Background: This article should demonstrate the problems concerning gonadal dose in seminoma pati... more Background: This article should demonstrate the problems concerning gonadal dose in seminoma patients, the impact of shielding and possible consequences for therapy and advising of patients with desire to have children. Patients and Method: Since November 1993 gonadal doses of 43 patients (Stage I/II, Royal Marsden) have been determined in 80 measurements with 2 ionization chambers on the ipsi- and contralateral side of the remaining testicle. The patients were all treated with ap/pa 'hockey-stick'- shaped fields on a 6 MV linear accelerator. With single doses of 1.8 Gy in midplane, total doses of 34.2 Gy were applied in 13, and 30.6 Gy in 30 men. Protection was used in 33 patients, 6 times with conventional shielding, later plus an additional clam-shell from ap. The results of 22 measurements on 6 men with and without protection are of special interest. In 25 patients a sperm analysis before radiotherapy was conducted. Results: Before the beginning of radiotherapy (RT) 56% ...
After conservative surgery 491 women with unilateral, invasive breast cancer were irradiated with... more After conservative surgery 491 women with unilateral, invasive breast cancer were irradiated with a median dose of 50 Gy (ICRU-point) for the whole breast and an additional boost of 20 Gy respectively. The mean (median) follow-up was 69.7 (60) months with a range from 24 to 221 months. The surgical interventions were called tumorectomy in 16.1%, lumpectomy in 63.5% and quadrantectomy in 20.4%. The tumour size was classified in 73.5% (361/491) as pT1 and in 23.5% (117/491) as pT2. 2.7% were > pT2-tumours. A dissection of the axilla (473/491) recovered at the median 16 lymph nodes (0 to 48), of whom on an average 3.7 (1 to 46) contained metastases. According to Kaplan-Meier the five and ten year survival rates yielded the following respective end-points: local relapse free 94.5% and 89.2%, free of distant metastases 84.5% and 75.6%, disease free 80.7% and 69.4%, cause specific 90.3% and 79.1% and overall survival 89.5% and 76.4%. In patients with positive margins local relapses wer...
Strahlentherapie und Onkologie : Organ der Deutschen Röntgengesellschaft ... [et al], 1999
This article should demonstrate the problems concerning gonadal dose in seminoma patients, the im... more This article should demonstrate the problems concerning gonadal dose in seminoma patients, the impact of shielding and possible consequences for therapy and advising of patients with desire to have children. Since November 1993 gonadal doses of 43 patients (Stage I/II, Royal Marsden) have been determined in 80 measurements with 2 ionization chambers on the ipsi- and contralateral side of the remaining testicle. The patients were all treated with ap/pa "hockey-stick"-shaped fields on a 6 MV linear accelerator. With single doses of 1.8 Gy in midplane, total doses of 34.2 Gy were applied in 13, and 30.6 Gy in 30 men. Protection was used in 33 patients, 6 times with conventional shielding, later plus an additional clam-shell from ap. The results of 22 measurements on 6 men with and without protection are of special interest. In 25 patients a sperm analysis before radiotherapy was conducted. Before the beginning of radiotherapy (RT) 56% of available patients have shown an impai...
Hypoxia-inducible factor 1 alpha (hif-1alpha) furnishes tumor cells with the means of adapting to... more Hypoxia-inducible factor 1 alpha (hif-1alpha) furnishes tumor cells with the means of adapting to stress parameters like tumor hypoxia and promotes critical steps in tumor progression and aggressiveness. We investigated the role of hif-1alpha expression in patients with node-positive breast cancer. Tumor samples from 77 patients were available for immunohistochemistry. The impact of hif-1alpha immunoreactivity on survival endpoints was determined by univariate and multivariate analyses, and correlations to clinicopathological characteristics were determined by cross-tabulations. hif-1alpha was expressed in 56% (n = 43/77) of the patients. Its expression correlated with progesterone receptor negativity (P = 0.002). The Kaplan-Meier curves revealed significantly shorter distant metastasis-free survival (DMFS) (P = 0.04, log-rank) and disease-free survival (DFS) (P = 0.04, log-rank) in patients with increased hif-1alpha expression. The difference in overall survival (OS) did not attain...
One third up to half of the patients treated by the radiation oncologist are referred for palliat... more One third up to half of the patients treated by the radiation oncologist are referred for palliative radiation therapy because of distant metastases, mostly for painful bone or symptomatic brain metastases. As malignant cells are often disseminating long before diagnosis and therapy of the primary tumor, solitary metastases occur very seldom. A single and good resectable brain metastasis is a well-known indication for surgical intervention, especially at infratentorial location. In spherical metastases below a size of 3 cm stereotaxic radio-surgery can be alternatively considered, especially at paramedian location. Bone metastases need more often a surgical therapy, e.g. an impending or already happened fracture of long hollow bones, or radio-resistent tumors of hands and feet. Surgical therapy of metastatic vertebrae are often demanding enormous efforts and skills. Indications for surgery are osteolytical metastases with potential static problems, highly advanced destruction and mo...
To assess the value of treatment-planning related parameters namely, the breast volume; the dista... more To assess the value of treatment-planning related parameters namely, the breast volume; the distance of the inferior field border to diaphragm; and the cardiothoracic ratio for left-tangential breast irradiation. Treatment plans of 27 consecutively left-sided breast cancer patients after breast conserving surgery were evaluated for several parameters concerning heart-irradiation. We measured the heart distance respective to the cardiothoracic ratio and the distance of the inferior field border to diaphragm, as well as the breast volume in correlation with the irradiated heart volume. The mean heart and left breast volumes were 504 cm(3) and 672.8 cm(3), respectively. The mean heart diameter was 13.4 cm; the mean cardiothoracic ratio 0.51 and the mean distance of the inferior field border to diaphragm was 1.4 cm. Cardiothoracic ratio (p=0.01), breast volume (p=0.0002), distance of the inferior field border to diaphragm (p=0.02) and central lung distance (p=0.02) were significantly correlated with the measured heart distance. A significant correlation was also found between cardiothoracic ratio, breast volume and distance of the inferior field border to diaphragm with the irradiated heart volume measured by V10, V20 and V40. The verification of parameters like cardiothoracic ratio, distance of the inferior field border to diaphragm and breast volume in left-sided breast cancer patients may help in determining which patients could benefit from more complex planning techniques such as intensity-modulated radiotherapy to reduced risk of late cardiac injury.
There is a trend towards hypofractionated stereotactic radiotherapy (RT) in prostate cancer to ap... more There is a trend towards hypofractionated stereotactic radiotherapy (RT) in prostate cancer to apply high single doses in a few fractions. Using the Cyberknife® robotic system multiple non-coplanar fields are usually given with a treatment time of one hour or more. We planned to evaluate organ motion in this setting injecting a hydrogel spacer to protect the anterior rectal wall during treatment. A 66 years old man with low risk prostate cancer was planned for robotic hypofractionated stereotactic RT. After implantation of fiducial markers and a hydrogel spacer a total dose of 36.25 Gy in 5 fractions was given to the planning target volume (clinical target volume + 3 mm). After each beam the corresponding data reporting on the intra-fractional movement were pre-processed, the generated log-files extracted and the data analysed according to different directions: left -right (LR); anterior - posterior (AP); inferior -superior (IS). Clinical assessments were prospectively done before R...
To evaluate if locoregional radiotherapy (RT) versus local irradiation only can alter the pattern... more To evaluate if locoregional radiotherapy (RT) versus local irradiation only can alter the pattern of failure in breast cancer patients with extranodal invasion. From 08/1988 to 06/1998, 81 patients with extranodal invasion were treated with adjuvant RT (median total dose: 50.4 Gy), 46/81 only locally, 35/81 loco regionally due to presumed adverse parameters. The mean number of resected (positive) lymph nodes was 17 (seven). 78 patients received adjuvant systemic treatment(s). Patients treated with locoregional RT had significantly more often lymphatic vessel invasion (LVI; 63% vs. 28%; p = 0.003), T3/T4 tumors (43% vs. 17%; p = 0.014), and four or more positive lymph nodes (91% vs. 46%; p < 0.001) than patients irradiated only locally. Disease progression occurred in 24/81 patients (locoregional RT: 26% vs. local RT: 33%). The above risk factors were highly significant of worse outcome. Despite their overrepresentation in the locoregional RT group, no difference was found between both groups in regard to disease-free survival (DFS; p = 0.83) and overall survival (OS; p = 0.56), suggesting that regional RT was able to counterbalance the increased risk. There was even a trend toward a better 3-year DFS, 61% in locoregional RT and 37% in local RT, in the subgroup of patients with four or more positive lymph nodes. In a Cox regression model, higher T-stage, four or more positive lymph nodes, and LVI remained significant. For DFS and distant metastasis-free survival (DMFS), the absence of estrogen receptors and the omission of regional RT were also significant. Our data suggest that the addition of regional RT might be beneficial in selected subgroups of patients with extranodal invasion and other poor prognostic factors.
Background: This article should demonstrate the problems concerning gonadal dose in seminoma pati... more Background: This article should demonstrate the problems concerning gonadal dose in seminoma patients, the impact of shielding and possible consequences for therapy and advising of patients with desire to have children. Patients and Method: Since November 1993 gonadal doses of 43 patients (Stage I/II, Royal Marsden) have been determined in 80 measurements with 2 ionization chambers on the ipsi- and contralateral side of the remaining testicle. The patients were all treated with ap/pa 'hockey-stick'- shaped fields on a 6 MV linear accelerator. With single doses of 1.8 Gy in midplane, total doses of 34.2 Gy were applied in 13, and 30.6 Gy in 30 men. Protection was used in 33 patients, 6 times with conventional shielding, later plus an additional clam-shell from ap. The results of 22 measurements on 6 men with and without protection are of special interest. In 25 patients a sperm analysis before radiotherapy was conducted. Results: Before the beginning of radiotherapy (RT) 56% ...
After conservative surgery 491 women with unilateral, invasive breast cancer were irradiated with... more After conservative surgery 491 women with unilateral, invasive breast cancer were irradiated with a median dose of 50 Gy (ICRU-point) for the whole breast and an additional boost of 20 Gy respectively. The mean (median) follow-up was 69.7 (60) months with a range from 24 to 221 months. The surgical interventions were called tumorectomy in 16.1%, lumpectomy in 63.5% and quadrantectomy in 20.4%. The tumour size was classified in 73.5% (361/491) as pT1 and in 23.5% (117/491) as pT2. 2.7% were > pT2-tumours. A dissection of the axilla (473/491) recovered at the median 16 lymph nodes (0 to 48), of whom on an average 3.7 (1 to 46) contained metastases. According to Kaplan-Meier the five and ten year survival rates yielded the following respective end-points: local relapse free 94.5% and 89.2%, free of distant metastases 84.5% and 75.6%, disease free 80.7% and 69.4%, cause specific 90.3% and 79.1% and overall survival 89.5% and 76.4%. In patients with positive margins local relapses wer...
Strahlentherapie und Onkologie : Organ der Deutschen Röntgengesellschaft ... [et al], 1999
This article should demonstrate the problems concerning gonadal dose in seminoma patients, the im... more This article should demonstrate the problems concerning gonadal dose in seminoma patients, the impact of shielding and possible consequences for therapy and advising of patients with desire to have children. Since November 1993 gonadal doses of 43 patients (Stage I/II, Royal Marsden) have been determined in 80 measurements with 2 ionization chambers on the ipsi- and contralateral side of the remaining testicle. The patients were all treated with ap/pa "hockey-stick"-shaped fields on a 6 MV linear accelerator. With single doses of 1.8 Gy in midplane, total doses of 34.2 Gy were applied in 13, and 30.6 Gy in 30 men. Protection was used in 33 patients, 6 times with conventional shielding, later plus an additional clam-shell from ap. The results of 22 measurements on 6 men with and without protection are of special interest. In 25 patients a sperm analysis before radiotherapy was conducted. Before the beginning of radiotherapy (RT) 56% of available patients have shown an impai...
Hypoxia-inducible factor 1 alpha (hif-1alpha) furnishes tumor cells with the means of adapting to... more Hypoxia-inducible factor 1 alpha (hif-1alpha) furnishes tumor cells with the means of adapting to stress parameters like tumor hypoxia and promotes critical steps in tumor progression and aggressiveness. We investigated the role of hif-1alpha expression in patients with node-positive breast cancer. Tumor samples from 77 patients were available for immunohistochemistry. The impact of hif-1alpha immunoreactivity on survival endpoints was determined by univariate and multivariate analyses, and correlations to clinicopathological characteristics were determined by cross-tabulations. hif-1alpha was expressed in 56% (n = 43/77) of the patients. Its expression correlated with progesterone receptor negativity (P = 0.002). The Kaplan-Meier curves revealed significantly shorter distant metastasis-free survival (DMFS) (P = 0.04, log-rank) and disease-free survival (DFS) (P = 0.04, log-rank) in patients with increased hif-1alpha expression. The difference in overall survival (OS) did not attain...
One third up to half of the patients treated by the radiation oncologist are referred for palliat... more One third up to half of the patients treated by the radiation oncologist are referred for palliative radiation therapy because of distant metastases, mostly for painful bone or symptomatic brain metastases. As malignant cells are often disseminating long before diagnosis and therapy of the primary tumor, solitary metastases occur very seldom. A single and good resectable brain metastasis is a well-known indication for surgical intervention, especially at infratentorial location. In spherical metastases below a size of 3 cm stereotaxic radio-surgery can be alternatively considered, especially at paramedian location. Bone metastases need more often a surgical therapy, e.g. an impending or already happened fracture of long hollow bones, or radio-resistent tumors of hands and feet. Surgical therapy of metastatic vertebrae are often demanding enormous efforts and skills. Indications for surgery are osteolytical metastases with potential static problems, highly advanced destruction and mo...
To assess the value of treatment-planning related parameters namely, the breast volume; the dista... more To assess the value of treatment-planning related parameters namely, the breast volume; the distance of the inferior field border to diaphragm; and the cardiothoracic ratio for left-tangential breast irradiation. Treatment plans of 27 consecutively left-sided breast cancer patients after breast conserving surgery were evaluated for several parameters concerning heart-irradiation. We measured the heart distance respective to the cardiothoracic ratio and the distance of the inferior field border to diaphragm, as well as the breast volume in correlation with the irradiated heart volume. The mean heart and left breast volumes were 504 cm(3) and 672.8 cm(3), respectively. The mean heart diameter was 13.4 cm; the mean cardiothoracic ratio 0.51 and the mean distance of the inferior field border to diaphragm was 1.4 cm. Cardiothoracic ratio (p=0.01), breast volume (p=0.0002), distance of the inferior field border to diaphragm (p=0.02) and central lung distance (p=0.02) were significantly correlated with the measured heart distance. A significant correlation was also found between cardiothoracic ratio, breast volume and distance of the inferior field border to diaphragm with the irradiated heart volume measured by V10, V20 and V40. The verification of parameters like cardiothoracic ratio, distance of the inferior field border to diaphragm and breast volume in left-sided breast cancer patients may help in determining which patients could benefit from more complex planning techniques such as intensity-modulated radiotherapy to reduced risk of late cardiac injury.
There is a trend towards hypofractionated stereotactic radiotherapy (RT) in prostate cancer to ap... more There is a trend towards hypofractionated stereotactic radiotherapy (RT) in prostate cancer to apply high single doses in a few fractions. Using the Cyberknife® robotic system multiple non-coplanar fields are usually given with a treatment time of one hour or more. We planned to evaluate organ motion in this setting injecting a hydrogel spacer to protect the anterior rectal wall during treatment. A 66 years old man with low risk prostate cancer was planned for robotic hypofractionated stereotactic RT. After implantation of fiducial markers and a hydrogel spacer a total dose of 36.25 Gy in 5 fractions was given to the planning target volume (clinical target volume + 3 mm). After each beam the corresponding data reporting on the intra-fractional movement were pre-processed, the generated log-files extracted and the data analysed according to different directions: left -right (LR); anterior - posterior (AP); inferior -superior (IS). Clinical assessments were prospectively done before R...
To evaluate if locoregional radiotherapy (RT) versus local irradiation only can alter the pattern... more To evaluate if locoregional radiotherapy (RT) versus local irradiation only can alter the pattern of failure in breast cancer patients with extranodal invasion. From 08/1988 to 06/1998, 81 patients with extranodal invasion were treated with adjuvant RT (median total dose: 50.4 Gy), 46/81 only locally, 35/81 loco regionally due to presumed adverse parameters. The mean number of resected (positive) lymph nodes was 17 (seven). 78 patients received adjuvant systemic treatment(s). Patients treated with locoregional RT had significantly more often lymphatic vessel invasion (LVI; 63% vs. 28%; p = 0.003), T3/T4 tumors (43% vs. 17%; p = 0.014), and four or more positive lymph nodes (91% vs. 46%; p < 0.001) than patients irradiated only locally. Disease progression occurred in 24/81 patients (locoregional RT: 26% vs. local RT: 33%). The above risk factors were highly significant of worse outcome. Despite their overrepresentation in the locoregional RT group, no difference was found between both groups in regard to disease-free survival (DFS; p = 0.83) and overall survival (OS; p = 0.56), suggesting that regional RT was able to counterbalance the increased risk. There was even a trend toward a better 3-year DFS, 61% in locoregional RT and 37% in local RT, in the subgroup of patients with four or more positive lymph nodes. In a Cox regression model, higher T-stage, four or more positive lymph nodes, and LVI remained significant. For DFS and distant metastasis-free survival (DMFS), the absence of estrogen receptors and the omission of regional RT were also significant. Our data suggest that the addition of regional RT might be beneficial in selected subgroups of patients with extranodal invasion and other poor prognostic factors.
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