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ABSTRACT: BACKGROUND: While evidence on safety and efficacy of primary hypofractionated radiotherapy in prostate cancer is accumulating, data on postoperative hypofractionated treatment of the prostate bed and of the pelvic lymph nodes is still scarce. This phase II trial was initiated to investigate safety and feasibility of hypofractionated treatment of the prostate bed alone or with the pelvic lymph nodes. METHODS: A total of 80 prostate cancer patients with the indication for adjuvant radiotherapy will be enrolled, where 40 patients with a low risk of lymph node involvement (arm 1) and another 40 patients with a high risk of lymph node involvement (arm 2) will each receive 54 Gy in 18 fractions to the prostate bed. Arm 2 will be given 45 Gy to the pelvic lymph nodes additionally. Helical Tomotherapy and daily image guidance wil be used. DISCUSSION: This trial was initiated to substantiate data on hypofractionated treatment of the prostate bed and generate first data on adjuvant hypofractionated radiotherapy of the pelvic lymph nodes.Trial registrationClinicalTrials.gov; NCT01620710.
BMC Cancer 10/2012; 12(1):504. · 3.01 Impact Factor
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ABSTRACT: To retrospectively access outcome and toxicity of whole brain radiotherapy (WBRT) in patients with multiple brain metastases (BM) from malignant melanoma (MM).
Results of 87 patients (median age 58 years; 35 female, 52 male) treated by WBRT for BM of MM between 2000 and 2011 were reviewed. Total dose applied was either 30 Gy in 10 fractions (n = 56) or 40 Gy in 20 fractions (n = 31). All but 9 patients suffered from extra-cerebral metastases. Prior surgical resection of BM was performed in 18 patients, salvage stereotactic radiosurgery in 13 patients.
Mean follow-up was 8 months (range, 0-57 months), the 6- and 12-months overall-(OS) survival rates were 29.2% and 16.5%, respectively. The median OS was 3.5 months. In cerebral follow-up imaging 6 (11) patients showed a complete (partial) remission, while 11 (17) patients had stable disease (intra-cerebral tumor progression). In comparison of total dose, the group treated with 40 Gy in 20 fractions achieved a significant longer OS (p = 0.003, median 3.1 vs. 5.6 months). Furthermore, DS-GPA score (p < 0.001) as well as RPA class (p < 0.001) influenced significantly on OS and patients had a significantly longer OS after surgical resection (p = 0.001, median 3.0 vs. 5.8 months, multivariate p = 0.007). Having extra-cerebral metastases didn't significantly impact on OS (p = 0.21).
Treatment of BM from MM with WBRT is tolerated well and some remissions of BM could be achieved. An advantage for higher treatment total doses was seen. However, outcome is non-satisfying, and further improvements in treatment of BM from MM are warranted.
Radiation Oncology 08/2012; 7:130. · 2.32 Impact Factor
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ABSTRACT: Background and Purpose:
Recurrent brain metastases or new brain lesions after whole-brain radiotherapy represent a therapeutic challenge. While several
treatment methods for single or few lesions have been described, options for multiple lesions are limited. This case report
is intended to show an approach of whole-brain reirradiation with a simultaneous multifocal integrated boost using helical
tomotherapy. Technique, feasibility, and acute side effects are presented.
Patients and Methods:
Two patients with multiple relapsed brain metastases (eight and eleven lesions) were reirradiated after previous whole-brain
radiotherapy (total dose of 40 Gy 18 months before). Whole-brain reirradiation was performed using helical tomotherapy with
a total dose of 15 Gy (single dose 1.5 Gy) and a multifocal simultaneous integrated boost with a total dose of 30 Gy (single
dose 3 Gy) to the brain lesions. The boost planning target volume was delineated around the lesions visible on MRI plus a
2-mm margin. Follow-up of these patients was 6 and 12 months.
Results:
Radiation plans with excellent conformity and homogeneity were obtained. High dose exposure to normal brain tissue was kept
minimal. Mean radiation time was 13 min. The only acute side effect observed was a mild headache over 2 days at the end of
treatment. So far, no further side effects and no signs of recurrence have been observed.
Conclusion:
Helical tomotherapy offers new treatment options for the reirradiation of multiple brain metastases. The number of cases treated
with the described protocol is very limited but it is considered a promising option for patients that have responded well
to the initial radiotherapy and are in a good performance status.
Hintergrund und Ziel:
Rezidive von Hirnmetastasen oder neue Herde nach vorangegangener Ganzhirnbestrahlung stellen eine therapeutische Herausforderung
dar. Während mehrere Techniken zur Behandlung singulärer oder weniger Läsionen beschrieben wurden, sind die Optionen bei multiplen
Metastasen limitiert. Dieser Fallbericht beschreibt einen Ansatz der Ganzhirnrebestrahlung mit simultanem multifokalem integriertem
Boost mittels helikaler Tomotherapie. Technik, Machbarkeit und akute Nebenwirkungen werden berichtet.
Patienten und Methodik:
Zwei Patienten mit multiplen Rezidiven von Hirnmetastasen (acht bzw. elf Herde) wurden nach vorangegangener Ganzhirnradiotherapie
rebestrahlt (40 Gy 18 Monate zuvor). Mittels helikaler Tomotherapie wurden das Neurokranium mit einer Dosis von 15 Gy (Einzeldosis
1,5 Gy) und die Metastasen selbst mit einem multifokalen simultanen integrierten Boost mit einer Dosis von 30 Gy (Einzeldosis
3 Gy) rebestrahlt. Das Planungszielvolumen des Boosts wurde mit einem 2-mm-Sicherheitssaum um die Kontrastmittelaufnahme im
MRT definiert. Der Nachbeobachtungszeitraum dieser Patienten betrug 6 bzw. 12 Monate.
Ergebnisse:
Es konnten Bestrahlungspläne mit hervorragender Konformität und Homogenität erreicht werden. Die Hochdosisbelastung des Hirnparenchyms
konnte gering gehalten werden. Die mittlere Bestrahlungszeit betrug 13 min. Einzige Akutnebenwirkung war ein geringer Kopfschmerz
zum Ende der Behandlung. Es wurden keine weiteren Toxizitäten oder Zeichen eines Rezidivs beobachtet.
Schlussfolgerung:
Die helikale Tomotherapie eröffnet neue Optionen in der Rebestrahlung multipler Hirnmetastasen. Die Anzahl der so behandelten
Patienten ist sehr limitiert, dennoch erscheint diese Behandlungsmöglichkeit sehr vielversprechend für Patienten, die auf
die initiale Therapie gut angesprochen haben.
Strahlentherapie und Onkologie 04/2012; 185(2):89-93. · 3.56 Impact Factor
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ABSTRACT: High-dose irradiation or reirradiation of spinal and paraspinal tumors is a challenge particularly in the presence of metal artifacts after surgery. Image-guided advanced intensity-modulated radiotherapy delivers high-dose radiation to the tumor sparing the spinal cord. Precise delineation of the spinal cord is necessary treating para- and intraspinal tumors with a sufficient dose.
The use of myelo-CT was evaluated in 23 patients with spinal and paraspinal tumors. All patients had had previous surgery with metal implants in the radiation area. All patients had an indication for high-dose irradiation. Treatment planning was performed using nonenhanced and contrast-enhanced myelo-CT in the same position and immobilization and both CT scans were matched. Treatment was performed by using a tomotherapy treatment unit.
Contouring of the myelon in all slices of the myelo-CT was possible in 20 of 23 patients. All these patients were treated with doses of median 69.4 Gy in 2 Gy/1.8 Gy single doses using daily image guidance. One patient received an integrated boost with a TD/SD of 70/2.3 Gy. No side effects have been observed so far during a median follow-up of 15.5 months. No separation between tumor and myelon could be observed in 3 patients.
Myelo-CT offers a distinct delineation of the myelon and the paraspinal tumor in case of artifacts due to metal implants after surgery. Using this tool in combination with advanced image guidance and IMRT techniques, patients with relatively radioresistent paraspinal tumors might have the chance of improved local control using higher target doses.
Strahlentherapie und Onkologie 06/2011; 187(7):416-20. · 3.56 Impact Factor
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Vasileios Askoxylakis,
Alexandra D Jensen,
Matthias F Häfner,
Leonie Fetzner, Florian Sterzing,
Joerg Heil,
Christof Sohn,
Johannes Hüsing,
Uta Tiefenbacher,
Frederik Wenz,
Jürgen Debus,
Holger Hof
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ABSTRACT: Radiation therapy is an essential modality in the treatment of breast cancer. Addition of radiotherapy to surgery has significantly increased local control and survival rates of the disease. However, radiotherapy is also associated with side effects, such as tissue fibrosis or enhanced vascular morbidity. Modern radiotherapy strategies, such as intensity modulated radiotherapy (IMRT), can shorten the overall treatment time by integration of the additional tumor bed boost significantly. To what extent this might be possible without impairing treatment outcome and cosmetic results remains to be clarified.
The IMRT-MC2 study is a prospective, two armed, multicenter, randomized phase-III-trial comparing intensity modulated radiotherapy with integrated boost to conventional radiotherapy with consecutive boost in patients with breast cancer after breast conserving surgery. 502 patients will be recruited and randomized into two arms: patients in arm A will receive IMRT in 28 fractions delivering 50.4 Gy to the breast and 64.4 Gy to the tumor bed by integrated boost, while patients in arm B will receive conventional radiotherapy of the breast in 28 fractions to a dose of 50.4 Gy and consecutive boost in 8 fractions to a total dose of 66.4 Gy.
Primary objectives of the study are the evaluation of the cosmetic results 6 weeks and 2 years post treatment and the 2- and 5-year local recurrence rates for the two different radiotherapy strategies. Secondary objectives are long term overall survival, disease free survival and quality of life.
ClinicalTrials.gov Protocol ID: NCT01322854.
BMC Cancer 06/2011; 11:249. · 3.01 Impact Factor
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ABSTRACT: Aim was to access outcome and toxicity of repeated linac-based radiosurgery in incompletely obliterated cerebral AVM.
Between 1998 and 2008, 11 patients were treated with repeated radiosurgery. The median dose to the 80%-isodose was 15 Gy (range, 12-18 Gy). During initial radiosurgery the median dose was 18 Gy (range, 9-22 Gy).
The median time interval between initial radiosurgery and re-treatment was 9 years (range, 4-16 years). The median follow-up was 26 months (range, 2-115 months). Treatment response was seen in 8 patients (89%). Complete (partial) obliteration was achieved in 5 (3) patients (56%, 33%, respectively).The median time to complete obliteration was 26 months (range, 5-45 months). Pre-existing neurological symptoms improved in 2 patients (18%), were stable in 7 patients (64%) and worsened in 2 patients (18%). Prevalence of intracranial hemorrhage was 9% (1/11). Post-re-treatment intracranial hemorrhage rate was 2.7% (1/38 years at risk). During follow-up, no secondary malignancies or toxicity>grade III were observed.
Repeated linac-based radiosurgery in incompletely obliterated cerebral AVM is an effective treatment option with a high rate of treatment response and an acceptable risk for side effects. Marginal doses above 15 Gy might further improve the rate of complete obliterations.
Radiotherapy and Oncology 02/2011; 98(2):217-22. · 5.58 Impact Factor
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ABSTRACT: Abstract Background The prognosis for patients with advanced FIGO stage III epithelial ovarian cancer remains poor despite the aggressive standard treatment, consisting of maximal cytoreductive surgery and platinum-based chemotherapy. The median time to recurrence is less than 2 years, with a 5-years survival rate of -20-25%. Recurrences of the disease occur mostly intraperitoneally. Ovarian cancer is a radiosensitive tumor, so that the use of whole abdominal radiotherapy (WAR) as a consolidation therapy would appear to be a logical strategy. WAR used to be the standard treatment after surgery before the chemotherapy era; however, it has been almost totally excluded from the treatment of ovarian cancer during the past decade because of its high toxicity. Modern intensity-modulated radiation therapy (IMRT) has the potential of sparing organs at risk like kidneys, liver, and bone marrow while still adequately covering the peritoneal cavity with a homogenous dose. Our previous phase I study showed for the first time the clinical feasibility of intensity-modulated WAR and pointed out promising results concerning treatment tolerance. The current phase-II study succeeds to the phase-I study to further evaluate the toxicity of this new treatment. Methods/design The OVAR-IMRT-02 study is a single-center one arm phase-II trial. Thirty seven patients with optimally debulked ovarian cancer stage FIGO III having a complete remission after chemotherapy will be treated with intensity-modulated WAR as a consolidation therapy. A total dose of 30 Gy in 20 fractions of 1.5 Gy will be applied to the entire peritoneal cavity including the liver surface and the pelvic and para-aortic node regions. Organ at risk are kidneys, liver (except the 1 cm-outer border), heart, vertebral bodies and pelvic bones. Primary endpoint is tolerability; secondary objectives are toxicity, quality of life, progression-free and overall survival. Discussion Intensity-modulated WAR provides a new promising option in the consolidation treatment of ovarian carcinoma in patients with a complete pathologic remission after adjuvant chemotherapy. Further consequent studies will be needed to enable firm conclusions regarding the value of consolidation radiotherapy within the multimodal treatment of advanced ovarian cancer. Trial registration Clinicaltrials.gov: NCT01180504
BMC Cancer. 01/2011;
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ABSTRACT: The prognosis for patients with advanced FIGO stage III epithelial ovarian cancer remains poor despite the aggressive standard treatment, consisting of maximal cytoreductive surgery and platinum-based chemotherapy. The median time to recurrence is less than 2 years, with a 5-years survival rate of -20-25%. Recurrences of the disease occur mostly intraperitoneally.Ovarian cancer is a radiosensitive tumor, so that the use of whole abdominal radiotherapy (WAR) as a consolidation therapy would appear to be a logical strategy. WAR used to be the standard treatment after surgery before the chemotherapy era; however, it has been almost totally excluded from the treatment of ovarian cancer during the past decade because of its high toxicity. Modern intensity-modulated radiation therapy (IMRT) has the potential of sparing organs at risk like kidneys, liver, and bone marrow while still adequately covering the peritoneal cavity with a homogenous dose.Our previous phase I study showed for the first time the clinical feasibility of intensity-modulated WAR and pointed out promising results concerning treatment tolerance. The current phase-II study succeeds to the phase-I study to further evaluate the toxicity of this new treatment.
The OVAR-IMRT-02 study is a single-center one arm phase-II trial. Thirty seven patients with optimally debulked ovarian cancer stage FIGO III having a complete remission after chemotherapy will be treated with intensity-modulated WAR as a consolidation therapy.A total dose of 30 Gy in 20 fractions of 1.5 Gy will be applied to the entire peritoneal cavity including the liver surface and the pelvic and para-aortic node regions. Organ at risk are kidneys, liver (except the 1 cm-outer border), heart, vertebral bodies and pelvic bones.Primary endpoint is tolerability; secondary objectives are toxicity, quality of life, progression-free and overall survival.
Intensity-modulated WAR provides a new promising option in the consolidation treatment of ovarian carcinoma in patients with a complete pathologic remission after adjuvant chemotherapy. Further consequent studies will be needed to enable firm conclusions regarding the value of consolidation radiotherapy within the multimodal treatment of advanced ovarian cancer.
Clinicaltrials.gov: NCT01180504.
BMC Cancer 01/2011; 11:41. · 3.01 Impact Factor
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ABSTRACT: Different radiation-techniques in treating local staged prostate cancer differ in their dose- distribution. Physical phantom measurements indicate that for 3D, less healthy tissue is exposed to a relatively higher dose compared to SSIMRT. The purpose is to substantiate a dose distribution in lymphocytes in-vivo and to discuss the possibility of comparing it to the physical model of total body dose distribution.
For each technique (3D and SSIMRT), blood was taken from 20 patients before and 10 min after their first fraction of radiotherapy. The isolated leukocytes were fixed 2 hours after radiation. DNA double-strand breaks (DSB) in lymphocytes' nuclei were stained immunocytochemically using the gamma-H2AX protein. Gamma-H2AX foci inside each nucleus were counted in 300 irradiated as well as 50 non-irradiated lymphocytes per patient. In addition, lymphocytes of 5 volunteer subjects were irradiated externally at different doses and processed under same conditions as the patients' lymphocytes in order to generate a calibration-line. This calibration-line assigns dose-value to mean number of gamma-H2AX foci/ nucleus. So the dose distributions in patients' lymphocytes were determined regarding to the gamma-H2AX foci distribution. With this information a cumulative dose-lymphocyte-histogram (DLH) was generated. Visualized distribution of gamma-H2AX foci, correspondingly dose per nucleus, was compared to the technical dose-volume-histogram (DVH), related to the whole body-volume.
Measured in-vivo (DLH) and according to the physical treatment-planning (DVH), more lymphocytes resulted with low-dose exposure (< 20% of the applied dose) and significantly fewer lymphocytes with middle-dose exposure (30%-60%) during Step-and-Shoot-IMRT, compared to conventional 3D conformal radiotherapy. The high-dose exposure (> 80%) was equal in both radiation techniques. The mean number of gamma-H2AX foci per lymphocyte was 0.49 (3D) and 0.47 (SSIMRT) without significant difference.
In-vivo measurement of the dose distribution within patients' lymphocytes can be performed by detecting gamma-H2AX foci. In case of 3D and SSIMRT, the results of this method correlate with the physical calculated total body dose-distribution, but cannot be interpreted unrestrictedly due to the blood circulation. One possible application of the present method could be in radiation-protection for in-vivo dose estimation after accidental exposure to radiation.
Radiation Oncology 01/2011; 6:62. · 2.32 Impact Factor
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ABSTRACT: To evaluate local positioning errors of the lumbar spine during fractionated intensity-modulated radiotherapy of patients treated with craniospinal irradiation and to assess the impact of rotational error correction on these uncertainties for one patient setup correction strategy.
8 patients (6 adults, 2 children) treated with helical tomotherapy for craniospinal irradiation were retrospectively chosen for this analysis. Patients were immobilized with a deep-drawn Aquaplast head mask. Additionally to daily megavoltage control computed tomography scans of the skull, once-a-week positioning of the lumbar spine was assessed. Therefore, patient setup was corrected by a target point correction, derived from a registration of the patient's skull. The residual positioning variations of the lumbar spine were evaluated applying a rigid-registration algorithm. The impact of different rotational error corrections was simulated.
After target point correction, residual local positioning errors of the lumbar spine varied considerably. Craniocaudal axis rotational error correction did not improve or deteriorate these translational errors, whereas simulation of a rotational error correction of the right-left and anterior-posterior axis increased these errors by a factor of 2 to 3.
The patient fixation used allows for deformations between the patient's skull and spine. Therefore, for the setup correction strategy evaluated in this study, generous margins for the lumbar spinal target volume are needed to prevent a local geographic miss. With any applied correction strategy, it needs to be evaluated whether or not a rotational error correction is beneficial.
International journal of radiation oncology, biology, physics 09/2010; 81(5):1552-9. · 4.59 Impact Factor
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ABSTRACT: The purpose of this study was to present planning, feasibility, toxicity, and outcome of helical tomotherapy for spinal cord-sparing reirradiation of spinal metastases and tumors.
Thirty-six patients with spinal metastases and tumors who had undergone previous radiotherapy were reirradiated with helical tomotherapy because of tumor progression, pain, or compromised stability. Mean spinal cord dose of previous radiotherapy was 36.3 grays (Gy) after a median time interval of 17.5 months. Mean prescribed dose of reirradiation was 34.8 Gy. Daily megavoltage computed tomography (CT) image guidance was performed to assure precise dose application.
Mean beam time was 8.4 minutes; the dose maximum to the spinal cord at reirradiation could be limited to a 9.8-Gy median dose (minimum, 5.2 Gy; maximum, 21.8 Gy). Significant pain relief from a median value of 7 on the visual analogue scale before therapy to a median value of 3 at 6 weeks after radiotherapy was achieved. One- and 2-year local control was 76% and 63%; overall survival was 67% after 1 year and 58% after 2 years. One grade 2 skin toxicity and no grade 3 or higher toxicities were observed.
Helical tomotherapy makes reirradiation of spinal metastases and excellent avoidance of the spinal cord possible and achieves good pain relief and local control. With a minimal distance of several millimeters between target volume and spinal cord, tailor-made dose distributions with steep dose gradients around previously irradiated tissue are obtained and precisely applied with daily megavoltage CT-based image guidance.
Cancer 08/2010; 116(16):3961-8. · 4.77 Impact Factor
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Florian Sterzing,
Matthias Uhl,
Henrik Hauswald,
Kai Schubert,
Gabriele Sroka-Perez,
Yu Chen,
Weiguo Lu,
Rock Mackie,
Jürgen Debus,
Klaus Herfarth,
Gustavo Oliveira
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ABSTRACT: To investigate the next generation of helical tomotherapy delivery with dynamic jaw and dynamic couch movements.
The new technique of dynamic jaw and dynamic couch movements is described, and a comparative planning study is performed. Ten nasopharyngeal cancer patients with skull base infiltration were chosen for this comparison of longitudinal dose profiles using regular tomotherapy delivery, running-start-stop treatment, and dynamic jaw and dynamic couch delivery. A multifocal simultaneous integrated boost concept was used (70.4Gy to the primary tumor and involved lymph nodes; 57.4Gy to the bilateral cervical lymphatic drainage pathways, 32 fractions). Target coverage, conformity, homogeneity, sparing of organs at risk, integral dose, and radiation delivery time were evaluated.
Mean parotid dose for all different deliveries was between 24.8 and 26.1Gy, without significant differences. The mean integral dose was lowered by 6.3% by using the dynamic technique, in comparison with a 2.5-cm-field width for regular delivery and 16.7% with 5-cm-field width for regular delivery. Dynamic jaw and couch movements reduced the calculated radiation time by 66% of the time required with regular 2.5-cm-field width delivery (199 sec vs. 595 sec, p < 0.001).
The current delivery mode of helical tomotherapy produces dose distributions with conformal avoidance of parotid glands, brain stem, and spinal cord. The new technology with dynamic jaw and couch movements improves the plan quality by reducing the dose penumbra and thereby reducing the integral dose. In addition, radiation time is reduced by 66% of the regular delivery time.
International journal of radiation oncology, biology, physics 11/2009; 76(4):1266-73. · 4.59 Impact Factor
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ABSTRACT: Arc-modulated cone beam therapy (AMCBT) is a fast treatment technique deliverable in a single rotation with a conventional C-arm shaped linac. In this planning study, the authors assess the dosimetric properties of single-arc therapy in comparison to helical tomotherapy for three different tumor types.
Treatment plans for three patients with prostate carcinoma, three patients with anal cancer, and three patients with head and neck cancer were optimized for helical tomotherapy and AMCBT. The dosimetric comparison of the two techniques is based on physical quantities derived from dose-volume histograms.
For prostate cancer, the quality of dose distributions calculated for AMCBT was of equal quality as that generated for tomotherapy with the additional benefits of a faster delivery and a lower integral dose. For highly complex geometries, the plan quality achievable with helical tomotherapy could not be achieved with arc-modulated cone beam therapy.
Rotation therapy with a conventional linac in a single arc is capable to deliver a high and homogeneous dose to the target and spare organs at risk. Advantages of this technique are a fast treatment time and a lower integral dose in comparison to helical tomotherapy. For highly complex cases, e.g., with several target regions, the dose shaping capabilities of AMCBT are inferior to those of tomotherapy. However, treatment plans for AMCBT were also clinically acceptable.
Medical Physics 10/2009; 36(10):4702-10. · 2.83 Impact Factor
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ABSTRACT: While IMRT is widely used in treating complex oncological cases in adults, it is not commonly used in pediatric radiation oncology for a variety of reasons. This report evaluates our 9 year experience using stereotactic-guided, inverse planned intensity-modulated radiotherapy (IMRT) in children and adolescents in the context of the current literature.
Between 1999 and 2008 thirty-one children and adolescents with a mean age of 14.2 years (1.5 - 20.5) were treated with IMRT in our department. This heterogeneous group of patients consisted of 20 different tumor entities, with Ewing's sarcoma being the largest (5 patients), followed by juvenile nasopharyngeal fibroma, esthesioneuroblastoma and rhabdomyosarcoma (3 patients each). In addition a review of the available literature reporting on technology, quality, toxicity, outcome and concerns of IMRT was performed.
With IMRT individualized dose distributions and excellent sparing of organs at risk were obtained in the most challenging cases. This was achieved at the cost of an increased volume of normal tissue receiving low radiation doses. Local control was achieved in 21 patients. 5 patients died due to progressive distant metastases. No severe acute or chronic toxicity was observed.
IMRT in the treatment of children and adolescents is feasible and was applied safely within the last 9 years at our institution. Several reports in literature show the excellent possibilities of IMRT in selective sparing of organs at risk and achieving local control. In selected cases the quality of IMRT plans increases the therapeutic ratio and outweighs the risk of potentially increased rates of secondary malignancies by the augmented low dose exposure.
Radiation Oncology 09/2009; 4:37. · 2.32 Impact Factor
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ABSTRACT: Investigation of the effects of breathing motion- and misregistration-induced errors on the superficial dose in the treatment of breast cancer using helical tomotherapy (HT).
Surface dose measurements were performed with thermoluminescence dosimetry (TLD). Two treatment plans with different planning target volume (PTV) definitions of the left breast were used: PTVskin had its ventral border exactly on skin level, while PTVair included also a 10-mm extension ventral to the PTVskin. With a thoracic static phantom, misregistration errors in an HT were simulated. A dynamic phantom was used to simulate a breathing patient during HT. Surface doses of breast cancer patients were measured both for an HT (179 points) and a conventional three-dimensional conformal treatment (70 points).
In the static phantom misregistration setup, dose deviations of -31.9% for PTVskin to +35.4% for PTVair could be observed. The dynamic phantom measurements resulted in surface dose deviations from those in a static position between 0.8% and 3.8% without a significant difference for the PTV definitions. The measured surface doses on patients averaged (mean +/- standard deviation) 1.65 +/- 0.13 Gy for the HT and 1.42 +/- 0.11 Gy for the three-dimensional conformal treatment.
HT enables a homogeneous and reproducible surface dose with small dose deviations in the treatment of breast cancer. HT is a feasible method to treat breast cancer under free shallow breathing of the patient using a treatment plan with a ventral PTV border on the skin level.
Strahlentherapie und Onkologie 09/2009; 185(9):574-81. · 3.56 Impact Factor
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Nathalie Rochet, Florian Sterzing,
Alexandra D Jensen,
Julien Dinkel,
Klaus K Herfarth,
Kai Schubert,
Michael H Eichbaum,
Andreas Schneeweiss,
Christof Sohn,
Juergen Debus,
Wolfgang Harms
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ABSTRACT: To assess the feasibility and toxicity of consolidative intensity-modulated whole abdominal radiotherapy (WAR) after surgery and chemotherapy in high-risk patients with advanced ovarian cancer.
Ten patients with optimally debulked ovarian cancer International Federation of Gynecology and Obstetrics Stage IIIc were treated in a Phase I study with intensity-modulated WAR up to a total dose of 30 Gy in 1.5-Gy fractions as consolidation therapy after adjuvant carboplatin/taxane chemotherapy. Treatment was delivered using intensity-modulated radiotherapy in a step-and-shoot technique (n = 3) or a helical tomotherapy technique (n = 7). The planning target volume included the entire peritoneal cavity and the pelvic and para-aortal node regions. Organs at risk were kidneys, liver, heart, vertebral bodies, and pelvic bones.
Intensity-modulated WAR resulted in an excellent coverage of the planning target volume and an effective sparing of the organs at risk. The treatment was well tolerated, and no severe Grade 4 acute side effects occurred. Common Toxicity Criteria Grade III toxicities were as follows: diarrhea (n = 1), thrombocytopenia (n = 1), and leukopenia (n = 3). Radiotherapy could be completed by all the patients without any toxicity-related interruption. Median follow-up was 23 months, and 4 patients had tumor recurrence (intraperitoneal progression, n = 3; hepatic metastasis, n = 1). Small bowel obstruction caused by adhesions occurred in 3 patients.
The results of this Phase I study showed for the first time, to our knowledge, the clinical feasibility of intensity-modulated whole abdominal radiotherapy, which could offer a new therapeutic option for consolidation treatment of advanced ovarian carcinoma after adjuvant chemotherapy in selected subgroups of patients. We initiated a Phase II study to further evaluate the toxicity of this intensive multimodal treatment.
International journal of radiation oncology, biology, physics 08/2009; 76(5):1382-9. · 4.59 Impact Factor
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ABSTRACT: Daily image guidance in irradiation of prostate cancer can be based on simple portal images or on soft-tissue imaging. This study compares daily bone alignment with daily pretreatment megavoltage computed tomography (MVCT).
Ten patients with a total of 356 fractions were analyzed. Before each fraction, the patient was positioned to match the prostate on pretreatment MVCT and planning CT. In seven fractions, rectum distension prevented a satisfactory match and the fraction was restarted after the patient went to the restroom. After treatment, organs were manually contoured on each daily MVCT and doses recalculated. Bone alignment was simulated by a software that matches the bones on MVCT and planning CT.
In the seven interrupted fractions, median improvement of rectum volume receiving full fraction dose was 14 cm(3) between simulated treatment before and actual treatment after the patient went to the restroom. In the 349 noninterrupted fractions, the average difference of the isodose that covers 95% of the prostate between actual treatment position and simulated bone match position was < 1% and there was no significant change in the rectum volume with a fraction dose > or = 2 Gy.
Full fraction dose rectum irradiation can be avoided with daily MVCT by interruption of single fractions. There was no relevant benefit of daily MVCT in the noninterrupted fractions with the margins used in this study.
Strahlentherapie und Onkologie 04/2009; 185(4):241-7. · 3.56 Impact Factor
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ABSTRACT: : Recurrent brain metastases or new brain lesions after whole-brain radiotherapy represent a therapeutic challenge. While several treatment methods for single or few lesions have been described, options for multiple lesions are limited. This case report is intended to show an approach of whole-brain reirradiation with a simultaneous multifocal integrated boost using helical tomotherapy. Technique, feasibility, and acute side effects are presented.
: Two patients with multiple relapsed brain metastases (eight and eleven lesions) were reirradiated after previous whole-brain radiotherapy (total dose of 40 Gy 18 months before). Whole-brain reirradiation was performed using helical tomotherapy with a total dose of 15 Gy (single dose 1.5 Gy) and a multifocal simultaneous integrated boost with a total dose of 30 Gy (single dose 3 Gy) to the brain lesions. The boost planning target volume was delineated around the lesions visible on MRI plus a 2-mm margin. Follow-up of these patients was 6 and 12 months.
: Radiation plans with excellent conformity and homogeneity were obtained. High dose exposure to normal brain tissue was kept minimal. Mean radiation time was 13 min. The only acute side effect observed was a mild headache over 2 days at the end of treatment. So far, no further side effects and no signs of recurrence have been observed.
: Helical tomotherapy offers new treatment options for the reirradiation of multiple brain metastases. The number of cases treated with the described protocol is very limited but it is considered a promising option for patients that have responded well to the initial radiotherapy and are in a good performance status.
Strahlentherapie und Onkologie 03/2009; 185(2):89-93. · 3.56 Impact Factor
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Nathalie Rochet, Florian Sterzing,
Alexandra Jensen,
Julien Dinkel,
Klaus Herfarth,
Kai Schubert,
Michael Eichbaum,
Andreas Schneeweiss,
Christof Sohn,
Juergen Debus,
Wolfgang Harms
[show abstract]
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ABSTRACT: To describe a new intensity-modulated radiotherapy (IMRT) technique using helical tomotherapy for whole abdominal irradiation (WAI) in patients with advanced ovarian cancer.
A patient with radically operated ovarian cancer FIGO stage IIIc was treated in a prospective clinical trial with WAI to a total dose of 30 Gy in 1.5-Gy fractions as an additional therapy after adjuvant platinum-based chemotherapy. The planning target volume (PTV) included the entire peritoneal cavity. PTV was adapted according to breathing motion as detected in a four-dimensional respiratory-triggered computed tomography (4D-CT). Inverse treatment planning was done with the Hi-Art tomotherapy planning station. Organs at risk (OARs) were kidneys, liver, bone marrow, spinal cord, thoracic and lumbosacral vertebral bodies, and pelvic bones. Daily control of positioning accuracy was performed with megavoltage computed tomography (MV-CT).
Helical tomotherapy enabled a very homogeneous dose distribution with excellent sparing of OARs and coverage of the PTV (V90 of 93.1%, V95 of 86.9%, V105 of 1.9%, and V110 of 0.01%). Mean liver dose was 21.57 Gy and mean kidney doses were 9.75 Gy and 9.14 Gy, respectively. Treatment could be performed in 18.1 min daily and no severe side effects occurred.
Helical tomotherapy is feasible and fast for WAI. Tomotherapy enabled excellent coverage of the PTV and effective sparing of liver, kidneys and bone marrow.
Strahlentherapie und Onkologie 04/2008; 184(3):145-9. · 3.56 Impact Factor
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ABSTRACT: To evaluate the potential of helical tomotherapy in the adjuvant treatment of malignant pleural mesothelioma and compare target homogeneity, conformity and normal tissue dose with step-and-shoot intensity-modulated radiotherapy.
Ten patients with malignant pleural mesothelioma who had undergone neoadjuvant chemotherapy with cisplatin and permetrexed followed by extrapleural pneumonectomy (EPP) were treated in our department with 54 Gy to the hemithorax delivered by step-and-shoot IMRT. A planning comparison was performed by creating radiation plans for helical tomotherapy. The different plans were compared by analysing target homogeneity using the homogeneity indices HI(max) and HI(min) and target conformity by using the conformity index CI(95). To assess target coverage and normal tissue sparing TV(90), TV(95) and mean and maximum doses were compared.
Both modalities achieved excellent dose distributions while sparing organs at risk. Target coverage and homogeneity could be increased significantly with helical tomotherapy compared with step-and-shoot IMRT. Mean dose to the contralateral lung could be lowered beyond 5 Gy.
Our planning study showed that helical tomotherapy is an excellent option for the adjuvant intensity-modulated radiotherapy of MPM. It is capable of improving target coverage and homogeneity.
Radiotherapy and Oncology 03/2008; 86(2):251-7. · 5.58 Impact Factor
