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Mohamed AA, Goncalves M, Singh BP, Tometten M, Rashad A, Hölzle F, Hackenberg S, Eble M. Stereotactic radiotherapy in the management of oligometastatic and recurrent head and neck cancer: a single-center experience. Strahlenther Onkol 2024; 200:400-408. [PMID: 38063900 DOI: 10.1007/s00066-023-02180-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 11/01/2023] [Indexed: 04/24/2024]
Abstract
INTRODUCTION Oligometastatic disease (OMD) is a metastatic stage that could benefit maximally from local therapies. Patients in this state have a better prognosis relative to those with disseminated metastases. Stereotactic radiotherapy provides a non-invasive ablative tool for primary malignant tumors and metastases. MATERIALS AND METHODS We searched our register for patients with oligometastatic or recurrent head and neck cancer (OMD/R-HNC) who received stereotactic radiotherapy to manage their OMD/R. We evaluated the survival outcomes and prognostic factors that affected the survival of those patients. RESULTS In all, 31 patients with 48 lesions met the inclusion criteria for the analysis. The lesions comprised various metastatic sites, with the majority being pulmonary (37 lesions). Squamous cell cancer was the most common histology (26 patients). The median overall survival (mOS) was 33 months, with a progression-free survival (PFS) of 9.6 months. Eight patients received subsequent stereotactic radiotherapy after disease progression. The local control (LC) rates were 91.3, 87.7, and 83% at 6, 12, and 36 months. Patients with the de novo OMD who received stereotactic radiotherapy as their initial treatment had a median systemic treatment-free survival of 23.9 months. In univariate analysis, a trend for better OS was observed in patients with p16-positive squamous cell tumors; patients who progressed within 150 days after diagnosis had a significantly lower OS. De novo OMD showed significantly better PFS compared to induced OMD. Multivariate analyses identified p16-positive squamous cell cancer, metachronous OMD and a longer time to progression as positive predictors of OS, while de novo OMD was the only positive predictor for PFS. Treatment-related toxicities were generally mild, with two cases of grade 3 dysphagia reported. CONCLUSION Stereotactic radiotherapy demonstrated favorable outcomes in patients with OMD/R-HNC with limited toxicities. Further studies are warranted to validate these findings and optimize treatment strategies for this patient population.
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Affiliation(s)
- Ahmed Allam Mohamed
- Department of Radiation Oncology, RWTH Aachen University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany.
- Center for Integrated Oncology Aachen, Bonn, Cologne and Duesseldorf (CIO ABCD), Aachen, Germany.
| | - Miguel Goncalves
- Center for Integrated Oncology Aachen, Bonn, Cologne and Duesseldorf (CIO ABCD), Aachen, Germany
- Department of Oto-Rhino-Laryngology-Head and Neck Surgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Biney Pal Singh
- Department of Radiation Oncology, RWTH Aachen University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany
- Center for Integrated Oncology Aachen, Bonn, Cologne and Duesseldorf (CIO ABCD), Aachen, Germany
| | - Mareike Tometten
- Center for Integrated Oncology Aachen, Bonn, Cologne and Duesseldorf (CIO ABCD), Aachen, Germany
- Department of Hematology, Oncology and Stem Cell Transplantation, RWTH Aachen University Hospital, Aachen, Germany
| | - Ashkan Rashad
- Center for Integrated Oncology Aachen, Bonn, Cologne and Duesseldorf (CIO ABCD), Aachen, Germany
- Department of Oral and Maxillofacial Surgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Frank Hölzle
- Center for Integrated Oncology Aachen, Bonn, Cologne and Duesseldorf (CIO ABCD), Aachen, Germany
- Department of Oral and Maxillofacial Surgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Stephan Hackenberg
- Center for Integrated Oncology Aachen, Bonn, Cologne and Duesseldorf (CIO ABCD), Aachen, Germany
- Department of Oto-Rhino-Laryngology-Head and Neck Surgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Michael Eble
- Department of Radiation Oncology, RWTH Aachen University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany
- Center for Integrated Oncology Aachen, Bonn, Cologne and Duesseldorf (CIO ABCD), Aachen, Germany
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Mohamed AA, Berres ML, Bruners P, Lang SA, Trautwein C, Wiltberger G, Barabasch A, Eble M. Managing hepatocellular carcinoma across the stages: efficacy and outcomes of stereotactic body radiotherapy : A retrospective study. Strahlenther Onkol 2024:10.1007/s00066-024-02235-5. [PMID: 38689147 DOI: 10.1007/s00066-024-02235-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 03/17/2024] [Indexed: 05/02/2024]
Abstract
PURPOSE Hepatocellular carcinoma (HCC) poses a unique challenge due to its predilection for developing on compromised livers, often limiting surgical options. Stereotactic body radiotherapy (SBRT) has emerged as a promising local treatment modality for HCC. This study aims to assess the effectiveness of SBRT in HCC patients not suitable for surgery, focusing on local control, optimal radiation dosing, and prognostic factors. METHODS In this retrospective analysis, 52 HCC patients treated with SBRT were examined. The study assessed local control, progression-free survival (PFS), and overall survival (OS) while conducting dosimetric analyses. The relationship between mean liver dose and Child-Pugh score (CPS) progression was also explored. RESULTS SBRT demonstrated 93.4% freedom from local progression (FFLP) at 12 months. Notably, a near minimum dose (D98%) below 61 Gy as an equivalent dose in 2‑Gy fractions with α/β 10 Gy (EQD2α/β10) was associated with reduced FFLP (p-value 0.034). Logistic regression analysis revealed a dose-response relationship for FFLP and D98% with 95% and 98% probability of FFLP at a dose of 56.9 and 73.1 Gy, respectively. The study observed OS rates of 63.7% at 1 year and 34.3% at 3 years. Patients with portal vein tumor thrombus (PVTT) and larger tumors (≥ 37 cm3) experienced decreased PFS and OS. Multivariate analysis identified PVTT, larger tumor volume, and performance status as independent predictors of reduced OS. Notably, classical radiation-induced disease (cRILD) was absent, but nonclassical (nc) RILD occurred in 7.7% of patients. Regression analysis linked a mean EQD2α/β3-8 dose to the liver (12.8-12.6) with a 10% likelihood of ncRILD. CONCLUSION SBRT offers a compelling option for achieving high local control and promising survival outcomes in HCC. The study supports a radiation dose range of 61-73.1 Gy, coupled with a mean liver dose under 12.6-12.8 Gy as EQD2, to achieve favorable FFLP rates, with acceptable toxicity rates.
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Affiliation(s)
- Ahmed Allam Mohamed
- Radiation Oncology Department, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany.
- Site: Aachen, Center for Integrated Oncology Aachen, Bonn, Cologne and Duesseldorf (CIO ABCD), Aachen, Germany.
| | - Marie-Luise Berres
- Gastroenterology, Hepatology and infectious Diseases Department, University Hospital RWTH Aachen, Aachen, Germany
- Site: Aachen, Center for Integrated Oncology Aachen, Bonn, Cologne and Duesseldorf (CIO ABCD), Aachen, Germany
| | - Philipp Bruners
- Diagnostic and IInterventional Radiology Department, University Hospital RWTH Aachen, Aachen, Germany
- Site: Aachen, Center for Integrated Oncology Aachen, Bonn, Cologne and Duesseldorf (CIO ABCD), Aachen, Germany
| | - Sven Arke Lang
- Visceral and Transplantation Surgery Department, University Hospital RWTH Aachen, Aachen, Germany
- Site: Aachen, Center for Integrated Oncology Aachen, Bonn, Cologne and Duesseldorf (CIO ABCD), Aachen, Germany
| | - Christian Trautwein
- Gastroenterology, Hepatology and infectious Diseases Department, University Hospital RWTH Aachen, Aachen, Germany
- Site: Aachen, Center for Integrated Oncology Aachen, Bonn, Cologne and Duesseldorf (CIO ABCD), Aachen, Germany
| | | | | | - Michael Eble
- Radiation Oncology Department, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
- Site: Aachen, Center for Integrated Oncology Aachen, Bonn, Cologne and Duesseldorf (CIO ABCD), Aachen, Germany
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Makowska A, Lelabi N, Nothbaum C, Shen L, Busson P, Tran TTB, Eble M, Kontny U. Radiotherapy Combined with PD-1 Inhibition Increases NK Cell Cytotoxicity towards Nasopharyngeal Carcinoma Cells. Cells 2021; 10:2458. [PMID: 34572108 PMCID: PMC8470143 DOI: 10.3390/cells10092458] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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: 08/19/2021] [Revised: 09/10/2021] [Accepted: 09/15/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Nasopharyngeal carcinoma (NPC) in endemic regions and younger patients is characterized by a prominent lymphomononuclear infiltration. Radiation is the principal therapeutic modality for patients with NPC. Recent data suggest that the efficacy of radiotherapy in various cancers can be augmented when combined with immune checkpoint blockade. Here, we investigate the effect of radiotherapy on the killing of NPC cells by Natural Killer (NK) cells. METHODS NPC cell lines and a patient-derived xenograft were exposed to NK cells in the context of radiotherapy. Cytotoxicity was measured using the calcein-release assay. The contribution of the PD-L1/PD-1 checkpoint and signaling pathways to killing were analyzed using specific inhibitors. RESULTS Radiotherapy sensitized NPC cells to NK cell killing and upregulated expression of PD-1 ligand (PD-L1) in NPC cells and PD-1 receptor (PD-1) in NK cells. Blocking of the PD-L1/PD-1 checkpoint further increased the killing of NPC cells by NK cells in the context of radiotherapy. CONCLUSION Radiation boosts the killing of NPC cells by NK cells. Killing can be further augmented by blockade of the PD-L1/PD-1 checkpoint. The combination of radiotherapy with PD-L1/PD-1 checkpoint blockade could therefore increase the efficacy of radiotherapy in NPC tumors.
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Affiliation(s)
- Anna Makowska
- Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, Medical Faculty, Rhenish-Westphalian Technical University, 52074 Aachen, Germany; (A.M.); (N.L.); (C.N.); (L.S.)
| | - Nora Lelabi
- Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, Medical Faculty, Rhenish-Westphalian Technical University, 52074 Aachen, Germany; (A.M.); (N.L.); (C.N.); (L.S.)
| | - Christina Nothbaum
- Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, Medical Faculty, Rhenish-Westphalian Technical University, 52074 Aachen, Germany; (A.M.); (N.L.); (C.N.); (L.S.)
| | - Lian Shen
- Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, Medical Faculty, Rhenish-Westphalian Technical University, 52074 Aachen, Germany; (A.M.); (N.L.); (C.N.); (L.S.)
| | - Pierre Busson
- CNRS UMR 8126, Gustave Roussy, Université Paris Sud, Université Paris-Saclay, 94805 Villejuif, France; (P.B.); (T.T.B.T.)
| | - Tram Thi Bao Tran
- CNRS UMR 8126, Gustave Roussy, Université Paris Sud, Université Paris-Saclay, 94805 Villejuif, France; (P.B.); (T.T.B.T.)
| | - Michael Eble
- Department of Radiation Oncology, Medical Faculty, Rhenish-Westphalian Technical University, 52074 Aachen, Germany;
| | - Udo Kontny
- Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, Medical Faculty, Rhenish-Westphalian Technical University, 52074 Aachen, Germany; (A.M.); (N.L.); (C.N.); (L.S.)
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Mohamed A, Gester K, Schmitz L, Schlenter M, Chughtai A, Ivanciu M, Eble M. PO-1160 An automated segmentation algorithm for GTV delineation in SBRT of the lung, a proof of concept. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07611-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Mohamed A, Gester K, Eble M. PO-1224 SBRT as a part of the multimodal management of intermediate and advanced hepatocellular carcinoma. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07675-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Huth S, Marquardt Y, Huth L, Schmitt L, Prescher K, Winterhalder P, Steiner T, Hölzle F, Eble M, Malte Baron J. Molecular effects of photon irradiation and subsequent aftercare treatment with dexpanthenol-containing ointment or liquid in 3D models of human skin and non-keratinized oral mucosa. Exp Dermatol 2021; 30:745-750. [PMID: 33403711 DOI: 10.1111/exd.14266] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 12/03/2020] [Accepted: 12/17/2020] [Indexed: 12/24/2022]
Abstract
This study aimed to investigate the molecular effects of radiation and subsequent aftercare treatment with dexpanthenol-containing ointment and liquid on established full-thickness 3D skin models depicting acute radiodermatitis and mucositis. To mimic radiomucositis and radiodermatitis, non-keratinized mucous membrane and normal human skin models were irradiated with 5 Gray. Afterwards, models were treated topically every second day with dexpanthenol-containing ointment or liquid in comparison with placebo and untreated controls. On day 7 after irradiation, histological examination showed impairments in irradiated models. In contrast, models treated with dexpanthenol-containing ointment or liquid showed a completely restored epidermal part. While gene expression profiling revealed an induction of genes related to a pro-inflammatory milieu, oxidative stress and an impaired epidermal differentiation after irradiation of the models, aftercare treatment with dexpanthenol-containing ointment or liquid revealed anti-oxidative and anti-inflammatory effects and had a positive effect on epidermal differentiation and structures important for physical and antimicrobial barrier function. Our findings confirm the potential of our established models as in vitro tools for the replacement of pharmacological in vivo studies regarding radiation-induced skin injuries and give indications of the positive effects of dexpanthenol-containing externals after radiation treatments as part of supportive tumor treatment.
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Affiliation(s)
- Sebastian Huth
- Department of Dermatology and Allergology, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Yvonne Marquardt
- Department of Dermatology and Allergology, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Laura Huth
- Department of Dermatology and Allergology, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Laurenz Schmitt
- Department of Dermatology and Allergology, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Kirsten Prescher
- Department of Radiation Oncology, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Philipp Winterhalder
- Interdisciplinary Center for Laser Medicine, Medical Faculty, RWTH Aachen University, Aachen, Germany.,Department of Oral and Maxillofacial Surgery, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Timm Steiner
- Interdisciplinary Center for Laser Medicine, Medical Faculty, RWTH Aachen University, Aachen, Germany.,Department of Oral and Maxillofacial Surgery, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Frank Hölzle
- Interdisciplinary Center for Laser Medicine, Medical Faculty, RWTH Aachen University, Aachen, Germany.,Department of Oral and Maxillofacial Surgery, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Michael Eble
- Department of Radiation Oncology, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Jens Malte Baron
- Department of Dermatology and Allergology, Medical Faculty, RWTH Aachen University, Aachen, Germany.,Interdisciplinary Center for Laser Medicine, Medical Faculty, RWTH Aachen University, Aachen, Germany
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7
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Klement RJ, Sonke JJ, Allgäuer M, Andratschke N, Appold S, Belderbos J, Belka C, Blanck O, Dieckmann K, Eich HT, Mantel F, Eble M, Hope A, Grosu AL, Nevinny-Stickel M, Semrau S, Sweeney RA, Hörner-Rieber J, Werner-Wasik M, Engenhart-Cabillic R, Ye H, Grills I, Guckenberger M. Correlating Dose Variables with Local Tumor Control in Stereotactic Body Radiation Therapy for Early-Stage Non-Small Cell Lung Cancer: A Modeling Study on 1500 Individual Treatments. Int J Radiat Oncol Biol Phys 2020; 107:579-586. [PMID: 32188579 DOI: 10.1016/j.ijrobp.2020.03.005] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 02/04/2020] [Accepted: 03/02/2020] [Indexed: 01/02/2023]
Abstract
BACKGROUND Large variation regarding prescription and dose inhomogeneity exists in stereotactic body radiation therapy (SBRT) for early-stage non-small cell lung cancer. The aim of this modeling study was to identify which dose metric correlates best with local tumor control probability to make recommendations regarding SBRT prescription. METHODS AND MATERIALS We combined 2 retrospective databases of patients with non-small cell lung cancer, yielding 1500 SBRT treatments for analysis. Three dose parameters were converted to biologically effective doses (BEDs): (1) the (near-minimum) dose prescribed to the planning target volume (PTV) periphery (yielding BEDmin); (2) the (near-maximum) dose absorbed by 1% of the PTV (yielding BEDmax); and (3) the average between near-minimum and near-maximum doses (yielding BEDave). These BED parameters were then correlated to the risk of local recurrence through Cox regression. Furthermore, BED-based prediction of local recurrence was attempted by logistic regression and fast and frugal trees. Models were compared using the Akaike information criterion. RESULTS There were 1500 treatments in 1434 patients; 117 tumors recurred locally. Actuarial local control rates at 12 and 36 months were 96.8% (95% confidence interval, 95.8%-97.8%) and 89.0% (87.0%-91.1%), respectively. In univariable Cox regression, BEDave was the best predictor of risk of local recurrence, and a model based on BEDmin had substantially less evidential support. In univariable logistic regression, the model based on BEDave also performed best. Multivariable classification using fast and frugal trees revealed BEDmax to be the most important predictor, followed by BEDave. CONCLUSIONS BEDave was generally better correlated with tumor control probability than either BEDmax or BEDmin. Because the average between near-minimum and near-maximum doses was highly correlated to the mean gross tumor volume dose, the latter may be used as a prescription target. More emphasis could be placed on achieving sufficiently high mean doses within the gross tumor volume rather than the PTV covering dose, a concept needing further validation.
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Affiliation(s)
- Rainer J Klement
- Department of Radiotherapy and Radiation Oncology, Leopoldina Hospital Schweinfurt, Schweinfurt, Germany.
| | - Jan-Jakob Sonke
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Michael Allgäuer
- Department of Radiotherapy, Barmherzige Brüder Regensburg, Regensburg, Germany
| | - Nicolaus Andratschke
- Department of Radiation Oncology, University Hospital Zurich, Zurich, Switzerland
| | - Steffen Appold
- Department of Radiation Oncology, Technische Universität Dresden, Dresden, Germany
| | - José Belderbos
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Claus Belka
- Department of Radiation Oncology, University Hospital of Ludwig-Maximilians-University Munich, Munich, Germany
| | - Oliver Blanck
- Department of Radiation Oncology, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Karin Dieckmann
- Department of Radiotherapy, Medical University of Vienna, Vienna, Austria
| | - Hans T Eich
- Department of Radiotherapy, University Hospital Münster, Münster, Germany
| | - Frederick Mantel
- Department of Radiotherapy and Radiation Oncology, University Hospital Wuerzburg, Wuerzberg, Germany
| | - Michael Eble
- Department of Radiation Oncology, RWTH Aachen University, Aachen, Germany
| | - Andrew Hope
- Department of Radiation Oncology, University of Toronto and Princess Margaret Cancer Center, Toronto, Canada
| | - Anca L Grosu
- Department of Radiation Oncology, University Hospital Freiburg, Freiburg, Germany
| | | | - Sabine Semrau
- Department of Radiation Oncology, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Reinhart A Sweeney
- Department of Radiotherapy and Radiation Oncology, Leopoldina Hospital Schweinfurt, Schweinfurt, Germany
| | - Juliane Hörner-Rieber
- Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany
| | - Maria Werner-Wasik
- Department of Radiation Oncology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Rita Engenhart-Cabillic
- Department of Radiotherapy and Radiation Oncology, Phillips-University Marburg, Marburg, Germany
| | - Hong Ye
- Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, Michigan
| | - Inga Grills
- Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, Michigan
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Pfenninger EG, Klingler W, Keiloweit T, Eble M, Wenzel V, Krüger WA. [Terrorist attack training exercise-What can be learned? : Baden-Württemberg counterterrorism exercise (BWTEX)]. Anaesthesist 2020; 69:477-486. [PMID: 32488534 DOI: 10.1007/s00101-020-00797-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND There is a risk of terror attacks in the Federal Republic of Germany, which might increase in the future. A timely comprehensive strategy for treatment and care of a large number of casualties helps minimize chaos and improve the outcome of patients. Adequate training is vital for successful implementation of an emergency plan. Therefore, the effectiveness of training should be assessed and evaluated; however, data collection capabilities for training events are extremely limited, so that publications on the topic are almost impossible to find. OBJECTIVE This study aimed to collect data from a simulated terrorist attack in order to draw conclusions from a clinical point of view concerning the improvement of preclinical and clinical management, taking interface problems into consideration. MATERIAL AND METHODS On 19 October 2019 the Ministry of the Interior, Digitalization and Migration of Baden-Württemberg conducted a large-scale simulation of a terrorist attack in the city center of Constance, called the Baden-Württemberg counterterrorism exercise (BWTEX). The simulation included an explosion of a car bomb as well as the use of firearms by terrorists. The large scale of the simulation with the high number of participants in combination with close cooperation between military and civil forces was unprecedented. The police force, the armed forces, civil protection forces, air rescue teams and staff from Constance, Friedrichshafen and Sigmaringen regional hospitals in southwest Germany worked together to treat simulated injuries to victims of the attack. The following parameters were recorded when the injured patients arrived at the hospital: prehospital triage time, prehospital triage score, initial treatment and quality of documentation on site as well as triage time, triage score, injury severity scale (ISS) score based on the specified injury pattern, treatment, and quality of documentation on hospital arrival. RESULTS Out of a total of 84 "injured patients" 55 were admitted to hospital and 80% were triaged at the scene. Injured patients of triage category 1 (TK1 red: life-threatening injury, immediate treatment) arrived at the hospital 198 ± 50 min after the attack, injured patients of triage category 2 (TK2 yellow: severely injured, urgent treatment) after 131 ± 44 min and injured patients of triage category 3 (TK3 green: slightly injured, non-urgent treatment) arrived after 157 ± 46 min. There was no significant difference in terms of arrival time at the hospital between the triage scores (r = 0.2) or between the ISS scores (r = 0.43). The authors assume that approximately 44% of TK1 patients would have died due to avoidable time delays. Prehospital medical documentation was insufficient in 78% and insufficient in 65% in the hospitals. CONCLUSION A mass casualty incident resulting from a terrorist attack differs greatly from a conventional mass casualty incident. The scene of the attack has to be evacuated as quickly as possible, which means that a large number of patients arrive untreated at the nearest hospitals. The setting up of treatment facilities in city centers and areas close to the city seems to be counterproductive because the time delay may result in higher mortality rates of victims. The particularities of mass casualties caused by a terrorist attack have to be incorporated into terrorist attack training.
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Affiliation(s)
- E G Pfenninger
- Stabsstelle Katastrophenschutz, Universitätsklinikum Ulm, Albert-Einstein-Allee 29, 89081, Ulm, Deutschland. .,Klinik für Anästhesie, Intensivmedizin und Schmerztherapie, SRH Kliniken Sigmaringen, Sigmaringen, Deutschland.
| | - W Klingler
- Klinik für Anästhesie, Intensivmedizin und Schmerztherapie, SRH Kliniken Sigmaringen, Sigmaringen, Deutschland
| | - Th Keiloweit
- Klinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Klinikum Konstanz, Konstanz, Deutschland
| | - M Eble
- Klinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Medizin Campus Bodensee, Klinikum Friedrichshafen, Friedrichshafen, Deutschland
| | - V Wenzel
- Klinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Medizin Campus Bodensee, Klinikum Friedrichshafen, Friedrichshafen, Deutschland
| | - W A Krüger
- Klinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Klinikum Konstanz, Konstanz, Deutschland
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Kober B, Dötsch M, Götzelmann E, Vogel M, Eble M, Wenzel V. Akute Ausweitung von inhalativem Sauerstoff in einer Pandemie. Anaesthesist 2020; 69:359-360. [PMID: 32246156 PMCID: PMC7119267 DOI: 10.1007/s00101-020-00774-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Mayer M, Hürtgen G, Schlenter M, Stahl A, Eble M. P04.89 Investigation of the interaction of simultaneously applied photon irradiation and Tumor Treating Fields using a Geant4 simulation. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy139.323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- M Mayer
- Clinic for Radiooncology and Radiotherapy, Uniklinik RWTH Aachen University, Aachen, Germany
| | - G Hürtgen
- Clinic for Radiooncology and Radiotherapy, Uniklinik RWTH Aachen University, Aachen, Germany
| | - M Schlenter
- Clinic for Radiooncology and Radiotherapy, Uniklinik RWTH Aachen University, Aachen, Germany
| | - A Stahl
- Physics Institute III B, RWTH Aachen University, Aachen, Germany
| | - M Eble
- Clinic for Radiooncology and Radiotherapy, Uniklinik RWTH Aachen University, Aachen, Germany
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Deist TM, Jochems A, van Soest J, Nalbantov G, Oberije C, Walsh S, Eble M, Bulens P, Coucke P, Dries W, Dekker A, Lambin P. Infrastructure and distributed learning methodology for privacy-preserving multi-centric rapid learning health care: euroCAT. Clin Transl Radiat Oncol 2017; 4:24-31. [PMID: 29594204 PMCID: PMC5833935 DOI: 10.1016/j.ctro.2016.12.004] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 12/11/2016] [Accepted: 12/15/2016] [Indexed: 12/31/2022] Open
Abstract
Developed and implemented IT infrastructure in 5 radiation clinics across 3 countries. Proof-of-principle for ‘big data’ infrastructure and distributed learning studies. General framework to execute learning algorithms on distributed data.
Machine learning applications for personalized medicine are highly dependent on access to sufficient data. For personalized radiation oncology, datasets representing the variation in the entire cancer patient population need to be acquired and used to learn prediction models. Ethical and legal boundaries to ensure data privacy hamper collaboration between research institutes. We hypothesize that data sharing is possible without identifiable patient data leaving the radiation clinics and that building machine learning applications on distributed datasets is feasible. We developed and implemented an IT infrastructure in five radiation clinics across three countries (Belgium, Germany, and The Netherlands). We present here a proof-of-principle for future ‘big data’ infrastructures and distributed learning studies. Lung cancer patient data was collected in all five locations and stored in local databases. Exemplary support vector machine (SVM) models were learned using the Alternating Direction Method of Multipliers (ADMM) from the distributed databases to predict post-radiotherapy dyspnea grade ⩾2. The discriminative performance was assessed by the area under the curve (AUC) in a five-fold cross-validation (learning on four sites and validating on the fifth). The performance of the distributed learning algorithm was compared to centralized learning where datasets of all institutes are jointly analyzed. The euroCAT infrastructure has been successfully implemented in five radiation clinics across three countries. SVM models can be learned on data distributed over all five clinics. Furthermore, the infrastructure provides a general framework to execute learning algorithms on distributed data. The ongoing expansion of the euroCAT network will facilitate machine learning in radiation oncology. The resulting access to larger datasets with sufficient variation will pave the way for generalizable prediction models and personalized medicine.
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Affiliation(s)
- Timo M Deist
- Department of Radiation Oncology (MAASTRO Clinic), Dr. Tanslaan 12, Maastricht, The Netherlands.,GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center+, Minderbroedersberg 4-6, Maastricht, The Netherlands
| | - A Jochems
- Department of Radiation Oncology (MAASTRO Clinic), Dr. Tanslaan 12, Maastricht, The Netherlands.,GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center+, Minderbroedersberg 4-6, Maastricht, The Netherlands
| | - Johan van Soest
- Department of Radiation Oncology (MAASTRO Clinic), Dr. Tanslaan 12, Maastricht, The Netherlands.,GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center+, Minderbroedersberg 4-6, Maastricht, The Netherlands
| | - Georgi Nalbantov
- Department of Radiation Oncology (MAASTRO Clinic), Dr. Tanslaan 12, Maastricht, The Netherlands
| | - Cary Oberije
- Department of Radiation Oncology (MAASTRO Clinic), Dr. Tanslaan 12, Maastricht, The Netherlands
| | - Seán Walsh
- Department of Radiation Oncology (MAASTRO Clinic), Dr. Tanslaan 12, Maastricht, The Netherlands
| | - Michael Eble
- Klinik für Strahlentherapie (University Clinic Aachen), Pauwelsstraße 30, Aachen, Germany
| | - Paul Bulens
- Department of Radiation Oncology (Jessa Hospital), Stadsomvaart 11, Hasselt, The Netherlands
| | - Philippe Coucke
- Departement de Physique Medicale (CHU de Liège), Bâtiment B 35, Liège, Belgium
| | - Wim Dries
- Catharina Hospital Eindhoven, Michelangelolaan 2, Eindhoven, The Netherlands
| | - Andre Dekker
- Department of Radiation Oncology (MAASTRO Clinic), Dr. Tanslaan 12, Maastricht, The Netherlands
| | - Philippe Lambin
- Department of Radiation Oncology (MAASTRO Clinic), Dr. Tanslaan 12, Maastricht, The Netherlands.,GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center+, Minderbroedersberg 4-6, Maastricht, The Netherlands
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Makowska A, Eble M, Prescher K, Hoß M, Kontny U. Chloroquine Sensitizes Nasopharyngeal Carcinoma Cells but Not Nasoepithelial Cells to Irradiation by Blocking Autophagy. PLoS One 2016; 11:e0166766. [PMID: 27902742 PMCID: PMC5130215 DOI: 10.1371/journal.pone.0166766] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 11/03/2016] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Treatment of nasopharyngeal carcinoma requires the application of high dosages of radiation, leading to severe long-term complications in the majority of patients. Sensitizing tumor cells to radiation could be a means to increase the therapeutic window of radiation. Nasopharyngeal carcinoma cells display alterations in autophagy and blockade of autophagy has been shown to sensitize them against chemotherapy. METHODS We investigated the effect of chloroquine, a known inhibitor of autophagy, on sensitization against radiation-induced apoptosis in a panel of five nasopharyngeal carcinoma cell lines and a SV40-transformed nasoepithelial cell line. Autophagy was measured by immunoblot of autophagy-related proteins, immunofluorescence of autophagosomic microvesicles and electron microscopy. Autophagy was blocked by siRNA against autophagy-related proteins 3, 5, 6 and 7 (ATG3, ATG5, ATG6 and ATG7). RESULTS Chloroquine sensitized four out of five nasopharyngeal cancer cell lines towards radiation-induced apoptosis. The sensitizing effect was based on the blockade of autophagy as inhibition of ATG3, ATG5, ATG6 and ATG7 by specific siRNA could substitute for the effect of chloroquine. No sensitization was seen in nasoepithelial cells. CONCLUSION Chloroquine sensitizes nasopharyngeal carcinoma cells but not nasoepithelial cells towards radiation-induced apoptosis by blocking autophagy. Further studies in a mouse-xenograft model are warranted to substantiate this effect in vivo.
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Affiliation(s)
- Anna Makowska
- Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Michael Eble
- Department of Radiation Oncology, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Kirsten Prescher
- Department of Radiation Oncology, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Mareike Hoß
- Electron Microscopic Facility, Institute of Pathology, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Udo Kontny
- Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, Medical Faculty, RWTH Aachen University, Aachen, Germany
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Kontny U, Franzen S, Behrends U, Bührlen M, Christiansen H, Delecluse H, Eble M, Feuchtinger T, Gademann G, Granzen B, Kratz C, Lassay L, Leuschner I, Mottaghy F, Schmitt C, Staatz G, Timmermann B, Vorwerk P, Wilop S, Wolff H, Mertens R. Diagnosis and Treatment of Nasopharyngeal Carcinoma in Children and Adolescents – Recommendations of the GPOH-NPC Study Group. Klin Padiatr 2016; 228:105-12. [DOI: 10.1055/s-0041-111180] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- U. Kontny
- Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, Medical Faculty, RWTH Aachen University , Aachen, Germany
| | - S. Franzen
- Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, Medical Faculty, RWTH Aachen University , Aachen, Germany
| | - U. Behrends
- Children’s Hospital München-Schwabing, Technische Universität, München, Germany
| | - M. Bührlen
- Prof.-Hess-Kinderklinik, Klinikum Bremen-Mitte, Bremen, Germany
| | - H. Christiansen
- Department of Radiotherapy and Radiation Oncology, Hannover Medical School, Hannover, Germany
| | - H. Delecluse
- Pathogenesis of Virus Associated Tumors (F100), German Cancer Research Center, Heidelberg, Germany
| | - M. Eble
- Medical Faculty, Department of Radiation Oncology, RWTH Aachen University, Aachen, Germany
| | - T. Feuchtinger
- Pediatric Hematology, Oncology and Stem Cell Transplantation, Dr. von Hauner’sches Kinderspital, Ludwig-Maximilians-University, München, Germany
| | - G. Gademann
- Department of Radiotherapy, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - B. Granzen
- Department of Pediatrics, Maastricht University Medical Center, Maastricht, Netherlands
| | - C. Kratz
- Hannover Medical School, Pediatric Hematology/Oncology, Hannover, Germany
| | - L. Lassay
- Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, Medical Faculty, RWTH Aachen University , Aachen, Germany
| | - I. Leuschner
- Kindertumorregister der GPOH, Sektion Kinderpathologie, Universitätsklinikum Schlewig-Holstein, Campus Kiel, Kiel, Germany
| | - F. Mottaghy
- Department of Nuclear Medicine, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - C. Schmitt
- Medical School Hannover, Institute of Virology, Hannover, Germany
| | - G. Staatz
- Section of Paediatric Radiology, University Medical Center Mainz, Mainz, Germany
| | - B. Timmermann
- University Essen, Westgerman Protontherapycenter Essen, Essen, Germany
| | - P. Vorwerk
- Pediatric Oncology, Otto von Guericke University Childrens Hospital, Magdeburg, Germany
| | - S. Wilop
- Department of Hematology, Oncology, Hemostaseology, and Stem Cell Transplantation, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - H. Wolff
- Radiologie München, Burgstraße 7, München, Germany
| | - R. Mertens
- Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, Medical Faculty, RWTH Aachen University , Aachen, Germany
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Jochems A, Deist T, van Soest J, Eble M, Bulens P, Coucke P, Dries W, Lambin P, Dekker A. Distributed learning: predictive models based on data from multiple hospitals without data leaving the hospital. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)30111-6] [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: 10/22/2022]
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Weinandy A, Piroth MD, Goswami A, Nolte K, Sellhaus B, Gerardo-Nava J, Eble M, Weinandy S, Cornelissen C, Clusmann H, Lüscher B, Weis J. Cetuximab induces eme1-mediated DNA repair: a novel mechanism for cetuximab resistance. Neoplasia 2014; 16:207-20, 220.e1-4. [PMID: 24731284 DOI: 10.1016/j.neo.2014.03.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Revised: 02/14/2014] [Accepted: 02/17/2014] [Indexed: 02/07/2023] Open
Abstract
Overexpression of the epidermal growth factor receptor (EGFR) is observed in a large number of neoplasms. The monoclonal antibody cetuximab/Erbitux is frequently applied to treat EGFR-expressing tumors. However, the application of cetuximab alone or in combination with radio- and/or chemotherapy often yields only little benefit for patients. In the present study, we describe a mechanism that explains resistance of both tumor cell lines and cultured primary human glioma cells to cetuximab. Treatment of these cells with cetuximab promoted DNA synthesis in the absence of increased proliferation, suggesting that DNA repair pathways were activated. Indeed, we observed that cetuximab promoted the activation of the DNA damage response pathway and prevented the degradation of essential meiotic endonuclease 1 homolog 1 (Eme1), a heterodimeric endonuclease involved in DNA repair. The increased levels of Eme1 were necessary for enhanced DNA repair, and the knockdown of Eme1 was sufficient to prevent efficient DNA repair in response to ultraviolet-C light or megavoltage irradiation. These treatments reduced the survival of tumor cells, an effect that was reversed by cetuximab application. Again, this protection was dependent on Eme1. Taken together, these results suggest that cetuximab initiates pathways that result in the stabilization of Eme1, thereby resulting in enhanced DNA repair. Accordingly, cetuximab enhances DNA repair, reducing the effectiveness of DNA-damaging therapies. This aspect should be considered when using cetuximab as an antitumor agent and suggests that Eme1 is a negative predictive marker.
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Affiliation(s)
- Agnieszka Weinandy
- Institute of Neuropathology, Medical Faculty, RWTH Aachen University and JARA-BRAIN (Jülich Aachen Research Alliance Brain) Translational Medicine, Aachen, Germany; Department of Neurosurgery, Medical Faculty, RWTH Aachen University and JARA-BRAIN Translational Medicine, Aachen, Germany.
| | - Marc D Piroth
- Department of Radiation Oncology, Medical Faculty, RWTH Aachen University and JARA-BRAIN Translational Medicine, Aachen, Germany
| | - Anand Goswami
- Institute of Neuropathology, Medical Faculty, RWTH Aachen University and JARA-BRAIN (Jülich Aachen Research Alliance Brain) Translational Medicine, Aachen, Germany
| | - Kay Nolte
- Institute of Neuropathology, Medical Faculty, RWTH Aachen University and JARA-BRAIN (Jülich Aachen Research Alliance Brain) Translational Medicine, Aachen, Germany
| | - Bernd Sellhaus
- Institute of Neuropathology, Medical Faculty, RWTH Aachen University and JARA-BRAIN (Jülich Aachen Research Alliance Brain) Translational Medicine, Aachen, Germany
| | - Jose Gerardo-Nava
- Institute of Neuropathology, Medical Faculty, RWTH Aachen University and JARA-BRAIN (Jülich Aachen Research Alliance Brain) Translational Medicine, Aachen, Germany
| | - Michael Eble
- Department of Radiation Oncology, Medical Faculty, RWTH Aachen University and JARA-BRAIN Translational Medicine, Aachen, Germany
| | - Stefan Weinandy
- Department of Tissue Engineering and Textile Implants, Applied Medical Engineering-Helmholtz Institute for Biomedical Engineering, Medical Faculty, RWTH Aachen University and JARA-BRAIN Translational Medicine, Aachen, Germany
| | - Christian Cornelissen
- Institute of Biochemistry and Molecular Biology, Medical Faculty, RWTH Aachen University and JARA-BRAIN Translational Medicine, Aachen, Germany
| | - Hans Clusmann
- Department of Neurosurgery, Medical Faculty, RWTH Aachen University and JARA-BRAIN Translational Medicine, Aachen, Germany
| | - Bernhard Lüscher
- Institute of Biochemistry and Molecular Biology, Medical Faculty, RWTH Aachen University and JARA-BRAIN Translational Medicine, Aachen, Germany
| | - Joachim Weis
- Institute of Neuropathology, Medical Faculty, RWTH Aachen University and JARA-BRAIN (Jülich Aachen Research Alliance Brain) Translational Medicine, Aachen, Germany
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Schmitz S, Brzozowska K, Pinkawa M, Eble M, Kriehuber R. Chromosomal Radiosensitivity Analyzed by FISH in Lymphocytes of Prostate Cancer Patients and Healthy Donors. Radiat Res 2013; 180:465-73. [DOI: 10.1667/rr3239.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Sabine Schmitz
- a Department of Safety and Radiation Protection, Forschungszentrum Jülich GmbH, D-52425 Jülich, Germany; and
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Dekker A, Nalbantov G, Oberije C, Wiessler W, Eble M, Dries W, Janvary L, Bulens P, Krishnapuram B, Lambin P. PD-0496: Multi-centric learning with a federated IT infrastructure: application to 2-year lung-cancer survival prediction. Radiother Oncol 2013. [DOI: 10.1016/s0167-8140(15)32802-4] [Citation(s) in RCA: 4] [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: 11/27/2022]
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Arenbeck H, Bornemann C, Escobar N, Bollue K, Eble M, Abel D. PD-0226: New robotic phantom: Evaluation of performance in radiotherapy. Radiother Oncol 2013. [DOI: 10.1016/s0167-8140(15)32532-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Mueller R, Eich H, Plütschow A, Debus J, Bamberg M, Wilborn K, Eble M, Müller-Hermelink H, Diehl V, Engert A. Two Cycles of ABVD Followed by Involved Field Radiotherapy with 20 Gray (Gy) is the New Standard of Care in the Treatment of Patients with Early Stage Hodgkin Lymphoma: Final Analysis of the Randomized German Hodgkin Study Group (GHSG) Trial HD10. Int J Radiat Oncol Biol Phys 2010. [DOI: 10.1016/j.ijrobp.2010.07.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Piroth M, Heindrichs U, Pinkawa M, Piroth D, Schmachtenberg A, Perez-Bouza A, Maass N, Eble M. Intraoperative Radiotherapie (IORT) des Mammakarzinoms mit Elektronen – eigene Erfahrungen, aktuelle Aspekte und Literaturübersicht. Geburtshilfe Frauenheilkd 2010. [DOI: 10.1055/s-0029-1240918] [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: 10/19/2022] Open
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Pinkawa M, Holy R, Piroth M, Klotz J, Borchers H, Eble M. 152 poster: PSA-Kinetics Following External Beam Radiotherapy (EBRT), Temporary Interstitial Brachytherapy as a Boost to EBRT (HDR-BT) and Permanent Interstitial Brachytherapy as Brachytherapy (LDR-BT) for Prostate Cancer. Radiother Oncol 2009. [DOI: 10.1016/s0167-8140(15)34409-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Pinkawa M, Piroth M, Fischedick K, Nussen S, Borchers H, Eble M. 153 poster: Rectal Morbidity Following Permanent Interstitial Brachytherapy for Prostate Cancer – Impact of day 1 VS. day 30 Computed Tomography Postplanning Dosimetry. Radiother Oncol 2009. [DOI: 10.1016/s0167-8140(15)34410-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Kälble T, Hendricks D, Brkovic D, Pomer S, Riedasch G, Eble M, Staehler G. Lokalrezidive des Nierenzellkarzinoms in der Fossa renalis nach Tumornephrektomie. Aktuelle Urol 2008. [DOI: 10.1055/s-2008-1057794] [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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Kreitschmann-Andermahr I, Hans F, Eble M, Cissewski K, Buchfelder M, Nolte K, Gilsbach JM. A rare case of frequently recurring lympocytic hypophysitis: How remission was finally achieved. Exp Clin Endocrinol Diabetes 2007. [DOI: 10.1055/s-2007-972244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Zimny M, Gagel B, DiMartino E, Hamacher K, Coenen HH, Westhofen M, Eble M, Buell U, Reinartz P. FDG--a marker of tumour hypoxia? A comparison with [18F]fluoromisonidazole and pO2-polarography in metastatic head and neck cancer. Eur J Nucl Med Mol Imaging 2006; 33:1426-31. [PMID: 16841141 DOI: 10.1007/s00259-006-0175-6] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2006] [Accepted: 05/11/2006] [Indexed: 02/08/2023]
Abstract
PURPOSE Experimental data suggest that the accumulation of [(18)F]fluorodeoxyglucose (FDG) in malignant tumours is related to regional hypoxia. The aim of this study was to evaluate the clinical potential of FDG positron emission tomography (PET) to assess tumour hypoxia in comparison with [(18)F]fluoromisonidazole (FMISO) PET and pO(2)-polarography. METHODS Twenty-four patients with head and neck malignancies underwent FDG PET, FMISO PET, and pO(2)-polarography within 1 week. Parameters of pO(2)-polarography were the relative frequency of pO(2) readings <or=2.5 mmHg, <or=5 mmHg and <or=10 mmHg, respectively, as well as the mean and median pO(2). RESULTS We observed a moderate correlation of the maximum standardised uptake value (SUV) of FDG with the tumour to blood ratio of FMISO at 2 h (R=0.53, p<0.05). However, SUV of FDG was similar in hypoxic and normoxic tumours as defined by pO(2)-polarography (6.9+/-3.2 vs 6.2+/-3.0, NS), and the FDG uptake was not correlated with the results of pO(2)-polarography. The retention of FMISO was significantly higher in hypoxic tumours than in normoxic tumours (tumour to muscle ratio at 2 h: 1.8+/-0.4 vs 1.4+/-0.1, p<0.05), and the FMISO tumour to muscle ratio showed a strong correlation with the frequency of pO(2) readings <or=5 mmHg (R=0.80, p<0.001). CONCLUSION These results support the hypothesis that tumour hypoxia has an effect on glucose metabolism. However, other factors affecting FDG uptake may be more predominant in chronic hypoxia, and thus FDG PET cannot reliably differentiate hypoxic from normoxic tumours.
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Affiliation(s)
- Michael Zimny
- Department of Nuclear Medicine, University Hospital Aachen, Aachen, Germany.
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Höcht S, Hammad R, Thiel HJ, Wiegel T, Siegmann A, Willner J, Wust P, Herrmann T, Eble M, Flentje M, Carstens D, Bottke D, Neumann P, Hinkelbein W. Recurrent rectal cancer within the pelvis. A multicenter analysis of 123 patients and recommendations for adjuvant radiotherapy. Strahlenther Onkol 2004; 180:15-20. [PMID: 14704840 DOI: 10.1007/s00066-004-1130-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2002] [Accepted: 05/06/2003] [Indexed: 01/12/2023]
Abstract
BACKGROUND AND PURPOSE Recommendations for radiation ports in adjuvant radiation therapy for rectal cancer are mainly based on analysis of recurrence patterns. To evaluate whether changes in surgical technique have influenced this pattern of recurrence, a multicenter retrospective analysis was carried out on a patient population treated recently. PATIENTS AND METHODS 123 patients were evaluated with the help of a CT-based self-developed 3-D data file system and an extensive questionnaire. Major inclusion criteria (one sufficient) for eligibility were: histological confirmation, clear bone destruction, and a positive PET scan, or at least three minor criteria: progressive soft tissue mass, invasion of adjacent organs on follow-up CT or MRI, rising tumor markers, and typical appearance in cross-sectional imaging. Clinical or serologic signs of inflammation were exclusion criteria. RESULTS Initially, 54% of the evaluated patients were N0; in the remainder, N1 and N2 were distributed evenly. Initial T-category was T1 in 2%, T2 in 24%, T3 in 60%, and T4 in 13%, the male-to-female ratio was 2:1. Recurrent tumors were mainly situated in the posterior part of the bony pelvis as displayed in the figures. When abdominoperineal resection was compared to low anterior resection as primary operation, there was a significant difference in extension of recurrent tumors in the inferior parts of the pelvis (p<0.025 in all statistical tests applied), whereas no significant difference was found in the superior parts of the pelvis. CONCLUSION Based on these results, a modest field size reduction in adjuvant radiotherapy for rectal cancer seems feasible, offering the perspective of a reduction in acute and late side effects.
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Affiliation(s)
- Stefan Höcht
- Department of Radiation Oncology and Radiotherapy, Charité Campus Benjamin Franklin, Berlin, Germany.
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Höcht S, Hammad R, Thiel H, Wiegel T, Siegmann A, Willner J, Wust P, Herrmann T, Eble M, Carstens D, Flentje M, Neumann P, Hinkelbein W. A multicenter analysis of 123 patients with recurrent rectal cancer within the pelvis. Front Radiat Ther Oncol 2004; 38:41-51. [PMID: 15458186 DOI: 10.1159/000078263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Affiliation(s)
- S Höcht
- Clinic for Radiation Oncology and Radiotherapy of Charité, Campus Benjamin Franklin, Berlin, Deutschland.
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Geldner G, Lang C, Hoffmann W, Hossfeld A, Weinberger J, Eble M, Blobner M. [The time-course of action of rapacuronium and mivacurium after early reversal following equally lasting relaxation]. Anasthesiol Intensivmed Notfallmed Schmerzther 2003; 38:594-9. [PMID: 12975739 DOI: 10.1055/s-2003-41857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This study was designed to compare the time course of action and the safety profile of Rapacuronium and Mivacurium in day case dental surgery. After Ethics Committee approval 61 healthy adult patients, scheduled for dental day case surgery, were randomised in an assessor-blinded manner to receive either 1.5 mg/kg Rapacuronium with and without 0.05 neostigmine 5 min later (19 patients each) or a total of 0.25 mg/kg Mivacurium (n = 16). Anaesthesia was induced using Propofol 2 - 5.1 mg/kg and Remifentanil 24 - 73 mcg/kg/h and maintained with Desflurane in N2O/O2 (2/1). Endotracheal intubation was performed when maximum blockade was achieved and scored by a blinded intubator. Neuromuscular block was monitored using the train-of-four response to supramaximal stimuli at the ulnar nerve every 15 seconds using acceleromyography (TOF Watch SX). Onset time, clinical duration (reappearance of the third twitch of a TOF-stimulation) and recovery to T4/T1 > 0.9 were recorded. Speed of recovery was evaluated by the time difference between reappearance of the third twitch and T4/T1 > 0.9. The intubating conditions at the time of maximum block revealed no statistically significant differences between the three groups. Changes in blood pressure, heart rate and airway pressure were not significant. Onset time in subjects who received Rapacuronium (99 +/- 29 s) was faster compared to the onset time in those who received Mivacurium (157 +/- 36 s). Also clinical duration was significantly shorter following Rapacuronium without reversal (12 +/- 4 min) as well as with reversal (9 +/- 1 min) compared with Mivacurium (21 +/- 5 min)). Patients treated with Rapacuronium and reversal recovered faster (14 +/- 8 min)) compared to the other two groups (Mivacurium: 20 +/- 6 min, Rapacuronium without reversal: 31 +/- 9 min). The fraction of clinical duration of the total duration was highest following Mivacurium (51 %) when compared with Rapacuronium/Neostigmine (43 %) and Rapacuronium (28 %).
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Affiliation(s)
- G Geldner
- Klinik für Anästhesiologie und Intensivtherapie, Philipps-Universität Marburg, Germany.
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Ryschich E, Harms W, Loeffler T, Eble M, Klar E, Schmidt J. Radiation-induced leukocyte adhesion to endothelium in normal pancreas and in pancreatic carcinoma of the rat. Int J Cancer 2003; 105:506-11. [PMID: 12712442 DOI: 10.1002/ijc.11073] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
High-dose radiation is known to induce an inflammatory reaction in normal and malignant tissue including leukocyte infiltration. The influence of radiation on leukocyte-endothelium interaction in tumor tissue, which precedes leukocyte migration, has not yet been investigated to our knowledge. In our study, intravital microscopy was used to compare the radiogenic effects on leukocyte-endothelium interaction and leukocyte migration in healthy and malignant pancreatic tissue in vivo. An established model of ductlike pancreatic cancer (DSL6A) of syngeneic Lewis rats was utilized. Irradiation with 15 Gy increased the high-affinity leukocyte-endothelium interaction both in normal and malignant tissue. The low-affinity leukocyte-endothelium interaction was not significantly altered. Radiation-induced tumor cell death 12 days after radiation was significantly higher in tumors with moderate and severe leukocyte infiltration compared to low leukocyte infiltration. Thus, radiation-induced leukocyte infiltration in pancreatic carcinoma correlates with the extent of tumor cell death.
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Affiliation(s)
- Edward Ryschich
- Department of Surgery, University of Heidelberg, Heidelberg, Germany
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Pinkawa M, Maurer U, Mulhern A, Gagel B, Block T, Borchers H, Grieger J, Henkel T, Eble M. Inverse automated treatment planning with and without individual optimization in interstitial permanent prostate brachytherapy with high- and low-activity 125I. Strahlenther Onkol 2003; 179:417-22. [PMID: 12789469 DOI: 10.1007/s00066-003-1042-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE To determine whether dose distribution achieved with treatment plans using high- and low-activity (125)I implants differs. PATIENTS AND METHODS Based on intraoperative transrectal ultrasound scans of 71 patients, inverse automated treatment plans (IATP) were performed with 15.5-kBq (0.42-mCi) and 25.2-kBq (0.68-mCi) (125)I implants using a commercial 3-D planning system (Variseed). A prescription dose of 145 Gy in 98% of the prostate volume (V100), a maximum dose to the urethra of 250 Gy (D1), and a maximum dose to 10% of the anterior rectal wall of 145 Gy (D10) were required. The plans were manually corrected, if necessary. RESULTS In the IATP, a better dose coverage of the prostate was found for high-activity seeds (V100 of 98% vs 84%). The prostate dose values increased with the prostate volume. After manual optimization, the differences were only marginal with a prostate V100 of 99% for both activities, a urethra D1 of 247 Gy and 239 Gy, and a rectum D10 of 135 Gy and 124 Gy for high- and low-activity seeds. Low-activity seeds required more sources (66 vs 47) and needles (24 vs 17; all numbers are median values). CONCLUSIONS Concerning the prostate dose coverage, high-activity seeds are superior in the IATP. After manual adjustment, the dose values for the prostate and the organs at risk are similar. Considering a supposedly decreased toxicity and a shorter implantation time for a lower number of seeds, we recommend high-activity seeds for experienced teams.
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Affiliation(s)
- Michael Pinkawa
- Department of Radiotherapy, University Hospital, RWTH Aachen, Germany.
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32
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Kinzel S, Hein S, Stopinski T, Koch J, Buecker A, Treusacher HP, Schmachtenberg A, Jansen T, Eble M, Küpper W. [Hypofractionated radiation therapy for the treatment of malignant melanoma and squamous cell carcinoma in dogs and cats]. Berl Munch Tierarztl Wochenschr 2003; 116:134-8. [PMID: 12680280] [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: 03/01/2023]
Abstract
This study describes the experience with hypofractionated radiation therapy of squamous cell carcinoma and melanoma in dogs and cats. A total dose of 32-48 Gray (Gy) was delivered once a week in 8 Gy fractions. 34 animals in which a complete surgical excision was impossible were treated. There was no tumor detectable macroscopically in 14 patients at the beginning of radiation therapy. In 20 animals the median volume of the tumor was 9.9 cm3. The median survival times and the local tumor control of squamous cell carcinoma of the oral and nasal cavities and of the body are comparable to results which were reached with a Monday-Wednesday-Friday scheme. For the treatment of Melanoma the hypofractionated radiation therapy is first choice. There are no significant side effects. Late side effects did not occur. 88% of the owners are satisfied with this kind of treatment and would choose it again.
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Affiliation(s)
- Sylvia Kinzel
- Institut für Versuchstierkunde, Universitätsklinikums Aachen.
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Wohlfrom M, Kotzerke J, Kamenz J, Eble M, Hess B, Wöhrle J, Reske SN, Hombach V, Hanke H, Höher M. Endovascular irradiation with the liquid beta-emitter Rhenium-188 to reduce restenosis after experimental wall injury. Cardiovasc Res 2001; 49:169-76. [PMID: 11121809 DOI: 10.1016/s0008-6363(00)00245-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Postinterventional irradiation is a new therapeutic concept in the prevention of restenosis. The liquid beta-emitter Rhenium-188 allows endovascular brachytherapy using a conventional balloon catheter without the problem of centering the radiation source. In an animal model of restenosis the feasibility and the dose dependent effect of intravascular brachytherapy with a Rhenium-188 filled balloon catheter was investigated. METHODS In 68 male New Zealand White rabbits after endothelial denudation of the right common carotid artery with a Fogarty catheter, endovascular irradiation was performed with a Rhenium-188 filled 3.0-mm balloon catheter using different dosages (0, 7.5, 15, 30, 45 and 60 Gy at the surface of the vessel). Then 4 weeks after the intervention the vessels were excised and histologically analyzed. RESULTS Whereas at 7.5 Gy the intimal area (median [first quartile; third quartile]) did not differ significantly from the control (0.46 mm(2) [0.33 mm(2), 0.75 mm(2)] vs. 0.49 mm(2) [0.34 mm(2), 0.66 mm(2)]), neointimal hyperplasia was decreased significantly at 15 Gy (0.15 mm(2) [0.04 mm(2), 0.17 mm(2)]) and 30 Gy (0.07 mm(2) [0.04 mm(2), 0. 10 mm(2)]), and completely inhibited at the highest dosages (45 Gy: 0 mm(2) [0 mm(2), 0.04 mm(2)]; 60 Gy: 0 mm(2) [0 mm(2), 0.01 mm(2)]). CONCLUSIONS Catheter transmitted endovascular irradiation with the liquid beta-emitter Rhenium-188 after vascular injury is feasible and effectively reduced neointimal hyperplasia in hypercholesterolemic rabbits. A significant reduction of the neointimal formation could be found already at a radiation absorbed dose of 15 Gy at the vessel surface. Following a surface dosage of 45 Gy the proliferative response to the vessel injury is almost completely abolished.
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Affiliation(s)
- M Wohlfrom
- Department of Internal Medicine II, Cardiology, University of Ulm, Robert-Koch-Strasse 8, D-89081, Ulm, Germany.
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Sabo D, Brocai DR, Eble M, Wannenmacher M, Ewerbeck V. Influence of extracorporeal irradiation on the reintegration of autologous grafts of bone and joint. Study in a canine model. J Bone Joint Surg Br 2000; 82:276-82. [PMID: 10755441 DOI: 10.1302/0301-620x.82b2.9447] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We studied the effects of irradiation on the reintegration of autologous osteoarticular grafts over a period of 24 weeks in a canine model. In 16 foxhounds the medial femoral condyle was resected, irradiated and immediately replanted. In the control group resection and replantation were performed without irradiation. Reintegration was assessed by macroscopic analysis, histology, radiography and gait analysis. Reintegration was equal at 12 weeks, but significantly inferior in the irradiated group after 24 weeks with delayed bone remodelling. The articular cartilage showed modest degeneration. Conventional radiography and histology showed corresponding changes. Limb function was adequate but the gait was inferior in the treated group.
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Affiliation(s)
- D Sabo
- Department of Orthopaedic Surgery, University of Heidelberg, Germany
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Sabo D, Brocai DRC, Eble M, Wannenmacher M, Ewerbeck V. Influence of extracorporeal irradiation on the reintegration of autologous grafts of bone and joint. ACTA ACUST UNITED AC 2000. [DOI: 10.1302/0301-620x.82b2.0820276] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We studied the effects of irradiation on the reintegration of autologous osteoarticular grafts over a period of 24 weeks in a canine model. In 16 foxhounds the medial femoral condyle was resected, irradiated and immediately replanted. In the control group resection and replantation were performed without irradiation. Reintegration was assessed by macroscopic analysis, histology, radiography and gait analysis. Reintegration was equal at 12 weeks, but significantly inferior in the irradiated group after 24 weeks with delayed bone remodelling. The articular cartilage showed modest degeneration. Conventional radiography and histology showed corresponding changes. Limb function was adequate but the gait was inferior in the treated group.
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Affiliation(s)
- D. Sabo
- Department of Orthopaedic Surgery, University of Heidelberg, Schlierbacher Landstrasse 200 a, D-69118 Heidelberg, Germany
| | - D. R. C. Brocai
- Department of Orthopaedic Surgery, University of Heidelberg, Schlierbacher Landstrasse 200 a, D-69118 Heidelberg, Germany
| | - M. Eble
- Department of Radiotherapy, University of Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
| | - M. Wannenmacher
- Department of Radiotherapy, University of Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
| | - V. Ewerbeck
- Department of Orthopaedic Surgery, University of Heidelberg, Schlierbacher Landstrasse 200 a, D-69118 Heidelberg, Germany
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Sabo D, Bernd L, Ewerbeck V, Eble M, Wannenmacher M, Schulte M. [Intraoperative extracorporeal irradiation and replantation (EIR) in the treatment of primary malignant bone tumors]. Unfallchirurg 1999; 102:580-8. [PMID: 10459306 DOI: 10.1007/s001130050453] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
In 6 patients with primary malignant bone tumors (4 Ewing, 1 recurrent Adamantinoma, 1 maligne Haemangioperizytoma) the local therapy was performed as intraoperative extracorporeal irradiation and replantation. During the follow-up 10 (6-24) months no local recurrence in the replanted segment occurred. One recurrence occurred in the host bed; in two cases the replanted segment had to be removed because of severe infection. The other cases showed good functional and radiological results. These clinical findings and the reports in the literature seem to allow the application of the intraoperative extracorporeal irradiation and replantation procedure for defect reconstruction in cases of chemo- and radiotherapy-sensitive bone tumors.
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Affiliation(s)
- D Sabo
- Abteilung Orthopädie I, Orthopädische Universitätsklinik Heidelberg
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37
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Schwarzbach M, Willeke F, Eble M, Wannenmacher M, Lehnert T, Herfarth C. [Morbidity and tumor control in limb-saving resection with intraoperative radiotherapy in a multimodality therapy concept in soft tissue sarcoma]. Langenbecks Arch Chir Suppl Kongressbd 1999; 115:1312-5. [PMID: 9931868] [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: 02/10/2023]
Abstract
This study evaluates limb-saving surgery (LSS) combined with intraoperative radiotherapy (IORT) and external beam radiotherapy (EBRT) for extremity sarcoma. Prospectively gathered data was analyzed for 50 patients. Advanced stages (UICC IIB-IIIB) predominated (80%) and 50% of the tumors were recurrent. Early local morbidity amounted to 32%, including wound infection (6), skin necrosis (3), hematoma (3) and others (4). Late morbidity of 10% consisted of a fracture, a fibrosis, two chronic lymphedemas and a neuropathy. One patient died (pulmonary embolism). Local control was obtained in 91% with an overall 3-year survival rate of 81% in cases treated with curative intent (follow-up 29 months). No survival benefit was found for patients with microscopically clear margins; however, local failure occurred less frequently (p = 0.02). Our results support the use of LSS with IORT and EBRT for extremity sarcoma and emphasize the importance of the surgical margin.
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Latz D, Fleckenstein K, Eble M, Blatter J, Wannenmacher M, Weber KJ. Radiosensitizing potential of gemcitabine (2',2'-difluoro-2'-deoxycytidine) within the cell cycle in vitro. Int J Radiat Oncol Biol Phys 1998; 41:875-82. [PMID: 9652852 DOI: 10.1016/s0360-3016(98)00105-9] [Citation(s) in RCA: 75] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE Gemcitabine (2',2'-difluorodeoxycytidine; dFdCyd) is a new deoxycitidine analog which exhibits substantial activity against solid tumors and radiosensitizing properties in vitro. To examine cell cycle-specific effects of a combined treatment with gemcitabine and radiation, the in vitro clonogenic survival of two different cell lines was measured for cells from log-phase culture, G1 and S-phase cells. METHODS AND MATERIALS Chinese hamster (V79) and human colon carcinoma (Widr) cells were exposed to different radiation doses and for different points of time relative to gemcitabine treatment (2 h). Experiments were also carried out with different cell-cycle populations obtained after mitotic selection (V79) or after serum stimulation of plateau-phase cells (Widr). The resulting survival curves were analyzed according to the LQ model, and mean inactivation doses (MID) and the cell cycle-specific enhancement ratios (ER) were calculated from the survival curve parameters. RESULTS Effectiveness of combined treatment of log-phase cells was greatest when cells were irradiated at the end of the gemcitabine exposure [ER: 1.28 (V79), 1.24 (Widr)]. For later times after the removal of the drug, radiosensitization declined, approaching independent toxicity. From the time course of interactive-type damage decay half-life values of 75 min (V79) and 92 min (Widr) were derived. Gemcitabine did not radiosensitize G1 Widr cells or V79 cells from the G1/S border, but substantial radiosensitization was observed for the S-phase cell preparations [ER: 1.45 (V79-lateS), 1.57 (Widr)]. CONCLUSIONS Treatment of cells with gemcitabine immediately before irradiation eliminates, or at least greatly reduces, the variation in radiosensitivity during the cell cycle that is manifested by radioresistance during S phase. This reversal of S-phase radioresistance could imply that gemcitabine interferes with the potentially lethal damage repair/fixation pathway. Other approaches have been taken to overcome S-phase radioresistance, such as hyperthermia or densely ionizing radiation, and combined treatments with dFdCyd could prove of value to complement such efforts.
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Affiliation(s)
- D Latz
- Department of Radiotherapy, University of Heidelberg, Germany
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Abstract
A total of 26 patients (6 with anaplastic astrocytoma; 20 with glioblastoma) were treated with crisnatol mesylate. All patients had residual or progressive disease following surgery and standard radiotherapy; nine patients had prior chemotherapy. Crisnatol was administered as a 72-hour infusion every 21 days at a starting dose of 2250 mg/m2. Two patients who had not received prior chemotherapy achieved a complete response and remain in continuous complete remission over seven and six years, respectively, post-diagnosis. Two other patients remained stable on crisnatol for 10 months before disease progression. One patient with mixed oligodendroglioma/glioblastoma progressed after 12 months on crisnatol. He survives at 7 years post-diagnosis, with Karnofsky Performance Status of 60 following other therapies. One patient with anaplastic astrocytoma stopped treatment by request after 10 months and remains stable 64 months post diagnosis. Seventeen evaluable patients, including nine patients with prior chemotherapy, progressed after 2-9 courses of therapy. Median survival is 9.25 months, with a one year survival rate of 30% and 2 years survival rate of 17%. Neurotoxicity was acute and dose-limiting. Side effects were tolerable and limited to duration of infusion. Two complete, long-lasting responses to crisnatol mesylate in patients with progressive malignant glioma are encouraging results and warrant further investigation.
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Affiliation(s)
- P New
- University of Texas Health Science Center, San Antonio, USA
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40
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Schwarzbach M, Willeke F, Eble M, Lehnert T, Ewerbeck V, Wannenmacher M, Herfarth C. [Intraoperative radiotherapy in advanced soft tissue sarcoma of the extremities]. Langenbecks Arch Chir Suppl Kongressbd 1996; 113:214-7. [PMID: 9101835] [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: 02/04/2023]
Abstract
Radical or wide excision is the treatment of choice for soft-tissue sarcomas (STS) of the extremities. Multimodality therapy made limb-sparing surgery possible. While external beam radiotherapy is well established in this setting, few data are available about intraoperative radiotherapy (IORT). We performed an analysis of 36 patients treated with IORT and external beam radiation following resection of STS of the extremities between 1991 and 1995. Only STS classified as UICC stage IIb, III or IV were included. Operative morbidity was 17%, 14% showed late complications. Within a mean follow-up of 24 months (min. 6), there was one local recurrence in 30 patients treated curatively. The 3-year survival rate of patients treated curatively was 75%; 3-year recurrence-free survival was 65%.
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Abstract
The interaction of cisplatin and irradiation was studied in vitro in four human cell lines. Additive effects were observed for the combination given either simultaneously or sequentially. No influence on recovery was seen in split-dose experiments. It is concluded that radiosensitization cannot be presumed in every clinical setting of combined treatment with radiation and cisplatin.
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Affiliation(s)
- M Flentje
- Department of Clinical Radiology, University of Heidelberg, F.R.G
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Latz D, Flentje M, Eble M, Hör A, Wannenmacher M. [Effects of lonidamine alone or in combination with radiotherapy on survival and metabolism in human and rodent cell lines]. Strahlenther Onkol 1991; 167:716-22. [PMID: 1763408] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
In vitro investigations on the combined effect of radiation and Lonidamine in one human (LXI) and two rodent cell lines (3T3, V79) showed not a clear radiosensitizing effect. Especially no inhibiting influence on the repair of potentially lethal damage of V79 cells was found. Incubation at lower pH values (6.7 to 6.9) caused no increasing effects. Lonidamine induced damage on the mitochondrial dehydrogenase-system was quantitatively measured with a modified MTT-assay.
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Affiliation(s)
- D Latz
- Radiologische Universitätsklinik, Allgemeine Radiologie und Poliklinik, Heidelberg
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43
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Flentje M, Eble M, Bühler J, Haner U, Trinh S, Wannenmacher M. Purley additive effects for the combination of cisplatinum and X-irradiation in human cervix carcinoma cell-lines. Int J Radiat Oncol Biol Phys 1989. [DOI: 10.1016/0360-3016(89)90869-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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44
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Beck A, Nanko N, Bruggmoser G, Eble M. [Problematic radiation protection devices in x-ray diagnosis]. Rontgenpraxis 1988; 41:427-30. [PMID: 3222709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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45
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Koeller J, Eble M. Mitoxantrone: a novel anthracycline derivative. Clin Pharm 1988; 7:574-81. [PMID: 3048848] [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: 01/03/2023]
Abstract
The chemistry, pharmacology, pharmacokinetics, clinical efficacy, dosage and administration, and adverse effects of mitoxantrone are reviewed. Mitoxantrone, an aminoanthraquinone that was synthesized in 1979, belongs to a new chemical class of agents known as the anthracenediones. It possesses antiviral, antibacterial, immunomodulatory, and antitumor activity. The drug's antitumor activity is attributed to its interaction with DNA topoisomerase II, and its interaction with human cells may also involve nonintercalary, electrostatic interactions. Mitoxantrone is poorly absorbed orally and is most commonly administered intravenously. The drug is rapidly distributed into the red blood cells, white blood cells, and platelets, followed by deep-tissue sequestration. Mitoxantrone has demonstrated clinical efficacy in the treatment of leukemia, lymphoma, and breast cancer. As a single agent, mitoxantrone has a response rate of roughly 30% in acute nonlymphocytic leukemia or acute myeloid leukemia. In combination with other standard agents (cytarabine, vincristine, and prednisone), the response rate may reach 60%. In breast cancer, mitoxantrone's response rate as a single agent is 25-30%, while combination regimens produce response rates of 60% or more. The drug can cause cardiotoxicity with cumulative doses. Other adverse effects include myelosuppression, nausea and vomiting, stomatitis, mucositis, and alopecia. The cost of mitoxantrone is comparable to that of doxorubicin, but it is substantially more expensive than daunorubicin. Mitoxantrone is an important new agent with antitumor activity in leukemia, lymphoma, and breast cancer. In most situations, mitoxantrone will be considered second-line treatment or a restricted-use item because of its high cost and because of the lack of FDA approval for indications other than acute nonlymphocytic leukemia.
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Affiliation(s)
- J Koeller
- College of Pharmacy, University of Texas, Austin
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