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Dávila Fajardo R, Scarzello G, Gaze MN, Boterberg T, Cameron A, Fuchs J, Guérin F, Hoskin P, Krasin MJ, Kroon P, Magelssen H, Mercke C, Merks JHM, Paulsen F, Pommier P, Ramos M, Rees H, Rogers T, Schmid M, Seitz G, Slater O, Smeulders N, Stenman J, Terwisscha S, Chargari C, Mandeville HC. Brachytherapy for rhabdomyosarcoma: Survey of international clinical practice and development of guidelines. Radiother Oncol 2024; 195:110273. [PMID: 38588921 DOI: 10.1016/j.radonc.2024.110273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 03/07/2024] [Accepted: 04/04/2024] [Indexed: 04/10/2024]
Abstract
BACKGROUND AND PURPOSE The purpose of this study was to address the lack of published data on the use of brachytherapy in pediatric rhabdomyosarcoma by describing current practice as starting point to develop consensus guidelines. MATERIALS AND METHODS An international expert panel on the treatment of pediatric rhabdomyosarcoma comprising 24 (pediatric) radiation oncologists, brachytherapists and pediatric surgeons met for a Brachytherapy Workshop hosted by the European paediatric Soft tissue Sarcoma Study Group (EpSSG). The panel's clinical experience, the results of a previously distributed questionnaire, and a review of the literature were presented. RESULTS The survey indicated the most common use of brachytherapy to be in combination with tumor resection, followed by brachytherapy as sole local therapy modality. HDR was increasingly deployed in pediatric practice, especially for genitourinary sites. Brachytherapy planning was mostly by 3D imaging based on CT. Recommendations for patient selection, treatment requirements, implant technique, delineation, dose prescription, dose reporting and clinical management were defined. CONCLUSIONS Consensus guidelines for the use of brachytherapy in pediatric rhabdomyosarcoma have been developed through multicenter collaboration establishing the basis for future work. These have been adopted for the open EpSSG overarching study for children and adults with Frontline and Relapsed RhabdoMyoSarcoma (FaR-RMS).
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Affiliation(s)
- Raquel Dávila Fajardo
- Department of Radiation Oncology, University Medical Center, Utrecht, the Netherlands; Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands; Division Imaging and Oncology, University Medical Center, Utrecht, the Netherlands.
| | | | - Mark N Gaze
- Department of Oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom.
| | - Tom Boterberg
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium.
| | - Alison Cameron
- Bristol Cancer Institute, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom.
| | - Joerg Fuchs
- Department of Pediatric Surgery and Pediatric Urology, University Childreńs Hospital, Tuebingen, Germany
| | - Florent Guérin
- Department of Paediatric Surgery, Paris-Saclay University, Assistance Publique-Hôpitaux de Paris, Bicêtre Hospital, Paris, France
| | - Peter Hoskin
- Department of Oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom.
| | - Matthew J Krasin
- Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, USA
| | - Petra Kroon
- Department of Radiation Oncology, University Medical Center, Utrecht, the Netherlands; Division Imaging and Oncology, University Medical Center, Utrecht, the Netherlands.
| | | | - Claes Mercke
- Department of Oncology-Pathology, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden.
| | - Johannes H M Merks
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands; Division Imaging and Oncology, University Medical Center, Utrecht, the Netherlands.
| | - Frank Paulsen
- Department of Radiation Oncology, University Hospital, Tuebingen, Germany.
| | - Pascal Pommier
- Department of Radiation Oncology, Centre Leon Berard, Lyon, France.
| | - Monica Ramos
- Department of Radiation Oncology, Vall d'Hebron University Hospital, Barcelona, Spain.
| | - Helen Rees
- Bristol Cancer Institute, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom.
| | - Tim Rogers
- Bristol Cancer Institute, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
| | - Maximilian Schmid
- Medical University of Vienna, Department of Radiation Oncology, Comprehensive Cancer Center, Vienna, Austria.
| | - Guido Seitz
- Department of Pediatric Surgery and Urology, University Hospital Giessen-Marburg, Campus Marburg, Marburg, Germany.
| | - Olga Slater
- Department of Paediatric Oncology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom.
| | - Naima Smeulders
- Department of Paediatric Urology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom.
| | - Jakob Stenman
- Childhood Cancer Research Unit, Department of Women's and Children's Health, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden.
| | - Sheila Terwisscha
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands.
| | - Cyrus Chargari
- Department of Radiation Oncology, Gustave Roussy Comprehensive Cancer Center, Villejuif, France.
| | - Henry C Mandeville
- The Royal Marsden Hospital and Institute of Cancer Research, Sutton, United Kingdom
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Ruff C, Bombach P, Gohla G, Hauser TK, Paulsen F, Farhang N, Boesmueller H, Beschorner R, Bongers M. Evolution of a Meningothelial Meningioma: From WHO Grade 1 to Anaplastic Grade 3 with Extracranial Metastasis Including Extensive Liver Metastasis. Diagnostics (Basel) 2024; 14:676. [PMID: 38611589 PMCID: PMC11011535 DOI: 10.3390/diagnostics14070676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 03/19/2024] [Accepted: 03/20/2024] [Indexed: 04/14/2024] Open
Abstract
A 61-year-old patient was diagnosed with a left-sided falx meningioma. Histopathological analysis following extirpation showed a meningothelial meningioma ZNS WHO grade 1 with sparse mitoses. Over the course of 12 years, the patient received irradiation (54.0 Gy), peptide radio-receptor therapy (177Lu-DOMITATE) and targeted therapy (mTOR inhibitor). Follow-up imaging revealed an increased size of the residual tumor. Due to increased liver function parameters, imaging of the liver was performed, showing widespread space-occupying lesions with atypical appearance. Biopsy revealed metastasis of the meningioma, now with 2.7 mitoses/mm2, necrosis and homozygous CDKN2A/B deletion, corresponding to an anaplastic CNS meningioma WHO grade 3. A second small meningioma on the left petroclival side has been consistent in size over 12 years. Metastatic meningiomas pose a pertinent clinical challenge due to poor prognosis. The lung, bone, liver and cervical lymph nodes are the most common sites of extracranial metastasis. According to the World Health Organization criteria, the most important predictive factor for recurrence and metastasis is the tumor grade.
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Affiliation(s)
- Christer Ruff
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Tübingen, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany
| | - Paula Bombach
- Department of Neurology and Interdisciplinary Neuro-Oncology, University Hospital Tübingen, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany;
- Hertie Institute for Clinical Brain Research, Eberhard Karls University Tübingen Center of Neuro-Oncology, Ottfried-Müller-Straße 27, 72076 Tübingen, Germany
- Center for Neuro-Oncology, Comprehensive Cancer Center Tübingen-Stuttgart, University Hospital of Tuebingen, Eberhard Karls University of Tübingen, Herrenberger Straße 23, 72070 Tübingen, Germany
| | - Georg Gohla
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Tübingen, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany
| | - Till-Karsten Hauser
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Tübingen, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany
| | - Frank Paulsen
- Department of Radiation Oncology, University Hospital Tübingen, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany
| | - Nick Farhang
- Department of Diagnostic and Interventional Radiology, Hanau Hospital GmbH, Leimenstraße 20, 63450 Hanau, Germany
| | - Hans Boesmueller
- Institute of Pathology and Neuropathology, University Hospital Tuebingen, Liebermeisterstr. 8, 72076 Tübingen, Germany
| | - Rudi Beschorner
- Department of Neuropathology, Institute of Pathology and Neuropathology, University Hospital Tübingen, Calwerstraße 3, 72076 Tübingen, Germany
| | - Malte Bongers
- Department of Diagnostic and Interventional Radiology, University Hospital Tübingen, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany;
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Bodensohn R, Fleischmann DF, Maier SH, Anagnostatou V, Garny S, Nitschmann A, Büttner M, Mücke J, Schönecker S, Unger K, Hoffmann E, Paulsen F, Thorwarth D, Holzgreve A, Albert NL, Corradini S, Tabatabai G, Belka C, Niyazi M. Dosimetric feasibility analysis and presentation of an isotoxic dose-escalated radiation therapy concept for glioblastoma used in the PRIDE trial (NOA-28; ARO-2022-12). Clin Transl Radiat Oncol 2024; 45:100706. [PMID: 38116137 PMCID: PMC10726217 DOI: 10.1016/j.ctro.2023.100706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 11/27/2023] [Accepted: 11/29/2023] [Indexed: 12/21/2023] Open
Abstract
Background and purpose The PRIDE trial (NOA-28; ARO-2022-12; NCT05871021) is scheduled to start recruitment in October 2023. Its primary objective is to enhance median overall survival (OS), compared to historical median OS rates, in patients with methylguanine methlyltransferase (MGMT) promotor unmethylated glioblastoma by incorporating isotoxic dose escalation to 75 Gy in 30 fractions. To achieve isotoxicity and counteract the elevated risk of radiation necrosis (RN) associated with dose-escalated regimens, the addition of protective concurrent bevacizumab (BEV) serves as an innovative approach. The current study aims to assess the dosimetric feasibility of the proposed concept. Materials and methods A total of ten patients diagnosed with glioblastoma were included in this dosimetric analysis. Delineation of target volumes for the reference plans adhered to the ESTRO-EANO 2023 guideline. The experimental plans included an additional volume for the integrated boost. Additionally, the 60 Gy-volume was reduced by using a margin of 1.0 cm instead of 1.5 cm. To assess the risk of symptomatic RN, the Normal Tissue Complication Probability (NTCP) was calculated and compared between the reference and experimental plans. Results Median NTCP of the reference plan (NTCPref) and of the experimental plan (NTCPex) were 0.24 (range 0.11-0.29) and 0.42 (range 0.18-0.54), respectively. NTCPex was a median of 1.77 (range 1.60-1.99) times as high as the NTXPref. In a logarithmic comparison, the risk of RN is enhanced by a factor of median 2.00 (range 1.66-2.35). The defined constraints for the organs at risk were feasible. Conclusion When considering the potential protective effect of BEV, which we hypothesized might reduce the risk of RN by approximately two-fold, achieving isotoxicity with the proposed dose-escalated experimental plan for the PRIDE trial seems feasible.
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Affiliation(s)
- Raphael Bodensohn
- Department of Radiation Oncology, University Hospital Tübingen, Tübingen, Germany
- Center for Neuro-Oncology, Comprehensive Cancer Center Tübingen-Stuttgart, University Hospital Tübingen, Tübingen, Germany
- Department of Radiation Oncology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Daniel F. Fleischmann
- Department of Radiation Oncology, LMU University Hospital, LMU Munich, Munich, Germany
- German Cancer Consortium (DKTK), partner site Munich, a partnership between DKFZ and LMU University Hospital, Munich, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Sebastian H. Maier
- Department of Radiation Oncology, LMU University Hospital, LMU Munich, Munich, Germany
- Bavarian Cancer Research Center (BZKF), Munich, Germany
| | - Vasiliki Anagnostatou
- Department of Radiation Oncology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Sylvia Garny
- Department of Radiation Oncology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Alexander Nitschmann
- Department of Radiation Oncology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Marcel Büttner
- Department of Radiation Oncology, University Hospital Tübingen, Tübingen, Germany
- Department of Radiation Oncology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Johannes Mücke
- Department of Radiation Oncology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Stephan Schönecker
- Department of Radiation Oncology, LMU University Hospital, LMU Munich, Munich, Germany
- Bavarian Cancer Research Center (BZKF), Munich, Germany
| | - Kristian Unger
- Helmholtz Zentrum Munich, Neuherberg, Germany
- Faculty of Medicine, LMU Munich, Munich Germany
| | - Elgin Hoffmann
- Department of Radiation Oncology, University Hospital Tübingen, Tübingen, Germany
- Center for Neuro-Oncology, Comprehensive Cancer Center Tübingen-Stuttgart, University Hospital Tübingen, Tübingen, Germany
| | - Frank Paulsen
- Department of Radiation Oncology, University Hospital Tübingen, Tübingen, Germany
- Center for Neuro-Oncology, Comprehensive Cancer Center Tübingen-Stuttgart, University Hospital Tübingen, Tübingen, Germany
| | - Daniela Thorwarth
- Section for Biomedical Physics, Department of Radiation Oncology, University Hospital Tübingen, Germany
- German Cancer Consortium (DKTK), partner site Tübingen, a partnership between DKFZ and University Hospital, Tübingen, Germany
| | - Adrien Holzgreve
- Department of Nuclear Medicine, LMU University Hospital, LMU Munich, Munich, Germany
| | - Nathalie L. Albert
- Department of Nuclear Medicine, LMU University Hospital, LMU Munich, Munich, Germany
| | - Stefanie Corradini
- Department of Radiation Oncology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Ghazaleh Tabatabai
- Center for Neuro-Oncology, Comprehensive Cancer Center Tübingen-Stuttgart, University Hospital Tübingen, Tübingen, Germany
- Department of Neurology and Interdisciplinary Neuro-Oncology, University Hospital Tübingen, Hertie Institute for Clinical Brain Research, Tübingen, Germany
- German Cancer Consortium (DKTK), partner site Tübingen, a partnership between DKFZ and University Hospital, Tübingen, Germany
| | - Claus Belka
- Department of Radiation Oncology, LMU University Hospital, LMU Munich, Munich, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
- Bavarian Cancer Research Center (BZKF), Munich, Germany
| | - Maximilian Niyazi
- Department of Radiation Oncology, University Hospital Tübingen, Tübingen, Germany
- Center for Neuro-Oncology, Comprehensive Cancer Center Tübingen-Stuttgart, University Hospital Tübingen, Tübingen, Germany
- Department of Radiation Oncology, LMU University Hospital, LMU Munich, Munich, Germany
- German Cancer Consortium (DKTK), partner site Tübingen, a partnership between DKFZ and University Hospital, Tübingen, Germany
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Eichholz T, Heubach F, Arendt AM, Seitz C, Brecht IB, Ebinger M, Flaadt T, Süsskind D, Richter L, Hülsenbeck I, Zerweck L, Göricke S, Paulsen F, Dombrowski F, Flotho C, Schönberger S, Ketteler P, Schulte J, Lang P. Targeted therapies in retinoblastoma: GD2-directed immunotherapy following autologous stem cell transplantation and evaluation of alternative target B7-H3. Cancer Immunol Immunother 2024; 73:19. [PMID: 38240863 PMCID: PMC10798927 DOI: 10.1007/s00262-023-03587-0] [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: 07/18/2023] [Accepted: 12/10/2023] [Indexed: 01/22/2024]
Abstract
BACKGROUND GD2-directed immunotherapy is highly effective in the treatment of high-risk neuroblastoma (NB), and might be an interesting target also in other high-risk tumors. METHODS The German-Austrian Retinoblastoma Registry, Essen, was searched for patients, who were treated with anti-GD2 monoclonal antibody (mAb) dinutuximab beta (Db) in order to evaluate toxicity, response and outcome in these patients. Additionally, we evaluated anti-GD2 antibody-dependent cell-mediated cytotoxicity (ADCC) and complement-dependent cytotoxicity (CDC) in retinoblastoma cell lines in vitro. Furthermore, in vitro cytotoxicity assays directed against B7-H3 (CD276), a new identified potential target in RB, were performed. RESULTS We identified four patients with relapsed stage IV retinoblastoma, who were treated with Db following autologous stem cell transplantation (ASCT). Two out of two evaluable patients with detectable tumors responded to immunotherapy. One of these and another patient who received immunotherapy without residual disease relapsed 10 and 12 months after start of Db. The other patients remained in remission until last follow-up 26 and 45 months, respectively. In vitro, significant lysis of RB cell lines by ADCC and CDC with samples from patients and healthy donors and anti-GD2 and anti-CD276-mAbs were demonstrated. CONCLUSION Anti-GD2-directed immunotherapy represents an additional therapeutic option in high-risk metastasized RB. Moreover, CD276 is another target of interest.
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Affiliation(s)
- Thomas Eichholz
- University Children's Hospital, Eberhard Karls University, Abteilung I, Hoppe-Seyler-Str. 1, 72076, Tuebingen, Germany.
| | - Florian Heubach
- University Children's Hospital, Eberhard Karls University, Abteilung I, Hoppe-Seyler-Str. 1, 72076, Tuebingen, Germany
| | - Anne-Marie Arendt
- University Children's Hospital, Eberhard Karls University, Abteilung I, Hoppe-Seyler-Str. 1, 72076, Tuebingen, Germany
| | - Christian Seitz
- University Children's Hospital, Eberhard Karls University, Abteilung I, Hoppe-Seyler-Str. 1, 72076, Tuebingen, Germany
| | - Ines B Brecht
- University Children's Hospital, Eberhard Karls University, Abteilung I, Hoppe-Seyler-Str. 1, 72076, Tuebingen, Germany
| | - Martin Ebinger
- University Children's Hospital, Eberhard Karls University, Abteilung I, Hoppe-Seyler-Str. 1, 72076, Tuebingen, Germany
| | - Tim Flaadt
- University Children's Hospital, Eberhard Karls University, Abteilung I, Hoppe-Seyler-Str. 1, 72076, Tuebingen, Germany
| | - Daniela Süsskind
- Department of Ophthalmology, Eberhard Karls University, Tuebingen, Germany
| | - Lisa Richter
- Department of Pediatrics III, University Children's Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Isabel Hülsenbeck
- Department of Ophthalmology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Leonie Zerweck
- Department of Radiology, Diagnostic and Interventional Neuroradiology, Eberhard Karls University, Tuebingen, Germany
| | - Sophia Göricke
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Frank Paulsen
- Department of Radiation Oncology, Eberhard Karls University, Tuebingen, Germany
| | - Frank Dombrowski
- Institute of Pathology, University Medicine of Greifswald, Greifswald, Germany
| | - Christian Flotho
- Division of Pediatric Hematology and Oncology, Department of Pediatric and Adolescent Medicine, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Stefan Schönberger
- Department of Pediatrics III, University Children's Hospital Essen, University of Duisburg-Essen, Essen, Germany
- RB-Registry, University Children's Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Petra Ketteler
- Department of Pediatrics III, University Children's Hospital Essen, University of Duisburg-Essen, Essen, Germany
- RB-Registry, University Children's Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Johannes Schulte
- University Children's Hospital, Eberhard Karls University, Abteilung I, Hoppe-Seyler-Str. 1, 72076, Tuebingen, Germany
| | - Peter Lang
- University Children's Hospital, Eberhard Karls University, Abteilung I, Hoppe-Seyler-Str. 1, 72076, Tuebingen, Germany
- Cluster of Excellence iFIT (EXC2180) "Image-Guided and Functionally Instructed Tumor Therapies", University of Tübingen, Tuebingen, Germany
- German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Partner Site Tübingen, University of Tuebingen, Tuebingen, Germany
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Eckert F, Ganser K, Bender B, Schittenhelm J, Skardelly M, Behling F, Tabatabai G, Hoffmann E, Zips D, Huber SM, Paulsen F. Potential of pre-operative MRI features in glioblastoma to predict for molecular stem cell subtype and patient overall survival. Radiother Oncol 2023; 188:109865. [PMID: 37619660 DOI: 10.1016/j.radonc.2023.109865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 07/31/2023] [Accepted: 08/14/2023] [Indexed: 08/26/2023]
Abstract
AIM OF THE STUDY A molecular signature based on 10 mRNA abundances that characterizes the mesenchymal-to-proneural phenotype of glioblastoma stem(like) cells (GSCs) enriched in primary culture has been previously established. As this phenotype has been proposed to be prognostic for disease outcome the present study aims to identify features of the preoperative MR imaging that may predict the GSC phenotype of individual tumors. MATERIAL/METHODS Molecular mesenchymal-to-proneural mRNA signatures and intrinsic radioresistance (SF4, survival fraction at 4 Gy) of primary GSC-enriched cultures were associated with survival data and pre-operative MR imaging of the corresponding glioblastoma patients of a prospective cohort (n = 24). The analyzed imaging parameters comprised linear vectors derived from tumor volume, necrotic volume and edema as contoured manually. RESULTS A necrosis/tumor vector ratio and to a weaker extent the product of this ratio and the edema vector were identified to correlate with the mesenchymal-to-proneural mRNA signature and the SF4 of the patient-derived GSC cultures. Importantly, both parameter combinations were predictive for overall survival of the whole patient cohort. Moreover, the combination of necrosis/tumor vector ratio and edema vector differed significantly between uni- and multifocally recurring tumors. CONCLUSION Features of the preoperative MR images may reflect the molecular signature of the GSC population and might be used in the future as a prognostic factor and for treatment stratification especially in the MGMT promotor-unmethylated sub-cohort of glioblastoma patients.
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Affiliation(s)
- Franziska Eckert
- Department of Radiation Oncology, University of Tübingen, Germany; Medical University Vienna, Department of Radiation Oncology, Comprehensive Cancer Center Vienna, Vienna, Austria.
| | - Katrin Ganser
- Department of Radiation Oncology, University of Tübingen, Germany
| | - Benjamin Bender
- Department of Diagnostic and Interventional Neuroradiology, University of Tübingen, Tübingen, Germany
| | - Jens Schittenhelm
- Department of Pathology and Neuropathology, University of Tübingen, Germany
| | - Marco Skardelly
- Department of Neurosurgery, University of Tübingen, Germany; Centre for Neurooncology, University of Tübingen, Germany
| | - Felix Behling
- Centre for Neurooncology, University of Tübingen, Germany
| | | | - Elgin Hoffmann
- Department of Radiation Oncology, University of Tübingen, Germany
| | - Daniel Zips
- Department of Radiation Oncology, University of Tübingen, Germany; Department of Radiation Oncology, Charité Universitaetsmedizin Berlin, Germany
| | - Stephan M Huber
- Department of Radiation Oncology, University of Tübingen, Germany
| | - Frank Paulsen
- Department of Radiation Oncology, University of Tübingen, Germany
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6
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Gruener JS, Paulsen F, Barth AA, Horch RE. Anconeus epitrochlearis muscle (epitrochlearisanconeus muscle; Musculus epitrochleoanconeus) with cubital tunnel syndrome - a rare but relevant clinical entity. Ann Anat 2023; 250:152152. [PMID: 37633501 DOI: 10.1016/j.aanat.2023.152152] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 08/06/2023] [Accepted: 08/06/2023] [Indexed: 08/28/2023]
Abstract
BACKGROUND Compression of the ulnar nerve at the elbow within the cubital tunnel is related to the anatomical structures and is generally believed to be caused by Osborne's ligament (also known as the cubital retinaculum). However, in rare cases an anatomical variation of the developmental peculiarity of a remaining anconeus epitrochlearis muscle may be responsible for the disease. METHODS We present a series of five cases in which an anconeus epitrochlearis muscle was found as the cause of illness. RESULTS All patients presented with typical symptoms of numbness and tingling in the hand and ulnar fingers, and recurring pain as well as weakness of the ulnar innervated muscles. With neurophysiologically confirmed diminished nerve conduction velocity and unsuccessful conservative treatment, surgical decompression revealed an anconeus epitrochlearis muscle as the reason of compression. Full symptom relief was achieved immediately after the procedure in all cases. CONCLUSIONS This article strives to call attention to this entity when diagnosing ulnar nerve compression. Myectomy and medial epicondylectomy is the preferred treatment option in such cases.
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Affiliation(s)
- J S Gruener
- Department of Plastic and Hand Surgery, Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany.
| | - F Paulsen
- Institute of Functional and Clinical Anatomy, Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - A A Barth
- Department of Plastic and Hand Surgery, Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - R E Horch
- Department of Plastic and Hand Surgery, Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany
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7
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Schneider K, Breuer G, Luibl L, Paulsen F, Scholz M, Burger PHM. Vulnerable in the end - Longitudinal study among medical students on mental health and personal and work-related resources over a 5.5-year-period. Ann Anat 2023; 250:152155. [PMID: 37683899 DOI: 10.1016/j.aanat.2023.152155] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 08/24/2023] [Accepted: 08/25/2023] [Indexed: 09/10/2023]
Abstract
BACKGROUND Mental health problems are common in medical professionals and their development already starts at the undergraduate level. Studies on medical students can replicate higher prevalence for depression and burnout in this group, but they normally compare semester cohorts in an anonymized, cross-sectional approach and without a preventive perspective. METHODS We surveyed medical students at the beginning and end of their medical curriculum and collected data on burnout, depressivity, work related experience and salutogenesis parameters with validated self-administered questionnaires. Most remarkably we obtained the data from the same 58 individuals after 5.5 years, representing data of the highest quality in order to compare the mental health status at the beginning and the end of our students´ medical curriculum. RESULTS Our results not only show a severe exacerbation of physical, mental and emotional burnout in the participants at the end of their studies. The students also do not seem to have sufficient personal (resilience) or social resources (e.g. experience of social support) for coping with their mental health problems around the time of their graduation. CONCLUSIONS Our participants reflect a development of mental health during their medical studies at university that is paving the way to the devastating prevalence of mental disorders and suicide in health professionals. From our results we derive an urgent need to integrate self-care and active coping in the learning goals of medical curricula.
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Affiliation(s)
- K Schneider
- Department of Functional and Clinical Anatomy, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - G Breuer
- REGIOMED Hospital Group, Coburg Hospital, Coburg, Germany
| | - L Luibl
- Child and Adolescent Psychiatry, University Hospital, Erlangen, Germany
| | - F Paulsen
- Triaplus Zugersee Hospital, Center of Psychiatry and Psychotherapy, Oberwil, Zug, Switzerland
| | - M Scholz
- Department of Functional and Clinical Anatomy, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany.
| | - P H M Burger
- Triaplus Zugersee Hospital, Center of Psychiatry and Psychotherapy, Oberwil, Zug, Switzerland
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8
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Flaadt T, Ebinger M, Schreiber M, Ladenstein RL, Simon T, Lode HN, Hero B, Schuhmann MU, Schäfer J, Paulsen F, Timmermann B, Eggert A, Lang P. Multimodal Therapy with Consolidating Haploidentical Stem Cell Transplantation and Dinutuximab Beta for Patients with High-Risk Neuroblastoma and Central Nervous System Relapse. J Clin Med 2023; 12:6196. [PMID: 37834840 PMCID: PMC10573405 DOI: 10.3390/jcm12196196] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 09/15/2023] [Accepted: 09/18/2023] [Indexed: 10/15/2023] Open
Abstract
Despite highly intensive multimodality treatment regimens, the prognosis of patients with high-risk neuroblastoma (HRNB) and central nervous system (CNS) relapse remains poor. We retrospectively reviewed data from 13 patients with HRNB and CNS relapse who received multimodal therapy with consolidating haploidentical stem cell transplantation (haplo-SCT) followed by dinutuximab beta ± subcutaneous interleukin-2 (scIL-2). Following individual relapse treatment, patients aged 1-21 years underwent haplo-SCT with T/B-cell-depleted grafts followed by dinutuximab beta 20 mg/m2/day × 5 days for 5-6 cycles. If a response was demonstrated after cycle 5 or 6, patients received up to nine treatment cycles. After haplo-SCT, eight patients had a complete response, four had a partial response, and one had a stable disease. All 13 patients received ≥3 cycles of immunotherapy. At the end of the follow-up, 9/13 patients (66.7%) demonstrated complete response. As of July 2023, all nine patients remain disease-free, with a median follow-up time of 5.1 years since relapse. Estimated 5-year event-free and overall survival rates were 55.5% and 65.27%, respectively. Dinutuximab beta ± scIL-2 following haplo-SCT is a promising treatment option with a generally well-tolerated safety profile for patients with HRNB and CNS relapse.
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Affiliation(s)
- Tim Flaadt
- Department of Hematology and Oncology, University Children’s Hospital, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany; (M.E.); (M.S.); (P.L.)
| | - Martin Ebinger
- Department of Hematology and Oncology, University Children’s Hospital, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany; (M.E.); (M.S.); (P.L.)
| | - Malin Schreiber
- Department of Hematology and Oncology, University Children’s Hospital, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany; (M.E.); (M.S.); (P.L.)
| | - Ruth L. Ladenstein
- Department of Pediatrics, St Anna Children’s Hospital, Medical University, 1090 Vienna, Austria;
- Studies and Statistics of Integrated Research and Projects, Children’s Cancer Research Institute, 1090 Vienna, Austria
| | - Thorsten Simon
- Department of Pediatric Oncology and Hematology, University Hospital, University of Cologne, 50937 Köln, Germany; (T.S.); (B.H.)
| | - Holger N. Lode
- Department of Pediatric Hematology and Oncology, University Medicine Greifswald, 17489 Greifswald, Germany;
| | - Barbara Hero
- Department of Pediatric Oncology and Hematology, University Hospital, University of Cologne, 50937 Köln, Germany; (T.S.); (B.H.)
| | - Martin U. Schuhmann
- Section of Pediatric Neurosurgery, Department of Neurosurgery, University Hospital of Tuebingen, 72076 Tuebingen, Germany;
| | - Jürgen Schäfer
- Department for Diagnostic and Interventional Radiology, University Hospital, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany;
| | - Frank Paulsen
- Department of Radiation Oncology, University Hospital Tuebingen, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany;
| | - Beate Timmermann
- Department of Particle Therapy, University Hospital Essen, West German Proton Therapy Centre Essen (WPE), West German Cancer Center (WTZ), German Cancer Consortium (DKTK), 45147 Essen, Germany;
| | - Angelika Eggert
- Department of Pediatric Oncology/Hematology, Charité-Universitaetsmedizin Berlin, 13353 Berlin, Germany;
| | - Peter Lang
- Department of Hematology and Oncology, University Children’s Hospital, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany; (M.E.); (M.S.); (P.L.)
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9
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Schmidt A, Roder C, Eckert F, Baumann D, Niyazi M, Fideler F, Ernemann U, Tatagiba M, Schäfer J, Urla C, Scherer S, Fuchs J, Paulsen F, Bender B. Increasing Patient Safety and Treatment Quality by Using Intraoperative MRI for Organ-Preserving Tumor Resection and High-Dose Rate Brachytherapy in Children with Bladder/Prostate and Perianal Rhabdomyosarcoma. Cancers (Basel) 2023; 15:3505. [PMID: 37444615 DOI: 10.3390/cancers15133505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 07/01/2023] [Accepted: 07/02/2023] [Indexed: 07/15/2023] Open
Abstract
In children with bladder/prostate (BP) and perianal rhabdomyosarcoma (RMS), we use a hybrid treatment concept for those suitable, combining organ-preserving tumor resection and high-dose rate brachytherapy (HDR-BT). This treatment concept has been shown to improve outcomes. However, it is associated with specific challenges for the clinicians. The exact position of the tubes for BT is a prerequisite for precise radiotherapy. It can finally be determined only with an MRI or CT scan. We evaluated the use of an intraoperative MRI (iMRI) to control the position of the BT tubes and for radiotherapy planning in all patients with BP and perianal RMS who received the above-mentioned combination therapy in our department since January 2021. iMRI was used in 12 children. All tubes were clearly localized. No adverse events occurred. In all 12 children, radiotherapy could be started on time. In a historical cohort without iMRI, this was not possible in 3 out of 20 children. The use of iMRI in children with BP and perianal RMS improved patient safety and treatment quality. This technology has proven to be successful for the patient population we have defined and has become a standard procedure in our institution.
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Affiliation(s)
- Andreas Schmidt
- Department of Pediatric Surgery and Pediatric Urology, University Children's Hospital, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany
| | - Constantin Roder
- Department of Neurosurgery, University Hospital, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany
- Center for Neuro-Oncology, Comprehensive Cancer Center Tuebingen-Stuttgart, University Hospital, Eberhard Karls University Tuebingen, 72070 Tuebingen, Germany
| | - Franziska Eckert
- Department of Radiation Oncology, University Hospital, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany
- Department of Radiation Oncology, AKH, Comprehensive Cancer Center Vienna, Medical University Vienna, 1090 Vienna, Austria
| | - David Baumann
- Department of Radiation Oncology, University Hospital, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany
| | - Maximilian Niyazi
- Department of Radiation Oncology, University Hospital, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany
| | - Frank Fideler
- Department of Anesthesiology and Intensive Care Medicine, University Hospital, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany
| | - Ulrike Ernemann
- Center for Neuro-Oncology, Comprehensive Cancer Center Tuebingen-Stuttgart, University Hospital, Eberhard Karls University Tuebingen, 72070 Tuebingen, Germany
- Department of Diagnostic and Interventional Neuroradiology, University Hospital, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany
| | - Marcos Tatagiba
- Department of Neurosurgery, University Hospital, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany
- Center for Neuro-Oncology, Comprehensive Cancer Center Tuebingen-Stuttgart, University Hospital, Eberhard Karls University Tuebingen, 72070 Tuebingen, Germany
| | - Jürgen Schäfer
- Department of Pediatric Radiology, University Hospital, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany
| | - Cristian Urla
- Department of Pediatric Surgery and Pediatric Urology, University Children's Hospital, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany
| | - Simon Scherer
- Department of Pediatric Surgery and Pediatric Urology, University Children's Hospital, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany
| | - Jörg Fuchs
- Department of Pediatric Surgery and Pediatric Urology, University Children's Hospital, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany
- Center for Pediatric Oncology, Comprehensive Cancer Center Tuebingen-Stuttgart, University Hospital, Eberhard Karls University Tuebingen, 72070 Tuebingen, Germany
| | - Frank Paulsen
- Department of Radiation Oncology, University Hospital, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany
| | - Benjamin Bender
- Center for Neuro-Oncology, Comprehensive Cancer Center Tuebingen-Stuttgart, University Hospital, Eberhard Karls University Tuebingen, 72070 Tuebingen, Germany
- Department of Diagnostic and Interventional Neuroradiology, University Hospital, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany
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10
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Nachbar M, Lo Russo M, Gani C, Boeke S, Wegener D, Paulsen F, Zips D, Roque T, Paragios N, Thorwarth D. Automatic AI-based contouring of prostate MRI for online adaptive radiotherapy. Z Med Phys 2023:S0939-3889(23)00053-3. [PMID: 37263911 DOI: 10.1016/j.zemedi.2023.05.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 04/03/2023] [Accepted: 05/02/2023] [Indexed: 06/03/2023]
Abstract
BACKGROUND AND PURPOSE MR-guided radiotherapy (MRgRT) online plan adaptation accounts for tumor volume changes, interfraction motion and thus allows daily sparing of relevant organs at risk. Due to the high interfraction variability of bladder and rectum, patients with tumors in the pelvic region may strongly benefit from adaptive MRgRT. Currently, fast automatic annotation of anatomical structures is not available within the online MRgRT workflow. Therefore, the aim of this study was to train and validate a fast, accurate deep learning model for automatic MRI segmentation at the MR-Linac for future implementation in a clinical MRgRT workflow. MATERIALS AND METHODS For a total of 47 patients, T2w MRI data were acquired on a 1.5 T MR-Linac (Unity, Elekta) on five different days. Prostate, seminal vesicles, rectum, anal canal, bladder, penile bulb, body and bony structures were manually annotated. These training data consisting of 232 data sets in total was used for the generation of a deep learning based autocontouring model and validated on 20 unseen T2w-MRIs. For quantitative evaluation the validation set was contoured by a radiation oncologist as gold standard contours (GSC) and compared in MATLAB to the automatic contours (AIC). For the evaluation, dice similarity coefficients (DSC), and 95% Hausdorff distances (95% HD), added path length (APL) and surface DSC (sDSC) were calculated in a caudal-cranial window of ± 4 cm with respect to the prostate ends. For qualitative evaluation, five radiation oncologists scored the AIC on the possible usage within an online adaptive workflow as follows: (1) no modifications needed, (2) minor adjustments needed, (3) major adjustments/ multiple minor adjustments needed, (4) not usable. RESULTS The quantitative evaluation revealed a maximum median 95% HD of 6.9 mm for the rectum and minimum median 95% HD of 2.7 mm for the bladder. Maximal and minimal median DSC were detected for bladder with 0.97 and for penile bulb with 0.73, respectively. Using a tolerance level of 3 mm, the highest and lowest sDSC were determined for rectum (0.94) and anal canal (0.68), respectively. Qualitative evaluation resulted in a mean score of 1.2 for AICs over all organs and patients across all expert ratings. For the different autocontoured structures, the highest mean score of 1.0 was observed for anal canal, sacrum, femur left and right, and pelvis left, whereas for prostate the lowest mean score of 2.0 was detected. In total, 80% of the contours were rated be clinically acceptable, 16% to require minor and 4% major adjustments for online adaptive MRgRT. CONCLUSION In this study, an AI-based autocontouring was successfully trained for online adaptive MR-guided radiotherapy on the 1.5 T MR-Linac system. The developed model can automatically generate contours accepted by physicians (80%) or only with the need of minor corrections (16%) for the irradiation of primary prostate on the clinically employed sequences.
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Affiliation(s)
- Marcel Nachbar
- Section for Biomedical Physics, Department of Radiation Oncology, University Hospital and Medical Faculty, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Monica Lo Russo
- Department of Radiation Oncology, University Hospital and Medical Faculty, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Cihan Gani
- Department of Radiation Oncology, University Hospital and Medical Faculty, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Simon Boeke
- Department of Radiation Oncology, University Hospital and Medical Faculty, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Daniel Wegener
- Department of Radiation Oncology, University Hospital and Medical Faculty, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Frank Paulsen
- Department of Radiation Oncology, University Hospital and Medical Faculty, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Daniel Zips
- Department of Radiation Oncology, University Hospital and Medical Faculty, Eberhard Karls University of Tübingen, Tübingen, Germany; German Cancer Consortium (DKTK), partner site Tübingen; and German Cancer Research Center (DKFZ), Heidelberg, Germany; Department of Radiation Oncology, Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | | | - Nikos Paragios
- TheraPanacea, Paris, France; CentraleSupelec, University of Paris-Saclay, Gif-sur-Yvette, France
| | - Daniela Thorwarth
- Section for Biomedical Physics, Department of Radiation Oncology, University Hospital and Medical Faculty, Eberhard Karls University of Tübingen, Tübingen, Germany; German Cancer Consortium (DKTK), partner site Tübingen; and German Cancer Research Center (DKFZ), Heidelberg, Germany.
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11
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Renovanz M, Kurz SC, Rieger J, Walter B, Becker H, Hille H, Bombach P, Rieger D, Grosse L, Häusser L, Skardelly M, Merk DJ, Paulsen F, Hoffmann E, Gani C, Neumann M, Beschorner R, Rieß O, Roggia C, Schroeder C, Ossowski S, Armeanu-Ebinger S, Gschwind A, Biskup S, Schulze M, Fend F, Singer S, Zender L, Lengerke C, Brucker SY, Engler T, Forschner A, Stenzl A, Kohlbacher O, Nahnsen S, Gabernet G, Fillinger S, Bender B, Ernemann U, Öner Ö, Beha J, Malek HS, Möller Y, Ruhm K, Tatagiba M, Schittenhelm J, Bitzer M, Malek N, Zips D, Tabatabai G. Clinical outcome of biomarker-guided therapies in adult patients with tumors of the nervous system. Neurooncol Adv 2023; 5:vdad012. [PMID: 36915613 PMCID: PMC10007909 DOI: 10.1093/noajnl/vdad012] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
Abstract
Background The clinical utility of molecular profiling and targeted therapies for neuro-oncology patients outside of clinical trials is not established. We aimed at investigating feasibility and clinical utility of molecular profiling and targeted therapy in adult patients with advanced tumors in the nervous system within a prospective observational study. Methods molecular tumor board (MTB)@ZPM (NCT03503149) is a prospective observational precision medicine study for patients with advanced tumors. After inclusion of patients, we performed comprehensive molecular profiling, formulated ranked biomarker-guided therapy recommendations based on consensus by the MTB, and collected prospective clinical outcome data. Results Here, we present initial data of 661 adult patients with tumors of the nervous system enrolled by December 31, 2021. Of these, 408 patients were presented at the MTB. Molecular-instructed therapy recommendations could be made in 380/408 (93.1%) cases and were prioritized by evidence levels. Therapies were initiated in 86/380 (22.6%) cases until data cutoff. We observed a progression-free survival ratio >1.3 in 31.3% of patients. Conclusions Our study supports the clinical utility of biomarker-guided therapies for neuro-oncology patients and indicates clinical benefit in a subset of patients. Our data might inform future clinical trials, translational studies, and even clinical care.
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Affiliation(s)
- Mirjam Renovanz
- Department of Neurology and Interdisciplinary Neuro-Oncology, Hertie Institute for Clinical Brain Research, Eberhard Karls University Tübingen, Germany.,Center for Neuro-Oncology, Comprehensive Cancer Center Tübingen-Stuttgart, University Hospital Tübingen, Germany.,Department of Neurosurgery, Eberhard Karls University Tübingen, Germany
| | - Sylvia C Kurz
- Department of Neurology and Interdisciplinary Neuro-Oncology, Hertie Institute for Clinical Brain Research, Eberhard Karls University Tübingen, Germany.,Center for Neuro-Oncology, Comprehensive Cancer Center Tübingen-Stuttgart, University Hospital Tübingen, Germany
| | - Johannes Rieger
- Department of Neurology and Interdisciplinary Neuro-Oncology, Hertie Institute for Clinical Brain Research, Eberhard Karls University Tübingen, Germany.,Center for Neuro-Oncology, Comprehensive Cancer Center Tübingen-Stuttgart, University Hospital Tübingen, Germany
| | - Bianca Walter
- Department of Neurology and Interdisciplinary Neuro-Oncology, Hertie Institute for Clinical Brain Research, Eberhard Karls University Tübingen, Germany
| | - Hannes Becker
- Department of Neurology and Interdisciplinary Neuro-Oncology, Hertie Institute for Clinical Brain Research, Eberhard Karls University Tübingen, Germany.,Center for Neuro-Oncology, Comprehensive Cancer Center Tübingen-Stuttgart, University Hospital Tübingen, Germany.,Department of Neurosurgery, Eberhard Karls University Tübingen, Germany
| | - Hanni Hille
- Department of Neurology and Interdisciplinary Neuro-Oncology, Hertie Institute for Clinical Brain Research, Eberhard Karls University Tübingen, Germany
| | - Paula Bombach
- Department of Neurology and Interdisciplinary Neuro-Oncology, Hertie Institute for Clinical Brain Research, Eberhard Karls University Tübingen, Germany.,Center for Neuro-Oncology, Comprehensive Cancer Center Tübingen-Stuttgart, University Hospital Tübingen, Germany.,Center for Personalized Medicine Tübingen, Eberhard Karls University Tübingen, Germany
| | - David Rieger
- Department of Neurology and Interdisciplinary Neuro-Oncology, Hertie Institute for Clinical Brain Research, Eberhard Karls University Tübingen, Germany.,Center for Neuro-Oncology, Comprehensive Cancer Center Tübingen-Stuttgart, University Hospital Tübingen, Germany
| | - Lucia Grosse
- Department of Neurology and Interdisciplinary Neuro-Oncology, Hertie Institute for Clinical Brain Research, Eberhard Karls University Tübingen, Germany.,Center for Neuro-Oncology, Comprehensive Cancer Center Tübingen-Stuttgart, University Hospital Tübingen, Germany
| | - Lara Häusser
- Department of Neurology and Interdisciplinary Neuro-Oncology, Hertie Institute for Clinical Brain Research, Eberhard Karls University Tübingen, Germany.,German Cancer Consortium (DKTK), DKFZ partner site Tübingen, Eberhard Karls University of Tübingen, Germany
| | - Marco Skardelly
- Department of Neurology and Interdisciplinary Neuro-Oncology, Hertie Institute for Clinical Brain Research, Eberhard Karls University Tübingen, Germany.,Center for Neuro-Oncology, Comprehensive Cancer Center Tübingen-Stuttgart, University Hospital Tübingen, Germany
| | - Daniel J Merk
- Department of Neurology and Interdisciplinary Neuro-Oncology, Hertie Institute for Clinical Brain Research, Eberhard Karls University Tübingen, Germany
| | - Frank Paulsen
- Center for Neuro-Oncology, Comprehensive Cancer Center Tübingen-Stuttgart, University Hospital Tübingen, Germany.,Center for Personalized Medicine Tübingen, Eberhard Karls University Tübingen, Germany.,Department of Radiation Oncology, Eberhard Karls University Tübingen, Germany
| | - Elgin Hoffmann
- Center for Neuro-Oncology, Comprehensive Cancer Center Tübingen-Stuttgart, University Hospital Tübingen, Germany.,Center for Personalized Medicine Tübingen, Eberhard Karls University Tübingen, Germany.,Department of Radiation Oncology, Eberhard Karls University Tübingen, Germany
| | - Cihan Gani
- Center for Neuro-Oncology, Comprehensive Cancer Center Tübingen-Stuttgart, University Hospital Tübingen, Germany.,Center for Personalized Medicine Tübingen, Eberhard Karls University Tübingen, Germany.,Department of Radiation Oncology, Eberhard Karls University Tübingen, Germany.,German Cancer Consortium (DKTK), DKFZ partner site Tübingen, Eberhard Karls University of Tübingen, Germany
| | - Manuela Neumann
- Center for Neuro-Oncology, Comprehensive Cancer Center Tübingen-Stuttgart, University Hospital Tübingen, Germany.,Center for Personalized Medicine Tübingen, Eberhard Karls University Tübingen, Germany.,Institute of Pathology and Neuropathology, Department of Neuropathology, Eberhard Karls University Tübingen, Germany.,German Cancer Consortium (DKTK), DKFZ partner site Tübingen, Eberhard Karls University of Tübingen, Germany
| | - Rudi Beschorner
- Center for Neuro-Oncology, Comprehensive Cancer Center Tübingen-Stuttgart, University Hospital Tübingen, Germany.,Center for Personalized Medicine Tübingen, Eberhard Karls University Tübingen, Germany.,Institute of Pathology and Neuropathology, Department of Neuropathology, Eberhard Karls University Tübingen, Germany.,German Cancer Consortium (DKTK), DKFZ partner site Tübingen, Eberhard Karls University of Tübingen, Germany
| | - Olaf Rieß
- Center for Personalized Medicine Tübingen, Eberhard Karls University Tübingen, Germany.,Institute of Medical Genetics and Applied Genomics, Eberhard Karls University Tübingen, Germany.,Cluster of Excellence (EXC 2180) "Image Guided and Functionally Instructed Tumor Therapies", Eberhard Karls University of Tübingen, Germany.,German Cancer Consortium (DKTK), DKFZ partner site Tübingen, Eberhard Karls University of Tübingen, Germany
| | - Cristiana Roggia
- Center for Personalized Medicine Tübingen, Eberhard Karls University Tübingen, Germany.,Institute of Medical Genetics and Applied Genomics, Eberhard Karls University Tübingen, Germany
| | - Christopher Schroeder
- Center for Personalized Medicine Tübingen, Eberhard Karls University Tübingen, Germany.,Institute of Medical Genetics and Applied Genomics, Eberhard Karls University Tübingen, Germany
| | - Stephan Ossowski
- Center for Personalized Medicine Tübingen, Eberhard Karls University Tübingen, Germany.,Institute of Medical Genetics and Applied Genomics, Eberhard Karls University Tübingen, Germany
| | - Sorin Armeanu-Ebinger
- Center for Personalized Medicine Tübingen, Eberhard Karls University Tübingen, Germany.,Institute of Medical Genetics and Applied Genomics, Eberhard Karls University Tübingen, Germany
| | - Axel Gschwind
- Center for Personalized Medicine Tübingen, Eberhard Karls University Tübingen, Germany.,Institute of Medical Genetics and Applied Genomics, Eberhard Karls University Tübingen, Germany
| | - Saskia Biskup
- Center for Genomics and Transcriptomics (CeGaT) & Center for Human Genetics Tübingen, Germany.,Cluster of Excellence (EXC 2180) "Image Guided and Functionally Instructed Tumor Therapies", Eberhard Karls University of Tübingen, Germany
| | - Martin Schulze
- Center for Genomics and Transcriptomics (CeGaT) & Center for Human Genetics Tübingen, Germany
| | - Falko Fend
- Center for Personalized Medicine Tübingen, Eberhard Karls University Tübingen, Germany.,Department of Pathology and Neuropathology, Institute of Pathology and Molecular Pathology, Eberhard Karls University Tübingen, Germany.,Cluster of Excellence (EXC 2180) "Image Guided and Functionally Instructed Tumor Therapies", Eberhard Karls University of Tübingen, Germany.,German Cancer Consortium (DKTK), DKFZ partner site Tübingen, Eberhard Karls University of Tübingen, Germany
| | - Stephan Singer
- Center for Personalized Medicine Tübingen, Eberhard Karls University Tübingen, Germany.,Department of Pathology and Neuropathology, Institute of Pathology and Molecular Pathology, Eberhard Karls University Tübingen, Germany.,Cluster of Excellence (EXC 2180) "Image Guided and Functionally Instructed Tumor Therapies", Eberhard Karls University of Tübingen, Germany.,German Cancer Consortium (DKTK), DKFZ partner site Tübingen, Eberhard Karls University of Tübingen, Germany
| | - Lars Zender
- Center for Personalized Medicine Tübingen, Eberhard Karls University Tübingen, Germany.,Department of Medical Oncology and Pneumology (Internal Medicine VIII), Eberhard Karls University Tübingen, Germany.,Cluster of Excellence (EXC 2180) "Image Guided and Functionally Instructed Tumor Therapies", Eberhard Karls University of Tübingen, Germany.,German Cancer Consortium (DKTK), DKFZ partner site Tübingen, Eberhard Karls University of Tübingen, Germany
| | - Claudia Lengerke
- Department of Internal Medicine II, Eberhard Karls University Tübingen, Germany.,German Cancer Consortium (DKTK), DKFZ partner site Tübingen, Eberhard Karls University of Tübingen, Germany
| | - Sara Yvonne Brucker
- Department of Gynecology and Obstetrics, Eberhard Karls University Tübingen, Germany.,German Cancer Consortium (DKTK), DKFZ partner site Tübingen, Eberhard Karls University of Tübingen, Germany
| | - Tobias Engler
- Department of Gynecology and Obstetrics, Eberhard Karls University Tübingen, Germany.,German Cancer Consortium (DKTK), DKFZ partner site Tübingen, Eberhard Karls University of Tübingen, Germany
| | - Andrea Forschner
- Department of Dermatology and Center for Dermato-Oncology, Eberhard Karls University Tübingen, Germany.,German Cancer Consortium (DKTK), DKFZ partner site Tübingen, Eberhard Karls University of Tübingen, Germany
| | - Arnulf Stenzl
- Department of Urology, Eberhard Karls University Tübingen, Germany.,German Cancer Consortium (DKTK), DKFZ partner site Tübingen, Eberhard Karls University of Tübingen, Germany
| | - Oliver Kohlbacher
- Center for Personalized Medicine Tübingen, Eberhard Karls University Tübingen, Germany.,Institute for Translational Bioinformatics, Eberhard Karls University Tübingen, Germany.,German Cancer Consortium (DKTK), DKFZ partner site Tübingen, Eberhard Karls University of Tübingen, Germany
| | - Sven Nahnsen
- Center for Personalized Medicine Tübingen, Eberhard Karls University Tübingen, Germany.,Quantitative Biology Center (QBiC), Eberhard Karls University Tübingen, Germany.,Department of Medical Oncology and Pneumology (Internal Medicine VIII), Eberhard Karls University Tübingen, Germany.,Cluster of Excellence (EXC 2180) "Image Guided and Functionally Instructed Tumor Therapies", Eberhard Karls University of Tübingen, Germany.,German Cancer Consortium (DKTK), DKFZ partner site Tübingen, Eberhard Karls University of Tübingen, Germany
| | - Gisela Gabernet
- Quantitative Biology Center (QBiC), Eberhard Karls University Tübingen, Germany
| | - Sven Fillinger
- Quantitative Biology Center (QBiC), Eberhard Karls University Tübingen, Germany
| | - Benjamin Bender
- Center for Neuro-Oncology, Comprehensive Cancer Center Tübingen-Stuttgart, University Hospital Tübingen, Germany.,Center for Personalized Medicine Tübingen, Eberhard Karls University Tübingen, Germany.,Department of Diagnostic and Interventional Neuroradiology, Department of Radiology, Eberhard Karls University Tübingen, Germany
| | - Ulrike Ernemann
- Center for Neuro-Oncology, Comprehensive Cancer Center Tübingen-Stuttgart, University Hospital Tübingen, Germany.,Center for Personalized Medicine Tübingen, Eberhard Karls University Tübingen, Germany.,Department of Diagnostic and Interventional Neuroradiology, Department of Radiology, Eberhard Karls University Tübingen, Germany
| | - Öznur Öner
- Center for Personalized Medicine Tübingen, Eberhard Karls University Tübingen, Germany
| | - Janina Beha
- Center for Personalized Medicine Tübingen, Eberhard Karls University Tübingen, Germany
| | - Holly Sundberg Malek
- Center for Personalized Medicine Tübingen, Eberhard Karls University Tübingen, Germany
| | - Yvonne Möller
- Center for Personalized Medicine Tübingen, Eberhard Karls University Tübingen, Germany
| | - Kristina Ruhm
- Center for Personalized Medicine Tübingen, Eberhard Karls University Tübingen, Germany
| | - Marcos Tatagiba
- Center for Neuro-Oncology, Comprehensive Cancer Center Tübingen-Stuttgart, University Hospital Tübingen, Germany.,Center for Personalized Medicine Tübingen, Eberhard Karls University Tübingen, Germany.,Department of Neurosurgery, Eberhard Karls University Tübingen, Germany
| | - Jens Schittenhelm
- Center for Neuro-Oncology, Comprehensive Cancer Center Tübingen-Stuttgart, University Hospital Tübingen, Germany.,Center for Personalized Medicine Tübingen, Eberhard Karls University Tübingen, Germany.,Institute of Pathology and Neuropathology, Department of Neuropathology, Eberhard Karls University Tübingen, Germany.,German Cancer Consortium (DKTK), DKFZ partner site Tübingen, Eberhard Karls University of Tübingen, Germany
| | - Michael Bitzer
- Center for Personalized Medicine Tübingen, Eberhard Karls University Tübingen, Germany.,Department of Internal Medicine I, Eberhard Karls University Tübingen, Germany.,Cluster of Excellence (EXC 2180) "Image Guided and Functionally Instructed Tumor Therapies", Eberhard Karls University of Tübingen, Germany.,German Cancer Consortium (DKTK), DKFZ partner site Tübingen, Eberhard Karls University of Tübingen, Germany
| | - Nisar Malek
- Center for Personalized Medicine Tübingen, Eberhard Karls University Tübingen, Germany.,Department of Internal Medicine I, Eberhard Karls University Tübingen, Germany.,Cluster of Excellence (EXC 2180) "Image Guided and Functionally Instructed Tumor Therapies", Eberhard Karls University of Tübingen, Germany.,German Cancer Consortium (DKTK), DKFZ partner site Tübingen, Eberhard Karls University of Tübingen, Germany
| | - Daniel Zips
- Center for Neuro-Oncology, Comprehensive Cancer Center Tübingen-Stuttgart, University Hospital Tübingen, Germany.,Center for Personalized Medicine Tübingen, Eberhard Karls University Tübingen, Germany.,Department of Radiation Oncology, Eberhard Karls University Tübingen, Germany.,German Cancer Consortium (DKTK), DKFZ partner site Tübingen, Eberhard Karls University of Tübingen, Germany
| | - Ghazaleh Tabatabai
- Department of Neurology and Interdisciplinary Neuro-Oncology, Hertie Institute for Clinical Brain Research, Eberhard Karls University Tübingen, Germany.,Center for Neuro-Oncology, Comprehensive Cancer Center Tübingen-Stuttgart, University Hospital Tübingen, Germany.,Center for Personalized Medicine Tübingen, Eberhard Karls University Tübingen, Germany.,Cluster of Excellence (EXC 2180) "Image Guided and Functionally Instructed Tumor Therapies", Eberhard Karls University of Tübingen, Germany.,German Cancer Consortium (DKTK), DKFZ partner site Tübingen, Eberhard Karls University of Tübingen, Germany
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12
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Potkrajcic V, Kolbenschlag J, Sachsenmaier S, Daigeler A, Ladurner R, Golf A, Gani C, Zips D, Paulsen F, Eckert F. Postoperative complications and oncologic outcomes after multimodal therapy of localized high risk soft tissue sarcoma. Radiat Oncol 2022; 17:210. [PMID: 36544149 PMCID: PMC9768905 DOI: 10.1186/s13014-022-02166-4] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 11/21/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Standard therapy for localized high-risk soft tissue sarcoma includes surgical resection and neoadjuvant or adjuvant radiation therapy (± chemotherapy and locoregional hyperthermia). No difference in oncologic outcomes for patients treated with neoadjuvant and adjuvant radiation therapy was reported, whereas side effect profiles differ. The aim of this analysis was to analyse oncologic outcomes and postoperative complications in patients treated with multimodal treatment. METHODS Oncologic outcomes and major wound complications (MWC, subclassified as wound healing disorder, infection, abscess, fistula, seroma and hematoma) were evaluated in 74 patients with localized high-risk soft tissue sarcoma of extremities and trunk undergoing multimodal treatment, and also separately for the subgroup of lower extremity tumors. Clinical factors and treatment modalities (especially neoadjuvant vs. adjuvant radiotherapy) were evaluated regarding their prognostic value and impact on postoperative wound complications. RESULTS Oncologic outcomes were dependent on number of high risk features (tumor size, depth to superficial fascia and grading), but not on therapy sequencing (however with higher risk patients in the neoadjuvant group). Different risk factors influenced different subclasses of wound healing complications. Slightly higher MWC-rates were observed in patients treated with neoadjuvant therapy, compared to adjuvant radiotherapy, although only with a trend to statistical significance (31.8% vs. 13.3%, p = 0.059). However, except for wound infections, no significant difference for other subclasses of postoperative complications was observed between neoadjuvant and adjuvant therapy. Diabetes was confirmed as a major risk factor for immune-related wound complications. CONCLUSION Rates of major wound complications in this cohort are comparable to published data, higher rates of wound infections were observed after neoadjuvant radiotherapy. Tumor localization, patient age and diabetes seem to be major risk factors. The number of risk factors for high risk soft tissue sarcoma seem to influence DMFS. Neoadjuvant treatment increases the risk only for wound infection treated with oral or intravenous antibiotic therapy and appears to be a safe option at an experienced tertiary center in absence of other risk factors.
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Affiliation(s)
- Vlatko Potkrajcic
- grid.10392.390000 0001 2190 1447Department of Radiation Oncology, Eberhard-Karls-University Tuebingen, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany
| | - Jonas Kolbenschlag
- grid.10392.390000 0001 2190 1447Department of Hand, Plastic, Reconstructive and Burn Surgery, BG Unfallklinik, Eberhard-Karls-University Tuebingen, Schnarrenbergstraße 95, 72076 Tübingen, Germany
| | - Saskia Sachsenmaier
- grid.10392.390000 0001 2190 1447Department of Orthopaedic Surgery, Eberhard-Karls-University Tuebingen, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany
| | - Adrien Daigeler
- grid.10392.390000 0001 2190 1447Department of Hand, Plastic, Reconstructive and Burn Surgery, BG Unfallklinik, Eberhard-Karls-University Tuebingen, Schnarrenbergstraße 95, 72076 Tübingen, Germany
| | - Ruth Ladurner
- grid.10392.390000 0001 2190 1447Department of General, Visceral and Transplant Surgery, Eberhard-Karls-University Tuebingen, Hoppe Seyler-Str. 3, 72076 Tübingen, Germany
| | - Alexander Golf
- grid.10392.390000 0001 2190 1447Department of Internal Medicine, Medical Oncology and Pulmonology, Eberhard-Karls-University Tuebingen, Otfried-Müller-Straße 14, 72076 Tuebingen, Germany
| | - Cihan Gani
- grid.10392.390000 0001 2190 1447Department of Radiation Oncology, Eberhard-Karls-University Tuebingen, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany
| | - Daniel Zips
- grid.10392.390000 0001 2190 1447Department of Radiation Oncology, Eberhard-Karls-University Tuebingen, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany ,grid.7497.d0000 0004 0492 0584German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK) Partnersite Tuebingen, Heidelberg, Germany ,grid.6363.00000 0001 2218 4662Department of Radiation Oncology and Radiotherapy, Charité University Hospital, Charitépl. 1, 10117 Berlin, Germany
| | - Frank Paulsen
- grid.10392.390000 0001 2190 1447Department of Radiation Oncology, Eberhard-Karls-University Tuebingen, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany
| | - Franziska Eckert
- grid.10392.390000 0001 2190 1447Department of Radiation Oncology, Eberhard-Karls-University Tuebingen, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany ,grid.22937.3d0000 0000 9259 8492Department of Radiation Oncology, Comprehensive Cancer Center, Medical University Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
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13
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Renovanz M, Bombach P, Grosse L, Rieger J, Skardelly M, Rieger D, Hille H, Volkmer S, Dörner L, Kurz S, Hippler M, Paulsen F, Öner Ö, Ruhm K, Beha J, Sundberg-Malek H, Möller Y, Tatagiba M, Wallwiener M, Eckert N, Escher P, Pfeiffer N, Forschner A, Bauer A, Zips D, Bitzer M, Malek N, Gani C, Tabatabai G. QOL-23. TOWARDS PATIENT-REPORTED OUTCOME ASSESSMENT IN THE MOLECULAR TUMOR BOARD – CANCER PATIENTS UNDER TARGETED THERAPY: APP-BASED ASSESSMENT OF PATIENT-REPORTED OUTCOMES (TRACE). Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac209.950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Comprehensive genomic profiling and biomarker-based therapeutic strategies are currently used in clinical trials and in innovative health care systems including the center for personalized medicine network. Systematic assessments of patient-reported outcomes are warranted to gain insight into the perspective of patients and their relatives during biomarker-based therapies. In the present study, we focused on health-related quality of life (HRQoL), psychosocial situation, and physical symptoms in patients treated at the Center for Personalized Medicine Tübingen. First, we retrospectively evaluated symptom burden of n=265 (neuro-)oncological patients in the Molecular Tumor Board (MTB). Sixty percent of patients reported at least 1 neurological symptom, and psychosocial burden/unmet needs were high (overall 156/265; 59%, patients with malignant tumors n=86/106; 81%, Fisher’s exact, p < 0.0001). We therefore developed an app by 14 expert rounds and pretesting including validated assessments of HRoL, symptom und psychological burden and tested it in a pilot study. We conducted a structured interview with users 3 months afterwards to assess the app’s usability and feasibility. The interview was transcribed and analyzed according to a qualitative content analysis. So far, a total of 10 patients and caregivers have been enrolled in this pilot study. They reported that (i) the app is compatible with their daily routine (median 9.3, range 0-10), that (ii) they are more aware of their health status, which was rated as positive, and that (iii) completing app-based questionnaires was easier compared to paper questionnaires. Two patients reported technical problems, which were resolved timely. The pilot study proved feasibility and acceptance of the app. The app might optimize symptom burden assessment, adapted to the patients’ profiles. The next step is to prospectively compare HRQoL before and after start of targeted therapy in a multicenter study.
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Affiliation(s)
- Mirjam Renovanz
- Department of Neurology & Interdisciplinary Neuro-Oncology, University Hospital Tübingen, Hertie Institute for Clinical Brain Research , Tübingen , Germany
| | - Paula Bombach
- Department of Neurology & Interdisciplinary Neuro-Oncology, University Hospital Tübingen, Hertie Institute for Clinical Brain Research , Tübingen , Germany
| | - Lucia Grosse
- Department of Neurology & Interdisciplinary Neuro-Oncology, University Hospital Tübingen, Hertie Institute for Clinical Brain Research , Tübingen , Germany
| | - Johannes Rieger
- Department of Neurology & Interdisciplinary Neuro-Oncology, University Hospital Tübingen , Tübingen , Germany
| | - Marco Skardelly
- Department of Neurology & Interdisciplinary Neuro-Oncology, University Hospital Tübingen, Tübingen, USA
| | - David Rieger
- Department of Neurology & Interdisciplinary Neuro-Oncology, University Hospital Tübingen , Tübingen , Germany
| | - Hanni Hille
- Department of Neurology & Interdisciplinary Neuro-Oncology, University Hospital Tübingen, Tübingen, USA
| | - Sebastian Volkmer
- Department of Neurology & Interdisciplinary Neuro-Oncology, University Hospital Tübingen , Tübingen , Germany
| | - Lorenz Dörner
- Department of Neurology & Interdisciplinary Neuro-Oncology, University Hospital Tübingen , Tübingen , Germany
| | - Sylvia Kurz
- Department of Neurology & Interdisciplinary Neuro-Oncology, University Hospital Tübingen , Tübingen , Germany
| | - Melina Hippler
- Department of Neurology & Interdisciplinary Neuro-Oncology, University Hospital Tübingen , Tübingen , Germany
| | - Frank Paulsen
- Department of Radiation Oncology, University Hospital Tübingen , Tübingen , Germany
| | - Öznur Öner
- Center for Personalized Medicine Tübingen, University Hospital Tübingen , Tübingen , Germany
| | - Kristina Ruhm
- Center for Personalized Medicine Tübingen, University Hospital Tübingen , Tübingen , Germany
| | - Janina Beha
- Center for Personalized Medicine Tübingen, University Hospital Tübingen , Tübingen , Germany
| | - Holly Sundberg-Malek
- Center for Personalized Medicine Tübingen, University Hospital Tübingen , Tübingen , Germany
| | - Yvonne Möller
- Center for Personalized Medicine Tübingen, University Hospital Tübingen , Tübingen , Germany
| | - Marcos Tatagiba
- Department of Neurosurgery University Hospital Tübingen , Tuebingen , Germany
| | - Markus Wallwiener
- Department of Gynecology, University Hospital Heidelberg , Heidelberg , Germany
| | - Nils Eckert
- Eckert & Partner - IT Consulting , Stuttgart , Germany
| | - Pascal Escher
- Methods in Medical Informatics, Department of Computer Science, Eberhard Karls University Tübingen , Tübingen , Germany
| | - Nico Pfeiffer
- Methods in Medical Informatics, Department of Computer Science, Eberhard Karls University Tübingen , Tübingen , Germany
| | - Andrea Forschner
- Department of Dermatology, University Hospital Tübingen, , Tübingen , Germany
| | - Armin Bauer
- Department of Women’s Health, University Hospital Tübingen , Tübingen , Germany
| | - Daniel Zips
- Department of Radiation Oncology, University Hospital Tübingen , Tübingen , Germany
| | - Michael Bitzer
- Department of Internal Medicine I, University Hospital Tübingen , Tübingen , Germany
| | - Nisar Malek
- Department of Internal Medicine I, University Hospital Tübingen , Tübingen , Germany
| | - Cihan Gani
- Department of Radiation Oncology, University Hospital Tübingen , Tübingen , Germany
| | - Ghazaleh Tabatabai
- Department of Neurology & Interdisciplinary Neuro-Oncology, University Hospital Tübingen, Hertie Institute for Clinical Brain Research , Tübingen , Germany
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14
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Eckert F, Ganser K, Bender B, Schittenhelm J, Noell S, Stransky N, Hoffmann E, Zips D, Huber S, Paulsen F. P03.07.A MRI signature in preoperative imaging predicts mesenchymal stem cell features and radioresistance in primary glioblastoma stem cell cultures. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac174.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Recently, a molecular signature describing the mesenchymal / proneural features of primary stem-cell-enriched glioblastoma cultures was identified correlating with invasiveness, radiation sensitivity and patient-outcome. However, generating and characterizing primary cultures is time-consuming and this might hamper translation into clinical concepts. The aim of this study was to evaluate the use of standard preoperative MR imaging (T1ce and T2FLAIR sequences) to predict the molecular signature and thus enable the development of clinical treatment concepts based on the molecular properties of the individual tumors.
Material and Methods
For 16 patients, for whom primary stem cell enriched cultures had been characterized for their mesenchymal / proneural signature and radiation sensitivity, tumor volume (hyperintense volume in T1ce), necrosis (hypointense volume inside the tumor volume) and edema (hyperintense volume in T2FLAIR) were contoured for volumetric analysis. Volume parameters were used to calculate ratios (edema/tumor and necrosis/tumor) and a MRI signature, which was then correlated with molecular parameters and patient outcome stratified by MGMT promoter methylation.
Results
As expected, the prognosis of patients with MGMT-promoter-methylated tumors was better (n.s.) compared to those with unmethylated MGMT promoters. Neither molecular nor imaging data were significantly different between these subgroups. In the subgroup of patients with unmethylated MGMT promoter, volumetric imaging parameters correlated with the molecular signature and cellular radiation sensitivity of the stem cell enriched cultures. This association was much weaker in the subgroup with methylated MGMT promoter.
Conclusion
In the subgroup of patients with unmethylated MGMT promoter, volumetric parameters on preoperative standard MR imaging might hint at the molecular properties of the respective tumor and its radiation sensitivity. This might be a clinically applicable method to stratify treatment according to molecular stem cell subtype without tissue culture and molecular analysis.
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Affiliation(s)
- F Eckert
- Medical University Vienna , Vienna , Austria
| | - K Ganser
- Eberhard Karls University Tuebingen , Tuebingen , Germany
| | - B Bender
- Eberhard Karls University Tuebingen , Tuebingen , Germany
| | - J Schittenhelm
- Eberhard Karls University Tuebingen , Tuebingen , Germany
| | - S Noell
- Eberhard Karls University Tuebingen , Tuebingen , Germany
| | - N Stransky
- Eberhard Karls University Tuebingen , Tuebingen , Germany
| | - E Hoffmann
- Eberhard Karls University Tuebingen , Tuebingen , Germany
| | - D Zips
- Eberhard Karls University Tuebingen , Tuebingen , Germany
| | - S Huber
- Eberhard Karls University Tuebingen , Tuebingen , Germany
| | - F Paulsen
- Eberhard Karls University Tuebingen , Tuebingen , Germany
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15
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Wegener D, Thome A, Paulsen F, Gani C, Boldt J, Butzer S, Thorwarth D, Moennich D, Nachbar M, Müller AC, Zips D, Boeke S. First Experience and Prospective Evaluation on Feasibility and Acute Toxicity of Online Adaptive Radiotherapy of the Prostate Bed as Salvage Treatment in Patients with Biochemically Recurrent Prostate Cancer on a 1.5T MR-Linac. J Clin Med 2022; 11:jcm11164651. [PMID: 36012885 PMCID: PMC9410121 DOI: 10.3390/jcm11164651] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 06/17/2022] [Revised: 08/02/2022] [Accepted: 08/05/2022] [Indexed: 12/02/2022] Open
Abstract
Introduction: Novel MRI-linear accelerator hybrids (MR-Linacs, MRL) promise an optimization of radiotherapy (RT) through daily MRI imaging with enhanced soft tissue contrast and plan adaptation on the anatomy of the day. These features might potentially improve salvage RT of prostate cancer (SRT), where the clinical target volume is confined by the mobile organs at risk (OAR) rectum and bladder. So far, no data exist about the feasibility of the MRL technology for SRT. In this study, we prospectively examined patients treated with SRT on a 1.5 T MRL and report on workflow, feasibility and acute toxicity. Patients and Methods: Sixteen patients were prospectively enrolled within the MRL-01 study (NCT: NCT04172753). All patients were staged and had an indication for SRT after radical prostatectomy according to national guidelines. RT consisted of 66 Gy in 33 fractions or 66.5/70 Gy in 35 fractions in case of a defined high-risk region. On the 1.5 T MRL, daily plan adaption was performed using one of two workflows: adapt to shape (ATS, using contour adaptation and replanning) or adapt to position (ATP, rigid replanning onto the online anatomy with virtual couch shift). Duration of treatment steps, choice of workflow and treatment failure were recorded for each fraction of each patient. Patient-reported questionnaires about patient comfort were evaluated as well as extensive reporting of acute toxicity (patient reported and clinician scored). Results: A total of 524/554 (94.6%) of fractions were successfully treated on the MRL. No patient-sided treatment failures occurred. In total, ATP was chosen in 45.7% and ATS in 54.3% of fractions. In eight cases, ATP was performed on top of the initial ATS workflow. Mean (range) duration of all fractions (on-table time until end of treatment) was 25.1 (17.6–44.8) minutes. Mean duration of the ATP workflow was 20.60 (17.6–25.2) minutes and of the ATS workflow 31.3 (28.2–34.1) minutes. Patient-reported treatment experience questionnaires revealed high rates of tolerability of the treatment procedure. Acute toxicity (RTOG, CTC as well as patient-reported CTC, IPSS and ICIQ) during RT and 3 months after was mild to moderate with a tendency of recovery to baseline levels at 3 months post RT. No G3+ toxicity was scored for any item. Conclusions: In this first report on SRT of prostate cancer patients on a 1.5 T MRL, we could demonstrate the feasibility of both available workflows. Daily MR-guided adaptive SRT of mean 25.1 min per fraction was well tolerated in this pretreated collective, and we report low rates of acute toxicity for this treatment. This study suggests that SRT on a 1.5 T MRL can be performed in clinical routine and it serves as a benchmark for future analyses.
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Affiliation(s)
- Daniel Wegener
- Department of Radiation Oncology, Eberhard Karls University, 72076 Tuebingen, Germany
- Correspondence:
| | - Alexandra Thome
- Department of Radiation Oncology, Eberhard Karls University, 72076 Tuebingen, Germany
| | - Frank Paulsen
- Department of Radiation Oncology, Eberhard Karls University, 72076 Tuebingen, Germany
| | - Cihan Gani
- Department of Radiation Oncology, Eberhard Karls University, 72076 Tuebingen, Germany
| | - Jessica Boldt
- Department of Radiation Oncology, Eberhard Karls University, 72076 Tuebingen, Germany
| | - Sarah Butzer
- Department of Radiation Oncology, Eberhard Karls University, 72076 Tuebingen, Germany
| | - Daniela Thorwarth
- Section for Biomedical Physics, Department of Radiation Oncology, Eberhard Karls University, 72076 Tuebingen, Germany
- German Cancer Consortium (DKTK), Partner Site Tübingen and German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - David Moennich
- Section for Biomedical Physics, Department of Radiation Oncology, Eberhard Karls University, 72076 Tuebingen, Germany
| | - Marcel Nachbar
- Section for Biomedical Physics, Department of Radiation Oncology, Eberhard Karls University, 72076 Tuebingen, Germany
| | - Arndt-Christian Müller
- Department of Radiation Oncology, Eberhard Karls University, 72076 Tuebingen, Germany
- Department of Radiation Oncology, Klinikum Ludwigsburg, 71640 Ludwigsburg, Germany
| | - Daniel Zips
- Department of Radiation Oncology, Eberhard Karls University, 72076 Tuebingen, Germany
- German Cancer Consortium (DKTK), Partner Site Tübingen and German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- Department of Radiation Oncology, Charité Berlin, 10117 Berlin, Germany
| | - Simon Boeke
- Department of Radiation Oncology, Eberhard Karls University, 72076 Tuebingen, Germany
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16
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Gonera B, Borowski A, Zielinska N, Palac W, Paulsen F, Olewnik Ł. Embryological approach to the morphology of the ligamentum mucosum of the human knee joint. Ann Anat 2022; 244:151983. [PMID: 35853532 DOI: 10.1016/j.aanat.2022.151983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 05/30/2022] [Accepted: 07/07/2022] [Indexed: 10/17/2022]
Abstract
PURPOSE The ligamentum mucosum is a ligamentous structure within the synovial layer of the knee joint capsule. It usually arises from the infrapatellar fat pad and is inserted into the intercondylar notch of the femur. In recent years, more attention has been paid to this structure because of its clinical significance. Despite the growing attention, the complex morphology of the ligamentum mucosum has led to many misunderstandings among the scientists and clinicians. Therefore, the main objective of this study was to characterize the morphology of the ligamentum mucosum and its attachment points, classify it, and evaluate its prevalence. METHODS Classical anatomical dissection was performed on 70 lower limbs of human fetuses fixed in 10% formalin solution. Morphology was carefully assessed, and morphometric measurements were performed. The types revealed were classified. RESULTS The ligamentum mucosum was present in 100% of all 70 specimens examined. Two types were detected. Type I (65.71%) - "cord-like". This type was the most common and is characterized by a single longitudinal ligament. The proximal attachment of the ligamentum mucosum was located in the middle of the infrapatellar fat, and the distal attachment was at the tip of the intercondylar notch. Type II (34.29%) - "vertical septum". This type is less common, but its morphology is much more complex compared to type I. It is wider and thicker than type I. Proximally, it is attached to the infrapatellar fat pad and distally through the entire intercondylar notch down to the anterior surface of the anterior cruciate ligament. It divides the joint cavity into medial and lateral sides. CONCLUSION The ligamentum mucosum exhibits high morphologic variability, and the view that it is a vestigial remnant of the embryologic development of the knee should be reconsidered. We have proposed an anatomical classification of its types in human fetuses, which is a valuable addition to existing knowledge and will hopefully change the approach of clinicians and scientists.
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Affiliation(s)
- B Gonera
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Poland
| | - A Borowski
- Clinic of Orthopaedic and Paediatric Orthopaedics, Medical University of Lodz, Poland
| | - N Zielinska
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Poland
| | - W Palac
- Medical University of Silesia, Katowice, Poland
| | - F Paulsen
- Institute of Functional and Clinical Anatomy, Friedrich-Alexander, University of Erlangen-Nürnberg, Germany; Sechenov University, Department of Topographic Anatomy and Operative Surgery, Moscow, Russia
| | - Ł Olewnik
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Poland.
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17
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Michel J, Sauter L, Neunhoeffer F, Hofbeck M, Kumpf M, Paulsen F, Schmidt A, Fuchs J. Sedation practices during high dose rate brachytherapy for children with urogenital and perianal rhabdomyosarcoma. J Pediatr Surg 2022; 57:1432-1438. [PMID: 33189299 DOI: 10.1016/j.jpedsurg.2020.10.026] [Citation(s) in RCA: 2] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 10/19/2020] [Accepted: 10/22/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND A novel concept for an organ-preserving treatment of pediatric urogenital and perianal rhabdomyosarcoma includes high dose rate brachytherapy following surgical tumor resection. For the duration of the brachytherapy of 6 days plus 2-day recovery break the patients are not allowed to move and are kept under deep sedation, which can lead to difficult weaning from mechanical ventilation, withdrawal, delirium, and prolonged hospital stay. The aim of this study was to evaluate a protocol which includes a switch from fentanyl to ketamine 3 days prior to extubation to help ensure a rapid extubation and transfer from PICU. METHODS Patients who underwent surgical tumor resection of rhabdomyosarcoma and subsequent brachytherapy were treated according to a standardized protocol. We evaluated doses of fentanyl, midazolam and clonidine, time of extubation, length of PICU stay and occurrence of withdrawal symptoms and delirium. We compared fentanyl dose at time of extubation, duration of weaning from mechanical ventilation and time to discharge from PICU with patients after isolated severe traumatic brain injury. RESULTS Twentytwo patients (age 39.9 ± 29.8 months) were treated in our PICU to undergo brachytherapy. Extubation was performed 21.6 ± 13.5 h after the last brachytherapy session with an average fentanyl dose of 1.5 ± 0.5 µg/kg/h and patients were discharged from PICU 58.4 ± 30.3 h after extubation, which all is significantly lower compared to the control group (extubation after 88.0 ± 42.2 h, p < 0.001; fentanyl dose at the time of extubation 2.5 ± 0.6 µg/kg/h, p < 0.001; PICU discharge after 130.1 ± 148.4 h, p < 0.009). Withdrawal symptoms were observed in 9 patients and delirium in 13 patients. CONCLUSION A standardized analgesia and sedation protocol including an opioid break, scoring systems to detect withdrawal symptoms and delirium, and tapering plans contributes to successful early extubation and discharge from PICU after long-term deep sedation.
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Affiliation(s)
- Jörg Michel
- Department of Pediatric Cardiology, Pulmonology and Pediatric Intensive Care Medicine, University Children's Hospital Tübingen, Hoppe-Seyler-Str. 1, 72076 Tübingen, Germany.
| | - Luisa Sauter
- Department of Pediatric Cardiology, Pulmonology and Pediatric Intensive Care Medicine, University Children's Hospital Tübingen, Hoppe-Seyler-Str. 1, 72076 Tübingen, Germany
| | - Felix Neunhoeffer
- Department of Pediatric Cardiology, Pulmonology and Pediatric Intensive Care Medicine, University Children's Hospital Tübingen, Hoppe-Seyler-Str. 1, 72076 Tübingen, Germany
| | - Michael Hofbeck
- Department of Pediatric Cardiology, Pulmonology and Pediatric Intensive Care Medicine, University Children's Hospital Tübingen, Hoppe-Seyler-Str. 1, 72076 Tübingen, Germany
| | - Matthias Kumpf
- Department of Pediatric Cardiology, Pulmonology and Pediatric Intensive Care Medicine, University Children's Hospital Tübingen, Hoppe-Seyler-Str. 1, 72076 Tübingen, Germany
| | - Frank Paulsen
- Department of Radiation Oncology, University Hospital, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany
| | - Andreas Schmidt
- Department of Pediatric Surgery and Pediatric Urology, University Children's Hospital Tübingen, Hoppe-Seyler-Str. 1, 72076 Tübingen, Germany
| | - Jörg Fuchs
- Department of Pediatric Surgery and Pediatric Urology, University Children's Hospital Tübingen, Hoppe-Seyler-Str. 1, 72076 Tübingen, Germany
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Eckert F, Hoffmann E, Zips D, Paulsen F. PO-1163 Metaanalysis of fractionation schedules to hypothesize a benefit of dose escalation in glioblastoma. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03127-9] [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: 11/28/2022]
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19
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Welz S, Paulsen F, Pfannenberg C, Reimold M, Reischl G, Nikolaou K, La Fougère C, Alber M, Belka C, Zips D, Thorwarth D. Dose escalation to hypoxic subvolumes in head and neck cancer: A randomized phase II study using dynamic [ 18F]FMISO PET/CT. Radiother Oncol 2022; 171:30-36. [PMID: 35395276 DOI: 10.1016/j.radonc.2022.03.021] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 03/15/2022] [Accepted: 03/30/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND PURPOSE Tumor hypoxia is a major cause of resistance to radiochemotherapy in locally advanced head-and-neck cancer (LASCCHN). We present results of a randomized phase II trial on hypoxia dose escalation (DE) in LASCCHN based on dynamic [18F]FMISO (dynFMISO) positron emission tomography (PET). The purpose was to confirm the prognostic value of hypoxia PET and assess feasibility, toxicity and efficacy of hypoxia-DE. MATERIALS AND METHODS Patients with LASCCHN underwent baseline dynFMISO PET/CT. Hypoxic volumes (HV) were derived from dynFMISO data. Patients with hypoxic tumors (HV>0) were randomized into standard radiotherapy (ST: 70Gy/35fx) or dose escalation (DE: 77Gy/35fx) to the HV. Patients with non-hypoxic tumors were treated with ST. After a minimum follow-up of 2 years, feasibility, acute/late toxicity and local control (LC) were analyzed. RESULTS The study was closed prematurely due to slow accrual. Between 2009 and 2017, 53 patients were enrolled, 39 (74%) had hypoxic tumors and were randomized into ST or DE. For non-hypoxic patients, 100% 5-year LC was observed compared to 74% in patients with hypoxic tumors (p=0.039). The difference in 5-year LC between DE (16/19) and ST (10/17) was 25%, p=0.150. No relevant differences related to acute and late toxicities between the groups were observed. CONCLUSION This study confirmed the prognostic value of hypoxia PET in LASCCHN for LC. Outcome after hypoxia DE appears promising and may support the concept of DE. Slow accrual and premature closure may partly be due to a high complexity of the study setup which needs to be considered for future multicenter trials.
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Affiliation(s)
- Stefan Welz
- Department of Radiation Oncology, University Hospital Tübingen, University of Tübingen, Tübingen, Germany
| | - Frank Paulsen
- Department of Radiation Oncology, University Hospital Tübingen, University of Tübingen, Tübingen, Germany
| | - Christina Pfannenberg
- Department of Radiology, Diagnostic and Interventional Radiology, University Hospital Tübingen, University of Tübingen, Tübingen, Germany
| | - Matthias Reimold
- Department of Nuclear Medicine, University Hospital Tübingen, University of Tübingen, Tübingen, Germany
| | - Gerald Reischl
- Department of Preclinical Imaging and Radiopharmacy, University Hospital Tübingen, University of Tübingen, Tübingen, Germany; Cluster of Excellence iFIT (EXC 2180) "Image Guided and Functionally Instructed Tumor Therapies", University of Tübingen, Germany
| | - Konstantin Nikolaou
- Department of Radiology, Diagnostic and Interventional Radiology, University Hospital Tübingen, University of Tübingen, Tübingen, Germany
| | - Christian La Fougère
- Department of Nuclear Medicine, University Hospital Tübingen, University of Tübingen, Tübingen, Germany
| | - Markus Alber
- Section for Medical Physics, Department of Radiation Oncology, Heidelberg University, Heidelberg, Germany
| | - Claus Belka
- Department of Radiation Oncology, University of Munich, Germany; Department of Radiation Oncology, LMU Munich, Germany
| | - Daniel Zips
- Department of Radiation Oncology, University Hospital Tübingen, University of Tübingen, Tübingen, Germany; German Cancer Consortium (DKTK), partner site Tübingen, Germany; German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Daniela Thorwarth
- German Cancer Consortium (DKTK), partner site Tübingen, Germany; German Cancer Research Center (DKFZ), Heidelberg, Germany; Section for Biomedical Physics, Department of Radiation Oncology, University Hospital Tübingen, University of Tübingen, Tübingen, Germany.
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20
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Ruzik K, Westrych K, Zielinska N, Podgórski M, Karauda P, Diogo R, Paulsen F, Polguj M, Olewnik Ł. The morphological variability of fibularis tertius origin in human foetuses. Ann Anat 2022; 243:151920. [PMID: 35278660 DOI: 10.1016/j.aanat.2022.151920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 01/24/2022] [Accepted: 02/20/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND The purpose of this study was to characterize the morphology of the fibularis tertius (FT) in human fetuses, and to provide a classification based on its modes of origin in human fetuses. METHODS The material comprised 100extremities from 50 spontaneously aborted human fetuses (19 male, 31 female, 100 lowerlimbs in total), aged 18- 38 weeks of gestation. These were dissected and the presence or absence of the FT muscle as well as the type of its proximal attachment were determined, and the FT was measured morphometrically. RESULTS The FT was present in 50% of fetuses. Four types of FT muscle origin were identified. The most common was Type 2, characterized by an origin on the middle third of the fibula and the intermuscular septum. Three other types were observed: Type 1 with an origin located on proximal third of the fibula and to the intermuscular septum, Type 3 characterized by an absent muscle belly, and an independent tendon originating from the that of the extensor digitorum longus, and Type 4 with an origin located on the distal third of the fibula and the intermuscular septum. CONCLUSIONS The fibularis tertius demonstrates high morphological variability, with the most common origin located on third of the fibula and to the intermuscular septum.
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Affiliation(s)
- K Ruzik
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Poland; Sechenov University, Department of Topographic Anatomy and Operative Surgery, Moscow, Russia.
| | - K Westrych
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Poland; Sechenov University, Department of Topographic Anatomy and Operative Surgery, Moscow, Russia.
| | - N Zielinska
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Poland; Sechenov University, Department of Topographic Anatomy and Operative Surgery, Moscow, Russia.
| | - M Podgórski
- Department of Diagnostic Imaging Lodz, Polish Mother's Memorial Hospital Research Institute, Lodz, Poland; Sechenov University, Department of Topographic Anatomy and Operative Surgery, Moscow, Russia.
| | - P Karauda
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Poland; Sechenov University, Department of Topographic Anatomy and Operative Surgery, Moscow, Russia.
| | - R Diogo
- Howard University, Department of Anatomy, Washington DC, USA; Sechenov University, Department of Topographic Anatomy and Operative Surgery, Moscow, Russia.
| | - F Paulsen
- Institute of Functional and Clinical Anatomy, Friedrich Alexander University Erlangen-Nürnberg, Erlangen, Germany; Sechenov University, Department of Topographic Anatomy and Operative Surgery, Moscow, Russia.
| | - M Polguj
- Sechenov University, Department of Topographic Anatomy and Operative Surgery, Moscow, Russia; Department of Normal and Clinical Anatomy, Chair of Anatomy and Histology, Medical University of Lodz, Poland.
| | - Ł Olewnik
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Poland; Sechenov University, Department of Topographic Anatomy and Operative Surgery, Moscow, Russia.
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21
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Behling F, Rang J, Dangel E, Noell S, Renovanz M, Mäurer I, Schittenhelm J, Bender B, Paulsen F, Brendel B, Martus P, Gempt J, Barz M, Meyer B, Tatagiba M, Skardelly M. Complete and Incomplete Resection for Progressive Glioblastoma Prolongs Post-Progression Survival. Front Oncol 2022; 12:755430. [PMID: 35251956 PMCID: PMC8888692 DOI: 10.3389/fonc.2022.755430] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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: 08/08/2021] [Accepted: 01/26/2022] [Indexed: 12/25/2022] Open
Abstract
Objective The role of resection in progressive glioblastoma (GBM) to prolong survival is still controversial. The aim of this study was to determine 1) the predictors of post-progression survival (PPS) in progressive GBM and 2) which subgroups of patients would benefit from recurrent resection. Methods We have conducted a retrospective bicentric cohort study on isocitrate dehydrogenase (IDH) wild-type GBM treated in our hospitals between 2006 and 2015. Kaplan-Maier analyses and univariable and multivariable Cox regressions were performed to identify predictors and their influence on PPS. Results Of 589 patients with progressive IDH wild-type GBM, 355 patients were included in analyses. Median PPS of all patients was 9 months (95% CI 8.0-10.0), with complete resection 12 months (95% CI 9.7-14.3, n=81), incomplete resection 11 months (95% CI 8.9-13.1, n=70) and without resection 7 months (95% CI 06-08, n=204). Multivariable Cox regression demonstrated a benefit for PPS with complete (HR 0.67, CI 0.49-0.90) and incomplete resection (HR 0.73, 95% CI 0.51-1.04) and confirmed methylation of the O6-methylguanine-DNA-methyltransferase (MGMT) gene promoter, lower age at diagnosis, absence of deep brain and multilocular localization, higher Karnofsky Performance Status (KPS) and recurrent therapies to be associated with longer PPS. In contrast, traditional eloquence and duration of progression-free survival had no effect on PPS. Subgroup analyses showed that all subgroups of confirmed predictors benefited from resection, except for patients in poor condition with a KPS <70. Conclusions Out data suggest a role for complete and incomplete recurrent resection in progressive GBM patients regardless of methylation of MGMT, age, or adjuvant therapy but not in patients with a poor clinical condition with a KPS <70.
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Affiliation(s)
- Felix Behling
- Department of Neurosurgery, University Hospital Tuebingen, Eberhard Karls University Tuebingen, Tuebingen, Germany.,Center for Neuro-Oncology, Comprehensive Cancer Center Tuebingen Stuttgart, University Hospital Tuebingen, Eberhard Karls University of Tuebingen, Tuebingen, Germany
| | - Julia Rang
- Department of Neurosurgery, University Hospital Tuebingen, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Elena Dangel
- Department of Neurosurgery, University Hospital Tuebingen, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Susan Noell
- Department of Neurosurgery, University Hospital Tuebingen, Eberhard Karls University Tuebingen, Tuebingen, Germany.,Center for Neuro-Oncology, Comprehensive Cancer Center Tuebingen Stuttgart, University Hospital Tuebingen, Eberhard Karls University of Tuebingen, Tuebingen, Germany
| | - Mirjam Renovanz
- Department of Neurosurgery, University Hospital Tuebingen, Eberhard Karls University Tuebingen, Tuebingen, Germany.,Center for Neuro-Oncology, Comprehensive Cancer Center Tuebingen Stuttgart, University Hospital Tuebingen, Eberhard Karls University of Tuebingen, Tuebingen, Germany.,Department of Neurology and Interdisciplinary Neuro-Oncology, University Hospital Tuebingen, Eberhard Karls University of Tübingen, Tuebingen, Germany
| | - Irina Mäurer
- Center for Neuro-Oncology, Comprehensive Cancer Center Tuebingen Stuttgart, University Hospital Tuebingen, Eberhard Karls University of Tuebingen, Tuebingen, Germany.,Department of Neurology and Interdisciplinary Neuro-Oncology, University Hospital Tuebingen, Eberhard Karls University of Tübingen, Tuebingen, Germany
| | - Jens Schittenhelm
- Center for Neuro-Oncology, Comprehensive Cancer Center Tuebingen Stuttgart, University Hospital Tuebingen, Eberhard Karls University of Tuebingen, Tuebingen, Germany.,Institute of Pathology and Neuropathology, Division of Neuropathology, University Hospital Tuebingen, Eberhard Karls University Tuebingen, Tübingen, Germany
| | - Benjamin Bender
- Center for Neuro-Oncology, Comprehensive Cancer Center Tuebingen Stuttgart, University Hospital Tuebingen, Eberhard Karls University of Tuebingen, Tuebingen, Germany.,Department of Neuroradiology, University Hospital Tuebingen, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Frank Paulsen
- University Department of Radiation Oncology, University Hospital Tuebingen, Eberhard Karls University of Tuebingen, Tuebingen, Germany
| | - Bettina Brendel
- Institute of Clinical Epidemiology and Applied Biometry, University Hospital Tuebingen, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Peter Martus
- Institute of Clinical Epidemiology and Applied Biometry, University Hospital Tuebingen, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Jens Gempt
- Department of Neurosurgery, School of Medicine, Klinikum rechts der Isar, Technische Universität Muenchen, Muenchen, Germany
| | - Melanie Barz
- Department of Neurosurgery, School of Medicine, Klinikum rechts der Isar, Technische Universität Muenchen, Muenchen, Germany
| | - Bernhard Meyer
- Department of Neurosurgery, School of Medicine, Klinikum rechts der Isar, Technische Universität Muenchen, Muenchen, Germany
| | - Marcos Tatagiba
- Department of Neurosurgery, University Hospital Tuebingen, Eberhard Karls University Tuebingen, Tuebingen, Germany.,Center for Neuro-Oncology, Comprehensive Cancer Center Tuebingen Stuttgart, University Hospital Tuebingen, Eberhard Karls University of Tuebingen, Tuebingen, Germany.,German Cancer Consortium (DKTK), Deutsche Krebsforschungszentrum (DKFZ) Partner Site Tuebingen, Tuebingen, Germany
| | - Marco Skardelly
- Department of Neurosurgery, University Hospital Tuebingen, Eberhard Karls University Tuebingen, Tuebingen, Germany.,Center for Neuro-Oncology, Comprehensive Cancer Center Tuebingen Stuttgart, University Hospital Tuebingen, Eberhard Karls University of Tuebingen, Tuebingen, Germany
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22
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Szewczyk B, Paulsen F, LaPrade RF, Borowski A, Zielinska N, Olewnik Ł. Anatomical variations of the biceps brachii insertion: a proposal for a new classification. Folia Morphol (Warsz) 2022; 82:359-367. [PMID: 35239179 DOI: 10.5603/fm.a2022.0022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 01/03/2022] [Accepted: 01/17/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND The biceps brachii (BB) muscle is one of the three muscles located in the anterior compartment of the of the arm. It insertion consists of two parts. The first part - main tendon - attached in the radial tuberosity and the second part - lacertus fibrosus (LF) - in the fascia of the forearm flexors.The intention of research was to reveal the morphological diversity of the insertion of this muscle. Thanks to the results of this work, have been created a classification of the distal attachment of BB. The results of that research can be used to further develop surgical procedures in the given region. MATERIALS AND METHODS Eighty (40 left, and 40 right, 42 female, 38 male) upper limbs fixed in 10 % formalin solution were examined. RESULTS Was observed three types of the insertion of the BB. Type I was characterized by a single tendon and occurred most frequently in 78.75% of the examined limbs. The second most common type was Type II which was characterized by a double tendon and was observed in 13.75% of all the limbs. The last and least common was Type III which was characterized by three tendons and occurred in 7.5% of the examined limbs. Additionally, the type of lacertus fibrosus (LF) was analyzed. In eight (10%) specimens it was absent, i.e. in two specimens with type II insertion and six specimens with type III, p = 0.0001. Therefore, it may be deduced that Type III BB insertion tendon predisposes to LF deficiency. CONCLUSIONS The biceps brachii tendon is characterized by high morphological variability. The new classification proposes three types of distal attachment: type I - one tendon; type II - two separated band-shaped tendons; type III - three separated band-shaped tendons. The presence of Type III BB tendon predisposes to a lack of LF.
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Affiliation(s)
- B Szewczyk
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Poland
| | - F Paulsen
- Institute of Functional and Clinical Anatomy, Erlangen, Germany.,Sechenov University, Department of Topographic Anatomy and Operative Surgery, Moscow, Russia
| | - R F LaPrade
- Twin Cities Orthopedics, Edina, Minnesota, United States
| | - A Borowski
- Clinic of Orthopaedic and Paediatric Orthopaedics, Medical University of Lodz, Poland
| | - N Zielinska
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Poland
| | - Ł Olewnik
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Poland.
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23
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Ganser K, Eckert F, Riedel A, Stransky N, Paulsen F, Noell S, Krueger M, Schittenhelm J, Beck-Wödl S, Zips D, Ruth P, Huber SM, Klumpp L. Patient-individual phenotypes of glioblastoma stem cells are conserved in culture and associate with radioresistance, brain infiltration and patient prognosis. Int J Cancer 2022; 150:1722-1733. [PMID: 35085407 DOI: 10.1002/ijc.33950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 12/30/2021] [Accepted: 01/12/2022] [Indexed: 11/08/2022]
Abstract
Identification of prognostic or predictive molecular markers in glioblastoma resection specimens may lead to strategies for therapy stratification and personalized treatment planning. Here, we analyzed in primary glioblastoma stem cell (pGSC) cultures the mRNA abundances of 7 stem cell (MSI1, Notch1, nestin, Sox2, Oct4, FABP7, ALDH1A3), and 3 radioresistance or invasion markers (CXCR4, IKCa , BKCa ). From these abundances, an mRNA signature was deduced which describes the mesenchymal-to-proneural expression profile of an individual GSC culture. To assess its functional significance, we associated the GSC mRNA signature with the clonogenic survival after irradiation with 4 Gy and the fibrin matrix invasion of the GSC cells. In addition, we compared the molecular pGSC mRNA signature with the tumor recurrence pattern and the overall survival of the glioblastoma patients from whom the pGSC cultures were derived. As a result, the molecular pGSC mRNA signature correlated positively with the pGSC radioresistance and matrix invasion capability in vitro. Moreover, patients with a mesenchymal (> median) mRNA signature in their pGSC cultures exhibited predominantly a multifocal tumor recurrence and a significantly (univariate log rank test) shorter overall survival than patients with proneural (≤ median mRNA signature) pGSCs. The tumors of the latter recurred predominately unifocally. We conclude that our pGSC cultures induce/select those cell subpopulations of the heterogeneous brain tumor that determine disease progression and therapy outcome. In addition, we further postulate a clinically relevant prognostic/predictive value for the 10 mRNAs-based mesenchymal-to-proneural signature of the GSC subpopulations in glioblastoma.
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Affiliation(s)
- Katrin Ganser
- Department of Radiation Oncology, University of Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - Franziska Eckert
- Department of Radiation Oncology, University of Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - Andreas Riedel
- Department of Radiation Oncology, University of Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - Nicolai Stransky
- Department of Radiation Oncology, University of Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany.,Department of Pharmacology, Toxicology and Clinical Pharmacy, Institute of Pharmacy, University of Tübingen, Auf der Morgenstelle 8, 72076, Tübingen, Germany
| | - Frank Paulsen
- Department of Radiation Oncology, University of Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - Susan Noell
- Department of Neurosurgery, University of Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - Marcel Krueger
- Preclinical Imaging and Radiopharmacy, Werner Siemens Imaging Center, University of Tübingen, Röntgenweg 13, 72076, Tübingen, Germany
| | - Jens Schittenhelm
- Department of Neuropathology, Calwerstr. 3, 72076, Tübingen, Germany
| | - Stefanie Beck-Wödl
- Institute of Medical Genetics und Applied Genomics, University of Tübingen, Calwerstr. 6, 72076, Tübingen, Germany
| | - Daniel Zips
- Department of Radiation Oncology, University of Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - Peter Ruth
- Department of Pharmacology, Toxicology and Clinical Pharmacy, Institute of Pharmacy, University of Tübingen, Auf der Morgenstelle 8, 72076, Tübingen, Germany
| | - Stephan M Huber
- Department of Radiation Oncology, University of Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - Lukas Klumpp
- Department of Radiation Oncology, University of Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
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24
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Skardelly M, Kaltenstadler M, Behling F, Mäurer I, Schittenhelm J, Bender B, Paulsen F, Hedderich J, Renovanz M, Gempt J, Barz M, Meyer B, Tabatabai G, Tatagiba MS. A Continuous Correlation Between Residual Tumor Volume and Survival Recommends Maximal Safe Resection in Glioblastoma Patients: A Nomogram for Clinical Decision Making and Reference for Non-Randomized Trials. Front Oncol 2021; 11:748691. [PMID: 34966669 PMCID: PMC8711700 DOI: 10.3389/fonc.2021.748691] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 11/12/2021] [Indexed: 11/13/2022] Open
Abstract
ObjectiveThe exact role of the extent of resection or residual tumor volume on overall survival in glioblastoma patients is still controversial. Our aim was to create a statistical model showing the association between resection extent/residual tumor volume and overall survival and to provide a nomogram that can assess the survival benefit of individual patients and serve as a reference for non-randomized studies.MethodsIn this retrospective multicenter cohort study, we used the non-parametric Cox regression and the parametric log-logistic accelerated failure time model in patients with glioblastoma. On 303 patients (training set), we developed a model to evaluate the effect of the extent of resection/residual tumor volume on overall survival and created a score to estimate individual overall survival. The stability of the model was validated by 20-fold cross-validation and predictive accuracy by an external cohort of 253 patients (validation set).ResultsWe found a continuous relationship between extent of resection or residual tumor volume and overall survival. Our final accelerated failure time model (pseudo R2 = 0.423; C-index = 0.749) included residual tumor volume, age, O6-methylguanine-DNA-methyltransferase methylation, therapy modality, resectability, and ventricular wall infiltration as independent predictors of overall survival. Based on these factors, we developed a nomogram for assessing the survival of individual patients that showed a median absolute predictive error of 2.78 (mean: 1.83) months, an improvement of about 40% compared with the most promising established models.ConclusionsA continuous relationship between residual tumor volume and overall survival supports the concept of maximum safe resection. Due to the low absolute predictive error and the consideration of uneven distributions of covariates, this model is suitable for clinical decision making and helps to evaluate the results of non-randomized studies.
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Affiliation(s)
- Marco Skardelly
- Department of Neurosurgery, University Hospital Tuebingen, Eberhard Karls University Tuebingen, Tuebingen, Germany
- Center for Neuro-Oncology, Comprehensive Cancer Center Tuebingen Stuttgart, University Hospital Tuebingen, Eberhard Karls University of Tuebingen, Tuebingen, Germany
- *Correspondence: Marco Skardelly,
| | - Marlene Kaltenstadler
- Department of Neurosurgery, University Hospital Tuebingen, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Felix Behling
- Department of Neurosurgery, University Hospital Tuebingen, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Irina Mäurer
- Department of Neurology, Eberhard Karls University of Tuebingen, Tuebingen, Germany
- Department Interdisciplinary Neuro-Oncology, Eberhard Karls University of Tuebingen, Tuebingen, Germany
| | - Jens Schittenhelm
- Institute of Pathology and Neuropathology, Division of Neuropathology, University Hospital Tuebingen, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Benjamin Bender
- Department of Neuroradiology, University Hospital Tuebingen, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Frank Paulsen
- Center for Neuro-Oncology, Comprehensive Cancer Center Tuebingen Stuttgart, University Hospital Tuebingen, Eberhard Karls University of Tuebingen, Tuebingen, Germany
- University Department of Radiation Oncology, University Hospital Tuebingen, Eberhard Karls University of Tuebingen, Tuebingen, Germany
| | | | - Mirjam Renovanz
- Department of Neurosurgery, University Hospital Tuebingen, Eberhard Karls University Tuebingen, Tuebingen, Germany
- Center for Neuro-Oncology, Comprehensive Cancer Center Tuebingen Stuttgart, University Hospital Tuebingen, Eberhard Karls University of Tuebingen, Tuebingen, Germany
- Department of Neurology, Eberhard Karls University of Tuebingen, Tuebingen, Germany
- Department Interdisciplinary Neuro-Oncology, Eberhard Karls University of Tuebingen, Tuebingen, Germany
- Department of Neurosurgery, University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Jens Gempt
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Melanie Barz
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Bernhard Meyer
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Ghazaleh Tabatabai
- Department of Neurosurgery, University Hospital Tuebingen, Eberhard Karls University Tuebingen, Tuebingen, Germany
- Center for Neuro-Oncology, Comprehensive Cancer Center Tuebingen Stuttgart, University Hospital Tuebingen, Eberhard Karls University of Tuebingen, Tuebingen, Germany
- Department of Neurology, Eberhard Karls University of Tuebingen, Tuebingen, Germany
- Department Interdisciplinary Neuro-Oncology, Eberhard Karls University of Tuebingen, Tuebingen, Germany
| | - Marcos Soares Tatagiba
- Department of Neurosurgery, University Hospital Tuebingen, Eberhard Karls University Tuebingen, Tuebingen, Germany
- Center for Neuro-Oncology, Comprehensive Cancer Center Tuebingen Stuttgart, University Hospital Tuebingen, Eberhard Karls University of Tuebingen, Tuebingen, Germany
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25
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Ovsepyan AL, Smirnov AA, Pustozerov EA, Mokhov DE, Mokhova ES, Trunin EM, Dydykin SS, Vasil'ev YL, Yakovlev EV, Budday S, Paulsen F, Zhivolupov SA, Starchik DA. Biomechanical analysis of the cervical spine segment as a method for studying the functional and dynamic anatomy of the human neck. Ann Anat 2021; 240:151856. [PMID: 34793958 DOI: 10.1016/j.aanat.2021.151856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 10/11/2021] [Accepted: 11/05/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Traditionally, dynamic and functional anatomy, in particular the dynamic anatomy of the neck, is studied on cadaveric material. However, the development of in vivo visualization technologies and in silico modeling has made it possible to expand these possibilities. Despite significant progress in the study of dynamic and functional anatomy of the neck by means of in silico methods, the issues of validating the developed models and taking into account the pronounced nonlinearity of soft tissues as well as local anisotropy remain open. The aim of this study was to develop a virtual dynamic anatomical model of the human neck and reproduce the dynamic processes in the cervical spine from this model using the finite element method. MATERIALS AND METHODS Reverse engineering was used to generate a dynamic anatomical model of the neck from CT data (both male, 24 and 22 years old). Two segments of the cervical spine (C3-C5, C2-T1) were isolated from the resulting model for finite element analysis. Finite element mesh generation and contact interactions were performed using the HyperMesh software (Altair Engineering Inc, Troy, Michigan, USA). The anisotropic hyperelastic Holzapfel-Gasser-Ogden model was used to describe the material behavior of the fibrous rings of the disc. Material modeling and finite element analysis were performed using Abaqus CAE 6.14 software (Simulia, Johnston, Rhode Island, USA). RESULTS A technique for creating a virtual dynamic anatomical model of the neck was elaborated and implemented. The model includes 79 major anatomical structures of the neck segmented from radiological data. A finite element analysis of the cervical spine was performed. The results of finite element analysis of the C3-C5 segment under axial load were compared with in vitro data. The proposed model shows nonlinear deformation of the disc under static loading; the model predicted displacement values agree well with the experimental ones. The displacement of the С3-С5 central vertebra with an axial load of 800 N reaches a value of 0.65 mm. For the segment C2-T1, data on intradiscal pressure, stress plots and displacements during flexion were obtained. The maximum stress value of 10.036 MPa is observed in the C3-C4 disc. CONCLUSION Simulation results using the proposed methodology are in good agreement with experimental data. The generated biomechanical models allow describing dynamic phenomena in the cervical spine and obtaining a wide range of quantitative properties of anatomical objects, which are otherwise inaccessible to classical methods for studying dynamic and functional anatomy.
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Affiliation(s)
- A L Ovsepyan
- Saint Petersburg Electrotechnical University "LETI", Department of Bioengineering Systems, St. Petersburg, Russia
| | - A A Smirnov
- Moscow Region State University, Moscow, Russia.
| | - E A Pustozerov
- Saint Petersburg Electrotechnical University "LETI", Department of Bioengineering Systems, St. Petersburg, Russia; Almazov National Medical Research Centre, Institute of Endocrinology, St. Petersburg, Russia
| | - D E Mokhov
- North-Western State Medical University Named After I.I. Mechnikov, Department of Osteopathy, St. Petersburg, Russia
| | - E S Mokhova
- Insitute of the Osteopathy, St. Petersburg State University, Russia
| | - E M Trunin
- North-Western State Medical University Named After I.I. Mechnikov, Department of Operative and Clinical Surgery with Topographical Anatomy Named After S.A. Simbirtsev, St. Petersburg, Russia
| | - S S Dydykin
- Sechenov University, Department of Operative Surgery and Topographic Anatomy, Moscow, Russia
| | - Yu L Vasil'ev
- Sechenov University, Department of Operative Surgery and Topographic Anatomy, Moscow, Russia
| | - E V Yakovlev
- Medical Center of JSC "Admiralteyskie Verfi", St. Petersburg, Russia; Department of Psychophysiology of the Institute of Applied Psychoanalysis and Psychology of the "University at the Interparliamentary Assembly of EurAsEC", St. Petersburg, Russia
| | - S Budday
- Friedrich Alexander University Erlangen-Nürnberg, Department of Mechanical Engineering, Erlangen, Germany
| | - F Paulsen
- Sechenov University, Department of Operative Surgery and Topographic Anatomy, Moscow, Russia; Friedrich Alexander University Erlangen-Nürnberg, Institute of Functional and Clinical Anatomy, Erlangen, Germany
| | - S A Zhivolupov
- Military Medical Academy Named After S.M. Kirov of the Ministry of Defense of the Russian Federation (St. Petersburg), Department of Nervous Diseases, St. Petersburg, Russia
| | - D A Starchik
- North-Western State Medical University Named After I.I. Mechnikov, Department of Morphology, St. Petersburg, Russia
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Behling F, Fodi C, Renovanz M, Paulsen F, Skardelly M, Honegger J, Tatagiba M, Schittenhelm J, Tabatabai G. BIOM-38. THE PROGNOSTIC ROLE OF THE IMMUNOHISTOCHEMICAL MARKERS H3K27me3, SSTR1-5 AND BAP1 IN MENINGIOMA. Neuro Oncol 2021. [DOI: 10.1093/neuonc/noab196.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Meningiomas are the most common primary tumors of the nervous system. These slow growing tumors arise from the meninges. Most patients can be cured by surgical excision. Yet, approximately 20% of patients suffer tumor recurrence. Prognostic markers are warranted to facilitate the identification of patients with an increased risk of tumor recurrence. Immunohistochemical markers are very interesting candidates in this regard and could be integrated into the routine clinical workflow as an inexpensive tool for prognostication and risk stratification. We analyzed the prognostic impact of the immunohistochemical expression of H3K27me3, somatostatin receptors 1-5 and BAP1 in the Tübingen meningioma cohort including > 1200 meningiomas. We identified an independent negative prognostic impact of the loss of H3K27me3. An increased expression score for SSTR2A was associated with a shorter progression-free survival. Higher expression of SSTR5 indicated a more favorable prognosis. The loss of BAP1 expression in meningioma cells was a negative prognostic factor with a shorter progression-free survival. Taken together, we present potential candidate prognostic markers that could be further investigated in prospective cohorts to determine their clinical utility.
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Affiliation(s)
- Felix Behling
- Department of Neurosurgery, Eberhard-Karls University, Tübingen, Germany
| | - Christina Fodi
- Department of Neurosurgery, Eberhard-Karls University, Tübingen, Germany
| | - Mirjam Renovanz
- Department of Neurology and Interdisciplinary Neuro-Oncology, Eberhard-Karls University, Tübingen, Germany
| | - Frank Paulsen
- Department of Radiooncology, Eberhard-Karls University, Tübingen, Germany
| | - Marco Skardelly
- Department of Neurosurgery, Eberhard-Karls University, Tübingen, Germany
| | - Jürgen Honegger
- Department of Neurosurgery, Eberhard-Karls University, Tübingen, Germany
| | - Marcos Tatagiba
- Department of Neurosurgery, Eberhard-Karls University, Tübingen, Germany
| | - Jens Schittenhelm
- Department of Neuropathology, Eberhard-Karls University, Tübingen, Germany
| | - Ghazaleh Tabatabai
- Department of Neurology and Interdisciplinary Neuro-Oncology, Eberhard-Karls University, Tübingen, Germany
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Paulsen F, Bedke J, Wegener D, Marzec J, Martus P, Nann D, Stenzl A, Zips D, Müller AC. On the probability of lymph node negativity in pN0-staged prostate cancer-a theoretically derived rule of thumb for adjuvant needs. Strahlenther Onkol 2021; 198:690-699. [PMID: 34476527 PMCID: PMC9300491 DOI: 10.1007/s00066-021-01841-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 08/09/2021] [Indexed: 12/02/2022]
Abstract
Purpose The extent of lymphadenectomy and clinical features influence the risk of occult nodes in node-negative prostate cancer. We derived a simple estimation model for the negative predictive value (npv) of histopathologically node-negative prostate cancer patients (pN0) to guide adjuvant treatment. Methods Approximations of sensitivities in detecting lymph node metastasis from current publications depending on the number of removed lymph nodes were used for a theoretical deduction of a simplified formulation of npv assuming a false node positivity of 0. Results A theoretical formula of npv = p(N0IpN0) = (100 − prevalence) / (100 − sensitivity × prevalence) was calculated (sensitivity and preoperative prevalence in %). Depending on the number of removed lymph nodes (nLN), the sensitivity of pN0-staged prostate cancer was derived for three sensitivity levels accordingly: sensitivity = f(nLN) = 9 × nLN /100 for 0 ≤ nLN ≤ 8 and f(nLN) = (nLN + 70) /100 for 9 ≤ nLN ≤ 29 and f(nLN) = 1 for nLN ≥ 30. Conclusion We developed a theoretical formula for estimation of the npv in pN0-staged prostate cancer patients. It is a sine qua non to use the formula in a clinically experienced context before deciding to electively irradiate pelvic lymph nodes or to intensify adjuvant systemic treatment.
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Affiliation(s)
- Frank Paulsen
- Department of Radiation Oncology, Eberhard Karls University, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany.
| | - Jens Bedke
- Department of Urology, Eberhard Karls University, Hoppe-Seyler-Straße 3, 72076, Tübingen, Germany
| | - Daniel Wegener
- Department of Radiation Oncology, Eberhard Karls University, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - Jolanta Marzec
- Department of Radiation Oncology, Eberhard Karls University, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - Peter Martus
- Institute for Clinical Epidemiology and Applied Biometry, Eberhard Karls University, Silcherstraße 5, 72076, Tübingen, Germany
| | - Dominik Nann
- Institute of Pathology, Eberhard Karls University, Liebermeisterstr. 8, 72076, Tübingen, Germany
| | - Arnulf Stenzl
- Department of Urology, Eberhard Karls University, Hoppe-Seyler-Straße 3, 72076, Tübingen, Germany
| | - Daniel Zips
- Department of Radiation Oncology, Eberhard Karls University, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - Arndt-Christian Müller
- Department of Radiation Oncology, Eberhard Karls University, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
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Wegener D, Lang P, Paulsen F, Weidner N, Zips D, Ebinger M, Holzer U, Döring M, Heinzelmann F. Primary immunosuppressive TNI-based conditioning regimens in pediatric patients treated with haploidentical hematopoietic cell transplantation. Strahlenther Onkol 2021; 198:66-72. [PMID: 34476532 PMCID: PMC8760200 DOI: 10.1007/s00066-021-01840-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 08/09/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE This retrospective analysis aims to address the toxicity and efficacy of a modified total nodal irradiation (TNI)-based conditioning regimen before haploidentical hematopoietic cell transplantation (HCT) in pediatric patients. MATERIALS AND METHODS Patient data including long-term follow-up were evaluated of 7 pediatric patients with malignant (n = 2) and non-malignant diseases (n = 5) who were treated by a primary TNI-based conditioning regimen. TNI was performed using anterior/posterior opposing fields. All patients received 7 Gy single-dose TNI combined with systemic agents followed by an infusion of peripheral blood stem cells (n = 7). All children had haploidentical family donors. RESULTS Engraftment was reached in 6/7 children after a median time of 9.5 days; 1 child had primary graft failure but was successfully reconditioned shortly thereafter. After an average follow-up time of 103.5 months (range 8.8-138.5 months), event-free (EFS) and overall survival (OS) rates were 71.4% and 85.7%, respectively. One child with a non-malignant disease died 8.8 months after transplantation due to a relapse and a multiple organ failure. Follow-up data was available for 5/6 long-term survivors with a median follow-up (FU) of 106.2 months (range 54.5-138.5 months). Hypothyroidism and deficiency of sexual hormones was present in 3/5 patients each. Mean forced expiratory volume in 1 s (FEV1) after TNI was 71%; mean vital capacity (VC) was 78%. Growth failure (< 10th percentile) occurred in 2/5 patients (height) and 1/5 patient (weight). No secondary malignancies were reported. CONCLUSION In this group of patients, a primary single-dose 7 Gy TNI-based conditioning regimen before HCT in pediatric patients allowed sustained engraftment combined with a tolerable toxicity profile leading to long-term OS/EFS. Late toxicity after a median FU of over 9 years includes growth failure, manageable hormonal deficiencies, and acceptable decrease in lung function.
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Affiliation(s)
- D Wegener
- Department of Radiation Oncology, University Clinic of Tuebingen, Tuebingen, Germany.
| | - P Lang
- Department of Paediatrics I, Hematology and Oncology, University Clinic of Tuebingen, Tuebingen, Germany
| | - F Paulsen
- Department of Radiation Oncology, University Clinic of Tuebingen, Tuebingen, Germany
| | - N Weidner
- Department of Radiation Oncology, University Clinic of Tuebingen, Tuebingen, Germany
| | - D Zips
- Department of Radiation Oncology, University Clinic of Tuebingen, Tuebingen, Germany
| | - M Ebinger
- Department of Paediatrics I, Hematology and Oncology, University Clinic of Tuebingen, Tuebingen, Germany
| | - U Holzer
- Department of Paediatrics I, Hematology and Oncology, University Clinic of Tuebingen, Tuebingen, Germany
| | - M Döring
- Department of Paediatrics I, Hematology and Oncology, University Clinic of Tuebingen, Tuebingen, Germany
| | - F Heinzelmann
- Department of Radiation Oncology, Clinic of Esslingen, Esslingen, Germany
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29
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Behling F, Fodi C, Gepfner-Tuma I, Kaltenbach K, Renovanz M, Paulsen F, Skardelly M, Honegger J, Tatagiba M, Schittenhelm J, Tabatabai G. H3K27me3 loss indicates an increased risk of recurrence in the Tübingen meningioma cohort. Neuro Oncol 2021; 23:1273-1281. [PMID: 33367841 PMCID: PMC8328015 DOI: 10.1093/neuonc/noaa303] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [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: 12/15/2022] Open
Abstract
Background A loss of the trimethylation of lysine 27 of histone H3 (H3K27me3) in meningioma has been recently suggested as an adjunct to identify subsets of higher risk of recurrence. The aim of the present study was to assess the prognostic value of H3K27 histone trimethylation and its potential clinical utility in the “Tübingen meningioma cohort.” Methods Patients who underwent meningioma resection between October 2003 and December 2015 at the University Hospital Tübingen were included. Immunohistochemical stainings for H3K27me3 and the proliferation marker MIB1 were assessed and correlated with clinical parameters using univariate and multivariate Cox regressions as well as Pearson's chi-squared and log-rank test. Results Overall, 1268 meningiomas were analyzed with a female to male ratio of 2.6 and a mean age of 58.7 years (range 8.3–91.0). With 163 cases lost to follow up, 1103 cases were available for further analysis with a mean follow-up of 40.3 months (range 1.1–186.3). Male gender, younger age, intracranial tumor localization, progressive tumor, subtotal resection, higher WHO grade, increased MIB1 rate, and loss of H3K27me3 were significant negative prognostic factors in the univariate analysis. H3K27me3 status and all other prognostic factors, except age and tumor location, remained significant in the multivariate model. Furthermore, adjuvant radiotherapy was an independent positive prognostic factor. Conclusions Loss of H3K27me3 combined with MIB1 labeling index are independent prognostic factors in meningioma. These data from the Tübingen meningioma cohort support the clinical utility of H3K27me3 immunohistochemical staining in meningioma and its integration into the routine histopathological workup.
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Affiliation(s)
- Felix Behling
- Center for Neuro-Oncology, Comprehensive Cancer Center Tübingen-Stuttgart, University Hospital Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany.,Department of Neurosurgery, University Hospital Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Christina Fodi
- Center for Neuro-Oncology, Comprehensive Cancer Center Tübingen-Stuttgart, University Hospital Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany.,Department of Neurosurgery, University Hospital Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Irina Gepfner-Tuma
- Center for Neuro-Oncology, Comprehensive Cancer Center Tübingen-Stuttgart, University Hospital Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany.,Department of Neurology and Interdisciplinary Neuro-Oncology, University Hospital Tübingen, Hertie Institute for Clinical Brain Research, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Kristina Kaltenbach
- Center for Neuro-Oncology, Comprehensive Cancer Center Tübingen-Stuttgart, University Hospital Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany.,Department of Neurology and Interdisciplinary Neuro-Oncology, University Hospital Tübingen, Hertie Institute for Clinical Brain Research, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Mirjam Renovanz
- Center for Neuro-Oncology, Comprehensive Cancer Center Tübingen-Stuttgart, University Hospital Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany.,Department of Neurosurgery, University Hospital Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany.,Department of Neurology and Interdisciplinary Neuro-Oncology, University Hospital Tübingen, Hertie Institute for Clinical Brain Research, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Frank Paulsen
- Center for Neuro-Oncology, Comprehensive Cancer Center Tübingen-Stuttgart, University Hospital Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany.,German Cancer Consortium (DKTK), DKFZ Partner Site Tübingen, Tübingen, Germany.,Department of Radiation Oncology, University Hospital Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Marco Skardelly
- Center for Neuro-Oncology, Comprehensive Cancer Center Tübingen-Stuttgart, University Hospital Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany.,Department of Neurosurgery, University Hospital Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Jürgen Honegger
- Center for Neuro-Oncology, Comprehensive Cancer Center Tübingen-Stuttgart, University Hospital Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany.,Department of Neurosurgery, University Hospital Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Marcos Tatagiba
- Center for Neuro-Oncology, Comprehensive Cancer Center Tübingen-Stuttgart, University Hospital Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany.,Department of Neurosurgery, University Hospital Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany
| | | | - Jens Schittenhelm
- Center for Neuro-Oncology, Comprehensive Cancer Center Tübingen-Stuttgart, University Hospital Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany.,German Cancer Consortium (DKTK), DKFZ Partner Site Tübingen, Tübingen, Germany.,Department of Neuropathology, University Hospital Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Ghazaleh Tabatabai
- Center for Neuro-Oncology, Comprehensive Cancer Center Tübingen-Stuttgart, University Hospital Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany.,Department of Neurosurgery, University Hospital Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany.,Department of Neurology and Interdisciplinary Neuro-Oncology, University Hospital Tübingen, Hertie Institute for Clinical Brain Research, Eberhard Karls University Tübingen, Tübingen, Germany.,German Cancer Consortium (DKTK), DKFZ Partner Site Tübingen, Tübingen, Germany.,Cluster of excellence (EXC 2180) "Image Guided and Functionally Instructed Tumor Therapies," Eberhard Karls University Tübingen, Tübingen, Germany
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30
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Brendle C, Maier C, Bender B, Schittenhelm J, Paulsen F, Renovanz M, Roder C, Castaneda-Vega S, Tabatabai G, Ernemann U, la Fougère C. Impact of 18F-FET PET/MR on clinical management of brain tumor patients. J Nucl Med 2021; 63:522-527. [PMID: 34353870 PMCID: PMC8973289 DOI: 10.2967/jnumed.121.262051] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 07/15/2021] [Indexed: 11/25/2022] Open
Abstract
Multiparametric PET/MRI with the amino-acid analog O-(2-18F-fluoroethyl)-l-tyrosine (18F-FET) enables the simultaneous assessment of molecular, morphologic, and functional brain tumor characteristics. Although it is considered the most accurate noninvasive approach in brain tumors, its relevance for patient management is still under debate. Here, we report the diagnostic performance of 18F-FET PET/MRI and its impact on clinical management in a retrospective patient cohort. Methods: We retrospectively analyzed brain tumor patients who underwent 18F-FET PET/MRI between 2017 and 2018. 18F-FET PET/MRI examinations were indicated clinically because of equivocal standard imaging results or the clinical course. Histologic confirmation or clinical and standard imaging follow-up served as the reference standard. We evaluated 18F-FET PET/MRI accuracy in identifying malignancy in untreated suspected lesions (category, new diagnosis) and true progression during adjuvant treatment (category, detection of progression) in a clinical setting. Using multiple regression, we also estimated the contribution of single modalities to produce an optimal PET/MRI outcome. We assessed the recommended and applied therapies before and after 18F-FET PET/MRI and noted whether the treatment changed on the basis of the 18F-FET PET/MRI outcome. Results: We included 189 patients in the study. 18F-FET PET/MRI allowed the identification of malignancy at new diagnosis with an accuracy of 85% and identified true progression with an accuracy of 93%. Contrast enhancement, 18F-FET PET uptake, and tracer kinetics were the major contributors to an optimal PET/MRI outcome. In the previously equivocal patients, 18F-FET PET/MRI changed the clinical management in 33% of the untreated lesions and 53% of the cases of tumor progression. Conclusion: Our results suggest that 18F-FET PET/MRI helps clarify equivocal conditions and profoundly supports the clinical management of brain tumor patients. The optimal modality setting for 18F-FET PET/MRI and the clinical value of a simultaneous examination need further exploration. At a new diagnosis, multiparametric 18F-FET PET/MRI might help prevent unnecessary invasive procedures by ruling out malignancy; however, adding static 18F-FET PET to an already existing MRI examination seems to be of equal value. At detection of progression, multiparametric 18F-FET PET/MRI may increase therapy effectiveness by distinguishing between tumor progression and therapy-related imaging alterations.
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Wegener D, Zips D, Gani C, Boeke S, Nikolaou K, Othman AE, Almansour H, Paulsen F, Müller AC. [Primary treatment of prostate cancer using 1.5 T MR-linear accelerator]. Radiologe 2021; 61:839-845. [PMID: 34297139 PMCID: PMC8410708 DOI: 10.1007/s00117-021-00882-8] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2021] [Indexed: 11/26/2022]
Abstract
Hintergrund Der potenzielle Nutzen des verbesserten Weichteilkontrastes von MR-Sequenzen gegenüber der Computertomographie (CT) für die Radiotherapie des Prostatakarzinoms ist bekannt und führt zu konsistenteren und kleineren Zielvolumina sowie verbesserter Risikoorganschonung. Hybridgeräte aus Magnetresonanztomographie (MRT) und Linearbeschleuniger (MR-Linac) stellen eine neue vielversprechende Erweiterung der radioonkologischen Therapieoptionen dar. Material und Methoden Dieser Artikel gibt eine Übersicht über bisherige Erfahrungen, Indikationen, Vorteile und Herausforderungen für die Radiotherapie des primären Prostatakarzinoms mit dem 1,5-T-MR-Linac. Ergebnisse Alle strahlentherapeutischen Therapieindikationen für das primäre Prostatakarzinom können mit dem 1,5-T-MR-Linac abgedeckt werden. Die potenziellen Vorteile umfassen die tägliche MR-basierte Lagekontrolle in Bestrahlungsposition und die Möglichkeit der täglichen Echtzeitanpassung des Bestrahlungsplans an die aktuelle Anatomie der Beckenorgane (adaptive Strahlentherapie). Zusätzlich werden am 1,5-T-MR-Linac funktionelle MRT-Sequenzen für individuelles Response-Assessment für die Therapieanpassung untersucht. Dadurch soll das therapeutische Fenster weiter optimiert werden. Herausforderungen stellen u. a. die technische Komplexität und die Dauer der Behandlungssitzung dar. Schlussfolgerung Der 1,5-T-MR-Linac erweitert das radioonkologische Spektrum in der Therapie des Prostatakarzinoms und bietet Vorteile durch tagesaktuelle MRT-basierte Zielvolumendefinition und Planadaptation. Weitere klinische Untersuchungen sind notwendig, um die Patienten zu identifizieren, die von der Behandlung am MR-Linac gegenüber anderen strahlentherapeutischen Methoden besonders profitieren.
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Affiliation(s)
- Daniel Wegener
- Universitätsklinik für Radioonkologie, Universitätsklinikum Tübingen, Eberhard Karls Universität Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Deutschland.
| | - Daniel Zips
- Universitätsklinik für Radioonkologie, Universitätsklinikum Tübingen, Eberhard Karls Universität Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Deutschland
| | - Cihan Gani
- Universitätsklinik für Radioonkologie, Universitätsklinikum Tübingen, Eberhard Karls Universität Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Deutschland
| | - Simon Boeke
- Universitätsklinik für Radioonkologie, Universitätsklinikum Tübingen, Eberhard Karls Universität Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Deutschland
| | - Konstantin Nikolaou
- Universitätsklinik für Radiologie, Eberhard Karls Universität Tübingen, Tübingen, Deutschland
| | - Ahmed E Othman
- Universitätsklinik für Radiologie, Eberhard Karls Universität Tübingen, Tübingen, Deutschland
- Universitätsklink für Neuroradiologie, Johannes Gutenberg-Universität Mainz, Mainz, Deutschland
| | - Haidara Almansour
- Universitätsklinik für Radiologie, Eberhard Karls Universität Tübingen, Tübingen, Deutschland
| | - Frank Paulsen
- Universitätsklinik für Radioonkologie, Universitätsklinikum Tübingen, Eberhard Karls Universität Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Deutschland
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Seravalli E, Kroon PS, Buatti JM, Hall MD, Mandeville HC, Marcus KJ, Onal C, Ozyar E, Paulino AC, Paulsen F, Saunders D, Tsang DS, Wolden SL, Janssens GO. The potential role of MR-guided adaptive radiotherapy in pediatric oncology: Results from a SIOPE-COG survey. Clin Transl Radiat Oncol 2021; 29:71-78. [PMID: 34159265 PMCID: PMC8202186 DOI: 10.1016/j.ctro.2021.05.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 05/22/2021] [Accepted: 05/24/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND AND PURPOSE Magnetic resonance guided radiotherapy (MRgRT) has been successfully implemented for several routine clinical applications in adult patients. The purpose of this study is to map the potential benefit of MRgRT on toxicity reduction and outcome in pediatric patients treated with curative intent for primary and metastatic sites. MATERIALS AND METHODS Between May and August 2020, a survey was distributed among SIOPE- and COG-affiliated radiotherapy departments, treating at least 25 pediatrics patients annually and being (candidate) users of a MRgRT system. The survey consisted of a table with 45 rows (clinical scenarios for primary (n = 28) and metastatic (n = 17) tumors) and 7 columns (toxicity reduction, outcome improvement, PTV margin reduction, target volume daily adaptation, online re-planning, intrafraction motion compensation and on-board functional imaging) and the option to answer by 'yes/no' . Afterwards, the Dutch national radiotherapy cohort was used to estimate the percentage of pediatric treatments that may benefit from MRgRT. RESULTS The survey was completed by 12/17 (71% response rate) institutions meeting the survey inclusion criteria. Responders indicated an 'expected benefit' from MRgRT for toxicity/outcome in 7% (for thoracic lymphomas and abdominal rhabdomyosarcomas)/0% and 18% (for mediastinal lymph nodes, lymph nodes located in the liver/splenic hilum, and liver metastases)/0% of the considered scenarios for the primary and metastatic tumor sites, respectively, and a 'possible benefit' was estimated in 64%/46% and 47%/59% of the scenarios. When translating the survey outcome into a clinical perspective a toxicity/outcome benefit, either expected or possible, was anticipated for 55%/24% of primary sites and 62%/38% of the metastatic sites. CONCLUSION Although the benefit of MRgRT in pediatric radiation oncology is estimated to be modest, the potential role for reducing toxicity and improving clinical outcomes warrants further investigation. This fits best within the context of prospective studies or registration trials.
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Affiliation(s)
- Enrica Seravalli
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Petra S. Kroon
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - John M. Buatti
- Departments of Radiation Oncology, University of Iowa, Iowa City, USA
| | - Matthew D. Hall
- Department of Radiation Oncology, Miami Cancer Institute, Miami, FL, USA
| | - Henry C. Mandeville
- Department of Radiotherapy, The Royal Marsden Hospital and Institute of Cancer Research, Sutton, United Kingdom
| | - Karen J. Marcus
- Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, Boston, MA, USA
| | - Cem Onal
- Department of Radiation Oncology, Baskent University, Ankara, Turkey
| | - Enis Ozyar
- Department of Radiation Oncology, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Arnold C. Paulino
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, USA
| | - Frank Paulsen
- Department of Radiation Oncology, University Hospital Tuebingen, Tuebingen, Germany
| | | | - Derek S. Tsang
- Radiation Medicine Program, University Health Network – Princess Margaret Cancer Centre, Toronto, Canada
| | - Suzanne L. Wolden
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, NY, USA
| | - Geert O. Janssens
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
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Hoffmann E, Clasen K, Frey B, Ehlers J, Behling F, Skardelly M, Bender B, Schittenhelm J, Reimold M, Tabatabai G, Zips D, Eckert F, Paulsen F. Retrospective analysis of recurrence patterns and clinical outcome of grade II meningiomas following postoperative radiotherapy. Radiat Oncol 2021; 16:116. [PMID: 34172069 PMCID: PMC8235826 DOI: 10.1186/s13014-021-01825-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 12/23/2020] [Accepted: 05/28/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Atypical meningiomas exhibit a high tendency for tumor recurrence even after multimodal therapy. Information regarding recurrence patterns after additive radiotherapy is scarce but could improve radiotherapy planning and therapy decision. We conducted an analysis of recurrence patterns with regard to target volumes and dose coverage assessing target volume definition and postulated areas of tumor re-growth origin. Prognostic factors contributing to relapse were evaluated. METHODS The clinical outcome of patients who had completed additive, somatostatin receptor (SSTR)-PET/CT-based fractionated intensity-modulated radiotherapy for atypical meningioma between 2007 and 2017 was analyzed. In case of tumor recurrence/progression, treatment planning was evaluated for coverage of the initial target volumes and the recurrent tumor tissue. We proposed a model evaluating the dose distribution in postulated areas of tumor re-growth origin. The median of proliferation marker MIB-1 was assessed as a prognostic factor for local progression and new distant tumor lesions. RESULTS Data from 31 patients who had received adjuvant (n = 11) or salvage radiotherapy (n = 20) were evaluated. Prescribed dose ranged from 54.0 to 60.0 Gy. Local control at five years was 67.9%. Analysis of treatment plans of the eight patients experiencing local failure proved sufficient extent of target volumes and coverage of the prescribed dose of at least 50.0 Gy as determined by mean dose, D98, D2, and equivalent uniform dose (EUD) of all initial target volumes, postulated growth-areas, and areas of recurrent tumor tissue. In all cases, local failure occurred in high-dose volumes. Tumors with a MIB-1 expression above the median (8%) showed a higher tendency for re-growth. CONCLUSIONS The model showed adequate target volume and relative dose distribution but absolute dose appears lower in recurrent tumors without reaching statistical significance. This might provide a rationale for dose escalation studies. Biological factors such as MIB-1 might aid patients' stratification for dose escalation.
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Affiliation(s)
- Elgin Hoffmann
- Department of Radiation Oncology, University Hospital Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany. .,Center of Neuro-Oncology, Comprehensive Cancer Center Tuebingen-Stuttgart, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany. .,Department of Radiation Oncology, Eberhard-Karls-University of Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany.
| | - Kerstin Clasen
- Department of Radiation Oncology, University Hospital Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany.,Center of Neuro-Oncology, Comprehensive Cancer Center Tuebingen-Stuttgart, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany
| | - Bettina Frey
- Department of Radiation Oncology, University Hospital Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany
| | - Jakob Ehlers
- Department of Radiation Oncology, University Hospital Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany.,Center of Neuro-Oncology, Comprehensive Cancer Center Tuebingen-Stuttgart, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany
| | - Felix Behling
- Center of Neuro-Oncology, Comprehensive Cancer Center Tuebingen-Stuttgart, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany.,Department of Neurosurgery, University Hospital Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany
| | - Marco Skardelly
- Center of Neuro-Oncology, Comprehensive Cancer Center Tuebingen-Stuttgart, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany.,Department of Neurosurgery, University Hospital Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany.,Clinic for Neurosurgery, Hospital Reutlingen, Reutlingen, Germany
| | - Benjamin Bender
- Center of Neuro-Oncology, Comprehensive Cancer Center Tuebingen-Stuttgart, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany.,Diagnostic and Interventional Neuroradiology, Department of Radiology, University Hospital Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany
| | - Jens Schittenhelm
- Center of Neuro-Oncology, Comprehensive Cancer Center Tuebingen-Stuttgart, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany.,Department of Neuropathology, Institute of Pathology and Neuropathology, University Hospital Tuebingen, Calwerstr. 3, 72076, Tuebingen, Germany
| | - Matthias Reimold
- Department of Nuclear Medicine, University Hospital Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany
| | - Ghazaleh Tabatabai
- Center of Neuro-Oncology, Comprehensive Cancer Center Tuebingen-Stuttgart, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany.,Department of Neurology and Interdisciplinary Neuro-Oncology, University Hospital Tuebingen, Hertie Institute for Clinical Brain Research, Hoppe-Seyler-Strasse 3, 72076, Tuebingen, Germany.,Department of Neurooncology, Department of Neurology, University Hospital Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany
| | - Daniel Zips
- Department of Radiation Oncology, University Hospital Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany.,Center of Neuro-Oncology, Comprehensive Cancer Center Tuebingen-Stuttgart, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany.,German Cancer Consortium (DKTK) Partnersite Tuebingen, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Franziska Eckert
- Department of Radiation Oncology, University Hospital Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany.,Center of Neuro-Oncology, Comprehensive Cancer Center Tuebingen-Stuttgart, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany.,German Cancer Consortium (DKTK) Partnersite Tuebingen, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Frank Paulsen
- Department of Radiation Oncology, University Hospital Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany.,Center of Neuro-Oncology, Comprehensive Cancer Center Tuebingen-Stuttgart, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany.,German Cancer Consortium (DKTK) Partnersite Tuebingen, German Cancer Research Center (DKFZ), Heidelberg, Germany
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Karauda P, Paulsen F, Polguj M, Diogo R, Olewnik Ł. Morphological variability of the fibularis tertius tendon in human fetuses. Folia Morphol (Warsz) 2021; 81:451-457. [PMID: 33899207 DOI: 10.5603/fm.a2021.0039] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/02/2021] [Accepted: 03/11/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND In adults, the fibularis tertius (FT) demonstrates great morphological variation. The present study classifies the types of FT insertion in human fetuses and compares their prevalence to the prevailing classification among adults. MATERIALS AND METHODS Fifty spontaneously-aborted human fetuses (19 male, 31 female, 100 upper limbs in total) aged 18-38 weeks of gestation at death were examined. The fetuses were obtained from spontaneous abortion after parental consent. The study was performed in accordance with the legal procedures in force in Poland and with the Donation Corpse program for both adults and fetuses. RESULTS The most common type of FT found was Type VI (32%), characterized by a bifurcated distal attachment: a main tendon inserting onto the base of the fourth metatarsal bone, and accessory bands inserting onto the fourth interosseous space. Five other types were observed: Type IV (20%), with a single tendon inserting distally to the fascia covering the fourth interosseous space; Type I (18%), with a single tendon inserting distally onto the shaft of the fifth metatarsal bone; Type V (14%), with a bifurcated arrangement comprising a main tendon characterized by a very wide insertion onto the base of the fifth metatarsal bone and an accessory band inserting onto the base of the fourth metatarsal bone; and Type III (12%) with a single tendon inserting distally onto the shaft of the fourth metatarsal bone and fascia covering the fourth interosseous space. Finally, Type II (4%) was characterized by a single tendon inserting onto the base of the fifth metatarsal bone via a very wide distal insertion. CONCLUSIONS The fibularis tertius demonstrates high morphological variability, with the most common configuration found in adults - a single insertion onto metatarsal 5 - being actually uncommonly found in fetuses.
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Affiliation(s)
- P Karauda
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Poland
| | - F Paulsen
- Institute of Functional and Clinical Anatomy, Friedrich Alexander University Erlangen-Nürnberg, Erlangen, Germany.,Department of Topographic Anatomy and Operative Surgery, Sechenov University, Moscow, Russia
| | - M Polguj
- Department of Normal and Clinical Anatomy, Chair of Anatomy and Histology, Medical University of Lodz, Poland
| | - R Diogo
- Department of Anatomy, Howard University, Washington, DC, United States
| | - Ł Olewnik
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Poland.
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Musayeva A, Gericke A, Jäger F, Paulsen F, Braun M, Fabry B, Braun R, Pauly D, Holtmann C, Geerling G. [Results of the Dry Eye Research Grant Award 2016]. Ophthalmologe 2021; 118:337-344. [PMID: 32638094 PMCID: PMC8043874 DOI: 10.1007/s00347-020-01163-w] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
The Sicca-Förderpreis (Dry Eye Award) supports the development of scientific research on the pathogenesis, diagnostics, and treatment of dry eye and ocular surface diseases. It is awarded after a limited call for proposals in German-speaking countries, written application and selection of the award winner after evaluation by a jury of ophthalmologists working in basic and clinical science. In this article examples of the results of funded projects of the Sicca-Förderpreis 2016 are cursorily described, which were presented at the Ophthalmological Academy of Germany 2019 (Augenärztliche Akademie Deutschland 2019) and therefore provide an insight into current scientific developments. The role of muscarinic receptors and those of urea in the pathogenesis of dry eye as well as the (missing) correlation of tear film stability, viscosity and surface tension are highlighted. A project on the early detection of ocular involvement in graft versus host disease and the idea of treating meibomian gland dysfunction with eyelid surgery techniques are also groundbreaking. The outlined projects represent the potential for further substantial developments in the understanding, diagnostics and treatment of dry eye; however, their long-term clinical relevance still needs to be established.
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Affiliation(s)
- A Musayeva
- Augenklinik und Poliklinik, Klinikum der Johannes-Gutenberg-Universität Mainz, Mainz, Deutschland
| | - A Gericke
- Augenklinik und Poliklinik, Klinikum der Johannes-Gutenberg-Universität Mainz, Mainz, Deutschland
| | - F Jäger
- Institut für Funktionelle und Klinische Anatomie, FAU Erlangen-Nürnberg, Erlangen, Deutschland
| | - F Paulsen
- Institut für Funktionelle und Klinische Anatomie, FAU Erlangen-Nürnberg, Erlangen, Deutschland
| | - M Braun
- Institut für Physik der kondensierten Materie, FAU Erlangen-Nürnberg, Erlangen, Deutschland
| | - B Fabry
- Institut für Physik der kondensierten Materie, FAU Erlangen-Nürnberg, Erlangen, Deutschland
| | - R Braun
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Regensburg, Regensburg, Deutschland
| | - D Pauly
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Regensburg, Regensburg, Deutschland
| | - C Holtmann
- Klinik für Augenheilkunde, Universitätsklinikum Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Deutschland
| | - G Geerling
- Klinik für Augenheilkunde, Universitätsklinikum Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Deutschland.
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Beck M, Ghadjar P, Mehrhof F, Zips D, Paulsen F, Wegener D, Burock S, Kaul D, Stromberger C, Nadobny J, Ott OJ, Fietkau R, Budach V, Wust P, Müller AC, Zschaeck S. Salvage-Radiation Therapy and Regional Hyperthermia for Biochemically Recurrent Prostate Cancer after Radical Prostatectomy (Results of the Planned Interim Analysis). Cancers (Basel) 2021; 13:cancers13051133. [PMID: 33800872 PMCID: PMC7961934 DOI: 10.3390/cancers13051133] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 01/31/2021] [Revised: 03/01/2021] [Accepted: 03/04/2021] [Indexed: 11/18/2022] Open
Abstract
Simple Summary Several efforts like dose-escalated salvage radiation therapy and the use of androgen deprivation therapy aimed to improve the postoperative treatment in patients with biochemical recurrence of prostate cancer after prostatectomy. However, the oncological outcome is still not satisfactory. Hyperthermia is well-known to improve the efficacy of radiation therapy, whereas only limited data for postoperative therapy in prostate cancer are available. Thus, we conducted a prospective multicenter non-randomized Phase-II-Trial (HTProstate) investigating the implementation of combined salvage radiation therapy and regional hyperthermia in case of biochemical recurrence after prostatectomy with the aim to evaluate the safety, feasibility, and oncological outcome of this approach. The results of our planned interim analysis (n = 50) met the criteria of safety (only one patient with acute grade 3 hyperthermia-specific toxicity), showed feasibility of planned radiation and hyperthermia therapy, no significant changes in quality of life and promising short-term prostate-specific antigen response. Late toxicity and robust oncological outcome data will be reported after completion of the trial. Abstract Efforts to improve the outcome of prostate cancer (PC) patients after radical prostatectomy (RP) include adjuvant or salvage radiation therapy (SRT), but still up to 50% of patients develop a disease progression after radiotherapy (RT). Regional hyperthermia (HT) is well-known to improve tumor sensitivity to RT in several entities. Here we report on a planned interim analysis of tolerability and feasibility after recruitment of the first 50 patients of a trial combining SRT and HT. We conducted a prospective multicenter non-randomized Phase-II-Trial (HTProstate-NCT04159051) investigating the implementation of combined moderate-dose escalated SRT (70 Gy in 35 fractions) and locoregional deep HT (7–10 HT sessions). The primary endpoints were the rate of acute genitourinary (GU), gastrointestinal (GI), and HT-related toxicities, completed HT sessions (≥7), and SRT applications per protocol (≥95% of patients). The two-step design included a planned interim analysis for acute GU-, GI- and HT-specific toxicities to ensure patients’ safety. Between November 2016 and December 2019, 52 patients entered into the trial. After 50 patients completed therapy and three months of follow-up, we performed the planned interim analysis. 10% of patients developed acute grade 2 GU and 4% grade 2 GI toxicities. No grade ≥3 GU or GI toxicities occurred. HT-specific symptoms grade 2 and 3 were observed in 4% and 2% of all patients. Thus, the pre-specified criteria for safety and continuation of recruitment were met. Moreover, ≥7 HT treatments were applicable, indicating the combination of SRT + HT to be feasible. Evaluation of early QoL showed no significant changes. With its observed low rate of GU and GI toxicities, moderate and manageable rates of HT-specific symptoms, and good feasibility, the combined SRT + HT seems to be a promising treatment approach for biochemical recurrence after RP in PC patients.
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Affiliation(s)
- Marcus Beck
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Radiation Oncology, 13353 Berlin, Germany; (P.G.); (F.M.); (D.K.); (C.S.); (J.N.); (V.B.); (P.W.); (S.Z.)
- Correspondence: ; Tel.: +49-30-450-627-343; Fax: +49-30-450-7527343
| | - Pirus Ghadjar
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Radiation Oncology, 13353 Berlin, Germany; (P.G.); (F.M.); (D.K.); (C.S.); (J.N.); (V.B.); (P.W.); (S.Z.)
| | - Felix Mehrhof
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Radiation Oncology, 13353 Berlin, Germany; (P.G.); (F.M.); (D.K.); (C.S.); (J.N.); (V.B.); (P.W.); (S.Z.)
| | - Daniel Zips
- Department of Radiation Oncology, University Hospital Eberhard-Karls-University Tübingen, 72076 Tübingen, Germany; (D.Z.); (F.P.); (D.W.); (A.-C.M.)
| | - Frank Paulsen
- Department of Radiation Oncology, University Hospital Eberhard-Karls-University Tübingen, 72076 Tübingen, Germany; (D.Z.); (F.P.); (D.W.); (A.-C.M.)
| | - Daniel Wegener
- Department of Radiation Oncology, University Hospital Eberhard-Karls-University Tübingen, 72076 Tübingen, Germany; (D.Z.); (F.P.); (D.W.); (A.-C.M.)
| | - Susen Burock
- Charité Comprehensive Cancer Center, Charité Universitätsmedizin Berlin, 10117 Berlin, Germany;
| | - David Kaul
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Radiation Oncology, 13353 Berlin, Germany; (P.G.); (F.M.); (D.K.); (C.S.); (J.N.); (V.B.); (P.W.); (S.Z.)
| | - Carmen Stromberger
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Radiation Oncology, 13353 Berlin, Germany; (P.G.); (F.M.); (D.K.); (C.S.); (J.N.); (V.B.); (P.W.); (S.Z.)
| | - Jacek Nadobny
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Radiation Oncology, 13353 Berlin, Germany; (P.G.); (F.M.); (D.K.); (C.S.); (J.N.); (V.B.); (P.W.); (S.Z.)
| | - Oliver J. Ott
- Department of Radiation Oncology, Universitätsklinikum Erlangen, 91054 Erlangen, Germany; (O.J.O.); (R.F.)
| | - Rainer Fietkau
- Department of Radiation Oncology, Universitätsklinikum Erlangen, 91054 Erlangen, Germany; (O.J.O.); (R.F.)
| | - Volker Budach
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Radiation Oncology, 13353 Berlin, Germany; (P.G.); (F.M.); (D.K.); (C.S.); (J.N.); (V.B.); (P.W.); (S.Z.)
| | - Peter Wust
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Radiation Oncology, 13353 Berlin, Germany; (P.G.); (F.M.); (D.K.); (C.S.); (J.N.); (V.B.); (P.W.); (S.Z.)
| | - Arndt-Christian Müller
- Department of Radiation Oncology, University Hospital Eberhard-Karls-University Tübingen, 72076 Tübingen, Germany; (D.Z.); (F.P.); (D.W.); (A.-C.M.)
| | - Sebastian Zschaeck
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Radiation Oncology, 13353 Berlin, Germany; (P.G.); (F.M.); (D.K.); (C.S.); (J.N.); (V.B.); (P.W.); (S.Z.)
- Berlin Institute of Health, 10117 Berlin, Germany
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Wegener D, Berger B, Outtagarts Z, Zips D, Paulsen F, Bleif M, Thorwarth D, Alber M, Dohm O, Müller AC. Prospective evaluation of probabilistic dose-escalated IMRT in prostate cancer. Radiol Oncol 2020; 55:88-96. [PMID: 33885246 PMCID: PMC7877263 DOI: 10.2478/raon-2020-0075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 11/02/2020] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Cure- and toxicity rates after intensity-modulated radiotherapy (IMRT) of prostate cancer are dose-and volume dependent. We prospectively studied the potential for organ at risk (OAR) sparing and compensation of tumor movement with the coverage probability (CovP) concept. PATIENTS AND METHODS Twenty-eight prostate cancer patients (median age 70) with localized disease (cT1c-2c, N0, M0) and intermediate risk features (prostate-specific antigen [PSA] < 20, Gleason score ≤ 7b) were treated in a prospective study with the CovP concept. Planning-CTs were performed on three subsequent days to capture form changes and movement of prostate and OARs. The clinical target volume (CTV) prostate and the OARs (bladder and rectum) were contoured in each CT. The union of CTV1-3 was encompassed by an isotropic margin of 7 mm to define the internal target volume (ITV). Dose prescription/escalation depended on coverage of all CTVs within the ITV. IMRT was given in 39 fractions to 78 Gy using the Monte-Carlo algorithm. Short-term androgen deprivation was recommended and given in 78.6% of patients. RESULTS Long-term toxicity was evaluated in 26/28 patients after a median follow-up of 7.1 years. At last follow-up, late bladder toxicity (Radiation Therapy Oncology Group, RTOG) G1 was observed in 14.3% of patients and late rectal toxicities (RTOG) of G1 (7.1%) and of G2 (3.6%) were observed. No higher graded toxicity occurred. After 7.1 years, biochemical control (biochemically no evidence of disease, bNED) was 95.5%, prostate cancer-specific survival and the distant metastasis-free survival after 7.1 years were 100% each. CONCLUSIONS CovP-based IMRT was feasible in a clinical study. Dose escalation with the CovP concept was associated by a low rate of toxicity and a high efficacy regarding local and distant control.
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Affiliation(s)
- Daniel Wegener
- Department of Radiation Oncology, University Hospital Tübingen, TübingenGermany
| | - Bernhard Berger
- Clinic for Radiation Oncology, St. Elisabethen-Clinic, Ravensburg, Germany
| | - Zhoulika Outtagarts
- Department of Radiation Oncology, University Hospital Tübingen, TübingenGermany
| | - Daniel Zips
- Department of Radiation Oncology, University Hospital Tübingen, TübingenGermany
- German Cancer Consortium (DKTK), Partner Site Tübingen; and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Frank Paulsen
- Department of Radiation Oncology, University Hospital Tübingen, TübingenGermany
| | - Martin Bleif
- Clinic for Radiology and Radiation Oncology, Alb Fils Clinic Göppingen, GöppingenGermany
| | - Daniela Thorwarth
- Section for Biomedical Physics, Department of Radiation Oncology, University Hospital Tübingen, TübingenGermany
| | - Markus Alber
- Clinic for Radiation Oncology, University Hospital Heidelberg, HeidelbergGermany
| | - Oliver Dohm
- Section for Biomedical Physics, Department of Radiation Oncology, University Hospital Tübingen, TübingenGermany
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Dietzsch S, Placzek F, Pietschmann K, von Bueren AO, Matuschek C, Glück A, Guckenberger M, Budach V, Welzel J, Pöttgen C, Schmidberger H, Heinzelmann F, Paulsen F, Pazos M, Schwarz R, Hornung D, Martini C, Grosu AL, Meyer FM, Jablonska K, Dunst J, Kapp KS, Dieckmann K, Timmermann B, Pietsch T, Warmuth-Metz M, Kwiecien R, Benesch M, Gerber NU, Pfister SM, Clifford SC, von Hoff K, Klagges S, Rutkowski S, Kortmann RD, Mynarek M. MBCL-11. TIME TO RADIOTHERAPY IMPACTS SURVIVAL IN PEDIATRIC AND ADOLESCENT NON-METASTATIC MEDULLOBLASTOMA TREATED BY UPFRONT RADIOTHERAPY – A REPORT FROM THE HIT 2000 TRIAL. Neuro Oncol 2020. [PMCID: PMC7715814 DOI: 10.1093/neuonc/noaa222.487] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
PURPOSE To evaluate prognostic factors and impact of participation in a randomized trial in non-metastatic medulloblastoma. METHODS AND PATIENTS 382 patients with non-metastatic medulloblastoma aged 4–21 years with primary neurosurgical resections between 2001 and 2011 were enrolled into the HIT 2000 trial and centrally reviewed. Between 2001 and 2006, 176 of these patients participated in the randomized trial HIT-SIOP PNET 4. Three different radiotherapy protocols were applied. Molecular subgroup was available for 157 patients. RESULTS Median follow-up was 6.35 [0.09–13.86] years. The 5-year progression-free (PFS) and overall survival (OS) rates were 80.3 % ± 2.1 % and 86.5 % ± 1.8 %, respectively. On univariate analysis, there was no difference in PFS and OS according to radiotherapy protocols or in patients who participated in the HIT-SIOP PNET 4 trial or not, while histology, molecular subgroup and postoperative residual tumor influenced PFS significantly. Time interval between surgery and irradiation (≤48 days vs. ≥49 days) failed the significance level (p=0.052). On multivariate analyses, molecular subgroup (WNT activated vs. Group3 HR 5.49; p=0.014) and time interval between surgery and irradiation (HR 2.2; p=0.018) were confirmed as independent risk factors. CONCLUSION Using a centralized review system, multiprofessional and multiinstitutional collaboration as established for pediatric brain tumor patients in Germany, and risk-stratified therapy, outcome for non-metastatic medulloblastoma treated within HIT-SIOP PNET4 could be maintained outside the randomized trial. Prolonged time to radiotherapy negatively influenced survival.
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Affiliation(s)
- Stefan Dietzsch
- Department for Radiation Oncology, University of Leipzig Medical Center, Leipzig, Germany
| | - Felix Placzek
- Department for Radiation Oncology, University of Leipzig Medical Center, Leipzig, Germany
| | - Klaus Pietschmann
- Department of Radiation Oncology, Chemnitz Municipal Hospital, Chemnitz, Germany
- Department for Radiation Oncology, University of Leipzig Medical Center, Leipzig, Germany
| | - André O von Bueren
- Department of Pediatric Hematology and Oncology, University Hospital Geneva, Geneva, Switzerland
| | - Christiane Matuschek
- Department of Radiation Oncology, Medical Faculty, Heinrich Heine University of Düsseldorf, Düsseldorf, Germany
| | - Albrecht Glück
- Radiation Oncology, Munich-Schwabing Municipal Hospital, Munich, Germany
| | - Matthias Guckenberger
- Department of Radiation Oncology, University of Zurich Medical Center, Zurich, Germany
| | - Volker Budach
- Department for Radiation Oncology, Charité School of Medicine and University Hospital Berlin, Berlin, Germany
| | - Jutta Welzel
- Department of Radiation Oncology, Pius Hospital Oldenburg, Oldenburg, Germany
| | - Christoph Pöttgen
- Department of Radiotherapy, West German Cancer Center, University of Duisburg-Essen, Essen, Germany
| | - Heinz Schmidberger
- Department for Radiation Oncology, University of Mainz Medical Center, Mainz, Germany
| | - Frank Heinzelmann
- Department for Radiation Oncology, University of Tuebingen Medical Center, Tuebingen, Germany
| | - Frank Paulsen
- Department for Radiation Oncology, University of Tuebingen Medical Center, Tuebingen, Germany
| | - Montserrat Pazos
- Department of Radiotherapy and Radiation Oncology, Ludwig Maximilian University Munich, Munich, Germany
| | - Rudolf Schwarz
- Department of Radiation Oncology, University Medical Center Eppendorf, Hamburg, Germany
| | - Dagmar Hornung
- Department of Radiation Oncology, University Medical Center Eppendorf, Hamburg, Germany
| | - Carmen Martini
- Department of Radiation Oncology, University Medical Center Freiburg, Freiburg, Germany
| | - Anca Ligia Grosu
- Department of Radiation Oncology, University Medical Center Freiburg, Freiburg, Germany
| | - Frank Michael Meyer
- Radiation Oncology, MVZ medical care center, Hospital Augsburg, Augsburg, Germany
| | - Karolina Jablonska
- Department of Radiation Oncology, University Medical Center Cologne, Cologne, Germany
| | - Juergen Dunst
- Department of Radiation Oncology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Karin S Kapp
- Department of Therapeutic Radiology and Oncology, Medical University of Graz, Graz, Austria
| | - Karin Dieckmann
- Department of Radiotherapy, Medical University of Vienna, Vienna, Austria
| | - Beate Timmermann
- Clinic for Particle Therapy, West German Proton Therapy Centre, University of Essen, Essen, Germany
| | - Torsten Pietsch
- Department of Neuropathology, University of Bonn, Bonn, Germany
| | | | - Robert Kwiecien
- Institute of Biometry and Clinical Research, University of Muenster, Muenster, Germany
| | - Martin Benesch
- Division of Pediatric Hematology/Oncology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | | | - Stefan M Pfister
- Hopp Children′s Cancer Center Heidelberg (KiTZ), Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), Department of Pediatric Oncology, Hematology and Immunology, Heidelberg University Hospital, Heidelberg, Germany
| | - Steven C Clifford
- Wolfson Childhood Cancer Research Centre, Newcastle University Centre for Cancer, Newcastle upon Tyne, United Kingdom
| | - Katja von Hoff
- Department of Paediatric Oncology and Hematology, Charité University Medicine Berlin, Berlin, Germany
| | - Sabine Klagges
- Department for Radiation Oncology, University of Leipzig Medical Center, Leipzig, Germany
| | - Stefan Rutkowski
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Rolf-Dieter Kortmann
- Department for Radiation Oncology, University of Leipzig Medical Center, Leipzig, Germany
| | - Martin Mynarek
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Weizel A, Distler T, Schneidereit D, Friedrich O, Bräuer L, Paulsen F, Detsch R, Boccaccini A, Budday S, Seitz H. Complex mechanical behavior of human articular cartilage and hydrogels for cartilage repair. Acta Biomater 2020; 118:113-128. [PMID: 33080391 DOI: 10.1016/j.actbio.2020.10.025] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 10/12/2020] [Accepted: 10/13/2020] [Indexed: 12/29/2022]
Abstract
The mechanical behavior of cartilage tissue plays a crucial role in physiological mechanotransduction processes of chondrocytes and pathological changes like osteoarthritis. Therefore, intensive research activities focus on the identification of implant substitute materials that mechanically mimic the cartilage extracellular matrix. This, however, requires a thorough understanding of the complex mechanical behavior of both native cartilage and potential substitute materials to treat cartilage lesions. Here, we perform complex multi-modal mechanical analyses of human articular cartilage and two surrogate materials, commercially available ChondroFillerliquid, and oxidized alginate-gelatin (ADA-GEL) hydrogels. We show that all materials exhibit nonlinearity and compression-tension asymmetry. However, while hyaline cartilage yields higher stresses in tension than in compression, ChondroFillerliquid and ADA-GEL exhibit the opposite trend. These characteristics can be attributed to the materials' underlying microstructure: Both cartilage and ChondroFillerliquid contain fibrillar components, but the latter constitutes a bi-phasic structure, where the 60% nonfibrillar hydrogel proportion dominates the mechanical response. Of all materials, ChondroFillerliquid shows the most pronounced viscous effects. The present study provides important insights into the microstructure-property relationship of cartilage substitute materials, with vital implications for mechanically-driven material design in cartilage engineering. In addition, we provide a data set to create mechanical simulation models in the future.
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Eckert F, Clasen K, Kelbsch C, Tonagel F, Bender B, Tabatabai G, Zips D, Thorwarth D, Frey B, Becker G, Wilhelm H, Paulsen F. Correction to: Retrospective analysis of fractionated intensity-modulated radiotherapy (IMRT) in the interdisciplinary management of primary optic nerve sheath meningiomas. Radiat Oncol 2020; 15:268. [PMID: 33213504 PMCID: PMC7677773 DOI: 10.1186/s13014-020-01706-0] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Franziska Eckert
- Department of Radiation Oncology, Eberhard-Karls-University Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany. .,Centre for Neurooncology, Eberhard-Karls-University Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany.
| | - Kerstin Clasen
- Department of Radiation Oncology, Eberhard-Karls-University Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany
| | - Carina Kelbsch
- Department for Ophthalmology, Eberhard-Karls-University Tuebingen, Elfriede-Aulhorn-Str. 7, 72076, Tuebingen, Germany
| | - Felix Tonagel
- Department for Ophthalmology, Eberhard-Karls-University Tuebingen, Elfriede-Aulhorn-Str. 7, 72076, Tuebingen, Germany
| | - Benjamin Bender
- Department of Diagnostic and Interventional Neuroradiology, Eberhard-Karls-University Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany
| | - Ghazaleh Tabatabai
- Centre for Neurooncology, Eberhard-Karls-University Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany
| | - Daniel Zips
- Department of Radiation Oncology, Eberhard-Karls-University Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany.,Centre for Neurooncology, Eberhard-Karls-University Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany
| | - Daniela Thorwarth
- Department of Radiation Oncology, Section for Biomedical Physics, Eberhard-Karls-University Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany
| | - Bettina Frey
- Department of Radiation Oncology, Section for Biomedical Physics, Eberhard-Karls-University Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany
| | - Gerd Becker
- RadioChirurgicum, CyberKnife Suedwest, Klinik Am Eichert, Eichertstr. 3, 73035, Goeppingen, Germany
| | - Helmut Wilhelm
- Department for Ophthalmology, Eberhard-Karls-University Tuebingen, Elfriede-Aulhorn-Str. 7, 72076, Tuebingen, Germany
| | - Frank Paulsen
- Department of Radiation Oncology, Eberhard-Karls-University Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany
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Othman A, Wegener D, Zips D, Paulsen F, De Colle C, Thorwarth D, Bedke J, Stenzl A, Afat S, Weiss J, Notohamiprodjo M, Nikolaou K, Müller A. PO-1682: MR-based adaptive IGRT for prostate cancer: Results of an exploratory cohort on DWI. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01700-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: 11/27/2022]
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Dietzsch S, Placzek F, Pietschmann K, von Bueren AO, Matuschek C, Glück A, Guckenberger M, Budach V, Welzel J, Pöttgen C, Schmidberger H, Heinzelmann F, Paulsen F, Escudero MP, Schwarz R, Hornung D, Martini C, Grosu AL, Stueben G, Jablonska K, Dunst J, Stranzl-Lawatsch H, Dieckmann K, Timmermann B, Pietsch T, Warmuth-Metz M, Bison B, Kwiecien R, Benesch M, Gerber NU, Grotzer MA, Pfister SM, Clifford SC, von Hoff K, Klagges S, Rutkowski S, Kortmann RD, Mynarek M. Evaluation of Prognostic Factors and Role of Participation in a Randomized Trial or a Prospective Registry in Pediatric and Adolescent Nonmetastatic Medulloblastoma - A Report From the HIT 2000 Trial. Adv Radiat Oncol 2020; 5:1158-1169. [PMID: 33305077 PMCID: PMC7718550 DOI: 10.1016/j.adro.2020.09.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 09/11/2020] [Accepted: 09/17/2020] [Indexed: 12/01/2022] Open
Abstract
Purpose We aimed to compare treatment results in and outside of a randomized trial and to confirm factors influencing outcome in a large retrospective cohort of nonmetastatic medulloblastoma treated in Austria, Switzerland and Germany. Methods and Materials Patients with nonmetastatic medulloblastoma (n = 382) aged 4 to 21 years and primary neurosurgical resection between 2001 and 2011 were assessed. Between 2001 and 2006, 176 of these patients (46.1%) were included in the randomized HIT SIOP PNET 4 trial. From 2001 to 2011 an additional 206 patients were registered to the HIT 2000 study center and underwent the identical central review program. Three different radiation therapy protocols were applied. Genetically defined tumor entity (former molecular subgroup) was available for 157 patients. Results Median follow-up time was 7.3 (range, 0.09-13.86) years. There was no difference between HIT SIOP PNET 4 trial patients and observational patients outside the randomized trial, with 7 years progression-free survival rates (PFS) of 79.5% ± 3.1% versus 78.7% ± 3.1% (P = .62). On univariate analysis, the time interval between surgery and irradiation (≤ 48 days vs ≥ 49 days) showed a strong trend to affect PFS (80.4% ± 2.2% vs 64.6% ± 9.1%; P = .052). Furthermore, histologically and genetically defined tumor entities and the extent of postoperative residual tumor influenced PFS. On multivariate analyses, a genetically defined tumor entity wingless-related integration site-activated vs non-wingless-related integration site/non-SHH, group 3 hazard ratio, 5.49; P = .014) and time interval between surgery and irradiation (hazard ratio, 2.2; P = .018) were confirmed as independent risk factors. Conclusions Using a centralized review program and risk-stratified therapy for all patients registered to the study center, outcome was identical for patients with nonmetastatic medulloblastoma treated on and off the randomized HIT SIOP PNET 4 trial. The prognostic values of prolonged time to RT and genetically defined tumor entity were confirmed.
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Affiliation(s)
- Stefan Dietzsch
- Department for Radiation Oncology, University of Leipzig Medical Center, Leipzig, Germany
| | - Felix Placzek
- Department for Radiation Oncology, University of Leipzig Medical Center, Leipzig, Germany
| | - Klaus Pietschmann
- Department for Radiation Oncology, University of Leipzig Medical Center, Leipzig, Germany
- Department of Radiation Oncology, Chemnitz Municipal Hospital, Chemnitz, Germany
| | - André O. von Bueren
- Department of Pediatrics, Obstetrics and Gynecology, Division of Pediatric Hematology and Oncology, University Hospital Geneva, CANSEARCH Research Laboratory, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Christiane Matuschek
- Department of Radiation Oncology, Medical Faculty, Heinrich Heine University of Düsseldorf, Düsseldorf, Germany
| | - Albrecht Glück
- Radiation Oncology, Munich-Schwabing Municipal Hospital, Munich, Germany
| | - Matthias Guckenberger
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Volker Budach
- Department for Radiation Oncology, Charité School of Medicine and University Hospital Berlin, Berlin, Germany
| | - Jutta Welzel
- Department of Radiation Oncology, Pius Hospital Oldenburg, Oldenburg, Germany
| | - Christoph Pöttgen
- Department of Radiotherapy, West German Cancer Center, University of Duisburg-Essen, Essen, Germany
| | - Heinz Schmidberger
- Department for Radiation Oncology, University of Mainz Medical Center, Mainz, Germany
| | - Frank Heinzelmann
- Department for Radiation Oncology, University of Tuebingen Medical Center, Tuebingen, Germany
| | - Frank Paulsen
- Department for Radiation Oncology, University of Tuebingen Medical Center, Tuebingen, Germany
| | - Montserrat Pazos Escudero
- Department of Radiotherapy and Radiation Oncology, Ludwig Maximilian University Munich, Munich, Germany
| | - Rudolf Schwarz
- Department of Radiation Oncology, University Medical Center Eppendorf, Hamburg, Germany
| | - Dagmar Hornung
- Department of Radiation Oncology, University Medical Center Eppendorf, Hamburg, Germany
| | - Carmen Martini
- Department of Radiation Oncology, University Medical Center Freiburg, Freiburg, Germany
| | - Anca Ligia Grosu
- Department of Radiation Oncology, University Medical Center Freiburg, Freiburg, Germany
| | - Georg Stueben
- Department of Radiation Oncology, University Medical Center Augsburg, Augsburg, Germany
| | - Karolina Jablonska
- Department of Radiation Oncology, University Medical Center Cologne, Cologne, Germany
| | - Juergen Dunst
- Department of Radiation Oncology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Heidi Stranzl-Lawatsch
- Department of Therapeutic Radiology and Oncology, Medical University of Graz, Graz, Austria
| | - Karin Dieckmann
- Department of Radiotherapy, Medical University of Vienna, Vienna, Austria
| | - Beate Timmermann
- Clinic for Particle Therapy, West German Proton Therapy Centre, University of Essen, Essen, Germany
| | - Torsten Pietsch
- Department of Neuropathology, DGNN Brain Tumor Reference Center, University of Bonn, Bonn, Germany
| | - Monika Warmuth-Metz
- Institute of Diagnostic and Interventional Neuroradiology, University Hospital of Wuerzburg, Wuerzburg, Germany
| | - Brigitte Bison
- Institute of Diagnostic and Interventional Neuroradiology, University Hospital of Wuerzburg, Wuerzburg, Germany
| | - Robert Kwiecien
- Institute of Biometry and Clinical Research, University of Muenster, Muenster, Germany
| | - Martin Benesch
- Division of Pediatric Hematology/Oncology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | | | | | - Stefan M. Pfister
- Hopp Children's Cancer Center Heidelberg (KiTZ), Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), Department of Pediatric Oncology, Hematology and Immunology, Heidelberg University Hospital, Heidelberg, Germany
| | - Steven C. Clifford
- Wolfson Childhood Cancer Research Centre, Newcastle University Centre for Cancer, Newcastle upon Tyne, United Kingdom
| | - Katja von Hoff
- Department of Pediatric Oncology and Hematology, Charité University Medicine Berlin, Berlin, Germany
| | - Sabine Klagges
- Department for Radiation Oncology, University of Leipzig Medical Center, Leipzig, Germany
| | - Stefan Rutkowski
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Rolf-Dieter Kortmann
- Department for Radiation Oncology, University of Leipzig Medical Center, Leipzig, Germany
- Corresponding author: Rolf-Dieter Kortmann, MD
| | - Martin Mynarek
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Olewnik Ł, Paulsen F, Tubbs RS, Zielińska N, Szewczyk B, Karauda P, Polguj M. Potential compression of the musculocutaneous, median and ulnar nerves by a very rare variant of the coracobrachialis longus muscle. Folia Morphol (Warsz) 2020; 80:707-713. [PMID: 32844391 DOI: 10.5603/fm.a2020.0085] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 07/21/2020] [Indexed: 11/25/2022]
Abstract
The coracobrachialis longus muscle (CBL) is an extremely rare variant of the coracobrachialis muscle (CRM). The CBL originates from the apex of the coracoid process together with the short head of the biceps brachii and inserts on the olecranon of the ulna. The CBL consists of three parts: a superior part (classical CRM - length 137.88 mm), a middle fibrous layer (23.41 mm), and an inferior part (185.37 mm). A rare relationship between the CBL and median, musculocutaneous and ulnar nerves was observed with potential compression at these three parts. In addition, this case report describes a connection between CBL and the medial head of the triceps brachii, as well as a third head of the biceps brachii, which originate from the fibrous layer. This case report highlights the relationships between the CBL and the median, ulnar and musculocutaneous nerves.
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Affiliation(s)
- Ł Olewnik
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Poland.
| | - F Paulsen
- Institute of Functional and Clinical Anatomy, Friedrich Alexander University Erlangen-Nürnberg, Erlangen, Germany.,Department of Topographic Anatomy and Operative Surgery, Sechenov University, Moscow, Russia
| | - R S Tubbs
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, LA, United States.,Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, LA, United States.,Department of Anatomical Sciences, St. George's University, Grenada
| | - N Zielińska
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Poland
| | - B Szewczyk
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Poland
| | - P Karauda
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Poland
| | - M Polguj
- Department of Normal and Clinical Anatomy, Medical University of Lodz, Poland
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Tzaridis T, Gepfner-Tuma I, Hirsch S, Skardelly M, Bender B, Paulsen F, Schaub C, Weller J, Schäfer N, Herrlinger U, Tabatabai G. Regorafenib in advanced high-grade glioma: a retrospective bicentric analysis. Neuro Oncol 2020; 21:954-955. [PMID: 31089718 DOI: 10.1093/neuonc/noz071] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Affiliation(s)
- Theophilos Tzaridis
- Division of Neuro-Oncology, Department of Neurology and Center of Integrated Oncology, University Hospital Bonn, Bonn, Germany.,Institute of Clinical Chemistry and Clinical Pharmacology, University Hospital Bonn, Bonn, Germany
| | - Irina Gepfner-Tuma
- Interdisciplinary Division of Neuro-Oncology, Departments of Neurology and Neurosurgery, Hertie Institute for Clinical Brain Research, University Hospital Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany.,Center for CNS Tumors, Comprehensive Cancer Center Tübingen-Stuttgart; Eberhard Karls University Tübingen, Tübingen, Germany
| | - Sophie Hirsch
- Interdisciplinary Division of Neuro-Oncology, Departments of Neurology and Neurosurgery, Hertie Institute for Clinical Brain Research, University Hospital Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany.,Center for CNS Tumors, Comprehensive Cancer Center Tübingen-Stuttgart; Eberhard Karls University Tübingen, Tübingen, Germany
| | - Marco Skardelly
- Interdisciplinary Division of Neuro-Oncology, Departments of Neurology and Neurosurgery, Hertie Institute for Clinical Brain Research, University Hospital Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany.,Center for CNS Tumors, Comprehensive Cancer Center Tübingen-Stuttgart; Eberhard Karls University Tübingen, Tübingen, Germany
| | - Benjamin Bender
- Center for CNS Tumors, Comprehensive Cancer Center Tübingen-Stuttgart; Eberhard Karls University Tübingen, Tübingen, Germany.,Department of Neuroradiology, University Hospital of Tübingen, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Frank Paulsen
- Center for CNS Tumors, Comprehensive Cancer Center Tübingen-Stuttgart; Eberhard Karls University Tübingen, Tübingen, Germany.,Department of Radiation Oncology, University Hospital of Tübingen, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Christina Schaub
- Center for CNS Tumors, Comprehensive Cancer Center Tübingen-Stuttgart; Eberhard Karls University Tübingen, Tübingen, Germany
| | - Johannes Weller
- Division of Neuro-Oncology, Department of Neurology and Center of Integrated Oncology, University Hospital Bonn, Bonn, Germany
| | - Niklas Schäfer
- Division of Neuro-Oncology, Department of Neurology and Center of Integrated Oncology, University Hospital Bonn, Bonn, Germany
| | - Ulrich Herrlinger
- Division of Neuro-Oncology, Department of Neurology and Center of Integrated Oncology, University Hospital Bonn, Bonn, Germany
| | - Ghazaleh Tabatabai
- Interdisciplinary Division of Neuro-Oncology, Departments of Neurology and Neurosurgery, Hertie Institute for Clinical Brain Research, University Hospital Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany.,Center for CNS Tumors, Comprehensive Cancer Center Tübingen-Stuttgart; Eberhard Karls University Tübingen, Tübingen, Germany.,German Consortium for Translational Oncology, German Cancer Research Center partner site Tübingen
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Outaggarts Z, Wegener D, Berger B, Zips D, Paulsen F, Bleif M, Thorwarth D, Alber M, Dohm O, Müller AC. Target miss using PTV-based IMRT compared to robust optimization via coverage probability concept in prostate cancer. Acta Oncol 2020; 59:911-917. [PMID: 32436467 DOI: 10.1080/0284186x.2020.1760349] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Purpose: Cure- and toxicity rates of prostate IGRT can both be affected by ill-chosen planning target volume (PTV) margins. For dose-escalated prostate radiotherapy, we studied the potential for organ at risk (OAR) sparing and compensation of prostate motion with robust plan optimization using the coverage probability (CovP) concept compared to conventional PTV-based IMRT.Material and methods: We evaluated plan quality of CovP-plans for 27 intermediate risk prostate cancer patients treated in a prospective study (78 Gy/39 fractions). Clinical target volume (CTV) and OARs were contoured on three separate CTs to capture movement and deformation. To define the internal target volume (ITV), the union of CTV1-3 was encompassed by an isotropic margin of 7 mm for the planning process. CovP-dose distribution is optimized considering weight factors for IMRT constraints derived from probabilities of systematic organ displacement in the three CTs. CovP-dose volume histograms (DVHs) were compared with additionally calculated conventional PTV-based IMRT plans. PTV-based IMRT was planned on one-single CT with an isotropically expanded CTV to generate the PTV (i.e., CTV1 + 7mm) and was evaluated on the two other CTs.Results: The CovP-concept showed higher robustness in target volume coverage. Target miss was frequently observed with PTV-based IMRT, resulting in cold spots until 70 Gy with the CovP-concept. The target dose at 74 Gy was comparable, while further the dose-escalation (75-78 Gy) was improved with PTV-based IMRT. However, dose-escalation with PTV-based IMRT was associated with increased OAR-doses, especially in high-dose areas.Conclusions: Probabilistic dose-escalated IMRT was feasible in this prospective study. Comparison of the CovP-concept with PTV-based IMRT revealed superiority with regard to target-coverage and sparing of OARs. The CovP-concept implements a robust plan optimization strategy for organ deformation and motions and could, therefore, serve as a less demanding compromise on the way to adaptive IGRT avoiding daily time-consuming re-planning. SUMMARYWe evaluated the robustness of coverage probability (CovP)-based IMRT plans within a prospective study for prostate cancer radiotherapy. The treatment plans were compared with newly calculated conventional PTV-based IMRT plans. We were able to show that CovP led to a clearly more robust target coverage by avoiding hot spots at OARs compared to conventional PTV-based IMRT. In addition, negative consequences of an inflated PTV can be ameliorated by a more relaxed CovP-based dose prescription.
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Affiliation(s)
- Zoulikha Outaggarts
- Department of Radiation Oncology, University Hospital Tübingen, Tübingen, Germany
| | - Daniel Wegener
- Department of Radiation Oncology, University Hospital Tübingen, Tübingen, Germany
| | - Bernhard Berger
- Clinic for Radiation Oncology, Oberschwaben Hospital Group, Ravensburg, Germany
| | - Daniel Zips
- Department of Radiation Oncology, University Hospital Tübingen, Tübingen, Germany
| | - Frank Paulsen
- Department of Radiation Oncology, University Hospital Tübingen, Tübingen, Germany
| | - Martin Bleif
- Clinic for Radiology and Radiation Oncology, ALB FILS Clinics Hospital on the Eichert, Goppingen, Germany
| | - Daniela Thorwarth
- Department of Radiation Oncology, Section Medical Physics, University Hospital Tübingen, Tübingen, Germany
| | - Markus Alber
- Clinic for Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany
| | - Oliver Dohm
- Department of Radiation Oncology, Section Medical Physics, University Hospital Tübingen, Tübingen, Germany
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46
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Marzec J, Becker J, Paulsen F, Wegener D, Olthof SC, Pfannenberg C, Schwenck J, Bedke J, Stenzl A, Nikolaou K, la Fougère C, Zips D, Müller AC. 68Ga-PSMA-PET/CT-directed IGRT/SBRT for oligometastases of recurrent prostate cancer after initial surgery. Acta Oncol 2020; 59:149-156. [PMID: 31559880 DOI: 10.1080/0284186x.2019.1669816] [Citation(s) in RCA: 3] [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] [Indexed: 10/25/2022]
Abstract
Background: We evaluated efficacy and toxicity of 68Ga-PSMA-Positron Emission Tomography/Computed Tomography (PET/CT)-directed stereotactic body radiotherapy and image-guided radiotherapy (SBRT/IGRT) for oligometastases of prostate cancer recurrences after previous surgery.Methods: Nineteen patients were analyzed within a prospective PET-registry study (064/2013BO1) and retrospectively analyzed (807/2017BO2) fulfilling the following inclusion criteria: biochemical recurrence after radical prostatectomy, ≤five 68Ga-PSMA-PET/CT positive lesions. Biochemical control was evaluated with EORTC (European Organization for Research and Treatment of Cancer)- and Phenix-definitions. Toxicity was scored according to CTCAE-criteria v. 4.03.Results: A total of 38 oligometastases (19 patients, 2 with re-treatment) were treated with SBRT/IGRT from October 2014 to July 2017. 68Ga-PSMA-PET/CT-positive lesions were detected on average 39 months (5-139) after prostatectomy (pT2b-3b pN0-1 cM0). Mean PSA (Prostate-specific antigen)-level at time of imaging reached 2.2 ng/mL (range 0.2-10.1). PET/CT-positive lesions were treated with different fractionation schedules reaching biological equivalent doses (BED) of 116.7-230.0 Gy. Concomitant androgen deprivation therapy (ADT) was given in seven patients. After a median follow-up of 17 months (4-42) all patients were alive. Estimated 1-year PSA- control (n = 19) reached 80.8% (Phenix) and 67.5% (EORTC). A PSA-decline (≥50%) was detected in 16/19 patients after radiotherapy. Higher graded G3+-acute toxicity did not occur. Temporary late G3-proctitis was detected in one patient.Conclusions: Reaching of nadir ≤0.1 or 0.2 ng/mL was associated by improved DMFS (distant metastases free survival) and could serve as a surrogate endpoint for RT of oligometastases after initial prostatectomy. Short term effects of 68Ga-PSMA-PET/CT-based ablative radiotherapy for oligometastases demonstrated an acceptable toxicity profile and favorable biochemical response.
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Affiliation(s)
- J. Marzec
- Department of Radiation Oncology, Eberhard Karls University, Tübingen, Germany
| | - J. Becker
- Department of Radiation Oncology, Eberhard Karls University, Tübingen, Germany
| | - F. Paulsen
- Department of Radiation Oncology, Eberhard Karls University, Tübingen, Germany
| | - D. Wegener
- Department of Radiation Oncology, Eberhard Karls University, Tübingen, Germany
| | - S.-C. Olthof
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University Tübingen, Tübingen, Germany
| | - C. Pfannenberg
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University Tübingen, Tübingen, Germany
| | - J. Schwenck
- Department of Nuclear Medicine and Clinical Molecular Imaging, Department of Radiology, Eberhard Karls University Tübingen, Tübingen, Germany
- Cluster of Excellnence iFIT (EXC 2180) “Image Guided and Functionally Instructed Tumor Therapies”, University of Tuebingen, Germany
| | - J. Bedke
- Department of Urology, Eberhard Karls University Tübingen, Tübingen, Germany
| | - A. Stenzl
- Department of Urology, Eberhard Karls University Tübingen, Tübingen, Germany
| | - K. Nikolaou
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University Tübingen, Tübingen, Germany
| | - C. la Fougère
- Department of Nuclear Medicine and Clinical Molecular Imaging, Department of Radiology, Eberhard Karls University Tübingen, Tübingen, Germany
- German Cancer Consortium (DKTK), Partner Site Tübingen; and German Cancer Research Center (DKFZ), Heidelberg, Germany
- Cluster of Excellnence iFIT (EXC 2180) “Image Guided and Functionally Instructed Tumor Therapies”, University of Tuebingen, Germany
| | - D. Zips
- Department of Radiation Oncology, Eberhard Karls University, Tübingen, Germany
- German Cancer Consortium (DKTK), Partner Site Tübingen; and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - A.-C. Müller
- Department of Radiation Oncology, Eberhard Karls University, Tübingen, Germany
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Gugel I, Ebner FH, Grimm F, Czemmel S, Paulsen F, Hagel C, Tatagiba M, Nahnsen S, Tabatabai G. Contribution of mTOR and PTEN to Radioresistance in Sporadic and NF2-Associated Vestibular Schwannomas: A Microarray and Pathway Analysis. Cancers (Basel) 2020; 12:cancers12010177. [PMID: 31936793 PMCID: PMC7016954 DOI: 10.3390/cancers12010177] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 12/19/2019] [Accepted: 01/07/2020] [Indexed: 01/29/2023] Open
Abstract
The use of radiation treatment has increased for both sporadic and neurofibromatosis type 2 (NF2)-associated vestibular schwannoma (VS). However, there are a subset of radioresistant tumors and systemic treatments that are seldom used in these patients. We investigated molecular alterations after radiation in three NF2-associated and five sporadically operated recurrent VS after primary irradiation. We compared these findings with 49 non-irradiated (36 sporadic and 13 NF2-associated) VS through gene-expression profiling and pathway analysis. Furthermore, we stained the key molecules of the distinct pathway by immunohistochemistry. A total of 195 differentially expressed genes in sporadic and NF2-related comparisons showed significant differences based on the criteria of p value < 0.05 and a two-fold change. These genes were involved in pathways that are known to be altered upon irradiation (e.g., mammalian target of rapamycin (mTOR), phosphatase and tensin homolog (PTEN) and vascular endothelial growth factor (VEGF) signaling). We observed a combined downregulation of PTEN signaling and an upregulation of mTOR signaling in progressive NF2-associated VS after irradiation. Immunostainings with mTOR and PTEN antibodies confirmed the respective molecular alterations. Taken together, mTOR inhibition might be a promising therapeutic strategy in NF2-associated VS progress after irradiation.
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Affiliation(s)
- Isabel Gugel
- Center for Neuro-Oncol., Comprehensive Cancer Center Tübingen Stuttgart, 72076 Tübingen, Germany
- Department of Neurosurgery, University Hospital Tübingen, 72076 Tübingen, Germany
- Centre of Neurofibromatosis and Rare Diseases, University Hospital Tübingen, 72076 Tübingen, Germany
- Interdisciplinary Division of Neuro-Oncol., University Hospital Tübingen, 72076 Tübingen, Germany
- Hertie Institute for Clinical Brain Research, Eberhard Karls University Tübingen, 72076 Tübingen, Germany
- Correspondence: ; Tel.: +49-7071-2980325; Fax: +49-07071-295245
| | - Florian H. Ebner
- Department of Neurosurgery, Alfried Krupp Hospital, 45131 Essen, Germany
| | - Florian Grimm
- Center for Neuro-Oncol., Comprehensive Cancer Center Tübingen Stuttgart, 72076 Tübingen, Germany
- Department of Neurosurgery, University Hospital Tübingen, 72076 Tübingen, Germany
- Interdisciplinary Division of Neuro-Oncol., University Hospital Tübingen, 72076 Tübingen, Germany
| | - Stefan Czemmel
- Quantitative Biology Center (QBiC), University of Tübingen, 72076 Tübingen, Germany
| | - Frank Paulsen
- Center for Neuro-Oncol., Comprehensive Cancer Center Tübingen Stuttgart, 72076 Tübingen, Germany
- Interdisciplinary Division of Neuro-Oncol., University Hospital Tübingen, 72076 Tübingen, Germany
- Department of Radiation Oncology, University Hospital Tübingen, 72076 Tübingen, Germany
| | - Christian Hagel
- Institute of Neuropathology, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany
| | - Marcos Tatagiba
- Center for Neuro-Oncol., Comprehensive Cancer Center Tübingen Stuttgart, 72076 Tübingen, Germany
- Department of Neurosurgery, University Hospital Tübingen, 72076 Tübingen, Germany
- Centre of Neurofibromatosis and Rare Diseases, University Hospital Tübingen, 72076 Tübingen, Germany
- Interdisciplinary Division of Neuro-Oncol., University Hospital Tübingen, 72076 Tübingen, Germany
- Hertie Institute for Clinical Brain Research, Eberhard Karls University Tübingen, 72076 Tübingen, Germany
| | - Sven Nahnsen
- Quantitative Biology Center (QBiC), University of Tübingen, 72076 Tübingen, Germany
| | - Ghazaleh Tabatabai
- Center for Neuro-Oncol., Comprehensive Cancer Center Tübingen Stuttgart, 72076 Tübingen, Germany
- Department of Neurosurgery, University Hospital Tübingen, 72076 Tübingen, Germany
- Interdisciplinary Division of Neuro-Oncol., University Hospital Tübingen, 72076 Tübingen, Germany
- Hertie Institute for Clinical Brain Research, Eberhard Karls University Tübingen, 72076 Tübingen, Germany
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Eckert F, Clasen K, Kelbsch C, Tonagel F, Bender B, Tabatabai G, Zips D, Thorwarth D, Frey B, Becker G, Wilhelm H, Paulsen F. Retrospective analysis of fractionated intensity-modulated radiotherapy (IMRT) in the interdisciplinary management of primary optic nerve sheath meningiomas. Radiat Oncol 2019; 14:240. [PMID: 31881902 PMCID: PMC6935075 DOI: 10.1186/s13014-019-1438-2] [Citation(s) in RCA: 19] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 12/06/2019] [Indexed: 12/15/2022] Open
Abstract
Background As optic nerve sheath meningiomas (ONSM) are rare, there are no prospective studies. Our retrospective analysis focusses on a cohort of patients with uniform disease characteristics all treated with the same radiotherapy regimen. We describe treatment decision making, radiotherapy planning and detailed neuro-ophthalmological outcome of the patients. Methods 26 patients with unilateral ONSM extending only to the orbit and the optic canal were evaluated for neuro-ophthalmological outcome. Radiation treatment was planned in a simultaneous integrated boost approach to gross tumor volume (GTV) + 2 mm / 5 mm to 54 Gy / 51 Gy in 1.8 Gy / 1.7 Gy fractions. Follow-up was done by specialized neuro-ophthalmologists. Visual acuity and visual field defects were evaluated after therapy as well as during follow-up. Results Interdisciplinary treatment decision for patients with ONSM follows a rather complex decision tree. Radiation treatment planning (equivalent uniform dose (EUD), maximum dose to the optic nerve) improved with experience over time. With this patient selection visual acuity as well as visual field improved significantly at first follow-up after treatment. For visual acuity this also applied to patients with severe defects before treatment. Long term evaluation showed 16 patients with improved visual function, 6 were stable, in 4 patients visual function declined. Interdisciplinary case discussion rated the visual decline as radiation-associated in two patients. Conclusions With stringent patient selection radiotherapy for unilateral primary ONSM to 51 Gy / 54 Gy is safe and leads to significantly improved visual function. Interdisciplinary treatment decision and experience of the radiation oncology team play a major role.
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Affiliation(s)
- Franziska Eckert
- Department of Radiation Oncology, Eberhard-Karls-University Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany. .,Centre for Neurooncology, Eberhard-Karls-University Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany.
| | - Kerstin Clasen
- Department of Radiation Oncology, Eberhard-Karls-University Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany
| | - Carina Kelbsch
- Department for Ophthalmology, Eberhard-Karls-University Tuebingen, Elfriede-Aulhorn-Str. 7, 72076, Tuebingen, Germany
| | - Felix Tonagel
- Department for Ophthalmology, Eberhard-Karls-University Tuebingen, Elfriede-Aulhorn-Str. 7, 72076, Tuebingen, Germany
| | - Benjamin Bender
- Department of Diagnostic and Interventional Neuroradiology, Eberhard-Karls-University Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany
| | - Ghazaleh Tabatabai
- Centre for Neurooncology, Eberhard-Karls-University Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany
| | - Daniel Zips
- Department of Radiation Oncology, Eberhard-Karls-University Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany.,Centre for Neurooncology, Eberhard-Karls-University Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany
| | - Daniela Thorwarth
- Department of Radiation Oncology, Section for Biomedical Physics, Eberhard-Karls-University Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany
| | - Bettina Frey
- Department of Radiation Oncology, Section for Biomedical Physics, Eberhard-Karls-University Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany
| | - Gerd Becker
- RadioChirurgicum, CyberKnife Suedwest, Klinik am Eichert, Eichertstr. 3, 73035, Goeppingen, Germany
| | - Helmut Wilhelm
- Department for Ophthalmology, Eberhard-Karls-University Tuebingen, Elfriede-Aulhorn-Str. 7, 72076, Tuebingen, Germany
| | - Frank Paulsen
- Department of Radiation Oncology, Eberhard-Karls-University Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany
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49
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Wilhelm H, Honegger JB, Paulsen F. [Neuro-Ophthalmological Considerations on Meningiomas of the Anterior Visual Pathways]. Klin Monbl Augenheilkd 2019; 236:1312-1317. [PMID: 31509885 DOI: 10.1055/a-0982-5390] [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: 10/26/2022]
Abstract
Meningiomas are slow growing tumours, usually becoming symptomatic with visual loss or diplopia, or they are found incidentally. Not all meningiomas need to be treated. Treatment consists of neuro-surgical removal or radiotherapy if surgery is not possible. Whether a meningioma of the anterior visual pathways needs to be treated is mainly determined by the ophthalmological state. This must also include assessment of the prognosis by evaluation of the clinical findings and OCT scanning. This contribution is intended as an overview of all relevant factors with meningiomas of the anterior visual pathways. It is mainly based on the authors' own experiences.
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Affiliation(s)
| | | | - Frank Paulsen
- Radioonkologie, Universitätsklinikum Tübingen, Tübingen
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50
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Voss M, Wagner M, von Mettenheim N, Harter PN, Wenger K, Franz K, Bojunga J, Gerlach R, Glatzel M, Paulsen F, Hattingen E, Baehr O, Ronellenfitsch MW, Fokas E, Imhoff D, Steinbach JP, Rödel C, Rieger J. OS6.5 ERGO2: A prospective randomized trial of a 9-day schedule of calorically restricted ketogenic diet and fasting or standard diet in addition to re-irradiation for malignant glioma. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz126.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
BACKGROUND
Ketogenic diet (KD) and fasting have anticancer effects in tumor models, possibly due to a differential stress response with sensitization of tumor cells and protection of normal tissue. We therefore set up ERGO2 (NCT01754350), the first randomized clinical trial of calorically-restricted KD and intermittent fasting (KD-IF) in addition to re-irradiation for recurrent malignant gliomas.
MATERIAL AND METHODS
Patients were randomized 1:1 to re-irradiation combined with either calorically unrestricted diet (standard diet, SD) or KD-IF. The KD-IF schedule included 3 days of KD (21–23 kcal/kg/d), followed by 3 days of fasting and again 3 days of KD. The primary endpoint was progression-free survival (PFS) rate at 6 months (PFS6). Secondary endpoints were PFS, local control, overall survival (OS), frequency of epileptic seizures, rate of ketosis and quality of life.
RESULTS
50 patients were included. Four patients quit the trial before treatment and three patients stopped KD-IF prematurely. Of the 20 patients who completed KD-IF, 17 patients developed ketosis at day 6, and glucose levels declined significantly. KD-IF was well-tolerated with a modest weight loss of -2.1±1.8 kg. No severe adverse events attributable to the diet occurred. There was no difference in PFS6 between the two groups (KD-IF: 20%, SD: 16%). Similarly, no difference in PFS, local PFS6 and OS were observable. Explorative analysis revealed that among patients of the KD-IF group, those who achieved ketosis of at least 1.5 mmol/l had significantly longer PFS compared to those with lesser or no ketosis.
CONCLUSION
KD-IF is feasible and effective in inducing ketosis in heavily pretreated patients with recurrent glioblastoma. However, the short schedule reported here failed to increase the efficacy of re-irradiation.
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Affiliation(s)
- M Voss
- Dr. Senckenberg Institute of Neurooncology, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - M Wagner
- Departement of Neuroradiology, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - N von Mettenheim
- Dr. Senckenberg Institute of Neurooncology, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - P N Harter
- Institute of Neurology (Edinger-Institute), University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - K Wenger
- Departement of Neuroradiology, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - K Franz
- Departement of Neurosurgery, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - J Bojunga
- Department of Medicine 1, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - R Gerlach
- Department of Neurosurgery, HELIOS Hospital Erfurt, Erfurt, Germany
| | - M Glatzel
- Department of Radiation Oncology, HELIOS Hospital Erfurt, Erfurt, Germany
| | - F Paulsen
- Department of Radiation Oncology, University Hospital Tübingen, Tübingen, Germany
| | - E Hattingen
- Departement of Neuroradiology, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - O Baehr
- Dr. Senckenberg Institute of Neurooncology, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - M W Ronellenfitsch
- Dr. Senckenberg Institute of Neurooncology, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - E Fokas
- Department of Radiotherapy and Oncology, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - D Imhoff
- Department of Radiotherapy and Oncology, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - J P Steinbach
- Dr. Senckenberg Institute of Neurooncology, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - C Rödel
- Department of Radiotherapy and Oncology, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - J Rieger
- Interdisciplinary Division of Neuro-Oncology, University Hospital Tübingen, Tübingen, Germany
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