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Reichardt CM, Muñoz-Becerra M, Rius Rigau A, Rückert M, Fietkau R, Schett G, Gaipl US, Frey B, Muñoz LE. Neutrophils seeking new neighbors: radiotherapy affects the cellular framework and the spatial organization in a murine breast cancer model. Cancer Immunol Immunother 2024; 73:67. [PMID: 38430241 PMCID: PMC10908631 DOI: 10.1007/s00262-024-03653-1] [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: 11/02/2023] [Accepted: 02/06/2024] [Indexed: 03/03/2024]
Abstract
Neutrophils are known to contribute in many aspects of tumor progression and metastasis. The presence of neutrophils or neutrophil-derived mediators in the tumor microenvironment has been associated with poor prognosis in several types of solid tumors. However, the effects of classical cancer treatments such as radiation therapy on neutrophils are poorly understood. Furthermore, the cellular composition and distribution of immune cells in the tumor is of increasing interest in cancer research and new imaging technologies allow to perform more complex spatial analyses within tumor tissues. Therefore, we aim to offer novel insight into intra-tumoral formation of cellular neighborhoods and communities in murine breast cancer. To address this question, we performed image mass cytometry on tumors of the TS/A breast cancer tumor model, performed spatial neighborhood analyses of the tumor microenvironment and quantified neutrophil-extracellular trap degradation products in serum of the mice. We show that irradiation with 2 × 8 Gy significantly alters the cellular composition and spatial organization in the tumor, especially regarding neutrophils and other cells of the myeloid lineage. Locally applied radiotherapy further affects neutrophils in a systemic manner by decreasing the serum neutrophil extracellular trap concentrations which correlates positively with survival. In addition, the intercellular cohesion is maintained due to radiotherapy as shown by E-Cadherin expression. Radiotherapy, therefore, might affect the epithelial-mesenchymal plasticity in tumors and thus prevent metastasis. Our findings underscore the growing importance of the spatial organization of the tumor microenvironment, particularly with respect to radiotherapy, and provide insight into potential mechanisms by which radiotherapy affects epithelial-mesenchymal plasticity and tumor metastasis.
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Affiliation(s)
- C M Reichardt
- Department of Internal Medicine 3, Rheumatology and Immunology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
- Deutsches Zentrum Für Immuntherapie (DZI), Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany
| | - M Muñoz-Becerra
- Department of Internal Medicine 3, Rheumatology and Immunology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
- Deutsches Zentrum Für Immuntherapie (DZI), Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany
| | - A Rius Rigau
- Department of Internal Medicine 3, Rheumatology and Immunology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
- Deutsches Zentrum Für Immuntherapie (DZI), Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany
| | - M Rückert
- Translational Radiobiology, Department of Radiation Oncology, Universitätsklinikum Erlangen, FAU Erlangen-Nürnberg, Erlangen, Germany
- Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - R Fietkau
- Deutsches Zentrum Für Immuntherapie (DZI), Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany
- Department of Radiation Oncology, Universitätsklinikum Erlangen, FAU Erlangen-Nürnberg, Erlangen, Germany
- Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - G Schett
- Department of Internal Medicine 3, Rheumatology and Immunology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
- Deutsches Zentrum Für Immuntherapie (DZI), Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany
| | - U S Gaipl
- Deutsches Zentrum Für Immuntherapie (DZI), Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany
- Translational Radiobiology, Department of Radiation Oncology, Universitätsklinikum Erlangen, FAU Erlangen-Nürnberg, Erlangen, Germany
- Department of Radiation Oncology, Universitätsklinikum Erlangen, FAU Erlangen-Nürnberg, Erlangen, Germany
- Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - B Frey
- Deutsches Zentrum Für Immuntherapie (DZI), Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany
- Translational Radiobiology, Department of Radiation Oncology, Universitätsklinikum Erlangen, FAU Erlangen-Nürnberg, Erlangen, Germany
- Department of Radiation Oncology, Universitätsklinikum Erlangen, FAU Erlangen-Nürnberg, Erlangen, Germany
- Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - L E Muñoz
- Department of Internal Medicine 3, Rheumatology and Immunology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany.
- Deutsches Zentrum Für Immuntherapie (DZI), Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany.
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2
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Beck M, Hartwich J, Eckstein M, Schmidt D, Gostian AO, Müller S, Rutzner S, Gaipl US, von der Grün J, Illmer T, Hautmann MG, Klautke G, Döscher J, Brunner T, Tamaskovics B, Hartmann A, Iro H, Kuwert T, Fietkau R, Hecht M, Semrau S. F18-FDG PET/CT imaging early predicts pathologic complete response to induction chemoimmunotherapy of locally advanced head and neck cancer: preliminary single-center analysis of the checkrad-cd8 trial. Ann Nucl Med 2022; 36:623-633. [PMID: 35534690 PMCID: PMC9226092 DOI: 10.1007/s12149-022-01744-6] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 04/12/2022] [Indexed: 11/05/2022]
Abstract
Aim In the CheckRad-CD8 trial patients with locally advanced head and neck squamous cell cancer are treated with a single cycle of induction chemo-immunotherapy (ICIT). Patients with pathological complete response (pCR) in the re-biopsy enter radioimmunotherapy. Our goal was to study the value of F-18-FDG PET/CT in the prediction of pCR after induction therapy. Methods Patients treated within the CheckRad-CD8 trial that additionally received FDG- PET/CT imaging at the following two time points were included: 3–14 days before (pre-ICIT) and 21–28 days after (post-ICIT) receiving ICIT. Tracer uptake in primary tumors (PT) and suspicious cervical lymph nodes (LN +) was measured using different quantitative parameters on EANM Research Ltd (EARL) accredited PET reconstructions. In addition, mean FDG uptake levels in lymphatic and hematopoietic organs were examined. Percent decrease (Δ) in FDG uptake was calculated for all parameters. Biopsy of the PT post-ICIT acquired after FDG-PET/CT served as reference. The cohort was divided in patients with pCR and residual tumor (ReTu). Results Thirty-one patients were included. In ROC analysis, ΔSUVmax PT performed best (AUC = 0.89) in predicting pCR (n = 17), with a decline of at least 60% (sensitivity, 0.77; specificity, 0.93). Residual SUVmax PT post-ICIT performed best in predicting ReTu (n = 14), at a cutpoint of 6.0 (AUC = 0.91; sensitivity, 0.86; specificity, 0.88). Combining two quantitative parameters (ΔSUVmax ≥ 50% and SUVmax PT post-ICIT ≤ 6.0) conferred a sensitivity of 0.81 and a specificity of 0.93 for determining pCR. Background activity in lymphatic organs or uptake in suspected cervical lymph node metastases lacked significant predictive value. Conclusion FDG-PET/CT can identify patients with pCR after ICIT via residual FDG uptake levels in primary tumors and the related changes compared to baseline. FDG-uptake in LN + had no predictive value. Trial registry ClinicalTrials.gov identifier: NCT03426657.
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Affiliation(s)
- M Beck
- Clinic of Nuclear Medicine, Friedrich-Alexander-Universität Erlangen-Nürnberg, University Hospital Erlangen, Ulmenweg 18, 91054, Erlangen, Bayern, Germany.
| | - J Hartwich
- Clinic of Nuclear Medicine, Friedrich-Alexander-Universität Erlangen-Nürnberg, University Hospital Erlangen, Ulmenweg 18, 91054, Erlangen, Bayern, Germany
| | - M Eckstein
- Institute of Pathology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Bayern, Germany
| | - D Schmidt
- Clinic of Nuclear Medicine, Friedrich-Alexander-Universität Erlangen-Nürnberg, University Hospital Erlangen, Ulmenweg 18, 91054, Erlangen, Bayern, Germany
| | - A O Gostian
- Department of Otolaryngology-Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Bayern, Germany
| | - S Müller
- Department of Otolaryngology-Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Bayern, Germany
| | - S Rutzner
- Department of Radiation Oncology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Bayern, Germany
| | - U S Gaipl
- Department of Radiation Oncology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Bayern, Germany
| | - J von der Grün
- Department of Radiotherapy and Oncology, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - T Illmer
- Medical Oncology Clinic Dresden Freiberg, Dresden, Saxony, Germany
| | - M G Hautmann
- Department of Radiotherapy, Universität Regensburg, Regensburg, Bayern, Germany
| | - G Klautke
- Department of Radiation Oncology, Chemnitz Hospital, Chemnitz, Sachsen, Germany
| | - J Döscher
- Department of Otolaryngology-Head and Neck Surgery, Universität Ulm, Ulm, Baden-Württemberg, Germany
| | - T Brunner
- Department of Radiation Oncology, Otto Von Guericke Universität Magdeburg, Magdeburg, Sachsen-Anhalt, Germany
| | - B Tamaskovics
- Department of Radiation Oncology, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Nordrhein-Westfalen, Germany
| | - A Hartmann
- Institute of Pathology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Bayern, Germany
| | - H Iro
- Department of Otolaryngology-Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Bayern, Germany
| | - T Kuwert
- Clinic of Nuclear Medicine, Friedrich-Alexander-Universität Erlangen-Nürnberg, University Hospital Erlangen, Ulmenweg 18, 91054, Erlangen, Bayern, Germany
| | - R Fietkau
- Department of Radiation Oncology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Bayern, Germany
| | - M Hecht
- Department of Radiation Oncology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Bayern, Germany
| | - S Semrau
- Department of Radiation Oncology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Bayern, Germany
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Dürrbeck C, Abu-Hossin N, Lotter M, Kreppner S, Lubgan D, Fietkau R, Strnad V, Bert C. OC-0631 Automatisation of catheter reconstruction in interstitial breast BT using electromagnetic tracking. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02653-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Gani C, Polat B, Ott O, Germer E, Königsrainer A, Kirschniak A, Clasen S, Grosse U, Diefenhardt M, Bitzer M, Reibetanz J, Martus P, Flentje M, Fietkau R, Fokas E, Zips D, Rödel C. OC-0833 Total neoadjuvant therapy for Organ Preservation in Rectal Cancer: The CAO/ARO/AIO-16 phase II trial. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02697-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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5
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Masitho S, Szkitsak J, Grigo J, Putz F, Fietkau R, Bert C. PD-0320 Two-ways validation of the feasibility of AI-based synthetic CT for MR-only brain radiotherapy. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02813-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Zhou JG, Yang J, Wang H, Wong AH, Tan F, Chen X, He S, Shen G, Wang YJ, Frey B, Fietkau R, Hecht M, Ma H, Gaipl U. 60P Machine learning based on blood biomarkers predicts fast progression in advanced NSCLC patients treated with immunotherapy. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.02.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Dapper H, Belka C, Bock F, Budach V, Budach W, Christiansen H, Debus J, Distel L, Dunst J, Eckert F, Eich H, Eicheler W, Engenhart-Cabillic R, Fietkau R, Fleischmann DF, Frerker B, Giordano FA, Grosu AL, Herfarth K, Hildebrandt G, Kaul D, Kölbl O, Krause M, Krug D, Martin D, Matuschek C, Medenwald D, Nicolay NH, Niewald M, Oertel M, Petersen C, Pohl F, Raabe A, Rödel C, Rübe C, Schmalz C, Schmeel LC, Steinmann D, Stüben G, Thamm R, Vordermark D, Vorwerk H, Wiegel T, Zips D, Combs SE. Integration of radiation oncology teaching in medical studies by German medical faculties due to the new licensing regulations : An overview and recommendations of the consortium academic radiation oncology of the German Society for Radiation Oncology (DEGRO). Strahlenther Onkol 2021; 198:1-11. [PMID: 34786605 PMCID: PMC8594460 DOI: 10.1007/s00066-021-01861-7] [Citation(s) in RCA: 3] [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: 09/01/2021] [Accepted: 09/19/2021] [Indexed: 11/30/2022]
Abstract
The new Medical Licensing Regulations 2025 (Ärztliche Approbationsordnung, ÄApprO) will soon be passed by the Federal Council (Bundesrat) and will be implemented step by step by the individual faculties in the coming months. The further development of medical studies essentially involves an orientation from fact-based to competence-based learning and focuses on practical, longitudinal and interdisciplinary training. Radiation oncology and radiation therapy are important components of therapeutic oncology and are of great importance for public health, both clinically and epidemiologically, and therefore should be given appropriate attention in medical education. This report is based on a recent survey on the current state of radiation therapy teaching at university hospitals in Germany as well as the contents of the National Competence Based Learning Objectives Catalogue for Medicine 2.0 (Nationaler Kompetenzbasierter Lernzielkatalog Medizin 2.0, NKLM) and the closely related Subject Catalogue (Gegenstandskatalog, GK) of the Institute for Medical and Pharmaceutical Examination Questions (Institut für Medizinische und Pharmazeutische Prüfungsfragen, IMPP). The current recommendations of the German Society for Radiation Oncology (Deutsche Gesellschaft für Radioonkologie, DEGRO) regarding topics, scope and rationale for the establishment of radiation oncology teaching at the respective faculties are also included.
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Affiliation(s)
- H Dapper
- Department of Radiation Oncology, Technical University of Munich, Munich, Germany. .,German Cancer Consortium (DKTK) Partner Site (DKTK), Munich, Germany.
| | - C Belka
- Department of Radiation Oncology, LMU University Hospital, Munich, Germany.,German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Heidelberg, Germany
| | - F Bock
- Department of Radiation Oncology, Rostock University Medical Center, Rostock, Germany
| | - V Budach
- Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Radiation Oncology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - W Budach
- Department of Radiation Oncology, Medical Faculty, Heinrich Heine University, Duesseldorf, Germany
| | - H Christiansen
- Department of Radiation Oncology, Hannover Medical School (MHH), Hannover, Germany
| | - J Debus
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,Heidelberg Ion-Beam Therapy Center, Heidelberg, Germany
| | - L Distel
- Department of Radiation Oncology, University Hospital Erlangen, Erlangen, Germany
| | - J Dunst
- Department of Radiation Oncology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - F Eckert
- Department of Radiation Oncology, University of Tübingen, Tübingen, Germany.,German Cancer Consortium (DKTK) Partner Site (DKTK), Tübingen, Germany
| | - H Eich
- Department of Radiation Oncology, University of Münster, Münster, Germany
| | - W Eicheler
- OncoRay-National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany
| | - R Engenhart-Cabillic
- Department of Radiotherapy and Radiation Oncology, University of Marburg, Marburg, Germany
| | - R Fietkau
- Department of Radiation Oncology, University Hospital Erlangen, Erlangen, Germany
| | - D F Fleischmann
- Department of Radiation Oncology, LMU University Hospital, Munich, Germany.,German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Heidelberg, Germany
| | - B Frerker
- Department of Radiation Oncology, Rostock University Medical Center, Rostock, Germany
| | - F A Giordano
- Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Bonn, Germany
| | - A L Grosu
- Department of Radiation Oncology, University Medical Center Freiburg, Freiburg, Germany.,German Cancer Consortium (DKTK) Partner Site (DKTK), Freiburg, Germany
| | - K Herfarth
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,Heidelberg Ion-Beam Therapy Center, Heidelberg, Germany
| | - G Hildebrandt
- Department of Radiation Oncology, Rostock University Medical Center, Rostock, Germany
| | - D Kaul
- Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Radiation Oncology, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Partner Site Berlin, German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Heidelberg, Germany
| | - O Kölbl
- Department of Radiotherapy, University of Regensburg, Regensburg, Germany
| | - M Krause
- Department of Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.,OncoRay-National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden and Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany.,Partner Site Dresden, German Cancer Research Center (DKFZ), National Center for Tumor Diseases (NCT), Heidelberg, Germany.,Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany.,Heidelberg and German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Dresden, Germany
| | - D Krug
- Department of Radiation Oncology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - D Martin
- Department of Radiotherapy and Oncology, University Hospital, Goethe University, Frankfurt, Germany.,German Cancer Consortium (DKTK) Partner Site (DKTK), Frankfurt, Germany
| | - C Matuschek
- Department of Radiation Oncology, Medical Faculty, Heinrich Heine University, Duesseldorf, Germany
| | - D Medenwald
- Deptartment of Radiation Oncology, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - N H Nicolay
- Department of Radiation Oncology, University Medical Center Freiburg, Freiburg, Germany.,German Cancer Consortium (DKTK) Partner Site (DKTK), Freiburg, Germany
| | - M Niewald
- Department of Radiotherapy and Radiooncology, Saarland University Medical Center, Homburg, Germany
| | - M Oertel
- Department of Radiation Oncology, University of Münster, Münster, Germany
| | - C Petersen
- Department of Radiotherapy and Radio-Oncology, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - F Pohl
- Department of Radiotherapy, University of Regensburg, Regensburg, Germany
| | - A Raabe
- Department of Radiotherapy and Radio-Oncology, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - C Rödel
- Department of Radiotherapy and Oncology, University Hospital, Goethe University, Frankfurt, Germany.,German Cancer Consortium (DKTK) Partner Site (DKTK), Frankfurt, Germany
| | - C Rübe
- Department of Radiotherapy and Radiooncology, Saarland University Medical Center, Homburg, Germany
| | - C Schmalz
- Department of Radiation Oncology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - L C Schmeel
- Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Bonn, Germany
| | - D Steinmann
- Department of Radiation Oncology, Hannover Medical School (MHH), Hannover, Germany
| | - G Stüben
- Department of Radiation Oncology, University of Augsburg, Augsburg, Germany
| | - R Thamm
- Department of Radiation Oncology and Radiotherapy, University Hospital Ulm, Ulm, Germany
| | - D Vordermark
- Deptartment of Radiation Oncology, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - H Vorwerk
- Department of Radiotherapy and Radiation Oncology, University of Marburg, Marburg, Germany
| | - T Wiegel
- Department of Radiation Oncology and Radiotherapy, University Hospital Ulm, Ulm, Germany
| | - D Zips
- Department of Radiation Oncology, University of Tübingen, Tübingen, Germany.,German Cancer Consortium (DKTK) Partner Site (DKTK), Tübingen, Germany
| | - S E Combs
- Department of Radiation Oncology, Technical University of Munich, Munich, Germany.,Institute of Radiation Medicine, Department of Radiation Sciences, Helmholtz Zentrum München, Munich, Germany.,German Cancer Consortium (DKTK) Partner Site (DKTK), Munich, Germany
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8
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Willner A, Fechner K, Agaimy A, Haller F, Eckstein M, Ott OJ, Putz F, Gaipl US, Kersting S, Meidenbauer N, Grützmann R, Fietkau R, Semrau S. Neoadjuvant concurrent chemoradiotherapy with and without hyperthermia in retroperitoneal sarcomas: feasibility, efficacy, toxicity, and long-term outcome. Strahlenther Onkol 2021; 197:1063-1071. [PMID: 34735576 PMCID: PMC8604874 DOI: 10.1007/s00066-021-01830-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 05/12/2021] [Accepted: 07/16/2021] [Indexed: 01/04/2023]
Abstract
Purpose Retroperitoneal (RPS) sarcomas are associated with poor local and abdominal tumor control. However, the benefit of preoperative radio- or chemotherapy alone for these entities is currently unclear. Moreover, as intermediate- and high-grade sarcomas have a tendency toward early metastasis, exploration of neoadjuvant strategies is of high importance. This analysis reports the results of our 20-year single-institution experience with preoperative neoadjuvant concurrent chemoradiation. Methods From 2000–2019, 27 patients with intermediate- or high-grade RPS (12 dedifferentiated liposarcoma, 10 leiomyosarcoma, 5 others) were treated with radiotherapy (median dose: 50.4 Gy; range 45–75 Gy) and two cycles of chemotherapy (doxorubicin 50 mg/m2 BSA/d3 q28 and ifosfamide 1.5 g/m2 BSA/d1‑5 q28) in neoadjuvant intent. Chemotherapy consisted of doxorubicin alone in two cases and ifosfamide alone in one case. Fifteen patients (56%) additionally received deep regional hyperthermia. Results The median follow-up time was 53 months (±56.7 months). 92% of patients received two cycles of chemotherapy as planned and 92% underwent surgery. At 5 and 10 years, abdominal-recurrence-free survival was 74.6% (±10.1%) and 66.3% (±11.9%), distant metastasis-free survival was 67.2% (±9.7%) and 59.7% (±11.1%), and overall survival was 60.3% (±10.5%) and 60.3% (±10.5%), respectively. CTC grade III and IV toxicities were leukocytopenia (85%), thrombocytopenia (33%), and anemia (11%). There were no treatment-related deaths. Conclusion Neoadjuvant chemoradiotherapy with and without hyperthermia for retroperitoneal sarcomas is feasible and provided high local control of intermediate- and high-grade sarcoma.
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Affiliation(s)
- A Willner
- Department of Radiation Oncology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitätsstraße 27, 91054, Erlangen, Germany
| | - K Fechner
- Department of Surgery, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Maximiliansplatz 1, 91054, Erlangen, Germany
| | - A Agaimy
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Krankenhausstraße 8-10, 91054, Erlangen, Germany
| | - F Haller
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Krankenhausstraße 8-10, 91054, Erlangen, Germany
| | - M Eckstein
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Krankenhausstraße 8-10, 91054, Erlangen, Germany
| | - O J Ott
- Department of Radiation Oncology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitätsstraße 27, 91054, Erlangen, Germany
| | - F Putz
- Department of Radiation Oncology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitätsstraße 27, 91054, Erlangen, Germany
| | - U S Gaipl
- Department of Radiation Oncology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitätsstraße 27, 91054, Erlangen, Germany
| | - S Kersting
- Department of Surgery, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Maximiliansplatz 1, 91054, Erlangen, Germany
| | - N Meidenbauer
- Department of Haematology and Oncology, University Hospital, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Ulmenweg 18, 91054, Erlangen, Germany
| | - R Grützmann
- Department of Surgery, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Maximiliansplatz 1, 91054, Erlangen, Germany
| | - R Fietkau
- Department of Radiation Oncology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitätsstraße 27, 91054, Erlangen, Germany
| | - S Semrau
- Department of Radiation Oncology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitätsstraße 27, 91054, Erlangen, Germany.
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Bähr O, Tabatabai G, Fietkau R, Goldbrunner R, Glas M. P14.20 Quality of life of patients with newly diagnosed glioblastoma during TTFields therapy in routine clinical care: first results of the TIGER study. Neuro Oncol 2021. [DOI: 10.1093/neuonc/noab180.143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
Glioblastoma (GBM) is an aggressive primary tumor of the central nervous system. Current interdisciplinary treatment strategies outside clinical trials include maximal safe resection, followed by treatment with radiation and an alkylating chemotherapy. Based on the results of the positive phase III trial EF-14, the addition of Tumor Treating Fields (TTFields) to temozolomide (TMZ) maintenance therapy brought an additional treatment method to clinical routine. The prospective non-interventional study TIGER (TTFields In GErmany in Routine Clinical Care) documents the use of TTFields in routine clinical care with a particular focus on health-related quality of life (HRQoL) within 4 months after starting therapy, treatment compliance and duration.
MATERIAL AND METHODS
This multi-center prospective non-interventional study in Germany (NCT03258021) included ndGBM patients eligible for TTFields therapy. Following their consent to participate in the study, patients received a comprehensive introduction to the therapy and their baseline demographic data were collected. Information on TTFields therapy decision is evaluated based on a dedicated TTFields questionnaire at baseline in both arms, follow-up information on how patients cope with the therapy is collected two months after TTFields treatment start, if applicable. HRQoL was assessed in patients deciding for TTFields therapy at baseline as well as at 2 months and 4 months thereafter using the EORTC-QLQ-C30/BN-20 questionnaires.
RESULTS
Between August 2017 and November 2019, 710 patients (259 female/451 male) were enrolled at 81 participating centers. The mean age was 58.5 years (range: 19.0–85.0; Cut-off: August 31, 2020). The overall baseline characteristics of the study group reflects a typical GBM population. Of these, 582 (82%) decided to start TTFields and 128 (18%) refused TTFields treatment. Health-related QoL did not decline during TTFields therapy except for itchy skin, comparable to the results of the EF-14 phase 3 trial. A detailed analysis of the cohort as well as their reported QoL will be presented.
CONCLUSION
The TIGER study is the largest non-interventional trial on the use of TTFields in routine clinical care. The use of TTFields in patients with ndGBM did not impair HRQoL during the follow-up period, except for more itchy skin.
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Affiliation(s)
- O Bähr
- General Hospital Aschaffenburg-Alzenau, Aschaffenburg, Germany
| | - G Tabatabai
- University Hospital Tuebingen, Tübingen, Germany
| | - R Fietkau
- University Hospital Erlangen, Erlangen, Germany
| | | | - M Glas
- University Hospital Essen, Essen, Germany
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Gruenwald V, Graeven U, Ivanyi P, Dietz A, Hahn D, Hackenberg S, Kasper S, Fietkau R, Moulin JC, Pink D, Schaaf M, Klinghammer K. 912P Results of a randomized phase II study comparing pembrolizumab with methotrexate in elderly, frail or cisplatin-ineligible patients with relapsed or metastatic squamous cell carcinoma of the head and neck (RM-SCCHN) (ELDORANDO-AIO-KHT-0115). Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1322] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Fokas E, Schlenska-Lange A, Polat B, Klautke G, Fietkau R, Kuhnt T, Brunner T, Grosu A, Kirste S, Flentje M, Germer C, Bechstein W, Friede T, Hofheinz R, Ghadimi M, Rödel C. OC-0293 TNT in rectal cancer: Final results of the CAO/ARO/AIO-12 randomized phase 2 trial. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)06841-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Abu-Hossin N, Gulde S, Dürrbeck C, Strnad V, Fietkau R, Bert C. PP-0146 Quality assurance of curved catheter paths in interstitial brachytherapy using a constructed phantom. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)06438-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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13
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Dürrbeck C, Pflaum L, Schulz M, Kallis K, Geimer T, Abu-Hossin N, Strnad V, Maier A, Fietkau R, Bert C. OC-0109 Implant-based CT estimation towards adaptive breast brachytherapy. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)06313-1] [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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Abu-Hossin N, Kallis K, Strnad V, Fietkau R, Bert C. OC-0108 Impact of patient positioning on interstitial multicatheter HDR brachytherapy of the breast. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)06312-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: 10/21/2022]
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Zhou J, Donaubauer A, Frey B, Becker I, Rutzner S, Sun R, Ma H, Fietkau R, Deutsch E, Gaipl U, Hecht M. P14.16 The Early Landscape of Immune Cell Subsets in Metastatic NSCLC Patients Treated with Immune Checkpoint Inhibitors. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.522] [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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Zhou JG, Donaubauer A, Frey B, Becker I, Rutzner S, Eckstein M, Sun R, Ma H, Schubert P, Schweizer C, Fietkau R, Deutsch E, Gaipl U, Hecht M. 302MO Development of a flow cytometry-based whole-blood prognostic immune signature in metastatic cancer patients treated with immune checkpoint inhibitors. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.10.296] [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] Open
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Mengling V, Perrin R, Putz F, Fietkau R, Bert C. PO-1750: Comparison of MRI coils and RT-positioning systems for optimal MRI scanning in SRS cases. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01768-0] [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: 11/17/2022]
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Sun R, Sundahl N, Hecht M, Putz F, Lancia A, Milic M, Carré A, Lerousseau M, Theo E, Battistella E, Andres EA, Louvel G, Durand-Labrunie J, Bockel S, Bahleda R, Robert C, Boutros C, Vakalopoulou M, Paragios N, Frey B, Massard C, Fietkau R, Ost P, Gaipl U, Deutsch E. PD-0425: Radiomics for selection of patients treated with immuno-radiotherapy: pooled analysis from 6 studies. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00447-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Putz F, Oft D, Perrin R, Mengling V, Weissmann T, Roesch J, Mansoorian S, Distel L, Bert C, Fietkau R. PD-0170: Volumetric regression in brain metastases after stereotactic RT: Time course and significance. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00194-8] [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: 11/26/2022]
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Sauer T, Popp D, Fietkau R, Bert C. PO-1904: ROI optimisation for surface guided radiation therapy. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01922-8] [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: 11/17/2022]
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Fietkau R, Grützmann R, Wittel UA, Croner RS, Jacobasch L, Neumann UP, Reinacher-Schick A, Imhoff D, Boeck S, Keilholz L, Oettle H, Hohenberger WM, Golcher H, Bechstein WO, Uhl W, Pirkl A, Adler W, Semrau S, Rutzner S, Ghadimi M, Lubgan D. R0 resection following chemo (radio)therapy improves survival of primary inoperable pancreatic cancer patients. Interim results of the German randomized CONKO-007± trial. Strahlenther Onkol 2020; 197:8-18. [PMID: 32914237 PMCID: PMC7801312 DOI: 10.1007/s00066-020-01680-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [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: 06/18/2020] [Accepted: 08/11/2020] [Indexed: 02/07/2023]
Abstract
Purpose Chemotherapy with or without radiotherapy is the standard in patients with initially nonmetastatic unresectable pancreatic cancer. Additional surgery is in discussion. The CONKO-007 multicenter randomized trial examines the value of radiotherapy. Our interim analysis showed a significant effect of surgery, which may be relevant to clinical practice. Methods One hundred eighty patients received induction chemotherapy (gemcitabine or FOLFIRINOX). Patients without tumor progression were randomized to either chemotherapy alone or to concurrent chemoradiotherapy. At the end of therapy, a panel of five independent pancreatic surgeons judged the resectability of the tumor. Results Following induction chemotherapy, 126/180 patients (70.0%) were randomized to further treatment. Following study treatment, 36/126 patients (28.5%) underwent surgery; (R0: 25/126 [19.8%]; R1/R2/Rx [n = 11/126; 6.1%]). Disease-free survival (DFS) and overall survival (OS) were significantly better for patients with R0 resected tumors (median DFS and OS: 16.6 months and 26.5 months, respectively) than for nonoperated patients (median DFS and OS: 11.9 months and 16.5 months, respectively; p = 0.003). In the 25 patients with R0 resected tumors before treatment, only 6/113 (5.3%) of the recommendations of the panel surgeons recommended R0 resectability, compared with 17/48 (35.4%) after treatment (p < 0.001). Conclusion Tumor resectability of pancreatic cancer staged as unresectable at primary diagnosis should be reassessed after neoadjuvant treatment. The patient should undergo surgery if a resectability is reached, as this significantly improves their prognosis.
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Affiliation(s)
- R Fietkau
- Department of Radiation Oncology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany.
| | - R Grützmann
- Department of Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - U A Wittel
- Department for General- and Visceral Surgery, Medical Center and Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - R S Croner
- Department of Surgery, University Hospital Magdeburg, Magdeburg, Germany
| | - L Jacobasch
- Private practice, Hematology/Oncology, Dresden, Germany
| | - U P Neumann
- Department of Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - A Reinacher-Schick
- Department for Hematology, Oncology and Palliative Care, St Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - D Imhoff
- Department of Radiation Oncology, Universitätsklinikum Frankfurt, Frankfurt, Germany
| | - S Boeck
- Department of Medical Oncology and Comprehensive Cancer Centre, Klinikum Grosshadern, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - L Keilholz
- Department of Radiotherapy, Clinical Center Bayreuth, Bayreuth, Germany
| | - H Oettle
- Outpatient Department Hematology/Oncology, Friedrichshafen, Germany
| | - W M Hohenberger
- Department of Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - H Golcher
- Department of Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - W O Bechstein
- Department of General and Visceral Surgery, Frankfurt University Hospital and Clinics, Frankfurt, Germany
| | - W Uhl
- Department of Surgery, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany
| | - A Pirkl
- Medical Centre for Information and Communication Technology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - W Adler
- Department of Medical Informatics, Biometry and Epidemiology, University of Erlangen-Nürnberg, Waldstraße 6, 91054, Erlangen, Germany
| | - S Semrau
- Department of Radiation Oncology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - S Rutzner
- Department of Radiation Oncology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - M Ghadimi
- Department of General, Visceral and Pediatric Surgery, Medical Center, Georg-August-University Göttingen, Göttingen, Germany
| | - D Lubgan
- Department of Radiation Oncology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
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Girard N, Fietkau R, Garassino M, Garrido P, Field J, Peters S, Smit H, Pérol M, Merle P, Sibille A, Markman B, Bouchaab H, Moskovitz M, Schumann C, Gregorc V, Klein A, Diaz Perez I, Sawyer W, Licour M, Christoph D. 1242P Characteristics of the first 615 patients enrolled in Pacific R: A study of the first real-world data on unresectable stage III NSCLC patients treated with durvalumab after chemoradiotherapy. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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23
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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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Hofheinz RD, Arnold D, Fokas E, Kaufmann M, Hothorn T, Folprecht G, Fietkau R, Hohenberger W, Ghadimi M, Liersch T, Grabenbauer GG, Sauer R, Rödel C, Graeven U. Impact of age on the efficacy of oxaliplatin in the preoperative chemoradiotherapy and adjuvant chemotherapy of rectal cancer: a post hoc analysis of the CAO/ARO/AIO-04 phase III trial. Ann Oncol 2019; 29:1793-1799. [PMID: 29873684 DOI: 10.1093/annonc/mdy205] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background The German rectal cancer trial CAO/ARO/AIO-04 has shown a significant benefit in 3-year disease-free survival (DFS) of adding oxaliplatin to a standard preoperative 5-fluorouracil (5-FU)-based chemoradiotherapy (CRT) and adjuvant chemotherapy in patients with locally advanced rectal cancer. The use of oxaliplatin as adjuvant treatment in elderly patients with colon cancer is controversial. We therefore investigated the impact of age on clinical outcome in the CAO/ARO/AIO-04 phase III trial. Patients and methods We carried out a post hoc analysis of the CAO/ARO/AIO-04 phase III trial evaluating primary and secondary end points according to age. Patient and tumor characteristics, NCI CTC adverse events grades 3-4 (version 3.0), dose intensities as well as survival and recurrence data were analyzed in three specified age groups (<60, 60-70, and ≥70 years). The influence of age as a continuous variable on DFS was modeled using a subpopulation treatment effect pattern plot (STEPP) analysis. Results A total of 1232 patients were assessable. With the exception of Eastern Cooperative Oncology Group status (P < 0.001), no differences in patient and tumor characteristics were noticed between age groups. Likewise, toxicity pattern, dose intensities of CRT and surgical results were similar in all age groups. After a median follow-up of 50 months, in patients aged <60 years a significant benefit of adding oxaliplatin to 5-FU-based CRT and adjuvant chemotherapy was observed for local (P = 0.013) and systemic recurrences (P = 0.023), DFS (P = 0.011), and even overall survival (OS; P = 0.044). The STEPP analysis revealed improved hazard ratios for DFS in patients aged 40-70 years compared with elderly patients treated with oxaliplatin. Conclusion The addition of oxaliplatin significantly improved DFS and OS in younger patients aged <60 years with advanced rectal cancer. Patients aged ≥70 years had no benefit. Clinical Trials Number NCT00349076.
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Affiliation(s)
- R-D Hofheinz
- Interdisciplinary Tumor Center, University Hospital Mannheim, University of Heidelberg, Heidelberg, Germany.
| | - D Arnold
- Department of Oncology and Hematology, Asklepios Clinic Altona, Hamburg, Germany
| | - E Fokas
- Department of Radiotherapy and Oncology, University of Frankfurt, German Cancer Research Center (DKFZ), Heidelberg; German Cancer Consortium (DKTK), Frankfurt, Germany
| | - M Kaufmann
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - T Hothorn
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - G Folprecht
- Department of Oncology, University Hospital Dresden, Dresden, Germany
| | - R Fietkau
- Department of Radiation Therapy, University of Erlangen-Nürnberg, Erlangen-Nürnberg, Germany
| | - W Hohenberger
- Department of General and Visceral Surgery, University of Erlangen-Nürnberg, Erlangen-Nürnberg, Germany
| | - M Ghadimi
- Department of General, Visceral and Pediatric Surgery, University Medical Center Göttingen, Göttingen, Germany
| | - T Liersch
- Department of General, Visceral and Pediatric Surgery, University Medical Center Göttingen, Göttingen, Germany
| | - G G Grabenbauer
- Department of Radiation Oncology and Radiotherapy, DiaCura & Klinikum, Coburg, Germany
| | - R Sauer
- Department of Radiation Therapy, University of Erlangen-Nürnberg, Erlangen-Nürnberg, Germany
| | - C Rödel
- Department of Radiotherapy and Oncology, University of Frankfurt, German Cancer Research Center (DKFZ), Heidelberg; German Cancer Consortium (DKTK), Frankfurt, Germany
| | - U Graeven
- Department of Hematology/Oncology and Gastroenterology, Kliniken Maria Hilf GmbH, Mönchengladbach, Germany
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Fokas E, Fietkau R, Hartmann A, Hohenberger W, Grützmann R, Ghadimi M, Liersch T, Ströbel P, Grabenbauer GG, Graeven U, Hofheinz RD, Köhne CH, Wittekind C, Sauer R, Kaufmann M, Hothorn T, Rödel C. Neoadjuvant rectal score as individual-level surrogate for disease-free survival in rectal cancer in the CAO/ARO/AIO-04 randomized phase III trial. Ann Oncol 2019; 29:1521-1527. [PMID: 29718095 DOI: 10.1093/annonc/mdy143] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background Surrogate end points in rectal cancer after preoperative chemoradiation are lacking as their statistical validation poses major challenges, including confirmation based on large phase III trials. We examined the prognostic role and individual-level surrogacy of neoadjuvant rectal (NAR) score that incorporates weighted cT, ypT and ypN categories for disease-free survival (DFS) in 1191 patients with rectal carcinoma treated within the CAO/ARO/AIO-04 phase III trial. Patients and methods Cox regression models adjusted for treatment arm, resection status, and NAR score were used in multivariable analysis. The four Prentice criteria (PC1-4) were used to assess individual-level surrogacy of NAR for DFS. Results After a median follow-up of 50 months, the addition of oxaliplatin to fluorouracil-based chemoradiotherapy (CRT) significantly improved 3-year DFS [75.9% (95% confidence interval [CI] 72.30% to 79.50%) versus 71.3% (95% CI 67.60% to 74.90%); P = 0.034; PC 1) and resulted in a shift toward lower NAR groups (P = 0.034, PC 2) compared with fluorouracil-only CRT. The 3-year DFS was 91.7% (95% CI 88.2% to 95.2%), 81.8% (95% CI 78.4% to 85.1%), and 58.1% (95% CI 52.4% to 63.9%) for low, intermediate, and high NAR score, respectively (P < 0.001; PC 3). NAR score remained an independent prognostic factor for DFS [low versus high NAR: hazard ratio (HR) 4.670; 95% CI 3.106-7.020; P < 0.001; low versus intermediate NAR: HR 1.971; 95% CI 1.303-2.98; P = 0.001] in multivariable analysis. Notwithstanding the inherent methodological difficulty in interpretation of PC 4 to establish surrogacy, the treatment effect on DFS was captured by NAR, supporting satisfaction of individual-level PC 4. Conclusion Our study validates the prognostic role and individual-level surrogacy of NAR score for DFS within a large randomized phase III trial. NAR score could help oncologists to speed up response-adapted therapeutic decision, and further large phase III trial data sets should aim to confirm trial-level surrogacy.
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Affiliation(s)
- E Fokas
- Department of Radiotherapy and Oncology, University of Frankfurt, Frankfurt, Germany; German Cancer Research Center (DKFZ), Heidelberg; German Cancer Consortium (DKTK), Partner Site: Frankfurt, Germany.
| | - R Fietkau
- Department of Radiation Therapy, University of Erlangen-Nürnberg, Erlangen, Germany
| | - A Hartmann
- Institute of Pathology, University of Erlangen-Nürnberg, Erlangen, Germany
| | - W Hohenberger
- Department of General and Visceral, University of Erlangen-Nürnberg, Erlangen, Germany
| | - R Grützmann
- Department of General and Visceral, University of Erlangen-Nürnberg, Erlangen, Germany
| | - M Ghadimi
- Department of General, Visceral and Pediatric Surgery, University Medical Center Göttingen, Göttingen, Germany
| | - T Liersch
- Department of General, Visceral and Pediatric Surgery, University Medical Center Göttingen, Göttingen, Germany
| | - P Ströbel
- Institute of Pathology, University Medical Center Göttingen, Göttingen, Germany
| | - G G Grabenbauer
- Department of Radiation Oncology and Radiotherapy, DiaCura & Klinikum Coburg, Coburg, Germany
| | - U Graeven
- Department of Hematology/Oncology, Kliniken Maria Hilf GmbH Mönchengladbach, Mönchengladbach, Germany
| | - R-D Hofheinz
- Department of Medical Oncology, University Hospital Mannheim, Mannheim, Germany
| | - C-H Köhne
- Department of Medical Oncology, University of Oldenburg, Oldenburg, Germany
| | - C Wittekind
- Institute of Pathology, University of Leipzig, Leipzig, Germany
| | - R Sauer
- Department of Radiation Therapy, University of Erlangen-Nürnberg, Erlangen, Germany
| | - M Kaufmann
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - T Hothorn
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - C Rödel
- Department of Radiotherapy and Oncology, University of Frankfurt, Frankfurt, Germany; German Cancer Research Center (DKFZ), Heidelberg; German Cancer Consortium (DKTK), Partner Site: Frankfurt, Germany
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Wittel UA, Lubgan D, Ghadimi M, Belyaev O, Uhl W, Bechstein WO, Grützmann R, Hohenberger WM, Schmid A, Jacobasch L, Croner RS, Reinacher-Schick A, Hopt UT, Pirkl A, Oettle H, Fietkau R, Golcher H. Consensus in determining the resectability of locally progressed pancreatic ductal adenocarcinoma - results of the Conko-007 multicenter trial. BMC Cancer 2019; 19:979. [PMID: 31640628 PMCID: PMC6805375 DOI: 10.1186/s12885-019-6148-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 09/10/2019] [Indexed: 01/05/2023] Open
Abstract
Background One critical step in the therapy of patients with localized pancreatic cancer is the determination of local resectability. The decision between primary surgery versus upfront local or systemic cancer therapy seems especially to differ between pancreatic cancer centers. In our cohort study, we analyzed the independent judgement of resectability of five experienced high volume pancreatic surgeons in 200 consecutive patients with borderline resectable or locally advanced pancreatic cancer. Methods Pretherapeutic CT or MRI scans of 200 consecutive patients with borderline resectable or locally advanced pancreatic cancer were evaluated by 5 independent pancreatic surgeons. Resectability and the degree of abutment of the tumor to the venous and arterial structures adjacent to the pancreas were reported. Interrater reliability and dispersion indices were compared. Results One hundred ninety-four CT scans and 6 MRI scans were evaluated and all parameters were evaluated by all surgeons in 133 (66.5%) cases. Low agreement was observed for tumor infiltration of venous structures (κ = 0.265 and κ = 0.285) while good agreement was achieved for the abutment of the tumor to arterial structures (interrater reliability celiac trunk κ = 0.708 P < 0.001). In patients with vascular tumor contact indicating locally advanced disease, surgeons highly agreed on unresectability, but in patients with vascular tumor abutment consistent with borderline resectable disease, the judgement of resectability was less uniform (dispersion index locally advanced vs. borderline resectable p < 0.05). Conclusion Excellent agreement between surgeons exists in determining the presence of arterial abutment and locally advanced pancreatic cancer. The determination of resectability in borderline resectable patients is influenced by additional subjective factors. Trial registration EudraCT:2009-014476-21 (2013-02-22) and NCT01827553 (2013-04-09).
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Affiliation(s)
- U A Wittel
- Department for General- und Visceral Surgery, Medical Center and Faculty of Medicine University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany.
| | - D Lubgan
- Department of Radiation Oncology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - M Ghadimi
- Department of General, Visceral and Pediatric Surgery, Medical Center Georg-August-University Göttingen, Göttingen, Germany
| | - O Belyaev
- Department of Surgery, St. Josef Hospital Ruhr-University Bochum, Bochum, Germany
| | - W Uhl
- Department of Surgery, St. Josef Hospital Ruhr-University Bochum, Bochum, Germany
| | - W O Bechstein
- Department of General and Visceral Surgery, Frankfurt University Hospital and Clinics, Frankfurt, Germany
| | - R Grützmann
- Department of Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - W M Hohenberger
- Department of Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - A Schmid
- Department of Radiology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - L Jacobasch
- Private Practice, Hematology/Oncology, Dresden, Germany
| | - R S Croner
- Department of Surgery, University Hospital Magdeburg, Magdeburg, Germany
| | - A Reinacher-Schick
- Department for Hematology, Oncology and Palliative Care, St Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - U T Hopt
- Department for General- und Visceral Surgery, Medical Center and Faculty of Medicine University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
| | - A Pirkl
- Medical Centre for Information and Communication Technology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - H Oettle
- Outpatient Department Hematology/Oncology, Friedrichshafen, Germany
| | - R Fietkau
- Department of Radiation Oncology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - H Golcher
- Department of Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
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Klinghammer K, Gauler T, Dietz A, Grünwald V, Stöhlmacher J, Knipping S, Schroeder M, Guntinas-Lichius O, Frickhofen N, Lindeman HW, Fietkau R, Haxel B, Große-Thie C, Maschmeyer G, Zipfel M, Martus P, Knoedler M, Keilholz U. Cetuximab, fluorouracil and cisplatin with or without docetaxel for patients with recurrent and/or metastatic squamous cell carcinoma of the head and neck (CeFCiD): an open-label phase II randomised trial (AIO/IAG-KHT trial 1108). Eur J Cancer 2019; 122:53-60. [PMID: 31618704 DOI: 10.1016/j.ejca.2019.08.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Revised: 08/21/2019] [Accepted: 08/28/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND The combination of cisplatin, 5-fluorouracil (5-FU) and cetuximab (PFC) is the reference first-line treatment for recurrent/metastatic (R/M) squamous cell carcinoma of the head and neck (SCCHN). We analysed whether treatment intensification by the addition of docetaxel to PFC improved efficacy in R/M SCCHN. METHODS A total of 180 patients with R/M SCCHN (1:1) were assigned to receive either cisplatin (40 mg/m2), docetaxel (40 mg/m2) and 5-FU (2000 mg/m2) at days 1 and 8 and cetuximab (400/250 mg/m2) at days 1, 8 and 15 (DPFC) or standard cisplatin (100 mg/m2) at day 1, 5-FU (1000 mg/m2) at days 1-4 and cetuximab (400/250 mg/m2) at days 1, 8 and 15 (PFC). Chemotherapy was repeated every 21 days and continued for a maximum of 6 cycles in absence of disease progression or limiting toxicity, followed by cetuximab maintenance (500 mg/m2 every 2 weeks). The primary end-point was progression-free survival (PFS). RESULTS A preplanned interim analysis for toxicity after 20 patients/arm revealed excessive grade 3 and 4 gastrointestinal (65%) and infectious toxicities (35%) in arm A, which led to dose reduction of cisplatin to 30 mg/m2 and 5-FU to 1000 mg/m2 for subsequent patients. With a median follow-up of 2 years, grade 4 toxicities were 21.3% vs. 30.8% for DPFC and PFC, respectively. More treatment-related deaths occurred with DPFC vs. PFC, with 11.2% and 6.6%, respectively. For DPFC and PFC, the median PFS was 6.3 vs. 6.4 months (hazard ratio [HR] = 0.97, p = 0.87), the median overall survival was 8.9 vs. 10.6 months (HR = 1.29 p = 0.1) and response rates were 38.2% vs. 31.9% (p = 0.9), respectively. CONCLUSIONS DPFC failed to improve efficacy in R/M SCCHN. On the contrary, a high toxicity and mortality rate was detected in both arms, which underscores the vulnerability of patients with R/M SCCHN, and research on the need for further optimisation of the front-line chemotherapy backbone is ongoing.
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Affiliation(s)
- K Klinghammer
- Department of Hematology & Oncology, Charité University, Berlin, Germany.
| | - T Gauler
- Department of Radiation Oncology, West German Cancer Center, University of Duisburg-Essen Medical School, Essen, Germany
| | - A Dietz
- Department of Otolaryngology, Head and Neck Surgery, University Leipzig, Leipzig, Germany
| | - V Grünwald
- Interdisciplinary Urooncology, West German Cancer Center, Clinic for Internal Medicine (tumor research) and Clinic for Urology, University of Duisburg-Essen Medical School, Essen, Germany
| | | | - S Knipping
- Department of Head and Neck Surgery, Klinikum Dessau, Dessau-Roßlau, Germany
| | - M Schroeder
- Department of Hematology and Oncology, Helios Duisburg, Duisburg, Germany
| | - O Guntinas-Lichius
- Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany
| | - N Frickhofen
- Department of Hematology & Oncology and Palliative Care, HELIOS Dr Horst Schmidt Kliniken, Wiesbaden, Germany
| | - H-W Lindeman
- Department of Hematology & Oncology, KKH Hagen, Germany
| | - R Fietkau
- Department of Radiation Oncology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - B Haxel
- Department of Otolaryngology, AMEOS Klinikum Haldensleben, Haldensleben, Germany; Department of Otolaryngology, Head and Neck Surgery, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - C Große-Thie
- Department of Medicine, Clinic III - Hematology, Oncology, Palliative Medicine, Rostock University Medical Center, Rostock, Germany
| | - G Maschmeyer
- Department of Hematology, Oncology and Palliative Care, Klinikum Ernst von Bergmann, Potsdam, Germany
| | - M Zipfel
- Department of Internal Medicine III, University Hospital Bonn, Bonn, Germany
| | - P Martus
- Institute for Clinical Epidemiology and Applied Biometry, University of Tuebingen, Tuebingen, Germany
| | - M Knoedler
- University Cancer Center Leipzig, University Leipzig, Leipzig, Germany
| | - U Keilholz
- Charité Comprehensive Cancer Center, Berlin, Germany
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Hecht M, Gostian AO, Eckstein M, Rutzner S, von der Grün J, Illmer T, Hautmann M, Brunner T, Laban S, Klautke G, Tamaskovics B, Frey B, Hartmann A, Rödel C, Budach W, Gaipl U, Iro H, Fietkau R. Single cycle induction treatment with cisplatin/docetaxel plus durvalumab/tremelimumab in stage III-IVB head and neck squamous cell cancer (CheckRad-CD8 trial). Ann Oncol 2019. [DOI: 10.1093/annonc/mdz252.016] [Citation(s) in RCA: 1] [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: 11/13/2022] Open
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Schreiner W, Dudek W, Rieker R, Fietkau R, Sirbu H. EP1.01-49 Histology-Depended Pattern of Patho-Histological Response After Induction Therapy in Locally Advanced Non-Small Cell Lung Cancer. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.2022] [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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Bähr O, Tabatabai G, Fietkau R, Goldbrunner R, Glas MG. P14.63 The use of TTFields for newly diagnosed GBM patients in Germany in routine clinical care (TIGER: TTFields in Germany in routine clinical care). Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz126.298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
Despite various clinical phase 3 trials, survival for the most common brain tumour, glioblastoma (GBM), has not improved since 2005. Alternating electric fields with low-intensity and intermediate frequency, known as tumor treating fields (TTFields) were shown to inhibit cancer cell division. In the EF-14 phase 3 trial, the addition of TTFields to adjuvant temozolomide (TMZ) chemotherapy demonstrated significant extension of median overall, progression-free and long-term survival in newly diagnosed GBM (ndGBM) patients. As there is very high interest among prescribing physicians from all disciplines in Germany to further evaluate these effects in routine clinical care, the aim of the TIGER study is to assess safety and efficacy of TTFields in routine clinical care as well as reasons for patients refusing TTFields treatment, changes in quality of life within 4 months after start of therapy, treatment duration and compliance.
METHODS
The TIGER study is a multi-centre, prospective, non-interventional study in Germany (NCT03258021). All ndGBM patients who are eligible for TTFields therapy are asked for consent for study participation and comprehensively introduced to the therapy to allow them to make a conscious positive or negative therapy decision. At baseline and 2–4 months after treatment start, demographic data as well as the QoL and reasons for therapy decision are evaluated applying the EORTC-QLQ-C30/BN-20 and TTFields questionnaire, respectively. A number of about 1000 patient is planned (500 in each arm with positive and negative treatment decision, respectively) with a follow-up period of 18 months.
RESULTS
At the time point of the last data cut-off (March 2019), more than 460 patients in the trial have made a decision for or against treatment with TTFields. Within this population, more than 80% of patients agreed to undergo TTFields therapy. The median age of patients included in the trial is actually 58.4 years (range 19–85). In this population 47 % received complete resection, 32 % partial resection and 22 % biopsy.
CONCLUSION
Systematic and prospective data analysis for the use of TTFields in routine clinical care including patient’s therapy decision can be assessed in the TIGER trial. Additionally, the study supports the evaluation of treatment duration and usage rate, which could drive future analysis of TTFields treatment duration. Most recent data will be presented at the EANO annual meeting.
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Affiliation(s)
- O Bähr
- Neurologische Klinik, Klinikum Aschaffenburg-Alzenau, Aschaffenburg, Germany
| | - G Tabatabai
- Interdisciplinary Division of Neurooncology, University Hospital Tübingen, Tübingen, Germany
| | - R Fietkau
- Department of Radiation Oncology, University Hospital Erlangen, Erlangen, Germany
| | - R Goldbrunner
- Center for Neurosurgery, University Hospital Cologne, Köln, Germany
| | - M G Glas
- Division of Clinical Neurooncology, Department of Neurology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
- West German Cancer Center (WTZ), University Hospital Essen, University Duisburg-Essen, Essen, Germany
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Hofheinz R, Fokas E, Allgäuer M, Polat B, Klautke G, Grabenbauer G, Fietkau R, Kuhnt T, Staib L, Brunner T, Grosu A, Schmiegel W, Jacobasch L, Weitz J, Folprecht G, Germer C, Grützmann R, Schwarzbach M, Bechstein W, Friede T, Ghadimi M, Rödel C. Randomized phase 2 trial of chemoradiotherapy plus induction or consolidation chemotherapy as total neoadjuvant therapy for locally advanced rectal cancer: CAO/ARO/AIO-12. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz154.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Kallis K, Kaltsas T, Kreppner S, Lotter M, Strnad V, Fietkau R, Bert C. PO-1048 Variability in catheter reconstruction for multi-catheter interstitial brachytherapy. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31468-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Ziegler M, Lettmaier S, Fietkau R, Bert C. EP-1959 Performance of Marker-less Tracking for Gimbaled Dynamic Tumor Tracking. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)32379-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Diefenhardt M, Hofheinz R, Beissbarth T, Arnold D, Müller von den Grün J, Liersch T, Ströbel P, Grabenbauer G, Fietkau R, Weitz J, Ghadimi M, Rödel C, Fokas E. OC-0499 Neutrophilia as prognostic factor for outcome in the CAO/ARO/AIO-04 phase 3 rectal cancer trial. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)30919-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Kosmala R, Fokas E, Flentje M, Sauer R, Liersch T, Graeven U, Fietkau R, Hohenberger W, Arnold D, Hofheinz R, Ghadimi M, Raab H, Ströbel P, Staib L, Grabenbauer G, Folprecht G, Uter W, Gall C, Rödel C, Polat B. OC-0384 QoL after multimodal treatment of rectal cancer with/without oxaliplatin (phase 3, CAO/ARO/AIO-04). Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)30804-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Fietkau R, Hecht M, Hofner B, Iro H, Gefeller O, Rödel C, Hautmann M, Kölbl O, Salay A, Rübe C, Breinl P, Krings W, Gripp S, Wollenberg B, Keerl R, Schreck U, Siekmeyer B, Grabenbauer G, Balermpas P. OC-0387 radiotherapy with paclitaxel/cisplatin vs. fluorouracil/cisplatin for head and neck cancer. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)30807-2] [Citation(s) in RCA: 1] [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: 11/29/2022]
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Masitho S, Kallis K, Strnad V, Fietkau R, Bert C. OC-0075 Error detection using an electromagnetic tracking system in multicatheter interstitial brachytherapy. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)30495-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Girard N, Mornex F, Christoph D, Fietkau R, Filippi A, Field J, Garrido Lopez P, McDonald F, Peters S, Klein A, Licour M, Garassino M. PACIFIC-R: First real-world study of patients with unresectable, stage III NSCLC treated with durvalumab after chemoradiotherapy. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz067.017] [Citation(s) in RCA: 5] [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: 11/14/2022] Open
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Semrau S, Agaimy A, Pavel M, Lubgan D, Schmidt D, Cavallaro A, Golcher H, Grützmann R, Fietkau R. Long-term control with chemoradiation of initially metastatic mixed adenoneuroendocrine carcinoma of the rectum: a case report. J Med Case Rep 2019; 13:82. [PMID: 30902067 PMCID: PMC6431024 DOI: 10.1186/s13256-019-1995-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 01/23/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Mixed adenoneuroendocrine carcinomas are highly malignant tumors with both adenocarcinomatous and neuroendocrine components. They can originate in any organ but are more common in the rectum. Due to their rarity, current treatment recommendations for mixed adenoneuroendocrine carcinoma are based on limited data and follow general guidelines for the management of adenocarcinomas and neuroendocrine neoplasms. Uncertainty regarding the efficacy of the available local and systemic treatment strategies is a compounding issue. Even those patients with locally limited disease have a relatively short life expectancy. In this report, we describe a case of deep rectal mixed adenoneuroendocrine carcinoma with long survival after chemoradiation. CASE PRESENTATION A 48-year-old Caucasian woman was diagnosed with a grade 3 rectal adenocarcinoma combined with a poorly differentiated large cell neuroendocrine carcinoma component and synchronous metastases (cT3cN1cM1) in both lobes of the liver in 2012. She received concomitant chemoradiotherapy followed by four additional cycles of cisplatin plus irinotecan. Initial treatment induced complete remission of the rectal tumor and liver metastases. Consequently, it was not necessary to surgically resect the primary tumor or any of the metastases. Three months after the end of treatment, one metastasis in the first segment of the liver showed regrowth, and stereotactic body radiotherapy of the metastasis and chemotherapy resulted in a clinical complete response. The patient has been recurrence-free for more than 5 years. CONCLUSIONS Extended long-term control of a poorly differentiated metastatic (stage IV) mixed adenoneuroendocrine carcinoma is rare. The multimodal first- and second-line regimens of radiotherapy and chemotherapy described in this case report represent a new therapeutic approach. Encouraged by the results in this case, we compiled a review of the literature on mixed adenoneuroendocrine carcinoma.
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Affiliation(s)
- S Semrau
- Department of Radiation Oncology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Universitätsstraße 27, 91054, Erlangen, Germany.
| | - A Agaimy
- Institute of Pathology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Krankenhausstraße 8-10, 91054, Erlangen, Germany
| | - M Pavel
- Department of Medicine, Division of Endocrinology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Ulmenweg 18, 91054, Erlangen, Germany
| | - D Lubgan
- Department of Radiation Oncology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Universitätsstraße 27, 91054, Erlangen, Germany
| | - D Schmidt
- Clinic of Nuclear Medicine, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Ulmenweg 18, 91054, Erlangen, Germany
| | - A Cavallaro
- Institute of Radiology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Maximiliansplatz 1, 91054, Erlangen, Germany
| | - H Golcher
- Department of Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Maximiliansplatz 1, 91054, Erlangen, Germany
| | - R Grützmann
- Department of Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Maximiliansplatz 1, 91054, Erlangen, Germany
| | - R Fietkau
- Department of Radiation Oncology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Universitätsstraße 27, 91054, Erlangen, Germany
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Böckelmann F, Hammon M, Lettmaier S, Fietkau R, Bert C, Putz F. Penile bulb sparing in prostate cancer radiotherapy : Dose analysis of an in-house MRI system to improve contouring. Strahlenther Onkol 2018; 195:153-163. [PMID: 30315483 DOI: 10.1007/s00066-018-1377-0] [Citation(s) in RCA: 5] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 09/20/2018] [Indexed: 01/01/2023]
Abstract
OBJECTIVE This study aimed to assess the reduction in dose to the penile bulb (PB) achieved by MRI-based contouring following drinking and endorectal balloon (ERB) instructions. PATIENTS AND METHODS A total of 17 prostate cancer patients were treated with intensity-modulated radiation therapy (IMRT) and interstitial brachytherapy (IBT). CT and MRI datasets were acquired back-to-back based on a 65 cm3 air-filled ERB and drinking instructions. After rigid co-registration of the imaging data, the CT-based planning target volume (PTV) used for treatment planning was retrospectively compared to an MRI-based adaptive PTV and the dose to the PB was determined in each case. The adapted PTV encompassed a caudally cropped CT-based PTV which was defined on the basis of the MRI-based prostate contour plus an additional 5 mm safety margin. RESULTS In the seven-field IMRT treatment plans, the MRI-based adapted PTV achieved mean (Dmean) and maximum (Dmax) doses to the PB which were significantly lower (by 7.6 Gy and 10.9 Gy, respectively; p <0.05) than those of the CT-contoured PTV. For 6 patients, the estimated PB Dmax (seven-field IMRT and IBT) for the adapted PTV was <70 Gy, whereas only 1 patient fulfilled this criterium with the CT-based PTV. CONCLUSION MRI-based contouring and seven-field IMRT-based treatment planning achieved dose sparing to the PB. Whereas the comparison of MRI and CT contouring only relates to external beam radiotherapy (EBRT) sparing, considering EBRT and IBT shows the improvement in PB sparing for the total treatment.
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Affiliation(s)
- F Böckelmann
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitätsstraße 27, 91054, Erlangen, Germany
| | - M Hammon
- Department of Radiology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Maximiliansplatz 1, 91054, Erlangen, Germany
| | - S Lettmaier
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitätsstraße 27, 91054, Erlangen, Germany
| | - R Fietkau
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitätsstraße 27, 91054, Erlangen, Germany
| | - C Bert
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitätsstraße 27, 91054, Erlangen, Germany.
| | - F Putz
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitätsstraße 27, 91054, Erlangen, Germany
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Bähr O, Tabatabai G, Fietkau R, Goldbrunner R, Glas M. P01.095 The use of TTFields for newly diagnosed GBM patients in Germany in routine clinical care (TIGER: TTFields in Germany in routine clinical care). Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy139.137] [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: 11/13/2022] Open
Affiliation(s)
- O Bähr
- Dr. Senckenberg Institute of Neurooncology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - G Tabatabai
- Interdisciplinary Division of Neurooncology, University Hospital Tubingen, Tübingen, Germany
| | - R Fietkau
- Department of Radiation Oncology, University Hospital Erlangen, Erlangen, Germany
| | - R Goldbrunner
- Center for Neurosurgery, University Hospital Cologne, Cologne, Germany
| | - M Glas
- Division of Clinical Neurooncology, University Hospital Essen, Essen, Germany
- West German Cancer Center (WTZ), University Hospital Essen, Essen, Germany
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Sprenger T, Beißbarth T, Sauer R, Tschmelitsch J, Fietkau R, Liersch T, Hohenberger W, Staib L, Gaedcke J, Raab HR, Rödel C, Ghadimi M. Long-term prognostic impact of surgical complications in the German Rectal Cancer Trial CAO/ARO/AIO-94. Br J Surg 2018; 105:1510-1518. [DOI: 10.1002/bjs.10877] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 02/11/2018] [Accepted: 03/09/2018] [Indexed: 12/29/2022]
Abstract
Abstract
Background
The influence of postoperative complications on survival in patients with locally advanced rectal cancer undergoing combined modality treatment is debatable. This study evaluated the impact of surgical complications on oncological outcomes in patients with locally advanced rectal cancer treated within the randomized CAO/ARO/AIO-94 (Working Group of Surgical Oncology/Working Group of Radiation Oncology/Working Group of Medical Oncology of the Germany Cancer Society) trial.
Methods
Patients were assigned randomly to either preoperative chemoradiotherapy (CRT) followed by total mesorectal excision (TME) or postoperative CRT between 1995 and 2002. Anastomotic leakage and wound healing disorders were evaluated prospectively, and their associations with overall survival, and distant metastasis and local recurrence rates after a long-term follow-up of more than 10 years were determined. Medical complications (such as cardiopulmonary events) were not analysed in this study.
Results
A total of 799 patients were included in the analysis. Patients who had anterior or intersphincteric resection had better 10-year overall survival than those treated with abdominoperineal resection (63·1 versus 51·3 per cent; P < 0·001). Anastomotic leakage was associated with worse 10-year overall survival (51 versus 65·2 per cent; P = 0·020). Overall survival was reduced in patients with impaired wound healing (45·7 versus 62·2 per cent; P = 0·009). At 10 years after treatment, patients developing any surgical complication (anastomotic leakage and/or wound healing disorder) had impaired overall survival (46·6 versus 63·8 per cent; P < 0·001), a lower distant metastasis-free survival rate (63·2 versus 72·0 per cent; P = 0·030) and more local recurrences (15·5 versus 6·4 per cent; P < 0·001). In a multivariable Cox regression model, lymph node metastases (P < 0·001) and surgical complications (P = 0·008) were the only independent predictors of reduced overall survival.
Conclusion
Surgical complications were associated with adverse oncological outcomes in this trial.
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Affiliation(s)
- T Sprenger
- Department of General, Visceral and Paediatric Surgery, University Medical Centre Göttingen, Göttingen, Germany
| | - T Beißbarth
- Department of Medical Statistics, University Medical Centre Göttingen, Göttingen, Germany
| | - R Sauer
- Department of Radiotherapy, University Medical Centre Erlangen, Erlangen, Germany
| | - J Tschmelitsch
- Department of Surgery, Krankenhaus der Barmherzigen Brüder, St Veit an der Glan, Austria
| | - R Fietkau
- Department of Radiotherapy, University Medical Centre Erlangen, Erlangen, Germany
| | - T Liersch
- Department of General, Visceral and Paediatric Surgery, University Medical Centre Göttingen, Göttingen, Germany
| | - W Hohenberger
- Department of Surgery, University Medical Centre Erlangen, Erlangen, Germany
| | - L Staib
- Department of General and Visceral Surgery, Klinikum Esslingen, Esslingen, Germany
| | - J Gaedcke
- Department of General, Visceral and Paediatric Surgery, University Medical Centre Göttingen, Göttingen, Germany
| | - H-R Raab
- University Department of General and Visceral Surgery, Klinikum Oldenburg, Oldenburg, Germany
| | - C Rödel
- Department of Radiotherapy and Oncology, University Medical Centre Frankfurt, Frankfurt/Main, Germany
| | - M Ghadimi
- Department of General, Visceral and Paediatric Surgery, University Medical Centre Göttingen, Göttingen, Germany
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Ziegler M, Brandt T, Lettmaier S, Fietkau R, Bert C. EP-2030: Examination of the automatic fiducial marker detection on the Vero system. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)32339-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Fokas E, Fietkau R, Hartmann A, Hohenberger W, Grützmann R, Ghadimi M, Liersch T, Ströbel P, Grabenbauer G, Wittekind C, Sauer R, Kaufmann M, Hothorn T, Rödel C. OC-0278: NAR score as surrogate for disease-free survival in the CAO/ARO/AIO-04 phase 3 rectal cancer trial. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)30588-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Schäfer R, Strnad V, Polgár C, Uter W, Hildebrandt G, Ott O, Kauer-Dorner D, Knauerhase H, Major T, Lyczek J, Guinot J, Dunst J, Gutierrez Miguelez C, Slampa P, Allgäuer M, Lössl K, Kovacs G, Fietkau R, Resch A, Kulik A, Arribas L, Niehoff P, Guedea F, Gall C, Polat B. OC-0326: QOL After APBI (Multicatheter Brachytherapy) Versus WBI: 5-Year Results, Phase 3 GEC-ESTRO Trial. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)30636-4] [Citation(s) in RCA: 1] [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: 11/29/2022]
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46
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Schreiner W, Dudek W, Fietkau R, Sirbu H. P2.08-004 Pathologic Complete Response as an Independed Prognostic Factor in Patients with Locally Advanced Non-Small Cell Lung Cancer. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.1322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Schreiner W, Dudek W, Fietkau R, Sirbu H. P2.08-005 Salvage Lung Surgery Following Definitive Chemoradiation in Locally Advanced Non-Small Cell Lung Cancer. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.1323] [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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Fahrig A, Koch T, Lenhart M, Rieckmann P, Fietkau R, Distel L, Schuster B. Lethal outcome after pelvic salvage radiotherapy in a patient with prostate cancer due to increased radiosensitivity : Case report and literature review. Strahlenther Onkol 2017; 194:60-66. [PMID: 28887683 DOI: 10.1007/s00066-017-1207-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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: 04/16/2017] [Accepted: 08/17/2017] [Indexed: 01/30/2023]
Abstract
BACKGROUND In general, late side effects after salvage radiotherapy (RT) for prostate cancer are below 10%. Patients with impaired DNA repair ability and genetic instability can have significantly increased reactions after RT. CASE, CLINICAL FOLLOW-UP, AND EXAMINATION We present a patient who experienced severe side effects after additive RT for prostate cancer and died from the complications 25 months after RT. Imaging (MR) is shown as well as three-color fluorescence in situ hybridization. The blood sample testing revealed that radiosensitivity was increased by 35-55%. We undertook a review of the literature to give an overview over the tests established that are currently considered useful. CONCLUSION This case highlights that the identification of patients with increased radiosensitivity is an important task in radiation protection. Groups of patients who should be screened have to be found and corresponding research facilities have to be set up.
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Affiliation(s)
- Antje Fahrig
- Klinik und Praxis für Radioonkologie und Strahlentherapie, Klinikum Bamberg, Sozialstiftung Bamberg, Buger Straße 80, 96049, Bamberg, Germany.
| | - T Koch
- Klinik und Praxis für Radioonkologie und Strahlentherapie, Klinikum Bamberg, Sozialstiftung Bamberg, Buger Straße 80, 96049, Bamberg, Germany
| | - M Lenhart
- Klinik für Diagnostische Radiologie, Interventionelle Radiologie und Neuroradiologie, Klinikum Bamberg, Sozialstiftung Bamberg, Buger Straße 80, 96049, Bamberg, Germany
| | - P Rieckmann
- Neurologische Klinik, Klinikum Bamberg, Sozialstiftung Bamberg, Buger Straße 80, 96049, Bamberg, Germany
| | - R Fietkau
- Strahlenklinik, Universitätsklinikum Erlangen, Universitätsstraße 27, 91054, Erlangen, Germany
| | - Luitpold Distel
- Strahlenklinik, Universitätsklinikum Erlangen, Universitätsstraße 27, 91054, Erlangen, Germany
| | - B Schuster
- Strahlenklinik, Universitätsklinikum Erlangen, Universitätsstraße 27, 91054, Erlangen, Germany
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Fietkau R. [When is a nonsurgical approach possible for metastatic primary tumors and lymph node metastases of the urinary bladder and prostate?]. Urologe A 2017; 56:570-578. [PMID: 28424830 DOI: 10.1007/s00120-017-0379-3] [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: 10/19/2022]
Abstract
For metastatic carcinomas of the urinary bladder and prostate, systemic therapy is of primary importance. Due to technological advances in radiation oncology such as stereotactic radiotherapy, intensity-modulated radiotherapy, interstitial radiotherapy, and the combination of radiotherapy and chemotherapy, pelvic irradiation can nowadays be carried out effectively and without the risk of major side effects. New data from other tumor entities and retrospective analyses suggest that the use of these technologies can lead to a clinical benefit in terms of improvement in quality of life, local control, and overall survival. For the time being, the decision to administer radiotherapy to the pelvic region should be made on an individual basis. Retrospective analyses of data from prostate carcinomas in particular are currently being planned. This review article introduces potential indications which are supported with real patient examples and discusses future developments giving an overview of the literature and referring to data from prospective randomized trials.
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Affiliation(s)
- R Fietkau
- Strahlenklinik des Universitätsklinikums Erlangen, Universitätsstr. 27, 91054, Erlangen, Deutschland.
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Hecht M, Hahn D, Beutner D, Reichert D, Göhler T, Wurm R, Welslau M, Renziehausen L, Balermpas P, Bergmann T, Aßmann M, Belka C, Orlowski K, Finzsch M, Illerhaus G, Fietkau R. Cetuximab in combination with platinum-based chemotherapy or radiotherapy in recurent and/or metastatic SCCHN in a non-selected patient cohort (interim analysis of the phase IV SOCCER trial). Ann Oncol 2016. [DOI: 10.1093/annonc/mdw376.46] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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