Dirk Boehmer

• Doctor of Medicine
• Managing Director at Charité Universitätsmedizin Berlin

Purpose Prostate cancer (PCa) is the most frequently diagnosed malignancy among men in Germany. Advances in diagnostics and treatment have transformed PCa into a chronic disease. Given the heterogeneity of PCa, there is a need for additional stratification tools. This review focuses on updating the evidence for genomic classifiers (GC; Decipher [Ve...

Purpose Fiducial markers (FM) are essential in prostate robotic stereotactic body radiotherapy (SBRT). Accuray® (Madison, WI, USA) provides an implantation guideline for reliable detection. We report on complication rates and analyze how the geometrical implantation quality correlated with subsequent detection rates. We also investigated whether fa...

Background Prostate-specific membrane antigen (PSMA) positron-emission tomography (PET) imaging can detect prostate cancer (PCa) nodal oligorecurrences (NOR) at very low prostate-specific antigen (PSA) levels. Prospective studies on oligorecurrent (OR) PCa have been hampered by either dated diagnostics or inhomogeneous cohorts and/or treatment appr...

A significant number of prostate cancer patients are long-term survivors after primary definitive therapy, and the occurrence of late side effects, such as second primary cancers, has gained interest. The aim of this editorial is to discuss the most current evidence on second primary cancers based on six retrospective studies published in 2021–2024...

In patients with prostate cancer (PCa), salvage radiotherapy (SRT) for biochemical progression (BP) after radical prostatectomy (RP) improves PCa-specific survival. However, no prospective randomized trials have compared the effect of SRT with untreated patients. In this analysis of 151 patients who received SRT for post-RP BP, we compared their ov...

For prostate cancer, the role of elective nodal irradiation (ENI) for cN0 or pN0 patients has been under discussion for years. Considering the recent publications of randomized controlled trials, the prostate cancer expert panel of the German Society of Radiation Oncology (DEGRO) aimed to discuss and summarize the current literature. Modern trials...

Background: Advances in prostate-specific membrane antigen (PSMA) PET-computed tomography (CT) and magnetic resonance imaging (MRI) allow the detection and localization of exclusively local prostate-cancer-recurrences after definitive first-line therapy. PSMA-based early detection of circumscribed local recurrences followed by hypofractionated hig...

Background: Up to 40% of patients with prostate cancer may develop biochemical recurrence after surgery, with salvage radiation therapy (SRT) being the only curative option. In 2016, Tendulkar et al. (Contemporary update of a multi-institutional predictive nomogram for salvage radiotherapy after radical prostatectomy. J Clin Oncol 2016;34:3648-54)...

Background: The European Association of Urology (EAU) has proposed a risk stratification for patients harboring biochemical recurrence (BCR) after radical prostatectomy (RP). Objective: To assess whether this risk stratification helps in choosing patients for salvage radiotherapy (SRT). Design, setting, and participants: Analyses of 2379 patie...

Background: Pelvic lymph node dissection (PLND) is the gold standard for diagnosis of lymph node involvement (LNI) in patients with prostate cancer. The Roach formula, Memorial Sloan Kettering Cancer Center (MSKCC) calculator, and Briganti 2012 nomogram are elegant and simple traditional tools used to estimate the risk of LNI and select patients f...

Introduction: Checkpoint-inhibitor pneumonitis (CIP) represents a major immune-related adverse event (irAE) in patients with lung cancer. We aimed for the clinical characterization, diagnostics, risk factors, treatment and outcome in a large cohort of patients from everyday clinical practice. Patients and methods: For this retrospective analysis...

Introduction: In lateralized oral squamous cell carcinoma (OSCC) with ipsilateral cervical lymph node metastasis (CLNM), the surgical management of the unsuspicious contralateral neck remains a matter of debate. The aim of this study was to analyze this cohort and to compare the outcomes of patients with and without contralateral elective neck dis...

Objective We prospectively addressed whether patient characteristics, oncological outcomes, or metastatic risk impacted depression and anxiety in patients undergoing curative proton treatment for uveal melanoma (UM). Methods We assessed patient‐reported outcomes regarding anxiety (GAD‐7) before and 2 years after proton therapy and depression (PHQ‐...

Purpose/Objective(s) Salvage radiotherapy (SRT) is the only curative option for patients with biochemical recurrence (BCR) following radical prostatectomy (RP). Tendulkar's nomogram was developed to predict outcomes following SRT in patients with a median pre-SRT PSA of 0.5 ng/mL. We aim to externally validate Tendulkar's nomogram and provide an up...

Purpose/Objective(s) Many tools are used to predict the probability of lymph node involvement (LNI) in patients with prostate cancer before radical prostatectomy (RP) and to select patients for lymph node dissection. Our goal was to externally validate common prediction tools and to create a machine learning model for the prediction of LNI in patie...

Background: For many years, the standard treatment of metastatic, hormone-sensitive prostatic carcinoma (mHSPC) was androgen deprivation therapy (ADT) alone. By lowering the testosterone level into the castration range, ADT deprives the tumor of a key growth factor. Methods: For this article, we evaluated the treatment recommendations contained...

Results of three randomized clinical trials (RCTs) comparing adjuvant radiotherapy (ART) and early salvage radiotherapy (eSRT) of prostate carcinoma and a subsequent meta-analysis of the individual patient data from these RCTs were recently published. The results suggest that early eSRT is as effective and potentially less toxic than ART. Therefore...

Objectives To investigate the oncological and functional outcomes of a large cohort of patients with a favorable stage of circumscribed and diffuse iris melanoma who underwent primary proton treatment and the risk factors related to initial tumor characteristics and the treatment field architecture. Design Retrospective, single-center, case study....

Purpose The DEGRO Expert Commission on Prostate Cancer has revised the indication for radiation therapy of the primary prostate tumor in patients with synchronous distant metastases with low metastatic burden. Methods The current literature in the PubMed database was reviewed regarding randomized evidence on radiotherapy of the primary prostate tu...

Background Cytogenetic testing (CGT) in uveal melanoma patients reveals prognostic information about the individual risk of developing distant metastasis with dismal prognosis. There is currently no medical intervention strategy with proven effect on the prognosis, rendering the result of the cytogenetic testing purely informative. We explored pati...

Introduction Local ablative therapy (LAT) improves survival in oligometastatic lung cancer (OMD), but there is limited information on recurrence patterns, re-treatments and in particular the role of brain metastases during the course of disease. We therefore conducted a retrospective multicenter analysis to evaluate course of disease, sequence of t...

Ziel Untersuchung des Zusatznutzens von radiomics der FDG-PET/CT zur Prädiktion des progressionsfreien Überlebens (PFS) beim nicht-kleinzelligen Lungenkarzinom (NSCLC). Methodik Retrospektive Analyse der prätherapeutischen FDG-PET/CT von 458 PatientInnen mit NSCLC im Stadium I-IIIB vor kurativ intendierter Therapie. Monozentrisches Trainings- (n=2...

Simple Summary This study evaluated 554 patients who underwent radical surgery for prostate cancer and later presented with persisting or rising PSA levels which required salvage radiotherapy. Our results showed that increasing the radiation dose during radiotherapy could reduce the risk of a second PSA relapse. These findings suggested that patien...

Background: Focal therapy (FT) is an option to treat localized prostate cancer (PCa) and preserve healthy prostate tissue in order to reduce known side effects from primary whole-gland treatment. The available FT modalities are manifold. Until now, national and international PCa guidelines have been cautious to propose recommendations regarding FT...

Background To analyze outcome and toxicity of 41 consecutive patients with localized low- and intermediate risk prostate cancer treated with CyberKnife-Stereotactic Body Radiotherapy. Patients and Methods Patient selection and treatment protocol was according to (but not on) the PACE-trial protocol. Staging was in accordance with the German S3-guid...

Background Total body irradiation (TBI) is an established part of conditioning regimens prior to stem cell transplantation in childhood leukemia but is associated with long-term toxicity. We retrospectively analyzed survival, long-term toxicity, and secondary malignancies in a pooled cohort of pediatric patients (pts.) treated with the same TBI reg...

Introduction: Proton beam therapy is an established primary treatment for patients with nonmetastasized uveal melanoma. Adjuvant local interventions, like intravitreal injections or surgery, were shown to improve long-term eye preservation; however, their impact on the patient's quality of life (QOL) remains unknown. Methods: In a post-radiother...

Purpose Various randomized phase III clinical trials have compared moderately hypofractionated to normofractionated radiotherapy (RT). These modalities showed similar effectiveness without major differences in toxicity. This project was conducted by the Prostate Cancer Expert Panel of the German Society of Radiation Oncology (DEGRO) and the Working...

Background Proton beam therapy is a well-established treatment option for patients with uveal melanoma (UM). The treatment procedure, in general, includes placing radiopaque clips to ensure exact eye-positioning during radiotherapy, followed by the delivery of proton irradiation. The short-term burden associated with proton therapy in patients with...

Objective The current article encompasses a literature review and recommendations for radiotherapy in nodal oligorecurrent prostate cancer. Materials and methods A literature review focused on studies comparing metastasis-directed stereotactic ablative radiotherapy (SABR) vs. external elective nodal radiotherapy (ENRT) and studies analyzing recurr...

PURPOSE Adjuvant compared with early salvage radiation therapy (sRT) following radical prostatectomy (RP) has not been shown to reduce progression-free survival in randomized controlled trials. However, these trials might have missed a benefit in men with adverse pathology at RP given that these men were under-represented and immortal time bias mig...

Objectives In patients with NSCLC, current ESTS and ESMO guidelines recommend invasive lymph node (LN) staging with EBUS-TBNA even if FDG-PET/CT is negative for mediastinal LNs if at least one of three risk factors is present (cN1, non-peripheral primary or primary >3 cm). Modified workflows to avoid unnecessary invasive procedures were evaluated....

Due to its low fractionation sensitivity, also known as “alpha/beta ratio,” in relation to its surrounding organs at risk, prostate cancer is predestined for hypofractionated radiation schedules assuming an increased therapeutic ratio compared to normofractionated regimens. While moderate hypofractionation (2.2–4 Gy) has been proven to be non-infer...

We comment on the paper of Di Maria Jiang et al. published in Current Oncology Reports 2020, https://doi.org/10.1007/s11912-020-0880-5. We disagree on a major recommendation of the authors because of lacking evidence. This response is considered to be important for readers of Current Oncology Reports.

PurposeTo analyze the impact of the dose to the optic disc and the irradiated length of the optic nerve on radiation-induced optic neuropathy, radiation-induced retinopathy, iris neovascularization, secondary glaucoma, enucleation, and local tumor control after proton beam therapy (PBT) of choroidal melanoma.Method Retrospective analysis of 1129 pa...

Background: In prostate cancer (PCa) recurring after radical prostatectomy (RP), salvage radiotherapy (SRT) is recommended to be given at PSA <0.5 ng/ml. It has been speculated, that the advantage from early SRT is mainly caused by lead-time bias: Calculating from time of SRT, earlier treatment would per-se result in longer time to event/censoring...

AimTo provide an overview on the available treatments to prevent and reduce gynecomastia and/or breast pain caused by antiandrogen therapy for prostate cancer.Methods The German Society of Radiation Oncology (DEGRO) expert panel summarized available evidence published and assessed the validity of the information on efficacy and treatment-related to...

Introduction There is no standard of care for recurrent high-grade glioma. Treatment strategies include re-resection, re-irradiation, systemic agents, intratumoral thermotherapy using magnetic iron-oxide nanoparticles (“nanotherapy”), and tumor treating fields. Only a small number of patients are eligible for re-resection, and since many patients r...

Objective This article aims to provide an overview of the role of combined radiation and androgen deprivation (ADT) therapy in patients with intermediate-risk prostate cancer. Materials and methods The current German, European, and NCCN (National Comprehensive Cancer Network) guidelines as well as relevant literature in the PubMed database which p...

Intermediate clinical endpoints (ICEs) might aid in trial design and potentially expedite study results. However, little is known about the most informative ICE for patients receiving salvage radiation therapy (sRT) after radical prostatectomy. To investigate the most informative ICE for patients receiving sRT, we used a multi-institutional databas...

Background: In patients with non-small-cell lung cancer (NSCLC), asphericity (ASP) of the primary tumor's metabolic tumor volume (MTV) has shown prognostic significance. This study aimed at validation in an independent and sufficiently large cohort. Patients and methods: A retrospective study was performed of 311 NSCLC patients undergoing 18F-fl...

Objective To test whether salvage radiotherapy (SRT) in patients with lymph node negative (N0) prostate cancer is equally effective with persistent prostate‐specific antigen (PSA) and PSA rising from the undetectable range (<0.1 ng/mL) after radical prostatectomy (RP). Patients and methods We assessed post‐SRT PSA progression‐free survival (PFS) i...

Background and purpose To evaluate the effect of changes in bladder volume during high-dose intensity-modulated-radiotherapy (IMRT) of prostate cancer on acute genitourinary (GU) toxicity and prospectively evaluate a simple biofeedback technique for reproducible bladder filling with the aim of reducing acute GU toxicity. Methods One hundred ninety...

Background In the case of intermediate-risk prostate cancer definitive percutaneous radiation therapy (RT) alone or combined with androgen deprivation therapy (ADT) are established treatment options. Objective This article gives a review of the currently applied different treatment concepts in cases of definitive percutaneous radiation therapy. M...

Background A paradigm shift in oligometastatic prostate cancer has begun and metastasization no longer necessarily means a classical palliative situation. Objective Presentation of the current diagnostic possibilities of oligometastatic prostate cancer in the context of metastases-directed interdisciplinary treatment and the therapeutic approach....

Background Salvage radiation therapy (SRT) is the standard of care for patients with primary pN0 stage and biochemical recurrence after prostatectomy. Recent randomized trials have assessed the potential benefit of adding androgen deprivation therapy (ADT) to SRT. Objective The results of an evidence-based systematic overview of the use of ADT add...

Background: The optimal duration of hormonal therapy (HT) when associated with postprostatectomy radiation therapy (RT) remains controversial. Objective: To test the impact of HT duration among patients treated with postprostatectomy RT, stratified by clinical and pathologic characteristics. Design, setting, and participants: The study include...

For patients with recurrent prostate cancer after radical prostatectomy (RP), salvage radiotherapy (SRT) offers a second chance of cure. European guidelines (EAU) recommend SRT at a PSA < 0.5 ng/ml. We analyze the efficacy of SRT given according to this recommendation and investigate the predictive power of the post-SRT PSA nadir. Between 1998 and...

Introduction: Local ablative treatment (LAT) improves outcome in lung cancer with oligometastatic disease (OMD) and potentially leads to long term survival. The aim of this retrospective study was to evaluate and quantify the additional benefit of LAT in synchronous OMD and to further identify prognostic factors for survival. Patients and methods:...

Aim: Overview on the use of androgen deprivation therapy (ADT) added to salvage radiation therapy (SRT) for prostate cancer patients with biochemical recurrence after prostatectomy. Methods: The German Society of Radiation Oncology (DEGRO) expert panel summarized available evidence published between January 2009 and May 2017, and assessed the va...

Die Debatte stellt die bekannte Evidenz zur Frage der PSMA-PET/CT beim biochemischen Rezidiv des Prostatakarzinoms dar und wägt interdisziplinär ab, in welcher Situation welcher Patient zur Wahl der adäquaten Therapieoption bildgebende Diagnostik erforderlich macht. Dabei werden grundsätzliche Überlegungen zur Versorgung onkologischer Patienten mit...

IntroductionFor high-dose radiation therapy (RT) of prostate cancer, image-guided (IGRT) and intensity-modulated RT (IMRT) approaches are standard. Less is known regarding comparisons of different IGRT techniques and the resulting residual errors, as well as regarding their influences on dose distributions. Patients and methodsA total of 58 patient...

Background: The optimal prostate-specific antigen (PSA) level after radical prostatectomy (RP) for defining biochemical recurrence and initiating salvage radiation therapy (SRT) is still debatable. Whereas adjuvant or extremely early SRT irrespective of PSA progression might be overtreatment for some patients, SRT at PSA >0.2 ng/ml might be undert...

Background: For patients with recurrent prostate cancer after radical prostatectomy (RP), salvage radiotherapy (SRT) is a second chance of cure. However, depending on risk factors, 40-70% of the patients experience further progression. With a focus on the pre- and post-SRT serum level of the prostate-specific antigen (PSA), we assessed the determi...

Das Magenkarzinom und das Adenokarzinom des ösophagogastralen Übergangs (AEG) werden hinsichtlich ihrer Prognose und Therapieempfehlungen oft zusammengefasst und viele randomisierte Studien untersuchten beide Krebsarten gemeinsam, weshalb sie im Folgenden zusammen betrachtet werden. Historisch spielte die Strahlentherapie nur eine untergeordnete Ro...

Aim: This article gives an overview on the current status of hypofractionated radiotherapy in the treatment of prostate cancer with a special focus on the applicability in routine use. Methods: Based on a recently published systematic review the German Society of Radiation Oncology (DEGRO) expert panel added additional information that has becom...

Purpose: To evaluate the incidence, risk factors, and dosages of proton beam therapy associated with cataract development, and long-term visual outcomes after treatment of uveal melanoma. Methods: All patients receiving primary proton beam therapy for uveal melanoma between 1998 and 2008 with no signs of cataract before irradiation were included...

Background Prostate cancer has the highest incidence of any type of cancer in Germany; an estimated 67 000 new diagnoses of prostate cancer will be made in 2016. In the current German S3 guideline for the treatment of prostate cancer, radiotherapy—sometimes in combination with androgen deprivation therapy (ADT)—is one of the two recommended options...

Purpose: Up to 30% of patients who undergo radiation for intermediate- or high-risk localized prostate cancer relapse biochemically within 5 years. We assessed if biochemical disease-free survival (DFS) is improved by adding 6 months of androgen suppression (AS; two injections of every-3-months depot of luteinizing hormone-releasing hormone agonis...

Locally advanced prostate cancer (LAPCA) comprises about 5-10 % of all newly diagnosed prostate cancers and is associated with the highest prostate cancer specific mortality (approximately 8-20 %). LAPCA is defined by the presence of extraprostatic extension, seminal vesicle invasion, and bladder neck infiltration of pelvic lymph node metastases. I...

Background For patients with high-risk prostate cancer there is currently no predefined standard treatment. In terms of curative treatment there are two alternatives: primary radiotherapy plus androgen deprivation therapy (ADT) and radical prostatectomy with pelvic lymph node dissection. Objective Presentation and evaluation of the evidence for the...

Sicher und erfolgreich lässt sich eine hormonablative Therapie nur durchführen, wenn die ideale Therapiedauer eingehalten wird. Die dazu vorliegende Datenlage zu überblicken, ist jedoch nicht einfach. Aktuelle Empfehlungen bieten eine gute Orientierung.

The organ contouring section of this book provides a summary of the available evidence on prostate cancer target volume definition. The reader will find comprehensive data supporting the extension of the clinical target volume beyond the prostate for patients with risk factors such as a high pretreatment PSA value or a high Gleason score. Furthermo...

The organ contouring section of this book provides a summary of the available evidence on prostate cancer target volume definition. The reader will find comprehensive data supporting the extension of the clinical target volume beyond the prostate for patients with risk factors such as a high pretreatment PSA value or a high Gleason score. Furthermo...

In patients with localized high-risk prostate cancer awaiting radiation therapy, pelvic lymphadenectomy (PL) is a reliable minimally invasive staging procedure. We compared outcomes after laparoendoscopic single site PL (LESSPL) with those after conventional multiport laparoscopic PL (MLPL). A retrospective case-control study was carried out at the...

Patients receiving radiotherapy often experience toxicity of the skin and mucous membranes. While radiotherapy is a mainstay of myeloablative conditioning for allogeneic hematopoietic stem cell transplantation (ASCT), no risk factors for radiotoxicity have been identified in this setting. Here, we report on a patient with excessive radiation-induce...