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Puccini S, Hoeft M, Großmann U, Halbur J, Völzke D, Semrau R, Rief H. PO-1658 Frameless Surface-Gated Single-Isocenter Radiosurgery: Setup Accuracy and Plan Robustness. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03622-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Baues C, Goergen H, Fuchs M, Kobe C, Dietlein M, Rosenbrock J, Celik E, Eich H, Kriz J, Semrau R, Borchmann P, Engert A, Marnitz S. Consolidating Involved Field Radiotherapy Prevents Early and Local Recurrences in Early Stage Hodgkin Lymphoma. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.445] [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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Klement RJ, Abbasi-Senger N, Adebahr S, Alheid H, Allgaeuer M, Becker G, Blanck O, Boda-Heggemann J, Brunner T, Duma M, Eble MJ, Ernst I, Gerum S, Habermehl D, Hass P, Henkenberens C, Hildebrandt G, Imhoff D, Kahl H, Klass ND, Krempien R, Lewitzki V, Lohaus F, Ostheimer C, Papachristofilou A, Petersen C, Rieber J, Schneider T, Schrade E, Semrau R, Wachter S, Wittig A, Guckenberger M, Andratschke N. The impact of local control on overall survival after stereotactic body radiotherapy for liver and lung metastases from colorectal cancer: a combined analysis of 388 patients with 500 metastases. BMC Cancer 2019; 19:173. [PMID: 30808323 PMCID: PMC6390357 DOI: 10.1186/s12885-019-5362-5] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Accepted: 02/11/2019] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND The aim of this analysis was to model the effect of local control (LC) on overall survival (OS) in patients treated with stereotactic body radiotherapy (SBRT) for liver or lung metastases from colorectal cancer. METHODS The analysis is based on pooled data from two retrospective SBRT databases for pulmonary and hepatic metastases from 27 centers from Germany and Switzerland. Only patients with metastases from colorectal cancer were considered to avoid histology as a confounding factor. An illness-death model was employed to model the relationship between LC and OS. RESULTS Three hundred eighty-eight patients with 500 metastatic lesions (lung n = 209, liver n = 291) were included and analyzed. Median follow-up time for local recurrence assessment was 12.1 months. Ninety-nine patients with 112 lesions experienced local failure. Seventy-one of these patients died after local failure. Median survival time was 27.9 months in all patients and 25.4 months versus 30.6 months in patients with and without local failure after SBRT. The baseline risk of death after local failure exceeds the baseline risk of death without local failure at 10 months indicating better survival with LC. CONCLUSION In CRC patients with lung or liver metastases, our findings suggest improved long-term OS by achieving metastatic disease control using SBRT in patients with a projected OS estimate of > 12 months.
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Affiliation(s)
- Rainer J Klement
- Department of Radiation Oncology, Leopoldina Hospital Schweinfurt, Schweinfurt, Germany
| | - N Abbasi-Senger
- Department of Radiation Oncology, University Hospital Jena, Jena, Germany
| | - S Adebahr
- Department of Radiation Oncology, University Hospital Freiburg, Freiburg, Germany
| | - H Alheid
- Strahlentherapie Bautzen, Bautzen, Germany
| | - M Allgaeuer
- Department of Radiation Oncology, Hospital Barmherzige Brueder, Regensburg, Germany
| | - G Becker
- RadioChirurgicum CyberKnife Suedwest, Goeppingen, Germany
| | - O Blanck
- Department of Radiation Oncology Universitaetsklinikum Schleswig-Holstein, Luebeck, Germany
| | - J Boda-Heggemann
- Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - T Brunner
- Department of Radiation Oncology, University Hospital Freiburg, Freiburg, Germany
| | - M Duma
- Department of Radiation Oncology, Klinikum rechts der Isar- Technische Universitaet Muenchen, Munich, Germany
| | - M J Eble
- Department of Radiation Oncology, University Hospital Aachen, Aachen, Germany
| | - I Ernst
- Department of Radiation Oncology, University Hospital Muenster, Muenster, Germany
| | - S Gerum
- Department of Radiation Oncology, Ludwig Maximilians University Munich, Munich, Germany
| | - D Habermehl
- Department of Radiation Oncology, Klinikum rechts der Isar- Technische Universitaet Muenchen, Munich, Germany.,Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany
| | - P Hass
- Department of Radiation Oncology, University Hospital Magdeburg, Magdeburg, Germany
| | - C Henkenberens
- Department of Radiotherapy and Special Oncology, Medical School Hannover, Hanover, Germany
| | - G Hildebrandt
- Department of Radiation Oncology, University of Rostock, Rostock, Germany
| | - D Imhoff
- Department of Radiation Oncology, University Hospital Frankfurt, Frankfurt, Germany
| | - H Kahl
- Department of Radiation Oncology, Hospital Augsburg, Augsburg, Germany
| | - N D Klass
- Department of Radiation Oncology, University Hospital Bern, Bern, Switzerland
| | - R Krempien
- Department of Radiation Oncology, Helios Klinikum Berlin Buch, Berlin, Germany
| | - V Lewitzki
- Department of Radiation Oncology, University Hospital Wuerzburg, Wuerzburg, Germany
| | - F Lohaus
- Department of Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - C Ostheimer
- Department of Radiation Oncology, University Hospital Halle, Halle, Germany
| | - A Papachristofilou
- Department of Radiation Oncology, University Hospital Hamburg, Hamburg, Germany
| | - C Petersen
- Department of Radiation Oncology, University Hospital Basel, Basel, Switzerland
| | - J Rieber
- Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany
| | | | - E Schrade
- Department of Radiation Oncology, Hospital Heidenheim, Heidenheim, Germany
| | - R Semrau
- Department of Radiation Oncology, University Hospital of Cologne, Cologne, Germany
| | - S Wachter
- Department of Radiation Oncology, Klinikum Passau, Passau, Germany
| | - A Wittig
- Department of Radiation Oncology, University Hospital Jena, Jena, Germany.,Department of Radiotherapy and Radiation Oncology, Philipps-University Marburg, University Hospital Giessen and Marburg, Marburg, Germany
| | - M Guckenberger
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - N Andratschke
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland.
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Andratschke N, Alheid H, Allgäuer M, Becker G, Blanck O, Boda-Heggemann J, Brunner T, Duma M, Gerum S, Guckenberger M, Hildebrandt G, Klement RJ, Lewitzki V, Ostheimer C, Papachristofilou A, Petersen C, Schneider T, Semrau R, Wachter S, Habermehl D. The SBRT database initiative of the German Society for Radiation Oncology (DEGRO): patterns of care and outcome analysis of stereotactic body radiotherapy (SBRT) for liver oligometastases in 474 patients with 623 metastases. BMC Cancer 2018; 18:283. [PMID: 29534687 PMCID: PMC5851117 DOI: 10.1186/s12885-018-4191-2] [Citation(s) in RCA: 92] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 03/06/2018] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND The intent of this pooled analysis as part of the German society for radiation oncology (DEGRO) stereotactic body radiotherapy (SBRT) initiative was to analyze the patterns of care of SBRT for liver oligometastases and to derive factors influencing treated metastases control and overall survival in a large patient cohort. METHODS From 17 German and Swiss centers, data on all patients treated for liver oligometastases with SBRT since its introduction in 1997 has been collected and entered into a centralized database. In addition to patient and tumor characteristics, data on immobilization, image guidance and motion management as well as dose prescription and fractionation has been gathered. Besides dose response and survival statistics, time trends of the aforementioned variables have been investigated. RESULTS In total, 474 patients with 623 liver oligometastases (median 1 lesion/patient; range 1–4) have been collected from 1997 until 2015. Predominant histologies were colorectal cancer (n = 213 pts.; 300 lesions) and breast cancer (n = 57; 81 lesions). All centers employed an SBRT specific setup. Initially, stereotactic coordinates and CT simulation were used for treatment set-up (55%), but eventually were replaced by CBCT guidance (28%) or more recently robotic tracking (17%). High variance in fraction (fx) number (median 1 fx; range 1–13) and dose per fraction (median: 18.5 Gy; range 3–37.5 Gy) was observed, although median BED remained consistently high after an initial learning curve. Median follow-up time was 15 months; median overall survival after SBRT was 24 months. One- and 2-year treated metastases control rate of treated lesions was 77% and 64%; if maximum isocenter biological equivalent dose (BED) was greater than 150 Gy EQD2Gy, it increased to 83% and 70%, respectively. Besides radiation dose colorectal and breast histology and motion management methods were associated with improved treated metastases control. CONCLUSION After an initial learning curve with regards to total cumulative doses, consistently high biologically effective doses have been employed translating into high local tumor control at 1 and 2 years. The true impact of histology and motion management method on treated metastases control deserve deeper analysis. Overall survival is mainly influenced by histology and metastatic tumor burden.
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Affiliation(s)
- N. Andratschke
- University Hospital Zürich, Department of Radiation Oncology, University of Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - H. Alheid
- Department of Radiation Oncology, Strahlentherapie Bautzen, Bautzen, Germany
| | - M. Allgäuer
- Department of Radiation Oncology, Krankenhaus Barmherzige Brüder, Regensburg, Germany
| | - G. Becker
- RadioChirurgicum CyberKnife Südwest, Radiation Oncology, Göppingen, Germany
| | - O. Blanck
- Department of Radiation Oncology, Universitätsklinikum Schleswig-Holstein, /Lübeck, Kiel, Germany
| | - J. Boda-Heggemann
- University Hospital Mannheim, Department of Radiation Oncology, University of Heidelberg, Mannheim, Germany
| | - T. Brunner
- Department of Radiation Oncology, University Hospital Freiburg, Freiburg, Germany
| | - M. Duma
- Department of Radiation Oncology, Klinikum rechts der Isar- Technische Universität München, Munich, Germany
| | - S. Gerum
- Department of Radiation Oncology, University of Munich – LMU Munich, Munich, Germany
| | - M. Guckenberger
- University Hospital Zürich, Department of Radiation Oncology, University of Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - G. Hildebrandt
- Department of Radiation Oncology, University Hospital Rostock, Rostock, Germany
| | - R. J. Klement
- Department of Radiation Oncology, Leopoldina Hospital Schweinfurt, Schweinfurt, Germany
| | - V. Lewitzki
- Department of Radiation Oncology, University Hospital Würzburg, Würzburg, Germany
| | - C. Ostheimer
- Department of Radiation Oncology, University Hospital Halle, Halle, Germany
| | - A. Papachristofilou
- Department of Radiation Oncology, University Hospital Basel, Basel, Switzerland
| | - C. Petersen
- Department of Radiation Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - T. Schneider
- Department of Radiation Oncology, Strahlenzentrum Hamburg, Hamburg, Germany
| | - R. Semrau
- Department of Radiation Oncology, University Hospital of Cologne, Cologne, Germany
| | - S. Wachter
- Klinikum Passau, Radiation Oncology, Passau, Germany
| | - D. Habermehl
- Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany
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Abstract
BACKGROUND CyberKnife® stereotactic radiosurgery is a new treatment option for uveal melanoma. OBJECTIVE This review outlines the technique of robot-assisted CyberKnife® therapy, as well as the pros and cons in the treatment of uveal melanoma. METHODS The study provides a PubMed literature review and own preliminary clinical experiences. RESULTS CyberKnife® therapy for choroidal and ciliary body melanomas shows comparable results concerning local tumor control and overall survival matching those of conventional therapies. With only low complication rates, a high level of quality of life can be conserved by possible preservation of visual acuity as well as the ocular globe. CONCLUSION Stereotactic radiosurgery using CyberKnife® seems to be an efficient and safe therapeutic option for malignant melanomas affecting the choroid and ciliary body. Comparative studies with conventional radiation strategies are now a high priority.
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Affiliation(s)
- J M Mor
- Zentrum für Augenheilkunde, Universität zu Köln, Kerpener Str. 62, 50924, Köln, Deutschland
| | - R Semrau
- Klinik und Poliklinik für Strahlentherapie, Universität zu Köln, Köln, Deutschland
| | - W Baus
- Klinik und Poliklinik für Strahlentherapie, Universität zu Köln, Köln, Deutschland
| | - K R Koch
- Zentrum für Augenheilkunde, Universität zu Köln, Kerpener Str. 62, 50924, Köln, Deutschland
| | - F Schaub
- Zentrum für Augenheilkunde, Universität zu Köln, Kerpener Str. 62, 50924, Köln, Deutschland
| | - C Cursiefen
- Zentrum für Augenheilkunde, Universität zu Köln, Kerpener Str. 62, 50924, Köln, Deutschland
| | - S Marnitz
- Klinik und Poliklinik für Strahlentherapie, Universität zu Köln, Köln, Deutschland.,Centrum für Integrierte Onkologie (CIO) Köln-Bonn, Köln, Deutschland
| | - L M Heindl
- Zentrum für Augenheilkunde, Universität zu Köln, Kerpener Str. 62, 50924, Köln, Deutschland. .,Centrum für Integrierte Onkologie (CIO) Köln-Bonn, Köln, Deutschland.
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Meyer M, Meinrath J, Seehawer J, Lechner A, Odenthal M, Quaas A, Semrau R, Huebbers C, Marnitz S, Büttner R, Beutner D. The relevance of the lymph node ratio as predictor of prognosis is higher in HPV-negative than in HPV-positive oropharyngeal squamous cell carcinoma. Clin Otolaryngol 2017; 43:192-198. [DOI: 10.1111/coa.12938] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2017] [Indexed: 01/03/2023]
Affiliation(s)
- M.F. Meyer
- Department of Otorhinolaryngology; Head and Neck Surgery; University of Cologne; Cologne Germany
- Center for Integrated Oncology Köln Bonn; University of Cologne; Cologne Germany
| | - J. Meinrath
- Center for Integrated Oncology Köln Bonn; University of Cologne; Cologne Germany
- Institute for Pathology; University of Cologne; Cologne Germany
| | - J. Seehawer
- Department of Otorhinolaryngology; Head and Neck Surgery; University of Cologne; Cologne Germany
- Center for Integrated Oncology Köln Bonn; University of Cologne; Cologne Germany
| | - A. Lechner
- Department of Otorhinolaryngology; Head and Neck Surgery; University of Cologne; Cologne Germany
- Center for Integrated Oncology Köln Bonn; University of Cologne; Cologne Germany
| | - M. Odenthal
- Center for Integrated Oncology Köln Bonn; University of Cologne; Cologne Germany
- Institute for Pathology; University of Cologne; Cologne Germany
- Center for Molecular Medicine Cologne; University of Cologne; Cologne Germany
| | - A. Quaas
- Center for Integrated Oncology Köln Bonn; University of Cologne; Cologne Germany
- Institute for Pathology; University of Cologne; Cologne Germany
| | - R. Semrau
- Center for Integrated Oncology Köln Bonn; University of Cologne; Cologne Germany
- Department of Radiation Oncology; University of Cologne; Cologne Germany
| | - C.U. Huebbers
- Jean-Uhrmacher Institute; University of Cologne; Cologne Germany
| | - S. Marnitz
- Center for Integrated Oncology Köln Bonn; University of Cologne; Cologne Germany
- Department of Radiation Oncology; University of Cologne; Cologne Germany
| | - R. Büttner
- Center for Integrated Oncology Köln Bonn; University of Cologne; Cologne Germany
- Institute for Pathology; University of Cologne; Cologne Germany
- Center for Molecular Medicine Cologne; University of Cologne; Cologne Germany
| | - D. Beutner
- Department of Otorhinolaryngology; Head and Neck Surgery; University of Cologne; Cologne Germany
- Center for Integrated Oncology Köln Bonn; University of Cologne; Cologne Germany
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7
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Gkika E, Tanadini-Lang S, Kirste S, Holzner PA, Neeff HP, Rischke HC, Reese T, Lohaus F, Duma MN, Dieckmann K, Semrau R, Stockinger M, Imhoff D, Kremers N, Häfner MF, Andratschke N, Nestle U, Grosu AL, Guckenberger M, Brunner TB. Interobserver variability in target volume delineation of hepatocellular carcinoma. Strahlenther Onkol 2017; 193:823-830. [DOI: 10.1007/s00066-017-1177-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Accepted: 06/22/2017] [Indexed: 12/22/2022]
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8
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Favi F, Bollschweiler E, Berlth F, Plum P, Hescheler DA, Alakus H, Semrau R, Celik E, Mönig SP, Drebber U, Hölscher AH. Neoadjuvant chemotherapy or chemoradiation for patients with advanced adenocarcinoma of the oesophagus? A propensity score-matched study. Eur J Surg Oncol 2017; 43:1572-1580. [PMID: 28666624 DOI: 10.1016/j.ejso.2017.06.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [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: 01/14/2017] [Revised: 04/10/2017] [Accepted: 06/06/2017] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Multimodal therapies are the standard of care for advanced adenocarcinomas of the oesophagus and gastro-oesophageal junction (AEG Types I and II). Only three randomised trials have compared preoperative chemotherapy with and without radiation. The results showed a small benefit for combined chemoradiation. In the meantime, newer therapy protocols are available. AIM In a propensity-score matched study, we analysed patients with locally advanced AEG type I or II, treated with chemotherapy (FLOT-protocol) or chemoradiation (CROSS-protocol), followed by oesophagectomy, in a single high-volume centre. PATIENTS AND METHODS Between 2011 and 2015, 137 patients with advanced (cT3NxcM0) adenocarcinoma received pre-operative therapy; 70% had chemoradiation (CROSS-protocol) and 30% had chemotherapy (FLOT-protocol). After propensity-score matching, 40 patients from the CROSS-group were selected for analysis. Postoperative histopathological response and prognosis were analysed. RESULTS The two groups were comparable according to the matching criteria age, gender, tumour location, and year of surgery. R0-resection was achieved in 97% of patients in the CROSS-group and 85% of the FLOT-group (p = 0.049). Major response of the primary tumour was evident more often in the CROSS-group (17/40 pts. 43%) versus FLOT-group (11/40 pts. 27%) as well no lymph node metastasis (ypN0 = 68% versus ypN0 = 40%) (p = 0.014). Prognosis were not significantly different between the two groups. In multivariate analysis, only ypN-category was an independent prognostic factor. CONCLUSION Compared to FLOT-chemotherapy, neoadjuvant chemoradiotherapy with the CROSS-protocol in locally advanced adenocarcinoma AEG types I and II resulted in better response by the primary tumour and less lymph node metastasis but without superior survival.
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Affiliation(s)
- F Favi
- Department of General, Visceral and Cancer Surgery, University of Cologne, Cologne, Germany
| | - E Bollschweiler
- Department of General, Visceral and Cancer Surgery, University of Cologne, Cologne, Germany.
| | - F Berlth
- Department of General, Visceral and Cancer Surgery, University of Cologne, Cologne, Germany
| | - P Plum
- Department of General, Visceral and Cancer Surgery, University of Cologne, Cologne, Germany
| | - D A Hescheler
- Department of General, Visceral and Cancer Surgery, University of Cologne, Cologne, Germany
| | - H Alakus
- Department of General, Visceral and Cancer Surgery, University of Cologne, Cologne, Germany
| | - R Semrau
- Department of Radiation Oncology, University of Cologne, Cologne, Germany
| | - E Celik
- Department of Radiation Oncology, University of Cologne, Cologne, Germany
| | - S P Mönig
- Department of General, Visceral and Cancer Surgery, University of Cologne, Cologne, Germany; Service de Chirurgie Viscéral, Hôpitaux Universitaires de Genève, Switzerland
| | - U Drebber
- Institute of Pathology, University of Cologne, Cologne, Germany
| | - A H Hölscher
- Department of General, Visceral and Cancer Surgery, University of Cologne, Cologne, Germany; Department of Surgery, AGAPLESION Markus Krankenhaus, Frankfurt, Germany
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Gkika E, Tandini-Lang S, Kirste S, Holzner P, Neeff H, Rischke H, Reese T, Lohaus F, Duma M, Dieckmann K, Semrau R, Stockinger M, Imhoff D, Kremers N, Häfner M, Andratschke N, Nestle U, Grosu A, Guckenberger M, Brunner T. EP-1253: Interobserver variability in the target delineation of hepatocellular carcinoma. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)31688-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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10
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Klement R, Guckenberger M, Alheid H, Allgaeuer M, Becker G, Blanck O, Boda-Hegemann J, Brunner T, Duma M, Gerum S, Habermehl D, Hildebrandt G, Lewitzki V, Ostheimer C, Papachristofilou A, Petersen C, Schneider T, Semrau R, Wachter S, Andratschke N. OC-0523: SBRT for oligo-metastatic liver disease–effect of chemotherapy and histology on local tumor control. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)30963-5] [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: 11/29/2022]
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11
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Klement RJ, Guckenberger M, Alheid H, Allgäuer M, Becker G, Blanck O, Boda-Heggemann J, Brunner T, Duma M, Gerum S, Habermehl D, Hildebrandt G, Lewitzki V, Ostheimer C, Papachristofilou A, Petersen C, Schneider T, Semrau R, Wachter S, Andratschke N. Stereotactic body radiotherapy for oligo-metastatic liver disease - Influence of pre-treatment chemotherapy and histology on local tumor control. Radiother Oncol 2017; 123:227-233. [PMID: 28274491 DOI: 10.1016/j.radonc.2017.01.013] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 01/02/2017] [Accepted: 01/21/2017] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Stereotactic body radiation therapy (SBRT) is applied in the oligometastatic setting to treat liver metastases. However, factors influencing tumor control probability (TCP) other than radiation dose have not been thoroughly investigated. Here we set out to investigate such factors with a focus on the influence of histology and chemotherapy prior to SBRT using a large multi-center database from the German Society of Radiation Oncology. METHODS 452 SBRT treatments in 363 patients were analyzed after collection of patient, tumor and treatment data in a multi-center database. Histology was considered through random effects in semi-parametric and parametric frailty models. Dose prescriptions were parametrized by conversion to the maximum biologically effective dose using alpha/beta of 10Gy (BEDmax). RESULTS After adjusting for histology, BEDmax was the strongest predictor of TCP. Larger PTV volumes, chemotherapy prior to SBRT and simple motion management techniques predicted significantly lower TCP. The model predicted a BED of 209±67Gy10 necessary for 90% TCP at 2years with no prior chemotherapy, but 286±78Gy10 when chemotherapy had been given. Breast cancer metastases were significantly more responsive to SBRT compared to other histologies with 90% TCP at 2years achievable with BEDmax of 157±80Gy10 or 80±62Gy10 with and without prior chemotherapy, respectively. CONCLUSIONS Besides dose, histology and pretreatment chemotherapy were important factors influencing local TCP in this large cohort of liver metastases. After adjusting for prior chemotherapy, our data add to the emerging evidence that breast cancer metastases do respond better to hypofractionated SBRT compared to other histologies.
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Affiliation(s)
- R J Klement
- Leopoldina Hospital Schweinfurt, Department of Radiation Oncology, Germany
| | - M Guckenberger
- University Hospital Zürich, Department of Radiation Oncology, University of Zurich, Switzerland
| | - H Alheid
- Strahlentherapie Bautzen, Radiation Oncology, Germany
| | - M Allgäuer
- Krankenhaus Barmherzige Brüder, Radiation Oncology, Regensburg, Germany
| | - G Becker
- RadioChirurgicum CyberKnife Südwest, Radiation Oncology, Göppingen, Germany
| | - O Blanck
- Universitätsklinikum Schleswig-Holstein, Radiation Oncology, Kiel/Lübeck, Germany
| | - J Boda-Heggemann
- University Hospital Mannheim, Radiation Oncology, University of Heidelberg, Germany
| | - T Brunner
- University Hospital Freiburg, Radiation Oncology, Germany
| | - M Duma
- Klinikum rechts der Isar- Technische Universität München, Radiation Oncology, Germany
| | - S Gerum
- Department of Radiation Oncology, University of Munich - LMU Munich, Germany
| | - D Habermehl
- University Hospital Heidelberg, Radiation Oncology, Germany
| | - G Hildebrandt
- University Hospital Rostock, Radiation Oncology, Germany
| | - V Lewitzki
- University Hospital Würzburg, Radiation Oncology, Germany
| | - C Ostheimer
- University Hospital Halle, Radiation Oncology, Germany
| | | | - C Petersen
- University Medical Center Hamburg-Eppendorf, Radiation Oncology, Germany
| | - T Schneider
- Strahlenzentrum Hamburg, Radiation Oncology, Germany
| | - R Semrau
- University Hospital of Cologne, Radiation Oncology, Germany
| | - S Wachter
- Klinikum Passau, Radiation Oncology, Germany
| | - N Andratschke
- University Hospital Zürich, Department of Radiation Oncology, University of Zurich, Switzerland.
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Baues C, Semrau R, Gaipl US, Bröckelmann PJ, Rosenbrock J, Engert A, Marnitz S. Checkpoint inhibitors and radiation treatment in Hodgkin's lymphoma : New study concepts of the German Hodgkin Study Group. Strahlenther Onkol 2016; 193:95-99. [PMID: 27704149 DOI: 10.1007/s00066-016-1050-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [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: 07/03/2016] [Accepted: 09/01/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Patients with classical Hodgkin's lymphoma (cHL) have a good prognosis even in advanced stages. However, combined chemo- and radiotherapy, as the standard of care, is also associated with treatment-related toxicities such as organ damage, secondary neoplasias, infertility, or fatigue and long-term fatigue. Many patients suffer from this burden although their cHL was cured. Therefore, the efficacy of immune checkpoint inhibitors like anti-PD1/PD-L1 antibodies in the treatment of solid cancers and also in HL offers new options. A remarkable and durable response rate with a favorable toxicity profile was observed in heavily pretreated cHL patients. METHODS Planning to perform prospective randomized clinical trials in the content of radio-immune treatment in patients with Hodgkin's lymphoma (HL), we transferred the results of preliminary clinical studies and basic research in clinical relevant study concepts. RESULTS Based on these promising early phase trial data, the German Hodgkin Study Group (GHSG) will investigate innovative treatment regimens in upcoming phase II trials. CONCLUSION The therapeutic efficacy and potential synergies of anti-PD1 antibodies in combination with chemo- or radiotherapy will be investigated in various settings of HL.
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Affiliation(s)
- C Baues
- Medical Faculty, Department of Radiooncology, University of Cologne, Cologne, Germany. .,German Hodgkin Study Group (GHSG), University of Cologne, Cologne, Germany.
| | - R Semrau
- Medical Faculty, Department of Radiooncology, University of Cologne, Cologne, Germany.,German Hodgkin Study Group (GHSG), University of Cologne, Cologne, Germany
| | - U S Gaipl
- Department of Radiooncology, University hospital Erlangen, Erlangen, Germany
| | - P J Bröckelmann
- German Hodgkin Study Group (GHSG), University of Cologne, Cologne, Germany.,Medical Faculty, Department of Internal Medicine I, University of Cologne, Cologne, Germany
| | - J Rosenbrock
- Medical Faculty, Department of Radiooncology, University of Cologne, Cologne, Germany
| | - A Engert
- German Hodgkin Study Group (GHSG), University of Cologne, Cologne, Germany.,Medical Faculty, Department of Internal Medicine I, University of Cologne, Cologne, Germany
| | - S Marnitz
- Medical Faculty, Department of Radiooncology, University of Cologne, Cologne, Germany.,German Hodgkin Study Group (GHSG), University of Cologne, Cologne, Germany
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Meyer M, Kreppel M, Meinrath J, Grünewald I, Stenner M, Drebber U, Quaas A, Odenthal M, Semrau R, Huebbers C, Zöller J, Huettenbrink KB, Buettner R, Beutner D. Prediction of outcome by lymph node ratio in patients with parotid gland cancer. Clin Otolaryngol 2016; 42:98-103. [DOI: 10.1111/coa.12672] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2016] [Indexed: 12/17/2022]
Affiliation(s)
- M.F. Meyer
- Department of Otorhinolaryngology, Head and Neck Surgery; University of Cologne; Cologne Germany
| | - M. Kreppel
- Department for Oral and Maxillofacial Plastic Surgery; University of Cologne; Cologne Germany
| | - J. Meinrath
- Department of Pathology; University of Cologne; Cologne Germany
| | - I. Grünewald
- Department of Pathology; University of Cologne; Cologne Germany
| | - M. Stenner
- Department of Otorhinolaryngology, Head and Neck Surgery; University of Cologne; Cologne Germany
| | - U. Drebber
- Department of Pathology; University of Cologne; Cologne Germany
| | - A. Quaas
- Department of Pathology; University of Cologne; Cologne Germany
| | - M. Odenthal
- Department of Pathology; University of Cologne; Cologne Germany
| | - R. Semrau
- Department of Radiation Oncology; University of Cologne; Cologne Germany
| | - C.U. Huebbers
- Jean-Uhrmacher Institute; University of Cologne; Cologne Germany
| | - J. Zöller
- Department for Oral and Maxillofacial Plastic Surgery; University of Cologne; Cologne Germany
| | - K-B. Huettenbrink
- Department of Otorhinolaryngology, Head and Neck Surgery; University of Cologne; Cologne Germany
| | - R. Buettner
- Department of Pathology; University of Cologne; Cologne Germany
| | - D. Beutner
- Department of Otorhinolaryngology, Head and Neck Surgery; University of Cologne; Cologne Germany
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Andratschke N, Alheid H, Allgäuer M, Becker G, Blanck O, Boda-Hegemann J, Brunner T, Combs S, Duma M, Gerum S, Guckenberger M, Hildebrandt G, Ostheimer C, Panje C, Papachristofilou A, Petersen C, Schneider T, Semrau R, Wachter S, Habermehl D. OC-0445: Patterns of care and outcome analysis of SBRT for liver metastases - a DEGRO database initiative. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)31694-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Temming S, Kocher M, Semrau R, Stoelben E. Outcome and Toxicity of CyberKnife Stereotactic Body Radiation Therapy for Inoperable Patients With NSCLC. Int J Radiat Oncol Biol Phys 2015. [DOI: 10.1016/j.ijrobp.2015.07.1567] [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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16
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Malter W, Kirn V, Semrau R, Bongartz R, Markiefka B, Mallmann P, Krämer S. Update of single institution experiences with intraoperative radiotherapy (IORT) in targeted oncoplastic breast surgery. Geburtshilfe Frauenheilkd 2014. [DOI: 10.1055/s-0034-1388456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Kocher M, Semrau R, Temming S, Baus WW, Treuer H, Ruge MI. [Stereotactic radiotherapy with the cyberknife]. Dtsch Med Wochenschr 2014; 139:1059-63. [PMID: 24801302 DOI: 10.1055/s-0034-1370022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- M Kocher
- Klinik und Poliklinik für Strahlentherapie, UniKlinik Köln
| | - R Semrau
- Klinik und Poliklinik für Strahlentherapie, UniKlinik Köln
| | - S Temming
- Klinik und Poliklinik für Strahlentherapie, UniKlinik Köln
| | - W W Baus
- Klinik und Poliklinik für Strahlentherapie, UniKlinik Köln
| | - H Treuer
- Klinik für Stereotaxie und funktionelle Neurochirurgie, UniKlinik Köln
| | - M I Ruge
- Klinik für Stereotaxie und funktionelle Neurochirurgie, UniKlinik Köln
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Franke M, Persigehl T, Chang DH, Semrau R, Kocher M, Maintz D, Bangard C. Sicherheit, Effektivität und Erfolg der perkutanen, CT-gesteuerten fiducial marker-Implantation/Goldmarkerimplantation in der Vorbereitung zur streotaktischen Cyberknife- Radiotherapie. ROFO-FORTSCHR RONTG 2014. [DOI: 10.1055/s-0034-1373049] [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: 10/25/2022]
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Kocher M, Treuer H, Hoevels M, Semrau R, Sturm V, Mueller RP. Endocrine and visual function after fractionated stereotactic radiotherapy of perioptic tumors. Strahlenther Onkol 2012; 189:137-41. [PMID: 23283589 DOI: 10.1007/s00066-012-0269-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2012] [Accepted: 11/08/2012] [Indexed: 11/29/2022]
Abstract
PURPOSE To find out whether the use of stereotactic techniques for fractionated radiotherapy reduces toxicity to the endocrine and visual system in patients with benign perioptic tumors. PATIENTS AND METHODS From 1993 to 2009, 29 patients were treated with fractionated stereotactic radiotherapy. The most frequent tumor types were grade I meningioma (n = 11) and pituitary adenoma (n = 10, 7 nonfunctioning, 3 growth hormone-producing). Patients were immobilized with the GTC frame (Radionics, USA) and the planning target volume (PTV; median 24.7, 4.6-58.6 ml) was irradiated with a total dose of 52.2 Gy (range, 45.0-55.8 Gy) in 1.8-Gy fractions using a linear accelerator (6 MeV photons) equipped with a micro-multileaf collimator. Maximum doses to the optic system and pituitary gland were 53.4 Gy (range, 11.5-57.6 Gy) and 53.6 Gy (range, 12.0-57.9 Gy). RESULTS Median follow-up was 45 months (range, 10-105 months). Local control was achieved in all but 1 patient (actuarial rate 92% at 5 years and 10 years). In 9 of 29 patients (31%), partial remission was observed (actuarial response rate 40% at 5 years and 10 years). In 4 of 26 patients (15%) with at least partial pituitary function, new hormonal deficits developed (actuarial rate 21% at 5 years and 10 years). This rate was significantly higher in patients treated for a larger PTV (< /> 25 ml: 0% vs. 42% at 5 years and 10 years, p = 0.028). Visual function improved in 4 of 15 patients (27%) who had prior impairment. None of the patients developed treatment-related optic neuropathy, but 2 patients experienced new disease-related visual deficits. CONCLUSION Fractionated stereotactic radiotherapy for benign tumors of the perioptic and sellar region results in satisfactory response and local control rates and does not affect the visual system. The assumption that patients can be spared hypophyseal insufficiency only holds for small tumors.
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Affiliation(s)
- M Kocher
- Klinik und Poliklinik für Strahlentherapie, UniKlinik Köln, Cologne, Deutschland.
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Semrau R, Temming S, Duerbaum H, Huebbers C, Klussmann J, Mueller R, Preuss S. Prognostic Importance of HPV Association in Locally Advanced Inoperable Oropharyngeal Cancer. Int J Radiat Oncol Biol Phys 2012. [DOI: 10.1016/j.ijrobp.2012.07.1261] [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: 10/27/2022]
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Semrau R, Herzog SL, Vallböhmer D, Kocher M, Hölscher AH, Müller RP. Prognostic factors in definitive radiochemotherapy of advanced inoperable esophageal cancer. Dis Esophagus 2012; 25:545-54. [PMID: 22133297 DOI: 10.1111/j.1442-2050.2011.01286.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The aim of this study was to assess the efficacy and prognostic factors of definitive radiochemotherapy (RCT) for inoperable esophageal cancer. Between 1995 and 2005 all patients with inoperable esophageal cancer that underwent concurrent RCT were included in this retrospective study. Conventional computed tomography-based treatment planning as well as 3D-conformal radiotherapy (RT) was used. Maximum radiotherapy dose was 63 Gy. Chemotherapy consisted of cisplatin (20 mg/m(2) d1-5 and 29-33) and 5-FU (650-1000 mg/m(2) d1-5 and 29-33). Patients not suitable for RCT received radiotherapy alone. Toxicity was measured according to common toxicity criteria (CTC). Two hundred three consecutive patients with inoperable esophageal cancer that received definitive therapy were identified in this time period (160 with squamous cell carcinoma and 43 with adenocarcinoma). The 2-year overall survival probability was 21.2% whereas the progression-free survival at 2 years was 13.8% for all patients. In the univariate analysis, type of histology, T-stage, N-stage, application of chemotherapy, and the radiation dose were significantly correlated with overall/progression-free survival. Moreover, multivariate analysis revealed an independent prognostic impact for N-stage, radiation dose, and concurrent chemotherapy. Definitive RCT is an important palliative treatment option for patients with inoperable esophageal cancer. N-stage, radiation dose, and concurrent chemotherapy are important prognostic factors for survival.
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Affiliation(s)
- R Semrau
- Department of Radiation Oncology, University of Cologne, Cologne, Germany.
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22
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Abstract
Oropharyngeal squamous cell carcinoma (OSCC) is associated with oncogenic human papillomavirus (HPV) infection in 30-40% of all cases in Germany. The use of PCR and / or in situ hybridisation to detect HPV in tumour tissue is used in combination with p16 immunohistochemistry to reliably distinguish HPV-related and HPV-unrelated OSCC. The distinct biological behaviour of the HPV-related subset of OSCC results in a more favourable prognosis. This might be the result of a greater response to chemotherapy and radiotherapy as seen in recent studies. Ongoing and future clinical trials will stratify for HPV status. If the results of these prospective, randomized trials are consistent with the preliminary results of recent studies, HPV status will be of enormous clinical relevance in the future.
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Affiliation(s)
- S F Preuss
- Klinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, Kopf-Hals-Chirurgie, Klinikum der Universität zu Köln, Kerpener Str. 62, 50924, Köln, Deutschland.
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23
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Malter W, Puppe J, Rogee K, Wuerstlein R, Semrau R, Bongartz R, Markiefka B, Mallmann P, Kraemer S. 598 Single Center Experiences with Intraoperative Radiotherapy as a Boost During Oncoplastic Breast-conserving Surgery. Eur J Cancer 2012. [DOI: 10.1016/s0959-8049(12)70663-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Semrau R, Herzog SL, Vallböhmer D, Kocher M, Hölscher A, Müller RP. Radiotherapy in elderly patients with inoperable esophageal cancer. Is there a benefit? Strahlenther Onkol 2012; 188:226-32. [PMID: 22318327 DOI: 10.1007/s00066-011-0039-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2011] [Accepted: 12/02/2011] [Indexed: 01/30/2023]
Abstract
BACKGROUND Radiation oncologists increasingly face elderly cancer patients impaired by comorbidities and reduced performance status. As less data are available for this particular group of patients, the aim of the study was to assess the prognosis of inoperable esophageal cancer patients ≥ 70 years undergoing definitive radiotherapy or radiochemotherapy. PATIENTS AND TREATMENT PROTOCOL: Patients aged ≥ 70 with inoperable carcinoma of the esophagus undergoing definitive radio(chemo)therapy between 1995 and 2006 at the University of Cologne were included retrospectively. Maximal total dose of radiotherapy administered was 63 Gy (5 × 1.8 Gy/week). Chemotherapy consisted of cisplatin (20 mg/m(2) on days 1-5 and days 29-33) and 5-fluorouracil (650-1,000 mg/m(2) on days 1-5 and days 29-33). Efficacy was compared with a cohort of 152 patients < 70 years treated with the same protocol during the same time period. RESULTS A total of 51 patients aged ≥ 70 with inoperable cancer of the esophagus undergoing definitive therapy were identified (stage I/II 23.5%, stage III 56.9%, stage IV 9.8%; squamous cell carcinoma 74.5%, adenocarcinoma 25.5%). While 15 patients (29.4%) received combined radiochemotherapy (RCT), 40 patients (70.6%) were treated with radiotherapy alone (RT). Median progression-free survival (PFS) was 9.5 months; median overall survival (OS) was 13.9 months. Patients treated with RCT had a 2-year OS rate of 53.3% compared with 16.7% for RT patients (p = 0.039). The 2-year OS for clinically lymph node negative patients was 38.5% compared with 21.2% for lymph node positive patients (p = 0.072). Median OS was not significantly different between patients ≥ 70 years versus the patient cohort (n = 152) aged < 70 years (13.9 vs. 7.2 months, p = 0.072) but PFS showed a significant difference (4.9 vs. 9.5 months, p = 0.026) in favor of the > 70 years group. CONCLUSION Prognosis in elderly patients with inoperable esophageal cancer undergoing definitive radiotherapy/radiochemotherapy is limited, although it is not inferior to patients < 70 years.
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Affiliation(s)
- R Semrau
- Department of Radiation Oncology, University of Cologne, Kerpener Str. 62, 50924, Cologne, Germany.
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Gieseke J, Morakkabati-Spitz N, Muscheler E, Semrau R, Träber F, Willinek AW. T2-gewichtete 3T MR-Bildgebung der Prostata und des Beckens: Hohe räumliche Auflösung mit paralleler HF-Anregung. ROFO-FORTSCHR RONTG 2010. [DOI: 10.1055/s-0030-1252831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Semrau R, Herzog S, Kocher M, Mueller R. Radiotherapy and Chemoradiation for Advanced Inoperable Esophageal Cancer. Int J Radiat Oncol Biol Phys 2009. [DOI: 10.1016/j.ijrobp.2009.07.668] [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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27
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Temming S, Kocher M, Klussmann J, Preuss S, Guntinas-Lichius O, Semrau R, Müller R. Concurrent Chemoradiation with Carboplatin and Paclitaxel with or without Concomitant Boost in Advanced Inoperable Head and Neck Cancers - Efficacy and Toxicity. Int J Radiat Oncol Biol Phys 2009. [DOI: 10.1016/j.ijrobp.2009.07.977] [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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Preuss SF, Klussmann JP, Wittekindt C, Damm M, Semrau R, Drebber U, Guntinas-Lichius O. Long-term results of the combined modality therapy for advanced cervical metastatic head and neck squamous cell carcinoma. European Journal of Surgical Oncology (EJSO) 2007; 33:358-63. [PMID: 17157472 DOI: 10.1016/j.ejso.2006.10.043] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2006] [Accepted: 10/27/2006] [Indexed: 11/18/2022]
Abstract
AIM A consensus treatment strategy for advanced cervical metastatic head and neck squamous cell carcinoma has not been established. The aim of this retrospective study was to investigate the outcome of these patients uniformely using a strategy which consists of surgery for the primary tumor and the neck metastases followed by postoperative radio(chemo)therapy. METHODS We included a selected series of 518 patients with previously untreated head and neck squamous cell carcinoma. The overall survival (OS), the disease specific survival (DSS), the disease free survival (DFS), the local control (LC) and regional control (RC) estimates were calculated. The statistical relationship of various clinical and histopathological variables on the above mentioned estimates were analyzed. RESULTS The overall survival probability was 73.2% for pN0 stage, 43% for pN>1 stages and 31% for pN2c/pN3 stages. The pN stage significantly influenced the survival probabilities in oropharyngeal (p=0.0001) and laryngeal tumors (p<0.0001) in univariate analyses. In multivariate analysis, age, pT stage, pN stage, M stage, and extranodal spreading were independent risk factors for decreased disease-specific survival. CONCLUSIONS We could show that pN stage is an important independent prognostic factor in head and neck cancer. The presented multimodal treatment protocol provides excellent oncological outcomes and should therefore be standard of care for patients with operable advanced cervical metastatic head and neck squamous cell carcinoma.
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Affiliation(s)
- S F Preuss
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical School, University of Cologne, Josef Stelzmann Str. 9, 50924 Cologne, Germany.
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Guntinas-Lichius O, Kreppel MP, Stuetzer H, Semrau R, Eckel HE, Mueller RP. Single modality and multimodality treatment of nasal and paranasal sinuses cancer: a single institution experience of 229 patients. Eur J Surg Oncol 2006; 33:222-8. [PMID: 17127030 DOI: 10.1016/j.ejso.2006.10.033] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2006] [Accepted: 10/20/2006] [Indexed: 11/24/2022] Open
Abstract
AIMS To assess the single and multimodal treatment results and prognostic factors for sinonasal carcinoma. METHODS Overall survival (OS), disease-specific survival (DSS), local control (LC), and disease-free survival (DFS) in 229 patients with sinonasal carcinoma treated from 1967 to 2003 were calculated. Prognostic factors were univariately and multivariately analyzed. The median follow-up period for survivors was 126 months. RESULTS 32% of the patients were operated only, 47% underwent multimodal therapy, and 20% were treated without operation. The 5-year OS rate was 41%, and the DSS rate was 51%. The LC rate was 64%, and the DFS rate was 34%. Prognostic for DSS were M status (p<0.001), UICC stage (p<0.001), T classification (p=0.001), N status (p=0.002), intracranial tumor infiltration (p=0.008), infiltration of the pterygopalatine fossa (p=0.02), infiltration of the skull base (p=0.021), infiltration of the orbita (p=0.041), and the type of therapy (p<0.001): The 5-year DSS rate was 63% for patients operated only, 56% for all operated patients, 46% for patients undergoing surgery and radiotherapy, but only 21% for patients treated with radiotherapy+/-chemotherapy. Multivariate analysis revealed that T classification (p=0.042), N classification (p=0.035), M classification (p=0.007), UICC stage (p=0.038), and type of therapy (p=0.038) were independent prognostic factors for DSS. CONCLUSIONS Radical surgery is recommended for stage I/II sinonasal carcinomas. Stage III/IV carcinomas still have a poor prognosis, but multimodal treatment seems to favor the outcome.
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Affiliation(s)
- O Guntinas-Lichius
- Clinic of Otorhinolaryngology, Head and Neck Surgery, University of Cologne, D-50924 Koeln, Germany.
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Semrau R, Mueller RP, Stuetzer H, Staar S, Schroeder U, Rudat V, Dietz A, Volling P, Schroeder M, Flentje M, Eckel HE. High pretherapeutic Hb- levels tend to decrease SLC: Updated results of a randomized multicentric trial of hf-acc radiotherapy and concurrent chemotherapy in advanced HNC. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.5525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- R. Semrau
- Univ of Cologne, Koeln, Germany; Krankenhaus-St-Juergens-Strasse, Bremen, Germany; Univ of Hamburg, Hamburg, Germany; Univ of Leipzig, Leipzig, Germany; Evangelisches Krankenhaus Oldenburg, Oldenburg, Germany; Klin Kassel, Kassel, Germany; Univ of Wuerzburg, Wuerzburg, Germany; Landeskrankenhaus Klagenfurt, Klagenfurt, Austria
| | - R.-P. Mueller
- Univ of Cologne, Koeln, Germany; Krankenhaus-St-Juergens-Strasse, Bremen, Germany; Univ of Hamburg, Hamburg, Germany; Univ of Leipzig, Leipzig, Germany; Evangelisches Krankenhaus Oldenburg, Oldenburg, Germany; Klin Kassel, Kassel, Germany; Univ of Wuerzburg, Wuerzburg, Germany; Landeskrankenhaus Klagenfurt, Klagenfurt, Austria
| | - H. Stuetzer
- Univ of Cologne, Koeln, Germany; Krankenhaus-St-Juergens-Strasse, Bremen, Germany; Univ of Hamburg, Hamburg, Germany; Univ of Leipzig, Leipzig, Germany; Evangelisches Krankenhaus Oldenburg, Oldenburg, Germany; Klin Kassel, Kassel, Germany; Univ of Wuerzburg, Wuerzburg, Germany; Landeskrankenhaus Klagenfurt, Klagenfurt, Austria
| | - S. Staar
- Univ of Cologne, Koeln, Germany; Krankenhaus-St-Juergens-Strasse, Bremen, Germany; Univ of Hamburg, Hamburg, Germany; Univ of Leipzig, Leipzig, Germany; Evangelisches Krankenhaus Oldenburg, Oldenburg, Germany; Klin Kassel, Kassel, Germany; Univ of Wuerzburg, Wuerzburg, Germany; Landeskrankenhaus Klagenfurt, Klagenfurt, Austria
| | - U. Schroeder
- Univ of Cologne, Koeln, Germany; Krankenhaus-St-Juergens-Strasse, Bremen, Germany; Univ of Hamburg, Hamburg, Germany; Univ of Leipzig, Leipzig, Germany; Evangelisches Krankenhaus Oldenburg, Oldenburg, Germany; Klin Kassel, Kassel, Germany; Univ of Wuerzburg, Wuerzburg, Germany; Landeskrankenhaus Klagenfurt, Klagenfurt, Austria
| | - V. Rudat
- Univ of Cologne, Koeln, Germany; Krankenhaus-St-Juergens-Strasse, Bremen, Germany; Univ of Hamburg, Hamburg, Germany; Univ of Leipzig, Leipzig, Germany; Evangelisches Krankenhaus Oldenburg, Oldenburg, Germany; Klin Kassel, Kassel, Germany; Univ of Wuerzburg, Wuerzburg, Germany; Landeskrankenhaus Klagenfurt, Klagenfurt, Austria
| | - A. Dietz
- Univ of Cologne, Koeln, Germany; Krankenhaus-St-Juergens-Strasse, Bremen, Germany; Univ of Hamburg, Hamburg, Germany; Univ of Leipzig, Leipzig, Germany; Evangelisches Krankenhaus Oldenburg, Oldenburg, Germany; Klin Kassel, Kassel, Germany; Univ of Wuerzburg, Wuerzburg, Germany; Landeskrankenhaus Klagenfurt, Klagenfurt, Austria
| | - P. Volling
- Univ of Cologne, Koeln, Germany; Krankenhaus-St-Juergens-Strasse, Bremen, Germany; Univ of Hamburg, Hamburg, Germany; Univ of Leipzig, Leipzig, Germany; Evangelisches Krankenhaus Oldenburg, Oldenburg, Germany; Klin Kassel, Kassel, Germany; Univ of Wuerzburg, Wuerzburg, Germany; Landeskrankenhaus Klagenfurt, Klagenfurt, Austria
| | - M. Schroeder
- Univ of Cologne, Koeln, Germany; Krankenhaus-St-Juergens-Strasse, Bremen, Germany; Univ of Hamburg, Hamburg, Germany; Univ of Leipzig, Leipzig, Germany; Evangelisches Krankenhaus Oldenburg, Oldenburg, Germany; Klin Kassel, Kassel, Germany; Univ of Wuerzburg, Wuerzburg, Germany; Landeskrankenhaus Klagenfurt, Klagenfurt, Austria
| | - M. Flentje
- Univ of Cologne, Koeln, Germany; Krankenhaus-St-Juergens-Strasse, Bremen, Germany; Univ of Hamburg, Hamburg, Germany; Univ of Leipzig, Leipzig, Germany; Evangelisches Krankenhaus Oldenburg, Oldenburg, Germany; Klin Kassel, Kassel, Germany; Univ of Wuerzburg, Wuerzburg, Germany; Landeskrankenhaus Klagenfurt, Klagenfurt, Austria
| | - H. E. Eckel
- Univ of Cologne, Koeln, Germany; Krankenhaus-St-Juergens-Strasse, Bremen, Germany; Univ of Hamburg, Hamburg, Germany; Univ of Leipzig, Leipzig, Germany; Evangelisches Krankenhaus Oldenburg, Oldenburg, Germany; Klin Kassel, Kassel, Germany; Univ of Wuerzburg, Wuerzburg, Germany; Landeskrankenhaus Klagenfurt, Klagenfurt, Austria
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Semrau R, Mueller R, Stuetzer H, Schroeder U, Staar S, Rudat V, Dietz A, Volling P, Schroeder M, Flentje M, Eckel H. Ceiling effect of hemoglobin (Hb)-levels increasing efficacy of intensified hyperfractionated (HF) and accelerated (ACC) radiotherapy (RT) and concurrent chemotherapy with carboplatin and 5-FU - updated results of a randomized multicentric German trial in advanced head and neck cancer. Int J Radiat Oncol Biol Phys 2004. [DOI: 10.1016/j.ijrobp.2004.06.127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Zulkowski K, Kath R, Semrau R, Merkle K, Höffken K. Regression of brain metastases from breast carcinoma after chemotherapy with bendamustine. J Cancer Res Clin Oncol 2002; 128:111-3. [PMID: 11862482 DOI: 10.1007/s00432-001-0303-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2001] [Accepted: 10/04/2001] [Indexed: 10/27/2022]
Abstract
PURPOSE Bendamustinehydrochloride (bendamustine) is an alkylator with anticipated antimetabolic activity. It has shown activity in malignant lymphoma and breast cancer. Up to now there are no reports about the activity of bendamustine in the treatment of brain metastases. We report on a 38-year-old woman with brain metastases from breast cancer. The first diagnosis of an invasive ductal, hormone receptor negative breast cancer was made in October 1997, stage pT1c pN2 (11/11)cM0 - G3. After lumpectomy and resection of axillary lymph nodes, the patient received adjuvant chemo- and radiotherapy. Twenty six months after the first diagnosis, bone metastases occurred and were treated with radiotherapy. One month later, multiple liver metastases developed which were treated with trastuzumab and paclitaxel. Four months later, progress of the liver metastases and malignant infiltration of bone marrow with thrombopenia occurred. METHODS Chemotherapy with bendamustine at a dose of 150 mg/m(2) on day 1 and 2 was initiated. Two days later, the patient suffered from central facial palsy and subsequent computed tomography (CT) revealed three brain metastases in the frontal, parietal and occipital region. Because of the advanced liver metastases with clinical and laboratory signs of liver insufficiency and the reduced performance status of the patient, chemotherapy with bendamustine was continued and no local treatment of the brain metastases was performed. RESULTS After two courses of bendamustine, ultrasound showed regression of the liver metastases. Liver enzymes decreased, platelets increased, and the patient's performance status improved. Additionally, two of the three brain metastases were no longer detectable by CT, the third had decreased compared to the time of diagnosis. CONCLUSION To the best of our knowledge, this is the first report describing major activity of bendamustine in cerebral metastases. Thus, it may be considered as another therapeutic strategy against metastatic brain cancer. However, this finding warrants further investigation in clinical trials.
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Affiliation(s)
- K Zulkowski
- Klinik und Poliklinik für Innere Medizin II (Onkologie-Hämatologie-Endokrinologie-Stoffwechselerkrankungen) des Klinikums der Friedrich-Schiller-Universität Jena, Erlanger Allee 101, 07740 Jena, Germany
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Issa CM, Semrau R, Kath R, Höffken K. Isolated brain metastases as the sole manifestation of a late relapse in breast cancer. J Cancer Res Clin Oncol 2002; 128:61-3. [PMID: 11862474 DOI: 10.1007/s004320100286] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2000] [Accepted: 07/23/2001] [Indexed: 11/27/2022]
Abstract
We report on a 62-year-old female patient suffering from breast cancer (invasive ductal, premenopausal, estrogen- and progesterone-receptor status unknown) first diagnosed in July 1991. After mastectomy and axillary lymphonodectomy (pT2 N2 (12/15) M0 G2), adjuvant chemotherapy consisting of six courses epirubicin and cyclophosphamide was performed. Since 1993, serum Ca 15-3 levels began to climb slowly. As of June 1996, Ca 15-3 was measured 50.1 U/ml (normal value <28.0 U/ml). In routine follow-ups, Ca 15-3 increased slowly, but no metastases of the breast cancer could be detected. In September 2000, the patient attended a routine follow-up examination with poor performance status, presenting with ataxia and a psychic syndrome. Computed tomography revealed multiple suprasellar brain metastases. We conclude that this is an unusual case of a very late clinical manifestation of sole brain metastases in a patient with breast cancer. A slow preceding increase of Ca 15-3-level over a period of 7 years was the only indicator of the upcoming brain metastases.
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Affiliation(s)
- Charbel M Issa
- Klinik und Poliklinik für Innere Medizin II (Hämatologie, Onkologie, Endokrinologie und Stoffwechselerkrankungen), Klinikum der Friedrich-Schiller-Universität, Erlanger Allee 101, 07740 Jena
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