Strahlentherapie und Onkologie最新文献

{"title":"Full bladder, empty rectum? Revisiting a paradigm in the era of adaptive radiotherapy.","authors":"Hanna Malygina, Hendrik Auerbach, Frank Nuesken, Jan Palm, Markus Hecht, Yvonne Dzierma","doi":"10.1007/s00066-024-02306-7","DOIUrl":"10.1007/s00066-024-02306-7","url":null,"abstract":"<p><strong>Background and purpose: </strong>Many patients find it challenging to comply with instructions regarding rectum and bladder filling during pelvic radiotherapy. With the implementation of online adaptive radiotherapy, the reproducibility of organ volumes is no longer a prerequisite. This study aims to analyze the sparing of the bladder and the posterior rectum wall (PRW) in conditions of full versus empty bladder and rectum.</p><p><strong>Methods: </strong>280 fractions from 14 patients with prostate cancer who underwent adaptive radiotherapy using the Varian Ethos system were analyzed post-hoc. Various metrics for the bladder and PRW were correlated with respect to organ volume.</p><p><strong>Results: </strong>Our analysis quantitatively confirms the advantage of a full bladder during radiotherapy, as metrics V48Gy and V40Gy significantly inversely correlate with bladder filling for each patient individually. While bladder volume did not show a gradual decrease over the course of radiotherapy, it was observed to be higher during planning CT scans compared to treatment sessions. A full rectum condition either significantly improved (in 2 out of 7 patients) or at least did not impair (in 5 out of 7 patients) PRW sparing, as represented by the V30Gy metric, when patients were compared individually. The average V30Gy across all patients demonstrated a significant improvement in PRW sparing for the full rectum condition, with a [Formula: see text]-value of 0.039.</p><p><strong>Conclusion: </strong>Despite the implementation of adaptive therapy, maintaining a high bladder filling remains important. However, the recommendation for rectum filling can be abandoned, as reproducibility is not critical for adaptive radiotherapy and no dosimetric advantage per se is associated with an empty rectum. Patients may even be encouraged not to void their bowels shortly before treatment, as long as this is tolerated over the treatment session.</p>","PeriodicalId":21998,"journal":{"name":"Strahlentherapie und Onkologie","volume":" ","pages":"47-56"},"PeriodicalIF":2.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142547567","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":"[Improved prognosis with radiotherapy in early-stage Hodgkin lymphoma: a critical analysis of the long-term data from the EORTC/LYSA/FIL H10 trial].","authors":"Michael Oertel, Hans Theodor Eich","doi":"10.1007/s00066-024-02325-4","DOIUrl":"10.1007/s00066-024-02325-4","url":null,"abstract":"","PeriodicalId":21998,"journal":{"name":"Strahlentherapie und Onkologie","volume":" ","pages":"85-87"},"PeriodicalIF":2.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142772399","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":"The role of radiotherapy in intracranial hemangiopericytoma/solitary fibrous tumors : A Turkish Society for Radiation Oncology Central Nervous System Tumors Group Study (TROD 07-008).","authors":"Nuri Kaydıhan, Gözde Yazıcı, Petek Erpolat, Serra Kamer, Burak Erdemci, Emine Canyılmaz, Beste Melek Atasoy, Dicle Aslan, Ela Delikgöz Soykut, Enis Özyar, Fatih Demircioğlu, Fazilet Öner Dinçbaş, Meltem Kirli Bolukbas, Ramazan Aksu, Selvi Tabak Dinçer, Yasemin Bölükbaşı, Yıldız Güney","doi":"10.1007/s00066-024-02338-z","DOIUrl":"https://doi.org/10.1007/s00066-024-02338-z","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;Intracranial hemangiopericytomas (HPC) are rare tumors. Radiotherapy (RT) is frequently performed after surgery, depending on tumor size, location, and the type of resection. Moreover, RT is preferred as an effective treatment for local recurrence and metastasis. With this multicenter study, we aimed to investigate the effectiveness of postoperative RT in intracranial HPC patients using modern RT techniques.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and methods: &lt;/strong&gt;Patients aged 16 years and older who underwent RT for histologically confirmed intracranial HPC were evaluated retrospectively. Forty-four patients from 17 institutions were included. Demographic characteristics of the patients, pathological findings, and prognostic factors were documented. The Kaplan-Meier method was used for local control (LC), distant metastasis-free survival (DMFS), progression-free survival (PFS), and overall survival (OS). The interval for survival analyses was calculated according to the end date of RT. Univariate and multivariate analysis methods were used for factors associated with survival and recurrence.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Median age was 42 years (16-71) and 70% of the patients were male. The most common initial symptoms were pain (47.7%) and vision problems (15.9%). A supratentorial location was observed in 79.5% of patients. The median maximum tumor dimension was 4.7 (1.6-14) cm. Gross total (GTR) and subtotal resection (STR) were performed in 43.2% and 47.7% of patients, respectively. Adjuvant RT commenced a median of 6 (2-16) weeks after surgery. Postoperative RT was administered using conventionally fractionated intensity-modulated radiotherapy (IMRT) or stereotactic radiosurgery (SRS). A total median dose of 60 (38-66) Gy in a median of 30 (19-33) fractions was used for patients treated with IMRT and a total median dose of 24 (12-25) Gy in a median of 3 (1-5) fractions was used for patients treated with SRS. Local recurrence occurred in 9 patients and locoregional recurrence in 2 patients at a median of 48 months (range 26-143 months) after RT. Reoperation and reirradiation were applied to 5 patients, reirradiation to 4 patients, and reoperation to 2 patients as salvage treatments. Reirradiation was administered at a median dose of 35 (13.5-54) Gy using a median of 5 (1-30) fractions. At a median follow-up of 63 (6-262) months, 5‑year LC was 68.7%, DMFS 87.2%, PFS 60.8%, and OS 95.7%. The presence of residual macroscopic tumor before RT was associated with lower LC (p = 0.01) and shorter PFS (p = 0.04). In the presence of residual tumor before RT, 5‑year LC decreased from 92.9% to 46.7%, while 5‑year PFS decreased from 81.1% to 43.5% compared to patients with GTR. The presence of postoperative tumor was associated with a lower LC rate in Cox regression analyzes (p = 0.02). The hazard ratio was 6.2 (1.2-30). However, the effect of residual disease before RT on OS was not statistically significant.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusio","PeriodicalId":21998,"journal":{"name":"Strahlentherapie und Onkologie","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142847802","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":"[Olaparib for high-risk biochemically recurrent prostate cancer following prostatectomy].","authors":"Katharina Hintelmann, Lukas Böckelmann","doi":"10.1007/s00066-024-02350-3","DOIUrl":"https://doi.org/10.1007/s00066-024-02350-3","url":null,"abstract":"","PeriodicalId":21998,"journal":{"name":"Strahlentherapie und Onkologie","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142847800","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":"Toxicity profile and clinical outcomes of stereotactic body radiotherapy with a focal boost without fiducials or perirectal hydrogel spacer for localized prostate cancer.","authors":"Yuichiro Tsurugai, Atsuya Takeda, Naoko Sanuki, Yousuke Aoki, Yuto Kimura, Yohei Oku, Tomohiro Eriguchi, Hiroyuki Yamanaka, Maiko Machida, Tomohiko Matsushita, Shiro Saito","doi":"10.1007/s00066-024-02333-4","DOIUrl":"https://doi.org/10.1007/s00066-024-02333-4","url":null,"abstract":"<p><strong>Purpose: </strong>Whole-prostate dose escalation in stereotactic body radiotherapy (SBRT) for localized prostate cancer (PCa) can improve oncological outcomes, albeit at the cost of increased toxicity. A focal boost to the dominant intraprostatic lesion (DIL) is gaining interest as an alternative approach. Herein, we investigate the safety and efficacy of this approach.</p><p><strong>Methods: </strong>This retrospective study enrolled patients with localized PCa who underwent five-fraction SBRT with a focal boost to the DIL at our institution between May 2016 and August 2021. The prescription doses to the whole prostate were 35 and 36.25 Gy for low- to favorable intermediate-risk PCa and unfavorable intermediate- to high-risk PCa, respectively. The focal boost to the DIL was up to 115-140% of the prescribed dose. None of the patients underwent pretreatment fiducial or perirectal hydrogel spacer placement. Acute and late genitourinary (GU) and gastrointestinal (GI) toxicities and oncological outcomes were assessed.</p><p><strong>Results: </strong>Among the 520 patients, 44% were categorized as patients with high-risk PCa. The median follow-up period was 42.9 months. No acute or late grade ≥3 toxicities were observed. Acute and late grade 2 GU toxicities were observed in 22.3 and 6.1%, respectively, while GI toxicities were observed in 2.1 and 0.8% of the patients. The 4‑year relapse-free survival rate was 94.8% among all patients.</p><p><strong>Conclusion: </strong>Our results indicate that SBRT with a focal boost without fiducials or perirectal hydrogel spacer for localized PCa has a promising toxicity profile and oncological outcomes. Longer follow-up studies are necessary to adequately evaluate late toxicities and efficacy.</p>","PeriodicalId":21998,"journal":{"name":"Strahlentherapie und Onkologie","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142802313","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":"In memory of Univ.-Prof. Dr. med. Normann Willich (1946-2024).","authors":"Hans Theodor Eich, Oliver Micke, Michael Baumann, Wilfried Budach, Jürgen Debus, Jürgen Dunst, Rainer Fietkau, Uwe Haverkamp, Mechthild Krause, Franz-Josef Prott, Gabriele Reinartz, Claudia Rübe, Christian Rübe","doi":"10.1007/s00066-024-02349-w","DOIUrl":"https://doi.org/10.1007/s00066-024-02349-w","url":null,"abstract":"","PeriodicalId":21998,"journal":{"name":"Strahlentherapie und Onkologie","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142802312","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":"Evaluating the impact of cardiac substructure dosimetric parameters on survival in lung cancer patients undergoing postoperative radiotherapy.","authors":"Melek Tugce Yilmaz, Pervin Hurmuz, Ezgi Gurlek, Demet Yildiz, Mustafa Cengiz","doi":"10.1007/s00066-024-02339-y","DOIUrl":"https://doi.org/10.1007/s00066-024-02339-y","url":null,"abstract":"<p><strong>Purpose: </strong>The association of cardiac dosimetric parameters with survival in lung cancer patients is well established. However, most research has concentrated on patients undergoing definitive treatment. This study aims to investigate the relationship between cardiac dosimetric parameters and survival in patients receiving postoperative radiotherapy (PORT).</p><p><strong>Methods: </strong>Sixty patients who received PORT between 2011 and 2021 were retrospectively evaluated. The substructures of the heart were delineated on the simulation computed tomography scans of the patients. Univariate and multivariate Cox regression analyses were conducted to investigate the correlation between dosimetric parameters and overall survival. The Statistical Package for the Social Sciences (SPSS) version 23.0 (IBM Corp., Armonk, NY, USA) was utilized for statistical analyses.</p><p><strong>Results: </strong>Right atrium (RA) maximum dose (Dmax) was the only variable that was significantly associated with a shorter OS. Further receiver operating characteristic (ROC) analysis revealed that the optimum cut-off value for RA Dmax was 43.6 Gy, with a sensitivity of 69% and a specificity of 62%. In addition, inclusion of the upper right paratracheal (2R), lower right paratracheal (4R), left pulmonary ligament (9L), and right hilus (10R) lymphatic stations in the treatment field led to an increase in RA Dmax.</p><p><strong>Conclusion: </strong>The results of this retrospective study show that RA Dmax appears to have an impact on overall survival in patients undergoing PORT. Limiting the RA Dmax dose to below 43.6 Gy and avoiding elective nodal irradiation might potentially enhance survival in this patient cohort.</p>","PeriodicalId":21998,"journal":{"name":"Strahlentherapie und Onkologie","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142786864","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":"Comparative effectiveness of kilo- and megavoltage energies in low-dose radiotherapy for painful degenerative musculoskeletal diseases: a systematic review and meta-analysis.","authors":"Aram Kim, Jeanny Kwon, Ji Young Kim, Byoung Hyuck Kim","doi":"10.1007/s00066-024-02329-0","DOIUrl":"https://doi.org/10.1007/s00066-024-02329-0","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to assess the impact of different energy levels on the effectiveness of low-dose radiotherapy (LDRT) for treating painful degenerative musculoskeletal diseases, as comparative efficacy data are currently lacking.</p><p><strong>Methods: </strong>A systematic review was conducted in PubMed, Embase, and the Cochrane Library databases to identify studies with response information on the energy used (kilovoltage [kV] vs. megavoltage [MV]). The primary endpoint was the overall response rate (ORR), and the secondary endpoint was the complete response rate (CRR). Exploratory subgroup analyses included treatment site, study period, study design, country, and dose per fraction.</p><p><strong>Results: </strong>A total of 33 studies involving 12,143 patients were analyzed. Short-term follow-up (up to 6 months) showed a pooled ORR of 64% (95% CI 46-78%) for kV and of 62% (95% CI 54-70%) for MV. Long-term follow-up (at least 12 months) revealed a pooled ORR of 85% (95% CI 65-95%) for kV and of 69% (95% CI 62-75%) for MV. Subgroup analysis indicated no significant differences in ORR for energy level stratified by treatment site and other factors. Regarding dose per fraction (0.5 Gy vs. 1.0 Gy), comparable ORRs were demonstrated between the two energies. No clinical side effects were noted.</p><p><strong>Conclusion: </strong>This meta-analysis suggests that the known effectiveness of LDRT in painful degenerative musculoskeletal disease may not depend on the energy used. Additional studies using standardized evaluation methods are warranted to establish consistency and enhance the comprehensiveness of research. Further research is also needed to explore treatment modality selection considering disease-specific biology.</p>","PeriodicalId":21998,"journal":{"name":"Strahlentherapie und Onkologie","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142781109","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":"Ampelopsis japonica enhances the effect of radiotherapy in non-small cell lung cancer.","authors":"Zhaohua Liu, Peixia Cui, Qian Wu, Xiao Ji","doi":"10.1007/s00066-024-02322-7","DOIUrl":"https://doi.org/10.1007/s00066-024-02322-7","url":null,"abstract":"<p><strong>Background: </strong>Radiotherapy is widely used in the clinical treatment of non-small cell lung cancer (NSCLC); however, its effectiveness often proves unsatisfactory. Ampelopsis japonica (AJ) is a traditional Chinese herb with anti-inflammatory and anticancer activities. However, whether AJ could enhance the effect of radiotherapy in NSCLC needs to be further explored.</p><p><strong>Methods: </strong>In vivo, BALB/c nude mice were used for a xenograft tumor model to explore whether AJ could enhance the effect of radiation therapy (RT) in NSCLC. In vitro, human NSCLC cell lines HCC827 and H1299 were used to explore the effect of AJ on the cell proliferation and apoptosis of RT-treated NSCLC. Moreover, bioinformatic analysis was performed to analyze the signaling pathways regulated by AJ.</p><p><strong>Results: </strong>Ampelopsis japonica enhanced the inhibitory effect of RT on NSCLC tumor growth in vivo. Simultaneously, AJ further enhanced the inhibitory effect of RT on NSCLC proliferation and the promoting effect of RT on NSCLC apoptosis. Bioinformatic analysis showed that AJ regulated the PI3K-Akt signaling pathway. We confirmed that AJ decreased the protein levels of the PI3K-Akt signaling pathway. Furthermore, the combination of AJ and RT suppressed activation of the PI3K-Akt signaling pathway.</p><p><strong>Conclusion: </strong>Ampelopsis japonica augmented the inhibitory impact of RT on NSCLC cell proliferation and tumor growth by suppressing the PI3K-Akt signaling pathway.</p>","PeriodicalId":21998,"journal":{"name":"Strahlentherapie und Onkologie","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142772486","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":"Use of surface tracking recordings to identify pitfalls during surface-guided radiotherapy.","authors":"G Klumpp, S Baumbach, N Wegner, P Freislederer, L Wagner, K P Aninditha, T Ellethy, M Münter","doi":"10.1007/s00066-024-02331-6","DOIUrl":"https://doi.org/10.1007/s00066-024-02331-6","url":null,"abstract":"<p><strong>Objective: </strong>The precise daily positioning of patients during radiation therapy determines the quality of the entire treatment. To avoid additional radiation exposure from regular cone-beam CT (CBCT) scans, surface-guided radiotherapy systems (SGRT) are increasingly used. The aim of this prospective clinical study was to evaluate the advantages, feasibility, and pitfalls of SGRT using the surface tracking recorder prototype of the camera component of ExacTrac Dynamic (Brainlab AG, Munich, Germany). This system combines both surface-based imaging technology and a thermographic camera that records patients via thermal imaging to accurately measure patient geometry.</p><p><strong>Methods: </strong>The surfaces of patients with various tumor entities and therefore different regions of interest (ROIs) were recorded with the surface camera during positioning and throughout treatment. Subsequently, these surface camera datasets were analyzed to compare the accuracy of patient positioning with the current treatment standard (X-ray-based IGRT). The camera components were used only as an imaging tool and not to correct any deviations. For evaluation of typical pitfalls, errors > 5 mm for extracranial indications and > 2 mm for cranial indications were analyzed using parameters extracted from the surface recordings and the corresponding CBCT shifts.</p><p><strong>Results: </strong>In total, 162 displacement vector datasets for 130 patients were generated and evaluated. The smallest deviations were found in the head and neck regions (mean deviation 1.9 mm/0.8°). The largest mean translational deviation (4.8 mm) and mean rotational deviation (1.1°) were found in the pelvic area. In all regions, most datasets showed clinically acceptable deviations; however, large outliers were observed in some measurements, particularly longitudinally. These outliers are of special interest because they may indicate mistakes in the use of SGRT, and they were therefore analyzed separately in detail. Several reasons for the outliers were identified, and potential solutions to avoid these pitfalls are presented.</p><p><strong>Conclusion: </strong>This observational study demonstrated the advantages and pitfalls of SGRT by using the surface tracking recorder prototype of the camera component of ExacTrac Dynamic. These pitfalls can be avoided through thorough application of SGRT. This study may serve as a practical guide for clinicians already using or introducing SGRT for patient positioning.</p>","PeriodicalId":21998,"journal":{"name":"Strahlentherapie und Onkologie","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142772437","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}