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Koerber SA, Höcht S, Aebersold D, Albrecht C, Boehmer D, Ganswindt U, Schmidt-Hegemann NS, Hölscher T, Mueller AC, Niehoff P, Peeken JC, Pinkawa M, Polat B, Spohn SKB, Wolf F, Zamboglou C, Zips D, Wiegel T. Prostate cancer and elective nodal radiation therapy for cN0 and pN0-a never ending story? : Recommendations from the prostate cancer expert panel of the German Society of Radiation Oncology (DEGRO). Strahlenther Onkol 2024; 200:181-187. [PMID: 38273135 PMCID: PMC10876748 DOI: 10.1007/s00066-023-02193-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 12/17/2023] [Indexed: 01/27/2024]
Abstract
For prostate cancer, the role of elective nodal irradiation (ENI) for cN0 or pN0 patients has been under discussion for years. Considering the recent publications of randomized controlled trials, the prostate cancer expert panel of the German Society of Radiation Oncology (DEGRO) aimed to discuss and summarize the current literature. Modern trials have been recently published for both treatment-naïve patients (POP-RT trial) and patients after surgery (SPPORT trial). Although there are more reliable data to date, we identified several limitations currently complicating the definitions of general recommendations. For patients with cN0 (conventional or PSMA-PET staging) undergoing definitive radiotherapy, only men with high-risk factors for nodal involvement (e.g., cT3a, GS ≥ 8, PSA ≥ 20 ng/ml) seem to benefit from ENI. For biochemical relapse in the postoperative situation (pN0) and no PSMA imaging, ENI may be added to patients with risk factors according to the SPPORT trial (e.g., GS ≥ 8; PSA > 0.7 ng/ml). If PSMA-PET/CT is negative, ENI may be offered for selected men with high-risk factors as an individual treatment approach.
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Affiliation(s)
- S A Koerber
- Department of Radiation Oncology, Barmherzige Brüder Hospital Regensburg, Prüfeninger Straße 86, 93049, Regensburg, Germany.
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
| | - S Höcht
- Department of Radiation Oncology, Ernst von Bergmann Hospital Potsdam, Charlottenstraße 72, 14467, Potsdam, Germany
| | - D Aebersold
- Department of Radiation Oncology, Inselspital-Bern University Hospital, University of Bern, Freiburgstraße 4, 3010, Bern, Switzerland
| | - C Albrecht
- Nordstrahl Radiation Oncology Unit, Nürnberg North Hospital, Prof.-Ernst-Nathan-Str. 1, 90149, Nürnberg, Germany
| | - D Boehmer
- Department of Radiation Oncology, University Hospital Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - U Ganswindt
- Department of Radiation Oncology, University Hospital Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - N-S Schmidt-Hegemann
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - T Hölscher
- Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, TU Dresden, Fiedlerstraße 19, 01307, Dresden, Germany
| | - A-C Mueller
- Department of Radiation Oncology, RKH Hospital Ludwigsburg, Posilipostraße 4, 71640, Ludwigsburg, Germany
| | - P Niehoff
- Department of Radiation Oncology, Sana Hospital Offenbach, Starkenburgring 66, 63069, Offenbach, Germany
| | - J C Peeken
- Department of Radiation Oncology, Technische Universität München, Ismaninger Straße 22, 81675, Munich, Germany
| | - M Pinkawa
- Department of Radiation Oncology, Robert Janker Klinik, Villenstraße 8, 53129, Bonn, Germany
| | - B Polat
- Department of Radiation Oncology, University Hospital Würzburg, Josef-Schneider-Straße 11, 97080, Würzburg, Germany
| | - S K B Spohn
- Department of Radiation Oncology, University Hospital Freiburg, Robert-Koch-Straße 3, 79106, Freiburg, Germany
| | - F Wolf
- Department of Radiation Oncology, Paracelsus Medical University of Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Austria
| | - C Zamboglou
- Department of Radiation Oncology, University Hospital Freiburg, Robert-Koch-Straße 3, 79106, Freiburg, Germany
- German Oncology Center, 1, Nikis Avenue, Agios Athanasios, 4108, Limassol, Cyprus
| | - D Zips
- Department of Radiation Oncology, University Hospital Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - T Wiegel
- Department of Radiation Oncology, University Hospital Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany
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Wang R, Uretzki M, Boehmer D, Hein R, Biedermann T, Posch C. Severe thrombocytopenia and excellent response following combined immune checkpoint inhibition for metastatic malignant melanoma. J Eur Acad Dermatol Venereol 2020; 35:e89-e92. [PMID: 32701189 DOI: 10.1111/jdv.16829] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- R Wang
- Department of Dermatology and Allergy Biederstein, Technical University Munich, Munich, Germany
| | - M Uretzki
- Department of Dermatology and Allergy Biederstein, Technical University Munich, Munich, Germany
| | - D Boehmer
- Department of Dermatology and Allergy Biederstein, Technical University Munich, Munich, Germany
| | - R Hein
- Department of Dermatology and Allergy Biederstein, Technical University Munich, Munich, Germany
| | - T Biedermann
- Department of Dermatology and Allergy Biederstein, Technical University Munich, Munich, Germany
| | - C Posch
- Department of Dermatology and Allergy Biederstein, Technical University Munich, Munich, Germany
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Boehmer D, Eyerich K, Darsow U, Biedermann T, Zink A. Variable response to low‐dose naltrexone in patients with Darier disease: a case series. J Eur Acad Dermatol Venereol 2019; 33:950-953. [DOI: 10.1111/jdv.15457] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 12/19/2018] [Indexed: 12/12/2022]
Affiliation(s)
- D. Boehmer
- Dermatology Technical University of Munich Munich Germany
| | - K. Eyerich
- Dermatology Technical University of Munich Munich Germany
| | - U. Darsow
- Dermatology Technical University of Munich Munich Germany
| | - T. Biedermann
- Dermatology Technical University of Munich Munich Germany
| | - A. Zink
- Dermatology Technical University of Munich Munich Germany
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Budach V, Becker ET, Boehmer D, Badakhshi H, Jahn U, Wernecke KD, Stromberger C. Concurrent hyperfractionated accelerated radiotherapy with 5-FU and once weekly cisplatin in locally advanced head and neck cancer. Strahlenther Onkol 2013; 190:250-5. [DOI: 10.1007/s00066-013-0481-4] [Citation(s) in RCA: 11] [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] [Received: 06/10/2013] [Accepted: 09/26/2013] [Indexed: 12/01/2022]
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Badakhshi H, Barelkowski T, Wust P, Budach V, Boehmer D, Graf R. Intrafraction variations in linac-based image-guided radiosurgery of intracranial lesions. Cancer Radiother 2013; 17:664-7. [PMID: 24176665 DOI: 10.1016/j.canrad.2013.05.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Revised: 05/17/2013] [Accepted: 05/25/2013] [Indexed: 11/20/2022]
Abstract
PURPOSE This study investigated image-guided patient positioning during frameless, mask-based, single-fraction stereotactic radiosurgery of intracranial lesions and intrafractional translational and rotational variations in patient positions. PATIENTS AND METHODS A non-invasive head and neck thermoplastic mask was used for immobilization. The Exactrac/Novalis Body system (BrainLAB AG, Germany) was used for kV X-ray imaging guided positioning. Intrafraction displacement data, obtained by imaging after each new table position, were evaluated. RESULTS There were 269 radiosurgery treatments performed on 190 patients and a total of 967 setups within different angles. The first measured error after each table rotation (mean 2.6) was evaluated (698 measurements). Intrafraction translational errors were (1 standard deviation [SD]) on average 0.8, 0.8, and 0.7mm for the left-right, superior-inferior, and anterior-posterior directions, respectively, with a mean 3D-vector of 1.0mm (SD 0.9mm) and a range from -5mm to +5mm. On average, 12%, 3%, and 1% of the translational deviations exceeded 1, 2, and 3mm, respectively, in the three directions. CONCLUSION The range of intrafraction patient motion in frameless image-guided stereotactic radiosurgery is often not fully mapped by pre- and post-treatment imaging. In the current study, intrafraction motion was assessed by performing measurements at several time points during the course of stereotactic radiosurgery. It was determined that 12% of the intrafraction values in the three dimensions are above 1mm, the usual safety margin applied in stereotactic radiosurgery.
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Affiliation(s)
- H Badakhshi
- Department of Radiation Oncology, Charité School of Medicine and University Hospital, Augustenburger Platz 1, 13353 Berlin, Germany.
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Badakhshi H, Grün A, Stromberger C, Budach V, Boehmer D. Oligometastases: the new paradigm and options for radiotherapy. A critical review. Strahlenther Onkol 2013; 189:357-62. [PMID: 23512205 DOI: 10.1007/s00066-013-0326-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Accepted: 02/06/2013] [Indexed: 01/22/2023]
Abstract
Traditional oncology distinguishes between two separate and incommensurable states in the evolution of solid malignancies: the localized disease, which is curable; and the disseminated status, which is per se palliative. Recently, a huge body of evidence suggests a fundamental change in the understanding of cancer, indicating an intermediate state in the trajectory of solid malignancies: the oligometastatic state. The following review will critically analyse existing hypotheses and facts from the basic sciences and try to contextualize it in regard to the clinical evidence available to date. Consecutively, it will try to draw possible clinical consequences for application of radiotherapy in this specific clinical scenario.
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Affiliation(s)
- H Badakhshi
- Department for Radiation Oncology, Charité University Medicine, Augustenburger Platz 1, 13353, Berlin, Germany.
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Sehouli J, Runnebaum IB, Fotopoulou C, Blohmer U, Belau A, Leber H, Hanker LC, Hartmann W, Richter R, Keyver-Paik MD, Oberhoff C, Heinrich G, du Bois A, Olbrich C, Simon E, Friese K, Kimmig R, Boehmer D, Lichtenegger W, Kuemmel S. A randomized phase III adjuvant study in high-risk cervical cancer: simultaneous radiochemotherapy with cisplatin (S-RC) versus systemic paclitaxel and carboplatin followed by percutaneous radiation (PC-R): a NOGGO-AGO Intergroup Study. Ann Oncol 2012; 23:2259-2264. [PMID: 22357252 DOI: 10.1093/annonc/mdr628] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Simultaneous adjuvant platinum-based radiochemotherapy in high-risk cervical cancer (CC) is an established treatment strategy. Sequential paclitaxel (Taxol) and platinum followed by radiotherapy may offer further advantages regarding toxicity. PATIENTS AND METHODS An open-labeled randomized phase III trial was conducted to compare paclitaxel (175 mg/m(2)) plus carboplatin (AUC5) followed by radiation (50.4 Gy) (experimental arm-A) versus simultaneous radiochemotherapy with cisplatin (40 mg/m(2)/week) (arm-B) in patients with stage IB-IIB CC after surgery. Primary objective was progression-free survival (PFS). RESULTS Overall, 271 patients were randomized and 263 were eligible for evaluation; 132 in arm-A and 131 in arm-B appropriately balanced. The estimated 2-year PFS was 81.8% [95% confidence interval (CI) 74.4-89.1] in arm-B versus 87.2% (95% CI 81.2-93.3) in arm-A (P = 0.235) and the corresponding 5-year survival rates were 85.8% in arm-A and 78.9% in arm-B (P = 0.25). Hematological grade 3/4 toxicity was higher in arm-B. Alopecia (87.9% versus 4.1%; P < 0.001) and neurotoxicity (65.9% versus 15.6%; P < 0.001) were significantly higher in arm-A. Early treatment termination was significantly more frequent in arm-B than in arm-A (32.1% versus 12.9%; P = 0.001). CONCLUSIONS Sequential chemotherapy and radiation in high-risk CC could not show any significant survival benefit; however, a different toxicity profile appeared. This sequential regime may constitute an alternative option when contraindications for immediate postoperative radiation are present.
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Affiliation(s)
- J Sehouli
- Department of Gynecology, European Competence Centre for Ovarian Cancer, Charité-University Hospital, Berlin.
| | - I B Runnebaum
- Department of Gynecology, Jena University Hospital, Jena
| | - C Fotopoulou
- Department of Gynecology, European Competence Centre for Ovarian Cancer, Charité-University Hospital, Berlin
| | - U Blohmer
- Brustzentrum, Sankt-Gertrauden-Krankenhaus, Berlin
| | - A Belau
- Department of Gynecology, Ernst-Moritz-Arndt-Universität Greifswald, Greifswald
| | - H Leber
- Klinik fuer Strahlentherapie, Bruederkrankenhaus St Josef, Paderborn
| | - L C Hanker
- Department of Obstetrics and Gynecology, J.W. Goethe-University, Frankfurt
| | - W Hartmann
- Department of Gynecology, Klinikum Frankfurt (Oder) GmbH, Frankfurt-Oder
| | - R Richter
- Department of Gynecology, European Competence Centre for Ovarian Cancer, Charité-University Hospital, Berlin
| | | | - C Oberhoff
- Department of Gynecology, Kath. Kliniken Essen-Nord Marienhospital, Altenessen
| | | | - A du Bois
- Department of Gynecology, Horst Schmidt Klinik, Wiesbaden
| | - C Olbrich
- Department of Gynecology, DRK Kliniken Berlin Westend, Berlin
| | - E Simon
- Department of Gynecology, Kreiskrankenhaus Torgau Johann Kentmann GmbH, Torgau
| | - K Friese
- Department of Gynecology, Universitätsklinik LMU, Munich
| | - R Kimmig
- Department of Gynecology, Universitätsklinikum Essen, Essen
| | - D Boehmer
- Department of Radiation Oncology, Charite-University Medicine Berlin, Campus Virchow-Klinikum, Berlin
| | - W Lichtenegger
- Department of Gynecology, European Competence Centre for Ovarian Cancer, Charité-University Hospital, Berlin
| | - S Kuemmel
- Brustzentrum, Kliniken Essen-Mitte, Essen, Germany
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Sehouli J, Pietzner K, Harter P, Münstedt K, Mahner S, Hasenburg A, Camara O, Wimberger P, Boehmer D, Buehling KJ, Richter R, El Khalfaoui K, Oskay-Ozcelik G. Prognostic role of platinum sensitivity in patients with brain metastases from ovarian cancer: results of a German multicenter study. Ann Oncol 2010; 21:2201-2205. [PMID: 20439341 DOI: 10.1093/annonc/mdq229] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Ovarian cancer is the leading cause of death in women with gynecological malignancies. Brain metastases are considered an uncommon metastatic site. Only few data exist on prognostic factors for this patient collective. PATIENTS AND METHODS A multicenter retrospective chart review was carried out including all patients with histologically confirmed ovarian cancer from six different German hospitals from 1981 to 2008. Overall, 4277 cases of patients with ovarian cancer were screened and patients with brain metastasis were identified and analyzed regarding various clinical variables and survival. RESULTS A total of 74 women with brain metastases were identified, resulting in an incidence of 1.73%. In multivariate analysis, the following clinical parameters had a significant impact on overall survival: multiple lesions [hazard ratio (HR) 4.4, 95% confidence interval (CI) 2.0-9.7] and low grading (HR 3.1, 95% CI 1.7-5.8) were associated with a negative impact. Platinum sensitivity (HR 0.23, 95% CI 0.12-0.48) was significantly associated with a favorable outcome. Good performance status (60%-80% HR 0.48, 95% CI 0.23-0.99 and 90%-100% HR 0.21, 95% CI 0.08-0.53) also had a positive impact on overall survival. CONCLUSIONS Platinum sensitivity is the most important prognostic factor in patients with ovarian cancer metastatic to the brain. This novel finding should be considered in the strategy of multimodal therapy for brain metastases in ovarian cancer.
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Affiliation(s)
- J Sehouli
- Department of Gynecology and Obstetrics, Charité-Campus Virchow Klinikum, University Medicine of Berlin, Berlin.
| | - K Pietzner
- Department of Gynecology and Obstetrics, Charité-Campus Virchow Klinikum, University Medicine of Berlin, Berlin
| | - P Harter
- Department of Gynecology & Gynecologic Oncology, Dr. Horst Schmidt Klinik (HSK), Wiesbaden
| | - K Münstedt
- Department of Obstetrics and Gynecology, Justus-Liebig-University of Giessen, Giessen
| | - S Mahner
- Department of Gynecology, University Medical Center Hamburg-Eppendorf, Hamburg
| | - A Hasenburg
- Department of Obstetrics and Gynecology, Freiburg University Medical Center, Freiburg
| | - O Camara
- Department of Gynaecology and Obstetrics, Friedrich Schiller University, Jena
| | - P Wimberger
- Department of Gynecology and Obstetrics, University Hospital Essen, Essen
| | - D Boehmer
- Department of Radiation Oncology and Radiotherapy, Charité-Campus Virchow Klinikum, University Medicine of Berlin, Berlin, Germany
| | - K J Buehling
- Department of Gynecology, University Medical Center Hamburg-Eppendorf, Hamburg
| | - R Richter
- Department of Gynecology and Obstetrics, Charité-Campus Virchow Klinikum, University Medicine of Berlin, Berlin
| | - K El Khalfaoui
- Department of Gynecology and Obstetrics, Charité-Campus Virchow Klinikum, University Medicine of Berlin, Berlin
| | - G Oskay-Ozcelik
- Department of Gynecology and Obstetrics, Charité-Campus Virchow Klinikum, University Medicine of Berlin, Berlin
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Chekerov R, Denkert C, Boehmer D, Suesse A, Widing A, Ruhmland B, Giese A, Mustea A, Lichtenegger W, Sehouli J. Online tumor conference in the clinical management of gynecological cancer: experience from a pilot study in Germany. Int J Gynecol Cancer 2008; 18:1-7. [PMID: 17466034 DOI: 10.1111/j.1525-1438.2007.00971.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The concept of the online tumor conference was established in 2004 as a pilot project. We developed specific web-based software to organize and conduct online tumor board meetings of gynecologists, surgeons, radiologists, oncologists, and pathologists from different hospitals and gynecological practitioners, discussing individual patient's cases, defining therapy options, and exchanging clinical experience. Following a didactic approach, patient data are presented to the participants, with a special focus toward patient's preference and late toxicity from prior therapy. Then different national (eg, Arbeitsgemeinschaft Gynaekologische Onkologie, Deutsche Gesellschag fur Gynaekologic und Geburtshilfe) and international guidelines (eg, American Society of Clinical Oncology, National Cancer Institute), current study results based on literature review and open clinical trials are discussed. An individual diagnosis and therapy recommendation for each patient is reached by consensus. All protocols, guidelines, and publication data are upgraded and dispersed via Internet for all participants. In the period from December 2004 to August 2006, 39 tumor board conferences were performed with a total of 667 participants. One hundred forty-four patients' cases were presented, and 121 peer-reviewed second-opinions were sought. In an anonymous survey, 84% of the participants reported to be satisfied with the information content and 72% with the technical support. Overall 98% of the individual therapy recommendations were accepted and implemented. The tumor board conference presents an optimal possibility for extensive scientific discussions and exchange (92%) and improves advanced educational training (81%). In conclusion, the online tumor conference is feasible and represents a time-saving possibility for gynecological oncologist to receive a treatment recommendation based on the best available clinical and scientific evidence.
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Affiliation(s)
- R Chekerov
- Department of Obstetrics and Gynecology, Campus Virchow, Charité University Hospital, Berlin, Germany
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Budach V, Badakhshi H, Boehmer D, Schlenger L, WerNecke K. 4-Year Results of a Phase II Trial Using Hyperfractionated Accelerated Radiation with Concurrent Once-Weekly cis-Platinum and 5-FU (C-HART) in Locally Advanced Head and Neck Cancer. Int J Radiat Oncol Biol Phys 2007. [DOI: 10.1016/j.ijrobp.2007.06.003] [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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Badakhshi H, Boehmer D, Moser L, Schlenger L, Wernecke K, Lammert I, Budach V. Results of a phase-ii trial using hyperfractionated accelerated radiation with concurrent cis-platinum/5-FU (C-HART) in locally advanced head and neck cancer. Int J Radiat Oncol Biol Phys 2004. [DOI: 10.1016/j.ijrobp.2004.07.460] [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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Boehmer D, Buchali A, Deger S, Loening SA, Budach V. [Value of radiotherapy in urology]. Urologe A 2000; 39:120-5. [PMID: 10768221 DOI: 10.1007/s001200050019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Radiotherapy of patients with prostate cancer offers an alternative to radical prostatectomy in early stages (T1-T2). In locally advanced prostate cancer a high dose or combined radiotherapy is more effective than radical surgery with concurrent lower morbidity and mortality. Recent developments in linear accelerator technique, the progress in dose calculation and planning techniques provide the means to apply higher doses to a given tumor volume while effectively protecting the surrounding normal tissue at the same time. These improvements may possibly reduce the rate of therapy related side effects or complications significantly. The combination of external beam radiotherapy and interstitial brachytherapy as well as the combination of hormone therapy and external beam radiotherapy are most likely more effective than percutaneous irradiation alone. In special cases with a very low risk of recurrent tumor an interstitial permanent brachytherapy alone is indicated. Future developments (i.e. intensity modulated radiotherapy-IMRT, combined thermo-radiotherapy, proton- or neutrontherapy) may further increase the rate of curative treatments in patients with prostate cancer.
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Affiliation(s)
- D Boehmer
- Klinik für Strahlentherapie, Humboldt-Universität Berlin.
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Boehmer D, Koswig S, Budach V. [Radiotherapy of distant metastases of urological malignant tumors]. Urologe A 2000; 39:133-40. [PMID: 10768223 DOI: 10.1007/s001200050021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The largest subgroup of patients with metastasised urological malignancies are those with metastases of the bone. Lesions of bones frequently reduce the patients quality of life. Therefore a sufficient therapy is crucial. First of all the appropriate diagnostic procedure of the lesion/lesions is necessary because e the right choice of diagnostic measures may already improve quality of life. Besides the most frequently used local irradiation a systemic radiotherapy may be the adequate therapy in patients with disseminated disease. Renal cell-, bladder and penile cancer respectively are the urological malignancies frequently metastasising into the brain. Adequate diagnostic procedures and therapy are crucial to the patients quality of life for the remaining lifetime. Besides a whole brain irradiation as standard therapy stereotactic radiotherapy is a high precision tool to destroy intracerebral tumour. There are many other locations of metastatic disease (i.e. lymph node or soft tissue metastasis, et cetera) where palliative external beam irradiation may provide relief from symptoms such as pain, lymph oedema or bleeding and thus increase quality of life. Psychological and social care are of great value besides symptom oriented therapy (i.e. radiotherapy, drugs, et cetera) to achieve an optimal palliation/quality of life.
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Affiliation(s)
- D Boehmer
- Klinik für Strahlentherapie, Humboldt-Universität zu Berlin.
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Dinges S, Deger S, Koswig S, Boehmer D, Schnorr D, Wiegel T, Loening SA, Dietel M, Hinkelbein W, Budach V. High-dose rate interstitial with external beam irradiation for localized prostate cancer--results of a prospective trial. Radiother Oncol 1998; 48:197-202. [PMID: 9783892 DOI: 10.1016/s0167-8140(98)00054-1] [Citation(s) in RCA: 90] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
PURPOSE A prospective phase II trial was carried out to test the feasibility and effectiveness of a combined interstitial with external beam radiotherapy approach for localized prostate cancer. MATERIALS AND METHODS Between October 1992 and December 1994, 82 evaluable patients were treated. T2 and T3 tumours, according to the AJCC classification system of 1992, were found in 21 and 61 cases, respectively. The median follow-up was 24 months; three patients were lost during follow-up. All of the patients were pathologically proven to be node-negative by laparoscopic node dissection of the fossa obturatoria region. A dose of 9 Gy a week was prescribed during the first and second weeks of treatment (10 Gy each week from October 1992 to December 1993) interstitially with high-dose rate Iridium-192 brachytherapy to the prostate and tumour extension beyond the capsule. External beam four-field box irradiation was then given to the prostate to a dose of 45 Gy/25 fractions (40 Gy/20 fractions from October 1992 to December 1993). RESULTS Before starting treatment, a PSA value of > or =10 ng/ml was found in 64.6% (53/82) of patients with a median PSA of 14.0 ng/ml. The median PSA 3, 12 and 24 months after completion of therapy was 1.20, 0.78 and 0.70 ng/ml, respectively. The PSA value was < 1.0 ng/ ml in 52.9% of patients at 2 years. Negative punch biopsies 12 and 24 months after therapy were observed in 69.8% (44/63) and 73. 1% (38/ 52) of patients, respectively. A positive biopsy combined with a PSA value of > 1.0 ng/ml was considered as local failure. The local tumour control rate was 79.5% at 2 years. Acute side-effects were not increased relative to external beam irradiation alone. Severe side-effects were observed in three patients (two of the three patients had additional risk factors (colitis ulcerosa and diabetes mellitus)); they developed rectourethral fistulae requiring colostomy after biopsies from the anterior rectal wall. CONCLUSION The described method is feasible and well tolerable. The three complications observed were not caused by irradiation alone. Biopsies from the anterior rectal wall after definitive high-dose radiotherapy for prostate cancer have to be seen as obsolete. The rate of negative prostate biopsies of 73.1% after 24 months represents an encouraging result.
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Affiliation(s)
- S Dinges
- Department of Radiotherapy, Charité, Humboldt University of Berlin, Germany
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Dinges S, Budach V, Stuschke M, Budach W, Boehmer D, Schrader M, Jahnke K, Sack H. Chemo-radiotherapy for locally advanced head and neck cancer--long-term results of a phase II trial. Eur J Cancer 1997; 33:1152-5. [PMID: 9376198 DOI: 10.1016/s0959-8049(97)00099-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The feasibility and effectiveness of a combined chemo-radiotherapy treatment modality for locally advanced head and neck cancer was tested in a phase II trial. Between 1990 and 1993, 74 patients (20 female/54 male) with head and neck cancer stage III (n = 12) and IV (n = 62) were treated with accelerated radiotherapy (72 Gy) and simultaneous chemotherapy (5-FU, folinic acid, mitomycin C). The median follow-up time was 43 months (1-72). Complete remission (CR) was absent in 76% (56/74) of patients and, after subsequent resection of residual lymph nodes, another 8 patients achieved CR. The cumulative local control rate was 72% and disease-specific survival rate was 59% at 4 years. Two patients died with treatment-related conditions (pancytopenia, larynx oedema). By multivariate analysis, only lymph node status was an independent parameter for local control (P = 0.04). This treatment was feasible and toxicity was not a treatment-limiting factor. As a consequence, a German multicentre phase III trial was initiated in 1995.
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Affiliation(s)
- S Dinges
- Department of Radiotherapy, Charité Humboldt University of Berlin, Germany
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Tomo I, Brezanyova J, Kriska M, Boehmer D, Handzo I. Teratoepidemiologic study—drug intervention system monitoring. Reprod Toxicol 1992. [DOI: 10.1016/0890-6238(92)90161-l] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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