1
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Oertel M, Hering D, Kittel C, Nacke N, Kröger K, Kriz J, Fuchs M, Baues C, Vordermark D, Engenhart-Cabillic R, Herfarth KK, Lukas P, Schmidberger H, Marnitz-Schulze S, Borchmann P, Engert A, Haverkamp U, Eich HTT. Quality Analysis of Radiation Therapy for Hodgkin Lymphoma in the HD 16/17 Trials: A Final Report By the Reference Radiation Oncology Panel of the German Hodgkin Study Group. Int J Radiat Oncol Biol Phys 2023; 117:S62. [PMID: 37784540 DOI: 10.1016/j.ijrobp.2023.06.361] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) The HD 16 and 17 trials by the German Hodgkin Study Group (GHSG) have evaluated the use of consolidative radiotherapy (RT) in early-favorable and -unfavorable stage Hodgkin lymphoma (HL), respectively (1, 2). Quality of RT planning and execution is pivotal for treatment outcome in HL with protocol violations jeopardizing prognosis (3). Consequently, the present work aims at a decisive analysis of quality and dosimetry in the modern era. MATERIALS/METHODS Random samples of 100 involved-field RT (IFRT) plans in HD16 and 176 plans in HD17 (134 involved-node RT (INRT) and 42 IFRT) were selected for analysis. Evaluation was performed systematically by the reference radiation oncology panel using pre-chemotherapy imaging, recommendation by the reference radiation oncology and RT planning imaging and graded as "correct", "minor" or "major deviation", respectively. RT doses to the target volume and organs at risks (OAR) were analyzed using dose-volume histograms. RESULTS Median RT doses were 20 Gy (19.8 Gy-21.6 Gy) in HD16 and 30 Gy in HD17 (IFRT: 18-30.6 Gy, INRT: 14 Gy-40 Gy). Overall, 84.0%, 69.0%, and 76.1% of RT series in HD16, the IFRT-group of HD17 and the INRT-group of HD17, respectively, were planned correctly. The main reason for major deviation was an insufficient coverage of an involved region (11 %-14.3 %). There was no significant difference in quality between IFRT and INRT in HD17 (p = 0.418 for any deviations; p = 0.466 for major deviations). In comparison to previous GHSG studies in the respective stages, a significant increase in correct RT-series (p<0.001) and decrease in major deviations (p<0.001) occurred. However, doses to OAR varied individually with median values of 4.3 Gy (0.2 Gy-9.2 Gy), 4.7 Gy (0.2 Gy-15.2 Gy) and 3.8 Gy (0.0 Gy-16.0 Gy) for mean doses to the right lung, left lung and heart in HD16, respectively. Correspondingly, values were 9.8 Gy (0.3 Gy-20.0 Gy), 10.5 Gy (0.2 Gy-26.5 Gy) and 13.1 Gy (0.5 Gy-30.4 Gy) for mean doses to the right lung, left lung and heart in HD17, respectively. The size of the planning target volume decreased significantly with INRT compared to IFRT (median values: 1163.1 ml vs. 1464.3 ml; p = 0.043). However, only some OAR-parameters (V25 of the right and left lung, respectively, thyroid and spinal cord) showed significant differences between INRT and IFRT in HD17. The use of intensity-modulated techniques in HD 17 resulted in an increase in V5 and V10 of the lungs with a concomitant decrease in V20-V30. CONCLUSION Quality of RT in the planning and treatment of HL has improved significantly with the latest GHSG study generation. Future analyses will focus on a further individualization of treatment fields. LITERATURE
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Affiliation(s)
- M Oertel
- Department of Radiation Oncology, University Hospital Muenster, Muenster, Germany
| | - D Hering
- Department of Radiation Oncology, University Hospital Muenster, Muenster, Germany
| | - C Kittel
- Department of Radiation Oncology, University Hospital Muenster, Muenster, Germany
| | - N Nacke
- Department of Radiation Oncology, University Hospital Muenster, Muenster, Germany
| | - K Kröger
- Department of Radiation Oncology, University Hospital Muenster, Muenster, Germany
| | - J Kriz
- Department of Radiation Oncology, Alexianer Clemenshospital Muenster, Muenster, Germany
| | - M Fuchs
- German Hodgkin Study Group (GHSG), Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
| | - C Baues
- Department of Radiation Oncology and CyberKnife Center, University Hospital of Cologne, Cologne, Germany
| | - D Vordermark
- Department of Radiation Oncology, University Hospital Halle (Saale), Halle (Saale), Germany
| | - R Engenhart-Cabillic
- Department of Radiotherapy and Radiation Oncology, University Hospital Giessen-Marburg, Marburg, Germany
| | - K K Herfarth
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - P Lukas
- Department of Radiooncology, Medical University Innsbruck, Innsbruck, Austria
| | - H Schmidberger
- Department of Radiotherapy and Radiation Oncology, University Hospital Mainz, Mainz, Germany
| | - S Marnitz-Schulze
- Department of Radiation Oncology and CyberKnife Center, University Hospital of Cologne, Cologne, Germany
| | - P Borchmann
- German Hodgkin Study Group (GHSG), Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
| | - A Engert
- German Hodgkin Study Group (GHSG), Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
| | - U Haverkamp
- Department of Radiation Oncology, University Hospital Muenster, Muenster, Germany
| | - H T T Eich
- Department of Radiation Oncology, University Hospital Muenster, Muenster, Germany
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2
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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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Glowka A, Vordermark D, Mesrogli H, Medenwald D. PO-1467 Prophylactic use of dexamethasone during cerebral irradiation: Survey in Germany. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07918-4] [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: 10/20/2022]
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Plontke SK, Caye-Thomasen P, Strauss C, Kösling S, Götze G, Siebolts U, Vordermark D, Wagner L, Fröhlich L, Rahne T. Management of transmodiolar and transmacular cochleovestibular schwannomas with and without cochlear implantation. HNO 2021; 69:7-19. [PMID: 33044580 PMCID: PMC7862215 DOI: 10.1007/s00106-020-00919-9] [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] [Indexed: 12/21/2022]
Abstract
Introduction Hearing rehabilitation with cochlear implants has attracted increasing interest also for patients with cochleovestibular schwannoma. The authors report their experience with the surgical management of tumors with rare transmodiolar or transmacular extension and outcomes after cochlear implantation (CI). Methods This retrospective case series included nine patients with either primary intralabyrinthine tumors or secondary invasion of the inner ear from the internal auditory canal. The primary endpoint with CI, performed in six patients, was word recognition score at 65 dB SPL (sound pressure level). Secondary endpoints were intra- and postoperative electrophysiological parameters, impedance measures, the presence of a wave V in the electrically evoked (via the CI) auditory brainstem responses, the specifics of postoperative CI programming, and adverse events. Results Hearing rehabilitation with CI in cases of transmodiolar tumor growth could be achieved only with incomplete tumor removal, whereas tumors with transmacular growth could be completely removed. All six patients with CI had good word recognition scores for numbers in quiet conditions (80–100% at 65 dB SPL, not later than 6 to 12 months post CI activation). Four of these six patients achieved good to very good results for monosyllabic words within 1–36 months (65–85% at 65 dB SPL). The two other patients, however, had low scores for monosyllables at 6 months (25 and 15% at 65 dB SPL, respectively) with worsening of results thereafter. Conclusions Cochleovestibular schwannomas with transmodiolar and transmacular extension represent a rare entity with specific management requirements. Hearing rehabilitation with CI is a principal option in these patients. Video online The online version of this article (10.1007/s00106-020-00919-9) includes a video (2D and 3D versions) of the described surgical technique. Article and supplementary material are available at www.springermedizin.de. Please enter the title of the article in the search field, the supplementary material can be found under “Ergänzende Inhalte”. ![]()
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Affiliation(s)
- S K Plontke
- Department of Otorhinolaryngology, Head & Neck Surgery, Martin Luther University Halle-Wittenberg, University Medicine Halle, Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany.
| | - P Caye-Thomasen
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - C Strauss
- Department of Neurosurgery, Martin Luther University Halle-Wittenberg, University Medicine Halle, Halle, Germany
| | - S Kösling
- Department of Radiation Medicine, Clinic for Radiology, Martin Luther University Halle-Wittenberg, University Medicine Halle, Halle, Germany
| | - G Götze
- Department of Otorhinolaryngology, Head & Neck Surgery, Martin Luther University Halle-Wittenberg, University Medicine Halle, Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany
| | - U Siebolts
- Institute of Pathology, Martin Luther University Halle-Wittenberg, University Medicine Halle, Halle, Germany
| | - D Vordermark
- Department of Radiation Medicine, Clinic for Radiotherapy, Martin Luther University Halle-Wittenberg, University Medicine Halle, Halle, Germany
| | - L Wagner
- Department of Otorhinolaryngology, Head & Neck Surgery, Martin Luther University Halle-Wittenberg, University Medicine Halle, Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany
| | - L Fröhlich
- Department of Otorhinolaryngology, Head & Neck Surgery, Martin Luther University Halle-Wittenberg, University Medicine Halle, Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany
| | - T Rahne
- Department of Otorhinolaryngology, Head & Neck Surgery, Martin Luther University Halle-Wittenberg, University Medicine Halle, Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany
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5
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Oertel M, Elsayad K, Engenhart-Cabillic R, Reinartz G, Baues C, Schmidberger H, Vordermark D, Marnitz S, Lukas P, Ruebe C, Engert A, Lenz G, Eich HT. Radiation treatment of hemato-oncological patients in times of the COVID-19 pandemic : Expert recommendations from the radiation oncology panels of the German Hodgkin Study Group and the German Lymphoma Alliance. Strahlenther Onkol 2020; 196:1096-1102. [PMID: 33125504 PMCID: PMC7596809 DOI: 10.1007/s00066-020-01705-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 06/02/2020] [Accepted: 10/22/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE The coronavirus pandemic is affecting global health systems, endangering daily patient care. Hemato-oncological patients are particularly vulnerable to infection, requiring decisive recommendations on treatment and triage. The aim of this survey amongst experts on radiation therapy (RT) for lymphoma and leukemia is to delineate typical clinical scenarios and to provide counsel for high-quality care. METHODS A multi-item questionnaire containing multiple-choice and free-text questions was developed in a peer-reviewed process and sent to members of the radiation oncology panels of the German Hodgkin Study Group and the German Lymphoma Alliance. Answers were assessed online and analyzed centrally. RESULTS Omission of RT was only considered in a minority of cases if alternative treatment options were available. Hypofractionated regimens and reduced dosages may be used for indolent lymphoma and fractures due to multiple myeloma. Overall, there was a tendency to shorten RT rather than to postpone or omit it. Even in case of critical resource shortage, panelists agreed to start emergency RT for typical indications (intracranial pressure, spinal compression, superior vena cava syndrome) within 24 h. Possible criteria to consider for patient triage are the availability of (systemic) options, the underlying disease dynamic, and the treatment rationale (curative/palliative). CONCLUSION RT for hemato-oncological patients receives high-priority and should be maintained even in later stages of the pandemic. Hypofractionation and shortened treatment schedules are feasible options for well-defined constellations, but have to be discussed in the clinical context.
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Affiliation(s)
- M Oertel
- Department of Radiation Oncology, University Hospital Muenster, Albert-Schweitzer-Campus 1 building A1, 48149, Muenster, Germany
| | - K Elsayad
- Department of Radiation Oncology, University Hospital Muenster, Albert-Schweitzer-Campus 1 building A1, 48149, Muenster, Germany
| | - R Engenhart-Cabillic
- Department of Radiotherapy and Radiation Oncology, University Hospital Giessen-Marburg, Marburg, Germany
| | - G Reinartz
- Department of Radiation Oncology, University Hospital Muenster, Albert-Schweitzer-Campus 1 building A1, 48149, Muenster, Germany
| | - C Baues
- Department of Radiation Oncology and Cyberknife Center, University Hospital of Cologne, Cologne, Germany
| | - H Schmidberger
- Department of Radiotherapy and Radiation Oncology, University Hospital Mainz, Mainz, Germany
| | - D Vordermark
- Department of Radiation Oncology, University Hospital Halle (Saale), Halle (Saale), Germany
| | - S Marnitz
- Department of Radiation Oncology and Cyberknife Center, University Hospital of Cologne, Cologne, Germany
| | - P Lukas
- Department of Radiooncology, Medical University Innsbruck, Innsbruck, Austria
| | - C Ruebe
- Department of Radiation Oncology, Saarland University Hospital, Homburg, Germany
| | - A Engert
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf, University Hospital of Cologne, Cologne, Germany
| | - G Lenz
- Department of Medicine A, Hematology, Oncology, University Hospital Muenster, Muenster, Germany
| | - H T Eich
- Department of Radiation Oncology, University Hospital Muenster, Albert-Schweitzer-Campus 1 building A1, 48149, Muenster, Germany.
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Medenwald D, Medenwald K, Glowka A, Vordermark D. PO-1283: Public health predictors of the geographical variation of prostatectomy or radiotherapy in Germany. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01301-3] [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: 11/27/2022]
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Vordermark D. SP-0254: Implementation of ePROMs in a clinical workflow. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00278-4] [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: 11/25/2022]
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Kooymann J, Witte S, Medenwald D, Golla A, Stangl G, Steckelberg A, Vordermark D, Schmidt H. INFLUENCING FACTORS ON THE DEVELOPMENT OF PHYSICAL FUNCTIONING OF OLDER CANCER PATIENTS DURING AND 12 MONTHS AFTER CANCER THERAPY: RESULTS OF A PROSPECTIVE OBSERVATIONAL STUDY. J Geriatr Oncol 2019. [DOI: 10.1016/s1879-4068(19)31239-1] [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: 11/30/2022]
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Witte S, Medenwald D, Golla A, Shehu E, Vordermark D, Michl P, Binder M, Ruessel J, Steckelberg A, Schmidt H. TRAINING PROGRAMS PROMOTING DAILY ACTIVITY AND PHYSICAL FUNCTION OF OLDER PATIENTS WITH CANCER: A QUESTIONNAIRE-BASED SURVEY REGARDING INDIVIDUAL NEEDS AND PREFERENCES. J Geriatr Oncol 2019. [DOI: 10.1016/s1879-4068(19)31240-8] [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: 11/29/2022]
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Shehu E, Roggendorf S, Golla A, Hübner G, Stangl G, Lau A, Diestelhorst A, Vordermark D, Steckelberg A, Schmidt H. DEVELOPMENT OF A COMPLEX SUPPORTIVE INTERVENTION TO PROMOTE PHYSICAL FUNCTIONING OF OLDER CANCER PATIENTS, CONSIDERING INDIVIDUAL PLASTICITY (SIDEKICK). J Geriatr Oncol 2019. [DOI: 10.1016/s1879-4068(19)31229-9] [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: 11/29/2022]
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Ostheimer C, Evers C, Palm F, Mikolajczyk R, Vordermark D, Medenwald D. Mortality after radiotherapy or surgery in the treatment of early stage non-small-cell lung cancer: a population-based study on recent developments. J Cancer Res Clin Oncol 2019; 145:2813-2822. [DOI: 10.1007/s00432-019-03013-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 08/20/2019] [Indexed: 12/23/2022]
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Lautenschlaeger S, Iancu G, Flatten V, Baumann K, Thiemer M, Dumke C, Zink K, Hauswald H, Vordermark D, Mauz-Körholz C, Engenhart-Cabillic R, Eberle F. Advantage of proton-radiotherapy for pediatric patients and adolescents with Hodgkin's disease. Radiat Oncol 2019; 14:157. [PMID: 31477141 PMCID: PMC6721251 DOI: 10.1186/s13014-019-1360-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 08/16/2019] [Indexed: 01/26/2023] Open
Abstract
Abstract Radiotherapy is frequently used in the therapy of lymphoma. Since lymphoma, for example Hodgkin’s disease, frequently affect rather young patients, the induction of secondary cancer or other long-term adverse effects after irradiation are important issues to deal with. Especially for mediastinal manifestations numerous organs and substructures at risk play a role. The heart, its coronary vessels and cardiac valves, the lungs, the thyroid and, for female patients, the breast tissue are only the most important organs at risk. In this study we investigated if proton-radiotherapy might reduce the dose delivered to the organs at risk and thus minimize the therapy-associated toxicity. Methods In this work we compared the dose delivered to the heart, its coronary vessels and valves, the lungs, the thyroid gland and the breast tissue by different volumetric photon plans and a proton plan, all calculated for a dose of 28.8 Gy (EURO-NET-PHL-C2). Target Volumes have been defined by F18-FDG PET-positive areas, following a modified involved node approach. Data from ten young female patients with mediastinal lymphoma have been evaluated. Three different modern volumetric IMRT (VMAT) photon plans have been benchmarked against each other and against proton-irradiation concepts. For plan-evaluation conformity- and homogeneity-indices have been calculated as suggested in ICRU 83. The target volume coverage as well as the dose to important organs at risk as the heart with its substructures, the lungs, the breast tissue, the thyroid and the spinal cord were calculated and compared. For statistical evaluation mean doses to organs at risk were evaluated by non- parametric Kruskal-Wallis calculations with pairwise comparisons. Results Proton-plans and three different volumetric photon-plans have been calculated. Proton irradiation results in significant lower doses delivered to organ at risk. The median doses and the mean doses could be decreased while PTV coverage is comparable. As well conformity as homogeneity are slightly better for proton plans. For several organs a risk reduction for secondary malignancies has been calculated using literature data as reference. According to the used data derived from literature especially the secondary breast cancer risk, the secondary lung cancer risk and the risk for ischemic cardiac insults can be reduced significantly by using protons for radiotherapy of mediastinal lymphomas. Conclusion Irradiation with protons for mediastinal Hodgkin-lymphoma results in significant lower doses for almost all organs at risk and is suitable to reduce long term side effects for pediatric and adolescent patients. Electronic supplementary material The online version of this article (10.1186/s13014-019-1360-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- S Lautenschlaeger
- Klinik für Strahlentherapie und Radioonkologie, Klinikum der Philipps Universität Marburg, Baldingerstr, 35043, Marburg, Germany.
| | - G Iancu
- Klinik für Strahlentherapie und Radioonkologie, Klinikum der Philipps Universität Marburg, Baldingerstr, 35043, Marburg, Germany
| | - V Flatten
- Klinik für Strahlentherapie und Radioonkologie, Klinikum der Philipps Universität Marburg, Baldingerstr, 35043, Marburg, Germany.,Technische Hochschule Mittelhessen, Institut für Medizinische Physik und Strahlenschutz, Gießen, Germany
| | - K Baumann
- Klinik für Strahlentherapie und Radioonkologie, Klinikum der Philipps Universität Marburg, Baldingerstr, 35043, Marburg, Germany.,Technische Hochschule Mittelhessen, Institut für Medizinische Physik und Strahlenschutz, Gießen, Germany
| | - M Thiemer
- Klinik für Strahlentherapie und Radioonkologie, Klinikum der Philipps Universität Marburg, Baldingerstr, 35043, Marburg, Germany
| | - C Dumke
- Klinik für Strahlentherapie und Radioonkologie, Klinikum der Philipps Universität Marburg, Baldingerstr, 35043, Marburg, Germany
| | - K Zink
- Klinik für Strahlentherapie und Radioonkologie, Klinikum der Philipps Universität Marburg, Baldingerstr, 35043, Marburg, Germany.,Technische Hochschule Mittelhessen, Institut für Medizinische Physik und Strahlenschutz, Gießen, Germany
| | - H Hauswald
- Klinik für Strahlentherapie und Radioonkologie, Klinikum der Philipps Universität Marburg, Baldingerstr, 35043, Marburg, Germany.,Klinik für Radio-Onkologie, Universitätsklinikum Heidelberg, Heidelberg, Germany.,Marburg Ion-Beam Therapy Center (MIT), Marburg, Germany
| | - D Vordermark
- Klinik und Poliklinik für Strahlentherapie, Universitätsklinikum der Martin-Luther-Universität Halle-Wittenberg, Halle, Germany
| | - C Mauz-Körholz
- Abteilung für Pädiatrische Hämatologie und Onkologie, Universitätsklinikum Gießen, Gießen, Germany.,Department für operative und konservative Kinder- und Jugendmedizin, Universitätsklinikum der Martin-Luther-Universität Halle-Wittenberg, Halle, Germany
| | - R Engenhart-Cabillic
- Klinik für Strahlentherapie und Radioonkologie, Klinikum der Philipps Universität Marburg, Baldingerstr, 35043, Marburg, Germany.,Marburg Ion-Beam Therapy Center (MIT), Marburg, Germany
| | - F Eberle
- Klinik für Strahlentherapie und Radioonkologie, Klinikum der Philipps Universität Marburg, Baldingerstr, 35043, Marburg, Germany.,Marburg Ion-Beam Therapy Center (MIT), Marburg, Germany
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Abstract
This article presents a case of malignant transformation of vestibular schwannoma 13 years after stereotactic radiation therapy, which lead to an acute life-threatening condition. Although the observation is currently only based on case reports, an increasing number of these support the hypothesis that there is a relevant risk of malignant transformation in the long-term course of previously irradiated vestibular schwannomas. Therefore, long-term MRI follow-up should be considered.
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Affiliation(s)
- S Simmermacher
- Universitätsklinik und Poliklinik für Neurochirurgie, Universitätsklinikum Halle (Saale), Ernst-Grube-Straße 40, 06120, Halle (Saale), Deutschland.
| | - D Vordermark
- Klinik für Strahlentherapie, Universitätsklinikum Halle, Halle (Saale), Deutschland
| | - T Kegel
- Klinik für Hämatologie und Onkologie, Universitätsklinikum Halle, Halle (Saale), Deutschland
| | - C Strauss
- Universitätsklinik und Poliklinik für Neurochirurgie, Universitätsklinikum Halle (Saale), Ernst-Grube-Straße 40, 06120, Halle (Saale), Deutschland
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Vordermark D. SP-0342 From geriatric assessment in radiation oncology to interventions: experience from the PIVOG trial. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)30762-5] [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: 11/25/2022]
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15
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Käsmann L, Janssen S, Fahlbusch F, Vordermark D, Rades D. EP-1565 Quality of online information about radiotherapy for prostate cancer. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31985-1] [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: 10/26/2022]
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16
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Medenwald D, Medenwald K, Glowka A, Vordermark D, Dietzel C. PO-0848 Early mortality of prostatectomy vs. radiotherapy as a primary treatment for prostate cancer. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31268-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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17
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Medenwald D, Glowka A, Vordermark D, Medenwald K. EP-1316 Radiotherapy in elderly breast cancer patients with hormone therapy: A population-based study. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31736-0] [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: 10/26/2022]
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18
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Ostheimer C, Palm F, Christoph E, Katharina M, Rafael M, Vordermark D, Medenwald D. PV-0204 Mortality after radiotherapy or surgery in early stage NSCLC: a population based study. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)30624-3] [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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19
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Dunst J, Hildebrandt G, Becker-Schiebe M, Kuhnt T, Weykamp F, Martucci F, Vordermark D, Pless M, Hofmann D, Bühler V, Rothschild S. Can concomitant diseases predict the compliance with cisplatin plus RT in patients with LA SCCHN? An exploratory endpoint analysis of the COMPLY trial. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy287.064] [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: 11/13/2022] Open
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20
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Ostheimer C, Ensminger S, Janich M, Sieker F, Izaguirre V, Gerlach R, Vordermark D. EP-1869: Dosimetric plan comparison of VMAT vs. IMRT in 257 patients with head-and-neck and prostate cancer. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)32178-9] [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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21
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Ostheimer C, Gunther S, Bache M, Vordermark D, Multhoff G. EP-1360: Heat shock protein 70 serum levels as a predictor of clinical response in non-small-cell lung cancer. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)31669-4] [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: 10/14/2022]
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22
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Ostheimer C, Evers C, Reese T, Bache M, Vordermark D. EP-2307: Prognostic implications of the urokinase plasminogen activator system and osteopontin in NSCLC. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)32616-1] [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: 10/14/2022]
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23
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Janssen S, Käsmann L, Fahlbusch FB, Rades D, Vordermark D. Side effects of radiotherapy in breast cancer patients. Strahlenther Onkol 2017; 194:136-142. [DOI: 10.1007/s00066-017-1197-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 08/08/2017] [Indexed: 12/01/2022]
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25
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Vordermark D. SP-0019: Measuring anorectal toxicity and function. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)31268-3] [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: 10/21/2022]
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Denschlag D, Thiel FC, Ackermann S, Harter P, Juhasz-Boess I, Mallmann P, Strauss HG, Ulrich U, Horn LC, Schmidt D, Vordermark D, Vogl T, Reichardt P, Gaß P, Gebhardt M, Beckmann MW. Erratum: Sarcoma of the Uterus. Guideline of the DGGG (S2k-Level, AWMF Registry No. 015/074, August 2015). Geburtshilfe Frauenheilkd 2015; 75:e3. [PMID: 26756886 DOI: 10.1055/s-0035-1558288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
[This corrects the article DOI: 10.1055/s-0035-1558120.].
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Affiliation(s)
- D Denschlag
- Frauenklinik, Hochtaunuskliniken Bad Homburg, Bad Homburg
| | - F C Thiel
- Frauenklinik, Alb Fils Kliniken, Göppingen
| | | | - P Harter
- Klinik für Gynäkologie und Gynäkologische Onkologie, Klinikum Essen Mitte, Essen
| | - I Juhasz-Boess
- Klinik für Gynäkologie, Geburtshilfe und Reproduktionsmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar
| | - P Mallmann
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Köln, Cologne
| | - H-G Strauss
- Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Halle, Halle/Saale
| | - U Ulrich
- Klinik für Gynäkologie und Geburtshilfe, Martin-Luther-Krankenhaus Berlin, Paul Gerhardt Diakonie, Berlin
| | - L-C Horn
- Abteilung für Mamma-, Urogenital, und Perinatalpathologie, Institut für Pathologie, Universitätsklinikum Leipzig, Leipzig
| | - D Schmidt
- Institut für Pathologie Mannheim, Mannheim
| | - D Vordermark
- Universitätsklinik und Poliklinik für Strahlentherapie, Universitätsklinikum Halle, Halle/Saale
| | - T Vogl
- Institut für diagnostische und interventionelle Radiologie, Universitätsklinikum Frankfurt, Frankfurt/Main
| | - P Reichardt
- Klinik für interdisziplinäre Onkologie, Helios Kliniken Berlin-Buch, Berlin
| | - P Gaß
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen
| | - M Gebhardt
- Frauenselbsthilfe nach Krebs e. V., Erlangen
| | - M W Beckmann
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen
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27
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Denschlag D, Thiel FC, Ackermann S, Harter P, Juhasz-Boess I, Mallmann P, Strauss HG, Ulrich U, Horn LC, Schmidt D, Vordermark D, Vogl T, Reichardt P, Gaß P, Gebhardt M, Beckmann MW. Sarcoma of the Uterus. Guideline of the DGGG (S2k-Level, AWMF Registry No. 015/074, August 2015). Geburtshilfe Frauenheilkd 2015; 75:1028-1042. [PMID: 26640293 DOI: 10.1055/s-0035-1558120] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Purpose: Official guideline published and coordinated by the German Society of Gynecology and Obstetrics (DGGG). Due to their rarity and their heterogeneous histopathology uterine sarcomas remain challenging tumors to manage and need a multidisciplinary approach. To our knowledge so far there is no evidence-based guideline on the appropiate management of these heterogeneous tumors. Methods: This S2k-guideline is the work of an representative committee of experts from a variety of different professions who were commissioned by the DGGG to carry out a systematic literature review of uterine sarcoma. Members of the participating scientific societies developed a structured consensus in a formal procedure. Recommendations: 1. The incidence and histopathologic classification of uterine sarcoma. 2. The clinical manifestations, diagnosis and staging of uterine sarcoma. 3. The management of leiomyosarcoma. 4. The management of endometrial stromal sarcoma and undifferentiated uterine sarcoma. 5. The management of adenosarcoma as well as carcinosarcomas. 6. The management of morcellated uterine sarcoma.
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Affiliation(s)
- D Denschlag
- Frauenklinik, Hochtaunuskliniken Bad Homburg, Bad Homburg
| | - F C Thiel
- Frauenklinik, Alb Fils Kliniken, Göppingen
| | | | - P Harter
- Klinik für Gynäkologie und Gynäkologische Onkologie, Klinikum Essen Mitte, Essen
| | - I Juhasz-Boess
- Klinik für Gynäkologie, Geburtshilfe und Reproduktionsmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar
| | - P Mallmann
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Köln, Cologne
| | - H-G Strauss
- Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Halle, Halle/Saale
| | - U Ulrich
- Klinik für Gynäkologie und Geburtshilfe, Martin-Luther-Krankenhaus Berlin, Paul Gerhardt Diakonie, Berlin
| | - L-C Horn
- Abteilung für Mamma-, Urogenital, und Perinatalpathologie, Institut für Pathologie, Universitätsklinikum Leipzig, Leipzig
| | - D Schmidt
- Institut für Pathologie Mannheim, Mannheim
| | - D Vordermark
- Universitätsklinik und Poliklinik für Strahlentherapie, Universitätsklinikum Halle, Halle/Saale
| | - T Vogl
- Institut für diagnostische und interventionelle Radiologie, Universitätsklinikum Frankfurt, Frankfurt/Main
| | - P Reichardt
- Klinik für interdisziplinäre Onkologie, Helios Kliniken Berlin-Buch, Berlin
| | - P Gaß
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen
| | - M Gebhardt
- Frauenselbsthilfe nach Krebs e. V., Erlangen
| | - M W Beckmann
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen
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Mauz-Körholz C, Lange T, Hasenclever D, Burkhardt B, Feller A, Dörffel W, Kluge R, Vordermark D, Körholz D. Pediatric Nodular Lymphocyte-predominant Hodgkin Lymphoma: Treatment Recommendations of the GPOH-HD Study Group. Klin Padiatr 2015; 227:314-21. [DOI: 10.1055/s-0035-1559664] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- C. Mauz-Körholz
- Klinik für Kinder- und Jugendmedizin, Martin-Luther-Universität Halle/ Wittenberg, Halle/ Saale, Germany
| | - T. Lange
- Klinik für Kinder- und Jugendmedizin, Martin-Luther-Universität Halle/ Wittenberg, Halle/ Saale, Germany
| | - D. Hasenclever
- Institut für Medizinische Informatik, Statistik & Epidemiologie (IMISE), Universität Leipzig, Leipzig, Germany
| | - B. Burkhardt
- Clinic for Pediatric Hematology and Oncology, University Hospital Münster, Münster, Germany
| | - A. Feller
- Institute for Pathology, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - W. Dörffel
- Clinic for Pediatric and Youth Medicine, Helios Hospital Berlin-Buch, Berlin, Germany
| | - R. Kluge
- Klinik und Poliklinik für Nuklearmedizin, Universitätsklinikum Leipzig, Leipzig, Germany
| | - D. Vordermark
- Clinic and Policlinic for Radiation Therapy, University Hospital Halle (Saale), Halle (Saale), Germany
| | - D. Körholz
- Klinik für Kinder- und Jugendmedizin, Martin-Luther-Universität Halle/ Wittenberg, Halle/ Saale, Germany
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Ostheimer C, Meyer F, Kornhuber C, Reese T, Vordermark D. [What does the general and abdominal surgeon need to know about radiotherapy? - aspects of radiotherapy in general and abdominal surgery]. Zentralbl Chir 2015; 140:83-93. [PMID: 25723755 DOI: 10.1055/s-0034-1383338] [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: 10/23/2022]
Abstract
Radiooncological therapies are an integral part of the multimodal oncological treatment concepts in general and abdominal surgery. These include therapeutic approaches with a curative intention such as the neoadjuvant (pre-operative) radiotherapy of locoregionally advanced and/or N+ oesophageal and rectal cancer, definitive combined chemoradiotherapy of locally advanced, unresectable oesophageal cancer or oesophageal tumour lesions of the upper third, definitive radiotherapy of anal cancer (sphincter sparing) and pre- or post-operative radiotherapy of soft tissue sarcoma on the one hand. A yT0 stage achieved as characteristic of a curative effect by radiation in oesophageal and rectal cancer (omitting subsequent surgical intervention, naturally under clinical and imaging-based controls within short-term follow-up intervals) can be considered as a very interesting set-up with regard to its reasonable integration in daily clinical practice, which needs to be further and critically discussed. By integrating radiotherapy in interdisciplinary therapy concepts, improved tumour control and survival rates with clinically acceptable toxicity can be achieved. On the other hand, non-invasive, locally ablative radiooncological therapies such as extracranial stereotactic body radiotherapy constitute an effective and feasible treatment method for liver metastases in oligometastatic colorectal cancer or other tumour entities according to the decisions by the institutional tumour board, offering high local tumour control rates which can be part of multistep, multimodal procedures with curative intention. This review aims at providing an overview for the general and abdominal surgeon, outlining relevant radiooncological treatment aspects in the multimodal cancer therapy with a focus on the treatment of rectal, oesophageal and anal cancer as well as soft tissue sarcoma and hepatic metastases in oligometastatic colorectal cancer.
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Affiliation(s)
- C Ostheimer
- Klinik und Poliklinik für Strahlentherapie, Universitätsklinikum Halle, Deutschland
| | - F Meyer
- Universitätsklinik für Allgemein-, Viszeral- & Gefäßchirurgie, Universitätsklinikum Magdeburg A. ö. R., Deutschland
| | - C Kornhuber
- Klinik und Poliklinik für Strahlentherapie, Universitätsklinikum Halle, Deutschland
| | - T Reese
- Klinik und Poliklinik für Strahlentherapie, Universitätsklinikum Halle, Deutschland
| | - D Vordermark
- Klinik und Poliklinik für Strahlentherapie, Universitätsklinikum Halle, Deutschland
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Körholz D, Mauz-Körholz C, Vordermark D, Kluge R, Dieckmann K. Increased relapse rates in early stage hodgkin lymphoma (HL) patients without radiotherapy: the German Society of Radiooncology (DEGRO) advises to treat all early stage HL patients with radiotherapy. Klin Padiatr 2014; 226:307-8. [PMID: 25431863 DOI: 10.1055/s-0034-1389928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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31
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Kurch L, Hasenclever D, Tchavdarova L, Georgi T, Stoevesandt D, Pelz T, Vordermark D, Sabri O, Mauz-Körholz C, Körholz D, Kluge R. Impact of Non-FDG-Avid Areas Inside a Tumour Mass in Paediatric Hodgkin Lymphoma (PHL) Patients. Klin Padiatr 2014. [DOI: 10.1055/s-0034-1371171] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Vordermark D, Kaufmann A, Schmidt H, Ostheimer C, Ullrich J, Landenberger M. OC-0568: Quality of life in very elderly radiotherapy patients: prospective study using the new EORTC QLQ-ELD14 module. Radiother Oncol 2014. [DOI: 10.1016/s0167-8140(15)30674-5] [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: 11/26/2022]
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Ostheimer C, Bache M, Güttler A, Kotzsch M, Vordermark D. A pilot study on potential plasma hypoxia markers in the radiotherapy of non-small cell lung cancer. Osteopontin, carbonic anhydrase IX and vascular endothelial growth factor. Strahlenther Onkol 2013; 190:276-82. [PMID: 24322994 DOI: 10.1007/s00066-013-0484-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Accepted: 10/16/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Hypoxic radioresistance plays a critical role in the radiotherapy of cancer and adversely impacts prognosis and treatment response. This prospective study investigated the interrelationship and the prognostic significance of several hypoxia-related proteins in non-small cell lung cancer (NSCLC) patients treated by radiotherapy ± chemotherapy. MATERIAL AND METHODS Pretreatment osteopontin (OPN), vascular endothelial growth factor (VEGF) and carbonic anhydrase IX (CA IX) plasma levels were determined by ELISA in 55 NSCLC (M0) patients receiving 66 Gy curative-intent radiotherapy or chemoradiation. Marker correlation, association with clinicopathological parameters and the prognostic value of a biomarker combination was evaluated. RESULTS All biomarkers were linearly correlated and linked to different clinical parameters including lung function, weight loss (OPN), gross tumor volume (VEGF) and T stage (CA IX). High OPN (p = 0.03), VEGF (p = 0.02) and CA IX (p = 0.04) values were significantly associated with poor survival. Double marker combination additively increased the risk of death by a factor of 2 and high plasma levels of the triple combination OPN/VEGF/CA IX yielded a 5.9-fold risk of death (p = 0.009). The combined assessment of OPN/VEGF/CA IX correlated independently with prognosis (p = 0.03) in a multivariate Cox regression model including N stage, T stage and GTV. CONCLUSION This pilot study suggests that a co-detection augments the prognostic value of single markers and that the integration of OPN, VEGF and CA IX into a hypoxic biomarker profile for the identification of patients with largely hypoxic and radioresistant tumors should be further evaluated.
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Affiliation(s)
- C Ostheimer
- Department of Radiation Oncology, Martin-Luther-University Halle-Wittenberg, Dryanderstr. 4, 06110, Halle (Saale), Germany,
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Müller K, Schlamann A, Seidel C, Warmuth-Metz M, Christiansen H, Vordermark D, Kortmann RD, Kramm C, von Bueren A. Craniospinal irradiation with concurrent temozolomide and nimotuzumab in a child with primary metastatic diffuse intrinsic pontine glioma. Strahlenther Onkol 2013; 189:693-6. [DOI: 10.1007/s00066-013-0370-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2013] [Accepted: 04/29/2013] [Indexed: 12/01/2022]
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Vordermark D. SP-0145: The volume perspective - whole brain vs no whole brain. Radiother Oncol 2013. [DOI: 10.1016/s0167-8140(15)32451-8] [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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Steinmann D, Vordermark D, Geinitz H, Aschoff R, Bayerl A, Gerstein J, Hipp M, van Oorschot B, Wypior HJ, Schäfer C. Proxy assessment of patients before and after radiotherapy for brain metastases. Results of a prospective study using the DEGRO brain module. Strahlenther Onkol 2012; 189:47-53. [PMID: 23161120 DOI: 10.1007/s00066-012-0239-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2012] [Accepted: 09/17/2012] [Indexed: 11/29/2022]
Abstract
PURPOSE Proxies of patients with poor performance status could give useful information about the patients' quality of life (QoL). We applied a newly developed questionnaire in a prospective QoL study of patients undergoing radiotherapy for brain metastases in order to make the first move to validate this instrument, and we compared the results with scores obtained using validated patient-completed instruments. MATERIALS AND METHODS From January 2007 to June 2010, 166 patients with previously untreated brain metastases were recruited at 14 centers in Germany and Austria. The EORTC-QLQ-C15-PAL and the brain module BN20 were used to assess QoL in patients at the start of treatment and 3 months later. At the same time points, 141 of their proxies estimated the QoL with the new DEGRO brain module (DBM), a ten-item questionnaire rating the general condition as well as functions and impairment by symptoms in areas relevant to patients with brain metastases. RESULTS At 3 months, 85 of 141 patients (60%) with initial response by a proxy were alive. Sixty-seven of these patients (79% of 3-month survivors) and 65 proxies completed the second set of questionnaires. After 3 months, QoL significantly deteriorated in all items of proxy-assessed QoL except headache. Correlations between self-assessed and proxy-assessed QoL were high in single items such as nausea, headache, and fatigue. CONCLUSIONS The high correlation between self-assessment and proxy ratings as well as a similar change over time for both approaches suggest that in patients with brain metastases, proxy assessment using the DBM questionnaire can be an alternative approach to obtaining QoL data when patients are unable to complete questionnaires themselves. Our self-constructed and first applied DBM is the only highly specific instrument for patients with brain metastases, but further tests are needed for its final validation.
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Affiliation(s)
- D Steinmann
- Department of Radiation Oncology, Medical School Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
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Körholz D, Mauz-Körholz C, Kluge R, Bernig T, Staege MS, Vordermark D, Hasenclever D. Konzept der Langzeitnachsorge für in Deutschland behandelte Patienten der GPOH-HD2002 und EuroNet-PHL-C1 Studien. Klin Padiatr 2012. [DOI: 10.1055/s-0032-1306252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Oskan F, Vordermark D. [Quality of life after prophylactic cranial irradiation in locally advanced non-small-cell lung cancer]. Strahlenther Onkol 2012; 188:363-4. [PMID: 22349637 DOI: 10.1007/s00066-012-0089-0] [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: 10/28/2022]
Affiliation(s)
- F Oskan
- Universitätsklinik für Strahlentherapie, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Deutschland
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Schweyen R, Hey J, Fränzel W, Vordermark D, Hildebrandt G, Kuhnt T. [Radiation-related caries: etiology and possible preventive strategies. What should the radiotherapist know?]. Strahlenther Onkol 2011; 188:21-8. [PMID: 22189435 DOI: 10.1007/s00066-011-0011-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2011] [Accepted: 06/30/2011] [Indexed: 11/30/2022]
Abstract
BACKGROUND After radiation treatment of head-and-neck cancer, the impairment of patient's quality of life still remains an issue. After completion of the treatment course, a substantial number of patients develop so-called radiation caries. In addition, almost 50% of all cases of infectious osteoradionecrosis (iORN) of the jaws are directly associated with radiation caries. This review addresses our current knowledge on the etiology and pathogenesis of radiation caries including possible preventive strategies. MATERIALS AND METHODS A PubMed search using the terms "radiation caries" ("radiation related caries", "radiation related damage to dentition") and "radiogenic caries" ("postradiation caries", "dental complications and radiotherapy") was performed. The analysis of its content focused on the etiology, the pathogenesis, and the available knowledge on prophylaxis as well as treatment of radiation caries. RESULTS For this review, 60 publications were selected. As main causal factors for radiogenic caries, either indirect impairment, resulting from alterations in the oral environment (e.g., radiation-induced xerostomia) or direct radiation-induced damage in teeth hard tissues are discussed. Radiation caries remains a lifelong threat and, therefore, requires permanent prevention programs. CONCLUSION To enable optimal medical care of the patients during the time course of radiotherapy as well as afterwards, close interdisciplinary cooperation between radiotherapists, oral surgeons, otorhinolaryngologists, and dentists is absolutely essential.
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Affiliation(s)
- R Schweyen
- Universitätspoliklinik für Prothetik, Martin-Luther-Universität Halle-Wittenberg, Halle-Wittenberg, Deutschland
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Kuhnt T, Seidel J, Setz J, Gerlach R, Vordermark D, Gernhardt C, Hey J. Recovery of the Parotid Gland Function after Radiotherapy of Head and Neck Cancer. Int J Radiat Oncol Biol Phys 2010. [DOI: 10.1016/j.ijrobp.2010.07.1033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Polat B, Said H, Katzer A, Guckenberger M, Mlynski R, Flentje M, Vordermark D. Osteopontin Plasma Levels in Head and Neck Cancer Patients During Radiotherapy. Int J Radiat Oncol Biol Phys 2010. [DOI: 10.1016/j.ijrobp.2010.07.1537] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Dellas K, Roedel F, Arnold D, Kappler M, Hipp M, Bataille F, Vordermark D, Roedel C, Hartmann A. EGFR, PTEN, and survivin expression in pre- and posttherapeutic specimens does not predict a clinical benefit from preoperative chemoradiation with cetuximab in patients (pts) with locally advanced rectal cancer (LARC). J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.3653] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Bache M, Kappler M, Said HM, Staab A, Vordermark D. Detection and specific targeting of hypoxic regions within solid tumors: current preclinical and clinical strategies. Curr Med Chem 2008; 15:322-38. [PMID: 18288988 DOI: 10.2174/092986708783497391] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Poor oxygenation of solid tumors is a major indicator of adverse prognosis after standard treatment, e.g. radiotherapy. This observation founded on intratumoral pO(2) electrode measurements has been supported more recently by studies of injected hypoxia markers (pimonidazole, EF5) or hypoxia-related proteins (hypoxia-inducible factor-1alpha, carbonic anhydrase IX) detected immunohistochemically. Alternative approaches include imaging of tumor hypoxia by nuclear medicine studies and the measurement of hypoxia-related proteins (osteopontin) in patient plasma. Low oxygen levels as found in tumors are rarely observed in normal tissues. The presence of hypoxic tumor cells is therefore regarded not only as an adverse prognostic factor but as an opportunity for tumor-specific treatment. Classic approaches to normalize tumor oxygenation involve the breathing of modified gas mixtures and pharmacologic modification of blood flow as in the "accelerated radiotherapy, carbogen, nicotinamide" (ARCON) scheme. Specific killing of hypoxic tumor cells can potentially be achieved by hypoxia-selective cytotoxins (model substance tirapazamine), which has shown promise in head and neck cancer. Direct targeting of hypoxia-related molecules such as hypoxia-inducible factor-1alpha, the central regulator of the hypoxic response in tumor cells, is an attractive approach currently tested in preclinical models. For clinical applications, the appropriate combination of hypoxia detection for patient selection with a hypoxia-specific treatment is essential. A therapeutic benefit has been suggested for the selection of patients by plasma osteopontin level and treatment with the hypoxic radiosensitizer nimorazole in addition to radiotherapy, for selection by F-misonidazole positron-emission tomography (PET) and treatment with tirapazamine in addition to chemoradiation and for selection by pimonidazole immunohistochemistry and ARCON treatment, all in head and neck cancer.
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Affiliation(s)
- M Bache
- Dept. of Radiation Oncology, Martin Luther University Halle-Wittenberg, Germany
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Djakovic A, Ott G, Zollner U, Vordermark D, Dietl J. [Mediastinal large B-cell lymphoma with symptomatic superior vena cava syndrome in a patient with bichorial twin pregnancy in the 26th week of gestation: peri-and postpartal management -- a case report]. Zentralbl Gynakol 2005; 127:248-51. [PMID: 16037907 DOI: 10.1055/s-2005-836499] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Non-Hodgkin lymphoma (NHL) is rarely observed during pregnancy. The clinical behavior of this malignancy does not differ significantly from that outside of the setting of pregnancy. Antineoplastic chemotherapy is usually given during the second and third trimester. However, irradiation is another therapeutic option. The teratogenic potential limits its use in pregnancy. Finding an appropriate therapeutic management in an emergency setting is therefore difficult. CASE REPORT In this report, we describe the case of a 31-year-old gravida three, para two, in whom a mediastinal large B-cell lymphoma with symptomatic superior vena cava syndrome was diagnosed in a bichorial twin pregnancy in the 26 (th) week of gestation. After premature delivery by caesarean section at 26 + 0 weeks gestation the patient was immediately submitted to mediastinal irradiation. The clinical symptoms resolved and adjuvant CHOEP-chemotherapy was instituted. Chemotherapy was well tolerated and a partial remission was observed after 4 cycles. The neonatological follow-up was uneventful. DISCUSSION To our knowledge, this is the first case in the literature of a patient with bichorial twin pregnancy with large cell mediastinal NHL and symptomatic superior vena cava syndrome who underwent irradiation after caesarean section because of life-threatening medical condition.
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Vordermark D, Katzer A, Kaffer A, Riedel S, Flentje M. 96 Characterization of carbonic anhydrase 9 (CA9) overexpression: endogenous hypoxia marker and potential tumor-specific target. EJC Suppl 2004. [DOI: 10.1016/s1359-6349(04)80104-6] [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: 10/26/2022] Open
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Affiliation(s)
- D Vordermark
- Klinik und Poliklinik für Strahlentherapie, Würzburg, Germany.
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Koelbl O, Bratengeier K, Vordermark D, Flentje M. Radiotherapy of prostatic cancer: optimization of the MLC caused cascade field shapes by a new, uncomplicated, individualized MLC adaptation. Int J Radiat Oncol Biol Phys 2001. [DOI: 10.1016/s0360-3016(01)02420-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Vordermark D, Shibata T, Menke D, Brown J. Detection of hypoxia in live HT 1080 human fibrosarcoma cells using enhanced green fluorescent protein (EGFP) driven by a hypoxia-responsive vector. Int J Radiat Oncol Biol Phys 2001. [DOI: 10.1016/s0360-3016(01)01965-4] [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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Vordermark D, Shibata T, Brown JM. Green fluorescent protein is a suitable reporter of tumor hypoxia despite an oxygen requirement for chromophore formation. Neoplasia 2001; 3:527-34. [PMID: 11774035 PMCID: PMC1506559 DOI: 10.1038/sj.neo.7900192] [Citation(s) in RCA: 82] [Impact Index Per Article: 3.6] [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: 06/14/2001] [Accepted: 07/18/2001] [Indexed: 11/08/2022] Open
Abstract
The oxygen requirement for chromophore formation potentially limits the use of green fluorescent protein as a reporter under hypoxic conditions. In the light of this, the applicability of a hypoxia-responsive enhanced green fluorescent protein (EGFP)-based system to the measurement of tumor hypoxia was tested in human HT 1080 fibrosarcoma cells stably transfected with a destabilized EGFP vector containing the hypoxia-responsive 5HRE-hCMVmp promoter or, as a positive control, the strong constitutive CMV promoter. After various schedules of hypoxia and reoxygenation, EGFP fluorescence of live cells was assessed by flow cytometry, and protein levels were analyzed by Western blot. Fluorescence of CMV promoter positive control cells dropped to 38+/-5% of aerobic levels after 12 hours at <0.02% oxygen, but was unaffected by higher oxygen concentrations. Following 12 hours at <0.02% oxygen, cells transfected with the hypoxia-responsive vector exhibited maximum fluorescence after 4 hours of subsequent reoxygenation, reaching 68+/-2% of the levels in CMV promoter controls under aerobic conditions. With such reoxygenation, these cells exhibited a constant increase in fluorescence between 2% and <0.02% oxygen. EGFP chromophore formation is only affected by near-anoxic oxygen concentrations. The correlation of fluorescence and oxygen concentration is restored by a 4-hour reoxygenation period due to oxidation of pre-synthesized EGFP and a delayed increase in EGFP protein synthesis.
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Affiliation(s)
- D Vordermark
- Department of Radiation Oncology, Division of Radiation and Cancer Biology, Stanford University School of Medicine, Stanford, CA 94305-5152, USA
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Vordermark D, Flentje M, Sailer M, Kölbl O. Intracavitary afterloading boost in anal canal carcinoma. Results, function and quality of life. Strahlenther Onkol 2001; 177:252-8. [PMID: 11398611 DOI: 10.1007/pl00002405] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [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: 10/25/2022]
Abstract
BACKGROUND First clinical data on a new intracavitary afterloading boost method for anal canal carcinoma is reported. PATIENTS AND METHODS 20 consecutive patients (T1 5%, T2 70%, T3 20%, T4 5%; N0 75%, N1 10%, N2 15%; all M0) treated with external beam pelvic radiotherapy (median dose 56 Gy, range 46-64 Gy), simultaneous 5-FU and mitomycin (in 75%) and an intracavitary afterloading boost (one or two fractions of 5 Gy at 5 mm depth) were analyzed after a mean +/- SD follow-up for living patients of 4.4 +/- 2.1 years. Quality of Life (QoL) and anorectal manometry parameters were assessed in ten colostomy-free survivors. RESULTS Overall, recurrence-free and colostomy-free survival at 5 years were 84%, 79% and 69%, respectively. No death was tumor-related. The only local failure was successfully salvaged by local excision. All three colostomies were performed for toxicity. Resting pressure and maximum squeeze pressure of the anal sphincter were reduced by 51% and 71%, as compared with control subjects, but quality of life was similar compared to healthy volunteers. CONCLUSION The described regimen is highly effective but associated with increased toxicity.
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Affiliation(s)
- D Vordermark
- Klinik für Strahlentherapie, Universität Würzburg, Germany.
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