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Prezado Y, Grams M, Jouglar E, Martínez-Rovira I, Ortiz R, Seco J, Chang S. Spatially fractionated radiation therapy: a critical review on current status of clinical and preclinical studies and knowledge gaps. Phys Med Biol 2024; 69:10TR02. [PMID: 38648789 DOI: 10.1088/1361-6560/ad4192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 04/22/2024] [Indexed: 04/25/2024]
Abstract
Spatially fractionated radiation therapy (SFRT) is a therapeutic approach with the potential to disrupt the classical paradigms of conventional radiation therapy. The high spatial dose modulation in SFRT activates distinct radiobiological mechanisms which lead to a remarkable increase in normal tissue tolerances. Several decades of clinical use and numerous preclinical experiments suggest that SFRT has the potential to increase the therapeutic index, especially in bulky and radioresistant tumors. To unleash the full potential of SFRT a deeper understanding of the underlying biology and its relationship with the complex dosimetry of SFRT is needed. This review provides a critical analysis of the field, discussing not only the main clinical and preclinical findings but also analyzing the main knowledge gaps in a holistic way.
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Affiliation(s)
- Yolanda Prezado
- Institut Curie, Université PSL, CNRS UMR3347, Inserm U1021, Signalisation Radiobiologie et Cancer, F-91400, Orsay, France
- Université Paris-Saclay, CNRS UMR3347, Inserm U1021, Signalisation Radiobiologie et Cancer, F-91400, Orsay, France
- New Approaches in Radiotherapy Lab, Center for Research in Molecular Medicine and Chronic Diseases (CIMUS), Instituto de investigación Sanitaria de Santiago de Compostela (IDIS), University of Santiago de Compostela, Santiago de Compostela, A Coruña, E-15706, Spain
- Oportunius Program, Galician Agency of Innovation (GAIN), Xunta de Galicia, Santiago de Compostela, A Coruña, Spain
| | - Michael Grams
- Department of Radiation Oncology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, United States of America
| | - Emmanuel Jouglar
- Institut Curie, PSL Research University, Department of Radiation Oncology, F-75005, Paris and Orsay Protontherapy Center, F-91400, Orsay, France
| | - Immaculada Martínez-Rovira
- Physics Department, Universitat Auto`noma de Barcelona, E-08193, Cerdanyola del Valle`s (Barcelona), Spain
| | - Ramon Ortiz
- University of California San Francisco, Department of Radiation Oncology, 1600 Divisadero Street, San Francisco, CA 94143, United States of America
| | - Joao Seco
- Division of Biomedical physics in Radiation Oncology, DKFZ-German Cancer Research Center, Heidelberg, Germany
- Department of Physics and Astronomy, Heidelberg University, Heidelberg, Germany
| | - Sha Chang
- Dept of Radiation Oncology and Department of Biomedical Engineering, University of North Carolina School of Medicine, United States of America
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolin State University, United States of America
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Rehn S, Oertel M, Linde P, Mäurer M, Elsayad K, Pepper NB, Rolf D, Kahn JM, Plastaras JP, Gunther JR, Eich HT. Knowledge and competences in hematological malignancies amongst radiation oncology residents in Germany-results from a national survey. Strahlenther Onkol 2024:10.1007/s00066-024-02236-4. [PMID: 38683476 DOI: 10.1007/s00066-024-02236-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 04/07/2024] [Indexed: 05/01/2024]
Abstract
INTRODUCTION Radiation oncology is a pivotal modality in the treatment of hematologic malignancies. To enable state-of-the-art patient care, structured education during residency is essential. However, given the lack of detailed data, the scope of educational opportunities available to trainees remains elusive. This prompted our group to perform a national survey amongst radiation oncology residents in Germany assessing the status quo of competences in the treatment of lymphoma and leukemia patients. Furthermore, areas of potential improvement were identified to further the goal of competence-based education for residents. METHODS A survey-based analysis was conducted to assess the knowledge and competence of radiation oncology residents in Germany regarding hematological malignancies. A decisive questionnaire covering demographics, self-assessment of competences, and areas for improvement was developed in adaption of a survey by the Association of Residents in Radiation Oncology and distributed amongst 1439 members of the German Society of Radiation Oncology. Responses were collected anonymously via an online survey tool and analyzed using descriptive statistics and chi-square tests. RESULTS A total of 59 complete and 22 partial responses were collected, yielding a 5.6% response rate. Participants' competence varied, with notable experience gaps in pediatric cases, proton therapy, and large-field techniques like total-skin irradiation or pediatric total body irradiation. While participants felt confident in treatment planning and patient counseling, they showed deficiencies in the definition of the planning target volume for modern involved site radiotherapy. Resources for education included national and international guidelines, scientific reviews, and textbooks. Board-certified radiation oncologists and physicians from specialized lymphoma centers demonstrated higher overall competence levels. CONCLUSION This survey highlights the diversity of resident education regarding hematological malignancies in German radiation oncology programs. Knowledge gaps exist in key areas, including pediatric cases and specialized techniques. Competence-based education, interactive teaching formats, and rotations to specialized centers are potential strategies to address these gaps. The study contributes to the understanding of the federal educational landscape, underscoring the need for standardized and comprehensive training to ensure optimal patient care in hematological malignancies within the context of radiation oncology. Further research and collaborations are warranted to enhance training and expertise in this critical domain.
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Affiliation(s)
- Stephan Rehn
- Department of Radiation Oncology, University Hospital Muenster, Albert-Schweitzer-Campus 1, building A1, 48149, Muenster, Germany
| | - Michael Oertel
- Department of Radiation Oncology, University Hospital Muenster, Albert-Schweitzer-Campus 1, building A1, 48149, Muenster, Germany.
| | - Philipp Linde
- Department of Radiation Oncology, Cyberknife and Radiation Therapy, University Hospital of Cologne, Cologne, Germany
| | - Matthias Mäurer
- Department for Radiotherapy and Radiation Oncology, University Hospital Jena, Jena, Germany
| | - Khaled Elsayad
- Department of Radiation Oncology, University Hospital Muenster, Albert-Schweitzer-Campus 1, building A1, 48149, Muenster, Germany
| | - Niklas B Pepper
- Department of Radiation Oncology, University Hospital Muenster, Albert-Schweitzer-Campus 1, building A1, 48149, Muenster, Germany
| | - Daniel Rolf
- Department of Radiation Oncology, University Hospital Muenster, Albert-Schweitzer-Campus 1, building A1, 48149, Muenster, Germany
| | - Jenna M Kahn
- Department of Radiation Medicine, Oregon Health and Science University, Portland, OR, USA
| | - John P Plastaras
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Jillian R Gunther
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Hans T Eich
- Department of Radiation Oncology, University Hospital Muenster, Albert-Schweitzer-Campus 1, building A1, 48149, Muenster, Germany
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Sonnhoff M, Graff M, Paal K, Becker JN, Hermann RM, Christiansen H, Nitsche M, Merten R. Influence of demographic change on the demand for radiotherapy using forecasted predictions for prostate cancer in Germany. Strahlenther Onkol 2023:10.1007/s00066-023-02133-2. [PMID: 37638976 DOI: 10.1007/s00066-023-02133-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 07/27/2023] [Indexed: 08/29/2023]
Abstract
PURPOSE Demographic change will lead to an increase in age-associated cancers. The demand for primary treatment, especially oncologic therapies, is difficult to predict. This work is an attempt to project the demand for radiation therapy (RT) in 2030, taking into account demographic changes using prostate cancer (PC) as an example. MATERIALS AND METHODS Using the GENESIS database of the Federal Statistical Office, we retrieved demographic population projections for 2030 and retrospective demographic surveys from 1999 to 2019. Additionally, we queried incidence rates for PC in the respective age groups of 50-54, 55-59, 60-64, 65-69, 70-74, 75-79, 80-84, and +85 years from 1999-2019 via the Federal Cancer Registry of the Robert Koch Institute. We used a regression method to determine the age-dependent correlation between the incidence of PC and the population size of the respective age group by combining the data from 1999 to 2019. This information was used to calculate the incidence rates in the age groups of the expected population for 2030 and the expected new cases of PC in 2030. Finally, we extrapolated the indications for the demand for RT based on data from the Report on Cancer Incidence in Germany from 2016. RESULTS Considering a population-dependent incidence rate, an increase in new cases of PC is expected. This increase is particularly evident in the age groups of 70-74 and 80-84 years. With regards to RT, the estimate indicates an overall increase of 27.4% in demand. There is also a shift in RT demands towards older patients, especially in the 80- to 84-year-old age group. CONCLUSION We observe an age-associated increase in primary cases of PC. This is likely to result in an increased demand for RT. The exact demand cannot be predicted. However, trends can be estimated to plan for the demand. This, though, requires a good database from cancer registries.
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Affiliation(s)
- M Sonnhoff
- Department of Radiotherapy and Special Oncology, Hannover Medical School, 30625, Hannover, Germany.
- Center for Radiotherapy and Radiooncology Bremen and Westerstede, 28239, Bremen, Germany.
| | - M Graff
- Center for Radiotherapy and Radiooncology Bremen and Westerstede, 28239, Bremen, Germany
| | - K Paal
- Depatment für Radiotherapy University Hospital Graz, 8036, Graz, Austria
| | - J-N Becker
- Department of Radiotherapy and Special Oncology, Hannover Medical School, 30625, Hannover, Germany
| | - R-M Hermann
- Department of Radiotherapy and Special Oncology, Hannover Medical School, 30625, Hannover, Germany
- Center for Radiotherapy and Radiooncology Bremen and Westerstede, 28239, Bremen, Germany
| | - H Christiansen
- Department of Radiotherapy and Special Oncology, Hannover Medical School, 30625, Hannover, Germany
| | - M Nitsche
- Center for Radiotherapy and Radiooncology Bremen and Westerstede, 28239, Bremen, Germany
| | - R Merten
- Department of Radiotherapy and Special Oncology, Hannover Medical School, 30625, Hannover, Germany
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Oertel M, Schmidt R, Steike DR, Eich HT, Lenz P. Palliative care on the radiation oncology ward-improvements in clinical care through interdisciplinary ward rounds. Strahlenther Onkol 2023; 199:251-257. [PMID: 35951037 PMCID: PMC9938032 DOI: 10.1007/s00066-022-01989-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 07/15/2022] [Indexed: 10/15/2022]
Abstract
INTRODUCTION Palliative care is essential for patients with terminal diseases and aims at effective symptom control. This may stand in opposition to radiation treatment as an oncological treatment modality. The hereby presented work demonstrates the successful integration of a palliative care service in the radiation oncology ward. METHODS Since 2015, 1018 patients were seen by the palliative care service on the radiation oncology ward and have been analyzed in this single center study. To assess teaching efficacy of the consultation service, a survey was conducted among 15 radiation oncology residents. RESULTS Cooperation between the two departments proved to be efficient with rising patient numbers. Palliative care was able to guide appropriate postdischarge care with the number of patients dying on the radiation oncology ward decreasing significantly (p = 0.009). The main topics for consultation were pain medication (92.3%), organization of postdischarge care (92.3%), and psycho-oncological support (84.6%). Most residents had a positive image of the palliative care service and consented on adjectives like "enriching", "empathic", "collegial", "professionally founded", and a "low threshold for consultation". All participants agreed that cooperation deepened their knowledge on palliative care. CONCLUSION A synergistic cooperation between a palliative care consultation service and a radiation oncology department addresses patient symptoms on an individual level. It confers advanced knowledge on palliative care which is essential for resident education and patient treatment.
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Affiliation(s)
- Michael Oertel
- Department of Radiation Oncology, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany.
| | - Renate Schmidt
- Department of Palliative Care, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany
| | - David Rene Steike
- Department of Radiation Oncology, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany
| | - Hans Theodor Eich
- Department of Radiation Oncology, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany
| | - Philipp Lenz
- Department of Palliative Care, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany
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[Cardiovascular risk evaluation in the treatment of Hodgkin lymphoma-are we on the road to individualized planning?]. Strahlenther Onkol 2023; 199:333-336. [PMID: 36749383 PMCID: PMC9938026 DOI: 10.1007/s00066-023-02051-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2023] [Indexed: 02/08/2023]
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Oertel M, Hering D, Baues C, Kittel C, Fuchs M, Kriz J, Kröger K, Vordermark D, Herfarth K, Engenhart-Cabillic R, Lukas P, Haverkamp U, Borchmann P, Eich HT. Radiation doses to mediastinal organs at risk in early-stage unfavorable Hodgkin lymphoma- a risk stratified analysis of the GHSG HD17 trial. Front Oncol 2023; 13:1183906. [PMID: 37213291 PMCID: PMC10196378 DOI: 10.3389/fonc.2023.1183906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 04/14/2023] [Indexed: 05/23/2023] Open
Abstract
Introduction The German Hodgkin Study Group (GHSG) HD17 trial established the omission of radiotherapy (RT) for patients with early-stage unfavorable Hodgkin lymphoma being PET-negative after 2 cycles of BEACOPP escalated plus 2 cycles of ABVD. This patient group reveals heterogeneity in characteristics and disease extent which prompted us to perform a decisive dosimetric analysis according to GHSG risk factors. This may help to tailor RT individually balancing risks and benefits. Methods For quality assurance, RT-plans were requested from the treating facilities (n= 141) and analyzed centrally. Dose-volume histograms were scanned either paper-based or digitally to obtain doses to mediastinal organs. These were registered and compared according to GHSG risk factors. Results Overall, RT plans of 176 patients were requested, 139 of which had dosimetric information on target volumes within the mediastinum. Most of these patients were stage II (92.8%), had no B-symptoms (79.1%) and were aged < 50 years (89.9%). Risk factors were present in 8.6% (extranodal involvement), 31.7% (bulky disease), 46.0% (elevated erythrocyte sedimentation rate) and 64.0% (three involved areas), respectively. The presence of bulky disease significantly affected the mean RT doses to the heart (p=0.005) and to the left lung (median: 11.3 Gy vs. 9.9 Gy; p=0.042) as well as V5 of the right and left lung, respectively (median right lung: 67.4% vs. 51.0%; p=0.011; median left lung: 65.9% vs. 54.2%; p=0.008). Significant differences in similar organs at risk parameters could be found between the sub-cohorts with the presence or absence of extranodal involvement, respectively. In contrast, an elevated erythrocyte sedimentation rate did not deteriorate dosimetry significantly. No association of any risk factor with radiation doses to the female breast was found. Conclusion Pre-chemotherapy risk factors may help to predict potential RT exposure to normal organs and to critically review treatment indication. Individualized risk-benefit evaluations for patients with HL in early-stage unfavorable disease are mandatory.
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Affiliation(s)
- Michael Oertel
- Department of Radiation Oncology, University Hospital Muenster, Muenster, Germany
| | - Dominik Hering
- Department of Radiation Oncology, University Hospital Muenster, Muenster, Germany
| | - Christian Baues
- Department of Radiation Oncology and Cyberknife Center, University Hospital of Cologne, Cologne, Germany
| | - Christopher Kittel
- Department of Radiation Oncology, University Hospital Muenster, Muenster, Germany
| | - Michael Fuchs
- Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne, Dusseldorf, University Hospital of Cologne, Cologne, Germany
| | - Jan Kriz
- Department of Radiation Oncology, Alexianer Clemenshospital Muenster, Muenster, Germany
| | - Kai Kröger
- Department of Radiation Oncology, University Hospital Muenster, Muenster, Germany
| | - Dirk Vordermark
- Department of Radiation Oncology, University Hospital Halle (Saale), Halle (Saale), Germany
| | - Klaus Herfarth
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Rita Engenhart-Cabillic
- Department of Radiotherapy and Radiation Oncology, University Hospital Giessen-Marburg, Marburg, Germany
| | - Peter Lukas
- Department of Radiooncology, Medical University Innsbruck, Innsbruck, Austria
| | - Uwe Haverkamp
- Department of Radiation Oncology, University Hospital Muenster, Muenster, Germany
| | - Peter Borchmann
- Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne, Dusseldorf, University Hospital of Cologne, Cologne, Germany
| | - Hans Theodor Eich
- Department of Radiation Oncology, University Hospital Muenster, Muenster, Germany
- *Correspondence: Hans Theodor Eich,
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Oertel M, Eich HT. Strahlentherapeutische Behandlung von Leukämien. BEST PRACTICE ONKOLOGIE 2022. [PMCID: PMC9472722 DOI: 10.1007/s11654-022-00431-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Hintergrund Ziel der Arbeit Material und Methoden Ergebnisse Schlussfolgerung
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Affiliation(s)
- Michael Oertel
- Klinik für Strahlentherapie – Radioonkologie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149 Münster, Deutschland
| | - Hans Theodor Eich
- Klinik für Strahlentherapie – Radioonkologie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149 Münster, Deutschland
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Synchronous/Metachronous Multiple Primary Malignancies: Review of Associated Risk Factors. Diagnostics (Basel) 2022; 12:diagnostics12081940. [PMID: 36010291 PMCID: PMC9406460 DOI: 10.3390/diagnostics12081940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 08/03/2022] [Accepted: 08/09/2022] [Indexed: 11/23/2022] Open
Abstract
The incidence of secondary primary malignancy (SPM) has been reported to range from 1.33% to 5.8%, according to the location of the primary cancer and the follow-up duration. The highest occurrence rate of SPM, of 36.6% within 6 months, has been reported in lung cancer. Genitourinary malignancies were reported to be the third-most-common SPM in several reports. However, the incidence of genitourinary malignancy as the first primary cancer associated with SPM has not been reported. Several risk factors are related to the occurrence of SPM, including viral infection chemotherapy, radiation, genetics, smoking, betel quid chewing, and environmental factors. An early survey for SPM is indicated in first primary malignancy patients with these associated factors. In this study, we summarize several risk factors related to the occurrence of SPMs and preventive tests, which may help in their early detection and, consequently, better survival.
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Definition of an Normal Tissue Complication Probability Model for the Inner Ear in Definitive Radiochemotherapy of Nasopharynx Carcinoma. Cancers (Basel) 2022; 14:cancers14143422. [PMID: 35884484 PMCID: PMC9320660 DOI: 10.3390/cancers14143422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 07/09/2022] [Accepted: 07/11/2022] [Indexed: 11/26/2022] Open
Abstract
Background: Definitive radiochemotherapy is the treatment of choice for locally advanced nasopharyngeal carcinoma. Due to the vicinity of the nasopharynx to the inner ear and the use of ototoxic platinum-based chemotherapy, there is a risk for irreversible damage to the auditory system. To avoid or minimize these critical side effects, radiation exposure to each inner ear must be balanced between target volume coverage and toxicity. However, normal tissue complication probability (NTCP) models of the inner ear validated by clinical data are rare. Patients and Methods: This retrospective study investigates the inner ear toxicity of 46 patients who received radio(chemo-)therapy for nasopharyngeal carcinoma at our institution from 2004 to 2021 according to CTCAE 5.0 criteria. For each inner ear, the mean (Dmean) and maximum (Dmax) dose in Gray (Gy) was evaluated and correlated with clinical toxicity data. Based on the data, an NTCP model and a cutoff dose logistic regression model (CDLR) were created. Results: In 11 patients (23.9%) hearing impairment and/or tinnitus was observed as a possible therapy-associated toxicity. Dmean was between 15−60 Gy, whereas Dmax was between 30−75 Gy. There was a dose-dependent, sigmoidal relation between inner ear dose and toxicity. A Dmean of 44 Gy and 65 Gy was associated with inner ear damage in 25% and 50% of patients, respectively. The maximum curve slope (m) was found at 50% and is m=0.013. The Dmax values showed a 25% and 50% complication probability at 58 Gy and 69 Gy, respectively, and a maximum slope of the sigmoid curve at 50% with m=0.025. Conclusion: There is a sigmoidal relation between radiation dose and incidence of inner ear toxicities. Dose constraints for the inner ear of <44 Gy (Dmean) or <58 Gy (Dmax) are suggested to limit the probability of inner ear toxicity <25%.
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Abstract
Hintergrund Lymphoide Zellen weisen eine hohe Strahlensensitivität auf, sodass die Strahlentherapie eine sinnvolle Ergänzung der Systemtherapie bei Leukämien darstellt. Vor allem als konditionierende Behandlung vor allogener Stammzelltransplantation ist die Radiotherapie in Form einer Ganzkörperbestrahlung etabliert. Ziel der Arbeit Die vorliegende Arbeit ermöglicht einen Überblick über Durchführung und Nebenwirkungen der strahlentherapeutischen Behandlung bei Leukämien. Hierbei werden insbesondere die (Langzeit‑)Nebenwirkungen nach Ganzkörperbestrahlung dargestellt. Material und Methoden Es erfolgte eine selektive Literaturrecherche über die Datenbank PubMed zur Radiotherapie von Leukämien und zu Ganzkörperbestrahlungen mit Fokus auf Nebenwirkungen sowie technische und konzeptionelle Neuerungen. Ergebnisse Die Ganzkörperbestrahlung ist eine effektive Therapie zur Konditionierung vor allogener Stammzelltransplantation und weist ein diverses, aber beherrschbares, Toxizitätsspektrum mit endokrinen, kardiopulmonalen, okulären, nephrologischen und neurologischen Langzeitnebenwirkungen sowie Sekundärneoplasien auf. Zusätzlich kann eine Radiotherapie in Niedrigdosis effektiv zur Behandlung myeloider Sarkome (Chlorome) angewendet werden. Schlussfolgerung Die Vielfalt der Nebenwirkungen nach Ganzkörperbestrahlung erfordert eine interdisziplinäre und langfristige Nachsorgebetreuung durch internistische Onkolog*innen/Transplantationsmediziner*innen und Radioonkolog*innen. Technische Entwicklungen der Strahlentherapie können in Zukunft eine selektive Adressierung des Knochenmarks sowie der lymphatischen Organe realisieren. Aktuell sind diese noch nicht in der klinischen Routine etabliert und werden im Rahmen klinischer Studien evaluiert.
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Oertel M, Martel J, Mikesch JH, Scobioala S, Reicherts C, Kröger K, Lenz G, Stelljes M, Eich HT. The Burden of Survivorship on Hematological Patients-Long-Term Analysis of Toxicities after Total Body Irradiation and Allogeneic Stem Cell Transplantation. Cancers (Basel) 2021; 13:cancers13225640. [PMID: 34830802 PMCID: PMC8616356 DOI: 10.3390/cancers13225640] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 11/04/2021] [Accepted: 11/09/2021] [Indexed: 12/12/2022] Open
Abstract
Simple Summary Total body irradiation is an essential large-field technique enabling myeloablation before allogeneic stem cell transplantation. With its field encompassing all organs, a diverse spectrum of toxicities may arise. This work analyzes long-term pulmonary, cardiac, ocular, neurological and renal toxicities in a monocentric patient cohort and identifies possible risk factors. Both the number of patients and the duration of the follow-up period exceed those of many comparable studies in the literature. Abstract Total body irradiation is an effective conditioning modality before autologous or allogeneic stem cell transplantation. With the whole body being the radiation target volume, a diverse spectrum of toxicities has been reported. This fact prompted us to investigate the long-term sequelae of this treatment concept in a large patient cohort. Overall, 322 patients with acute leukemia or myelodysplastic syndrome with a minimum follow-up of one year were included (the median follow-up in this study was 68 months). Pulmonary, cardiac, ocular, neurological and renal toxicities were observed in 23.9%, 14.0%, 23.6%, 23.9% and 20.2% of all patients, respectively. The majority of these side effects were grades 1 and 2 (64.9–89.2% of all toxicities in the respective categories). The use of 12 Gray total body irradiation resulted in a significant increase in ocular toxicities (p = 0.013) and severe mucositis (p < 0.001). Renal toxicities were influenced by the age at transplantation (relative risk: 1.06, p < 0.001) and disease entity. In summary, total body irradiation triggers a multifaceted, but manageable, toxicity profile. Except for ocular toxicities and mucositis, a 12 Gray regimen did not lead to an increase in long-term side effects.
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Affiliation(s)
- Michael Oertel
- Department of Radiation Oncology, University Hospital Muenster, 48149 Munster, Germany; (J.M.); (S.S.); (K.K.); (H.T.E.)
- Correspondence: ; Tel.: +49-251-83-47384; Fax: +49-251-83-47355
| | - Jonas Martel
- Department of Radiation Oncology, University Hospital Muenster, 48149 Munster, Germany; (J.M.); (S.S.); (K.K.); (H.T.E.)
| | - Jan-Henrik Mikesch
- Department of Medicine A—Hematology, Hemostaseology, Oncology, Pulmonology, University Hospital Muenster, 48149 Munster, Germany; (J.-H.M.); (C.R.); (G.L.); (M.S.)
| | - Sergiu Scobioala
- Department of Radiation Oncology, University Hospital Muenster, 48149 Munster, Germany; (J.M.); (S.S.); (K.K.); (H.T.E.)
| | - Christian Reicherts
- Department of Medicine A—Hematology, Hemostaseology, Oncology, Pulmonology, University Hospital Muenster, 48149 Munster, Germany; (J.-H.M.); (C.R.); (G.L.); (M.S.)
| | - Kai Kröger
- Department of Radiation Oncology, University Hospital Muenster, 48149 Munster, Germany; (J.M.); (S.S.); (K.K.); (H.T.E.)
| | - Georg Lenz
- Department of Medicine A—Hematology, Hemostaseology, Oncology, Pulmonology, University Hospital Muenster, 48149 Munster, Germany; (J.-H.M.); (C.R.); (G.L.); (M.S.)
| | - Matthias Stelljes
- Department of Medicine A—Hematology, Hemostaseology, Oncology, Pulmonology, University Hospital Muenster, 48149 Munster, Germany; (J.-H.M.); (C.R.); (G.L.); (M.S.)
| | - Hans Theodor Eich
- Department of Radiation Oncology, University Hospital Muenster, 48149 Munster, Germany; (J.M.); (S.S.); (K.K.); (H.T.E.)
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Kranz J, Steffens J. Additional Aspects. DEUTSCHES ARZTEBLATT INTERNATIONAL 2021; 118:616. [PMID: 34857079 DOI: 10.3238/arztebl.m2021.0279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Höller U, Oertel M. In Reply. DEUTSCHES ARZTEBLATT INTERNATIONAL 2021; 118:616-617. [PMID: 34857080 DOI: 10.3238/arztebl.m2021.0280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Streitbürger A, Nottrott M, Guder W, Podleska L, Dudda M, Hardes J. [Strategic approach to pathological fractures]. Unfallchirurg 2021; 124:687-694. [PMID: 34398277 DOI: 10.1007/s00113-021-01068-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2021] [Indexed: 10/20/2022]
Abstract
Pathological tumor-associated fractures are overall rare. They can occur in every age group and every bone. Although tumor-related fractures only form a small proportion of bone fractures, the early recognition of the cause of the fracture and treatment according to oncological guidelines are of enormous importance for affected patients. False treatment is frequently associated with far-reaching negative consequences with respect to the course of the disease. The great challenge is not the expeditious surgical treatment but much more the adequate diagnostics and the incorporation of local fracture treatment into an interdisciplinary overall oncological concept.
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Affiliation(s)
- Arne Streitbürger
- Klinik für Tumororthopädie, Universitätsklinikum Essen, Hufelandstr. 55, 45147, Essen, Deutschland.
| | - Markus Nottrott
- Klinik für Tumororthopädie, Universitätsklinikum Essen, Hufelandstr. 55, 45147, Essen, Deutschland
| | - Wiebke Guder
- Klinik für Tumororthopädie, Universitätsklinikum Essen, Hufelandstr. 55, 45147, Essen, Deutschland
| | - Lars Podleska
- Klinik für Tumororthopädie, Universitätsklinikum Essen, Hufelandstr. 55, 45147, Essen, Deutschland
| | - Marcel Dudda
- Klinik für Unfall‑, Hand-, und Wiederherstellungschirurgie, Universitätsmedizin Essen, Essen, Deutschland
| | - Jendrik Hardes
- Klinik für Tumororthopädie, Universitätsklinikum Essen, Hufelandstr. 55, 45147, Essen, Deutschland
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Pulmonary Toxicity after Total Body Irradiation-An Underrated Complication? Estimation of Risk via Normal Tissue Complication Probability Calculations and Correlation with Clinical Data. Cancers (Basel) 2021; 13:cancers13122946. [PMID: 34204603 PMCID: PMC8231208 DOI: 10.3390/cancers13122946] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 06/05/2021] [Accepted: 06/09/2021] [Indexed: 12/25/2022] Open
Abstract
Simple Summary Total body irradiation is an integral part of many conditioning regimens prior to allogeneic stem cell transplantation. It is a large-field technique affecting all organs at risk, of which the lungs are critical for patient survival. However, the precise rates of long-term pulmonary toxicities are unknown. This analysis provides a large patient cohort with long-term follow-up investigating TBI sequelae. Additionally, we present normal tissue complication probability calculations for acute and chronic lung toxicities to enable comparison between biophysical and real-world data. To our knowledge, this is the first adaption of this model to a total-body irradiation patient cohort, which will help to evaluate the feasibility and appropriateness of this approach. Abstract Total body irradiation (TBI) is an essential part of various conditioning regimens prior to allogeneic stem cell transplantation, but is accompanied by relevant (long-term) toxicities. In the lungs, a complex mechanism induces initial inflammation (pneumonitis) followed by chronic fibrosis. The hereby presented analysis investigates the occurrence of pulmonary toxicity in a large patient collective and correlates it with data derived from normal tissue complication probability (NTCP) calculations. The clinical data of 335 hemato-oncological patients undergoing TBI were analyzed with a follow-up of 85 months. Overall, 24.8% of all patients displayed lung toxicities, predominantly pneumonia and pulmonary obstructions (13.4% and 6.0%, respectively). NTCP calculations estimated median risks to be 20.3%, 0.6% and 20.4% for overall pneumonitis (both radiological and clinical), symptomatic pneumonitis and lung fibrosis, respectively. These numbers are consistent with real-world data from the literature and further specify radiological and clinical apparent toxicity rates. Overall, the estimated risk for clinical apparent pneumonitis is very low, corresponding to the probability of non-infectious acute respiratory distress syndrome, although the underlying pathophysiology is not identical. Radiological pneumonitis and lung fibrosis are expected to be more common but require a more precise documentation by the transplantation team, radiologists and radiation oncologists.
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