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Harms W, Krempien R, Grehn C, Hensley F, Berns C, Wannenmacher M, Debus J. [Reirradiation of chest wall local recurrences from breast cancer]. ACTA ACUST UNITED AC 2004; 126:19-23. [PMID: 14981565 DOI: 10.1055/s-2004-820531] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [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: 10/26/2022]
Abstract
OBJECTIVE The aim of this article was to describe the radio-therapeutic treatment options in previously irradiated patients suffering from breast cancer local recurrences and to review the literature. MATERIAL AND METHODS Reirradiation of the chest wall can be performed using electron beams or alternatively CLDR/PDR (continuous/pulsed low dose rate) brachytherapy techniques with large skin moulds. With both techniques high doses can be applied to the chest wall while deeper-seated organs (lung, heart) can be spared to a large extent. Electron-beam therapy is readily available and the depth of treatment can be easily controlled by selecting the appropriate energy. The protracted irradiation schedule of CLDR/PDR brachytherapy results due to radiobiological reasons in a broad therapeutic ratio and safe treatment time. RESULTS In the literature, more than 250 cases being reirradiated for chest wall local recurrences have been published. After retreatment using electron beams complete remissions were obtained in 41-74 % of the patients (brachytherapy 79-82 %). Severe grade IV complications (RTOG/EORTC) occurred in less than 10 % of the patients. CONCLUSIONS With regard to the limited treatment options reirradiation of chest wall local recurrences resulted in high local control rates while toxicity remained acceptable. These data weaken the radio-therapeutic dogma that reirradiation of the chest wall may not be possible.
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Affiliation(s)
- W Harms
- Universität Heidelberg, Radiologische Klinik, Abteilung für Klinische Radiologie, INF 400, 69190 Heidelberg.
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Treiber M, Lehnert T, Oertel S, Krempien R, Bischof M, Buechler M, Wannenmacher M, Debus J. Intraoperative radiotherapy--special focus: recurrent rectal carcinoma. Front Radiat Ther Oncol 2004; 38:52-6. [PMID: 15458187 DOI: 10.1159/000078264] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- M Treiber
- Department of Clinical Radiology, University of Heidelberg, Heidelberg, Germany.
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Trinh T, Abdollahi A, Krempien R, Hlatky L, Lipson K, Huber P. SU5416 and SU6668 decrease angiogenic effects of radiation-induced factor productions by tumor cells and amplify the direct anti-endothelial action of radiation in vitro. Int J Radiat Oncol Biol Phys 2003. [DOI: 10.1016/s0360-3016(03)01194-5] [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: 11/16/2022]
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Kayhan N, Krempien R, Harms W, Wannenmacher M, Hagl S, Vahl CF. [Computer-assisted reconstruction of coronary vessels]. BIOMED ENG-BIOMED TE 2003; 47 Suppl 1 Pt 2:930-2. [PMID: 12465347 DOI: 10.1515/bmte.2002.47.s1b.930] [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: 11/15/2022]
Abstract
End stage coronary artery disease with linear stenosis of the main vessels despite several coronary interventions is a current challenge for surgical treatment. As the long term results are mainly determined by the pathology of the coronary vessels a simple revascularisation with arterial or venous grafts provides no adequate solution of the problem. An exactly controlled 3D-reconstruction of the coronary vessels enabling selective thrombendarteriectomy (TEA) seems to be a new approach, that may be limited by neointimal hyperproliferation of the coronary vessels. Intraoperative brachytherapy may be a tool to inhibit this process.
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Affiliation(s)
- N Kayhan
- Universität Heidelberg, Deutschland.
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Abstract
Three-dimensional models of the patient's anatomy are the basis for modern applications in computer-assisted surgery or radiology. To create these models the data is processed in a series of steps that transforms the initial raw data (generally CT/MRT volume images) into the three-dimensional models (e.g. triangle meshes). In doing so, a multitude of parameters adjustments, interactions and decisions are necessary to be made by the physician in order to create the models adapted to the specific needs of the patient and to the surgery. The quality of the models therefore strongly depends on that process chain. As a result of the high requirements on the quality and security of a clinical application the quality of the models itself and the capability to use them flexibly are essential. This work present a method to adjust and optimise the creation of the models and to asses their quality afterwards.
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Affiliation(s)
- S Däuber
- Institut für Prozessrechentechnik, Automation und Robotik Universität Karlsruhe, Deutschland.
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Abstract
BACKGROUND Experiences with inflammatory skin reactions after treatment with docetaxel and prior exposure to radiotherapy like a recall phenomenon are very rare. We present the case of an uncommon and severe skin reaction after docetaxel application and prior radiotherapy. PATIENT AND METHODS A 40-year-old female was treated with an upper body irradiation with electrons because of relapsed breast cancer. In addition, because of metastases of brain and bone she received radiotherapy on the whole brain and the left pelvis. One week after radiotherapy weekly chemotherapy with docetaxel was started. RESULTS Radiotherapy was well tolerated. There was a cutaneous erythema RTOG grade 1. After second application of docetaxel the patient developed a severe skin erythema, after fourth application confluent desquamations exactly demarcated the previously irradiated skin area. After discontinuation of docetaxel and after antiinflammatory treatment the skin reactions improved rapidly. CONCLUSION In our opinion the severe skin reaction was clearly associated with the application of docetaxel like a recall phenomenon after previous radiotherapy. In case of severe skin reaction after this therapy it is important to know the possibility of recall phenomenon.
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Affiliation(s)
- M D Piroth
- Abt für Klinische Radiologie der Universitätsklinik Heidelberg, Germany.
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Mende U, Krempien R, Hassfeld S, Wörn H, Mühling J, Wannenmacher M. [3D-ultrasound: a valuable adjunct for therapy planning and follow-up of head and neck tumours]. Ultraschall Med 2002; 23:101-107. [PMID: 11961723 DOI: 10.1055/s-2002-25194] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
AIM The three-dimensional visualization of orofacial tumours and adjacent organs at risk of infiltration is an important requirement for staging, therapy planning and follow-up. Artifacts from the mandible or metal implants often reduce the diagnostic power of computed tomography (CT). The value of 3D-ultrasound (3D-US) in respect to the standard methods CT and magnetic resonance imaging (MRI) was therefore analyzed. METHOD Between 9/97 and 10/99 the visualization of orofacial tumours in 243 patients by 3D-US was examined, classified on a five-point scale and compared to the corresponding CT and MRI scans. RESULTS Complete visualization of the tumours was possible in 85.6 % by 3D-US, whereas the rates of MRI and CT were lower with 77.4 % and 61.3 % respectively, mainly because of artifacts. The best combinations of methods, 3D-US + CT (96.7 %) and 3D-US + MRI (95.1 %) gave almost equivalent results, whereas CT + MRI (83.5 %) was inferior. In 2.5 % of the cases none of the methods produced adequate results. CONCLUSION By free selection of sectional planes and direct correlation to the clinical findings 3D-ultrasound can improve staging, therapy planning and follow-up of orofacial tumours, especially in the case of small tumour size, dental crowns/inlays, metal implants or contraindications to MRI.
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Affiliation(s)
- U Mende
- Radiologische Universitätsklinik, Abt. Klinische Radiologie und Poliklinik, Heidelberg, Germany
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Abstract
Sonography is an integral part of primary tumor diagnosis and follow-up for the great majority of organ systems. However, its value in the field of space-occupying processes of the locomotor system, especially of malignant bone tumors, has mostly been underestimated. The sonographic examination has to investigate the whole tumor region and the corresponding lymph nodes statically and dynamically. The examination procedure should be standardized and the documentation reliable. Evaluation criteria are the localization, dimensions, and volume of the tumors, echogenicity and homogeneity, peri- and intratumoral vascularization (vessel density and architecture), borders of the tumor, and neighboring structures. Pathologic changes not only of the soft tissues but also of the bones can be evaluated sonographically. Even subtle analysis does not permit definitive assessment of tumor status. Taking its physical limitations into consideration, high-resolution sonography, enhanced by color/PowerDoppler and three-dimensional techniques, is a valuable adjunct to improve diagnosis, therapy planning, monitoring, and posttherapeutic care of tumors of the locomotor system.
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Affiliation(s)
- U Mende
- Abteilung Klinische Radiologie und Poliklinik, Radiologische Universitätsklinik, Im Neuenheimer Feld 400, 69120 Heidelberg.
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