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Fink C, Ristau J, Buchele C, Klüter S, Liermann J, Hoegen-Saßmannshausen P, Sandrini E, Lentz-Hommertgen A, Baumann L, Andratschke N, Baumgartl M, Li M, Reiner M, Corradini S, Hörner-Rieber J, Bonekamp D, Schlemmer HP, Belka C, Guckenberger M, Debus J, Koerber S. Stereotactic ultrahypofractionated MR-guided radiotherapy for localized prostate cancer - Acute toxicity and patient-reported outcomes in the prospective, multicenter SMILE phase II trial. Clin Transl Radiat Oncol 2024; 46:100771. [PMID: 38586081 PMCID: PMC10998039 DOI: 10.1016/j.ctro.2024.100771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 02/07/2024] [Accepted: 03/24/2024] [Indexed: 04/09/2024] Open
Abstract
Background Due to superior image quality and daily adaptive planning, MR-guided stereotactic body radiation therapy (MRgSBRT) has the potential to further widen the therapeutic window in radiotherapy of localized prostate cancer. This study reports on acute toxicity rates and patient-reported outcomes after MR-guided adaptive ultrahypofractionated radiotherapy for localized prostate cancer within the prospective, multicenter phase II SMILE trial. Materials and methods A total of 69 patients with localized prostate cancer underwent MRgSBRT with daily online plan adaptation. Inclusion criteria comprised a tumor stage ≤ T3a, serum PSA value ≤ 20 ng/ml, ISUP Grade group ≤ 4. A dose of 37.5 Gy was prescribed to the PTV in five fractions on alternating days with an optional simultaneous boost of 40 Gy to the dominant intraprostatic lesion defined by multiparametric MRI. Acute genitourinary (GU-) and gastrointestinal (GI-) toxicity, as defined by CTCAE v. 5.0 and RTOG as well as patient-reported outcomes according to EORTC QLQ-C30 and -PR25 scores were analyzed at completion of radiotherapy, 6 and 12 weeks after radiotherapy and compared to baseline symptoms. Results There were no toxicity-related treatment discontinuations. At the 12-week follow-up visit, no grade 3 + toxicities were reported according to CTCAE. Up until the 12-week visit, in total 16 patients (23 %) experienced a grade 2 GU or GI toxicity. Toxicity rates peaked at the end of radiation therapy and subsided within the 12-week follow-up period. At the 12-week follow-up visit, no residual grade 2 GU toxicities were reported and 1 patient (1 %) had residual grade 2 enteritic symptoms. With exception to a significant improvement in the emotional functioning score following MRgSBRT, no clinically meaningful changes in the global health status nor in relevant subscores were reported. Conclusion Daily online-adaptive MRgSBRT for localized prostate cancer resulted in an excellent overall toxicity profile without any major negative impact on quality of life.
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Affiliation(s)
- C.A. Fink
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - J. Ristau
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- Department of Radiation Oncology, Maria Hilf Hospital Mönchengladbach, Mönchengladbach, Germany
| | - C. Buchele
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - S. Klüter
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - J. Liermann
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | | | - E. Sandrini
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - A. Lentz-Hommertgen
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - L. Baumann
- Institute of Medical Biometry, Heidelberg University, Heidelberg, Germany
| | - N. Andratschke
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - M. Baumgartl
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - M. Li
- Department of Radiation Oncology, LMU University Hospital Munich, Munich, Germany
| | - M. Reiner
- Department of Radiation Oncology, LMU University Hospital Munich, Munich, Germany
| | - S. Corradini
- Department of Radiation Oncology, LMU University Hospital Munich, Munich, Germany
| | - J. Hörner-Rieber
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - D. Bonekamp
- Division of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - H.-P. Schlemmer
- Division of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - C. Belka
- Department of Radiation Oncology, LMU University Hospital Munich, Munich, Germany
| | - M. Guckenberger
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - J. Debus
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - S.A. Koerber
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- Department of Radiation Oncology, Barmherzige Brueder Hospital Regensburg, Regensburg, Germany
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Guckenberger M, Andratschke N, Belka C, Bellut D, Cuccia F, Dahele M, Guninski RS, Josipovic M, Mancosu P, Minniti G, Niyazi M, Ricardi U, Munck Af Rosenschold P, Sahgal A, Tsang Y, Verbakel W, Alongi F. ESTRO clinical practice guideline: Stereotactic body radiotherapy for spine metastases. Radiother Oncol 2024; 190:109966. [PMID: 37925107 DOI: 10.1016/j.radonc.2023.109966] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 10/18/2023] [Indexed: 11/06/2023]
Abstract
BACKGROUND AND PURPOSE Recent progress in diagnostics and treatment of metastatic cancer patients have improved survival substantially. These developments also affect local therapies, with treatment aims shifting from short-term palliation to long-term symptom or disease control. There is consequently a need to better define the value of stereotactic body radiotherapy (SBRT) for the treatment of spinal metastases. METHODS This ESTRO clinical practice guideline is based on a systematic literature review conducted according to PRISMA standards, which formed the basis for answering four key questions about the indication and practice of SBRT for spine metastases. RESULTS The analysis of the key questions based on current evidence yielded 22 recommendations and 5 statements with varying levels of endorsement, all achieving a consensus among experts of at least 75%. In the majority, the level of evidence supporting the recommendations and statements was moderate or expert opinion, only, indicating that spine SBRT is still an evolving field of clinical research. Recommendations were established concerning the selection of appropriate patients with painful spine metastases and oligometastatic disease. Recommendations about the practice of spinal SBRT covered technical planning aspects including dose and fractionation, patient positioning, immobilization and image-guided SBRT delivery. Finally, recommendations were developed regarding quality assurance protocols, including description of potential SBRT-related toxicity and risk mitigation strategies. CONCLUSIONS This ESTRO clinical practice guideline provides evidence-based recommendations and statements regarding the selection of patients with spinal metastases for SBRT and its safe implementation and practice. Enrollment of patients into well-designed prospective clinical trials addressing clinically relevant questions is considered important.
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Affiliation(s)
- M Guckenberger
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
| | - N Andratschke
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - C Belka
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany; German Cancer Consortium (DKTK), partner site Munich, Munich, Germany; Bavarian Cancer Research Center (BZKF), Munich, Germany
| | - D Bellut
- University Hospital Zurich, University of Zurich, Department of Neurosurgery, Zurich, Switzerland
| | - F Cuccia
- ARNAS Civico Hospital, Radiation Oncology Unit, Palermo, Italy
| | - M Dahele
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Radiation Oncology and Cancer Center Amsterdam, de Boelelaan 1117, Amsterdam, the Netherlands
| | - R S Guninski
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - M Josipovic
- Department of Oncology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9 2100, Copenhagen, Denmark; Department of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B 2200, Copenhagen, Denmark
| | - P Mancosu
- IRCCS Humanitas Research Hospital, Medical Physics Unit, Radiation Oncology department, via Manzoni 56 I-20089, Rozzano, Milan, Italy
| | - G Minniti
- Department of Radiological Sciences, Oncology and Anatomical Pathology Sapienza University of Rome, Rome, Italy; IRCCS Neuromed, Pozzilli, IS, Italy
| | - M Niyazi
- Department of Radiation Oncology, University Hospital Tübingen, Tübingen, Germany
| | - U Ricardi
- University of Turin, Department of Oncology, Turin, Italy
| | | | - A Sahgal
- Odette Cancer Center of the Sunnybrook Health Sciences Center, Department of Radiation Oncology, Toronto, Canada
| | - Y Tsang
- Princess Margaret Cancer Centre, Radiation Medicine Program, Toronto, Canada
| | - Wfar Verbakel
- Amsterdam University Medical Center, Department of Radiation Oncology, Amsterdam, the Netherlands
| | - F Alongi
- Advanced Radiation Department, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar-Verona, Italy; University of Brescia, Italy
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Guninski RS, Cuccia F, Alongi F, Andratschke N, Belka C, Bellut D, Dahele M, Josipovic M, Kroese TE, Mancosu P, Minniti G, Niyazi M, Ricardi U, Munck Af Rosenschold P, Sahgal A, Tsang Y, Verbakel WFAR, Guckenberger M. Efficacy and safety of SBRT for spine metastases: A systematic review and meta-analysis for preparation of an ESTRO practice guideline. Radiother Oncol 2024; 190:109969. [PMID: 37922993 DOI: 10.1016/j.radonc.2023.109969] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 10/18/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND AND PURPOSE Advances in characterizing cancer biology and the growing availability of novel targeted agents and immune therapeutics have significantly changed the prognosis of many patients with metastatic disease. Palliative radiotherapy needs to adapt to these developments. In this study, we summarize the available evidence for stereotactic body radiotherapy (SBRT) in the treatment of spinal metastases. MATERIALS AND METHODS A systematic review and meta-analysis was performed using PRISMA methodology, including publications from January 2005 to September 2021, with the exception of the randomized phase III trial RTOG-0631 which was added in April 2023. Re-irradiation was excluded. For meta-analysis, a random-effects model was used to pool the data. Heterogeneity was assessed with the I2-test, assuming substantial and considerable as I2 > 50 % and I2 > 75 %, respectively. A p-value < 0.05 was considered statistically significant. RESULTS A total of 69 studies assessing the outcomes of 7236 metastases in 5736 patients were analyzed. SBRT for spine metastases showed high efficacy, with a pooled overall pain response rate of 83 % (95 % confidence interval [CI] 68 %-94 %), pooled complete pain response of 36 % (95 % CI: 20 %-53 %), and 1-year local control rate of 94 % (95 % CI: 86 %-99 %), although with high levels of heterogeneity among studies (I2 = 93 %, I2 = 86 %, and 86 %, respectively). Furthermore, SBRT was safe, with a pooled vertebral fracture rate of 9 % (95 % CI: 4 %-16 %), pooled radiation induced myelopathy rate of 0 % (95 % CI 0-2 %), and pooled pain flare rate of 6 % (95 % CI: 3 %-17 %), although with mixed levels of heterogeneity among the studies (I2 = 92 %, I2 = 0 %, and 95 %, respectively). Only 1.7 % of vertebral fractures required surgical stabilization. CONCLUSION Spine SBRT is characterized by a favorable efficacy and safety profile, providing durable results for pain control and disease control, which is particularly relevant for oligometastatic patients.
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Affiliation(s)
- R S Guninski
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
| | - F Cuccia
- ARNAS Civico Hospital, Radiation Oncology Unit, Palermo, Italy
| | - F Alongi
- Advanced Radiation Department, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar-Verona, Italy. University of Brescia, Italy
| | - N Andratschke
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - C Belka
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany. German Cancer Consortium (DKTK), partner site Munich, Munich, Germany. Bavarian Cancer Research Center (BZKF), Munich, Germany
| | - D Bellut
- University Hospital Zurich, University of Zurich, Department of Neurosurgery. Zurich, Switzerland
| | - M Dahele
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Radiation Oncology and Cancer Center Amsterdam, de Boelelaan 1117, Amsterdam, The Netherlands
| | - M Josipovic
- Department of Oncology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark; Department of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
| | - T E Kroese
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - P Mancosu
- IRCCS Humanitas Research Hospital, Medical Physics Unit, Radiation Oncology department, via Manzoni 56, I-20089 Rozzano, Milan, Italy
| | - G Minniti
- Department of Radiological Sciences, Oncology and Anatomical PathologySapienza University of Rome, Rome; IRCCS Neuromed, Pozzilli, IS, Italy
| | - M Niyazi
- Department of Radiation Oncology, University hospital Tübingen, Tübingen, Germany
| | - U Ricardi
- University of Turin, Department of Oncology, Turin, Italy
| | - P Munck Af Rosenschold
- Radiation Physics, Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden; Medical Radiation Physics, Lund University, Lund, Sweden
| | - A Sahgal
- Odette Cancer Center of the Sunnybrook Health Sciences Center, Department of Radiation Oncology, Toronto, Canada
| | - Y Tsang
- Princess Margaret Cancer Centre, Radiation Medicine Program, Toronto, Canada
| | - W F A R Verbakel
- Amsterdam University Medical Center, Department of Radiation Oncology, Amsterdam, The Netherlands
| | - M Guckenberger
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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Buchner JA, Kofler F, Mayinger MC, Brunner TB, Wittig A, Menze B, Zimmer C, Meyer B, Guckenberger M, Andratschke N, Shafie RE, Rogers S, Schulze K, Blanck O, Zamboglou C, Grosu A, Combs SE, Bernhardt D, Wiestler B, Peeken JC. What MRI Sequences are Necessary for Automated Neural Network-Based Metastasis Segmentation - An Ablation Study. Int J Radiat Oncol Biol Phys 2023; 117:e704-e705. [PMID: 37786065 DOI: 10.1016/j.ijrobp.2023.06.2195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Brain metastasis (BM) delineation is a time-consuming process in both daily clinical practice and research. Automated BM segmentation algorithms can be used to assist in this task. Most approaches to brain tumor segmentation, such as algorithms trained on the BraTS challenge, use four magnetic resonance imaging (MRI) sequences as input, making them susceptible to missing or corrupted sequences and increase the number of sequences necessary for MRI RT planning. The goal of this project is to compare neural networks with different combinations of input sequences for the segmentation of the contrast-enhancing metastasis and the surrounding FLAIR hyperintense edema. All models were tested in a multicenter international external test cohort. This allows us to determine which MRI sequences are needed for effective automated segmentations. MATERIALS/METHODS In total, we had T1-weighted sequences without (T1) and with contrast enhancement (T1-CE), T2-weighted sequences (T2), and T2 fluid-attenuated inversion recovery (FLAIR) sequences from 339 patients with at least one brain metastasis from seven centers available. Preprocessing yielded co-registered, skull-stripped sequences with an isotropic resolution of 1 millimeter. The contrast-enhancing metastasis as well as the surrounding FLAIR hyperintense edema were manually segmented to create reference labels. A baseline 3D U-Net with all four sequences as well as six additional U-Nets with different clinically plausible combinations (T1-CE; T1; FLAIR; T1-CE+FLAIR; T1-CE+T1+FLAIR; T1-CE+T1) of input sequences were trained on a cohort of 239 patients from two centers and subsequently tested on an external cohort of 100 patients from the remaining five centers. RESULTS All models that included T1-CE in their selected sequences showed similar performance for metastasis segmentation with a median Dice similarity coefficient (DSC) of 0.93-0.96. T1-CE alone likewise achieved a performance of 0.96 (IQR 0.93-0.97). The model trained with only FLAIR performed worse (DSC = 0.73, IQR 0.54-0.84). For edema segmentation, models that included both T1-CE and FLAIR performed best (median DSC = 0.93), while the remaining four models without simultaneous inclusion of these two sequences (T1-CE; T1; FLAIR; T1-CE+T1) reached a median DSC of 0.81-0.89. CONCLUSION Automatic segmentation of brain metastases with less than four input sequences is feasible with minimal or no loss of quality. A T1-CE-only protocol suffices for metastasis segmentation. In contrast, for edema segmentation, the combination of T1-CE and FLAIR seems to be important. Missing either T1-CE or FLAIR decreases performance. These findings may improve future imaging routines by omitting unnecessary sequences, thus speeding up procedures in daily clinical practice while allowing for optimal neural network-based target definitions.
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Affiliation(s)
- J A Buchner
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - F Kofler
- Helmholtz AI, Helmholtz Zentrum Munich, Munich, Germany; Department of Informatics, Technical University of Munich, Munich, Germany
| | - M C Mayinger
- Department of Radiation Oncology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - T B Brunner
- Medical University of Graz, Dept. of Radiation Oncology, Graz, Austria; Department of Radiation Oncology, University Hospital Magdeburg, Magdeburg, Germany
| | - A Wittig
- Department of Radiotherapy and Radiation Oncology, University Hospital Jena, Friedrich-Schiller University, Jena, Germany
| | - B Menze
- Department of Informatics, Technical University of Munich, Munich, Germany
| | - C Zimmer
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - B Meyer
- Department of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - M Guckenberger
- Department of Radiation Oncology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - N Andratschke
- Department of Radiation Oncology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - R El Shafie
- Heidelberg Institute for Radiation Oncology (HIRO), National Center for Radiation Oncology (NCRO), Heidelberg, Germany; Department of Radiation Oncology, University Medical Center Göttingen, Göttingen, Germany
| | - S Rogers
- Radiation Oncology Center KSA-KSB, Kantonsspital Aarau, Aarau, Switzerland
| | - K Schulze
- Department of Radiation Oncology, General Hospital Fulda, Fulda, Germany
| | - O Blanck
- Department of Radiation Oncology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - C Zamboglou
- Department of Radiation Oncology, German Oncology Center, European University of Cyprus, Limassol, Cyprus; Department of Radiation Oncology, University of Freiburg - Medical Center, Freiburg, Germany
| | - A Grosu
- Department of Radiation Oncology, University of Freiburg - Medical Center, Freiburg, Germany; German Cancer Consortium (DKTK), Partner Site Freiburg, Freiburg, Germany
| | - S E Combs
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Institute of Radiation Medicine (IRM), Department of Radiation Sciences (DRS), Helmholtz Center Munich, Munich, Germany
| | - D Bernhardt
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; German Cancer Consortium (DKTK), partner site Munich, Munich, Germany
| | - B Wiestler
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; TranslaTUM - Central Institute for Translational Cancer Research, Technical University of Munich, Munich, Germany
| | - J C Peeken
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Institute of Radiation Medicine (IRM), Department of Radiation Sciences (DRS), Helmholtz Center Munich, Munich, Germany
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Bernhardt D, Peeken JC, Kehl V, Eitz K, Guckenberger M, Andratschke N, Mayinger MC, Lindel K, Dieckmann K, El Shafie R, Debus J, Riesterer O, Rogers S, Blanck O, Wolff R, Grosu A, Bilger A, Henkenberens C, Schulze K, Gani C, Müller AC, Radlanski K, Janssen S, Ferentinos K, Combs SE. Post-Operative Stereotactic Radiotherapy for Resected Brain Metastases: Results of the Multicenter Analysis (AURORA) of the German Working Group "Stereotactic Radiotherapy". Int J Radiat Oncol Biol Phys 2023; 117:e87-e88. [PMID: 37786203 DOI: 10.1016/j.ijrobp.2023.06.842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) While the results of prospective studies support the use of postoperative stereotactic radiotherapy (RT) to the resection cavity (RC) as the standard of care after surgery, there are several issues that need to be investigated such as factors for improving local control, risk of leptomeningeal disease and radiation necrosis. Further, the optimal dose and fractionation is still under debate. MATERIALS/METHODS The working group "Stereotactic Radiotherapy" of the German Society of Radiation Oncology (DEGRO) analyzed its multi-institutional database with 661 patients who received postoperative stereotactic RT to the RC. Treatment was performed at 13 centers between 2008 and 2021. Patient characteristics, treatment details, and follow-up data including overall survival (OS), local control (LC) were evaluated. Cox Regression and Kaplan-Meier curves with Log-rank Tests were calculated for selected variables. RESULTS In this retrospective study, overall survival was 61.5% at 1 year, 47.6% at 2 years, and 35.5% at 3 years, and local control was 84.6% at 1 year, 74.8% at 2 years, and 72.8% at 3 years. 96% of patients were treated with hypofractionated stereotactic radiotherapy (HSRT), only 26 patients received single fraction radiosurgery (4%). Prognostic factors associated with overall survival were Karnofsky Performance Status, RPA and GPA class, controlled primary tumor and absence of extracranial metastases, whereas prognostic factor associated with local control was planning target volume (23 mL or less). CONCLUSION HSRT is the most common fractionation form in the treatment of RCs in this multicenter analysis. This approach results in excellent OS and LC outcomes. OS in patients with resected brain metastases is mainly influenced by performance status. In regard to local control, RT of large cavities remain a challenge with significantly worse outcome.
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Affiliation(s)
- D Bernhardt
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; German Cancer Consortium (DKTK), Partner Site Munich, Germany, Munich, Germany
| | - J C Peeken
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Institute of Radiation Medicine (IRM), Department of Radiation Sciences (DRS), Helmholtz Center Munich, Munich, Germany
| | - V Kehl
- Institute for AI and Informatics in Medicine, Munich, NA, Germany
| | - K Eitz
- Department of Radiation Oncology - Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany
| | - M Guckenberger
- Department of Radiation Oncology, University Hospital Zurich (USZ), University of Zurich (UZH), Zurich, Switzerland
| | - N Andratschke
- Department of Radiation Oncology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - M C Mayinger
- Department of Radiation Oncology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - K Lindel
- Municipal Hospital, Department for Radiation Oncology, Karlsruhe, Germany
| | - K Dieckmann
- Department of Radiation Oncology, Vienna, Austria
| | - R El Shafie
- 8Department of Radiation Oncology, University Hospital Göttingen, Göttingen, Germany
| | - J Debus
- CCU Translational Radiation Oncology, German Cancer Consortium (DKTK) Core-Center Heidelberg, National Center for Tumor Diseases (NCT), Heidelberg University Hospital (UKHD) and German Cancer Research Center (DKFZ), Heidelberg, Germany; Radiation Oncology University Hospital Heidelberg, Heidelberg, Germany
| | - O Riesterer
- Center for Radiation Oncology KSA-KSB, Cantonal Hospital Aarau, Aarau, Switzerland
| | - S Rogers
- Radiation Oncology Center KSA-KSB, Kantonsspital Aarau, Aarau, Switzerland
| | - O Blanck
- Department of Radiation Oncology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - R Wolff
- University Hospital Frankfurt, Department of Neurosurgery, Frankfurt, Germany
| | - A Grosu
- German Cancer Consortium (DKTK), Partner Site Freiburg, Freiburg, Germany; Department of Radiation Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - A Bilger
- Department of Radiation Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - C Henkenberens
- Department of Radiotherapy and Special Oncology, Medical School Hannover, Hannover, Germany
| | - K Schulze
- Klinikum Fulda, 36251 Bad Hersfeld, Germany
| | - C Gani
- Department of Radiation Oncology, University Hospital and Medical Faculty Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany
| | - A C Müller
- Department of Radiotherapy, Klinikum Ludwigsburg, Ludwigsburg, Germany
| | - K Radlanski
- Radiation Oncology and Radiotherapy, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - S Janssen
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
| | - K Ferentinos
- Radiation Oncology Department, German Oncology Center, Limassol, Cyprus
| | - S E Combs
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Institute of Innovative Radiotherapy (iRT), Department of Radiation Sciences (DRS), Helmholtz Zentrum München, Neuherberg, Germany
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Lew A, Berghmans T, Andratschke N, Dempsey C, Flackett L, Leonetti G, Koller M, Faivre-Finn C. 174TiP PRIMALung (EORTC-1901): Prophylactic cerebral irradiation or active brain magnetic resonance imaging surveillance in small cell lung cancer patients. J Thorac Oncol 2023. [DOI: 10.1016/s1556-0864(23)00428-8] [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: 04/03/2023]
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Azria D, Andratschke N, Balermpas P, Boldrini L, Bourdais R, Bruynzeel A, Chuong M, De Ridder M, Fenoglietto P, Gevaert T, Gungor G, Hardy L, Kandiban S, Lagerwaard F, Maingon P, Marciscano A, Mittauer K, Nagar H, Paragios N, Pennell R, Placidi L, Riou O, Simon J, Tanadini-Lang S, Ugurluer G, Valdes S, Valentini V, Vanspeybroeck B, Ozyar E. A Multi-Centric Evaluation of AI-Driven OARs Low Field MRgRT Pelvic /Abdomen Contouring. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.898] [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: 10/31/2022]
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McDonald F, Guckenberger M, Popat S, Faivre-Finn C, Andratschke N, Riddell A, Hanna G, Hiley C, Prakash V, Nair A, Diez P, Patel P, Kilburn L, Emmerson A, Toms C, Bliss J. EP08.03-005 HALT - Targeted Therapy with or without Dose-Intensified Radiotherapy in Oligo-Progressive Disease in Oncogene Addicted Lung Tumours. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Grehn M, Mandija S, Andratschke N, Zeppenfeld K, Blamek S, Fast M, Botrugno C, Blanck O, Verhoeff J, Pruvot E. Survey results of the STOPSTORM consortium about stereotactic arrhythmia radioablation in Europe. Europace 2022. [DOI: 10.1093/europace/euac053.376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public grant(s) – EU funding. Main funding source(s): Horizon 2020 research and innovation programme
Background/Introduction
In patients with structural heart disease (SHD), ventricular tachycardia (VT) plays a decisive role in sudden cardiac death. VT patients are often treated with antiarrhythmic medication and catheter ablation. For refractory VTs, STereotactic Arrhythmia Radioablation (STAR) delivered to the underlying VT substrate has recently been introduced and showed promising results for otherwise untreatable patients. [1]
Purpose
The purpose of the STOPSTORM consortium is to harmonize and optimize STAR across Europe. It consists of 31 members including 24 electrophysiology and 22 radiation oncology departments performing or participating in STAR throughout eight European countries. To obtain initial overview of organization, equipment, procedures, experiences, and quality levels for STAR, a detailed survey was circulated among STOPSTORM members.
Methods
The survey included questions for electrophysiology (18 questions), radiation oncology (24 questions) and medical physics (23 questions). The survey was the first step for accreditation of the centres and therefore mandatory for all consortium members.
Results
All centres participating in STOPSTORM completed the survey. 16 centres performed a total of 84 STAR treatments until May 2021 and 11 centres already participate in clinical trials for STAR.
Annual number of VT ablations in SHD: less than 20 (17%), 20-50 (50%), 50-100 (21%), more than 100 (12%) and epicardial: less than 20 (71%), 20-50 (17%), n/s (12%). An overview of the availability of a clinical program for catheter ablation of ventricular arrhythmia with certification of the respective national cardiology society and the practice of general quality audits for ablation is given in figure 1. Participation in multicentre clinical trials in cardiology/EP were indicated by 19 departments (79%).
Target volume definition is based on invasive electroanatomical mapping during VT (96%), pace mapping (75%), reduced voltage areas (63%) and/or late ventricular potentials (75%). Half of the centres includes the clinical VT substrate, while the other half includes the whole arrhythmogenic substrate. Non-invasive surface ECG mapping has so far found little application: used clinically (13%), research purposes (8%) and evaluation (4%).
Stereotactic Body Radiotherapy experience (> 10 years: 82%, > 200 p.a.: 59%) is high. In all but one clinic, a dose of 25 Gy in a single fraction is applied. The prescription method, planning technique and inhomogeneity in the target volume, however, varies greatly. All departments perform patient-specific plan verifications for STAR, but with various evaluation criteria.
Conclusion
Experience in STAR within the STOPSTORM consortium is adequate, while the survey shows areas of harmonization and optimization need for substrate mapping, target delineation, dosimetry and quality assurance which will be addressed in the STOPSTORM project work-packages.
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Affiliation(s)
- M Grehn
- University Medical Center of Schleswig-Holstein, Radiotherapy, Kiel, Germany
| | - S Mandija
- University Medical Center Utrecht, Radiotherapy, Utrecht, Netherlands (The)
| | - N Andratschke
- University Hospital Zurich, Radiation Oncology, Zurich, Switzerland
| | - K Zeppenfeld
- Leiden University Medical Center, Clinical Electrophysiology, Leiden, Netherlands (The)
| | - S Blamek
- Maria Sklodowska-Curie National Research Institute of Oncology, Radiotherapy, Gliwice, Poland
| | - M Fast
- University Medical Center Utrecht, Radiotherapy, Utrecht, Netherlands (The)
| | - C Botrugno
- University of Florence, Research Unit on Everyday Bioethics and Ethics of Science, Florence, Italy
| | - O Blanck
- University Medical Center of Schleswig-Holstein, Radiotherapy, Kiel, Germany
| | - J Verhoeff
- University Medical Center Utrecht, Radiotherapy, Utrecht, Netherlands (The)
| | - E Pruvot
- Lausanne university hospital, Heart and Vessel, Lausanne, Switzerland
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Wahlstedt I, Andratschke N, Behrens C, Ehrbar S, Gabryś H, Garcia Schüler H, Guckenberger M, Smith A, Tanadini-Lang S, Tascón-Vidarte J, Vogelius I, van Timmeren J. OC-0041 Gating has small impact on dose to OARs and PTV coverage in MR-guided daily ART of prostate cancer. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02460-4] [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: 11/30/2022]
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11
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Wallimann P, Mayinger M, Bogowicz M, Guckenberger M, Andratschke N, Tanadini-Lang S, van Timmeren J. PD-0153 Comparison of methods for T1-w brain MRI intensity normalization for quantitative MRI analysis. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02758-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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12
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Kraft J, van Timmeren J, Frei S, Mayinger M, Borsky K, Kirchner C, Stark L, Tanadini-Lang S, Wolpert F, Weller M, Guckenberger M, Andratschke N. PO-1157 Comprehensive comparison of prognostic scores for patients with newly diagnosed brain metastases. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03121-8] [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: 10/18/2022]
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13
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Alyamani N, Sargos P, Blanchard P, Supiot S, Ronchin P, Pommier P, Duberge T, Silva M, Hammoud Y, Hasbini A, Khalifa J, Gnep K, Scrase C, Saez J, Vieillevigne L, Christiaens M, Zilli T, Ribault H, Bossi A, Fizazi K, Andratschke N. OC-0609 Radiotherapy quality assurance of the PEACE-1 trial: Initial results of individual case reviews. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02631-7] [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: 11/25/2022]
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Willmann J, Vlaskou Badra E, Adilovic S, van Timmeren J, Mayinger M, Guckenberger M, Andratschke N. PD-0077 Systemic Therapy-Free Survival after Stereotactic Body Radiotherapy for Oligorecurrent Disease. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02747-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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15
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Ristau J, Hörner-Rieber J, Buchele C, Klüter S, Jäkel C, Baumann L, Andratschke N, Garcia Schüler H, Guckenberger M, Li M, Niyazi M, Belka C, Herfarth K, Debus J, Koerber SA. Stereotactic MRI-guided radiation therapy for localized prostate cancer (SMILE): a prospective, multicentric phase-II-trial. Radiat Oncol 2022; 17:75. [PMID: 35428327 PMCID: PMC9011377 DOI: 10.1186/s13014-022-02047-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 03/31/2022] [Indexed: 11/10/2022] Open
Abstract
Background Normofractionated radiation regimes for definitive prostate cancer treatment usually extend over 7–8 weeks. Recently, moderate hypofractionation with doses per fraction between 2.2 and 4 Gy has been shown to be safe and feasible with oncologic non-inferiority compared to normofractionation. Radiobiologic considerations lead to the assumption that prostate cancer might benefit in particular from hypofractionation in terms of tumor control and toxicity. First data related to ultrahypofractionation demonstrate that the overall treatment time can be reduced to 5–7 fractions with single doses > 6 Gy safely, even with simultaneous focal boosting of macroscopic tumor(s). With MR-guided linear accelerators (MR-linacs) entering clinical routine, invasive fiducial implantations become unnecessary. The aim of the multicentric SMILE study is to evaluate the use of MRI-guided stereotactic radiotherapy for localized prostate cancer in 5 fractions regarding safety and feasibility. Methods The study is designed as a prospective, one-armed, two-stage, multi-center phase-II-trial with 68 patients planned. Low- and intermediate-risk localized prostate cancer patients will be eligible for the study as well as early high-risk patients (cT3a and/or Gleason Score ≤ 8 and/or PSA ≤ 20 ng/ml) according to d’Amico. All patients will receive definitive MRI-guided stereotactic radiation therapy with a total dose of 37.5 Gy in 5 fractions (single dose 7.5 Gy) on alternating days. A focal simultaneous integrated boost to MRI-defined tumor(s) up to 40 Gy can optionally be applied. The primary composite endpoint includes the assessment of urogenital or gastrointestinal toxicity ≥ grade 2 or treatment-related discontinuation of therapy. The use of MRI-guided radiotherapy enables online plan adaptation and intrafractional gating to ensure optimal target volume coverage and protection of organs at risk. Discussion With moderate hypofractionation being the standard in definitive radiation therapy for localized prostate cancer at many institutions, ultrahypofractionation could be the next step towards reducing treatment time without compromising oncologic outcomes and toxicities. MRI-guided radiotherapy could qualify as an advantageous tool as no invasive procedures have to precede in therapeutic workflows. Furthermore, MRI guidance combined with gating and plan adaptation might be essential in order to increase treatment effectivity and reduce toxicity at the same time.
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Schaule J, Chamberlain M, Wilke L, Baumgartl M, Krayenbühl J, Zamburlini M, Mayinger M, Andratschke N, Tanadini-Lang S, Guckenberger M. Intrafractional stability of MR-guided online adaptive SBRT for prostate cancer. Radiat Oncol 2021; 16:189. [PMID: 34565439 PMCID: PMC8474766 DOI: 10.1186/s13014-021-01916-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 09/15/2021] [Indexed: 12/25/2022] Open
Abstract
Background MR-guided online adaptive stereotactic body radiation therapy (SBRT) for prostate cancer aims to reduce toxicity by full compensation of interfractional uncertainties. However, the process of online adaptation currently takes approximately 45 min during which intrafractional movements remain unaccounted for. This study aims to analyze the dosimetric benefit of online adaptation and to evaluate its robustness over the duration of one treatment fraction. Methods Baseline MR-scans at a MR-linear accelerator were acquired for ten healthy male volunteers for generation of mock-prostate SBRT plans with a dose prescription of 5 × 7.25 Gy. On a separate day, online MR-guided adaptation (ViewRay® MRIdian) was performed, and thereafter MR images were acquired every 15 min for 1 h to assess the stability of the adapted plan. Results A dosimetric benefit of online MR-guided adaptive re-planning was observed in 90% of volunteers. The median D95CTV- and D95PTV-coverage was improved from 34.8 to 35.5 Gy and from 30.7 to 34.6 Gy, respectively. Improved target coverage was not associated with higher dose to the organs at risk, most importantly the rectum (median D1ccrectum baseline plan vs. adapted plan 33.3 Gy vs. 32.3 Gy). The benefit of online adaptation remained stable over 45 min for all volunteers. However, at 60 min, CTV-coverage was below a threshold of 32.5 Gy in 30% of volunteers (30.6 Gy, 32.0 Gy, 32.3 Gy). Conclusion The dosimetric benefit of MR-guided online adaptation for prostate SBRT was robust over 45 min in all volunteers. However, intrafractional uncertainties became dosimetrically relevant at 60 min and we therefore recommend verification imaging before delivery of MR-guided online adapted SBRT. Supplementary Information The online version contains supplementary material available at 10.1186/s13014-021-01916-0.
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Affiliation(s)
- J Schaule
- Department of Radiation Oncology, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland.
| | - M Chamberlain
- Department of Radiation Oncology, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - L Wilke
- Department of Radiation Oncology, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - M Baumgartl
- Department of Radiation Oncology, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - J Krayenbühl
- Department of Radiation Oncology, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - M Zamburlini
- Department of Radiation Oncology, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - M Mayinger
- Department of Radiation Oncology, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - N Andratschke
- Department of Radiation Oncology, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - S Tanadini-Lang
- Department of Radiation Oncology, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - M Guckenberger
- Department of Radiation Oncology, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
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Sharabiani M, Clementel E, Andratschke N, Reynaert N, van Elmpt W, Hurkmans C. OC-0474 Bias and reporting quality of artificial intelligence models in radiotherapy treatment planning. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)06923-1] [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: 11/16/2022]
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Kry S, Lye J, Clark C, Andratschke N, Dimitriadis A, Followill D, Howell R, Hussein M, Ishikawa M, Kito S, Kron T, Lee J, Michalski J, Monti A, Reynaert N, Taylor P, Venables K, Xiao Y, Lehmann J. PD-0899 Report dose-to-medium in clinical trials; a consensus from the Global Harmonisation Group. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07178-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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19
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Willmann J, Vlaskou Badra E, Adilovic S, Ahmadsei M, Christ S, Mayinger M, Guckenberger M, Andratschke N. PD-0742 Prognostic Value of The ESTRO EORTC Classification System of Oligometastatic Disease. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07021-3] [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: 10/20/2022]
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20
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Mayinger M, Borsky K, Kraft J, Frei S, Stark L, van Timmeren J, Tanadini-Lang S, Guckenberger M, Andratschke N. PD-0734 Validating Brain Metastases Velocity for survival prediction in patients treated with radiosurgery. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07013-4] [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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21
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Chamberlain M, Krayenbühl J, van Timmeren J, Wilke L, Andratschke N, Tanadini-Lang S, Garcia Schüler H, Guckenberger M, Balermpas P. OC-0645 Head and neck radiotherapy on the MR-Linac: a multicentre planning challenge on MRIdianplatform. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07001-8] [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: 11/16/2022]
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22
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van Timmeren J, Bogowicz M, Chamberlain M, Ehrbar S, Dal Bello R, Garcia Schüler H, Krayenbuehl J, Wilke L, Andratschke N, Guckenberger M, Tanadini-Lang S, Balermpas P. PO-1015 Prospective evaluation of anatomical changes of salivary glands during MRI-guided ART for HNC. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07466-1] [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: 11/28/2022]
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van Timmeren J, Hoogeman M, Ehrbar S, Mayinger M, Andratschke N, Guckenberger M, Tanadini-Lang S. OC-0088 Margin calculation for multiple metastases in single-isocenter lung SBRT. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)06782-7] [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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Weitkamp N, Ehrbar S, Chamberlain M, Perryck S, Rudolf T, Wilke L, Garcia Schüler H, Tanadini-Lang S, Guckenberger M, Andratschke N. PO-1971 Patient experience and gating efficiency using a visual tracking system for breath hold during MRgRT. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)08422-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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25
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John C, Dal Bello R, Andratschke N, Guckenberger M, Boda-Heggemann J, Gkika E, Mantel F, Specht H, Stromberger C, Zehentmayr F, Blanck O, Balermpas P. PD-0872 Second In-field course of stereotactic body radiotherapy for thoracic tumors: a multicentre analysis. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07151-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Ehrbar S, Braga Magalhaes S, Chamberlain M, Krayenbühl J, Wilke L, Mayinger M, Garcia Schüler H, Guckenberger M, Andratschke N, Tanadini-Lang S. OC-0362 What to expect from MR-guided beam gating: Residual motion, efficiency and dose reconstruction. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)06877-8] [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: 10/20/2022]
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Stelmes JJ, Vu E, Grégoire V, Simon C, Clementel E, Kazmierska J, Grant W, Ozsahin M, Tomsej M, Vieillevigne L, Fortpied C, Hurkmans EC, Branquinho A, Andratschke N, Zimmermann F, Weber DC. Quality assurance of radiotherapy in the ongoing EORTC 1420 "Best of" trial for early stage oropharyngeal, supraglottic and hypopharyngeal carcinoma: results of the benchmark case procedure. Radiat Oncol 2021; 16:81. [PMID: 33933118 PMCID: PMC8088557 DOI: 10.1186/s13014-021-01809-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 04/19/2021] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION The current phase III EORTC 1420 Best-of trial (NCT02984410) compares the swallowing function after transoral surgery versus intensity modulated radiotherapy (RT) in patients with early-stage carcinoma of the oropharynx, supraglottis and hypopharynx. We report the analysis of the Benchmark Case (BC) procedures before patient recruitment with special attention to dysphagia/aspiration related structures (DARS). MATERIALS AND METHODS Submitted RT volumes and plans from participating centers were analyzed and compared against the gold-standard expert delineations and dose distributions. Descriptive analysis of protocol deviations was conducted. Mean Sorensen-Dice similarity index (mDSI) and Hausdorff distance (mHD) were applied to evaluate the inter-observer variability (IOV). RESULTS 65% (23/35) of the institutions needed more than one submission to achieve Quality assurance (RTQA) clearance. OAR volume delineations were the cause for rejection in 53% (40/76) of cases. IOV could be improved in 5 out of 12 OARs by more than 10 mm after resubmission (mHD). Despite this, final IOV for critical OARs in delineation remained significant among DARS by choosing an aleatory threshold of 0.7 (mDSI) and 15 mm (mHD). CONCLUSIONS This is to our knowledge the largest BC analysis among Head and neck RTQA programs performed in the framework of a prospective trial. Benchmarking identified non-common OARs and target delineations errors as the main source of deviations and IOV could be reduced in a significant number of cases after this process. Due to the substantial resources involved with benchmarking, future benchmark analyses should assess fully the impact on patients' clinical outcome.
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Affiliation(s)
- J-J Stelmes
- Radiation Oncology Department, Oncology Institute of Southern Switzerland, Via Athos Gallino 12, 6500, Bellinzona, Switzerland.
| | - E Vu
- Department of Radiation Oncology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | | | - C Simon
- Lausanne University Hospital, Lausanne, Switzerland
| | | | | | - W Grant
- Gloucestershire Hospitals, NHS Foundation Trust, Gloucester, UK
| | - M Ozsahin
- Lausanne University Hospital, Lausanne, Switzerland
| | - M Tomsej
- Hospital of Charleroi, Charleroi, Belgium
| | | | | | | | - A Branquinho
- Centro Hospitalar Lisboa Norte, Lisbon, Portugal
| | | | - F Zimmermann
- University Hospital of Basel, Basel, Switzerland
| | - D-C Weber
- University Hospital of Bern, Bern, Switzerland
- Paul-Scherrer-Institute, Villigen, Switzerland
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Sharabiani M, Clementel E, Andratschke N, Collette L, Fortpied C, Grégoire V, Overgaard J, Willmann J, Hurkmans C. Independent external validation using the EORTC HNCG-ROG 1219 DAHANCA trial data of NTCP models for acute oral mucositis. Radiother Oncol 2021; 161:35-39. [PMID: 33872641 DOI: 10.1016/j.radonc.2021.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 04/07/2021] [Accepted: 04/07/2021] [Indexed: 11/15/2022]
Abstract
PURPOSE To externally validate previously published Normal Tissue Complication Probability (NTCP) models developed by separate teams for grade 3 oral mucositis (g3OM). MATERIALS AND METHODS Two models were validated: a logistic model, based on 144 head and neck cancer (HNC) patients receiving induction chemotherapy followed by chemo-IMRT; a multivariable logistic model for prediction of g3OM for 253 patients receiving radical treatment for the head and neck squamous cell carcinoma (HNSCC). The EORTC HNCG-ROG 1219 DAHANCA trial dataset, consisting of 169 patients was used as the validation cohort. This cohort was treated with accelerated fractionated chemo-IMRT, with/without the hypoxic radiosensitizer Nimorazole for HNSCC. External validity was assessed using the scaled Brier score. Calibration was assessed in terms of calibration curves as well as measures of mean and weak calibration. Hosmer-Lemeshow was used for goodness-of-fit test. Discrimination was calculated using the area under the receiver operating curve (AUC-ROC). RESULTS The prevalence of g3OM in the validation cohort (35.5%) was similar to that of two development cohorts, i.e. 38.7% and 31.9% for Bhide logistic and Otter multivariable logistic models respectively. The scaled Brier scores showed good overall model performance. Perfect calibration was observed in the prevalence range of 20% to 40%. AUC-ROC was acceptable in external validation (0.67). The Hosmer-Lemeshow test showed good agreement between predicted and observed outcomes for two models. CONCLUSION The NTCP models were validated and lead to valid predictions in a wide range of diverse treatment techniques and patient characteristics, also when Nimorazole is added as hypoxic radiosensitizer.
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Affiliation(s)
| | | | - N Andratschke
- Department of Radiation Oncology, University Hospital Zürich, University of Zurich, Switzerland
| | - L Collette
- Department of Biostatistics, International Drug Development Institute, Louvain-la-Neuve, Belgium
| | | | - V Grégoire
- Radiation Oncology Department, Léon Bérard Cancer Center, Lyon, France
| | - J Overgaard
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Denmark
| | - J Willmann
- Department of Radiation Oncology, University Hospital Zürich, University of Zurich, Switzerland
| | - C Hurkmans
- Department of Radiation Oncology, Catharina Hospital, Eindhoven, the Netherlands
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Stiefel I, Schröder C, Tanadini-Lang S, Pytko I, Vu E, Klement R, Guckenberger M, Andratschke N. High-dose re-irradiation of intracranial lesions - Efficacy and safety including dosimetric analysis based on accumulated EQD2Gy dose EQD calculation. Clin Transl Radiat Oncol 2021; 27:132-138. [PMID: 33659717 PMCID: PMC7890358 DOI: 10.1016/j.ctro.2021.01.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 01/30/2021] [Indexed: 01/05/2023] Open
Abstract
Re-irradiation of the brain is feasible with an encouraging overall survival. Treatment related toxicity was low within the reported dose range. EQD2 cumulative dose distributions were calculated using rigid registration. Dose-Response-Modelling with logistic regression showed a correlation of the D1cc brain with any grade of acute toxicity.
Introduction The use of cranial re-irradiation is growing with improving overall survival and the advent of high-precision radiotherapy techniques. Still the value of re-irradiation needs careful evaluation regarding safety and efficacy. We analyzed dosimetric and clinical data of patients receiving cranial re-irradiation using EQD2 sum plans. Methods and material We retrospectively analyzed the data of 76 patients who received repeated cranial radiotherapy from 02/2013 to 09/2016. 34 patients suffered from recurrent primary brain tumors, 42 from brain metastases. Dosimetric analysis was performed accumulating EQD2 dose distributions based on rigid image registration. Clinical and radiological data was collected at follow-ups including toxicity, local control and overall survival. Results In total 76 patients had at least 2 courses of intracranial radiotherapy. The median accumulated prescription EQD2 dose was 96.5 Gy2 for all radiation courses combined. The median D(0.1 cc) of the brain for patients receiving more than 100 Gy2 was 114 Gy2 with a highest dose of 161.5 Gy2. 74% of patients suffered from low grade (G1–G2) acute toxicity, only two high grade (>G3) toxicities were recorded. Median overall survival from the time of first re-irradiation was 57 weeks (range 4–186 weeks). The median time to local failure for patients with a primary brain tumor was not reached and 24 weeks (range 1–77 weeks) for patients with brain metastases. Conclusion Repeated radiotherapy appears both safe and efficient in patients with recurrent primary or secondary brain tumors with doses to the brain up to 120 Gy2 EQD2, doses below 100 Gy2 for brainstem and doses below 75 Gy2 EQD2 to chiasm and optic nerves.
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Affiliation(s)
- I. Stiefel
- Department of Radiation Oncology, University Hospital Zurich, Zurich, Switzerland
| | - C. Schröder
- Department of Radiation Oncology, University Hospital Zurich, Zurich, Switzerland
- Center for Proton Therapy, Paul Scherrer-Institut, Villigen, Switzerland
| | - S. Tanadini-Lang
- Department of Radiation Oncology, University Hospital Zurich, Zurich, Switzerland
| | - I. Pytko
- Department of Radiation Oncology, University Hospital Zurich, Zurich, Switzerland
| | - E. Vu
- Department of Radiation Oncology, University Hospital Zurich, Zurich, Switzerland
| | - R.J. Klement
- Department of Radiation Oncology, Leopoldina Hospital, Schweinfurt, Germany
- University of Zurich, Zurich, Switzerland
| | - M. Guckenberger
- Department of Radiation Oncology, University Hospital Zurich, Zurich, Switzerland
| | - N. Andratschke
- Department of Radiation Oncology, University Hospital Zurich, Zurich, Switzerland
- Corresponding author at: Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091 Zurich, Switzerland.
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Day J, Moreira A, Weber C, Weitkamp N, Wilke L, Guckenberger M, Schüler HG, Tanadini-Lang S, Andratschke N. OC-0710: Initial clinical experience with the MR-Linac System – Treatment workflow management. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00732-5] [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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Willmann J, Monti A, Poortmans P, Grant W, Clementel E, Corning C, Reynaert N, Hurkmans C, Andratschke N. PO-1273: Infrastructure and staffing in the EORTC Radiation Oncology Group’s international network. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01291-3] [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: 10/22/2022]
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Chamberlain M, Tanadini-Lang S, Wilke L, Moreira A, Weitkamp N, Ehrbar S, Andratschke N, Guckenberger M, Schüler HG. OC-0592: Implementation of MR-only one-day radiosurgery workflow for non-spinal bone metastases on MR-Linac. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00614-9] [Citation(s) in RCA: 1] [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: 11/29/2022]
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Andratschke N. SP-0025: Upfront radiotherapy is mandatory in patients with brain mets even in the era of immunotherapy. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00051-7] [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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Weitkamp N, Moreira A, Day J, Perryck S, Wilke L, Guckenberger M, Garcia Schüler H, Tanadini-Lang S, Andratschke N. PO-1928: Initial clinical experience with the MR-Linac System - Patient perspective. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01945-9] [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: 10/22/2022]
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Wilke L, Ehrbar S, Safarkhanlo Y, Bogowicz M, Krayenbühl J, Baumgartl M, Chamberlain M, Stark L, Zamburlini M, Andratschke N, Guckenberger M, Tanadini-Lang S. PO-1784: Quality Assurance for the adaptive workflow on an MRI Linac. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01802-8] [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: 11/24/2022]
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Kovacs B, Mayinger M, Tanadini-Lang S, Ehrbar S, Wilke L, Chamberlain M, Duru F, Steffel J, Garcia Schueler H, Manka R, Ruschitzka F, Guckenberger M, Andratschke N, Saguner A. First two MRI guided stereotactic body radiation therapy of recurrent sustained ventricular tachycardia. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0758] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Stereotactic body radiation therapy (SBRT) is emerging as a bail-out treatment in patients suffering from therapy resistant ventricular tachyarrhythmias (VT).
Purpose
We report the worldwide first cases of real-time magnetic resonance image guided SBRT (MR-SBRT) in recurrent sustained VT and electrical storm (ES) due to dilated cardiomyopathy (DCM).
Methods
The patients were male, 71- (patient A) and 74-year-old (patients B) suffering from recurrent VT and ES with ICD shocks, despite guideline-directed medical therapy including maximal antiarrhythmic therapy. Patient A had two endocardial radiofrequency catheter ablation (RFA) and one epicardial surgical RFA and patient B had one endocardial RFA prior. An interdisciplinary decision was made to perform MR-SBRT in palliative intent to minimize repetitive ICD shocks.
Results
Areas of VT-substrate were identified to build a volumetric target using the performed EP studies as well as cardiac MRI and CT. A single fraction of 25Gy at isodose 80% was delivered to a planned target volume of 115.1ml and 73ml in the anterior/anteroseptal basal regions in patients A and B, respectively on a dedicated MR linac using real-time MRI tracking. Patient A developed a prolonged ES interpreted as acute radiation-induced inflammation following the treatment, which ceased two days after administration of high-dose dexamethasone. Patient B had no immediate adverse effects from the treatment. Left-ventricular ejection fraction remained stable in both patients at 25%. Both patients had significant improvement of their quality of life. Patient A died 222 days after MR-SBRT due to recurrent ES at another hospital. Patient B is free from VT over six months after treatment.
Conclusion
In these first two cases, we demonstrate feasibility, safety and short-term efficacy of MR-SBRT.
ICD therapies before and after MR-SBRT
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- B Kovacs
- University Hospital Zurich, Department of Cardiology, Zurich, Switzerland
| | - M Mayinger
- University Hospital Zurich, Department of Radiation Oncology, Zurich, Switzerland
| | - S Tanadini-Lang
- University Hospital Zurich, Department of Radiation Oncology, Zurich, Switzerland
| | - S Ehrbar
- University Hospital Zurich, Department of Radiation Oncology, Zurich, Switzerland
| | - L Wilke
- University Hospital Zurich, Department of Radiation Oncology, Zurich, Switzerland
| | - M Chamberlain
- University Hospital Zurich, Department of Radiation Oncology, Zurich, Switzerland
| | - F Duru
- University Hospital Zurich, Department of Cardiology, Zurich, Switzerland
| | - J Steffel
- University Hospital Zurich, Department of Cardiology, Zurich, Switzerland
| | - H.I Garcia Schueler
- University Hospital Zurich, Department of Radiation Oncology, Zurich, Switzerland
| | - R Manka
- University Hospital Zurich, Department of Cardiology, Zurich, Switzerland
| | - F Ruschitzka
- University Hospital Zurich, Department of Cardiology, Zurich, Switzerland
| | - M Guckenberger
- University Hospital Zurich, Department of Radiation Oncology, Zurich, Switzerland
| | - N Andratschke
- University Hospital Zurich, Department of Radiation Oncology, Zurich, Switzerland
| | - A.M Saguner
- University Hospital Zurich, Department of Cardiology, Zurich, Switzerland
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Schröder C, Stiefel I, Tanadini-Lang S, Pytko I, Vu E, Guckenberger M, Andratschke N. Re-irradiation in the thorax - An analysis of efficacy and safety based on accumulated EQD2 doses. Radiother Oncol 2020; 152:56-62. [PMID: 32717358 DOI: 10.1016/j.radonc.2020.07.033] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [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: 03/26/2020] [Revised: 07/13/2020] [Accepted: 07/20/2020] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Thoracic re-irradiation remains a challenge regarding the balance of local efficacy and acceptable toxicities. In this retrospective analysis we analyzed dosimetrical and clinical data of patients treated with thoracic re-irradiation based on accumulated EQD2Gy doses. METHODS AND MATERIAL We retrospectively analyzed the data of 42 consecutive single-institutional patients treated with repeated courses of thoracic radiotherapy from 12/2011 to 01/2017. Accumulated EQD2 dose distributions were calculated and dose parameters for organs at risk and target volumes were analysed. RESULTS The median prescription dose was 42.2 Gy (10-70.6 Gy) for all RT courses. The median Dmean of both lungs was 10.1 Gy3 (range: 1.9 Gy3-17.9 Gy3) with a maximum D0.1 cc of 253.86 Gy3. The median D0.1 cc of the esophagus was 62.2 Gy3 with a maximum of 103.78 Gy3. The maximum D0.1 cc for the bronchial tree was 187.33 Gy3 (median 74.35 Gy3) and for the Aorta 216.1 Gy3 (median 70.9 Gy3). Median OS after first re-irradiation was 19 months (range 1-45 months). 12-month local control after a course of re-irradiation was 52.6%. 80% of patients suffered from a G1-G2 toxicity, most frequently coughing. One patient suffered from a G5 complication probably unrelated to re-irradiation. CONCLUSION Even though several organs at risk received maximum accumulated doses of >100 Gy3, thoracic reirradiation resulted in an acceptable toxicity profile. Local tumor control and overall survival remained encouraging even after multiple courses of thoracic radiotherapy.
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Affiliation(s)
- C Schröder
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland; Canter for Proton Therapy, Paul Scherrer-Institut, Villigen, Switzerland
| | - I Stiefel
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - S Tanadini-Lang
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - I Pytko
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - E Vu
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - M Guckenberger
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - N Andratschke
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
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Pavic M, Bogowicz M, Kraft J, Vuong D, Mayinger M, Kroeze SGC, Friess M, Frauenfelder T, Andratschke N, Huellner M, Weder W, Guckenberger M, Tanadini-Lang S, Opitz I. FDG PET versus CT radiomics to predict outcome in malignant pleural mesothelioma patients. EJNMMI Res 2020; 10:81. [PMID: 32661672 PMCID: PMC7359199 DOI: 10.1186/s13550-020-00669-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 07/02/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Careful selection of malignant pleural mesothelioma (MPM) patients for curative treatment is of highest importance, as the multimodal treatment regimen is challenging for patients and harbors a high risk of substantial toxicity. Radiomics-a quantitative method for image analysis-has shown its prognostic ability in different tumor entities and could therefore play an important role in optimizing patient selection for radical cancer treatment. So far, radiomics as a prognostic tool in MPM was not investigated. MATERIALS AND METHODS This study is based on 72 MPM patients treated with surgery in a curative intent at our institution between 2009 and 2017. Pre-treatment Fluorine-18 fluorodeoxyglucose (FDG) PET and CT scans were used for radiomics outcome modeling. After extraction of 1404 CT and 1410 FDG PET features from each image, a preselection by principal component analysis was performed to include only robust, non-redundant features for the cox regression to predict the progression-free survival (PFS) and the overall survival (OS). Results were validated on a separate cohort. Additionally, SUVmax and SUVmean, and volume were tested for their prognostic ability for PFS and OS. RESULTS For the PFS a concordance index (c-index) of 0.67 (95% CI 0.52-0.82) and 0.66 (95% CI 0.57-0.78) for the training cohort (n = 36) and internal validation cohort (n = 36), respectively, were obtained for the PET radiomics model. The PFS advantage of the low-risk group translated also into an OS advantage. On CT images, no radiomics model could be trained. SUV max and SUV mean were also not prognostic in terms of PFS and OS. CONCLUSION We were able to build a successful FDG PET radiomics model for the prediction of PFS in MPM. Radiomics could serve as a tool to aid clinical decision support systems for treatment of MPM in future.
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Affiliation(s)
- M Pavic
- Department of Radiation Oncology, University Hospital Zurich and University Zurich, Rämistrasse 100, 8091, Zurich, Switzerland.
| | - M Bogowicz
- Department of Radiation Oncology, University Hospital Zurich and University Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - J Kraft
- Department of Radiation Oncology, University Hospital Zurich and University Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - D Vuong
- Department of Radiation Oncology, University Hospital Zurich and University Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - M Mayinger
- Department of Radiation Oncology, University Hospital Zurich and University Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - S G C Kroeze
- Department of Radiation Oncology, University Hospital Zurich and University Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - M Friess
- Department of Thoracic Surgery, University Hospital Zurich and University Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - T Frauenfelder
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich and University Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - N Andratschke
- Department of Radiation Oncology, University Hospital Zurich and University Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - M Huellner
- Department of Nuclear Medicine, University Hospital Zurich and University Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - W Weder
- Department of Thoracic Surgery, University Hospital Zurich and University Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - M Guckenberger
- Department of Radiation Oncology, University Hospital Zurich and University Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - S Tanadini-Lang
- Department of Radiation Oncology, University Hospital Zurich and University Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - I Opitz
- Department of Thoracic Surgery, University Hospital Zurich and University Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
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Stahel RA, Curioni-Fontecedro A, Rohrmann S, Dafni U, Sandner U, Opitz I, Andratschke N, Franzen D, Dimopoulou G, Matthes KL, Kohler M, Guckenberger M, Weder W. Survival outcome of non-small cell lung cancer patients: Comparing results between the database of the Comprehensive Cancer Center Zürich and the Epidemiological Cancer Registry Zurich and Zug. Lung Cancer 2020; 146:217-223. [PMID: 32569900 DOI: 10.1016/j.lungcan.2020.05.037] [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: 04/14/2020] [Revised: 05/27/2020] [Accepted: 05/28/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Cancer cases among the population of the canton Zurich, are registered in the Cancer Registry of the cantons of Zurich and Zug (KKR). The Thoracic Oncology Center, founded in 2011 is one of 17 multidisciplinary centers within the Comprehensive Cancer Center Zurich (CCCZ). METHODS The aim of the current study is to quantify the mortality risk of patients with NSCLC and identify differences on survival and other factors between patients receiving their primary treatment at the CCCZ and those treated elsewhere and registered by KKR. The differential effect between CCCZ and KKR cohorts on survival: overall, by stage, sex and age, is explored. Stratified log-rank and Wilcoxon tests, Cox models and restricted mean survival times (RMST) are estimated. Propensity score matching (PSM) is also used to adjust for confounding factors. RESULTS Analysis included 848 NSCLC cases from the CCCZ and 1759 from the KKR, diagnosed between January 2011 and December 2015. At a median follow-up of 57 months, overall survival (OS) was significantly superior for patients treated at the CCCZ compared to KKR [Median OS: 36.0 months (95%CI: 31.0-45.0) and 12.0 months (95%CI: 11.0-13.0), respectively, stratified log-rank p < 0.001; adjusted HR = 1.31, (95% CI: 1.18-1.46), difference in RMST up to 72 months: 13.8 months (95%CI: 11.5-16.2), p < 0.001]. The effect of cohort was significant for stages III and IV (overall and also by sex and age). After PSM OS remained significantly superior for patients treated at the CCCZ compared to KKR. CONCLUSIONS The survival probability for patients in the CCCZ cohort was superior to that of patients in the canton Zürich treated outside the center. This analysis provides further evidence of the importance of the volume of experience and the availability of a multidisciplinary organization and research environment, as delivered by a comprehensive cancer center, on the outcome of patients with NSCLC.
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Affiliation(s)
- R A Stahel
- Comprehensive Cancer Center Zürich, University Hospital Zürich, Zurich, Switzerland.
| | - A Curioni-Fontecedro
- Department of Medical Oncology and Hematology, University Hospital Zürich, Zurich, Switzerland
| | - S Rohrmann
- Cancer Registry of the Cantons Zurich and Zug, University Hospital Zürich, Zurich, Switzerland
| | - U Dafni
- Laboratory of Biostatistics, School of Health Sciences, University of Athens, Athens, Greece
| | - U Sandner
- Comprehensive Cancer Center Zürich, University Hospital Zürich, Zurich, Switzerland
| | - I Opitz
- Thoracic Surgery Department, University Hospital Zürich, Zurich, Switzerland
| | - N Andratschke
- Department of Radiation Oncology, Universitätsspital Zürich, Zürich, Switzerland
| | - D Franzen
- Department of Pneumonology, University Hospital Zurich, Zurich, Switzerland
| | - G Dimopoulou
- Frontier Science Foundation-Hellas, Athens, Greece
| | - K L Matthes
- Cancer Registry of the Cantons Zurich and Zug, University Hospital Zürich, Zurich, Switzerland
| | - M Kohler
- Department of Pneumonology, University Hospital Zurich, Zurich, Switzerland
| | - M Guckenberger
- Department of Radiation Oncology, Universitätsspital Zürich, Zürich, Switzerland
| | - W Weder
- Thoracic Surgery Department, University Hospital Zürich, Zurich, Switzerland
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Stahel R, Curioni A, Rohrmann S, Dafni U, Sandner U, Andratschke N, Dimopoulou G, Guckenberger M, Kohler M, Matthes K, Opitz I, Weder W. Survival outcome of non-small cell lung cancer (NSCLC) patients: Comparing results between the database of the Comprehensive Cancer Center Zürich (CCCZ) and the Epidemiological Cancer Registry Zurich and Zug (KKR). Ann Oncol 2019. [DOI: 10.1093/annonc/mdz259.003] [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: 11/13/2022] Open
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Peters S, Felip E, Dafni U, Tufman A, Guckenberger M, Irigoyen A, Nadal E, Becker A, Vees H, Pless M, Martinez-Marti A, Lambrecht M, Andratschke N, Tsourti Z, Piguet AC, Roschitzki-Voser H, Rabaglio-Poretti M, Stahel R, Vansteenkiste J, De Ruysscher D. Efficacy evaluation of concurrent nivolumab addition to a first-line, concurrent chemo-radiotherapy regimen in unresectable locally advanced NSCLC: Results from the European Thoracic Oncology Platform (ETOP 6-14) NICOLAS phase II trial. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz259] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Le Rhun E, Wolpert F, Fialek M, Devos P, Andratschke N, Reyns N, Dummer R, Mortier L. Response assessment of melanoma brain metastases treated by stereotactic radiotherapy or immunotherapy or both: A comparison of RECIST 1.1, RANO and iRANO criteria. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz243.016] [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: 11/13/2022] Open
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Wolpert F, Grossenbacher B, Lareida A, Roth P, Neidert MC, Andratschke N, Le Rhun E, Weller M. P14.25 Venous thromboembolic events in patients with brain metastases: the PICOS score. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz126.260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
BACKGROUND
Venous thromboembolic events are significant complications in patients and possibly associated with an unfavorable outcome. Thrombosis risk is poorly defined for patients with brain metastasis, and available risk calculation scores are not validated for these patients.
MATERIAL AND METHODS
We identified 811 patients with brain metastasis followed at our institution and screened electronic charts retrospectively for the occurrence of venous thromboembolic events, along with candidate risk factors. Risk factors were tested in uni- and multivariate analyses and finally integrated in a score model for risk prediction.
RESULTS
Venous thromboembolic events were documented in 97 of 811 patients (12.0%). Primary tumors with high thrombogenicity (p=0.02, odds ratio 1.7, 95% CI 1.1–2.8), dexamethasone (p=0.011, odds ratio 2.27, 95% CI 1.5–4.5), chemotherapy (p=0.005, odds ratio 3.4, 95% CI 1.6–7.5), BMI > 35 kg/m2 (p=0.002, odds ratio 3.4, 95% CI 1.6–7.5) and immobilization (p=0.003, odds ratio 2.4, 95% CI 1.3–4.3) were confirmed as independent predictors of VTE. We derived a score model for venous thromboembolic event prediction, the PICOS (thrombogenic Primary, Immobilization, Chemotherapy, Obesity, Steroids) score (0–7 points). Receiver Operating Characteristic Curve Analysis demonstrated its prognostic accuracy (AUC=0.71, 95% CI 0.64–0.77), and its predictive capability was superior to that of other scores proposed for the evaluation of venous thromboembolic event risk such as the Khorana (AUC=0.51) or CONKO (AUC=0.52) scores.
CONCLUSION
We report a rate of venous thrombotic events of 12.0% in our cohort of 811 patients with brain metastasis. We define a risk model for prediction in of venous thrombotic events in patients with BM, the PICOS score. It may become a valuable tool for the identification of brain metastasis patients at high risk for venous thromboembolic events and be helpful for guidance of clinicians towards decision whether to start thrombosis prophylaxis. Further, the PICOS score might be used for stratification in controlled studies.
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Affiliation(s)
- F Wolpert
- Department of Neurology and Brain Tumor Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - B Grossenbacher
- Department of Neurology and Brain Tumor Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - A Lareida
- Department of Neurology and Brain Tumor Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - P Roth
- Department of Neurology and Brain Tumor Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - M C Neidert
- Department of Neurosurgery, University Hospital and University of Zurich, Zurich, Switzerland
| | - N Andratschke
- Department of Radiation Oncology, University Hospital and University of Zurich, Zurich, Switzerland
| | - E Le Rhun
- Department of Neurology and Brain Tumor Center, University Hospital and University of Zurich, Zurich, Switzerland
- Neuro-Oncology, Department of Neurosurgery, University Hospital Lille, Salengro Hospital, Rue Emile Laine, Lille, France
| | - M Weller
- Department of Neurology and Brain Tumor Center, University Hospital and University of Zurich, Zurich, Switzerland
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Ehrbar S, Andratschke N, Perryck S, Stüssi A, Moreira A, Tanadini-Lang S, Guckenberger M, Schuler HIG. Expiration Breath-Hold for SBRT in Liver and Abdominal Tumors. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.794] [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: 11/17/2022]
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Kaidar-Person O, Saez J, Andratschke N, de Abrunhosa Branquinho A, Clementel E, Corning C, Hurkmans C, Monti A, Roth P, Verhoeff J, Dhermain F. A Multi-Institutional Estimation of Interobserver Variability in Glioblastoma Delineation in the EORTC-1709-BTG /CCTG CE.8 Trial. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.1148] [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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Kraft J, Mayinger M, Willmann J, Schanne D, Lang S, Willke L, Lohaus N, Guckenberger M, Andratschke N. Leukoencephalopathy after Prophylactic Whole-Brain Irradiation with or without Hippocampal Sparing: A Long-Term MRI Analysis. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.2342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Monti A, de Abrunhosa Branquinho A, Andratschke N, Clementel E, Corning C, Dhermain F, Hurkmans C, Kaidar-Person O, Roth P, Saez J, Verhoeff J. A Multi-Institutional Estimation of Interobserver Variability in Glioblastoma Treatment Planning in the EORTC-1709-BTG / CCTG CE.8 trial. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.1150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Corradini S, Alongi F, Andratschke N, Belka C, Boldrini L, Cellini F, Debus J, Guckenberger M, Hörner-Rieber J, Lagerwaard FJ, Mazzola R, Palacios MA, Philippens MEP, Raaijmakers CPJ, Terhaard CHJ, Valentini V, Niyazi M. MR-guidance in clinical reality: current treatment challenges and future perspectives. Radiat Oncol 2019; 14:92. [PMID: 31167658 PMCID: PMC6551911 DOI: 10.1186/s13014-019-1308-y] [Citation(s) in RCA: 229] [Impact Index Per Article: 45.8] [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: 03/15/2019] [Accepted: 05/24/2019] [Indexed: 11/23/2022] Open
Abstract
Magnetic Resonance-guided radiotherapy (MRgRT) marks the beginning of a new era. MR is a versatile and suitable imaging modality for radiotherapy, as it enables direct visualization of the tumor and the surrounding organs at risk. Moreover, MRgRT provides real-time imaging to characterize and eventually track anatomical motion. Nevertheless, the successful translation of new technologies into clinical practice remains challenging. To date, the initial availability of next-generation hybrid MR-linac (MRL) systems is still limited and therefore, the focus of the present preview was on the initial applicability in current clinical practice and on future perspectives of this new technology for different treatment sites.MRgRT can be considered a groundbreaking new technology that is capable of creating new perspectives towards an individualized, patient-oriented planning and treatment approach, especially due to the ability to use daily online adaptation strategies. Furthermore, MRL systems overcome the limitations of conventional image-guided radiotherapy, especially in soft tissue, where target and organs at risk need accurate definition. Nevertheless, some concerns remain regarding the additional time needed to re-optimize dose distributions online, the reliability of the gating and tracking procedures and the interpretation of functional MR imaging markers and their potential changes during the course of treatment. Due to its continuous technological improvement and rapid clinical large-scale application in several anatomical settings, further studies may confirm the potential disruptive role of MRgRT in the evolving oncological environment.
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Affiliation(s)
- S. Corradini
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany
| | - F. Alongi
- Department of Radiation Oncology, IRCSS Sacro Cuore don Calabria Hospital, Negrar-Verona, Italy
- University of Brescia, Brescia, Italy
| | - N. Andratschke
- Department of Radiation Oncology, University Hospital Zürich, University of Zurich, Zürich, Switzerland
| | - C. Belka
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany
| | - L. Boldrini
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, Rome, Italy
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, UOC di Radioterapia Oncologica, Rome, Italy
| | - F. Cellini
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, UOC di Radioterapia Oncologica, Rome, Italy
| | - J. Debus
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - M. Guckenberger
- Department of Radiation Oncology, University Hospital Zürich, University of Zurich, Zürich, Switzerland
| | - J. Hörner-Rieber
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - F. J. Lagerwaard
- Department of Radiation Oncology, VU medical center, Amsterdam, The Netherlands
| | - R. Mazzola
- Department of Radiation Oncology, IRCSS Sacro Cuore don Calabria Hospital, Negrar-Verona, Italy
- University of Brescia, Brescia, Italy
| | - M. A. Palacios
- Department of Radiation Oncology, VU medical center, Amsterdam, The Netherlands
| | - M. E. P. Philippens
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - C. P. J. Raaijmakers
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - C. H. J. Terhaard
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - V. Valentini
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, Rome, Italy
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, UOC di Radioterapia Oncologica, Rome, Italy
| | - M. Niyazi
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany
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Peters S, Felip E, Dafni U, Belka C, Guckenberger M, Irigoyen A, Nadal E, Becker A, Vees H, Pless M, Martinez-Marti A, Tufman A, Lambrecht M, Andratschke N, Piguet AC, Kassapian M, Roschitzki-Voser H, Rabaglio-Poretti M, Stahel RA, Vansteenkiste J, De Ruysscher D. Safety evaluation of nivolumab added concurrently to radiotherapy in a standard first line chemo-radiotherapy regimen in stage III non-small cell lung cancer-The ETOP NICOLAS trial. Lung Cancer 2019; 133:83-87. [PMID: 31200833 DOI: 10.1016/j.lungcan.2019.05.001] [Citation(s) in RCA: 100] [Impact Index Per Article: 20.0] [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: 03/17/2019] [Revised: 04/25/2019] [Accepted: 05/03/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Chemo-radiotherapy (CRT) and concurrent PD-1 inhibition has shown promising results in pre-clinical models. So far, the feasibility of delivering concurrent CRT and PD-1/PD-L1 inhibition has never been assessed in a clinical trial. MATERIAL AND METHODS NICOLAS is a phase-II trial evaluating the safety and efficacy of nivolumab combined with CRT in stage III NSCLC. Patients received 3 cycles of platinum-based chemotherapy and concurrent RT (66 Gy/33fractions). Nivolumab started concurrently with RT. The primary endpoint was 6-month post-RT rate of grade-≥3-pneumonitis. A formal interim safety analysis (IA) was scheduled when the first 21 patients reached 3 months follow-up post-RT. An early positive safety conclusion would be reached at IA if there were no grade ≥3-pneumonitis in those patients. Efficacy evaluation was planned provided the safety conclusion was reached. RESULTS AND CONCLUSION As of 13 December 2018, 82 patients were recruited with median follow-up of 13.4 months. The most frequent adverse events (AEs) were anaemia, fatigue and pneumonitis. No unexpected AEs or increased toxicities were observed. For the first 21 patients, no grade-≥3-pneumonitis was observed by the end of the 3-month post-RT follow-up period. The early safety IA provides evidence that the addition of nivolumab to concurrent CRT is safe and tolerable regarding the 6-month rate of pneumonitis grade ≥3 at the one-sided significance level of 5%. Following that, the 1-year progression-free survival will be evaluated in an expanded patient cohort. NICOLAS trial creates the opportunity for assessing the activity of the combination of checkpoint with concurrent CRT in larger prospective trials for locally advanced NSCLC.
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Affiliation(s)
- S Peters
- Centre Hospitalier Universitaire Vaudois (CHUV), Département d'Oncologie, Lausanne, Switzerland
| | - E Felip
- Vall d'Hebron University Hospital, Institute of Oncology (VHIO), Barcelona, Spain
| | - U Dafni
- Frontier Science Foundation-Hellas & National and Kapodistrian University of Athens, Greece
| | - C Belka
- Department of Radiation Oncology and DZL Munich, University Hospital, LMU Munich, Germany
| | - M Guckenberger
- University Hospital Zurich, Department for Radiation Oncology, University of Zurich, Switzerland
| | - A Irigoyen
- Hospital Virgen De La Salud, Department of Medical Oncology, Toledo, Spain
| | - E Nadal
- Catalan Institute of Oncology, Department of Medical Oncology, IDIBELL L'Hospitalet, Barcelona, Spain
| | - A Becker
- Amsterdam University Medical Center, Department of Respiratory Diseases, Amsterdam, the Netherlands
| | - H Vees
- Clinic Hirslanden, Radiation Oncology, Zürich, Switzerland
| | - M Pless
- Cantonal Hospital Winterthur, Medical Oncology, Winterthur, Switzerland
| | - A Martinez-Marti
- Vall d'Hebron University Hospital, Institute of Oncology (VHIO), Barcelona, Spain
| | - A Tufman
- Ludwig Maximilian University of Munich (LMU), Medizinische Klinik and Poliklinik V, German Center for Lung Research, Munich, Germany
| | - M Lambrecht
- University Hospitals Gasthuisberg, Department of Radiotherapy-Oncology, Leuven, Belgium
| | - N Andratschke
- University Hospital Zurich, Department for Radiation Oncology, University of Zurich, Switzerland
| | - A C Piguet
- European Thoracic Oncology Platform (ETOP), Bern, Switzerland
| | - M Kassapian
- Frontier Science Foundation-Hellas, Athens, Greece
| | | | | | - R A Stahel
- University Hospital Zurich, Department of Haematology and Oncology, Switzerland
| | - J Vansteenkiste
- University Hospitals Gasthuisberg, Department of Respiratory Diseases, Leuven, Belgium
| | - D De Ruysscher
- Maastro Clinic, Department of Radiation Oncology Maastricht, the Netherlands.
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De Jong E, Guckenberger M, Andratschke N, Dieckmann K, Hoogeman M, Milder M, Moller DS, Nyeng TB, Tanadini-Lang S, Lartigau E, Lacornerie T, Romero AM, Verbakel W, Verellen D, De Kerf G, Hurkmans C. PV-103 Linking ACROP guidelines to ICRU91: a multicentre study in lung SBRT on prescription and reporting. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)30523-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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