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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.

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.

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.

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 Wurzburg | 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.,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.

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