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Daniello L, Elshiaty M, Lusky F, Blasi M, Schneider M, Bozorgmehr F, Shah R, Kazdal D, Angeles A, Liersch S, Eichhorn F, Allgäuer M, Janke F, Bischoff H, Thomas M, Sültmann H, Stenzinger A, Christopoulos P. 67P Blood cell gene expression and clinical characteristics in advanced non-small cell lung cancer with immune-related adverse events. J Thorac Oncol 2023. [DOI: 10.1016/s1556-0864(23)00321-0] [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: 04/04/2023]
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Pixberg C, Zapatka M, Hlevnjak M, Benedetto S, Suppelna JP, Heil J, Smetanay K, Michel L, Fremd C, Körber V, Rübsam M, Buschhorn L, Heublein S, Schäfgen B, Golatta M, Gomez C, von Au A, Wallwiener M, Wolf S, Dikow N, Schaaf C, Gutjahr E, Allgäuer M, Stenzinger A, Pfütze K, Kirsten R, Hübschmann D, Sinn HP, Jäger D, Trumpp A, Schlenk R, Höfer T, Thewes V, Schneeweiss A, Lichter P. COGNITION: a prospective precision oncology trial for patients with early breast cancer at high risk following neoadjuvant chemotherapy. ESMO Open 2022; 7:100637. [PMID: 36423362 PMCID: PMC9808485 DOI: 10.1016/j.esmoop.2022.100637] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 10/09/2022] [Accepted: 10/18/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND COGNITION (Comprehensive assessment of clinical features, genomics and further molecular markers to identify patients with early breast cancer for enrolment on marker driven trials) is a diagnostic registry trial that employs genomic and transcriptomic profiling to identify biomarkers in patients with early breast cancer with a high risk for relapse after standard neoadjuvant chemotherapy (NACT) to guide genomics-driven targeted post-neoadjuvant therapy. PATIENTS AND METHODS At National Center for Tumor Diseases Heidelberg patients were biopsied before starting NACT, and for patients with residual tumors after NACT additional biopsy material was collected. Whole-genome/exome and transcriptome sequencing were applied on tumor and corresponding blood samples. RESULTS In the pilot phase 255 patients were enrolled, among which 213 were assessable: thereof 48.8% were identified to be at a high risk for relapse following NACT; 86.4% of 81 patients discussed in the molecular tumor board were eligible for a targeted therapy within the interventional multiarm phase II trial COGNITION-GUIDE (Genomics-guided targeted post neoadjuvant therapy in patients with early breast cancer) starting enrolment in Q4/2022. An in-depth longitudinal analysis at baseline and in residual tumor tissue of 16 patients revealed some cases with clonal evolution but largely stable genetic alterations, suggesting restricted selective pressure of broad-acting cytotoxic neoadjuvant chemotherapies. CONCLUSIONS While most precision oncology initiatives focus on metastatic disease, the presented concept offers the opportunity to empower novel therapy options for patients with high-risk early breast cancer in the post-neoadjuvant setting within a biomarker-driven trial and provides the basis to test the value of precision oncology in a curative setting with the overarching goal to increase cure rates.
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Affiliation(s)
- C Pixberg
- National Center for Tumor Diseases (NCT) Heidelberg, a partnership between DKFZ and Heidelberg University Medical Center, Heidelberg, Germany; University Hospital Heidelberg, Heidelberg, Germany
| | - M Zapatka
- National Center for Tumor Diseases (NCT) Heidelberg, a partnership between DKFZ and Heidelberg University Medical Center, Heidelberg, Germany; Division of Molecular Genetics, German Cancer Research Center (DKFZ), Heidelberg, Germany; German Cancer Consortium (DKTK), Heidelberg, Germany
| | - M Hlevnjak
- National Center for Tumor Diseases (NCT) Heidelberg, a partnership between DKFZ and Heidelberg University Medical Center, Heidelberg, Germany; Division of Molecular Genetics, German Cancer Research Center (DKFZ), Heidelberg, Germany; German Cancer Consortium (DKTK), Heidelberg, Germany; Research Group Computational Oncology, Molecular Precision Oncology Program, National Center for Tumor Diseases (NCT) Heidelberg, a partnership between DKFZ and Heidelberg University Medical Center, Heidelberg, Germany
| | - S Benedetto
- Division of Theoretical Systems Biology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - J P Suppelna
- National Center for Tumor Diseases (NCT) Heidelberg, a partnership between DKFZ and Heidelberg University Medical Center, Heidelberg, Germany; University Hospital Heidelberg, Heidelberg, Germany
| | - J Heil
- Department of Obstetrics and Gynecology, Medical School, University of Heidelberg, Heidelberg, Germany
| | - K Smetanay
- National Center for Tumor Diseases (NCT) Heidelberg, a partnership between DKFZ and Heidelberg University Medical Center, Heidelberg, Germany; University Hospital Heidelberg, Heidelberg, Germany; Department of Obstetrics and Gynecology, Medical School, University of Heidelberg, Heidelberg, Germany
| | - L Michel
- National Center for Tumor Diseases (NCT) Heidelberg, a partnership between DKFZ and Heidelberg University Medical Center, Heidelberg, Germany; University Hospital Heidelberg, Heidelberg, Germany
| | - C Fremd
- National Center for Tumor Diseases (NCT) Heidelberg, a partnership between DKFZ and Heidelberg University Medical Center, Heidelberg, Germany; University Hospital Heidelberg, Heidelberg, Germany; Department of Medical Oncology, National Center for Tumor Diseases (NCT) Heidelberg, a partnership between DKFZ and Heidelberg University Medical Center, University Hospital Heidelberg, Heidelberg, Germany
| | - V Körber
- Division of Theoretical Systems Biology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - M Rübsam
- Research Group Computational Oncology, Molecular Precision Oncology Program, National Center for Tumor Diseases (NCT) Heidelberg, a partnership between DKFZ and Heidelberg University Medical Center, Heidelberg, Germany
| | - L Buschhorn
- National Center for Tumor Diseases (NCT) Heidelberg, a partnership between DKFZ and Heidelberg University Medical Center, Heidelberg, Germany; University Hospital Heidelberg, Heidelberg, Germany
| | - S Heublein
- National Center for Tumor Diseases (NCT) Heidelberg, a partnership between DKFZ and Heidelberg University Medical Center, Heidelberg, Germany; University Hospital Heidelberg, Heidelberg, Germany; Department of Obstetrics and Gynecology, Medical School, University of Heidelberg, Heidelberg, Germany
| | - B Schäfgen
- Department of Obstetrics and Gynecology, Medical School, University of Heidelberg, Heidelberg, Germany
| | - M Golatta
- Department of Obstetrics and Gynecology, Medical School, University of Heidelberg, Heidelberg, Germany
| | - C Gomez
- Department of Obstetrics and Gynecology, Medical School, University of Heidelberg, Heidelberg, Germany
| | - A von Au
- Department of Obstetrics and Gynecology, Medical School, University of Heidelberg, Heidelberg, Germany
| | - M Wallwiener
- Department of Obstetrics and Gynecology, Medical School, University of Heidelberg, Heidelberg, Germany
| | - S Wolf
- Genomics and Proteomics Core Facility, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - N Dikow
- Institute of Human Genetics, Heidelberg University Hospital, Heidelberg, Germany
| | - C Schaaf
- Institute of Human Genetics, Heidelberg University Hospital, Heidelberg, Germany
| | - E Gutjahr
- Department of General Pathology, University Hospital Heidelberg, Heidelberg, Germany
| | - M Allgäuer
- Department of General Pathology, University Hospital Heidelberg, Heidelberg, Germany
| | - A Stenzinger
- Department of General Pathology, University Hospital Heidelberg, Heidelberg, Germany
| | - K Pfütze
- National Center for Tumor Diseases (NCT) Heidelberg, a partnership between DKFZ and Heidelberg University Medical Center, Heidelberg, Germany
| | - R Kirsten
- Liquid Biobank, National Center for Tumor Diseases (NCT) Heidelberg, a partnership between DKFZ and Heidelberg University Medical Center, Heidelberg, Germany
| | - D Hübschmann
- German Cancer Consortium (DKTK), Heidelberg, Germany; Research Group Computational Oncology, Molecular Precision Oncology Program, National Center for Tumor Diseases (NCT) Heidelberg, a partnership between DKFZ and Heidelberg University Medical Center, Heidelberg, Germany; Heidelberg Institute for Stem Cell Technology and Experimental Medicine (HI-STEM gGmbH), Heidelberg, Germany
| | - H-P Sinn
- Department of General Pathology, University Hospital Heidelberg, Heidelberg, Germany
| | - D Jäger
- Department of Medical Oncology, National Center for Tumor Diseases (NCT) Heidelberg, a partnership between DKFZ and Heidelberg University Medical Center, University Hospital Heidelberg, Heidelberg, Germany
| | - A Trumpp
- Heidelberg Institute for Stem Cell Technology and Experimental Medicine (HI-STEM gGmbH), Heidelberg, Germany; Division of Stem Cells and Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - R Schlenk
- Department of Medical Oncology, National Center for Tumor Diseases (NCT) Heidelberg, a partnership between DKFZ and Heidelberg University Medical Center, University Hospital Heidelberg, Heidelberg, Germany; Department of Hematology, Oncology and Rheumatology, Heidelberg University Hospital, Heidelberg, Germany; NCT Trial Center, National Center for Tumor Diseases (NCT) Heidelberg, a partnership between DKFZ and Heidelberg University Medical Center and DKFZ, Heidelberg, Germany
| | - T Höfer
- Division of Theoretical Systems Biology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - V Thewes
- National Center for Tumor Diseases (NCT) Heidelberg, a partnership between DKFZ and Heidelberg University Medical Center, Heidelberg, Germany; University Hospital Heidelberg, Heidelberg, Germany; Division of Molecular Genetics, German Cancer Research Center (DKFZ), Heidelberg, Germany; German Cancer Consortium (DKTK), Heidelberg, Germany
| | - A Schneeweiss
- National Center for Tumor Diseases (NCT) Heidelberg, a partnership between DKFZ and Heidelberg University Medical Center, Heidelberg, Germany; University Hospital Heidelberg, Heidelberg, Germany; German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - P Lichter
- National Center for Tumor Diseases (NCT) Heidelberg, a partnership between DKFZ and Heidelberg University Medical Center, Heidelberg, Germany; Division of Molecular Genetics, German Cancer Research Center (DKFZ), Heidelberg, Germany; German Cancer Consortium (DKTK), Heidelberg, Germany.
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El Shafie RA, Seidensaal K, Bozorgmehr F, Kazdal D, Eichkorn T, Elshiaty M, Weber D, Allgäuer M, König L, Lang K, Forster T, Arians N, Rieken S, Heussel CP, Herth FJ, Thomas M, Stenzinger A, Debus J, Christopoulos P. Effect of timing, technique and molecular features on brain control with local therapies in oncogene-driven lung cancer. ESMO Open 2021; 6:100161. [PMID: 34090172 PMCID: PMC8182387 DOI: 10.1016/j.esmoop.2021.100161] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 02/06/2021] [Revised: 04/24/2021] [Accepted: 04/29/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The improved efficacy of tyrosine kinase inhibitors (TKI) mandates reappraisal of local therapy (LT) for brain metastases (BM) of oncogene-driven non-small-cell lung cancer (NSCLC). PATIENTS AND METHODS This study included all epidermal growth factor receptor-mutated (EGFR+, n = 108) and anaplastic lymphoma kinase-rearranged (ALK+, n = 33) TKI-naive NSCLC patients diagnosed with BM in the Thoraxklinik Heidelberg between 2009 and 2019. Eighty-seven patients (62%) received early LT, while 54 (38%) received delayed (n = 34; 24%) or no LT (n = 20; 14%). LT comprised stereotactic (SRT; n = 40; 34%) or whole-brain radiotherapy (WBRT; n = 77; 66%), while neurosurgical resection was carried out in 19 cases. RESULTS Median overall survival (OS) was 49.1 months for ALK+ and 19.5 months for EGFR+ patients (P = 0.001), with similar median intracranial progression-free survival (icPFS) (15.7 versus 14.0 months, respectively; P = 0.80). Despite the larger and more symptomatic BM (P < 0.001) of patients undergoing early LT, these experienced longer icPFS [hazard ratio (HR) 0.52; P = 0.024], but not OS (HR 1.63; P = 0.12), regardless of the radiotherapy technique (SRT versus WBRT) and number of lesions. High-risk oncogene variants, i.e. non-del19 EGFR mutations and 'short' EML4-ALK fusions (mainly variant 3, E6:A20), were associated with earlier intracranial progression (HR 2.97; P = 0.001). The longer icPFS with early LT was also evident in separate analyses of the EGFR+ and ALK+ subsets. CONCLUSIONS Despite preferential use for cases with poor prognostic factors, early LT prolongs the icPFS, but not OS, in TKI-treated EGFR+/ALK+ NSCLC. Considering the lack of survival benefit, and the neurocognitive effects of WBRT, patients presenting with polytopic BM may benefit from delaying radiotherapy, or from radiosurgery of multiple or selected lesions. For SRT candidates, the improved tumor control with earlier radiotherapy should be weighed against the potential toxicity and the enhanced intracranial activity of newer TKI. High-risk EGFR/ALK variants are associated with earlier intracranial failure and identify patients who could benefit from more aggressive management.
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Affiliation(s)
- R A El Shafie
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany; National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg, Germany; Department of Radiology and Nuclear Medicines, Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany.
| | - K Seidensaal
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany; National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg, Germany; Department of Radiology and Nuclear Medicines, Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany
| | - F Bozorgmehr
- Department of Thoracic Oncology, Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany; Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research (DZL), Heidelberg, Germany
| | - D Kazdal
- Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research (DZL), Heidelberg, Germany; Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany
| | - T Eichkorn
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany; National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg, Germany; Department of Radiology and Nuclear Medicines, Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany
| | - M Elshiaty
- Department of Thoracic Oncology, Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany; Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research (DZL), Heidelberg, Germany
| | - D Weber
- Institute of Medical Biometry and Informatics (IMBI), Heidelberg University Hospital, Heidelberg, Germany
| | - M Allgäuer
- Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research (DZL), Heidelberg, Germany; Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany
| | - L König
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany; National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg, Germany; Department of Radiology and Nuclear Medicines, Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany
| | - K Lang
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany; National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg, Germany; Department of Radiology and Nuclear Medicines, Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany
| | - T Forster
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany; National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg, Germany; Department of Radiology and Nuclear Medicines, Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany
| | - N Arians
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany; National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg, Germany; Department of Radiology and Nuclear Medicines, Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany
| | - S Rieken
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany; National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg, Germany; University Medical Center Göttingen, Department of Radiation Oncology, Göttingen, Germany
| | - C-P Heussel
- Department of Radiology and Nuclear Medicines, Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany; Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research (DZL), Heidelberg, Germany
| | - F J Herth
- Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research (DZL), Heidelberg, Germany; Department of Pneumology, Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany
| | - M Thomas
- Department of Thoracic Oncology, Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany; Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research (DZL), Heidelberg, Germany; National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - A Stenzinger
- Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research (DZL), Heidelberg, Germany; Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany
| | - J Debus
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany; National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg, Germany; National Center for Tumor Diseases (NCT), Heidelberg, Germany; Clinical Cooperation Unit Radiation Oncology (E050), German Cancer Research Center (DKFZ), Heidelberg, Germany; Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partner Site Heidelberg, German Cancer Research Center (DKFZ), Heidelberg, Germany; Heidelberger Ionenstrahltherapie-Zentrum (HIT), Heidelberg, Germany
| | - P Christopoulos
- Department of Thoracic Oncology, Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany; Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research (DZL), Heidelberg, Germany; National Center for Tumor Diseases (NCT), Heidelberg, Germany.
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Kazdal D, Allgäuer M, Budczies J, Kriegsmann M, Leichsenring J, Volckmar A, Kirchner M, Neumann O, Brandt R, Rempel E, Tala S, Harms A, Plögler C, Von Winterfeld M, Penzel R, Schirmacher P, Endris V, Stenzinger A. P1.04-13 Delineating Spatial Heterogeneity of Tumor Mutational Burden (TMB) Counts in Pulmonary Adenocarcinoma. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.916] [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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Budczies J, Allgäuer M, Litchfield K, Rempel E, Christopoulos P, Kazdal D, Endris V, Thomas M, Fröhling S, Peters S, Swanton C, Schirmacher P, Stenzinger A. Optimizing panel-based tumor mutational burden (TMB) measurement. Ann Oncol 2019; 30:1496-1506. [PMID: 31268125 DOI: 10.1093/annonc/mdz205] [Citation(s) in RCA: 103] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Panel sequencing based estimates of tumor mutational burden (psTMB) are increasingly replacing whole exome sequencing (WES) tumor mutational burden as predictive biomarker of immune checkpoint blockade (ICB). DESIGN A mathematical law describing psTMB variability was derived using a random mutation model and complemented by the contributions of non-randomly mutated real-world cancer genomes and intratumoral heterogeneity through simulations in publicly available datasets. RESULTS The coefficient of variation (CV) of psTMB decreased inversely proportional with the square root of the panel size and the square root of the TMB level. In silico simulations of all major commercially available panels in the TCGA pan-cancer cohort confirmed the validity of this mathematical law and demonstrated that the CV was 35% for TMB = 10 muts/Mbp for the largest panels of size 1.1-1.4 Mbp. Accordingly, misclassification rates (gold standard: WES) to separate 'TMBhigh' from 'TMBlow' using a cut-point of 199 mutations were 10%-12% in TCGA-LUAD and 17%-19% in TCGA-LUSC. A novel three-tier psTMB classification scheme which accounts for the likelihood of misclassification is proposed. Simulations in two WES datasets of immunotherapy treated patients revealed that small gene panels were poor predictors of ICB response. Moreover, we noted substantial intratumoral variance of psTMB scores in the TRACERx 100 cohort and identified indel burden as independent marker complementing missense mutation burden. CONCLUSIONS A universal mathematical law describes accuracy limitations inherent to psTMB, which result in substantial misclassification rates. This scenario can be controlled by two measures: (i) a panel design that is based on the mathematical law described in this article: halving the CV requires a fourfold increase in panel size, (ii) a novel three-tier TMB classification scheme. Moreover, inclusion of indel burden can complement TMB reports. This work has substantial implications for panel design, TMB testing, clinical trials and patient management.
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Affiliation(s)
- J Budczies
- Institute of Pathology, University Hospital Heidelberg, Heidelberg; German Cancer Consortium (DKTK), Partner Site Heidelberg, Heidelberg, Germany.
| | - M Allgäuer
- Institute of Pathology, University Hospital Heidelberg, Heidelberg
| | - K Litchfield
- Cancer Evolution and Genome Instability Translational Cancer Therapeutics Laboratory, Francis Crick Institute, London, UK
| | - E Rempel
- Institute of Pathology, University Hospital Heidelberg, Heidelberg
| | - P Christopoulos
- Department of Thoracic Oncology, Thoraxklinik at Heidelberg University Hospital, Heidelberg; German Center for Lung Research (DZL), Translational Lung Research Center Heidelberg (TLRC-H), Heidelberg
| | - D Kazdal
- Institute of Pathology, University Hospital Heidelberg, Heidelberg; German Center for Lung Research (DZL), Translational Lung Research Center Heidelberg (TLRC-H), Heidelberg
| | - V Endris
- Institute of Pathology, University Hospital Heidelberg, Heidelberg
| | - M Thomas
- Department of Thoracic Oncology, Thoraxklinik at Heidelberg University Hospital, Heidelberg; German Center for Lung Research (DZL), Translational Lung Research Center Heidelberg (TLRC-H), Heidelberg
| | - S Fröhling
- Department of Translational Oncology, National Center for Tumor Diseases (NCT), Heidelberg; German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - S Peters
- Department of Oncology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne University, Switzerland
| | - C Swanton
- Cancer Evolution and Genome Instability Translational Cancer Therapeutics Laboratory, Francis Crick Institute, London, UK
| | - P Schirmacher
- Institute of Pathology, University Hospital Heidelberg, Heidelberg; German Cancer Consortium (DKTK), Partner Site Heidelberg, Heidelberg, Germany
| | - A Stenzinger
- Institute of Pathology, University Hospital Heidelberg, Heidelberg; German Cancer Consortium (DKTK), Partner Site Heidelberg, Heidelberg, Germany.
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Hofheinz R, Fokas E, Allgäuer M, Polat B, Klautke G, Grabenbauer G, Fietkau R, Kuhnt T, Staib L, Brunner T, Grosu A, Schmiegel W, Jacobasch L, Weitz J, Folprecht G, Germer C, Grützmann R, Schwarzbach M, Bechstein W, Friede T, Ghadimi M, Rödel C. Randomized phase 2 trial of chemoradiotherapy plus induction or consolidation chemotherapy as total neoadjuvant therapy for locally advanced rectal cancer: CAO/ARO/AIO-12. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz154.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Leichsenring J, Kazdal D, Ploeger C, Allgäuer M, Endris V, Volckmar AL, Neumann O, Kirchner M, Penzel R, Rempel E, Budczies J, Schirmacher P, Fröhling S, Stenzinger A. [From panel diagnostics to comprehensive genomic analysis : Infobesity or empowerment?]. Pathologe 2019; 40:235-242. [PMID: 31089797 DOI: 10.1007/s00292-019-0608-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Precision oncology is obtaining a central role in the therapy of malignant diseases. The indication for targeted therapy is based on the identification of molecular targets for which next-generation sequencing (NGS) is commonly used nowadays. All approved predictive biomarkers and molecular targets, including gene fusions and copy number alterations, can be identified depending on panel design and method applied. Some clinical scenarios, however, may require more holistic genomic approaches, such as whole-genome/whole-exome and transcriptome analysis, which must be embedded in a clinical trial. Here, key aspects and applications of each method are summarized and discussed.
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Affiliation(s)
- J Leichsenring
- Pathologisches Institut, Molekularpathologisches Zentrum, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - D Kazdal
- Pathologisches Institut, Molekularpathologisches Zentrum, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - C Ploeger
- Pathologisches Institut, Molekularpathologisches Zentrum, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - M Allgäuer
- Pathologisches Institut, Molekularpathologisches Zentrum, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - V Endris
- Pathologisches Institut, Molekularpathologisches Zentrum, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - A-L Volckmar
- Pathologisches Institut, Molekularpathologisches Zentrum, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - O Neumann
- Pathologisches Institut, Molekularpathologisches Zentrum, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - M Kirchner
- Pathologisches Institut, Molekularpathologisches Zentrum, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - R Penzel
- Pathologisches Institut, Molekularpathologisches Zentrum, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - E Rempel
- Pathologisches Institut, Molekularpathologisches Zentrum, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - J Budczies
- Pathologisches Institut, Molekularpathologisches Zentrum, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - P Schirmacher
- Pathologisches Institut, Molekularpathologisches Zentrum, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - S Fröhling
- Abteilung Translationale Medizinische Onkologie, Nationales Centrum für Tumorerkrankungen (NCT) Heidelberg und Deutsches Krebsforschungszentrum (DKFZ), Heidelberg, Deutschland
| | - A Stenzinger
- Pathologisches Institut, Molekularpathologisches Zentrum, Universitätsklinikum Heidelberg, Heidelberg, Deutschland.
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Schäfer R, Strnad V, Polgár C, Uter W, Hildebrandt G, Ott O, Kauer-Dorner D, Knauerhase H, Major T, Lyczek J, Guinot J, Dunst J, Gutierrez Miguelez C, Slampa P, Allgäuer M, Lössl K, Kovacs G, Fietkau R, Resch A, Kulik A, Arribas L, Niehoff P, Guedea F, Gall C, Polat B. OC-0326: QOL After APBI (Multicatheter Brachytherapy) Versus WBI: 5-Year Results, Phase 3 GEC-ESTRO Trial. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)30636-4] [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: 11/29/2022]
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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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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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Polgár C, Strnad V, Ott O, Hildebrandt G, Kauer-Dorner D, Knauerhase H, Major T, Lyczek J, Guinot J, Dunst J, Gutierrez Miguelez C, Slampa P, Allgäuer M, Lössl K, Polat B, Kovács G, Fischedick A, Wendt T, Hindemith M, Resch A, Niehoff P, Guedea F, Pötter R, Gall C, Uter W. OC-0481: Late toxicity and cosmesis after APBI with brachytherapy vs WBI: 5-year results of a phase III trial. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)31730-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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12
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Andratschke N, Alheid H, Allgäuer M, Becker G, Blanck O, Boda-Hegemann J, Brunner T, Combs S, Duma M, Gerum S, Guckenberger M, Hildebrandt G, Ostheimer C, Panje C, Papachristofilou A, Petersen C, Schneider T, Semrau R, Wachter S, Habermehl D. OC-0445: Patterns of care and outcome analysis of SBRT for liver metastases - a DEGRO database initiative. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)31694-2] [Citation(s) in RCA: 2] [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: 11/15/2022]
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13
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Ried M, Braess J, Krause S, Allgäuer M, Szöke T, Hofmann HS. Die multimodale Therapie des Bronchialkarzinoms im Stadium IIIA – unter der besonderen Berücksichtigung der chirurgischen Resektion. Pneumologie 2016. [DOI: 10.1055/s-0036-1572113] [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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14
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Bartzsch O, Riepl M, Busch M, Michael G, Allgäuer M, Voss AC, Sauer R, Dühmke E, Gademann G, Molls M. [Use of G-CSF (Neupogen) in multimodal treatment in radiotherapy]. Strahlenther Onkol 1998; 174:551-5. [PMID: 9830435 DOI: 10.1007/bf03038291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Therapy-induced leukopenias with corresponding consequences repeatedly occur in radiotherapy using combined modalities treatment. In radiotherapy, where G-CSF (granulocyte-colony-stimulating-factor) is not licensed, G-CSF has been used successfully under individual circumstances. These results were confirmed in several studies with small patient groups. The aim of this study was to check former results in a larger patient group, to verify postulated side effects and specially to define a cost-effective schedule in the treatment with G-CSF (Neupogen). PATIENTS AND METHODS In this surveillance trial 50, partially previously treated patients with different malignant tumors were treated with G-CSF. According to the probability of a leucocytosis lower than 1000/mm3, G-CSF (Neuropogen) was already given at leukocyte values lower than 2500/mm3 (500/mm3 bis 2450/mm3). It administered subcutaneously every other day, based on body weight until reaching normal leucocyte levels. RESULTS In 92% of the patients the increase of leucocytes occurred in the first 24 hours. On average G-CSF was given 4.9 times per patient. Patients without prior therapies or less complex therapies needed less G-CSF applications (3.5 to 5.8 applications). Due to individually varying leucocyte courses the G-CSF therapy was started with leucocyte values between 500/mm3 and 2450/mm3. Patients who were treated with up to 3 G-CSF applications had higher leucocyte levels than those with 4 or more applications (1620/mm3 to 1250/mm3). Leucopenia related infections, therapy interruptions or break-offs did not occur. Besides light "flu like" symptoms in 14% of the patients, no side effects were observed. CONCLUSIONS When a decrease of leucocyte values lower than 1000/mm3 is expected, the most cost-effective treatment is given when starting the interventional G-CSF administration already at leucocyte values around 1600/mm3. Leucopenias can be treated effectively, with little side effects and in a cost-effective way when G-CSF is given on time.
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Abstract
HISTORY AND CLINICAL FINDINGS A 50-year-old female patient underwent extirpation of a moderately differentiated, partially tubular ductal carcinoma of the left mamma and dissection of the left axilla followed by postoperative radiation therapy (total dose 58/48 gy). 2 weeks after the radiation therapy was stopped, treatment with goserelin subcutaneously was started. 6 weeks later numerous open and closed comedons appeared which were sharply confined to the radiation areas of left mamma and sternum. DIAGNOSIS, TREATMENT AND COURSE Because of the clinical diagnosis of acne comedonica following radiation therapy a local treatment with benzoyl-peroxide gel 5% and erythromycin cream 2% was performed, which led to improvement of the skin lesions within a few weeks and total restitution within 3 months. During one year no comedons have occurred although the local therapeutics are not applied constantly anymore. CONCLUSION Acne comedonica in the radiation area is a rarely known side effect of radiation therapy. Although the skin lesions cause no pain or itching they can affect the patient due to cosmetic changes. Local treatment with comedolytic acne therapeutics is effective.
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MESH Headings
- Acne Vulgaris/drug therapy
- Acne Vulgaris/etiology
- Administration, Topical
- Anti-Bacterial Agents/administration & dosage
- Anti-Bacterial Agents/therapeutic use
- Antineoplastic Agents, Hormonal/therapeutic use
- Benzoyl Peroxide/administration & dosage
- Benzoyl Peroxide/therapeutic use
- Breast
- Breast Neoplasms/drug therapy
- Breast Neoplasms/radiotherapy
- Breast Neoplasms/surgery
- Carcinoma, Ductal, Breast/drug therapy
- Carcinoma, Ductal, Breast/radiotherapy
- Carcinoma, Ductal, Breast/surgery
- Chemotherapy, Adjuvant
- Erythromycin/administration & dosage
- Erythromycin/therapeutic use
- Female
- Gels
- Goserelin/therapeutic use
- Humans
- Keratolytic Agents/administration & dosage
- Keratolytic Agents/therapeutic use
- Middle Aged
- Radiodermatitis/drug therapy
- Radiodermatitis/etiology
- Radiotherapy, Adjuvant/adverse effects
- Thorax
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Affiliation(s)
- S Karrer
- Dermatologische Klinik und Poliklinik, Universität Regensburg
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16
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Schäfer CB, Allgäuer M. [Unexpected computerized tomography findings in neoplasm staging of a patient with plasmacytoma]. Aktuelle Radiol 1997; 7:279-80. [PMID: 9410003] [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: 02/05/2023]
Abstract
A case of a 69-year-old male patient is described. Staging CT brought unexpected findings with therapeutic consequences. Pneumoperitoneum was the most important sign. A pneumoretroperitoneum and a dilatation of the colon sigmoldeum were also found. Intraoperatively a perforated sigmadiverticulitis was detected. Therefore, one should pay attention to extraskeletal changes during the staging of multiple myeloma.
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Affiliation(s)
- C B Schäfer
- Abteilung für Computertomographie, Strahlentherapie und Nuklearmedizin, KH der Barmherzigen Brüder Regensburg
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17
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Schäfer CB, Bartzsch OM, Feldmann HJ, Molls M, Allgäuer M. [Ultrasound volumetry of cervical lymph nodes during radiotherapy as a method of therapy monitoring]. Ultraschall Med 1996; 17:289-294. [PMID: 9082556 DOI: 10.1055/s-2007-1003201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
PURPOSE Volumetric changes of cervical lymph nodes during radiotherapy (RT) should be evaluated with B-mode sonography. It was our intention to test whether ultrasound could be used for therapeutic monitoring. METHOD 30 lymph nodes of 20 patients were measured. All patients underwent radiotherapy of the cervical region. All lymph nodes were checked at first one day before RT, and then once a week. RESULTS Concerning the volume change, examined lymph nodes showed great differences. Pretreatment volume ranged from 0.26 to 96.5 cm3, median 4.9. Time volume 50%, i.e. time until volume had decreased by 50%, was reached after 21 (+/-11) days. Mean volume reduction was 1.3 (+/-1.6)% each day. Big lymph nodes needed more time until time volume 50%. Time volume 50% itself correlated positively with the therapeutic outcome. Sonographic lymph node volumetry was useful in 85% of all the patients. CONCLUSIONS Sonographic lymph node volumetry is a simple and practical method. It can be used easily in clinical routine. Radiotherapist can often gain therapeutically relevant information. We describe the use of sonography for therapy monitoring during RT. This has so far been an unknown potential of the method. However, further evaluation is required.
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Affiliation(s)
- C B Schäfer
- Abteilung für Strahlentherapie, KH der Barmherzigen Brüder Regensburg
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