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ABSTRACT: Tumor recurrence after surgery for cervical carcinoma is associated with high fatality and morbidity, forming a major therapeutic challenge. This paper presents our experience with treatment of this patient group by salvage radiotherapy with curative intent.
Thirty-five patients with a pelvic recurrence after hysterectomy received high-dose radiotherapy. A retrospective analysis of long-term outcome and prognostic factors was performed.
After a median follow-up period of 12.1 years, actuarial 2-,5- and 10-year overall survival rates were 66%, 43% and 33%; disease-free survival rates were 62%, 45% and 41%, respectively. Pelvic control rates at 2-,5- and 10-years were 77%, 69% and 62%. Unfavorable prognostic factors on univariate analysis for survival were: recurrence extending to the pelvic wall versus central recurrence, early recurrence after surgery, external boost versus brachytherapy boost, low total dose and high age. Only a brachytherapy boost and a long interval between surgery and recurrence were significant on multivariate analysis. Severe complications (> or = grade 3) were seen in 6 patients (17%; actuarial after 5 years, 21%).
Salvage radiotherapy for recurrent cervical carcinoma following surgery may result in 40-50% long-term disease-free survival and an acceptable risk of severe treatment complications, even in patient with recurrences extending to the pelvic wall.
Radiotherapy and Oncology 02/2008; 89(2):197-204. · 5.58 Impact Factor
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ABSTRACT: Investigation of the predictive value of a radiosurgery-relevant treatment of glioblastoma spheroids. Organotypic multicellular spheroids were cultured and irradiated (20 Gy). Morphology, apoptosis and immunohistochemical expression of p53, p21, MIB-1, TGF-beta and VEGF were examined 4 h, 24 h, 7 days, and 14 days following treatment. Cell proliferation decreased, while apoptosis was increased. No morphological damage was observed. p53 expression was significantly increased after 4 h. TGF-beta and VEGF expression were only slightly altered. Particularly early changes in proliferation and apoptosis can be observed in spheroids. Individual response differences suggest spheroids of human gliomas to be useful for monitoring radiosurgery effects.
Oncology Reports 03/2004; 11(2):477-85. · 1.84 Impact Factor
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ABSTRACT: To evaluate the feasibility and efficacy of a concomitant partial bladder boost schedule in radiotherapy for invasive bladder cancer, coupling a limited boost volume with shortening of the overall treatment time.
Between 1994 and 1999, 50 patients with a T2-T4 N0M0 transitional cell carcinoma of the bladder received radiotherapy delivered in a short overall treatment time with a concomitant boost technique. With this technique a dose of 40 Gy in 2-Gy fractions was administered to the small pelvis with a concomitant boost limited to the bladder tumor area plus margin of 15 Gy in fractions of 0.75 Gy. The total tumor dose was 55 Gy in 20 fractions in 4 weeks. Toxicity was scored according to EORTC/RTOG toxicity criteria.
The feasibility of the treatment was good. Severe acute toxicity >/=G3 was observed in seven patients (14%). Severe late toxicity >/=G3 was observed in six patients (13%). Thirty-seven patients (74%) showed a complete and five (10 %) a partial remission after treatment. The actuarial 3-year freedom of local progression was 55%.
In external radiotherapy for muscle invasive bladder cancer a concomitant boost technique coupling a partial bladder boost with shortening of the overall treatment time provides a high probability of local control with acceptable toxicity.
Radiotherapy and Oncology 08/2003; 68(1):75-80. · 5.58 Impact Factor
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ABSTRACT: To assess the spatial variability of a bladder tumor relative to the planning target volume boundaries during radical radiotherapy, and furthermore to develop strategies to reduce spatial variability.
Seventeen patients with solitary T2-T4N0M0 bladder cancer were treated with a technique delivering 40 Gy/2 Gy in 20 fractions to the whole bladder with a concomitant boost to the bladder tumor of 20 Gy in 1 Gy fractions in an overall time of 4 weeks. CT scans were made weekly, immediately after treatment, and matched with the planning CT scan. Spatial variability of the tumor, as well as bladder volume and rectal diameter, were scored for each patient each week.
In 65% of patients, a part of the tumor appeared outside the planning target volume boundaries at least one time during the course of radiotherapy. No consistent relation of this variability with time was found. Bladder volumes and rectal diameters showed marked variability during the course of treatment. A large initial bladder volume and rectal diameter predicted a large volume variation and a large tumor spatial variability.
In this study, a margin of 1.5 to 2 cm seemed to be inadequate in 65% of the patients with respect to spatial variability. Bladder volume and rectal diameter were found to be predictive for spatial variability of a bladder tumor during concomitant boost radiotherapy.
International Journal of Radiation OncologyBiologyPhysics 04/2003; 55(3):835-41. · 4.11 Impact Factor
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ABSTRACT: Background: To analyze prognostic factors in patients with a glioblastoma multiforme treated in an academic institute over the last 10 years. Patients and Method: From 1988 to 1998, 198 patients with pathologically confirmed glioblastoma multiforme were analyzed. Five radiation schedules were used mainly based on pretreatment selection criteria: 1. 60 Gy in 30 fractions followed by an interstitial iridium-192 (Ir-192) boost for selected patients with a good performance and a small circumscribed tumor, 2. 66 Gy in 33 fractions for good performance patients, 3. 40 Gy in eight fractions or 4. 28 Gy in four fractions for poor prognostic patients and 5. no irradiation. Results: Median survival was 16 months, 7 months, 5.6 months, 6.6 months and 1.8 months for the groups treated with Ir-192, 66 Gy, 40 Gy, 28 Gy and the group without treatment, respectively. No significant improvement in survival was encountered over the last 10 years. At multivariate analysis patients treated with a hypofractional scheme showed a similar survival probability and duration of palliative effect compared to the conventionally fractionated group. The poor prognostic groups receiving radiotherapy had a highly significant better survival compared to the no-treatment group. Patients treated with an Ir-192 boost had a better median survival compared to a historical group matched on selection criteria but without boost treatment (16 vs 9.7 months, n. s.). However, survival at 2 years was similar. Analysis on pretreatment characteristics at multivariate analysis revealed age, neurological performance, addition of radiotherapy, total resection, tumor size post surgery and deterioration before start of radiotherapy (borderline) as significant prognostic factors for survival. Conclusion: Despite technical developments in surgery and radiotherapy over the last 10 years, survival of patients with a glioblastoma multiforme has not improved in our institution. The analysis of prognostic factors corresponded well with data from the literature. A short hypofractionated scheme seems to be a more appropriate treatment for patients with intermediate or poor prognosis as compared to a conventional scheme. The benefit in median survival for patients treated with an interstitial boost is partly explained by patient selection. Since there were no long-term survivors with this boost treatment, its clinical value, if there is one, is still limited. Hintergrund: Es wurden Prognosefaktoren bei Patienten mit Glioblastoma multiforme ermittelt, die ber einen Zeitraum von 10 Jahren in einer Institution behandelt wurden. Patienten und Methoden: Die Analyse beruht auf 198 Patienten, die von 1988 bis 1998 nach histologischer Sicherung fnf verschiedenen Bestrahlungsschemata zugefhrt wurden: 1. 60 Gy in 30 Fraktionen gefolgt von einem Ir-192-(LDR-)Boost bei selektierten Patienten mit gutem Performance-Status und kleinen Tumoren, 2. 66 Gy in 33 Fraktionen bei Patienten mit gutem Performance-Status, 3. 40 Gy in acht Fraktionen oder 4. 28 Gy in vier Fraktionen bei Patienten in schlechtem Allgemeinzustand, 5. keine Bestrahlung. Ergebnisse: Das mediane berleben betrug 16 Monate fr die Ir-192-Boost-Gruppe, 7 Monate nach 66 Gy, 5,6 Monate nach 40 Gy, 6,6 Monate nach 28 Gy und 1,8 Monate fr unbehandelte Patienten. ber den Behandlungszeitraum von 10 Jahren waren keine signifikanten Verbesserungen der berlebensraten zu verzeichnen. In der Multivarianzanalyse wiesen Patienten, die hypofraktioniert bestrahlt wurden, hnliche berlebenswahrscheinlichkeiten und Palliativeffekte auf wie Patienten nach konventioneller Bestrahlung. Die Strahlentherapie fhrte bei Patienten mit schlechtem Allgemeinzustand zu signifikanten berlebenszeitverbesserungen im Vergleich zu Patienten ohne Behandlung. Verglichen mit einer historischen Kontrollgruppe ohne Ir-192-Boost-Bestrahlung hatten Patienten nach Ir-192-Boost-Bestrahlung nicht signifikante Verbesserungen der medianen berlebensraten (16 Monate v. 9,7 Monate), wobei sich jedoch die 2-Jahres-berlebensraten wieder angeglichen. In der Multivarianzanalyse waren Alter, neurologischer Status, Radiotherapie, totale Resektion, Resttumorgre nach Resektion und Verschlecherung vor Anfang der Strahlentherapie (Grenzwert) fr das berleben signifikante Prognosefaktoren. Schlussfolgerungen: Trotz technischer Entwicklungen sowohl im Bereich der Neurochirurgie als auch der Radiotherapie verbesserten sich die berlebensraten von Patienten mit Glioblastoma multiforme in den letzten 10 Jahren in unserer Institution nicht. Die Analyse der Prognosefaktoren korreliert gut mit Angaben aus der Literatur. Fr Patienten mit intermedirer oder schlechter Prognose ist ein abgekrztes hypofraktioniertes Bestrahlungsregime eine angemessene Therapieoption. Die beobachtete Verbesserung der medianen berlebensraten nach Ir-192-Boost ist zumindest teilweise durch eine Patientenselektion erklrbar. Da diese Behandlungsform zu keinem Langzeitberleben fhrt, ist der klinische Stellenwert weiterhin unklar.
Strahlentherapie und Onkologie 05/2001; 177(6):283-290. · 3.56 Impact Factor
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ABSTRACT: Purpose: To compare conventional fractionation with hypofractionation in patients with a glioblastoma multiforme. Endpoints of the analysis are overall survival and palliative effect.Materials and methods: From 1988 to 1998, 155 patients with pathologically confirmed glioblastoma multiforme were prospectively analysed. Patients without irradiation and patients receiving an interstitial boost were excluded from this analysis. Three different radiation schemes were used in subsequent periods; 33×2, 8×5 and 4×7 Gy. In the last 5 years a scheme of 4×7 Gy conformal irradiation was given to poor prognosis patients. The more favourable group received the conventionally fractionated scheme up to 66 Gy.Results: Median survival was 7, 5.6 and 6.6 months for the 33×2, 8×5 and 4×7 Gy, respectively. In general, patients in the hypofractionation group had far worse prognostic factors compared with patients treated with the conventional scheme. The period of neurological improvement or stabilisation was similar between the 4×7 and 33×2 Gy group.Conclusion: An extreme hypofractionation scheme of 4×7 Gy conformal irradiation in poor prognostic glioblastoma patients is well tolerated, convenient for the patient and provides equal palliation without negative effects on survival compared with conventional fractionation.
Radiotherapy and Oncology.
