Search

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.One hundred ninety-three patients were trained via a biofeedback mechanism to maintain a partially filled bladder with a reproducible volume of 200-300 cc at planning CT and subsequently at each fraction of radiotherapy. We prospectively analyzed whether and to what extent the patients' ability to maintain a certain bladder filling influenced the degree of acute GU toxicity and whether cut-off values could be differentiated.We demonstrated that the ability to reach a reproducible bladder volume above a threshold volume of 180 cc and maintain that volume via biofeedback throughout treatment predicts for a decrease in acute GU toxicity during curative high-dose IMRT of the prostate. Patients who were not able to reach a partial bladder filling to that cut-off value and were not able to maintain a partially filled bladder throughout treatment had a significantly higher risk of developing ≥grade 2 GU acute toxicity.Our results support the hypothesis that a biofeedback training for the patient is an easy-to-apply, useful, and cost-effective tool for reducing acute GU toxicity in high-dose IMRT of the prostate. Patients who are not able to reach and maintain a certain bladder volume during planning and treatment-two independent risk factors-might need special consideration.HINTERGRUND UND ZIEL: Auswertung des Einflusses des Harnblasenvolumens während hochdosierter intensitätsmodulierter Strahlentherapie (IMRT) bei Prostatakarzinom auf die akute urogenitale Toxizität sowie prospektive Auswertung eines einfachen Biofeedback-Mechanismus zur reproduzierbaren Harnblasenfüllung mit dem Ziel, akute urogenitale Nebenwirkungen zu reduzieren.Insgesamt 193 Patienten wurde mit Hilfe eines einfachen Biofeedback-Mechanismus beigebracht, während der Planungs-CT und jeder folgenden Fraktion ein Harnblasenvolumen von 200–300 ml zu reproduzieren. Es erfolgte eine prospektive Auswertung inwiefern sich die Fähigkeit, ein bestimmtes Harnblasenvolumen zu erreichen und zu halten, auf die Rate an akuten urogenitalen Nebenwirkungen auswirkt und ob Grenzwerte definiert werden können.Wir konnten zeigen, dass während einer hochdosierten IMRT der Prostata die Fähigkeit ein Harnblasenvolumen von mindestens 180 ml zu erreichen und zu jeder Fraktion der Therapie reproduzieren zu können, prädiktiv für eine Reduktion von akuten urogenitalen Nebenwirkungen ist. Patienten, die keine partielle Harnblasenfüllung erreichen und reproduzieren konnten, zeigten eine signifikant erhöhte Rate urogenitaler Nebenwirkungen ≥ Grad 2.Unsere Ergebnisse zeigen, dass akute urogenitale Nebenwirkungen während einer hochdosierten IMRT der Prostata kostengünstig mit einem einfachen Biofeedback-Mechanismus reduziert werden können. Patienten, die es nicht schaffen, ein bestimmtes Blasenvolumen zu erreichen und zu halten, benötigen möglicherweise intensivere Betreuung.

In this study, the acute toxicity and long-term outcome of a hyperfractionated accelerated chemoradiation regimen with cisplatin/5-fluorouracil (5-FU) in patients with locally advanced squamous cell carcinomas of head and neck were evaluated.From 2000-2002, 38 patients with stage III (5.3 %) and stage IV (94.7 %) head and neck cancer were enrolled in a phase II study. Patients received hyperfractionated-accelerated radiotherapy with 72 Gy in 15 fractions of 2 Gy followed by 1.4 Gy twice daily with concurrent, continuous infusion 5-FU of 600 mg/m(2) on days 1-5 and 6 cycles of weekly cisplatin (30 mg/m(2)). Acute toxicities (CTCAEv2.0), locoregional control (LRC), metastases-free (MFS), and overall survival (OS) were analyzed and exploratively compared with the ARO 95-06 trial.Median follow-up was 11.4 years (95 % CI 8.6-14.2) and mean dose 71.6 Gy. Of the patients, 82 % had 6 (n = 15) or 5 (n = 16) cycles of cisplatin, 5 and 2 patients received 4 and 3 cycles, respectively. Grade 3 anemia, leukopenia, and thrombocytopenia were observed in 15.8, 15.8, and 2.6 %, respectively. Grade 3 mucositis in 50 %, grade 3 and 4 dysphagia in 55 and 13 %. The 2-, 5-, and 10-year LRC was 65, 53.6, and 48.2 %, the MFS was 77.5, 66.7, and 57.2 % and the OS 59.6, 29.2, and 15 %, respectively.Chemoradiation with 5-FU and cisplatin seems feasible and superior in terms of LRC and OS to the ARO 95-06C-HART arm at 2 years. However, this did not persist at the 5- and 10-year follow-ups.

Traditional oncology distinguishes between two separate and incommensurable states in the evolution of solid malignancies: the localized disease, which is curable; and the disseminated status, which is per se palliative. Recently, a huge body of evidence suggests a fundamental change in the understanding of cancer, indicating an intermediate state in the trajectory of solid malignancies: the oligometastatic state. The following review will critically analyse existing hypotheses and facts from the basic sciences and try to contextualize it in regard to the clinical evidence available to date. Consecutively, it will try to draw possible clinical consequences for application of radiotherapy in this specific clinical scenario.

In Projekten der Versorgungsforschung werden im Gegensatz zu klinischen Studien alle Patienten einer Erkrankungsgruppe unabhangig von anderen Faktoren in einem bestimmten Zeitraum analysiert. Im hier vorliegenden Projekt zur Compliance der Strahlentherapie bei Brustkrebs soll untersucht werden, in welchem Prozentsatz letztlich von den Leitlinien zur Strahlentherapie beim Brustkrebs abgewichen wird, welche Patientengruppe pradestiniert ist und welchen Einfluss dies auf die Lokalrezidivrate hat. Retrospektiv wurden alle Patientinnen (n = 1903) erfasst, bei denen vom 1. November 2003 bis zum 31. Dezember 2008 im interdisziplinaren Brustzentrum der Charite ein primar invasives oder intraduktales Mammakarzinom diagnostiziert wurde. Die mediane Nachbeobachtung betrug 2,18 Jahre. Die entgegen des Vorschlags der interdisziplinaren Tumorkonferenz nicht postoperativ bestrahlten Patientinnen hatten ein 5-fach erhohtes Lokalrezidivrisiko (p

To evaluate rectal dose-volume relations during three-dimensional conformal radiotherapy of patients with prostate cancer by means of different rectal volume contours.55 patients with prostate cancer underwent three-dimensional conformal external-beam radiotherapy. Rectal dose-volume histograms were calculated for four separately contoured rectal volumes in all patients resulting in four groups. In group 1 the outer rectal wall was contoured two CT slices above and below the planning target volume. The rectal contour of group 2 was drawn from the anal verge up to the sigmoid. Furthermore, the posterior half of the rectum was contoured for both volumes mentioned above (groups 1a and 2a). Statistical analysis was then performed using nonparametric Wilcoxon tests.The mean target dose was 72.9 Gy (standard deviation [SD] +/- 2.1 Gy). The minimum target dose was 70.2 Gy. Mean rectum dose (+/- SD) over all patients was 50.7 Gy (+/- 4.6 Gy), 45.2 Gy (+/- 5.4 Gy), 43.2 Gy (+/- 4.2 Gy), and 38.7 Gy (+/- 5.5 Gy) for group 1, 2, 1a, and 2a, respectively. The corresponding volumes receivingor = 70 Gy for groups 1 and 2 were 14.0% (+/- 5.3%) and 11.9% (+/- 4.5%). These differences were statistically significant. Comparison of minimum and mean rectal dose also revealed a statistically significant difference toward higher doses in groups 1 and 1a (p0.001). Maximum rectal doses for groups 1 and 2 as well as for groups 1a and 2a revealed no statistically significant difference (p = 1.0).Data from the literature on normal-tissue complication probability (rectal bleeding) refer to different rectal contours. When applying dose restrictions to the rectum, contouring becomes a significant factor that determines the risk of rectal toxicity. The results of this study show that different ways of rectal contouring significantly influence doses to the rectum. The influence of organ at risk contouring should be considered thoroughly in conformal radiotherapy of prostate cancer patients, especially in dose escalation studies. It is recommended to calculate the doses for absolute rectal volumes and correlate these data with toxicity in order to be able to achieve comparable results among different institutions.