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Guckenberger M, Billiet C, Schnell D, Franzese C, Spałek M, Rogers S, Stelmes JJ, Aebersold DM, Hemmatazad H, Zimmermann F, Zimmer J, Zilli T, Bruni A, Baumert BG, Nägler F, Gut P, Förster R, Madani I. Dose-intensified stereotactic body radiotherapy for painful vertebral metastases: A randomized phase 3 trial. Cancer 2024. [PMID: 38581694 DOI: 10.1002/cncr.35310] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 01/25/2024] [Accepted: 03/12/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND The purpose of this randomised study was to determine whether dose-intensified stereotactic body radiotherapy (SBRT) for painful vertebral metastases results in increased rates of pain improvement compared with conventional external beam radiotherapy (cEBRT) (control) 6 months after treatment. METHODS This randomized, controlled phase 3 trial was conducted between November 2016 and January 2023, when it was stopped early. Patients were eligible if they were aged 18 years or older; had one or two painful, stable, or potentially unstable vertebral metastases; and had a life expectancy of 1 year or longer according to the investigator's estimates. Patients received 48.5 grays (Gy) in 10 fractions (with epidural involvement) or 40 Gy in five fractions (without epidural involvement) in the SBRT group and 30 Gy in 10 fractions or 20 Gy in five fractions in the cEBRT group, respectively. The primary end point was an improvement in the pain score at the treated site by at least 2 points (on a visual analog scale from 0 to 10 points) at 6-month follow-up. Data were analyzed on an intention-to-treat and per-protocol basis. RESULTS Of 214 patients who were screened for eligibility, 63 were randomized 1:1 between SBRT (33 patients with 36 metastases) and cEBRT (30 patients with 31 metastases). The median age of all patients was 66 years, and 40 patients were men (63.5%). In the intention-to-treat analysis, the 6-month proportion of patients who had metastases with pain reduction by 2 or more points was significantly higher in the SBRT group versus the control group (69.4% vs. 41.9%, respectively; two-sided p = .02). Changes in opioid medication intake relative to baseline were nonsignificant between the groups. No differences were observed in vertebral compression fracture or adverse event rates between the groups. CONCLUSIONS Dose-intensified SBRT improved pain score more effectively than cEBRT at 6 months.
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Affiliation(s)
- Matthias Guckenberger
- University Hospital Zurich, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
| | | | | | - Ciro Franzese
- Humanitas University, Humanitas Research Hospital IRCCS, Milan, Italy
| | - Mateusz Spałek
- Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | | | - Jean-Jacques Stelmes
- Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
- Luxemburg Health Directorate, Luxemburg, Luxemburg
| | - Daniel M Aebersold
- Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Hossein Hemmatazad
- Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | | | - Jörg Zimmer
- Städtisches Klinikum Dresden, Dresden, Germany
| | - Thomas Zilli
- Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
- Geneva University Hospital, Geneva, Switzerland
| | | | | | | | | | - Robert Förster
- University Hospital Zurich, Zurich, Switzerland
- Kantonsspital Winterthur, Winterthur, Switzerland
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Nobbe K, Erices-Leclercq M, Foerster F, Förster R, Baldus SE, Rudlowski C, Schröder L, Lubig S. HER2 Low Expression in Primary Male Breast Cancer. Breast Cancer (Dove Med Press) 2024; 16:141-148. [PMID: 38562651 PMCID: PMC10984208 DOI: 10.2147/bctt.s450682] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 02/27/2024] [Indexed: 04/04/2024]
Abstract
Purpose The introduction of HER2-targeting antibody drug conjugates (ADCs) offers new treatment options for female breast cancer patients (FBC) expressing low levels of HER2 (HER2 low). No evidence was found that HER2 low describes a new FBC subtype. There is a lack of studies determining the impact of HER2 low in male breast cancer (MBC). In this study, we evaluate the prevalence of HER2 low in primary MBC and correlate the results with patient characteristics. Patients and Methods In this study, histological specimens were obtained from 120 male patients diagnosed and treated for primary invasive breast cancer from 1995 to 2022 at Breast Cancer Units in Bergisch Gladbach, Chemnitz, and Zwickau, Germany. HER2 immunostaining and in situ hybridization were performed by central pathology and evaluated based on the ASCO/CAP guidelines. The correlation of expression of HER2 low with tumor biological characteristics and patient outcomes was investigated. Results Out of all cases, four patients (3.3%) showed HER2 positivity (3+), 39 (32.5%) patients were classified as HER2 low, 7 (5.8%) were HER2 2+ (no amplification), 32 (26.7%) were HER2 1+, and 77 (64.2%) were classified as HER2 zero. Out of 77 HER2 zero cases, 47 tumors (61.0%) showed incomplete staining, with <10% of tumor cells classified as HER2 ultralow. No statistical correlation between HER2 low and tumor biological characteristics and patients' survival was found. Conclusion Our findings show a notable, albeit lower, prevalence of HER2 low expression in primary MBC. However, tumors expressing HER2 low do not show specific tumor biological features to define a new breast cancer subtype in MBC. Our results suggest that a significant number of MBC patients could benefit from ADCs, as shown in FBC. Further studies are required to better understand HER2 low breast cancer, both generally and in MBC.
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Affiliation(s)
- Katleen Nobbe
- Breast Unit, Lutheran Hospital Bergisch Gladbach, Bergisch Gladbach, Germany
| | | | - Frank Foerster
- Department of Economical Sciences, University of Applied Sciences, Zwickau, Germany
- Outpatient Department of Gynaecological Oncology and Palliative Care, Chemnitz, Germany
| | - Robert Förster
- Institute for Radiation Oncology, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - Stephan E Baldus
- Institute for Pathology, Cytology and Molecular Pathology, Bergisch Gladbach, Germany
| | - Christian Rudlowski
- Breast Unit, Lutheran Hospital Bergisch Gladbach, Bergisch Gladbach, Germany
- Department of Gynecology, University Hospital Bonn, Bonn, Germany
| | - Lars Schröder
- Department of Gynaecology and Obstetrics, Ketteler Krankenhaus, Offenbach, Germany
| | - Sabine Lubig
- Breast Unit, Lutheran Hospital Bergisch Gladbach, Bergisch Gladbach, Germany
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Windisch P, Becker I, Tang H, Schröder C, Buchali A, Aebersold DM, Zwahlen DR, Förster R, Shelan M. Converting between the International Prostate Symptom Score (IPSS) and the Expanded Prostate Cancer Index Composite (EPIC) urinary subscales: modeling and external validation. BMC Urol 2024; 24:28. [PMID: 38310268 PMCID: PMC10837947 DOI: 10.1186/s12894-024-01421-y] [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: 10/07/2023] [Accepted: 01/30/2024] [Indexed: 02/05/2024] Open
Abstract
BACKGROUND Prostate-related quality of life can be assessed with a variety of different questionnaires. The 50-item Expanded Prostate Cancer Index Composite (EPIC) and the International Prostate Symptom Score (IPSS) are two widely used options. The goal of this study was, therefore, to develop and validate a model that is able to convert between the EPIC and the IPSS to enable comparisons across different studies. METHODS Three hundred forty-seven consecutive patients who had previously received radiotherapy and surgery for prostate cancer at two institutions in Switzerland and Germany were contacted via mail and instructed to complete both questionnaires. The Swiss cohort was used to train and internally validate different machine learning models using fourfold cross-validation. The German cohort was used for external validation. RESULTS Converting between the EPIC Urinary Irritative/Obstructive subscale and the IPSS using linear regressions resulted in mean absolute errors (MAEs) of 3.88 and 6.12, which is below the respective previously published minimal important differences (MIDs) of 5.2 and 10 points. Converting between the EPIC Urinary Summary and the IPSS was less accurate with MAEs of 5.13 and 10.45, similar to the MIDs. More complex model architectures did not result in improved performance in this study. The study was limited to the German versions of the respective questionnaires. CONCLUSIONS Linear regressions can be used to convert between the IPSS and the EPIC Urinary subscales. While the equations obtained in this study can be used to compare results across clinical trials, they should not be used to inform clinical decision-making in individual patients. TRIAL REGISTRATION This study was retrospectively registered on clinicaltrials.gov on January 14th, 2022, under the registration number NCT05192876.
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Affiliation(s)
- Paul Windisch
- Department of Radiation Oncology, Cantonal Hospital Winterthur, Brauerstrasse 15, Haus R, 8400, Winterthur, Switzerland.
| | - Ivo Becker
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Hongjian Tang
- Department of Radiation Oncology, Cantonal Hospital Winterthur, Brauerstrasse 15, Haus R, 8400, Winterthur, Switzerland
| | - Christina Schröder
- Department of Radiation Oncology, Cantonal Hospital Winterthur, Brauerstrasse 15, Haus R, 8400, Winterthur, Switzerland
| | - André Buchali
- Department of Radiation Oncology, Ruppiner Kliniken GmbH, Brandenburg Medical School (MHB), Neuruppin, Germany
| | - Daniel M Aebersold
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Daniel R Zwahlen
- Department of Radiation Oncology, Cantonal Hospital Winterthur, Brauerstrasse 15, Haus R, 8400, Winterthur, Switzerland
| | - Robert Förster
- Department of Radiation Oncology, Cantonal Hospital Winterthur, Brauerstrasse 15, Haus R, 8400, Winterthur, Switzerland
| | - Mohamed Shelan
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Schröder C, Mose L, Mathier E, Zwahlen DR, Aebersold DM, Förster R, Shelan M. Five Fractions versus Seven Fractions SBRT for Intermediate- and High-Risk Prostate Cancer: A Propensity Score Matched Pair Analysis. Cancers (Basel) 2023; 15:5815. [PMID: 38136360 PMCID: PMC10741876 DOI: 10.3390/cancers15245815] [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: 11/22/2023] [Revised: 12/07/2023] [Accepted: 12/09/2023] [Indexed: 12/24/2023] Open
Abstract
PURPOSE To compare two stereotactic body radiotherapy (SBRT) regimens in patients with intermediate- or high-risk prostate cancer with regards toxicity and efficacy. METHODS/MATERIAL We retrospectively collected data from 198 patients treated with SBRT for prostate cancer at two different institutions. Patients received either 35-36.25 Gy in five fractions (group A) using Cyberknife robotic platform or 42.7 Gy in seven fractions (group B) using a C-arm LINAC (image-guided). Propensity score matching was done (2:1 nearest neighbor matching without replacement), resulting in 120 patients (80 patients for group A, 40 patients for group B). Toxicity, PSA nadir, biochemical failure and disease-free survival (DFS) were analyzed. RESULTS Median follow up of all patients was 13 months (range 1-91 months). Overall, 23.3% of patients had ≥G2 acute GU toxicity (21.1% group A versus 30% group B (p = 0.222)) and 6.6% of patients ≥G2 GI toxicity (2.5% versus 15% (p = 0.010)). There was one acute G3 GU toxicity in arm A and one acute G4 rectal bleeding in group B (anticoagulated patient). Regarding late toxicity, 14.1% of patients had ≥G2 late GU toxicity (17.4% versus 6.6% (p = 0.159)) and 5.0% of patients had ≥G2 late GI toxicity (1.4% versus 13.3% (p = 0.013)). There was one G3 late GU toxicity in arm B and two G3 late GI toxicities, one in each arm. Relative median PSA reduction was 92.4% (-53.9-99.9%) from baseline PSA (93.7% (-53.9-99.9%) in group A versus 87.7% (39.8-99.9%) in group B (p = 0.043). In total, 4.2% of patients had biochemical relapse, 5.0% in group A and 2.5% in group B (p = 0.518). One-year DFS in the overall cohort was 97.3%, 98.8% in group A and 94.3% in group B (p = 0.318). CONCLUSION Both SBRT regimens have acceptable acute and late toxicity and good efficacy. There are significantly more GI toxicities in the seven-fraction regimen. Longer follow-up is warranted for better comparison of long-term efficacy.
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Affiliation(s)
- Christina Schröder
- Department of Radiation Oncology, Cantonal Hospital Winterthur, 8400 Winterthur, Switzerland
| | - Lucas Mose
- Department of Radiation Oncology, Inselspital/Bern University Hospital, University of Bern, CH-3010 Bern, Switzerland; (L.M.); (M.S.)
| | - Etienne Mathier
- Department of Radiation Oncology, Inselspital/Bern University Hospital, University of Bern, CH-3010 Bern, Switzerland; (L.M.); (M.S.)
| | - Daniel Rudolf Zwahlen
- Department of Radiation Oncology, Cantonal Hospital Winterthur, 8400 Winterthur, Switzerland
| | - Daniel Matthias Aebersold
- Department of Radiation Oncology, Inselspital/Bern University Hospital, University of Bern, CH-3010 Bern, Switzerland; (L.M.); (M.S.)
| | - Robert Förster
- Department of Radiation Oncology, Cantonal Hospital Winterthur, 8400 Winterthur, Switzerland
| | - Mohamed Shelan
- Department of Radiation Oncology, Inselspital/Bern University Hospital, University of Bern, CH-3010 Bern, Switzerland; (L.M.); (M.S.)
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Hanke L, Tang H, Schröder C, Windisch P, Kudura K, Shelan M, Buchali A, Bodis S, Förster R, Zwahlen DR. Dose-Volume Histogram Parameters and Quality of Life in Patients with Prostate Cancer Treated with Surgery and High-Dose Volumetric-Intensity-Modulated Arc Therapy to the Prostate Bed. Cancers (Basel) 2023; 15:3454. [PMID: 37444564 DOI: 10.3390/cancers15133454] [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: 05/19/2023] [Revised: 06/28/2023] [Accepted: 06/28/2023] [Indexed: 07/15/2023] Open
Abstract
INTRODUCTION Prostate bed radiotherapy (RT) is a major affecter of patients' long-term quality of life (QoL). To ensure the best possible outcome of these patients, dose constraints are key for optimal RT planning and delivery. However, establishing refined dose constraints requires access to patient-level data. Therefore, we aimed to provide such data on the relationship between OAR and gastrointestinal (GI) as well as genitourinary (GU) QoL outcomes of a homogenous patient cohort who received dose-intensified post-operative RT to the prostate bed. Furthermore, we aimed to conduct an exploratory analysis of the resulting data. METHODS Patients who were treated with prostate bed RT between 2010 and 2020 were inquired about their QoL based on the Expanded Prostate Cancer Index Composite (EPIC). Those (n = 99) who received volumetric arc therapy (VMAT) of at least 70 Gy to the prostate bed were included. Dose-volume histogram (DVH) parameters were gathered and correlated with the EPIC scores. RESULTS The median age at the time of prostate bed RT was 68.9 years, and patients were inquired about their QoL in the median 2.3 years after RT. The median pre-RT prostate-specific antigen (PSA) serum level was 0.35 ng/mL. The median duration between surgery and RT was 1.5 years. The median prescribed dose to the prostate bed was 72 Gy. A total of 61.6% received prostate bed RT only. For the bladder, the highest level of statistical correlation (p < 0.01) was seen for V10-20Gy, Dmean and Dmedian with urinary QoL. For bladder wall, the highest level of statistically significant correlation (p < 0.01) was seen for V5-25Gy, Dmean and Dmedian with urinary QoL. Penile bulb V70Gy was statistically significantly correlated with sexual QoL (p < 0.05). A larger rectal volume was significantly correlated with improved bowel QoL (p < 0.05). Sigmoid and urethral DVH parameters as well as the surgical approach were not statistically significantly correlated with QoL. CONCLUSION Specific dose constraints for bladder volumes receiving low doses seem desirable for the further optimization of prostate bed RT. This may be particularly relevant in the context of the aspiration of establishing focal RT of prostate cancer and its local recurrences. Our comprehensive dataset may aid future researchers in achieving these goals.
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Affiliation(s)
- Luca Hanke
- Department of Radiation Oncology, Cantonal Hospital Winterthur, Brauerstrasse 15, 8401 Winterthur, Switzerland
| | - Hongjian Tang
- Department of Radiation Oncology, Cantonal Hospital Winterthur, Brauerstrasse 15, 8401 Winterthur, Switzerland
| | - Christina Schröder
- Department of Radiation Oncology, Cantonal Hospital Winterthur, Brauerstrasse 15, 8401 Winterthur, Switzerland
| | - Paul Windisch
- Department of Radiation Oncology, Cantonal Hospital Winterthur, Brauerstrasse 15, 8401 Winterthur, Switzerland
| | - Ken Kudura
- Department of Nuclear Medicine, Sankt Clara Hospital, Kleinriehenstrasse 30, 4058 Basel, Switzerland
| | - Mohamed Shelan
- Department of Radiation Oncology, Inselspital, University Hospital Bern, Freiburgstrasse 18, 3010 Bern, Switzerland
| | - André Buchali
- Department of Radiation Oncology, University Hospital Ruppin-Brandenburg, Fehrbelliner Strasse 38, 16816 Neuruppin, Germany
| | - Stephan Bodis
- Department of Radiation Oncology, Cantonal Hospital Aarau, Tellstrasse 25, 5001 Aarau, Switzerland
| | - Robert Förster
- Department of Radiation Oncology, Cantonal Hospital Winterthur, Brauerstrasse 15, 8401 Winterthur, Switzerland
| | - Daniel R Zwahlen
- Department of Radiation Oncology, Cantonal Hospital Winterthur, Brauerstrasse 15, 8401 Winterthur, Switzerland
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Scolari C, Buchali A, Franzen A, Förster R, Windisch P, Bodis S, Zwahlen DR, Schröder C. Re-irradiation for head and neck cancer: outcome and toxicity analysis using a prospective single institution database. Front Oncol 2023; 13:1175609. [PMID: 37456239 PMCID: PMC10346436 DOI: 10.3389/fonc.2023.1175609] [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: 02/27/2023] [Accepted: 06/05/2023] [Indexed: 07/18/2023] Open
Abstract
Purpose Re-irradiation (re-RT) in head and neck cancer is challenging. This study prospectively explored the feasibility of re-RT in patients with loco-regionally recurrent or second primary head and neck cancer (LRR/SP HNC). Methods From 2004 to 2021, 61 LRR/SP HNC patients were treated with re-RT, defined as having a second course of RT with curative intent resulting in a cumulative dose of ≥100 Gy in an overlapping volume. Postoperative or definitive dynamic intensity-modulated and/or volumetric modulated re-RT was administered using twice daily hyperfractionation to 60 Gy combined with cisplatin or carboplatin/5-fluorouracil. Overall survival (OS), progression-free survival (PFS), locoregional control (LRC) and distant metastasis control (DMC) were analyzed and prognostic factors evaluated. Toxicity was prospectively recorded and graded. Results The median follow-up was 9.8 months. In 41 patients (67.1%), complete administration of the intended treatment was not feasible. In 9 patients (15%) re-RT was interrupted prematurely and in other 9, the complete re-RT dose was lower than 60 Gy, and 37 patients (61%) could not receive or complete chemotherapy. Two-year OS, PFS and LRC rates were 19%, 18% and 30%, respectively. 20 patients (33%) received the complete intended treatment, and 1- and 2-year OS rates were 70% and 47%, respectively. Charlson comorbidity index was an important predictor for treatment completion. Multivariate analysis revealed recurrent N stage 0-1, age, chemotherapy administration and re-RT dose of 60 Gy as prognostic factors for clinical outcomes. No grade 5 re-RT-related toxicity was observed. The most common new grade ≥3 acute toxicities were dysphagia (52%) and mucositis (46%). Late toxicity included grade ≥3 dysphagia in 5% and osteoradionecrosis in 10% of evaluable patients, respectively. 6 patients (10%) were alive after 9 years without progression and no late toxicity grade ≥3, except for 2 patients presenting with osteoradionecrosis. Conclusion Hyperfractionated re-RT with 60 Gy combined with platinum-based chemotherapy was a curative treatment option with acceptable toxicity in LRR/SP patients. Patients with higher comorbidity had a higher probability of failing to receive and complete the intended therapy. Consequently, they derived unsatisfactory benefits from re-RT, highlighting the importance of patient selection.
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Affiliation(s)
- Chiara Scolari
- Department of Radiation Oncology, University Hospital Ruppin-Brandenburg, Brandenburg Medical School Theodor Fontane (MHB), Neuruppin, Germany
- Department of Radiation Oncology, Cantonal Hospital Winterthur (KSW), Winterthur, Switzerland
| | - André Buchali
- Department of Radiation Oncology, University Hospital Ruppin-Brandenburg, Brandenburg Medical School Theodor Fontane (MHB), Neuruppin, Germany
| | - Achim Franzen
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital Ruppin-Brandenburg, Brandenburg Medical School Theodor Fontane (MHB), Neuruppin, Germany
- Faculty of Health Sciences Brandenburg, Joint Faculty of the University of Potsdam, Brandenburg university of Technology Cottbus-Senftenberg and Brandenburg Medical School, Potsdam, Germany
| | - Robert Förster
- Department of Radiation Oncology, Cantonal Hospital Winterthur (KSW), Winterthur, Switzerland
| | - Paul Windisch
- Department of Radiation Oncology, Cantonal Hospital Winterthur (KSW), Winterthur, Switzerland
| | - Stephan Bodis
- Center for Radiation Oncology, Cantonal Hospital Aarau and Baden (KSA-KSB), Aarau/Baden, Switzerland
| | - Daniel R. Zwahlen
- Department of Radiation Oncology, Cantonal Hospital Winterthur (KSW), Winterthur, Switzerland
| | - Christina Schröder
- Department of Radiation Oncology, Cantonal Hospital Winterthur (KSW), Winterthur, Switzerland
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Schröder C, Förster R, Zwahlen DR, Windisch P. The Apple Watch spO 2 sensor and outliers in healthy users. NPJ Digit Med 2023; 6:63. [PMID: 37031281 PMCID: PMC10082785 DOI: 10.1038/s41746-023-00814-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 03/30/2023] [Indexed: 04/10/2023] Open
Abstract
It is unclear how frequently the Apple Watch produces spO2 measurements outside of the normal range in healthy individuals at rest. We conducted a head-to-head comparison in 38 healthy individuals between two watches and two medical-grade pulse oximeters. Fourteen percent of watch measurements yielded spO2 values below 95%, with no values below 92%. Results suggest that outliers measured by the watch should not be a cause for concern in otherwise healthy individuals.
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Affiliation(s)
- Christina Schröder
- Department of Radiation Oncology, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Robert Förster
- Department of Radiation Oncology, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Daniel R Zwahlen
- Department of Radiation Oncology, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Paul Windisch
- Department of Radiation Oncology, Kantonsspital Winterthur, Winterthur, Switzerland.
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Windisch P, Schröder C, Förster R, Cihoric N, Zwahlen DR. Accuracy of the Apple Watch Oxygen Saturation Measurement in Adults: A Systematic Review. Cureus 2023; 15:e35355. [PMID: 36974257 PMCID: PMC10039641 DOI: 10.7759/cureus.35355] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2023] [Indexed: 02/25/2023] Open
Abstract
The purpose of this review is to summarize the research on the accuracy of oxygen saturation (spO2) measurements using the Apple Watch (Apple Inc., Cupertino, California). The Medline and Google Scholar databases were searched for papers evaluating the spO2 measurements of the Apple Watch vs. any kind of ground truth and records were analyzed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The five publications with 973 total patients that met the inclusion criteria all used the Apple Watch Series 6 and described 95% limits of agreement of +/- 2.7 to 5.9% spO2. However, outliers of up to 15% spO2 were reported. Only one study had patient-level data uploaded to a public repository. The Apple Watch Series 6 does not show a strong systematic bias compared to conventional, medical-grade pulse oximeters. However, outliers do occur and should not cause concern in otherwise healthy individuals. The impact of race on measurement accuracy should be investigated.
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Affiliation(s)
- Paul Windisch
- Department of Radiation Oncology, Kantonsspital Winterthur, Winterthur, CHE
| | - Christina Schröder
- Department of Radiation Oncology, Kantonsspital Winterthur, Winterthur, CHE
| | - Robert Förster
- Department of Radiation Oncology, Kantonsspital Winterthur, Winterthur, CHE
| | - Nikola Cihoric
- Department of Radiation Oncology, Inselspital, University Hospital of Bern, Bern, CHE
| | - Daniel R Zwahlen
- Department of Radiation Oncology, Kantonsspital Winterthur, Winterthur, CHE
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Schröder C, Windisch P, Lütscher J, Zwahlen DR, Förster R. Validation and discussion of clinical practicability of the 2022 graded prognostic assessment for NSCLC adenocarcinoma patients with brain metastases in a routine clinical cohort. Front Oncol 2023; 13:1042548. [PMID: 37020868 PMCID: PMC10067866 DOI: 10.3389/fonc.2023.1042548] [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: 09/12/2022] [Accepted: 02/16/2023] [Indexed: 04/07/2023] Open
Abstract
Introduction The goal of this analysis is to validate the 2022 graded prognostic assessment (GPA) for patients with brain metastases from adenocarcinoma of the lung and to discuss its clinical practicability. Methods/material 137 patients with adenocarcinoma of the lung were included in this analysis. The disease specific GPA for NSCLC, Lung-molGPA and the GPA for NSCLC adenocarcinoma were calculated. Overall survival was calculated for each GPA group. Additionally, expected and actual OS in the prognostic groups of the GPA available at the time of the patients' diagnosis was compared. Results Median overall survival (OS) from diagnosis of brain metastases was 15 months (95% confidence interval (CI) 9.7-20.3 months). The median OS in the three individual prognostic groups was 7 months for GPA 0-1, 16 months for GPA 1.5-2, 33 months for GPA 2.5-3 and not reached for GPA 3.5-4 (p<0.001). Median survival times for the individual groups were similar to those published in the original GPA publication. Regarding the expected and actual OS when using the available GPA at the time of diagnosis there was an underestimation of survival of more than 3 months for all except the worst prognosis group. Conclusion We were able to validate the 2022 GPA for NSCLC adenocarcinoma patients with brain metastases in a similar cohort from a non-academic center. However, the practical applicability regarding the expected median OS might be limited due to the constantly evolving treatment landscape and the consecutive improvement in overall survival.
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Gabryś HS, Basler L, Burgermeister S, Hogan S, Ahmadsei M, Pavic M, Bogowicz M, Vuong D, Tanadini-Lang S, Förster R, Kudura K, Huellner M, Dummer R, Levesque MP, Guckenberger M. PET/CT radiomics for prediction of hyperprogression in metastatic melanoma patients treated with immune checkpoint inhibitors. Front Oncol 2022; 12:977822. [PMID: 36505821 PMCID: PMC9730880 DOI: 10.3389/fonc.2022.977822] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 06/24/2022] [Accepted: 11/03/2022] [Indexed: 11/27/2022] Open
Abstract
Purpose This study evaluated pretreatment 2[18F]fluoro-2-deoxy-D-glucose (FDG)-PET/CT-based radiomic signatures for prediction of hyperprogression in metastatic melanoma patients treated with immune checkpoint inhibition (ICI). Material and method Fifty-six consecutive metastatic melanoma patients treated with ICI and available imaging were included in the study and 330 metastatic lesions were individually, fully segmented on pre-treatment CT and FDG-PET imaging. Lesion hyperprogression (HPL) was defined as lesion progression according to RECIST 1.1 and doubling of tumor growth rate. Patient hyperprogression (PD-HPD) was defined as progressive disease (PD) according to RECIST 1.1 and presence of at least one HPL. Patient survival was evaluated with Kaplan-Meier curves. Mortality risk of PD-HPD status was assessed by estimation of hazard ratio (HR). Furthermore, we assessed with Fisher test and Mann-Whitney U test if demographic or treatment parameters were different between PD-HPD and the remaining patients. Pre-treatment PET/CT-based radiomic signatures were used to build models predicting HPL at three months after start of treatment. The models were internally validated with nested cross-validation. The performance metric was the area under receiver operating characteristic curve (AUC). Results PD-HPD patients constituted 57.1% of all PD patients. PD-HPD was negatively related to patient overall survival with HR=8.52 (95%CI 3.47-20.94). Sixty-nine lesions (20.9%) were identified as progressing at 3 months. Twenty-nine of these lesions were classified as hyperprogressive, thereby showing a HPL rate of 8.8%. CT-based, PET-based, and PET/CT-based models predicting HPL at three months after the start of treatment achieved testing AUC of 0.703 +/- 0.054, 0.516 +/- 0.061, and 0.704 +/- 0.070, respectively. The best performing models relied mostly on CT-based histogram features. Conclusions FDG-PET/CT-based radiomic signatures yield potential for pretreatment prediction of lesion hyperprogression, which may contribute to reducing the risk of delayed treatment adaptation in metastatic melanoma patients treated with ICI.
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Affiliation(s)
- H. S. Gabryś
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - L. Basler
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - S. Burgermeister
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - S. Hogan
- Department of Dermatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - M. Ahmadsei
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - M. Pavic
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - M. Bogowicz
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - D. Vuong
- 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
| | - R. Förster
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - K. Kudura
- Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - M. Huellner
- Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - R. Dummer
- Department of Dermatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - M. P. Levesque
- Department of Dermatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - M. Guckenberger
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland,*Correspondence: M. Guckenberger,
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11
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Schröder C, Kirschke S, Blank E, Rohrberg S, Förster R, Buchali A. Deep inspiration breath-hold for patients with left-sided breast cancer - A one-fits-all approach? A prospective analysis of patient selection using dosimetrical and practical aspects. Br J Radiol 2022; 95:20210295. [PMID: 34111954 PMCID: PMC10996328 DOI: 10.1259/bjr.20210295] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 05/05/2021] [Accepted: 05/13/2021] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To prospectively analyze the feasibility of an algorithm for patient preparation, treatment planning, and selection for deep inspiration breath-hold (DIBH) treatment of left-sided breast cancer. METHODS From February 2017 to July 2019, 135 patients with left-sided breast cancer were selected and prepared for radiotherapy in DIBH. 99 received radiotherapy for the breast alone and 36 for the breast including the lymphatic drainage (RNI). Treatment plans DIBH and free breathing (FB) were calculated. Dosimetrical analyses were performed, and criteria were defined to assess whether a patient would dosimetrically profit from DIBH. RESULTS Of the 135 patients, 97 received a DIBH planning CT and 72 were selected for treatment in DIBH according to predefined criteria. When using DIBH, there was a mean reduction of the DmeanHeart of 2.8 Gy and DmeanLAD of 4.2 Gy. seven patients did not benefit from DIBH regarding DmeanHeart, 23 regarding DmeanLAD. For the left lung, the V20Gy was reduced by 4.9%, the V30Gy by 2.7% with 15 and 29 patients not benefiting from DIBH, respectively. In the 25 patients treated in FB, the benefit of DIBH would have been lower than for patients treated with DIBH (ΔDmeanHeart0.7 Gy vs 3.4 Gy). CONCLUSION Dosimetrically, DIBH is no "one-fits-all" approach. However, there is a statistically significant benefit when looking at a larger patient population. DIBH should be used for treatment of left-sided breast cancer in patients fit for DIBH. ADVANCES IN KNOWLEDGE This analysis offers a well-designed dosimetrical analysis in patients treated with DIBH radiotherapy in an "every day" cohort.
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Affiliation(s)
- Christina Schröder
- Clinic for Radiotherapy and Radiation Oncology, Ruppiner
Kliniken GmbH, University Hospital of the Medizinische Hochschule
Theodor Fontane Brandenburg,
Neuruppin, Germany
- Institute of Radiation Oncology, Cantonal Hospital Winterthur
(KSW), Brauerstrasse 15, 8401
Winterthur, Switzerland
| | - Sebastian Kirschke
- Clinic for Radiotherapy and Radiation Oncology, Ruppiner
Kliniken GmbH, University Hospital of the Medizinische Hochschule
Theodor Fontane Brandenburg,
Neuruppin, Germany
| | - Eyck Blank
- Clinic for Radiotherapy and Radiation Oncology, Ruppiner
Kliniken GmbH, University Hospital of the Medizinische Hochschule
Theodor Fontane Brandenburg,
Neuruppin, Germany
| | - Sophia Rohrberg
- Clinic for Radiotherapy and Radiation Oncology, Ruppiner
Kliniken GmbH, University Hospital of the Medizinische Hochschule
Theodor Fontane Brandenburg,
Neuruppin, Germany
| | - Robert Förster
- Institute of Radiation Oncology, Cantonal Hospital Winterthur
(KSW), Brauerstrasse 15, 8401
Winterthur, Switzerland
- Medical Faculty, University of Zurich (UZH), Pestalozzistrasse
3/5, 8091 Zurich,
Switzerland
| | - André Buchali
- Clinic for Radiotherapy and Radiation Oncology, Ruppiner
Kliniken GmbH, University Hospital of the Medizinische Hochschule
Theodor Fontane Brandenburg,
Neuruppin, Germany
- Medizinische Hochschule Theodor Fontane
Brandenburg, Neuruppin,
Germany
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12
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Braeker N, Schmitz C, Wagner N, Stanicki BJ, Schröder C, Ehret F, Fürweger C, Zwahlen DR, Förster R, Muacevic A, Windisch P. Classifying the Acquisition Sequence for Brain MRIs Using Neural Networks on Single Slices. Cureus 2022; 14:e22435. [PMID: 35345703 PMCID: PMC8941825 DOI: 10.7759/cureus.22435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2022] [Indexed: 11/13/2022] Open
Abstract
Background Neural networks for analyzing MRIs are oftentimes trained on particular combinations of perspectives and acquisition sequences. Since real-world data are less structured and do not follow a standard denomination of acquisition sequences, this impedes the transition from deep learning research to clinical application. The purpose of this study is therefore to assess the feasibility of classifying the acquisition sequence from a single MRI slice using convolutional neural networks. Methods A total of 113 MRI slices from 52 patients were used in a transfer learning approach to train three convolutional neural networks of different complexities to predict the acquisition sequence, while 27 slices were used for internal validation. The model then underwent external validation on 600 slices from 273 patients belonging to one of four classes (T1-weighted without contrast enhancement, T1-weighted with contrast enhancement, T2-weighted, and diffusion-weighted). Categorical accuracy was noted, and the results of the predictions for the validation set are provided with confusion matrices. Results The neural networks achieved a categorical accuracy of 0.79, 0.81, and 0.84 on the external validation data. The implementation of Grad-CAM showed no clear pattern of focus except for T2-weighted slices, where the network focused on areas containing cerebrospinal fluid. Conclusion Automatically classifying the acquisition sequence using neural networks seems feasible and could be used to facilitate the automatic labelling of MRI data.
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13
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Schröder C, Tang H, Windisch P, Zwahlen DR, Buchali A, Vu E, Bostel T, Sprave T, Zilli T, Murthy V, Förster R. Stereotactic Radiotherapy after Radical Prostatectomy in Patients with Prostate Cancer in the Adjuvant or Salvage Setting: A Systematic Review. Cancers (Basel) 2022; 14:cancers14030696. [PMID: 35158961 PMCID: PMC8833497 DOI: 10.3390/cancers14030696] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 01/22/2022] [Accepted: 01/26/2022] [Indexed: 12/04/2022] Open
Abstract
Simple Summary Stereotactic body radiotherapy, a type of high-precision radiotherapy delivering high doses within few treatment sessions has proven to be effective and well tolerated in prostate cancer patients treated with definite radiotherapy. This systematic review summarizes the available data and analyzes whether this modern treatment may routinely be offered to prostate cancer patients after radical prostatectomy. Abstract (1) Background: Prostate cancer is the most common cancer in men and can be treated with radical prostatectomy (RPE) or radiotherapy in the primary setting. Stereotactic radiotherapy (SBRT) has proven to be effective and well tolerated in this setting. However, if SBRT is an equally promising treatment option if applied in the adjuvant or salvage setting after RPE remains unknown. (2) Methods: We searched the PubMed and Embase databases with the following full-text queries in August 2021 for any combination of the terms “SBRT”, “prostate”, “adjuvant”, “postoperative”, “salvage”, “stereotactic radiotherapy”, “prostate bed”. There were no limitations regarding publication date or language. We adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations. (3) Results: We identified 11 individual studies that were included in this systematic review. Three publications included patients without prior radiotherapy and the remaining eight patients with prior radiotherapy. In all but two publications the radiation target was the macroscopic recurrence. SBRT was overall well tolerated with acceptable rates of acute and late gastrointestinal or genitourinary toxicity. Quality of life was published for two phase I trials with good results. There was a very heterogeneous reporting on biochemical control after SBRT. (4) Conclusions: At this point, ultra-hypofractionated RT using SBRT to the prostate bed remains experimental and its use should be restricted to clinical trials. Given the biological rationale for extreme hypofractionation in patients with prostate cancer and the acceptable toxicity rates that have been reported, further exploration of this field is warranted.
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Affiliation(s)
- Christina Schröder
- Institute for Radiation Oncology, Cantonal Hospital Winterthur (KSW), 8400 Winterthur, Switzerland; (C.S.); (H.T.); (P.W.); (D.R.Z.)
| | - Hongjian Tang
- Institute for Radiation Oncology, Cantonal Hospital Winterthur (KSW), 8400 Winterthur, Switzerland; (C.S.); (H.T.); (P.W.); (D.R.Z.)
| | - Paul Windisch
- Institute for Radiation Oncology, Cantonal Hospital Winterthur (KSW), 8400 Winterthur, Switzerland; (C.S.); (H.T.); (P.W.); (D.R.Z.)
| | - Daniel Rudolf Zwahlen
- Institute for Radiation Oncology, Cantonal Hospital Winterthur (KSW), 8400 Winterthur, Switzerland; (C.S.); (H.T.); (P.W.); (D.R.Z.)
| | - André Buchali
- Department of Radiation Oncology, Ruppiner Kliniken GmbH, Brandenburg Medical School (MHB), 16816 Neuruppin, Germany;
| | - Erwin Vu
- Department of Radiation Oncology, Cantonal Hospital St. Gallen (KSSG), 9000 St. Gallen, Switzerland;
| | - Tilman Bostel
- Department of Radiation Oncology, University Hospital Mainz, 55131 Mainz, Germany;
| | - Tanja Sprave
- Department of Radiation Oncology, University Hospital Freiburg, 79106 Freiburg im Breisgau, Germany;
| | - Thomas Zilli
- Department of Radiation Oncology, University Hospital Geneva (HUG), 1205 Geneva, Switzerland;
| | - Vedang Murthy
- Department of Radiation Oncology, Tata Memorial Hospital and Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Homi Bhabha National Institute (HBNI), Mumbai 400012, India;
| | - Robert Förster
- Institute for Radiation Oncology, Cantonal Hospital Winterthur (KSW), 8400 Winterthur, Switzerland; (C.S.); (H.T.); (P.W.); (D.R.Z.)
- Correspondence: ; Tel.: +41-52-266-31-40
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14
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Bostel T, Akbaba S, Wollschläger D, Klodt T, Oebel L, Mayer A, Drabke S, Sprave T, Debus J, Förster R, Rief H, Rühle A, Grosu AL, Schmidberger H, Nicolay NH. Comparative Analyses of Two Established Scores to Assess the Stability of Spinal Bone Metastases Before and After Palliative Radiotherapy. Front Oncol 2021; 11:753768. [PMID: 34737961 PMCID: PMC8562722 DOI: 10.3389/fonc.2021.753768] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 09/21/2021] [Indexed: 11/21/2022] Open
Abstract
Background and Purpose To compare two validated spinal instability scores regarding the stabilizing effects and skeletal-related events (SREs) of palliative radiotherapy (RT) in patients with spinal bone metastases (SBM). Materials and Methods Two hundred eighty-two osteolytic SBM of lung or breast cancer patients were analyzed for stability before and following RT based on the Spinal Instability Neoplastic Score (SINS) or the Taneichi score. Score concordance was quantified by absolute agreement and Cohen’s kappa coefficient. SREs were defined as fractures or local progression after RT. OS was quantified as the time between the start of RT and death from any cause. Results At 3 and 6 months after RT, 35 and 50% of initially unstable SBM were re-stabilized according to SINS in patients still alive. Corresponding Taneichi score-based stabilization proportions were 25 and 46%, respectively. Comparison of both stability scores showed high absolute agreement for all time-points (range 71–78%, kappa range 0.35–0.44). SRE occurred more frequently in initially unstable SBM compared to stable SBM according to SINS (14 vs. 5%), but no such association could be shown for the Taneichi-based instability criterion. Poor general condition of patients was negatively associated with SINS-measured re-stabilization after 6 months, but no predictive factor for re-stabilization could be found for the Taneichi score. Conclusions Despite the relatively high agreement between both stabilization scores, the SINS should be considered the standard for future studies on the stabilization effects of RT in SBM.
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Affiliation(s)
- Tilman Bostel
- Department of Radiation Oncology and Radiation Therapy, University Medical Center Mainz, Mainz, Germany.,German Cancer Consortium (DKTK) Partner Site Mainz, German Cancer Research Center, Heidelberg, Germany
| | - Sati Akbaba
- Department of Radiation Oncology and Radiation Therapy, University Medical Center Mainz, Mainz, Germany.,German Cancer Consortium (DKTK) Partner Site Mainz, German Cancer Research Center, Heidelberg, Germany
| | - Daniel Wollschläger
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center Mainz, Mainz, Germany
| | - Tristan Klodt
- Department of Radiation Oncology and Radiation Therapy, University Medical Center Mainz, Mainz, Germany.,German Cancer Consortium (DKTK) Partner Site Mainz, German Cancer Research Center, Heidelberg, Germany
| | - Laura Oebel
- Department of Radiation Oncology and Radiation Therapy, University Medical Center Mainz, Mainz, Germany.,German Cancer Consortium (DKTK) Partner Site Mainz, German Cancer Research Center, Heidelberg, Germany
| | - Arnulf Mayer
- Department of Radiation Oncology and Radiation Therapy, University Medical Center Mainz, Mainz, Germany.,German Cancer Consortium (DKTK) Partner Site Mainz, German Cancer Research Center, Heidelberg, Germany
| | - Sophia Drabke
- Department of Radiation Oncology and Radiation Therapy, University Medical Center Mainz, Mainz, Germany.,German Cancer Consortium (DKTK) Partner Site Mainz, German Cancer Research Center, Heidelberg, Germany
| | - Tanja Sprave
- Department of Radiation Oncology, University Hospital of Freiburg, Freiburg, Germany.,German Cancer Consortium (DKTK) Partner Site Freiburg, German Cancer Research Center, Heidelberg, Germany
| | - Jürgen Debus
- Department of Radiation Oncology, University Hospital of Heidelberg, Heidelberg, Germany.,German Cancer Consortium (DKTK) Partner Site Heidelberg, German Cancer Research Center, Heidelberg, Germany
| | - Robert Förster
- Institute of Radiation Oncology, Cantonal Hospital Winterthur, University of Zurich, Winterthur, Switzerland
| | - Harald Rief
- Radiation Therapy Practice Bonn-Rhein-Sieg, Bad Godesberg site, Bonn, Germany
| | - Alexander Rühle
- Department of Radiation Oncology, University Hospital of Freiburg, Freiburg, Germany.,German Cancer Consortium (DKTK) Partner Site Freiburg, German Cancer Research Center, Heidelberg, Germany
| | - Anca-Ligia Grosu
- Department of Radiation Oncology, University Hospital of Freiburg, Freiburg, Germany.,German Cancer Consortium (DKTK) Partner Site Freiburg, German Cancer Research Center, Heidelberg, Germany
| | - Heinz Schmidberger
- Department of Radiation Oncology and Radiation Therapy, University Medical Center Mainz, Mainz, Germany.,German Cancer Consortium (DKTK) Partner Site Mainz, German Cancer Research Center, Heidelberg, Germany
| | - Nils H Nicolay
- Department of Radiation Oncology, University Hospital of Freiburg, Freiburg, Germany.,German Cancer Consortium (DKTK) Partner Site Freiburg, German Cancer Research Center, Heidelberg, Germany
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15
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Sager P, Näf L, Vu E, Fischer T, Putora PM, Ehret F, Fürweger C, Schröder C, Förster R, Zwahlen DR, Muacevic A, Windisch P. Convolutional Neural Networks for Classifying Laterality of Vestibular Schwannomas on Single MRI Slices-A Feasibility Study. Diagnostics (Basel) 2021; 11:1676. [PMID: 34574017 PMCID: PMC8465488 DOI: 10.3390/diagnostics11091676] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 07/28/2021] [Revised: 09/04/2021] [Accepted: 09/07/2021] [Indexed: 11/16/2022] Open
Abstract
Introduction: Many proposed algorithms for tumor detection rely on 2.5/3D convolutional neural networks (CNNs) and the input of segmentations for training. The purpose of this study is therefore to assess the performance of tumor detection on single MRI slices containing vestibular schwannomas (VS) as a computationally inexpensive alternative that does not require the creation of segmentations. Methods: A total of 2992 T1-weighted contrast-enhanced axial slices containing VS from the MRIs of 633 patients were labeled according to tumor location, of which 2538 slices from 539 patients were used for training a CNN (ResNet-34) to classify them according to the side of the tumor as a surrogate for detection and 454 slices from 94 patients were used for internal validation. The model was then externally validated on contrast-enhanced and non-contrast-enhanced slices from a different institution. Categorical accuracy was noted, and the results of the predictions for the validation set are provided with confusion matrices. Results: The model achieved an accuracy of 0.928 (95% CI: 0.869-0.987) on contrast-enhanced slices and 0.795 (95% CI: 0.702-0.888) on non-contrast-enhanced slices from the external validation cohorts. The implementation of Gradient-weighted Class Activation Mapping (Grad-CAM) revealed that the focus of the model was not limited to the contrast-enhancing tumor but to a larger area of the cerebellum and the cerebellopontine angle. Conclusions: Single-slice predictions might constitute a computationally inexpensive alternative to training 2.5/3D-CNNs for certain detection tasks in medical imaging even without the use of segmentations. Head-to-head comparisons between 2D and more sophisticated architectures could help to determine the difference in accuracy, especially for more difficult tasks.
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Affiliation(s)
- Philipp Sager
- Department of Radiation Oncology, Kantonsspital Winterthur, 8400 Winterthur, Switzerland; (P.S.); (C.S.); (R.F.); (D.R.Z.)
| | - Lukas Näf
- Department of Radiology, Kantonsspital St. Gallen, 9007 St. Gallen, Switzerland; (L.N.); (T.F.)
| | - Erwin Vu
- Department of Radiation Oncology, Kantonsspital St. Gallen, 9007 St. Gallen, Switzerland; (E.V.); (P.M.P.)
| | - Tim Fischer
- Department of Radiology, Kantonsspital St. Gallen, 9007 St. Gallen, Switzerland; (L.N.); (T.F.)
| | - Paul M. Putora
- Department of Radiation Oncology, Kantonsspital St. Gallen, 9007 St. Gallen, Switzerland; (E.V.); (P.M.P.)
- Department of Radiation Oncology, University of Bern, 3010 Bern, Switzerland
| | - Felix Ehret
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Radiation Oncology, 13353 Berlin, Germany;
- European Cyberknife Center, 81377 Munich, Germany; (C.F.); (A.M.)
| | - Christoph Fürweger
- European Cyberknife Center, 81377 Munich, Germany; (C.F.); (A.M.)
- Department of Stereotaxy and Functional Neurosurgery, University of Cologne, Faculty of Medicine and University Hospital Cologne, 50937 Cologne, Germany
| | - Christina Schröder
- Department of Radiation Oncology, Kantonsspital Winterthur, 8400 Winterthur, Switzerland; (P.S.); (C.S.); (R.F.); (D.R.Z.)
| | - Robert Förster
- Department of Radiation Oncology, Kantonsspital Winterthur, 8400 Winterthur, Switzerland; (P.S.); (C.S.); (R.F.); (D.R.Z.)
- Faculty of Medicine, University of Zurich, 8006 Zurich, Switzerland
| | - Daniel R. Zwahlen
- Department of Radiation Oncology, Kantonsspital Winterthur, 8400 Winterthur, Switzerland; (P.S.); (C.S.); (R.F.); (D.R.Z.)
- Faculty of Medicine, University of Zurich, 8006 Zurich, Switzerland
| | | | - Paul Windisch
- Department of Radiation Oncology, Kantonsspital Winterthur, 8400 Winterthur, Switzerland; (P.S.); (C.S.); (R.F.); (D.R.Z.)
- European Cyberknife Center, 81377 Munich, Germany; (C.F.); (A.M.)
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16
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Vu E, Schröder C, Dülk J, Stelmes JJ, Vu J, Schilling J, Förster FG, Förster R. Nationwide Survey of German Outpatient Gynecologic Oncology Practices during the Coronavirus Disease 2019 Pandemic: Reactions to the First Wave and Future Perspectives. Breast Care (Basel) 2021; 382:1-7. [PMID: 34580581 PMCID: PMC8450854 DOI: 10.1159/000518858] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 07/23/2021] [Indexed: 11/19/2022] Open
Abstract
Introduction In the spring of 2020, coronavirus disease 2019 posed a substantial challenge for countries and their healthcare systems. In Germany, over 70% of all cancer patients are treated in an outpatient setting, so gynecologic oncology practices are the guarantors of optimal patient care. We developed a survey to evaluate the management of gynecologic oncology patients. Methods The survey consisted of 38 questions and was sent to the members of the Berufsverband Niedergelassener Gynäkologischer Onkologen in Deutschland e.V. (BNGO), a professional association of gynecologic oncologists in the outpatient sector in Germany. Results The survey was completed by 54 out of 133 (41%) gynecologic oncologists from 14 out of 15 (93%) federal states where the BNGO is represented. Facing the pandemic, popular measures were mask requirements (100%), restriction of access to practices (94%), increased number of disinfectant dispensers (85%), installment of panes of acrylic glass (76%), or spatial alterations (67%). For most patients the pandemic had no influence on prioritization of therapies (82%) or prescribed systemic treatments (87%). Despite an increase in perceived psychological burden among the staff (72%), 85% (45/54) of the practices were not offered any additional psychological support. Discussion and Conclusion As most cancer patients in Germany are treated in an outpatient setting, a suitable reaction of oncology centers to the new circumstances was crucial to secure optimal treatment and patient care. Nevertheless, the low prioritization of mental health or distress of healthcare workers poses a serious threat to the maintenance of optimal medical care in further waves of the pandemic.
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Affiliation(s)
- Erwin Vu
- Department of Radiation Oncology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Christina Schröder
- Institute for Radiation Oncology, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - Jonas Dülk
- Friedrich Alexander University Erlangen, Erlangen, Germany
| | - Jean-Jacques Stelmes
- Department of Radiation Oncology, Oncological Institute of Southern Switzerland, Cantonal Hospitals, Bellinzona, Switzerland
| | - Jennifer Vu
- Friedrich Alexander University Erlangen, Erlangen, Germany
| | - Jörg Schilling
- Gemeinschaftspraxis Dres. med. Schilling, Till and Kohn, Berlin, Germany
| | - Frank Gerhard Förster
- MVZ Flemmingstraße, Poliklinik GmbH, Chemnitz, Germany.,Faculty of Business and Economics, University of Applied Sciences Zwickau, Zwickau, Germany
| | - Robert Förster
- Institute for Radiation Oncology, Cantonal Hospital Winterthur, Winterthur, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
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17
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Zimmermann F, Eberhardt AL, Förster R, Zwahlen DR. [Smarter Medicine in Radiation Oncology - current and proven treatment concepts offering the greatest possible benefit to cancer patients in clinical practice]. Ther Umsch 2021; 78:349-358. [PMID: 34427109 DOI: 10.1024/0040-5930/a001283] [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: 11/19/2022]
Abstract
Smarter Medicine in Radiation Oncology - current and proven treatment concepts offering the greatest possible benefit to cancer patients in clinical practice Abstract. Modern procedures in radiation therapy with respect to indication, therapy planning and implementation of shorter treatment regimens result in high local tumor control and excellent quality of life in frequent and clinically relevant disease entities including breast and prostate cancer as well as bone metastases. In the adjuvant therapy for early breast cancer, a careful comparative analysis of the use of endocrine adjuvant treatment over five years versus postoperative radiation therapy over less than four weeks may result in omission of radiation treatment in a selected patient population. Partial breast irradiation, while treating the tumor bed only in low risk situations, and hypofractionated whole breast radiotherapy for patients with a higher risk profile for local recurrence, halved treatment time compared to 10 years ago, making adjuvant radiotherapy for patients with breast cancer more convenient. In patients with localized prostate cancer, the introduction of hypofractionated treatment regimens halved the number of daily fractions and current developments point towards a one-week outpatient therapy for locally limited disease using high precision stereotactic techniques and accurate therapy planning based on multifunctional imaging. Patients with bone metastases are more and more treated with a single fraction, high precision stereotactic radiotherapy (radiosurgery) with high analgesic potential and achieving long lasting local tumor control. These modern, often significantly shorter, radiotherapy treatment regimens not only result in an excellent treatment response and better quality of life for patients, but also include a better utilization of radiotherapy resources needing less treatment machines and thus helping to reduce costs in the Swiss healthcare system.
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Affiliation(s)
- Frank Zimmermann
- Klinik für Strahlentherapie und Radioonkologie, Universitätsspital Basel
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Burgermeister S, Hubert G, Basler L, Hogan S, Pavic M, Bogowicz M, Vuong D, Tanadini-Lang S, Förster R, Huellner M, Dummer R, Levesque M, Guckenberger M. PO-1409 Imaging and blood biomarkers in metastatic melanoma patients treated with immunotherapy. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07860-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Kudura K, Dimitriou F, Basler L, Förster R, Mihic-Probst D, Kutzker T, Dummer R, Mangana J, Burger IA, Kreissl MC. Prediction of Early Response to Immune Checkpoint Inhibition Using FDG-PET/CT in Melanoma Patients. Cancers (Basel) 2021; 13:cancers13153830. [PMID: 34359730 PMCID: PMC8345158 DOI: 10.3390/cancers13153830] [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: 06/30/2021] [Revised: 07/20/2021] [Accepted: 07/26/2021] [Indexed: 11/22/2022] Open
Abstract
Simple Summary Melanoma has become the most rapidly increasing cancer in Caucasian populations, causing 90% of skin cancer mortality. FDG-PET/CT has been recommended by the European 2019 guidelines for melanoma for staging and treatment response assessment in advanced melanoma highlighting the need for new outcome predictive biomarkers. In the context of melanoma, the evidence on the predictive value of semiquantitative parameters derived from FDG-PET/CT is still very limited. We here provide evidence, in a large cohort of metastatic melanoma patients, that FDG-PET/CT can be used to predict the early response to immune checkpoint inhibition. On a patient-basis, total tumor volume and semiquantitative parameters, such as total metabolic tumor volume MTV and total lesion glycolysis TLG of all metastases three months after treatment start are promising predictive biomarkers for the outcome in metastatic melanoma patients. Also, early complete response on a metastasis- and patient-level seems to be predictive for lasting complete response. Abstract We aimed to investigate, whether 18F-2-fluoro-2-desoxy-D-glucose positron emission tomography/computed tomography (FDG-PET/CT) scans performed at baseline (time point 0; TP 0) and three months after initiation of immunotherapy (time point 1; TP 1) can be used on a metastasis- and patient-level to predict the response to immune-checkpoint inhibition using FDG-PET/CT six months after treatment start (time point 2; TP 2) in metastatic melanoma patients. This single-center retrospective study considered metastatic melanoma patients treated with immune checkpoint inhibition from TP 0 to TP 2. An analysis on a metastasis- and patient-level was carried out. Tumor volume, standardized uptake values SUV (mean, maximum, and peak), metabolic tumor volume MTV and total lesion glycolysis TLG of each included metastasis were recorded at each time point, respectively TP 0, TP 1 and TP 2. Total tumor volume, total metabolic tumor volume and total lesion glycolysis per patient were also calculated at TP 0, TP 1 and TP 2. Treatment response was assessed at metastasis- and patient-level based on FDG-PET/CT scans at TP 2. 612 melanoma metastases in 111 patients were included. The analysis on a metastasis-level showed that metastatic SUVpeak at TP 1 and volume variation between TP 0 and TP 1 were the strongest negative predictive biomarkers for response. However, at TP 0, metastatic SUVmean and SUVpeak indicated a low negative prediction power, whereas initial metastatic volume was not a predictive biomarker. Also, melanoma metastases located in bone structures had a negative influence on the outcome at TP 2, particularly in women. The analysis on a patient-level showed, that total tumor volume, total metastatic tumor volume and total lesion glycolysis of all metastases three months after treatment initiation were strong negative predictive biomarkers for response to immunotherapy six months after initiation. Age and female sex were also found to be negative predictive biomarkers with lower predictive power. Interestingly, total tumor volume at TP 0 and number of metastases at TP 0 as well as the occurrence of early immune-related adverse events between TP 0 and TP 2 did not have any predictive value for early treatment response. FDG-PET/CT performed for treatment response assessment three months after initiation of immune checkpoint inhibition in metastatic melanoma patients can also be used to predict early response to treatment. On a metastasis-level SUV peak and volume variation of metastases are strong outcome predictive biomarkers. On a patient-level total tumor volume and semiquantitative parameters such as total metabolic tumor volume MTV and total lesion glycolysis TLG of all metastases are promising outcome predictive biomarkers. Also, early complete response on a metastasis- and patient-level seems to be predictive for lasting complete response.
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Affiliation(s)
- Ken Kudura
- Department of Nuclear Medicine, University Hospital Zurich, 8091 Zurich, Switzerland;
- Correspondence:
| | - Florentia Dimitriou
- Department of Dermatology, University Hospital Zurich, 8091 Zurich, Switzerland; (F.D.); (R.D.); (J.M.)
| | - Lucas Basler
- Center for Proton Therapy, Paul Scherrer Institute, 5232 Villigen, Switzerland;
| | - Robert Förster
- Institute of Radiation Oncology, Cantonal Hospital Winterthur, 8400 Winterthur, Switzerland;
| | - Daniela Mihic-Probst
- Institute of Pathology and Molecular Pathology, University Hospital Zurich, 8091 Zurich, Switzerland;
| | - Tim Kutzker
- Faculty of Applied Statistics, Humboldt University Berlin, 10117 Berlin, Germany;
| | - Reinhard Dummer
- Department of Dermatology, University Hospital Zurich, 8091 Zurich, Switzerland; (F.D.); (R.D.); (J.M.)
| | - Joanna Mangana
- Department of Dermatology, University Hospital Zurich, 8091 Zurich, Switzerland; (F.D.); (R.D.); (J.M.)
| | - Irene A. Burger
- Department of Nuclear Medicine, University Hospital Zurich, 8091 Zurich, Switzerland;
- Department of Nuclear Medicine, Cantonal Hospital Baden, 5404 Baden, Switzerland
| | - Michael C. Kreissl
- Department of Radiology and Nuclear Medicine, Division of Nuclear Medicine, University Hospital Magdeburg, 39120 Magdeburg, Germany;
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Erices-Leclercq M, Lubig S, Förster F, Förster R, Baldus S, Rudlowski C, Schröder L. Prognostic relevance of Ki67 expression in primary male breast cancer: determination of cut-off points by different evaluation methods and statistical examinations. J Cancer Res Clin Oncol 2021; 148:441-447. [PMID: 33991247 DOI: 10.1007/s00432-021-03623-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 01/24/2021] [Accepted: 03/29/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE 1% of all breast cancer cases occur in men. There are significant differences regarding clinical behaviour and genetic profiles between female (FBC) and male breast cancer (MBC). Parameters for decision-making on treatment and prognosis are derived from FBC. Ki67 has a high value as a prognostic and predictive factor in FBC, but accurate Ki67 cut-off points for MBC are missing. In this study, we aimed to evaluate adequate examination methods and reliable cut-off points for Ki67 to assess the highest prognostic value for patient's overall survival (OS). METHODS In this multicentric retrospective study, histological specimens were obtained from 104 male patients who were diagnosed and treated for primary invasive breast cancer. We applied three methods of Ki67 analysis: Tumor average scoring (TA), tumor border scoring (TB) and hot-spot scoring (HS). Calculated Ki67 cut-off points for each method were assessed as a threshold for patients' overall survival (OS). RESULTS Ki67 cut-off points were 13.5 for the TA group, 22.5 for the HS group and 17.5 for the TB group. Only Ki67 TA cut-off calculations demonstrated statistical significance (p = 0.04). Ki67 expression analysis of TA showed that more than 90% of patients with low Ki67 levels (< 13.5) were alive after 5-year follow-up. CONCLUSION Our findings demonstrate that determination of Ki67 expression in TA is the most reliable to define a cut-off point with high prognostic value. A Ki67 cut-off point of 13.5 shows highest statistical power to define luminal A subgroup and OS.
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Affiliation(s)
- Melanie Erices-Leclercq
- Department of Breast Cancer, Lutherian Hospital, Ferrenbergstr.24, 51465, Bergisch Gladbach, Germany
| | - Sabine Lubig
- Department of Breast Cancer, Lutherian Hospital, Ferrenbergstr.24, 51465, Bergisch Gladbach, Germany
| | - Frank Förster
- Department of Economical Sciences, University of Applied Sciences, Zwickau, Germany.,Outpatient Department of Gynecological Oncology and Palliative Care, Poliklinik GmbH, Chemnitz, Germany
| | - Robert Förster
- Institute for Radiation Oncology, Cantonal Hospital Winterthur, Winterthur, Switzerland.,Medical Faculty, University of Zurich, Zurich, Switzerland
| | - Stefan Baldus
- Institute for Pathology, Cytology and Molecular Pathology, Bergisch Gladbach, Germany
| | - Christian Rudlowski
- Department of Breast Cancer, Lutherian Hospital, Ferrenbergstr.24, 51465, Bergisch Gladbach, Germany. .,Medical Faculty, University Hospital Bonn, Bonn, Germany.
| | - Lars Schröder
- Department of Obstetrics and Gynecology, Medical Faculty, University Hospital Cologne, Cologne, Germany
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Kudura K, Dimitriou F, Mihic-Probst D, Muehlematter UJ, Kutzker T, Basler L, Förster R, Dummer R, Mangana J, Husmann L, Burger IA, Kreissl MC. Malignancy Rate of Indeterminate Findings on FDG-PET/CT in Cutaneous Melanoma Patients. Diagnostics (Basel) 2021; 11:diagnostics11050883. [PMID: 34063555 PMCID: PMC8156636 DOI: 10.3390/diagnostics11050883] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 04/11/2021] [Revised: 05/09/2021] [Accepted: 05/12/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The use of 18F-2-Fluor-2-desoxy-D-glucose Positron Emission Tomography/Computed Tomography FDG-PET/CT in clinical routine for staging, treatment response monitoring and post treatment surveillance in metastatic melanoma patients has noticeably increased due to significant improvement of the overall survival rate in melanoma patients. However, determining the dignity of the findings with increased metabolic activity on FDG-PET/CT can be sometimes challenging and may need further investigation. PURPOSE We aimed to investigate the malignancy rate of indeterminate findings on FDG-PET/CT in metastatic cutaneous melanoma patients. METHODS This single-center retrospective study included cutaneous melanoma patients who underwent FDG-PET/CT in clinical routine between 2015 and 2017 with findings reported as indeterminate and therefore requiring further evaluation. The dignity of the included findings was determined by subsequent imaging and, if required, additional histopathology. The impact of the outcome on the clinical management was also reported. RESULTS A total of 842 FDG-PET/CT reports of 244 metastatic cutaneous melanoma patients were reviewed. Sixty indeterminate findings were included. Almost half of all indeterminate findings were lymph nodes, lung nodules and cerebral lesions. In total, 43.3% of all included findings proved to be malignant. 81% of all malignant lesions were metastases of cutaneous melanoma, while 19% of all malignant lesions could be attributed to other primary malignancies, such as lung, breast, thyroid and colorectal cancers. Malignant findings influenced clinical management in 60% of the cases. CONCLUSION Indeterminate findings on FDG-PET/CT in metastatic cutaneous melanoma patients should be further investigated. Almost one out of every two indeterminate findings on FDG-PET/CT is malignant. The majority of the findings are melanoma manifestations, however, in a significant percentage, other primary tumors are found. Upon verification, patient management is changed in most cases.
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Affiliation(s)
- Ken Kudura
- Department of Nuclear Medicine, University Hospital Zurich, 8006 Zurich, Switzerland; (U.J.M.); (L.H.); (I.A.B.)
- Faculty of Medicine, University of Zurich, 8091 Zurich, Switzerland; (F.D.); (D.M.-P.); (L.B.); (R.F.); (R.D.); (J.M.)
- Correspondence:
| | - Florentia Dimitriou
- Faculty of Medicine, University of Zurich, 8091 Zurich, Switzerland; (F.D.); (D.M.-P.); (L.B.); (R.F.); (R.D.); (J.M.)
- Department of Dermatology, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Daniela Mihic-Probst
- Faculty of Medicine, University of Zurich, 8091 Zurich, Switzerland; (F.D.); (D.M.-P.); (L.B.); (R.F.); (R.D.); (J.M.)
- Institute of Pathology and Molecular Pathology, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Urs J. Muehlematter
- Department of Nuclear Medicine, University Hospital Zurich, 8006 Zurich, Switzerland; (U.J.M.); (L.H.); (I.A.B.)
- Faculty of Medicine, University of Zurich, 8091 Zurich, Switzerland; (F.D.); (D.M.-P.); (L.B.); (R.F.); (R.D.); (J.M.)
| | - Tim Kutzker
- Faculty of Applied Statistics, Humboldt University Berlin, 10117 Berlin, Germany;
| | - Lucas Basler
- Faculty of Medicine, University of Zurich, 8091 Zurich, Switzerland; (F.D.); (D.M.-P.); (L.B.); (R.F.); (R.D.); (J.M.)
- Center for Proton Therapy, Paul Scherrer Institute, 5232 Villigen, Switzerland
| | - Robert Förster
- Faculty of Medicine, University of Zurich, 8091 Zurich, Switzerland; (F.D.); (D.M.-P.); (L.B.); (R.F.); (R.D.); (J.M.)
- Institute of Radiation Oncology, Cantonal Hospital Winterthur, 8400 Winterthur, Switzerland
| | - Reinhard Dummer
- Faculty of Medicine, University of Zurich, 8091 Zurich, Switzerland; (F.D.); (D.M.-P.); (L.B.); (R.F.); (R.D.); (J.M.)
- Department of Dermatology, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Joanna Mangana
- Faculty of Medicine, University of Zurich, 8091 Zurich, Switzerland; (F.D.); (D.M.-P.); (L.B.); (R.F.); (R.D.); (J.M.)
- Department of Dermatology, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Lars Husmann
- Department of Nuclear Medicine, University Hospital Zurich, 8006 Zurich, Switzerland; (U.J.M.); (L.H.); (I.A.B.)
- Faculty of Medicine, University of Zurich, 8091 Zurich, Switzerland; (F.D.); (D.M.-P.); (L.B.); (R.F.); (R.D.); (J.M.)
| | - Irene A. Burger
- Department of Nuclear Medicine, University Hospital Zurich, 8006 Zurich, Switzerland; (U.J.M.); (L.H.); (I.A.B.)
- Faculty of Medicine, University of Zurich, 8091 Zurich, Switzerland; (F.D.); (D.M.-P.); (L.B.); (R.F.); (R.D.); (J.M.)
| | - Michael Christoph Kreissl
- Division of Nuclear Medicine, Department of Radiology and Nuclear Medicine, University Hospital Magdeburg, 39120 Magdeburg, Germany;
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Gabrys H, Basler L, Hogan S, Pavic M, Bogowicz M, Vuong D, Tanadini-Lang S, Förster R, Huellner M, Dummer R, Guckenberger M, Levesque M. PO-1571: Radiomics for prediction of metastatic melanoma patient survival after immunotherapy. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01589-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Matuschek C, Fischer JC, Combs SE, Fietkau R, Corradini S, Zänker K, Bölke E, Djiepmo-Njanang FJ, Tamaskovics B, Fischer JE, Stuschke M, Pöttgen C, Förster R, Zwahlen DR, Papachristofilou A, Ganswindt U, Pelka R, Schneider EM, Feldt T, Jensen BEO, Häussinger D, Knoefel WT, Kindgen-Milles D, Pedoto A, Grebe O, van Griensven M, Budach W, Haussmann J. Measures of infection prevention and incidence of SARS-CoV-2 infections in cancer patients undergoing radiotherapy in Germany, Austria and Switzerland. Strahlenther Onkol 2020; 196:1068-1079. [PMID: 32914236 PMCID: PMC7483062 DOI: 10.1007/s00066-020-01681-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 07/09/2020] [Accepted: 08/12/2020] [Indexed: 02/07/2023]
Abstract
Purpose COVID-19 infection has manifested as a major threat to both patients and healthcare providers around the world. Radiation oncology institutions (ROI) deliver a major component of cancer treatment, with protocols that might span over several weeks, with the result of increasing susceptibility to COVID-19 infection and presenting with a more severe clinical course when compared with the general population. The aim of this manuscript is to investigate the impact of ROI protocols and performance on daily practice in the high-risk cancer patients during this pandemic. Methods We addressed the incidence of positive COVID-19 cases in both patients and health care workers (HCW), in addition to the protective measures adopted in ROIs in Germany, Austria and Switzerland using a specific questionnaire. Results The results of the questionnaire showed that a noteworthy number of ROIs were able to complete treatment in SARS-CoV‑2 positive cancer patients, with only a short interruption. The ROIs reported a significant decrease in patient volume that was not impacted by the circumambient disease incidence, the type of ROI or the occurrence of positive cases. Of the ROIs 16.5% also reported infected HCWs. About half of the ROIs (50.5%) adopted a screening program for patients whereas only 23.3% also screened their HCWs. The range of protective measures included the creation of working groups, instituting home office work and protection with face masks. Regarding the therapeutic options offered, curative procedures were performed with either unchanged or moderately decreased schedules, whereas palliative or benign radiotherapy procedures were more often shortened. Most ROIs postponed or cancelled radiation treatment for benign indications (88.1%). The occurrence of SARS-CoV‑2 infections did not affect the treatment options for curative procedures. Non-university-based ROIs seemed to be more willing to change their treatment options for curative and palliative cases than university-based ROIs. Conclusion Most ROIs reported a deep impact of SARS-CoV‑2 infections on their work routine. Modification and prioritization of treatment regimens and the application of protective measures preserved a well-functioning radiation oncology service and patient care. Electronic supplementary material The online version of this article (10.1007/s00066-020-01681-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Christiane Matuschek
- Medical Faculty, Department of Radiation Oncology, Heinrich Heine University, Duesseldorf, Germany
| | - Johannes C Fischer
- Institute for Transplant Diagnostics and Cell Therapeutics, Heinrich Heine University, Düsseldorf, Germany
| | - Stephanie E Combs
- Department of Radiation Oncology, Technical University of Munich, Munich, Germany.,Institute of Radiation Medicine (IRM), Helmholtz Zentrum Munich, Munich, Germany.,Partner Site Munich, Deutsches Konsortium für Translationale Krebsforschung (DKTK), Munich, Germany
| | - Rainer Fietkau
- Department of Radiation Oncology, University of Erlangen, Erlangen, Germany
| | - Stefanie Corradini
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | | | - Edwin Bölke
- Medical Faculty, Department of Radiation Oncology, Heinrich Heine University, Duesseldorf, Germany.
| | | | - Balint Tamaskovics
- Medical Faculty, Department of Radiation Oncology, Heinrich Heine University, Duesseldorf, Germany
| | | | - Martin Stuschke
- Department of Radiation Oncology, University Essen, Essen, Germany
| | | | - Robert Förster
- Institute of Radiation Oncology, Cantonal Hospital Winterthur, University of Zurich, Zurich, Switzerland
| | - Daniel R Zwahlen
- Institute of Radiation Oncology, Cantonal Hospital Winterthur, University of Zurich, Zurich, Switzerland
| | | | - Ute Ganswindt
- Department of Radiation Oncology, Medical University Innsbruck, Innsbruck, Austria
| | - Rainer Pelka
- Institute for Applied Statistics, Unterföhring/Munich, Germany
| | - E Marion Schneider
- Division of Experimental Anesthesiology, University Hospital Ulm, Ulm, Germany
| | - Torsten Feldt
- Department of Gastroenterology, Hepatology and Infectious Diseases, Heinrich Heine University, Duesseldorf, Germany
| | - Björn Erik Ole Jensen
- Department of Gastroenterology, Hepatology and Infectious Diseases, Heinrich Heine University, Duesseldorf, Germany
| | - Dieter Häussinger
- Department of Gastroenterology, Hepatology and Infectious Diseases, Heinrich Heine University, Duesseldorf, Germany
| | - Wolfram Trudo Knoefel
- Department for General Visceral and Pediatric Surgery, Heinrich Heine University, Dusseldorf, Germany
| | - Detlef Kindgen-Milles
- Department of Intensive Care Medicine, Heinrich Heine University, Dusseldorf, Germany
| | - Alessia Pedoto
- Department of Anesthesiology, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Olaf Grebe
- Department for Cardiology, Rhythmology and Intensive Care Medicine, Evangelic Hospital, Dusseldorf, Germany
| | - Martijn van Griensven
- MERLN Institute for Technology-Inspired Regenerative Medicine, Department cBITE, Maastricht University, Maastricht, The Netherlands
| | - Wilfried Budach
- Medical Faculty, Department of Radiation Oncology, Heinrich Heine University, Duesseldorf, Germany
| | - Jan Haussmann
- Medical Faculty, Department of Radiation Oncology, Heinrich Heine University, Duesseldorf, Germany
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Bostel T, Rühle A, Rackwitz T, Mayer A, Klodt T, Oebel L, Förster R, Schlampp I, Wollschläger D, Rief H, Sprave T, Debus J, Grosu AL, Schmidberger H, Akbaba S, Nicolay NH. The Role of Palliative Radiotherapy in the Treatment of Spinal Bone Metastases from Head and Neck Tumors-A Multicenter Analysis of a Rare Event. Cancers (Basel) 2020; 12:cancers12071950. [PMID: 32708389 PMCID: PMC7409283 DOI: 10.3390/cancers12071950] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 07/08/2020] [Accepted: 07/15/2020] [Indexed: 01/04/2023] Open
Abstract
This retrospective multi-center analysis aimed to assess the clinical response and stabilizing effects of palliative radiotherapy (RT) for spinal bone metastases (SBM) in head and neck cancer (HNC), and to establish potential predictive factors for stability and overall survival (OS). Patients included in this analysis were treated at the University Hospitals of Mainz, Freiburg, and Heidelberg between 2001 and 2019. Clinical information was taken from the medical records. The stability of affected vertebral bodies was assessed according to the validated spine instability neoplastic score (SINS) based on CT-imaging before RT, as well as 3 and 6 months after RT. OS was quantified as the time between the start of palliative RT and death from any cause or last follow-up. Potential predictive factors for stability and OS were analyzed using generalized estimating equations and Cox regression for time-varying covariates to take into account multiple observations per patient. The mean follow-up time of 66 included patients after the first palliative RT was 8.1 months (range 0.3–85.0 months). The majority of patients (70%; n = 46) had squamous cell carcinomas (SCC) originating from the pharynx, larynx and oral cavity, while most of the remaining patients (26%; n = 17) suffered from salivary glands tumors. A total of 95 target volumes including 178 SBM were evaluated that received a total of 81 irradiation series. In patients with more than one metastasis per irradiated region, only the most critical bone metastasis was analyzed according to the SINS system. Prior to RT, pain and neurologic deficits were present in 76% (n = 72) and 22% (n = 21) of irradiated lesions, respectively, and 68% of the irradiated lesions (n = 65) were assessed as unstable or potentially unstable prior to RT. SBM-related pain symptoms and neurologic deficits responded to RT in 63% and 47% of the treated lesions, respectively. Among patients still alive at 3 and 6 months after RT with potentially unstable or unstable SBM, a shift to a better stability class according to the SINS was observed in 20% and 33% of the irradiated SBM, respectively. Pathological fractures of SBM were frequently detected before the start of irradiation (43%; n = 41), but after RT, new fractures or increasing vertebral body sintering within the irradiated region occurred rarely (8%; n = 8). A pathological fracture before RT was negatively associated with stabilization 6 months after RT (OR 0.1, 95% CI 0.02–0.49, p = 0.004), while a Karnofsky performance score (KPS) ≥ 70% was associated positively with a stabilization effect through irradiation (OR 6.09, 95% CI 1.68–22.05, p = 0.006). Mean OS following first palliative RT was 10.7 months, and the KPS (≥70% vs. <70%) was shown to be a strong predictive factor for OS after RT (HR 0.197, 95% CI 0.11–0.35, p < 0.001). There was no significant difference in OS between patients with SCC and non-SCC. Palliative RT in symptomatic SBM of HNC provides sufficient symptom relief in the majority of patients, while only about one third of initially unstable SBM show re-stabilization after RT. Since patients in our multi-center cohort exhibited very limited OS, fractionation schemes should be determined depending on the patients’ performance status.
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Affiliation(s)
- Tilman Bostel
- Department of Radiation Oncology, University Medical Center Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany; (A.M.); (T.K.); (L.O.); (H.S.); (S.A.)
- Correspondence: (T.B.); (A.R.)
| | - Alexander Rühle
- Department of Radiation Oncology, University Hospital of Freiburg, Robert-Koch-Strasse 3, 79106 Freiburg, Germany; (T.S.); (A.-L.G.); (N.H.N.)
- Correspondence: (T.B.); (A.R.)
| | - Tilmann Rackwitz
- Department of Radiation Oncology, University Hospital of Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany; (T.R.); (I.S.); (J.D.)
| | - Arnulf Mayer
- Department of Radiation Oncology, University Medical Center Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany; (A.M.); (T.K.); (L.O.); (H.S.); (S.A.)
| | - Tristan Klodt
- Department of Radiation Oncology, University Medical Center Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany; (A.M.); (T.K.); (L.O.); (H.S.); (S.A.)
| | - Laura Oebel
- Department of Radiation Oncology, University Medical Center Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany; (A.M.); (T.K.); (L.O.); (H.S.); (S.A.)
| | - Robert Förster
- Institute of Radiation Oncology, Cantonal Hospital Winterthur, University of Zurich, Brauerstrasse 15, 8401 Winterthur, Switzerland;
| | - Ingmar Schlampp
- Department of Radiation Oncology, University Hospital of Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany; (T.R.); (I.S.); (J.D.)
| | - Daniel Wollschläger
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center Mainz, 55131 Mainz, Germany;
| | - Harald Rief
- Radiotherapy Bonn-Rhein-Sieg, 53115 Bonn, Germany;
| | - Tanja Sprave
- Department of Radiation Oncology, University Hospital of Freiburg, Robert-Koch-Strasse 3, 79106 Freiburg, Germany; (T.S.); (A.-L.G.); (N.H.N.)
| | - Jürgen Debus
- Department of Radiation Oncology, University Hospital of Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany; (T.R.); (I.S.); (J.D.)
| | - Anca-Ligia Grosu
- Department of Radiation Oncology, University Hospital of Freiburg, Robert-Koch-Strasse 3, 79106 Freiburg, Germany; (T.S.); (A.-L.G.); (N.H.N.)
| | - Heinz Schmidberger
- Department of Radiation Oncology, University Medical Center Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany; (A.M.); (T.K.); (L.O.); (H.S.); (S.A.)
| | - Sati Akbaba
- Department of Radiation Oncology, University Medical Center Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany; (A.M.); (T.K.); (L.O.); (H.S.); (S.A.)
| | - Nils Henrik Nicolay
- Department of Radiation Oncology, University Hospital of Freiburg, Robert-Koch-Strasse 3, 79106 Freiburg, Germany; (T.S.); (A.-L.G.); (N.H.N.)
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Achard V, Aebersold DM, Allal AS, Andratschke N, Baumert BG, Beer KT, Betz M, Breuneval T, Bodis S, de Bari B, Förster R, Franzetti-Pellanda A, Guckenberger M, Herrmann E, Huck C, Khanfir K, Matzinger O, Peguret N, Pesce G, Putora PM, Reuter C, Richetti A, Vees H, Vrieling C, Zaugg K, Zimmermann F, Zwahlen DR, Tsoutsou P, Zilli T. A national survey on radiation oncology patterns of practice in Switzerland during the COVID-19 pandemic: Present changes and future perspectives. Radiother Oncol 2020; 150:1-3. [PMID: 32512075 PMCID: PMC7274968 DOI: 10.1016/j.radonc.2020.05.047] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 05/20/2020] [Accepted: 05/28/2020] [Indexed: 12/19/2022]
Affiliation(s)
- Vérane Achard
- Department of Radiation Oncology, Geneva University Hospital, Switzerland
| | - Daniel M Aebersold
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Abdelkarim S Allal
- Department of Radiation Oncology, Cantonal Hospital of Fribourg - HFR, Switzerland
| | - Nicolaus Andratschke
- Department of Radiation Oncology, University Hospital Zürich and University of Zürich, Switzerland
| | - Brigitta G Baumert
- Department of Radiation Oncology, Kantonsspital Graubünden, Chur, Switzerland
| | - Karl T Beer
- Radiation Oncology Center, Bienne-Seeland-Jura Bernois, Switzerland
| | - Michael Betz
- Department of Radiation Oncology, Hirslanden Clinique Bois-Cerf, Lausanne, Switzerland
| | - Thomas Breuneval
- Department of Radiation Oncology, Hôpital de La Tour, Geneva, Switzerland
| | - Stephan Bodis
- Department of Radiation Oncology, KSA-KSB, Kantonspital Aarau, Switzerland
| | - Berardino de Bari
- Department of Radiation Oncology, Réseau Hospitalier Neuchâtelois, La Chaux-de-Fonds, Switzerland
| | - Robert Förster
- Department of Radiation Oncology, Cantonal Hospital of Winthertur, Switzerland
| | | | - Matthias Guckenberger
- Department of Radiation Oncology, University Hospital Zürich and University of Zürich, Switzerland
| | - Evelyn Herrmann
- Department of Radiation Oncology, Hôpital Riviera-Chablais, Rennaz, Switzerland
| | - Constance Huck
- Department of Radiation Oncology, Geneva University Hospital, Switzerland
| | - Kaouthar Khanfir
- Department of Radiation Oncology, Hôpital du Valais, Sion, Switzerland
| | - Oscar Matzinger
- Department of Radiation Oncology, Clinique de Genôlier - Centre Médical des Eaux Vives, Geneva, Switzerland
| | - Nicolas Peguret
- Department of Radiation Oncology, Hirslanden Clinique Grangettes, Geneva, Switzerland
| | - Gianfranco Pesce
- Department of Radiation Oncology, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Paul M Putora
- Department of Radiation Oncology, Cantonal Hospital of St. Gallen, St. Gallen and Department of Radiation Oncology, University of Bern, Switzerland
| | - Christiane Reuter
- Department of Radiation Oncology, Spital Thurgau AG, Kantonsspitäler Frauenfeld und Münsterlingen, Switzerland
| | - Antonella Richetti
- Department of Radiation Oncology, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Hansjörg Vees
- Radiotherapy Institute, Hirslanden Klinik, Zürich, Switzerland
| | - Conny Vrieling
- Department of Radiation Oncology, Hirslanden Clinique Grangettes, Geneva, Switzerland
| | - Kathrin Zaugg
- Department of Radiation Oncology, City Hospital Triemli, Zürich and Department of Radiation Oncology, University of Bern, Switzerland
| | - Frank Zimmermann
- Department of Radiation Oncology, University Hospital Basel, Switzerland
| | - Daniel R Zwahlen
- Department of Radiation Oncology, Cantonal Hospital of Winthertur, Switzerland
| | - Pelagia Tsoutsou
- Department of Radiation Oncology, Geneva University Hospital, Switzerland; Faculty of Medicine, Geneva University, Switzerland
| | - Thomas Zilli
- Department of Radiation Oncology, Geneva University Hospital, Switzerland; Faculty of Medicine, Geneva University, Switzerland.
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Windisch P, Hertler C, Blum D, Zwahlen D, Förster R. Leveraging Advances in Artificial Intelligence to Improve the Quality and Timing of Palliative Care. Cancers (Basel) 2020; 12:E1149. [PMID: 32375249 PMCID: PMC7281519 DOI: 10.3390/cancers12051149] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 04/28/2020] [Accepted: 05/02/2020] [Indexed: 01/16/2023] Open
Abstract
In recent years, research on artificial intelligence (AI) in medicine has seen great advances, especially with regards to the detection of diseases [...].
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Affiliation(s)
- Paul Windisch
- Department of Radiation Oncology, Kantonsspital Winterthur, 8400 Winterthur, Switzerland; (D.Z.); (R.F.)
| | - Caroline Hertler
- Competence Center for Palliative Care, University Hospital Zurich, 8091 Zurich, Switzerland; (C.H.); (D.B.)
| | - David Blum
- Competence Center for Palliative Care, University Hospital Zurich, 8091 Zurich, Switzerland; (C.H.); (D.B.)
| | - Daniel Zwahlen
- Department of Radiation Oncology, Kantonsspital Winterthur, 8400 Winterthur, Switzerland; (D.Z.); (R.F.)
| | - Robert Förster
- Department of Radiation Oncology, Kantonsspital Winterthur, 8400 Winterthur, Switzerland; (D.Z.); (R.F.)
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Basler L, Gabryś HS, Hogan SA, Pavic M, Bogowicz M, Vuong D, Tanadini-Lang S, Förster R, Kudura K, Huellner MW, Dummer R, Guckenberger M, Levesque MP. Radiomics, Tumor Volume, and Blood Biomarkers for Early Prediction of Pseudoprogression in Patients with Metastatic Melanoma Treated with Immune Checkpoint Inhibition. Clin Cancer Res 2020; 26:4414-4425. [PMID: 32253232 DOI: 10.1158/1078-0432.ccr-20-0020] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Revised: 03/09/2020] [Accepted: 04/01/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE We assessed the predictive potential of positron emission tomography (PET)/CT-based radiomics, lesion volume, and routine blood markers for early differentiation of pseudoprogression from true progression at 3 months. EXPERIMENTAL DESIGN 112 patients with metastatic melanoma treated with immune checkpoint inhibition were included in our study. Median follow-up duration was 22 months. 716 metastases were segmented individually on CT and 2[18F]fluoro-2-deoxy-D-glucose (FDG)-PET imaging at three timepoints: baseline (TP0), 3 months (TP1), and 6 months (TP2). Response was defined on a lesion-individual level (RECIST 1.1) and retrospectively correlated with FDG-PET/CT radiomic features and the blood markers LDH/S100. Seven multivariate prediction model classes were generated. RESULTS Two-year (median) overall survival, progression-free survival, and immune progression-free survival were 69% (not reached), 24% (6 months), and 42% (16 months), respectively. At 3 months, 106 (16%) lesions had progressed, of which 30 (5%) were identified as pseudoprogression at 6 months. Patients with pseudoprogressive lesions and without true progressive lesions had a similar outcome to responding patients and a significantly better 2-year overall survival of 100% (30 months), compared with 15% (10 months) in patients with true progressions/without pseudoprogression (P = 0.002). Patients with mixed progressive/pseudoprogressive lesions were in between at 53% (25 months). The blood prediction model (LDH+S100) achieved an AUC = 0.71. Higher LDH/S100 values indicated a low chance of pseudoprogression. Volume-based models: AUC = 0.72 (TP1) and AUC = 0.80 (delta-volume between TP0/TP1). Radiomics models (including/excluding volume-related features): AUC = 0.79/0.78. Combined blood/volume model: AUC = 0.79. Combined blood/radiomics model (including volume-related features): AUC = 0.78. The combined blood/radiomics model (excluding volume-related features) performed best: AUC = 0.82. CONCLUSIONS Noninvasive PET/CT-based radiomics, especially in combination with blood parameters, are promising biomarkers for early differentiation of pseudoprogression, potentially avoiding added toxicity or delayed treatment switch.
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Affiliation(s)
- Lucas Basler
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Hubert S Gabryś
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Sabrina A Hogan
- Department of Dermatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Matea Pavic
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Marta Bogowicz
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Diem Vuong
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Stephanie Tanadini-Lang
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Robert Förster
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Ken Kudura
- Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Martin W Huellner
- Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Reinhard Dummer
- Department of Dermatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Matthias Guckenberger
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Mitchell P Levesque
- Department of Dermatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
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28
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Harbtn DN, Amleh A, Bernes A, Bodzian F, Boyer K, Conaway J, Dias H, Dommarco R, Duverney-Pret P, Earnest S, Ely D, Fornarelli L, Förster R, Gentry G, Görlitz G, Gomez F, Guess P, Hähnchen K, Hamilton D, Halley M, Hathaway M, Hickes H, Isono K, Kulinna H, Lucas P, Manger P, Manso L, Moffett S, Müller T, Orii T, Paul R, Reubke K, Rivera L, Rubbiani M, Schetter J, Schulz D, Shaocong L, Smead F, Tam K, Tengler H, Torma L, del Valle M, Verweij A, Walls G, Weiping G. Quantitation of Tebuconazole in Liquid and Solid Formulations by Capillary GC: Collaborative Study. J AOAC Int 2020. [DOI: 10.1093/jaoac/80.4.703] [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] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
A capillary gas chromatographic method has been developed for quantitation of tebuconazole (Folicur, Elite, Raxil, Lynx) in liquid and solid formulations. Tebuconazole is a broad-spectrum, systemic foliar fungicide used to control diseases of wheat, barley, peanut, and grasses grown for seed. Samples are dissolved in acetone and analyzed by capillary gas chromatography (GC) with dicyclohexyl phthalate as internal standard. Twenty-two laboratories from 11 countries participated in a collaborative study of the method. Each collaborator was provided reference standard, internal standard, and blind duplicate samples from 6 formulations: aqueous flowable (F), aqueous emulsifiable concentrate (EW), emulsifiable concentrate for seed treatment (ES), flowable for seed treatment (FS), wettable powder (WP), and dry flowable (DF). Collaborators were instructed to use peak area measurements for quantitation. The seed treatment flowable formulation required confirmation of accurate integration values by the collaborator. Relative standard deviation values for reproducibility (RSDR) for analysis of the formulations were as follows: 3.6 lb/gal F, 1.22; 250 g/L EW, 1.13; 15 g/L ES, 2.40; 25 g/L FS, 2.65; 25% WP, 0.96; 25% DF, 0.72; 45% DF, 0.72. The capillary GC method for quantitation of tebuconazole in fungicide formulations has been adopted first action by AOAC INTERNATIONAL.
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Affiliation(s)
- Donald N Harbtn
- Bayer Corporation, Agriculture Division, PO Box 4913, 8400 Hawthorne Rd, Kansas City, MO 64120-0013
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29
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Schröder C, Opitz I, Guckenberger M, Stahel R, Weder W, Förster R, Andratschke N, Lauk O. Stereotactic Body Radiation Therapy (SBRT) as Salvage Therapy for Oligorecurrent Pleural Mesothelioma After Multi-Modality Therapy. Front Oncol 2019; 9:961. [PMID: 31616640 PMCID: PMC6775182 DOI: 10.3389/fonc.2019.00961] [Citation(s) in RCA: 8] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 09/10/2019] [Indexed: 12/23/2022] Open
Abstract
Introduction: Therapy options for patients with oligoprogressive malignant pleural mesothelioma (MPM) are limited. Stereotactic Body Radiotherapy (SBRT) may be a promising therapeutic option, as it delivers a localized ablative dose of radiation and therefore balances efficacy and treatment related toxicities. The intent of this retrospective analysis was to evaluate the feasibility of SBRT for limited pleural recurrences. Methods and Materials: This retrospective single-institution study is based on the 21 consecutive patients treated with hypofractionated radiotherapy for oligoprogressive MPM. Clinical and radiological data was collected at regular follow-up visits including toxicity, local control and survival. Results: At primary diagnosis, 57% of the patients presented with stage III disease. Initial treatment of MPM consisted of induction chemotherapy (n = 12) prior to a macroscopic complete resection (n = 18). Three patients received additional intracavitary chemotherapy and another three patients were treated with chemotherapy alone without another treatment at the time of first diagnosis. A total of 50 lesions in recurrent MPM were treated with SBRT. The median number of radiotherapy fractions was 5 (range 3–20) with a median dose per fraction of 5 Gy (range 2.5–12.5 Gy). The median total treatment dose was 30 Gy (20–50 Gy) with a median prescription isodose line (IDL) of 65% (65–100%). Median follow-up of all patients from diagnosis was 28 months (range 7–152 months). Analyzing all lesions separately, the 12-months-local control from SBRT was 73.5%. The median progression free survival (PFS) after SBRT was 6 months (range 0–21 months) and the median OS from first first SBRT was 29 months (range 0–61 months). Only one patients experienced above Grade 3 toxicities. Conclusion: This analysis demonstrates the feasibility of a SBRT approach for oligorecurrent MPM. SBRT was well-tolerated even after multiple repetitions and local control was high with a promising median OS.
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Affiliation(s)
- Christina Schröder
- Department of Radiation Oncology, University Hospital Zurich, Zurich, Switzerland
| | - Isabelle Opitz
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | | | - Rolf Stahel
- Department of Medical Oncology, University Hospital Zurich, Zurich, Switzerland
| | - Walter Weder
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Robert Förster
- Department of Radiation Oncology, University Hospital Zurich, Zurich, Switzerland
| | - Nicolaus Andratschke
- Department of Radiation Oncology, University Hospital Zurich, Zurich, Switzerland
| | - Olivia Lauk
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
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30
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Bostel T, Förster R, Schlampp I, Sprave T, Akbaba S, Wollschläger D, Debus J, Mayer A, Schmidberger H, Rief H, Nicolay NH. Stability and survival analysis of elderly patients with osteolytic spinal bone metastases after palliative radiotherapy : Results from a large multicenter cohort. Strahlenther Onkol 2019; 195:1074-1085. [PMID: 31240346 PMCID: PMC6867989 DOI: 10.1007/s00066-019-01482-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 01/02/2019] [Accepted: 06/03/2019] [Indexed: 12/25/2022]
Abstract
Purpose This retrospective study aimed to evaluate the stability and fracture rates of osteolytic spinal bone metastases (SBM) in elderly patients following palliative radiotherapy (RT) and to derive prognostic factors for stability and survival. Methods A total of 322 patients aged at least 70 years received palliative RT at two major German academic medical centers or at the German Cancer Research Center. Stability assessment was based on the validated Taneichi score prior to RT and at 3 and 6 months after RT. The survival time following RT was assessed, and prognostic factors for stability and survival were analyzed. Results Prior to RT, 183 patients (57%) exhibited unstable SBM and 68 patients (21%) pathological fractures. At 3 and 6 months after RT, significant recalcification and stabilization were evident in 19% (23/118) and 40% (31/78) of surviving patients, respectively. Only 17 patients (5%) experienced new pathological fractures following RT. Tumor histology was found to significantly influence stabilization rates with only breast cancer patients exhibiting increased stabilization compared to patients with other histologies. The median survival time and 6‑month survival rates following RT were 5.4 months (95% confidence interval 4.4–7.2 months) and 48%, respectively. The patients’ performance status was found to be the strongest predictor for survival after RT in this patient cohort; further factors demonstrating a significant association with survival were the application of systemic treatment, the number of SBM and the primary tumor histology. To analyze the influence of age on survival after RT, study patients were stratified into 3 age groups (i.e., 70–74 years, 75–79 years, and ≥80 years). The subgroup of patients aged at least 80 years showed a strong trend towards a worse survival time following RT compared to younger patients (i.e., 6‑month survival rate 39% vs. 51%; p = 0.06, log-rank test). Conclusions Prognostic factors influencing overall survival such as performance status and histology should guide the choice for palliative RT for SBM. Strongly hypofractionated RT regimes may be advisable for most elderly patients considering the overall poor prognosis in order to reduce hospitalization times.
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Affiliation(s)
- Tilman Bostel
- Department of Radiation Oncology, University Hospital of Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
- Department of Radiation Oncology, University Medical Center Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
| | - Robert Förster
- Department of Radiation Oncology, University Hospital of Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
- Department of Radiation Oncology, University Hospital of Zurich, Raemistraße 100, 8091 Zurich, Switzerland
| | - Ingmar Schlampp
- Department of Radiation Oncology, University Hospital of Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
| | - Tanja Sprave
- Department of Radiation Oncology, University Hospital of Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
| | - Sati Akbaba
- Department of Radiation Oncology, University Hospital of Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
| | - Daniel Wollschläger
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center Mainz, Mainz, Germany
| | - Jürgen Debus
- Department of Radiation Oncology, University Hospital of Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
| | - Arnulf Mayer
- Department of Radiation Oncology, University Medical Center Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
| | - Heinz Schmidberger
- Department of Radiation Oncology, University Medical Center Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
| | - Harald Rief
- Department of Radiation Oncology, University Hospital of Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
| | - Nils Henrik Nicolay
- Department of Radiation Oncology, University Hospital of Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
- Department of Radiation Oncology, University Hospital of Freiburg, Robert-Koch-Straße 3, 79106 Freiburg, Germany
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31
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Bostel T, Förster R, Schlampp I, Sprave T, Akbaba S, Wollschläger D, Debus J, Schmidberger H, Rief H, Nicolay N. EP-1652 Stability and survival of elderly patients after palliative radiotherapy of spinal bone metastases. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)32072-9] [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: 10/26/2022]
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32
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Schröder C, Opitz I, Guckenberger M, Stahel R, Weder W, Förster R, Andratschke N, Lauk O. EP-1365 SBRT as salvage therapy for oligometastatic pleural mesothelioma after initial curative therapy. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31785-2] [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: 11/16/2022]
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33
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Sprave T, Verma V, Förster R, Schlampp I, Hees K, Bruckner T, Bostel T, El Shafie RA, Welzel T, Nicolay NH, Debus J, Rief H. Bone density and pain response following intensity-modulated radiotherapy versus three-dimensional conformal radiotherapy for vertebral metastases - secondary results of a randomized trial. Radiat Oncol 2018; 13:212. [PMID: 30376859 PMCID: PMC6208115 DOI: 10.1186/s13014-018-1161-4] [Citation(s) in RCA: 14] [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: 04/13/2018] [Accepted: 10/22/2018] [Indexed: 12/19/2022] Open
Abstract
Background This was a prespecified secondary analysis of a randomized trial that analyzed bone density and pain response following fractionated intensity-modulated radiotherapy (IMRT) versus three-dimensional conformal radiotherapy (3DCRT) for palliative management of spinal metastases. Methods/materials Sixty patients were enrolled in the single-institutional randomized exploratory trial, randomly assigned to receive IMRT or 3DCRT (30 Gy in 10 fractions). Along with pain response (measured by the Visual Analog Scale (VAS) and Chow criteria), quantitative bone density was evaluated at baseline, 3, and 6 months in both irradiated and unirradiated spinal bodies, along with rates of pathologic fractures and vertebral compression fractures. Results Relative to baseline, bone density increased at 3 and 6 months following IMRT by a median of 24.8% and 33.8%, respectively (p < 0.01 and p = 0.048). These figures in the 3DCRT cohort were 18.5% and 48.4%, respectively (p < 0.01 for both). There were no statistical differences in bone density between IMRT and 3DCRT at 3 (p = 0.723) or 6 months (p = 0.341). Subgroup analysis of osteolytic and osteoblastic metastases showed no differences between groups; however, mixed metastases showed an increase in bone density over baseline in the IMRT (but not 3DCRT) arm. The 3-month rate of the pathological fractures was 15.0% in the IMRT arm vs. 10.5% in the 3DCRT arm. There were no differences in pathological fractures at 3 (p = 0.676) and 6 (p = 1.000) months. The IMRT arm showed improved VAS scores at 3 (p = 0.037) but not 6 months (p = 0.430). Using Chow criteria, pain response was similar at both 3 (p = 0.395) and 6 (p = 0.732) months. Conclusions This the first prospective investigation evaluating the impact of IMRT vs. 3DCRT on bone density. Along with pain response and pathologic fracture rates, significant rises in bone density after 3 and 6 months were similar in both cohorts. Future randomized investigations with larger sample sizes are recommended. Trial registration NCT, NCT02832830. Registered 14 July 2016
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Affiliation(s)
- Tanja Sprave
- University Hospital of Heidelberg, Department of Radiation Oncology, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
| | - Vivek Verma
- Department of Radiation Oncology, Allegheny General Hospital, Pittsburgh, PA, USA
| | - Robert Förster
- University Hospital of Heidelberg, Department of Radiation Oncology, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany.,University Hospital Zurich, Department of Radiation Oncology, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Ingmar Schlampp
- University Hospital of Heidelberg, Department of Radiation Oncology, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
| | - Katharina Hees
- Department of Radiation Oncology, Allegheny General Hospital, Pittsburgh, PA, USA.,University Hospital of Heidelberg, Department of Medical Biometry, Im Neuenheimer Feld 305, 69120, Heidelberg, Germany
| | - Thomas Bruckner
- Department of Radiation Oncology, Allegheny General Hospital, Pittsburgh, PA, USA.,University Hospital of Heidelberg, Department of Medical Biometry, Im Neuenheimer Feld 305, 69120, Heidelberg, Germany
| | - Tilman Bostel
- University Hospital of Heidelberg, Department of Radiation Oncology, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Rami Ateyah El Shafie
- University Hospital of Heidelberg, Department of Radiation Oncology, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
| | - Thomas Welzel
- University Hospital of Heidelberg, Department of Radiation Oncology, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Nils Henrik Nicolay
- University Hospital of Heidelberg, Department of Radiation Oncology, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany.,University Hospital of Freiburg, Department of Radiation Oncology, Robert-Koch-Strasse 3, 79106, Freiburg, Germany
| | - Jürgen Debus
- University Hospital of Heidelberg, Department of Radiation Oncology, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
| | - Harald Rief
- University Hospital of Heidelberg, Department of Radiation Oncology, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany. .,Heidelberg Institute of Radiation Oncology (HIRO), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany.
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Zilli T, Scorsetti M, Zwahlen D, Franzese C, Förster R, Giaj-Levra N, Koutsouvelis N, Bertaut A, Zimmermann M, D'Agostino GR, Alongi F, Guckenberger M, Miralbell R. Correction to: ONE SHOT - single shot radiotherapy for localized prostate cancer: study protocol of a single arm, multicenter phase I/II trial. Radiat Oncol 2018; 13:182. [PMID: 30231884 PMCID: PMC6145342 DOI: 10.1186/s13014-018-1131-x] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 09/13/2018] [Indexed: 11/10/2022] Open
Abstract
Following publication of the original article [1], the authors reported that one of the authors' names is spelled incorrectly. In this Correction the incorrect and correct author name are shown. The original publication of this article has been corrected.
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Affiliation(s)
- Thomas Zilli
- Radiation Oncology, Geneva University Hospital, CH-1211, 14, Geneva, Switzerland.
- Faculty of Medicine, Geneva University, Geneva, Switzerland.
| | - Marta Scorsetti
- Radiation Oncology, Humanitas University, Rozzano, Milan, Italy
- Radiation Oncology, Humanitas Research Hospital and Cancer Center, Rozzano, Milan, Italy
| | - Daniel Zwahlen
- Radiation Oncology, Kantonsspital Graubünden, Chur, Switzerland
| | - Ciro Franzese
- Radiation Oncology, Humanitas Research Hospital and Cancer Center, Rozzano, Milan, Italy
| | - Robert Förster
- Radiation Oncology, University Hospital Zürich, Zürich, Switzerland
| | | | | | - Aurelie Bertaut
- Methodology and biostatistic unit, Centre Georges François Leclerc, Dijon, France
| | | | | | - Filippo Alongi
- Radiation Oncology, Sacro Cuore Don-Calabria, Negrar, Italy
- Faculty of Medecine, University of Brescia, Brescia, Italy
| | | | - Raymond Miralbell
- Radiation Oncology, Geneva University Hospital, CH-1211, 14, Geneva, Switzerland
- Faculty of Medicine, Geneva University, Geneva, Switzerland
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Zilli T, Scorsetti M, Zwahlen D, Franzese C, Förster R, Giaj-Levra N, Koutsouvelis N, Bertaut A, Zimmermann M, D'Agostino GR, Alongi F, Guckenberger M, Miralbell R. ONE SHOT - single shot radiotherapy for localized prostate cancer: study protocol of a single arm, multicenter phase I/II trial. Radiat Oncol 2018; 13:166. [PMID: 30180867 PMCID: PMC6123974 DOI: 10.1186/s13014-018-1112-0] [Citation(s) in RCA: 24] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 08/22/2018] [Indexed: 11/14/2022] Open
Abstract
Background Stereotactic body radiotherapy (SBRT) is an emerging treatment alternative for patients with localized prostate cancer. Promising results in terms of disease control and toxicity have been reported with 4 to 5 SBRT fractions. However, question of how far can the number of fractions with SBRT be reduced is a challenging research matter. As already explored by some authors in the context of brachytherapy, monotherapy appears to be feasible with an acceptable toxicity profile and a promising outcome. The aim of this multicenter phase I/II prospective trialis to demonstrate early evidence of safety and efficacy of a single-fraction SBRT approach for the treatment of localized disease. Methods Patients with low- and intermediate-risk localized prostate cancer without significant tumor in the transitional zone will be treated with a single SBRT fraction of 19 Gy to the whole prostate gland with urethra-sparing (17 Gy). Intrafractional motion will be monitored with intraprostatic electromagnetic transponders. The primary endpoint of the phase I part of the study will be safety as assessed by CTCAE 4.03 grading scale, while biochemical relapse-free survival will be the endpoint for the phase II. The secondary endpoints include acute and late toxicity, quality of life, progression-free survival, and prostate-cancer specific survival. Discussion This is the first multicenter phase I/II trial assessing the efficacy and safety of a single-dose SBRT treatment for patients with localized prostate cancer. If positive, results of ONE SHOT may help to design subsequent phase III trials exploring the role of SBRT monotherapy in the exclusive radiotherapy treatment of localized disease. Trial registration Clinicaltrials.gov identifier: NCT03294889; Registered 27 September 2017.
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Affiliation(s)
- Thomas Zilli
- Radiation Oncology, Geneva University Hospital, CH-1211, 14, Geneva, Switzerland. .,Faculty of Medicine, Geneva University, Geneva, Switzerland.
| | - Marta Scorsetti
- Radiation Oncology, Humanitas University, Rozzano, Milan, Italy.,Radiation Oncology, Humanitas Research Hospital and Cancer Center, Rozzano, Milan, Italy
| | - Daniel Zwahlen
- Radiation Oncology, Kantonsspital Graubünden, Chur, Switzerland
| | - Ciro Franzese
- Radiation Oncology, Humanitas Research Hospital and Cancer Center, Rozzano, Milan, Italy
| | - Robert Förster
- Radiation Oncology, University Hospital Zürich, Zürich, Switzerland
| | | | | | - Aurelie Bertaut
- Methodology and biostatistic unit, Centre Georges François Leclerc, Dijon, France
| | | | | | - Filippo Alongi
- Radiation Oncology, Sacro Cuore Don-Calabria, Negrar, Italy.,Faculty of Medecine, University of Brescia, Brescia, Italy
| | | | - Raymond Miralbell
- Radiation Oncology, Geneva University Hospital, CH-1211, 14, Geneva, Switzerland.,Faculty of Medicine, Geneva University, Geneva, Switzerland
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Sprave T, Verma V, Förster R, Schlampp I, Hees K, Bruckner T, Bostel T, El Shafie RA, Welzel T, Nicolay NH, Debus J, Rief H. Local response and pathologic fractures following stereotactic body radiotherapy versus three-dimensional conformal radiotherapy for spinal metastases - a randomized controlled trial. BMC Cancer 2018; 18:859. [PMID: 30170568 PMCID: PMC6119304 DOI: 10.1186/s12885-018-4777-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [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: 03/23/2018] [Accepted: 08/23/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This was a prespecified secondary analysis of a randomized trial, which analyzed bone density following stereotactic body radiotherapy (SBRT) versus conventional three-dimensional conformal radiotherapy (3DCRT) as part of palliative management of painful spinal metastases. METHODS Fifty-five patients were enrolled in this single-institutional randomized exploratory trial (NCT02358720). Participants were randomly assigned to receive SBRT (single-fraction 24 Gy) or 3DCRT (30 Gy/10 fractions). Quantitative bone density was evaluated at baseline, 3 and 6 months in both irradiated and unirradiated spinal bodies, along with rates of pathologic fractures and vertebral compression fractures. RESULTS As compared to baseline, bone density became significantly higher at 3 and 6 months following SBRT by a median of 33.8% and 72.1%, respectively (p < 0.01 for both). These figures in the 3DCRT cohort were 32.9% and 41.2%, respectively (p < 0.01 for both). There were no statistical differences in bone density between SBRT and 3DCRT at 3 (p = 0.629) or 6 months (p = 0.327). Subgroup analysis of osteolytic metastases showed an increase in bone density relative to baseline in the SBRT (but not 3DCRT) arm. Bone density in unaffected vertebrae did not show substantial changes in either group. The 3-month incidence of new pathological fractures was 8.7% in the SBRT arm vs. 4.3% in the 3DCRT arm. CONCLUSIONS Despite high ablative doses in the SBRT arm, the significant increase in bone density after 3 and 6 months was similar to that of 3DCRT. Our trial demonstrated a moderate rate of subsequent pathological fracture after SBRT. Future randomized investigations with larger sample sizes are recommended. TRIAL REGISTRATION www.clinicaltrials.gov : NCT02358720 on 9nd of February 2015.
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Affiliation(s)
- Tanja Sprave
- Department of Radiation Oncology, University Hospital of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
| | - Vivek Verma
- Department of Radiation Oncology, Allegheny General Hospital, Pittsburgh, PA, USA
| | - Robert Förster
- Department of Radiation Oncology, University Hospital of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany.,Department of Radiation Oncology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Ingmar Schlampp
- Department of Radiation Oncology, University Hospital of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
| | - Katharina Hees
- Department of Medical Biometry, University Hospital of Heidelberg, Im Neuenheimer Feld 305, 69120, Heidelberg, Germany
| | - Thomas Bruckner
- Department of Radiation Oncology, Allegheny General Hospital, Pittsburgh, PA, USA.,Department of Medical Biometry, University Hospital of Heidelberg, Im Neuenheimer Feld 305, 69120, Heidelberg, Germany
| | - Tilman Bostel
- Department of Radiation Oncology, University Hospital of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
| | - Rami Ateyah El Shafie
- Department of Radiation Oncology, University Hospital of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
| | - Thomas Welzel
- Department of Radiation Oncology, University Hospital of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
| | - Nils Henrik Nicolay
- Department of Radiation Oncology, University Hospital of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany.,Department of Radiation Oncology, University Hospital of Freiburg, Robert-Koch-Strasse 3, 79106, Freiburg, Germany
| | - Jürgen Debus
- Department of Radiation Oncology, University Hospital of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
| | - Harald Rief
- Department of Radiation Oncology, University Hospital of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany. .,Heidelberg Institute of Radiation Oncology (HIRO), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany. .,Department of Radiation Oncology, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
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Sprave T, Verma V, Förster R, Schlampp I, Bruckner T, Bostel T, El Shafie RA, Nicolay NH, Debus J, Rief H. Quality of Life Following Stereotactic Body Radiotherapy Versus Three-Dimensional Conformal Radiotherapy for Vertebral Metastases: Secondary Analysis of an Exploratory Phase II Randomized Trial. Anticancer Res 2018; 38:4961-4968. [PMID: 30061276 DOI: 10.21873/anticanres.12814] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [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: 05/31/2018] [Revised: 07/07/2018] [Accepted: 07/11/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM This was a prespecified secondary analysis of a randomized trial, which analyzed quality of life (QOL), fatigue, and emotional distress following stereotactic body radiotherapy (SBRT) versus conventional three-dimensional conformal radiotherapy (3DCRT) as part of palliative management of painful spinal metastases. MATERIALS AND METHODS Fifty-five patients were enrolled in this single-institutional randomized exploratory phase II trial (NCT02358720). Participants were randomly assigned to receive SBRT (single-fraction 24 Gy) or 3DCRT (30 Gy/10 fractions). QOL (EORTC QLQ-BM22), fatigue (EORTC QLQ FA13), and emotional distress (QSC-R10) at the end of radiotherapy, along with 3- and 6-month follow-up were assessed. RESULTS At all recorded time points, there were no significant QOL differences between cohorts, including painful sites, pain characteristics, functional impairment, or psychosocial aspects (p>0.05 for all). There were also no differences in all dimensions of fatigue between groups at each recorded time point (p>0.05 for all). Emotional distress was also similar at three (p=0.248) and six months (p=0.603). CONCLUSION Although these results demonstrate that SBRT does not cause worse QOL deteriorations compared to 3DCRT, larger randomized investigations are recommended to corroborate these findings.
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Affiliation(s)
- Tanja Sprave
- Department of Radiation Oncology, University Hospital of Heidelberg, Heidelberg, Germany .,Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany
| | - Vivek Verma
- Department of Radiation Oncology, Allegheny General Hospital, Pittsburgh, PA, U.S.A
| | - Robert Förster
- Department of Radiation Oncology, University Hospital of Heidelberg, Heidelberg, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany.,Department of Radiation Oncology, University Hospital Zurich, Zurich, Switzerland
| | - Ingmar Schlampp
- Department of Radiation Oncology, University Hospital of Heidelberg, Heidelberg, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany
| | - Thomas Bruckner
- Department of Medical Biometry, University Hospital of Heidelberg, Heidelberg, Germany
| | - Tilman Bostel
- Department of Radiation Oncology, University Hospital of Heidelberg, Heidelberg, Germany
| | - Rami Ateayh El Shafie
- Department of Radiation Oncology, University Hospital of Heidelberg, Heidelberg, Germany
| | - Nils Henrik Nicolay
- Department of Radiation Oncology, University Hospital of Heidelberg, Heidelberg, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany.,Department of Radiation Oncology, University Hospital of Freiburg, Freiburg, Germany
| | - Jürgen Debus
- Department of Radiation Oncology, University Hospital of Heidelberg, Heidelberg, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany
| | - Harald Rief
- Department of Radiation Oncology, University Hospital of Heidelberg, Heidelberg, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany
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Sprave T, Verma V, Förster R, Schlampp I, Bruckner T, Bostel T, Welte SE, Tonndorf-Martini E, Nicolay NH, Debus J, Rief H. Randomized phase II trial evaluating pain response in patients with spinal metastases following stereotactic body radiotherapy versus three-dimensional conformal radiotherapy. Radiother Oncol 2018; 128:274-282. [DOI: 10.1016/j.radonc.2018.04.030] [Citation(s) in RCA: 99] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 04/22/2018] [Accepted: 04/23/2018] [Indexed: 11/30/2022]
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Sprave T, Welte SE, Bruckner T, Förster R, Bostel T, Schlampp I, Nicolay NH, Debus J, Rief H. Intensity-modulated radiotherapy with integrated-boost in patients with bone metastasis of the spine: study protocol for a randomized controlled trial. Trials 2018; 19:59. [PMID: 29357902 PMCID: PMC5778628 DOI: 10.1186/s13063-018-2452-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 01/03/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Stereotactic body radiation therapy (SBRT) using intensity-modulated radiotherapy (IMRT) with dose escalation by simultaneous integrated boost (SIB) can be a safe modality for treating spinal bone metastases with enhanced targeting accuracy and improve local tumor control. METHODS/DESIGN This is a single-center, prospective, randomized, controlled trial. One hundred and twenty patients with spinal bone metastases will receive palliative radiation therapy at the Heidelberg University Hospital. SBRT will be given in five or ten fractions with or without SIB. Four treatment arms are planned: IMRT with 30 Gy in ten fractions, IMRT with 30 Gy in ten fractions and SIB to 40 Gy, IMRT with 20 Gy in five fractions, and IMRT with 20 Gy in five fractions and SIB to 30Gy in five fractions will be compared. The target parameters will be measured at baseline level and at three and six months after radiation. DISCUSSION The primary endpoint of this study was to assess and compare the local tumor control (by means of different fractionation schedules and biological doses to the tumor area). Secondary endpoints are acute and chronic adverse events, pain relief, quality of life, and fatigue. TRIAL REGISTRATION ClinicalTrials.gov, NCT02832765 . Registered on 27 July 2016.
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Affiliation(s)
- Tanja Sprave
- Department of Radiation Oncology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
| | - Stefan Ezechiel Welte
- Department of Radiation Oncology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
| | - Thomas Bruckner
- Department of Medical Biometry, University Hospital Heidelberg, Im Neuenheimer Feld 305, 69120 Heidelberg, Germany
| | - Robert Förster
- Department of Radiation Oncology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
| | - Tilman Bostel
- Department of Radiation Oncology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
| | - Ingmar Schlampp
- Department of Radiation Oncology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
| | - Nils Henrik Nicolay
- Department of Radiation Oncology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
- National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
- Department of Radiation Oncology, Heidelberg German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Jürgen Debus
- Department of Radiation Oncology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
- National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
- Department of Radiation Oncology, Heidelberg German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Harald Rief
- Department of Radiation Oncology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
- National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
- Department of Radiation Oncology, Heidelberg German Cancer Research Center (DKFZ), Heidelberg, Germany
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Lang K, König L, Bruckner T, Förster R, Sprave T, Schlampp I, Bostel T, Welte S, Nicolay NH, Debus J, Rief H. Stability of Spinal Bone Lesions in Patients With Multiple Myeloma After Radiotherapy-A Retrospective Analysis of 130 Cases. Clin Lymphoma Myeloma Leuk 2017; 17:e99-e107. [PMID: 28993162 DOI: 10.1016/j.clml.2017.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 08/13/2017] [Accepted: 09/11/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND The objective of the present retrospective analysis was the response evaluation regarding bone density and stability of patients with osteolytic spinal bone lesions due to multiple myeloma after palliative radiotherapy (RT). PATIENTS AND METHODS Patients with multiple myeloma who had undergone spinal RT from March 2003 to May 2016 were analyzed before and 3 and 6 months after RT. Assessment of spinal stability and bone density was performed using the internationally recognized Taneichi scoring system and measurement of bone density using computed tomography imaging-based Hounsfield units. For statistical analysis, we used the Bowker test, McNemar test, and κ statistics to detect possible asymmetries in the distribution of the Taneichi score over time. We used the Student t test for comparison of the density values (Hounsfield units) before and after treatment. Toxicity was evaluated using the Common Terminology Criteria for Adverse Events, version 4.0. Additionally, overall survival was calculated using the Kaplan-Meier method. RESULTS We evaluated 130 patients (69% male; 31% female) with multiple myeloma and a median age of 58 years. The median follow-up period was 41 months. Before treatment, 51% of the lesions were classified as unstable. At 3 and 6 months after RT, this rate had decreased to 41% (P = .0047) and 24% (P = .2393), respectively. The computed tomography measurements showed a significant increase in bone density at 3 and 6 months after RT. Acute RT-related grade 1 and 2 complications were detected in 34% of patients. Late side effects (grade 1-2) were detected in 23% of the patients. No severe grade 3 or 4 acute or late toxicities were identified. The median overall survival was 19.7 months for all patients and 6.6 months for patients with a Karnofsky performance score of ≤ 70%. CONCLUSION To the best of our knowledge, ours is the first report to analyze the bone density and stability in patients with multiple myeloma after RT using a validated scoring system and computed tomography imaging. Palliative RT is an effective method resulting in a significant increase in bone density for local response and stability without severe RT-related toxicity. Furthermore, recalcification could already be detected at 3 months after treatment.
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Affiliation(s)
- Kristin Lang
- Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany; National Center for Radiation Oncology, Heidelberg Institute for Radiation Oncology, Heidelberg, Germany
| | - Laila König
- Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany; National Center for Radiation Oncology, Heidelberg Institute for Radiation Oncology, Heidelberg, Germany
| | - Thomas Bruckner
- Department of Medical Biometry, University Hospital Heidelberg, Heidelberg, Germany
| | - Robert Förster
- Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany; National Center for Radiation Oncology, Heidelberg Institute for Radiation Oncology, Heidelberg, Germany
| | - Tanja Sprave
- Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany; National Center for Radiation Oncology, Heidelberg Institute for Radiation Oncology, Heidelberg, Germany
| | - Ingmar Schlampp
- Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany; National Center for Radiation Oncology, Heidelberg Institute for Radiation Oncology, Heidelberg, Germany
| | - Tilman Bostel
- Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany; National Center for Radiation Oncology, Heidelberg Institute for Radiation Oncology, Heidelberg, Germany
| | - Stefan Welte
- Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany
| | - Nils H Nicolay
- Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany; National Center for Radiation Oncology, Heidelberg Institute for Radiation Oncology, Heidelberg, Germany
| | - Jürgen Debus
- Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany; National Center for Radiation Oncology, Heidelberg Institute for Radiation Oncology, Heidelberg, Germany
| | - Harald Rief
- Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany; National Center for Radiation Oncology, Heidelberg Institute for Radiation Oncology, Heidelberg, Germany.
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Bostel T, Förster R, Schlampp I, Sprave T, Bruckner T, Nicolay NH, Welte SE, Debus J, Rief H. Spinal bone metastases in colorectal cancer: a retrospective analysis of stability, prognostic factors and survival after palliative radiotherapy. Radiat Oncol 2017; 12:115. [PMID: 28697786 PMCID: PMC5505142 DOI: 10.1186/s13014-017-0852-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 07/04/2017] [Indexed: 12/13/2022] Open
Abstract
Background This retrospective analysis aimed to analyse the stability of spinal bone metastases in colorectal cancer (CRC) patients following radiotherapy (RT) by use of a validated score and to assess prognostic factors for stability and survival. Methods Ninety-four patients with osteolytic spinal bone metastases from CRC were treated at the Department of Radiation Oncology at the University Hospital Heidelberg between 2000 and 2014. The stability of each affected vertebral body was assessed according to the validated Taneichi bone stability score on the basis of the treatment planning CT scan prior to RT and also based on the follow-up CT examinations at 3 and 6 months after RT. Additionally, bone survival rates (time between first day of RT and death from any cause) as well as prognostic factors for bone survival were evaluated for all study patients. Results Before RT, 59 patients (63%) were rated unstable according to the Taneichi score. Pathological fractures within the irradiated region were diagnosed in 43 patients (46%) prior to RT. New fractures or progression of previously collapsed vertebrae were diagnosed in 4 patients (4%) after irradiation. Significant re-calcification and stabilization of former unstable bone metastases was only observed in 3/59 patients (3%) and 5/59 patients (9%). The median bone survival was 4.2 months (range 0.5–67.3 months) and 6 months after RT 61% of the patients were dead. Karnofsky performance score (KPS) (< 70% vs. ≥ 70%), chemotherapy and bisphosphonate therapy were predictive prognostic factors for bone survival. Conclusions Our study population is characterized by poor bone survival and low re-calcification rates of unstable spinal bone lesions 3 and 6 months after RT. To avoid unnecessary hospitalisation and improve remaining QoL, short fractionated treatment schedules of RT may be prefered in this highly palliative situation, particularly for patients with a KPS < 70%.
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Affiliation(s)
- Tilman Bostel
- Department of Radiation Oncology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.,National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Robert Förster
- Department of Radiation Oncology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.,National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Ingmar Schlampp
- Department of Radiation Oncology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.,National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Tania Sprave
- Department of Radiation Oncology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.,National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Thomas Bruckner
- Department of Medical Biometry, University Hospital Heidelberg, Heidelberg, Germany
| | - Nils Henrik Nicolay
- Department of Radiation Oncology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.,National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Stefan Ezechiel Welte
- Department of Radiation Oncology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Jürgen Debus
- Department of Radiation Oncology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.,National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Harald Rief
- Department of Radiation Oncology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany. .,National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
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Welte SE, Wiskemann J, Scharhag-Rosenberger F, Förster R, Bostel T, Bruckner T, Schlampp I, Meyerhof E, Sprave T, Nicolay NH, Debus J, Rief H. Differentiated resistance training of the paravertebral muscles in patients with unstable spinal bone metastasis under concomitant radiotherapy: study protocol for a randomized pilot trial. Trials 2017; 18:155. [PMID: 28359283 PMCID: PMC5374677 DOI: 10.1186/s13063-017-1903-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 03/15/2017] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Metastatic bone disease is a common and severe complication in patients with advanced cancer. Radiotherapy (RT) has long been established as an effective local treatment for metastatic bone disorder. This study assesses the effects of RT combined with muscle-training exercises in patients with unstable bone metastases of the spinal column from solid tumors. The primary goal of this study is to evaluate the feasibility of muscle-training exercises concomitant to RT. Secondly, quality of life, fatigue, overall and bone survival, and local control will be assessed. METHODS/DESIGN This study is a single-center, prospective, randomized, controlled, explorative intervention study with a parallel-group design to determine multidimensional effects of a course of exercises concomitant to RT on patients who have unstable metastases of the vertebral column, first under therapeutic instruction and subsequently performed by the patients themselves independently for strengthening the paravertebral muscles. On the days of radiation treatment the patients will be given four different types of exercises to ensure even isometric muscle training of all the spinal muscles. In the control group progressive muscle relaxation will be carried out parallel to RT. The patients will be randomized into two groups: differentiated muscle training or progressive muscle relaxation with 30 patients in each group. DISCUSSION Despite the clinical experience that RT is an effective treatment for bone metastases, there is insufficient evidence for a positive effect of the combination with muscle-training exercises in patients with unstable bone metastases. Our previous DISPO-1 trial showed that adding muscle-training exercises to RT is feasible, whereas this was not proven in patients with an unstable spinal column. Although associated with several methodological and practical challenges, this randomized controlled trial is needed. TRIAL REGISTRATION ClinicalTrials.gov, identifier: NCT02847754 . Registered on 27 July 2016.
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Affiliation(s)
- Stefan Ezechiel Welte
- Department of Radiation Oncology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
- National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
| | - Joachim Wiskemann
- Department of Medical Oncology, National Center for Tumor Diseases (NCT) Heidelberg, Heidelberg University Hospital, Heidelberg, Germany
- Department of Preventive Oncology, National Center for Tumor Diseases (NCT) Heidelberg, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Friederike Scharhag-Rosenberger
- Department of Medical Oncology, National Center for Tumor Diseases (NCT) Heidelberg, Heidelberg University Hospital, Heidelberg, Germany
- Department of Preventive Oncology, National Center for Tumor Diseases (NCT) Heidelberg, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Robert Förster
- Department of Radiation Oncology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
- National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
| | - Tilman Bostel
- Department of Radiation Oncology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
- National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
| | - Thomas Bruckner
- Department of Medical Biometry, University Hospital Heidelberg, Im Neuenheimer Feld 305, 69120 Heidelberg, Germany
| | - Ingmar Schlampp
- Department of Radiation Oncology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
- National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
| | - Eva Meyerhof
- Department of Radiation Oncology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
- National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
| | - Tanja Sprave
- Department of Radiation Oncology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
- National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
| | - Nils H. Nicolay
- Department of Radiation Oncology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
- National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
| | - Jürgen Debus
- Department of Radiation Oncology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
- National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
| | - Harald Rief
- Department of Radiation Oncology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
- National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
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Meyerhof E, Sprave T, Welte SE, Nicolay NH, Förster R, Bostel T, Bruckner T, Schlampp I, Debus J, Rief H. Radiation-induced toxicity after image-guided and intensity-modulated radiotherapy versus external beam radiotherapy for patients with spinal bone metastases (IRON-1): a study protocol for a randomized controlled pilot trial. Trials 2017; 18:98. [PMID: 28253920 PMCID: PMC5335809 DOI: 10.1186/s13063-017-1847-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 11/08/2016] [Accepted: 02/17/2017] [Indexed: 11/17/2022] Open
Abstract
Background Radiation therapy (RT) of bone metastases provides an important treatment approach in palliative care treatment concepts. As a consequence of treatment, the extent of radiation-induced toxicity is a crucial feature with consequences to a patient’s quality of life. In this context this study aims at reducing the extent of radiation-induced side effects and toxicity by assuming a better sparing of normal tissue with the use of intensity-modulated instead of conventionally delivered external beam radiotherapy. Methods/design In this prospective, randomized, single-center trial for patients with spinal bone metastases, RT is performed as either image-guided intensity-modulated radiotherapy (10x3Gy) or conventionally fractionated external beam radiotherapy (10x3Gy). Afterwards radiation-induced toxicity will be assessed and compared 3 and 6 months after the end of radiation. Discussion The aim of this pilot study is the evaluation of achievable benefits, with reduced radiation toxicity being the primary endpoint in the comparison of intensity-modulated radiotherapy versus conventional radiotherapy for patients with spinal bone metastases. Secondarily, bone re-calcification, quality of life, pain relief, spinal instability, and local control will be measured and compared between the two treatment groups. Trial registration ClinicalTrials.gov, NCT02832830. Registered on 12 July 2016. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-1847-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Eva Meyerhof
- Department of Radiation Oncology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.,National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Tanja Sprave
- Department of Radiation Oncology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.,National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Stefan Ezechiel Welte
- Department of Radiation Oncology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.,National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Nils H Nicolay
- Department of Radiation Oncology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.,National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Robert Förster
- Department of Radiation Oncology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.,National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Tilman Bostel
- Department of Radiation Oncology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.,National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Thomas Bruckner
- Department of Medical Biometry, University Hospital Heidelberg, Im Neuenheimer Feld 305, 69120, Heidelberg, Germany
| | - Ingmar Schlampp
- Department of Radiation Oncology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.,National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Jürgen Debus
- Department of Radiation Oncology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.,National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Harald Rief
- Department of Radiation Oncology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany. .,National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
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Rief H, Bruckner T, Schlampp I, Bostel T, Welzel T, Debus J, Förster R. Resistance training concomitant to radiotherapy of spinal bone metastases - survival and prognostic factors of a randomized trial. Radiat Oncol 2016; 11:97. [PMID: 27464793 PMCID: PMC4963927 DOI: 10.1186/s13014-016-0675-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [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: 03/08/2016] [Accepted: 07/22/2016] [Indexed: 11/10/2022] Open
Abstract
Purpose To compare the effects of resistance training versus passive physical therapy on bone survival in the metastatic bone during radiation therapy (RT) as combined treatment in patients with spinal bone metastases. Secondly, to evaluate overall survival and progression-free-survival (PFS) as well as to quantify prognostic factors of bone survival after combined treatment. Methods In this randomized trial 60 patients were allocated from September 2011 until March 2013 into one of the two groups: resistance training (group A) or passive physical therapy (group B) with thirty patients in each group during RT. We estimated patient survival using Kaplan-Meier survival method. The Wald-test was used to evaluate the prognostic importance of pathological fracture, primary site, Karnofsky performance status, localization of metastases, number of metastases, and cerebral metastases. Results Median follow-up was 10 months (range 2–35). Bone survival showed no significant difference between groups (p = .303). Additionally no difference between groups could be detected in overall survival (p = .688) and PFS (p = .295). Local bone progression was detected in 16.7 % in group B, no irradiated bone in group A showed a local progression over the course (p = 0.019). In univariate analysis breast cancer, prostate cancer, and the presence of cerebral metastases had a significant impact on bone survival in group B, while no impact could be demonstrated in group A. Conclusions In this group of patients with spinal bone metastases we were able to show that guided resistance training of the paravertebral muscles had no essential impact on survival concomitant to RT. Importantly, no local bone progression in group A was detected, nevertheless no prognostic factor for combined treatment could be evaluated. Trial registration Clinical trial identifier NCT 01409720. Registered 8 February 2011.
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Affiliation(s)
- Harald Rief
- Department of Radiation Oncology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany. .,National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
| | - Thomas Bruckner
- Department of Medical Biometry, University Hospital Heidelberg, Im Neuenheimer Feld 305, 69120, Heidelberg, Germany
| | - Ingmar Schlampp
- Department of Radiation Oncology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Tilman Bostel
- Department of Radiation Oncology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Thomas Welzel
- Department of Radiation Oncology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Jürgen Debus
- Department of Radiation Oncology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.,National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Robert Förster
- Department of Radiation Oncology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
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Rief H, Omlor G, Akbar M, Bruckner T, Rieken S, Förster R, Schlampp I, Welzel T, Bostel T, Roth HJ, Debus J. Biochemical markers of bone turnover in patients with spinal metastases after resistance training under radiotherapy--a randomized trial. BMC Cancer 2016; 16:231. [PMID: 26983672 PMCID: PMC4794897 DOI: 10.1186/s12885-016-2278-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 12/09/2014] [Accepted: 03/13/2016] [Indexed: 12/25/2022] Open
Abstract
Background To compare the effects of resistance training versus passive physical therapy on bone turnover markers (BTM) in the metastatic bone during radiation therapy (RT) in patients with spinal bone metastases. Secondly, to evaluate an association of BTM to local response, skeletal-related events (SRE), and number of metastases. Methods In this randomized trial, 60 patients were allocated from September 2011 to March 2013 into one of the two arms: resistance training (Arm A) or passive physical therapy (Arm B) with thirty patients in each arm during RT. Biochemical markers such as pyridinoline (PYD), desoxy-pyridinoline (DPD), bone alkaline phosphatase (BAP), total amino-terminal propeptide of type I collagen (PINP), beta-isomer of carboxy-terminal telopeptide of type I collagen (CTX-I), and cross-linked N-telopeptide of type I collagen (NTX) were analyzed at baseline, and three months after RT. Results Mean change values of PYD and CTX-I were significantly lower at 3 months after RT (p = 0.035 and p = 0.043) in Arm A. Importantly, all markers decreased in both arms, except of PYD and CTX-I in arm B, although significance was not reached for some biomarkers. In arm A, the local response was significantly higher (p = 0.003) and PINP could be identified as a predictor for survivors (OR 0.968, 95%CI 0.938–0.999, p = 0.043). BAP (OR 0.974, 95%CI 0.950–0.998, p = 0.034) and PINP (OR 1.025, 95%CI 1.001–1.049, p = 0.044) were related with an avoidance of SRE. Conclusions In this group of patients with spinal bone metastases, we were able to show that patients with guided resistance training of the paravertebral muscles can influence BTM. PYD and CTX-I decreased significantly in arm A. PINP can be considered as a complementary tool for prediction of local response, and PINP as well as BAP for avoidance of SRE. Trial registration Clinical trial identifier NCT 01409720. August 2, 2011.
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Affiliation(s)
- Harald Rief
- Department of Radiation Oncology, University Hospital of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
| | - Georg Omlor
- Department of Orthopaedics and Trauma Surgery, University Hospital of Heidelberg, Schlierbacherstrasse 120a, 69118, Heidelberg, Germany
| | - Michael Akbar
- Department of Orthopaedics and Trauma Surgery, University Hospital of Heidelberg, Schlierbacherstrasse 120a, 69118, Heidelberg, Germany
| | - Thomas Bruckner
- Department of Medical Biometry, University Hospital of Heidelberg, Im Neuenheimer Feld 305, 69120, Heidelberg, Germany
| | - Stefan Rieken
- Department of Radiation Oncology, University Hospital of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Robert Förster
- Department of Radiation Oncology, University Hospital of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Ingmar Schlampp
- Department of Radiation Oncology, University Hospital of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Thomas Welzel
- Department of Radiation Oncology, University Hospital of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Tilman Bostel
- Department of Radiation Oncology, University Hospital of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Heinz Jürgen Roth
- Department of Endocrinology/Oncology, Limbach Laboratory Heidelberg, Im Breitspiel 15, 69126, Heidelberg, Germany
| | - Jürgen Debus
- Department of Radiation Oncology, University Hospital of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
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Rief H, Chaudhri N, Tonndorf-Martini E, Bruckner T, Rieken S, Bostel T, Förster R, Schlampp I, Debus J, Sterzing F. Intensity-modulated radiotherapy versus proton radiotherapy versus carbon ion radiotherapy for spinal bone metastases: a treatment planning study. J Appl Clin Med Phys 2015; 16:186–194. [PMID: 26699573 PMCID: PMC5690994 DOI: 10.1120/jacmp.v16i6.5618] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 06/10/2015] [Accepted: 06/19/2015] [Indexed: 11/23/2022] Open
Abstract
Outcomes for selected patients with spinal metastases may be improved by dose escalation using stereotactic body radiotherapy (SBRT). As target geometry is complex, we compared SBRT plans using step‐and‐shoot intensity‐modulated radiotherapy (IMRT), carbon ion RT, and proton RT. We prepared plans treating cervical, thoracic, and lumbar metastases for three different techniques — IMRT, carbon ion, and proton plans — to deliver a median single 24 Gy fraction such that at least 90% of the planning target volume (PTV) received more than 18 Gy and were compared for PTV coverage, normal organ sparing, and estimated delivery time. PTV coverage did not show significant differences for the techniques, spinal cord dose sparing was lowered with the particle techniques. For the cervical lesion spinal cord maximum dose, dose of 1% (D1), and percent volume receiving 10 Gy (V10Gy) were 11.9 Gy, 9.1 Gy, and 0.5% in IMRT. This could be lowered to 4.3 Gy, 2.5 Gy, and 0% in carbon ion planning and to 8.1 Gy, 6.1 Gy, and 0% in proton planning. Regarding the thoracic lesion no difference was found for the spinal cord. For the lumbar lesion maximum dose, D1 and percent volume receiving 5 Gy (V5Gy) were 13.4 Gy, 8.9 Gy, and 8.9% for IMRT; 1.8 Gy, 0.7 Gy, and 0% for carbon ions; and 0 Gy,<0.01 Gy, and 0% for protons. Estimated mean treatment times were shorter in particle techniques (6–7 min vs. 12–14 min with IMRT). This planning study indicates that carbon ion and proton RT can deliver high‐quality PTV coverage for complex treatment volumes that surround the spinal cord. PACS number: 87.55.dk
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Arians N, Förster R, Uhl M, Rom J, Debus J, Lindel K. Outcome of Patients With Local Recurrent Gynecologic Malignancies After Resection Combined With Intraoperative Radiation. Int J Radiat Oncol Biol Phys 2015. [DOI: 10.1016/j.ijrobp.2015.07.1209] [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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Rief H, Förster R, Rieken S, Bruckner T, Schlampp I, Bostel T, Debus J. The influence of orthopedic corsets on the incidence of pathological fractures in patients with spinal bone metastases after radiotherapy. BMC Cancer 2015; 15:745. [PMID: 26486754 PMCID: PMC4612425 DOI: 10.1186/s12885-015-1797-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 10/15/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Clinical care of unstable spinal bone metastases in many centers often includes patient immobilization by means of an orthopedic corset in order to prevent pathological fractures. The aim of this retrospective analysis was to evaluate the incidence of pathological fractures after radiotherapy (RT) in patients with and without orthopedic corsets and to assess prognostic factors for pathological fractures in patients with spinal bone metastases. METHODS The incidence of pathological fractures in 915 patients with 2.195 osteolytic metastases in the thoracic and lumbar spine was evaluated retrospectively on the basis of computed tomography (CT) scans between January 2000 and January 2012 depending on prescription and wearing of patient-customized orthopedic corsets. RESULTS In the corset group, 6.8 and 8.0 % in no-corset group showed pathological fractures prior to RT, no significant difference between groups was detected (p = 0.473). After 6 months, patients in the corset group showed pathological fractures in 8.6 % and in no-corset group in 9.3 % (p = 0.709). The univariate and bivariate analyses demonstrated no significant prognostic factor for incidence of pathological fractures in both groups. CONCLUSIONS In this analysis, we could show for the first time in more than 900 patients, that abandoning a general corset supply in patients with spinal metastases does not significantly cause increased rates of pathological fractures. Importantly, the incidence of pathological fracture after RT was small.
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Affiliation(s)
- Harald Rief
- Department of Radiation Oncology, University Hospital of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
| | - Robert Förster
- Department of Radiation Oncology, University Hospital of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
| | - Stefan Rieken
- Department of Radiation Oncology, University Hospital of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
| | - Thomas Bruckner
- Department of Medical Biometry, University Hospital of Heidelberg, Im Neuenheimer Feld 305, 69120, Heidelberg, Germany.
| | - Ingmar Schlampp
- Department of Radiation Oncology, University Hospital of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
| | - Tilman Bostel
- Department of Radiation Oncology, University Hospital of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
| | - Jürgen Debus
- Department of Radiation Oncology, University Hospital of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
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Rief H, Katayama S, Bruckner T, Rieken S, Bostel T, Förster R, Schlampp I, Wolf R, Debus J, Sterzing F. High-dose single-fraction IMRT versus fractionated external beam radiotherapy for patients with spinal bone metastases: study protocol for a randomized controlled trial. Trials 2015; 16:264. [PMID: 26054533 PMCID: PMC4465731 DOI: 10.1186/s13063-015-0761-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2015] [Accepted: 05/18/2015] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Stereotactic body radiation therapy (SBRT)using intensity-modulated radiotherapy (IMRT) can be a safe modality for treating spinal bone metastasis with enhanced targeting accuracy and an effective method for achieving good tumor control and a rigorous pain response. METHODS/DESIGN This is a single-center, prospective randomized controlled trial to evaluate pain relief after RT and consists of two treatment groups with 30 patients in each group. One group will receive single-fraction intensity-modulated RT with 1 × 24 Gy, and the other will receive fractionated RT with 10 × 3 Gy. The target parameters will be measured at baseline and at 3 and 6 months after RT. DISCUSSION The aim of this study is to evaluate pain relief after RT in patients with spinal bone metastases by means of two different techniques: stereotactic body radiation therapy and fractionated RT. The primary endpoint is pain relief at the 3-month time-point after RT. Secondly, quality of life, fatigue, overall and bone survival, and local control will be assessed. TRIAL REGISTRATION ClinicalTrials.gov identifier NCT02358720 (June 2, 2015).
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Affiliation(s)
- Harald Rief
- Department of Radiation Oncology, University Hospital of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
| | - Sonja Katayama
- Department of Radiation Oncology, University Hospital of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
| | - Thomas Bruckner
- Department of Medical Biometry, University Hospital of Heidelberg, Im Neuenheimer Feld 305, 69120, Heidelberg, Germany.
| | - Stefan Rieken
- Department of Radiation Oncology, University Hospital of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
| | - Tilman Bostel
- Department of Radiation Oncology, University Hospital of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
| | - Robert Förster
- Department of Radiation Oncology, University Hospital of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
| | - Ingmar Schlampp
- Department of Radiation Oncology, University Hospital of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
| | - Robert Wolf
- Department of Radiation Oncology, University Hospital of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
| | - Jürgen Debus
- Department of Radiation Oncology, University Hospital of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany. .,Heidelberg Institute of Radiation Oncology, Im Neuenheimer Feld 280, 69120, Heidelberg, Germany.
| | - Florian Sterzing
- Department of Radiation Oncology, University Hospital of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany. .,Heidelberg Institute of Radiation Oncology, Im Neuenheimer Feld 280, 69120, Heidelberg, Germany.
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