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Schwanke D, Schüle S, Stewart S, Fatanmi OO, Wise SY, Hackenbroch C, Wiegel T, Singh VK, Port M, Abend M, Ostheim P. Validating a Four-gene Set for H-ARS Severity Prediction in Peripheral Blood Samples of Irradiated Rhesus Macaques. Radiat Res 2024; 201:504-513. [PMID: 38471521 DOI: 10.1667/rade-23-00162.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 10/26/2023] [Indexed: 03/14/2024]
Abstract
Increased radiological and nuclear threats require preparedness. Our earlier work identified a set of four genes (DDB2, FDXR, POU2AF1 and WNT3), which predicts severity of the hematological acute radiation syndrome (H-ARS) within the first three days postirradiation In this study of 41 Rhesus macaques (Macaca mulatta, 27 males, 14 females) irradiated with 5.8-7.2 Gy (LD29-50/60), including some treated with gamma-tocotrienol (GT3, a radiation countermeasure) we independently validated these genes as predictors in both sexes and examined them after three days. At the Armed Forces Radiobiology Research Institute/Uniformed Services University of the Health Sciences, peripheral whole blood (1 ml) of Rhesus macaques was collected into PAXgene® Blood RNA tubes pre-irradiation after 1, 2, 3, 35 and 60 days postirradiation, stored at -80°C for internal experimental analyses. Leftover tubes from these already ongoing studies were kindly provided to Bundeswehr Institute of Radiobiology. RNA was isolated (QIAsymphony), converted into cDNA, and for further gene expression (GE) studies quantitative RT-PCR was performed. Differential gene expression (DGE) was measured relative to the pre-irradiation Rhesus macaques samples. Within the first three days postirradiation, we found similar results to human data: 1. FDXR and DDB2 were up-regulated, FDXR up to 3.5-fold, and DDB2 up to 13.5-fold in the median; 2. POU2AF1 appeared down regulated around tenfold in nearly all Rhesus macaques; 3. Contrary to human data, DDB2 was more up-regulated than FDXR, and the difference of the fold change (FC) ranged between 2.4 and 10, while the median fold changes of WNT3, except days 1 and 35, were close to 1. Nevertheless, 46% of the Rhesus macaques showed down-regulated WNT3 on day one postirradiation, which decreased to 12.2% on day 3 postirradiation. Considering the extended phase, there was a trend towards decreased fold changes at day 35, with median-fold changes ranging from 0.7 for DDB2 to 0.1 for POU2AF1, and on day 60 postirradiation, DGE in surviving animals was close to pre-exposure values for all four genes. In conclusion, the diagnostic significance for radiation-induced H-ARS severity prediction of FDXR, DDB2, and POU2AF1 was confirmed in this Rhesus macaques model. However, DDB2 showed higher GE values than FDXR. As shown in previous studies, the diagnostic significance of WNT3 could not be reproduced in Rhesus macaques; this could be due to the choice of animal model and methodological challenges.
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Affiliation(s)
- D Schwanke
- Bundeswehr Institute of Radiobiology, Munich, Germany
| | - S Schüle
- Bundeswehr Institute of Radiobiology, Munich, Germany
| | - S Stewart
- Bundeswehr Institute of Radiobiology, Munich, Germany
| | - O O Fatanmi
- Division of Radioprotectants, Department of Pharmacology and Molecular Therapeutics, F. Edward Hébert School of Medicine, and
- Armed Forces Radiobiology Research Institute, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - S Y Wise
- Division of Radioprotectants, Department of Pharmacology and Molecular Therapeutics, F. Edward Hébert School of Medicine, and
- Armed Forces Radiobiology Research Institute, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - C Hackenbroch
- Department of Radiology, Bundeswehrkrankenhaus Ulm, Ulm Germany
| | - T Wiegel
- Department of Radiation Oncology, University Hospital, Ulm, Germany
| | - V K Singh
- Division of Radioprotectants, Department of Pharmacology and Molecular Therapeutics, F. Edward Hébert School of Medicine, and
- Armed Forces Radiobiology Research Institute, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - M Port
- Bundeswehr Institute of Radiobiology, Munich, Germany
| | - M Abend
- Bundeswehr Institute of Radiobiology, Munich, Germany
| | - P Ostheim
- Bundeswehr Institute of Radiobiology, Munich, Germany
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2
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Schwanke D, Fatanmi OO, Wise SY, Ostheim P, Schüle S, Kaletka G, Stewart S, Wiegel T, Singh VK, Port M, Abend M. Validating Radiosensitivity with Pre-Exposure Differential Gene Expression in Peripheral Blood Predicting Survival and Non-Survival in a Second Irradiated Rhesus Macaque Cohort. Radiat Res 2024; 201:384-395. [PMID: 38282135 DOI: 10.1667/rade-23-00099.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 09/27/2023] [Indexed: 01/30/2024]
Abstract
Radiosensitivity differs in humans and possibly in closely related nonhuman primates. The reasons for variation in radiosensitivity are not well known. In an earlier study, we examined gene expression (GE) pre-radiation in peripheral blood among male (n = 62) and female (n = 60) rhesus macaques (n = 122), which did or did not survive (up to 60 days) after whole-body exposure of 7.0 Gy (LD66/60). Eight genes (CHD5, CHI3L1, DYSF, EPX, IGF2BP1, LCN2, MBOAT4, SLC22A4) revealed significant associations with survival. Access to a second rhesus macaque cohort (males = 40, females = 23, total n = 63) irradiated with 5.8-7.2 Gy (LD29-50/60) and some treated with gamma-tocotrienol (GT3, a radiation countermeasure) allowed us to validate these gene expression changes independently. Total RNA was isolated from whole blood samples and examined by quantitative RT-PCR on a 96-well format. cycle threshold (Ct)-values normalized to 18S rRNA were analyzed for their association with survival. Regardless of the species-specific TaqMan assay, similar results were obtained. Two genes (CHD5 and CHI3L1) out of eight revealed a significant association with survival in the second cohort, while only CHD5 (involved in DNA damage response and proliferation control) showed mean gene expression changes in the same direction for both cohorts. No expected association of CHD5 GE with dose, treatment, or sex could be established. Instead, we observed significant associations for those comparisons comprising pre-exposure samples with CHD5 Ct values ≤ 11 (total n = 17). CHD5 Ct values ≤ 11 in these comparisons were mainly associated with increased frequencies (61-100%) of non-survivors, a trend which depending on the sample numbers, reached significance (P = 0.03) in males and, accordingly, in females. This was also reflected by a logistic regression model including all available samples from both cohorts comprising CHD5 measurements (n = 104, odds ratio 1.38, 95% CI 1.07-1.79, P = 0.01). However, this association was driven by males (odds ratio 1.62, 95% CI 1.10-2.38, P = 0.01) and CHD5 Ct values ≤ 11 since removing low CHD5 Ct values from this model, converted to insignificance (P = 0.19). A second male subcohort comprising high CHD5 Ct values ≥ 14.4 in both cohorts (n = 5) appeared associated with survival. Removing these high CHD5 Ct values converted the model borderline significant (P = 0.051). Based on the probability function of the receiver operating characteristics (ROC) curves, 8 (12.3%) and 5 (7.7%) from 65 pre-exposure RNA measurements in males, death and survival could be predicted with a negative and positive predictive value ranging between 85-100%. An associated odds ratio reflected a 62% elevated risk for dying or surviving per unit change (Ct-value) in gene expression, considering the before-mentioned CHD5 thresholds in RNA copy numbers. In conclusion, we identified two subsets of male animals characterized by increased (Ct values ≤ 11) and decreased (Ct values ≥ 14.4) CHD5 GE copy numbers before radiation exposure, which independently of the cohort, radiation exposure or treatment appeared to predict the death or survival in males.
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Affiliation(s)
- D Schwanke
- Bundeswehr Institute of Radiobiology, Munich, Germany
| | - O O Fatanmi
- Division of Radioprotectants, Department of Pharmacology and Molecular Therapeutics, F. Edward Hébert School of Medicine, and
- Armed Forces Radiobiology Research Institute, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - S Y Wise
- Division of Radioprotectants, Department of Pharmacology and Molecular Therapeutics, F. Edward Hébert School of Medicine, and
- Armed Forces Radiobiology Research Institute, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - P Ostheim
- Bundeswehr Institute of Radiobiology, Munich, Germany
| | - S Schüle
- Bundeswehr Institute of Radiobiology, Munich, Germany
| | - G Kaletka
- Bundeswehr Institute of Radiobiology, Munich, Germany
| | - S Stewart
- Bundeswehr Institute of Radiobiology, Munich, Germany
| | - T Wiegel
- Department of Radiation Oncology, University Hospital, Ulm, Germany
| | - V K Singh
- Division of Radioprotectants, Department of Pharmacology and Molecular Therapeutics, F. Edward Hébert School of Medicine, and
- Armed Forces Radiobiology Research Institute, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - M Port
- Bundeswehr Institute of Radiobiology, Munich, Germany
| | - M Abend
- Bundeswehr Institute of Radiobiology, Munich, Germany
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Koerber SA, Höcht S, Aebersold D, Albrecht C, Boehmer D, Ganswindt U, Schmidt-Hegemann NS, Hölscher T, Mueller AC, Niehoff P, Peeken JC, Pinkawa M, Polat B, Spohn SKB, Wolf F, Zamboglou C, Zips D, Wiegel T. Prostate cancer and elective nodal radiation therapy for cN0 and pN0-a never ending story? : Recommendations from the prostate cancer expert panel of the German Society of Radiation Oncology (DEGRO). Strahlenther Onkol 2024; 200:181-187. [PMID: 38273135 PMCID: PMC10876748 DOI: 10.1007/s00066-023-02193-4] [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: 12/11/2023] [Accepted: 12/17/2023] [Indexed: 01/27/2024]
Abstract
For prostate cancer, the role of elective nodal irradiation (ENI) for cN0 or pN0 patients has been under discussion for years. Considering the recent publications of randomized controlled trials, the prostate cancer expert panel of the German Society of Radiation Oncology (DEGRO) aimed to discuss and summarize the current literature. Modern trials have been recently published for both treatment-naïve patients (POP-RT trial) and patients after surgery (SPPORT trial). Although there are more reliable data to date, we identified several limitations currently complicating the definitions of general recommendations. For patients with cN0 (conventional or PSMA-PET staging) undergoing definitive radiotherapy, only men with high-risk factors for nodal involvement (e.g., cT3a, GS ≥ 8, PSA ≥ 20 ng/ml) seem to benefit from ENI. For biochemical relapse in the postoperative situation (pN0) and no PSMA imaging, ENI may be added to patients with risk factors according to the SPPORT trial (e.g., GS ≥ 8; PSA > 0.7 ng/ml). If PSMA-PET/CT is negative, ENI may be offered for selected men with high-risk factors as an individual treatment approach.
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Affiliation(s)
- S A Koerber
- Department of Radiation Oncology, Barmherzige Brüder Hospital Regensburg, Prüfeninger Straße 86, 93049, Regensburg, Germany.
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
| | - S Höcht
- Department of Radiation Oncology, Ernst von Bergmann Hospital Potsdam, Charlottenstraße 72, 14467, Potsdam, Germany
| | - D Aebersold
- Department of Radiation Oncology, Inselspital-Bern University Hospital, University of Bern, Freiburgstraße 4, 3010, Bern, Switzerland
| | - C Albrecht
- Nordstrahl Radiation Oncology Unit, Nürnberg North Hospital, Prof.-Ernst-Nathan-Str. 1, 90149, Nürnberg, Germany
| | - D Boehmer
- Department of Radiation Oncology, University Hospital Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - U Ganswindt
- Department of Radiation Oncology, University Hospital Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - N-S Schmidt-Hegemann
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - T Hölscher
- Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, TU Dresden, Fiedlerstraße 19, 01307, Dresden, Germany
| | - A-C Mueller
- Department of Radiation Oncology, RKH Hospital Ludwigsburg, Posilipostraße 4, 71640, Ludwigsburg, Germany
| | - P Niehoff
- Department of Radiation Oncology, Sana Hospital Offenbach, Starkenburgring 66, 63069, Offenbach, Germany
| | - J C Peeken
- Department of Radiation Oncology, Technische Universität München, Ismaninger Straße 22, 81675, Munich, Germany
| | - M Pinkawa
- Department of Radiation Oncology, Robert Janker Klinik, Villenstraße 8, 53129, Bonn, Germany
| | - B Polat
- Department of Radiation Oncology, University Hospital Würzburg, Josef-Schneider-Straße 11, 97080, Würzburg, Germany
| | - S K B Spohn
- Department of Radiation Oncology, University Hospital Freiburg, Robert-Koch-Straße 3, 79106, Freiburg, Germany
| | - F Wolf
- Department of Radiation Oncology, Paracelsus Medical University of Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Austria
| | - C Zamboglou
- Department of Radiation Oncology, University Hospital Freiburg, Robert-Koch-Straße 3, 79106, Freiburg, Germany
- German Oncology Center, 1, Nikis Avenue, Agios Athanasios, 4108, Limassol, Cyprus
| | - D Zips
- Department of Radiation Oncology, University Hospital Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - T Wiegel
- Department of Radiation Oncology, University Hospital Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany
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4
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Sandler H, Shore N, Dearnaley D, Freedland S, Smith M, Rosales R, Brookman-May S, Dicker A, McKenzie M, Bossi A, Widmark A, Wiegel T, Martin J, Miladinovic B, Lefresne F, Ciprotti M, McCarthy S, Mundle S, Tombal B, Feng F. Challenges and Solutions during the COVID Pandemic for Patient Retention and Physician Engagement in the Phase 3 ATLAS Study of Apalutamide Added to Androgen Deprivation Therapy (ADT) in High-Risk Localized or Locally Advanced Prostate Cancer (HRLPC). Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.1217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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5
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Spohn S, Draulans C, Kishan A, Spratt D, Ross A, Maurer T, Tilki D, Berlin A, Blanchard P, Collins S, Bronsert P, Chen R, Dal Pra A, De Meerler G, Eade T, Haustermans K, Hölscher T, Höcht S, Ghadjar P, Davicioni E, Heck M, Kerkmeijer L, Kirste S, Tselis N, Tran P, Pinkawa M, Pommier P, Deltas C, Schmidt-Hegemann NS, Wiegel T, Zilli T, Tree A, Qiu X, Murthy V, Epstein J, Graztke C, Grosu A, Kamran S, Zamboglou C, Pinkawa. Genomic classifiers in personalized prostate cancer radiotherapy approaches – a systematic review and future perspectives based on international consensus. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)02485-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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6
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Sabbagh A, Tilki D, Feng J, Hong J, Chen M, Wu J, Huland H, Graefen M, Wiegel T, Böhmer D, Washington S, Cowan J, Cooperberg M, Feng F, Carroll P, Trock B, Partin A, DAmico A, Mohamad O. Machine Learning for the Prediction of Distant Metastases Following Postprostatectomy Salvage Radiation Therapy. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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7
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Cannoletta D, Fossati N, Karnes R, Boorjan S, Bossi A, Di Muzio N, Cozzarini C, Chiorda BN, Gandaglia G, Bartkowiak D, Shariat S, Goldner G, Berghen C, Joniau S, De Meerleer G, Scilipoti P, Mazzone E, Stabile A, van Poppel H, Gallina A, Wiegel T, Montorsi F, Briganti A. Toxicity profile of immediate post-prostatectomy radiation therapy: results from a large multi-institutional series. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)01090-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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8
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Scilipoti P, Fossati N, Mazzone E, Karnes J, Boorjian S, Motterle G, Bossi A, Kumar T, Di Muzio N, Cozzarini C, Chiorda BN, Robesti D, Cirulli G, Gandaglia G, Suardi N, Bartkowiak D, Shariat S, Goldner G, Berghen C, Joniau S, Stabile A, Cucchiara V, van Poppel H, De Meerleer G, Karakiewicz P, Wiegel T, Montorsi F, Briganti A. Development and validation of a novel nomogram predicting long-term progression in patients treated with early salvage radiation therapy after radical prostatectomy: the key role of PSA kinetics. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)01089-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Spohn SKB, Adebahr S, Huber M, Jenkner C, Wiehle R, Nagavci B, Schmucker C, Carl EG, Chen RC, Weber WA, Mix M, Rühle A, Sprave T, Nicolay NH, Gratzke C, Benndorf M, Wiegel T, Weis J, Baltas D, Grosu AL, Zamboglou C. Feasibility, pitfalls and results of a structured concept-development phase for a randomized controlled phase III trial on radiotherapy in primary prostate cancer patients. BMC Cancer 2022; 22:337. [PMID: 35351058 PMCID: PMC8960686 DOI: 10.1186/s12885-022-09434-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 03/09/2022] [Indexed: 11/15/2022] Open
Abstract
Objective Failure rate in randomized controlled trials (RCTs) is > 50%, includes safety-problems, underpowered statistics, lack of efficacy, lack of funding or insufficient patient recruitment and is even more pronounced in oncology trials. We present results of a structured concept-development phase (CDP) for a phase III RCT on personalized radiotherapy (RT) in primary prostate cancer (PCa) patients implementing prostate specific membrane antigen targeting positron emission tomography (PSMA-PET). Materials and methods The 1 yr process of the CDP contained five main working packages: (i) literature search and scoping review, (ii) involvement of individual patients, patients’ representatives and patients’ self-help groups addressing the patients’ willingness to participate in the preparation process and the conduct of RCTs as well as the patient informed consent (PIC), (iii) involvement of national and international experts and expert panels (iv) a phase II pilot study investigating the safety of implementation of PSMA-PET for focal dose escalation RT and (v) in-silico RT planning studies assessing feasibility of envisaged dose regimens and effects of urethral sparing in focal dose escalation. Results (i) Systematic literature searches confirmed the high clinical relevance for more evidence on advanced RT approaches, in particular stereotactic body RT, in high-risk PCa patients. (ii) Involvement of patients, patient representatives and randomly selected males relevantly changed the PIC and initiated a patient empowerment project for training of bladder preparation. (iii) Discussion with national and international experts led to adaptions of inclusion and exclusion criteria. (iv) Fifty patients were treated in the pilot trial and in- and exclusion criteria as well as enrollment calculations were adapted accordingly. Parallel conduction of the pilot trial revealed pitfalls on practicability and broadened the horizon for translational projects. (v) In-silico planning studies confirmed feasibility of envisaged dose prescription. Despite large prostate- and boost-volumes of up to 66% of the prostate, adherence to stringent anorectal dose constraints was feasible. Urethral sparing increased the therapeutic ratio. Conclusion The dynamic framework of interdisciplinary working programs in CDPs enhances robustness of RCT protocols and may be associated with decreased failure rates. Structured recommendations are warranted to further define the process of such CDPs in radiation oncology trials. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-022-09434-2.
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Fossati N, Mazzone E, Karnes R, Boorjian S, Motterle G, Bossi A, Kumar T, Di Muzio N, Cozzarini C, Noris Chiorda B, Robesti D, Stabile A, Gandaglia G, Suardi N, Bartkowiak D, Shariat S, Goldner G, Joniau S, Van Poppel H, Berghen C, De Meerleer G, Karakiewicz P, Montorsi F, Wiegel T, Briganti A. Development and validation of a novel nomogram predicting long-term progression in patients treated with early salvage radiation therapy after radical prostatectomy: The key role of PSA kinetics. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00272-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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11
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Fossati N, Karnes J, Boorjan S, Bossi A, Di Muzio N, Cozzarini C, Noris Chiorda B, Gandaglia G, Mazzone E, Stabile A, Bartkowiak D, Shariat S, Goldner G, Joniau S, Berghen C, De Meerleer G, Van Poppel H, Gallina A, Montorsi F, Wiegel T, Briganti A. PSA doubling time as predictor of relapse after early salvage radiation therapy: When should imaging be used to select patients who might not benefit from early local treatments? Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00281-0] [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: 11/04/2022]
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12
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Dapper H, Belka C, Bock F, Budach V, Budach W, Christiansen H, Debus J, Distel L, Dunst J, Eckert F, Eich H, Eicheler W, Engenhart-Cabillic R, Fietkau R, Fleischmann DF, Frerker B, Giordano FA, Grosu AL, Herfarth K, Hildebrandt G, Kaul D, Kölbl O, Krause M, Krug D, Martin D, Matuschek C, Medenwald D, Nicolay NH, Niewald M, Oertel M, Petersen C, Pohl F, Raabe A, Rödel C, Rübe C, Schmalz C, Schmeel LC, Steinmann D, Stüben G, Thamm R, Vordermark D, Vorwerk H, Wiegel T, Zips D, Combs SE. Integration of radiation oncology teaching in medical studies by German medical faculties due to the new licensing regulations : An overview and recommendations of the consortium academic radiation oncology of the German Society for Radiation Oncology (DEGRO). Strahlenther Onkol 2021; 198:1-11. [PMID: 34786605 PMCID: PMC8594460 DOI: 10.1007/s00066-021-01861-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 09/19/2021] [Indexed: 11/30/2022]
Abstract
The new Medical Licensing Regulations 2025 (Ärztliche Approbationsordnung, ÄApprO) will soon be passed by the Federal Council (Bundesrat) and will be implemented step by step by the individual faculties in the coming months. The further development of medical studies essentially involves an orientation from fact-based to competence-based learning and focuses on practical, longitudinal and interdisciplinary training. Radiation oncology and radiation therapy are important components of therapeutic oncology and are of great importance for public health, both clinically and epidemiologically, and therefore should be given appropriate attention in medical education. This report is based on a recent survey on the current state of radiation therapy teaching at university hospitals in Germany as well as the contents of the National Competence Based Learning Objectives Catalogue for Medicine 2.0 (Nationaler Kompetenzbasierter Lernzielkatalog Medizin 2.0, NKLM) and the closely related Subject Catalogue (Gegenstandskatalog, GK) of the Institute for Medical and Pharmaceutical Examination Questions (Institut für Medizinische und Pharmazeutische Prüfungsfragen, IMPP). The current recommendations of the German Society for Radiation Oncology (Deutsche Gesellschaft für Radioonkologie, DEGRO) regarding topics, scope and rationale for the establishment of radiation oncology teaching at the respective faculties are also included.
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Affiliation(s)
- H Dapper
- Department of Radiation Oncology, Technical University of Munich, Munich, Germany. .,German Cancer Consortium (DKTK) Partner Site (DKTK), Munich, Germany.
| | - C Belka
- Department of Radiation Oncology, LMU University Hospital, Munich, Germany.,German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Heidelberg, Germany
| | - F Bock
- Department of Radiation Oncology, Rostock University Medical Center, Rostock, Germany
| | - V Budach
- Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Radiation Oncology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - W Budach
- Department of Radiation Oncology, Medical Faculty, Heinrich Heine University, Duesseldorf, Germany
| | - H Christiansen
- Department of Radiation Oncology, Hannover Medical School (MHH), Hannover, Germany
| | - J Debus
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,Heidelberg Ion-Beam Therapy Center, Heidelberg, Germany
| | - L Distel
- Department of Radiation Oncology, University Hospital Erlangen, Erlangen, Germany
| | - J Dunst
- Department of Radiation Oncology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - F Eckert
- Department of Radiation Oncology, University of Tübingen, Tübingen, Germany.,German Cancer Consortium (DKTK) Partner Site (DKTK), Tübingen, Germany
| | - H Eich
- Department of Radiation Oncology, University of Münster, Münster, Germany
| | - W Eicheler
- OncoRay-National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany
| | - R Engenhart-Cabillic
- Department of Radiotherapy and Radiation Oncology, University of Marburg, Marburg, Germany
| | - R Fietkau
- Department of Radiation Oncology, University Hospital Erlangen, Erlangen, Germany
| | - D F Fleischmann
- Department of Radiation Oncology, LMU University Hospital, Munich, Germany.,German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Heidelberg, Germany
| | - B Frerker
- Department of Radiation Oncology, Rostock University Medical Center, Rostock, Germany
| | - F A Giordano
- Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Bonn, Germany
| | - A L Grosu
- Department of Radiation Oncology, University Medical Center Freiburg, Freiburg, Germany.,German Cancer Consortium (DKTK) Partner Site (DKTK), Freiburg, Germany
| | - K Herfarth
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,Heidelberg Ion-Beam Therapy Center, Heidelberg, Germany
| | - G Hildebrandt
- Department of Radiation Oncology, Rostock University Medical Center, Rostock, Germany
| | - D Kaul
- Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Radiation Oncology, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Partner Site Berlin, German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Heidelberg, Germany
| | - O Kölbl
- Department of Radiotherapy, University of Regensburg, Regensburg, Germany
| | - M Krause
- Department of Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.,OncoRay-National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden and Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany.,Partner Site Dresden, German Cancer Research Center (DKFZ), National Center for Tumor Diseases (NCT), Heidelberg, Germany.,Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany.,Heidelberg and German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Dresden, Germany
| | - D Krug
- Department of Radiation Oncology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - D Martin
- Department of Radiotherapy and Oncology, University Hospital, Goethe University, Frankfurt, Germany.,German Cancer Consortium (DKTK) Partner Site (DKTK), Frankfurt, Germany
| | - C Matuschek
- Department of Radiation Oncology, Medical Faculty, Heinrich Heine University, Duesseldorf, Germany
| | - D Medenwald
- Deptartment of Radiation Oncology, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - N H Nicolay
- Department of Radiation Oncology, University Medical Center Freiburg, Freiburg, Germany.,German Cancer Consortium (DKTK) Partner Site (DKTK), Freiburg, Germany
| | - M Niewald
- Department of Radiotherapy and Radiooncology, Saarland University Medical Center, Homburg, Germany
| | - M Oertel
- Department of Radiation Oncology, University of Münster, Münster, Germany
| | - C Petersen
- Department of Radiotherapy and Radio-Oncology, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - F Pohl
- Department of Radiotherapy, University of Regensburg, Regensburg, Germany
| | - A Raabe
- Department of Radiotherapy and Radio-Oncology, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - C Rödel
- Department of Radiotherapy and Oncology, University Hospital, Goethe University, Frankfurt, Germany.,German Cancer Consortium (DKTK) Partner Site (DKTK), Frankfurt, Germany
| | - C Rübe
- Department of Radiotherapy and Radiooncology, Saarland University Medical Center, Homburg, Germany
| | - C Schmalz
- Department of Radiation Oncology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - L C Schmeel
- Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Bonn, Germany
| | - D Steinmann
- Department of Radiation Oncology, Hannover Medical School (MHH), Hannover, Germany
| | - G Stüben
- Department of Radiation Oncology, University of Augsburg, Augsburg, Germany
| | - R Thamm
- Department of Radiation Oncology and Radiotherapy, University Hospital Ulm, Ulm, Germany
| | - D Vordermark
- Deptartment of Radiation Oncology, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - H Vorwerk
- Department of Radiotherapy and Radiation Oncology, University of Marburg, Marburg, Germany
| | - T Wiegel
- Department of Radiation Oncology and Radiotherapy, University Hospital Ulm, Ulm, Germany
| | - D Zips
- Department of Radiation Oncology, University of Tübingen, Tübingen, Germany.,German Cancer Consortium (DKTK) Partner Site (DKTK), Tübingen, Germany
| | - S E Combs
- Department of Radiation Oncology, Technical University of Munich, Munich, Germany.,Institute of Radiation Medicine, Department of Radiation Sciences, Helmholtz Zentrum München, Munich, Germany.,German Cancer Consortium (DKTK) Partner Site (DKTK), Munich, Germany
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Mazzone E, Fossati N, Karnes R, Boorjan S, Motterle G, Bossi A, Kumar T, Di Muzio N, Cozzarini C, Chiorda BN, Gandaglia G, Stabile A, Scuderi S, Bartkowiak D, Shariat S, Goldner G, Joniau S, Van Poppel H, Berghen C, De Meerleer G, Montorsi F, Wiegel T, Briganti A. There is no way to compensate a non-timely use of early salvage radiation therapy in men with recurrent prostate cancer after radical prostatectomy. a retrospective, multi-centre analyses on oncological and toxicity outcomes. EUR UROL SUPPL 2021. [DOI: 10.1016/s2666-1683(21)00890-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Dal Pra A, Dirix P, Khoo V, Carrie C, Cozzarini C, Fonteyne V, Ghadjar P, Gomez-Iturriaga A, Panebianco V, Zapatero A, Bossi A, Wiegel T. OC-0508 ESTRO ACROP Guideline on Prostate Bed Delineation for Postoperative Radiotherapy in Prostate Cancer. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)06934-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Mazzone E, Fossati N, Stabile A, Martini A, Karnes R, Boorjan S, Bossi A, Di Muzio N, Cozzarini C, Gandaglia G, Bartkowiak D, Böhmer D, Shariat S, Goldner G, Devos G, Joniau S, Berghen C, De Meerleer G, Van Poppel H, Necchi A, Montorsi F, Wiegel T, Briganti A. Very long-term outcomes, time patterns of recurrence and other-cause mortality in patients treated with salvage radiation therapy for recurrent prostate cancer after radical prostatectomy: Implications for risk tailored follow-up strategies. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01559-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Fossati N, Mazzone E, Karnes R, Boorjian S, Motterle G, Bossi A, Kumar T, Di Muzio N, Cozzarini C, Noris Chiorda B, Gandaglia G, Stabile A, Cucchiara V, Robesti D, Bartkowiak D, Shariat S, Goldner G, Joniau S, Van Poppel H, Berghen C, De Meerleer G, Montorsi F, Wiegel T, Briganti A. What is the optimal duration of hormonal treatment during salvage radiotherapy in men with pN1 Prostate Cancer? Results form a large Multi-Institutional series. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01591-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Fossati N, Mazzone E, Karnes R, Boorjian S, Motterle G, Bossi A, Kumar T, Di Muzio N, Cozzarini C, Noris Chiorda B, Gandaglia G, Stabile A, Cucchiara V, Scuderi S, Robesti D, Bartkowiak D, Shariat S, Goldner G, Joniau S, Van Poppel H, Berghen C, De Meerleer G, Montorsi F, Wiegel T, Briganti A. Assessing the effect of concomitant hormonal therapy on severe toxicity in patients treated with post-prostatectomy radiation therapy: Results from a large, multi-institutional study. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01549-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Mazzone E, Fossati N, Karnes R, Boorjan S, Motterle G, Bossi A, Kumar T, Di Muzio N, Cozzarini C, Noris Chiorda B, Gandaglia G, Stabile A, Scuderi S, Bartkowiak D, Shariat S, Goldner G, Joniau S, Van Poppel H, Berghen C, De Meerleer G, Montorsi F, Wiegel T, Briganti A. There is no way to compensate a non-timely use of early salvage radiation therapy in men with recurrent Prostate Cancer after Radical Prostatectomy. A retrospective, multi-centre analyses on oncological and toxicity outcomes. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01552-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Moris L, Gandaglia G, Vilaseca A, Van Den Broeck T, Briers E, De Santis M, Gillessen S, Grivas N, Henry A, Lam T, Lardas M, Mason M, Oprea-Lager D, Ploussard G, Rouvière O, Schoots I, Van Der Poel H, Wiegel T, Willemse PP, Grummet J, Tilke D, Van Den Bergh R, Cornford P, Mottet N. Evaluation of oncological outcomes and data quality in studies assessing nerve sparing versus non-nerve sparing radical prostatectomy in non-metastatic prostate cancer: A systematic review. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)00684-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Preisser F, Abrams-Pompe R, Stelwagen P, Böhmer D, Zattoni F, Magli A, Gómez Rivas J, Vives Dilme R, Sepulcri M, Eguibar A, Heidegger I, Arnold C, Fankhauser C, Chun F, Van Der Poel H, Gandaglia G, Wiegel T, Van Den Bergh R, Tilki D. EAU BCR risk classification as decision tool for salvage radiotherapy? A multicenter study. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01548-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Fossati N, Karnes J, Boorjian S, Motterle G, Bossi A, Kumar T, Di Muzio N, Cozzarini C, Noris Chiorda B, Mazzone E, Robesti D, Gandaglia G, Bartkowiak D, Shariat S, Goldner G, Joniau S, Van Poppel H, Berghen C, De Meerleer G, Montorsi F, Wiegel T, Briganti A. The key role of PSA doubling time in patients treated with salvage radiation therapy after radical prostatectomy: Implications for the extent of radiation and the concomitant use of hormonal therapy. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01554-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Wiegel T, Tilki D, Preisser F, Pompe R, Chun F, Graefen M, Huland H, Siegmann A, Böhmer D, Budach V, Thamm R, Bartkowiak D. PD-0671: Matched pair analysis of salvage radiotherapy vs observation for post-prostatectomy PSA recurrence. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00693-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Fossati N, Karnes R, Boorjian S, Motterle G, Bossi A, Mazzone E, Cucchiara V, Scuderi S, Zito E, Gandaglia G, Kumar T, Di Muzio N, Cozzarini C, Chiorda B, Bartkowiak D, Shariat S, Goldner G, Devos G, Joniau S, Berghen C, De Meerleer G, Van Poppel H, Montorsi F, Wiegel T, Briganti A. Association between the extent of lymph node dissection and severe toxicity in men with prostate cancer treated with post-prostatectomy radiation therapy: results from a large multi-institutional series. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)35565-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Fossati N, Karnes R, Boorjan S, Motterle G, Bossi A, Kumar T, Di Muzio N, Cozzarini C, Chiorda B, Mazzone E, Bravi C, Stabile A, Gandaglia G, Cucchiara V, Bartkowiak D, Shariat S, Goldner G, Devos G, Joniau S, Berghen C, De Meerleer G, Van Poppel H, Montorsi F, Wiegel T, Briganti A. Cure without toxicity: development of a novel model predicting trifecta outcomes after salvage radiation therapy for recurrent prostate cancer after radical prostatectomy. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)35560-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Bozorgmehr F, Fischer J, Bischof M, Atmaca A, Wetzel S, Faehling M, Bottke D, Wermke M, Troost E, Schmidtke-Schrezenmeier G, Wiegel T, van Laak V, Stupavsky A, Engel-Riedel W, Ingenhoff E, Reinmuth N, Krisam J, Stenzinger A, Thomas M, Rieken S. LBA58 ORR in patients receiving nivolumab plus radiotherapy in advanced non-small cell lung cancer: First results from the FORCE trial. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.2291] [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] Open
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Pompe R, Wiegel T, Bartkowiak D, Preisser F, Leyh-Bannurah S, Gild P, Salomon G, Graefen M, Siegmann A, Böhmer D, Budach V, Fisch M, Huland H, Tilki D. EAU BCR risk classification as decision tool for salvage radiatiotherapy. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33532-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Fossati N, Karnes R, Boorjian S, Motterle G, Bossi A, Kumar T, Di Muzio N, Cozzarini C, Noris Chiorda B, Mazzone E, Gandaglia G, Barletta F, Rizzo A, Cannoletta D, Bartkowiak D, Shariat S, Goldner G, Devos G, Joniau S, Berghen C, De Meerleer G, Van Poppel H, Montorsi F, Wiegel T, Briganti A. Assessing the optimal timing of salvage radiation therapy administration after radical prostatectomy: A stage-specific analysis from a large multi-institutional series. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33291-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Van Den Broeck T, Van Den Bergh R, Arfi N, Gross T, Moris L, Briers E, Markus C, Maria D, Fanti S, Fossati N, Gillessen S, Grummet J, Henry A, Lardas M, Rouvière O, Mason M, Schoots I, Van Der Kwast T, Van Der Poel H, Wiegel T, Willemse P, Lam T, Cornford P, Mottet N, Tilki D. The EAU biochemical recurrence risk stratification after radical prostatectomy. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33810-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Moris L, Cumberbatch M, Van Den Broeck T, Gandaglia G, Fossati N, Briers E, Cornford P, De Santis M, Fanti S, Gillessen S, Grummet J, Henry A, Lam T, Lardas M, Liew M, Mason M, Rouvière O, Tilki D, Schoots I, Van Den Bergh R, Van Der Kwast T, Van Der Poel H, Willemse P, Mottet N, Wiegel T. Current treatment options for locally advanced prostate cancer: EAU (-SIOG) guidelines view and recommendations. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33811-8] [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: 10/23/2022] Open
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Horwich A, Babjuk M, Bellmunt J, Bruins HM, De Reijke TM, De Santis M, Gillessen S, James N, Maclennan S, Palou J, Powles T, Ribal MJ, Shariat SF, Van Der Kwast T, Xylinas E, Agarwal N, Arends T, Bamias A, Birtle A, Black PC, Bochner BH, Bolla M, Boormans JL, Bossi A, Briganti A, Brummelhuis I, Burger M, Castellano D, Cathomas R, Chiti A, Choudhury A, Compérat E, Crabb S, Culine S, De Bari B, DeBlok W, De Visschere PJL, Decaestecker K, Dimitropoulos K, Dominguez-Escrig JL, Fanti S, Fonteyne V, Frydenberg M, Futterer JJ, Gakis G, Geavlete B, Gontero P, Grubmüller B, Hafeez S, Hansel DE, Hartmann A, Hayne D, Henry AM, Hernandez V, Herr H, Herrmann K, Hoskin P, Huguet J, Jereczek-Fossa BA, Jones R, Kamat AM, Khoo V, Kiltie AE, Krege S, Ladoire S, Lara PC, Leliveld A, Linares-Espinós E, Løgager V, Lorch A, Loriot Y, Meijer R, Carmen Mir M, Moschini M, Mostafid H, Müller AC, Müller CR, N'Dow J, Necchi A, Neuzillet Y, Oddens JR, Oldenburg J, Osanto S, Oyen WJG, Pacheco-Figueiredo L, Pappot H, Patel MI, Pieters BR, Plass K, Remzi M, Retz M, Richenberg J, Rink M, Roghmann F, Rosenberg JE, Rouprêt M, Rouvière O, Salembier C, Salminen A, Sargos P, Sengupta S, Sherif A, Smeenk RJ, Smits A, Stenzl A, Thalmann GN, Tombal B, Turkbey B, Vahr Lauridsen S, Valdagni R, Van Der Heijden AG, Van Poppel H, Vartolomei MD, Veskimäe E, Vilaseca A, Vives Rivera FA, Wiegel T, Wiklund P, Williams A, Zigeuner R, Witjes JA. EAU-ESMO consensus statements on the management of advanced and variant bladder cancer-an international collaborative multi-stakeholder effort: under the auspices of the EAU and ESMO Guidelines Committees†. Ann Oncol 2019; 30:1697-1727. [PMID: 31740927 PMCID: PMC7360152 DOI: 10.1093/annonc/mdz296] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [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] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Although guidelines exist for advanced and variant bladder cancer management, evidence is limited/conflicting in some areas and the optimal approach remains controversial. OBJECTIVE To bring together a large multidisciplinary group of experts to develop consensus statements on controversial topics in bladder cancer management. DESIGN A steering committee compiled proposed statements regarding advanced and variant bladder cancer management which were assessed by 113 experts in a Delphi survey. Statements not reaching consensus were reviewed; those prioritised were revised by a panel of 45 experts before voting during a consensus conference. SETTING Online Delphi survey and consensus conference. PARTICIPANTS The European Association of Urology (EAU), the European Society for Medical Oncology (ESMO), experts in bladder cancer management. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Statements were ranked by experts according to their level of agreement: 1-3 (disagree), 4-6 (equivocal), 7-9 (agree). A priori (level 1) consensus was defined as ≥70% agreement and ≤15% disagreement, or vice versa. In the Delphi survey, a second analysis was restricted to stakeholder group(s) considered to have adequate expertise relating to each statement (to achieve level 2 consensus). RESULTS AND LIMITATIONS Overall, 116 statements were included in the Delphi survey. Of these, 33 (28%) statements achieved level 1 consensus and 49 (42%) statements achieved level 1 or 2 consensus. At the consensus conference, 22 of 27 (81%) statements achieved consensus. These consensus statements provide further guidance across a broad range of topics, including the management of variant histologies, the role/limitations of prognostic biomarkers in clinical decision making, bladder preservation strategies, modern radiotherapy techniques, the management of oligometastatic disease and the evolving role of checkpoint inhibitor therapy in metastatic disease. CONCLUSIONS These consensus statements provide further guidance on controversial topics in advanced and variant bladder cancer management until a time where further evidence is available to guide our approach.
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Affiliation(s)
- A Horwich
- Emeritus Professor, The Institute of Cancer Research, London, UK; Emeritus Professor, The Institute of Cancer Research, London, UK.
| | - M Babjuk
- Depatment of Urology, 2nd Faculty of Medicine, Hospital Motol, Charles University, Prague, Czech Republic; Department of Urology, Medical University of Vienna, Vienna, Austria
| | - J Bellmunt
- IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain; Harvard Medical School, Boston, USA
| | - H M Bruins
- Department of Urology, Radboud University Medical Center, Nijmegen
| | - T M De Reijke
- Department of Urology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - M De Santis
- Department of Urology, Medical University of Vienna, Vienna, Austria; Department of Urology, Charité University Hospital, Berlin, Germany
| | - S Gillessen
- Division of Cancer Sciences, University of Manchester, Manchester; The Christie NHS Foundation Trust, Manchester, UK; Division of Oncology and Haematology, Kantonsspital St Gallen, St Gallen; University of Bern, Bern, Switzerland
| | - N James
- University Hospitals Birmingham NHS Foundation Trust, Birmingham; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham
| | - S Maclennan
- Academic Urology Unit, University of Aberdeen, Aberdeen, UK
| | - J Palou
- Department of Urology, Fundació Puigvert, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - T Powles
- The Royal Free NHS Trust, London; Barts Cancer Institute, Queen Mary University of London, London, UK
| | - M J Ribal
- Uro-Oncology Unit, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - S F Shariat
- Depatment of Urology, 2nd Faculty of Medicine, Hospital Motol, Charles University, Prague, Czech Republic; Department of Urology, Medical University of Vienna, Vienna, Austria; Department of Urology, Weill Cornell Medical College, New York; Department of Urology, University of Texas Southwestern Medical Center, Dallas, USA; Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - T Van Der Kwast
- Department of Pathology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - E Xylinas
- Department of Urology, Bichat-Claude Bernard Hospital, Assistance Publique Hôpitaux de Paris, Paris; Paris Descartes University, Paris, France
| | - N Agarwal
- Huntsman Cancer Institute, University of Utah (NCI-CCC), Salt Lake City, USA
| | - T Arends
- Urology Department, Canisius-Wilhelmina Ziekenhuis Nijmegen, Nijmegen, The Netherlands
| | - A Bamias
- 2nd Propaedeutic Dept of Internal Medicine, Medical School, National & Kapodistrian University of Athens, Athens, Greece
| | - A Birtle
- Division of Cancer Sciences, University of Manchester, Manchester; Rosemere Cancer Centre, Lancashire Teaching Hospitals, Preston, UK
| | - P C Black
- Department of Urologic Sciences, Vancouver Prostate Centre, University of British Columbia, Vancouver, Canada
| | - B H Bochner
- Department of Urology, Weill Cornell Medical College, New York; Urology Service, Department of Urology, Memorial Sloan Kettering Cancer Center, New York, USA
| | - M Bolla
- Emeritus Professor of Radiation Oncology, Grenoble - Alpes University, Grenoble, France
| | - J L Boormans
- Department of Urology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - A Bossi
- Department of Radiation Oncology, Gustave Roussy Institute, Villejuif, France
| | - A Briganti
- Department of Urology, Urological Research Institute, Milan; Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy
| | - I Brummelhuis
- Department of Urology, Radboud University Medical Center, Nijmegen
| | - M Burger
- Department of Urology, Caritas-St. Josef Medical Center, University of Regensburg, Regensburg, Germany
| | - D Castellano
- Medical Oncology Department, 12 de Octubre University Hospital (CIBERONC), Madrid, Spain
| | - R Cathomas
- Department Innere Medizin, Abteilung Onkologie und Hämatologie, Kantonsspital Graubünden, Chur, Switzerland
| | - A Chiti
- Department of Biomedical Sciences, Humanitas University, Milan; Humanitas Research Hospital, Milan, Italy
| | - A Choudhury
- Division of Cancer Sciences, University of Manchester, Manchester; The Christie NHS Foundation Trust, Manchester, UK
| | - E Compérat
- Department of Pathology, Tenon Hospital, HUEP, Paris; Sorbonne University, Paris, France
| | - S Crabb
- Cancer Sciences Unit, University of Southampton, Southampton, UK
| | - S Culine
- Department of Cancer Medicine, Hôpital Saint Louis, Paris
| | - B De Bari
- Radiation Oncology Department, Centre Hospitalier Régional Universitaire "Jean Minjoz" of Besançon, INSERM UMR 1098, Besançon, France; Radiation Oncology Department, Centre Hospitalier Universitaire Vaudois, Université de Lausanne, Lausanne, Switzerland
| | - W DeBlok
- Department of Urology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - P J L De Visschere
- Department of Radiology and Nuclear Medicine, Division of Genitourinary Radiology and Mammography, Ghent University Hospital, Ghent
| | - K Decaestecker
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - K Dimitropoulos
- Department of Urology, Aberdeen Royal Infirmary, Aberdeen, UK
| | - J L Dominguez-Escrig
- Servicio de Urología, Fundación Instituto Valenciano de Oncología, Valencia, Spain
| | - S Fanti
- Department of Nuclear Medicine, Policlinico S Orsola, University of Bologna, Bologna, Italy
| | - V Fonteyne
- Department of Radiotherapy Oncology, Ghent University Hospital, Ghent, Belgium
| | - M Frydenberg
- Department of Surgery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Australia
| | - J J Futterer
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - G Gakis
- Department of Urology and Paediatric Urology, University Hospital of Würzburg, Julius-Maximillians University, Würzburg, Germany
| | - B Geavlete
- Department of Urology, Saint John Emergency Clinical Hospital, Bucharest, Romania
| | - P Gontero
- Division of Urology, Molinette Hospital, University of Studies of Torino, Torino, Italy
| | - B Grubmüller
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | - S Hafeez
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London; Department of Clinical Oncology, The Royal Marsden NHS Foundation Trust, London, UK
| | - D E Hansel
- Department of Urology, University of California, San Diego Pathology, La Jolla, USA
| | - A Hartmann
- Institute of Pathology, Friedrich-Alexander University (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - D Hayne
- Department of Urology, UWA Medical School, University of Western Australia, Perth, Australia
| | - A M Henry
- Leeds Institute of Medical Research, University of Leeds, Leeds, UK
| | - V Hernandez
- Department of Urology, Hospital Universitario Fundación de Alcorcón, Madrid, Spain
| | - H Herr
- Urology Service, Department of Urology, Memorial Sloan Kettering Cancer Center, New York, USA
| | - K Herrmann
- Department of Nuclear Medicine, Universitätsklinikum Essen, Essen, Germany
| | - P Hoskin
- Division of Cancer Sciences, University of Manchester, Manchester; The Christie NHS Foundation Trust, Manchester, UK; Mount Vernon Centre for Cancer Treatment, London, UK
| | - J Huguet
- Department of Urology, Fundació Puigvert, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - B A Jereczek-Fossa
- Department of Oncology and Hemato-oncology, University of Milan, Milan; Division of Radiotherapy, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - R Jones
- Institute of Cancer Sciences, College of Medicine, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - A M Kamat
- Department of Urology - Division of Surgery, The University of Texas, MD Anderson Cancer Center, Houston, USA
| | - V Khoo
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London; Department of Clinical Oncology, The Royal Marsden NHS Foundation Trust, London, UK; Department of Medicine, University of Melbourne, Melbourne; Monash University, Melbourne, Australia
| | - A E Kiltie
- CRUK/MRC Oxford Institute for Radiation Oncology, University of Oxford, Oxford, UK
| | - S Krege
- Department of Urology, Pediatric Urology and Urologic Oncology, Kliniken Essen-Mitte, Essen, Germany
| | - S Ladoire
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon, France
| | - P C Lara
- Department of Oncology, Hospital Universitario San Roque, Canarias; Universidad Fernando Pessoa, Canarias, Spain
| | - A Leliveld
- Department of Urology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | | | - V Løgager
- Department of Radiology, Copenhagen University Hospital Herlev and Gentofte, Herlev, Denmark
| | - A Lorch
- Department of Medical Oncology and Hematology, University Hospital Zürich, Zürich, Switzerland
| | - Y Loriot
- Département de Médecine Oncologique, Gustave Roussy, INSERM U981, Université Paris-Sud, Université Paris-Saclay, Villejuif, France
| | - R Meijer
- UMC Utrecht Cancer Center, MS Oncologic Urology, Utrecht, The Netherlands
| | - M Carmen Mir
- Servicio de Urología, Fundación Instituto Valenciano de Oncología, Valencia, Spain
| | - M Moschini
- Department of Urology, Luzerner Kantonsspital, Luzern, Switzerland
| | - H Mostafid
- Department of Urology, Royal Surrey County Hospital, Guildford, UK
| | - A-C Müller
- Department of Radiation Oncology, Eberhard Karls University, Tübingen, Germany
| | - C R Müller
- Cancer Treatment Centre, Sorlandet Hospital, Kristiansand, Norway
| | - J N'Dow
- Academic Urology Unit, University of Aberdeen, Aberdeen, UK; Department of Urology, Aberdeen Royal Infirmary, Aberdeen, UK
| | - A Necchi
- Department of Medical Oncology, Istituto Nazionale Tumori of Milan, Milan, Italy
| | - Y Neuzillet
- Department of Urology, Hospital Foch, University of Versailles-Saint-Quentin-en-Yvelines, Suresnes, France
| | - J R Oddens
- Department of Urology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - J Oldenburg
- Department of Oncology, Akershus University Hospital, Lørenskog; Faculty of Medicine, University of Oslo, Oslo, Norway
| | - S Osanto
- Department of Clinical Oncology, Leiden University Medical Center, Leiden
| | - W J G Oyen
- Department of Biomedical Sciences, Humanitas University, Milan; Humanitas Research Hospital, Milan, Italy; Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands; Department of Radiology and Nuclear Medicine, Rijnstate Hospital, Arnhem, The Netherlands
| | - L Pacheco-Figueiredo
- Department of Urology, Centro Hospitalar São João, Porto; Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
| | - H Pappot
- Department of Oncology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - M I Patel
- Department of Urology, Westmead Hospital, University of Sydney, Sydney, Australia
| | - B R Pieters
- Department of Radiation Oncology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam
| | - K Plass
- EAU Guidelines Office, Arnhem, The Netherlands
| | - M Remzi
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | - M Retz
- Department of Urology, Rechts der Isar Medical Center, Technical University of Munich, Munich, Germany
| | - J Richenberg
- Department of Imaging and Nuclear Medicine, Royal Sussex County Hospital, Brighton; Brighton and Sussex Medical School, Brighton, UK
| | - M Rink
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg
| | - F Roghmann
- Department of Urology, Ruhr-University Bochum, Marien Hospital, Herne, Germany
| | - J E Rosenberg
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York; Weill Cornell Medical College, New York, USA
| | - M Rouprêt
- Department of Urology, Sorbonne Université, GRC n°5, ONCOTYPE-URO, AP-HP, Hôpital Pitié-Salpêtrière, Paris
| | - O Rouvière
- Hospices Civils de Lyon, Service d'Imagerie Urinaire et Vasculaire, Hôpital Edouard Herriot, Lyon; Université de Lyon, Université Lyon 1, Faculté de Médecine Lyon Est, Lyon, France
| | - C Salembier
- Department of Radiation Oncology, Europe Hospitals Brussels, Brussels, Belgium
| | - A Salminen
- Department of Urology, University Hospital of Turku, Turku, Finland
| | - P Sargos
- Department of Radiotherapy, Institut Bergonié, Bordeaux, France
| | - S Sengupta
- Department of Surgery, Austin Health, University of Melbourne, Melbourne; Eastern Health Clinical School, Monash University, Melbourne, Australia
| | - A Sherif
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden
| | - R J Smeenk
- Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - A Smits
- Department of Urology, Radboud University Medical Center, Nijmegen
| | - A Stenzl
- Department of Urology, Eberhard Karls University Tübingen, Tübingen, Germany
| | - G N Thalmann
- Department of Urology, Inselspital, Bern University Hospital, Berne, Switzerland
| | - B Tombal
- Division of Urology, IREC, Cliniques Universitaires Saint Luc, UCL, Brussels, Belgium
| | - B Turkbey
- Molecular Imaging Program, National Cancer Institute, Bethesda, USA
| | - S Vahr Lauridsen
- Department of Urology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - R Valdagni
- Department of Oncology and Hemato-oncology, Università degli Studi di Milano, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - H Van Poppel
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - M D Vartolomei
- Department of Urology, Medical University of Vienna, Vienna, Austria; Department of Cell and Molecular Biology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Targu Mures, Romania
| | - E Veskimäe
- Department of Urology, Tampere University Hospital, Tampere, Finland
| | - A Vilaseca
- Uro-Oncology Unit, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - F A Vives Rivera
- Clinica HematoOncologica Bonadona Prevenir, Universidad Metropolitana, Clinica Club de Leones, Barranquilla, Colombia
| | - T Wiegel
- Department of Radiation Oncology, University Hospital Ulm, Ulm, Germany
| | - P Wiklund
- Icahn School of Medicine, Mount Sinai Health System, New York City, USA; Department of Urology, Karolinska Institutet, Stockholm, Sweden
| | - A Williams
- Department of Urology, Auckland City Hospital, Auckland, New Zealand
| | - R Zigeuner
- Department of Urology, Medizinische Universität Graz, Graz, Austria
| | - J A Witjes
- Department of Urology, Radboud University Medical Center, Nijmegen
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Wiegel T, Bartkowiak D, Siegmann A, Böhmer D. The Impact of Post-RP Persisting PSA on SRT Efficiency – A Matched Pair Analysis. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.288] [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: 10/28/2022]
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Fossati N, Willemse PP, Van Den Broeck T, Yuan Y, Briers E, Bellmunt J, Bolla M, Cornford P, De Santis M, MacPepple E, Henry A, Matveev S, Van Der Poel H, Van Der Kwast T, Rouvière O, Wiegel T, Lam T, Mottet N, Joniau S. The benefits and harms of different extents of lymph node dissection during radical prostatectomy for prostate cancer: A systematic review. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/s1569-9056(18)32049-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Hoffmann TK, Schuler PJ, Laban S, Grässlin R, Beer M, Beer AJ, Friebe-Hoffmann U, Bullinger L, Möller P, Wiegel T. Response Evaluation in Head and Neck Oncology: Definition and Prediction. ORL J Otorhinolaryngol Relat Spec 2017; 79:14-23. [PMID: 28231577 DOI: 10.1159/000455726] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Curative treatment of head and neck squamous cell carcinoma includes surgery and/or (chemo)radiation, whereas in the palliative setting, chemotherapy and/or immunotherapy represent(s) the standard approach. With regard to quality control, methods for determining treatment response are sorely needed. For surgical therapy, histopathology is the standard quality control. Established criteria for high-risk patients include resection margins of the primary tumor and extracapsular extension of lymph node metastases. After definitive chemoradiation, treatment response is generally evaluated by tomographic imaging combined with endoscopy including re-biopsy of the tumor region. Single-cycle induction chemotherapy may be used to determine the radiosensitivity of tumors, helping to define surgical and nonsurgical treatment options. Innovative approaches with implications for prognosis include the analysis of immune infiltrates, liquid biopsy, molecular characterization (proteomics, genomics), molecular and functional imaging (PET-CT, PET-MRI), as well as advanced imaging data analysis (radio[geno]mics/texture analysis). Human papilloma virus, as a prognostically relevant parameter, is currently being investigated for de-escalation strategies. With regard to the extended personalization of oncologic therapy, markers predicting treatment response are desirable and seem to be important, also from a socioeconomic perspective.
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Affiliation(s)
- T K Hoffmann
- Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Center, Ulm, Germany
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Bossi A, Dearnaley D, McKenzie M, Baskin-Bey E, Tyler R, Tombal B, Freedland S, Roach M, Widmark A, Dicker A, Wiegel T, Shore N, Smith M, Yu M, Kheoh T, Thomas S, Sandler H. ATLAS: A phase 3 trial evaluating the efficacy of apalutamide (ARN-509) in patients with high-risk localized or locally advanced prostate cancer receiving primary radiation therapy. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw372.52] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Fossati N, Karnes J, Morlacco A, Moschini M, Boorjian S, Seisen T, Bossi A, Cozzarini C, Fiorino C, Noris Chiorda B, Gandaglia G, Tosco L, De Ridder D, Joniau S, Goldner G, Shariat S, Hinkelbein W, Haustermans K, Tombal B, Montorsi F, Van Poppel H, Wiegel T, Briganti A. 544 Long-term impact of adjuvant versus early salvage radiation therapy on clinical recurrence in pT3N0 prostate cancer patients treated with radical prostatectomy: Results of a multi-institutional analysis. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/s1569-9056(16)60546-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Bottke D, Bartkowiak D, Bolenz C, Wiegel T. [Radiotherapy in node-positive prostate cancer]. Urologe A 2016; 55:345-9. [PMID: 26893137 DOI: 10.1007/s00120-016-0044-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND There are numerous randomized trials to guide the management of patients with localized (and metastatic) prostate cancer, but only a few (mostly retrospective) studies have specifically addressed node-positive patients. Therefore, there is uncertainty regarding optimal treatment in this situation. Current guidelines recommend long-term androgen deprivation therapy (ADT) alone or radiotherapy plus long-term ADT as treatment options. OBJECTIVES This overview summarizes the existing literature on the use of radiotherapy for node-positive prostate cancer as definitive treatment and as adjuvant or salvage therapy after radical prostatectomy. In this context, we also discuss several PET tracers in the imaging evaluation of patients with biochemical recurrence of prostate cancer after radical prostatectomy. As for definitive treatment, retrospective studies suggest that ADT plus radiotherapy improves overall survival compared with ADT alone. These studies also consistently demonstrated that many patients with node-positive prostate cancer can achieve long-term survival - and are likely curable - with aggressive therapy. RESULTS The beneficial impact of adjuvant radiotherapy on survival in patients with pN1 prostate cancer seems to be highly influenced by tumor characteristics. Men with ≤ 2 positive lymph nodes in the presence of intermediate- to high-grade disease, or positive margins, and those with 3 or 4 positive lymph nodes are the ideal candidates for adjuvant radiotherapy (plus long-term ADT) after surgery. CONCLUSION There is a need for randomized trials to further examine the potential role of radiotherapy as either definitive or adjuvant treatment, for patients with node-positive prostate cancer.
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Affiliation(s)
- D Bottke
- Fachbereich Strahlentherapie und Radioonkologie, MVZ Klinikum Esslingen GmbH, Hirschlandstraße 97, 73730, Esslingen a. N., Deutschland.
| | - D Bartkowiak
- Klinik für Strahlentherapie und Radioonkologie, Universitätsklinikum Ulm, Albert-Einstein-Straße 23, 89081, Ulm, Deutschland
| | - C Bolenz
- Klinik für Urologie und Kinderurologie, Universitätsklinikum Ulm, Prittwitzstraße 43, 89075, Ulm, Deutschland
| | - T Wiegel
- Klinik für Strahlentherapie und Radioonkologie, Universitätsklinikum Ulm, Albert-Einstein-Straße 23, 89081, Ulm, Deutschland
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Fiorino C, Broggi S, Fossati N, Cozzarini C, Goldner G, Wiegel T, Hinkelbein W, Karnes J, Haustermans K, Joniau S, Shariat S, Montorsi F, Van Poppel H, Di Muzio N, Calandrino R, Briganti A. Predicting Clinical Outcome Following Post Prostatectomy Radiation Therapy: A Poisson-Based Tumor Control Probability (TCP) Model Based on a Large Multi-institutional Series. Int J Radiat Oncol Biol Phys 2015. [DOI: 10.1016/j.ijrobp.2015.07.128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Wiegel T, Bartkowiak D, Bottke R, Hinkelbein W, Siegmann A. PSA After Salvage Radiation Therapy for Postprostatectomy Biochemical Recurrence Predicts Long-term Outcome Including Overall Survival. Int J Radiat Oncol Biol Phys 2015. [DOI: 10.1016/j.ijrobp.2015.07.315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Wiegel T, Bottke D, Siegmann A, Bartkowiak D. 2528 Long-term follow-up of post-prostatectomy salvage radiotherapy for biochemical recurrence. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)31347-8] [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: 10/22/2022]
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Abstract
BACKGROUND After radical prostatectomy (RP) the pre-RP PSA value, Gleason Score, pT-stage, state of seminal vesicles and state of surgical margins are key indicators for the risk of biochemical or clinical recurrence. Depending on the tumour stage, 50-70% of the high-risk patients suffer biochemical progression. The treatment options in these circumstances are adjuvant radiotherapy (ART, for an undetectable PSA) or salvage radiotherapy (SRT, for persisting PSA or PSA re-rising above detection limits). Data from ongoing randomised trials that compare ART and SRT directly have not yet been published. METHOD A search in PubMed for ART and SRT after RP for prostate cancer was undertaken to compare the results of the 2 treatment approaches. RESULTS 3 randomised phase-III studies have shown a nearly 20% advantage in terms of biochemical progression after ART (60-64 Gy) compared with a wait-and-see strategy. The largest effect was seen in patients with pT3 prostate cancer with positive surgical margins. According to the German S3-guidelines, SRT with at least 66 Gy can be offered to patients with a post-RP persisting PSA or a PSA re-rising above detection limits. 30-70% of these patients re-achieve an undetectable PSA. Thus, there is a second option for curative treatment. Due to the lower total dose, ART seems to be connected with fewer late complications than SRT. SRT, on the other hand, reduces the risk of potential interactions with post-RP complications and of overtreatment. There is a controversial discussion about the inclusion of the pelvic lymph nodes in the treatment volume, the additional application of anti-androgens and the total dose of both ART and SRT. CONCLUSIONS The comparison of SRT after PSA progression with ART at a PSA below the detection limits cannot yet be judged conclusively. The indication for ART depends on the associated risk factors. However, regarding freedom from biochemical progression, it is backed up by high level evidence. If SRT is applied for biochemical progression, then it should be initiated early, i. e., at the lowest PSA possible.
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Affiliation(s)
- D. Bartkowiak
- Klinik für Strahlentherapie und Radioonkologie, Universitätsklinikum Ulm
| | - A. Schrader
- Klinik für Urologie, Universitätsklinikum Münster
| | - T. Wiegel
- Klinik für Strahlentherapie und Radioonkologie, Universitätsklinikum Ulm
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Bellmunt J, Orsola A, Leow JJ, Wiegel T, De Santis M, Horwich A. Bladder cancer: ESMO Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2014; 25 Suppl 3:iii40-8. [PMID: 25096609 DOI: 10.1093/annonc/mdu223] [Citation(s) in RCA: 230] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- J Bellmunt
- Department of Medical Oncology, University Hospital del Mar-IMIM, Barcelona, Spain Bladder Cancer Center, Dana-Farber Cancer Institute/Brigham and Women's Cancer Center, Boston, USA
| | - A Orsola
- Department of Urology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - J J Leow
- Department of Medical Oncology, University Hospital del Mar-IMIM, Barcelona, Spain Bladder Cancer Center, Dana-Farber Cancer Institute/Brigham and Women's Cancer Center, Boston, USA
| | - T Wiegel
- Department of Radio Oncology, University Hospital Ulm, Ulm, Germany
| | - M De Santis
- Ludwig Boltzmann Institute for Applied Cancer Research, Kaiser Franz Josef- Spital, Vienna, Austria
| | - A Horwich
- Institute of Cancer Research and Royal Marsden Hospital, Sutton, UK
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Wöckel A, Wolters R, Wiegel T, Novopashenny I, Janni W, Kreienberg R, Wischnewsky M, Schwentner L. The impact of adjuvant radiotherapy on the survival of primary breast cancer patients: a retrospective multicenter cohort study of 8935 subjects. Ann Oncol 2014; 25:628-632. [PMID: 24515935 PMCID: PMC4433516 DOI: 10.1093/annonc/mdt584] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Revised: 11/19/2013] [Accepted: 11/20/2013] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Radiotherapy (RT) is proven to be an important backbone for adjuvant therapy in randomized, controlled trials, but it is unclear if these effects are provable in a daily routine cohort of breast cancer patients. This study sought to answer the following questions in a daily routine cohort of breast cancer patients: 1. Does guideline-adherent RT improve primary breast cancer patient survival? 2. Is breast-conserving surgery (BCS) followed by RT equal to a mastectomy (MA) with regard to outcome parameters? 3. Does adjuvant RT compensate for an incomplete tumor resection (R1)? PATIENTS AND METHODS In this retrospective, multicenter cohort study, we investigated data from 8935 primary breast cancer patients recruited from 17 participating certified breast cancer centers in Germany between 1992 and 2008. Guideline adherence based on internationally validated guidelines. RESULTS The patients who received guideline-adherent RT for primary breast cancer were associated with significantly improved survival parameters [recurrence-free survival (RFS): P < 0.001; overall survival (OS): P < 0.001] compared with patients who did not receive guideline-adherent adjuvant RT. Furthermore, the results demonstrated that there were no significant differences in RFS and OS between BCS followed by RT and MA [RFS: P = 0.293; OS: P = 0.104]. Adjuvant RT did not improve the outcome of patients receiving nonguideline-adherent incomplete tumor resection via BCS (R1); these patients showed a significantly impaired RFS [P < 0.001] and OS [P < 0.001] compared with patients who underwent guideline-adherent complete tumor resection via BCS (R0). In addition, non-guideline-adherent RT after MA (overtherapy) did not significantly influence survival [RFS: P = 0.838; OS: P = 0.613]. CONCLUSION Our study confirms the importance of guideline-adherent adjuvant RT. It shows highly significant associations between RFS or OS and guideline adherent RT. Nevertheless, inadequate (R1-) surgical resection in a daily routine cohort of patients increases the risk of local recurrence and appears not to be compensated by the following RT.
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Affiliation(s)
- A Wöckel
- Department of Gynecology and Obstetrics, University Ulm, Ulm
| | - R Wolters
- Department of Mathematics and Computer Science, University Bremen, Bremen
| | - T Wiegel
- Department of Radiotherapy and Radiooncology, University Ulm, Ulm, Germany
| | - I Novopashenny
- Department of Mathematics and Computer Science, University Bremen, Bremen
| | - W Janni
- Department of Gynecology and Obstetrics, University Ulm, Ulm
| | - R Kreienberg
- Department of Gynecology and Obstetrics, University Ulm, Ulm
| | - M Wischnewsky
- Department of Mathematics and Computer Science, University Bremen, Bremen
| | - L Schwentner
- Department of Gynecology and Obstetrics, University Ulm, Ulm.
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Wöckel A, Wolters R, Wiegel T, Janni W, Kreienberg R, Wischnewsky M, Schwentner L. Abstract P5-14-03: The impact of adjuvant radiotherapy on survival in primary breast caner: What is the role of guideline adherence in radiotherapy – A retrospective multi-center cohort study of 8935. Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-p5-14-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction:
Breast cancer remains the most common malignancy in women in industrialized countries. Over the last decades improved adjuvant therapy strategies were the key for a favorable prognosis in patients. Among these, radiotherapy is one of the important backbones in adjuvant therapy strategies. This study tries to answer the following questions:
1. Does guideline adherent radiotherapy improve survival in primary breast cancer patients?
2. Is breast conserving surgery followed by RT equal to mastectomy in outcome parameters?
3. Is there a difference in survival between patients receiving BCT followed by RT with non guideline conform incomplete tumor resection (R1)? Does adjuvant RT compensate incomplete resection of the tumor?
Material and Methods:
In this German retrospective multi-center cohort study called BRENDA (breast cancer care under evidence based guidelines) we investigate data of 8.935 primary breast cancer patients recruited from 17 participating breast cancer centers in Germany (all certified breast cancer centers by the German Cancer Society). Guideline adherence is established in all adjuvant treatment modalities based on internationally validated guidelines.
Results:
Patients who received guideline adherent RT in primary breast cancer were associated with significantly improved survival parameters [RFS: p < 0.001; HR = 0.28 (95% CI: (0.24 – 0.33)] [OAS: p < 0.001; HR = 0.26 (95% CI: 0.19 – 0.36)] compared to patients who did not receive guideline adherent adjuvant RT. Compared to other adjuvant treatment modalities (surgery/chemotherapy/endocrine therapy) guideline violations concerning radiotherapy and chemotherapy have the most important impact on survival parameters. Furthermore, the results of Fisher et al. and Veronesi et al. were confirmed by demonstrating that BCT followed by RT is equal to mastectomy [RFS: p = 0.293; HR = 1.20 (95% CI:0.85-1.70)] [OAS: p = 0.104; HR = 1.31 (95% CI: 0.95-1.81)]. Adjuvant RT could not improve the outcome in patients with non-guideline conform incomplete tumor resection via BCT (R1) showing a significantly impaired RFS [p<0.001; HR = 2.87 (95% CI: 2.00-4.12)] and OAS [p<0.001; HR = 2.06 (95% CI: 1.43-2.98)] compared to guideline conform complete tumor resection via BCT (R0). Additionally, non guideline adherent RT after mastectomy (only T1/T2) (overtherapy) did not influence survival significantly [RFS: p = 0.838; HR = 1.07 (95% CI: 0.57-1.98)] [OAS: p = 0.613; HR = 1.18 (95% CI: 0.63-2.20)].
Discussion:
Guideline adherent adjuvant RT is associated with an improvement of survival parameters in primary breast cancer. Patients undergoing guideline conform BCT (R0) followed by RT present an equal outcome as patients undergoing mastectomy. However adjuvant RT can not compensate an inadequate tumor resection via BCT and RT overtherapy after mastectomy does not improve survival parameters.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P5-14-03.
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Affiliation(s)
- A Wöckel
- University Ulm, Ulm, Germany; University Bremen, Bremen, Germany
| | - R Wolters
- University Ulm, Ulm, Germany; University Bremen, Bremen, Germany
| | - T Wiegel
- University Ulm, Ulm, Germany; University Bremen, Bremen, Germany
| | - W Janni
- University Ulm, Ulm, Germany; University Bremen, Bremen, Germany
| | - R Kreienberg
- University Ulm, Ulm, Germany; University Bremen, Bremen, Germany
| | - M Wischnewsky
- University Ulm, Ulm, Germany; University Bremen, Bremen, Germany
| | - L Schwentner
- University Ulm, Ulm, Germany; University Bremen, Bremen, Germany
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Wiegel T, Pötter R. Prof. Dr. Wolfgang Hinkelbein zur Emeritierung. Strahlenther Onkol 2013; 189:801-2. [DOI: 10.1007/s00066-013-0422-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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45
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Lubgan D, Lewitzki V, Kuhnt T, Hölscher T, Hess CF, Berger B, Wiegel T, Rödel C, Niewald M, Hermann R, Fietkau R. PP093-SUN A CANCER-SPECIFIC ENTERAL NUTRITION FORMULA IMPROVES NUTRITIONAL STATUS AND FUNCTIONAL PERFORMANCE IN PATIENTS WITH HEAD AND NECK AND OESOPHAGEAL CANCER UNDERGOING CHEMORADIOTHERAPY – A RANDOMISED, CONTROLLED MULTICENTER TRIAL. Clin Nutr 2013. [DOI: 10.1016/s0261-5614(13)60138-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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46
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Kristiansen G, Stöckle M, Albers P, Schmidberger H, Martus P, Wellek S, Härter M, Bussar-Maatz R, Wiegel T. Die Bedeutung der Pathologie in der deutschen Prostatakrebsstudie PREFERE. Pathologe 2013; 34:449-62. [DOI: 10.1007/s00292-013-1788-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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47
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Horwich A, Hugosson J, de Reijke T, Wiegel T, Fizazi K, Kataja V, Parker C, Bellmunt J, Berthold D, Bill-Axelson A, Carlsson S, Daugaard G, De Meerleer G, de Reijke T, Dearnaley D, Fizazi K, Fonteyne V, Gillessen S, Heinrich D, Horwich A, Hugosson J, Kataja V, Kwiatkowski M, Nilsson S, Padhani A, Papandreou C, Parker C, Roobol M, Sella A, Valdagni R, Van der Kwast T, Verhagen P, Wiegel T. Prostate cancer: ESMO Consensus Conference Guidelines 2012. Ann Oncol 2013; 24:1141-62. [DOI: 10.1093/annonc/mds624] [Citation(s) in RCA: 114] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
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48
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Wiegel T, Albers P, Bussar-Maatz R, Gottberg A, Härter M, Kieser M, Kristiansen G, Nettekoven G, Martus P, Schmidberger H, Wellek S, Stöckle M. PREFERE – die Deutsche Prostatakrebsstudie. Urologe A 2013; 52:576-9. [DOI: 10.1007/s00120-013-3186-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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49
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Briganti A, Bianchi M, Joniau S, Cozzarini C, Tombal B, Haustermans K, Hinkelbein W, Di Muzio N, Suardi N, Van Poppel H, Wiegel T. 182 Development and internal validation of a nomogram predicting biochemical recurrence after early salvage radiotherapy in prostate cancer patients treated with radical prostatectomy. ACTA ACUST UNITED AC 2013. [DOI: 10.1016/s1569-9056(13)60670-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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50
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Wiegel T, Bottke D, Bartkowiak D, Bronner C, Steiner U, Siegmann A, Golz R, Störkel S, Willich N, Semjonow A, Stöckle M, Rübe C, Althaus P, Rebmann U, Kälble T, Feldmann H, Wirth M, Hinke A, Hinkelbein W, Miller K. 192 The 10-years follow-up of the ARO 96-02/AUO AP 09/95 trial on adjuvant radiotherapy (ART) versus wait-and-see (WS) after prostatectomy for pT3 cancer – subgroup analysis. ACTA ACUST UNITED AC 2013. [DOI: 10.1016/s1569-9056(13)60680-6] [Citation(s) in RCA: 2] [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: 11/16/2022]
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