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Ferdinandus J, van Heek L, Roth K, Dietlein M, Eich HT, Baues C, Borchmann P, Kobe C. Patterns of PET-positive residual tissue at interim restaging and risk of treatment failure in advanced-stage Hodgkin's lymphoma: an analysis of the randomized phase III HD18 trial by the German Hodgkin Study Group. Eur J Nucl Med Mol Imaging 2024; 51:490-495. [PMID: 37735258 PMCID: PMC10774157 DOI: 10.1007/s00259-023-06431-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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 09/06/2023] [Indexed: 09/23/2023]
Abstract
PURPOSE Response-adapted treatment using early interim functional imaging with PET after two cycles of chemotherapy (PET-2) for advanced-stage Hodgkin's lymphoma (AS-HL) is the standard of care in several countries. However, the distribution of residual metabolic disease in PET-2 and the prognostic relevance of multiple involved regions have not been reported to date. METHODS We retrospectively analyzed data from all PET-2-positive patients included in HD18. Residual tissue was visually compared with reference regions according to the Deauville score (DS). PET-2 positivity was defined as residual tissue with uptake above the liver (DS4). PFS was defined as the time from staging until progression, relapse, or death from any cause, or to the day when information was last received on the patient's disease status and analyzed using Kaplan-Meier and Cox regressions. Comparisons were made between patients with 1-2 and >2 positive regions in PET-2 as well as patients without PET-2-positive regions randomized into comparator arms of HD18. RESULTS Between 2008 and 2014, 1964 patients with newly diagnosed AS-HL were recruited in HD18 and randomized following their PET-2 scan. Of these, 480 patients had a positive PET-2 and were eligible for this analysis. Upper and lower mediastinum in almost half of all patients: 230 (47.9%) and 195 (40.6%), respectively. 372 (77.5%) of patients have 1-2 positive regions in PET-2. 5y-PFS for patients with 1-2 regions was 91.7% (CI95: 88.7-94.6) vs. 81.8% (CI95: 74.2-90.1) for those with >2 regions with a corresponding hazard ratio (HR) of 2.2 (CI95: 1.2-4.0). Compared with patients without PET-2-positive disease receiving 6-8 cycles of chemotherapy, patients with 1-2 had a higher risk for a PFS event (HR 1.35; CI95 0.81-2.28), but it was not statistically significant (p=0.25). Patients with >2 PET-2-positive lesions had a significantly higher risk (HR 2.95; CI95: 1.62-5.37; p<0.001). CONCLUSION PET-2-positive residuals of AS-HL are mostly located in the mediastinum, and a majority of patients have few affected regions. The risk of progression was twofold higher in patients with more than two positive regions in PET-2.
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Affiliation(s)
- Justin Ferdinandus
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Medical Faculty and University Hospital Cologne, Gleueler Straße 269-273, 50935, Cologne, Germany.
- German Hodgkin Study Group (GHSG), Cologne, Germany.
| | - Lutz van Heek
- German Hodgkin Study Group (GHSG), Cologne, Germany
- Department of Nuclear Medicine, University Hospital Cologne, Cologne, Germany
| | - Katrin Roth
- German Hodgkin Study Group (GHSG), Cologne, Germany
- Department of Nuclear Medicine, University Hospital Cologne, Cologne, Germany
| | - Markus Dietlein
- German Hodgkin Study Group (GHSG), Cologne, Germany
- Department of Nuclear Medicine, University Hospital Cologne, Cologne, Germany
| | - Hans-Theodor Eich
- German Hodgkin Study Group (GHSG), Cologne, Germany
- Department of Radiation Oncology, University Hospital Münster, Münster, Germany
| | - Christian Baues
- German Hodgkin Study Group (GHSG), Cologne, Germany
- Department of Radiotherapy and Cyberknife Center, University Hospital Cologne, Cologne, Germany
- Department of Radiooncology, Marienhospital Herne, Ruhr University Bochum, Bochum, Germany
| | - Peter Borchmann
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Medical Faculty and University Hospital Cologne, Gleueler Straße 269-273, 50935, Cologne, Germany
- German Hodgkin Study Group (GHSG), Cologne, Germany
| | - Carsten Kobe
- German Hodgkin Study Group (GHSG), Cologne, Germany
- Department of Nuclear Medicine, University Hospital Cologne, Cologne, Germany
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2
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Fuchs M, Jacob AS, Kaul H, Kobe C, Kuhnert G, Pabst T, Greil R, Bröckelmann PJ, Topp MS, Just M, Hertenstein B, Soekler M, Vogelhuber M, Zijlstra JM, Keller UB, Krause SW, Dührsen U, Meissner J, Viardot A, Eich HT, Baues C, Diehl V, Rosenwald A, Buehnen I, von Tresckow B, Dietlein M, Borchmann P, Engert A, Eichenauer DA. Follow-up of the GHSG HD16 trial of PET-guided treatment in early-stage favorable Hodgkin lymphoma. Leukemia 2024; 38:160-167. [PMID: 37845285 PMCID: PMC10776396 DOI: 10.1038/s41375-023-02064-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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 09/25/2023] [Accepted: 10/05/2023] [Indexed: 10/18/2023]
Abstract
The primary analysis of the GHSG HD16 trial indicated a significant loss of tumor control with PET-guided omission of radiotherapy (RT) in patients with early-stage favorable Hodgkin lymphoma (HL). This analysis reports long-term outcomes. Overall, 1150 patients aged 18-75 years with newly diagnosed early-stage favorable HL were randomized between standard combined-modality treatment (CMT) (2x ABVD followed by PET/CT [PET-2] and 20 Gy involved-field RT) and PET-2-guided treatment omitting RT in case of PET-2 negativity (Deauville score [DS] < 3). The study aimed at excluding inferiority of PET-2-guided treatment and assessing the prognostic impact of PET-2 in patients receiving CMT. At a median follow-up of 64 months, PET-2-negative patients had a 5-year progression-free survival (PFS) of 94.2% after CMT (n = 328) and 86.7% after ABVD alone (n = 300; HR = 2.05 [1.20-3.51]; p = 0.0072). 5-year OS was 98.3% and 98.8%, respectively (p = 0.14); 4/12 documented deaths were caused by second primary malignancies and only one by HL. Among patients assigned to CMT, 5-year PFS was better in PET-2-negative (n = 353; 94.0%) than in PET-2-positive patients (n = 340; 90.3%; p = 0.012). The difference was more pronounced when using DS4 as cut-off (DS 1-3: n = 571; 94.0% vs. DS ≥ 4: n = 122; 83.6%; p < 0.0001). Taken together, CMT should be considered standard treatment for early-stage favorable HL irrespective of the PET-2-result.
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Grants
- Sanofi-Genzyme, Takeda
- Employment/leadership position (University Hospital of Cologne, Head of the GHSG Trial Coordination Centre), honorarium (Celgene, BMS, Takeda, Affimed, Lukon, Janssen)
- Takeda Medical Research Foundation
- Bristol-Myers Squibb Company | Bristol-Myers Squibb Canada (BMS Canada)
- BeiGene, MSD Stemline
- Gilead Sciences (Gilead)
- Miltenyi Biotec
- Novartis
- Roche (F. Hoffmann-La Roche Ltd)
- Amgen (Amgen Inc.)
- Pfizer (Pfizer Inc.)
- Merck & Co., Inc. | Merck Sharp and Dohme (Merck Sharp & Dohme)
- AbbVie (AbbVie Inc.)
- AstraZeneca
- allogene, Cerus, incyte, IQVIA, Noscendo, Pentixapharm,
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Affiliation(s)
- Michael Fuchs
- German Hodgkin Study Group (GHSG), Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Cologne, Germany
| | - Anne Sophie Jacob
- German Hodgkin Study Group (GHSG), Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Cologne, Germany
| | - Helen Kaul
- German Hodgkin Study Group (GHSG), Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Cologne, Germany
| | - Carsten Kobe
- Department of Nuclear Medicine, University of Cologne, Cologne, Germany
| | | | - Thomas Pabst
- Department of Medical Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland
| | - Richard Greil
- IIIrd Medical Department, Paracelcus Medical University and Salzburg Cancer Research Institute, Salzburg, Austria
- Salzburg Cancer Research Institute and AGMT (Arbeitsgemeinschaft Medikamentöse Tumortherapie), Salzburg, Austria
| | - Paul J Bröckelmann
- German Hodgkin Study Group (GHSG), Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Cologne, Germany
| | - Max S Topp
- Medizinische Klinik und Poliklinik II, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Marianne Just
- Dres. med. Just/Düwel/Riesenberg/Steinke/Schäfer, Studiengesellschaft, Bielefeld, Germany
| | - Bernd Hertenstein
- Department of Internal Medicine I, Klinikum Bremen Mitte, Bremen, Germany
| | - Martin Soekler
- Onkology, Spital Thun, Switzerland, formerly University of Tübingen, Tübingen, Germany
| | - Martin Vogelhuber
- Medizinische Klinik III, Universitätsklinik Regensburg, Regensburg, Germany
| | - Josée M Zijlstra
- Department of Hematology, Amsterdam UMC, Vrije Universiteit, Amsterdam, Netherlands
| | - Ulrich Bernd Keller
- Department of Internal Medicine III, Klinikum "Rechts der Isar", Munich, Germany
| | - Stefan W Krause
- Department of Internal Medicine 5, Haematology/Oncology, Uniklinikum Erlangen, Erlangen, Germany
| | - Ulrich Dührsen
- Department of Haematology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | | | - Andreas Viardot
- Department of Internal Medicine III, University Hospital Ulm, Ulm, Germany
| | - Hans-Theodor Eich
- Department of Radiotherapy, University Hospital of Muenster, Muenster, Germany
| | - Christian Baues
- Department of Radiotherapy, University of Cologne, Cologne, Germany
| | - Volker Diehl
- German Hodgkin Study Group (GHSG), Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Cologne, Germany
| | - Andreas Rosenwald
- Institute of Pathology, Julius Maximilian University of Würzburg and Comprehensive Cancer Center Mainfranken, Würzburg, Germany
| | - Ina Buehnen
- German Hodgkin Study Group (GHSG), Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Cologne, Germany
| | - Bastian von Tresckow
- German Hodgkin Study Group (GHSG), Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Cologne, Germany
- Department of Haematology and Stem Cell Transplantation, West German Cancer Center and German Cancer Consortium (DKTK partner site Essen), University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Markus Dietlein
- Department of Nuclear Medicine, University of Cologne, Cologne, Germany
| | - Peter Borchmann
- German Hodgkin Study Group (GHSG), Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Cologne, Germany
| | - Andreas Engert
- German Hodgkin Study Group (GHSG), Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Cologne, Germany
| | - Dennis A Eichenauer
- German Hodgkin Study Group (GHSG), Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Cologne, Germany.
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3
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Eichenauer DA, Bühnen I, Baues C, Kobe C, Kaul H, Greil R, Moccia A, Zijlstra JM, Hertenstein B, Topp MS, Just M, von Tresckow B, Eich HT, Fuchs M, Dietlein M, Hartmann S, Engert A, Borchmann P. Interim PET-guided treatment for early-stage NLPHL: a subgroup analysis of the randomized GHSG HD16 and HD17 studies. Blood 2023; 142:553-560. [PMID: 37257195 DOI: 10.1182/blood.2023019939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 04/25/2023] [Accepted: 04/25/2023] [Indexed: 06/02/2023] Open
Abstract
The optimal first-line treatment for nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) diagnosed in early stages is largely undefined. We, therefore, analyzed 100 NLPHL patients treated in the randomized HD16 (early-stage favorable; n = 85) and HD17 (early-stage unfavorable; n = 15) studies. These studies investigated the omission of consolidation radiotherapy (RT) in patients with a negative interim positron emission tomography (iPET) (ie, Deauville score <3) after chemotherapy (HD16: 2× doxorubicin, bleomycin, vinblastine, and dacarbazine [ABVD]; HD17: 2× escalated bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone [BEACOPP] plus 2× ABVD). Patients with NLPHL treated in the HD16 and HD17 studies had 5-year progression-free survival (PFS) rates of 90.3% and 92.9%, respectively. Thus, the 5-year PFS did not differ significantly from that of patients with classical Hodgkin lymphoma treated within the same studies (HD16: P = .88; HD17: P = .50). Patients with early-stage favorable NLPHL who had a negative iPET after 2× ABVD and did not undergo consolidation RT tended to have a worse 5-year PFS than patients with a negative iPET who received consolidation RT (83% vs 100%; P = .05). There were 10 cases of NLPHL recurrence. However, no NLPHL patient died during follow-up. Hence, the 5-year overall survival rate was 100%. Taken together, contemporary Hodgkin lymphoma-directed treatment approaches result in excellent outcomes for patients with newly diagnosed early-stage NLPHL and, thus, represent valid treatment options. In early-stage favorable NLPHL, consolidation RT appears necessary after 2× ABVD to achieve the optimal disease control irrespective of the iPET result.
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Affiliation(s)
- Dennis A Eichenauer
- First Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, University of Cologne, Cologne, Germany
- German Hodgkin Study Group, University Hospital Cologne, Cologne, Germany
| | - Ina Bühnen
- First Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, University of Cologne, Cologne, Germany
- German Hodgkin Study Group, University Hospital Cologne, Cologne, Germany
| | - Christian Baues
- German Hodgkin Study Group, University Hospital Cologne, Cologne, Germany
- Department of Radiation Oncology, University of Cologne, Cologne, Germany
| | - Carsten Kobe
- German Hodgkin Study Group, University Hospital Cologne, Cologne, Germany
- Department of Nuclear Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Helen Kaul
- First Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, University of Cologne, Cologne, Germany
- German Hodgkin Study Group, University Hospital Cologne, Cologne, Germany
| | - Richard Greil
- Salzburg Cancer Research Institute, Center for Clinical Cancer and Immunology Trials, Cancer Cluster Salzburg, Austrian Group for Medical Tumor Therapy, Paracelsus Medical University, Salzburg, Austria
| | - Alden Moccia
- Department of Medical Oncology, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
- Swiss Group for Clinical Cancer Research, Bern, Switzerland
| | - Joseé M Zijlstra
- Department of Hematology, Amsterdam UMC, Vrije universiteit, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Bernd Hertenstein
- Department of Internal Medicine I, Klinikum Bremen-Mitte, Bremen, Germany
| | - Max S Topp
- Second Department of Internal Medicine, University Hospital Würzburg, Würzburg, Germany
| | - Marianne Just
- Onkologische Schwerpunktpraxis Bielefeld, Bielefeld, Germany
| | - Bastian von Tresckow
- German Hodgkin Study Group, University Hospital Cologne, Cologne, Germany
- Department of Hematology and Stem Cell Transplantation, University Hospital Essen, University Duisburg-Essen, German Cancer Consortium (DKTK partner site Essen), Essen, Germany
| | - Hans-Theodor Eich
- German Hodgkin Study Group, University Hospital Cologne, Cologne, Germany
- Department of Radiotherapy, University Hospital Münster, Münster, Germany
| | - Michael Fuchs
- First Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, University of Cologne, Cologne, Germany
- German Hodgkin Study Group, University Hospital Cologne, Cologne, Germany
| | - Markus Dietlein
- German Hodgkin Study Group, University Hospital Cologne, Cologne, Germany
- Department of Nuclear Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Sylvia Hartmann
- Dr. Senckenberg Institute of Pathology, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Andreas Engert
- First Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, University of Cologne, Cologne, Germany
- German Hodgkin Study Group, University Hospital Cologne, Cologne, Germany
| | - Peter Borchmann
- First Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, University of Cologne, Cologne, Germany
- German Hodgkin Study Group, University Hospital Cologne, Cologne, Germany
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4
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Heesen P, Ranft A, Bhadri V, Brichard B, Collaud S, Cyprova S, Eich HT, Ek T, Gelderblom H, Havemann L, Hauser P, Juergens H, Kanerva J, Kuehne T, Raciborska A, Rascon J, Streitbuerger A, Timmermann B, Uhlenbruch Y, Dirksen U. Value of adjuvant radiotherapy in patients with localized Ewing sarcoma at the extremities: Report from the Ewing 2008 trial. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.11531] [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: 11/20/2022] Open
Abstract
11531 Background: In patients with Ewing Sarcoma (EWS), adjuvant radiotherapy is often performed after surgery that could not obtain wide margins or after poor histological response to surgery. However, the benefit of adjuvant radiotherapy needs further investigation. Therefore, we compared event-free survival (EFS) between surgery (SX) alone and SX combined with radiation therapy (RT), performed a subgroup analysis and identified independent prognostic factors. Methods: The data from localized EWS patients with tumors at the extremities that were treated in the Ewing 2008 trial from 2009-2018 were included in this analysis. Patients received induction chemotherapy according to the protocol and then underwent local therapy. Patients receiving SX or adjuvant RT (combined SX/RT) were included in this analysis. Hazard ratios (HRs) (95% Confidence Intervals (CIs)) were calculated using Cox regression. Results: 360 out of 863 patients (41.7%) presented with an EWS at the extremities with 81 tumors at the upper extremity, and 279 tumors at the lower extremity. Most patients were treated with surgery only (223, 61.94%), while 125 patients (34.72%) were treated with SX plus RT. Adjuvant radiotherapy was conducted after a median time of 69 days (1st quartile, 3rd quartile; 54, 109). Median EFS at 5-years for all patients was 0.74 (0.69, 0.80), 0.76 (0.70, 0.83) for patients after surgery only, and 0.73 (0.64, 0.83) after combined RT/SX. After adjusting for sex, age, tumor volume, histological response and surgical margins, the HR for combined RT/SX vs SX alone was 0.69 (0.37, 1.26), p = 0.22. In patients with poor histological response to surgery (≥10% vital tumor cells) and with high tumor volume (≥ 200mL), additional radiotherapy did not decrease the hazards of any event, HR 0.72 (0.25, 2.06), p = 0.54. We identified high tumor volume, poor histological response to surgery as well as intralesional resection of the tumor as independent prognostic factors after adjusting for other known prognostic factors with HRs of 1.73 (1.04, 2.90), p = 0.03; 2.79 (1.69, 4.62), p < 0.0001 and 215.9 (13.17, 3538.61), p = 0.0002, respectively. Surgical complication was not a prognostic factor after adjusting for above mentioned variables, HR 0.85 (0.31, 2.34), p = 0.75. Conclusions: In our cohort, adjuvant radiotherapy was not superior compared to surgery alone in all patients with localized EWS at the extremities and neither in a subgroup of patients with high-risk factors. Poor histological response, intralesional tumor resection as well as high tumor volume were identified as independent negative prognostic factors. Clinical trial information: NCT00987636.
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Affiliation(s)
| | - Andreas Ranft
- Pediatrics III, West German Cancer Centre Essen, University Hospital Essen, German Cancer Consortium Essen, Essen, Germany
| | | | - Bénédicte Brichard
- Department of Pediatric Oncology and Hematology, Cliniques Universitaires Saint Luc, Brussels, Belgium
| | - Stephane Collaud
- Department of Thoracic Surgery and Thoracic Endoscopy-Ruhrlandklinik, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Sona Cyprova
- Charles University, Motol Children´s Hospital, Prague, Czech Republic
| | | | - Torben Ek
- Children´s Cancer Centre, Queen Silvia Children´s Hospital, Gothenburg, Sweden
| | | | | | - Peter Hauser
- Velkey László Child’s, Health Center, Miskolc, Hungary
| | | | - Jukka Kanerva
- HUS Helsinki University Hospital, New Children’s Hospital Division of Hematology-Oncology and Stem Cell Transplantation, Helsinki, Finland
| | - Thomas Kuehne
- University Children's Hospital Basel, Basel, Switzerland
| | - Anna Raciborska
- Department of Oncology and Surgical Oncology for Children and Youth, Mother and Child Institute, Warsaw, Warsaw, Poland
| | - Jelena Rascon
- Center for Pediatric Oncology and Hematology, Vilnius University, Vilnius, Lithuania
| | - Arne Streitbuerger
- Tumororthopedics and Sarcomasurgery, West German Cancer Centre, University Hospital Essen, German Cancer Consortium (DKTK), Essen, Germany
| | - Beate Timmermann
- West German Proton Therapy Centre, Clinic for Particle Therapy, Essen, Germany
| | | | - Uta Dirksen
- Pediatrics III, University Hospital Essen, West German Cancer Center, Essen, Germany
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5
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Buske C, Dreyling M, Alvarez-Larrán A, Apperley J, Arcaini L, Besson C, Bullinger L, Corradini P, Giovanni Della Porta M, Dimopoulos M, D'Sa S, Eich HT, Foà R, Ghia P, da Silva MG, Gribben J, Hajek R, Harrison C, Heuser M, Kiesewetter B, Kiladjian JJ, Kröger N, Moreau P, Passweg JR, Peyvandi F, Rea D, Ribera JM, Robak T, San-Miguel JF, Santini V, Sanz G, Sonneveld P, von Lilienfeld-Toal M, Wendtner C, Pentheroudakis G, Passamonti F. Managing hematological cancer patients during the COVID-19 pandemic: an ESMO-EHA Interdisciplinary Expert Consensus. ESMO Open 2022; 7:100403. [PMID: 35272130 PMCID: PMC8795783 DOI: 10.1016/j.esmoop.2022.100403] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 01/13/2022] [Accepted: 01/18/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has created enormous challenges for the clinical management of patients with hematological malignancies (HMs), raising questions about the optimal care of this patient group. METHODS This consensus manuscript aims at discussing clinical evidence and providing expert advice on statements related to the management of HMs in the COVID-19 pandemic. For this purpose, an international consortium was established including a steering committee, which prepared six working packages addressing significant clinical questions from the COVID-19 diagnosis, treatment, and mitigation strategies to specific HMs management in the pandemic. During a virtual consensus meeting, including global experts and lead by the European Society for Medical Oncology and the European Hematology Association, statements were discussed and voted upon. When a consensus could not be reached, the panel revised statements to develop consensual clinical guidance. RESULTS AND CONCLUSION The expert panel agreed on 33 statements, reflecting a consensus, which will guide clinical decision making for patients with hematological neoplasms during the COVID-19 pandemic.
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Affiliation(s)
- C Buske
- Institute of Experimental Cancer Research, Department of Internal Medicine III, University Hospital Ulm, Ulm, Germany.
| | - M Dreyling
- Department of Medicine III at LMU Hospital, Munich, Germany
| | - A Alvarez-Larrán
- Hematology Department, Hospital Clínic, IDIBAPS, Barcelona, Spain
| | - J Apperley
- Centre for Haematology, Imperial College London, Hammersmith Hospital, London, UK
| | - L Arcaini
- Division of Hematology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - C Besson
- Service d'Hématologie Oncologie, Centre Hospitalier de Versailles, Le Chesnay, France; UVSQ, Inserm, CESP, Villejuif, France
| | - L Bullinger
- Department of Hematology, Oncology, and Tumorimmunology, Campus Virchow Klinikum, Berlin, Germany; Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - P Corradini
- Hematology Division, University of Milan, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - M Giovanni Della Porta
- Cancer Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - M Dimopoulos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - S D'Sa
- UCLH Centre for Waldenström and Neurohaematology, University College London Hospitals NHS Foundation Trust, London, UK
| | - H T Eich
- Department of Radiation Oncology, University of Muenster, Münster, Germany
| | - R Foà
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - P Ghia
- Strategic Research Program on Chronic Lymphocytic Leukemia and Laboratory of B Cell Neoplasia, Division of Molecular Oncology, Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milan, Italy
| | - M G da Silva
- Department Of Hematology, Portuguese Institute of Oncology, Lisbon, Portugal
| | - J Gribben
- Barts Cancer Institute, Queen Mary University of London, London, UK
| | - R Hajek
- Department of Hematooncology, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - C Harrison
- Clinical Director - Haematology, Haemostasis, Palliative Care, Cellular Pathology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - M Heuser
- Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hanover, Germany
| | - B Kiesewetter
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - J J Kiladjian
- Université de Paris, APHP, Hôpital Saint-Louis, Centre d'Investigations Cliniques, Paris, France
| | - N Kröger
- Department of Stem Cell Transplantation, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - P Moreau
- Hematology Department, University Hospital Hotel-Dieu, Nantes, France
| | - J R Passweg
- Hematology Division, Basel University Hospital, Basel, Switzerland
| | - F Peyvandi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - D Rea
- University Medical Department of Hematology and Immunology, France Intergroupe des Leucémies Myéloïdes Chroniques (Fi-LMC), Hôpital Saint-Louis, Paris, France
| | - J-M Ribera
- Clinical Hematology Department, ICO-Hospital Germans Trias i Pujol, Josep Carreras Research Institute, Universitat Autònoma de Barcelona, Badalona, Spain
| | - T Robak
- Department of Hematology, Medical University of Lodz, Lodz, Poland
| | - J F San-Miguel
- Clínica Universidad de Navarra (CUN), Centro de Investigación Aplicada (CIMA), Instituto de Investigación Sanitaria de Navarra (IDISNA), CIBERONC, Pamplona, Spain
| | - V Santini
- MDS Unit, Hematology, DMSC, AOUC, University of Florence, Florence, Italy
| | - G Sanz
- Hematology Department, Hospital Univesitario y Politecnico La Fe, Valencia; CIBERONC, IS Carlos III, Madrid, Spain
| | - P Sonneveld
- Erasmus MC Cancer Institute, Department of Haematology, Rotterdam, The Netherlands
| | - M von Lilienfeld-Toal
- Department of Hematology and Medical Oncology, University Hospital Jena, Jena, Germany; Leibniz Institute for Natural Product Research and Infection Biology, Hans Knöll Institute, Jena, Germany
| | - C Wendtner
- Munich Clinic Schwabing, Academic Teaching Hospital, Ludwig-Maximilian University, Munich, Germany
| | - G Pentheroudakis
- Scientific and Medical Division, European Society for Medical Oncology, Lugano, Switzerland
| | - F Passamonti
- Department of Medicine and Surgery, University of Insubria, Varese, Italy.
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6
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Dirksen U, Ranft A, Baumhoer D, van den Berg H, Brichard B, Eich HT, Gelderblom H, Hardes J, Hartmann W, Juergens H, Kollar A, Kruseova J, Kuehne T, Ladenstein RL, Leithner A, Streitbuerger A, Timmermann B, Tunn PU, Andreou D. Association of treatment delays with an unfavorable outcome in patients with localized Ewing sarcoma: A retrospective analysis of data from the GPOH Euro-E.W.I.N.G.99 trial. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.11502] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
11502 Background: Outcome in EwS has improved by the implementation of dose or time intense systemic treatment. Aim of the study was evaluate whether treatment delays have impact on outcome of patients with localized Ewing sarcoma (EWS). Methods: Data from 692 patients with a tumor of the extremities, the pelvis, the chest wall and the trunk registered in the international database of the German Society for Pediatric Oncology and Hematology (GPOH) and treated in the Euro-E.W.I.N.G. 99 trial (NCT00020566) were analyzed. All patients underwent surgical treatment after induction chemotherapy. The optimal interval cut-off values for survival analyses were calculated with receiver operating characteristics curves. Hazard ratios (HR) were estimated with respective 95% confidence intervals (CI) in multivariate Cox regression models. Results: As per protocol, patients were to receive six cycles of VIDE induction chemotherapy in 21-day intervals. The duration between induction cycles as per protocol was fulfilled in only 5% of patients. In 72% of patients, the average interval duration between induction chemotherapy cycles was 25 days. Median interval between day 1 of the first induction chemotherapy cycle and definitive tumor surgery was 141 (IQR, 133 – 153) days in patients receiving six VIDE cycles prior to surgery. The optimal cut-off value for survival analyses in these patients amounted to 150 days. Patients with a duration of induction chemotherapy > 150 days were at higher risk to develop an event (HR, 1.546; 95% CI, 1.103 – 2.166) and had a higher risk of death (HR, 1.574; 95% CI, 1.095 – 2.262), compared to patients with a duration of induction chemotherapy < 150 days. Patients with delays during the induction chemotherapy also experienced a significant delay between VIDE 6 and surgery (36 vs. 27 days, p < 0.001) and were treated significantly more often at smaller low-volume centers (63% vs. 48%, p = 0.005). Patients with a prolonged interval > 21 days between surgery and day one of postoperative chemotherapy were at a higher risk to develop an event (HR, 1.406; 95% CI, 1.011 – 1.955), and also had a significantly higher rate of postoperative complications (26% vs. 11%, p < 0.001), compared to patients with a shorter interval. Conclusions: Delays between induction chemotherapy and surgery and between surgery and consolidation chemotherapy are independently associated with a poor outcome in patients with localized EWS. Our results also underscore the need to treat EWS patients in larger and experienced sarcoma centers. The implementation of new and standardized methods in the operative strategy and optimized supportive care during systemic therapy are required to reduce perioperative morbidity and treatment delays.
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Affiliation(s)
- Uta Dirksen
- Pediatrics III, West German Cancer Center, University Hospital Essen, German Cancer Consortium (DKTK), Essen, Germany
| | - Andreas Ranft
- Pediatrics III, West German Cancer Centre Essen, University Hospital Essen, German Cancer Consortium Essen, Essen, Germany
| | - Daniel Baumhoer
- Bone Tumour Reference Center at the Institute of Pathology, University Hospital Basel, Basel, Switzerland
| | | | - Bénédicte Brichard
- Department of Pediatric Oncology and Hematology, Cliniques Universitaires Saint Luc, Brussels, Belgium
| | | | - Hans Gelderblom
- Department of Medical Oncology, Leiden University Medical Center, Leiden, Netherlands
| | - Jendrik Hardes
- Tumororthopedics and Sarcomasurgery, West German Cancer Centre, University Hospital Essen, German Cancer Consortium, Essen, Germany
| | - Wolfgang Hartmann
- Gerhard-Domagk-Institute of Pathology, University Hospital of Muenster, Muenster, Germany
| | | | - Attila Kollar
- Medical Oncology Inselspital Bern, Bern, Switzerland
| | - Jarmila Kruseova
- Charles University, 2nd School of Medicine, Department of Paediatric Haematology and Oncology, Prague, Czech Republic
| | - Thomas Kuehne
- University Children's Hospital Basel, Basel, Switzerland
| | - Ruth Lydia Ladenstein
- St. Anna Children's Hospital and St. Anna Kinderkrebsforschung, Department of Paediatrics, Medical University Vienna, Vienna, Austria
| | - Andreas Leithner
- Medical University of Graz, Department of Orthopaedic Surgery, Graz, Austria
| | - Arne Streitbuerger
- Tumororthopedics and Sarcomasurgery, West German Cancer Centre, University Hospital Essen, German Cancer Consortium (DKTK), Essen, Germany
| | - Beate Timmermann
- West German Proton Therapy Centre, Clinic for Particle Therapy, Essen, Germany
| | - Per-Ulf Tunn
- Department of Orthopedic Oncology, Sarcoma Centre, Helios Klinikum Berlin-Buch, Berlin, Germany
| | - Dimosthenis Andreou
- Division of Orthopedic Oncology and Sarcoma Surgery, Sarcoma Center Berlin-Brandenburg, Helios Hospital Bad Saarow, Bad Saarow, Germany
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7
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Oertel M, Elsayad K, Engenhart-Cabillic R, Reinartz G, Baues C, Schmidberger H, Vordermark D, Marnitz S, Lukas P, Ruebe C, Engert A, Lenz G, Eich HT. Radiation treatment of hemato-oncological patients in times of the COVID-19 pandemic : Expert recommendations from the radiation oncology panels of the German Hodgkin Study Group and the German Lymphoma Alliance. Strahlenther Onkol 2020; 196:1096-1102. [PMID: 33125504 PMCID: PMC7596809 DOI: 10.1007/s00066-020-01705-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 10/22/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE The coronavirus pandemic is affecting global health systems, endangering daily patient care. Hemato-oncological patients are particularly vulnerable to infection, requiring decisive recommendations on treatment and triage. The aim of this survey amongst experts on radiation therapy (RT) for lymphoma and leukemia is to delineate typical clinical scenarios and to provide counsel for high-quality care. METHODS A multi-item questionnaire containing multiple-choice and free-text questions was developed in a peer-reviewed process and sent to members of the radiation oncology panels of the German Hodgkin Study Group and the German Lymphoma Alliance. Answers were assessed online and analyzed centrally. RESULTS Omission of RT was only considered in a minority of cases if alternative treatment options were available. Hypofractionated regimens and reduced dosages may be used for indolent lymphoma and fractures due to multiple myeloma. Overall, there was a tendency to shorten RT rather than to postpone or omit it. Even in case of critical resource shortage, panelists agreed to start emergency RT for typical indications (intracranial pressure, spinal compression, superior vena cava syndrome) within 24 h. Possible criteria to consider for patient triage are the availability of (systemic) options, the underlying disease dynamic, and the treatment rationale (curative/palliative). CONCLUSION RT for hemato-oncological patients receives high-priority and should be maintained even in later stages of the pandemic. Hypofractionation and shortened treatment schedules are feasible options for well-defined constellations, but have to be discussed in the clinical context.
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Affiliation(s)
- M Oertel
- Department of Radiation Oncology, University Hospital Muenster, Albert-Schweitzer-Campus 1 building A1, 48149, Muenster, Germany
| | - K Elsayad
- Department of Radiation Oncology, University Hospital Muenster, Albert-Schweitzer-Campus 1 building A1, 48149, Muenster, Germany
| | - R Engenhart-Cabillic
- Department of Radiotherapy and Radiation Oncology, University Hospital Giessen-Marburg, Marburg, Germany
| | - G Reinartz
- Department of Radiation Oncology, University Hospital Muenster, Albert-Schweitzer-Campus 1 building A1, 48149, Muenster, Germany
| | - C Baues
- Department of Radiation Oncology and Cyberknife Center, University Hospital of Cologne, Cologne, Germany
| | - H Schmidberger
- Department of Radiotherapy and Radiation Oncology, University Hospital Mainz, Mainz, Germany
| | - D Vordermark
- Department of Radiation Oncology, University Hospital Halle (Saale), Halle (Saale), Germany
| | - S Marnitz
- Department of Radiation Oncology and Cyberknife Center, University Hospital of Cologne, Cologne, Germany
| | - P Lukas
- Department of Radiooncology, Medical University Innsbruck, Innsbruck, Austria
| | - C Ruebe
- Department of Radiation Oncology, Saarland University Hospital, Homburg, Germany
| | - A Engert
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf, University Hospital of Cologne, Cologne, Germany
| | - G Lenz
- Department of Medicine A, Hematology, Oncology, University Hospital Muenster, Muenster, Germany
| | - H T Eich
- Department of Radiation Oncology, University Hospital Muenster, Albert-Schweitzer-Campus 1 building A1, 48149, Muenster, Germany.
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8
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Baehr A, Trog D, Oertel M, Welsch S, Kröger K, Grauer O, Haverkamp U, Eich HT. Re-irradiation for recurrent glioblastoma multiforme: a critical comparison of different concepts. Strahlenther Onkol 2020; 196:457-464. [PMID: 32016497 DOI: 10.1007/s00066-020-01585-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 06/24/2019] [Accepted: 01/16/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE Purpose of this study was to investigate outcome and toxicity of re-irradiation for recurrent primary glioblastoma (rGBM). We evaluated a group of patients with rGBM and identical primary treatment comprising adjuvant radiotherapy (30 × 2 Gy) with concurrent temozolomide (TMZ). METHODS In this retrospective study of 46 patients, all received adjuvant or definitive normofractionated radiotherapy to a pretreated area, some with concurrent chemotherapy. Impact of different clinical, histological, or epidemiological factors on survival and radiation toxicity was reviewed. RESULTS Of 46 patients, 40 completed the intended therapy. Overall survival (OS) was 20 months (range 6-72 months). Overall survival and progression-free survival after re-irradiation (OS2 and PFS2) were 9.5 and 3.4 months (range 2-40 and 0.7-44 months). Simultaneous systemic therapy improved PFS2 and OS2 (4.3 vs. 2.0, p < 0.001 and 12 vs. 4 months, p = 0.13, respectively). Therapy with TMZ or bevacizumab improved PFS2 vs. nitrosureas (6.6 vs. 2.9, p = 0.03 and 5.1 vs. 2.9 months, p = 0.035, respectively). TMZ also improved PFS2 and OS2 vs. all other systemic therapies (6.6 vs. 4, p < 0.001 and 17 vs. 10 months, p = 0.1). In a subgroup analysis for patients with methylation of the MGMT promoter, doses of >36 Gy as well as TMZ vs. no systemic therapy improved PFS2 (p = 0.045 and p = 0.03, respectively). 27.5% of all patients had no acute toxicity. Three patients with acute and four patients with late grade 3 toxicities were reported. CONCLUSION Normofractionated radiotherapy is a feasible option for rGBM with a good toxicity profile. Simultaneously applied systemic therapy was associated with improved outcome. For MGMT promoter-methylated histology, higher radiation doses improved survival.
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Affiliation(s)
- A Baehr
- Department of Radiation Oncology, University Hospital Münster, Albert-Schweitzer Campus 1, 48149, Muenster, Germany.
| | - D Trog
- Department of Radiation Oncology, University Hospital Münster, Albert-Schweitzer Campus 1, 48149, Muenster, Germany
| | - M Oertel
- Department of Radiation Oncology, University Hospital Münster, Albert-Schweitzer Campus 1, 48149, Muenster, Germany
| | - S Welsch
- Department of Radiation Oncology, University Hospital Münster, Albert-Schweitzer Campus 1, 48149, Muenster, Germany
| | - K Kröger
- Department of Radiation Oncology, University Hospital Münster, Albert-Schweitzer Campus 1, 48149, Muenster, Germany
| | - O Grauer
- Department of Neurology, University Hospital Münster, Albert-Schweitzer Campus 1, 48149, Muenster, Germany
| | - U Haverkamp
- Department of Radiation Oncology, University Hospital Münster, Albert-Schweitzer Campus 1, 48149, Muenster, Germany
| | - H T Eich
- Department of Radiation Oncology, University Hospital Münster, Albert-Schweitzer Campus 1, 48149, Muenster, Germany
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9
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Dietz A, Wichmann G, Kuhnt T, Pfreundner L, Hagen R, Scheich M, Kölbl O, Hautmann MG, Strutz J, Schreiber F, Bockmühl U, Schilling V, Feyer P, de Wit M, Maschmeyer G, Jungehülsing M, Schroeder U, Wollenberg B, Sittel C, Münter M, Lenarz T, Klussmann JP, Guntinas-Lichius O, Rudack C, Eich HT, Foerg T, Preyer S, Westhofen M, Welkoborsky HJ, Esser D, Thurnher D, Remmert S, Sudhoff H, Görner M, Bünzel J, Budach V, Held S, Knödler M, Lordick F, Wiegand S, Vogel K, Boehm A, Flentje M, Keilholz U. Induction chemotherapy (IC) followed by radiotherapy (RT) versus cetuximab plus IC and RT in advanced laryngeal/hypopharyngeal cancer resectable only by total laryngectomy-final results of the larynx organ preservation trial DeLOS-II. Ann Oncol 2019; 29:2105-2114. [PMID: 30412221 DOI: 10.1093/annonc/mdy332] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [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
Background The German multicenter randomized phase II larynx organ preservation (LOP) trial DeLOS-II was carried out to prove the hypothesis that cetuximab (E) added to induction chemotherapy (IC) and radiotherapy improves laryngectomy-free survival (LFS; survival with preserved larynx) in locally advanced laryngeal/hypopharyngeal cancer (LHSCC). Patients and methods Treatment-naïve patients with stage III/IV LHSCC amenable to total laryngectomy (TL) were randomized to three cycles IC with TPF [docetaxel (T) and cisplatin (P) 75 mg/m2/day 1, 5-FU (F) 750 mg/m2/day days 1-5] followed by radiotherapy (69.6 Gy) without (A) or with (B) standard dose cetuximab for 16 weeks throughout IC and radiotherapy (TPFE). Response to first IC-cycle (IC-1) with ≥30% endoscopically estimated tumor surface shrinkage (ETSS) was used to define early responders; early salvage TL was recommended to non-responders. The primary objective was 24 months LFS above 35% in arm B. Results Of 180 patients randomized (July 2007 to September 2012), 173 fulfilled eligibility criteria (A/B: larynx 44/42, hypopharynx 41/46). Because of 4 therapy-related deaths among the first 64 randomized patients, 5-FU was omitted from IC in the subsequent 112 patients reducing further fatal toxicities. Thus, IC was TPF in 61 patients and TP in 112 patients, respectively. The primary objective (24 months LFS above 35%) was equally met by arms A (40/85, 47.1%) as well as B (41/88, 46.6%). One hundred and twenty-three early responders completed IC+RT; their overall response rates (TPF/TP) were 94.7%/87.2% in A versus 80%/86.0% in B. The 24 months overall survival (OS) rates were 68.2% and 69.3%. Conclusions Despite being accompanied by an elevated frequency in adverse events, the IC with TPF/TP plus cetuximab was feasible but showed no superiority to IC with TPF/TP regarding LFS and OS at 24 months. Both early response and 24 months LFS compare very well to previous LOP trials and recommend effective treatment selection and stratification by ETSS. Clinical trial information NCT00508664.
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Affiliation(s)
- A Dietz
- Department of Otolaryngology, Head and Neck Surgery, University Leipzig, Leipzig, Germany.
| | - G Wichmann
- Department of Otolaryngology, Head and Neck Surgery, University Leipzig, Leipzig, Germany
| | - T Kuhnt
- Department of Radiation Oncology, University Leipzig, Leipzig, Germany
| | - L Pfreundner
- Department of Radiation Oncology, University Würzburg, Würzburg, Germany
| | - R Hagen
- Department of Otolaryngology, Head and Neck Surgery, University Würzburg, Würzburg, Germany
| | - M Scheich
- Department of Otolaryngology, Head and Neck Surgery, University Würzburg, Würzburg, Germany
| | - O Kölbl
- Department of Radiation Oncology, University Regensburg, Regensburg, Germany
| | - M G Hautmann
- Department of Radiation Oncology, University Regensburg, Regensburg, Germany
| | - J Strutz
- Department of Otolaryngology, Head and Neck Surgery, University Regensburg, Regensburg, Germany
| | - F Schreiber
- Department of Otolaryngology, Head and Neck Surgery, Klinikum Kassel, Kassel, Germany
| | - U Bockmühl
- Department of Otolaryngology, Head and Neck Surgery, Klinikum Kassel, Kassel, Germany
| | - V Schilling
- Department of Otolaryngology, Head and Neck Surgery, Vivantes, Berlin, Neukölln, Germany
| | - P Feyer
- Department of Radiation Oncology, Vivantes, Berlin, Neukölln, Germany
| | - M de Wit
- Department of Hemato-Oncology, Vivantes, Berlin, Neukölln, Germany
| | - G Maschmeyer
- Department of Hematology, Oncology and Palliative Care, Klinikum Ernst von Bergmann, Potsdam, Germany
| | - M Jungehülsing
- Department of Otolaryngology, Head and Neck Surgery, Potsdam Klinikum, Potsdam, Germany
| | - U Schroeder
- Department of Otolaryngology, Head and Neck Surgery, University Lübeck, Lübeck, Germany
| | - B Wollenberg
- Department of Otolaryngology, Head and Neck Surgery, University Lübeck, Lübeck, Germany
| | - C Sittel
- Department of Otolaryngology, Head and Neck Surgery, Katharinen Hospital, Stuttgart, Germany
| | - M Münter
- Department of Radiation Oncology, Katharinen Hospital, Stuttgart, Germany
| | - T Lenarz
- Department of Otolaryngology, Head and Neck Surgery, MHH Hannover, Hannover, Germany
| | - J P Klussmann
- Department of Otolaryngology, Head and Neck Surgery, University Gießen, Gießen, Germany
| | - O Guntinas-Lichius
- Department of Otolaryngology, Head and Neck Surgery, Jena University Hospital, Jena, Germany
| | - C Rudack
- Department of Otolaryngology, Head and Neck Surgery, University Münster, Münster, Germany
| | - H T Eich
- Department of Radiation Oncology, University Münster, Münster, Germany
| | - T Foerg
- Department of Radiation Oncology, Head and Neck Surgery, St. Vincentius, ViDia Christliche Kliniken Karlsruhe, Karlsruhe, Germany
| | - S Preyer
- Department of Otolaryngology, Head and Neck Surgery, St. Vincentius, ViDia Christliche Kliniken Karlsruhe, Karlsruhe, Germany
| | - M Westhofen
- Department of Otolaryngology, Head and Neck Surgery, University Aachen, Aachen, Germany
| | - H J Welkoborsky
- Department of Otolaryngology, Head and Neck Surgery, Klinikum Nordstadt, Hannover, Germany
| | - D Esser
- Department of Otolaryngology, Head and Neck Surgery, Helios Klinikum, Erfurt, Germany
| | - D Thurnher
- Department of Otolaryngology, Head and Neck Surgery, University Graz, Graz, Austria
| | - S Remmert
- Department of Otolaryngology, Head and Neck Surgery, Malteser Hospital Duisburg, Duisburg, Germany
| | - H Sudhoff
- Department of Otolaryngology, Head and Neck Surgery, Klinikum Bielefeld, Bielefeld, Germany
| | - M Görner
- Department of Hemato-Oncology, Klinikum Bielefeld, Bielefeld, Germany
| | - J Bünzel
- Department of Otolaryngology, Head and Neck Surgery, Klinikum Nordhausen, Nordhausen, Germany
| | - V Budach
- Department of Radiation Oncology, CCC, Charité-University Medicine, Berlin, Germany
| | - S Held
- ClinAssess GmbH, Leverkusen, Germany
| | - M Knödler
- Department of Oncology, University Cancer Center Leipzig (UCCL), Leipzig, Germany
| | - F Lordick
- Department of Oncology, University Cancer Center Leipzig (UCCL), Leipzig, Germany
| | - S Wiegand
- Department of Otolaryngology, Head and Neck Surgery, University Leipzig, Leipzig, Germany
| | - K Vogel
- Department of Otolaryngology, Head and Neck Surgery, University Leipzig, Leipzig, Germany
| | - A Boehm
- Department of Otolaryngology, Head and Neck Surgery, St. Georg Hospital Leipzig, Leipzig, Germany
| | - M Flentje
- Department of Radiation Oncology, University Würzburg, Würzburg, Germany
| | - U Keilholz
- Charité Comprehensive Cancer Center, Berlin, Germany
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10
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Oertel M, Eich HT. Some Necessary Additional Points. Dtsch Arztebl Int 2018; 115:417. [PMID: 29968561 PMCID: PMC6050430 DOI: 10.3238/arztebl.2018.0417a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Michael Oertel
- *Klinik für Strahlentherapie – Radioonkologie, Universitätsklinikum Münster
| | - Hans-Theodor Eich
- *Klinik für Strahlentherapie – Radioonkologie, Universitätsklinikum Münster
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11
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Dabaja BS, Zelenetz AD, Ng AK, Tsang RW, Qi S, Allen PK, Hodgson D, Ricardi U, Hoppe RT, Advani R, Mauch PM, Constine LS, Specht L, Li Y, Terezakis SA, Wirth A, Reinartz G, Eich HT, Aleman BMP, Barr P, Yahalom J. Early-stage mantle cell lymphoma: a retrospective analysis from the International Lymphoma Radiation Oncology Group (ILROG). Ann Oncol 2018; 28:2185-2190. [PMID: 28911068 DOI: 10.1093/annonc/mdx334] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Mantle cell lymphoma (MCL) rarely presents as early-stage disease, but clinical observations suggest that patients who present with early-stage disease may have better outcomes than those with advanced-stage disease. Patients and methods In this 13-institution study, we examined outcomes among 179 patients with early-stage (stage I or II) MCL in an attempt to identify prognostic factors that influence treatment selection and outcome. Variables examined included clinical characteristics, treatment modality, response to therapy, sites of failure, and survival. Results Patients were predominantly male (78%) with head and neck being the most common presenting sites (75%). Most failures occurred outside the original disease site (79%). Although the administration of radiation therapy, either alone or with chemotherapy, reduced the risk of local failure, it did not translate into an improved freedom from progression or overall survival (OS). The treatment outcomes were independent of treatment modality. The 10-year OS for patients treated with chemotherapy alone, chemo-radiation therapy and radiation therapy alone were 69%, 62%, and 74% (P = 0.79), and the 10-year freedom from progression were 46%, 43%, and 31% (P = 0.64), respectively. Conclusion Given the excellent OS rates regardless of initial therapy in patients with early-stage MCL, de-intensified therapy to limit treatment-related toxicity is a reasonable approach.
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Affiliation(s)
- B S Dabaja
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - A D Zelenetz
- Memorial Sloan-Kettering Cancer Center, New York
| | - A K Ng
- Department of Radiation Oncology, Brigham & Women's Hospital, Boston, USA
| | - R W Tsang
- Department of Radiation Oncology, Princess Margaret Hospital, Toronto, Canada
| | - S Qi
- Memorial Sloan-Kettering Cancer Center, New York
| | - P K Allen
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - D Hodgson
- Department of Radiation Oncology, Princess Margaret Hospital, Toronto, Canada
| | - U Ricardi
- Department of Oncology, University of Turin, Turin, Italy
| | | | | | - P M Mauch
- Department of Radiation Oncology, Brigham & Women's Hospital, Boston, USA
| | - L S Constine
- University of Rochester Medical Center, Rochester, USA
| | - L Specht
- Department of Oncology and Hematology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Y Li
- Department of Radiation Oncology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - S A Terezakis
- Department of Radiation Oncology, Johns Hopkins School of Medicine, Baltimore, USA
| | - A Wirth
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, East Melbourne, Australia
| | - G Reinartz
- Department of Radiation Oncology, University of Muenster, Muenster, Germany
| | - H T Eich
- Department of Radiation Oncology, University of Muenster, Muenster, Germany
| | - B M P Aleman
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - P Barr
- University of Rochester Medical Center, Rochester, USA
| | - J Yahalom
- Memorial Sloan-Kettering Cancer Center, New York
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12
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Kriz J, Baues C, Engenhart-Cabillic R, Haverkamp U, Herfarth K, Lukas P, Schmidberger H, Marnitz-Schulze S, Fuchs M, Engert A, Eich HT. New quality assurance program integrating "modern radiotherapy" within the German Hodgkin Study Group. Strahlenther Onkol 2016; 193:100-108. [PMID: 27678010 DOI: 10.1007/s00066-016-1048-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [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: 05/11/2016] [Accepted: 08/29/2016] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Field design changed substantially from extended-field RT (EF-RT) to involved-field RT (IF-RT) and now to involved-node RT (IN-RT) and involved-site RT (IS-RT) as well as treatment techniques in radiotherapy (RT) of Hodgkin's lymphoma (HL). The purpose of this article is to demonstrate the establishment of a quality assurance program (QAP) including modern RT techniques and field designs within the German Hodgkin Study Group (GHSG). METHODS In the era of modern conformal RT, this QAP had to be fundamentally adapted and a new evaluation process has been intensively discussed by the radiotherapeutic expert panel of the GHSG. RESULTS The expert panel developed guidelines and criteria to analyse "modern" field designs and treatment techniques. This work is based on a dataset of 11 patients treated within the sixth study generation (HD16-17). CONCLUSION To develop a QAP of "modern RT", the expert panel defined criteria for analysing current RT procedures. The consensus of a modified QAP in ongoing and future trials is presented. With this schedule, the QAP of the GHSG could serve as a model for other study groups.
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Affiliation(s)
- J Kriz
- Department of Radiation Oncology, University of Muenster, Albert-Schweitzer Campus 1, Gebäude 1 A, 48419, Muenster, Germany
| | - C Baues
- Department of Radiation Oncology, University of Cologne, Köln, Deutschland
| | | | - U Haverkamp
- Department of Radiation Oncology, University of Muenster, Albert-Schweitzer Campus 1, Gebäude 1 A, 48419, Muenster, Germany
| | - K Herfarth
- Department of Radiation Oncology, University of Heidelberg, Heidelberg, Deutschland
| | - P Lukas
- Department of Radiation Oncology, University of Innsbruck, Innsbruck, Deutschland
| | - H Schmidberger
- Department of Radiation Oncology, University of Mainz, Mainz, Deutschland
| | - S Marnitz-Schulze
- Department of Radiation Oncology, University of Cologne, Köln, Deutschland
| | - M Fuchs
- Department of Internal Medicine, University of Cologne, Köln, Deutschland
| | - A Engert
- Department of Internal Medicine, University of Cologne, Köln, Deutschland
| | - H T Eich
- Department of Radiation Oncology, University of Muenster, Albert-Schweitzer Campus 1, Gebäude 1 A, 48419, Muenster, Germany.
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13
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Kriz J, Baues C, Engenhart-Cabillic R, Haverkamp U, Herfart K, Lukas P, Plütschow A, Schmidberger H, Staar S, Fuchs M, Engert A, Eich HT. Quality control of involved field radiotherapy in the HD 13 and HD 14 trials : Report of the radiotherapy panel of the German Hodgkin Study Group (GHSG). Strahlenther Onkol 2016; 193:109-115. [PMID: 27596217 DOI: 10.1007/s00066-016-1036-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 05/11/2016] [Accepted: 08/02/2016] [Indexed: 11/29/2022]
Abstract
INTRODUCTION As part of the foundation of the German Hodgkin Study Group (GHSG) in 1978, a central radiotherapy (RT) reference centre was established to evaluate and to improve the quality of treatment. During the study generations, the quality assurance programs (QAP) were continued and adapted to the demands of each study. The purpose of this article is to demonstrate the results of the fifth study generation and to compare them to the previous findings. METHODS With the start of the fourth GHSG study generation (HD10-12), a central prospective review of all diagnostic images was established to create an individual treatment plan for each early stage study patient. The quality of involved field RT was retrospectively evaluated by an expert panel of radiation oncologists. In the fifth study generation (HD13-15), the retrospective review of radiotherapy performed was refined and the results were compared with the findings of the fourth generation. RESULTS The expert panel analyzed the RT planning and application of 1037 (28 %) patients (HD13 n = 465, HD14 n = 572). Simulation films were available in 85 % of cases and verification films in 87 %. RT was assessed as major violation in 46 % (HD13 = 38 %, HD14 = 52 %), minor violation in 9 % (HD13 = 9 %, HD14 = 9 %) and according to the protocol in 45 % (HD13 = 52 %, HD14 = 38 %). CONCLUSION The value for QAP of RT within the GHSG trials is well known. Still there were several protocol violations. In the future, the QAP program has to be adapted to the requirements of "modern RT" in malignant lymphoma.
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Affiliation(s)
- J Kriz
- Department of Radiation Oncology, University of Muenster, Albert-Schweitzer Campus 1, Gebäude 1 A, 48419, Muenster, Germany
| | - C Baues
- Department of Radiation Oncology, University of Cologne, Cologne, Germany
| | | | - U Haverkamp
- Department of Radiation Oncology, University of Muenster, Albert-Schweitzer Campus 1, Gebäude 1 A, 48419, Muenster, Germany
| | - K Herfart
- Department of Radiation Oncology, University of Heidelberg, Heidelberg, Germany
| | - P Lukas
- Department of Radiation Oncology, University of Innsbruck, Innsbruck, Austria
| | - A Plütschow
- Department of Internal Medicine, University of Cologne, Cologne, Germany
| | - H Schmidberger
- Department of Radiation Oncology, University of Mainz, Mainz, Germany
| | - S Staar
- Department of Radiation Oncology, Bremen Mitte, Bremen, Germany
| | - M Fuchs
- Department of Internal Medicine, University of Cologne, Cologne, Germany
| | - A Engert
- Department of Internal Medicine, University of Cologne, Cologne, Germany
| | - H T Eich
- Department of Radiation Oncology, University of Muenster, Albert-Schweitzer Campus 1, Gebäude 1 A, 48419, Muenster, Germany.
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14
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Hecht M, Zimmer L, Loquai C, Weishaupt C, Gutzmer R, Schuster B, Gleisner S, Schulze B, Goldinger SM, Berking C, Forschner A, Clemens P, Grabenbauer G, Müller-Brenne T, Bauch J, Eich HT, Grabbe S, Schadendorf D, Schuler G, Keikavoussi P, Semrau S, Fietkau R, Distel LV, Heinzerling L. Radiosensitization by BRAF inhibitor therapy-mechanism and frequency of toxicity in melanoma patients. Ann Oncol 2015; 26:1238-1244. [PMID: 25762352 DOI: 10.1093/annonc/mdv139] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [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: 01/17/2015] [Accepted: 03/02/2015] [Indexed: 08/08/2023] Open
Abstract
BACKGROUND Recent evidence suggests that ionizing radiation may be associated with unexpected side-effects in melanoma patients treated with concomitant BRAF inhibitors. A large multicenter analysis was carried out to generate reliable safety data and elucidate the mechanism. METHODS A total of 161 melanoma patients from 11 European skin cancer centers were evaluated for acute and late toxicity, of whom 70 consecutive patients received 86 series of radiotherapy with concomitant BRAF inhibitor therapy. To further characterize and quantify a possible radiosensitization by BRAF inhibitors, blood samples of 35 melanoma patients were used for individual radiosensitivity testing by fluorescence in situ hybridization of chromosomal breaks after ex vivo irradiation. RESULTS With radiotherapy and concomitant BRAF inhibitor therapy the rate of acute radiodermatitis ≥2° was 36% and follicular cystic proliferation was seen in 13% of all radiotherapies. Non-skin toxicities included hearing disorders (4%) and dysphagia (2%). Following whole-brain radiotherapy, rates of radiodermatitis ≥2° were 44% and 8% (P < 0.001) for patients with and without BRAF inhibitor therapy, respectively. Concomitant treatment with vemurafenib induced acute radiodermatitis ≥2° more frequently than treatment with dabrafenib (40% versus 26%, P = 0.07). In line with these findings, analysis of chromosomal breaks ex vivo indicated significantly increased radiosensitivity for patients under vemurafenib (P = 0.004) and for patients switched from vemurafenib to dabrafenib (P = 0.002), but not for patients on dabrafenib only. No toxicities were reported after stereotactic treatment. CONCLUSION Radiotherapy with concomitant BRAF inhibitor therapy is feasible with an acceptable increase in toxicity. Vemurafenib is a more potent radiosensitizer than dabrafenib.
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Affiliation(s)
- M Hecht
- Department of Radiation Oncology, University Hospital Erlangen, Erlangen
| | - L Zimmer
- Department of Dermatology, University Hospital Essen, Essen
| | - C Loquai
- Department of Dermatology, University Hospital Mainz, Mainz
| | - C Weishaupt
- Department of Dermatology, University Hospital Münster, Münster
| | - R Gutzmer
- Department of Dermatology, Hannover Medical School, Hannover
| | - B Schuster
- Department of Radiation Oncology, University Hospital Erlangen, Erlangen
| | - S Gleisner
- Department of Radiation Oncology, University Hospital Erlangen, Erlangen
| | - B Schulze
- Department of Radiation Oncology, University Hospital Frankfurt, Frankfurt, Germany
| | - S M Goldinger
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - C Berking
- Department of Dermatology, University Hospital München (LMU), München
| | - A Forschner
- Department of Dermatology, University Hospital Tübingen, Tübingen, Germany
| | - P Clemens
- Department of Radiation Oncology, Hospital Feldkirch, Feldkirch, Austria
| | - G Grabenbauer
- Department of Radiation Oncology, Hospital Coburg, Coburg
| | - T Müller-Brenne
- Department of Radiation Oncology, University Hospital Mainz, Mainz
| | - J Bauch
- Department of Radiation Oncology, University Hospital Münster, Münster
| | - H T Eich
- Department of Radiation Oncology, University Hospital Münster, Münster
| | - S Grabbe
- Department of Dermatology, University Hospital Mainz, Mainz
| | - D Schadendorf
- Department of Dermatology, University Hospital Essen, Essen
| | - G Schuler
- Department of Dermatology, University Hospital Erlangen, Erlangen, Germany
| | - P Keikavoussi
- Department of Dermatology, University Hospital Erlangen, Erlangen, Germany
| | - S Semrau
- Department of Radiation Oncology, University Hospital Erlangen, Erlangen
| | - R Fietkau
- Department of Radiation Oncology, University Hospital Erlangen, Erlangen
| | - L V Distel
- Department of Radiation Oncology, University Hospital Erlangen, Erlangen.
| | - L Heinzerling
- Department of Dermatology, University Hospital Erlangen, Erlangen, Germany
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15
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Kobe C, Kuhnert G, Kahraman D, Haverkamp H, Eich HT, Franke M, Persigehl T, Klutmann S, Amthauer H, Bockisch A, Kluge R, Wolf HH, Maintz D, Fuchs M, Borchmann P, Diehl V, Drzezga A, Engert A, Dietlein M. Assessment of tumor size reduction improves outcome prediction of positron emission tomography/computed tomography after chemotherapy in advanced-stage Hodgkin lymphoma. J Clin Oncol 2014; 32:1776-81. [PMID: 24799482 DOI: 10.1200/jco.2013.53.2507] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
PURPOSE Positron emission tomography (PET) after chemotherapy can guide consolidating radiotherapy in advanced-stage Hodgkin lymphoma (HL). This analysis aims to improve outcome prediction by integrating additional criteria derived by computed tomography (CT). PATIENTS AND METHODS The analysis set consisted of 739 patients with residues≥2.5 cm after chemotherapy from a total of 2,126 patients treated in the HD15 trial (HD15 for advanced stage Hodgkin's disease: Quality assurance protocol for reduction of toxicity and the prognostic relevance of fluorodeoxyglucose-positron-emission tomography [FDG-PET] in the first-line treatment of advanced-stage Hodgkin's disease) performed by the German Hodgkin Study Group. A central panel performed image analysis and interpretation of CT scans before and after chemotherapy as well as PET scans after chemotherapy. Prognosis was evaluated by using progression-free survival (PFS); groups were compared with the log-rank test. Potential prognostic factors were investigated by using receiver operating characteristic analysis and logistic regression. RESULTS In all, 548 (74%) of 739 patients had PET-negative residues after chemotherapy; these patients did not receive additional radiotherapy and showed a 4-year PFS of 91.5%. The 191 PET-positive patients (26%) receiving additional radiotherapy had a 4-year PFS of 86.1% (P=.022). CT alone did not allow further separation of patients in partial remission by risk of recurrence (P=.9). In the subgroup of the 54 PET-positive patients with a relative reduction of less than 40%, the risk of progression or relapse within the first year was 23.1% compared with 5.3% for patients with a larger reduction (difference, 17.9%; 95% CI, 5.8% to 30%). CONCLUSION Patients with HL who have PET-positive residual disease after chemotherapy and poor tumor shrinkage are at high risk of progression or relapse.
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Affiliation(s)
- Carsten Kobe
- Carsten Kobe, Georg Kuhnert, Deniz Kahraman, Heinz Haverkamp, Hans-Theodor Eich, Mareike Franke, Thorsten Persigehl, David Maintz, Michael Fuchs, Peter Borchmann, Volker Diehl, Alexander Drzezga, Andreas Engert, and Markus Dietlein, University Hospital of Cologne, Cologne; Hans-Theodor Eich, University Hospital of Münster, Münster; Susanne Klutmann, University Medical Center Hamburg-Eppendorf, Hamburg; Holger Amthauer, Klinik für Strahlenheilkunde, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin; Andreas Bockisch, University of Duisburg-Essen, Duisburg and Essen; Regine Kluge, University of Leipzig, Leipzig; and Hans-Heinrich Wolf, Martin Luther University Halle-Wittenberg, Halle, Germany.
| | - Georg Kuhnert
- Carsten Kobe, Georg Kuhnert, Deniz Kahraman, Heinz Haverkamp, Hans-Theodor Eich, Mareike Franke, Thorsten Persigehl, David Maintz, Michael Fuchs, Peter Borchmann, Volker Diehl, Alexander Drzezga, Andreas Engert, and Markus Dietlein, University Hospital of Cologne, Cologne; Hans-Theodor Eich, University Hospital of Münster, Münster; Susanne Klutmann, University Medical Center Hamburg-Eppendorf, Hamburg; Holger Amthauer, Klinik für Strahlenheilkunde, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin; Andreas Bockisch, University of Duisburg-Essen, Duisburg and Essen; Regine Kluge, University of Leipzig, Leipzig; and Hans-Heinrich Wolf, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Deniz Kahraman
- Carsten Kobe, Georg Kuhnert, Deniz Kahraman, Heinz Haverkamp, Hans-Theodor Eich, Mareike Franke, Thorsten Persigehl, David Maintz, Michael Fuchs, Peter Borchmann, Volker Diehl, Alexander Drzezga, Andreas Engert, and Markus Dietlein, University Hospital of Cologne, Cologne; Hans-Theodor Eich, University Hospital of Münster, Münster; Susanne Klutmann, University Medical Center Hamburg-Eppendorf, Hamburg; Holger Amthauer, Klinik für Strahlenheilkunde, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin; Andreas Bockisch, University of Duisburg-Essen, Duisburg and Essen; Regine Kluge, University of Leipzig, Leipzig; and Hans-Heinrich Wolf, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Heinz Haverkamp
- Carsten Kobe, Georg Kuhnert, Deniz Kahraman, Heinz Haverkamp, Hans-Theodor Eich, Mareike Franke, Thorsten Persigehl, David Maintz, Michael Fuchs, Peter Borchmann, Volker Diehl, Alexander Drzezga, Andreas Engert, and Markus Dietlein, University Hospital of Cologne, Cologne; Hans-Theodor Eich, University Hospital of Münster, Münster; Susanne Klutmann, University Medical Center Hamburg-Eppendorf, Hamburg; Holger Amthauer, Klinik für Strahlenheilkunde, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin; Andreas Bockisch, University of Duisburg-Essen, Duisburg and Essen; Regine Kluge, University of Leipzig, Leipzig; and Hans-Heinrich Wolf, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Hans-Theodor Eich
- Carsten Kobe, Georg Kuhnert, Deniz Kahraman, Heinz Haverkamp, Hans-Theodor Eich, Mareike Franke, Thorsten Persigehl, David Maintz, Michael Fuchs, Peter Borchmann, Volker Diehl, Alexander Drzezga, Andreas Engert, and Markus Dietlein, University Hospital of Cologne, Cologne; Hans-Theodor Eich, University Hospital of Münster, Münster; Susanne Klutmann, University Medical Center Hamburg-Eppendorf, Hamburg; Holger Amthauer, Klinik für Strahlenheilkunde, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin; Andreas Bockisch, University of Duisburg-Essen, Duisburg and Essen; Regine Kluge, University of Leipzig, Leipzig; and Hans-Heinrich Wolf, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Mareike Franke
- Carsten Kobe, Georg Kuhnert, Deniz Kahraman, Heinz Haverkamp, Hans-Theodor Eich, Mareike Franke, Thorsten Persigehl, David Maintz, Michael Fuchs, Peter Borchmann, Volker Diehl, Alexander Drzezga, Andreas Engert, and Markus Dietlein, University Hospital of Cologne, Cologne; Hans-Theodor Eich, University Hospital of Münster, Münster; Susanne Klutmann, University Medical Center Hamburg-Eppendorf, Hamburg; Holger Amthauer, Klinik für Strahlenheilkunde, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin; Andreas Bockisch, University of Duisburg-Essen, Duisburg and Essen; Regine Kluge, University of Leipzig, Leipzig; and Hans-Heinrich Wolf, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Thorsten Persigehl
- Carsten Kobe, Georg Kuhnert, Deniz Kahraman, Heinz Haverkamp, Hans-Theodor Eich, Mareike Franke, Thorsten Persigehl, David Maintz, Michael Fuchs, Peter Borchmann, Volker Diehl, Alexander Drzezga, Andreas Engert, and Markus Dietlein, University Hospital of Cologne, Cologne; Hans-Theodor Eich, University Hospital of Münster, Münster; Susanne Klutmann, University Medical Center Hamburg-Eppendorf, Hamburg; Holger Amthauer, Klinik für Strahlenheilkunde, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin; Andreas Bockisch, University of Duisburg-Essen, Duisburg and Essen; Regine Kluge, University of Leipzig, Leipzig; and Hans-Heinrich Wolf, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Susanne Klutmann
- Carsten Kobe, Georg Kuhnert, Deniz Kahraman, Heinz Haverkamp, Hans-Theodor Eich, Mareike Franke, Thorsten Persigehl, David Maintz, Michael Fuchs, Peter Borchmann, Volker Diehl, Alexander Drzezga, Andreas Engert, and Markus Dietlein, University Hospital of Cologne, Cologne; Hans-Theodor Eich, University Hospital of Münster, Münster; Susanne Klutmann, University Medical Center Hamburg-Eppendorf, Hamburg; Holger Amthauer, Klinik für Strahlenheilkunde, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin; Andreas Bockisch, University of Duisburg-Essen, Duisburg and Essen; Regine Kluge, University of Leipzig, Leipzig; and Hans-Heinrich Wolf, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Holger Amthauer
- Carsten Kobe, Georg Kuhnert, Deniz Kahraman, Heinz Haverkamp, Hans-Theodor Eich, Mareike Franke, Thorsten Persigehl, David Maintz, Michael Fuchs, Peter Borchmann, Volker Diehl, Alexander Drzezga, Andreas Engert, and Markus Dietlein, University Hospital of Cologne, Cologne; Hans-Theodor Eich, University Hospital of Münster, Münster; Susanne Klutmann, University Medical Center Hamburg-Eppendorf, Hamburg; Holger Amthauer, Klinik für Strahlenheilkunde, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin; Andreas Bockisch, University of Duisburg-Essen, Duisburg and Essen; Regine Kluge, University of Leipzig, Leipzig; and Hans-Heinrich Wolf, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Andreas Bockisch
- Carsten Kobe, Georg Kuhnert, Deniz Kahraman, Heinz Haverkamp, Hans-Theodor Eich, Mareike Franke, Thorsten Persigehl, David Maintz, Michael Fuchs, Peter Borchmann, Volker Diehl, Alexander Drzezga, Andreas Engert, and Markus Dietlein, University Hospital of Cologne, Cologne; Hans-Theodor Eich, University Hospital of Münster, Münster; Susanne Klutmann, University Medical Center Hamburg-Eppendorf, Hamburg; Holger Amthauer, Klinik für Strahlenheilkunde, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin; Andreas Bockisch, University of Duisburg-Essen, Duisburg and Essen; Regine Kluge, University of Leipzig, Leipzig; and Hans-Heinrich Wolf, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Regine Kluge
- Carsten Kobe, Georg Kuhnert, Deniz Kahraman, Heinz Haverkamp, Hans-Theodor Eich, Mareike Franke, Thorsten Persigehl, David Maintz, Michael Fuchs, Peter Borchmann, Volker Diehl, Alexander Drzezga, Andreas Engert, and Markus Dietlein, University Hospital of Cologne, Cologne; Hans-Theodor Eich, University Hospital of Münster, Münster; Susanne Klutmann, University Medical Center Hamburg-Eppendorf, Hamburg; Holger Amthauer, Klinik für Strahlenheilkunde, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin; Andreas Bockisch, University of Duisburg-Essen, Duisburg and Essen; Regine Kluge, University of Leipzig, Leipzig; and Hans-Heinrich Wolf, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Hans-Heinrich Wolf
- Carsten Kobe, Georg Kuhnert, Deniz Kahraman, Heinz Haverkamp, Hans-Theodor Eich, Mareike Franke, Thorsten Persigehl, David Maintz, Michael Fuchs, Peter Borchmann, Volker Diehl, Alexander Drzezga, Andreas Engert, and Markus Dietlein, University Hospital of Cologne, Cologne; Hans-Theodor Eich, University Hospital of Münster, Münster; Susanne Klutmann, University Medical Center Hamburg-Eppendorf, Hamburg; Holger Amthauer, Klinik für Strahlenheilkunde, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin; Andreas Bockisch, University of Duisburg-Essen, Duisburg and Essen; Regine Kluge, University of Leipzig, Leipzig; and Hans-Heinrich Wolf, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - David Maintz
- Carsten Kobe, Georg Kuhnert, Deniz Kahraman, Heinz Haverkamp, Hans-Theodor Eich, Mareike Franke, Thorsten Persigehl, David Maintz, Michael Fuchs, Peter Borchmann, Volker Diehl, Alexander Drzezga, Andreas Engert, and Markus Dietlein, University Hospital of Cologne, Cologne; Hans-Theodor Eich, University Hospital of Münster, Münster; Susanne Klutmann, University Medical Center Hamburg-Eppendorf, Hamburg; Holger Amthauer, Klinik für Strahlenheilkunde, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin; Andreas Bockisch, University of Duisburg-Essen, Duisburg and Essen; Regine Kluge, University of Leipzig, Leipzig; and Hans-Heinrich Wolf, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Michael Fuchs
- Carsten Kobe, Georg Kuhnert, Deniz Kahraman, Heinz Haverkamp, Hans-Theodor Eich, Mareike Franke, Thorsten Persigehl, David Maintz, Michael Fuchs, Peter Borchmann, Volker Diehl, Alexander Drzezga, Andreas Engert, and Markus Dietlein, University Hospital of Cologne, Cologne; Hans-Theodor Eich, University Hospital of Münster, Münster; Susanne Klutmann, University Medical Center Hamburg-Eppendorf, Hamburg; Holger Amthauer, Klinik für Strahlenheilkunde, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin; Andreas Bockisch, University of Duisburg-Essen, Duisburg and Essen; Regine Kluge, University of Leipzig, Leipzig; and Hans-Heinrich Wolf, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Peter Borchmann
- Carsten Kobe, Georg Kuhnert, Deniz Kahraman, Heinz Haverkamp, Hans-Theodor Eich, Mareike Franke, Thorsten Persigehl, David Maintz, Michael Fuchs, Peter Borchmann, Volker Diehl, Alexander Drzezga, Andreas Engert, and Markus Dietlein, University Hospital of Cologne, Cologne; Hans-Theodor Eich, University Hospital of Münster, Münster; Susanne Klutmann, University Medical Center Hamburg-Eppendorf, Hamburg; Holger Amthauer, Klinik für Strahlenheilkunde, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin; Andreas Bockisch, University of Duisburg-Essen, Duisburg and Essen; Regine Kluge, University of Leipzig, Leipzig; and Hans-Heinrich Wolf, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Volker Diehl
- Carsten Kobe, Georg Kuhnert, Deniz Kahraman, Heinz Haverkamp, Hans-Theodor Eich, Mareike Franke, Thorsten Persigehl, David Maintz, Michael Fuchs, Peter Borchmann, Volker Diehl, Alexander Drzezga, Andreas Engert, and Markus Dietlein, University Hospital of Cologne, Cologne; Hans-Theodor Eich, University Hospital of Münster, Münster; Susanne Klutmann, University Medical Center Hamburg-Eppendorf, Hamburg; Holger Amthauer, Klinik für Strahlenheilkunde, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin; Andreas Bockisch, University of Duisburg-Essen, Duisburg and Essen; Regine Kluge, University of Leipzig, Leipzig; and Hans-Heinrich Wolf, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Alexander Drzezga
- Carsten Kobe, Georg Kuhnert, Deniz Kahraman, Heinz Haverkamp, Hans-Theodor Eich, Mareike Franke, Thorsten Persigehl, David Maintz, Michael Fuchs, Peter Borchmann, Volker Diehl, Alexander Drzezga, Andreas Engert, and Markus Dietlein, University Hospital of Cologne, Cologne; Hans-Theodor Eich, University Hospital of Münster, Münster; Susanne Klutmann, University Medical Center Hamburg-Eppendorf, Hamburg; Holger Amthauer, Klinik für Strahlenheilkunde, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin; Andreas Bockisch, University of Duisburg-Essen, Duisburg and Essen; Regine Kluge, University of Leipzig, Leipzig; and Hans-Heinrich Wolf, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Andreas Engert
- Carsten Kobe, Georg Kuhnert, Deniz Kahraman, Heinz Haverkamp, Hans-Theodor Eich, Mareike Franke, Thorsten Persigehl, David Maintz, Michael Fuchs, Peter Borchmann, Volker Diehl, Alexander Drzezga, Andreas Engert, and Markus Dietlein, University Hospital of Cologne, Cologne; Hans-Theodor Eich, University Hospital of Münster, Münster; Susanne Klutmann, University Medical Center Hamburg-Eppendorf, Hamburg; Holger Amthauer, Klinik für Strahlenheilkunde, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin; Andreas Bockisch, University of Duisburg-Essen, Duisburg and Essen; Regine Kluge, University of Leipzig, Leipzig; and Hans-Heinrich Wolf, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Markus Dietlein
- Carsten Kobe, Georg Kuhnert, Deniz Kahraman, Heinz Haverkamp, Hans-Theodor Eich, Mareike Franke, Thorsten Persigehl, David Maintz, Michael Fuchs, Peter Borchmann, Volker Diehl, Alexander Drzezga, Andreas Engert, and Markus Dietlein, University Hospital of Cologne, Cologne; Hans-Theodor Eich, University Hospital of Münster, Münster; Susanne Klutmann, University Medical Center Hamburg-Eppendorf, Hamburg; Holger Amthauer, Klinik für Strahlenheilkunde, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin; Andreas Bockisch, University of Duisburg-Essen, Duisburg and Essen; Regine Kluge, University of Leipzig, Leipzig; and Hans-Heinrich Wolf, Martin Luther University Halle-Wittenberg, Halle, Germany
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Kohl A, Kemper B, Müller-Uthoff H, Eich HT, Kiesel L, Greve B, Götte M. siRNA-mediated inhibition of the stemness-related Musashi pathway affects LIF receptor expression and prometastatic motility of human MDA-MB-231 breast cancer cells. Exp Clin Endocrinol Diabetes 2014. [DOI: 10.1055/s-0034-1372124] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Wischmann FJ, Pätzel M, Vijaya Kumar A, Braun T, Kemper B, Ernst I, Eich HT, Götte M, Greve B. Contribution of miR-218-dependent EGFR-signaling to the radiation response of breast cancer cells. Exp Clin Endocrinol Diabetes 2014. [DOI: 10.1055/s-0034-1372126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Klimm B, Goergen H, Fuchs M, von Tresckow B, Böll B, Meissner J, Glunz A, Diehl V, Eich HT, Engert A, Borchmann P. Impact of risk factors on outcomes in early-stage Hodgkin's lymphoma: an analysis of international staging definitions. Ann Oncol 2013; 24:3070-6. [PMID: 24148816 DOI: 10.1093/annonc/mdt413] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [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: 11/14/2022] Open
Abstract
BACKGROUND In early-stage Hodgkin's lymphoma (HL), treatment according to the early favorable or unfavorable subgroup is guided by staging definitions, which differ between various study groups worldwide. We analyzed risk factors used in different international staging systems and their impact on the outcome of early-stage HL patients. PATIENTS AND METHODS In 1173 early-stage HL patients treated homogenously within the German Hodgkin Study Group (GHSG) trials HD10 and HD11, the impact of three staging systems developed and used by the GHSG, the European Organization for Research and Treatment of Cancer (EORTC), and the National Comprehensive Cancer Network (NCCN) in discriminating risk groups for progression-free survival (PFS) and overall survival (OS) was assessed and the relevance of their single risk factors was investigated. RESULTS All the three staging systems defined an unfavorable risk group out of early-stage patients of comparable size (56%, 55%, and 57%), having a significantly poorer PFS and OS as compared with the corresponding favorable group; 5-year differences between early favorable and early unfavorable in terms of PFS were 9.4% (HR 2.61, 95% CI 1.74-3.91), 6.7% (HR 2.10, 95% CI 1.41-3.13), and 8.6% (HR 2.14, 95% CI 1.45-3.16) with the GHSG, EORTC, and NCCN definition, respectively. Sensitivity was high for all systems (84%, 79%, and 83%); however, there was a low specificity with high rates of false-positive results (1-specificity 54%, 53%, and 55%, respectively). Models of high sensitivity included risk factors associated with large tumor burden and high tumor activity. Most risk factors for tumor-specific end points were also predictive of OS. CONCLUSIONS Differentiating between a favorable and an unfavorable risk group has significant impact on PFS and OS in early-stage HL patients in the modern treatment era. Risk-adapted treatment strategies using new risk factors with higher specificity are needed.
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Affiliation(s)
- B Klimm
- Department I of Internal Medicine, German Hodgkin Study Group (GHSG), University Hospital Cologne
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Hay AE, Klimm B, Chen BE, Goergen H, Shepherd LE, Fuchs M, Gospodarowicz MK, Borchmann P, Connors JM, Markova J, Crump M, Lohri A, Winter JN, Dörken B, Pearcey RG, Diehl V, Horning SJ, Eich HT, Engert A, Meyer RM. An individual patient-data comparison of combined modality therapy and ABVD alone for patients with limited-stage Hodgkin lymphoma. Ann Oncol 2013; 24:3065-9. [PMID: 24121121 DOI: 10.1093/annonc/mdt389] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [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] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Treatment options for patients with nonbulky stage IA-IIA Hodgkin lymphoma include combined modality therapy (CMT) using doxorubicin, bleomycin, vinblastine and dacarbazine (ABVD) plus involved-field radiation therapy (IFRT), and chemotherapy with ABVD alone. There are no mature randomized data comparing ABVD with CMT using modern radiation techniques. PATIENTS AND METHODS Using German Hodgkin Study Group HD10/HD11 and NCIC Clinical Trials Group HD.6 databases, we identified 588 patients who met mutually inclusive eligibility criteria from the preferred arms of HD10 or 11 (n = 406) and HD.6 (n = 182). We evaluated time to progression (TTP), progression-free (PFS) and overall survival, including in three predefined exploratory subset analyses. RESULTS With median follow-up of 91 (HD10/11) and 134 (HD.6) months, respective 8-year outcomes were for TTP, 93% versus 87% [hazard ratio (HR) 0.44, 95% confidence interval (CI) 0.24-0.78]; for PFS, 89% versus 86% (HR 0.71, 95% CI 0.42-1.18) and for overall survival, 95% versus 95% (HR 1.09, 95% CI 0.49-2.40). In the exploratory subset analysis including HD10 eligible patients who achieved complete response (CR) or unconfirmed complete response (CRu) after two cycles of ABVD, 8-year PFS was 87% (HD10) versus 95% (HD.6) (HR 2.8; 95% CI 0.64-12.5) and overall survival 96% versus 100%. In contrast, among those without CR/CRu after two cycles of ABVD, 8-year PFS was 88% versus 74% (HR 0.35; 95% CI 0.16-0.79) and overall survival 95% versus 91%, respectively (HR 0.42; 95% CI 0.12-1.44). CONCLUSIONS In patients with nonbulky stage IA-IIA Hodgkin lymphoma, CMT provides better disease control than ABVD alone, especially among those not achieving complete response after two cycles of ABVD. Within the follow-up duration evaluated, overall survivals were similar. Longer follow-up is required to understand the implications of radiation and chemotherapy-related late effects. CLINICAL TRIALS The trials included in this analysis were registered at ClinicalTrials.gov: HD10 - NCT00265018, HD11 - NCT00264953, HD.6 - NCT00002561.
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Affiliation(s)
- A E Hay
- NCIC Clinical Trials Group and Queen's University, Kingston, Ontario, Canada
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Eich HT, Kriz J. Role of Radiological Imaging in Radiation Oncology: Experiences within the German Hodgkin Study Group (GHSG). ROFO-FORTSCHR RONTG 2013. [DOI: 10.1055/s-0033-1345805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Eich HT, Kriz J, Schmidberger H, Böll B, Klimm B, Rancea M, Müller RP, Engert A. The German evidence-based guidelines for Hodgkin's lymphoma. Aspects for radiation oncologists. Strahlenther Onkol 2013; 189:445-7. [PMID: 23604187 DOI: 10.1007/s00066-013-0331-4] [Citation(s) in RCA: 5] [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] [Received: 02/07/2013] [Accepted: 02/13/2013] [Indexed: 11/29/2022]
Abstract
This report reviews aspects of the German evidence-based guidelines for Hodgkin's lymphoma relevant to radiation oncologists. Stage-adapted treatment is discussed with the focus on radiotherapy. Up-to-date literature citations provide an overview of current recommendations.
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Affiliation(s)
- H T Eich
- Department of Radiation Oncology, University of Muenster, Albert-Schweitzer-Campus 1, Münster, Germany.
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Mounessi FS, Lehrich P, Haverkamp U, Willich N, Bölling T, Eich HT. Pelvic Ewing sarcomas. Three-dimensional conformal vs. intensity-modulated radiotherapy. Strahlenther Onkol 2013; 189:308-14. [PMID: 23443613 DOI: 10.1007/s00066-012-0304-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2012] [Accepted: 12/20/2012] [Indexed: 12/21/2022]
Abstract
PURPOSE The goal of the present work was to assess the potential advantage of intensity-modulated radiotherapy (IMRT) over three-dimensional conformal radiotherapy (3D-CRT) planning in pelvic Ewing's sarcoma. PATIENTS AND METHODS A total of 8 patients with Ewing sarcoma of the pelvis undergoing radiotherapy were analyzed. Plans for 3D-CRT and IMRT were calculated for each patient. Dose coverage of the planning target volume (PTV), conformity and homogeneity indices, as well as further parameters were evaluated. RESULTS The average dose coverage values for PTV were comparable in 3D-CRT and IMRT plans. Both techniques had a PTV coverage of V95 > 98 % in all patients. Whereas the IMRT plans achieved a higher conformity index compared to the 3D-CRT plans (conformity index 0.79 ± 0.12 vs. 0.54 ± 0.19, p = 0.012), the dose distribution across the target volumes was less homogeneous with IMRT planning than with 3D-CRT planning. This difference was statistically significant (homogeneity index 0.11 ± 0.03 vs. 0.07 ± 0.0, p = 0.035). For the bowel, Dmean and D1%, as well as V2 to V60 were reduced in IMRT plans. For the bladder and the rectum, there was no significant difference in Dmean. However, the percentages of volumes receiving at least doses of 30, 40, 45, and 50 Gy (V30 to V50) were lower for the rectum in IMRT plans. The volume of normal tissue receiving at least 2 Gy (V2) was significantly higher in IMRT plans compared with 3D-CRT, whereas at high dose levels (V30) it was significantly lower. CONCLUSION Compared to 3D-CRT, IMRT showed significantly better results regarding dose conformity (p = 0.012) and bowel sparing at dose levels above 30 Gy (p = 0.012). Thus, dose escalation in the radiotherapy of pelvic Ewing's sarcoma can be more easily achieved using IMRT.
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Affiliation(s)
- F S Mounessi
- Department of Radiation Oncology, University of Münster, Albert-Schweitzer-Campus 1, Münster, Germany.
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Kreppel M, Dreiseidler T, Rothamel D, Eich HT, Drebber U, Zöller JE, Scheer M. The role of clinical versus histopathological staging in patients with advanced oral squamous cell carcinoma treated with neoadjuvant radiochemotherapy followed by radical surgery. J Craniomaxillofac Surg 2013; 41:22-7. [DOI: 10.1016/j.jcms.2012.05.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2011] [Revised: 05/11/2012] [Accepted: 05/14/2012] [Indexed: 11/24/2022] Open
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Sasse S, Klimm B, Görgen H, Fuchs M, Heyden-Honerkamp A, Lohri A, Koch O, Wilhelm M, Trenn G, Finke J, Müller RP, Diehl V, Eich HT, Borchmann P, Engert A. Comparing long-term toxicity and efficacy of combined modality treatment including extended- or involved-field radiotherapy in early-stage Hodgkin's lymphoma. Ann Oncol 2012; 23:2953-2959. [PMID: 22767583 DOI: 10.1093/annonc/mds110] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND To evaluate long-term toxicity and efficacy of a combined modality strategy including extended-field radiotherapy (EF-RT) or involved-field radiotherapy (IF-RT), the German Hodgkin Study Group carried out a follow-up analysis in patients with early unfavorable Hodgkin's lymphoma (HL). PATIENTS AND METHODS One thousand two hundred and four patients were randomized to four cycles of chemotherapy followed by either 30 Gy EF- or 30 Gy IF-RT (HD8 trial); 532 patients in each treatment arm were eligible. RESULTS At 10 years, no arm differences were revealed with respect to freedom from treatment failure (FFTF) (79.8% versus 79.7%), progression-free survival (79.8% versus 80.0%), and overall survival (86.4% versus 87.3%). Non-inferiority of IF-RT was demonstrated for the primary end point FFTF (95% confidence interval for hazard ratio 0.72-1.25). Elderly patients had a poorer outcome when treated with EF-RT. So far, 15.0% of patients in arm A and 12.2% in arm B died, mostly due to secondary malignancies (5.3% versus 3.4%) or HL (3.2% versus 3.4%). After EF-RT, there were more secondary malignancies overall (58 versus 45), especially acute myeloid leukemias (11 versus 4). CONCLUSION Radiotherapy intensity reduction to IF-RT does not result in poorer long-term outcome but is associated with less acute toxicity and might be associated with less secondary malignancies.
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Affiliation(s)
- S Sasse
- First Department of Internal Medicine, University Hospital Cologne, Cologne; German Hodgkin Study Group, Cologne, Germany
| | - B Klimm
- First Department of Internal Medicine, University Hospital Cologne, Cologne; German Hodgkin Study Group, Cologne, Germany
| | - H Görgen
- German Hodgkin Study Group, Cologne, Germany
| | - M Fuchs
- German Hodgkin Study Group, Cologne, Germany
| | | | - A Lohri
- Department of Internal Medicine, Kantonsspital Liestal, Liestal, Switzerland
| | - O Koch
- Third Department of Internal Medicine, Klinikum Osnabrück, Osnabrück
| | - M Wilhelm
- Fifth Department of Internal Medicine, Klinikum Nuernberg, Nuernberg
| | - G Trenn
- Department of Internal Medicine, Knappschaftskrankenhaus Bottrop, Bottrop
| | - J Finke
- First Department of Internal Medicine, University Hospital Freiburg, Freiburg
| | - R P Müller
- Department of Radiotherapy, University Hospital Cologne, Cologne
| | - V Diehl
- German Hodgkin Study Group, Cologne, Germany
| | - H T Eich
- Department of Radiotherapy, University Hospital Muenster, Muenster, Germany
| | - P Borchmann
- German Hodgkin Study Group, Cologne, Germany
| | - A Engert
- First Department of Internal Medicine, University Hospital Cologne, Cologne; German Hodgkin Study Group, Cologne, Germany.
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Greve B, Sheikh-Mounessi F, Kemper B, Ernst I, Götte M, Eich HT. Survivin, a target to modulate the radiosensitivity of Ewing's sarcoma. Strahlenther Onkol 2012; 188:1038-47. [PMID: 23053158 DOI: 10.1007/s00066-012-0223-z] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2012] [Accepted: 08/06/2012] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND PURPOSE Radiotherapy constitutes an essential element in the multimodal therapy of Ewing's sarcoma. Compared to other sarcomas, Ewing tumors normally show a good response to radiotherapy. However, there are consistently tumors with a radioresistant phenotype, and the underlying mechanisms are not known in detail. Here we investigated the association between survivin protein expression and the radiosensitivity of Ewing's sarcoma in vitro. MATERIAL AND METHODS An siRNA-based knockdown approach was used to investigate the influence of survivin expression on cell proliferation, double-strand break (DSB) induction and repair, apoptosis and colony-forming ability in four Ewing's sarcoma cell lines with and without irradiation. RESULTS Survivin protein and mRNA were upregulated in all cell lines tested in a dose-dependent manner. As a result of survivin knockdown, STA-ET-1 cells showed reduced cell proliferation, an increased number of radiation-induced DSBs, and reduced repair. Apoptosis was increased by knockdown alone and increased further in combination with irradiation. Colony formation was significantly reduced by survivin knockdown in combination with irradiation. CONCLUSION Survivin is a radiation-inducible protein in Ewing's sarcoma and its down-regulation sensitizes cells toward irradiation. Survivin knockdown in combination with radiation inhibits cell proliferation, repair, and colony formation significantly and increases apoptosis more than each single treatment alone. This might open new perspectives in the radiation treatment of Ewing's sarcoma.
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Affiliation(s)
- B Greve
- Klinik und Poliklinik für Strahlentherapie -Radioonkologie, Universitätsklinikum Münster, Albert-Schweitzer Campus 1 Gebäude A1, 48149, Münster, Germany.
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Kreppel M, Eich HT, Brüggenolte C, Dreiseidler T, Rothamel D, Drebber U, Kübler A, Zöller JE, Scheer M. Preoperative vs. postoperative radiochemotherapy in patients with N2 squamous cell carcinoma of the oral cavity. Oral Oncol 2012; 48:1019-1024. [DOI: 10.1016/j.oraloncology.2012.04.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Revised: 04/01/2012] [Accepted: 04/03/2012] [Indexed: 11/29/2022]
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Koeck J, Abo-Madyan Y, Eich HT, Stieler F, Fleckenstein J, Kriz J, Mueller RP, Wenz F, Lohr F. Clinical relevance of different dose calculation strategies for mediastinal IMRT in Hodgkin's disease. Strahlenther Onkol 2012; 188:653-9. [PMID: 22740169 DOI: 10.1007/s00066-012-0144-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2012] [Accepted: 04/23/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND AND PURPOSE Conventional algorithms show uncertainties in dose calculation already for three-dimensional conformal radiotherapy (3D-CRT). Intensity-modulated radiotherapy (IMRT) might even increase these. We wanted to assess differences in dose distribution for pencil beam (PB), collapsed cone (CC), and Monte Carlo (MC) algorithm for both 3D-CRT and IMRT in patients with mediastinal Hodgkin lymphoma. PATIENTS AND METHODS Based on 20 computed tomograph (CT) datasets of patients with mediastinal Hodgkin lymphoma, we created treatment plans according to the guidelines of the German Hodgkin Study Group (GHSG) with PB and CC algorithm for 3D-CRT and with PB and MC algorithm for IMRT. Doses were compared for planning target volume (PTV) and organs at risk. RESULTS For 3D-CRT, PB overestimated PTV(95) and V(20) of the lung by 6.9% and 3.3% and underestimated V(10) of the lung by 5.8%, compared to the CC algorithm. For IMRT, PB overestimated PTV(95), V(20) of the lung, V(25) of the heart and V(10) of the female left/right breast by 8.1%, 25.8%, 14.0% and 43.6%/189.1%, and underestimated V(10) of the lung, V(4) of the heart and V(4) of the female left/right breast by 6.3%, 6.8% and 23.2%/15.6%, compared to MC. CONCLUSION The PB algorithm underestimates low doses to the organs at risk and overestimates dose to PTV and high doses to the organs at risk. For 3D-CRT, a well-modeled PB algorithm is clinically acceptable; for IMRT planning, however, an advanced algorithm such as CC or MC should be used at least for part of the plan optimization.
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Affiliation(s)
- J Koeck
- Klinik für Strahlentherapie und Radioonkologie, Universitätsmedizin Mannheim, Universität Heidelberg, Theodor-Kutzer-Ufer 1-3, 68135, Mannheim, Germany.
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Kriz J, Bangard C, Haverkamp U, Bongartz R, Baues C, Engert A, Mueller RP, Eich HT. Quality control of involved-field radiotherapy for patients with early stage Hodgkin's lymphoma based on a central prospective review. Comparison of the results between two study generations of the German Hodgkin Study Group. Strahlenther Onkol 2012; 188:660-5. [PMID: 22692351 DOI: 10.1007/s00066-012-0103-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2012] [Accepted: 03/08/2012] [Indexed: 11/25/2022]
Abstract
PURPOSE Based on experience in trials HD10 and HD11 (1998-2003), the radiotherapy reference center of the German Hodgkin Study Group (GHSG) continued their central prospective radiation oncological review in trials HD13 and HD14. The purpose of this analysis was to identify the impact of this procedure on radiotherapeutic management and to compare findings with former trials. METHODS Between 2003 and 2009, 1,710 patients were enrolled in the HD13 trial (early favorable stages) and 2,039 patients in the HD14 trial (early unfavorable stages). All patients received a total of 30 Gy involved-field (IF) radiotherapy within a combined modality approach. RESULTS For patients in HD13, there was a correction of disease involvement in 847/1,518 patients (56%), and for patients in HD14 in 1,370/1,905 patients (72%). Most discrepancies were observed in the lower mediastinum (19.2%), infraclavicular (31.7%), upper cervical (12.7%), and supraclavicular (10.8%) lymph nodes. This resulted in a change of disease stage in 241 (7%) patients and a shift into another study protocol in 66 (2%) patients. Due to the incorrect lymph node documentation of the participating study centers, the IF radiotherapy volume had to be enlarged in 1,063/3,423 patients (31%) and reduced in 244/3,423 patients (7.1%). These findings are comparable to the results of the quality control in the trials HD10 and HD11 (2,611 patients reviewed). CONCLUSION Central review of the diagnostic imaging and clinical findings of Hodgkin's lymphoma patients shows a considerable number of discrepancies compared with the local evaluation. Thus, meticulous evaluation of all imaging information in close collaboration between the radiation oncologist and diagnostic radiologist is mandatory.
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Affiliation(s)
- J Kriz
- Department of Radiation Oncology, University of Muenster, Albert-Schweitzer Campus 1, Gebäude 1A, 48419, Muenster, Germany
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Kobe C, Engert A, Markova J, Haverkamp H, Eich HT, Müller RP, Holstein A, Kahraman D, Dietlein M, Borchmann P, Diehl V. Assessment of residual bulky tumor using FDG-PET in patients with advanced stages after completion of chemotherapy. Final report of the GHSG HD15 trial. ROFO-FORTSCHR RONTG 2012. [DOI: 10.1055/s-0032-1311119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Borchmann P, Haverkamp H, Diehl V, Cerny T, Markova J, Ho AD, Eich HT, Mueller-Hermelink HK, Kanz L, Greil R, Rank A, Paulus U, Smardova L, Huber C, Dörken B, Nerl C, Krause SW, Mueller RP, Fuchs M, Engert A. Eight Cycles of Escalated-Dose BEACOPP Compared With Four Cycles of Escalated-Dose BEACOPP Followed by Four Cycles of Baseline-Dose BEACOPP With or Without Radiotherapy in Patients With Advanced-Stage Hodgkin's Lymphoma: Final Analysis of the HD12 Trial of the German Hodgkin Study Group. J Clin Oncol 2011; 29:4234-42. [DOI: 10.1200/jco.2010.33.9549] [Citation(s) in RCA: 153] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Eight cycles of BEACOPPescalated (escalated dose of bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone) followed by radiotherapy (RT) to initial bulk or residual tumor mass is the German Hodgkin Study Group standard of care for advanced-stage Hodgkin's lymphoma (HL). However, treatment-related toxicity is a concern, and the role of RT in this setting is unclear. The HD12 study thus aimed to reduce toxicity while maintaining efficacy. Patients and Methods In this prospectively randomized multicenter trial, eight cycles of BEACOPPescalated was compared with four cycles of BEACOPPescalated followed by four cycles of the baseline dose of BEACOPP (BEACOPPbaseline; 4 + 4), and RT with no RT in the case of initial bulk or residual disease. The study was designed to exclude a difference in 5-year freedom from treatment failure (FFTF) rate of 6%. Results Between January 1999 and January 2003, 1,670 patients age 16 to 65 years were enrolled onto the HD12 study. At 5 years, FFTF was 86.4% in the BEACOPPescalated arm and 84.8% in the 4 + 4 arm (difference, −1.6%; 95% CI, −5.2% to 1.9%), and overall survival was 92% versus 90.3% (difference, −1.7%; 95% CI, −4.6% to 1.1%). Deaths related to acute toxicity of chemotherapy were observed in 2.9% of patients (BEACOPPescalated, n = 19; 4 + 4, n = 27). FFTF was inferior without RT (90.4% v 87%; difference, −3.4%; 95% CI, −6.6% to −0.1%), particularly in patients who had residual disease after chemotherapy (difference, −5.8%; 95% CI, −10.7% to −1.0%), but not in patients with bulk in complete response after chemotherapy (difference, −1.1%; 95% CI, −6.2% to 4%). Conclusion The reduction of BEACOPP to the 4 + 4 regimen did not substantially reduce severe toxicity but might decrease efficacy. Our results do not support the omission of consolidation RT for patients with residual disease. Alternative strategies for improving the risk-to-benefit ratio for patients with advanced HL are needed.
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Affiliation(s)
- Peter Borchmann
- Peter Borchmann, Heinz Haverkamp, Volker Diehl, Hans-Theodor Eich, Ursula Paulus, Rolf-Peter Mueller, Michael Fuchs, and Andreas Engert, University Hospital of Cologne, Cologne; Anthony D. Ho, University of Heidelberg, Heidelberg; Hans Konrad Mueller-Hermelink, University of Wuerzburg, Wuerzburg; Lothar Kanz, University of Tübingen, Tübingen; Andreas Rank, University Hospital of Munich; Christoph Nerl, Klinikum Schwabing, Munich; Christoph Huber, University Hospital of Mainz, Mainz; Bernd Dörken, Charité
| | - Heinz Haverkamp
- Peter Borchmann, Heinz Haverkamp, Volker Diehl, Hans-Theodor Eich, Ursula Paulus, Rolf-Peter Mueller, Michael Fuchs, and Andreas Engert, University Hospital of Cologne, Cologne; Anthony D. Ho, University of Heidelberg, Heidelberg; Hans Konrad Mueller-Hermelink, University of Wuerzburg, Wuerzburg; Lothar Kanz, University of Tübingen, Tübingen; Andreas Rank, University Hospital of Munich; Christoph Nerl, Klinikum Schwabing, Munich; Christoph Huber, University Hospital of Mainz, Mainz; Bernd Dörken, Charité
| | - Volker Diehl
- Peter Borchmann, Heinz Haverkamp, Volker Diehl, Hans-Theodor Eich, Ursula Paulus, Rolf-Peter Mueller, Michael Fuchs, and Andreas Engert, University Hospital of Cologne, Cologne; Anthony D. Ho, University of Heidelberg, Heidelberg; Hans Konrad Mueller-Hermelink, University of Wuerzburg, Wuerzburg; Lothar Kanz, University of Tübingen, Tübingen; Andreas Rank, University Hospital of Munich; Christoph Nerl, Klinikum Schwabing, Munich; Christoph Huber, University Hospital of Mainz, Mainz; Bernd Dörken, Charité
| | - Thomas Cerny
- Peter Borchmann, Heinz Haverkamp, Volker Diehl, Hans-Theodor Eich, Ursula Paulus, Rolf-Peter Mueller, Michael Fuchs, and Andreas Engert, University Hospital of Cologne, Cologne; Anthony D. Ho, University of Heidelberg, Heidelberg; Hans Konrad Mueller-Hermelink, University of Wuerzburg, Wuerzburg; Lothar Kanz, University of Tübingen, Tübingen; Andreas Rank, University Hospital of Munich; Christoph Nerl, Klinikum Schwabing, Munich; Christoph Huber, University Hospital of Mainz, Mainz; Bernd Dörken, Charité
| | - Jana Markova
- Peter Borchmann, Heinz Haverkamp, Volker Diehl, Hans-Theodor Eich, Ursula Paulus, Rolf-Peter Mueller, Michael Fuchs, and Andreas Engert, University Hospital of Cologne, Cologne; Anthony D. Ho, University of Heidelberg, Heidelberg; Hans Konrad Mueller-Hermelink, University of Wuerzburg, Wuerzburg; Lothar Kanz, University of Tübingen, Tübingen; Andreas Rank, University Hospital of Munich; Christoph Nerl, Klinikum Schwabing, Munich; Christoph Huber, University Hospital of Mainz, Mainz; Bernd Dörken, Charité
| | - Anthony D. Ho
- Peter Borchmann, Heinz Haverkamp, Volker Diehl, Hans-Theodor Eich, Ursula Paulus, Rolf-Peter Mueller, Michael Fuchs, and Andreas Engert, University Hospital of Cologne, Cologne; Anthony D. Ho, University of Heidelberg, Heidelberg; Hans Konrad Mueller-Hermelink, University of Wuerzburg, Wuerzburg; Lothar Kanz, University of Tübingen, Tübingen; Andreas Rank, University Hospital of Munich; Christoph Nerl, Klinikum Schwabing, Munich; Christoph Huber, University Hospital of Mainz, Mainz; Bernd Dörken, Charité
| | - Hans-Theodor Eich
- Peter Borchmann, Heinz Haverkamp, Volker Diehl, Hans-Theodor Eich, Ursula Paulus, Rolf-Peter Mueller, Michael Fuchs, and Andreas Engert, University Hospital of Cologne, Cologne; Anthony D. Ho, University of Heidelberg, Heidelberg; Hans Konrad Mueller-Hermelink, University of Wuerzburg, Wuerzburg; Lothar Kanz, University of Tübingen, Tübingen; Andreas Rank, University Hospital of Munich; Christoph Nerl, Klinikum Schwabing, Munich; Christoph Huber, University Hospital of Mainz, Mainz; Bernd Dörken, Charité
| | - Hans Konrad Mueller-Hermelink
- Peter Borchmann, Heinz Haverkamp, Volker Diehl, Hans-Theodor Eich, Ursula Paulus, Rolf-Peter Mueller, Michael Fuchs, and Andreas Engert, University Hospital of Cologne, Cologne; Anthony D. Ho, University of Heidelberg, Heidelberg; Hans Konrad Mueller-Hermelink, University of Wuerzburg, Wuerzburg; Lothar Kanz, University of Tübingen, Tübingen; Andreas Rank, University Hospital of Munich; Christoph Nerl, Klinikum Schwabing, Munich; Christoph Huber, University Hospital of Mainz, Mainz; Bernd Dörken, Charité
| | - Lothar Kanz
- Peter Borchmann, Heinz Haverkamp, Volker Diehl, Hans-Theodor Eich, Ursula Paulus, Rolf-Peter Mueller, Michael Fuchs, and Andreas Engert, University Hospital of Cologne, Cologne; Anthony D. Ho, University of Heidelberg, Heidelberg; Hans Konrad Mueller-Hermelink, University of Wuerzburg, Wuerzburg; Lothar Kanz, University of Tübingen, Tübingen; Andreas Rank, University Hospital of Munich; Christoph Nerl, Klinikum Schwabing, Munich; Christoph Huber, University Hospital of Mainz, Mainz; Bernd Dörken, Charité
| | - Richard Greil
- Peter Borchmann, Heinz Haverkamp, Volker Diehl, Hans-Theodor Eich, Ursula Paulus, Rolf-Peter Mueller, Michael Fuchs, and Andreas Engert, University Hospital of Cologne, Cologne; Anthony D. Ho, University of Heidelberg, Heidelberg; Hans Konrad Mueller-Hermelink, University of Wuerzburg, Wuerzburg; Lothar Kanz, University of Tübingen, Tübingen; Andreas Rank, University Hospital of Munich; Christoph Nerl, Klinikum Schwabing, Munich; Christoph Huber, University Hospital of Mainz, Mainz; Bernd Dörken, Charité
| | - Andreas Rank
- Peter Borchmann, Heinz Haverkamp, Volker Diehl, Hans-Theodor Eich, Ursula Paulus, Rolf-Peter Mueller, Michael Fuchs, and Andreas Engert, University Hospital of Cologne, Cologne; Anthony D. Ho, University of Heidelberg, Heidelberg; Hans Konrad Mueller-Hermelink, University of Wuerzburg, Wuerzburg; Lothar Kanz, University of Tübingen, Tübingen; Andreas Rank, University Hospital of Munich; Christoph Nerl, Klinikum Schwabing, Munich; Christoph Huber, University Hospital of Mainz, Mainz; Bernd Dörken, Charité
| | - Ursula Paulus
- Peter Borchmann, Heinz Haverkamp, Volker Diehl, Hans-Theodor Eich, Ursula Paulus, Rolf-Peter Mueller, Michael Fuchs, and Andreas Engert, University Hospital of Cologne, Cologne; Anthony D. Ho, University of Heidelberg, Heidelberg; Hans Konrad Mueller-Hermelink, University of Wuerzburg, Wuerzburg; Lothar Kanz, University of Tübingen, Tübingen; Andreas Rank, University Hospital of Munich; Christoph Nerl, Klinikum Schwabing, Munich; Christoph Huber, University Hospital of Mainz, Mainz; Bernd Dörken, Charité
| | - Lenka Smardova
- Peter Borchmann, Heinz Haverkamp, Volker Diehl, Hans-Theodor Eich, Ursula Paulus, Rolf-Peter Mueller, Michael Fuchs, and Andreas Engert, University Hospital of Cologne, Cologne; Anthony D. Ho, University of Heidelberg, Heidelberg; Hans Konrad Mueller-Hermelink, University of Wuerzburg, Wuerzburg; Lothar Kanz, University of Tübingen, Tübingen; Andreas Rank, University Hospital of Munich; Christoph Nerl, Klinikum Schwabing, Munich; Christoph Huber, University Hospital of Mainz, Mainz; Bernd Dörken, Charité
| | - Christoph Huber
- Peter Borchmann, Heinz Haverkamp, Volker Diehl, Hans-Theodor Eich, Ursula Paulus, Rolf-Peter Mueller, Michael Fuchs, and Andreas Engert, University Hospital of Cologne, Cologne; Anthony D. Ho, University of Heidelberg, Heidelberg; Hans Konrad Mueller-Hermelink, University of Wuerzburg, Wuerzburg; Lothar Kanz, University of Tübingen, Tübingen; Andreas Rank, University Hospital of Munich; Christoph Nerl, Klinikum Schwabing, Munich; Christoph Huber, University Hospital of Mainz, Mainz; Bernd Dörken, Charité
| | - Bernd Dörken
- Peter Borchmann, Heinz Haverkamp, Volker Diehl, Hans-Theodor Eich, Ursula Paulus, Rolf-Peter Mueller, Michael Fuchs, and Andreas Engert, University Hospital of Cologne, Cologne; Anthony D. Ho, University of Heidelberg, Heidelberg; Hans Konrad Mueller-Hermelink, University of Wuerzburg, Wuerzburg; Lothar Kanz, University of Tübingen, Tübingen; Andreas Rank, University Hospital of Munich; Christoph Nerl, Klinikum Schwabing, Munich; Christoph Huber, University Hospital of Mainz, Mainz; Bernd Dörken, Charité
| | - Christoph Nerl
- Peter Borchmann, Heinz Haverkamp, Volker Diehl, Hans-Theodor Eich, Ursula Paulus, Rolf-Peter Mueller, Michael Fuchs, and Andreas Engert, University Hospital of Cologne, Cologne; Anthony D. Ho, University of Heidelberg, Heidelberg; Hans Konrad Mueller-Hermelink, University of Wuerzburg, Wuerzburg; Lothar Kanz, University of Tübingen, Tübingen; Andreas Rank, University Hospital of Munich; Christoph Nerl, Klinikum Schwabing, Munich; Christoph Huber, University Hospital of Mainz, Mainz; Bernd Dörken, Charité
| | - Stefan W. Krause
- Peter Borchmann, Heinz Haverkamp, Volker Diehl, Hans-Theodor Eich, Ursula Paulus, Rolf-Peter Mueller, Michael Fuchs, and Andreas Engert, University Hospital of Cologne, Cologne; Anthony D. Ho, University of Heidelberg, Heidelberg; Hans Konrad Mueller-Hermelink, University of Wuerzburg, Wuerzburg; Lothar Kanz, University of Tübingen, Tübingen; Andreas Rank, University Hospital of Munich; Christoph Nerl, Klinikum Schwabing, Munich; Christoph Huber, University Hospital of Mainz, Mainz; Bernd Dörken, Charité
| | - Rolf-Peter Mueller
- Peter Borchmann, Heinz Haverkamp, Volker Diehl, Hans-Theodor Eich, Ursula Paulus, Rolf-Peter Mueller, Michael Fuchs, and Andreas Engert, University Hospital of Cologne, Cologne; Anthony D. Ho, University of Heidelberg, Heidelberg; Hans Konrad Mueller-Hermelink, University of Wuerzburg, Wuerzburg; Lothar Kanz, University of Tübingen, Tübingen; Andreas Rank, University Hospital of Munich; Christoph Nerl, Klinikum Schwabing, Munich; Christoph Huber, University Hospital of Mainz, Mainz; Bernd Dörken, Charité
| | - Michael Fuchs
- Peter Borchmann, Heinz Haverkamp, Volker Diehl, Hans-Theodor Eich, Ursula Paulus, Rolf-Peter Mueller, Michael Fuchs, and Andreas Engert, University Hospital of Cologne, Cologne; Anthony D. Ho, University of Heidelberg, Heidelberg; Hans Konrad Mueller-Hermelink, University of Wuerzburg, Wuerzburg; Lothar Kanz, University of Tübingen, Tübingen; Andreas Rank, University Hospital of Munich; Christoph Nerl, Klinikum Schwabing, Munich; Christoph Huber, University Hospital of Mainz, Mainz; Bernd Dörken, Charité
| | - Andreas Engert
- Peter Borchmann, Heinz Haverkamp, Volker Diehl, Hans-Theodor Eich, Ursula Paulus, Rolf-Peter Mueller, Michael Fuchs, and Andreas Engert, University Hospital of Cologne, Cologne; Anthony D. Ho, University of Heidelberg, Heidelberg; Hans Konrad Mueller-Hermelink, University of Wuerzburg, Wuerzburg; Lothar Kanz, University of Tübingen, Tübingen; Andreas Rank, University Hospital of Munich; Christoph Nerl, Klinikum Schwabing, Munich; Christoph Huber, University Hospital of Mainz, Mainz; Bernd Dörken, Charité
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Markova J, Kahraman D, Kobe C, Skopalova M, Mocikova H, Klaskova K, Dedeckova K, Eich HT, Böll B, Dietlein M, Kozak T. Role of [18F]-fluoro-2-deoxy-d-glucose positron emission tomography in early and late therapy assessment of patients with advanced Hodgkin lymphoma treated with bleomycin, etoposide, adriamycin, cyclophosphamide, vincristine, procarbazine and prednisone. Leuk Lymphoma 2011; 53:64-70. [DOI: 10.3109/10428194.2011.603444] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Kreppel M, Drebber U, Wedemeyer I, Eich HT, Backhaus T, Zöller JE, Scheer M. Podoplanin expression predicts prognosis in patients with oral squamous cell carcinoma treated with neoadjuvant radiochemotherapy. Oral Oncol 2011; 47:873-8. [PMID: 21767977 DOI: 10.1016/j.oraloncology.2011.06.508] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2010] [Revised: 06/21/2011] [Accepted: 06/26/2011] [Indexed: 10/17/2022]
Abstract
Despite new therapeutic approaches patients with advanced oral squamous cell carcinoma still have a dismal prognosis. The main factor contributing to this problem is locoregional failure due to a lack of response to treatment. Several trials have proven the effect of neoadjuvant radiochemotherapy followed by radical surgery in comparison to primary surgery followed by adjuvant radiochemotherapy. No reliable parameters have been identified so far to predict response to radiochemotherapy. The aim of our study was to assess whether podoplanin expression in pretreatment biopsies could serve as a biomarker to predict the host response to neoadjuvant radiochemotherapy. In this retrospective study, podoplanin expression was examined in a set of 63 patients with oral squamous cell carcinoma by immunohistochemistry. We analyzed associations between the level of podoplanin expression and various clinicopathologic parameters, including response to radiochemotherapy, clinical and histological N-status. Furthermore we evaluated the effects of these parameters on overall survival and on locoregional control in univariate and multivariate analysis. The χ(2)-test revealed that high expression of podoplanin in pretreatment biopsy material was associated with non-regression of the tumor (p=0.013) and poor overall survival (p<0.001). Five-year survival rates of 92.9% for patients with weak expression and 15.0% for high expression were revealed. Podoplanin expression was also significantly associated with ypN status (p=0.004) and ypUICC status (p<0.001). We concluded that podoplanin might serve as a factor to predict treatment response in oral squamous cell carcinoma treated with neoadjuvant platin-based radiochemotherapy as well as a prognostic factor for overall survival and locoregional control.
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Affiliation(s)
- Matthias Kreppel
- Department for Oral and Cranio-Maxillo and Facial Plastic Surgery, University of Cologne, Kerpenerstrasse 62, 50937 Cologne, Germany.
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Kreppel M, Drebber U, Rothamel D, Eich HT, Kübler A, Scheer M, Zöller JE. Prognostic impact of different TNM-based stage groupings for oral squamous cell carcinoma. Head Neck 2010; 33:1467-75. [PMID: 21928419 DOI: 10.1002/hed.21630] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The purpose of this study was to evaluate the prognostic significance of different TNM-based stage groupings proposed in the literature. METHODS We conducted a retrospective analysis of 300 patients with primary oral squamous cell carcinoma (T1-4, N0-2, M0). The stage grouping systems of the sixth edition of the Union Internationale Contre le Cancer (UICC), T and N Integer Score (TANIS), the Snyderman scheme, the Hart scheme, and the Berg scheme were tested for their prognostic significance. Disease free survival (DFS) was plotted by Kaplan-Meier analysis. Prognostic factors were identified through univariate and multivariate analysis. RESULTS On univariate analysis, all systems revealed discriminatory power for DFS; however, on multivariate analysis, only the Hart scheme predicted DFS. The TANIS did not have a better prognostic ability than the UICC stage grouping. CONCLUSION Unlike in previous studies, the UICC stage grouping did perform worse than other TNM-based stage groupings, which may be due to the alterations made in the sixth edition.
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Affiliation(s)
- Matthias Kreppel
- Department for Oral and Cranio-Maxillo and Facial Plastic Surgery, University of Cologne, Cologne, Germany.
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Markova J, Kobe C, Skopalova M, Klaskova K, Dedeckova K, Plütschow A, Eich HT, Dietlein M, Engert A, Kozak T. FDG-PET for assessment of early treatment response after four cycles of chemotherapy in patients with advanced-stage Hodgkin's lymphoma has a high negative predictive value. Ann Oncol 2009; 20:1270-4. [PMID: 19228806 DOI: 10.1093/annonc/mdn768] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [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
BACKGROUND As positron emission tomography (PET) seems to be a powerful prognostic marker in the treatment of Hodgkin's lymphoma (HL), we analysed the prognostic value of PET after four cycles of combination therapy with bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine and prednisone (BEACOPP) in patients with advanced-stage HL. PATIENTS AND METHODS From January 2004 to March 2007, 50 patients with newly diagnosed HL in clinical stages IIB with large mediastinal mass or extranodal disease, III and IV were treated according to the HD15 protocol of the German Hodgkin Study Group. All patients received a PET scan after four cycles of BEACOPP (PET-4). RESULTS Of the overall group, 14 of 50 patients had a positive PET-4 while 36 had a negative PET-4. At a median observation time of 25 months, 2 of the 14 patients with a positive PET-4 had progressed or relapsed, while there was no progression or relapse in PET-4-negative patients. CONCLUSION Our results indicate a very good negative predictive value of PET-4 in advanced-stage HL patients treated with BEACOPP.
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Affiliation(s)
- J Markova
- Department of Clinical Hematology, University Hospital Kralovske Vinohrady, Third Faculty of Medicine, Charles University, Prague, Czech Republic.
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Klimm B, Eich HT, Haverkamp H, Lohri A, Koch P, Boissevain F, Trenn G, Worst P, Dühmke E, Müller RP, Müller-Hermelink K, Pfistner B, Diehl V, Engert A. Poorer outcome of elderly patients treated with extended-field radiotherapy compared with involved-field radiotherapy after chemotherapy for Hodgkin's lymphoma: an analysis from the German Hodgkin Study Group. Ann Oncol 2007; 18:357-63. [PMID: 17071932 DOI: 10.1093/annonc/mdl379] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The optimal treatment of elderly patients with Hodgkin's lymphoma (HL) is still a matter of debate. Since many of these patients receive combined modality treatment, we evaluated the impact of different radiation field sizes, that is extended-field (EF) or involved-field (IF) technique when given after four cycles of chemotherapy. PATIENTS AND METHODS In the multicenter HD8 study of the German Hodgkin Study Group, 1204 patients with early-stage unfavorable HL were randomized to receive four cycles of chemotherapy followed by either radiotherapy (RT) of 30 Gy EF + 10 Gy to bulky disease (arm A) or 30 Gy IF + 10 Gy to bulky disease (arm B). A total of 1064 patients were assessable for the analysis. Of these, 89 patients (8.4%) were 60 years or older. RESULTS Elderly patients had a poorer risk profile. Acute toxicity from RT was more pronounced in elderly patients receiving EF-RT compared with IF-RT [World Health Organization (WHO) grade 3/4: 26.5% versus 8.6%)]. Freedom from treatment failure (FFTF, 64% versus 87%) and overall survival (OS, 70% versus 94%) after 5 years was lower in elderly patients compared with younger patients. Importantly, elderly patients had poorer outcome when treated with EF-RT compared with IF-RT in terms of FFTF (58% versus 70%; P = 0.034) and OS (59% versus 81%; P = 0.008). CONCLUSION Elderly patients with early-stage unfavorable HL generally have a poorer risk profile and outcome when compared with younger patients. Treatment with EF-RT instead of IF-RT after chemotherapy has a negative impact on survival of elderly patients and should be avoided.
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Affiliation(s)
- B Klimm
- Department I of Internal Medicine, University Hospital Cologne, Germany.
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Eich HT, Schneeweiss A, Skripnitchenko R, Hansemann K, Gossmann A, Müller RP. [A teleradiotherapeutic network for lymphoma patients within the competence network malignant lymphomas]. Rontgenpraxis 2007; 56:145-51. [PMID: 17390954 DOI: 10.1016/j.rontge.2006.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
PURPOSE The aim of the subproject "Radiotherapy" within the competence network malignant lymphoma, funded by the Federal German Ministry of Education and Research (BMBF), was to build-up an electronic imaging transfer between five University departments of Radiation Oncology to improve communication between study centers and reference centers. MATERIALS AND METHODS We describe our experiences with these modern teleradiotherapeutic possibilities, its feasibility within mutticentric clinical trials. RESULTS Telemedical functions could successfully be integrated into the existing quality asssurance programs of radiotherapy. Since January 2001 more than 700 patients (trials HD10-HD15 of the German Hodgkin Study Group, GHSG) could be assessed after digital transfer via internet, on mobile data carriers or an ISDN-connection in the radiotherapy reference center Cologne. Transfer of digital imaging between participating study centers and the radiotherapy reference center allows immediate or a short-term evaluation of adequacy of treatment fields by expert radiation oncologists before the start of radiotherapy. This improves dialogue and consensus between radiotherapy reference centers and study centers and thus contributes towards high radiotherapy quality for lymphoma patients. CONCLUSION The long-term aim is to network all those hospitals, institutions and private facilities taking part in the GHSG trials to achieve an integrated system of cooperation. This improves dialogue and consensus between the radiotherapy reference center and the study centers and thus contributes towards high radiotherapy quality for patients with Hodgkin's lymphoma.
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Affiliation(s)
- H T Eich
- Klinik und Poliklinik für Strahlentherapie, Klinikum der Universität zu Köln, Joseph-Stelzmann-Str. 9, 50924 Köln, Germany.
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Nogová L, Reineke T, Eich HT, Josting A, Müller-Hermelink HK, Wingbermühle K, Brillant C, Gossmann A, Oertel J, Bollen MV, Müller RP, Diehl V, Engert A. Extended field radiotherapy, combined modality treatment or involved field radiotherapy for patients with stage IA lymphocyte-predominant Hodgkin's lymphoma: a retrospective analysis from the German Hodgkin Study Group (GHSG). Ann Oncol 2005; 16:1683-7. [PMID: 16093276 DOI: 10.1093/annonc/mdi323] [Citation(s) in RCA: 113] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Since there are no randomized studies, the treatment of choice for patients with early stage lymphocyte-predominant Hodgkin's lymphoma (LPHL) remains unclear. We thus reviewed all LPHL cases registered in the database of the German Hodgkin Study Group (GHSG) and compared the different treatment approaches, such as extended field (EF), involved field (IF) radiation and combined modality (CM) treatment for LPHL stage IA patients. PATIENTS AND METHODS One hundred and thirty-one patients with LPHL in clinical stage IA without risk factors were analyzed. Forty-five patients were treated with EF radiotherapy, 45 patients with IF radiation and 41 patients received CM treatment. The median follow-up was 78 months in the EF group, 40 months after CM and 17 months after IF, respectively. RESULTS A total of 129 patients achieved complete remission (CR and CRu): 98% after EF radiotherapy, 100% after IF radiation and 95% after CM. With a median follow-up of 43 months there were 5% relapses and only three patients died. Toxicity of treatment was generally mild with most events observed after CM. CONCLUSION In terms of remission induction IF radiotherapy for stage IA LPHL patients is as effective as EF or CM treatment. However, longer follow-up is needed before final conclusion as the optimal therapy.
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Affiliation(s)
- L Nogová
- Clinic I for Internal Medicine, Clinic of Radiotherapy and Department of Radiology of University Hospital Cologne
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Kocher M, Kunze S, Eich HT, Semrau R, Müller RP. Efficacy and Toxicity of Postoperative Temozolomide Radiochemotherapy in Malignant Glioma. Strahlenther Onkol 2005; 181:157-63. [PMID: 15756519 DOI: 10.1007/s00066-005-1314-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2004] [Accepted: 01/14/2005] [Indexed: 11/24/2022]
Abstract
PURPOSE To evaluate the feasibility, safety and efficacy of daily temozolomide concurrent with postoperative radiotherapy in malignant glioma. PATIENTS AND METHODS From 11/1999 to 03/2003, n = 81 patients aged 15-72 years (median 52 years, Karnofsky score 80-100% in 83%) suffering from primary glioblastoma (n = 47), anaplastic astrocytoma (n = 6), anaplastic oligodendroglioma (n = 16), and recurrent glioma (n = 12) were treated. Patients with primary gliomas received a combination of postoperative radiotherapy (60 Gy/1.8- to 2.0-Gy fractions) and daily oral temozolomide (75 mg/m(2)) at all irradiation days (30-33 doses), while recurrent tumors were treated with 45-60 Gy and temozolomide. Initially, 6/81 patients had daily temozolomide doses of 50 mg/m(2). RESULTS In total, 70/81 patients (86%) completed both radio- and chemotherapy. Grade 1 nausea/vomiting was seen in 28%, grade 2 in 11%, grade 3 in 1%. Antiemetics were applied in 41%. Hematologic toxicities were observed as follows: leukopenia grade 3/4 1%, lymphopenia grade 3/4 46%, thrombopenia grade 3/4 1%. Two patients under dexamethasone suffered herpes encephalitis after one and 16 doses of temozolomide (75 mg/m(2)). Median survival was 15 months for glioblastoma. In oligodendroglioma patients, a 4-year survival rate of 78% was observed. CONCLUSION Postoperative radiochemotherapy with 30-33 daily doses of temozolomide (75 mg/m(2)) is safe in patients with malignant glioma. The combined schedule is effective in oligodendroglioma patients and may prolong survival in glioblastoma. Effort should be taken to minimize corticosteroid doses, since both steroids and temozolomide lead to immunosuppression.
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Affiliation(s)
- Martin Kocher
- Department of Radiation Oncology, University of Cologne, Köln, Germany.
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Kocher M, Eich HT, Semrau R, Güner SA, Müller RP. Phase I/II Trial of Simultaneous Whole-Brain Irradiation and Dose-Escalating Topotecan for Brain Metastases. Strahlenther Onkol 2005; 181:20-5. [PMID: 15660189 DOI: 10.1007/s00066-005-1242-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2003] [Accepted: 07/23/2004] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE Topotecan penetrates the blood-brain barrier and sensitizes tumor cells against radiation. A phase I/II dose-escalating trial of repetitive daily i. v. topotecan application simultaneously with whole-brain irradiation (WBRT) was conducted to estimate toxicity, maximum tolerated dose and survival in patients with inoperable brain metastases. PATIENTS AND METHODS In 47 patients suffering from previously untreated brain metastases, topotecan was applied on a daily i. v. schedule simultaneously with WBRT (36 Gy/3-Gy fractions). The infusion schedule started at the beginning of WBRT and was discontinued during weekends. Each infusion was completed within 1-2 h before irradiation. In a dose-finding study, topotecan was escalated from 5 x 0.5 mg/m(2), 8 x 0.5 mg/m(2), 12 x 0.5 mg/m(2) to 12 x 0.6 mg/m(2). RESULTS Altogether, 38/47 patients (81%) completed the prescribed schedule. Leukopenia and thrombocytopenia were dose-limiting. Grade 3/4 hematologic toxicity occurred in 5/32 chemonaïve patients (16%) and 7/15 patients (47%) with previous chemotherapy. At 12 x 0.6 mg/m(2), 2/4 patients experienced grade 4 leukopenia/thrombopenia. Nonhematologic toxicities were generally mild to moderate and unrelated to topotecan. Response evaluation was possible in 26/47 patients, overall response rate was 58% (CR [complete remission] 5/26, PR [partial remission] 10/26, NC [no change] 8/26). Median survival amounted to 5.1 months. In 15/42 patients (36%), brain metastases were the dominant cause of death. CONCLUSION For a daily topotecan schedule simultaneous to WBRT, the maximum tolerated dose is 12 x 0.5 mg/m(2) in chemonaïve patients. For chemo-pretreated patients, daily doses should be reduced to 0.4 mg/m(2). A phase III trial has now been started to find out whether WBRT + topotecan increases survival compared to WBRT alone.
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Affiliation(s)
- Martin Kocher
- Department of Radiotherapy, University of Cologne, Joseph-Stelzmann-Strasse 9, 50924 Köln, Germany.
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Ballova V, Rüffer JU, Haverkamp H, Pfistner B, Müller-Hermelink HK, Dühmke E, Worst P, Wilhelmy M, Naumann R, Hentrich M, Eich HT, Josting A, Löffler M, Diehl V, Engert A. A prospectively randomized trial carried out by the German Hodgkin Study Group (GHSG) for elderly patients with advanced Hodgkin's disease comparing BEACOPP baseline and COPP-ABVD (study HD9elderly). Ann Oncol 2004; 16:124-31. [PMID: 15598949 DOI: 10.1093/annonc/mdi023] [Citation(s) in RCA: 104] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
In contrast to younger patients, the prognosis of elderly patients with advanced Hodgkin's disease (HD) has not improved substantially over the last 20 years. We thus carried out a prospectively randomized study (HD9(elderly)) to compare the BEACOPP regimen in this setting against standard COPP-ABVD. Between February 1993 and 1998, 75 patients aged 66-75 years with newly diagnosed HD in advanced stages were recruited into the HD9 trial as a separate stratum (HD9(elderly)). Patients were assigned to eight alternating cycles of COPP and ABVD or eight cycles of BEACOPP in baseline doses. Radiotherapy was given to initial bulky or residual disease. In total, 68 of 75 registered patients were assessable: 26 were treated with COPP-ABVD and 42 with BEACOPP baseline. There were no significant differences between COPP-ABVD and BEACOPP in terms of complete remission (76%), overall survival (50%) and freedom from treatment failure (FFTF) (46%) at 5 years. At a median follow-up of 80 months, a total of 37 patients died: 14/26 patients (54%) treated with COPP-ABVD and 23/42 patients (55%) with BEACOPP. Two patients (8%) treated with COPP-ABVD and nine patients (21%) treated with BEACOPP died of acute toxicity. Hodgkin-specific FFTF at 5 years was 55% after COPP-ABVD and 74% after BEACOPP (P=0.13). Thus, there are no differences in survival between these regimens in elderly patients.
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Affiliation(s)
- V Ballova
- Department of Internal Medicine I, University Hospital of Cologne, Cologne and the German Hodgkin Lymphoma Study Group, Germany
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Behringer K, Josting A, Schiller P, Eich HT, Bredenfeld H, Diehl V, Engert A. Solid tumors in patients treated for Hodgkin's disease: a report from the German Hodgkin Lymphoma Study Group. Ann Oncol 2004; 15:1079-85. [PMID: 15205202 DOI: 10.1093/annonc/mdh273] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Long-term survivors of successfully treated Hodgkin's disease (HD) are at risk for late complications. Among these, secondary solid tumors are most serious because they are often fatal. The aim of this retrospective analysis was to assess the incidence, relative risk and risk factors of secondary solid tumors in HD patients registered in the database of the German Hodgkin Lymphoma Study Group (GHSG). PATIENTS AND METHODS From 1983 to 1998, the GHSG conducted three generations of clinical trials for early, intermediate and advanced stage HD (HD1-HD9) involving a total of 5367 patients. Data on incidence, risk factors and relative risk were updated in March 2003. RESULTS A total of 127 patients with secondary solid tumors were identified. Among these, lung cancer (23.6%), colorectal cancer (20.5%) and breast cancer (10.2%) were the most frequent. After a median follow-up of 72 months the cumulative risk of developing a solid tumor was 2%, with an overall relative risk (RR) of 2.4 (lung cancer, 3.8; colorectal cancer, 3.2; breast cancer, 1.9). For most patients (n=67; 52.8%) developing a secondary solid tumor, treatment modality consisted of chemotherapy combined with radiotherapy in extended field technique (RR = 3.3). CONCLUSIONS With a median follow-up of 72 months, there were 127 patients developing solid tumors out of a total of 5367 HD patients treated in the GHSG studies HD1-HD9. The cumulative risk of 2% is expected to increase over time due to the rather short median observation time and slow progression of solid malignancies.
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Affiliation(s)
- K Behringer
- First Department of Internal Medicine, University Hospital Cologne, German Hodgkin Lymphoma Study Group (GHSG).
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Eich P, Twilfer H, Eich HT, John K, Wiesmann W, Kagel KO. MR-Bildgebung beim Aicardi-Syndrom. ROFO-FORTSCHR RONTG 2004. [DOI: 10.1055/s-2004-828097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Eich P, Eich HT, Twilfer H, Lange E, Kagel KO. Hypereosinophiles Syndrom mit schwerer respiratorischer Partialinsuffizienz, eine schwierige Differentialdiagnose. ROFO-FORTSCHR RONTG 2004. [DOI: 10.1055/s-2004-828126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Abstract
PURPOSE Only 3% of all malignant intranasal tumors are esthesioneuroblastomas (ENB). As the tumor is very rare, the number of ENB treated in individual departments is small. In order to evaluate the efficacy of radiotherapy (RT), patients' data of 2 centres were analysed with reference to new reports in literature. METHODS AND MATERIALS From 1981 to 1998, 17 patients with ENB, 8 men and 9 women aged between 6 and 81 years, were treated in the departments of radiotherapy of the universities of Cologne and Muenster. The tumors were Kadish Stage B in 4/17 patients and Stage C in 13/17 patients. Treatment included incomplete surgery and irradiation in 2/17 patients, adjuvant RT postoperatively in 6/17 patients, definitive RT in 7/17 patients and RT after incomplete surgery of recurrent tumors in 2/17 patients. Postoperatively, the median target dose of EBRT was 56 (range 50-60) Gy; for definitive RT it was 58 (range 40-70) Gy. RESULTS After a median follow-up period of 86 (range 2-208) months 10/17 patients showed no evidence of disease (NED). There were 6 patients treated with radical complete surgery plus postoperative irradiation and 5 of them were NED. There were 7 patients treated with only irradiation and 3 of those patients were NED. Of 2 patients with incomplete surgery and irradiation there was one patient NED. Of 2 patients with incomplete resection of recurrent tumor who received irradiation, there was one patient NED. 2 of the patients with NED died after 22 and 94 months respectively. 4/17 patients died as a result of local recurrence and 2/17 patients as a result of distant metastases (liver, brain). One patient with a recurrent tumor is alive. Median survival of all 17 patients was 94 months. Progressive disease after definitive RT occurred after a median of 11 months. CONCLUSION Esthesioneuroblastomas are radiocurable tumors. In correlation to literature a primarily complete tumor resection followed by adjuvant RT (50-60 Gy) offers the best disease free survival.
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Affiliation(s)
- H T Eich
- Radiotherapy, University of Cologne, Germany
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Eich HT, Haverkamp U, Micke O, Prott FJ, Müller RP. Dosimetric analysis at ICRU reference points in HDR-brachytherapy of cervical carcinoma. Rontgenpraxis 2000; 53:62-6. [PMID: 10994367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
In vivo dosimetry in bladder and rectum as well as determining doses on suggested reference points following the ICRU report 38 contribute to quality assurance in HDR-brachytherapy of cervical carcinoma, especially to minimize side effects. In order to gain information regarding the radiation exposure at ICRU reference points in rectum, bladder, ureter and regional lymph nodes those were calculated (digitalisation) by means of orthogonal radiographs of 11 applications in patients with cervical carcinoma, who received primary radiotherapy. In addition, the doses at the ICRU rectum reference point was compared to the results of in vivo measurements in the rectum. The in vivo measurements were by factor 1.5 below the doses determined for the ICRU rectum reference point (4.05 +/- 0.68 Gy versus 6.11 +/- 1.63 Gy). Reasons for this were: calibration errors, non-orthogonal radiographs, movement of applicator and probe in the time span between X-ray and application, missing connection of probe and anterior rectal wall. The standard deviation of calculations at ICRU reference points was on average +/- 30%. Possible reasons for the relatively large standard deviation were difficulties in defining the points, identifying them on radiographs and the different locations of the applicators. Although 3 D CT, US or MR based treatment planning using dose volume histogram analysis is more and more established, this simple procedure of marking and digitising the ICRU reference points lengthened treatment planning only by 5 to 10 minutes. The advantages of in vivo dosimetry are easy practicability and the possibility to determine rectum doses during radiation. The advantages of computer-aided planning at ICRU reference points are that calculations are available before radiation and that they can still be taken into account for treatment planning. Both methods should be applied in HDR-brachytherapy of cervical carcinoma.
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Affiliation(s)
- H T Eich
- Department of Radiotherapy, University of Cologne, Germany
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Abstract
BACKGROUND Cystosarcoma phylloides is a rare, mostly benign tumor of the breast. In most cases curative treatment is possible with complete surgical excision of the lesions. However, there is a high local recurrence rate up to 46%. There are only few reported successful treatments with radiotherapy in cystosarcoma phylloides. Radiotherapy is indicated in patients with locoregional recurrent disease and those with symptomatic metastases. PATIENT We present a case of a 54-year-old woman with a painless mass in the right breast. Clinical examination showed a large, firm tumor and axillary lymph node metastases. The patient underwent mastectomy and axillary lymph node dissection. Histopathology showed a cystosarcoma phylloides measuring 30 x 25 x 19 cm as well as lymph node metastases measuring 9.5 cm. Despite a R0 resection the patient developed 4 thoracic wall recurrences within 2 years. At 18 months there were additional multiple pulmonary and pleural lesions with a maximum diameter of 6.5 cm. Subsequently the patient received polychemotherapy. There was a significant response of the thoracic wall disease as well as of the pulmonary and pleural lesions. Six months later there was further progress of the thoracic wall disease and the pulmonary lesions. Following this the patient underwent radiation therapy of her right thoracic wall with 50 Gy which lead clinically to a quick response. For the past 5 months there has been no evidence of thoracic wall disease recurrence. CONCLUSION This is an unusual case of cystosarcoma phylloides and response to different therapeutic modalities. Cystosarcoma phylloides showed to be a radiosensitive tumor. Thus postopertive radiation therapy is indicated to prevent local recurrences.
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Affiliation(s)
- P D Eich
- Institut für Klinische Radiologie, Westfälische Wilhelms-Universität Münster, Germany.
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Abstract
PURPOSE The intention of this study was to reduce patient dose during dental CT in the planning for osseointegrated implants. METHODS AND MATERIALS Dental CTs were performed with a spiral CT (Somatom Plus 4, Siemens) and a dental software package. Use of the usual dental CT technique [1] (120 kVp; 165 mA, 1 s rotation time, 165 mAs; pitch factor 1) was compared with a new protocol (120 kVp; 50 mA; 0.7 s rotation time; 35 mAs; pitch factor 2) which delivered the best image quality at the lowest possible radiation dose, as tested in a preceding study. Image quality was analysed using a human anatomic head preparation. Four radiologists analysed the images independently. A Wilcoxon rank pair-test was used for statistic evaluation. The doses to the thyroid gland, the active bone marrow, the salivary glands, and the eye lens were determined in a tissue-equivalent phantom (Alderson-Rando Phantom) with lithium fluoride thermoluminescent dosimeters at the appropriate locations. RESULTS By mAs reduction from 165 to 35 and using a pitch factor of 2, the radiation dose could be reduced by a factor of nine (max.) (e.g., the bone marrow dose could be reduced from 23.6 mSv to 2.9 mSv, eye lens from 0.5 mSv to 0.3 mSv, thyroid gland from 2.5 mSv to 0.5 mSv, parotid glands from 2.3 mSv to 0.4 mSv). The dose reduction did not lead to an actual loss of image quality or diagnostic information. CONCLUSION A considerable dose reduction without loss of diagnostic information is achievable in dental CT. Dose-reducing examination protocols like the one presented may further expand the use of preoperative dental CT.
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Affiliation(s)
- P Rustemeyer
- Zentralinstitut für Röntgendiagnostik, Universität Essen.
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Eich HT, Eich PD, Stuschke M, Müller RD, Sack H. [CT densitometry for the grading of subcutaneous fibrosis after the photon-neutron therapy of malignant salivary gland tumors]. Strahlenther Onkol 1999; 175:128-32. [PMID: 10093615 DOI: 10.1007/bf02742346] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND To evaluate alternative treatment regimen e.g. neutron therapy determination of treatment efficacy as well as side effects is important. Sensitivity of computed tomography (CT) in detecting changes of connective tissue after neutron therapy was examined. PATIENTS AND METHODS In the course of their follow-up period (median 45 months) 12 patients with malignant salivary gland tumors who had postoperatively received neutron (1/12) or photon/neutron therapy (11/12) were examined by means of CT densitometry on 3 representative scans in the area of radiotherapy. In 3 ROI (regions of interest) in subcutaneous fatty tissue the density at the irradiated and the non-irradiated side was determined according to Hounsfield units (HU) and the average density was calculated. The average density of both sides was compared and correlated with the clinical grade of fibrosis according to LENT SOMA. RESULTS All CT measurements (216 ROI, 18 ROI per patient) showed higher density levels on the irradiated side than on the non-irradiated side. The average density on the irradiated side was -57.7 +/- 4.7 HU and on the non-irradiated side -69.4 +/- 5.8 HU (p = 0.002). In 3/12 patients a clinical fibrosis was not seen; however, the relative density measured on the irradiated and non-irradiated side deviated by up to 8%. This could have been caused by minimal changes not being noticed by either patient and examiner. In patients with determined fibrosis Grade 1 (8/12) the relative density deviation was 4 to 39%. In 1/12 patients with determined fibrosis Grade 2 the relative density deviation was 50% (Figures 1a and 1b). Fibrosis Grade 3 and 4 did not occur (Table 1). CONCLUSIONS Fibrosis is correlated with an increasing value of HU of the tissue density in CT. With the described method it is possible to graduate radiation induced subcutaneous fibrosis in correlation to the clinical fibrosis grade according to LENT SOMA. In the patients we examined subcutaneous fibroses after photon/neutron therapy were moderate. Especially in characterising subclinical or slight changes of connective tissue after radiotherapy computed tomography is of value.
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Affiliation(s)
- H T Eich
- Zentralinstitut für Röntgendiagnostik, Universitätsklinikum Essen.
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Abstract
Therapy of the heterogenous group of primary cutaneous B- and T-cell lymphomas is based upon type of lymphoma and its staging. Treatment, especially for rare forms, has not yet been standardised. Two patients with uncommon primary cutaneous T-cell lymphomas received both traditional therapy and topical photodynamic therapy (PDT) in areas that are difficult to reach with classic methods (ear, eyebrow, side of foot). The first patient had a rare type of medium/large cell pleomorphic, CD8-positive, CD30-negative, primary cutaneous T-cell lymphoma with primary involvement of the ear. As the tumor progressed during PUVA, interferon alpha and retinoid therapy, topical PDT was employed. A histologically confirmed partial remission was obtained. As the disease further evolved the patient received radiotherapy and has now been in complete remission for 10 months. The other patient preserted with the classical picture of mycosis fungoides in initial tumour stage. This patient received in addition to PUVA therapy and interferon alpha, topical PDT to the eyebrow and side of the foot. A complete remission was achieved and histologically confirmed. In the palliative treatment of cutaneous T-cell lymphoma, PDT is a new experimental method, especially for problem locations. It is tissue sparing, has few side effects, can be repeated as often as necessary and achieves good cosmetic results.
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Affiliation(s)
- D Eich
- Hautklinik, Klinikum Minden
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Eich HT, Haverkamp U, Micke O, Prott FJ, Pötter R. [Dosimetry methods in determining radiation dosage of the rectum in HDR-brachytherapy of cervix carcinoma]. Strahlenther Onkol 1998; 174:375-80. [PMID: 9689959 DOI: 10.1007/bf03038352] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Dosage measurements in brachytherapy of cervix carcinoma are usually obtained with semiconductor dosimeters intrarectally and calculated using approximation methods for additional points, e.g. chosen according to ICRU Report 38. This procedure allows minimizing organ risk dosages and avoiding side effects. This study compares actual dosage measurements with computed approximations. METHODS In 75 applications the measured actual rectum dosage was analyzed retrospectively. Using graphic approximation methods in conjunction with the localization radiographs the expected dose values at 5 detector points of the intrarectal semiconductor dosimeter and at the ICRU rectal reference point were determined. Prospectively for 11 additional applications the expected dosage for various points within the rectum were computed during therapy planning and additionally for specific reference points corresponding to Fletcher's lymphatic trapezoid and Chassagne's pelvic wall points. RESULTS The retrospective evaluation showed that 95% of values determined by graphic approximation methods varied by as much as +/- 30% from measured values. Factors causing errors were incorrect assessment of the applicator's spatial positioning, non-orthogonal radiographs, incorrect calibration of the semiconductor probe, movement of applicator and/or probe in the time between radiograph and application. In the prospective group 95% of deviations between measured and calculated values lay within an interval of +/- 40% (Figure 1). Possible sources of error could be similar to those in using the graphic approximation, although the reconstruction of spatial positioning of the applicator is possibly more exact. Doses determined at the ICRU rectal reference point were 5.6 +/- 2.5 Gy in the retrospective analysis and 6.1 +/- 1.6 Gy in the prospective study (Figure 2). The standard deviation of measured values at the specific reference points was +/- 30%. The mean dosage distribution was nearly symmetrical with regard to the body axis, i.e. to the applicator position. Reasons for the relatively large standard deviation are e.g. difficulties in defining the reference points as well as in identifying them on the radiographs, also differences in applicator positioning. CONCLUSIONS The retrospective analysis led to a larger error than the prospective one. The graphic approximation method should only be utilized when computer-assisted treatment planning is not possible. Conspicuous are the differences between values obtained in computer planning and actual measured values. As these deviations cannot always be explained unequivocally, both computation and measurement should always be conducted in order to obtain an adequate survey of dosage distribution within the rectum. Computer planning offers the additional advantage of determining the dose at various other reference points.
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Affiliation(s)
- H T Eich
- Zentralinstitut für Röntgendiagnostik, Universität Essen.
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