A Kaiser’s research while affiliated with Charité Universitätsmedizin Berlin and other places

There is an increasing body of evidence showing that patients with resectable pancreatic cancer might benefit from adjuvant therapy. Based on phase III trials, potential options for adjuvant treatment are chemotherapy alone or a multimodal approach involving radiotherapy. Available data are heterogeneous and have been discussed controversially. Hitherto, a worldwide standard of care has not yet been established. Adequate patient selection might be the key element for a tailored adjuvant treatment. Clinical research currently focusses on gemcitabine alone or in combination, and some molecular biologic approaches with epidermal growth factor receptor monoclonal antibodies (EGFR-MoABs) and anti-angiogenic drugs. Recent advances in radiooncology offer better dose conformality and reduced morbidities. Currently, the co-operative Radiotherapy and Gastrointestinal Groups have launched a multicentric European Organization for Research and Treatment of Cancer (EORTC) trial investigating the impact of radiotherapy in combination with gemcitabine in R0-resected pancreatic head cancer.

There is an increasing body of evidence showing that patients with resectable pancreatic cancer might benefit from adjuvant therapy. Based on phase III trials, potential options for adjuvant treatment are chemotherapy alone or a multimodal approach involving radiotherapy. Available data are heterogeneous and have been discussed controversially. Hitherto, a worldwide standard of care has not yet been established. Adequate patient selection might be the key element for a tailored adjuvant treatment. Clinical research currently focusses on gemcitabine alone or in combination, and some molecular biologic approaches with epidermal growth factor receptor monoclonal antibodies (EGFR-MoABs) and anti-angiogenic drugs. Recent advances in radiooncology offer better dose conformality and reduced morbidities. Currently, the co-operative Radiotherapy and Gastrointestinal Groups have launched a multicentric European Organization for Research and Treatment of Cancer (EORTC) trial investigating the impact of radiotherapy in combination with gemcitabine in R0-resected pancreatic head cancer.

In CT-based adjuvant radiotherapy of the breast, virtual simulation techniques have been developed. This paper demonstrates a simple virtual simulation of a boost field. 41 fields were planned virtually, 26 as electron beams, 15 as tangential photon beams. Depending on the user's expertise the geometric accuracy was high; possible sources of error are illustrated. Resulting field sizes tended to be slightly larger compared to conventional simulation when applying the same rules of field definition. Differences in focus-skin distances with consecutive divergence effects as well as partial volume effects were discussed to be causal. Virtual simulation of a boost field has the potential to elegantly link the simplicity of a conventional simulation with the accurate tumor bed identification provided by a CT data set. It was shown to be feasible and favorable with regard to the patient, the medical staff, and the simulator time. Moreover, it offers a visualization of dose distributions, which was found helpful in some cases.

In radiation oncology more and more effort is taken to include the dose conformity to the target as well as the dose sparing of risk organs (OAR) and healthy tissue to the treatment planing. Conformal stereotactic radiosurgery and radiotherapy (CSRS and CSRT) offer the potential to optimise these parameters according to the demands of the physician and the physicist. The study compares treatment plans using different techniques for dose delivery as static beams, arcs or multiple isocentres. Also different beam shaping devices for CSRS and CSRT as conformal blocks, circular cones or multileaf collimators have been considered.