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  • 1
    Online Resource
    Online Resource
    Excluding Lung Tissue from the PTV during Internal Mammary Irradiation. A Safe Technique for OAR-Sparing?
    MDPI AG ; 2021
    In:  Cancers Vol. 13, No. 8 ( 2021-04-18), p. 1951-
    Details
    In: Cancers, MDPI AG, Vol. 13, No. 8 ( 2021-04-18), p. 1951-
    Abstract: The current study aims to determine whether exclusion of lung tissue from planning treatment volume (PTV) is a valid organ at risk (OAR)-sparing technique during internal mammary irradiation (IMNI). Twenty patients with left-sided breast cancer undergoing adjuvant radiotherapy including IMNI after mastectomy or lumpectomy with daily ConeBeam CT (CBCT; median n = 28) were enrolled in the current study. The daily dose distribution of the patients was estimated by recalculating treatment plans on CBCT-scans based on a standard PTV (PTV margin: 5mm-STD) and a modified PTV, which excluded overlapping lung tissue (ExLung). Using 3D-deformable dose accumulation, the dose coverage in the target volume was estimated in dependence of the PTV-margins. The estimated delivered dose in the IMN-CTV was significantly lower for the ExLung PTV compared to the STD PTV: ExLung: V95%: 76.6 ± 22.9%; V90%: 89.6 ± 13.2%, STD: V95%: 95.6 ± 7.4%; V90%: 99.1 ± 2.7%. Daily CBCT imaging cannot sufficiently compensate the anatomic changes and intrafraction movement throughout the treatment. Therefore, to ensure adequate delivery of the prescribed dose to the IMN-CTV, exclusion of lung tissue from the PTV to spare the OARs is not recommended.
    Type of Medium: Online Resource
    ISSN: 2072-6694
    URL: Article
    DOI: 10.3390/cancers13081951
    Language: English
    Publisher: MDPI AG
    Publication Date: 2021
    detail.hit.zdb_id: 2527080-1
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  • 2
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    Interfraction variation and dosimetric changes during image-guided radiation therapy in prostate cancer patients
    Korean Society for Therapeutic Radiology and Oncology ; 2019
    In:  Radiation Oncology Journal Vol. 37, No. 2 ( 2019-06-30), p. 127-133
    Details
    In: Radiation Oncology Journal, Korean Society for Therapeutic Radiology and Oncology, Vol. 37, No. 2 ( 2019-06-30), p. 127-133
    Type of Medium: Online Resource
    ISSN: 2234-1900 , 2234-3156
    URL: Article
    DOI: 10.3857/roj.2018.00514
    Language: English
    Publisher: Korean Society for Therapeutic Radiology and Oncology
    Publication Date: 2019
    detail.hit.zdb_id: 2712565-8
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  • 3
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    PSMA-PET/CT–based Lymph Node Atlas for Prostate Cancer Patients Recurring After Primary Treatment: Clinical Implications for Salvage Radiation Therapy
    Elsevier BV ; 2021
    In:  European Urology Oncology Vol. 4, No. 1 ( 2021-02), p. 73-83
    Details
    In: European Urology Oncology, Elsevier BV, Vol. 4, No. 1 ( 2021-02), p. 73-83
    Type of Medium: Online Resource
    ISSN: 2588-9311
    URL: Article
    DOI: 10.1016/j.euo.2020.04.004
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2021
    detail.hit.zdb_id: 2945338-0
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  • 4
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    Patterns of care for prostate cancer radiotherapy—results from a survey among German-speaking radiation oncologists
    Springer Science and Business Media LLC ; 2021
    In:  Strahlentherapie und Onkologie Vol. 197, No. 11 ( 2021-11), p. 962-970
    Details
    In: Strahlentherapie und Onkologie, Springer Science and Business Media LLC, Vol. 197, No. 11 ( 2021-11), p. 962-970
    Abstract: Emerging moderately hypofractionated and ultra-hypofractionated schemes for radiotherapy (RT) of prostate cancer (PC) have resulted in various treatment options. The aim of this survey was to evaluate recent patterns of care of German-speaking radiation oncologists for RT of PC. Methods We developed an online survey which we distributed via e‑mail to all registered members of the German Society of Radiation Oncology (DEGRO). The survey was completed by 109 participants between March 3 and April 3, 2020. For evaluation of radiation dose, we used the equivalent dose at fractionation of 2 Gy with α/β = 1.5 Gy, equivalent dose (EQD2 [1.5 Gy]). Results Median EQD2(1.5 Gy) for definitive RT of the prostate is 77.60 Gy (range: 64.49–84.00) with median single doses (SD) of 2.00 Gy (range: 1.80–3.00), while for postoperative RT of the prostate bed, median EQD2(1.5 Gy) is 66.00 Gy (range: 60.00–74.00) with median SD of 2.00 Gy (range: 1.80–2.00). For definitive RT, the pelvic lymph nodes (LNs) are treated in case of suspect findings in imaging (82.6%) and/or according to risk formulas/tables (78.0%). In the postoperative setting, 78.9% use imaging and 78.0% use the postoperative tumor stage for LN irradiation. In the definitive and postoperative situation, LNs are irradiated with a median EQD2(1.5 Gy) of 47.52 Gy with a range of 42.43–66.00 and 41.76–62.79, respectively. Conclusion German-speaking radiation oncologists’ patterns of care for patients with PC are mainly in line with the published data and treatment recommendation guidelines. However, dose prescription is highly heterogenous for RT of the prostate/prostate bed, while the dose to the pelvic LNs is mainly consistent.
    Type of Medium: Online Resource
    ISSN: 0179-7158 , 1439-099X
    URL: Article
    DOI: 10.1007/s00066-020-01738-1
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2021
    detail.hit.zdb_id: 2003907-4
    detail.hit.zdb_id: 84983-2
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  • 5
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    Targeted Natural Killer Cell–Based Adoptive Immunotherapy for the Treatment of Patients with NSCLC after Radiochemotherapy: A Randomized Phase II Clinical Trial
    American Association for Cancer Research (AACR) ; 2020
    In:  Clinical Cancer Research Vol. 26, No. 20 ( 2020-10-15), p. 5368-5379
    Details
    In: Clinical Cancer Research, American Association for Cancer Research (AACR), Vol. 26, No. 20 ( 2020-10-15), p. 5368-5379
    Abstract: Non–small cell lung cancer (NSCLC) is a fatal disease with poor prognosis. A membrane-bound form of Hsp70 (mHsp70) which is selectively expressed on high-risk tumors serves as a target for mHsp70-targeting natural killer (NK) cells. Patients with advanced mHsp70-positive NSCLC may therefore benefit from a therapeutic intervention involving mHsp70-targeting NK cells. The randomized phase II clinical trial (EudraCT2008-002130-30) explores tolerability and efficacy of ex vivo–activated NK cells in patients with NSCLC after radiochemotherapy (RCT). Patients and Methods: Patients with unresectable, mHsp70-positive NSCLC (stage IIIa/b) received 4 cycles of autologous NK cells activated ex vivo with TKD/IL2 [interventional arm (INT)] after RCT (60–70 Gy, platinum-based chemotherapy) or RCT alone [control arm (CTRL)] . The primary objective was progression-free survival (PFS), and secondary objectives were the assessment of quality of life (QoL, QLQ-LC13), toxicity, and immunobiological responses. Results: The NK-cell therapy after RCT was well tolerated, and no differences in QoL parameters between the two study arms were detected. Estimated 1-year probabilities for PFS were 67% [95% confidence interval (CI), 19%–90%] for the INT arm and 33% (95% CI, 5%–68%) for the CTRL arm (P = 0.36, 1-sided log-rank test). Clinical responses in the INT group were associated with an increase in the prevalence of activated NK cells in their peripheral blood. Conclusions: Ex vivo TKD/IL2-activated, autologous NK cells are well tolerated and deliver positive clinical responses in patients with advanced NSCLC after RCT.
    Type of Medium: Online Resource
    ISSN: 1078-0432 , 1557-3265
    URL: Article
    DOI: 10.1158/1078-0432.CCR-20-1141
    RVK:
    XA 36791
    Language: English
    Publisher: American Association for Cancer Research (AACR)
    Publication Date: 2020
    detail.hit.zdb_id: 1225457-5
    detail.hit.zdb_id: 2036787-9
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  • 6
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    Adjuvant versus early salvage radiotherapy: outcome of patients with prostate cancer treated with postoperative radiotherapy after radical prostatectomy
    Springer Science and Business Media LLC ; 2019
    In:  Radiation Oncology Vol. 14, No. 1 ( 2019-12)
    Details
    In: Radiation Oncology, Springer Science and Business Media LLC, Vol. 14, No. 1 ( 2019-12)
    Abstract: Adjuvant (ART) and salvage radiotherapy (SRT) are two common concepts to enhance biochemical relapse free survival (BCRFS) in patients with prostate cancer (PC). We analyzed differences in outcome between ART and SRT in patients with steep decline of PSA-levels after surgery to compare outcome. Methods We evaluated 253 patients treated with postoperative RT with a median age of 66 years (range 42–85 years) treated between 2004 and 2014. Patients with additive radiotherapy due to PSA persistence and patients in the SRT group, who did not achieve a postoperative PSA level  〈 0.1 ng/mL were excluded. Hence, data of 179 patients was evaluated. We used propensity score matching to build homogenous groups. A Cox regression model was used to determine differences between treatment options. Median follow-up was 32.5 months (range 1.4–128.0 months). Results Early SRT at PSA levels 〈 0.3 ng/mL was associated with significant longer BCRFS than late SRT (HR: 0.32, 95%-CI: 0.14–0.75, p  = 0.009). Multiple Cox regression showed pre-RT PSA level, tumor stage, and Gleason score as predictive factors for biochemical relapse. In the overall group, patients treated with either ART or early SRT showed no significant difference in BCRFS (HR: 0.17, 95%-CI: 0.02–1.44, p  = 0.1). In patients with locally advanced PC (pT3/4) BCRFS was similar in both groups as well (HR: 0.21, 95%-CI:0.02–1.79, p  = 0.15). Conclusion For patients with PSA-triggered follow-up, close observation is essential and early initiation of local treatment at low PSA levels ( 〈 0.3 ng/mL) is beneficial. Our data suggest, that SRT administered at early PSA rise might be equieffective to postoperative ART in patients with locally advanced PC. However, the individual treatment decision must be based on any adverse risk factors and the patients’ postoperative clinical condition. Study registration The present work is approved by the Ethics Commission of the Technical University of Munich (TUM) and is registered with the project number 320/14.
    Type of Medium: Online Resource
    ISSN: 1748-717X
    URL: Article
    DOI: 10.1186/s13014-019-1391-0
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2019
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  • 7
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    Online Resource
    A survey among German-speaking radiation oncologists on PET-based radiotherapy of prostate cancer
    Springer Science and Business Media LLC ; 2021
    In:  Radiation Oncology Vol. 16, No. 1 ( 2021-12)
    Details
    In: Radiation Oncology, Springer Science and Business Media LLC, Vol. 16, No. 1 ( 2021-12)
    Abstract: Positron emission tomography-(PET) has evolved as a powerful tool to guide treatment for prostate cancer (PC). The aim of this survey was to evaluate the acceptance and use of PET—especially with prostate-specific membrane antigen (PSMA) targeting tracers—in clinical routine for radiotherapy (RT) and the impact on target volume definition and dose prescription. Methods We developed an online survey, which we distributed via e-mail to members of the German Society of Radiation Oncology (DEGRO). The survey included questions on patterns of care of RT for PC with/without PET. For evaluation of doses we used the equivalent dose at fractionation of 2 Gy with α/β = 1.5 Gy [EQD2(1.5 Gy)]. Results From 109 participants, 78.9% have the possibility to use PET for RT planning. Most centers use PSMA-targeting tracers (98.8%). In 39.5%, PSMA-PET for biochemical relapse after prior surgery is initiated at PSA ≥ 0.5 ng/mL, while 30.2% will perform PET at ≥ 0.2 ng/mL (≥ 1.0 ng/mL: 16.3%, ≥ 2.0 ng/mL: 2.3%, regardless of PSA: 11.7%). In case of PET-positive local recurrence (LR) and pelvic lymph nodes (LNs), 97.7% and 96.5% of the participants will apply an escalated dose. The median total dose in EQD2(1.5 Gy) was 70.00 Gy (range: 56.89–85.71) for LR and 62.00 Gy (range: 52.61–80.00) for LNs. A total number of ≤ 3 (22.0%) or ≤ 5 (20.2%) distant lesions was most often described as applicable for the definition as oligometastatic PC. Conclusion PSMA-PET is widely used among German radiation oncologists. However, specific implications on treatment planning differ among physicians. Therefore, further trials and guidelines for PET-based RT are warranted.
    Type of Medium: Online Resource
    ISSN: 1748-717X
    URL: Article
    DOI: 10.1186/s13014-021-01811-8
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2021
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  • 8
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    Report on planning comparison of VMAT, IMRT and helical tomotherapy for the ESCALOX-trial pre-study
    Springer Science and Business Media LLC ; 2020
    In:  Radiation Oncology Vol. 15, No. 1 ( 2020-12)
    Details
    In: Radiation Oncology, Springer Science and Business Media LLC, Vol. 15, No. 1 ( 2020-12)
    Abstract: The ESCALOX trial was designed as a multicenter, randomized prospective dose escalation study for head and neck cancer. Therefore, feasibility of treatment planning via different treatment planning systems (TPS) and radiotherapy (RT) techniques is essential. We hypothesized the comparability of dose distributions for simultaneous integrated boost (SIB) volumes respecting the constraints by different TPS and RT techniques. Methods CT data sets of the first six patients (all male, mean age: 61.3 years) of the pre-study (up to 77 Gy) were used for comparison of IMRT, VMAT, and helical tomotherapy (HT). Oropharynx was the primary tumor location. Normalization of the three step SIB (77 Gy, 70 Gy, 56 Gy) was D95% = 77 Gy. Coverage (CVF), healthy tissue conformity index (HTCI), conformation number (CN), and dose homogeneity (HI) were compared for PTVs and conformation index (COIN) for parotids. Results All RT techniques achieved good coverage. For SIB77Gy, CVF was best for IMRT and VMAT, HT achieved highest CN followed by VMAT and IMRT. HT reached good HTCI value, and HI compared to both other techniques. For SIB70Gy, CVF was best by IMRT. HTCI favored HT, consequently CN as well. HI was slightly better for HT. For SIB56Gy, CVF resulted comparably. Conformity favors VMAT as seen by HTCI and CN. Dmean of ipsilateral and contralateral parotids favor HT. Conclusion Different TPS for dose escalation reliably achieved high plan quality. Despite the very good results of HT planning for coverage, conformity, and homogeneity, the TPS also achieved acceptable results for IMRT and VMAT. Trial registration ClinicalTrials.gov Identifier: NCT 01212354, EudraCT-No.: 2010-021139-15. ARO: ARO 14-01
    Type of Medium: Online Resource
    ISSN: 1748-717X
    URL: Article
    DOI: 10.1186/s13014-020-01693-2
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2020
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  • 9
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    Stereotactic Body Radiotherapy (SBRT) für die Behandlung von Knochenmetastasen beim oligometastasierten Prostatakarzinom
    Georg Thieme Verlag KG ; 2020
    In:  Aktuelle Urologie Vol. 51, No. 03 ( 2020-06), p. 265-270
    Details
    In: Aktuelle Urologie, Georg Thieme Verlag KG, Vol. 51, No. 03 ( 2020-06), p. 265-270
    Abstract: Hintergrund Die lokale Strahlentherapie von Metastasen bei Prostatakarzinompatienten in der oligometastasierten Situation hat in den letzten Jahren an Bedeutung gewonnen. Um die Wirkung auf das Outcome weiter zu evaluieren haben wir oligometastasierte Prostatakarzinompatienten, die eine stereotaktische Strahlentherapie (SBRT) von Knochenmetastasen erhielten, untersucht. Patienten und Methodik Es wurden 24 Patienten mit insgesamt 30 Knochenmetastasen eingeschlossen und das Ansprechen auf die SBRT (biochemisch und bildgebend) sowie das progressionsfreie Überleben und das Zeitintervall bis zum Beginn einer antihormonellen Therapie (aHT) untersucht. Ergebnisse Das mittlere Follow-Up-Intervall nach Abschluss der SBRT lag bei 32,7 Monaten (1,4 – 84 Monate). Die SBRT wurde ohne das Auftreten von Akut- oder Spät-Nebenwirkungen sehr gut vertragen. Bei 16 Patienten kam es zu einem Abfall des PSA-Wertes von im Mittel 4,58 ng/ml (0,05 – 50,25 ng/ml) vor der SBRT auf 1,19 ng/ml (0,01 – 8,85 ng/ml) nach Abschluss der SBRT. Das mittlere biochemische progressionsfreie Überleben dieser Patienten betrug 17,6 Monate (0,7 – 85,0 Monate). 6 Patienten erhielten bereits vor der SBRT oder parallel dazu eine aHT. Bei 10 Patienten wurde die aHT nach einem mittleren Intervall von 20,6 Monaten (1,8 – 85,0 Monate) nach Abschluss der SBRT initiiert, während weitere 6 Patienten keine aHT während des gesamten Beobachtungszeitraumes erhielten. Bei 18 der 30 Metastasen konnte im Bereich der SBRT im PSMA-PET eine Abnahme der PSMA-Expression im Sinne eines partiellen funktionellen Ansprechens beobachtet werden, während bei 5 Patienten nach SBRT eine gleichbleibende PSMA-Überexpression bestand und bei 7 Patienten keine PSMA-Bildgebung vorlag. Bei 17 Patienten kam es im Mittel nach 16,2 Monaten (1,6 – 40,6 Monate) bildgebend zum Progress der Fernmetastasierung, während 3 Patienten ein Lokalrezidiv in der Prostataloge zeigten. Zusammenfassung Die SBRT von Knochenmetastasen bei oligometastasierten Prostatakarzinompatienten stellt eine effektive und gut verträgliche Therapie dar, durch die eine hohe lokale Kontrolle im Bereich der Metastasen sowie eine zeitliche Verzögerung des Beginns oder der Eskalation einer Systemtherapie erzielt werden kann. Jedoch zeigt die hohe Rate an Progression der Fernmetastasierung die Wichtigkeit der richtigen Patientenselektion auf und ggf. die Notwendigkeit der Kombination mit einer aHT.
    Type of Medium: Online Resource
    ISSN: 0001-7868 , 1438-8820
    URL: Article
    DOI: 10.1055/a-1140-5646
    RVK:
    XA 17482
    Language: German
    Publisher: Georg Thieme Verlag KG
    Publication Date: 2020
    detail.hit.zdb_id: 2038466-X
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  • 10
    Online Resource
    Online Resource
    Stereotactic Body Radiotherapy (SBRT) für die Behandlung von Knochenmetastasen beim oligometastasierten Prostatakarzinom
    Georg Thieme Verlag KG ; 2020
    In:  TumorDiagnostik & Therapie Vol. 41, No. 06 ( 2020-08), p. 393-398
    Details
    In: TumorDiagnostik & Therapie, Georg Thieme Verlag KG, Vol. 41, No. 06 ( 2020-08), p. 393-398
    Abstract: Hintergrund Die lokale Strahlentherapie von Metastasen bei Prostatakarzinompatienten in der oligometastasierten Situation hat in den letzten Jahren an Bedeutung gewonnen. Um die Wirkung auf das Outcome weiter zu evaluieren, haben wir oligometastasierte Prostatakarzinompatienten, die eine stereotaktische Strahlentherapie (SBRT) von Knochenmetastasen erhielten, untersucht. Patienten und Methodik Es wurden 24 Patienten mit insgesamt 30 Knochenmetastasen eingeschlossen und das Ansprechen auf die SBRT (biochemisch und bildgebend) sowie das progressionsfreie Überleben und das Zeitintervall bis zum Beginn einer antihormonellen Therapie (aHT) untersucht. Ergebnisse Das mittlere Follow-up-Intervall nach Abschluss der SBRT lag bei 32,7 Monaten (1,4–84 Monate). Die SBRT wurde ohne das Auftreten von Akut- oder Spät-Nebenwirkungen sehr gut vertragen. Bei 16 Patienten kam es zu einem Abfall des PSA-Wertes von im Mittel 4,58 ng/ml (0,05–50,25 ng/ml) vor der SBRT auf 1,19 ng/ml (0,01–8,85 ng/ml) nach Abschluss der SBRT. Das mittlere biochemische progressionsfreie Überleben dieser Patienten betrug 17,6 Monate (0,7–85,0 Monate). 6 Patienten erhielten bereits vor der SBRT oder parallel dazu eine aHT. Bei 10 Patienten wurde die aHT nach einem mittleren Intervall von 20,6 Monaten (1,8–85,0 Monate) nach Abschluss der SBRT initiiert, während weitere 6 Patienten keine aHT während des gesamten Beobachtungszeitraums erhielten. Bei 18 der 30 Metastasen konnte im Bereich der SBRT im PSMA-PET eine Abnahme der PSMA-Expression im Sinne eines partiellen funktionellen Ansprechens beobachtet werden, während bei 5 Patienten nach SBRT eine gleichbleibende PSMA-Überexpression bestand und bei 7 Patienten keine PSMA-Bildgebung vorlag. Bei 17 Patienten kam es im Mittel nach 16,2 Monaten (1,6–40,6 Monate) bildgebend zum Progress der Fernmetastasierung, während 3 Patienten ein Lokalrezidiv in der Prostataloge zeigten. Zusammenfassung Die SBRT von Knochenmetastasen bei oligometastasierten Prostatakarzinompatienten stellt eine effektive und gut verträgliche Therapie dar, durch die eine hohe lokale Kontrolle im Bereich der Metastasen sowie eine Verzögerung des Beginns oder der Eskalation einer Systemtherapie erzielt werden kann. Jedoch zeigt die hohe Rate an Progression der Fernmetastasierung die Wichtigkeit der richtigen Patientenselektion auf und ggf. die Notwendigkeit der Kombination mit einer aHT.
    Type of Medium: Online Resource
    ISSN: 0722-219X , 1439-1279
    URL: Article
    DOI: 10.1055/a-1202-9478
    RVK:
    XA 10000
    Language: German
    Publisher: Georg Thieme Verlag KG
    Publication Date: 2020
    detail.hit.zdb_id: 604664-2
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