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Nitsche M.,Zentrum Fur Strahlentherapie und Radioonkologie | Nitsche M.,University of Kiel | Brannath W.,University of Bremen | Bruckner M.,University of Bremen | And 5 more authors.
British Journal of Radiology | Year: 2017

Objective: The objective of this retrospective planning study was to find a contouring definition for the rectum as an organ at risk (OAR) in curative three-dimensional external beam radiotherapy (EBRT) for prostate cancer (PCa) with a predictive correlation between the dose- volume histogram (DVH) and rectal toxicity. Methods: In a pre-study, the planning CT scans of 23 patients with PCa receiving definitive EBRT were analyzed. The rectum was contoured according to 13 different definitions, and the dose distribution was correlated with the respective rectal volumes by generating DVH curves. Three definitions were identified to represent the most distinct differences in the shapes of the DVH curves: one anatomical definition recommended by the Radiation Therapy Oncology Group (RTOG) and two functional definitions based on the target volume. In the main study, the correlation between different relative DVH parameters derived from these three contouring definitions and the occurrence of rectal toxicity during and after EBRT was studied in two consecutive collectives. The first cohort consisted of 97 patients receiving primary curative EBRT and the second cohort consisted of 66 patients treated for biochemical recurrence after prostatectomy. Rectal toxicity was investigated by clinical investigation and scored according to the Common Terminology Criteria for Adverse Events. Candidate parameters were the volume of the rectum, mean dose, maximal dose, volume receiving at least 60Gy (V60), area under the DVH curve up to 25Gy and area under the DVH curve up to 75Gy in dependence of each chosen rectum definition. Multivariable logistic regression considered other clinical factors such as pelvine lymphatics vs local target volume, diabetes, prior rectal surgery, anticoagulation or haemorrhoids too. Results: In Cohort 1 (primary EBRT), the mean rectal volumes for definitions "RTOG", planning target volume "(PTV)-based" and "PTV-linked" were 100cm3 [standard deviation (SD) 43 cm3], 60cm3 (SD 26cm3) and 74cm3 (SD 31cm3), respectively (p,0.01; analysis of variance). The mean rectal doses according to these definitions were 35Gy (SD 8 Gy), 48Gy (SD 4Gy) and 44Gy (SD 5 Gy) (p,0.01). In Cohort 2 (salvage EBRT), the mean rectal volumes were 114cm3 (SD 47cm3), 64cm3 (SD 26cm3) and 81cm3 (SD 30cm3) (p,0.01) and the mean doses received by the rectum were 36Gy (SD 8 Gy), 49Gy (SD 5 Gy) and 44Gy (SD 5 Gy) (p,0.01). Acute or subacute rectal inflammation occurred in 69 (71.9%) patients in Cohort 1 and in 43 (70.5%) in Cohort 2. We did not find a correlation between all investigated DVH parameters and rectal toxicity, irrespective of the investigated definition. By adding additional variables in multivariate analysis, the predictive ability was substantially improved. Still, there was essentially no difference in the probability of predicting rectal inflammation occurrence between the tested contouring definitions. Conclusion: The RTOG anatomy-based recommendations are questionable in comparison with functional definitions, as they result in higher variances in several relative DVH parameters. Moreover, the anatomy-based definition is no better and no worse in the predictive value concerning clinical end points. Advances in knowledge: Functional definitions for the rectum as OAR are easier to apply, faster to contour, have smaller variances and do not offer less information than the anatomy-based RTOG definition. © 2016 The Authors. Published by the British Institute of Radiology.


Nitsche M.,Facharzt fur Strahlentherapie und Radioonkologie | Hermann R.,Zentrum fur Strahlentherapie und Radioonkologie
Breast Care | Year: 2011

At the moment, positive sentinel lymph node dissection (SLND) of the axilla is followed by axillary lymph node dissection (ALND) as standard of care. Recent data proves that omitting ALND after positive SLND in clinically lymph nodenegative early stage breast cancer patients is feasible with low recurrence rates. The well known effect of radiotherapy to destroy occult tumor cells highly contributes to these results as a large extent of level I and II lymph nodes are unavoidably included in standard tangential radiation treatment fields. Reviewing the up to date published data on axillary lymph node treatment with radiotherapy, we hypothesize that full dosage coverage of level I and II of the axilla in early stage breast cancer will improve outcome and should be further evaluated. © 2011 S. Karger GmbH, Freiburg.


Nitsche M.,Zentrum fur Strahlentherapie und Radioonkologie | Nitsche M.,University of Kiel | Reible M.,Zentrum fur Strahlentherapie und Radioonkologie | Pfluger K.-H.,Abteilung fur Hamatologie und Internistische Onkologie | And 2 more authors.
Case Reports in Oncology | Year: 2014

Late effects of therapy for Hodgkin's disease include secondary malignancies like leukemia, lymphoma or solid tumors developing after long periods of latency. Ionizing radiation often causes the last group. The highest risks have been described for induced breast and lung cancers. We are the first to report a malignant triton tumor (MTT) as a secondary malignancy after radiotherapy and chemotherapy for Hodgkin's lymphoma. MTT is a very rare subtype of malignant peripheral nerve sheath tumors with rhabdomyoblastic differentiation and an aggressive course of disease. © 2014 S. Karger AG, Basel.


PubMed | Zentrum fur Strahlentherapie und Radioonkologie, University of Kiel and Bremen University of Applied Sciences
Type: Journal Article | Journal: Breast care (Basel, Switzerland) | Year: 2015

Hypofractionated radiotherapy for breast cancer is becoming increasingly important. The scientific background of this development as well as the introduction of the simultaneous integrated boost to the primary tumor region in this context are discussed here.


Nitsche M.,Zentrum fur Strahlentherapie und Radioonkologie | Nitsche M.,University of Kiel | Temme N.,Zentrum fur Strahlentherapie und Radioonkologie | Forster M.,Zentrum fur Strahlentherapie und Radioonkologie | And 2 more authors.
Strahlentherapie und Onkologie | Year: 2014

Purpose. Recent studies have demonstrated low regional recurrence rates in early-stage breast cancer omitting axillary lymph node dissection (ALND) in patients who have positive nodes in sentinel lymph node dissection (SLND). This finding has triggered an active discussion about the effect of radiotherapy within this approach. The purpose of this study was to analyze the dose distribution in the axilla in standard tangential radiotherapy (SRT) for breast cancer and the effects on normal tissue exposure when anatomic level I-III axillary lymph node areas are included in the tangential radiotherapy field configuration. Patients and methods. We prospectively analyzed the dosimetric treatment plans from 51 consecutive women with early-stage breast cancer undergoing radiotherapy. We compared and analyzed the SRT and the defined radiotherapy (DRT) methods for each patient. The clinical target volume (CTV) of SRT included the breast tissue without specific contouring of lymph node areas, whereas the CTV of DRT included the level I-III lymph node areas. Results. We evaluated the dose given in SRT covering the axillary lymph node areas of level I-III as contoured in DRT. The mean VD95% of the entire level I-III lymph node area in SRT was 50.28% (range, 37.31-63.24%), VD45 Gy was 70.1% (54.8-85.4%), and VD40 Gy was 83.5% (72.3-94.8%). A significant difference was observed between lung dose and heart toxicity in SRT vs. DRT. The V20 Gy and V30 Gy of the right and the left lung in DRT were significantly higher in DRT than in SRT (p<0.001). The mean heart dose in SRT was significantly lower (3.93 vs. 4.72 Gy, p=0.005). Conclusion. We demonstrated a relevant dose exposure of the axilla in SRT that should substantially reduce local recurrences. Furthermore, we demonstrated a significant increase in lung and heart exposure when including the axillary lymph nodes regions in the tangential radiotherapy field set-up. © 2014 Springer-Verlag.


Nitsche M.,Zentrum fur Strahlentherapie und Radioonkologie | Nitsche M.,University of Kiel | Dunst J.,University of Kiel | Carl U.M.,Zentrum fur Strahlentherapie und Radioonkologie | Hermann R.M.,Zentrum fur Strahlentherapie und Radioonkologie
Breast Care | Year: 2015

Hypofractionated radiotherapy for breast cancer is becoming increasingly important. The scientific background of this development as well as the introduction of the simultaneous integrated boost to the primary tumor region in this context are discussed here. © 2015 S. Karger GmbH, Freiburg.


Hermann R.M.,Zentrum fur Strahlentherapie und Radioonkologie | Meyer A.,Abteilung Strahlentherapie und Spezielle Onkologie | Becker A.,Zentrum fur Strahlentherapie und Radioonkologie | Schneider M.,University of Würzburg | And 5 more authors.
International Journal of Radiation Oncology Biology Physics | Year: 2013

Purpose Radiation therapy is well established in the treatment of painful plantar fasciitis or heel spur. A retrospective analysis was conducted to investigate the effect of field definition on treatment outcome and to determine the impact of factors potentially involved. Methods and Materials A review of treatment data of 250 patients (285 heels) with a mean follow-up time of 11 months showed that complete symptom remission occurred in 38%, partial remission in 32%, and no change in 19% (11% were lost to follow-up). Variables such as radiologic evidence of plantar spurs, their length, radiation dose, field size, age, sex, and onset of pain before administration of radiation therapy were investigated in univariate and multivariate regression analyses. Results Treatment response depended upon age >53 years, length of heel spur ≤6.5 mm (or no radiologic evidence of a heel spur), and onset of pain <12 months before radiation therapy. Patients with these clinical prerequisites stood a 93% chance of clinical response. Without these prerequisites, only 49% showed any impact. No influence of field size on treatment outcome became evident. Conclusion Patients with short plantar heel spurs benefit from radiation therapy equally well as patients without any radiologic evidence. Moreover, smaller field sizes have the same positive effect as commonly used large field definitions covering the entire calcaneal bone. This leads to a recommendation of a considerable reduction of field size in future clinical practice. © 2013 The Authors. Published by Elsevier Inc. All rights reserved.


Nitsche M.,Zentrum fur Strahlentherapie und Radioonkologie | Nitsche M.,University of Kiel | Pahl R.,University of Kiel | Huber K.,University of Kiel | And 2 more authors.
Breast Care | Year: 2015

Radiotherapy is an important component in the multidisciplinary treatment of breast cancer. In recent years, the cardiac risks of radiation have been discussed several times. This problem has long been known and resolved from the radiotherapeutic point of view. The current data is briefly described here. © 2015 S. Karger GmbH, Freiburg.


Hermann R.M.,Zentrum fur Strahlentherapie und Radioonkologie | Christiansen H.,Klinik fur Strahlentherapie und Spezielle Onkologie
Onkologe | Year: 2016

Background: External beam radiotherapy (EBRT) is a curative therapeutic option in prostate cancer. Percutaneous radiotherapy with curative intent: Patients with low risk can be cured with EBRT. For patients at intermediate risk, EBRT may be combined with androgen deprivation therapy (ADT) for 4 months. For patients at high risk, ADT should be administered for 2–3 years and the EBRT dose should be escalated. Hypofractionation is currently under intensive clinical investigation, but is currently not a clinical standard. Recurrence: A recurrence after EBRT is defined as two prostate-specific antigen (PSA) values higher than nadir +2 ng/ml. Adjuvant radiotherapy: Adjuvant EBRT is recommended after pT3 and/or R1 resection. In patients with lower stages or with more comorbidities, a PSA follow-up can be recommended with initiation of salvage EBRT only after increase of PSA (but preferably < 0.5 ng/ml). © 2016, Springer-Verlag Berlin Heidelberg.


PubMed | Zentrum fur Strahlentherapie und Radioonkologie
Type: Journal Article | Journal: Breast care (Basel, Switzerland) | Year: 2012

At the moment, positive sentinel lymph node dissection (SLND) of the axilla is followed by axillary lymph node dissection (ALND) as standard of care. Recent data proves that omitting ALND after positive SLND in clinically lymph node-negative early stage breast cancer patients is feasible with low recurrence rates. The well known effect of radiotherapy to destroy occult tumor cells highly contributes to these results as a large extent of level I and II lymph nodes are unavoidably included in standard tangential radiation treatment fields. Reviewing the up to date published data on axillary lymph node treatment with radiotherapy, we hypothesize that full dosage coverage of level I and II of the axilla in early stage breast cancer will improve outcome and should be further evaluated.

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