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  • 1
    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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  • 2
    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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  • 3
    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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  • 4
    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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  • 5
    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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  • 6
    Language: English
    In: International journal of radiation oncology, biology, physics, 2011, Vol.80 (3), p.815-823
    Description: Purpose To identify predictors for the development of temporal lobe reactions (TLR) after carbon ion radiation therapy (RT) for radiation-resistant tumors in the central nervous system and to evaluate the predictions of the local effect model (LEM) used for calculation of the biologically effective dose. Methods and Materials This retrospective study reports the TLR rates in patients with skull base chordomas and chondrosarcomas irradiated with carbon ions at GSI, Darmstadt, Germany, in the years 2002 and 2003. Calculation of the relative biological effectiveness and dose optimization of treatment plans were performed on the basis of the LEM. Clinical examinations and magnetic resonance imaging (MRI) were performed at 3, 6, and 12 months after RT and annually thereafter. Local contrast medium enhancement in temporal lobes, as detected on MRI, was regarded as radiation-induced TLR. Dose-volume histograms of 118 temporal lobes in 59 patients were analyzed, and 16 therapy-associated and 2 patient-associated factors were statistically evaluated for their predictive value for the occurrence of TLR. Results Median follow-up was 2.5 years (range, 0.3--6.6 years). Age and maximum dose applied to at least 1 cm3 of the temporal lobe ( D max, V − 1 cm 3, maximum dose in the remaining temporal lobe volume, excluding the volume 1 cm3 with the highest dose) were found to be the most important predictors for TLR. Dose response curves of D max, V − 1 cm 3 were calculated. The biologically equivalent tolerance doses for the 5% and 50% probabilities to develop TLR were 68.8 ± 3.3 Gy equivalents (GyE) and 87.3 ± 2.8 GyE, respectively. Conclusions D max, V − 1 cm 3 is predictive for radiation-induced TLR. The tolerance doses obtained seem to be consistent with published data for highly conformal photon and proton irradiations. We could not detect any clinically relevant deviations between clinical findings and expectations based on predictions of the LEM.
    Subject(s): Radiology ; Hematology, Oncology and Palliative Medicine ; Chordoma ; Carbon ion radiation therapy ; Chondrosarcoma ; Local effect model (LEM) ; Toxicity ; Biological and medical sciences ; Medical sciences ; Diseases of the osteoarticular system ; Tumors of striated muscle and skeleton ; Radiotherapy Dosage ; Age Factors ; Chordoma - radiotherapy ; Humans ; Middle Aged ; Radiation Tolerance ; Carbon Radioisotopes - therapeutic use ; Radiation Injuries - diagnosis ; Magnetic Resonance Imaging - methods ; Male ; Young Adult ; Contrast Media ; Skull Base Neoplasms - radiotherapy ; Models, Biological ; Adolescent ; Adult ; Female ; Aged ; Retrospective Studies ; Relative Biological Effectiveness ; Temporal Lobe - radiation effects ; Germany ; Chondrosarcoma - radiotherapy ; Oncology, Experimental ; Analysis ; Radiation ; Models ; Universities and colleges ; Research ; Radiotherapy ; Cancer ; Index Medicus ; NERVOUS SYSTEM ; SKELETAL DISEASES ; SKULL ; IONS ; RADIATION DOSES ; MEDICINE ; SKELETON ; IRRADIATION ; NMR IMAGING ; THERAPY ; CHARGED PARTICLES ; RADIOLOGY AND NUCLEAR MEDICINE ; RADIOTHERAPY ; RADIOLOGY ; DIAGNOSTIC TECHNIQUES ; NEOPLASMS ; CENTRAL NERVOUS SYSTEM ; TOXICITY ; NUCLEAR MEDICINE ; ORGANS ; DISEASES ; DOSES ; SARCOMAS ; CONTRAST MEDIA ; CARBON IONS ; BODY
    ISSN: 0360-3016
    E-ISSN: 1879-355X
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  • 7
    Language: English
    In: International journal of radiation oncology, biology, physics, 2008, Vol.71 (4), p.999-1005
    Description: Purpose To evaluate toxicity and outcomes in patients with primary glioblastoma (GB) treated with postoperative radiochemotherapy (RCHT) with temozolomide (TMZ) comparing two dose regimens. Methods and Materials A total of 160 patients with histologically confirmed GB were treated with postoperative RCHT with TMZ. Of the patients, 66 were female and 94 were male, with a median age of 60 years. After the primary diagnosis, a biopsy had been performed in 42 patients; a subtotal and total resection was conducted in 66 and 52 patients. Postoperative radiotherapy was applied with a median dose of 60 Gy with a median fractionation of 5 × 2Gy/week. Concomitant TMZ was prescribed at 50 mg/m2 in 123 patients (Group A) and at 75 mg/m2 in 37 patients (Group B). Patients were followed in 3-months intervals, with a median follow-up of 13 months. Results Overall survival (OS) rates in Group A vs. Group B were 67% and 79% at 1 year and 43% vs. 49% at 2 years, respectively ( p = 0.69). Progression-free survival was 49% vs. 54% at 1 year and 22% vs. 29% at 2 years ( p = 0.31). Hematologic toxicity was not statistically significant over the 6-week RCHT period except for a significant decrease in platelets during Week 6 ( p = 0.01) in Group B. Conclusions Overall survival seems to be comparable in both groups, although longer follow-up and a larger group of patients are needed to corroborate these results. Lower dosing of TMZ also is associated with a more beneficial toxicity profile.
    Subject(s): Radiology ; Hematology, Oncology and Palliative Medicine ; Temozolomide ; Toxicity ; Outcome ; Glioblastoma ; Radiochemotherapy ; Risk Assessment - methods ; Dacarbazine - administration & dosage ; Prevalence ; Radiotherapy - mortality ; Drug Administration Schedule ; Humans ; Middle Aged ; Risk Factors ; Male ; Survival Rate ; Treatment Outcome ; Antineoplastic Agents, Alkylating - administration & dosage ; Germany - epidemiology ; Dose-Response Relationship, Drug ; Glioblastoma - therapy ; Brain Neoplasms - therapy ; Dacarbazine - analogs & derivatives ; Survival Analysis ; Adult ; Female ; Aged ; Brain Neoplasms - mortality ; Combined Modality Therapy - statistics & numerical data ; Glioblastoma - mortality ; GLIOMAS ; DIAGNOSIS ; PATIENTS ; FRACTIONATION ; BIOPSY ; RADIOLOGY AND NUCLEAR MEDICINE ; RADIATION DOSES ; TOXICITY ; RADIOTHERAPY
    ISSN: 0360-3016
    E-ISSN: 1879-355X
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  • 8
    Language: English
    In: International journal of radiation oncology, biology, physics, 2007, Vol.68 (3), p.873-882
    Description: Background: The majority of glioblastoma multiforme (GBM) cells express the epidermal growth factor receptor (EGFR). The present study evaluates the combination of temozolomide (TMZ), EGFR inhibition, and radiotherapy (RT) in GBM cell lines. Methods and Materials: Human GBM cell lines U87, LN229, LN18, NCH 82, and NCH 89 were treated with various combinations of TMZ, RT, and the monoclonal EGFR antibody cetuximab. Responsiveness of glioma cells to the combination treatment was measured by clonogenic survival. Results: Overall, double and triple combinations of RT, TMZ, and cetuximab lead to additive cytotoxic effects (independent toxicity). A notable exception was observed for U87 and LN 18 cell lines, where the combination of TMZ and cetuximab showed substantial antagonism. Interestingly, in these two cell lines, the combination of RT with cetuximab resulted in a substantial increase in cell killing over that expected for independent toxicity. The triple combination with RT, cetuximab, and TMZ was nearly able to overcome the antagonism for the TMZ/cetuximab combination in U87, however only marginally in LN18, GBM cell lines. Conclusion: It appears that EGFR expression is not correlated with cytotoxic effects exerted by cetuximab. Combination treatment with TMZ, cetuximab and radiation resulted in independent toxicity in three out of five cell lines evaluated, the antagonistic effect of the TMZ/cetuximab combination in two cell lines could indicate that TMZ preferentially kills cetuximab-resistant cells, suggesting for some cross-talk between toxicity mechanisms. Expression of EGFR was no surrogate marker for responsiveness to cetuximab, alone or in combination with RT and TMZ.
    Subject(s): Radiology ; Hematology, Oncology and Palliative Medicine ; Human glioma cells ; Temozolomide ; Toxicity ; EGFR ; Radiation ; Cell Survival - drug effects ; Dacarbazine - administration & dosage ; Antineoplastic Combined Chemotherapy Protocols - administration & dosage ; Humans ; Epidermal Growth Factor - metabolism ; Antineoplastic Agents - administration & dosage ; Radiation Dosage ; Cell Survival - radiation effects ; Dose-Response Relationship, Drug ; Antibodies, Monoclonal, Humanized ; Antibodies, Monoclonal - administration & dosage ; Chemotherapy, Adjuvant - methods ; Glioblastoma - pathology ; Dacarbazine - analogs & derivatives ; Cell Line, Tumor ; Epidermal Growth Factor - antagonists & inhibitors ; Glioblastoma - metabolism ; Cetuximab ; Dose-Response Relationship, Radiation ; Epidermal growth factor ; Radiotherapy ; Gliomas ; Nuclear radiation ; Cells ; ANTIBODIES ; GLIOMAS ; GROWTH FACTORS ; INHIBITION ; IN VITRO ; CELL KILLING ; RADIOLOGY AND NUCLEAR MEDICINE ; TOXICITY ; RADIOTHERAPY ; RECEPTORS
    ISSN: 0360-3016
    E-ISSN: 1879-355X
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  • 9
    Language: English
    In: International journal of radiation oncology, biology, physics, 2008, Vol.71 (4), p.972-978
    Description: Purpose To assess the outcome of 57 patients with localized ependymomas treated with radiotherapy (RT). Methods and Materials Fifty-seven patients with localized ependymomas were treated with RT. Histology was myxopapillary ependymoma ( n = 4), ependymoma ( n = 23), and anaplastic ependymoma ( n = 30). In 16 patients, irradiation of the craniospinal axis (CSI) was performed with a median dose of 20 Gy. Forty-one patients were treated with local RT, with a local dose of 45 Gy to the posterior fossa, including a boost to the tumor bed of 9 Gy. In 19 patients, the tumor bed was irradiated with a median dose of 54 Gy. Results Overall survival after primary diagnosis was 83% and 71% at 3 and 5 years. Five-year overall survival was 80% in low-grade and 79% in high-grade tumors. Survival from RT was 79% at 3 and 64% at 5 years. We could not show a significant difference in overall survival between CSI and local RT only. Freedom of local failure was 67% at 5 years in patients treated with CSI and 60% at 5 years after local RT. A rate of 83% for distant failure-free survival could be observed in the CSI group as opposed to 93% in the group receiving local RT only. Conclusion Local RT in patients with localized tumors is equieffective to CSI. The radiation oncologist must keep in mind that patients with localized ependymomas benefit from local doses ≥45 Gy.
    Subject(s): Radiology ; Hematology, Oncology and Palliative Medicine ; Radiation therapy ; Dose escalation ; Toxicity ; Outcome ; Ependymoma ; Risk Assessment - methods ; Prevalence ; Radiotherapy - mortality ; Brain Neoplasms - diagnostic imaging ; Humans ; Middle Aged ; Child, Preschool ; Infant ; Male ; Ependymoma - mortality ; Adult ; Female ; Brain Neoplasms - mortality ; Child ; Radiotherapy Dosage ; Risk Factors ; Survival Rate ; Treatment Outcome ; Germany - epidemiology ; Disease-Free Survival ; Adolescent ; Radionuclide Imaging ; Survival Analysis ; Aged ; Dose-Response Relationship, Radiation ; Ependymoma - radiotherapy ; DIAGNOSIS ; IRRADIATION ; PATIENTS ; NEOPLASMS ; FAILURES ; RADIOLOGY AND NUCLEAR MEDICINE ; MEDICAL PERSONNEL ; RADIATION DOSES ; TOXICITY ; RADIOTHERAPY ; HISTOLOGY
    ISSN: 0360-3016
    E-ISSN: 1879-355X
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