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Grimmer M, Sarria GR, Hamed M, Banat M, Koch D, Lorenzana H, Holz JA, Schmeel C, Kowark A, Schmeel LC, Garbe S. Image-Guided IORT after Surgical Resection of Brain Malignancies: A Feasibility Study. Int J Radiat Oncol Biol Phys 2023; 117:e715. [PMID: 37786089 DOI: 10.1016/j.ijrobp.2023.06.2217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Intraoperative radiation therapy (IORT) can be used to locally apply radiation doses to surgical cavities of resected brain metastases and glioblastoma. The miniaturized linear accelerator INTRABEAM 600® offers a low-energy system of 50kV X-rays. To date, placing the spherical applicator in the surgical bed has been done manually and without final positioning verification. Ultimately, without positional control, it must be assumed that the applicator is optimally positioned against the tissue in the tumor cavity, without any air interference or fluid underlying. Misplacements could lead to incomplete dose delivery, potentially yielding an increased risk of recurrence. Therefore, we deemed relevant to assess intraoperative imaging as a novel option for easing the applicator positioning. MATERIALS/METHODS A surgical environment was mimicked in two test runs with an interdisciplinary team, accounting for operating and anesthesia times. The IORT planning software Radiance (GMV Innovating Solutions, Madrid, Spain) was previously calibrated with a "cheese" phantom, using twelve different density levels from 0.3 to 1.842 g/cm3, yielding a value-to-density table with -600 to +600 HU range. Furthermore, two inserts were placed in the phantom to evaluate the quality and spatial resolution of the cone-beam CT (CBCT) imaging. The O-Arm System (Medtronic, Minneapolis, MN, USA) was employed for acquiring tomographic intraoperative imaging, once the applicator was placed in a skull-shaped phantom. Two expert radiation oncologists contoured the acquired dataset and performed the treatment calculations, based on a 30 Gy prescription dose. RESULTS We achieved the best possible CBCT imaging quality with the 120kV and 20mA setting parameters. This corresponds to the "HD3D (large)" O-Arm setting mode. With this, the image quality with artifact reduction, minimization of image noise and consideration of a low radiation exposure of only 0.5mSv for the patients is feasible. Approximately 15 additional minutes were accounted for contouring and planning times. CONCLUSION Good-quality intraoperative imaging can be obtained when performing IORT, easing the applicator positioning and resulting in a more precise target irradiation. Operating times would be minimally extended with this procedure. A clinical study will initiate based on these findings.
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Affiliation(s)
- M Grimmer
- Department of Radiation Oncology, University Hospital Bonn, Bonn, Germany
| | - G R Sarria
- Department of Radiation Oncology, University Hospital Bonn, Bonn, Germany
| | - M Hamed
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | - M Banat
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | - D Koch
- Department of Radiation Oncology, University Hospital Bonn, Bonn, Germany
| | - H Lorenzana
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | - J A Holz
- Department of Radiation Oncology, University Hospital Bonn, Bonn, Germany
| | - C Schmeel
- Department of Neuro-Radiology, University Hospital Bonn, Bonn, Germany
| | - A Kowark
- Department of Anesthesiology, University Hospital Bonn, Bonn, Germany
| | - L C Schmeel
- Department of Radiation Oncology, University Hospital Bonn, Bonn, Germany
| | - S Garbe
- Department of Radiation Oncology, University Hospital Bonn, Bonn, Germany
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Layer K, Layer JP, Glasmacher AR, Sarria GR, Böhner AMC, Layer YL, Dejonckheere CS, Garbe S, Feyer P, Baumert BG, Schendera A, Baumann R, Krug D, Köksal MA, Koch D, Scafa D, Leitzen C, Hölzel M, Giordano FA, Schmeel LC. Risk assessment, surveillance, and nonpharmaceutical prevention of acute radiation dermatitis: results of a multicentric survey among the German-speaking radiation oncology community. Strahlenther Onkol 2023; 199:891-900. [PMID: 37099166 PMCID: PMC10542714 DOI: 10.1007/s00066-023-02074-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [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: 10/14/2022] [Accepted: 03/05/2023] [Indexed: 04/27/2023]
Abstract
PURPOSE Radiation dermatitis (RD) represents one of the most frequent side effects in radiotherapy (RT). Despite technical progress, mild and moderate RD still affects major subsets of patients and identification and management of patients with a high risk of severe RD is essential. We sought to characterize surveillance and nonpharmaceutical preventive management of RD in German-speaking hospitals and private centers. METHODS We conducted a survey on RD among German-speaking radiation oncologists inquiring for their evaluation of risk factors, assessment methods, and nonpharmaceutical preventive management of RD. RESULTS A total of 244 health professionals from public and private institutions in Germany, Austria, and Switzerland participated in the survey. RT-dependent factors were deemed most relevant for RD onset followed by lifestyle factors, emphasizing the impact of treatment conceptualization and patient education. While a broad majority of 92.8% assess RD at least once during RT, 59.0% of participants report RD at least partially arbitrarily and 17.4% stated to classify RD severity solely arbitrarily. 83.7% of all participants were unaware of patient-reported outcomes (PROs). Consensus exists on some lifestyle recommendations like avoidance of sun exposure (98.7%), hot baths (95.1%), and mechanical irritation (91.8%) under RT, while deodorant use (63.4% not at all, 22.1% with restrictions) or application of skin lotion (15.1% disapproval) remain controversial and are not recommended by guidelines or evidence-based practices. CONCLUSION Identification of patients at an increased risk of RD and subsequent implementation of adequate preventive measures remain relevant and challenging aspects of clinical routines. Consensus exists on several risk factors and nonpharmaceutical prevention recommendations, while RT-dependent risk factors, e.g., the fractionation scheme, or hygienic measures like deodorant use remain controversial. Surveillance is widely lacking methodology and objectivity. Intensifying outreach in the radiation oncology community is needed to improve practice patterns.
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Affiliation(s)
- Katharina Layer
- Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Julian P Layer
- Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
- Institute of Experimental Oncology, University Hospital Bonn, University of Bonn, Bonn, Germany
| | - Andrea R Glasmacher
- Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Gustavo R Sarria
- Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Alexander M C Böhner
- Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Yonah L Layer
- Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Cas S Dejonckheere
- Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Stephan Garbe
- Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Petra Feyer
- Department of Radiation Oncology, Vivantes Hospital Neukölln, Berlin, Germany
| | - Brigitta G Baumert
- Institute of Radiation Oncology, Cantonal Hospital Graubünden, Graubünden, Switzerland
| | - Anke Schendera
- Department of Radiation Oncology, Community Hospital Mittelrhein, Koblenz, Germany
| | - René Baumann
- Department of Radiation Oncology, St. Marien Hospital Siegen, Siegen, Germany
| | - David Krug
- Department of Radiation Oncology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Mümtaz A Köksal
- Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - David Koch
- Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Davide Scafa
- Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Christina Leitzen
- Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Michael Hölzel
- Institute of Experimental Oncology, University Hospital Bonn, University of Bonn, Bonn, Germany
| | - Frank A Giordano
- Department of Radiation Oncology, University Hospital Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Leonard Christopher Schmeel
- Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
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Dejonckheere CS, Layer JP, Hamed M, Layer K, Glasmacher A, Friker LL, Potthoff AL, Zeyen T, Scafa D, Koch D, Garbe S, Holz JA, Kugel F, Grimmer M, Schmeel FC, Gielen GH, Forstbauer H, Vatter H, Herrlinger U, Giordano FA, Schneider M, Schmeel LC, Sarria GR. Intraoperative or postoperative stereotactic radiotherapy for brain metastases: time to systemic treatment onset and other patient-relevant outcomes. J Neurooncol 2023; 164:683-691. [PMID: 37812290 PMCID: PMC10589145 DOI: 10.1007/s11060-023-04464-7] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 09/23/2023] [Indexed: 10/10/2023]
Abstract
PURPOSE Intraoperative radiotherapy (IORT) has become a viable treatment option for resectable brain metastases (BMs). As data on local control and radiation necrosis rates are maturing, we focus on meaningful secondary endpoints such as time to next treatment (TTNT), duration of postoperative corticosteroid treatment, and in-hospital time. METHODS Patients prospectively recruited within an IORT study registry between November 2020 and June 2023 were compared with consecutive patients receiving adjuvant stereotactic radiotherapy (SRT) of the resection cavity within the same time frame. TTNT was defined as the number of days between BM resection and start of the next extracranial oncological therapy (systemic treatment, surgery, or radiotherapy) for each of the groups. RESULTS Of 95 BM patients screened, IORT was feasible in 84 cases (88%) and ultimately performed in 64 (67%). The control collective consisted of 53 SRT patients. There were no relevant differences in clinical baseline features. Mean TTNT (range) was 36 (9 - 94) days for IORT patients versus 52 (11 - 126) days for SRT patients (p = 0.01). Mean duration of postoperative corticosteroid treatment was similar (8 days; p = 0.83), as was mean postoperative in-hospital time (11 versus 12 days; p = 0.97). Mean total in-hospital time for BM treatment (in- and out-patient days) was 11 days for IORT versus 19 days for SRT patients (p < 0.001). CONCLUSION IORT for BMs results in faster completion of interdisciplinary treatment when compared to adjuvant SRT, without increasing corticosteroid intake or prolonging in-hospital times. A randomised phase III trial will determine the clinical effects of shorter TTNT.
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Affiliation(s)
- Cas S Dejonckheere
- Department of Radiation Oncology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
| | - Julian P Layer
- Department of Radiation Oncology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
- Institute of Experimental Oncology, University Hospital Bonn, 53127, Bonn, Germany
| | - Motaz Hamed
- Department of Neurosurgery, University Hospital Bonn, 53127, Bonn, Germany
| | - Katharina Layer
- Department of Radiation Oncology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Andrea Glasmacher
- Department of Radiation Oncology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Lea L Friker
- Institute of Experimental Oncology, University Hospital Bonn, 53127, Bonn, Germany
- Institute of Neuropathology, University Hospital Bonn, 53127, Bonn, Germany
| | | | - Thomas Zeyen
- Division of Clinical Neuro-Oncology, Department of Neurology, University Hospital Bonn, 53127, Bonn, Germany
| | - Davide Scafa
- Department of Radiation Oncology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - David Koch
- Department of Radiation Oncology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Stephan Garbe
- Department of Radiation Oncology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Jasmin A Holz
- Department of Radiation Oncology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Fabian Kugel
- Department of Radiation Oncology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Molina Grimmer
- Department of Radiation Oncology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | | | - Gerrit H Gielen
- Institute of Neuropathology, University Hospital Bonn, 53127, Bonn, Germany
| | | | - Hartmut Vatter
- Department of Neurosurgery, University Hospital Bonn, 53127, Bonn, Germany
| | - Ulrich Herrlinger
- Division of Clinical Neuro-Oncology, Department of Neurology, University Hospital Bonn, 53127, Bonn, Germany
| | - Frank A Giordano
- Department of Radiation Oncology, University Medical Center Mannheim, 68167, Mannheim, Germany
| | - Matthias Schneider
- Department of Neurosurgery, University Hospital Bonn, 53127, Bonn, Germany
| | | | - Gustavo R Sarria
- Department of Radiation Oncology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
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Köksal M, Baumert J, Jazmati D, Schoroth F, Garbe S, Koch D, Scafa D, Sarria GR, Leitzen C, Massoth G, Delis A, Heine A, Holderried T, Brossart P, Müdder T, Schmeel LC. Whole body irradiation with intensity-modulated helical tomotherapy prior to haematopoietic stem cell transplantation: analysis of organs at risk by dose and its effect on blood kinetics. J Cancer Res Clin Oncol 2023; 149:7007-7015. [PMID: 36856852 PMCID: PMC10374741 DOI: 10.1007/s00432-023-04657-7] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 02/15/2023] [Indexed: 03/02/2023]
Abstract
BACKGROUND Intensity-modulated helical tomotherapy (HT) is a promising technique in preparation for bone marrow transplantation. Nevertheless, radiation-sensitive organs can be substantially compromised due to suboptimal delivery techniques of total body irradiation (TBI). To reduce the potential burden of radiation toxicity to organs at risk (OAR), high-quality coverage and homogeneity are essential. We investigated dosimetric data from kidney, lung and thorax, liver, and spleen in relation to peripheral blood kinetics. To further advance intensity-modulated total body irradiation (TBI), the potential for dose reduction to lung and kidney was considered in the analysis. PATIENTS AND METHODS 46 patients undergoing TBI were included in this analysis, partially divided into dose groups (2, 4, 8, and 12 Gy). HT was performed using a rotating gantry to ensuring optimal reduction of radiation to the lungs and kidneys and to provide optimal coverage of other OAR. Common dosimetric parameters, such as D05, D95, and D50, were calculated and analysed. Leukocytes, neutrophils, platelets, creatinine, GFR, haemoglobin, overall survival, and graft-versus-host disease were related to the dosimetric evaluation using statistical tests. RESULTS The mean D95 of the lung is 48.23%, less than half the prescribed and unreduced dose. The D95 of the chest is almost twice as high at 84.95%. Overall liver coverage values ranged from 96.79% for D95 to 107% for D05. The average dose sparing of all patients analysed resulted in an average D95 of 68.64% in the right kidney and 69.31% in the left kidney. Average D95 in the spleen was 94.28% and D05 was 107.05%. Homogeneity indexes ranged from 1.12 for liver to 2.28 for lung. The additional significance analyses conducted on these blood kinetics showed a significant difference between the 2 Gray group and the other three groups for leukocyte counts. Further statistical comparisons of the dose groups showed no significant differences. However, there were significant changes in the dose of OAR prescribed with dose sparing (e.g., lung vs. rib and kidney). CONCLUSION Using intensity-modulated helical tomotherapy to deliver TBI is a feasible method in preparation for haematopoietic stem cell transplantation. Significant dose sparing in radiosensitive organs such as the lungs and kidneys is achievable with good overall quality of coverage. Peripheral blood kinetics support the positive impact of HT and its advantages strongly encourage its implementation within clinical routine.
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Affiliation(s)
- Mümtaz Köksal
- Radiation Oncology, University Hospital Bonn, Bonn, Germany.
| | | | - Danny Jazmati
- Radiation Oncology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Felix Schoroth
- Radiation Oncology, University Hospital Bonn, Bonn, Germany
| | - Stephan Garbe
- Radiation Oncology, University Hospital Bonn, Bonn, Germany
| | - David Koch
- Radiation Oncology, University Hospital Bonn, Bonn, Germany
| | - Davide Scafa
- Radiation Oncology, University Hospital Bonn, Bonn, Germany
| | | | | | - Gregor Massoth
- Anaesthesiology, Perioperative and Pain Medicine, University Hospital Bonn, Bonn, Germany
| | - Achilles Delis
- Anaesthesiology, Perioperative and Pain Medicine, University Hospital Bonn, Bonn, Germany
| | - Annkristin Heine
- Internal Medicine-Oncology, Haematology and Rheumatology, University Hospital Bonn, Bonn, Germany
| | - Tobias Holderried
- Internal Medicine-Oncology, Haematology and Rheumatology, University Hospital Bonn, Bonn, Germany
| | - Peter Brossart
- Internal Medicine-Oncology, Haematology and Rheumatology, University Hospital Bonn, Bonn, Germany
| | - Thomas Müdder
- Radiation Oncology, University Hospital Bonn, Bonn, Germany
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5
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Layer JP, Hamed M, Potthoff AL, Dejonckheere CS, Layer K, Sarria GR, Scafa D, Koch D, Köksal M, Kugel F, Grimmer M, Holz JA, Zeyen T, Friker LL, Borger V, Schmeel FC, Weller J, Hölzel M, Schäfer N, Garbe S, Forstbauer H, Giordano FA, Herrlinger U, Vatter H, Schneider M, Schmeel LC. Outcome assessment of intraoperative radiotherapy for brain metastases: results of a prospective observational study with comparative matched-pair analysis. J Neurooncol 2023; 164:107-116. [PMID: 37477822 PMCID: PMC10462513 DOI: 10.1007/s11060-023-04380-w] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 06/20/2023] [Indexed: 07/22/2023]
Abstract
PURPOSE Intraoperative radiation therapy (IORT) is an emerging alternative to adjuvant stereotactic external beam radiation therapy (EBRT) following resection of brain metastases (BM). Advantages of IORT include an instant prevention of tumor regrowth, optimized dose-sparing of adjacent healthy brain tissue and immediate completion of BM treatment, allowing an earlier admission to subsequent systemic treatments. However, prospective outcome data are limited. We sought to assess long-term outcome of IORT in comparison to EBRT. METHODS A total of 35 consecutive patients, prospectively recruited within a study registry, who received IORT following BM resection at a single neuro-oncological center were evaluated for radiation necrosis (RN) incidence rates, local control rates (LCR), distant brain progression (DBP) and overall survival (OS) as long-term outcome parameters. The 1 year-estimated OS and survival rates were compared in a balanced comparative matched-pair analysis to those of our institutional database, encompassing 388 consecutive patients who underwent adjuvant EBRT after BM resection. RESULTS The median IORT dose was 30 Gy prescribed to the applicator surface. A 2.9% RN rate was observed. The estimated 1 year-LCR was 97.1% and the 1 year-DBP-free survival 73.5%. Median time to DBP was 6.4 (range 1.7-24) months in the subgroup of patients experiencing intracerebral progression. The median OS was 17.5 (0.5-not reached) months with a 1 year-survival rate of 61.3%, which did not not significantly differ from the comparative cohort (p = 0.55 and p = 0.82, respectively). CONCLUSION IORT is a safe and effective fast-track approach following BM resection, with comparable long-term outcomes as adjuvant EBRT.
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Affiliation(s)
- Julian P Layer
- Department of Radiation Oncology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
- Institute of Experimental Oncology, University Hospital Bonn, Bonn, Germany.
| | - Motaz Hamed
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | | | - Cas S Dejonckheere
- Department of Radiation Oncology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Katharina Layer
- Department of Radiation Oncology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Gustavo R Sarria
- Department of Radiation Oncology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Davide Scafa
- Department of Radiation Oncology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - David Koch
- Department of Radiation Oncology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Mümtaz Köksal
- Department of Radiation Oncology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Fabian Kugel
- Department of Radiation Oncology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Molina Grimmer
- Department of Radiation Oncology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Jasmin A Holz
- Department of Radiation Oncology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Thomas Zeyen
- Division of Clinical Neuro-Oncology, Department of Neurology, University Hospital Bonn, Bonn, Germany
| | - Lea L Friker
- Institute of Experimental Oncology, University Hospital Bonn, Bonn, Germany
- Institute of Neuropathology, University Hospital Bonn, Bonn, Germany
| | - Valeri Borger
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | - F Carsten Schmeel
- Department of Neuroradiology, University Hospital Bonn, Bonn, Germany
| | - Johannes Weller
- Division of Clinical Neuro-Oncology, Department of Neurology, University Hospital Bonn, Bonn, Germany
| | - Michael Hölzel
- Institute of Experimental Oncology, University Hospital Bonn, Bonn, Germany
| | - Niklas Schäfer
- Division of Clinical Neuro-Oncology, Department of Neurology, University Hospital Bonn, Bonn, Germany
| | - Stephan Garbe
- Department of Radiation Oncology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | | | - Frank A Giordano
- Department of Radiation Oncology, University Medical Center Mannheim, Mannheim, Germany
- DKFZ-Hector Cancer Institute of the University Medical Center Mannheim, Mannheim, Germany
- Mannheim Institute of Intelligent Systems in Medicine (MIISM), Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Ulrich Herrlinger
- Division of Clinical Neuro-Oncology, Department of Neurology, University Hospital Bonn, Bonn, Germany
| | - Hartmut Vatter
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | | | - L Christopher Schmeel
- Department of Radiation Oncology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
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Lambing S, Tan YP, Vasileiadou P, Holdenrieder S, Müller P, Hagen C, Garbe S, Behrendt R, Schlee M, van den Boorn JG, Bartok E, Renn M, Hartmann G. RIG-I immunotherapy overcomes radioresistance in p53-positive malignant melanoma. J Mol Cell Biol 2023; 15:mjad001. [PMID: 36626927 PMCID: PMC10394996 DOI: 10.1093/jmcb/mjad001] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 09/25/2022] [Accepted: 01/09/2023] [Indexed: 01/12/2023] Open
Abstract
Radiotherapy induces DNA damage, resulting in cell-cycle arrest and activation of cell-intrinsic death pathways. However, the radioresistance of some tumour entities such as malignant melanoma limits its clinical application. The innate immune sensing receptor retinoic acid-inducible gene I (RIG-I) is ubiquitously expressed and upon activation triggers an immunogenic form of cell death in a variety of tumour cell types including melanoma. To date, the potential of RIG-I ligands to overcome radioresistance of tumour cells has not been investigated. Here, we demonstrate that RIG-I activation enhanced the extent and immunogenicity of irradiation-induced tumour cell death in human and murine melanoma cells in vitro and improved survival in the murine B16 melanoma model in vivo. Transcriptome analysis pointed to a central role for p53, which was confirmed using p53-/- B16 cells. In vivo, the additional effect of RIG-I in combination with irradiation on tumour growth was absent in mice carrying p53-/- B16 tumours, while the antitumoural response to RIG-I stimulation alone was maintained. Our results identify p53 as a pivotal checkpoint that is triggered by RIG-I resulting in enhanced irradiation-induced tumour cell death. Thus, the combined administration of RIG-I ligands and radiotherapy is a promising approach to treating radioresistant tumours with a functional p53 pathway, such as melanoma.
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Affiliation(s)
- Silke Lambing
- Institute of Clinical Chemistry and Clinical Pharmacology, University Hospital Bonn, Bonn 53127, Germany
| | - Yu Pan Tan
- Institute of Clinical Chemistry and Clinical Pharmacology, University Hospital Bonn, Bonn 53127, Germany
| | - Paraskevi Vasileiadou
- Institute of Clinical Chemistry and Clinical Pharmacology, University Hospital Bonn, Bonn 53127, Germany
| | - Stefan Holdenrieder
- Institute of Clinical Chemistry and Clinical Pharmacology, University Hospital Bonn, Bonn 53127, Germany
- Institute of Laboratory Medicine, German Heart Centre, Munich 80636, Germany
| | - Patrick Müller
- Institute of Clinical Chemistry and Clinical Pharmacology, University Hospital Bonn, Bonn 53127, Germany
| | - Christian Hagen
- Institute of Clinical Chemistry and Clinical Pharmacology, University Hospital Bonn, Bonn 53127, Germany
| | - Stephan Garbe
- Department of Radiation Oncology, University Hospital Bonn, Bonn 53127, Germany
| | - Rayk Behrendt
- Institute of Clinical Chemistry and Clinical Pharmacology, University Hospital Bonn, Bonn 53127, Germany
| | - Martin Schlee
- Institute of Clinical Chemistry and Clinical Pharmacology, University Hospital Bonn, Bonn 53127, Germany
| | - Jasper G van den Boorn
- Institute of Clinical Chemistry and Clinical Pharmacology, University Hospital Bonn, Bonn 53127, Germany
| | - Eva Bartok
- Institute of Clinical Chemistry and Clinical Pharmacology, University Hospital Bonn, Bonn 53127, Germany
- Unit of Experimental Immunology, Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp 2000, Belgium
- Institute of Experimental Haematology and Transfusion Medicine, University Hospital Bonn, Bonn 53127, Germany
| | - Marcel Renn
- Institute of Clinical Chemistry and Clinical Pharmacology, University Hospital Bonn, Bonn 53127, Germany
- Mildred Scheel School of Oncology, Bonn, University Hospital Bonn, Medical Faculty, Bonn 53127, Germany
| | - Gunther Hartmann
- Institute of Clinical Chemistry and Clinical Pharmacology, University Hospital Bonn, Bonn 53127, Germany
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7
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Scheunemann JF, Risch F, Reichwald JJ, Lenz B, Neumann AL, Garbe S, Frohberger SJ, Koschel M, Ajendra J, Rothe M, Latz E, Coch C, Hartmann G, Schumak B, Hoerauf A, Hübner MP. Potential of Nucleic Acid Receptor Ligands to Improve Vaccination Efficacy against the Filarial Nematode Litomosoides sigmodontis. Vaccines (Basel) 2023; 11:vaccines11050966. [PMID: 37243070 DOI: 10.3390/vaccines11050966] [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: 04/14/2023] [Revised: 05/03/2023] [Accepted: 05/04/2023] [Indexed: 05/28/2023] Open
Abstract
More than two-hundred-million people are infected with filariae worldwide. However, there is no vaccine available that confers long-lasting protection against filarial infections. Previous studies indicated that vaccination with irradiated infective L3 larvae reduces the worm load. This present study investigated whether the additional activation of cytosolic nucleic acid receptors as an adjuvant improves the efficacy of vaccination with irradiated L3 larvae of the rodent filaria Litomosoides sigmodontis with the aim of identifying novel vaccination strategies for filarial infections. Subcutaneous injection of irradiated L3 larvae in combination with poly(I:C) or 3pRNA resulted in neutrophil recruitment to the skin, accompanied by higher IP-10/CXCL10 and IFN-β RNA levels. To investigate the impact on parasite clearance, BALB/c mice received three subcutaneous injections in 2-week intervals with irradiated L3 larvae in combination with poly(I:C) or 3pRNA prior to the challenge infection. Vaccination with irradiated L3 larvae in combination with poly(I:C) or 3pRNA led to a markedly greater reduction in adult-worm counts by 73% and 57%, respectively, compared to the immunization with irradiated L3 larvae alone (45%). In conclusion, activation of nucleic acid-sensing immune receptors boosts the protective immune response against L. sigmodontis and nucleic acid-receptor agonists as vaccine adjuvants represent a promising novel strategy to improve the efficacy of vaccines against filariae and potentially other helminths.
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Affiliation(s)
- Johanna F Scheunemann
- Institute for Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, 53127 Bonn, Germany
| | - Frederic Risch
- Institute for Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, 53127 Bonn, Germany
| | - Julia J Reichwald
- Institute for Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, 53127 Bonn, Germany
| | - Benjamin Lenz
- Institute for Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, 53127 Bonn, Germany
| | - Anna-Lena Neumann
- Institute for Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, 53127 Bonn, Germany
| | - Stephan Garbe
- Clinic for Radiotherapy and Radiation Oncology, University Hospital Bonn, 53127 Bonn, Germany
| | - Stefan J Frohberger
- Institute for Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, 53127 Bonn, Germany
| | - Marianne Koschel
- Institute for Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, 53127 Bonn, Germany
| | - Jesuthas Ajendra
- Institute for Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, 53127 Bonn, Germany
| | - Maximilian Rothe
- Institute for Innate Immunity, University Hospital Bonn, 53127 Bonn, Germany
| | - Eicke Latz
- Institute for Innate Immunity, University Hospital Bonn, 53127 Bonn, Germany
| | - Christoph Coch
- Institute for Clinical Chemistry and Clinical Pharmacology, University Hospital Bonn, 53127 Bonn, Germany
- Nextevidence GmbH, 81541 Munich, Germany
| | - Gunther Hartmann
- Institute for Clinical Chemistry and Clinical Pharmacology, University Hospital Bonn, 53127 Bonn, Germany
- German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, 53127 Bonn, Germany
| | - Beatrix Schumak
- Institute for Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, 53127 Bonn, Germany
| | - Achim Hoerauf
- Institute for Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, 53127 Bonn, Germany
- German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, 53127 Bonn, Germany
| | - Marc P Hübner
- Institute for Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, 53127 Bonn, Germany
- German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, 53127 Bonn, Germany
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8
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Köksal M, Kersting L, Schoroth F, Garbe S, Koch D, Scafa D, Sarria GR, Leitzen C, Heine A, Holderried T, Brossart P, Zoga E, Attenberger U, Schmeel LC. Total marrow irradiation versus total body irradiation using intensity-modulated helical tomotherapy. J Cancer Res Clin Oncol 2023:10.1007/s00432-022-04565-2. [PMID: 36607428 PMCID: PMC10356893 DOI: 10.1007/s00432-022-04565-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 12/27/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Total body irradiation (TBI) is often a component of the conditioning regimen prior to hematopoietic stem cell transplantation in patients with hematological malignancies. However, total marrow irradiation (TMI) could be an alternative method for reducing radiation therapy-associated toxicity, as it specifically targets the skeleton and thus could better protect organs at risk. Here, we compared dosimetric changes in irradiation received by the target volume and organs at risk between TBI and TMI plans. MATERIALS AND METHODS Theoretical TMI plans were calculated for 35 patients with various hematological malignancies who had already received TBI in our clinic. We then statistically compared irradiation doses between the new TMI plans and existing TBI plans. We examined whether TMI provides greater protection of organs at risk while maintaining the prescribed dose in the targeted skeletal area. We also compared beam-on times between TBI and TMI. RESULTS TMI planning achieved significant reductions in the mean, minimum, and maximum irradiation doses in the lungs, kidneys, liver, spleen, and body (i.e., remaining tissue except organs and skeleton). In particular, the mean dose was reduced by 49% in the liver and spleen and by 55-59% in the kidneys. Moreover, TMI planning reduced the corpus beam-on time by an average of 217 s. CONCLUSION TMI planning achieved significant dose reduction in organs at risk while still achieving the prescribed dose in the target volume. Additionally, TMI planning reduced the beam-on time for corpus plans despite a high modulation factor.
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Affiliation(s)
- Mümtaz Köksal
- Department of Radiation Oncology, University Hospital Bonn, Bonn, Germany.
| | - Laura Kersting
- Department of Radiation Oncology, University Hospital Bonn, Bonn, Germany
| | - Felix Schoroth
- Department of Radiation Oncology, University Hospital Bonn, Bonn, Germany
| | - Stephan Garbe
- Department of Radiation Oncology, University Hospital Bonn, Bonn, Germany
| | - David Koch
- Department of Radiation Oncology, University Hospital Bonn, Bonn, Germany
| | - Davide Scafa
- Department of Radiation Oncology, University Hospital Bonn, Bonn, Germany
| | - Gustavo R Sarria
- Department of Radiation Oncology, University Hospital Bonn, Bonn, Germany
| | - Christina Leitzen
- Department of Radiation Oncology, University Hospital Bonn, Bonn, Germany
| | - Annkristin Heine
- Department of Internal Medicine-Oncology/ Hematology and Rheumatology, University Hospital Bonn, Bonn, Germany
| | - Tobias Holderried
- Department of Internal Medicine-Oncology/ Hematology and Rheumatology, University Hospital Bonn, Bonn, Germany
| | - Peter Brossart
- Department of Internal Medicine-Oncology/ Hematology and Rheumatology, University Hospital Bonn, Bonn, Germany
| | - Eleni Zoga
- Deprtment of Radiation Oncology, Sana Hospital Offenbach, Offenbach, Germany
| | | | - Leonard C Schmeel
- Department of Radiation Oncology, University Hospital Bonn, Bonn, Germany
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9
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Axer B, Garbe S, Hadizadeh DR. Comparative Evaluation of Diagnostic Quality in Native Low-dose CT without and with Spectral Shaping employing a Tin Filter in Urolithiasis with implanted Ureteral Stent. ROFO-FORTSCHR RONTG 2022; 194:1358-1366. [PMID: 35850141 DOI: 10.1055/a-1856-3522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
PURPOSE Spectral shaping employing a tin filter can be used for dose reduction in CT of the abdomen in patients with urolithiasis. As ureteral stents may be in direct contact with the calculus, a good image quality is mandatory. The goal of this study was to obtain data of the effect of tin filtering on image quality and dose in patients with urolithiasis in direct contact with ureteral stents. MATERIALS AND METHODS 84 examinations (conventional low dose vs. modified low dose protocol with tin filtering, randomized) were performed in 65 patients (48 men, 17 women, age 55.0 ± 15.2 years (18-90 years), maximum of one examination per protocol). Image quality and visibility of the calculus was rated on a 5-point-Likert scale by 2 experienced radiologists. Quantitative indicators of image quality were signal-to-noise-(SNR) and contrast-to-noise-ratios (CNR) as well as a figure-of-merit (FOM). RESULTS With a non-inferiority margin of 0.5 points of the 5-point Likert scale, there was non-inferiority of the examinations with tin filter regarding image quality (95 % CI 4.1-4.3, rejection limit 3.5). Non-inferiority regarding visibility of the calculus could be shown (calculus size: 1-2.4 mm: 95 % CI 3.39-4.12; limit 2.73; 2.4-3.8mm: 95 % CI 4.09-4.47; limit 3.65; > 3.8mm: all maximal ratings). Average values of CNR were significantly higher using tin filters (17.0 vs. 10.6). Doses were significantly reduced in the modified protocol (effective dose 1.2 mSv vs. 1.5 mSv; size-specific dose estimate 2.33 mGy vs. 3.09 mGy) with non-significant effect in the subgroup of patients with BMI ≥ 35. CONCLUSION Even with direct contact between a calculus and ureteral stent, radiation reduced examinations by spectral shaping by tin filters are non-inferior to examinations without tin filtering at a concurrent significant dose reduction. KEY POINTS · Spectral shaping by tin filter is suitable for dose reduction.. · The image quality in patients with ureteral stents with tin filtering is non-inferior to that in a conventional low-dose protocol.. CITATION FORMAT · Axer B, Garbe S, Hadizadeh DR. Comparative Evaluation of Diagnostic Quality in Native Low-dose CT without and with Spectral Shaping employing a Tin Filter in Urolithiasis with implanted Ureteral Stent. Fortschr Röntgenstr 2022; DOI: 10.1055/a-1856-3522.
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Affiliation(s)
- Benedikt Axer
- Department of Radiology, Mechernich District Hospital, Mechernich, Germany
| | - Stephan Garbe
- Department of Radiology, University of Bonn, Germany
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10
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Kravchenko D, Hart C, Garbe S, Luetkens JA, Isaak A, Mesropyan N, Vergnat M, Leyens J, Attenberger U, Kuetting D. Image quality and radiation dose of dual source high pitch computed tomography in pediatric congenital heart disease. Sci Rep 2022; 12:9934. [PMID: 35705551 PMCID: PMC9200716 DOI: 10.1038/s41598-022-13404-w] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 05/24/2022] [Indexed: 11/10/2022] Open
Abstract
To explore the image quality and radiation dose of dual source high-pitch cardiac computed tomography with tailored contrast injection protocols for pediatric congenital heart disease patients (CHD). In total, 27 infants with CHD (median age 109 days [IQR 6-199]) were retrospectively analyzed regarding dose length product (DLP) and effective dose (ED) after undergoing cardiothoracic CT imaging. Scan parameters were adjusted on a dual source/detector CT (DSCT) to minimize radiation dose while maintaining adequate quality. Image acquisition was performed at 70% of the R-R interval. Dose reducing measures included prospective electrocardiogram gating, utilizing slow injection velocities and foregoing bolus tracking during contrast injection. Image quality was assessed for artefacts, vessel definition, and noise on a 5-point scale (1 non-diagnostic, 5 excellent). Series were scored on a 0-to-3-point scale regarding answered clinical questions (0 non-diagnostic, 3 all clinical questions could be answered). The median DLP was 5.2 mGy*cm (IQR 3.5-7.8) leading to a median ED of 0.20 mSv (IQR 0.14-0.30). On average the acquired images scored 13.3 ± 2.1 (SD) out of a maximum 15 points with an intraclass correlation coefficient (ICC) of 0.94. All acquired series were able to fully answer all clinical questions scoring maximum points (ICC 1.0). Dual source high pitch CT protocols combined with custom contrast agent injection protocols in pediatric patients with CHD delivered sufficiently high diagnostic imaging quality combined with low submilisievert radiation doses. Prospective high pitch imaging is a reliable method for depiction of cardiac anatomy even in very young pediatric CHD patients with elevated heart rates.
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Affiliation(s)
- Dmitrij Kravchenko
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany. .,Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, Bonn, Germany.
| | - Christopher Hart
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.,Department for Pediatric Cardiology, Children's Hospital, University of Bonn, Bonn, Germany
| | - Stephan Garbe
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Julian A Luetkens
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.,Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, Bonn, Germany
| | - Alexander Isaak
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.,Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, Bonn, Germany
| | - Narine Mesropyan
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.,Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, Bonn, Germany
| | - Mathieu Vergnat
- Department of Pediatric Cardiothoracic Surgery, Children's Hospital, University of Bonn, Bonn, Germany
| | - Judith Leyens
- Department of Neonatology and Pediatric Intensive Care, Children's Hospital, University of Bonn, Bonn, Germany
| | - Ulrike Attenberger
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Daniel Kuetting
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.,Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, Bonn, Germany
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11
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Scafa D, Sarria G, Giordano F, Koch D, Muedder T, Holz J, Nour Y, Garbe S, Gonzalez-Carmona M, Feldmann G, Vilz T, Köksal M, Schmeel L. PO-1530 Dosimetric comparison of Intraoperative Radiotherapy and SRS for liver metastases. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03494-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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12
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Hamed M, Potthoff AL, Layer JP, Koch D, Borger V, Heimann M, Scafa D, Sarria GR, Holz JA, Schmeel FC, Radbruch A, Güresir E, Schäfer N, Schuss P, Garbe S, Giordano FA, Herrlinger U, Vatter H, Schmeel LC, Schneider M. Benchmarking Safety Indicators of Surgical Treatment of Brain Metastases Combined with Intraoperative Radiotherapy: Results of Prospective Observational Study with Comparative Matched-Pair Analysis. Cancers (Basel) 2022; 14:cancers14061515. [PMID: 35326666 PMCID: PMC8946541 DOI: 10.3390/cancers14061515] [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: 01/25/2022] [Revised: 03/05/2022] [Accepted: 03/08/2022] [Indexed: 12/07/2022] Open
Abstract
Simple Summary Patients with brain metastasis (BM) are at advanced stages of metastatic cancer, and surgical resection is often required in order to avoid severe neurologic deficits. After surgery, patients are usually committed to postoperative radiotherapy. In recent years, intraoperative radiotherapy (IORT) has been proposed as an alternative to conventional postsurgical radiation approaches. This possibility has several advantages, e.g., as IORT is administered only once during the surgical procedure, patients do not have to attend several radiotherapy sessions afterward. However, the application of radiation therapy directly into the open brain during surgery might be accompanied by severe perioperative complications and, therefore, might negatively impact the overall benefit. In the present study, we show that patients who underwent surgery for BM combined with IORT do not suffer from elevated levels of perioperative complications compared to patients without IORT. Therefore, IORT constitutes a safe treatment strategy for cancer patients with BM. Abstract Intraoperative radiotherapy (IORT) of the operative cavity for surgically treated brain metastasis (BM) has gained increasing prominence with respect to improved local tumor control. However, IORT immediately performed at the time of surgery might be associated with increased levels of perioperative adverse events (PAEs). In the present study, we performed safety metric profiling in patients who had undergone surgery for BM with and without IORT in order to comparatively analyze feasibility of IORT as an adjuvant radiation approach. Between November 2020 and October 2021, 35 patients were surgically treated for BM with IORT at our neuro-oncological center. Perioperative complication profiles were collected in a prospective observational cohort study by means of patient safety indicators (PSIs), hospital-acquired conditions (HACs), and specific cranial-surgery-related complications (CSCs) as high-standard quality metric tools and compared to those of an institutional cohort of 388 patients with BM resection without IORT in a balanced comparative matched-pair analysis. Overall, 4 out of 35 patients (11%) with IORT in the course BM resection suffered from PAEs, accounting for 3 PSIs (9%) and 1 HAC (3%). Balanced matched-pair analysis did not reveal significant differences in the perioperative complication profiles between the cohorts of patients with and without IORT (p = 0.44). Thirty-day mortality rates were 6% for patients with IORT versus 8% for patients without IORT (p = 0.73). The present study demonstrates that IORT constitutes a safe and clinically feasible adjuvant treatment modality in patients undergoing surgical resection of BM.
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Affiliation(s)
- Motaz Hamed
- Department of Neurosurgery, University Hospital Bonn, 53127 Bonn, Germany; (M.H.); (V.B.); (M.H.); (E.G.); (P.S.); (H.V.)
| | - Anna-Laura Potthoff
- Department of Neurosurgery, University Hospital Bonn, 53127 Bonn, Germany; (M.H.); (V.B.); (M.H.); (E.G.); (P.S.); (H.V.)
- Correspondence: (A.-L.P.); (M.S.)
| | - Julian P. Layer
- Department of Radiation Oncology, University Hospital Bonn, 53127 Bonn, Germany; (J.P.L.); (D.K.); (D.S.); (G.R.S.); (J.A.H.); (S.G.); (F.A.G.); (L.C.S.)
| | - David Koch
- Department of Radiation Oncology, University Hospital Bonn, 53127 Bonn, Germany; (J.P.L.); (D.K.); (D.S.); (G.R.S.); (J.A.H.); (S.G.); (F.A.G.); (L.C.S.)
| | - Valeri Borger
- Department of Neurosurgery, University Hospital Bonn, 53127 Bonn, Germany; (M.H.); (V.B.); (M.H.); (E.G.); (P.S.); (H.V.)
| | - Muriel Heimann
- Department of Neurosurgery, University Hospital Bonn, 53127 Bonn, Germany; (M.H.); (V.B.); (M.H.); (E.G.); (P.S.); (H.V.)
| | - Davide Scafa
- Department of Radiation Oncology, University Hospital Bonn, 53127 Bonn, Germany; (J.P.L.); (D.K.); (D.S.); (G.R.S.); (J.A.H.); (S.G.); (F.A.G.); (L.C.S.)
| | - Gustavo R. Sarria
- Department of Radiation Oncology, University Hospital Bonn, 53127 Bonn, Germany; (J.P.L.); (D.K.); (D.S.); (G.R.S.); (J.A.H.); (S.G.); (F.A.G.); (L.C.S.)
| | - Jasmin A. Holz
- Department of Radiation Oncology, University Hospital Bonn, 53127 Bonn, Germany; (J.P.L.); (D.K.); (D.S.); (G.R.S.); (J.A.H.); (S.G.); (F.A.G.); (L.C.S.)
| | | | - Alexander Radbruch
- Department of Neuroradiology, University Hospital Bonn, 53127 Bonn, Germany; (F.C.S.); (A.R.)
| | - Erdem Güresir
- Department of Neurosurgery, University Hospital Bonn, 53127 Bonn, Germany; (M.H.); (V.B.); (M.H.); (E.G.); (P.S.); (H.V.)
| | - Niklas Schäfer
- Division of Clinical Neuro-Oncology, Department of Neurology, University Hospital Bonn, 53127 Bonn, Germany; (N.S.); (U.H.)
| | - Patrick Schuss
- Department of Neurosurgery, University Hospital Bonn, 53127 Bonn, Germany; (M.H.); (V.B.); (M.H.); (E.G.); (P.S.); (H.V.)
- Department of Neurosurgery, BG Klinikum Unfallkrankenhaus Berlin, 12683 Berlin, Germany
| | - Stephan Garbe
- Department of Radiation Oncology, University Hospital Bonn, 53127 Bonn, Germany; (J.P.L.); (D.K.); (D.S.); (G.R.S.); (J.A.H.); (S.G.); (F.A.G.); (L.C.S.)
| | - Frank A. Giordano
- Department of Radiation Oncology, University Hospital Bonn, 53127 Bonn, Germany; (J.P.L.); (D.K.); (D.S.); (G.R.S.); (J.A.H.); (S.G.); (F.A.G.); (L.C.S.)
| | - Ulrich Herrlinger
- Division of Clinical Neuro-Oncology, Department of Neurology, University Hospital Bonn, 53127 Bonn, Germany; (N.S.); (U.H.)
| | - Hartmut Vatter
- Department of Neurosurgery, University Hospital Bonn, 53127 Bonn, Germany; (M.H.); (V.B.); (M.H.); (E.G.); (P.S.); (H.V.)
| | - Leonard Christopher Schmeel
- Department of Radiation Oncology, University Hospital Bonn, 53127 Bonn, Germany; (J.P.L.); (D.K.); (D.S.); (G.R.S.); (J.A.H.); (S.G.); (F.A.G.); (L.C.S.)
| | - Matthias Schneider
- Department of Neurosurgery, University Hospital Bonn, 53127 Bonn, Germany; (M.H.); (V.B.); (M.H.); (E.G.); (P.S.); (H.V.)
- Correspondence: (A.-L.P.); (M.S.)
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13
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Scafa D, Muedder T, Holz JA, Koch D, Nour Y, Garbe S, Gonzalez-Carmona MA, Feldmann G, Vilz TO, Köksal M, Giordano FA, Schmeel LC, Sarria GR. Dosimetric Comparison of Intraoperative Radiotherapy and SRS for Liver Metastases. Front Oncol 2021; 11:767468. [PMID: 34926271 PMCID: PMC8674179 DOI: 10.3389/fonc.2021.767468] [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: 08/30/2021] [Accepted: 11/11/2021] [Indexed: 11/30/2022] Open
Abstract
Purpose/Objectives To perform a dosimetric comparison between kilovoltage intraoperative radiotherapy (IORT) and stereotactic radiosurgery (SRS) simulating both deep-inspiration breath-hold (DIBH) and free-breathing (FB) modalities for patients with liver metastases. Methods/Materials Diagnostic computed tomographies (CT) of patients carrying one or two lesions <4 cm and who underwent surgery were retrospectively screened and randomly selected for the study. For DIBH-SRS, a gross target volume (GTV) plus planning target volume (PTV) were delineated. For FB-SRS, a GTV plus an internal target volume (ITV) and PTV were defined. Accounting for the maximal GTV diameters, a modified GTV (GTV-IORT) was expanded circumferentially to simulate a resection cavity. The best suitable round-applicator size was thereafter selected. All treatment plans were calculated homogeneously to deliver 40 Gy. Doses delivered to organs at risk (OAR) and target volumes were compared for IORT vs. both SRS modalities. Results Eight patients encompassing 10 lesions were included in the study. The mean liver volume was 2,050.97 cm3 (SD, 650.82), and the mean GTV volume was 12.23 cm3 (SD, 12.62). As for target structures, GTV-IORT [19.44 cm3 (SD, 17.26)] were significantly smaller than both PTV DIBH-SRS [30.74 cm3 (SD, 24.64), p = 0.002] and PTV FB-SRS [75.82 cm3 (SD, 45.65), p = 0.002]. The median applicator size was 3 cm (1.5–4.5), and the mean IORT simulated delivery time was 45.45 min (SD, 19.88). All constraints were met in all modalities. Liver V9.1 showed significantly smaller volumes with IORT [63.39 cm3 (SD, 35.67)] when compared to DIBH-SRS [150.12 cm3 (SD, 81.43), p = 0.002] or FB-SRS [306.13 cm3 (SD, 128.75), p = 0.002]. No other statistical or dosimetrically relevant difference was observed for stomach, spinal cord, or biliary tract. Mean IORT D90 was 85.3% (SD, 6.05), whereas D95 for DIBH-SRS and FB-SRS were 99.03% (SD, 1.71; p = 0.042) and 98.04% (SD, 3.46; p = 0.036), respectively. Conclusion Kilovoltage IORT bears the potential as novel add-on treatment for resectable liver metastases, significantly reducing healthy liver exposure to radiation in comparison to SRS. Prospective clinical evidence is required to confirm this hypothesis.
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Affiliation(s)
- Davide Scafa
- Department of Radiation Oncology, University Hospital Bonn, Bonn, Germany
| | - Thomas Muedder
- Department of Radiation Oncology, University Hospital Bonn, Bonn, Germany
| | - Jasmin A Holz
- Department of Radiation Oncology, University Hospital Bonn, Bonn, Germany
| | - David Koch
- Department of Radiation Oncology, University Hospital Bonn, Bonn, Germany
| | - Younéss Nour
- Department of Radiation Oncology, University Hospital Bonn, Bonn, Germany
| | - Stephan Garbe
- Department of Radiation Oncology, University Hospital Bonn, Bonn, Germany
| | | | - Georg Feldmann
- Department of Internal Medicine III, University Hospital Bonn, Bonn, Germany
| | - Tim O Vilz
- Department of Surgery, University Hospital Bonn, Bonn, Germany
| | - Mümtaz Köksal
- Department of Radiation Oncology, University Hospital Bonn, Bonn, Germany
| | - Frank A Giordano
- Department of Radiation Oncology, University Hospital Bonn, Bonn, Germany
| | | | - Gustavo R Sarria
- Department of Radiation Oncology, University Hospital Bonn, Bonn, Germany
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14
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Sarria GR, Smalec Z, Muedder T, Holz JA, Scafa D, Koch D, Garbe S, Schneider M, Hamed M, Vatter H, Herrlinger U, Giordano FA, Schmeel LC. Dosimetric Comparison of Upfront Boosting With Stereotactic Radiosurgery Versus Intraoperative Radiotherapy for Glioblastoma. Front Oncol 2021; 11:759873. [PMID: 34778080 PMCID: PMC8581360 DOI: 10.3389/fonc.2021.759873] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 08/17/2021] [Accepted: 10/13/2021] [Indexed: 11/30/2022] Open
Abstract
Purpose To simulate and analyze the dosimetric differences of intraoperative radiotherapy (IORT) or pre-operative single-fraction stereotactic radiosurgery (SRS) in addition to post-operative external beam radiotherapy (EBRT) in Glioblastoma (GB). Methods Imaging series of previously treated patients with adjuvant radiochemotherapy were analyzed. For SRS target definition, pre-operative MRIs were co-registered to planning CT scans and a pre-operative T1-weighted gross target volume (GTV) plus a 2-mm planning target volume (PTV) were created. For IORT, a modified (m)GTV was expanded from the pre-operative volume, in order to mimic a round cavity as during IORT. Dose prescription was 20 Gy, homogeneously planned for SRS and calculated at the surface for IORT, to cover 99% and 90% of the volumes, respectively. For tumors > 2cm in maximum diameter, a 15 Gy dose was prescribed. Plan assessment was performed after calculating the 2-Gy equivalent doses (EQD2) for both boost modalities and including them into the EBRT plan. Main points of interest encompass differences in target coverage, brain volume receiving 12 Gy or more (V12), and doses to various organs-at-risk (OARs). Results Seventeen pre-delivered treatment plans were included in the study. The mean GTV was 21.72 cm3 (SD ± 19.36) and mGTV 29.64 cm3 (SD ± 25.64). The mean EBRT and SRS PTV were 254.09 (SD ± 80.0) and 36.20 cm3 (SD ± 31.48), respectively. Eight SRS plans were calculated to 15 Gy according to larger tumor sizes, while all IORT plans to 20 Gy. The mean EBRT D95 was 97.13% (SD ± 3.48) the SRS D99 99.91% (SD ± 0.35) and IORT D90 83.59% (SD ± 3.55). Accounting for only-boost approaches, the brain V12 was 49.68 cm3 (SD ± 26.70) and 16.94 cm3 (SD ± 13.33) (p<0.001) for SRS and IORT, respectively. After adding EBRT results respectively to SRS and IORT doses, significant lower doses were found in the latter for mean Dmax of chiasma (p=0.01), left optic nerve (p=0.023), right (p=0.008) and left retina (p<0.001). No significant differences were obtained for brainstem and cochleae. Conclusion Dose escalation for Glioblastoma using IORT results in lower OAR exposure as conventional SRS.
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Affiliation(s)
- Gustavo R Sarria
- Department of Radiation Oncology, University Hospital Bonn, Bonn, Germany
| | - Zuzanna Smalec
- Department of Radiation Oncology, University Hospital Bonn, Bonn, Germany
| | - Thomas Muedder
- Department of Radiation Oncology, University Hospital Bonn, Bonn, Germany
| | - Jasmin A Holz
- Department of Radiation Oncology, University Hospital Bonn, Bonn, Germany
| | - Davide Scafa
- Department of Radiation Oncology, University Hospital Bonn, Bonn, Germany
| | - David Koch
- Department of Radiation Oncology, University Hospital Bonn, Bonn, Germany
| | - Stephan Garbe
- Department of Radiation Oncology, University Hospital Bonn, Bonn, Germany
| | | | - Motaz Hamed
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | - Hartmut Vatter
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | - Ulrich Herrlinger
- Department of Neurology, Division of Neuro-Oncology, University Hospital Bonn, Bonn, Germany
| | - Frank A Giordano
- Department of Radiation Oncology, University Hospital Bonn, Bonn, Germany
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Müdder T, Sarria GR, Henkenberens C, Holz J, Garbe S, Röhner F, Stumpf S, Buchstab T, Giordano FA, Leitzen C. Dosimetric Comparison Between Helical Tomotherapy and Volumetric Modulated Arc Therapy in Patients With Malignant Pleural Mesothelioma. Clin Oncol (R Coll Radiol) 2021; 34:164-171. [PMID: 34429236 DOI: 10.1016/j.clon.2021.08.005] [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: 06/11/2021] [Revised: 07/07/2021] [Accepted: 08/09/2021] [Indexed: 01/15/2023]
Abstract
AIMS To carry out a dosimetric comparison and constraints feasibility proof of adjuvant radiotherapy through helical tomotherapy or volumetric modulated arc therapy (VMAT) for malignant pleural mesothelioma patients after pleurectomy/decortication. MATERIALS AND METHODS Retrospective calculations were carried out on previously acquired simulations. A whole-pleura volume with 50.4 Gy in 28 fractions was prescribed, simulating a no residual tumour situation. Calculations were carried out using an anisotropic analytical algorithm with a 2.0 mm grid. Beam-on time, planning target volume (PTV) coverage, homogeneity index and organ at risk exposure were compared. RESULTS Sixteen patient plans were calculated per device. Constraints were met overall by both modalities. For helical tomotherapy and VMAT plans, median beam-on times were 13.8 (11.6-16.1) min and 6.4 (6.1-7.0) min; P = 0.006. The median left-sided radiotherapy PTV D98 were 48.1 (48.0-48.8) Gy and 47.6 (46.5-48.3) Gy; P = 0.023. No significant difference for right-sided radiotherapy was found. PTV D2 for left-sided radiotherapy was higher with VMAT (P = 0.014). For right-sided radiotherapy, helical tomotherapy showed higher doses (P = 0.039). No homogeneity index differences for left-sided radiotherapy (P = 1.00) and right-sided radiotherapy (P = 0.598) were seen. Significant organ at risk exposure differences were found on left-sided radiotherapy whole-lung V20, as well as D50 (both P = 0.008). Higher contralateral lung and ipsilateral kidney exposures were found with VMAT plans for both treatment sides. CONCLUSION Adjuvant radiotherapy after pleurectomy/decortication in malignant pleural mesothelioma patients, with a VMAT- or helical tomotherapy-based platform, is dosimetrically feasible. Lung sparing was mostly improved with helical tomotherapy. Technique selection must be carried out according to availability and clinical criteria.
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Affiliation(s)
- T Müdder
- Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Bonn, Germany
| | - G R Sarria
- Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Bonn, Germany.
| | - C Henkenberens
- Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Bonn, Germany
| | - J Holz
- Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Bonn, Germany
| | - S Garbe
- Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Bonn, Germany
| | - F Röhner
- Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Bonn, Germany
| | - S Stumpf
- Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Bonn, Germany
| | - T Buchstab
- Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Bonn, Germany
| | - F A Giordano
- Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Bonn, Germany
| | - C Leitzen
- Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Bonn, Germany
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Schmeel LC, Koch D, Schmeel FC, Röhner F, Schoroth F, Bücheler BM, Mahlmann B, Leitzen C, Schüller H, Tschirner S, Fuhrmann A, Heimann M, Brüser D, Abramian AV, Müdder T, Garbe S, Vornholt S, Schild HH, Baumert BG, Wilhelm-Buchstab TM. Acute radiation-induced skin toxicity in hypofractionated vs. conventional whole-breast irradiation: An objective, randomized multicenter assessment using spectrophotometry. Radiother Oncol 2020; 146:172-179. [PMID: 32171945 DOI: 10.1016/j.radonc.2020.02.018] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 02/11/2020] [Accepted: 02/23/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE Radiation dermatitis represents one of the most frequent side effects in breast cancer patients undergoing adjuvant whole-breast irradiation (WBI). Whether hypofractionated WBI induces comparable or less acute radiation-induced skin reactions than conventional WBI is still not fully clarified, as randomized evidence and objective assessments are limited. The aim of this study was to objectively determine frequency and severity of acute radiation-induced skin reactions during hypofractionated vs. conventionally fractionated adjuvant WBI. METHODS In this randomized multicenter study, a total of 140 breast cancer patients underwent either hypofractionated or conventional WBI following breast-preserving surgery. Maximum radiation dermatitis severity was assessed at completion and during follow-up by physician-assessed CTCAE v4.03 and the patient-reported RISRAS scale. Additionally, photospectrometric skin readings were performed to objectify skin color differences between both treatment arms. RESULTS Radiation dermatitis severity was significantly lower in patients receiving hypofractionation compared with conventional fractionation (mean 1.05 vs. 1.43, p = .024). Grade 0 radiation dermatitis occurred in 21.43% vs. 4.28%, grade ≥2 in 27.14% vs. 42.91% and grade ≥3 in 0% vs. 4.34% of patients following hypofractionated and conventional WBI, respectively. Objective photospectrometric measurements (n = 4200) showed both decreased erythema severity (p = .008) and hyperpigmentation (p = .002) in the hypofractionation arm. Patients allocated to hypofractionated WBI also reported less pain (p = .006), less hyperpigmentation (p = <0.001) and less limitations of day-to-day activities (p = <0.001). CONCLUSION Physician and patient-assessed toxicity scorings as well as objective photospectrometric skin measurements revealed that hypofractionated WBI yielded lower rates and severity of acute radiation-induced skin toxicity.
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Affiliation(s)
| | - David Koch
- Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Germany
| | | | - Fred Röhner
- Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Germany
| | - Felix Schoroth
- Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Germany
| | - Bettina Maja Bücheler
- Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Germany
| | - Birgit Mahlmann
- Radiotherapy Bonn-Rhein-Sieg, Practice at Academic St. Marien Hospital, Bonn, Germany
| | - Christina Leitzen
- Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Germany
| | - Heinrich Schüller
- Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Germany
| | - Sabine Tschirner
- Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Germany
| | - Arne Fuhrmann
- Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Germany
| | - Martina Heimann
- Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Germany
| | - Dilini Brüser
- Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Germany
| | - Alina-Valik Abramian
- Department of Gynecology and Obstetrics, Division of Senology, University Hospital Bonn, University of Bonn, Germany
| | - Thomas Müdder
- Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Germany
| | - Stephan Garbe
- Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Germany
| | - Susanne Vornholt
- Department of Radiation Oncology, Agaplesion General Hospital, Academic Hospital of the University of Bochum, Hagen, Germany
| | - Hans Heinz Schild
- Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Germany; Department of Radiology, University Hospital Bonn, University of Bonn, Germany
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Schmeel LC, Koch D, Schmeel FC, Bücheler B, Leitzen C, Mahlmann B, Kunze D, Heimann M, Brüser D, Abramian AV, Schoroth F, Müdder T, Röhner F, Garbe S, Baumert BG, Schild HH, Wilhelm-Buchstab TM. Hydrofilm Polyurethane Films Reduce Radiation Dermatitis Severity in Hypofractionated Whole-Breast Irradiation: An Objective, Intra-Patient Randomized Dual-Center Assessment. Polymers (Basel) 2019; 11:E2112. [PMID: 31888185 PMCID: PMC6960998 DOI: 10.3390/polym11122112] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Revised: 12/09/2019] [Accepted: 12/12/2019] [Indexed: 01/04/2023] Open
Abstract
Radiation-induced skin injury represents the most frequent side effect in breast cancer patients undergoing whole-breast irradiation (WBI). Numerous clinical studies on systemic and topical treatments for radiation dermatitis have failed to provide sustainable treatment strategies. While protective skin products such as dressings are undoubtedly the standard of care in wound care management, their utilization as preventive treatment in radiotherapy has been somewhat neglected in recent years. In this prospective, intra-patient randomized observational study, Hydrofilm polyurethane films were prophylactically applied to either the medial or lateral breast-half of 74 patients with breast cancer undergoing hypofractionated whole-breast irradiation following breast-preserving surgery. Maximum radiation dermatitis severity was assessed using Common Terminology Criteria for Adverse Events (CTCAE) v4.03 toxicity scores, photospectrometric erythema and pigmentation measurements and patient-assessed modified Radiation-Induced Skin Reaction Assessment Scale (RISRAS) scale. Phantom studies revealed a clinically negligible dose build-up of less than 0.1% with Hydrofilm. Compared to the control compartments physician-assessed radiation dermatitis severity was reduced in the hydrofilm compartments (mean 0.54 vs. 1.34; p = < 0.001). Objective photospectrometric skin measurements showed decreased erythema (p = 0.0001) and hyperpigmentation (p = 0.002) underneath Hydrofilm. Hydrofilm also completely prevented moist desquamation, and significantly reduced patients' treatment-related symptoms of itching, burning, pain, and limitations of day-to-day-activities. Significant beneficial effects were observed in terms of radiation dermatitis severity, erythema, hyperpigmentation as well as subjective treatment-related symptom experiences, while adverse reactions were rare and minor. Therefore, a prophylactic application of Hydrofilm polyurethane films can be suggested in hypofractionated WBI.
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Affiliation(s)
- Leonard Christopher Schmeel
- Department of Radiology and Radiation Oncology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - David Koch
- Department of Radiology and Radiation Oncology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Frederic Carsten Schmeel
- Department of Radiology and Radiation Oncology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Bettina Bücheler
- Department of Radiology and Radiation Oncology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Christina Leitzen
- Department of Radiology and Radiation Oncology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Birgit Mahlmann
- Radiotherapy Bonn-Rhein-Sieg, Practice at academic St. Marien Hospital, Robert-Koch-Str. 1, 53115 Bonn, Germany
| | - Dorothea Kunze
- Radiotherapy Bonn-Rhein-Sieg, Practice at academic St. Marien Hospital, Robert-Koch-Str. 1, 53115 Bonn, Germany
| | - Martina Heimann
- Department of Radiology and Radiation Oncology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Dilini Brüser
- Department of Radiology and Radiation Oncology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Alina-Valik Abramian
- Department of Gynecology and Obstetrics, Division of Senology, University Hospital Bonn, University of Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - Felix Schoroth
- Department of Radiology and Radiation Oncology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Thomas Müdder
- Department of Radiology and Radiation Oncology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Fred Röhner
- Department of Radiology and Radiation Oncology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Stephan Garbe
- Department of Radiology and Radiation Oncology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Brigitta Gertrud Baumert
- Department of Radiology and Radiation Oncology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
- Institute of Radiation Oncology, Graubuenden Cantonal Hospital, Loestr. 170, 7000 Chur, Switzerland
| | - Hans Heinz Schild
- Department of Radiology and Radiation Oncology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Timo Martin Wilhelm-Buchstab
- Department of Radiology and Radiation Oncology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
- Radiotherapy Bonn-Rhein-Sieg, Practice at academic Protestant Johanniter Clinics Bonn, Waldstr. 73, 53177 Bonn, Germany
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Leitzen C, Wilhelm-Buchstab T, Stumpf S, Heimann M, Koch D, Schmeel C, Simon B, Vornholt S, Garbe S, Röhner F, Schoroth F, Schild HH, Schüller H, Müdder T. Tomotherapy in malignant mesothelioma: a planning study to establish dose constraints. Strahlenther Onkol 2019; 195:668-676. [PMID: 30915490 DOI: 10.1007/s00066-019-01458-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 10/01/2018] [Accepted: 03/14/2019] [Indexed: 01/15/2023]
Abstract
PURPOSE A planning study was performed for helical tomotherapy treatment. We evaluated the maximum achievable protection of organs at risk (OARs) in patients with malignant pleural mesothelioma after pleurectomy with simultaneous optimal target coverage. MATERIALS AND METHODS The datasets of 13 patients were included. The applied dose to the planning target volume (PTV) was 50.4 Gy with single doses of 1.8 Gy per fraction. Presuming optimal target coverage, we evaluated the applied dose to the OARs with special regard to the contralateral lung. RESULTS For left-(lsRT)/right(rsRT)-sided radiotherapy, target coverage for the PTV showed a D98 (mean) of 49.37/49.71 Gy (98.0%/98.6%) and a D2 (mean) of 54.19/54.61 Gy (107.5%/108.3%). The beam-on time was kept below 15 min. The achieved mean dose (D50) to the contralateral lung was kept below 4 Gy for lsRT and rsRT. With regard to the other organs at risk the applied doses were as follows: mean dose (lsRT): ipsilateral kidney (Dmean) 13.03 (5.32-22.18) Gy, contralateral kidney (Dmean) <2.0 Gy, heart (Dmean) 22.23 (13.57-27.72) Gy, spinal cord D1 <Gy; mean dose (rsRT): ipsilateral kidney (Dmean) 10.22 (6.30-18.04) Gy, contralateral kidney (Dmean) <2.1 Gy, heart (Dmean) 8.02 (6.0-10.38) Gy, spinal cord D1 <35.5 Gy. CONCLUSION With helical tomotherapy, postoperative treatment for malignant pleural mesothelioma after pleurectomy achieves good target coverage combined with simultaneous dose sparing to the (especially contralateral) OARs.
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Affiliation(s)
- Christina Leitzen
- Radiologische Klinik, FE Strahlentherapie, Universitätsklinik Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany.
| | - Timo Wilhelm-Buchstab
- Radiologische Klinik, FE Strahlentherapie, Universitätsklinik Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany
| | - Sabina Stumpf
- Radiologische Klinik, FE Strahlentherapie, Universitätsklinik Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany
| | - Martina Heimann
- Radiologische Klinik, FE Strahlentherapie, Universitätsklinik Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany
| | - David Koch
- Radiologische Klinik, FE Strahlentherapie, Universitätsklinik Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany
| | - Christopher Schmeel
- Radiologische Klinik, FE Strahlentherapie, Universitätsklinik Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany
| | - Birgit Simon
- Radiologische Klinik, FE Strahlentherapie, Universitätsklinik Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany
| | - Susanne Vornholt
- Radiologische Klinik, FE Strahlentherapie, Universitätsklinik Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany
| | - Stephan Garbe
- Radiologische Klinik, FE Strahlentherapie, Universitätsklinik Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany
| | - Fred Röhner
- Radiologische Klinik, FE Strahlentherapie, Universitätsklinik Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany
| | - Felix Schoroth
- Radiologische Klinik, FE Strahlentherapie, Universitätsklinik Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany
| | - Hans Heinz Schild
- Radiologische Klinik, FE Strahlentherapie, Universitätsklinik Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany
| | - Heinrich Schüller
- Radiologische Klinik, FE Strahlentherapie, Universitätsklinik Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany
| | - Thomas Müdder
- Radiologische Klinik, FE Strahlentherapie, Universitätsklinik Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany
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Schmeel LC, Koch D, Stumpf S, Leitzen C, Simon B, Schüller H, Vornholt S, Schoroth F, Müdder T, Röhner F, Garbe S, Schmeel FC, Schild HH, Wilhelm-Buchstab TM. Prophylactically applied Hydrofilm polyurethane film dressings reduce radiation dermatitis in adjuvant radiation therapy of breast cancer patients. Acta Oncol 2018; 57:908-915. [PMID: 29463159 DOI: 10.1080/0284186x.2018.1441542] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE Radiation-induced skin injury represents one of the most common side effects in breast cancer patients receiving adjuvant whole-breast radiotherapy. Numerous systemic and topical treatments have been studied in the prevention and management of radiation-induced skin injury without providing sustainable treatment strategies. While superficial barrier-forming skin products such as dressings are the standard of care in wound care management, their utilization as preventive treatment approach in radiotherapy has barely attracted attention. METHODS In this prospective, intra-patient randomized study, Hydrofilm polyurethane film dressings were applied prophylactically to either the medial or lateral breast half of 62 patients with breast cancer undergoing adjuvant radiation therapy following breast conserving surgery. The breast half contralateral to the film dressing was concurrently treated with 5% urea lotion as control skin care. Maximum severity of radiation dermatitis was assessed using RTOG/EORTC toxicity scores, photospectrometric erythema measurements and patient-assessed modified RISRAS scale. RESULTS In the Hydrofilm compartments, mean maximum RTOG/EORTC radiation dermatitis severity grades were significantly reduced from 1.33 to 0.35 and photospectrometric measurements showed significantly reduced erythema severity, as compared to the control compartments, with an overall response rate of 89.3%. Hydrofilm completely prevented moist desquamation and significantly reduced patients' subjective experience of itching and pain. CONCLUSION The obtained results along with a favorable cost-benefit ratio and an easy and quick application suggest a prophylactic application of Hydrofilm in adjuvant radiotherapy of breast cancer patients to reduce or even prevent radiation dermatitis.
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Affiliation(s)
- Leonard Christopher Schmeel
- Department of Radiology and Radiation Oncology, University Hospital Bonn, Rheinische-Friedrich-Wilhelms-Universität Bonn, Bonn, Germany
| | - David Koch
- Department of Radiology and Radiation Oncology, University Hospital Bonn, Rheinische-Friedrich-Wilhelms-Universität Bonn, Bonn, Germany
| | - Sabina Stumpf
- Department of Radiology and Radiation Oncology, University Hospital Bonn, Rheinische-Friedrich-Wilhelms-Universität Bonn, Bonn, Germany
| | - Christina Leitzen
- Department of Radiology and Radiation Oncology, University Hospital Bonn, Rheinische-Friedrich-Wilhelms-Universität Bonn, Bonn, Germany
| | - Birgit Simon
- Department of Radiology and Radiation Oncology, University Hospital Bonn, Rheinische-Friedrich-Wilhelms-Universität Bonn, Bonn, Germany
| | - Heinrich Schüller
- Department of Radiology and Radiation Oncology, University Hospital Bonn, Rheinische-Friedrich-Wilhelms-Universität Bonn, Bonn, Germany
| | - Susanne Vornholt
- Department of Radiology and Radiation Oncology, University Hospital Bonn, Rheinische-Friedrich-Wilhelms-Universität Bonn, Bonn, Germany
| | - Felix Schoroth
- Department of Radiology and Radiation Oncology, University Hospital Bonn, Rheinische-Friedrich-Wilhelms-Universität Bonn, Bonn, Germany
| | - Thomas Müdder
- Department of Radiology and Radiation Oncology, University Hospital Bonn, Rheinische-Friedrich-Wilhelms-Universität Bonn, Bonn, Germany
| | - Fred Röhner
- Department of Radiology and Radiation Oncology, University Hospital Bonn, Rheinische-Friedrich-Wilhelms-Universität Bonn, Bonn, Germany
| | - Stephan Garbe
- Department of Radiology and Radiation Oncology, University Hospital Bonn, Rheinische-Friedrich-Wilhelms-Universität Bonn, Bonn, Germany
| | - Frederic Carsten Schmeel
- Department of Radiology and Radiation Oncology, University Hospital Bonn, Rheinische-Friedrich-Wilhelms-Universität Bonn, Bonn, Germany
| | - Hans Heinz Schild
- Department of Radiology and Radiation Oncology, University Hospital Bonn, Rheinische-Friedrich-Wilhelms-Universität Bonn, Bonn, Germany
| | - Timo Martin Wilhelm-Buchstab
- Department of Radiology and Radiation Oncology, University Hospital Bonn, Rheinische-Friedrich-Wilhelms-Universität Bonn, Bonn, Germany
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Schmeel L, Stumpf S, Koch D, Leitzen C, Vornholt S, Simon B, Schoroth F, Müdder T, Röhner F, Garbe S, Schmeel F, Schild H, Wilhelm-Buchstab T. EP-1264: Prophylactically applied Hydrofilm reduces radiation dermatitis in whole-breast radiation therapy. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)31574-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Leitzen C, Wilhelm-Buchstab T, Müdder T, Heimann M, Koch D, Schmeel C, Simon B, Stumpf S, Vornholt S, Garbe S, Röhner F, Schoroth F, Schild HH, Schüller H. Patient positioning in head and neck cancer : Setup variations and safety margins in helical tomotherapy. Strahlenther Onkol 2018; 194:386-391. [PMID: 29372290 DOI: 10.1007/s00066-018-1265-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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: 10/09/2017] [Accepted: 01/05/2018] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To evaluate the interfractional variations of patient positioning during intensity-modulated radiotherapy (IMRT) with helical tomotherapy in head and neck cancer and to calculate the required safety margins (sm) for bony landmarks resulting from the necessary table adjustments. MATERIALS AND METHODS In all, 15 patients with head and neck cancer were irradiated using the Hi-Art II tomotherapy system between April and September 2016. Before therapy sessions, patient position was frequently checked by megavolt computed tomography (MV-CT). Necessary table adjustments (ta) in the right-left (rl), superior-inferior (si) and anterior-posterior (ap) directions were recorded for four anatomical points: second, fourth and sixth cervical vertebral body (CVB), anterior nasal spine (ANS). Based upon these data sm were calculated for non-image-guided radiotherapy, image-guided radiotherapy (IGRT) and image guidance limited to a shortened area (CVB 2). RESULTS Based upon planning CT the actual treatment required ta from -0.05 ± 1.31 mm for CVB 2 (ap) up to 2.63 ± 2.39 mm for ANS (rl). Considering the performed ta resulting from image control (MV-CT) we detected remaining ta from -0.10 ± 1.09 mm for CVB 4 (rl) up to 1.97 ± 1.64 mm for ANS (si). After theoretical adjustment of patients position to CVB 2 the resulting ta ranged from -0.11 ± 2.44 mm for CVB6 (ap) to 2.37 ± 2.17 mm for ANS (si). These data imply safety margins: uncorrected patient position: 3.63-9.95 mm, corrected positioning based upon the whole target volume (IGRT): 1.85-6.63 mm, corrected positioning based upon CVB 2 (IGRT): 3.13-6.66 mm. CONCLUSIONS The calculated safety margins differ between anatomic regions. Repetitive and frequent image control of patient positioning is necessary that, however, possibly may be focussed on a limited region.
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Affiliation(s)
- Christina Leitzen
- Radiologische Klinik, FE Strahlentherapie, Universitätsklinik Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany.
| | - Timo Wilhelm-Buchstab
- Radiologische Klinik, FE Strahlentherapie, Universitätsklinik Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany
| | - Thomas Müdder
- Radiologische Klinik, FE Strahlentherapie, Universitätsklinik Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany
| | - Martina Heimann
- Radiologische Klinik, FE Strahlentherapie, Universitätsklinik Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany
| | - David Koch
- Radiologische Klinik, FE Strahlentherapie, Universitätsklinik Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany
| | - Christopher Schmeel
- Radiologische Klinik, FE Strahlentherapie, Universitätsklinik Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany
| | - Birgit Simon
- Radiologische Klinik, FE Strahlentherapie, Universitätsklinik Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany
| | - Sabina Stumpf
- Radiologische Klinik, FE Strahlentherapie, Universitätsklinik Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany
| | - Susanne Vornholt
- Radiologische Klinik, FE Strahlentherapie, Universitätsklinik Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany
| | - Stephan Garbe
- Radiologische Klinik, FE Strahlentherapie, Universitätsklinik Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany
| | - Fred Röhner
- Radiologische Klinik, FE Strahlentherapie, Universitätsklinik Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany
| | - Felix Schoroth
- Radiologische Klinik, FE Strahlentherapie, Universitätsklinik Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany
| | - Hans Heinz Schild
- Radiologische Klinik, FE Strahlentherapie, Universitätsklinik Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany
| | - Heinrich Schüller
- Radiologische Klinik, FE Strahlentherapie, Universitätsklinik Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany
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Leitzen C, Wilhelm-Buchstab T, Schmeel LC, Garbe S, Greschus S, Müdder T, Oberste-Beulmann S, Simon B, Schild HH, Schüller H. MRI during radiotherapy of glioblastoma : Does MRI allow for prognostic stratification? Strahlenther Onkol 2016; 192:481-8. [PMID: 27259515 DOI: 10.1007/s00066-016-0983-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2015] [Accepted: 04/20/2016] [Indexed: 10/21/2022]
Abstract
AIM To evaluate the role of magnetic resonance imaging (MRI) as a predictor for the clinical course in patients with glioblastoma. PATIENTS AND METHODS In 64 patients with glioblastoma undergoing (chemo)radiotherapy MRI studies were obtained before radiation, after 30 gray (Gy), after 60 Gy and during follow-up. MRI findings were assigned to categories: definite progression, questionable progression, no change. Patients were followed clinically. RESULTS At 30 Gy, 23 of 64 patients (36 %) demonstrated definite (dp; n = 15) or questionable (qp; n = 8) progression; in 41/64 (64 %) no change was found compared with preradiation MRI. After radiotherapy at 60 Gy, 26 of 64 (41 %) patients showed dp (n = 18) or qp (n = 8). In 2 cases with qp at the 30 Gy MRI, progress was unquestionable in the 60 Gy MRI study. In the 64 patients, 5 of the 60 Gy MRIs showed dp/qp after being classified as no change at the 30 Gy MRI, 2 of the 30 Gy MRIs showed qp, while the 60 Gy MRI showed tumour regression and 3 fulfilled the criteria for pseudoprogression during ongoing radiotherapy. The 30 Gy study allowed for prognostic stratification: dp/qp compared to stable patients showed median survival of 10.5 versus 20 months. CONCLUSION MR follow-up after 30 Gy in patients undergoing (chemo)radiotherapy for glioblastoma allows prognostic appraisal. Pseudoprogression has to be taken into account, though rare in our setting. Based on these findings, early discussion of treatment modification is possible.
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Affiliation(s)
- C Leitzen
- Radiologische Klinik, FE Strahlentherapie, Universitätsklinik Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany.
| | - T Wilhelm-Buchstab
- Radiologische Klinik, FE Strahlentherapie, Universitätsklinik Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany
| | - L C Schmeel
- Radiologische Klinik, FE Strahlentherapie, Universitätsklinik Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany
| | - S Garbe
- Radiologische Klinik, FE Strahlentherapie, Universitätsklinik Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany
| | - S Greschus
- Radiologische Klinik, Universitätsklinik Bonn, Bonn, Germany
| | - T Müdder
- Radiologische Klinik, FE Strahlentherapie, Universitätsklinik Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany
| | - S Oberste-Beulmann
- Radiologische Klinik, FE Strahlentherapie, Universitätsklinik Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany
| | - B Simon
- Radiologische Klinik, FE Strahlentherapie, Universitätsklinik Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany
| | - H H Schild
- Radiologische Klinik, Universitätsklinik Bonn, Bonn, Germany
| | - H Schüller
- Radiologische Klinik, FE Strahlentherapie, Universitätsklinik Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany
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Wilhelm-Buchstab T, Buchstab BM, Leitzen C, Garbe S, Müdder T, Oberste-Beulmann S, Sprinkart AM, Simon B, Nelles M, Block W, Schoroth F, Schild HH, Schüller H. Extraretinal induced visual sensations during IMRT of the brain. PLoS One 2015; 10:e0123440. [PMID: 25875609 PMCID: PMC4398354 DOI: 10.1371/journal.pone.0123440] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Accepted: 03/03/2015] [Indexed: 11/19/2022] Open
Abstract
Background We observed visual sensations (VSs) in patients undergoing intensity modulated radiotherapy (IMRT) of the brain without the beam passing through ocular structures. We analyzed this phenomenon especially with regards to reproducibility, and origin. Methods and Findings Analyzed were ten consecutive patients (aged 41-71 years) with glioblastoma multiforme who received pulsed IMRT (total dose 60Gy) with helical tomotherapy (TT). A megavolt—CT (MVCT) was performed daily before treatment. VSs were reported and recorded using a triggered event recorder. The frequency of VSs was calculated and VSs were correlated with beam direction and couch position. Subjective patient perception was plotted on an 8x8 visual field (VF) matrix. Distance to the orbital roof (OR) from the first beam causing a VS was calculated from the Dicom radiation therapy data and MVCT data. During 175 treatment sessions (average 17.5 per patient) 5959 VSs were recorded and analyzed. VSs occurred only during the treatment session not during the MVCTs. Plotting events over time revealed patient-specific patterns. The average cranio-caudad extension of VS-inducing area was 63.4mm (range 43.24-92.1mm). The maximum distance between the first VS and the OR was 56.1mm so that direct interaction with the retina is unlikely. Data on subjective visual perception showed that VSs occurred mainly in the upper right and left quadrants of the VF. Within the visual pathways the highest probability for origin of VSs was seen in the optic chiasm and the optic tract (22%). Conclusions There is clear evidence that interaction of photon irradiation with neuronal structures distant from the eye can lead to VSs.
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Affiliation(s)
- Timo Wilhelm-Buchstab
- University of Bonn, Department of Radiology, Radiooncology, Sigmund-Freud-Straße 25, 53105, Bonn, Deutschland, Germany
- * E-mail:
| | - Barbara Myrthe Buchstab
- University of Bonn, Department of Radiology, Radiooncology, Sigmund-Freud-Straße 25, 53105, Bonn, Deutschland, Germany
| | - Christina Leitzen
- University of Bonn, Department of Radiology, Radiooncology, Sigmund-Freud-Straße 25, 53105, Bonn, Deutschland, Germany
| | - Stephan Garbe
- University of Bonn, Department of Radiology, Radiooncology, Sigmund-Freud-Straße 25, 53105, Bonn, Deutschland, Germany
| | - Thomas Müdder
- University of Bonn, Department of Radiology, Radiooncology, Sigmund-Freud-Straße 25, 53105, Bonn, Deutschland, Germany
| | - Susanne Oberste-Beulmann
- University of Bonn, Department of Radiology, Radiooncology, Sigmund-Freud-Straße 25, 53105, Bonn, Deutschland, Germany
| | - Alois Martin Sprinkart
- University of Bonn, Department of Radiology, Radiooncology, Sigmund-Freud-Straße 25, 53105, Bonn, Deutschland, Germany
| | - Birgit Simon
- University of Bonn, Department of Radiology, Radiooncology, Sigmund-Freud-Straße 25, 53105, Bonn, Deutschland, Germany
| | - Michael Nelles
- University of Bonn, Department of Radiology, Radiooncology, Sigmund-Freud-Straße 25, 53105, Bonn, Deutschland, Germany
| | - Wolfgang Block
- University of Bonn, Department of Radiology, Radiooncology, Sigmund-Freud-Straße 25, 53105, Bonn, Deutschland, Germany
| | - Felix Schoroth
- University of Bonn, Department of Radiology, Radiooncology, Sigmund-Freud-Straße 25, 53105, Bonn, Deutschland, Germany
| | - Hans Heinz Schild
- University of Bonn, Department of Radiology, Radiooncology, Sigmund-Freud-Straße 25, 53105, Bonn, Deutschland, Germany
| | - Heinrich Schüller
- University of Bonn, Department of Radiology, Radiooncology, Sigmund-Freud-Straße 25, 53105, Bonn, Deutschland, Germany
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Leitzen C, Herberhold S, Wilhelm-Buchstab T, Garbe S, Müdder T, Schoroth F, Schild HH, Bootz F, Schüller H. [Change of Taste during and after IM- /IG-Radiotherapy for Head and Neck Cancer Patients]. Laryngorhinootologie 2014; 94:383-7. [PMID: 25437837 DOI: 10.1055/s-0034-1390430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Taste dysfunction is a common side effect during irradiation of head and neck. Our aim was to determine the time-dependent course and a possible dependency of this side effect to the radiation-dose during irradiation with helical tomotherapy. PATIENTS AND METHODS 31 patients with malignant tumours in the region of head and neck received an IG-/IM-radiotherapy (helical tomotherapy).The median total dose was 63 Gy (range 30-66 Gy). For all patients the subjective taste dysfunction was documented and correlated to the median (D50) tongue dose. RESULTS A subjective taste dysfunction was registered by the patients themselves after 9 BT (days of radiotherapy) (median). This correlates to a mean dose (D50) of 15.3 Gy (back third of tongue (back ZD)), 11.3 Gy (middle ZD), 8.2 Gy (front ZD). A subjective ageusia occurred after 15 BT (median) (28.9 Gy (back ZD), 22.2 Gy (middle ZD), 17.7 Gy (front ZD)). A starting recovery was registered by 77% of the patients in the first 6-8 weeks after the end of radiotherapy. CONCLUSION The time-dependent course of taste dysfunction during radiotherapy and the following recovery is predictable. A dependency of taste dysfunction to radiation-dose exists. Based on the collected data a targeted dose reduction to the tongue with a view to minimize the taste dysfunction is thinkable and aim of further studies.
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Affiliation(s)
- C Leitzen
- Radiologie, Universitätsklinikum Bonn, Bonn
| | - S Herberhold
- Klinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, Universitätsklinikum Bonn, Bonn
| | | | - S Garbe
- Radiologie, Universitätsklinikum Bonn, Bonn
| | - T Müdder
- Radiologie, Universitätsklinikum Bonn, Bonn
| | - F Schoroth
- Radiologie, Universitätsklinikum Bonn, Bonn
| | - H H Schild
- Radiologie, Universitätsklinikum Bonn, Bonn
| | - F Bootz
- Klinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, Universitätsklinikum Bonn, Bonn
| | - H Schüller
- Radiologie, Universitätsklinikum Bonn, Bonn
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Affiliation(s)
- H. Ewald
- Physikalisches Institut der Technischen Hochschule München
| | - S. Garbe
- Physikalisches Institut der Technischen Hochschule München
| | - P. Ney
- Physikalisches Institut der Technischen Hochschule München
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Leitzen C, Wilhelm-Buchstab T, Garbe S, Lütter C, Müdder T, Simon B, Schild H, Schüller H. Quality of patient positioning during cerebral tomotherapy irradiation using different mask systems. Strahlenther Onkol 2013; 190:382-5. [DOI: 10.1007/s00066-013-0496-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Accepted: 10/24/2013] [Indexed: 12/25/2022]
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Affiliation(s)
| | | | | | | | - Nicole Eter
- Department for OphthalmologyUniversity of Munster, Germany
| | - Uwe Schlegel
- Department of NeurologyUniversity Hospital Bochum, Knappschaftskrankenhaus, Germany
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Glas M, Rath BH, Simon M, Reinartz R, Schramme A, Trageser D, Eisenreich R, Leinhaas A, Keller M, Schildhaus HU, Garbe S, Steinfarz B, Pietsch T, Steindler DA, Schramm J, Herrlinger U, Brüstle O, Scheffler B. Residual tumor cells are unique cellular targets in glioblastoma. Ann Neurol 2010; 68:264-9. [PMID: 20695020 DOI: 10.1002/ana.22036] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Residual tumor cells remain beyond the margins of every glioblastoma (GBM) resection. Their resistance to postsurgical therapy is considered a major driving force of mortality, but their biology remains largely uncharacterized. In this study, residual tumor cells were derived via experimental biopsy of the resection margin after standard neurosurgery for direct comparison with samples from the routinely resected tumor tissue. In vitro analysis of proliferation, invasion, stem cell qualities, GBM-typical antigens, genotypes, and in vitro drug and irradiation challenge studies revealed these cells as unique entities. Our findings suggest a need for characterization of residual tumor cells to optimize diagnosis and treatment of GBM.
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Affiliation(s)
- Martin Glas
- Institute of Reconstructive Neurobiology, University of Bonn Medical Center, Germany.
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Garbe S, Schoroth F, Leitzen C, Jouaou F, Muedder T, Holz D. VERIFICATION OF STEEP DOSE GRADIENTS IN TOMOTHERAPY® USING A CROSSED 2D-DIODE ARRAY. Radiother Oncol 2009. [DOI: 10.1016/s0167-8140(12)73177-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Becher UM, Breitbach M, Sasse P, Garbe S, van der Ven PFM, Fürst DO, Fleischmann BK. Enrichment and terminal differentiation of striated muscle progenitors in vitro. Exp Cell Res 2009; 315:2741-51. [PMID: 19615359 DOI: 10.1016/j.yexcr.2009.07.005] [Citation(s) in RCA: 7] [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] [Received: 12/02/2008] [Revised: 07/06/2009] [Accepted: 07/08/2009] [Indexed: 11/25/2022]
Abstract
Enrichment and terminal differentiation of mammalian striated muscle cells is severely hampered by fibroblast overgrowth, de-differentiation and/or lack of functional differentiation. Herein we report a new, reproducible and simple method to enrich and terminally differentiate muscle stem cells and progenitors from mice and humans. We show that a single gamma irradiation of muscle cells induces their massive differentiation into structurally and functionally intact myotubes and cardiomyocytes and that these cells can be kept in culture for many weeks. Similar results are also obtained when treating skeletal muscle-derived stem cells and progenitors with Mitomycin C.
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Affiliation(s)
- Ulrich M Becher
- Institute of Physiology I, Life and Brain Center, University of Bonn, Bonn, Germany
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31
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Piehlmeier W, Renner R, Schramm W, Kimmerling T, Garbe S, Proetzsch R, Fahn J, Piwernetz K, Landgraf R. Screening of diabetic patients for microalbuminuria in primary care — The PROSIT-Project. Exp Clin Endocrinol Diabetes 2009. [DOI: 10.1055/s-0029-1212104] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Trog D, Garbe S, Lutterbey G, Lütter C, Barwig P, Boldt I, Stolz A, Richter O, Schild HH, Schüller H. [Volumetric changes of the breast during radiotherapy. Is a replanning necessary for the electron boost?]. Strahlenther Onkol 2006; 181:255-9. [PMID: 15827696 DOI: 10.1007/s00066-005-1316-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2004] [Accepted: 12/09/2004] [Indexed: 10/25/2022]
Abstract
BACKGROUND AND PURPOSE Radiotherapy can induce tissue reactions with an edema leading to increased breast volume. The aim of the present study was to quantify this increase and analyze its effect on the electron boost technique. PATIENTS AND METHODS 140 patients with breast cancer treated with breast-conserving surgery underwent CT planning before, during and/or after radiotherapy in order to evaluate breast volume changes due to radiotherapy. CT data were analyzed using the HELAX planning system and dose distribution was assessed. Determination of the breast volume was achieved using an interpolation algorithm. Three subgroups were analyzed: group 1 (n = 47): < or = 670 cm(3), group 2 (n = 46): 671-999 cm(3), and group 3 (n = 47): > or = 1000 cm(3) breast volume. RESULTS The mean initial breast volume was 907 cm(3) (100-3073 cm(3)). After radiotherapy, mean breast volume increased by 81 cm(3) to 988 cm(3) (109-3185 cm(3)). Significant changes in volume were observed after a dose of 40 Gy. According to the subgroups mean volume increase was as follows: group 1: 53 cm(3) (3-120 cm(3)), group 2: 85 cm(3) (20-200 cm(3)), and group 3: 105 cm(3) (5-340 cm(3)). This difference was statistically significant for all subgroups (p < 0.001). Corresponding to the volume increase, depth of the boost target volume changed up to 1.0 cm. CONCLUSION As radiotherapy may lead to a significant increase in breast volume, it seems appropriate to perform a second planning CT after about 40 Gy in order to optimize dose distribution for boost irradiation.
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Affiliation(s)
- Daniela Trog
- Radiologische Universitätsklinik, Friedrich-Wilhelms-Universität, Bonn.
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Garbe S, Nour Y, Wolf K, Müller-Veggian M, Bender M. 468 Scatter dose determination at the eye lens during a mask based whole brain radiotherapy (WBRT). Radiother Oncol 2005. [DOI: 10.1016/s0167-8140(05)81444-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Eter N, Brinken R, Garbe S, Spitznas M. Intraocular humidity immediately after fluid–air exchange in pars plana vitrectomy. Graefes Arch Clin Exp Ophthalmol 2005; 244:305-8. [PMID: 16133014 DOI: 10.1007/s00417-005-1168-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2004] [Revised: 02/14/2005] [Accepted: 02/25/2005] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To study vitreous cavity humidity during fluid-air exchange in pars plana vitrectomy. METHODS Intraocular humidity in the vitreous cavity was recorded for 2 min in six artificial eyes, six enucleated pig eyes, and ten patient eyes, after the eyes had been filled with either humidified air (75% humidity) or dry air (8% humidity). RESULTS In artificial eyes the humidity levelled off at a value that was approximately equal to the humidity of the infused air, i.e., a mean of 71.9% when humidified air was used and a mean of 14.4% when dry air was used. In enucleated pig eyes humidity increased slightly with humidified air and remained stable with dry air. In patients intraocular humidity increased to over 90%, regardless of whether humidified or dry air was used. CONCLUSION In the living eye, dry air deprives the retinal tissue of humidity, which is lost into the vitreous cavity. This effect can be reduced by using humidified air.
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Affiliation(s)
- Nicole Eter
- Department of Ophthalmology, University of Bonn Medical Center, Sigmund-Freud-Strasse 25, 53105, Bonn, Germany.
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Eter N, Garbe S, Pauleit D, Schüttoff T, Schüller H. Magnetic resonance imaging analysis of anterior and posterior eye segment displacement during ocular gaze shifts. Eur J Ophthalmol 2003; 13:196-201. [PMID: 12696640 DOI: 10.1177/112067210301300212] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To determine the relationship between movements of the posterior and anterior eye segments during arbitrary gaze shifts and to obtain information for monitoring fixation during radiotherapy for ocular diseases. METHODS We examined eye movements of ten emmetropic volunteers in a 1.5 T magnetic resonance system. Using a T2-weighted ultrafast turbo-spin echo sequence (UTSE), the eyes were examined within 21 seconds. Sagittal and transversal eye slices were obtained in five passages in five gaze directions (straight ahead, 15 degrees above, 15 degrees below, 15 degrees right and 15 degrees left of the primary position). Displacement of the posterior eye segment was analyzed in relation to the movement of the anterior segment in all directions. RESULTS The relationship between the movements of the anterior and posterior eye segment was 1:0.8 (+/- 0.06 SD) during horizontal gaze shifts and 1:1.16 (+/- 0.11 SD) during vertical gaze shifts. CONCLUSIONS Magnetic resonance imaging showed that the relationship between anterior and posterior eye segments was different during horizontal and vertical eye movements, indicating the presence of more than one center of rotation. Compared to the anterior eye segment, there was less displacement of the posterior eye segment during horizontal eye movements and more displacement during vertical eye movements.
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Affiliation(s)
- N Eter
- Department of Ophthalmology, University of Bonn Medical Center, Bonn, Germany.
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Piehlmeier W, Renner R, Schramm W, Kimmerling T, Garbe S, Proetzsch R, Fahn J, Piwernetz K, Landgraf R. Screening of diabetic patients for microalbuminuria in primary care--The PROSIT-Project. Proteinuria Screening and Intervention. Exp Clin Endocrinol Diabetes 1999; 107:244-51. [PMID: 10433063 DOI: 10.1055/s-0029-1212107] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The PROSIT (Proteinuria Screening and Intervention) Project started in 1993 in order to obtain data on the prevalence of micro- and macroalbuminuria in diabetic patients treated in primary care, to establish an easy screening programme for microalbuminuria, in which also diabetic patients can participate in self-responsibility, and to implement a specific intervention programme for incipient nephropathy. In 58 representative doctor's offices 647 diabetic patients were included, who performed at home self-tests for microalbuminuria on three days within one week using the early morning urine and a newly developed qualitative immunologic test-strip for microalbuminuria. After storage they returned the same urine samples to their doctors' offices for semiquantitative retesting with the immunologic test-strip Micral-Test II. In case of positive results the proteinuria dipstick Combur-9-Test was applied in order to exclude other causes of positive microalbuminuria (e.g. urinary tract infection). Data of 569 patients (6% Type 1, 88% Type 2 and 6% secondary diabetes) could be analysed. Both qualitative self-testing for microalbuminuria at home and semiquantitative retesting in doctors' offices were found to be feasible. Based on semiquantitative retesting the prevalences of microalbuminuria (macroalbuminuria) were 19.6% (0%) in Type 1 diabetes, 17.2% (10.8%) in Type 2 diabetes and 11.7% (7.8%) in secondary diabetes. Type 2 diabetic patients showed a clear correlation between albuminuria and diabetes duration, HbA1c, serum creatinine, triglycerides as well as micro- and macrovascular complications. 227 patients with micro- or macroalbuminuria were included into the ongoing PROSIT intervention programme.
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Affiliation(s)
- W Piehlmeier
- Dept. of Internal Medicine, Innenstadt, University of Munich, Germany.
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Fisker R, Poulsen HF, Schou J, Carstensen JM, Garbe S. Use of Image-Processing Tools for Texture Analysis of High-Energy X-ray Synchrotron Data. J Appl Crystallogr 1998. [DOI: 10.1107/s0021889897016439] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
The introduction of synchrotron beamlines for high-energy X-ray diffraction raises new possibilities for texture determination of polycrystalline materials. The local texture can be mapped out in three dimensions and texture developments can be studiedin situin complicated environments. However, it is found that a full alignment of the two-dimensional detector used in many cases is impractical and that data-sets are often partially subject to geometric restrictions. Estimating the parameters of the traces of the Debye–Scherrer cones on the detector therefore becomes a concern. Moreover, the background may vary substantially on a local scale as a result of inhomogeneities in the sample environmentetc. A set of image-processing tools has been employed to overcome these complications. An automatic procedure for estimating the parameters of the traces (taken as ellipses) is described, based on a combination of a circular Hough transform and nonlinear least-squares fitting. Using the estimated ellipses the background is subtracted and the intensity along the Debye–Scherrer cones is integrated by a combined fit of the local diffraction pattern. The corresponding algorithms are presented together with the necessary coordinate transform for pole-figure determination. The image-processing tools may be useful for the analysis of noisy or partial powder diffraction data-sets in general, provided flat two-dimensional detectors are used.
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Piehlmeier W, Renner R, Kimmerling T, Schramm W, Garbe S, Proetzsch R, Fahn J, Piwernetz K, Landgraf R. Evaluation of the Micral-Test S, a qualitative immunologic patient self-test for microalbuminuria: the PROSIT project. Proteinuria Screening and Intervention. Diabet Med 1998; 15:883-5. [PMID: 9796891 DOI: 10.1002/(sici)1096-9136(199810)15:10<883::aid-dia684>3.0.co;2-n] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- W Piehlmeier
- Department of Internal Medicine Innenstadt, University of Munich, Germany.
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Lienert U, Schulze C, Honkimäki V, Tschentscher T, Garbe S, Hignette O, Horsewell A, Lingham M, Poulsen HF, Thomsen NB, Ziegler E. Focusing Optics for High-Energy X-ray Diffraction. J Synchrotron Radiat 1998; 5:226-231. [PMID: 15263483 DOI: 10.1107/s0909049598001393] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/1997] [Accepted: 01/20/1998] [Indexed: 05/24/2023]
Abstract
Novel focusing optical devices have been developed for synchrotron radiation in the energy range 40-100 keV. Firstly, a narrow-band-pass focusing energy-tuneable fixed-exit monochromator was constructed by combining meridionally bent Laue and Bragg crystals. Dispersion compensation was applied to retain the high momentum resolution despite the beam divergence caused by the focusing. Next, microfocusing was achieved by a bent multilayer arranged behind the crystal monochromator and alternatively by a bent Laue crystal. A 1.2 micro m-high line focus was obtained at 90 keV. The properties of the different set-ups are described and potential applications are discussed. First experiments were performed, investigating with high spatial resolution the residual strain gradients in layered polycrystalline materials. The results underline that focused high-energy synchrotron radiation can provide unique information on the mesoscopic scale to the materials scientist, complementary to existing techniques based on conventional X-ray sources, neutron scattering or electron microscopy.
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Affiliation(s)
- U Lienert
- ESRF, BP 220, F-38043 Grenoble CEDEX, France, and Risø National Laboratory, Materials Department, DK-4000 Roskilde, Denmark
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Poulsen HF, Garbe S, Lorentzen T, Juul Jensen D, Poulsen FW, Andersen NH, Frello T, Feidenhans'l R, Graafsma H. Applications of high-energy synchrotron radiation for structural studies of polycrystalline materials. J Synchrotron Radiat 1997; 4:147-54. [PMID: 16699221 DOI: 10.1107/s0909049597002021] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
The large penetration power of high-energy X-rays (>60 keV) raises interesting prospects for new types of structural characterizations of polycrystalline materials. It becomes possible in a non-destructive manner to perform local studies, within the bulk of the material, of the fundamental materials physics properties: grain orientations, strain, dislocation densities etc. In favourable cases these properties may be mapped in three dimensions with a spatial resolution that matches the dimensions of the individual grains. Imbedded volumes and interfaces become accessible. Moreover, the high energies allow better in-situ studies of samples in complicated environments (industrial process optimization). General techniques for research in this energy range have been developed using broad-band angle-dispersive methods, on-line two-dimensional detectors and conical slits. Characterizations have been made at the level of the individual grains and grain boundaries as well as on ensembles of grains. The spatial resolution is presently of the order of 10-100 micom. Four examples of applications are presented along with an outlook.
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Affiliation(s)
- H F Poulsen
- Materials Department, Ris~ National Laboratory, DK-4000 Roskilde, Denmark
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Garbe S. [Double-barrelled replacement-plasty of the anterior cruciate ligament with fascia lata strips]. Unfallchirurg 1991; 94:346-50. [PMID: 1925608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
An intra-articular reconstruction of the anterior cruciate ligament (ACL) in chronic and acute ruptures is described, which we call doubling-back ACL substitution. The McIntosh graft is used to fix it, starting from the posterior origin of the ACL and passing to the anterior region of its insertion and through the anteromedial tibial head, returning over the top with isometric conditions. Since April 1987, this procedure has been applied in 60 patients this way, 48 of whom we saw again between April and June 1990. There are only 2 unstable joints; 46 patients have stable knees. Most of them are engaging in sport again.
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Affiliation(s)
- S Garbe
- Traumatologische Abteilung mit Sektion Orthopädie, St. Elisabethen-Krankenhaus Ravensburg
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Garbe S, Garbe E. [Health in the USSR in the era of Perestroika]. Cah Sociol Demogr Med 1990; 30:5-45. [PMID: 2357622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
For years, the Health Service of the USSR was considered a model and a guide. Countries in the Third World were invited to follow its various elements in organizing their own national health systems. But, since August 1987, everybody has known that the Health Service of the USSR is in a very bad situation. Official reports, journals of the Party and declarations of the health authorities all emphasized the catastrophic state of the health care organization in USSR: rising mortality rates, alcohol and drug abuse, extensive pollution, hospitals without hygiene or equipment, lack of professionalism and extended corruption among medical doctors and other health workers, patients' dissatisfaction etc... Of special concern are the cardiovascular and maternal mortality rates which are now much higher than in other countries. In the wake of perestroïka, a plan of reform was initiated by the Party and the Government, and was announced in 1988 by Health Minister E.N. Tchazov. The basic principle of the Health Service in the USSR remains prevention. Nevertheless, a great number of new measures will be implemented. Health information and care will be brought to the people by health workers. Mass screening for the most frequent diseases will be performed. Computers will be used on a large scale for managing high risk groups. Health centers will be strengthened. But the most revolutionary element of the reform will be the extension of the "paying sector", with increased number of facilities having financial autonomy. These facilities provide care and require some payment from the patients. They existed previously, but in the future they will be increased and strengthened. This means that the patients will have to pay more money but the services will be likely improved. The future will show whether the plan will succeed or fail.
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Affiliation(s)
- S Garbe
- Institut Pédagogique de Kiev, URSS
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Abstract
The implication of activated oxygen in the interaction between hypoxic rat liver and circulating erythrocytes was investigated. Reduced species of oxygen generated in hypoxic liver owing to accelerated purine nucleotide degradation via xanthine oxidase initiate alterations of plasma membrane and glutathione system of erythrocytes. Osmotic fragility, hemolysis rate and erythrocytic GSSG:GSH ratio may be considered as appropriate indicators of oxidative load in liver and other tissues. Addition of erythrocytes to the perfusion medium attenuates the GSSG efflux of hypoxic liver from 2.7 +/- 0.5 nmol x g w.w.-1 x min-1 to 1.4 +/- 0.2 nmol x g w.w.-1 x min-1 Thus, circulating erythrocytes protect the liver against oxidative attack.
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Affiliation(s)
- W Siems
- Institut für Biochemie and Chirurgische Klinik, Bereich Medizin (Charité), DDR
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Döge G, Dittgen M, Garbe S. [The storage capability of pre-filled disposable plastic syringes]. Pharmazie 1985; 40:559-61. [PMID: 4080803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The storage stability of a pre-filled plastic disposable syringe (piston type) of polypropylene as to solvents and ambient oxygen has been studied. To assess the permeability and impermeability of the sealing component parts, the syringes had been stored in a long-time test under different types of seal and different temperatures. Based on the results, the polypropylene plastic disposable syringes were on principal suited to be used in solvents as glycol, ethanol or water, the protection against ambient oxygen is, however, an insufficient one.
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