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[en] Retrospective study of effectiveness, toxicity, and relapse patterns after low-dose radiotherapy (LDRT) in patients with low-grade lymphomas. 47 patients (median age 64 years) with 50 lesions were treated with LDRT (2 x 2 Gy). In 60%, LDRT was the primary and curative treatment, in 40% offered as second-line therapy in recurrent disease. Histology included follicular (57%) and marginal zone lymphomas (43%). Patients were followed-up regularly clinically (skin) and with CT or MRI scans. Median follow-up was 21 months. 84% of the lesions were extranodal disease (32% orbit, 14% salivary glands, 30% skin, and 8% others). Most lesions were ≤5 cm (90%) with a singular affection (74%). 26% of the patients received rituximab simultaneously. Overall response rate (ORR) was 90% (all lesions), 93.3% (primary treatment), and 85% (recurrence treatment); p = 0.341. 2-year Local progression-free survival (LPFS) for all, curative, and palliative patients was 91.1%, 96.7%, and 83.8%, respectively; p = 0.522. Five relapses were detected: three infield only, and were therefore treated with LDRT or subsequent local RT of 30 Gy. Two patients showed an in- and outfield progression and were consequently treated with chemotherapy. Predictive factors for higher LPFS were tumor size ≤5 cm (p = 0.003), ≤2 previous treatments (p = 0.027), no skin involvement (p = 0.05), singular affection (p = 0.075), and simultaneous rituximab application (p = 0.148). LDRT was tolerated well, without detectable acute or long-term side effects. Primary LDRT is an effective treatment with high ORR and long-lasting remissions in a subset of patients with low-grade lymphoma, and may therefore be a curative treatment option for patients with low tumor burden. LDRT with the CD20 antibody obinutuzumab will soon be tested in a prospective multicenter trial. (orig.)
[de]
Retrospektive Analyse zur Erfassung von Effektivitaet, Nebenwirkungen und Rezidivmuster nach Niedrigdosis-Bestrahlung (LDRT) von Patienten mit indolenten Lymphomen. Ausgewertet wurden 47 Patienten mit 50 Laesionen (medianes Alter 64 Jahre), die mittels LDRT (2 x 2 Gy) bestrahlt wurden. Die LDRT wurde bei 60% als primaere und kurativ-intendierte Therapie durchgefuehrt, bei 40% in der Rezidivsituation im palliativen Ansatz. In 57% der Faelle handelte es sich um follikulaere und in 43% um Marginalzonenlymphome. Die Patienten wurden nach LDRT regelmaessig klinisch (Hautbefall) und mittels Computertomographie oder Magnetresonanztomographie nachbeobachtet. Das mediane Follow-up betrug 21 Monate. Bei 85% der Laesionen lag eine extranodale Manifestation vor (32% Orbita, 14% Speicheldruesen, 30% Haut, 8% andere Organe). Meist waren die Laesionen klein (≤5 cm, 90%) und mit singulaerem Befall (74%). Eine simultane Rituximab-Gabe erhielten 26% der Patienten. Die Ansprechrate nach LDRT war mit 90% (alle Laesionen), 93,3% (Primaersituation) und 85% (Rezidivsituation) hoch (p = 0,341). Das lokale progressionsfreie 2-Jahres-Ueberleben fuer alle, kurativ und palliativ behandelte Patienten betrug 91,1%, 96,7% und 83,8% (p = 0,522). Insgesamt wurden 5 Rezidive detektiert: 3 befanden sich im Bestrahlungsfeld und wurden entweder erneut mittels LDRT oder mit einer Dosisaufsaettigung von 30 Gy therapiert. Bei 2 Patienten zeigte sich ein generalisierter Progress der gesamten Erkrankung, sodass eine systemische Therapie initiiert wurde. Die primaere LDRT ist eine effektive Behandlung mit hohen Ansprechraten und anhaltenden Remissionen und kann bei einer Subgruppe von Patienten mit indolenten Lymphomen auch als kurativer Ansatz angeboten werden. LDRT mit dem CD20-Antikoerper Obinutuzumab wird zukuenftig in einer prospektiven, multizentrischen Studie untersucht. (orig.)Journal
[en] The Working Group for Neuro-Oncology of the German Society for Radiation Oncology in cooperation with members of the Neuro-Oncology Working Group of the German Cancer Society aimed to define a practical guideline for the diagnosis and treatment of radiation-induced necrosis (RN) of the central nervous system (CNS). Panel members of the DEGRO working group invited experts, participated in a series of conferences, supplemented their clinical experience, performed a literature review, and formulated recommendations for medical treatment of RN including bevacizumab in clinical routine. Diagnosis and treatment of RN requires multidisciplinary structures of care and defined processes. Diagnosis has to be made on an interdisciplinary level with the joint knowledge of a neuroradiologist, radiation oncologist, neurosurgeon, neuropathologist, and neuro-oncologist. A multistep approach as an opportunity to review as many characteristics as possible to improve diagnostic confidence is recommended. Additional information about radiotherapy (RT) techniques is crucial for the diagnosis of RN. Misdiagnosis of untreated and progressive RN can lead to severe neurological deficits. In this practice guideline, we propose a detailed nomenclature of treatment-related changes and a multistep approach for their diagnosis.
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[en] For planning CyberKnife stereotactic radiosurgery (CK SRS) of brain metastases (BM), it is essential to precisely determine the exact number and location of BM in MRI. Recent MR studies suggest the superiority of contrast-enhanced 3D fast spin echo SPACE (sampling perfection with application-optimized contrast by using different flip angle evolutions) images over 3D gradient echo (GE) T1-weighted MPRAGE (magnetization-prepared rapid gradient echo) images for detecting small BM. The aim of this study is to test the usability of the SPACE sequence for MRI-based radiation treatment planning and its impact on changing treatment. For MRI-based radiation treatment planning using 3T MRI in 199 patients with cerebral oligometastases, we compared the detectability of BM in post-gadolinium SPACE images, post-gadolinium MPRAGE images, and post-gadolinium late-phase MPRAGE images. When SPACE images were used for MRI-based radiation treatment planning, 29.8% and 16.9% more BM, respectively, were detected and included in treatment planning than in the post-gadolinium MPRAGE images and the post-gadolinium late-phase MPRAGE images (post-gadolinium MPRAGE imaging: n = 681, mean ± SD 3.4 ± 4.2; post-gadolinium SPACE imaging: n = 884, mean ± SD 4.4 ± 6.0; post-gadolinium late-phase MPRAGE imaging: n = 796, mean ± SD 4.0 ± 5.3; P< 0.0001, P< 0.0001). For 3T MRI-based treatment planning of stereotactic radiosurgery of BM, we recommend the use of post-gadolinium SPACE imaging rather than post-gadolinium MPRAGE imaging.
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[en] The benefits of new innovations in glioblastoma therapies should not be curtailed as a result of delays in commencement of radiation therapy, caused by clinical circumstances as well as diagnostic procedures. This study evaluates whether delays in chemo-radiotherapy after surgery, while determining O6-methylguanine-DNA-methyltransferase (MGMT) promoter status, affect the survival rates of patients with glioblastoma (GBM). Our sample comprised 50 GBM patients in a retrospective analysis of three prospective studies that focused on combined radiotherapy and required MGMT promoter-status testing as inclusion criteria. Results were compared with a reference group of 127 favourable GBM cases (Karnofsky performance-status scale ≥ 70), in which the patients underwent standard postoperative chemo-radiotherapy with temozolomide. Survival time was calculated using the Kaplan-Meier method, and a multivariate analysis of the delays between surgical and radiotherapy procedures was performed using the Cox regression model. The study group’s median overall survival time was 16.2 months (with a range of 2 to 56 months), versus the reference group’s survival time of 18.2 months (with a range of 1 to 92 months) (p = 0.64). The delay between surgery and radiotherapy was increased by 8 days in the study patients (p < 0.001), with a median delay of 35 days (range: 18–49 days) corresponding to the typical 27-day delay (range: 5–98 days) for those in the reference group. Univariate and multivariate analyses did not show any negative association between survival time and delaying radiation therapy to determine MGMT-promoter status; commencement of radiation therapy sooner than 24 days after surgery was the threshold for significantly decreased overall survival (p = 0.01) and progression-free (p = 0.03) survival. Delaying postoperative chemoradiation for GBM patients—carried out in order to determine MGMT-promoter status—did not have a negative impact on survival time. Indeed, the data of the present study shows that initiating radiation therapy sooner than 24 days after surgery has a negative impact on progression and survival
Journal
BMC cancer (Online); ISSN 1471-2407; 
; v. 15; vp
; v. 15; vp
[en] To retrospectively assess the feasibility and safety of a sequential proton boost following conventional chemoradiation in high-grade glioma (HGG).
Journal
[en] To summarize evidence on the comparative value of amino acid (AA) PET and conventional MRI for prediction of overall survival (OS) in patients with recurrent high grade glioma (rHGG) under bevacizumab therapy. Medical databases were screened for studies with individual data on OS, follow-up MRI, and PET findings in the same patient. MRI images were assessed according to the RANO criteria. A receiver operating characteristic curve analysis was used to predict OS at 9 months. Five studies with a total of 72 patients were included. Median OS was significantly lower in the PET-positive than in the PET-negative group. PET findings predicted OS with a pooled sensitivity and specificity of 76% and 71%, respectively. Corresponding values for MRI were 32% and 82%. Area under the curve and sensitivity were significantly higher for PET than for MRI. For monitoring of patients with rHGG under bevacizumab therapy, AA-PET should be preferred over RANO MRI.
Journal
European Journal of Nuclear Medicine and Molecular Imaging; ISSN 1619-7070; ; CODEN EJNMA6; v. 51(6); p. 1698-1702
; CODEN EJNMA6; v. 51(6); p. 1698-1702
[en] Whole brain radiation therapy (WBRT) is historically the standard of care for patients with brain metastases (BM) from small-cell lung cancer (SCLC), although locally ablative treatments are the standard of care for patients with 1-4 BM from other solid tumors. The objective of this analysis was to find prognostic factors influencing overall survival (OS) and intracranial progression-free survival (iPFS) in SCLC patients with single BM (SBM) treated with WBRT. A total of 52 patients were identified in the authors' cancer center database with histologically confirmed SCLC and contrast-enhanced magnet resonance imaging (MRI) or computed tomography (CT), which confirmed SBM between 2006 and 2015 and were therefore treated with WBRT. A Kaplan-Meier survival analysis was performed for OS analyses. The log-rank (Mantel-Cox) test was used to compare survival curves. Univariate Cox proportional-hazards ratios (HRs) were used to assess the influence of cofactors on OS and iPFS. The median OS after WBRT was 5 months and the median iPFS after WBRT 16 months. Patients that received surgery prior to WBRT had a significantly longer median OS of 19 months compared to 5 months in the group receiving only WBRT (p = 0.03; HR 2.24; 95% confidence interval [CI] 1.06-4.73). Patients with synchronous disease had a significantly longer OS compared to patients with metachronous BM (6 months vs. 3 months, p = 0.005; HR 0.27; 95% CI 0.11-0.68). Univariate analysis for OS revealed a statistically significant effect for metachronous disease (HR 2.25; 95% CI 1.14-4.46; p = 0.019), initial response to first-line chemotherapy (HR 0.58; 95% CI 0.35-0.97; p = 0.04), and surgical resection (HR 0.36; 95% CI 0.15-0.88; p = 0.026). OS was significantly affected by metachronous disease in multivariate analysis (HR 2.20; 95% CI 1.09-4.45; p = 0.028). Univariate analysis revealed that surgery followed by WBRT can improve OS in patients with SBM in SCLC. Furthermore, synchronous disease and response to initial chemotherapy appeared to be major prognostic factors. Multivariate analysis revealed metachronous disease as a significantly negative prognostic factor on OS. The value of WBRT, stereotactic radiosurgery (SRS), or surgery alone or in combination for patients with a limited number of BM in SCLC should be evaluated in further prospective clinical trials. (orig.)
[de]
Die Ganzhirnradiotherapie (WBRT) ist historisch die Standardtherapie zur Behandlung von Hirnmetastasen beim kleinzelligen Bronchialkarzinom (SCLC), auch wenn sich fuer andere solide Tumoren die lokal-ablativen Verfahren als Therapieoption bei Patienten mit 1-4 Hirnmetastasen etabliert haben. Ziel dieser Analyse war es, Prognosefaktoren zu finden, die das Gesamtueberleben (OS) und das intrakraniell progressionsfreie Ueberleben (iPFS) von Patienten mit einer singulaeren Hirnmetastase bei SCLC, die mit einer WBRT behandelt wurden, beeinflussen. In unserer internen Datenbank wurden 52 Patienten identifiziert, die an einem histologisch gesicherten SCLC erkrankt waren, eine in der kontrastmittelgestuetzten Computertomographie (CT) oder Magnetresonanztomographie (MRT) diagnostizierte singulaere Hirnmetastase aufwiesen und diesbezueglich zwischen 2006 und 2015 mit einer WBRT behandelt worden waren. Fuer das OS wurde eine Kaplan-Meier-Ueberlebensanalyse durchgefuehrt. Die Ueberlebenskurven wurden unter Anwendung des Log-Rang-Tests (Mantel-Cox) verglichen. Mithilfe univariater ''proportional-hazards ratios'' (HR) wurde der Einfluss von Kofaktoren auf OS und iPFS untersucht. Das mediane OS nach einer WBRT betrug 5 Monate, das mediane iPFS 16 Monate. Patienten, die eine operative Behandlung der Hirnmetastase vor der WBRT erhielten, zeigten ein signifikant verlaengertes medianes OS von 19 Monaten im Vergleich zu 5 Monaten bei Patienten, die lediglich eine WBRT erhielten (p = 0,03; HR 2,24; 95 %-Konfidenzintervall [KI] 1,06-4,73). Patienten mit synchronen Hirnmetastasen zeigten ein signifikant laengeres OS im Vergleich zu Patienten mit metachron aufgetretenen Hirnmetastasen (6 Monate vs. 3 Monate; p = 0,005; HR 0,27; 95 %-KI 0,11-0,68). In der univariaten Analyse wurde das OS signifikant beeinflusst von einer metachronen Hirnmetastasierung (HR 2,25; 95 %-KI 1,14-4,46; p = 0,019), dem Ansprechen auf die initiale Chemotherapie (HR 0,58; 95 %-KI 0,35-0,97; p = 0,04) und der operativen Resektion der Hirnmetastase (HR 0,36; 95 %-KI 0,15-0,88; p = 0,026). Das OS wurde in der multivariaten Analyse durch eine metachrone Erkrankungssituation signifikant negativ beeinflusst (HR 2,20; 95 %-KI 1,09-4,45; p = 0,028). Die Ergebnisse der univariaten Analyse zeigen, dass die Operation gefolgt von einer adjuvanten WBRT ggf. das Ueberleben von Patienten mit SCLC und singulaerer Hirnmetastase verlaengern kann. Ausserdem erwiesen sich eine synchrone Hirnmetastasierung und das Ansprechen auf die initiale Chemotherapie in der univariaten Analyse als wichtige positive Prognosefaktoren fuer das OS. Aus der multivariaten Analyse ergibt sich, dass eine metachrone Erkrankungssituation einen signifikanten negativen Einfluss auf das Ueberleben hat. In zukuenftigen prospektiven Studien sollte die Bedeutung der WBRT, Stereotaxie, Operation oder Kombination dieser Therapien fuer SCLC-Patienten mit limitierter Anzahl von Hirnmetastasen ueberprueft werden. (orig.)Journal
[en] Spinal metastases (SM) are a common radiotherapy (RT) indication. There is limited level I data to drive decision making regarding dose regimen (DR) and target volume definition (TVD). We aim to depict the patterns of care for RT of SM among German Society for Radiation Oncology (DEGRO) members. An online survey on conventional RT and Stereotactic Body Radiation Therapy (SBRT) for SM, distributed via e-mail to all DEGRO members, was completed by 80 radiation oncologists between February 24 and April 29, 2022. Participation was voluntary and anonymous. A variety of DR was frequently used for conventional RT (primary: n = 15, adjuvant: n = 14). 30 Gy/10 fractions was reported most frequently. TVD in adjuvant RT was heterogenous, with a trend towards larger volumes. SBRT was offered in 65% (primary) and 21% (adjuvant) of participants' institutions. A variety of DR was reported (primary: n = 40, adjuvant: n = 27), most commonly 27 Gy/3 fractions and 30 Gy/5 fractions. 59% followed International Consensus Guidelines (ICG) for TVD. We provide a representative depiction of RT practice for SM among DEGRO members. DR and TVD are heterogeneous. SBRT is not comprehensively practiced, especially in the adjuvant setting. Further research is needed to provide a solid data basis for detailed recommendations.
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[en] The rapid rise of particle therapy across the world necessitates evidence to justify its ever-increasing utilization. This narrative review summarizes the current status of these technologies on treatment of both meningiomas and gliomas, the most common benign and malignant primary brain tumors, respectively. Proton beam therapy (PBT) for meningiomas displays high rates of long-term local control, low rates of symptomatic deterioration, along with the potential for safe dose-escalation in select (but not necessarily routine) cases. PBT is also associated with low adverse events and maintenance of functional outcomes, which have implications for quality of life and cost-effectiveness measures going forward. Data on carbon ion radiation therapy (CIRT) are limited; existing series describe virtually no high-grade toxicities and high local control. Regarding the few available data on low-grade gliomas, PBT provides opportunities to dose-escalate while affording no increase of severe toxicities, along with maintaining appropriate quality of life. Although dose-escalation for low-grade disease has been less frequently performed than for glioblastoma, PBT and CIRT continue to be utilized for the latter, and also have potential for safer re-irradiation of high-grade gliomas. For both neoplasms, the impact of superior dosimetric profiles with endpoints such as neurocognitive decline and neurologic funcionality, are also discussed to the extent of requiring more data to support the utility of particle therapy. Caveats to these data are also described, such as the largely retrospective nature of the available studies, patient selection, and heterogeneity in patient population as well as treatment (including mixed photon/particle treatment). Nevertheless, multiple prospective trials (which may partially attenuate those concerns) are also discussed. In light of the low quantity and quality of available data, major questions remain regarding economic concerns as well.
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Radiation Oncology (Online); ISSN 1748-717X; ; v. 12; vp
; v. 12; vp
[en] Background and purpose: To investigate the prognostic impact of different histological subtypes of non-small cell lung cancer (NSCLC) on outcome following stereotactic body radiotherapy (SBRT) for NSCLC patients.
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