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Gkika E, Kostyszyn D, Fechter T, Moustakis C, Ernst F, Boda-Heggemann J, Sarria G, Dieckmann K, Dobiasch S, Duma MN, Eberle F, Kroeger K, Häussler B, Izaguirre V, Jazmati D, Lautenschläger S, Lohaus F, Mantel F, Menzel J, Pachmann S, Pavic M, Radlanski K, Riesterer O, Gerum S, Röder F, Willner J, Barczyk S, Imhoff D, Blanck O, Wittig A, Guckenberger M, Grosu AL, Brunner TB. Interobserver agreement on definition of the target volume in stereotactic radiotherapy for pancreatic adenocarcinoma using different imaging modalities. Strahlenther Onkol 2023; 199:973-981. [PMID: 37268767 PMCID: PMC10598103 DOI: 10.1007/s00066-023-02085-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 04/11/2023] [Indexed: 06/04/2023]
Abstract
PURPOSE The aim of this study was to evaluate interobserver agreement (IOA) on target volume definition for pancreatic cancer (PACA) within the Radiosurgery and Stereotactic Radiotherapy Working Group of the German Society of Radiation Oncology (DEGRO) and to identify the influence of imaging modalities on the definition of the target volumes. METHODS Two cases of locally advanced PACA and one local recurrence were selected from a large SBRT database. Delineation was based on either a planning 4D CT with or without (w/wo) IV contrast, w/wo PET/CT, and w/wo diagnostic MRI. Novel compared to other studies, a combination of four metrics was used to integrate several aspects of target volume segmentation: the Dice coefficient (DSC), the Hausdorff distance (HD), the probabilistic distance (PBD), and the volumetric similarity (VS). RESULTS For all three GTVs, the median DSC was 0.75 (range 0.17-0.95), the median HD 15 (range 3.22-67.11) mm, the median PBD 0.33 (range 0.06-4.86), and the median VS was 0.88 (range 0.31-1). For ITVs and PTVs the results were similar. When comparing the imaging modalities for delineation, the best agreement for the GTV was achieved using PET/CT, and for the ITV and PTV using 4D PET/CT, in treatment position with abdominal compression. CONCLUSION Overall, there was good GTV agreement (DSC). Combined metrics appeared to allow a more valid detection of interobserver variation. For SBRT, either 4D PET/CT or 3D PET/CT in treatment position with abdominal compression leads to better agreement and should be considered as a very useful imaging modality for the definition of treatment volumes in pancreatic SBRT. Contouring does not appear to be the weakest link in the treatment planning chain of SBRT for PACA.
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Affiliation(s)
- E Gkika
- Department of Radiation Oncology, University Medical Center Freiburg, Robert Koch Str 3, Freiburg, Germany.
| | - D Kostyszyn
- Department of Radiation Oncology, University Medical Center Freiburg, Robert Koch Str 3, Freiburg, Germany
| | - T Fechter
- Department of Radiation Oncology, University Medical Center Freiburg, Robert Koch Str 3, Freiburg, Germany
| | - C Moustakis
- Department of Radiation Oncology, University Medical Center Muenster, Muenster, Germany
| | - F Ernst
- Institute for Robotics and Cognitive Systems, University of Luebeck, Luebeck, Germany
| | - J Boda-Heggemann
- Department of Radiation Oncology, Faculty of Medicine Mannheim, Department of Radiation Oncology, University of Heidelberg, Mannheim, Germany
| | - G Sarria
- Department of Radiation Oncology, University Hospital Bonn, Bonn, Germany
| | - K Dieckmann
- Department of Radiation Oncology, University Departments of the MedUni Vienna, Vienna General Hospital, Vienna, Austria
| | - S Dobiasch
- Department of Radiation Oncology, Klinikum Rechts der Isar, TU Munich, Munich, Germany
| | - M N Duma
- Department of Radiotherapy and Radiation Oncology, University Hospital Jena, Friedrich-Schiller University, Jena, Germany
| | - F Eberle
- Department of Radiation Oncology, University Hospital Marburg, Marburg, Germany
| | - K Kroeger
- Department of Radiation Oncology, University Medical Center Muenster, Muenster, Germany
| | - B Häussler
- Radiation Oncology Dr. Häussler/Dr. Schorer, Munich, Germany
| | - V Izaguirre
- Department of Radiation Oncology, University Hospital Halle, Halle, Germany
| | - D Jazmati
- Proton Therapy Centre, University Hospital Essen, Essen, Germany
| | - S Lautenschläger
- Department of Radiation Oncology, University Hospital, Marburg, Germany
| | - F Lohaus
- Department of Radiation Oncology, University Hospital Dresden, Dresden, Germany
| | - F Mantel
- Department of Radiation Oncology, University Hospital Würzburg, Würzburg, Germany
| | - J Menzel
- Department of Radiation Oncology, University Hospital Hannover, Hannover, Germany
| | - S Pachmann
- Department of Radiation Oncology, Weilheim Clinic, Weilheim, Germany
| | - M Pavic
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - K Radlanski
- Department of Radiation Oncology, Charite, University Hospital Berlin, Berlin, Germany
| | - O Riesterer
- Centre for Radiation Oncology KSA-KSB, Kantonsspital Aarau, Aarau, Switzerland
| | - S Gerum
- Department of Radiation Oncology, University Clinic, Paracelsus Medical University (PMU), Salzburg, Austria
| | - F Röder
- Department of Radiation Oncology, University Clinic, Paracelsus Medical University (PMU), Salzburg, Austria
| | - J Willner
- Department of Radiation Oncology, University Hospital Bayreuth, Bayreuth, Germany
| | - S Barczyk
- Center for Radiation Oncology, Belegklinik am St. Agnes-Hospital, Bocholt, Germany
| | - D Imhoff
- Department of Radiation Oncology, Saphir Radiosurgery, University Hospital Frankfurt, Frankfurt, Germany
| | - O Blanck
- Saphir Radiosurgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - A Wittig
- Department of Radiotherapy and Radiation Oncology, University Hospital Jena, Friedrich-Schiller University, Jena, Germany
| | - M Guckenberger
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Anca-L Grosu
- Department of Radiation Oncology, University Medical Center Freiburg, Robert Koch Str 3, Freiburg, Germany
| | - T B Brunner
- Department of Therapeutic Radiology and Oncology, Comprehensive Cancer Center, Medical University of Graz, Graz, Austria
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Zaman A, Krug D, Eidinger L, Boda-Heggemann J, Rudic B, Mehrhof F, Boldt LH, Fleckenstein J, Kluge A, Siebert FA, Schweikard A, Vontlein R, Dunst J, Bonnemeier H, Blanck O. A step towards routine for stereotactic radioablation in refractory ventricular tachycardia – interim analysis on short term safety of the first prospective, multi-centre, multi-platform study RAVENTA. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.697] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Ventricular tachycardia (VT) is a potentially life-threatening heart rhythm disorder originating in heterogeneous conduction velocity in the ventricular myocardium, e.g. by scar formation in ischaemic or dilated cardiomyopathy. Current guideline-directed medical therapy comprises implantable cardioverter defibrillator (ICD), antiarrhythmic drugs, and endocardial/epicardial catheter ablation. There is a serious recurrence rate for example due to diffuse fibrosis, progress of disease, or insufficient ablation depth or volume.
In cases when Catheter ablation and antiarrhythmic medication failed to reduce VT burden, stereotactic body radiation therapy (SBRT) may become an additional treatment option. To date there have been several small retrospective case series and some single-centre prospective studies showing promising results.
Purpose
For the purpose of obtaining the authorization of a randomized trial, a feasibility study was designed. The primary objective is to demonstrate sufficient safety of cardiac SBRT for the non-invasive treatment of VT and whether the dose needed can be delivered while sparing sensitive surrounding structures (e.g. stomach, oesophagus, vena cava, coronary arteries, ICD). Secondarily, the effect on VT burden is reported.
Methods
The RAVENTA study (RAdiosurgery for VENtricular TAchycardias) is the first prospective, multicentre study on SBRT in patients suffering from refractory VTs worldwide. Patients were enrolled according to strict inclusion criteria. First, an electrophysiology study using a high definition mapping system was performed to identify the substrate (target region). In order to plan SBRT a planning computed tomography scan was obtained. Finally, a single dose of 25 Gy was administered to the target region. Neither sedation nor anaesthesia is necessary during SBRT.
Primary endpoint is feasibility defined as complete dose application and absence of severe (grade ≥3) treatment-related toxicity within 30 days of treatment. RAVENTA is powered to reject the hypothesis of 70% feasibility, if in fact feasibility is 95%. This is a pre-defined interim analysis with the aim of stopping early for futility.
Results
Between October 2019 and December 2021, the first 5 patients (characteristics shown in Table 1) could be enrolled and radiotherapy was delivered without major complications. Cardiac SBRT took on average 30 minutes. There was no treatment-related severe toxicity. Furthermore, we could not record any negative effect on functionality of the ICD: constant sensing amplitude and pacing capture threshold. In the short-term, patients showed a clear decrease in VT burden.
Conclusion
These preliminary data of the first multi-centre, multi-platform study on cardiac SBRT on refractory VT demonstrated sufficient short-term feasibility to continue the RAVENTA study. Meanwhile the study has been expanded to 6 centres in Germany.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A Zaman
- University Medical Center of Schleswig-Holstein, Department of Internal Medicine III , Kiel , Germany
| | - D Krug
- University Medical Center of Schleswig-Holstein, Department of Radiation Oncology , Kiel , Germany
| | - L Eidinger
- University Medical Center of Schleswig-Holstein, Department of Radiation Oncology , Kiel , Germany
| | - J Boda-Heggemann
- University Medical Centre of Mannheim, Department of Radiation Oncology , Mannheim , Germany
| | - B Rudic
- University Medical Centre of Mannheim, First Department of Medicine , Mannheim , Germany
| | - F Mehrhof
- Charité - University Medicine Berlin, Department of Radiation Oncology , Berlin , Germany
| | - L H Boldt
- Charite - Campus Virchow-Klinikum (CVK), Department of Cardiology , Berlin , Germany
| | - J Fleckenstein
- University Medical Centre of Mannheim, Department of Radiation Oncology , Mannheim , Germany
| | - A Kluge
- Charité - University Medicine Berlin, Department of Radiation Oncology , Berlin , Germany
| | - F A Siebert
- University Medical Center of Schleswig-Holstein, Department of Radiation Oncology , Kiel , Germany
| | - A Schweikard
- University of Luebeck, Institute for Robotics and Cognitive Systems , Luebeck , Germany
| | - R Vontlein
- Schleswig-Holstein University Clinic, Lubeck Campus, Institut für Medizinische Biometrie und Statistik , Luebeck , Germany
| | - J Dunst
- University Medical Center of Schleswig-Holstein, Department of Radiation Oncology , Kiel , Germany
| | - H Bonnemeier
- University Medical Center of Schleswig-Holstein, Department of Internal Medicine III , Kiel , Germany
| | - O Blanck
- University Medical Center of Schleswig-Holstein, Department of Radiation Oncology , Kiel , Germany
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Eckl M, Hoppen L, Sarria G, Boda-Heggemann J, Springer S, Simeonova-Chergou A, Steil V, Ehmann M, Giordano F, Fleckenstein J. Evaluation of a cycle-generative adversarial network-based synthetic cone-beam CT generation method for adaptive radiation therapy and daily treatment planning. Phys Med 2021. [DOI: 10.1016/s1120-1797(22)00136-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Sarria G, Dreher C, Miebach G, Henkenberens C, Stera S, Wojtal P, Krug D, Oppitz H, Giordano F, Schäfer J, Lohr F, Dunst J, Blanck O, Boda-Heggemann J. Long-Term Characterization of MRI-Morphologic Alterations After Active Motion-Compensated Liver SBRT. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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John C, Dal Bello R, Andratschke N, Guckenberger M, Boda-Heggemann J, Gkika E, Mantel F, Specht H, Stromberger C, Zehentmayr F, Blanck O, Balermpas P. PD-0872 Second In-field course of stereotactic body radiotherapy for thoracic tumors: a multicentre analysis. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07151-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Schuster H, Boda-Heggemann J, Jahnke L, Bürgy D, Wenz F, Siebenlist K, Giordano F, Jahnke A, Sarria G. PO-1634: Cone-beam CT-based adaptive planning or filling protocol for neoadjuvant gastric cancer radiotherapy. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01652-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Boda-Heggemann J, Hofheinz R, Gkika E, Brunner T, Krug D. Beyond the scalpel - mortality after liver surgery in patients with liver metastases - time to rethink the indications. Br J Surg 2019; 107:149. [PMID: 31869462 DOI: 10.1002/bjs.11412] [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] [Received: 09/09/2019] [Accepted: 10/02/2019] [Indexed: 11/11/2022]
Abstract
Comment to Filman et al., Mortality after liver surgery in Germany. Br J Surg, 2019.
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Affiliation(s)
- J Boda-Heggemann
- Department of Radiation Oncology, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - R Hofheinz
- Tagestherapiezentrum, Interdisziplinäres Tumorzentrum, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - E Gkika
- Department of Radiation Oncology, University Medical Center Freiburg, Freiburg in Breisgau, Magdeburg, Germany
| | - T Brunner
- Department for Radiation Oncology, University Medical Center Magdeburg, Magdeburg, Germany
| | - D Krug
- Department of Radiation Oncology, University Medical Center Schleswig-Holstein, Kiel, Germany
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Klement RJ, Abbasi-Senger N, Adebahr S, Alheid H, Allgaeuer M, Becker G, Blanck O, Boda-Heggemann J, Brunner T, Duma M, Eble MJ, Ernst I, Gerum S, Habermehl D, Hass P, Henkenberens C, Hildebrandt G, Imhoff D, Kahl H, Klass ND, Krempien R, Lewitzki V, Lohaus F, Ostheimer C, Papachristofilou A, Petersen C, Rieber J, Schneider T, Schrade E, Semrau R, Wachter S, Wittig A, Guckenberger M, Andratschke N. The impact of local control on overall survival after stereotactic body radiotherapy for liver and lung metastases from colorectal cancer: a combined analysis of 388 patients with 500 metastases. BMC Cancer 2019; 19:173. [PMID: 30808323 PMCID: PMC6390357 DOI: 10.1186/s12885-019-5362-5] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Accepted: 02/11/2019] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND The aim of this analysis was to model the effect of local control (LC) on overall survival (OS) in patients treated with stereotactic body radiotherapy (SBRT) for liver or lung metastases from colorectal cancer. METHODS The analysis is based on pooled data from two retrospective SBRT databases for pulmonary and hepatic metastases from 27 centers from Germany and Switzerland. Only patients with metastases from colorectal cancer were considered to avoid histology as a confounding factor. An illness-death model was employed to model the relationship between LC and OS. RESULTS Three hundred eighty-eight patients with 500 metastatic lesions (lung n = 209, liver n = 291) were included and analyzed. Median follow-up time for local recurrence assessment was 12.1 months. Ninety-nine patients with 112 lesions experienced local failure. Seventy-one of these patients died after local failure. Median survival time was 27.9 months in all patients and 25.4 months versus 30.6 months in patients with and without local failure after SBRT. The baseline risk of death after local failure exceeds the baseline risk of death without local failure at 10 months indicating better survival with LC. CONCLUSION In CRC patients with lung or liver metastases, our findings suggest improved long-term OS by achieving metastatic disease control using SBRT in patients with a projected OS estimate of > 12 months.
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Affiliation(s)
- Rainer J Klement
- Department of Radiation Oncology, Leopoldina Hospital Schweinfurt, Schweinfurt, Germany
| | - N Abbasi-Senger
- Department of Radiation Oncology, University Hospital Jena, Jena, Germany
| | - S Adebahr
- Department of Radiation Oncology, University Hospital Freiburg, Freiburg, Germany
| | - H Alheid
- Strahlentherapie Bautzen, Bautzen, Germany
| | - M Allgaeuer
- Department of Radiation Oncology, Hospital Barmherzige Brueder, Regensburg, Germany
| | - G Becker
- RadioChirurgicum CyberKnife Suedwest, Goeppingen, Germany
| | - O Blanck
- Department of Radiation Oncology Universitaetsklinikum Schleswig-Holstein, Luebeck, Germany
| | - J Boda-Heggemann
- Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - T Brunner
- Department of Radiation Oncology, University Hospital Freiburg, Freiburg, Germany
| | - M Duma
- Department of Radiation Oncology, Klinikum rechts der Isar- Technische Universitaet Muenchen, Munich, Germany
| | - M J Eble
- Department of Radiation Oncology, University Hospital Aachen, Aachen, Germany
| | - I Ernst
- Department of Radiation Oncology, University Hospital Muenster, Muenster, Germany
| | - S Gerum
- Department of Radiation Oncology, Ludwig Maximilians University Munich, Munich, Germany
| | - D Habermehl
- Department of Radiation Oncology, Klinikum rechts der Isar- Technische Universitaet Muenchen, Munich, Germany.,Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany
| | - P Hass
- Department of Radiation Oncology, University Hospital Magdeburg, Magdeburg, Germany
| | - C Henkenberens
- Department of Radiotherapy and Special Oncology, Medical School Hannover, Hanover, Germany
| | - G Hildebrandt
- Department of Radiation Oncology, University of Rostock, Rostock, Germany
| | - D Imhoff
- Department of Radiation Oncology, University Hospital Frankfurt, Frankfurt, Germany
| | - H Kahl
- Department of Radiation Oncology, Hospital Augsburg, Augsburg, Germany
| | - N D Klass
- Department of Radiation Oncology, University Hospital Bern, Bern, Switzerland
| | - R Krempien
- Department of Radiation Oncology, Helios Klinikum Berlin Buch, Berlin, Germany
| | - V Lewitzki
- Department of Radiation Oncology, University Hospital Wuerzburg, Wuerzburg, Germany
| | - F Lohaus
- Department of Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - C Ostheimer
- Department of Radiation Oncology, University Hospital Halle, Halle, Germany
| | - A Papachristofilou
- Department of Radiation Oncology, University Hospital Hamburg, Hamburg, Germany
| | - C Petersen
- Department of Radiation Oncology, University Hospital Basel, Basel, Switzerland
| | - J Rieber
- Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany
| | | | - E Schrade
- Department of Radiation Oncology, Hospital Heidenheim, Heidenheim, Germany
| | - R Semrau
- Department of Radiation Oncology, University Hospital of Cologne, Cologne, Germany
| | - S Wachter
- Department of Radiation Oncology, Klinikum Passau, Passau, Germany
| | - A Wittig
- Department of Radiation Oncology, University Hospital Jena, Jena, Germany.,Department of Radiotherapy and Radiation Oncology, Philipps-University Marburg, University Hospital Giessen and Marburg, Marburg, Germany
| | - M Guckenberger
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - N Andratschke
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland.
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Vogel L, Sihono D, Weiß C, Lohr F, Stieler F, Wertz H, von Swietochowski S, Simeonova-Chergou A, Wenz F, Blessing M, Boda-Heggemann J. Intrafraction Residual Error of Image-Guided Dibh Liver-SBRT: An Estimation By Ultrasound-Based Tracking Correlated with Diaphragm Position in CBCT. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Klement R, Hoerner-Rieber J, Adebahr S, Andratschke N, Blanck O, Boda-Heggemann J, Duma M, Eble M, Eich H, Flentje M, Gerum S, Hass P, Henkenberens C, Hildebrandt G, Imhoff D, Kahl K, Klass N, Krempien R, Lohaus F, Petersen C, Schrade E, Wendt T, Wittig A, Guckenberger M. Stereotactic body radiotherapy (SBRT) for multiple pulmonary oligometastases: Analysis of number and timing of repeat SBRT as impact factors on treatment safety and efficacy. Radiother Oncol 2018; 127:246-252. [DOI: 10.1016/j.radonc.2018.02.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 02/14/2018] [Accepted: 02/15/2018] [Indexed: 12/25/2022]
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Hörner-Rieber J, Abbasi-Senger N, Blanck O, Boda-Heggemann J, Duma M, Eble M, Eich H, Flentje M, Gerum S, Haas P, Henkenberens C, Imhoff D, Kahl H, Klass N, Krempien R, Lohaus F, Petersen C, Sackerer I, Schrade E, Uhlmann L, Wittig A, Guckenberger M. PV-0043: Histology as predictor for outcome following SBRT in NSCLC patients with lung oligo-metastases. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)30353-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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12
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Arns A, Fleckenstein J, Schneider F, Boda-Heggemann J, Abo-Madyan Y, Steil V, Wenz F, Wertz H. EP-2041: Registration accuracy of high-speed single breath-hold kV-CBCT lung cancer imaging. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)32350-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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13
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Guckenberger M, Klement R, Rieber J, Adebahr S, Andratschke N, Blanck O, Boda-Heggemann J, Duma M, Eble M, Eich H, Flentje M, Gerum S, Haas P, Henkenberens C, Hildebrandt G, Imhoff D, Kahl H, Klass N, Krempien R, Lohaus F, Petersen C, Schrade E, Wendt T, Wittig A. PV-0044: Repeat sbrt for pulmonary oligo-metastases. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)30354-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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14
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Andratschke N, Alheid H, Allgäuer M, Becker G, Blanck O, Boda-Heggemann J, Brunner T, Duma M, Gerum S, Guckenberger M, Hildebrandt G, Klement RJ, Lewitzki V, Ostheimer C, Papachristofilou A, Petersen C, Schneider T, Semrau R, Wachter S, Habermehl D. The SBRT database initiative of the German Society for Radiation Oncology (DEGRO): patterns of care and outcome analysis of stereotactic body radiotherapy (SBRT) for liver oligometastases in 474 patients with 623 metastases. BMC Cancer 2018; 18:283. [PMID: 29534687 PMCID: PMC5851117 DOI: 10.1186/s12885-018-4191-2] [Citation(s) in RCA: 92] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 03/06/2018] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND The intent of this pooled analysis as part of the German society for radiation oncology (DEGRO) stereotactic body radiotherapy (SBRT) initiative was to analyze the patterns of care of SBRT for liver oligometastases and to derive factors influencing treated metastases control and overall survival in a large patient cohort. METHODS From 17 German and Swiss centers, data on all patients treated for liver oligometastases with SBRT since its introduction in 1997 has been collected and entered into a centralized database. In addition to patient and tumor characteristics, data on immobilization, image guidance and motion management as well as dose prescription and fractionation has been gathered. Besides dose response and survival statistics, time trends of the aforementioned variables have been investigated. RESULTS In total, 474 patients with 623 liver oligometastases (median 1 lesion/patient; range 1–4) have been collected from 1997 until 2015. Predominant histologies were colorectal cancer (n = 213 pts.; 300 lesions) and breast cancer (n = 57; 81 lesions). All centers employed an SBRT specific setup. Initially, stereotactic coordinates and CT simulation were used for treatment set-up (55%), but eventually were replaced by CBCT guidance (28%) or more recently robotic tracking (17%). High variance in fraction (fx) number (median 1 fx; range 1–13) and dose per fraction (median: 18.5 Gy; range 3–37.5 Gy) was observed, although median BED remained consistently high after an initial learning curve. Median follow-up time was 15 months; median overall survival after SBRT was 24 months. One- and 2-year treated metastases control rate of treated lesions was 77% and 64%; if maximum isocenter biological equivalent dose (BED) was greater than 150 Gy EQD2Gy, it increased to 83% and 70%, respectively. Besides radiation dose colorectal and breast histology and motion management methods were associated with improved treated metastases control. CONCLUSION After an initial learning curve with regards to total cumulative doses, consistently high biologically effective doses have been employed translating into high local tumor control at 1 and 2 years. The true impact of histology and motion management method on treated metastases control deserve deeper analysis. Overall survival is mainly influenced by histology and metastatic tumor burden.
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Affiliation(s)
- N. Andratschke
- University Hospital Zürich, Department of Radiation Oncology, University of Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - H. Alheid
- Department of Radiation Oncology, Strahlentherapie Bautzen, Bautzen, Germany
| | - M. Allgäuer
- Department of Radiation Oncology, Krankenhaus Barmherzige Brüder, Regensburg, Germany
| | - G. Becker
- RadioChirurgicum CyberKnife Südwest, Radiation Oncology, Göppingen, Germany
| | - O. Blanck
- Department of Radiation Oncology, Universitätsklinikum Schleswig-Holstein, /Lübeck, Kiel, Germany
| | - J. Boda-Heggemann
- University Hospital Mannheim, Department of Radiation Oncology, University of Heidelberg, Mannheim, Germany
| | - T. Brunner
- Department of Radiation Oncology, University Hospital Freiburg, Freiburg, Germany
| | - M. Duma
- Department of Radiation Oncology, Klinikum rechts der Isar- Technische Universität München, Munich, Germany
| | - S. Gerum
- Department of Radiation Oncology, University of Munich – LMU Munich, Munich, Germany
| | - M. Guckenberger
- University Hospital Zürich, Department of Radiation Oncology, University of Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - G. Hildebrandt
- Department of Radiation Oncology, University Hospital Rostock, Rostock, Germany
| | - R. J. Klement
- Department of Radiation Oncology, Leopoldina Hospital Schweinfurt, Schweinfurt, Germany
| | - V. Lewitzki
- Department of Radiation Oncology, University Hospital Würzburg, Würzburg, Germany
| | - C. Ostheimer
- Department of Radiation Oncology, University Hospital Halle, Halle, Germany
| | - A. Papachristofilou
- Department of Radiation Oncology, University Hospital Basel, Basel, Switzerland
| | - C. Petersen
- Department of Radiation Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - T. Schneider
- Department of Radiation Oncology, Strahlenzentrum Hamburg, Hamburg, Germany
| | - R. Semrau
- Department of Radiation Oncology, University Hospital of Cologne, Cologne, Germany
| | - S. Wachter
- Klinikum Passau, Radiation Oncology, Passau, Germany
| | - D. Habermehl
- Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany
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Vogel L, Sihono D, Lohr F, Stieler F, Wertz H, Simeonova-Chergou A, Blessing M, Wenz F, Boda-Heggemann J. Ultrasound-Based Tracking of Upper Abdominal Targets during Breath-Hold SBRT: Correlation of Ultrasound Data to Surface Position. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.2363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Klement RJ, Guckenberger M, Alheid H, Allgäuer M, Becker G, Blanck O, Boda-Heggemann J, Brunner T, Duma M, Gerum S, Habermehl D, Hildebrandt G, Lewitzki V, Ostheimer C, Papachristofilou A, Petersen C, Schneider T, Semrau R, Wachter S, Andratschke N. Stereotactic body radiotherapy for oligo-metastatic liver disease - Influence of pre-treatment chemotherapy and histology on local tumor control. Radiother Oncol 2017; 123:227-233. [PMID: 28274491 DOI: 10.1016/j.radonc.2017.01.013] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 01/02/2017] [Accepted: 01/21/2017] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Stereotactic body radiation therapy (SBRT) is applied in the oligometastatic setting to treat liver metastases. However, factors influencing tumor control probability (TCP) other than radiation dose have not been thoroughly investigated. Here we set out to investigate such factors with a focus on the influence of histology and chemotherapy prior to SBRT using a large multi-center database from the German Society of Radiation Oncology. METHODS 452 SBRT treatments in 363 patients were analyzed after collection of patient, tumor and treatment data in a multi-center database. Histology was considered through random effects in semi-parametric and parametric frailty models. Dose prescriptions were parametrized by conversion to the maximum biologically effective dose using alpha/beta of 10Gy (BEDmax). RESULTS After adjusting for histology, BEDmax was the strongest predictor of TCP. Larger PTV volumes, chemotherapy prior to SBRT and simple motion management techniques predicted significantly lower TCP. The model predicted a BED of 209±67Gy10 necessary for 90% TCP at 2years with no prior chemotherapy, but 286±78Gy10 when chemotherapy had been given. Breast cancer metastases were significantly more responsive to SBRT compared to other histologies with 90% TCP at 2years achievable with BEDmax of 157±80Gy10 or 80±62Gy10 with and without prior chemotherapy, respectively. CONCLUSIONS Besides dose, histology and pretreatment chemotherapy were important factors influencing local TCP in this large cohort of liver metastases. After adjusting for prior chemotherapy, our data add to the emerging evidence that breast cancer metastases do respond better to hypofractionated SBRT compared to other histologies.
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Affiliation(s)
- R J Klement
- Leopoldina Hospital Schweinfurt, Department of Radiation Oncology, Germany
| | - M Guckenberger
- University Hospital Zürich, Department of Radiation Oncology, University of Zurich, Switzerland
| | - H Alheid
- Strahlentherapie Bautzen, Radiation Oncology, Germany
| | - M Allgäuer
- Krankenhaus Barmherzige Brüder, Radiation Oncology, Regensburg, Germany
| | - G Becker
- RadioChirurgicum CyberKnife Südwest, Radiation Oncology, Göppingen, Germany
| | - O Blanck
- Universitätsklinikum Schleswig-Holstein, Radiation Oncology, Kiel/Lübeck, Germany
| | - J Boda-Heggemann
- University Hospital Mannheim, Radiation Oncology, University of Heidelberg, Germany
| | - T Brunner
- University Hospital Freiburg, Radiation Oncology, Germany
| | - M Duma
- Klinikum rechts der Isar- Technische Universität München, Radiation Oncology, Germany
| | - S Gerum
- Department of Radiation Oncology, University of Munich - LMU Munich, Germany
| | - D Habermehl
- University Hospital Heidelberg, Radiation Oncology, Germany
| | - G Hildebrandt
- University Hospital Rostock, Radiation Oncology, Germany
| | - V Lewitzki
- University Hospital Würzburg, Radiation Oncology, Germany
| | - C Ostheimer
- University Hospital Halle, Radiation Oncology, Germany
| | | | - C Petersen
- University Medical Center Hamburg-Eppendorf, Radiation Oncology, Germany
| | - T Schneider
- Strahlenzentrum Hamburg, Radiation Oncology, Germany
| | - R Semrau
- University Hospital of Cologne, Radiation Oncology, Germany
| | - S Wachter
- Klinikum Passau, Radiation Oncology, Germany
| | - N Andratschke
- University Hospital Zürich, Department of Radiation Oncology, University of Zurich, Switzerland.
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Tanadini-Lang S, Rieber J, Filippi AR, Fode MM, Streblow J, Adebahr S, Andratschke N, Blanck O, Boda-Heggemann J, Duma M, Eble MJ, Ernst I, Flentje M, Gerum S, Hass P, Henkenberens C, Hildebrandt G, Imhoff D, Kahl H, Klass ND, Krempien R, Lohaus F, Petersen C, Schrade E, Wendt TG, Wittig A, Høyer M, Ricardi U, Sterzing F, Guckenberger M. Nomogram based overall survival prediction in stereotactic body radiotherapy for oligo-metastatic lung disease. Radiother Oncol 2017; 123:182-188. [PMID: 28169042 DOI: 10.1016/j.radonc.2017.01.003] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [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: 08/06/2016] [Revised: 12/28/2016] [Accepted: 01/03/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND Radical local treatment of pulmonary metastases is practiced with increasing frequency due to acknowledgment and better understanding of oligo-metastatic disease. This study aimed to develop a nomogram predicting overall survival (OS) after stereotactic body radiotherapy (SBRT) for pulmonary metastases. PATIENTS AND METHODS A multi-institutional database of 670 patients treated with SBRT for pulmonary metastases was used as training cohort. Cox regression analysis with bidirectional variable elimination was performed to identify factors to be included into the nomogram model to predict 2-year OS. The calibration rate of the nomogram was assessed by plotting the actual Kaplan-Meier 2-year OS against the nomogram predicted survival. The nomogram was externally validated using two separate monocentric databases of 145 and 92 patients treated with SBRT for pulmonary metastases. RESULTS The median follow up of the trainings cohort was 14.3months, the 2-year and 5-year OS was 52.6% and 23.7%, respectively. Karnofsky performance index, type of the primary tumor, control of the primary tumor, maximum diameter of the largest treated metastasis and number of metastases (1 versus >1) were significant prognostic factors in the Cox model (all p<0.05). The calculated concordance-index for the nomogram was 0.73 (concordance indexes of all prognostic factors between 0.54 and 0.6). Based on the nomogram the training cohort was divided into 4 groups and 2-year OS ranged between 24.2% and 76.1% (predicted OS between 30.2% and 78.4%). The nomogram discriminated between risk groups in the two validation cohorts (concordance index 0.68 and 0.67). CONCLUSIONS A nomogram for prediction of OS after SBRT for pulmonary metastases was generated and externally validated. This tool might be helpful for interdisciplinary discussion and evaluation of local and systemic treatment options in the oligo-metastatic setting. KEY MESSAGE A nomogram for prediction of overall survival after stereotactic body radiotherapy (SBRT) for pulmonary metastases was developed and externally validated. This tool might be helpful for interdisciplinary discussion and evaluation of local and systemic treatment options in the oligo-metastatic setting.
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Affiliation(s)
- S Tanadini-Lang
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Switzerland
| | - J Rieber
- Department of Radiation Oncology, University Hospital Heidelberg, Germany; Heidelberg Institute of Radiation Oncology, Germany
| | - A R Filippi
- Department of Oncology, University of Torino, Torino, Italy
| | - M M Fode
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - J Streblow
- Department of Radiation Oncology, University Hospital Heidelberg, Germany; Heidelberg Institute of Radiation Oncology, Germany
| | - S Adebahr
- Department of Radiation Oncology, University Hospital Freiburg, Germany
| | - N Andratschke
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Switzerland; Department of Radiation Oncology, University of Rostock, Germany
| | - O Blanck
- Department of Radiation Oncology, UKSH Universitätsklinikum Schleswig Holstein, Kiel, Germany
| | - J Boda-Heggemann
- Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Germany
| | - M Duma
- Department of Radiation Oncology, Technical University Munich, Germany
| | - M J Eble
- Department of Radiation Oncology, University Hospital Aachen, Germany
| | - I Ernst
- Department of Radiation Oncology, University Hospital Münster, Germany
| | - M Flentje
- Department of Radiation Oncology, University Hospital Wuerzburg, Germany
| | - S Gerum
- Department of Radiation Oncology, 11 Ludwig Maximilians University Munich, Germany
| | - P Hass
- Department of Radiation Oncology, University Hospital Magdeburg, Germany
| | - C Henkenberens
- Department of Radiotherapy and Special Oncology, Medical School Hannover, Germany
| | - G Hildebrandt
- Department of Radiation Oncology, University of Rostock, Germany
| | - D Imhoff
- Department of Radiation Oncology, University Hospital Frankfurt, Germany
| | - H Kahl
- Department of Radiation Oncology, Hospital Augsburg, Germany
| | - N D Klass
- Department of Radiation Oncology, Bern University Hospital, Bern, Switzerland
| | - R Krempien
- Department of Radiation Oncology, Helios Klinikum Berlin Buch, Germany
| | - F Lohaus
- Department of Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany; German Cancer Research Center (DKFZ), Heidelberg Germany and German Cancer Consortium (DKTK), Dresden, Germany; OncoRay - National Center for Radiation Research in Oncology (NCRO), Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany
| | - C Petersen
- Department of Radiation Oncology, University Hospital Hamburg, Germany
| | - E Schrade
- Department of Radiation Oncology, Hospital Heidenheim, Germany
| | - T G Wendt
- Department of Radiation Oncology, University Hospital Jena, Germany
| | - A Wittig
- Department of Radiotherapy and Radiation Oncology, Philipps-University Marburg, University Hospital Giessen and Marburg, Germany
| | - M Høyer
- Danish Center for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - U Ricardi
- Department of Oncology, University of Torino, Torino, Italy
| | - F Sterzing
- Department of Radiation Oncology, University Hospital Heidelberg, Germany; Heidelberg Institute of Radiation Oncology, Germany; German Cancer Research Center, Clinical Cooperation Unit Radiation Oncology, Heidelberg, Germany
| | - M Guckenberger
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Switzerland.
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Sihono D, Boda-Heggemann J, Vogel L, Thölking J, Lohr F, Wenz F, Wertz H. Development and Evaluation of a New 4-Dimensional Ultrasound Real-Time Tracking System for External Beam Radiation Therapy of Upper Abdominal Lesions Under Breath Hold—A Phantom Study. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.2152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Boda-Heggemann J, Weiss C, Vogel L, Siebenlist K, Sihono D, Wertz H, Jahnke A, Simeonova-Chergou A, Ehmann M, Wenz F, Lohr F. Ultrasound-Based Real-Time Tracking During Abdominal Stereotactic Body Radiation Therapy: Ultrasound Probe Does Not Influence Plan Quality Significantly. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.2144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Simeonova A, Jahnke A, Stieler F, Boda-Heggemann J, Hofmann J, Rheinschmidt S, Schmidt-Beißner C, Ottstadt M, Wenz F, Lohr F, Jahnke L. Deep Inspiration Breath-Hold Gating With Surface Imaging and Visual Coaching Is a Reproducible Treatment Technique for Patients With Advanced Lung Cancer. Int J Radiat Oncol Biol Phys 2015. [DOI: 10.1016/j.ijrobp.2015.07.525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Simeonova A, Hofmann J, Jahnke L, Hauck D, Roß C, Boda-Heggemann J, Wenz F, Lohr F, Stieler F. Quantification of the Correlation Between Surface Tracking Signal and Internal Body Structure Position During Deep Inspiration Breath Hold (DIBH) Based on Single-Acquisition CBCT. Int J Radiat Oncol Biol Phys 2015. [DOI: 10.1016/j.ijrobp.2015.07.2088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Sterzing F, Streblow J, Scherer K, Adebahr S, Adratschke N, Boda-Heggemann J, Blanck O, Duma M, Ernst I, Gademann G, Ganswindt U, Henkenberens C, Imhoff D, Kahl H, Lohaus F, Lubinski-de Lange G, Maertin A, Petersen C, Wittig A, Guckenberger M. SBRT for Lung Metastases: A Pooled Analysis of 651 Patients and 868 Lesions of the German Working Group Stereotactic Radiotherapy. Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2014.05.137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Simeonova A, Jahnke A, Jahnke L, Siebenlist K, Stieler F, Mai S, Boda-Heggemann J, Wenz F, Lohr F. Automatically Gated CBCT-Controlled Fast Breath-Hold SBRT Is Dosimetrically Robust and Facilitates Precision Treatments for Patients With Lung Cancer. Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2014.05.2537] [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: 10/24/2022]
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24
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Blessing M, Arns A, Wertz H, Stsepankou D, Boda-Heggemann J, Lohr F, Hesser J, Wenz F. Image Guided Radiation Therapy Using Ultrafast kV-MV CBCT: End-to-End Test Results of the Finalized Implementation. Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2014.05.2385] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Boda-Heggemann J, Budjan J, Ong M, Michaely H, Schoenberg S, Konstandin S, Schad L, Siebenlist K, Schneider V, Wertz H, Hofheinz R, Wenz F, Lohr F, Haneder S. Dose-Dependent Changes in Renal 1H-/23Na-MRI After Adjuvant Radiochemotherapy for Gastric Cancer. Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2014.05.1145] [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: 10/24/2022]
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Boda-Heggemann J, Jahnke A, Jahnke L, Simeonova A, Mai S, Wertz H, Zimmermann A, von Swietochowski S, Wenz F, Lohr F. Breath-Hold Cone Beam CT (CBCT): Improved Image Quality With “Stop-and-Go” Breath Hold–Only Acquisition Versus Repetitive Breath Hold During Continuous Rotation. Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2014.05.2378] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Haneder S, Michaely HJ, Schoenberg SO, Konstandin S, Schad LR, Siebenlist K, Wertz H, Wenz F, Lohr F, Boda-Heggemann J. Assessment of renal function after conformal radiotherapy and intensity-modulated radiotherapy by functional 1H-MRI and 23Na-MRI. Strahlenther Onkol 2012; 188:1146-54. [PMID: 23111472 DOI: 10.1007/s00066-012-0254-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2012] [Accepted: 09/24/2012] [Indexed: 01/24/2023]
Abstract
PURPOSE Adjuvant radiochemotherapy (RCHT) improves survival of patients with locally advanced gastric cancer. Conventional three-dimensional conformal radiotherapy (3D-CRT) results in ablative doses to a significant amount of the left kidney, while image-guided intensity-modulated radiotherapy (IG-IMRT) provides excellent target coverage with improved kidney sparing. Few long-term results on IMRT for gastric cancer, however, have been published. Functional magnetic resonance imaging (fMRI) at 3.0 T including blood oxygenation-level dependent (BOLD) imaging, diffusion-weighted imaging (DWI) and, for the first time, (23)Na imaging was used to evaluate renal status after radiotherapy with 3D-CRT or IG-IMRT. PATIENTS AND METHODS Four disease-free patients (2 after 3D-CRT and 2 after IMRT; FU for all patients > 5 years) were included in this feasibility study. Morphological sequences, axial DWI images, 2D-gradient echo (GRE)-BOLD images, and (23)Na images were acquired. Mean values/standard deviations for ((23)Na), the apparent diffusion coefficient (ADC), and R2* values were calculated for the upper/middle/lower parts of both kidneys. Corticomedullary (23)Na-concentration gradients were determined. RESULTS Surprisingly, IG-IMRT patients showed no morphological alterations and no statistically significant differences of ADC and R2* values in all renal parts. Values for mean corticomedullary (23)Na-concentration matched those for healthy volunteers. Results were similar in 3D-CRT patients, except for the cranial part of the left kidney. This was atrophic and presented significantly reduced functional parameters (p = 0.001-p = 0.033). Reduced ADC values indicated reduced cell density and reduced extracellular space. Cortical and medullary R2* values of the left cranial kidney in the 3D-CRT group were higher, indicating more deoxygenated hemoglobin due to reduced blood flow/oxygenation. ((23)Na) of the renal cranial parts in the 3D-CRT group was significantly reduced, while the expected corticomedullary (23)Na-concentration gradient was partially conserved. CONCLUSIONS Functional MRI can assess postradiotherapeutic renal changes. As expected, marked morphological/functional effects were observed in high-dose areas (3D-CRT), while, unexpectedly, no alteration in kidney function was observed in IG-IMRT patients, supporting the hypothesis that reducing total/fractional dose to the renal parenchyma by IMRT is clinically beneficial.
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Affiliation(s)
- S Haneder
- Institute of Clinical Radiology and Nuclear Medicine, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
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Haneder S, Boda-Heggemann J, Schoenberg SO, Michaely HJ. [Functional magnetic resonance imaging for evaluation of radiation-induced renal damage]. Radiologe 2012; 52:243-51. [PMID: 22374084 DOI: 10.1007/s00117-011-2195-x] [Citation(s) in RCA: 3] [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: 10/28/2022]
Abstract
The diagnosis of radiation-induced (especially chronic) renal alterations/damage is difficult and currently relies primarily on clinical evaluation. The importance of renal diagnostic evaluation will increase continuously due to the increasing number of long-term survivors after radiotherapy. This article evaluates the potentia diagnostic contribution of magnetic resonance (MR) imaging with a focus on functional MRI. The following functional MRI approaches are briefly presented and evaluated: blood oxygenation level-dependent imaging (BOLD), diffusion-weighted imaging (DWI) or diffusion tensor imaging (DTI), MR perfusion measurements and (23)Na imaging. In summary, only DWI and contrast-enhanced MR perfusion currently seem to be suitable approaches for a broader, clinical implementation. However, up to now valid data from larger patient studies are lacking for both techniques in regard to radiation-induced renal alterations. The BOLD and (23)Na imaging procedures have a huge potential but are currently neither sufficiently evaluated with regard to radiation-induced renal alterations nor technically simple and reliable for implementation into the clinical routine.
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Affiliation(s)
- S Haneder
- Institut für Klinische Radiologie und Nuklearmedizin, Universitätsmedizin Mannheim, Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim
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Boda-Heggemann J, Haneder S, Konstandin S, Schad L, Wenz F, Michaely H, Lohr F. Assessment of 3D-conformal Radiotherapy (3DCRT) and Image-guided Intensity Modulated Radiotherapy (IG-IMRT) Induced Renal Damage by Means of Functional MR-imaging and 23Na-MR-imaging. Int J Radiat Oncol Biol Phys 2011. [DOI: 10.1016/j.ijrobp.2011.06.534] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Wertz H, Stsepankou D, Blessing M, Boda-Heggemann J, Walter C, Hesser J, Lohr F, Wenz F. Fast Kilovoltage/Megavoltage (KVMV) Breathhold Cone-beam-CT for Image-guided-radiotherapy of Lung Cancer. Int J Radiat Oncol Biol Phys 2010. [DOI: 10.1016/j.ijrobp.2010.07.134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Boda-Heggemann J, Lohr F, Wertz H, Löb I, Küpper B, Kavanagh A, Hansen V, Brada M, Wenz F, McNair H. Repeat ABC-breath Hold Imaging with Cone-beam CT. Int J Radiat Oncol Biol Phys 2010. [DOI: 10.1016/j.ijrobp.2010.07.1705] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Boda-Heggemann J, Mennemeyer P, Wertz H, Ehmann M, Hermann B, Koehler F, Riesenacker N, Lohr F, Wenz F. Accuracy of Stereotactic Ultrasound (BAT) for Daily Repositioning in Upper Abdomen - An Online Comparison by 3D-3D Matching with Cone-beam CT. Int J Radiat Oncol Biol Phys 2008. [DOI: 10.1016/j.ijrobp.2008.06.088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Koehler F, Boda-Heggemann J, Wertz H, Ehmann M, Riesenacker N, Küpper B, Mennemeyer P, Hermann B, Lohr F, Wenz F. Intrafraction Motion of the Prostate during One IMRT Session: A Fiducial-based 3D Measurement with Cone-beam CT. Int J Radiat Oncol Biol Phys 2008. [DOI: 10.1016/j.ijrobp.2008.06.1106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Boda-Heggemann J, Köhler F, Wertz H, Mennemeyer P, Löb I, Mai S, Hesser J, Lohr F, Wenz F. Accuracy of Stereotactic Ultrasound (BAT®) for Prostate Repositioning–A 3D On-Line Fiducial Based Assessment With Cone-Beam CT. Int J Radiat Oncol Biol Phys 2007. [DOI: 10.1016/j.ijrobp.2007.07.2132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Boggula R, Wertz H, Lorenz F, Abo Madyan Y, Boda-Heggemann J, Schneider F, Polednik M, Hesser J, Lohr F, Wenz F. A Proposed Strategy to Implement CBCT Images for Replanning and Dose Calculations. Int J Radiat Oncol Biol Phys 2007. [DOI: 10.1016/j.ijrobp.2007.07.2004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Wertz H, Lohr F, Dobler B, Mai S, Welzel G, Boda-Heggemann J, Wenz F. Dosimetric consequences of a translational isocenter correction based on image guidance for intensity modulated radiotherapy (IMRT) of the prostate. Phys Med Biol 2007; 52:5655-65. [PMID: 17804887 DOI: 10.1088/0031-9155/52/18/012] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Interfractional prostate motion during radiotherapy can have deleterious clinical consequences. It has become clinical practice to re-position the patient according to ultrasound or other imaging techniques. We investigated the dosimetric consequences of the linear translational position correction (isocenter correction) when a conformal IMRT technique with nine fields was used. Treatment plans of seven patients with empty and distended rectums were analyzed. The reference plans were calculated on the CT with an empty rectum. The treatment plans were transferred to a second CT with a distended rectum for an uncorrected setup of the patient referenced to bony anatomy and a corrected setup after translational position correction of the isocenter. The dosimetric consequences (with and without correction) were analyzed. For single treatment fractions, organ motion decreased the volume of the prostate encompassed by the 95% isodose (V95%) by up to -24%-p (percentage points). The mean rectum dose increased by up to 41%-p. Linear translational correction increased V95% of the prostate by up to 17%-p while the mean rectum dose was reduced by up to -23%-p compared to the uncorrected setup. Linear translational correction can improve radiation treatment accuracy for prostate cancer if geometrical changes are within certain limits.
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Affiliation(s)
- H Wertz
- Department of Radiation Oncology, Mannheim Medical Center, University of Heidelberg, 68167 Mannheim, Germany.
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Abstract
Intensity modulated radiotherapy (IMRT) has improved the capability to apply geometrically individualised high radiotherapy doses to the prostate bed, prostate and seminal vesicles. A high risk of geometrical miss with conformal methods, however, has been documented for mobile targets such as the prostate. Modern, non-invasive localisation techniques are therefore mandatory to further optimise conformal radiotherapy for prostate cancer. This review summarises technological advances related to "image-guided radiotherapy" (IGRT) which will further improve target positioning in prostate cancer radiotherapy.
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Affiliation(s)
- F Lohr
- Klinik für Strahlentherapie und Radioonkologie, Universitätsklinikum Mannheim.
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Walter C, Wertz H, Boda-Heggemann J, Loeb I, Rahn A, Lohr F, Wenz F. 2761. Int J Radiat Oncol Biol Phys 2006. [DOI: 10.1016/j.ijrobp.2006.07.1178] [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: 10/24/2022]
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Boda-Heggemann J, Walter C, Wertz H, Küpper B, Loeb I, Rahn A, Lohr F, Wenz F. 2057. Int J Radiat Oncol Biol Phys 2006. [DOI: 10.1016/j.ijrobp.2006.07.460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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