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Maligne Meningiome weisen ohne additive Therapie nach chirurgischer Intervention eine hohe Lokalrezidivrate auf. über die Stellung der Strahlentherapie und die benötigte Dosis als additive TherapiemodalitÄt liegen nur wenige Daten vor. Mittels dieser Studie sollte die Rolle der Strahlentherapie mit Zielvolumendosen > -60 Gy/CGE in der Behandlung von malignen Meningiomen untersucht werden. Die Daten von 16 Patienten mit histologisch gesicherten malignen Meningiomen, die sich zwischen 1974 und 1995 einer Strahlentherapie unterzogen, wurden retrospektiv analysiert. Das Alter bei Diagnosestellung betrug zwischen sechs und 79 Jahren (Mittel 49 Jahre). Drei Patienten entwickelten ein malignes Meningiom mehr als 14 Jahre nach einer Strahlentherapie im SchÄdelbereich. Bei zehn Patienten wurde ein PrimÄrtumor, bei sechs ein Rezidivtumor behandelt. Sechs Patienten hatte eine totale, zehn Patienten eine subtotale Tumorresektion. Die Bestrahlung erfolgte entweder als alleinige Photonentherapie oder als kombinierte Protonen/Photonen-Therapie. Fast alle Patienten, eine Ausnahme, erhielten im Zielvolumen eine Dosis zwischen 40 und 72 Gy/CGE (Mittel: 58 Gy/CGE). Die mittlere Beobachtungszeit betrug 59 Monate (zehn bis 155 Monate). Die lokale Tumorkontrollrate lag nach fünf bzw. acht Jahren bei 52% bzw. 17%. Bei Zielvolumendosen > 60 Gy/CGE zeigte sich eine signifikante Verbesserung der lokalen Tumorkontrolle (100% versus 17%, p = 0,0006) und der Fünf-Jahres-überlebensrate (87% versus 15%, p = 0,025). Zum Zeitpunkt der Analyse lebten 6/16 Patienten (38%). Zwei Patienten entwickelten symptomatische SpÄteffekte bei Dosen von 59,3 und 72 Gy/CGE nach Ende der Strahlentherapie. Eine konformale Strahlentherapie mit Dosen > - 60 Gy/CGE führte zu einer signifikanten Verbesserung der lokalen Tumorkontrolle und damit letztendlich zu einer Verbesserung der überlebenszeiten. Most malignant meningiomas will recur following surgical resection only. The role of irradiation and radiation dose levels is poorly defined. This study reviews a single institution experience using both, conventional and high doses > 60 Gy/CGE radiation regimen. Between 1974 and 1995 16 patients with histologically proven malignant meningioma underwent radiation therapy (RT). Age at diagnosis ranged between 6 and 79 years (median: 49 years). Three patients reported previous irradiation to the head at least 14 years prior to diagnosis. Ten patients were treated for primary, and 6 patients for recurrent disease. Six patients underwent gross total and 10 patients subtotal resection (Table 1). RT was delivered using conventional, megavoltage photons or combined 160 MeV proton and photon irradiation. Except 1 patient, who died during RT, the radiation doses ranged between 40 and 70 Gy/CGE (= Cobalt Gray Equivalent) (median: 58 Gy/CGE, Table 2). With median observation time of 59 months (range: 10 to 155 months), actuarial local control rates at 5 and 8 years were 52% and 17%, respectively. Target doses > -60 Gy/CGE resulted in significantly improved tumor control (100%) compared to < 60 Gy/CGE (17%) (p = 0.0006, Table 3 and Figure 1). Improved local control translated also in increased overall survival: 87% (> 60 Gy/CGE) versus 15% (< 60 Gy/CGE) at 5 years (p = 0.025, Figure 2). At time of analysis, 6/16 patients (38%) were alive. Two patients developed symptomatic brain damage at doses of 59.3 and 72 Gy/CGE. Conformal, radiation therapy with target doses > 60 Gy/CGE, in this study by use of combined proton and photon irradiation, can significantly improve chances of long-term local control and survival for patients diagnosed with these challenging tumors.

Xerostomia is a debilitating side effect of radiotherapy in patients with head and neck cancer. We undertook a prospective study of the effect on xerostomia and outcomes of sparing one or both parotid glands during radiotherapy for patients with squamous cell carcinoma of the head and neck. Patients with locally advanced squamous cell carcinoma of the head and neck received definitive (70 Gy in 2 Gy fractions) or adjuvant (60–66 Gy in 2 Gy fractions) curative-intent radiotherapy using helical tomotherapy with concurrent chemotherapy if appropriate. Group A received < 26 Gy to the left and right parotids and group B received < 26 Gy to either parotid. The study included 126 patients; 114 (55 in group A and 59 in group B) had follow-up data. There were no statistically significant differences between groups in disease stage. Xerostomia was significantly reduced in group A vs. group B (p = 0.0381). Patients in group A also had significantly less dysphagia. Relapse-free and overall survival were not compromised in group A: 2-year relapse-free survival was 86% vs. 72% in group B (p = 0.361); 2-year overall survival was 88% and 76%, respectively (p = 0.251). This analysis suggests that reducing radiotherapy doses to both parotid glands to < 26 Gy can reduce xerostomia and dysphagia significantly without compromising survival. Sparing both parotids while maintaining target volume coverage and clinical outcome should be the treatment goal and reporting radiotherapy doses delivered to the individual parotids should be standard practice.

Due to its properties rhenium-188 (188Re) seems to be a promising radionuclide for stent coating to reduce restenosis following percutaneous transluminal angioplasty (PTA). In order to characterize the early effects of local 188Re treatment, human aortic smooth muscle cells (HaSMCs) were incubated with different doses of 188Re. 2 days after plating, HaSMCs were treated for a period of 5 days with 188Re. The total radiation doses applied were 1 Gy, 4 Gy, 8 Gy, 16 Gy, and 32 Gy. On days 1, 3, 5, and 7 (i.e., 2 days after the end of 188Re incubation), cell growth, clonogenic activity, cell migration, cell-cycle distribution, as well as matrix synthesis were evaluated. From the 1st day on, a dose-dependent growth inhibition was observed. Cumulative doses of ≥ 8 Gy completely inhibited colony formation. The results of the migration tests were contradictory; on day 3 the migratory activity of all treated cells was increased compared to the controls, on day 5 it was reduced. Cumulative radiation doses of ≥ 8 Gy resulted in an increased fraction of cells in G2/M-phase. The synthesis of the extracellular matrix protein tenascin was not affected by the treatment. Incubating human smooth muscle cells with 188Re for a period of 5 days (i.e., seven half-lives) results in an effective inhibition of muscle cell proliferation and colony formation. Partially, this is due to a radiation-induced G2/M-phase block. Cell migration and matrix synthesis were not effectively affected in the presented in vitro system.

Little is known about the use of psychosocial services in lung cancer survivors and patients who have survived the diagnosis for at least one year. We investigated the frequency of use, stratified by radiation therapy received, its associated factors, and the reasons for non-use of those services. We performed a multicenter (n = 6 hospitals) cross-sectional study using data from medical records, patient reported questionnaires, and computer-assisted telephone interviews. Odds ratios (OR) for factors potentially associated with the use of any type of psychosocial services were calculated using multivariable logistic regression. We included 604 lung cancer patients/survivors. Of them, 60% (69% of those who had received radiotherapy) had used some kind of psychological and/or social service in the past (47% psychological, 42% social); 39% had used inpatient care, 24% outpatient care (cancer counselling center, general counselling center, psychological counselling by family doctor, psychotherapy, patient support group, pastoral work). Of those who visited a rehabilitation clinic, 66% received psychosocial care there. Factors associated with using psychosocial services in general were female gender (OR 1.96, 95% CI 1.32–2.93), poor emotional functioning (per unit decrease: OR 0.99, 95% CI 0.98–0.996), and younger age (per year decrease: OR 0.95, 95% CI 0.93–0.97). The high proportion of psychosocial care users among lung cancer survivors in Germany indicates that patients are interested in using it and that an unmet need exists. The creation of a broad spectrum of easily accessible services with high quality is important to enable and facilitate use.

Untersuchungen haben gezeigt, dass die Angehörigen aus Patientensicht einen sehr hohen Stellenwert bei der Entscheidungsfindung zur Durchführung medizinischer Behandlungsmaßnahmen einnehmen. Durch eine gezielte Befragung der nächsten Angehörigen von Strahlentherapiepatienten wurde daher die Situation dieser Personengruppe im Sinne einer Bestandsaufnahme untersucht. Mittels eines neu entwickelten Fragebogens wurden in einem definierten Erhebungszeitraum von 6 Wochen insgesamt 470 Angehörige von Strahlentherapiepatienten (auswertbarer Rücklauf: n = 287, Rücklaufquote = 61%) über die Zufriedenheit mit ihrer Einbindung in den Therapieablauf befragt. Des Weiteren wurden bei der befragten Stichprobe Auskünfte über die spezifischen Bedürfnisse von Angehörigen sowie Vorschläge zu konkreten Verbesserungsmöglichkeiten im Kontext einer strahlentherapeutischen Behandlung erhoben. Insgesamt waren die Angehörigen mit ihrer Einbindung in die Therapieabläufe und mit der Betreuung der Patienten zufrieden. So gab es z.B. zu der Aussage „Hier in der Klinik wird mein kranker Angehöriger gut betreut“ zu über 95% Zustimmung. Unmittelbare Verbesserungsmöglichkeiten ergaben sich jedoch im Bereich der interdisziplinären Information über onkologische Themen sowie beim Organisationsablauf. Die Situation der Angehörigen von Strahlentherapiepatienten war in der Bestandsaufnahme insgesamt zufriedenstellend. Weitere Verbesserungen für die Zukunft sind vor allem aus dem Bereich interdisziplinärer Tumorzentren zu erwarten, die im Bedarfsfall die besten Voraussetzungen für eine Betreuung der Angehörigen haben. Als Vorbild können Strukturen aus der Palliativmedizin dienen.

In the literature, HPV infection and/or p16 positivity have been consistently demonstrated to correlate with improved response rates in oropharyngeal squamous cell carcinoma (OPSCC) patients treated with primary radiotherapy (RT) alone and in combination with chemotherapy. However, the exact role of HPV/p16 positivity in patients treated with postoperative RT is still unclear. We analyzed tumor samples for HPV-DNA and p16 expression and correlated these variables with treatment outcome in a series of 63 consecutively treated oropharyngeal cancer patients (95 % stage III/IV). HPV and p16 analysis were performed using validated test systems. Survival was estimated by the Kaplan–Meier method. Cox proportional hazard regression models were applied to compare the risk of death among patients stratified according to risk factors. Expression of p16 or high-risk HPV-DNA was detected in 60.3 % and 39.6 % of the tumors, respectively. p16 expression [overall survival (OS) at 2 years: 91 %] as well as HPV infection (OS at 2 years: 95 %) was associated with improved OS. Mean survival in p16-positive patients was 112 months compared to 64.6 months in case of p16 negativity. All HPV-positive tumors stained positive for p16. In a multivariable analysis, p16 positivity was associated with improved OS and with disease-free survival. p16 expression and HPV infection are strongly associated with the outcome of postoperatively irradiated OPSCC patients. HPV and p16 double-negative OPSCC patients should be regarded as a distinct “very high-risk patient group” that may benefit from intensified or novel treatment combinations.

Bệnh di căn từ ung thư phổi không tế bào nhỏ đến tuyến thượng thận là phổ biến, và điều trị hệ thống là lựa chọn điều trị thường gặp nhất. Tuy nhiên, ở những bệnh nhân bị di căn tuyến thượng thận đơn độc, có thể đạt được lợi ích sống sót sau khi phẫu thuật cắt bỏ. Xạ trị thân thể định hướng (SBRT) tăng cường kiểm soát khối u tại chỗ và có thể là một lựa chọn thay thế. Chúng tôi xin trình bày những kinh nghiệm ban đầu của chúng tôi tại cơ sở với SBRT cho di căn tuyến thượng thận. Giữa tháng 7 năm 2002 và tháng 9 năm 2009, 18 bệnh nhân bị ung thư phổi không tế bào nhỏ và di căn tuyến thượng thận đã nhận SBRT. Di căn tuyến thượng thận đơn độc được chẩn đoán ở 13 bệnh nhân, trong khi 5 bệnh nhân có tổn thương di căn nhiều nơi đã nhận SBRT do bị đau lưng. Tùy thuộc vào mục tiêu điều trị và kích thước mục tiêu, khái niệm liều/nhát khác nhau từ 5 x 4 Gy đến 5 x 8 Gy. Liều được cung cấp bằng kỹ thuật chùm tia hội tụ đồng nhất với liều tối đa trung vị lên đến 132% vào phần trung tâm của mục tiêu. Thể tích tổn thương lâm sàng (CTV) và thể tích mục tiêu lập kế hoạch (PTV) trung bình lần lượt là 89 cm³ (5–260 cm³) và 176 cm³ (20–422 cm³). Thời gian sống không tiến triển trung vị (PFS) là 4.2 tháng cho toàn bộ nhóm bệnh nhân, với PFS tăng rõ rệt là 12 tháng ở 13 bệnh nhân mắc di căn tuyến thượng thận đơn độc. Sau thời gian theo dõi trung vị 21 tháng, 10/13 bệnh nhân (77%) có di căn tuyến thượng thận đơn độc đạt được kiểm soát tại chỗ. Ở những bệnh nhân này, thời gian sống toàn bộ trung vị (OS) là 23 tháng. SBRT là một kỹ thuật khả thi và an toàn cho bệnh nhân ung thư phổi có di căn tuyến thượng thận. Ở những bệnh nhân có di căn tuyến thượng thận đơn độc, thời gian OS trung vị là 23 tháng là rất tốt và so sánh được với dữ liệu sau khi phẫu thuật cắt bỏ, nhưng không xâm lấn. Các tác dụng phụ cấp tính là nhẹ.