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  • 1
    Language: English
    In: Fertility and sterility, 2010, Vol.94 (6), p.2329.e5-2329.e7
    Description: Objective To provide a safe particle therapy treatment for a pregnant woman with skull-base cancer. Design Case report. Setting University clinic. Patient(s) A 27-year-old woman diagnosed for a skull-base chordoma and whose pregnancy was found during the course of radiotherapy with accelerated carbon ions. Intervention(s) Therapy was continued as scheduled, and fetal dose produced by photons and neutrons was measured at each radiotherapy fraction using passive and active monitors. Main Outcome Measure(s) Radiation dose to the uterus. Health of the mother and the newborn. Result(s) Total dose to the uterus was 〈0.2 mSv. About 30% of this dose was caused by neutrons. Magnetic resonance imaging of the skull base showed no evidence of recurrent disease in the mother. The child was healthy with normal development. Conclusion(s) Heavy ion cancer therapy produces a very low dose in distal organs.
    Subject(s): Internal Medicine ; Obstetrics and Gynecology ; heavy ions ; Radiotherapy ; in utero exposure ; neutrons ; pregnancy ; Chordoma - radiotherapy ; Humans ; Carbon Radioisotopes - therapeutic use ; Male ; Radiation Protection ; Heavy Ions - therapeutic use ; Pregnancy ; Pregnancy Complications, Neoplastic - radiotherapy ; Skull Base Neoplasms - radiotherapy ; Adult ; Female ; Radiometry ; Infant, Newborn ; Pregnant women ; Index Medicus
    ISSN: 0015-0282
    E-ISSN: 1556-5653
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  • 2
    Language: English
    In: International journal of radiation oncology, biology, physics, 2012, Vol.83 (3), p.859-864
    Description: Purpose Previously, we could show that the new World Health Organization (WHO) classification of meningiomas significantly correlated with outcome in patients with atypical and anaplastic histology. In the present work, we analyzed our long-term experience in radiotherapy for atypical and malignant meningioma diagnosed according to the most recent WHO categorization system. Patients and Methods Sixty-two patients with atypical and 23 patients with malignant meningioma have been treated with radiotherapy. Sixty percent of all patients received radiotherapy (RT) after surgical resection, 19% at disease progression and 8.3% as a primary treatment. Radiation was applied using different techniques including fractionated stereotactic RT (FSRT), intensity-modulated RT, and combination treatment with carbon ions. The median PTV was 156.0 mL. An average dose of 57.6 Gy (range, 30–68.4 Gy) in 1.8–3 Gy fractions was applied. All patients were followed regularly including clinical-neurological follow-up as well as computed tomographies or magnetic resonance imaging. Results Overall survival was impacted significantly by histological grade, with 81% and 53% at 5 years for atypical or anaplastic meningiomas, respectively. This difference was significant at p = 0.022. Eighteen patients died of tumor progression during follow-up. Progression-free survival was 95% and 50% for atypical, and 63% and 13% for anaplastic histology at 2 and 5 years. This difference was significant at p = 0.017. Despite histology, we could not observe any prognostic factors including age, resection status, or Karnofsky performance score. However, preexisting clinical symptoms observed in 63 patients improved in 29.3% of these patients. Conclusion RT resulted in improvement of preexisting clinical symptoms; outcome is comparable to other series reported in the literature. RT should be offered after surgical resection after initial diagnosis to increase progression-free survival as well as overall survival. Novel clinical concepts are under investigation to further improve outcome in patients with high-grade meningiomas.
    Subject(s): Radiology ; Hematology, Oncology and Palliative Medicine ; Radiation therapy ; Outcome ; High-risk meningiomas ; Prognostic factors ; Neurology ; Biological and medical sciences ; Medical sciences ; Tumors of the nervous system. Phacomatoses ; Prognosis ; Humans ; Meningioma - surgery ; Middle Aged ; Radiotherapy, Intensity-Modulated - methods ; Carbon Radioisotopes - therapeutic use ; Male ; Treatment Outcome ; Disease Progression ; Meningeal Neoplasms - mortality ; Disease-Free Survival ; Meningioma - pathology ; Karnofsky Performance Status ; Meningeal Neoplasms - surgery ; Dose Fractionation ; Female ; Meningeal Neoplasms - radiotherapy ; Meningioma - radiotherapy ; Meningeal Neoplasms - pathology ; Radiosurgery - methods ; Radiotherapy, Adjuvant ; Meningioma - mortality ; Practice Guidelines as Topic ; Nuclear radiation ; Oncology, Experimental ; Radiation ; Research ; Universities and colleges ; Radiotherapy ; Public health ; Cancer ; Index Medicus ; SURGERY ; DIAGNOSIS ; PATIENTS ; NEOPLASMS ; PERFORMANCE ; CLASSIFICATION ; RADIATION DOSES ; SYMPTOMS ; HISTOLOGY ; COMPUTERIZED TOMOGRAPHY ; GY RANGE 10-100 ; NMR IMAGING ; RECOMMENDATIONS ; RADIOLOGY AND NUCLEAR MEDICINE ; CARBON IONS ; RADIOTHERAPY ; HAZARDS
    ISSN: 0360-3016
    E-ISSN: 1879-355X
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  • 3
    Language: English
    In: International journal of radiation oncology, biology, physics, 2007, Vol.68 (2), p.449-457
    Description: Purpose: The aim of this study was to evaluate the effectiveness and toxicity of carbon ion radiotherapy in chordomas of the skull base. Methods and Materials: Between November 1998 and July 2005, a total of 96 patients with chordomas of the skull base have been treated with carbon ion radiation therapy (RT) using the raster scan technique at the Gesellschaft für Schwerionenforschung (GSI) in Darmstadt, Germany. All patients had gross residual tumors. Median total dose was 60 CGE (range, 60–70 CGE) delivered in 20 fractions within 3 weeks. Local control and overall survival rates were calculated using the Kaplan-Meier method. Toxicity was assessed according to the Common Terminology Criteria (CTCAE v.3.0) and the Radiation Therapy Oncology Group (RTOG) / European Organization for Research and Treatment of Cancer (EORTC) score. Results: Mean follow-up was 31 months (range, 3–91 months). Fifteen patients developed local recurrences after carbon ion RT. The actuarial local control rates were 80.6% and 70.0% at 3 and 5 years, respectively. Target doses in excess of 60 CGE and primary tumor status were associated with higher local control rates. Overall survival was 91.8% and 88.5% at 3 and 5 years, respectively. Late toxicity consisted of optic nerve neuropathy RTOG/EORTC Grade 3 in 4.1% of the patients and necrosis of a fat plomb in 1 patient. Minor temporal lobe injury (RTOG/EORTC Grade 1–2) occurred in 7 patients (7.2%). Conclusions: Carbon ion RT offers an effective treatment option for skull-base chordomas with acceptable toxicity. Doses in excess of 75 CGE with 2 CGE per fraction are likely to increase local control probability.
    Subject(s): Radiology ; Hematology, Oncology and Palliative Medicine ; Carbon ion radiation therapy ; Active beam delivery ; Particle therapy ; Skull-base chordoma ; Radiotherapy Dosage ; Follow-Up Studies ; Chordoma - radiotherapy ; Humans ; Middle Aged ; Carbon Radioisotopes - therapeutic use ; Neoplasm Recurrence, Local ; Child, Preschool ; Male ; Skull Base Neoplasms - mortality ; Radiation Injuries - etiology ; Neoplasm, Residual ; Carbon Radioisotopes - adverse effects ; Skull Base Neoplasms - radiotherapy ; Adolescent ; Survival Analysis ; Adult ; Female ; Aged ; Chordoma - mortality ; Child ; Dose-Response Relationship, Radiation ; Radiotherapy ; PATIENTS ; INJURIES ; NECROSIS ; BEAMS ; CARCINOMAS ; RADIOLOGY AND NUCLEAR MEDICINE ; SKULL ; FATS ; RADIATION DOSES ; TOXICITY ; CARBON IONS ; RADIOTHERAPY
    ISSN: 0360-3016
    E-ISSN: 1879-355X
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  • 4
    Language: English
    In: International journal of radiation oncology, biology, physics, 2008, Vol.70 (4), p.987-992
    Description: Purpose To evaluate efficacy and toxicity in elderly patients with glioblastoma multiforme (GBM) treated with postoperative radiochemotherapy with temozolomide (TMZ). Patients and Methods Forty-three patients aged 65 years or older were treated with postoperative with radiochemotherapy using TMZ for primary GBM. Median age at primary diagnosis was 67 years; 14 patients were female, 29 were male. A complete surgical resection was performed in 12 patients, subtotal resection in 17 patients, and biopsy only in 14 patients. Radiotherapy was applied with a median dose of 60 Gy, in a median fractionation of 5 × 2 Gy/wk. Thirty-five patients received concomitant TMZ at 50 mg/m2 , and in 8 patients 75 mg/m2 of TMZ was applied. Adjuvant cycles of TMZ were prescribed in 5 patients only. Results Median overall survival was 11 months in all patients; the actuarial overall survival rate was 48% at 1 year and 8% at 2 years. Median overall survival was 18 months after complete resection, 16 months after subtotal resection, and 6 months after biopsy only. Median progression-free survival was 4 months; the actuarial progression-free survival rate was 41% at 6 months and 18% at 12 months. Radiochemotherapy was well tolerated in most patients and could be completed without interruption in 38 of 43 patients. Four patients developed hematologic side effects greater than Common Terminology Criteria Grade 2, which led to early discontinuation of TMZ in 1 patient. Conclusions Radiochemotherapy is safe and effective in a subgroup of elderly patients with GBM and should be considered in patients without major comorbidities.
    Subject(s): Radiology ; Hematology, Oncology and Palliative Medicine ; Chemotherapy ; Glioblastoma multiforme ; Elderly patients ; Outcome ; Radiation ; Dacarbazine - therapeutic use ; Humans ; Male ; Combined Modality Therapy ; Brain Neoplasms - drug therapy ; Glioblastoma - radiotherapy ; Brain Neoplasms - surgery ; Glioblastoma - surgery ; Antineoplastic Agents, Alkylating - therapeutic use ; Dacarbazine - analogs & derivatives ; Survival Analysis ; Female ; Aged ; Brain Neoplasms - radiotherapy ; Glioblastoma - drug therapy ; Aged patients ; Care and treatment ; Temozolomide ; Radiotherapy ; GLIOMAS ; SURGERY ; DIAGNOSIS ; PATIENTS ; ELDERLY PEOPLE ; BIOPSY ; RADIATION DOSES ; TOXICITY ; CHEMOTHERAPY ; FRACTIONATED IRRADIATION ; RADIOLOGY AND NUCLEAR MEDICINE ; RADIOTHERAPY ; SIDE EFFECTS
    ISSN: 0360-3016
    E-ISSN: 1879-355X
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  • 5
    Language: English
    In: International journal of radiation oncology, biology, physics, 2010, Vol.76 (1), p.193-200
    Description: Purpose To evaluate the outcomes of patients with vestibular schwannoma (VS) treated with fractionated stereotactic radiotherapy (FSRT) vs. those treated with stereotactic radiosurgery (SRS). Methods and Materials This study is based on an analysis of 200 patients with 202 VSs treated with FSRT ( n = 172) or SRS ( n = 30). Patients with tumor progression and/or progression of clinical symptoms were selected for treatment. In 165 out of 202 VSs (82%), RT was performed as the primary treatment for VS, and for 37 VSs (18%), RT was conducted for tumor progression after neurosurgical intervention. For patients receiving FSRT, a median total dose of 57.6 Gy was prescribed, with a median fractionation of 5 x 1.8 Gy per week. For patients who underwent SRS, a median single dose of 13 Gy was prescribed to the 80% isodose. Results FSRT and SRS were well tolerated. Median follow-up time was 75 months. Local control was not statistically different for both groups. The probability of maintaining the pretreatment hearing level after SRS with doses of ≤13 Gy was comparable to that of FSRT. The radiation dose for the SRS group (≤13 Gy vs. 〉13 Gy) significantly influenced hearing preservation rates ( p = 0.03). In the group of patients treated with SRS doses of ≤13 Gy, cranial nerve toxicity was comparable to that of the FSRT group. Conclusions FSRT and SRS are both safe and effective alternatives for the treatment of VS. Local control rates are comparable in both groups. SRS with doses of ≤13 Gy is a safe alternative to FSRT. While FSRT can be applied safely for the treatment of VSs of all sizes, SRS should be reserved for smaller lesions.
    Subject(s): Radiology ; Hematology, Oncology and Palliative Medicine ; Precision radiotherapy ; Acoustic neuroma ; Local control ; Hearing preservation ; Facial Nerve - radiation effects ; Follow-Up Studies ; Humans ; Neuroma, Acoustic - surgery ; Dose Fractionation ; Female ; Male ; Neuroma, Acoustic - pathology ; Trigeminal Nerve - radiation effects ; Radiosurgery - methods ; Radiosurgery - adverse effects ; Hearing - radiation effects ; Research ; Radiotherapy ; Oncology, Experimental ; Cancer ; SURGERY ; NEOPLASMS ; NERVES ; NERVOUS SYSTEM ; RADIATION DOSES ; HEARINGS ; MEDICINE ; DOCUMENT TYPES ; NUCLEAR MEDICINE ; LINEAR ACCELERATORS ; IRRADIATION ; FRACTIONATED IRRADIATION ; DISEASES ; THERAPY ; DOSES ; ACCELERATORS ; RADIOLOGY AND NUCLEAR MEDICINE ; RADIOTHERAPY ; RADIOLOGY ; CONTROL
    ISSN: 0360-3016
    E-ISSN: 1879-355X
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  • 6
    Language: English
    In: International journal of radiation oncology, biology, physics, 2010, Vol.78 (1), p.237-245
    Description: Purpose Histone deacetylase inhibitors (HDACIs) can enhance the sensitivity of cells to photon radiation treatment (XRT) by altering numerous molecular pathways. We investigated the effect of pan-HDACIs such as suberoylanilide hydroxamic acid (SAHA) on radiation response in two osteosarcoma (OS) and two rhabdomyosarcoma (RMS) cell lines. Methods and Materials Clonogenic survival, cell cycle analysis, and apoptosis were examined in OS (KHOS-24OS, SAOS2) and RMS (A-204, RD) cell lines treated with HDACI and HDACI plus XRT, respectively. Protein expression was investigated via immunoblot analysis, and cell cycle analysis and measurement of apoptosis were performed using flow cytometry. Results SAHA induced an inhibition of cell proliferation and clonogenic survival in OS and RMS cell lines and led to a significant radiosensitization of all tumor cell lines. Other HDACI such as M344 and valproate showed similar effects as investigated in one OS cell line. Furthermore, SAHA significantly increased radiation-induced apoptosis in the OS cell lines, whereas in the RMS cell lines radiation-induced apoptosis was insignificant with and without SAHA. In all investigated sarcoma cell lines, SAHA attenuated radiation-induced DNA repair protein expression (Rad51, Ku80). Conclusion Our results show that HDACIs enhance radiation action in OS and RMS cell lines. Inhibition of DNA repair, as well as increased apoptosis induction after exposure to HDACIs, can be mechanisms of radiosensitization by HDACIs.
    Subject(s): Radiology ; Hematology, Oncology and Palliative Medicine ; suberoylanilide hydroxamic acid (SAHA) ; Sarcoma ; histone deacetylase inhibition ; radiosensitization ; Biological and medical sciences ; Medical sciences ; Diseases of the osteoarticular system ; Tumors of striated muscle and skeleton ; Osteosarcoma ; Oncology, Experimental ; Radiation ; Research ; Universities and colleges ; Radiotherapy ; Cancer ; RADIOSENSITIVITY EFFECTS ; APOPTOSIS ; HYDROXAMIC ACIDS ; NEOPLASMS ; ORGANIC COMPOUNDS ; SKELETAL DISEASES ; CELL PROLIFERATION ; TUMOR CELLS ; ANIMAL CELLS ; MEDICINE ; NUCLEAR MEDICINE ; INHIBITION ; DISEASES ; HYDROXY COMPOUNDS ; THERAPY ; AMINES ; SARCOMAS ; RADIOLOGY AND NUCLEAR MEDICINE ; CELL CYCLE ; RADIOTHERAPY ; SOMATIC CELLS ; OSTEOSARCOMAS ; CONNECTIVE TISSUE CELLS ; RADIOLOGY
    ISSN: 0360-3016
    E-ISSN: 1879-355X
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  • 7
    Language: English
    In: International journal of radiation oncology, biology, physics, 2007, Vol.67 (1), p.171-177
    Description: Purpose: To evaluate the effectiveness and toxicity of carbon ion radiotherapy in chondrosarcomas of the skull base. Patients and Methods: Between November 1998 and September 2005, 54 patients with low-grade and intermediate-grade chondrosarcomas of the skull base have been treated with carbon ion radiation therapy (RT) using the raster scan technique at the Gesellschaft für Schwerionenforschung in Darmstadt, Germany. All patients had gross residual tumors after surgery. Median total dose was 60 CGE (weekly fractionation 7 × 3.0 CGE). All patients were followed prospectively in regular intervals after treatment. Local control and overall survival rates were calculated using the Kaplan-Meier method. Toxicity was assessed according to the Common Terminology Criteria (CTCAE v.3.0) and the Radiation Therapy Oncology Group (RTOG)/European Organization for Research and Treatment of Cancer (EORTC) score. Results: Median follow-up was 33 months (range, 3–84 months). Only 2 patients developed local recurrences. The actuarial local control rates were 96.2% and 89.8% at 3 and 4 years; overall survival was 98.2%at 5 years. Only 1 patient developed a mucositis CTCAE Grade 3; the remaining patients did not develop any acute toxicities 〉CTCAE Grade 2. Five patients developed minor late toxicities (RTOG/EORTC Grades 1–2), including bilateral cataract ( n = 1), sensory hearing loss ( n = 1), a reduction of growth hormone ( n = 1), and asymptomatic radiation-induced white matter changes of the adjacent temporal lobe ( n = 2). Grade 3 late toxicity occurred in 1 patient (1.9%) only. Conclusions: Carbon ion RT is an effective treatment for low- and intermediate-grade chondrosarcomas of the skull base offering high local control rates with low toxicity.
    Subject(s): Radiology ; Hematology, Oncology and Palliative Medicine ; Carbon ion radiation therapy ; Chondrosarcoma ; Skull base ; Particle therapy ; Radiotherapy Dosage ; Carbon Isotopes - therapeutic use ; Neoplasm Recurrence, Local - radiotherapy ; Follow-Up Studies ; Chondrosarcoma - mortality ; Humans ; Middle Aged ; Carbon Isotopes - adverse effects ; Salvage Therapy ; Protons - therapeutic use ; Male ; Survival Rate ; Skull Base Neoplasms - mortality ; Neoplasm, Residual ; Skull Base Neoplasms - radiotherapy ; Adolescent ; Adult ; Female ; Aged ; Child ; Chondrosarcoma - radiotherapy ; Radiotherapy ; SURGERY ; PATIENTS ; CATARACTS ; STH ; SKELETAL DISEASES ; SKULL ; RADIATION DOSES ; TOXICITY ; FRACTIONATED IRRADIATION ; SARCOMAS ; RADIOLOGY AND NUCLEAR MEDICINE ; CARBON IONS ; RADIOTHERAPY
    ISSN: 0360-3016
    E-ISSN: 1879-355X
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  • 8
    Language: English
    In: International journal of radiation oncology, biology, physics, 2011, Vol.81 (5), p.1415-1421
    Description: Purpose To evaluate the correlation between the 1993 and 2000/2007 World Health Organization (WHO) classification with the outcome in patients with high-grade meningiomas. Patients and Methods Between 1985 and 2004, 73 patients diagnosed with atypical or anaplastic meningiomas were treated with radiotherapy. Sections from the paraffin-embedded tumor material from 66 patients (90%) from 13 different pathology departments were re-evaluated according to the first revised WHO classification from 1993 and the revised classifications from 2000/2007. In 4 cases, the initial diagnosis meningioma was not reproducible (5%). Therefore, 62 patients with meningiomas were analyzed. Results All 62 tumors were reclassified according to the 1993 and 2000/2007 WHO classification systems. Using the 1993 system, 7 patients were diagnosed with WHO grade I meningioma (11%), 23 with WHO grade II (37%), and 32 with WHO grade III meningioma (52%). After scoring using the 2000/2007 system, we found 17 WHO grade I meningiomas (27%), 32 WHO grade II meningiomas (52%), and 13 WHO grade III meningiomas (21%). According to the 1993 classification, the difference in overall survival was not statistically significant among the histologic subgroups ( p = .96). Using the 2000/2007 WHO classifications, the difference in overall survival became significant ( p = .02). Of the 62 reclassified patients 29 developed tumor progression (47%). No difference in progression-free survival was observed among the histologic subgroups ( p = .44). After grading according to the 2000/2007 WHO classifications, significant differences in progression-free survival were observed among the three histologic groups ( p = .005). Conclusion The new 2000/2007 WHO classification for meningiomas showed an improved correlation between the histologic grade and outcome. This classification therefore provides a useful basis to determine the postoperative indication for radiotherapy. According to our results, a comparison of the published data for future treatment decision-making remains difficult when the histologic diagnosis has not been based on the new improved classification system.
    Subject(s): Radiology ; Hematology, Oncology and Palliative Medicine ; Neurology ; Biological and medical sciences ; Medical sciences ; Tumors of the nervous system. Phacomatoses ; Meningeal Neoplasms - classification ; World Health Organization ; Humans ; Middle Aged ; Meningioma - classification ; Male ; Disease Progression ; Meningeal Neoplasms - mortality ; Neoplasm Staging - methods ; Young Adult ; Meningioma - pathology ; Adolescent ; Survival Analysis ; Aged, 80 and over ; Adult ; Female ; Aged ; Meningeal Neoplasms - radiotherapy ; Meningioma - radiotherapy ; Meningeal Neoplasms - pathology ; Meningioma - mortality ; Peace movements ; Oncology, Experimental ; Research ; Universities and colleges ; Radiotherapy ; Public health ; Cancer ; Index Medicus ; PARAFFIN ; DIAGNOSIS ; MENINGES ; PATIENTS ; NEOPLASMS ; NEUROLOGY ; DECISION MAKING ; RADIOLOGY AND NUCLEAR MEDICINE ; CLASSIFICATION ; PATHOLOGY ; RADIOTHERAPY ; WHO
    ISSN: 0360-3016
    E-ISSN: 1879-355X
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  • 9
    Language: English
    In: International journal of radiation oncology, biology, physics, 2012, Vol.83 (1), p.394-399
    Description: Purpose To investigate the effect of carbon ion irradiation on glioma cell migration. Methods and Materials U87 and Ln229 glioma cells were irradiated with photons and carbon ions. Migration was analyzed 24 h after irradiation. Fluorescence-activated cell sorting analysis was performed in order to quantify surface expression of integrins. Results Single photon doses of 2 Gy and 10 Gy enhanced αν β3 and αν β5 integrin expression and caused tumor cell hypermigration on both vitronectin (Vn) and fibronectin (Fn). Compared to integrin expression in unirradiated cells, carbon ion irradiation caused decreased integrin expression and inhibited cell migration on both Vn and Fn. Conclusion Photon radiotherapy (RT) enhances the risk of tumor cell migration and subsequently promotes locoregional spread via photon induction of integrin expression. In contrast to photon RT, carbon ion RT causes decreased integrin expression and suppresses glioma cell migration on both Vn and Fn, thus promising improved local control.
    Subject(s): Radiology ; Hematology, Oncology and Palliative Medicine ; Integrin ; Glioma ; Radiotherapy ; Migration ; Particle therapy ; Neurology ; Biological and medical sciences ; Medical sciences ; Tumors of the nervous system. Phacomatoses ; Carbon - therapeutic use ; Photons - adverse effects ; Humans ; Radiation Dosage ; Down-Regulation - radiation effects ; Neoplasm Proteins - metabolism ; Glioma - radiotherapy ; Cell Movement - physiology ; Integrin alphaVbeta3 - metabolism ; Photons - therapeutic use ; Cell Movement - radiation effects ; Glioma - metabolism ; Down-Regulation - physiology ; Neoplasm Proteins - radiation effects ; Glioma - pathology ; Receptors, Vitronectin - radiation effects ; Integrin alphaVbeta3 - radiation effects ; Cell Line, Tumor ; Fibronectins - physiology ; Receptors, Vitronectin - metabolism ; Vitronectin - physiology ; Nuclear radiation ; Gliomas ; Cells ; Radiation ; Integrins ; Index Medicus ; GLIOMAS ; IRRADIATION ; FLUORESCENCE ; PHOTONS ; RADIOLOGY AND NUCLEAR MEDICINE ; RADIATION DOSES ; TUMOR CELLS ; RADIOTHERAPY ; HAZARDS
    ISSN: 0360-3016
    E-ISSN: 1879-355X
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  • 10
    Language: English
    In: International journal of radiation oncology, biology, physics, 2007, Vol.68 (3), p.858-863
    Description: Purpose: We analyzed our long-term experience with intensity-modulated radiotherapy (IMRT) in patients with complex-shaped meningioma of the skull base. Patients and Methods: Between January 1998 and December 2004, 94 patients with complex-shaped meningioma were treated using IMRT at our institution. Tumor distribution was: World Health Organization (WHO) Grade 1 in 54.3%, WHO Grade 2 in 9.6%, and WHO Grade 3 in 4.2%. In 31.9% of patients, the clinical and radiologic characteristics of the tumor were consistent with the diagnosis of meningioma. Twenty-six patients received radiotherapy as primary treatment and 14 patients postoperative for residual disease. Fifty-four patients were treated after local recurrence. Median target volume was 81.4 mL, median total dose was 57.6 Gy given in 32 fractions. Results: Median follow-up was 4.4 years. Overall local control was 93.6%. Sixty-nine patients had stable disease based on computed tomography/magnetic resonance imaging (MRI), whereas 19 had a tumor volume reduction after IMRT. Six patients showed local tumor progression on MRI 22.3 months’ median after IMRT. Three patients died from non–treatment-related conditions after IMRT. In 39.8% of the patients, preexisting neurologic deficits improved. Worsening of preexisting neurologic symptoms was seen in 4 patients and 2 patients developed new clinical symptoms from local tumor progression. Transient side effects such as headache were seen in 7 patients. Treatment-induced loss of vision was seen in 1 of 53 reirradiated patients with a Grade 3 meningioma 9 months after retreatment with IMRT. Conclusion: These data demonstrate that IMRT is an effective and safe treatment modality for long-term local control of complex-shaped and otherwise difficult to treat meningioma.
    Subject(s): Radiology ; Hematology, Oncology and Palliative Medicine ; Long-term experience ; Intensity-modulated radiotherapy (IMRT) ; Meningioma ; Risk Assessment - methods ; Prognosis ; Humans ; Middle Aged ; Risk Factors ; Male ; Survival Rate ; Treatment Outcome ; Skull Base Neoplasms - mortality ; Germany - epidemiology ; Meningeal Neoplasms - mortality ; Skull Base Neoplasms - radiotherapy ; Radiotherapy, Conformal - mortality ; Adolescent ; Survival Analysis ; Adult ; Female ; Aged ; Meningeal Neoplasms - radiotherapy ; Meningioma - radiotherapy ; Longitudinal Studies ; Meningioma - mortality ; Radiotherapy ; Development and progression ; Index Medicus ; DIAGNOSIS ; PATIENTS ; NMR IMAGING ; NEOPLASMS ; RADIOLOGY AND NUCLEAR MEDICINE ; SKULL ; SYMPTOMS ; RADIOTHERAPY ; SIDE EFFECTS ; COMPUTERIZED TOMOGRAPHY
    ISSN: 0360-3016
    E-ISSN: 1879-355X
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