Strahlentherapie und Onkologie最新文献

{"title":"Neoadjuvant radiochemotherapy in patients with high-risk locally advanced cervical cancer-results of a clinical series.","authors":"S Donath, M A Schirmer, F Bremmer, A Seif, L H Dröge, M Guhlich, L A Fischer, D A Ziegler, S Ziegler, M Leu, C F Pagel, C M Zwerenz, J T Oelmann, R El Shafie, A Hille, H E Ammon, G Fleckenstein, C F Hess, S Rieken, S Bendrich","doi":"10.1007/s00066-024-02340-5","DOIUrl":"https://doi.org/10.1007/s00066-024-02340-5","url":null,"abstract":"<p><strong>Purpose: </strong>Neoadjuvant radiochemotherapy (NARCT) is an established standard of care in various tumor entities, promoting high response rates at commonly lower toxicities as compared to adjuvant approaches. This retrospective analysis was designed to investigate NARCT in early-stage high-risk cervical cancer.</p><p><strong>Methods: </strong>Forty patients with early-stage high-risk cervical cancer (i.e., L1, V1, G3, N+, > ²/₃ stromal invasion, > 4 cm tumor size, borderline resectability) were treated with NARCT prior to surgical resection. Downstagings based on clinical, imaging, and pathological responses were recorded. Survival rates were calculated according to Kaplan-Meier, and prognostic factors were analyzed with uni- and multivariable Cox regression analyses using SPSS software (v. 26; IBM Corp., Armonk, NY, USA).</p><p><strong>Results: </strong>Both NARCT and subsequent tumor resection were feasible and conducted in 39 of 40 patients (95%). Early toxicity was moderate, with no grade 3 or higher toxicities following NARCT and surgery. NARCT yielded significant downstaging in all patients, and pathological complete remission (pCR) was achieved in 14 patients (36%). After 5 years, overall survival (OS), freedom from local progression (FFLP), and freedom from distant progression (FFDP) rates were 84.2%, 75.9%, and 73.1%, respectively. Late proctitis (grade 1 in 8%) and urinary cystitis (grade 1-3 in 35%) occurred at acceptable rates.</p><p><strong>Conclusion: </strong>In resectable early-stage high-risk cervical cancer, NARCT is feasible and safe. Clinical, imaging, and pathological response rates are high. Impressive long-term survival and tumor control rates at modest toxicities encourage the initiation of a prospective and randomized trial.</p>","PeriodicalId":21998,"journal":{"name":"Strahlentherapie und Onkologie","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142955460","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Came to stay? Nivolumab in first-line treatment of advanced stage Hodgkin's lymphoma-A radiotherapeutic afterthought of the SWOG S1826 study].","authors":"Michael Oertel, Hans Theodor Eich","doi":"10.1007/s00066-024-02353-0","DOIUrl":"https://doi.org/10.1007/s00066-024-02353-0","url":null,"abstract":"","PeriodicalId":21998,"journal":{"name":"Strahlentherapie und Onkologie","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142927165","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is model-based dose calculation based on cone-beam computed tomography suitable for adaptive treatment planning in brachytherapy?","authors":"Andre Karius, Maya Shariff, Sabrina Schaller, Michael Lotter, Vratislav Strnad, Niklas Lackner, Rainer Fietkau, Christoph Bert, Ricarda Merten, Claudia Schweizer","doi":"10.1007/s00066-024-02318-3","DOIUrl":"10.1007/s00066-024-02318-3","url":null,"abstract":"<p><strong>Background and purpose: </strong>Model-based dose calculation considering tissue compositions is increasingly being investigated in brachytherapy. The aim of this study was to assess the suitability of modern cone-beam computed tomography (CBCT) imaging compared to conventional computed tomography (CT) scans for this purpose.</p><p><strong>Materials and methods: </strong>By means of a phantom study, we evaluated the CT numbers and electron densities measured using a modern CBCT device as well as a conventional CT scanner for various materials. Based on this, we compared dose calculations (using the TG-43 formalism as well as model-based collapsed cone calculations assuming uniform materials [ACE_uniform] and considering CT numbers [ACE_CT#]) on planning CTs and control CBCTs for patients with cervical and breast cancer as well as phantom-simulated skin cancer cases. Assessing dosimetric deviations between the planning CTs and control CBCTs acquired during the treatment course served to estimate interfractional implant variations.</p><p><strong>Results: </strong>The comparison of ACE_uniform-ACE_CT# deviations between planning CTs and control CBCTs revealed no statistically significant difference for almost all examined dose parameters. Dosimetric deviations between model-based dose calculations and TG-43 were partly significant but of small magnitude (< 10 cGy per fraction). Interfractional dosimetric variations were substantially larger than the dosimetric differences found between the various dose calculation procedures.</p><p><strong>Conclusion: </strong>Model-based dose calculation based on modern CBCT imaging was suitable. However, the found differences between these calculations and the TG-43 formalism should be investigated in dose-outcome analyses. The observed interfractional dosimetric variations revealed the importance of performing treatment quality assurance.</p>","PeriodicalId":21998,"journal":{"name":"Strahlentherapie und Onkologie","volume":" ","pages":"57-70"},"PeriodicalIF":2.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11739252/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142732876","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early and repetitive novel-tracer PET-guided stereotactic body radiotherapy for nodal oligorecurrent prostate cancer after definitive first-line therapy.","authors":"Arne Grün, Selin Cumaoglu, Anne Kluge, Thorsten Schlomm, Dirk Böhmer, Kurt Miller, Holger Heidenreich, Daniel Zips, Goda Kalinauskaite","doi":"10.1007/s00066-024-02304-9","DOIUrl":"10.1007/s00066-024-02304-9","url":null,"abstract":"<p><strong>Background: </strong>Prostate-specific membrane antigen (PSMA) positron-emission tomography (PET) imaging can detect prostate cancer (PCa) nodal oligorecurrences (NOR) at very low prostate-specific antigen (PSA) levels. Prospective studies on oligorecurrent (OR) PCa have been hampered by either dated diagnostics or inhomogeneous cohorts and/or treatment approaches. We hypothesized that early and-if necessary and feasible-repetitive PSMA-PET-based metastasis-directed therapy (MDT) using stereotactic body radiotherapy (SBRT) would improve freedom from palliative (systemic) therapy at low toxicity.</p><p><strong>Methods: </strong>This study is a retrospective analysis of patients treated for OR PCa after definitive first-line therapy using PSMA-PET/CT-based SBRT. Endpoints were biochemical progression-free survival (bPFS), SBRT-free survival (SBRT-FS), androgen deprivation therapy (ADT)-free survival (ADT-FS), and toxicity.</p><p><strong>Results: </strong>A total of 67 patients and 248 metastases (211 nodal) were treated. Patients on concurrent ADT were excluded. Median PSA at inclusion was 2.175 ng/ml. bPFS, SBRT-FS, and ADT-FS for multiple-course SBRT were 9.5, 19.5, and 35.0 months, respectively; 32 patients had ≥ 1 course of SBRT. Median PSA nadir was 0.585 ng/ml. There was no ≥ grade 2 toxicity.</p><p><strong>Conclusion: </strong>Modern-tracer PET/CT-based early and repetitive focal SBRT yields promising results with regard to bPFS, SBRT-FS, and ADT-FS with low toxicity. The ability of this approach to postpone initiation of palliative treatment with low toxicity should be re-evaluated prospectively.</p>","PeriodicalId":21998,"journal":{"name":"Strahlentherapie und Onkologie","volume":" ","pages":"36-46"},"PeriodicalIF":2.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11739206/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142354138","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Stereotactic radiotherapy with five fractions vs. robot-assisted prostatectomy: first results of the PACE-A study].","authors":"David Krug, Oliver Blanck, Jürgen Dunst","doi":"10.1007/s00066-024-02326-3","DOIUrl":"10.1007/s00066-024-02326-3","url":null,"abstract":"","PeriodicalId":21998,"journal":{"name":"Strahlentherapie und Onkologie","volume":" ","pages":"88-91"},"PeriodicalIF":2.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142819214","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Through the labyrinth towards the goal: doxorubicin/trabectedin in metastatic and initially unresectable leiomyosarcoma].","authors":"Felix Grabenbauer, Sabine Semrau","doi":"10.1007/s00066-024-02324-5","DOIUrl":"10.1007/s00066-024-02324-5","url":null,"abstract":"","PeriodicalId":21998,"journal":{"name":"Strahlentherapie und Onkologie","volume":" ","pages":"82-84"},"PeriodicalIF":2.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142751720","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcome of intraoperative brachytherapy as a salvage treatment for locally recurrent rectal cancer.","authors":"Raluca Stoian, Hannes P Neeff, Mark Gainey, Michael Kollefrath, Simon Kirste, Constantinos Zamboglou, Jan Philipp Harald Exner, Dimos Baltas, Stefan Fichtner Feigl, Anca-Ligia Grosu, Tanja Sprave","doi":"10.1007/s00066-024-02271-1","DOIUrl":"10.1007/s00066-024-02271-1","url":null,"abstract":"<p><strong>Background: </strong>Locally advanced recurrent rectal cancer (RRC) requires a multimodal approach. Intraoperative high-dose-rate brachytherapy (HDR-BT) may reduce the risk of local recurrence. However, the optimal therapeutic regimen remains unclear. The aim of this retrospective monocentric study was to evaluate the toxicity of HDR-BT after resection of RRC.</p><p><strong>Methods: </strong>Between 2018 and 2022, 17 patients with RRC received resection and HDR-BT. HDR-BT was delivered alone or as an anticipated boost with a median dose of 13 Gy (range 10-13 Gy) using an ¹⁹²iridium microSelectron HDR remote afterloader (Elekta AB, Stockholm, Sweden). All participants were followed for assessment of acute and late adverse events using the Common Terminology Criteria for Adverse Events version 5.0 and the modified Late Effects in Normal Tissues criteria (subjective, objective, management, and analytic; LENT-SOMA) at 3‑ to 6‑month intervals.</p><p><strong>Results: </strong>A total of 17 patients were treated by HDR-BT with median dose of 13 Gy (range 10-13 Gy). Most patients (47%) had an RRC tumor stage of cT3‑4 N0. At the time of RRC diagnosis, 7 patients (41.2%) had visceral metastases (hepatic, pulmonary, or peritoneal) in the sense of oligometastatic disease. The median interval between primary tumor resection and diagnosis of RRC was 17 months (range 1-65 months). In addition to HDR-BT, 2 patients received long-course chemoradiotherapy (CRT; up to 50.4 Gy in 1.8-Gy fractions) and 2 patients received short-course CRT up to 36 Gy in 2‑Gy fractions. For concomitant CRT, all patients received 5‑fluorouracil (5-FU) or capecitabine. Median follow-up was 13 months (range 1-54). The most common acute grade 1-2 toxicities were pain in 7 patients (41.2%), wound healing disorder in 3 patients (17.6%), and lymphedema in 2 patients (11.8%). Chronic toxicities were similar: grade 1-2 pain in 7 patients (41.2%), wound healing disorder in 3 patients (17.6%), and incontinence in 2 patients (11.8%). No patient experienced a grade ≥3 event.</p><p><strong>Conclusion: </strong>Reirradiation using HDR-BT is well tolerated with low toxicity. An individualized multimodality approach using HDR-BT in the oligometastatic setting should be evaluated in prospective multi-institutional studies.</p>","PeriodicalId":21998,"journal":{"name":"Strahlentherapie und Onkologie","volume":" ","pages":"27-35"},"PeriodicalIF":2.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11739204/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141903004","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The risk of second malignancies following prostate cancer radiotherapy in the era of conformal radiotherapy: a statement of the Prostate Cancer Working Group of the German Society of Radiation Oncology (DEGRO).","authors":"C Zamboglou, D M Aebersold, C Albrecht, D Boehmer, U Ganswindt, N-S Schmidt-Hegemann, S Hoecht, T Hölscher, S A Koerber, A-C Mueller, P Niehoff, J C Peeken, M Pinkawa, B Polat, S K B Spohn, F Wolf, D Zips, T Wiegel","doi":"10.1007/s00066-024-02288-6","DOIUrl":"10.1007/s00066-024-02288-6","url":null,"abstract":"<p><p>A significant number of prostate cancer patients are long-term survivors after primary definitive therapy, and the occurrence of late side effects, such as second primary cancers, has gained interest. The aim of this editorial is to discuss the most current evidence on second primary cancers based on six retrospective studies published in 2021-2024 using large data repositories not accounting for all possible confounding factors, such as smoking or pre-existing comorbidities. Overall, prostate cancer patients treated with curative radiotherapy have an increased risk (0.7-1%) of the development of second primary cancers compared to patients treated with surgery up to 25 years after treatment. However, current evidence suggests that the implementation of intensity modulated radiation therapy is not increasing the risk of second primary cancers compared to conformal 3D-planned radiotherapy. Furthermore, increasing evidence indicates that highly conformal radiotherapy techniques may not increase the probability of second primary cancers compared to radical prostatectomy. Consequently, future studies should consider the radiotherapy technique and other confounding factors to provide a more accurate estimation of the occurrence of second primary cancers.</p>","PeriodicalId":21998,"journal":{"name":"Strahlentherapie und Onkologie","volume":" ","pages":"4-10"},"PeriodicalIF":2.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11739244/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142081586","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Protocol-based CT-guided brachytherapy for patients with prostate cancer and previous rectal extirpation-a curative approach.","authors":"Philipp Schubert, Vratislav Strnad, Thomas Weißmann, Claudia Schweizer, Michael Lotter, Stephan Kreppner, Andre Karius, Rainer Fietkau, Ricarda Merten","doi":"10.1007/s00066-024-02266-y","DOIUrl":"10.1007/s00066-024-02266-y","url":null,"abstract":"<p><strong>Objective: </strong>There are numerous curative treatment possibilities for prostate cancer. In patients who have undergone rectal extirpation for rectal cancer treatment, curative options are limited due to anatomic changes and previous irradiation of the pelvis. In this analysis, we validate the feasibility of CT-guided transperineal interstitial brachytherapy for this specific scenario.</p><p><strong>Patients and methods: </strong>We analyzed the treatment procedures and outcomes of 5 patients with metachronic nonmetastatic prostate cancer. Ultrasound-guided brachytherapy was not possible in any of the patients. Of these 5 patients, 3 were treated for prostate cancer using temporary brachytherapy with Ir-192 only, and 2 were treated with external-beam radiation therapy and temporary brachytherapy as a boost. CT-guided brachytherapy was performed in all patients. We analyzed the feasibility, efficacy, treatment-related toxicity, and quality of life (EORTC-30, IEFF, IPSS, and ICIQ questionnaires) of the treatments.</p><p><strong>Results: </strong>Median follow-up was 35 months. Two out of five patients received boost irradiation (HDR 2 × 9 Gy, PDR 30 Gy). Three out of five patients were treated with PDR brachytherapy in two sessions up to a total dose of 60 Gy. Dosimetric parameters were documented as median values as follows: V100 94.7% (94.5-98.4%), D2_bladder 64.3% (50.9-78.3%), D10_urethra 131.05% (123.2%-141.2%), and D30_urethra 122.45% (116.2%-129.5%). At the time of analysis, no biochemical recurrence had been documented. Furthermore, neither early nor late side effects exceeding CTCAE grade 2 were documented.</p><p><strong>Conclusion: </strong>CT-guided transperineal brachytherapy of the prostate in patients with previous rectal surgery and radiation therapy is safe and represents a possible curative treatment option. Brachytherapy can be considered for patients with metachronic prostate cancer in this specific scenario, albeit preferably in experienced high-volume centers.</p>","PeriodicalId":21998,"journal":{"name":"Strahlentherapie und Onkologie","volume":" ","pages":"20-26"},"PeriodicalIF":2.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11739314/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141879491","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biochemical control in intermediate- and high-risk prostate cancer after EBRT with and without brachytherapy boost.","authors":"Matthias Moll, Łukasz Magrowski, Martina Mittlböck, Harald Heinzl, Christian Kirisits, Jakub Ciepał, Oliwia Masri, Gerd Heilemann, Rafał Stando, Tomasz Krzysztofiak, Gabriela Depowska, Andrea d'Amico, Tomasz Techmański, Anna Kozub, Wojciech Majewski, Rafał Suwiński, Piotr Wojcieszek, Jacek Sadowski, Joachim Widder, Gregor Goldner, Marcin Miszczyk","doi":"10.1007/s00066-024-02245-3","DOIUrl":"10.1007/s00066-024-02245-3","url":null,"abstract":"<p><strong>Purpose: </strong>External beam radiotherapy (EBRT) with or without brachytherapy boost (BTB) has not been compared in prospective studies using guideline-recommended radiation dose and recommended androgen-deprivation therapy (ADT). In this multicenter retrospective analysis, we compared modern-day EBRT with BTB in terms of biochemical control (BC) for intermediate-risk (IR) and high-risk (HR) prostate cancer.</p><p><strong>Methods: </strong>Patients were treated for primary IR or HR prostate cancer during 1999-2019 at three high-volume centers. Inclusion criteria were prescribed ≥ 76 Gy EQD2 (α/β = 1.5 Gy) for IR and ≥ 78 Gy EQD2 (α/β = 1.5 Gy) for HR as EBRT alone or with BTB. All HR patients received ADT and pelvic irradiation, which were optional in IR cases. BC between therapies was compared in survival analyses.</p><p><strong>Results: </strong>Of 2769 initial patients, 1176 met inclusion criteria: 468 HR (260 EBRT, 208 BTB) and 708 IR (539 EBRT, 169 BTB). Median follow-up was 49 and 51 months for HR and IR, respectively. BTB patients with ≥ 113 Gy EQD_2Gy experienced a stable, good BC outcome compared with BTB at lower doses. Patients treated with ≥ 113 Gy EQD_2Gy also experienced significantly improved BC compared with EBRT (10-year BC failure rates after ≥ 113 Gy BTB and EBRT: respectively 20.4 and 41.8% for HR and 7.5 and 20.8% for IR).</p><p><strong>Conclusions: </strong>In patients with IR and HR prostate cancer, BTB with ≥ 113 Gy EQD_2Gy offered a BC advantage compared with dose-escalated EBRT and lower BTB doses.</p>","PeriodicalId":21998,"journal":{"name":"Strahlentherapie und Onkologie","volume":" ","pages":"11-19"},"PeriodicalIF":2.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11739258/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141200554","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}