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Borm KJ, Behzadi ST, Hörner-Rieber J, Krug D, Baumann R, Corradini S, Duma MN, Dunst J, Fastner G, Feyer P, Fietkau R, Haase W, Harms W, Hehr T, Matuschek C, Piroth MD, Schmeel LC, Souchon R, Strnad V, Budach W, Combs SE. DEGRO guideline for personalized radiotherapy of brain metastases and leptomeningeal carcinomatosis in patients with breast cancer. Strahlenther Onkol 2024; 200:259-275. [PMID: 38488902 DOI: 10.1007/s00066-024-02202-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 01/07/2024] [Indexed: 03/17/2024]
Abstract
PURPOSE The aim of this review was to evaluate the existing evidence for radiotherapy for brain metastases in breast cancer patients and provide recommendations for the use of radiotherapy for brain metastases and leptomeningeal carcinomatosis. MATERIALS AND METHODS For the current review, a PubMed search was conducted including articles from 01/1985 to 05/2023. The search was performed using the following terms: (brain metastases OR leptomeningeal carcinomatosis) AND (breast cancer OR breast) AND (radiotherapy OR ablative radiotherapy OR radiosurgery OR stereotactic OR radiation). CONCLUSION AND RECOMMENDATIONS Despite the fact that the biological subtype of breast cancer influences both the occurrence and relapse patterns of breast cancer brain metastases (BCBM), for most scenarios, no specific recommendations regarding radiotherapy can be made based on the existing evidence. For a limited number of BCBM (1-4), stereotactic radiosurgery (SRS) or fractionated stereotactic radiotherapy (SRT) is generally recommended irrespective of molecular subtype and concurrent/planned systemic therapy. In patients with 5-10 oligo-brain metastases, these techniques can also be conditionally recommended. For multiple, especially symptomatic BCBM, whole-brain radiotherapy (WBRT), if possible with hippocampal sparing, is recommended. In cases of multiple asymptomatic BCBM (≥ 5), if SRS/SRT is not feasible or in disseminated brain metastases (> 10), postponing WBRT with early reassessment and reevaluation of local treatment options (8-12 weeks) may be discussed if a HER2/Neu-targeting systemic therapy with significant response rates in the central nervous system (CNS) is being used. In symptomatic leptomeningeal carcinomatosis, local radiotherapy (WBRT or local spinal irradiation) should be performed in addition to systemic therapy. In patients with disseminated leptomeningeal carcinomatosis in good clinical condition and with only limited or stable extra-CNS disease, craniospinal irradiation (CSI) may be considered. Data regarding the toxicity of combining systemic therapies with cranial and spinal radiotherapy are sparse. Therefore, no clear recommendations can be given, and each case should be discussed individually in an interdisciplinary setting.
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Affiliation(s)
- Kai J Borm
- TUM School of Medicine, Department of Radiation Oncology, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
| | - Sophie T Behzadi
- TUM School of Medicine, Department of Radiation Oncology, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
| | - Juliane Hörner-Rieber
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - David Krug
- Department of Radiation Oncology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Rene Baumann
- Department of Radiation Oncology, St. Marien-Krankenhaus, Siegen, Germany
| | - Stefanie Corradini
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Marciana Nona Duma
- Department of Radiation Oncology, Helios Clinics of Schwerin-University Campus of MSH Medical School Hamburg, Schwerin, Germany
- Department for Human Medicine, MSH Medical School Hamburg, Hamburg, Germany
| | - Jürgen Dunst
- Department of Radiation Oncology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Gerd Fastner
- Department of Radiotherapy and Radio-Oncology, University Hospital Salzburg, Landeskrankenhaus, Paracelsus Medical University, Salzburg, Austria
| | - Petra Feyer
- Formerly Department of Radiation Oncology, Vivantes Hospital Neukölln, Berlin, Germany
| | - Rainer Fietkau
- Department of Radiation Oncology, University Hospital Erlangen, Erlangen, Germany
| | - Wulf Haase
- Formerly Department of Radiation Oncology, St.-Vincentius-Hospital Karlsruhe, Karlsruhe, Germany
| | - Wolfgang Harms
- Department of Radiation Oncology, St. Claraspital, Basel, Switzerland
| | - Thomas Hehr
- Department of Radiation Oncology, Marienhospital Stuttgart, Stuttgart, Germany
| | - Christiane Matuschek
- Department of Radiation Oncology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Marc D Piroth
- Department of Radiation Oncology, HELIOS University Hospital Wuppertal, Witten/Herdecke University, Wuppertal, Germany
| | | | - Rainer Souchon
- Formerly Department of Radiation Oncology, University Hospital Tübingen, Tübingen, Germany
| | - Vratislav Strnad
- Department of Radiation Oncology, University Hospital Erlangen, Erlangen, Germany
| | - Wilfried Budach
- Department of Radiation Oncology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Stephanie E Combs
- TUM School of Medicine, Department of Radiation Oncology, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany.
- Partner Site Munich, Deutsches Konsortium für Translationale Krebsforschung (DKTK), Munich, Germany.
- Department of Radiation Medicine (IRM), Helmholtz Zentrum München (HMGU), Neuherberg, Germany.
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Peters R, Rogge A, Dunst J, Freitag-Wolf S, Schmalz C. Moral Distress in Radiation Oncology: Insights From Residents in Germany. Adv Radiat Oncol 2024; 9:101378. [PMID: 38405316 PMCID: PMC10885585 DOI: 10.1016/j.adro.2023.101378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 09/12/2023] [Indexed: 02/27/2024] Open
Abstract
Purpose Being challenged by circumstances that force one to act in discordance with one's moral compass can lead to moral distress. The phenomenon has been widely investigated among nurses. This study was designed to shed some light on the situation of resident physicians in radiation oncology. Methods and Materials To gain insight into moral distress among residents in radiation oncology, a web-based questionnaire was developed and distributed throughout Germany. Participants were asked to evaluate possible burdensome situations and different options for relief. To outline the main issues of moral distress, an exploratory factor analysis was conducted. Relief options were examined by frequencies. Results The factor analysis yielded lack of time, contradiction between patient request and indication, nonmedical interests, and decisions between curative treatment and best supportive care as main issues for the 84 participants. Support from supervisors and senior physicians, as well as exchanges with resident colleagues were indicated as forms of relief. Professional support, such as ethics consultations, structured conversation groups (Balint), or psychological case supervisions, were rated as less helpful, although most participants reported a lack of experience with these. Conclusions The results are in accordance with existing assumptions that moral distress among physicians is mainly due to uncertainty. Regarding radiation oncology residents in particular, moral distress seems to be related to uncertainty in decisions and conflicts about treatment options. Although senior physicians and supervisors present important role models in dealing with moral distress, professional services such as ethics consultations offer an opportunity for relief that can still be expanded.
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Affiliation(s)
- Ricarda Peters
- Klinik für Strahlentherapie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Annette Rogge
- Paracelsus Nordseeklinik Helgoland, Helgoland, Germany
| | - Jürgen Dunst
- Klinik für Strahlentherapie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Sandra Freitag-Wolf
- Institut für Medizinische Informatik und Statistik, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Claudia Schmalz
- Klinik für Strahlentherapie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
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Krug D, Dunst J. [Moderate hypofractionated adjuvant radiotherapy with simultaneous integrated boost for breast cancer]. Strahlenther Onkol 2023; 199:1033-1035. [PMID: 37698593 PMCID: PMC10598182 DOI: 10.1007/s00066-023-02144-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2023] [Indexed: 09/13/2023]
Affiliation(s)
- David Krug
- Klinik für Strahlentherapie/Radioonkologie, UKSH, Campus Kiel, Kiel, Deutschland
| | - Jürgen Dunst
- Klinik für Strahlentherapie/Radioonkologie, UKSH, Campus Kiel, Kiel, Deutschland.
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Wittenstein O, Dunst J. [A wait-and-see approach or radiosurgery for asymptomatic vestibular schwannoma]. Strahlenther Onkol 2023; 199:1031-1032. [PMID: 37604985 PMCID: PMC10598179 DOI: 10.1007/s00066-023-02142-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2023] [Indexed: 08/23/2023]
Affiliation(s)
- Olaf Wittenstein
- Klinik für Strahlentherapie/Radioonkologie, UKSH, Campus Kiel, Kiel, Deutschland
| | - Jürgen Dunst
- Klinik für Strahlentherapie/Radioonkologie, UKSH, Campus Kiel, Kiel, Deutschland.
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Krug D, Dunst J. [Stereotactic radiotherapy plus nivolumab in the treatment of non-small-cell lung cancer]. Strahlenther Onkol 2023; 199:957-959. [PMID: 37640868 PMCID: PMC10542284 DOI: 10.1007/s00066-023-02143-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2023] [Indexed: 08/31/2023]
Affiliation(s)
- David Krug
- Klinik für Strahlentherapie/Radioonkologie, UKSH, Campus Kiel, Kiel, Deutschland
| | - Jürgen Dunst
- Klinik für Strahlentherapie/Radioonkologie, UKSH, Campus Kiel, Kiel, Deutschland.
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Schmalz C, Rogge A, Dunst J, Krug D, Liethmann K. Teaching communication skills in medical education : Best practice example of an interdisciplinary seminar in radiation oncology. Strahlenther Onkol 2023; 199:820-827. [PMID: 37308589 PMCID: PMC10449999 DOI: 10.1007/s00066-023-02099-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 05/07/2023] [Indexed: 06/14/2023]
Abstract
BACKGROUND Communication with patients is challenging, especially in radiation oncology. Therefore, radiation oncology is particularly suited to sensitize medical students for this topic and to train them competently. We report on experiences with an innovative teaching project for fourth- and fifth-year medical students. MATERIALS AND METHODS The course, funded as an innovative teaching project by the medical faculty, was offered as an optional course for medical students in 2019 and again in 2022 after a pandemic-related break. The curriculum and evaluation form were developed through a two-stage Delphi process. The course consisted of, first, participation during counselling of patients prior to radiotherapy, mainly on topics with shared decision-making, and, second, a 1-week interdisciplinary block seminar with practical exercises. The topics covered a broad spectrum of the competence areas defined in the National Competence-Based Learning Objectives Catalog for Medicine (NKLM). The number of participants was limited to approximately 15 students because of the practical components. RESULTS So far, 30 students (all at least in the seventh semester or higher) have participated in the teaching project. The most frequent reasons for participation were the desire to acquire competence in breaking bad news and confidence in talking to patients. The overall evaluation of the course was very positive, with a grade of 1.08 + 0.28 (on a scale of 1 = totally agree to 5 = totally disagree) plus German grade 1 (very good) to 6 (very bad). Notably, participants' expectations regarding specific competencies (e.g., breaking bad news) were also met. CONCLUSION Although the evaluation results cannot be generalized to the entirety of medical students due to the limited number of voluntary participants, the very positive evaluation shows the need for such projects among students and can also be seen as an indication that radiation oncology as a patient-centered discipline is particularly well suited to teach medical communication.
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Affiliation(s)
- Claudia Schmalz
- Department of Radiation Oncology, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, 24105, Kiel, Germany.
| | - Annette Rogge
- Nordseeklinik Helgoland, Helgoland, Germany, Invasorenpfad 1040, 27498
- Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Jürgen Dunst
- Department of Radiation Oncology, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, 24105, Kiel, Germany
| | - David Krug
- Department of Radiation Oncology, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, 24105, Kiel, Germany
| | - Katrin Liethmann
- Department of Radiation Oncology, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, 24105, Kiel, Germany
- Psychooncology, Center for integrative Psychiatry ZiP gGmbH, Kiel, Germany
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Schmalz C, Dunst J. [Definitive radiotherapy versus radiochemotherapy with weekly docetaxel in patients with head and neck cancer and cisplatin intolerance]. Strahlenther Onkol 2023; 199:869-870. [PMID: 37358595 PMCID: PMC10449941 DOI: 10.1007/s00066-023-02113-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2023] [Indexed: 06/27/2023]
Affiliation(s)
- Claudia Schmalz
- Klinik für Strahlentherapie/Radioonkologie, UKSH, Campus Kiel, Kiel, Deutschland
| | - Jürgen Dunst
- Klinik für Strahlentherapie/Radioonkologie, UKSH, Campus Kiel, Kiel, Deutschland.
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von Wieding E, Dunst J. [Endocavitary contact radiation therapy vs. EBRT as a boost in organ-preserving radiotherapy of T2-T3 rectal cancer: results of the OPERA study]. Strahlenther Onkol 2023; 199:784-786. [PMID: 37358594 PMCID: PMC10361854 DOI: 10.1007/s00066-023-02112-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2023] [Indexed: 06/27/2023]
Affiliation(s)
- Emilie von Wieding
- Klinik für Strahlentherapie/Radioonkologie, UKSH, Campus Kiel, Kiel, Deutschland
| | - Jürgen Dunst
- Klinik für Strahlentherapie/Radioonkologie, UKSH, Campus Kiel, Kiel, Deutschland.
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Bolten JH, Dunst J, Siebert FA. Geometric accuracy in patient positioning for stereotactic radiotherapy of intracranial tumors. Phys Imaging Radiat Oncol 2023; 27:100461. [PMID: 37720460 PMCID: PMC10500024 DOI: 10.1016/j.phro.2023.100461] [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: 01/06/2023] [Revised: 06/20/2023] [Accepted: 06/20/2023] [Indexed: 09/19/2023] Open
Abstract
Background/Purpose This study determines and compares the geometric setup errors between stereoscopic x-ray and kilo-voltage cone beam CT (CBCT) in phantom tests on a linear accelerator (linac) for image-guided (IG) stereotactic radiotherapy of intracranial tumors. Additionally, dose-volume metrics in the target volumes of the setup errors of CBCT were evaluated. Materials/Methods A Winston-Lutz- and an anthropomorphic phantom were used. The mean deviation and root mean square error (RMSE) of CBCT and stereoscopic x-ray were compared. Dose-volume metrics of the planning target volume (PTV) and gross target volume (GTV) for CBCT were calculated. Results The RMSEs in the tests with the Winston-Lutz-Phantom were 0.3 mm, 1.1 mm and 0.3 mm for CBCT and 0.1 mm, 0,1 mm and <0.1 mm for stereoscopic x-ray in the translational dimensions (right-left, anterior-posterior and superior-inferior). The RMSEs in the tests with the anthropomorphic phantom were 0.3 mm, 0.2 mm and 0.1 mm for CBCT and 0.1 mm, 0,1 mm and <0.1 mm for stereoscopic x-ray. The effects on dose-volume metrics of the setup errors of CBCT on the GTV were within 1 % for all considered dose values. The effects on the PTV were within 5 % for all considered dose values. Conclusion Both IG systems provide high accuracy patient positioning within a submillimeter range. The phantom tests exposed a slightly higher accuracy of stereoscopic x-ray than CBCT. The comparison with other studies with a similar purpose emphasizes the importance of individual IG installation quality assurance.
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Affiliation(s)
- Jan-Hendrik Bolten
- Clinic of Radiotherapy (Radiooncology), University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Jürgen Dunst
- Clinic of Radiotherapy (Radiooncology), University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Frank-André Siebert
- Clinic of Radiotherapy (Radiooncology), University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
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Weiss ML, Domschikowski J, Krug D, Sonnhoff M, Nitsche M, Hoffmann W, Becker-Schiebe M, Bock F, Hoffmann M, Schmalz C, Dunst J, Fabian A. The impact of palliative radiotherapy on health-related quality of life in patients with head and neck cancer - Results of a multicenter prospective cohort study. Clin Transl Radiat Oncol 2023; 41:100633. [PMID: 37206410 PMCID: PMC10189372 DOI: 10.1016/j.ctro.2023.100633] [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: 01/24/2023] [Revised: 04/13/2023] [Accepted: 04/24/2023] [Indexed: 05/21/2023] Open
Abstract
Purpose Palliative radiotherapy for patients with head and neck cancer can be used to alleviate symptoms. Only a few studies have investigated its impact on patient-reported outcomes (PRO). Therefore, we conducted a prospective multicenter observational study. The primary objective was to assess changes in health-related quality of life (HrQoL) per PRO. Methods Eligibility criteria included i.) head and neck cancer and ii.) palliative radiotherapy indicated (EQD2Gy < 60 Gy). The primary follow-up date was eight weeks after radiotherapy (t8w). PRO measures included the EORTC QLQ-C30 and EORTC QLQ-H&N43 and pain per Numeric Rating Scale (NRS). Per protocol, five PRO domains were to be reported in detail as well as PRO domains corresponding to a primary and secondary symptom as determined by the individual patient. We defined a minimal important difference (MID) of 10 points. Results From 06/2020 to 06/2022, 61 patients were screened and 21 patients were included. Due to death or decline in health-status, HrQoL data was available for 18 patients at the first fraction and for eight patients at t8w. The MID was not met for the predefined domains in terms of mean values as compared from first fraction to t8w. Individually in those patients with available HrQoL data at t8w, 71% (5/7) improved in their primary and 40% (2/5) in their secondary symptom domain reaching the MID from first fraction to t8w, respectively. There was a significant improvement in pain per NRS in those patients with available data at t8w per Wilcoxon signed rank test (p = 0.041). Acute mucositis of grade ≥3 per CTCAE v5.0 occurred in 44% (8/18) of the patients. The median overall survival was 11 months. Conclusion Despite low patient numbers and risk of selection bias, our study shows some evidence of a benefit from palliative radiotherapy for head and neck cancer as measured by PRO.German Clinical Trial Registry identifier: DRKS00021197.
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Affiliation(s)
- Marie-Luise Weiss
- Department of Radiation Oncology, University Hospital Schleswig-Holstein, 24105 Kiel, Germany
| | - Justus Domschikowski
- Department of Radiation Oncology, University Hospital Schleswig-Holstein, 24105 Kiel, Germany
| | - David Krug
- Department of Radiation Oncology, University Hospital Schleswig-Holstein, 24105 Kiel, Germany
| | - Mathias Sonnhoff
- Center for Radiotherapy and Radiation Oncology, 28239 Bremen, Germany
| | - Mirko Nitsche
- Center for Radiotherapy and Radiation Oncology, 28239 Bremen, Germany
| | - Wolfgang Hoffmann
- Radiotherapy & Radiation Oncology, Hospital Braunschweig, 38114 Braunschweig, Germany
| | | | - Felix Bock
- Department of Radiotherapy, University of Rostock, 18059 Rostock, Germany
| | - Markus Hoffmann
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Schleswig-Holstein Campus Kiel, Germany
| | - Claudia Schmalz
- Department of Radiation Oncology, University Hospital Schleswig-Holstein, 24105 Kiel, Germany
| | - Jürgen Dunst
- Department of Radiation Oncology, University Hospital Schleswig-Holstein, 24105 Kiel, Germany
| | - Alexander Fabian
- Department of Radiation Oncology, University Hospital Schleswig-Holstein, 24105 Kiel, Germany
- Corresponding author at: Department of Radiation Oncology, University Hospital Schleswig-Holstein, Arnold-Heller-Str. 3, 24105 Kiel, Germany.
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Krug D, Zaman A, Eidinger L, Grehn M, Boda-Heggemann J, Rudic B, Mehrhof F, Boldt LH, Hohmann S, Merten R, Buergy D, Fleckenstein J, Kluge A, Rogge A, Both M, Rades D, Tilz RR, Olbrich D, König IR, Siebert FA, Schweikard A, Vonthein R, Bonnemeier H, Dunst J, Blanck O. Radiosurgery for ventricular tachycardia (RAVENTA): interim analysis of a multicenter multiplatform feasibility trial. Strahlenther Onkol 2023:10.1007/s00066-023-02091-9. [PMID: 37285038 DOI: 10.1007/s00066-023-02091-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 04/23/2023] [Indexed: 06/08/2023]
Abstract
BACKGROUND Single-session cardiac stereotactic radiation therapy (SBRT) has demonstrated promising results for patients with refractory ventricular tachycardia (VT). However, the full safety profile of this novel treatment remains unknown and very limited data from prospective clinical multicenter trials are available. METHODS The prospective multicenter multiplatform RAVENTA (radiosurgery for ventricular tachycardia) study assesses high-precision image-guided cardiac SBRT with 25 Gy delivered to the VT substrate determined by high-definition endocardial and/or epicardial electrophysiological mapping in patients with refractory VT ineligible for catheter ablation and an implanted cardioverter defibrillator (ICD). Primary endpoint is the feasibility of full-dose application and procedural safety (defined as an incidence of serious [grade ≥ 3] treatment-related complications ≤ 5% within 30 days after therapy). Secondary endpoints comprise VT burden, ICD interventions, treatment-related toxicity, and quality of life. We present the results of a protocol-defined interim analysis. RESULTS Between 10/2019 and 12/2021, a total of five patients were included at three university medical centers. In all cases, the treatment was carried out without complications. There were no serious potentially treatment-related adverse events and no deterioration of left ventricular ejection fraction upon echocardiography. Three patients had a decrease in VT episodes during follow-up. One patient underwent subsequent catheter ablation for a new VT with different morphology. One patient with local VT recurrence died 6 weeks after treatment in cardiogenic shock. CONCLUSION The interim analysis of the RAVENTA trial demonstrates early initial feasibility of this new treatment without serious complications within 30 days after treatment in five patients. Recruitment will continue as planned and the study has been expanded to further university medical centers. TRIAL REGISTRATION NUMBER NCT03867747 (clinicaltrials.gov). Registered March 8, 2019. Study start: October 1, 2019.
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Affiliation(s)
- David Krug
- Klinik für Strahlentherapie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, Haus L, 24105, Kiel, Germany.
| | - Adrian Zaman
- Klinik für Innere Medizin III, Kardiologie, Abteilung für Elektrophysiologie und Rhythmologie, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Lina Eidinger
- Klinik für Strahlentherapie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, Haus L, 24105, Kiel, Germany
- Klinik für Innere Medizin III, Kardiologie, Abteilung für Elektrophysiologie und Rhythmologie, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Melanie Grehn
- Klinik für Strahlentherapie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, Haus L, 24105, Kiel, Germany
| | - Judit Boda-Heggemann
- Universitätsmedizin Mannheim, Klinik für Strahlentherapie und Radioonkologie, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Germany
| | - Boris Rudic
- Universitätsmedizin Mannheim, Medizinische Klinik I, Abteilung für Elektrophysiologie und Rhythmologie, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Germany
| | - Felix Mehrhof
- Klinik für Radioonkologie und Strahlentherapie, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Leif-Hendrik Boldt
- Medizinische Klinik mit Schwerpunkt Kardiologie (CVK), Abteilung für Elektrophysiologie und Rhythmologie, Charité Universitätsmedizin Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - Stephan Hohmann
- Hannover Herzrhythmus Centrum, Klinik für Kardiologie und Angiologie, Medizinische Hochschule Hannover, Hannover, Germany
| | - Roland Merten
- Klinik für Strahlentherapie und Spezielle Onkologie, Medizinische Hochschule Hannover, Hannover, Germany
| | - Daniel Buergy
- Universitätsmedizin Mannheim, Klinik für Strahlentherapie und Radioonkologie, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Germany
| | - Jens Fleckenstein
- Universitätsmedizin Mannheim, Klinik für Strahlentherapie und Radioonkologie, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Germany
| | - Anne Kluge
- Klinik für Radioonkologie und Strahlentherapie, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Annette Rogge
- Klinisches Ethikkomitee, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Marcus Both
- Klinik für Radiologie und Neuroradiologie, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Dirk Rades
- Klinik für Strahlentherapie, Universitätsklinikum Schleswig-Holstein, Lübeck, Germany
| | - Roland Richard Tilz
- Klinik für Rhythmologie, Universitätsklinikum Schleswig-Holstein, Lübeck, Germany
| | - Denise Olbrich
- Zentrum für Klinische Studien, Universität zu Lübeck, Lübeck, Germany
| | - Inke R König
- Institut für Medizinische Biometrie und Statistik, Universitätsklinikum Schleswig-Holstein, Lübeck, Germany
| | - Frank-Andre Siebert
- Klinik für Strahlentherapie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, Haus L, 24105, Kiel, Germany
| | - Achim Schweikard
- Institut für Robotik und Kognitive Systeme, Universität zu Lübeck, Lübeck, Germany
| | - Reinhard Vonthein
- Institut für Medizinische Biometrie und Statistik, Universitätsklinikum Schleswig-Holstein, Lübeck, Germany
| | - Hendrik Bonnemeier
- Klinik für Innere Medizin III, Kardiologie, Abteilung für Elektrophysiologie und Rhythmologie, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
- Klinik für Kardiologie, Helios Klinik Cuxhaven, Cuxhaven, Germany
| | - Jürgen Dunst
- Klinik für Strahlentherapie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, Haus L, 24105, Kiel, Germany
| | - Oliver Blanck
- Klinik für Strahlentherapie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, Haus L, 24105, Kiel, Germany
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12
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Dreher C, Sarria GR, Miebach G, Weiss C, Buergy D, Wojtal P, Tavakoli AA, Krug D, Oppitz H, Giordano FA, Both M, Lohr F, Dunst J, Blanck O, Boda-Heggemann J. Long-term characterization of MRI-morphologic alterations after active motion-compensated liver SBRT: a multi-institutional pooled analysis. Acta Oncol 2023; 62:281-289. [PMID: 37017543 DOI: 10.1080/0284186x.2023.2187707] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2023]
Abstract
BACKGROUND Stereotactic body radiotherapy (SBRT) is an effective therapeutic approach in patients with liver metastases. However, long-term changes in hepatic normal tissue have to be taken into account in multimodal treatment regimes. Magnetic-resonance-imaging (MRI) based morphologic liver alterations (MMA) after liver SBRT have been analyzed longitudinally. MATERIAL AND METHODS 57 patients treated with gantry-based or robotic-based SBRT of 69 treatment volumes of liver metastases, who had long-term follow-up (FU) ≥6 months were included in this retrospective analysis. Post-SBRT MMAs were contoured on each contrast-enhanced-T1-weighted (T1w) MRI-sequence. Morphologic/volumetric data of the liver and MMAs were evaluated longitudinally, including the dependency on treatment-related factors of the planning target volume (PTV) and liver. RESULTS The median FU time was 1 year [6-48 months]. 66 of 69 treatment volumes developed MMAs (mean 143.8 ± 135.1 ccm at first appearance). 31.8% of MMAs resolved completely during FU. Of the persisting MMAs 82.2%/13.3% decreased/increased in size until last available FU. Morphological characterization of the MMAs at first appearance included 75% hypointense and 25% hyperintense T1w-MRI-based appearances. Hypointense as compared to hyperintense appearance was significantly associated with a higher mean liver dose EQD2α/β=3 Gy (p = 0.0212) and non-significantly greater MMA size. Variance analysis demonstrated a significant reduction of MMA and total liver volume after SBRT (p < 0.0001). The volume reduction decelerated longitudinally for both MMA (p < 0.0001) and liver size (p = 0.0033). Radiation doses (PTV-BEDα/β=3 Gy and 10 Gy) were not significantly associated with MMA volume reduction. SBRT of liver metastases with mean liver dose EQD2α/β=3 Gy > 18 Gy were characterized by greater MMA volumes (p = 0.0826) and steeper MMA reduction gradients during FU than those with EQD2α/β=3 Gy ≤ 18 Gy (p < 0.0001). CONCLUSION Radiogenic MMAs either completely resolve or usually decrease in volume with pronounced reduction during short-term FU. This course was independent of the MMA's morphological appearance. Further, increased mean liver dose was associated with greater MMA size and a greater gradient of MMA size reduction during FU.
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Affiliation(s)
- Constantin Dreher
- Department of Radiation Oncology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
- DKFZ-Hector Cancer Institute, University Medical Center Mannheim, Mannheim, Germany
| | - Gustavo R Sarria
- Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Bonn, Germany
| | - Georgia Miebach
- Department of Radiation Oncology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Christel Weiss
- Department of Medical Statistics and Biomathematics, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Daniel Buergy
- Department of Radiation Oncology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
- DKFZ-Hector Cancer Institute, University Medical Center Mannheim, Mannheim, Germany
| | - Paulina Wojtal
- Department of Radiation Oncology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Anoshirwan A Tavakoli
- Department of Radiology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - David Krug
- Department of Radiation Oncology, University Medical Center Schleswig-Holstein, Kiel, Germany
- Saphir Radiosurgery Center Northern Germany, Kiel, Germany
| | - Hans Oppitz
- Department of Radiation Oncology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Frank A Giordano
- Department of Radiation Oncology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
- DKFZ-Hector Cancer Institute, University Medical Center Mannheim, Mannheim, Germany
| | - Marcus Both
- Department of Radiology and Neuroradiology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Frank Lohr
- Dipartimento di Oncologia, UO di Radioterapia, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Jürgen Dunst
- Department of Radiation Oncology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Oliver Blanck
- Department of Radiation Oncology, University Medical Center Schleswig-Holstein, Kiel, Germany
- Saphir Radiosurgery Center Northern Germany, Kiel, Germany
| | - Judit Boda-Heggemann
- Department of Radiation Oncology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
- DKFZ-Hector Cancer Institute, University Medical Center Mannheim, Mannheim, Germany
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13
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Strnad V, Polgár C, Ott OJ, Hildebrandt G, Kauer-Dorner D, Knauerhase H, Major T, Łyczek J, Guinot JL, Gutierrez Miguelez C, Slampa P, Allgäuer M, Lössl K, Polat B, Fietkau R, Schlamann A, Resch A, Kulik A, Arribas L, Niehoff P, Guedea F, Dunst J, Gall C, Uter W. Accelerated partial breast irradiation using sole interstitial multicatheter brachytherapy compared with whole-breast irradiation with boost for early breast cancer: 10-year results of a GEC-ESTRO randomised, phase 3, non-inferiority trial. Lancet Oncol 2023; 24:262-272. [PMID: 36738756 DOI: 10.1016/s1470-2045(23)00018-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [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: 11/29/2022] [Revised: 01/13/2023] [Accepted: 01/13/2023] [Indexed: 02/04/2023]
Abstract
BACKGROUND Several randomised, phase 3 trials have investigated the value of different techniques of accelerated partial breast irradiation (APBI) for patients with early breast cancer after breast-conserving surgery compared with whole-breast irradiation. In a phase 3 randomised trial, we evaluated whether APBI using multicatheter brachytherapy is non-inferior compared with whole-breast irradiation. Here, we present the 10-year follow-up results. METHODS We did a randomised, phase 3, non-inferiority trial at 16 hospitals and medical centres in Austria, Czech Republic, Germany, Hungary, Poland, Spain, and Switzerland. Patients aged 40 years or older with early invasive breast cancer or ductal carcinoma in situ treated with breast-conserving surgery were centrally randomly assigned (1:1) to receive either whole-breast irradiation or APBI using multicatheter brachytherapy. Whole-breast irradiation was delivered in 25 daily fractions of 50 Gy over 5 weeks, with a supplemental boost of 10 Gy to the tumour bed, and APBI was delivered as 30·1 Gy (seven fractions) and 32·0 Gy (eight fractions) of high-dose-rate brachytherapy in 5 days or as 50 Gy of pulsed-dose-rate brachytherapy over 5 treatment days. Neither patients nor investigators were masked to treatment allocation. The primary endpoint was ipsilateral local recurrence, analysed in the as-treated population; the non-inferiority margin for the recurrence rate difference (defined for 5-year results) was 3 percentage points. The trial is registered with ClinicalTrials.gov, NCT00402519; the trial is complete. FINDINGS Between April 20, 2004, and July 30, 2009, 1328 female patients were randomly assigned to whole breast irradiation (n=673) or APBI (n=655), of whom 551 in the whole-breast irradiation group and 633 in the APBI group were eligible for analysis. At a median follow-up of 10·36 years (IQR 9·12-11·28), the 10-year local recurrence rates were 1·58% (95% CI 0·37 to 2·8) in the whole-breast irradiation group and 3·51% (1·99 to 5·03) in the APBI group. The difference in 10-year rates between the groups was 1·93% (95% CI -0·018 to 3·87; p=0·074). Adverse events were mostly grade 1 and 2, in 234 (60%) of 393 participants in the whole-breast irradiation group and 314 (67%) of 470 participants in the APBI group, at 7·5-year or 10-year follow-up, or both. Patients in the APBI group had a significantly lower incidence of treatment-related grade 3 late side-effects than those in the whole-breast irradiation group (17 [4%] of 393 for whole-breast irradiation vs seven [1%] of 470 for APBI; p=0·021; at 7·5-year or 10-year follow-up, or both). At 10 years, the most common type of grade 3 adverse event in both treatment groups was fibrosis (six [2%] of 313 patients for whole-breast irradiation and three [1%] of 375 patients for APBI, p=0·56). No grade 4 adverse events or treatment-related deaths have been observed. INTERPRETATION Postoperative APBI using multicatheter brachytherapy after breast-conserving surgery in patients with early breast cancer is a valuable alternative to whole-breast irradiation in terms of treatment efficacy and is associated with fewer late side-effects. FUNDING German Cancer Aid, Germany.
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Affiliation(s)
- Vratislav Strnad
- Department of Radiation Oncology, University Hospital Erlangen and Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany.
| | - Csaba Polgár
- Center of Radiotherapy, National Institute of Oncology, Budapest, Hungary; Department of Oncology, Semmelweis University, Budapest, Hungary
| | - Oliver J Ott
- Department of Radiation Oncology, University Hospital Erlangen and Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - Guido Hildebrandt
- Department of Radiation Oncology, University Hospital Leipzig, Leipzig, Germany; Department of Radiation Oncology, University Hospital Rostock, Rostock, Germany
| | | | - Hellen Knauerhase
- Department of Radiation Oncology, University Hospital Rostock, Rostock, Germany
| | - Tibor Major
- Center of Radiotherapy, National Institute of Oncology, Budapest, Hungary; Department of Oncology, Semmelweis University, Budapest, Hungary
| | - Jarosław Łyczek
- Brachytherapy Department, Centrum Onkologii-Instytut im Marii Skł odowskej, Warsaw, Poland; Podkarpacki Hospital Cancer Center Brzozów, Brzozów, Poland
| | - Jose Luis Guinot
- Department of Radiation Oncology, Valencian Institute of Oncology Valencia, Valencia, Spain
| | | | - Pavel Slampa
- Department of Radiation Oncology, Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - Michael Allgäuer
- Department of Radiation Oncology, Hospital Barmherzige Brüder Regensburg, Regensburg, Germany
| | - Kristina Lössl
- Department of Radiation Oncology, University Hospital Bern, Inselspital, Bern, Switzerland
| | - Bülent Polat
- Department of Radiation Oncology, University Hospital Würzburg, Würzburg, Germany
| | - Rainer Fietkau
- Department of Radiation Oncology, University Hospital Erlangen and Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany; Department of Radiation Oncology, University Hospital Rostock, Rostock, Germany
| | - Annika Schlamann
- Department of Radiation Oncology, University Hospital Leipzig, Leipzig, Germany
| | - Alexandra Resch
- Department of Radiation Oncology, University Hospital AKH Wien, Vienna, Austria
| | - Anna Kulik
- Brachytherapy Department, Centrum Onkologii-Instytut im Marii Skł odowskej, Warsaw, Poland
| | - Leo Arribas
- Department of Radiation Oncology, Valencian Institute of Oncology Valencia, Valencia, Spain
| | - Peter Niehoff
- Department of Radiation Oncology, University Hospital Kiel, Kiel, Germany; Department of Radiotherapy, Sana Clinic, Offenbach, Germany
| | - Ferran Guedea
- Department of Radiation Oncology, Catalan Institute of Oncology, Barcelona, Spain
| | - Jürgen Dunst
- Department of Radiation Oncology, University Hospital Kiel, Kiel, Germany
| | - Christine Gall
- Department of Medical Informatics, Biometry and Epidemiology, University Erlangen-Nuremberg, Nuremberg, Germany
| | - Wolfgang Uter
- Department of Medical Informatics, Biometry and Epidemiology, University Erlangen-Nuremberg, Nuremberg, Germany
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14
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Krug D, Imhoff D, Haidenberger A, Heßler N, Schäfer J, Huttenlocher S, Chatzikonstantinou G, Fürweger C, Ramm U, König IR, Chun F, Staehler M, Rödel C, Muacevic A, Vonthein R, Dunst J, Blanck O. Robotic stereotactic body radiotherapy for localized prostate cancer: final analysis of the German HYPOSTAT trial. Strahlenther Onkol 2023; 199:565-573. [PMID: 36757424 DOI: 10.1007/s00066-023-02044-2] [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] [Received: 11/16/2022] [Accepted: 01/04/2023] [Indexed: 02/10/2023]
Abstract
PURPOSE We report results of the first German prospective multicenter single-arm phase II trial (ARO 2013-06; NCT02635256) of hypofractionated robotic stereotactic body radiotherapy (SBRT) for patients with localized prostate cancer (HYPOSTAT). METHODS Patients eligible for the HYPOSTAT study had localized prostate cancer (cT1‑3 cN0 cM0), Gleason score ≤ 7, prostate-specific antigen (PSA) ≤ 15 ng/ml, prostate volume ≤ 80 cm3, and an International Prostate Symptom Score (IPSS) ≤ 12. Initially, inclusion was limited to patients ≥ 75 years or patients 70-74 years with additional risk factors. The trial protocol was later amended to allow for enrolment of patients aged ≥ 60 years. The treatment consisted of 35 Gy delivered in 5 fractions to the prostate and for intermediate- or high-risk patients, also to the proximal seminal vesicles using the CyberKnife system (Accuray Inc., Sunnyvale, CA, USA). Primary endpoint was the rate of treatment-related gastrointestinal or genitourinary grade ≥ 2 toxicity based on the RTOG scale 12-15 months after treatment. Secondary endpoints were acute toxicity, late toxicity, urinary function, quality of life, and PSA response. RESULTS From July 2016 through December 2018, 85 eligible patients were enrolled and received treatment, of whom 83 could be evaluated regarding the primary endpoint. Patients mostly had intermediate-risk disease with a median PSA value of 7.97 ng/ml and Gleason score of 7a and 7b in 43.5% and 25.9% of patients, respectively. At the final follow-up 12-15 months after treatment, no patient suffered from treatment-related gastrointestinal or genitourinary grade ≥ 2 toxicity. Acute toxicity was mostly mild, with three grade 3 events, and the cumulative rate of grade ≥ 2 genitourinary toxicity was 8.4% (95% CI 4.1-16.4%). There were no major changes in urinary function or quality of life. The median PSA value dropped to 1.18 ng/ml 12-15 months after treatment. There was one patient who developed distant metastases. CONCLUSION Robotic SBRT with 35 Gy in 5 fractions was associated with a favorable short-term toxicity profile. Recruitment for the HYPOSTAT‑2 trial (ARO-2018‑4; NCT03795337), which further analyses the late toxicity of this regimen with a planned sample size of 500 patients, is ongoing.
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Affiliation(s)
- David Krug
- Klinik für Strahlentherapie, Universitätsklinikum Schleswig-Holstein - Campus Kiel, Arnold-Heller-Str. 3, Haus L, 24105, Kiel, Germany. .,Saphir Radiochirurgie Zentrum Frankfurt am Main und Norddeutschland, Kiel, Germany.
| | - Detlef Imhoff
- Saphir Radiochirurgie Zentrum Frankfurt am Main und Norddeutschland, Kiel, Germany.,Klinik für Strahlentherapie, Universitätsklinikum Frankfurt, Frankfurt am Main, Germany
| | | | - Nicole Heßler
- Institut für Medizinische Biometrie und Statistik, Universitätsklinikum Schleswig-Holstein, Lübeck, Germany
| | - Jane Schäfer
- Zentrum für Klinische Studien, Universität zu Lübeck, Lübeck, Germany
| | - Stefan Huttenlocher
- Klinik für Strahlentherapie, Universitätsklinikum Schleswig-Holstein - Campus Kiel, Arnold-Heller-Str. 3, Haus L, 24105, Kiel, Germany.,Saphir Radiochirurgie Zentrum Frankfurt am Main und Norddeutschland, Kiel, Germany
| | - Georgios Chatzikonstantinou
- Saphir Radiochirurgie Zentrum Frankfurt am Main und Norddeutschland, Kiel, Germany.,Klinik für Strahlentherapie, Universitätsklinikum Frankfurt, Frankfurt am Main, Germany
| | | | - Ulla Ramm
- Saphir Radiochirurgie Zentrum Frankfurt am Main und Norddeutschland, Kiel, Germany.,Klinik für Strahlentherapie, Universitätsklinikum Frankfurt, Frankfurt am Main, Germany
| | - Inke R König
- Institut für Medizinische Biometrie und Statistik, Universitätsklinikum Schleswig-Holstein, Lübeck, Germany.,German Center for Cardiovascular Research (DZHK), Lübeck, Germany
| | - Felix Chun
- Klinik für Urologie, Universitätsklinikum Frankfurt, Frankfurt am Main, Germany
| | - Michael Staehler
- Urologische Klinik und Poliklinik, LMU Klinikum der Universität München, Munich, Germany
| | - Claus Rödel
- Klinik für Strahlentherapie, Universitätsklinikum Frankfurt, Frankfurt am Main, Germany
| | | | - Reinhard Vonthein
- Institut für Medizinische Biometrie und Statistik, Universitätsklinikum Schleswig-Holstein, Lübeck, Germany
| | - Jürgen Dunst
- Klinik für Strahlentherapie, Universitätsklinikum Schleswig-Holstein - Campus Kiel, Arnold-Heller-Str. 3, Haus L, 24105, Kiel, Germany
| | - Oliver Blanck
- Klinik für Strahlentherapie, Universitätsklinikum Schleswig-Holstein - Campus Kiel, Arnold-Heller-Str. 3, Haus L, 24105, Kiel, Germany.,Saphir Radiochirurgie Zentrum Frankfurt am Main und Norddeutschland, Kiel, Germany
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15
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Polzer C, Dunst J. [Radiotherapy dose escalation in the treatment of unresectable Ewing sarcoma]. Strahlenther Onkol 2023; 199:204-207. [PMID: 36650309 PMCID: PMC9877040 DOI: 10.1007/s00066-023-02046-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2023] [Indexed: 01/19/2023]
Affiliation(s)
- Constanze Polzer
- grid.412468.d0000 0004 0646 2097Klinik für Strahlentherapie Kiel, UKSH, Kiel, Deutschland
| | - Jürgen Dunst
- grid.412468.d0000 0004 0646 2097Klinik für Strahlentherapie Kiel, UKSH, Kiel, Deutschland
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16
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Dunst J, Krug D. [Enzalutamide vs active surveillance in patients with low-risk prostate cancer]. Strahlenther Onkol 2023; 199:201-203. [PMID: 36260108 PMCID: PMC9877082 DOI: 10.1007/s00066-022-02015-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2022] [Indexed: 01/29/2023]
Affiliation(s)
- Jürgen Dunst
- Klinik für Strahlentherapie Kiel, UKSH, Kiel, Deutschland
| | - David Krug
- Klinik für Strahlentherapie Kiel, UKSH, Kiel, Deutschland
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17
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Mayinger M, Boda-Heggemann J, Mehrhof F, Krug D, Hohmann S, Xie J, Ehrbar S, Kovacs B, Merten R, Grehn M, Zaman A, Fleckenstein J, Kaestner L, Buergy D, Rudic B, Kluge A, Boldt LH, Dunst J, Bonnemeier H, Saguner AM, Andratschke N, Blanck O, Schweikard A. Quality assurance process within the RAdiosurgery for VENtricular TAchycardia (RAVENTA) trial for the fusion of electroanatomical mapping and radiotherapy planning imaging data in cardiac radioablation. Phys Imaging Radiat Oncol 2022; 25:100406. [PMID: 36655216 PMCID: PMC9841340 DOI: 10.1016/j.phro.2022.12.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 12/21/2022] [Accepted: 12/22/2022] [Indexed: 12/27/2022] Open
Abstract
A novel quality assurance process for electroanatomical mapping (EAM)-to-radiotherapy planning imaging (RTPI) target transport was assessed within the multi-center multi-platform framework of the RAdiosurgery for VENtricular TAchycardia (RAVENTA) trial. A stand-alone software (CARDIO-RT) was developed to enable platform independent registration of EAM and RTPI of the left ventricle (LV), based on pre-generated radiotherapy contours (RTC). LV-RTC were automatically segmented into the American-Heart-Association 17-segment-model and a manual 3D-3D method based on EAM 3D-geometry data and a semi-automated 2D-3D method based on EAM screenshot projections were developed. The quality of substrate transfer was evaluated in five clinical cases and the structural analyses showed substantial differences between manual target transfer and target transport using CARDIO-RT.
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Affiliation(s)
- Michael Mayinger
- Department of Radiation Oncology, University Hospital Zürich, University of Zürich, Zürich, Switzerland,Corresponding author.
| | - Judit Boda-Heggemann
- Department of Radiation Oncology, University Medicine Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Felix Mehrhof
- Department of Radiation Oncology, Charité University Medicine Berlin, Berlin, Germany
| | - David Krug
- Department of Radiation Oncology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Stephan Hohmann
- Department of Cardiology and Angiology, Hannover Heart Rhythm Center, Hannover Medical School, Hannover, Germany
| | - Jingyang Xie
- Institute for Robotics and Cognitive Systems, Univesity of Lübeck, Lübeck, Germany
| | - Stefanie Ehrbar
- Department of Radiation Oncology, University Hospital Zürich, University of Zürich, Zürich, Switzerland
| | - Boldizsar Kovacs
- Department of Cardiology, University Heart Center Zurich, University Hospital Zurich, Switzerland
| | - Roland Merten
- Department of Radiotherapy, Hannover Medical School, Hannover, Germany
| | - Melanie Grehn
- Department of Radiation Oncology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Adrian Zaman
- Department of Internal Medicine III, Section for Electrophysiology und Rhythmology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Jens Fleckenstein
- Department of Radiation Oncology, University Medicine Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Lena Kaestner
- Department of Radiation Oncology, University Medicine Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Daniel Buergy
- Department of Radiation Oncology, University Medicine Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Boris Rudic
- Medizinische Klinik I, Abteilung für Elektrophysiologie und Rhythmologie, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Anne Kluge
- Department of Radiation Oncology, Charité University Medicine Berlin, Berlin, Germany
| | - Leif-Hendrik Boldt
- Department of Cardiology, University Medicine Berlin, Campus Virchow-Klinikum, Berlin, Germany
| | - Jürgen Dunst
- Department of Radiation Oncology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Hendrik Bonnemeier
- Department of Internal Medicine III, Section for Electrophysiology und Rhythmology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Ardan M. Saguner
- Department of Cardiology, University Heart Center Zurich, University Hospital Zurich, Switzerland
| | - Nicolaus Andratschke
- Department of Radiation Oncology, University Hospital Zürich, University of Zürich, Zürich, Switzerland
| | - Oliver Blanck
- Department of Radiation Oncology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Achim Schweikard
- Institute for Robotics and Cognitive Systems, Univesity of Lübeck, Lübeck, Germany
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18
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Giralt J, Bunea A, Holečková P, Arias de la Vega F, Rutkowski T, Hervas A, Dunst J, Filarska D, Fernandez JC, Holmlund J, Lybaert W. EUSOM: Phase 2 Trial of Avasopasem Manganese (GC4419) for Oral Mucositis in Patients Receiving Chemoradiotherapy for Locally Advanced, Nonmetastatic Head and Neck Cancer. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.1362] [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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19
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Zaman A, Krug D, Eidinger L, Boda-Heggemann J, Rudic B, Mehrhof F, Boldt LH, Fleckenstein J, Kluge A, Siebert FA, Schweikard A, Vontlein R, Dunst J, Bonnemeier H, Blanck O. A step towards routine for stereotactic radioablation in refractory ventricular tachycardia – interim analysis on short term safety of the first prospective, multi-centre, multi-platform study RAVENTA. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.697] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Ventricular tachycardia (VT) is a potentially life-threatening heart rhythm disorder originating in heterogeneous conduction velocity in the ventricular myocardium, e.g. by scar formation in ischaemic or dilated cardiomyopathy. Current guideline-directed medical therapy comprises implantable cardioverter defibrillator (ICD), antiarrhythmic drugs, and endocardial/epicardial catheter ablation. There is a serious recurrence rate for example due to diffuse fibrosis, progress of disease, or insufficient ablation depth or volume.
In cases when Catheter ablation and antiarrhythmic medication failed to reduce VT burden, stereotactic body radiation therapy (SBRT) may become an additional treatment option. To date there have been several small retrospective case series and some single-centre prospective studies showing promising results.
Purpose
For the purpose of obtaining the authorization of a randomized trial, a feasibility study was designed. The primary objective is to demonstrate sufficient safety of cardiac SBRT for the non-invasive treatment of VT and whether the dose needed can be delivered while sparing sensitive surrounding structures (e.g. stomach, oesophagus, vena cava, coronary arteries, ICD). Secondarily, the effect on VT burden is reported.
Methods
The RAVENTA study (RAdiosurgery for VENtricular TAchycardias) is the first prospective, multicentre study on SBRT in patients suffering from refractory VTs worldwide. Patients were enrolled according to strict inclusion criteria. First, an electrophysiology study using a high definition mapping system was performed to identify the substrate (target region). In order to plan SBRT a planning computed tomography scan was obtained. Finally, a single dose of 25 Gy was administered to the target region. Neither sedation nor anaesthesia is necessary during SBRT.
Primary endpoint is feasibility defined as complete dose application and absence of severe (grade ≥3) treatment-related toxicity within 30 days of treatment. RAVENTA is powered to reject the hypothesis of 70% feasibility, if in fact feasibility is 95%. This is a pre-defined interim analysis with the aim of stopping early for futility.
Results
Between October 2019 and December 2021, the first 5 patients (characteristics shown in Table 1) could be enrolled and radiotherapy was delivered without major complications. Cardiac SBRT took on average 30 minutes. There was no treatment-related severe toxicity. Furthermore, we could not record any negative effect on functionality of the ICD: constant sensing amplitude and pacing capture threshold. In the short-term, patients showed a clear decrease in VT burden.
Conclusion
These preliminary data of the first multi-centre, multi-platform study on cardiac SBRT on refractory VT demonstrated sufficient short-term feasibility to continue the RAVENTA study. Meanwhile the study has been expanded to 6 centres in Germany.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A Zaman
- University Medical Center of Schleswig-Holstein, Department of Internal Medicine III , Kiel , Germany
| | - D Krug
- University Medical Center of Schleswig-Holstein, Department of Radiation Oncology , Kiel , Germany
| | - L Eidinger
- University Medical Center of Schleswig-Holstein, Department of Radiation Oncology , Kiel , Germany
| | - J Boda-Heggemann
- University Medical Centre of Mannheim, Department of Radiation Oncology , Mannheim , Germany
| | - B Rudic
- University Medical Centre of Mannheim, First Department of Medicine , Mannheim , Germany
| | - F Mehrhof
- Charité - University Medicine Berlin, Department of Radiation Oncology , Berlin , Germany
| | - L H Boldt
- Charite - Campus Virchow-Klinikum (CVK), Department of Cardiology , Berlin , Germany
| | - J Fleckenstein
- University Medical Centre of Mannheim, Department of Radiation Oncology , Mannheim , Germany
| | - A Kluge
- Charité - University Medicine Berlin, Department of Radiation Oncology , Berlin , Germany
| | - F A Siebert
- University Medical Center of Schleswig-Holstein, Department of Radiation Oncology , Kiel , Germany
| | - A Schweikard
- University of Luebeck, Institute for Robotics and Cognitive Systems , Luebeck , Germany
| | - R Vontlein
- Schleswig-Holstein University Clinic, Lubeck Campus, Institut für Medizinische Biometrie und Statistik , Luebeck , Germany
| | - J Dunst
- University Medical Center of Schleswig-Holstein, Department of Radiation Oncology , Kiel , Germany
| | - H Bonnemeier
- University Medical Center of Schleswig-Holstein, Department of Internal Medicine III , Kiel , Germany
| | - O Blanck
- University Medical Center of Schleswig-Holstein, Department of Radiation Oncology , Kiel , Germany
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20
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Pfaffendorf C, Vonthein R, Krockenberger-Ziegler K, Dellas K, Schreiber A, Uhlemann D, Dinges S, Würschmidt F, Andreas P, Weinstrauch E, Eilf K, Rades D, Höller U, Combs SE, Kazmierczak R, Fehlauer F, Schreck U, Zimmer J, Dunst J, Krug D. Hypofractionation with simultaneous integrated boost after breast-conserving surgery: Long term results of two phase-II trials. Breast 2022; 64:136-142. [PMID: 35691249 PMCID: PMC9190051 DOI: 10.1016/j.breast.2022.05.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 05/29/2022] [Accepted: 05/30/2022] [Indexed: 11/24/2022] Open
Abstract
Purpose Methods Results Conclusion Hypofractionated breast radiotherapy with SIB was safe and feasible. The local control rate at 5 years was 99.6%. The rate of late grade 3 toxicity was 0.7%.
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21
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Fabian A, Domschikowski J, Letsch A, Schmalz C, Freitag-Wolf S, Dunst J, Krug D. Clinical endpoints in trials of palliative radiotherapy: A systematic meta-research analysis. Radiother Oncol 2022; 174:123-131. [PMID: 35868602 DOI: 10.1016/j.radonc.2022.07.013] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 07/12/2022] [Accepted: 07/13/2022] [Indexed: 11/18/2022]
Abstract
PURPOSE Up to 50% of radiotherapy courses are delivered in palliative intent for various indications. Despite the large number of treated patients, we know little about the choice of endpoints in trials of palliative radiotherapy. Our primary aim was, therefore, to analyze primary endpoints in trials of palliative radiotherapy. METHODS We conducted a pre-registered (https://doi.org/10.17605/OSF.IO/GMCAF) meta-research analysis searching Pubmed/MEDLINE, EMBASE, CENTRAL, and "ClinicalTrials.gov" for clinical trials of palliative radiotherapy published 1990-2020. Endpoints were categorized in "patient-centered endpoints", including overall survival and patient-reported outcomes, and "tumor-centered endpoints" such as local control. The remainder were "other endpoints" including toxicity or observer-rated symptoms. We applied descriptive statistics to summarize data and logistic regression to assess if year of publication predicted the choice of primary endpoints. RESULTS Of 7379 records screened, 292 were eligible. Trials were characterized by small sample sizes and use of external beam radiotherapy for metastases or thoracic primaries. Median patient age was 64 and median ECOG was 1. Only 64.4%(145/225) of published trials clearly stated their primary endpoint. Published trials employed a "patient-centered primary endpoint" in 45.5%(66/145) and a "tumor-centered primary endpoint" in 17.3%(25/145) of the cases. There was no statistically significant trend in time for the use of "patient-centered primary endpoints". Registered ongoing trials used a "patient-centered primary endpoint" in 32.8%(22/67) and a "tumor-centered primary endpoint" in 26.9%(18/67) of the cases. CONCLUSION Although "patient-centered primary endpoints" appear relatively prevalent in published trials of palliative radiotherapy, their use is still suboptimal and appears to be lower in currently ongoing trials.
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Affiliation(s)
- Alexander Fabian
- Department of Radiation Oncology, University Hospital Schleswig-Holstein, 24105 Kiel, Germany.
| | - Justus Domschikowski
- Department of Radiation Oncology, University Hospital Schleswig-Holstein, 24105 Kiel, Germany
| | - Anne Letsch
- Department of Hematology and Oncology, University Hospital Schleswig-Holstein, 24105 Kiel, Germany
| | - Claudia Schmalz
- Department of Radiation Oncology, University Hospital Schleswig-Holstein, 24105 Kiel, Germany
| | - Sandra Freitag-Wolf
- Institute of Medical Informatics and Statistics, Christian-Albrechts-University Kiel, 24118 Kiel, Germany
| | - Jürgen Dunst
- Department of Radiation Oncology, University Hospital Schleswig-Holstein, 24105 Kiel, Germany
| | - David Krug
- Department of Radiation Oncology, University Hospital Schleswig-Holstein, 24105 Kiel, Germany
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22
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Kluge A, Ehrbar S, Grehn M, Fleckenstein J, Baus WW, Siebert FA, Schweikard A, Andratschke N, Mayinger MC, Boda-Heggemann J, Buergy D, Celik E, Krug D, Kovacs B, Saguner AM, Rudic B, Bergengruen P, Boldt LH, Stauber A, Zaman A, Bonnemeier H, Dunst J, Budach V, Blanck O, Mehrhof F. Treatment Planning for Cardiac Radioablation: Multicenter Multiplatform Benchmarking for the XXX Trial. Int J Radiat Oncol Biol Phys 2022; 114:360-372. [PMID: 35716847 DOI: 10.1016/j.ijrobp.2022.06.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 05/15/2022] [Accepted: 06/05/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Cardiac radioablation is a novel treatment option for patients with refractory ventricular tachycardia (VT) unsuitable for catheter ablation. The quality of treatment planning depends on dose specifications, platform capabilities, and experience of the treating staff. To harmonize the treatment planning, benchmarking of this process is necessary for multicenter clinical studies such as the XXX trial. METHODS AND MATERIALS Planning computed tomography data and consensus structures from three patients were sent to five academic centers for independent plan development using a variety of platforms and techniques with the XXX study protocol serving as guideline. Three-dimensional dose distributions and treatment plan details were collected and analyzed. In addition, an objective relative plan quality ranking system for VT treatments was established. RESULTS For each case, three coplanar volumetric modulated arc (VMAT) plans for C-arm linear accelerators (LINAC) and three non-coplanar treatment plans for robotic arm LINAC were generated. All plans were suitable for clinical applications with minor deviations from study guidelines in most centers. Eleven of 18 treatment plans showed maximal one minor deviation each for target and cardiac substructures. However, dose-volume histograms showed substantial differences: in one case, the PTV≥30Gy ranged from 0.0% to 79.9% and the RIVA V14Gy ranged from 4.0% to 45.4%. Overall, the VMAT plans had steeper dose gradients in the high dose region, while the plans for the robotic arm LINAC had smaller low dose regions. Thereby, VMAT plans required only about half as many monitor units, resulting in shorter delivery times, possibly an important factor in treatment outcome. CONCLUSIONS Cardiac radioablation is feasible with robotic arm and C-arm LINAC systems with comparable plan quality. Although cross-center training and best practice guidelines have been provided, further recommendations, especially for cardiac substructures, and ranking of dose guidelines will be helpful to optimize cardiac radioablation outcomes.
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Affiliation(s)
- Anne Kluge
- Klinik für Radioonkologie und Strahlentherapie, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Stefanie Ehrbar
- Klinik für Radio-Onkologie, UniversitätsSpital Zürich, University of Zurich, Zürich, CH
| | - Melanie Grehn
- Department of Radiation Oncology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Jens Fleckenstein
- Department of Radiation Oncology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Wolfgang W Baus
- Department of Radiation Oncology and Cyberknife Center, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Frank-Andre Siebert
- Department of Radiation Oncology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Achim Schweikard
- University of Lübeck, Institute for Robotic and Cognitive Systems, Lübeck, Germany
| | - Nicolaus Andratschke
- Klinik für Radio-Onkologie, UniversitätsSpital Zürich, University of Zurich, Zürich, CH
| | - Michael C Mayinger
- Klinik für Radio-Onkologie, UniversitätsSpital Zürich, University of Zurich, Zürich, CH
| | - Judit Boda-Heggemann
- Department of Radiation Oncology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Daniel Buergy
- Department of Radiation Oncology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Eren Celik
- Department of Radiation Oncology and Cyberknife Center, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - David Krug
- Department of Radiation Oncology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Boldizsar Kovacs
- Universitäres Herzzentrum, Klinik für Kardiologie, UniversitätsSpital Zürich, University of Zurich, Zürich, CH
| | - Ardan M Saguner
- Universitäres Herzzentrum, Klinik für Kardiologie, UniversitätsSpital Zürich, University of Zurich, Zürich, CH
| | - Boris Rudic
- Medizinische Klinik, Universitätsmedizin Mannheim and German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Paula Bergengruen
- Klinik für Radioonkologie und Strahlentherapie, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Leif-Hendrik Boldt
- Med. Klinik m.S. Kardiologie, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Annina Stauber
- Department of Radiation Oncology and Cyberknife Center, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Adrian Zaman
- Klinik für Innere Medizin III, Abteilung für Elektrophysiologie und Rhythmologie, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Hendrik Bonnemeier
- Klinik für Innere Medizin III, Abteilung für Elektrophysiologie und Rhythmologie, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Jürgen Dunst
- Department of Radiation Oncology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Volker Budach
- Klinik für Radioonkologie und Strahlentherapie, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Oliver Blanck
- Department of Radiation Oncology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Felix Mehrhof
- Klinik für Radioonkologie und Strahlentherapie, Charité - Universitätsmedizin Berlin, Berlin, Germany.
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23
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Fabian A, Domschikowski J, Greiner W, Bockelmann G, Karsten E, Rühle A, Nicolay NH, Grosu AL, Dunst J, Krug D. Financial toxicity in cancer patients treated with radiotherapy in Germany—a cross-sectional study. Strahlenther Onkol 2022; 198:1053-1061. [DOI: 10.1007/s00066-022-01936-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 03/20/2022] [Indexed: 01/15/2023]
Abstract
Abstract
Purpose
Financial toxicity arises in cancer patients from subjective financial distress due to objective financial burden from the disease or treatment. Financial toxicity associates with worse outcomes. It has not been described in cancer patients undergoing radiotherapy in Germany and its publicly funded health system. In this context, we therefore investigated the prevalence of financial toxicity, associated risk factors, and patient preferences on communication of financial burden.
Methods
We conducted a preregistered (10.17605/OSF.IO/KH6VX) cross-sectional study surveying patients at the end of their course of radiotherapy in two institutions. Objective financial burden was assessed by direct costs and loss of income. Financial toxicity was measured by subjective financial distress per EORTC QLQ-C30. We used Spearman’s correlation and Fisher’s exact test for univariate analysis, an ordinal regression for multivariate analysis. A p-value < 0.05 was considered statistically significant.
Results
Of the 100 patients participating in the study, 68% reported direct costs, 25% loss of income, and 31% subjective financial distress. Per univariate analysis, higher subjective financial distress was significantly associated with active employment, lower quality of life, lower household income, higher direct costs, and higher loss of income. The latter three factors remained statistically significant in the multivariate analysis. A relative majority of the patients welcomed communication regarding financial burden with their radiation oncologist.
Conclusion
Financial toxicity is prevalent in cancer patients treated with radiotherapy in Germany. The reported risk factors may help to identify patients at risk. Future studies should validate these results and investigate interventions for financial toxicity to potentially improve outcomes.
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24
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Piroth MD, Strnad V, Krug D, Fastner G, Baumann R, Combs SE, Duma MN, Dunst J, Feyer P, Fietkau R, Haase W, Harms W, Hehr T, Sedlmayer F, Souchon R, Budach W. Long-Term Results of the TARGIT-A Trial: More Questions than Answers. Breast Care (Basel) 2022; 17:81-84. [PMID: 35355706 PMCID: PMC8914270 DOI: 10.1159/000515386] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 02/20/2021] [Indexed: 02/03/2023] Open
Abstract
Background During the last decade, partial breast irradiation (PBI) has gained traction as a relevant treatment option for patients with early-stage low-risk breast cancer after breast-conserving surgery. The TARGIT-A prospective randomized trial compared a "risk-adapted" intraoperative radiotherapy (IORT) approach with 50-kv X-rays (INTRABEAM®) as the PBI followed by optional whole-breast irradiation (WBI) and conventional adjuvant WBI in terms of observed 5-year in-breast recurrence rates. Recently, long-term data were published. Since the first publication of the TARGIT-A trial, a broad debate has been emerged regarding several uncertainties and limitations associated with data analysis and interpretation. Our main objective was to summarize the data, with an emphasis on the updated report and the resulting implications. Summary From our point of view, the previously unresolved questions still remain and more have been added, especially with regard to the study design, a change in the primary outcome measure, the significant number of patients lost to follow-up, and the lack of a subgroup analysis according to risk factors and treatment specifications. Key Message Taking into account the abovementioned limitations of the recently published long-term results of the TARGIT-A trial, the German Society of Radiation Oncology (DEGRO) Breast Cancer Expert Panel adheres to its recently published recommendations on PBI: "the 50-kV system (INTRABEAM) cannot be recommended for routine adjuvant PBI treatment after breast-conserving surgery."
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Affiliation(s)
- Marc D. Piroth
- Department of Radiation Oncology, Helios University Hospital Wuppertal, Witten/Herdecke University, Wuppertal, Germany
| | - Vratislav Strnad
- Department of Radiation Oncology, University Hospital, Erlangen, Germany
| | - David Krug
- Department of Radiation Oncology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Gerd Fastner
- Department of Radiation Oncology, Paracelsus Medical University Hospital, Salzburg, Austria
| | - René Baumann
- Department of Radiation Oncology, St. Marien-Krankenhaus, Siegen, Germany
| | - Stephanie E. Combs
- Department of Radiation Oncology, Technical University of Munich (TUM), München, Germany
| | - Marciana Nona Duma
- Department of Radiation Oncology, Friedrich-Schiller-University Hospital, Jena, Germany
| | - Jürgen Dunst
- Department of Radiation Oncology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Petra Feyer
- Department of Radiation Oncology, Vivantes Hospital Neukoelln, Berlin, Germany
| | - Rainer Fietkau
- Department of Radiation Oncology, University Hospital, Erlangen, Germany
| | - Wulf Haase
- Formerly St.-Vincentius-Hospital Karlsruhe, Karlsruhe, Germany
| | - Wolfgang Harms
- Department of Radiation Oncology, St. Claraspital, Basel, Switzerland
| | - Thomas Hehr
- Department of Radiation Oncology, Marienhospital, Stuttgart, Germany
| | - Felix Sedlmayer
- Department of Radiation Oncology, Paracelsus Medical University Hospital, Salzburg, Austria
| | | | - Wilfried Budach
- Department of Radiation Oncology, Heinrich-Heine-University Hospital, Düsseldorf, Germany
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25
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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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Sarria G, Dreher C, Miebach G, Henkenberens C, Stera S, Wojtal P, Krug D, Oppitz H, Giordano F, Schäfer J, Lohr F, Dunst J, Blanck O, Boda-Heggemann J. Long-Term Characterization of MRI-Morphologic Alterations After Active Motion-Compensated Liver SBRT. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.435] [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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Krug D, Blanck O, Andratschke N, Guckenberger M, Jumeau R, Mehrhof F, Boda-Heggemann J, Seidensaal K, Dunst J, Pruvot E, Scholz E, Saguner AM, Rudic B, Boldt LH, Bonnemeier H. Recommendations regarding cardiac stereotactic body radiotherapy for treatment refractory ventricular tachycardia. Heart Rhythm 2021; 18:2137-2145. [PMID: 34380072 DOI: 10.1016/j.hrthm.2021.08.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 08/02/2021] [Accepted: 08/03/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Ventricular tachycardia (VT) is a potentially lethal complication of structural heart disease. Despite optimal management, a subgroup of patients continue to suffer from recurrent VT. Recently, cardiac stereotactic body radiotherapy (CSBRT) has been introduced as a treatment option in patients with VT refractory to antiarrhythmic drugs and catheter ablation. OBJECTIVE The purpose of this study was to establish an expert consensus regarding the conduct and use of CSBRT for refractory VT. METHODS We conducted a modified Delphi process. Thirteen experts from institutions from Germany and Switzerland participated in the modified Delphi process. Statements regarding the following topics were generated: treatment setting, institutional expertise and technical requirements, patient selection, target volume definition, and monitoring during and after CSBRT. Agreement was rated on a 5-point Likert scale. Cutoffs for agreement were defined in analogy to the RAND methodology. RESULTS There was strong agreement regarding the experimental status of the procedure and the preference for treatment in clinical trials. CSBRT should be conducted at specialized centers with a strong expertise in the management of patients with ventricular arrhythmias and in stereotactic body radiotherapy for moving targets. CSBRT should be restricted to patients with refractory VT with optimal antiarrhythmic medication who underwent prior catheter ablation or have contraindications. Target volume delineation for CSBRT is complex. Therefore, interdisciplinary processes that should include cardiology/electrophysiology and radiation oncology as well as medical physics, radiology, and nuclear medicine are needed. Optimal follow-up is required. CONCLUSION Prospective trials and pooled registries are needed to gain further insight into this promising treatment option for patients with refractory VT.
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Affiliation(s)
- David Krug
- Department of Radiation Oncology, University Hospital Schleswig-Holstein, Kiel, Germany.
| | - Oliver Blanck
- Department of Radiation Oncology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Nicolaus Andratschke
- Department of Radiation Oncology, University Hospital Zurich, Zurich, Switzerland
| | | | - Raphael Jumeau
- Department of Radiation Oncology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland; Radiation Oncology Institute, Hirslanden Clinique Bois-Cerf, Lausanne, Switzerland
| | - Felix Mehrhof
- Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Judit Boda-Heggemann
- Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Medical Faculty Mannheim, Mannheim, Germany
| | - Katharina Seidensaal
- Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany
| | - Jürgen Dunst
- Department of Radiation Oncology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Etienne Pruvot
- Heart and Vessel Department, Service of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Eberhard Scholz
- Department of Cardiology, Heidelberg Center for Heart Rhythm Disorders (HCR), University of Heidelberg, Heidelberg, Germany
| | - Ardan M Saguner
- Department of Cardiology, University Heart Center Zurich, Zurich, Switzerland
| | - Boris Rudic
- Department of Internal Medicine I, Section for Electrophysiology und Rhythmology, University Medical Center Mannheim, University of Heidelberg, Medical Faculty Mannheim, Mannheim, Germany
| | - Leif-Hendrik Boldt
- Department of Internal Medicine and Cardiology, Charité University Medicine Berlin-Campus Virchow Klinikum, Berlin, Germany
| | - Hendrik Bonnemeier
- Department of Internal Medicine III, Section for Electrophysiology und Rhythmology, University Hospital Schleswig-Holstein, Kiel, Germany
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Boda-Heggemann J, Blanck O, Mehrhof F, Ernst F, Buergy D, Fleckenstein J, Tülümen E, Krug D, Siebert FA, Zaman A, Kluge AK, Parwani AS, Andratschke N, Mayinger MC, Ehrbar S, Saguner AM, Celik E, Baus WW, Stauber A, Vogel L, Schweikard A, Budach V, Dunst J, Boldt LH, Bonnemeier H, Rudic B. Interdisciplinary Clinical Target Volume Generation for Cardiac Radioablation: Multicenter Benchmarking for the RAdiosurgery for VENtricular TAchycardia (RAVENTA) Trial. Int J Radiat Oncol Biol Phys 2021; 110:745-756. [DOI: 10.1016/j.ijrobp.2021.01.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 01/19/2021] [Accepted: 01/21/2021] [Indexed: 02/05/2023]
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von Fallois M, Kosyna FK, Mandl M, Landesman Y, Dunst J, Depping R. Selinexor decreases HIF-1α via inhibition of CRM1 in human osteosarcoma and hepatoma cells associated with an increased radiosensitivity. J Cancer Res Clin Oncol 2021; 147:2025-2033. [PMID: 33856525 PMCID: PMC8164574 DOI: 10.1007/s00432-021-03626-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 03/30/2021] [Indexed: 10/29/2022]
Abstract
BACKGROUND The nuclear pore complexes (NPCs) are built of about 30 different nucleoporins and act as key regulators of molecular traffic between the cytoplasm and the nucleus for sizeable proteins (> 40 kDa) which must enter the nucleus. Various nuclear transport receptors are involved in import and export processes of proteins through the nuclear pores. The most prominent nuclear export receptor is chromosome region maintenance 1 (CRM1), also known as exportin 1 (XPO1). One of its cargo proteins is the prolyl hydroxylase 2 (PHD2) which is involved in the initiation of the degradation of hypoxia-inducible factors (HIFs) under normoxia. HIFs are proteins that regulate the cellular adaptation under hypoxic conditions. They are involved in many aspects of cell viability and play an important role in the hypoxic microenvironment of cancer. In cancer, CRM1 is often overexpressed thus being a putative target for the development of new cancer therapies. The newly FDA-approved pharmaceutical Selinexor (KPT-330) selectively inhibits nuclear export via CRM1 and is currently tested in additional Phase-III clinical trials. In this study, we investigated the effect of CRM1 inhibition on the subcellular localization of HIF-1α and radiosensitivity. METHODS Human hepatoma cells Hep3B and human osteosarcoma cells U2OS were treated with Selinexor. Intranuclear concentration of HIF-1α protein was measured using immunoblot analysis. Furthermore, cells were irradiated with 2-8 Gy after treatment with Selinexor compared to untreated controls. RESULTS Selinexor significantly reduced the intranuclear level of HIF-1α protein in human hepatoma cells Hep3B and human osteosarcoma cells U2OS. Moreover, we demonstrated by clonogenic survival assays that Selinexor leads to dose-dependent radiosensitization in Hep3B-hepatoma and U2OS-osteosarcoma cells. CONCLUSION Targeting the HIF pathway by Selinexor might be an attractive tool to overcome hypoxia-induced radioresistance.
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MESH Headings
- Apoptosis
- Bone Neoplasms/drug therapy
- Bone Neoplasms/metabolism
- Bone Neoplasms/pathology
- Bone Neoplasms/radiotherapy
- Carcinoma, Hepatocellular/drug therapy
- Carcinoma, Hepatocellular/metabolism
- Carcinoma, Hepatocellular/pathology
- Carcinoma, Hepatocellular/radiotherapy
- Cell Proliferation
- Gene Expression Regulation, Neoplastic
- Humans
- Hydrazines/pharmacology
- Hypoxia-Inducible Factor 1, alpha Subunit/antagonists & inhibitors
- Hypoxia-Inducible Factor 1, alpha Subunit/genetics
- Hypoxia-Inducible Factor 1, alpha Subunit/metabolism
- Karyopherins/antagonists & inhibitors
- Karyopherins/genetics
- Karyopherins/metabolism
- Liver Neoplasms/drug therapy
- Liver Neoplasms/metabolism
- Liver Neoplasms/pathology
- Liver Neoplasms/radiotherapy
- Osteosarcoma/drug therapy
- Osteosarcoma/metabolism
- Osteosarcoma/pathology
- Osteosarcoma/radiotherapy
- Radiation Tolerance/drug effects
- Radiation-Sensitizing Agents/pharmacology
- Receptors, Cytoplasmic and Nuclear/antagonists & inhibitors
- Receptors, Cytoplasmic and Nuclear/genetics
- Receptors, Cytoplasmic and Nuclear/metabolism
- Triazoles/pharmacology
- Tumor Cells, Cultured
- Exportin 1 Protein
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Affiliation(s)
- Moritz von Fallois
- Universität Zu Lübeck, Institut Für Physiologie, Working Group Hypoxia, Ratzeburger Allee 160, 23562, Lübeck, Germany
| | - Friederike Katharina Kosyna
- Universität Zu Lübeck, Institut Für Physiologie, Working Group Hypoxia, Ratzeburger Allee 160, 23562, Lübeck, Germany
| | - Markus Mandl
- Universität Zu Lübeck, Institut Für Physiologie, Working Group Hypoxia, Ratzeburger Allee 160, 23562, Lübeck, Germany
| | - Yosef Landesman
- Karyopharm Therapeutics, 85 Wells Ave, Newton, MA, 02459, USA
| | - Jürgen Dunst
- Universitätsklinikum Schleswig-Holstein, Campus Kiel-Klinik für Strahlentherapie, Arnold-Heller-Straße 3, 24105, Kiel, Germany
| | - Reinhard Depping
- Universität Zu Lübeck, Institut Für Physiologie, Working Group Hypoxia, Ratzeburger Allee 160, 23562, Lübeck, Germany.
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Richter J, Dunst J. [Lorlatinib: a promising drug in the future treatment of advanced ALK-positive non-small-cell lung cancer]. Strahlenther Onkol 2021; 197:657-660. [PMID: 34110434 PMCID: PMC8219586 DOI: 10.1007/s00066-021-01788-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2021] [Indexed: 12/27/2022]
Affiliation(s)
- Johanna Richter
- Strahlentherapie und Onkologie, Christian-Albrechts-Universität zu Kiel, Kiel, Deutschland.
| | - Jürgen Dunst
- Klinik für Strahlentherapie, Campus Kiel, Universitätsklinikum Schleswig-Holstein, Feldstr. 21, 24105, Kiel, Deutschland.
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Fabian A, Domschikowski J, Hoffmann M, Weiner O, Schmalz C, Dunst J, Krug D. Patient-Reported Outcomes Assessing the Impact of Palliative Radiotherapy on Quality of Life and Symptom Burden in Head and Neck Cancer Patients: A Systematic Review. Front Oncol 2021; 11:683042. [PMID: 34150646 PMCID: PMC8213366 DOI: 10.3389/fonc.2021.683042] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 04/28/2021] [Indexed: 01/02/2023] Open
Abstract
Incurable head and neck cancer has a poor prognosis and impairs a patient's health-related quality of life. Palliative radiotherapy may improve or stabilize health-related quality of life and symptoms, best measured by patient-reported outcomes. There is no systematic analysis if palliative radiotherapy for head and neck cancer improves or stabilizes health-related quality of life or symptoms as validly measured by patient-reported outcomes. Therefore, the primary objective of this systematic review (PROSPERO-ID: CRD42020166434) was to assess the effect of palliative radiotherapy for head and neck cancer on patient-reported outcomes. The secondary objective was to assess the rate and quality of use of patient-reported outcomes in relevant studies claiming a "palliative effect" of radiotherapy. The databases MEDLINE/PubMed, EMBASE, Cochrane CENTRAL, "ClinicalTrials.gov" were searched. Concerning the primary objective, four studies were eligible to assess the effectiveness of palliative radiotherapy as measured by patient-reported outcomes. A narrative synthesis suggests a favorable impact of palliative radiotherapy on health-related quality of life and symptom burden. The risk of bias, however, is considerable and the overall quality of evidence low. Concerning the secondary objective, over 90% of studies claiming a "palliative effect" of palliative radiotherapy did either not use patient-reported outcomes or did so by limited quality. In conclusion, implementation of patient-reported outcomes in studies assessing palliative radiotherapy for head and neck cancer should be fostered. Palliative radiotherapy remains an option for head and neck cancer patients, although more studies focusing on patient-reported outcomes are needed. SYSTEMATIC REVIEW REGISTRATION https://www.crd.york.ac.uk/prospero/, identifier CRD42020166434.
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Affiliation(s)
- Alexander Fabian
- Department of Radiation Oncology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Justus Domschikowski
- Department of Radiation Oncology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Markus Hoffmann
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Oliver Weiner
- University Library Kiel, Christian-Albrechts-University Kiel, Kiel, Germany
| | - Claudia Schmalz
- Department of Radiation Oncology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Jürgen Dunst
- Department of Radiation Oncology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - David Krug
- Department of Radiation Oncology, University Hospital Schleswig-Holstein, Kiel, Germany
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Krug D, Blanck O, Dunst J, Bonnemeier H. Stereotactic ablative radiotherapy for cardiac arrhythmia - A rising STAR? Trends Cardiovasc Med 2021; 32:297-298. [PMID: 34062260 DOI: 10.1016/j.tcm.2021.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 05/22/2021] [Indexed: 11/24/2022]
Affiliation(s)
- D Krug
- Department of Radiation Oncology, University Hospital Schleswig- Holstein, Campus Kiel, Arnold-Heller-Str. 3, Haus L, Kiel 24105, Germany.
| | - O Blanck
- Department of Radiation Oncology, University Hospital Schleswig- Holstein, Campus Kiel, Arnold-Heller-Str. 3, Haus L, Kiel 24105, Germany
| | - J Dunst
- Department of Radiation Oncology, University Hospital Schleswig- Holstein, Campus Kiel, Arnold-Heller-Str. 3, Haus L, Kiel 24105, Germany
| | - H Bonnemeier
- Department of Internal Medicine III, Section for Electrophysiology und Rhythmology, University Hospital Schleswig- Holstein, Campus Kiel, Kiel, Germany
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Krug D, Vonthein R, Illen A, Olbrich D, Barkhausen J, Richter J, Klapper W, Schmalz C, Rody A, Maass N, Bauerschlag D, Heßler N, König IR, Dellas K, Dunst J. Metastases-directed Radiotherapy in Addition to Standard Systemic Therapy in Patients with Oligometastatic Breast Cancer: Study protocol for a randomized controlled multi-national and multi-center clinical trial (OLIGOMA). Clin Transl Radiat Oncol 2021; 28:90-96. [PMID: 33912695 PMCID: PMC8065185 DOI: 10.1016/j.ctro.2021.03.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 03/27/2021] [Accepted: 03/29/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Several recent randomized therapeutic exploratory trials demonstrated improvement of progression-free survival and in some even overall survival using stereotactic body radiotherapy in patients with oligometastatic disease. However, only very few patients enrolled in these trials had breast cancer, and results from confirmatory trials are lacking. METHODS/DESIGN The OLIGOMA-trial is a randomized controlled multi-national multi-center therapeutic confirmatory trial studying the role of local ablative radiotherapy as an additive treatment in patients with oligometastatic breast cancer receiving standard systemic therapy. Patients will be randomized 1:1 to standard systemic therapy according to national guidelines with or without radiotherapy to all metastatic sites. Randomization will be stratified according to type and line of systemic therapy, which has to be determined by a multidisciplinary tumor board before enrollment. Patients with up to five metastatic lesions are eligible, including patients with up to three brain metastases (only in case of extracranial disease) and with locoregional recurrence (only in case of additional metastatic lesions). In the standard arm, palliative radiotherapy to symptomatic metastases is permitted if at least one lesion remains untreated. The co-primary endpoints are progression-free survival and quality of life. The primary hypothesis is that progression-free survival in the experimental arm will be superior to the standard arm while simultaneously demonstrating non-inferiority of quality of life at 12 weeks after randomization. Secondary endpoints are feasibility, overall survival, toxicity, quality of life and patient satisfaction. A translational sub-study with collection of ctDNA will be conducted. DISCUSSION The OLIGOMA-trial will provide high level evidence on the use of and benefit from local ablative radiotherapy for patients with oligometastatic breast cancer. TRIAL REGISTRATION The OLIGOMA-trial is registered at clinicialtrials.gov under the identification NCT04495309. The related information was first posted on July 31st 2020.
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Affiliation(s)
- David Krug
- Klinik für Strahlentherapie, Universitätsklinikum Schleswig-Holstein, Kiel, Deutschland
| | - Reinhard Vonthein
- Institut für Medizinische Biometrie und Statistik, Universität zu Lübeck, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Deutschland
| | - Alicia Illen
- ZKS Lübeck, Universität zu Lübeck, Lübeck, Deutschland
| | | | - Jörg Barkhausen
- Klinik für Radiologie und Nuklearmedizin, Universitätsklinikum Schleswig-Holstein, Lübeck, Deutschland
| | - Julia Richter
- Sektion für Hämatopathologie, Institut für Pathologie, Universitätsklinikum Schleswig-Holstein, Kiel, Deutschland
| | - Wolfram Klapper
- Sektion für Hämatopathologie, Institut für Pathologie, Universitätsklinikum Schleswig-Holstein, Kiel, Deutschland
| | - Claudia Schmalz
- Klinik für Strahlentherapie, Universitätsklinikum Schleswig-Holstein, Kiel, Deutschland
| | - Achim Rody
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Lübeck, Deutschland
| | - Nicolai Maass
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Kiel, Deutschland
| | - Dirk Bauerschlag
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Kiel, Deutschland
| | - Nicole Heßler
- Institut für Medizinische Biometrie und Statistik, Universität zu Lübeck, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Deutschland
| | - Inke R. König
- Institut für Medizinische Biometrie und Statistik, Universität zu Lübeck, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Deutschland
| | - Kathrin Dellas
- Klinik für Strahlentherapie, Universitätsklinikum Schleswig-Holstein, Kiel, Deutschland
| | - Jürgen Dunst
- Klinik für Strahlentherapie, Universitätsklinikum Schleswig-Holstein, Kiel, Deutschland
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Kalisch AK, Dunst A, Dunst J. [Preoperative radiotherapy for primary retroperitoneal sarcomas: results from the EORTC-STRASS study]. Strahlenther Onkol 2021; 197:455-457. [PMID: 33665707 PMCID: PMC8062335 DOI: 10.1007/s00066-021-01753-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2021] [Indexed: 11/26/2022]
Affiliation(s)
| | - Andreas Dunst
- Christian-Albrechts-Universität zu Kiel, Kiel, Deutschland.
| | - Jürgen Dunst
- Christian-Albrechts-Universität zu Kiel, Kiel, Deutschland
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Dunst J. [Curative radiotherapy of oligometastatic cancer: long-term results of the SABR-COMET phase II trial]. Strahlenther Onkol 2021; 197:365-367. [PMID: 33532894 PMCID: PMC7987717 DOI: 10.1007/s00066-021-01745-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2021] [Indexed: 12/04/2022]
Affiliation(s)
- Jürgen Dunst
- Klinik für Strahlentherapie, Campus Kiel, Universitätsklinikum Schleswig-Holstein, Feldstr. 21, 24105, Kiel, Deutschland.
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Affiliation(s)
- Cedric Curt Cappel
- Klinik für Strahlentherapie Kiel, UKSH, Arnold-Heller-Str. 3, Hs. L, 24105, Kiel, Deutschland
| | - Denise Dopcke
- Klinik für Strahlentherapie Kiel, UKSH, Arnold-Heller-Str. 3, Hs. L, 24105, Kiel, Deutschland.
| | - Jürgen Dunst
- Klinik für Strahlentherapie Kiel, UKSH, Arnold-Heller-Str. 3, Hs. L, 24105, Kiel, Deutschland.
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Piroth MD, Krug D, Sedlmayer F, Duma MN, Baumann R, Budach W, Dunst J, Feyer P, Fietkau R, Haase W, Harms W, Hehr T, Souchon R, Strnad V, Sauer R. Post-neoadjuvant treatment with capecitabine and trastuzumab emtansine in breast cancer patients-sequentially, or better simultaneously? Strahlenther Onkol 2021; 197:1-7. [PMID: 32737515 PMCID: PMC7801351 DOI: 10.1007/s00066-020-01667-z] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 07/01/2020] [Indexed: 10/27/2022]
Abstract
PURPOSE Following neoadjuvant chemotherapy for breast cancer, postoperative systemic therapy, also called post-neoadjuvant treatment, has been established in defined risk settings. We reviewed the evidence for sequencing of postoperative radiation and chemotherapy, with a focus on a capecitabine and trastuzumab emtansine (T-DM1)-based regimen. METHODS A systematic literature search using the PubMed/MEDLINE/Web of Science database was performed. We included prospective and retrospective reports published since 2015 and provided clinical data on toxicity and effectiveness. RESULTS Six studies were included, five of which investigated capecitabine-containing regimens. Of these, four were prospective investigations and one a retrospective matched comparative analysis. One randomized prospective trial was found for T‑DM1 and radiotherapy. In the majority of these reports, radiation-associated toxicities were not specifically addressed. CONCLUSION Regarding oncologic outcome, the influence of sequencing radiation therapy with maintenance capecitabine chemotherapy in the post-neoadjuvant setting is unclear. Synchronous administration of capecitabine is feasible, but reports on possible excess toxicities are partially conflicting. Dose reduction of capecitabine should be considered, especially if normofractionated radiotherapy is used. In terms of tolerance, hypofractionated schedules seem to be superior in terms of toxicity in concurrent settings. T‑DM1 can safely be administered concurrently with radiotherapy.
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Affiliation(s)
- Marc D. Piroth
- Dpt. of Radiation Oncology, Wuppertal University Hospital (Helios), Witten/Herdecke University, Heusnerstraße 40, 42283 Wuppertal, Germany
| | - David Krug
- University Hospital Schleswig-Holstein, Kiel, Germany
| | - Felix Sedlmayer
- Paracelsus Medical University Hospital Salzburg, Salzburg, Austria
| | | | | | - Wilfried Budach
- Heinrich-Heine-University Hospital Düsseldorf, Düsseldorf, Germany
| | - Jürgen Dunst
- University Hospital Schleswig-Holstein, Kiel, Germany
| | - Petra Feyer
- Vivantes Hospital Neukoelln, Berlin, Germany
| | | | - Wulf Haase
- formerly St.-Vincentius-Hospital Karlsruhe, Karlsruhe, Germany
| | | | - Thomas Hehr
- Marienhospital Stuttgart, Stuttgart, Germany
| | | | | | - Rolf Sauer
- University Hospital Erlangen, Erlangen, Germany
| | - Breast Cancer Expert Panel of the German Society of Radiation Oncology (DEGRO)
- Dpt. of Radiation Oncology, Wuppertal University Hospital (Helios), Witten/Herdecke University, Heusnerstraße 40, 42283 Wuppertal, Germany
- University Hospital Schleswig-Holstein, Kiel, Germany
- Paracelsus Medical University Hospital Salzburg, Salzburg, Austria
- Friedrich-Schiller-University Hospital Jena, Jena, Germany
- St. Marien-Krankenhaus Siegen, Siegen, Germany
- Heinrich-Heine-University Hospital Düsseldorf, Düsseldorf, Germany
- Vivantes Hospital Neukoelln, Berlin, Germany
- University Hospital Erlangen, Erlangen, Germany
- formerly St.-Vincentius-Hospital Karlsruhe, Karlsruhe, Germany
- St. Claraspital Basel, Basel, Switzerland
- Marienhospital Stuttgart, Stuttgart, Germany
- formerly University Hospital, Tübingen, Germany
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Krug D, Vonthein R, Schreiber A, Boicev AD, Zimmer J, Laubach R, Weidner N, Dinges S, Hipp M, Schneider R, Weinstrauch E, Martin T, Hörner-Rieber J, Olbrich D, Illen A, Heßler N, König IR, Dellas K, Dunst J. Impact of guideline changes on adoption of hypofractionation and breast cancer patient characteristics in the randomized controlled HYPOSIB trial. Strahlenther Onkol 2020; 197:802-811. [PMID: 33320286 PMCID: PMC8397631 DOI: 10.1007/s00066-020-01730-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 11/30/2020] [Indexed: 12/17/2022]
Abstract
Purpose Hypofractionated radiotherapy is the standard of care for adjuvant whole breast radiotherapy (RT). However, adoption has been slow. The indication for regional nodal irradiation has been expanded to include patients with 0–3 involved lymph nodes. We investigated the impact of the publication of the updated German S3 guidelines in 2017 on adoption of hypofractionation and enrollment of patients with lymph node involvement within a randomized controlled phase III trial. Methods In the experimental arm of the HYPOSIB trial (NCT02474641), hypofractionated RT with simultaneous integrated boost (SIB) was used. In the standard arm, RT could be given as hypofractionated RT with sequential boost (HFseq), normofractionated RT with sequential boost (NFseq), or normofractionated RT with SIB (NFSIB). The cutoff date for the updated German S3 guidelines was December 17, 2017. Temporal trends were analyzed by generalized linear regression models. Multiple logistic regression models were used to investigate the influence of time (prior to/after guideline) and setting (university hospital/other institutions) on the fractionation patterns. Results Enrollment of patients with involved lymph nodes was low throughout the trial. Adoption of HFseq increased over time and when using the guideline publication date as cutoff. Results of the multiple logistic regressions showed an interaction between time and setting. Furthermore, the use of HFseq was significantly more common in university hospitals. Conclusion The use of HFseq in the standard arm increased over the course of the HYPOSIB trial and after publication of the S3 guideline update. This was primarily driven by patients treated in university hospitals. Enrolment of patients with lymph node involvement was low throughout the trial.
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Affiliation(s)
- David Krug
- Klinik für Strahlentherapie, Universitätsklinikum Schleswig-Holstein Campus Kiel, Arnold-Heller-Str. 3, 24105, Kiel, Germany.
| | - Reinhard Vonthein
- Institut für Medizinische Biometrie und Statistik, Universität zu Lübeck, Universitätsklinikum Schleswig-Holstein, Lübeck, Germany
| | - Andreas Schreiber
- Praxis für Strahlentherapie Dr. med. Andreas Schreiber, Dresden, Germany
| | - Alexander D Boicev
- Klinik für Strahlentherapie und Radioonkologie, Heinrich-Braun-Klinikum Zwickau, Zwickau, Germany
| | - Jörg Zimmer
- Praxis für Strahlentherapie Dr. med. Andreas Schreiber, Dresden, Germany
| | - Reinhold Laubach
- Klinik für Radio-Onkologie, St. Marien-Krankenhaus Siegen, Siegen, Germany
| | - Nicola Weidner
- Klinik für Strahlentherapie, Universitätsklinikum Tübingen, Tübingen, Germany
| | - Stefan Dinges
- Klinik für Strahlentherapie & Radioonkologie, Klinikum Lüneburg, Lüneburg, Germany
| | - Matthias Hipp
- Klinik für Strahlentherapie, Klinikum Amberg, Amberg, Germany
| | - Ralf Schneider
- Klinik für Strahlentherapie, Helios-Kliniken Schwerin, Schwerin, Germany
| | - Evelyn Weinstrauch
- Praxis für Radioonkologie, Johanniter-Zentren für Medizinische Versorgung Stendal, Stendal, Germany
| | - Thomas Martin
- Medizinisches Versorgungszentrum Fachbereich RadioOnkologie, Klinikum Bremen-Mitte, Bremen, Germany
| | - Juliane Hörner-Rieber
- RadioOnkologie und Strahlentherapie, UniversitätsKlinikum Heidelberg, Heidelberg, Germany
| | - Denise Olbrich
- ZKS Lübeck (Zentrum für klinische Studien Lübeck), Universität zu Lübeck, Lübeck, Germany
| | - Alicia Illen
- ZKS Lübeck (Zentrum für klinische Studien Lübeck), Universität zu Lübeck, Lübeck, Germany
| | - Nicole Heßler
- Institut für Medizinische Biometrie und Statistik, Universität zu Lübeck, Universitätsklinikum Schleswig-Holstein, Lübeck, Germany
| | - Inke R König
- Institut für Medizinische Biometrie und Statistik, Universität zu Lübeck, Universitätsklinikum Schleswig-Holstein, Lübeck, Germany
| | - Kathrin Dellas
- Klinik für Strahlentherapie, Universitätsklinikum Schleswig-Holstein Campus Kiel, Arnold-Heller-Str. 3, 24105, Kiel, Germany
| | - Jürgen Dunst
- Klinik für Strahlentherapie, Universitätsklinikum Schleswig-Holstein Campus Kiel, Arnold-Heller-Str. 3, 24105, Kiel, Germany
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Fabian A, Krug D, Dunst J. Randomisierte, kontrollierte Studie zur palliativen Radiotherapie von Kopf-Hals-Tumoren – Herausforderungen bleiben bestehen. Strahlenther Onkol 2020; 196:1062-1064. [PMID: 32821954 PMCID: PMC7581577 DOI: 10.1007/s00066-020-01672-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2022]
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Dunst J, Krug D, Schreiber A, Boicev A, Zimmer J, Laubach R, Weidner N, Dinges S, Hipp M, Schneider R, Weinstrauch E, Martin T, Hörner-Rieber J, Vonthein R, Olbrich D, Illen A, Koenig I, Dellas K. Patient Reported Experience with Treatment Modalities and Safety of Adjuvant Breast Radiotherapy - First Results of the Randomized HYPOSIB – Study. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.2091] [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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Krug D, Baumann R, Krockenberger K, Vonthein R, Schreiber A, Boicev A, Würschmidt F, Weinstrauch E, Eilf K, Andreas P, Höller U, Dinges S, Piefel K, Zimmer J, Dellas K, Dunst J. Adjuvant hypofractionated radiotherapy with simultaneous integrated boost after breast-conserving surgery: results of a prospective trial. Strahlenther Onkol 2020; 197:48-55. [PMID: 33001241 PMCID: PMC7801347 DOI: 10.1007/s00066-020-01689-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 08/31/2020] [Indexed: 01/22/2023]
Abstract
PURPOSE We report results of a multicenter prospective single-arm phase II trial (ARO-2013-04, NCT01948726) of moderately accelerated hypofractionated radiotherapy with a simultaneous integrated boost (SIB) in patients with breast cancer receiving adjuvant radiotherapy after breast-conserving surgery. METHODS The eligibility criteria included unifocal breast cancer with an indication for adjuvant radiotherapy to the whole breast and boost radiotherapy to the tumor bed. The whole breast received a dose of 40 Gy and the tumor bed a total dose of 48 Gy in 16 fractions of 2.5 and 3 Gy, respectively. Radiotherapy could be given either as 3D conformal RT (3D-CRT) or as intensity-modulated radiotherapy (IMRT). The study was designed as a prospective single-arm trial to evaluate the acute toxicity of the treatment regimen. The study hypothesis was that the frequency of acute skin reaction grade ≥2 would be 20% or less. RESULTS From November 2013 through July 2014, 149 patients were recruited from 12 participating centers. Six patients were excluded, leaving 143 patients for analysis. Eighty-four patients (58.7%) were treated with 3D-CRT and 59 (41.3%) with IMRT. Adherence to the treatment protocol was high. The rate of grade ≥2 skin toxicity was 14.7% (95% confidence interval 9.8-21.4%). The most frequent grade 3 toxicity (11%) was hot flashes. CONCLUSION This study demonstrated low toxicity of and high treatment adherence to hypofractionated adjuvant radiotherapy with SIB in a multicenter prospective trial, although the primary hypothesis was not met.
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Affiliation(s)
- David Krug
- Klinik für Strahlentherapie, Universitätsklinikum Schleswig-Holstein, Arnold-Heller-Str. 3, 24105, Kiel, Germany.
| | - René Baumann
- Klinik für Strahlentherapie, Universitätsklinikum Schleswig-Holstein, Arnold-Heller-Str. 3, 24105, Kiel, Germany.,Klinik für Radio-Onkologie, St. Marien-Krankenhaus Siegen, Siegen, Germany
| | - Katja Krockenberger
- ZKS Lübeck, Universität zu Lübeck, Lübeck, Germany.,AMEDOM GmbH, Lübeck, Germany
| | - Reinhard Vonthein
- Institut für Medizinische Biometrie und Statistik, Universität zu Lübeck, Lübeck, Germany
| | - Andreas Schreiber
- Praxis für Strahlentherapie Dr. med. Andreas Schreiber, Dresden, Germany
| | - Alexander Boicev
- Klinik für Strahlentherapie und Radioonkologie, Heinrich-Braun-Klinikum Zwickau, Zwickau, Germany
| | | | - Evelyn Weinstrauch
- Praxis für Radioonkologie, Johanniter-Zentren für Medizinische Versorgung Stendal, Stendal, Germany
| | | | - Peter Andreas
- Abteilung für Strahlentherapie, Krankenhaus Buchholz, Buchholz in der Nordheide, Germany
| | | | - Stefan Dinges
- Klinik für Strahlentherapie & Radioonkologie, Lüneburg, Germany
| | - Karen Piefel
- Strahlenzentrum Hamburg MVZ, Hamburg, Germany.,Fachbereich Strahlentherapie, Ambulanzzentrum des UKE, Hamburg, Germany
| | - Jörg Zimmer
- Praxis für Strahlentherapie Dr. med. Andreas Schreiber, Dresden, Germany
| | - Kathrin Dellas
- Klinik für Strahlentherapie, Universitätsklinikum Schleswig-Holstein, Arnold-Heller-Str. 3, 24105, Kiel, Germany
| | - Jürgen Dunst
- Klinik für Strahlentherapie, Universitätsklinikum Schleswig-Holstein, Arnold-Heller-Str. 3, 24105, Kiel, Germany
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Wilhelm ML, Chan MKH, Abel B, Cremers F, Siebert FA, Wurster S, Krug D, Wolff R, Dunst J, Hildebrandt G, Schweikard A, Rades D, Ernst F, Blanck O. Tumor-dose-rate variations during robotic radiosurgery of oligo and multiple brain metastases. Strahlenther Onkol 2020; 197:581-591. [PMID: 32588102 PMCID: PMC8219559 DOI: 10.1007/s00066-020-01652-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 06/02/2020] [Indexed: 12/31/2022]
Abstract
Purpose For step-and-shoot robotic stereotactic radiosurgery (SRS) the dose delivered over time, called local tumor-dose-rate (TDR), may strongly vary during treatment of multiple lesions. The authors sought to evaluate technical parameters influencing TDR and correlate TDR to clinical outcome. Material and methods A total of 23 patients with 162 oligo (1–3) and multiple (>3) brain metastases (OBM/MBM) treated in 33 SRS sessions were retrospectively analyzed. Median PTV were 0.11 cc (0.01–6.36 cc) and 0.50 cc (0.12–3.68 cc) for OBM and MBM, respectively. Prescription dose ranged from 16 to 20 Gy prescribed to the median 70% isodose line. The maximum dose-rate for planning target volume (PTV) percentage p in time span s during treatment (TDRs,p) was calculated for various p and s based on treatment log files and in-house software. Results TDR60min,98% was 0.30 Gy/min (0.23–0.87 Gy/min) for OBM and 0.22 Gy/min (0.12–0.63 Gy/min) for MBM, respectively, and increased by 0.03 Gy/min per prescribed Gy. TDR60min,98% strongly correlated with treatment time (ρ = −0.717, p < 0.001), monitor units (MU) (ρ = −0.767, p < 0.001), number of beams (ρ = −0.755, p < 0.001) and beam directions (ρ = −0.685, p < 0.001) as well as lesions treated per collimator (ρ = −0.708, P < 0.001). Median overall survival (OS) was 20 months and 1‑ and 2‑year local control (LC) was 98.8% and 90.3%, respectively. LC did not correlate with any TDR, but tumor response (partial response [PR] or complete response [CR]) correlated with all TDR in univariate analysis (e.g., TDR60min,98%: hazard ration [HR] = 0.974, confidence interval [CI] = 0.952–0.996, p = 0.019). In multivariate analysis only concomitant targeted therapy or immunotherapy and breast cancer tumor histology remained a significant factor for tumor response. Local grade ≥2 radiation-induced tissue reactions were noted in 26.3% (OBM) and 5.2% (MBM), respectively, mainly influenced by tumor volume (p < 0.001). Conclusions Large TDR variations are noted during MBM-SRS which mainly arise from prolonged treatment times. Clinically, low TDR corresponded with decreased local tumor responses, although the main influencing factor was concomitant medication.
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Affiliation(s)
- Maria-Lisa Wilhelm
- Department of Radiation Oncology, University Medicine Rostock, Rostock, Germany.,Saphir Radiosurgery Center Frankfurt and Northern Germany, Guestrow, Germany
| | - Mark K H Chan
- Department of Radiation Oncology, Karl-Lennert-Krebscentrum Nord, University Medical Center Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, Haus 50, 24105, Kiel, Germany.,Strahlenklinik, University Hospital Essen, Hufelandstr. 55, Essen, Germany
| | - Benedikt Abel
- Institute for Robotics and Cognitive Systems, University of Luebeck, Luebeck, Germany
| | - Florian Cremers
- Department of Radiation Oncology, University Medical Center Schleswig-Holstein, Luebeck, Germany
| | - Frank-Andre Siebert
- Department of Radiation Oncology, Karl-Lennert-Krebscentrum Nord, University Medical Center Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, Haus 50, 24105, Kiel, Germany
| | - Stefan Wurster
- Saphir Radiosurgery Center Frankfurt and Northern Germany, Guestrow, Germany.,Department of Radiation Oncology, University Medicine Greifswald, Greifswald, Germany
| | - David Krug
- Saphir Radiosurgery Center Frankfurt and Northern Germany, Guestrow, Germany.,Department of Radiation Oncology, Karl-Lennert-Krebscentrum Nord, University Medical Center Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, Haus 50, 24105, Kiel, Germany
| | - Robert Wolff
- Saphir Radiosurgery Center Frankfurt and Northern Germany, Guestrow, Germany.,Department of Neurosurgery, University Hospital Frankfurt, Frankfurt, Germany
| | - Jürgen Dunst
- Department of Radiation Oncology, Karl-Lennert-Krebscentrum Nord, University Medical Center Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, Haus 50, 24105, Kiel, Germany
| | - Guido Hildebrandt
- Department of Radiation Oncology, University Medicine Rostock, Rostock, Germany
| | - Achim Schweikard
- Institute for Robotics and Cognitive Systems, University of Luebeck, Luebeck, Germany
| | - Dirk Rades
- Department of Radiation Oncology, University Medical Center Schleswig-Holstein, Luebeck, Germany
| | - Floris Ernst
- Institute for Robotics and Cognitive Systems, University of Luebeck, Luebeck, Germany
| | - Oliver Blanck
- Saphir Radiosurgery Center Frankfurt and Northern Germany, Guestrow, Germany. .,Department of Radiation Oncology, Karl-Lennert-Krebscentrum Nord, University Medical Center Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, Haus 50, 24105, Kiel, Germany.
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Affiliation(s)
| | | | - Jürgen Dunst
- Klinik für Strahlentherapie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Feldstr. 21, 24105, Kiel, Deutschland.
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Pape L, Richter J, Dunst J. [Adjuvant chemotherapy in the treatment of urothelial carcinoma of the upper urinary tract]. Strahlenther Onkol 2020; 196:837-840. [PMID: 32561938 DOI: 10.1007/s00066-020-01640-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
| | | | - Jürgen Dunst
- Klinik für Strahlentherapie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Feldstr. 21, 24105, Kiel, Deutschland.
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Strnad V, Krug D, Sedlmayer F, Piroth MD, Budach W, Baumann R, Feyer P, Duma MN, Haase W, Harms W, Hehr T, Fietkau R, Dunst J, Sauer R. DEGRO practical guideline for partial-breast irradiation. Strahlenther Onkol 2020; 196:749-763. [PMID: 32350554 PMCID: PMC7449998 DOI: 10.1007/s00066-020-01613-z] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 03/19/2020] [Indexed: 12/24/2022]
Abstract
Purpose This consensus statement from the Breast Cancer Working Group of the German Society for Radiation Oncology (DEGRO) aims to define practical guidelines for accelerated partial-breast irradiation (APBI). Methods Recent recommendations for relevant aspects of APBI were summarized and a panel of experts reviewed all the relevant literature. Panel members of the DEGRO experts participated in a series of conferences, supplemented their clinical experience, performed a literature review, and formulated recommendations for implementing APBI in clinical routine, focusing on patient selection, target definition, and treatment technique. Results Appropriate patient selection, target definition for different APBI techniques, and basic rules for appropriate APBI techniques for clinical routine outside of clinical trials are described. Detailed recommendations for APBI in daily practice, including dose constraints, are given. Conclusion Guidelines are mandatory to assure optimal results of APBI using different techniques.
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Affiliation(s)
- V Strnad
- University Hospital Erlangen, Erlangen, Germany.
| | - D Krug
- University Hospital Schleswig-Holstein, Kiel, Germany
| | - F Sedlmayer
- Paracelsus Medical University Hospital Salzburg, Salzburg, Austria
| | - M D Piroth
- Helios University Hospital Wuppertal, Witten/Herdecke University, Wuppertal, Germany
| | - W Budach
- Heinrich-Heine-University Hospital Düsseldorf, Düsseldorf, Germany
| | - R Baumann
- St. Marien-Krankenhaus Siegen, Siegen, Germany
| | - P Feyer
- Vivantes Hospital Neukoelln, Berlin, Germany
| | - M N Duma
- University Hospital, Jena, Germany
| | - W Haase
- St.-Vincentius-Hospital Karlsruhe, Karlsruhe, Germany
| | - W Harms
- St. Claraspital Basel, Basel, Switzerland
| | - T Hehr
- Marienhospital Stuttgart, Stuttgart, Germany
| | - R Fietkau
- University Hospital Erlangen, Erlangen, Germany
| | - J Dunst
- University Hospital Schleswig-Holstein, Kiel, Germany
| | - R Sauer
- University Hospital Erlangen, Erlangen, Germany
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Blanck O, Buergy D, Vens M, Eidinger L, Zaman A, Krug D, Rudic B, Boda-Heggemann J, Giordano FA, Boldt LH, Mehrhof F, Budach V, Schweikard A, Olbrich D, König IR, Siebert FA, Vonthein R, Dunst J, Bonnemeier H. Radiosurgery for ventricular tachycardia: preclinical and clinical evidence and study design for a German multi-center multi-platform feasibility trial (RAVENTA). Clin Res Cardiol 2020; 109:1319-1332. [PMID: 32306083 PMCID: PMC7588361 DOI: 10.1007/s00392-020-01650-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 04/08/2020] [Indexed: 12/25/2022]
Abstract
Background Single-session high-dose stereotactic radiotherapy (radiosurgery) is a new treatment option for otherwise untreatable patients suffering from refractory ventricular tachycardia (VT). In the initial single-center case studies and feasibility trials, cardiac radiosurgery has led to significant reductions of VT burden with limited toxicities. However, the full safety profile remains largely unknown. Methods/design In this multi-center, multi-platform clinical feasibility trial which we plan is to assess the initial safety profile of radiosurgery for ventricular tachycardia (RAVENTA). High-precision image-guided single-session radiosurgery with 25 Gy will be delivered to the VT substrate determined by high-definition endocardial electrophysiological mapping. The primary endpoint is safety in terms of successful dose delivery without severe treatment-related side effects in the first 30 days after radiosurgery. Secondary endpoints are the assessment of VT burden, reduction of implantable cardioverter defibrillator (ICD) interventions [shock, anti-tachycardia pacing (ATP)], mid-term side effects and quality-of-life (QoL) in the first year after radiosurgery. The planned sample size is 20 patients with the goal of demonstrating safety and feasibility of cardiac radiosurgery in ≥ 70% of the patients. Quality assurance is provided by initial contouring and planning benchmark studies, joint multi-center treatment decisions, sequential patient safety evaluations, interim analyses, independent monitoring, and a dedicated data and safety monitoring board. Discussion RAVENTA will be the first study to provide the initial robust multi-center multi-platform prospective data on the therapeutic value of cardiac radiosurgery for ventricular tachycardia. Trial registration number NCT03867747 (clinicaltrials.gov). Registered March 8, 2019. The study was initiated on November 18th, 2019, and is currently recruiting patients. Graphic abstract ![]()
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Affiliation(s)
- Oliver Blanck
- Klinik für Strahlentherapie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, Haus 50, 24105, Kiel, Germany.
| | - Daniel Buergy
- Klinik für Strahlentherapie und Radioonkologie, Universitätsmedizin Mannheim, Universität Heidelberg, Medizinische Fakultät Mannheim, Mannheim, Germany
| | - Maren Vens
- Universität zu Lübeck, Zentrum für Klinische Studien, Lübeck, Germany.,Institut für Medizinische Biometrie und Statistik, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Lina Eidinger
- Klinik für Strahlentherapie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, Haus 50, 24105, Kiel, Germany.,Klinik für Innere Medizin III, Abteilung für Elektrophysiologie und Rhythmologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Adrian Zaman
- Klinik für Innere Medizin III, Abteilung für Elektrophysiologie und Rhythmologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - David Krug
- Klinik für Strahlentherapie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, Haus 50, 24105, Kiel, Germany
| | - Boris Rudic
- Medizinische Klinik I, Abteilung für Elektrophysiologie und Rhythmologie, Universitätsmedizin Mannheim, Universität Heidelberg, Medizinische Fakultät Mannheim, Mannheim, Germany
| | - Judit Boda-Heggemann
- Klinik für Strahlentherapie und Radioonkologie, Universitätsmedizin Mannheim, Universität Heidelberg, Medizinische Fakultät Mannheim, Mannheim, Germany
| | - Frank A Giordano
- Klinik für Strahlentherapie und Radioonkologie, Universitätsmedizin Mannheim, Universität Heidelberg, Medizinische Fakultät Mannheim, Mannheim, Germany
| | - Leif-Hendrik Boldt
- Medizinische Klinik mit Schwerpunkt Kardiologie (CVK), Abteilung für Elektrophysiologie und Rhythmologie, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Felix Mehrhof
- Klinik für Radioonkologie und Strahlentherapie, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Volker Budach
- Klinik für Radioonkologie und Strahlentherapie, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Achim Schweikard
- Institut für Robotik und Kognitive Systeme, Universität zu Lübeck, Lübeck, Germany
| | - Denise Olbrich
- Universität zu Lübeck, Zentrum für Klinische Studien, Lübeck, Germany
| | - Inke R König
- Institut für Medizinische Biometrie und Statistik, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Frank-Andre Siebert
- Klinik für Strahlentherapie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, Haus 50, 24105, Kiel, Germany
| | - Reinhard Vonthein
- Institut für Medizinische Biometrie und Statistik, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Jürgen Dunst
- Klinik für Strahlentherapie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, Haus 50, 24105, Kiel, Germany
| | - Hendrik Bonnemeier
- Klinik für Innere Medizin III, Abteilung für Elektrophysiologie und Rhythmologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
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Krug D, Fabian A, Dunst J. Ribociclib in Kombination mit endokriner Therapie verbessert Überleben von prä-/perimenopausalen Mammakarzinom-Patientinnen. Strahlenther Onkol 2020; 196:286-288. [PMID: 31950201 PMCID: PMC8012308 DOI: 10.1007/s00066-019-01574-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Krug D, Baumann R, Budach W, Duma MN, Dunst J, Feyer P, Fietkau R, Haase W, Harms W, Hehr T, Piroth MD, Sedlmayer F, Souchon R, Wenz F, Sauer R. Commercially Available Gene Expression Assays as Predictive Tools for Adjuvant Radiotherapy? A Critical Review. Breast Care (Basel) 2020; 15:118-126. [PMID: 32398980 DOI: 10.1159/000505656] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Accepted: 12/23/2019] [Indexed: 12/17/2022] Open
Abstract
Background Gene expression assays are increasingly used for decision-making regarding adjuvant chemotherapy in patients with hormone receptor-positive, HER2-negative breast cancer. There are some clinical situations in which there is also a need for better prognostic and predictive markers to better estimate the amount of benefit from adjuvant radiotherapy. The rising availability of gene expression analyses prompts the question whether their results can also be used to guide clinical decisions regarding adjuvant radiation. Summary Multiple studies suggest a correlation between results from gene expression assays and locoregional recurrence rates. Only few publications addressed the predictive value of results from gene expression analysis for the role of adjuvant radiotherapy in different settings. Key Messages To date, the available evidence on the possible predictive value of gene expression assays for radiotherapy does not support their inclusion into the decision-making process for adjuvant radiation. This is due to methodological weaknesses and limitations regarding patient selection, the nonrandomized design of all studies in terms of radiotherapy use, and limited availability of tissue from prospective trials. Thus, utilization of the present knowledge for clinical indication of radiotherapy should be very cautious.
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Affiliation(s)
- David Krug
- Department of Radiation Oncology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - René Baumann
- Department of Radiation Oncology, University Hospital Schleswig-Holstein, Kiel, Germany.,Department of Radiation Oncology, St. Marien-Krankenhaus, Siegen, Germany
| | - Wilfried Budach
- Department of Radiation Oncology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Marciana Nona Duma
- Department of Radiation Oncology, University Hospital Jena, Jena, Germany
| | - Jürgen Dunst
- Department of Radiation Oncology, University Hospital Schleswig-Holstein, Kiel, Germany
| | | | | | - Wulf Haase
- St.-Vincentius-Hospital, Karlsruhe, Germany
| | | | - Thomas Hehr
- Department of Radiation Oncology, Marienhospital Stuttgart, Stuttgart, Germany
| | - Marc D Piroth
- HELIOS University Hospital Wuppertal, Witten/Herdecke University, Wuppertal, Germany
| | | | | | | | - Rolf Sauer
- University Hospital Erlangen, Erlangen, Germany
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Krug D, Dunst J. [Whole- or partial-breast radiotherapy after 5 years from a patient perspective: longitudinal analysis of the IMPORT LOW (CRUK/06/003) phase III trial]. Strahlenther Onkol 2020; 195:767-768. [PMID: 31001645 DOI: 10.1007/s00066-019-01472-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- David Krug
- Klinik für Strahlentherapie, Campus Kiel, Universitätsklinikum Schleswig-Holstein, Arnold-Heller-Str. 3, 24105, Kiel, Deutschland.
| | - Jürgen Dunst
- Klinik für Strahlentherapie, Campus Kiel, Universitätsklinikum Schleswig-Holstein, Arnold-Heller-Str. 3, 24105, Kiel, Deutschland
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Duma MN, Baumann R, Budach W, Dunst J, Feyer P, Fietkau R, Haase W, Harms W, Hehr T, Krug D, Piroth MD, Sedlmayer F, Souchon R, Sauer R. Heart-sparing radiotherapy techniques in breast cancer patients: a recommendation of the breast cancer expert panel of the German society of radiation oncology (DEGRO). Strahlenther Onkol 2019; 195:861-871. [PMID: 31321461 DOI: 10.1007/s00066-019-01495-w] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [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: 06/20/2019] [Accepted: 06/27/2019] [Indexed: 02/08/2023]
Abstract
PURPOSE The aim of this review was to analyze the respective efficacy of various heart-sparing radiotherapy techniques. MATERIAL AND METHODS Heart-sparing can be performed in three different ways in breast cancer radiotherapy: by seeking to keep the heart out of treated volumes (i.e. by prone position or specific breathing techniques such as deep inspiration breath-hold [DIBH] and/or gating), by solely irradiating a small volume around the lumpectomy cavity (partial breast irradiation, PBI), or by using modern radiation techniques like intensity-modulated radiation therapy (IMRT), volumetric modulated arc therapy (VMAT) or protons. This overview presents the available data on these three approaches. RESULTS Studies on prone position are heterogeneous and most trials only refer to patients with large breasts; therefore, no definitive conclusion can be drawn for clinical routine. Nonetheless, there seems to be a trend toward better sparing of the left anterior descending artery in supine position even for these selected patients. The data on the use of DIBH for heart-sparing in breast cancer patients is consistent and the benefit compared to free-breathing is supported by several studies. In comparison with whole breast irradiation (WBI), PBI has an advantage in reducing the heart dose. Of note, DIBH and PBI with multicatheter brachytherapy are similar with regard to the dose reduction to heart structures. WBI by IMRT/VMAT techniques without DIBH is not an effective strategy for heart-sparing in breast cancer patients with "standard" anatomy. A combination of DIBH and IMRT may be used for internal mammary radiotherapy. CONCLUSION Based on the available findings, the DEGRO breast cancer expert panel recommends the use of DIBH as the best heart-sparing technique. Nonetheless, depending on the treatment volume and localization, other techniques may be employed or combined with DIBH when appropriate.
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Affiliation(s)
- Marciana-Nona Duma
- Department of Radiotherapy and Radiation Oncology, University Hospital, Friedrich-Schiller-University, Bachstr. 18, 07745, Jena, Germany.
| | | | - Wilfried Budach
- Heinrich-Heine-University Hospital Düsseldorf, Düsseldorf, Germany
| | - Jürgen Dunst
- University Hospital Schleswig-Holstein, Kiel, Germany
| | - Petra Feyer
- Vivantes Hospital Neukoelln, Berlin, Germany
| | | | - Wulf Haase
- St.-Vincentius-Hospital Karlsruhe, Karlsruhe, Germany
| | | | - Thomas Hehr
- Marienhospital Stuttgart, Stuttgart, Germany
| | - David Krug
- University Hospital Schleswig-Holstein, Kiel, Germany
| | - Marc D Piroth
- Helios University Hospital Wuppertal, Witten/Herdecke University, Wuppertal, Germany
| | - Felix Sedlmayer
- Paracelsus Medical University Hospital Salzburg, Salzburg, Austria
| | | | - Rolf Sauer
- University Hospital Erlangen, Erlangen, Germany
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