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  • CANCER  (11)
  • 1
    Keywords: radiotherapy ; CANCER ; THERAPY ; CT ; IMAGES ; radiation ; RADIATION-THERAPY ; NECK ; HEAD ; CT images ; NECK-CANCER ; head and neck cancer ; radiation therapy ; THERAPIES ; NECK CANCER
    Type of Publication: Book chapter
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  • 2
    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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  • 3
    Keywords: CANCER ; carcinoma ; PROSTATE ; QUANTIFICATION ; DISEASE ; TISSUE ; QUALITY ; MRI ; SPECTROSCOPY ; prostate cancer ; LOCALIZATION ; PATTERN ; pattern recognition ; postprocessing ; proton MR spectroscopic imaging
    Abstract: RATIONALE AND OBJECTIVES: The aim of this study was to assess (1) automated analysis methods versus manual evaluation by human experts of three-dimensional proton magnetic resonance spectroscopic imaging (MRSI) data from patients with prostate cancer and (2) the contribution of spatial information to decision making. MATERIALS AND METHODS: Three-dimensional proton MRSI was applied at 1.5 T. MRSI data from 10 patients with histologically proven prostate adenocarcinoma, scheduled either for prostatectomy or intensity-modulated radiation therapy, were evaluated. First, two readers manually labeled spectra using spatial information to identify the localization of spectra and neighborhood information, establishing the reference set of this study. Then, spectra were labeled again manually in a blinded and randomized manner and evaluated automatically using software that applied spectral line fitting as well as pattern recognition routines. Statistical analysis of the results of the different approaches was performed. RESULTS: Altogether, 1018 spectra were evaluable by all methods. Numbers of evaluable spectra differed significantly depending on patient and evaluation method. Compared to automated analysis, the readers made rather binary decisions, using information from neighboring spectra in ambiguous cases, when evaluating MRSI data as a whole. Differences between anatomically blinded and unblinded evaluation were larger than differences between evaluations using blinded data and automated techniques. CONCLUSIONS: An automated approach, which evaluates each spectrum individually, can be as good as an anatomy-blinded human reader. Spatial information is routinely used by human experts to support their final decisions. Automated procedures that consider anatomic information for spectral evaluation will enhance the diagnostic impact of MRSI of the human prostate.
    Type of Publication: Journal article published
    PubMed ID: 22578226
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  • 4
    Keywords: CANCER ; radiotherapy ; tumor ; COMBINATION ; Germany ; LUNG ; PROSTATE ; ALGORITHM ; CT ; imaging ; INFORMATION ; lung cancer ; LUNG-CANCER ; MASK ; TISSUE ; TIME ; PATIENT ; COMPLEX ; COMPLEXES ; CONTRAST ; treatment ; TARGET ; ACQUISITION ; EXPERIENCE ; VECTOR ; NUMBER ; prostate cancer ; PROSTATE-CANCER ; REGISTRATION ; BEAM ; DELIVERY ; HEAD ; CANCER-PATIENTS ; MULTILEAF COLLIMATOR ; treatment planning ; BODY ; CANCER PATIENTS ; LINEAR-ACCELERATOR ; RECONSTRUCTION ; IMRT ; PATIENT FIXATION ; IMPLEMENTATION ; INCREASE ; chordoma ; LEVEL ; methods ; fractionated stereotactic radiotherapy ; technique ; MUTUAL INFORMATION ; cancer research ; cone beam CT ; LANDMARK ; INCREASES ; CLINICAL IMPLEMENTATION ; ACCELERATOR ; WORKLOAD
    Abstract: ABSTRACT: BACKGROUND: The purpose of the study was the clinical implementation of a kV cone beam CT (CBCT) for setup correction in radiotherapy. PATIENTS AND METHODS: For evaluation of the setup correction workflow, six tumor patients (lung cancer, sacral chordoma, head-and-neck and paraspinal tumor, and two prostate cancer patients) were selected. All patients were treated with fractionated stereotactic radiotherapy, five of them with intensity modulated radiotherapy (IMRT). For patient fixation, a scotch cast body frame or a vacuum pillow, each in combination with a scotch cast head mask, were used. The imaging equipment, consisting of an x-ray tube and a flat panel imager (FPI), was attached to a Siemens linear accelerator according to the in-line approach, i.e. with the imaging beam mounted opposite to the treatment beam sharing the same isocenter. For dose delivery, the treatment beam has to traverse the FPI which is mounted in the accessory tray below the multi-leaf collimator. For each patient, a predefined number of imaging projections over a range of at least 200 degrees were acquired. The fast reconstruction of the 3D-CBCT dataset was done with an implementation of the Feldkamp-David-Kress (FDK) algorithm. For the registration of the treatment planning CT with the acquired CBCT, an automatic mutual information matcher and manual matching was used. RESULTS AND DISCUSSION: Bony landmarks were easily detected and the table shifts for correction of setup deviations could be automatically calculated in all cases. The image quality was sufficient for a visual comparison of the desired target point with the isocenter visible on the CBCT. Soft tissue contrast was problematic for the prostate of an obese patient, but good in the lung tumor case. The detected maximum setup deviation was 3 mm for patients fixated with the body frame, and 6 mm for patients positioned in the vacuum pillow. Using an action level of 2 mm translational error, a target point correction was carried out in 4 cases. The additional workload of the described workflow compared to a normal treatment fraction led to an extra time of about 10-12 minutes, which can be further reduced by streamlining the different steps. CONCLUSION: The cone beam CT attached to a LINAC allows the acquisition of a CT scan of the patient in treatment position directly before treatment. Its image quality is sufficient for determining target point correction vectors. With the presented workflow, a target point correction within a clinically reasonable time frame is possible. This increases the treatment precision, and potentially the complex patient fixation techniques will become dispensable
    Type of Publication: Journal article published
    PubMed ID: 16723023
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  • 5
    Keywords: CANCER ; PROSTATE ; QUANTIFICATION ; SYSTEM ; CONFORMAL RADIOTHERAPY ; EXPERIENCE ; RADIATION-THERAPY ; dynamic MRI ; ORGAN MOTION ; MOVEMENT ; CINE-MRI ; GLAND ; BEAM COMPUTED-TOMOGRAPHY ; INTRAFRACTION MOTION
    Abstract: To investigate prostate movement during deep breathing and contraction of abdominal musculature by means of dynamic MRI and analyze implications for image-guided radiotherapy of prostate cancer. A total of 43 patients and 8 healthy volunteers were examined with MRI. Images during deep respiration and during contraction of abdominal musculature (via a coughing maneuver) were obtained with dynamic two-dimensional (2D) balanced SSFP; 3 frames/s were obtained over an acquisition time of 15 s. Images were acquired in sagittal orientation to evaluate motion along both the craniocaudal (cc)-axis and anteroposterior (ap)-axis. Prostate motion was quantified semi-automatically using dedicated software tools. Respiratory induced mean cc-axis displacement of the prostate was 2.7 +/- 1.9 (SD) mm (range, 0.5-10.6 mm) and mean ap-axis displacement 1.8 +/- 1.0 (SD) mm (range, 0.3-10 mm). In 69% of the subjects, breathing-related prostate movements were found to be negligible (〈 3 mm). The prostate displacement for abdominal contraction was significantly higher: mean cc-axis displacement was max. 8.4 +/- 6.7 (SD) mm (range, 0.6-27 mm); mean anteroposterior movement was 8.3 +/- 7.7 (SD) mm (range, 0.7-26 mm). Dynamic MRI is an excellent tool for noninvasive real-time imaging of prostate movement. Further investigations regarding possible applications in image-guided radiotherapy, e.g., for individualized planning and in integrated linac/MRI systems, are warranted
    Type of Publication: Journal article published
    PubMed ID: 21713396
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  • 6
    Keywords: CANCER ; SURVIVAL ; Germany ; LUNG ; PROSTATE ; THERAPY ; lung cancer ; LUNG-CANCER ; DEATH ; DISEASE ; LONG-TERM ; MORTALITY ; POPULATION ; RISK ; HEART ; prognosis ; BREAST ; breast cancer ; BREAST-CANCER ; MALIGNANCIES ; AGE ; colorectal cancer ; COLORECTAL-CANCER ; COUNTRIES ; PROSTATE-CANCER ; LONG-TERM SURVIVAL ; CANCER-PATIENTS ; UNITED-STATES ; FAILURE ; TRENDS ; STROKE ; ONCOLOGY ; HEART-FAILURE ; COMPETING RISKS ; 1ST-EVER STROKE ; 5 CONTINENTS ; 5-YEAR SURVIVAL ; PERTH COMMUNITY STROKE ; PRESERVED EJECTION FRACTION
    Abstract: Background: Cancer, heart failure and stroke are among the most common causes of death worldwide. Investigation of the prognostic impact of each disease is important, especially for a better understanding of competing risks. Aim of this study is to provide an overview of long term survival of cancer, heart failure and stroke patients based on the results of large population- and hospital-based studies. Methods: Records for our study were identified by searches of Medline via Pubmed. We focused on observed and relative age- and sex-adjusted 5-year survival rates for cancer in general and for the four most common malignancies in developed countries, i.e. lung, breast, prostate and colorectal cancer, as well as for heart failure and stroke. Results: Twenty studies were identified and included for analysis. Five-year observed survival was about 43% for all cancer entities, 40-68% for stroke and 26-52% for heart failure. Five-year age and sex adjusted relative survival was 50-57% for all cancer entities, about 50% for stroke and about 62% for heart failure. In regard to the four most common malignancies in developed countries 5-year relative survival was 12-18% for lung cancer, 73-89% for breast cancer, 50-99% for prostate cancer and about 43-63% for colorectal cancer. Trend analysis revealed a survival improvement over the last decades. Conclusions: The results indicate that long term survival and prognosis of cancer is not necessarily worse than that of heart failure and stroke. However, a comparison of the prognostic impact of the different diseases is limited, corroborating the necessity for further systematic investigation of competing risks
    Type of Publication: Journal article published
    PubMed ID: 20307299
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  • 7
    Keywords: LONG-TERM ; radiotherapy ; CANCER ; imaging ; TOXICITY ; Germany ; ONCOLOGY ; IMRT ; chemotherapy ; Jun ; outcome ; CONCURRENT CHEMOTHERAPY
    Type of Publication: Meeting abstract published
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  • 8
    Keywords: NUCLEAR ; intensity ; MEDICINE ; USA ; dynamic ; MRI ; NUCLEAR-MEDICINE ; PATIENT ; NEW-YORK ; imaging ; FOLLOW-UP ; PROSTATE ; CANCER ; radiotherapy ; radiology ; ONCOLOGY ; nuclear medicine ; dynamic MRI ; MANAGEMENT ; CANCER PATIENTS ; CANCER-PATIENTS ; PROSTATE-CANCER ; prostate cancer
    Type of Publication: Meeting abstract published
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  • 9
    Keywords: MANAGEMENT ; IMRT ; nuclear medicine ; ONCOLOGY ; radiology ; prostate cancer ; PROSTATE-CANCER ; SIGNAL ; NUCLEAR-MEDICINE ; MRI ; NEW-YORK ; imaging ; PROSTATE ; CANCER ; USA ; MEDICINE ; NUCLEAR
    Type of Publication: Meeting abstract published
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  • 10
    Keywords: CANCER ; IRRADIATION ; radiotherapy ; COMBINATION ; Germany ; THERAPY ; ALGORITHM ; CT ; QUANTIFICATION ; VOLUME ; ACCURACY ; radiation ; PATIENT ; COMPLEX ; COMPLEXES ; treatment ; RADIATION-THERAPY ; PROSTATE-CANCER ; MODULATION ; DELIVERY ; HEAD ; NECK ; COMPUTED-TOMOGRAPHY ; treatment planning ; LINEAR-ACCELERATOR ; DEVICES ; PATIENT FIXATION ; technique ; UNIT ; cancer research ; EXTENT ; adaptation ; SCANS ; MOVEMENTS ; ACCELERATOR
    Abstract: Modern radiotherapy techniques such as intensity modulation are capable of generating complex dose distributions whose high dose areas tightly conform to the tumour target volume, sparing critical organs even when they are located in close proximity. This potential can only be exploited to its full extent when the accumulated dose actually delivered over the complete treatment course is sufficiently close to the dose computed on the initial CT scan used for treatment planning. Exact patient repositioning is mandatory, but also other sources of error, e.g. changes of the patient's anatomy under therapy, should be taken into account. At the German Cancer Research Center, we use a combination of a linear accelerator and a CT scanner installed in one room and sharing the same couch. it allows the quantification and correction of interfractional variations between planning and treatment delivery. in this paper, we describe treatments of prostate, paraspinal and head and neck tumours. All patients were immobilized by customized fixation devices and treated in a stereotactic setup For each patient, frequent CT scans were taken during the treatment course. Each scan was compared with the original planning CT using manual checks and automatic rigid matching algorithms. Depending on the individual case, the adaptation to variations was carried out offline after several fractions or in real-time between the CT scan and linac irradiation. We discuss the techniques for detecting and correcting interfractional errors and outline the procedural steps of a linac-CT scanner-supported radiation treatment course. (C) 2006 The British Institute of Radiology
    Type of Publication: Journal article published
    PubMed ID: 16980687
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