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    Keywords: CANCER ; IRRADIATION ; radiotherapy ; tumor ; carcinoma ; THERAPY ; RISK ; CONFORMAL RADIOTHERAPY ; EXPERIENCE ; head and neck ; IMRT ; ACCELERATED FRACTIONATION ; ADENOID CYSTIC CARCINOMA ; intensity modulated radiation therapy ; inverse treatment planning ; NASOPHARYNGEAL CARCINOMA ; PAROTID-GLAND ; SALIVARY-GLAND CARCINOMA
    Abstract: Purpose/Objective: The aim of this analysis is to evaluate the feasibility of inverse treatment planning and intensity modulated radiation therapy (IMRT) for head and neck cancer in daily clinical routine. A step and shoot IMRT approach was developed which allows the treatment of large target volumes without the need to use a split beam technique. By using the INIRT approach better protection of different organs at risk in the head and neck region may be achieved and an escalation of the dose in the tumor should be possible. We evaluated the feasibility of the treatment technique and the patient tolerance to the treatment. First clinical results are reported. Materials and Methods: Between 1999 and 2002, 48 patients with a carcinoma of the head and neck region were treated with curative intention. All patients were treated in a patient-specific Scotch-Cast mask. Patients who required treatment of the lymph node levels I-VI, were additionally positioned by a vacuum pillow in order to immobilize the upper part of the thorax. For inverse treatment planning, the software module KonRad was used which was integrated into the VIRTUOS planning system. Each treatment plan was verified using quantitative film dosimetry in a head and neck phantom. The step and shoot IMRT technique with a multileaf collimator integrated in a Primus (Siemens(R)) accelerator was used for treatment. For all target volumes the whole target including the lymph nodes were covered completely by the INIRT treatment. Results: The mean total dose for the target volumes of macroscopic disease ranged between 63.0 and 64.1 Gy. The mean total dose of microscopic disease ranged between 55.2 and 60.1 Gy. The mean percentage of planning target volume receiving 〈 90% of the prescribed dose ranged between 3.0 and 11.5%. For the treatment, the median number of beams was seven (range: five to nine). The time to deliver the treatment ranged between 9 and 18 min. The results of the verification revealed a mean deviation between measured and calculated absolute doses for the 48 patients of 0.1 +/- 1.4%. Including the phantom verification the IMRT treatment of the patients could be started approximately after five working days. The treatment was well tolerated by all patients. The 2-year actuarial overall survival was 92% and the 2-year actuarial local control rate was 93%. According to the Radiation Therapy Oncology Group (RTOG), no higher acute toxicity than Grade 3 was seen. Observation of the late effects revealed only one transient Grade 4 toxicity of the bone and only four patients had a xerostomia higher than Grade 1. Conclusion: The use of an inversely-planned and intensity-modulated step and shoot approach is feasible in clinical routine for head and neck tumors. Treatment could be applied as planned and no increased toxicity was found. Compared to other IMRT approaches for the head and neck region the used technique allows the treatment of the primary tumor and the lymph nodes level I-VI with only one intensity modulated treatment volume. The presented technique avoids to match conventional radiotherapy fields and INIRT fields, and therefore, reduce the risk of overdosage or underdosage at the matching line. Compared to conventional treatment techniques INIRT shows advantages in tumor dose and dose at the organs at risk. (C) 2003 Elsevier Science Ireland Ltd. All rights reserved
    Type of Publication: Journal article published
    PubMed ID: 12742271
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  • 3
    Keywords: CANCER ; radiotherapy ; CLINICAL-TRIAL ; COMBINATION ; Germany ; THERAPY ; SURGERY ; radiation ; tumour ; MR ; CELL-LINES ; treatment ; TRIAL ; CONFORMAL RADIOTHERAPY ; EXPERIENCE ; RADIATION-THERAPY ; CLINICAL-TRIALS ; chemotherapy ; FUTURE ; MALIGNANT MESOTHELIOMA ; malignant pleural mesothelioma ; quality of life ; intensity modulated radiotherapy ; thoracic radiation therapy ; three-dimensional radiotherapy planning
    Abstract: Pleural mesothelioma is a rare but fatal tumour. Numerous attempts to find effective treatment approaches have, in general, been disappointing. To date, the most promising treatment is surgery, or surgery in combination with radio and chemotherapy as a part of a multidisciplinary approach. Preliminary results from clinical trials evaluating intensity modulated radiotherapy are encouraging. Further randomised trials are proposed. (C) 2004 Elsevier Ireland Ltd. All rights reserved
    Type of Publication: Journal article published
    PubMed ID: 15261441
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  • 4
    Keywords: IRRADIATION ; radiotherapy ; tumor ; Germany ; MODEL ; THERAPY ; CT ; DISEASE ; liver ; TISSUE ; TUMORS ; radiation ; TIME ; RAT ; TOLERANCE ; TRIAL ; RADIATION-THERAPY ; INDUCED HEPATIC-INJURY ; animal model ; INTRAOPERATIVE RADIATION-THERAPY ; LIVER-TUMORS
    Abstract: Background: A focal reaction of the liver is radiologically seen after stereotactic high dose radiotherapy of liver tumors. The histological counterpart of this reaction should be clarified using an animal model. Materials and Methods: Six New Zealand white rabbits were positioned on a special stereotactic set-up. Parts of the liver (1.5 - 8 ml) were irradiated with either 20 - 24 Gy/80% (n = 3) or 36 Gy/80% (n = 3). The animals were followed by CT examination up to 2 years after radiotherapy. Finally, the animals were sacrificed and the liver macroscopically and microscopically inspected. Results: No focal reaction could be observed in any liver at any time by CT examination. The liver macroscopically and microscopically showed no changes 6 months or 2 years after radiotherapy. Conclusion: Up to a single dose of 36 Gy/80%, rabbits seem to show no focal tissue reaction after high dose radiation therapy of small parts of the liver
    Type of Publication: Journal article published
    PubMed ID: 16982551
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  • 5
    Keywords: radiotherapy ; Germany ; imaging ; NEW-YORK ; NUCLEAR-MEDICINE ; HEAD ; nuclear medicine ; radiology ; ONCOLOGY ; RE ; AMIFOSTINE ; NUCLEAR ; USA ; UNIT ; - ; NECK CANCER ; PAROTID-GLAND FUNCTION
    Type of Publication: Journal article published
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  • 6
    Keywords: radiotherapy ; tumor ; Germany ; imaging ; LONG-TERM ; NEW-YORK ; RISK ; TUMORS ; SURGERY ; radiation ; TIME ; PATIENT ; COMPLEX ; IMPACT ; QUALITY ; FIELD ; EXPERIENCE ; RADIATION-THERAPY ; chemotherapy ; BEAM ; EVOLUTION ; HEAD ; INTENSITY-MODULATED RADIOTHERAPY ; carbon ion therapy ; NECK-CANCER ; proton therapy ; ONCOLOGY ; CONVENTIONAL RADIOTHERAPY ; QUALITY-OF-LIFE ; technique ; USA ; carbon ion radiotherapy ; BEAMS ; ACCELERATOR ; intensity-modulated radiotherapy (IMRT) ; particle therapy ; CLINICAL-PRACTICE ; long-term toxicities ; image-guided radiotherapy (IGRT)
    Abstract: Radiation oncology, along with surgery and chemotherapy, is one of the cornerstones in the treatment of head and neck tumors. Within the last years, this field has experienced a remarkable evolution of new technical possibilities. New imaging modalities have been introduced into radiation planning and into linear accelerators themselves. In addition, new techniques enable the tailor-made conformation of radiation beams and dose distributions to complex tumor geometries. At the same time, organs at risk can be spared, and long-term toxicities are considerably reduced. This report presents the new techniques in radiation oncology and describes the effects on new treatment options and patients' quality of life
    Type of Publication: Journal article published
    PubMed ID: 18483796
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  • 7
    Keywords: CANCER ; IRRADIATION ; radiotherapy ; tumor ; Germany ; MODEL ; DIAGNOSIS ; FOLLOW-UP ; TUMORS ; PATIENT ; PROGRESSION ; EXPERIENCE ; TUMOR PROGRESSION ; CHILDREN ; CERVICAL-SPINE ; PROTON RADIATION-THERAPY ; ADULT ; ADULTS ; SKULL BASE TUMORS ; CHONDROSARCOMAS ; CHORDOMAS ; survival analysis ; carbon ion radiotherapy ; BEAMS ; childhood cancer ; SCAN
    Abstract: BACKGROUND: The current study was conducted to evaluate the outcome of carbon ion radiotherapy (RT) in children and young adults with skull base chordomas and chondrosarcomas. METHODS: Between 1997 and 2007, 394 patients were treated with carbon ion RT at Geselischaft fur Schwerionenforschung in Darmstadt, Germany. Of these patients, 17 patients were aged 〈= 21 years. Seventeen of these young patients were treated for chordoma or low-grade chondrosarcoma of the skull base and were analyzed in this study. Irradiation was performed after primary diagnosis in 14 patients (82%) and for recurrent tumors in 3 patients (18%). The authors applied a median total dose of 60 gray equivalents (Gy E) (range, 60-66.6 Gy E) in a fractionation of 7 x 3 Gy E per week of carbon ion RT using the raster scan technique. All patients were observed prospectively on a regular basis after carbon ion RT. RESULTS: The median follow-up time was 49 months. Treatment was well tolerated without severe side effects and could be completed on an outpatient basis in all patients without interruptions. One patient with chordoma developed tumor progression at 60 months after carbon ion RT. All other patients demonstrated no signs of tumor progression during follow-up. CONCLUSIONS: Despite its promising outcome in children and young adults with chordomas and chondrosarcomas, further evaluation in a larger patient collective is required. Randomized studies comparing the outcome after carbon ion RT with proton RT are especially needed to evaluate the role of particle beams in the treatment of skull base tumors in children and young adults. Cancer 2009;115:1348-55. (C) 2009 American Cancer Society
    Type of Publication: Journal article published
    PubMed ID: 19156905
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  • 8
    Keywords: CANCER ; radiotherapy ; tumor ; carcinoma ; Germany ; THERAPY ; CT ; FOLLOW-UP ; imaging ; SURGERY ; radiation ; PATIENT ; prognosis ; CONTRAST ; RADIATION-THERAPY ; chemotherapy ; DELIVERY ; AD ; ESOPHAGUS ; RANDOMIZED-TRIAL ; IMRT ; radiology ; GUIDANCE ; THERAPIES ; LIBRARIES ; chemoradiation ; radiation therapy ; CT SCANS ; LIBRARY ; ESOPHAGEAL CANCER ; IMAGE GUIDANCE ; JUNCTION ; ATRIAL-FIBRILLATION ; outcome ; GUIDED RADIOTHERAPY ; RADIOCHEMOTHERAPY ; POSITION ; SCAN ; STRATEGY ; LIMITATIONS ; Esophageal carcinoma
    Abstract: Background: Despite maximum therapy the prognosis of esophageal carcinoma still remains extremely poor. New treatment strategies including improved radiation therapy techniques promise better outcome by improving local control through precise dose delivery due to higher conformality. Case Report: A 62-year-old patient with locally advanced carcinoma of the gastroesophageal junction underwent definitive radiochemotherapy with intensity-modulated radiation therapy (IMRT). On positioning control with the in-room CT, the distal. esophagus, and hence the tumor, was found to be highly mobile exhibiting changes in position of up to 4 cm from fraction to fraction. Result: IMRT plans were created for various positions establishing a plan library to choose from as appropriate. CT scans were performed prior to each treatment fraction to clarify esophagus position in order to choose the adequate treatment plan. Conclusion. Image guidance was crucial in this unusual case of esophageal carcinoma. Without the information from position control CTs, the tumor would have received only about half the prescribed dose due to variations in position. For this specific case, in-room CT scans are probably superior to kilo- or megavoltage CTs due to the higher soft-tissue contrast enabling detection of positioning variation of the organ and offering the possibility to use the CT for treatment planning
    Type of Publication: Journal article published
    PubMed ID: 19714309
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  • 9
    Abstract: PURPOSE: We analyzed our experience with intraoperative electron radiotherapy (IOERT) followed by moderate doses of external beam radiotherapy (EBRT) after organ-sparing surgery in patients with primary or recurrent aggressive fibromatosis. METHODS AND MATERIALS: Indication for IOERT and postoperative EBRT as an individual treatment approach to avoid mutilating surgical procedures was seen when complete surgical removal seemed to be unlikely or impossible. A total of 31 lesions in 30 patients were treated by surgery and IOERT with a median dose of 12 Gy. Median age was 31 years (range, 13-59 years). Resection status was close margin in six lesions, microscopically positive in 13, and macroscopically positive in 12. Median tumor size was 9 cm. In all, 25 patients received additional EBRT, with a median dose of 45 Gy (range, 36-54 Gy). RESULTS: After a median follow-up of 32 months (range, 3-139 months), no disease-related deaths occurred. A total of five local recurrences were seen, resulting in actuarial 3-year local control rates of 82% overall and 91% inside the IOERT areas. Trends to improved local control were seen for older age (〉31 years) and negative margins, but none of these factors reached significance. Perioperative complications were found in six patients, in particular as wound healing disturbances in five patients and venous thrombosis in one patient. Late toxicity was seen in five patients. CONCLUSION: Introduction of IOERT into a multimodal treatment approach in patients with aggressive fibromatosis is feasible with low toxicity and yielded good local control rates even in patients with microscopical or gross residual disease. Copyright 2010 Elsevier Inc. All rights reserved.
    Type of Publication: Journal article published
    PubMed ID: 19647952
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  • 10
    Keywords: radiotherapy ; TUMORS ; RADIATION-THERAPY ; chemotherapy ; SQUAMOUS-CELL CARCINOMA ; INTENSITY-MODULATED RADIOTHERAPY ; CISPLATIN ; IMRT ; reirradiation ; NASOPHARYNGEAL CARCINOMA ; ONCOLOGY-GROUP ; head and neck cancer ; XEROSTOMIA ; Recurrent head and neck cancer ; late toxicity ; UNRESECTABLE HEAD
    Abstract: Background In this retrospective investigation we analyzed outcome and toxicity after intensity-modulated reirradiation of recurrent head and neck cancer. Results Median overall survival was 17 months, and the 1- and 2-year overall survival rates were 63% and 34%. The 1- and 2-year local control rates were 57% and 53%. Distant spread occurred in 34%, and reirradiation induced considerable late toxicity in 21% of the patients. Thirty-two percent showed increased xerostomia after reirradiation. The risk for xerostomia was significantly higher for cumulative mean doses of greater-than-or-equal 45 Gy to parotid glands. Considering median cumulative maximum doses of 53 Gy to the spinal cord and 63 Gy to the brainstem, no late toxicities were observed. Conclusions Reirradiation with intensity-modulated radiotherapy in recurrent head and neck cancer is feasible with acceptable toxicity and yields encouraging rates of local control and overall survival.
    Type of Publication: Journal article published
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