Institute of Radiotherapy

Tel Aviv, Israel

Institute of Radiotherapy

Tel Aviv, Israel
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News Article | May 4, 2017
Site: www.businesswire.com

MUNICH--(BUSINESS WIRE)--Brainlab, a leader in radiosurgery innovation for more than twenty years, has begun to successfully transition institutions in its considerable global install base to its latest planning software, known as Brainlab Elements. These subscription-based, indication-specific software applications add a higher degree of automation and delivery efficiency to planning. “The customers that use our radiosurgery planning software already have a desire to remain leaders in the field, both clinically and technically,” commented Stefan Vilsmeier, Brainlab President and CEO. “Upgrading to Elements is the logical next step in staying at the forefront of technological innovation in SRS treatment planning.” While each Elements application has the common goals of quick planning, sparing organs at risk and creating highly conformal doses, each is specifically targeted to the unique needs of its respective area. Cranial SRS optimizes planning with an integrated 4π algorithm for patient-tailored treatments. Multiple Brain Mets SRS enables the simultaneous delivery of single-session treatments for multiple metastases. Spine SRS is fully focused on important dose falloff along specific vertebrae for enhanced spinal cord sparing. All workflows are complemented by indication-specific segmentation, fusion and outlining tools. First installations of Elements have taken place at seven hospitals in Germany, Switzerland, Italy and France, with dozens more scheduled in the coming weeks. Leading hospitals in the US have also followed suit and the first installation in Latin America, the Institute of Radiotherapy – Marie Curie Foundation in Cordoba, Argentina, has already begun treating patients. With Elements at a number of these institutions having gone into clinical use, patients are already benefitting from the upgrade to this new generation of software applications. “Elements Multiple Brain Mets SRS has come to us at exactly the right time in which we are distancing ourselves more and more from whole brain radiation therapy (WBRT), given the negative side effects on neurocognitive function. Recently, we were able to treat a patient with 14 brain metastases in about 20 minutes with a plan created with the software,” commented Prof. Cordula Petersen, UKE Hamburg. “We are very pleased to offer the option of treating patients with multiple brain metastases with Elements software and potentially improving their quality of life.” To learn more about Brainlab Elements, visit Brainlab booth #2800 at ESTRO 2017 in Vienna or online at https://www.brainlab.com/en/radiosurgery-products/. Brainlab develops, manufactures and markets software-driven medical technology, enabling access to advanced, less invasive patient treatments. Brainlab technology powers treatments in radiosurgery as well as numerous surgical fields including neurosurgery, orthopedic, ENT, CMF, spine and trauma. Founded in Munich in 1989, Brainlab has over 11,700 systems installed in over 100 countries.


Shahar T.,Tel Aviv Medical Center | Nossek E.,Tel Aviv Medical Center | Steinberg D.M.,Tel Aviv University | Rozovski U.,Tel Aviv Medical Center | And 7 more authors.
Journal of Clinical Neuroscience | Year: 2012

The impact of enrollment in a clinical study on the survival of patients with glioblastoma has not been established. We retrospectively analyzed 564 patients with newly diagnosed glioblastoma treated between 1995 and 2008. They were divided into those enrolled in a clinical trial and randomized to a treatment or control arm, and those not enrolled and who received best standard of care (BSC). The three groups were matched for age and Karnofsky performance scale (KPS) score at presentation, and included only patients who underwent at least one tumor resection. Survival analysis was performed and multivariate Cox proportional hazards model and recursive partitioning analysis (RPA) identified predictors of survival. Following the matching process, 261 patients remained to form the final cohort. Of the 124 patients enrolled in a study, 81 (31.0%) were randomized to the treatment and 43 (16.5%) to the control arms. The overall median survival for the BSC (n = 137), control, and treatment groups was 11.57 months (95% confidence interval [CI], 10.41-12.73), 16.27 months (95% CI, 14.10-18.43) and 16.10 months (95% CI, 14.34-17.86), respectively (p = 0.002). Participation in a clinical trial, regardless of the arm, was a significant predictor of survival, as were age and KPS at diagnosis. The RPA also demonstrated a favorable impact of participation in a clinical trial. Additional tumor resections and various treatment modalities were administered with significantly higher frequency among patients enrolled in clinical studies. Thus, enrollment in a clinical study carried a significant survival advantage for patients with glioblastoma, raising practical and ethical issues regarding the quality of care of patients who receive "standard" therapy. © 2012 Elsevier Ltd. All rights reserved.


PubMed | University of Zürich, Kantonsspital Graubuenden and Institute of Radiotherapy
Type: Journal Article | Journal: Radiation oncology (London, England) | Year: 2016

To investigate second cancer risk (SCR) comparing volumetric modulated arc therapy (VMAT) and 3D conformal radiotherapy (3DCRT) with different high dose fractionation schemes.VMAT and 3DCRT virtual treatment plans for 25 patients previously treated with radiotherapy for rectal cancer were evaluated retrospectively. Doses prescribed were 251.8Gy and 55Gy, respectively. SCR was estimated using a carcinogenesis model and epidemiological data for carcinoma and sarcoma induction. SCR was determined by lifetime attributable risk (LAR).Mean excess LAR was highest for organs adjacent to the PTV. Total LAR for VMAT and 3DCRT was 2.3-3.0 and 2.0-2.7%, respectively. For 55Gy, LAR was 1.4-1.9% for VMAT and 1.2-1.6% for 3DCRT. Organ-specific excess LAR was significantly higher for VMAT, and highest for bladder and colon. Size and shape of the PTV influenced SCR and was highest for age40years. For a patient with an additional lifetime risk of 60years, LAR was 10% for 251.8Gy and 6% for 55Gy.No statistically significant difference was detected in SCR using VMAT or 3DCRT. For bladder and colon, organ-specific excess LAR was statistically lower using 3DCRT, however the difference was small. Compared to epidemiological data, SCR was smaller when using a hypofractionated schedule. SCR was 2% higher at normal life expectancy.ClinicalTrials.gov Identifier NCT02572362 . Registered 4 October 2015. Retrospectively registered.


Bae K.,Radiation Therapy Oncology Group | Bruner D.W.,University of Pennsylvania | Baek S.,University of Pennsylvania | Movsas B.,Ford Motor Company | And 3 more authors.
Journal of Neuro-Oncology | Year: 2011

The Mini Mental Status Exam (MMSE) instrument has been commonly used in the Radiation Therapy Oncology Group (RTOG) to assess mental status in brain cancer patients. Evaluating patient factors in relation to patterns of incomplete MMSE assessments can provide insight into predictors of missingness and optimal MMSE collection schedules in brain cancer clinical trials. This study examined eight RTOG brain cancer trials with ten treatment arms and 1,957 eligible patients. Patient data compliance patterns were categorized as: (1) evaluated at all time points (Complete), (2) not evaluated from a given time point or any subsequent time points but evaluated at all the previous time points (Monotone drop-out), (3) not evaluated at any time point (All missing), and (4) all other patterns (Mixed). Patient characteristics and reasons for missingness were summarized and compared among the missing pattern groups. Baseline MMSE scores and change scores after radiation therapy (RT) were compared between these groups, adjusting for differences in other characteristics. There were significant differences in frequency of missing patterns by age, treatment type, education, and Zubrod performance status (ZPS; P < 0.001). Ninety-two percent of patients were evaluated at least once: seven percent of patients were complete pattern, 49% were Monotone pattern, and 36% were mixed pattern. Patients who received RT only regimens were evaluated at a higher rate than patients who received RT + other treatments (49-64% vs. 27-45%). Institutional error and request to not be contacted were the most frequent known reasons for missing data, but most often, reasons for missing MMSE was unspecified. Differences in baseline mean MMSE scores by missing pattern (Complete, Monotone dropout, Mixed) were statistically significant (P < 0.001) but differences were small (<1.5 points) and significance did not persist after adjustment for age, ZPS, and other factors related to missingness. Post-RT change scores did not differ significantly by missing pattern. While baseline and change scores did not differ widely by missing pattern for available measurements, incomplete data was common and of unknown reason, and has potential to substantially bias conclusions. Higher compliance rates may be achievable by addressing institutional compliance with assessment schedules and patient refusal issues, and further exploration of how educational and health status barriers influence compliance with MMSE and other tools used in modern neurocognitive batteries. © 2011 Springer Science+Business Media, LLC.


Lutz S.,Blanchard Valley Regional Cancer Center | Korytko T.,Ohio State University | Nguyen J.,Sunnybrook Odette Cancer Center | Khan L.,University of Toronto | And 2 more authors.
Cancer Journal | Year: 2010

Palliative radiotherapy has been prescribed since shortly after the discovery of the x-ray in the late 1800s, and it provides symptom relief that is successful, time-efficient, and cost-effective. Although palliative radiotherapy is worthwhile in a wide variety of clinical circumstances, there are situations where it is less worthwhile. We contrast the effective use of palliative radiotherapy with its ineffective use because of issues related to the patient, treatment, or health care system. Copyright © 2010 by Lippincott Williams & Wilkins.


PubMed | Boston Medical Center, Thomas Jefferson University, The Chester County Hospital, University of Maryland Baltimore County and 11 more.
Type: Clinical Trial, Phase II | Journal: Journal of neuro-oncology | Year: 2016

Whole brain radiotherapy (WBRT) is associated with memory dysfunction. As part of NRG Oncology RTOG 0933, a phase II study of WBRT for brain metastases that conformally avoided the hippocampal stem cell compartment (HA-WBRT), memory was assessed pre- and post-HA-WBRT using both traditional and computerized memory tests. We examined whether the computerized tests yielded similar findings and might serve as possible alternatives for assessment of memory in multi-institution clinical trials. Adult patients with brain metastases received HA-WBRT to 30 Gy in ten fractions and completed Hopkins Verbal Learning Test-Revised (HVLT-R), CogState International Shopping List Test (ISLT) and One Card Learning Test (OCLT), at baseline, 2 and 4 months. Tests completion rates were 52-53 % at 2 months and 34-42 % at 4 months. All baseline correlations between HVLT-R and CogState tests were significant (p 0.003). At baseline, both CogState tests and one component of HVLT-R differentiated those who were alive at 6 months and those who had died (p 0.01). At 4 months, mean relative decline was 7.0 % for HVLT-R Delayed Recall and 18.0 % for ISLT Delayed Recall. OCLT showed an 8.0 % increase. A reliable change index found no significant changes from baseline to 2 and 4 months for ISLT Delayed Recall (z = -0.40, p = 0.34; z = -0.68, p = 0.25) or OCLT (z = 0.15, p = 0.56; z = 0.41, p = 0.66). Study findings support the possibility that hippocampal avoidance may be associated with preservation of memory test performance, and that these computerized tests also may be useful and valid memory assessments in multi-institution adult brain tumor trials.


Liberman G.,Wohl Institute for Advanced Imaging | Liberman G.,Bar - Ilan University | Louzoun Y.,Bar - Ilan University | Aizenstein O.,Wohl Institute for Advanced Imaging | And 5 more authors.
European Journal of Radiology | Year: 2013

Background: Current methods for evaluation of treatment response in glioblastoma are inaccurate, limited and time-consuming. This study aimed to develop a multi-modal MRI automatic classification method to improve accuracy and efficiency of treatment response assessment in patients with recurrent glioblastoma (GB). Materials and methods: A modification of the k-Nearest-Neighbors (kNN) classification method was developed and applied to 59 longitudinal MR data sets of 13 patients with recurrent GB undergoing bevacizumab (anti-angiogenic) therapy. Changes in the enhancing tumor volume were assessed using the proposed method and compared with Macdonald's criteria and with manual volumetric measurements. The edema-like area was further subclassified into peri- and non-peri-tumoral edema, using both the kNN method and an unsupervised method, to monitor longitudinal changes. Results: Automatic classification using the modified kNN method was applicable in all scans, even when the tumors were infiltrative with unclear borders. The enhancing tumor volume obtained using the automatic method was highly correlated with manual measurements (N = 33, r = 0.96, p < 0.0001), while standard radiographic assessment based on Macdonald's criteria matched manual delineation and automatic results in only 68% of cases. A graded pattern of tumor infiltration within the edema-like area was revealed by both automatic methods, showing high agreement. All classification results were confirmed by a senior neuro-radiologist and validated using MR spectroscopy. Conclusion: This study emphasizes the important role of automatic tools based on a multi-modal view of the tissue in monitoring therapy response in patients with high grade gliomas specifically under anti-angiogenic therapy. © 2012 Elsevier Ireland Ltd.


PubMed | Institute of Radiotherapy, Hebrew University of Jerusalem, Tel Aviv University and Neuro Oncology Service Tel Aviv Sourasky Medical Center
Type: Journal Article | Journal: PloS one | Year: 2014

Advanced MR imaging methods have an essential role in classification, grading, follow-up and therapeutic management in patients with brain tumors. With the introduction of new therapeutic options, the challenge for better tissue characterization and diagnosis increase, calling for new reliable non-invasive imaging methods. In the current study we evaluated the added value of a combined protocol of blood oxygen level dependent (BOLD) imaging during hyperoxic challenge (termed hemodynamic response imaging (HRI)) in an orthotopic mouse model for glioblastoma under anti-angiogenic treatment with B20-4.1.1, an anti-VEGF antibody. In glioblastoma tumors, the elevated HRI indicated progressive angiogenesis as further confirmed by histology. In the current glioblastoma model, B20-treatment caused delayed tumor progression with no significant changes in HRI yet with slightly reduced tumor vascularity as indicated by histology. Furthermore, fewer apoptotic cells and higher proliferation index were detected in the B20-treated tumors compared to control-treated tumors. In conclusion, HRI provides an easy, safe and contrast agent free method for the assessment of the brain hemodynamic function, an additionally important clinical information.


BACKGROUND: There is a trend towards hypofractionated stereotactic radiotherapy (RT) in prostate cancer to apply high single doses in a few fractions. Using the Cyberknife® robotic system multiple non-coplanar fields are usually given with a treatment time of one hour or more. We planned to evaluate organ motion in this setting injecting a hydrogel spacer to protect the anterior rectal wall during treatment.METHODS: A 66 years old man with low risk prostate cancer was planned for robotic hypofractionated stereotactic RT. After implantation of fiducial markers and a hydrogel spacer a total dose of 36.25 Gy in 5 fractions was given to the planning target volume (clinical target volume + 3 mm). After each beam the corresponding data reporting on the intra-fractional movement were pre-processed, the generated log-files extracted and the data analysed according to different directions: left -right (LR); anterior - posterior (AP); inferior -superior (IS). Clinical assessments were prospectively done before RT start, one week after the end of treatment as well as 1, 6 and 12 months afterwards. Symptoms were documented using Common Toxicity and Adverse Events Criteria 4.0.RESULTS: Tolerability of marker and hydrogel implantation was excellent. A total of 284 non-coplanar fields were used per fraction. The total treatment time for all fields per fraction lasted more than 60 minutes. The detected and corrected movements over all 5 fractions were in a range of +/- 4 mm in all directions (LR: mean 0,238 - SD 0,798; AP: mean 0,450 - SD 1,690; and IS: mean 0,908 - SD 1,518). V36Gy for the rectum was 0.062 ccm. After RT, grade 1-2 intestinal toxicity and grade 1 genitourinarytoxicity occurred, but resolved completely after 10 days. On 1-, 6- and 12-months follow-up the patient was free of any symptoms with only slight decrease of erectile function (grade 1). There was a continuous PSA decline.CONCLUSIONS: Prostate movement was relatively low (+/- 4 mm) even during fraction times of more than 60 minutes. The hydrogel spacer might serve as a kind of stabilisator for the prostate, but this should be analysed in a larger cohort of patients.


PubMed | Institute of Radiotherapy
Type: | Journal: Radiation oncology (London, England) | Year: 2014

There is a trend towards hypofractionated stereotactic radiotherapy (RT) in prostate cancer to apply high single doses in a few fractions. Using the Cyberknife robotic system multiple non-coplanar fields are usually given with a treatment time of one hour or more. We planned to evaluate organ motion in this setting injecting a hydrogel spacer to protect the anterior rectal wall during treatment.A 66years old man with low risk prostate cancer was planned for robotic hypofractionated stereotactic RT. After implantation of fiducial markers and a hydrogel spacer a total dose of 36.25Gy in 5 fractions was given to the planning target volume (clinical target volume+3mm). After each beam the corresponding data reporting on the intra-fractional movement were pre-processed, the generated log-files extracted and the data analysed according to different directions: left -right (LR); anterior - posterior (AP); inferior -superior (IS). Clinical assessments were prospectively done before RT start, one week after the end of treatment as well as 1, 6 and 12months afterwards. Symptoms were documented using Common Toxicity and Adverse Events Criteria 4.0.Tolerability of marker and hydrogel implantation was excellent. A total of 284 non-coplanar fields were used per fraction. The total treatment time for all fields per fraction lasted more than 60minutes. The detected and corrected movements over all 5 fractions were in a range of +/- 4mm in all directions (LR: mean 0,238 - SD 0,798; AP: mean 0,450 - SD 1,690; and IS: mean 0,908 - SD 1,518). V36Gy for the rectum was 0.062 ccm. After RT, grade 1-2 intestinal toxicity and grade 1 genitourinarytoxicity occurred, but resolved completely after 10days. On 1-, 6- and 12-months follow-up the patient was free of any symptoms with only slight decrease of erectile function (grade 1). There was a continuous PSA decline.Prostate movement was relatively low (+/- 4mm) even during fraction times of more than 60minutes. The hydrogel spacer might serve as a kind of stabilisator for the prostate, but this should be analysed in a larger cohort of patients.

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