Local progression and pseudo progression after single fraction or fractionated stereotactic radiotherapy for large brain metastases

Purpose

The 1-year local control rates after single-fraction stereotactic radiotherapy (SRT) for brain metastases >?3?cm diameter are less than 70%, but with fractionated SRT (FSRT) higher local control rates have been reported. The purpose of this study was to compare our treatment results with SRT and FSRT for large brain metastases.

Materials and methods

In two consecutive periods, 41?patients with 46?brain metastases received SRT with 1 fraction of 15?Gy, while 51?patients with 65?brain metastases received FSRT with 3?fractions of 8?Gy. We included patients with brain metastases with a planning target volume of >?13?cm³ or metastases in the brainstem.

Results

The minimum follow-up of patients still alive was 22?months. Comparing 1?fraction of 15?Gy ?with 3?fractions of 8?Gy, the 1-year rates of freedom from any local progression (54% and 61%, p?=?0.93) and pseudo progression (85% and 75%, p?=?0.25) were not significantly different. Overall survival rates were also not different.

Conclusion

The 1-year local progression and pseudo progression rates after 1 fraction of 15?Gy or 3?fractions of 8?Gy for large brain metastases and metastases in the brainstem are similar. For better local control rates, FSRT schemes with a higher biological equivalent dose may be necessary.     

Can single-phase dual-energy CT reliably identify adrenal adenomas?

Purpose

To evaluate whether single-phase dual-energy-CT-based attenuation measurements can reliably differentiate lipid-rich adrenal adenomas from malignant adrenal lesions.

Materials and methods

We retrospectively identified 51 patients with adrenal masses who had undergone contrast-enhanced dual-energy-CT (140/100 or 140/80 kVp). Virtual non-contrast and colour-coded iodine images were generated, allowing for measurement of pre- and post-contrast density on a single-phase acquisition. Adrenal adenoma was diagnosed if density on virtual non-contrast images was ≤10 HU. Clinical follow-up, true non-contrast CT, PET/CT, in- and opposed-phase MRI, and histopathology served as the standard of reference.

Results

Based on the standard of reference, 46/57 (80.7 %) adrenal masses were characterised as adenomas or other benign lesions; 9 malignant lesions were detected. Based on a cutoff value of 10 HU, virtual non-contrast images allowed for correct identification of adrenal adenomas in 33 of 46 (71 %), whereas 13/46 (28 %) adrenal adenomas were lipid poor with a density ≥10 HU. Based on the threshold of 10 HU on the virtual non-contrast images, the sensitivity, specificity, and accuracy for detection of benign adrenal lesions was 73 %, 100 %, and 81 % respectively.

Conclusion

Virtual non-contrast images derived from dual-energy-CT allow for accurate characterisation of lipid-rich adrenal adenomas and can help to avoid additional follow-up imaging.

Key Points

? Adrenal adenomas are a common lesion of the adrenal glands. ? Differentiation of benign adrenal adenomas from malignant adrenal lesions is important. ? Dual-energy based virtual non-contrast images help to evaluate patients with adrenal adenomas.     

Radiation therapy for angiosarcoma of the scalp

Background and purpose

Wide surgical excision is the standard treatment for angiosarcoma of the scalp, but many patients are inoperable. Therefore, we investigated the outcome of radiation therapy for angiosarcoma of the scalp.

Patients and methods

Seventeen patients with angiosarcoma of the scalp underwent radiation therapy with total scalp irradiation. Four patients had cervical lymph node metastases, but none had distant metastases. A median initial dose of 50 Gy in 25 fractions was delivered to the entire scalp. Subsequently, local radiation boost to the tumor sites achieved a median total dose of 70 Gy in 35 fractions.

Results

Fourteen of the 17 patients developed recurrences during the median follow-up period of 14 months after radiation therapy; 7 had recurrences in the scalp, including primary tumor progression in 2 patients and new disease in 5, and 12 patients developed distant metastases. The primary progression-free, scalp relapse-free, and distant metastasis-free rates were 86, 67, and 38?% at 1 year and 86, 38, and 16?% at 3 years, respectively. Thirteen patients died; the overall and cause-specific survival rates were both 73?% at 1 year and 23 and 44?% at 3 years, respectively. The median survival time was 16 months. There were no therapy-related toxicities ≥?grade 3.

Conclusion

Total scalp irradiation is safe and effective for local tumor control, but a dose of ≤?50 Gy in conventional fractions may be insufficient to eradicate microscopic tumors. For gross tumors, a total dose of 70 Gy, and >?70 Gy for tumors with deep invasion, is recommended.     

Endocrine and visual function after fractionated stereotactic radiotherapy of perioptic tumors

Purpose

To find out whether the use of stereotactic techniques for fractionated radiotherapy reduces toxicity to the endocrine and visual system in patients with benign perioptic tumors.

Patients and methods

From 1993 to 2009, ?29 patients were treated with fractionated stereotactic radiotherapy. The most frequent tumor types were grade I meningioma (n ?=?11) and pituitary adenoma (n ?=?10, 7 nonfunctioning, 3 growth hormone-producing). Patients were immobilized with the GTC frame (Radionics, USA) and the planning target volume (PTV; median 24.7, 4.6–58.6 ml) was irradiated with a total dose of 52.2 Gy (range, 45.0–55.8 Gy) in 1.8-Gy fractions using a linear accelerator (6 MeV photons) equipped with a micro-multileaf collimator. Maximum doses to the optic system and pituitary gland were 53.4 Gy (range, 11.5–57.6 Gy) and 53.6 Gy (range, 12.0–57.9 Gy).

Results

Median follow-up was 45 months (range, 10–105 months). Local control was achieved in all but 1 patient (actuarial rate 92% at 5 years and 10 years). In 9 of 29 patients (31%), partial remission was observed (actuarial response rate 40% at 5 years and 10 years). In 4 of 26 patients (15%) with at least partial pituitary function, new hormonal deficits developed (actuarial rate 21% at 5 years and 10 years). This rate was significantly higher in patients treated for a larger PTV (<?/>?25 ml: 0% vs. 42% at 5 years and 10 years, p?=?0.028). Visual function improved in 4 of 15 patients (27%) who had prior impairment. None of the patients developed treatment-related optic neuropathy, but 2 patients experienced new disease-related visual deficits.

Conclusion

Fractionated stereotactic radiotherapy for benign tumors of the perioptic and sellar region results in satisfactory response and local control rates and does not affect the visual system. The assumption that patients can be spared hypophyseal insufficiency only holds for small tumors.     

Predictive factors for gastroduodenal toxicity based on endoscopy following radiotherapy in patients with hepatocellular carcinoma

Purpose

The aim of this work was to determine predictive factors for gastroduodenal (GD) toxicity in hepatocellular carcinoma (HCC) patients who were treated with radiotherapy (RT).

Patients and methods

A total of 90 HCC patients who underwent esophagogastroduodenoscopy (EGD) before and after RT were enrolled. RT was delivered as 30–50 Gy (median 37.5 Gy) in 2–5 Gy (median 3.5 Gy) per fraction. All endoscopic findings were reviewed and GD toxicities related to RT were graded by the Common Toxicity Criteria for Adverse Events, version 3.0. The predictive factors for the ≥?grade 2 GD toxicity were investigated.

Results

Endoscopic findings showed erosive gastritis in 14 patients (16?%), gastric ulcers in 8 patients (9?%), erosive duodenitis in 15 patients (17?%), and duodenal ulcers in 14 patients (16?%). Grade 2 toxicity developed in 19 patients (21?%) and grade 3 toxicity developed in 8 patients (9?%). V₂₅ for stomach and V₃₅ for duodenum (volume receiving a RT dose of more than x Gy) were the most predictive factors for ≥?grade 2 toxicity. The gastric toxicity rate at 6 months was 2.9?% for V₂₅ ≤?6.3?% and 57.1?% for V₂₅ >?6.3?%. The duodenal toxicity rate at 6 months was 9.4?% for V₃₅ ≤?5.4?% and 45.9?% for V₃₅ >?5.4?%. By multivariate analysis including the clinical factors, V₂₅ for stomach and V₃₅ for duodenum were the significant factors.

Conclusion

EGD revealed that GD toxicity is common following RT for HCC. V₂₅ for the stomach and V₃₅ for the duodenum were the significant factors to predict ≥?grade 2 GD toxicity.     

Incidental pituitary uptake on whole-body 18F-FDG PET/CT: a multicentre study

Purpose

The purpose of this study was to determine the incidence of incidental pituitary uptake on whole-body ¹⁸F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) and to investigate its clinical significance.

Methods

The files of 40,967 patients who underwent whole-body FDG PET/CT were retrospectively reviewed. Quantification of pituitary metabolic activity was obtained by using the maximum standardized uptake value (SUV_max). Hormone assays and pituitary MRIs were performed to assess pituitary lesions.

Results

Focally increased pituitary FDG uptake on PET/CT was found in 30 of 40,967 patients, accounting for an incidence of 0.073%. The mean SUV_max of 30 patients was 8.9?±?6.6 (range: 3.2–32.6). Histological diagnosis was obtained in three patients and included two growth hormone-secreting adenomas and one non-functioning adenoma. Hormone assays were performed on serum samples from 11 patients, 2 of whom were shown to have hypersecretion of pituitary hormone. MRI was performed on 19 patients. Abnormal MRI findings suggesting a pituitary mass were found in 18 of 19 cases (94.7%). The mean SUV_max calculated without correction for partial volume effect for macroadenomas was significantly higher than the SUV_max for microadenomas (11.5?±?8.4 vs 4.8?±?1.3; p?<?0.05). There were no cases diagnosed with metastasis to the pituitary gland during clinical follow-up.

Conclusion

Incidental pituitary FDG uptake was a very rare finding. Cases with incidental pituitary FDG uptake were diagnosed primarily with clinically non-functioning adenomas, and there were also a few functioning adenomas. Further evaluations, including hormone assays and pituitary MRI, are warranted when pituitary uptake is found on FDG PET/CT.     

Endocrinological and MRI features of pituitary adenomas with marked xanthogranulomatous reaction

Introduction

The study aims to describe the endocrinological and magnetic resonance imaging (MRI) features of the rarely reported xanthogranulomas associated with pituitary adenoma.

Methods

Of 231 consecutive pituitary adenomas treated surgically, those with xanthogranulomatous reaction on histology were reviewed.

Results

Five patients (2.2%) had an adenoma with marked xanthogranulomatous reaction. They were all nonfunctioning macroadenomas and presented with anterior pituitary insufficiencies. On MRI, all adenomas showed mixed signal intensities on T1- and T2-weighted images with heterogeneous gadolinium enhancement, reflecting their complex histological features: Cholesterol clefts typically showed T1 high- and T2 low-signal intensities. Preoperative diagnosis was difficult in a case predominantly featuring xanthogranuloma. Although none of them had episodes of pituitary apoplexy, hemosiderin deposits and cysts with xanthochromic-like fluid were observed in five and four cases, respectively.

Conclusions

Xanthogranulomatous reaction may develop in macroadenomas, probably triggered by hemorrhagic processes despite no apoplectic episodes. They typically exhibit complex mixed signal intensity on MRI, particularly T1 high- and T2 low-signal intensities, and patients present with pituitary dysfunction.     

Re-irradiation of recurrent anaplastic ependymoma using radiosurgery or fractionated stereotactic radiotherapy

Purpose

Recurrent ependymomas were retreated with stereotactic radiosurgery (SRS) or fractionated stereotactic radiotherapy (FSRT). The efficacy, toxicities, and differences between SRS and FSRT were analyzed.

Methods

Eight patients with recurrent ependymomas fulfilling the criteria described below were evaluated. Inclusion criteria were: (1) the patient had previously undergone surgery and conventional radiotherapy as first-line treatment; (2) targets were located in or adjacent to the eloquent area or were deep-seated; and (3) the previously irradiated volume overlapped the target lesion.

Results

FSRT was delivered to 18 lesions, SRS to 20 lesions. A median follow-up period was 23 months. The local control rate was 76 % at 3 years. No significant differences in local control were observed due to tumor size or fractionation schedule. Lesions receiving >25 Gy/5 fr or 21 Gy/3 fr did not recur within 1 year, whereas no dose–response relationship was observed in those treated with SRS. No grade ≥2 toxicity was observed.

Conclusion

Our treatment protocol provided an acceptable LC rate and minimal toxicities. Because local recurrence of tumors may result in patient death, a minimum dose of 21 Gy/3 fr or 25 Gy/5 fr or higher may be most suitable for treatment of these cases.

     

Does high-dose radiotherapy benefit palliative lung cancer patients?

Background and purpose

The present analysis compares two palliative treatment concepts for lung cancer in terms of overall survival.

Patients and methods

Survival data from 207 patients were used in a retrospective analysis. All patients received palliative treatment comprising either 25 Gy applied in 5 fractions or 50 Gy in 20 fractions. A subgroup analysis was performed to compare patients with a good–fair vs. poor overall condition.

Results

Median survival times were 21 weeks (range 6–26 weeks) for patients treated with 25 Gy in 5 fractions and 23 weeks (range 14.5–31.5 weeks) for patients treated with 50 Gy in 20 fractions (95?% confidence interval, CI; p?=?0.334). For patients with a good–fair overall condition, median survival times were 30 weeks (21.8–39.2 weeks) for 25 Gy in 5 fractions and 28 weeks (14.2–41.8 weeks) for 50 Gy in 20 fractions (CI 95?%, p?=?0.694). In patients with a poor overall condition, these values were 18 weeks (14.5–21.5 weeks) and 21 weeks (13.0–29.0 weeks), respectively (CI 95?%, p?=?0.248).

Conclusion

The palliative treatment concept of 25 Gy applied in 5 fractions is sufficient for radiation of lung cancer, given that there was no obvious survival improvement in patients treated with the higher total dose regimen.     

High-dose-rate interstitial brachytherapy in combination with androgen deprivation therapy for prostate cancer

Background and purpose

To evaluate the effectiveness of high-dose-rate interstitial brachytherapy (HDR-ISBT) as the only form of radiotherapy for high-risk prostate cancer patients.

Patients and methods

Between July 2003 and June 2008, we retrospectively evaluated the outcomes of 48 high-risk patients who had undergone HDR-ISBT at the National Hospital Organization Osaka National Hospital. Risk group classification was according to the criteria described in the National Comprehensive Cancer Network (NCCN) guidelines. Median follow-up was 73 months (range 12–109 months). Neoadjuvant androgen deprivation therapy (ADT) was administered to all 48 patients; 12 patients also received adjuvant ADT. Maximal androgen blockade was performed in 37 patients. Median total treatment duration was 8 months (range 3–45 months). The planned prescribed dose was 54 Gy in 9 fractions over 5 days for the first 13 patients and 49 Gy in 7 fractions over 4 days for 34 patients. Only one patient who was over 80 years old received 38 Gy in 4 fractions over 3 days. The clinical target volume (CTV) was calculated for the prostate gland and the medial side of the seminal vesicles. A 10-mm cranial margin was added to the CTV to create the planning target volume (PTV).

Results

The 5-year overall survival and biochemical control rates were 98 and 87?%, respectively. Grade 3 late genitourinary and gastrointestinal complications occurred in 2 patients (4?%) and 1 patient (2?%), respectively; grade 2 late genitourinary and gastrointestinal complications occurred in 5  patients (10?%) and 1 patient (2?%), respectively.

Conclusion

Even for high-risk patients, HDR-ISBT as the only form of radiotherapy combined with ADT achieved promising biochemical control results, with acceptable late genitourinary and gastrointestinal complication rates.     

High-dose radiotherapy alone for patients with T4-stage laryngeal cancer

Background and purpose

The purpose of this retrospective study was to report on the efficacy of radiotherapy alone in patients with T4-stage laryngeal cancer and to establish the prognostic value of (a) the size and location of the extralaryngeal tumor extensions and (b) of emergency tracheostomy.

Patients and methods

A group of 114 patients were treated with definitive radiotherapy between 1990 and 1996. The piriform recess was involved in 37 cases (33?%), the base of the tongue and glosso-epiglottic vallecula in 34 cases (30?%), and the hypopharyngeal wall in 10 cases (9?%). In 16 cases (14?%), emergency tracheostomy was performed before radiotherapy. The mean total dose was 68 Gy (range, 60–77.6 Gy). The mean treatment time was 49 days (range, 42–74 days).

Results

Actuarial 3-year local control (LC) was noted in 42?% of patients, disease-free survival (DFS) in 35?%, and overall survival (OS) in 40?%. The best prognosis was for the lesion suspected of cartilage infiltration: 56?% 3-year LC. The worst results were noted in the cases with massive infiltrations spreading from the larynx through the hypopharynx: 13?% 3-year LC. Emergency tracheostomy before radiotherapy was significantly connected with the worst treatment results (p?=?0.000): 3-year LC in patients with tracheostomy was 0?% vs. 48?% in patients without tracheostomy.

Conclusion

Conventional radiotherapy of T4 laryngeal cancer is a method of treatment with limited effectiveness. The efficacy of radiotherapy is dependent on the location and extent of extralaryngeal infiltrations. Emergency tracheostomy is a prognostic factor connected with the worst prognosis.     

Effect of a combined surgery, re-irradiation and hyperthermia therapy on local control rate in radio-induced angiosarcoma of the chest wall

Purpose

Radiation-induced angiosarcoma (RAS) of the chest wall/breast has a poor prognosis due to the high percentage of local failures. The efficacy and side effects of re-irradiation plus hyperthermia (reRT + HT) treatment alone or in combination with surgery were assessed in RAS patients.

Patients and methods

RAS was diagnosed in 23 breast cancer patients and 1 patient with melanoma. These patients had previously undergone breast conserving therapy (BCT, n?=?18), mastectomy with irradiation (n=5) or axillary lymph node dissection with irradiation (n?=?1). Treatment consisted of surgery followed by reRT + HT (n?=?8), reRT + HT followed by surgery (n?=?3) or reRT + HT alone (n?=?13). Patients received a mean radiation dose of 35 Gy (32–54 Gy) and 3–6 hyperthermia treatments (mean 4). Hyperthermia was given once or twice a week following radiotherapy (RT).

Results

The median latency interval between previous radiation and diagnosis of RAS was 106 months (range 45–212 months). Following reRT + HT, the complete response (CR) rate was 56?%. In the subgroup of patients receiving surgery, the 3-month, 1- and 3-year actuarial local control (LC) rates were 91, 46 and 46?%, respectively. In the subgroup of patients without surgery, the rates were 54, 32 and 22?%, respectively. Late grade 4 RT toxicity was seen in 2 patients.

Conclusion

The present study shows that reRT + HT treatment—either alone or combined with surgery—improves LC rates in patients with RAS.     

Impact of different setup approaches in image-guided radiotherapy as primary treatment for prostate cancer

Aim

The goal of this study was to assess the impact of different setup approaches in image-guided radiotherapy (IMRT) of the prostatic gland.

Methods

In all, 28 patients with prostate cancer were enrolled in this study. After the placement of an endorectal balloon, the planning target volume (PTV) was treated to a dose of 70 Gy in 35 fractions. A simultaneously integrated boost (SIB) of 76 Gy (2.17 Gy per fraction and per day) was delivered to a smaller target volume. All patients underwent daily prostate-aligned IGRT by megavoltage CT (MVCT). Retrospectively, three different setup approaches were evaluated by comparison to the prostate alignment: setup by skin alignment, endorectal balloon alignment, and automatic registration by bones.

Results

A total of 2,940 setup deviations were analyzed in 980 fractions. Compared to prostate alignment, skin mark alignment was associated with substantial displacements, which were ≥?8 mm in 13?%, 5?%, and 44?% of all fractions in the lateral, longitudinal, and vertical directions, respectively. Endorectal balloon alignment yielded displacements ≥?8 mm in 3?%, 19?%, and 1?% of all setups; and ≥?3 mm in 27?%, 58?%, and 18?% of all fractions, respectively. For bone matching, the values were 1?%, 1?%, and 2?% and 3?%, 11?%, and 34?%, respectively.

Conclusion

For prostate radiotherapy, setup by skin marks alone is inappropriate for patient positioning due to the fact that, during almost half of the fractions, parts of the prostate would not be targeted successfully with an 8-mm safety margin. Bone matching performs better but not sufficiently for safety margins ≤?3 mm. Endorectal balloon matching can be combined with bone alignment to increase accuracy in the vertical direction when prostate-based setup is not available. Daily prostate alignment remains the gold standard for high-precision radiotherapy with small safety margins.     

Computed tomography-guided interstitial high dose rate brachytherapy for centrally located liver tumours: a single institution study

Objectives

To evaluate the clinical outcome of computed tomography (CT)-guided interstitial (IRT) high-dose-rate (HDR) brachytherapy (BRT) in the treatment of unresectable primary and secondary liver malignancies. This report updates and expands our previously described experience with this treatment technique.

Methods

Forty-one patients with 50 tumours adjacent to the liver hilum and bile duct bifurcation were treated in 59 interventions of CT-guided IRT HDR BRT. The tumours were larger than 4 cm with a median volume of 84 cm³ (38–1,348 cm³). The IRT HDR BRT delivered a median total physical dose of 20.0 Gy (7.0–32.0 Gy) in twice daily fractions of median 7.0 Gy (4.0–10.0 Gy) in 19 patients and in once daily fractions of median 8.0 Gy (7.0–14.0 Gy) in 22 patients.

Results

With a median follow-up of 12.4 months, the local control for metastatic hepatic tumours was 89 %, 73 % and 63 % at 6, 12 and 18 months respectively. The local control for primary hepatic tumours was 90 %, 81 % and 50 % at 6, 12 and 18 months respectively. Severe side effects occurred in 5.0 % of interventions with no treatment-related deaths.

Conclusions

CT-guided IRT HDR BRT is a promising procedure for the radiation treatment of centrally located liver malignancies.

Key points

? Interstitial high-dose-rate brachytherapy (IRT HDR BRT) is a promising treatment for central liver tumours ? CT-guided IRT HDR BRT is safe for treating extensive tumours ? CT-guided IRT HDR BRT could play a role in managing unresectable hepatic malignancies     

Low-dose fractionated radiotherapy and concomitant chemotherapy for recurrent or progressive glioblastoma

Backgroud

Evaluated in this study were the feasibility and the efficacy of concurrent low dose fractionated radiotherapy (LD-FRT) and chemotherapy as palliative treatment for recurrent/progressive glioblastoma multiforme (GBM).

Patients and methods

Eligible patients had recurrent or progressive GBM, Karnofsky performance status ≥?70, prior surgery, and standard radiochemotherapy treatment. Recurrence/progression disease during temozolomide (TMZ) received cisplatin (CDDP; 30 mg/m² on days 1, 8, 15), fotemustine (FTM; 40 mg/m² on days 2, 9, 16), and concurrent LD-FRT (0.3 Gy twice daily); recurrence/progression after 4 months from the end of adjuvant TMZ were treated by TMZ (150/200 mg/m² on days 1–5) concomitant with LD-FRT (0.4 Gy twice daily). Primary endpoints were safety and toxicity.

Results

A total of 32 patients were enrolled. Hematologic toxicity G1–2 was observed in 18.7?% of patients and G3–4 in 9.4?%. One patient (3.1?%) had complete response, 3 (9.4?%) had partial response, 8 (25?%) had stable disease for at least 8 weeks, while 20 patients (62.5?%) experienced progressive disease. The clinical benefit was 37.5?%. Median progression-free survival (PFS) and overall survival (OS) were 5 and 8 months, respectively. Survival rate at 12 months was of 27.8?%.

Conclusion

LD-FRT and chemotherapy for recurrent/progressive GBM have a good toxicity profile and clinical outcomes, even though further investigation of this novel palliative treatment approach is warranted.     

Concurrent hyperfractionated accelerated radiotherapy with 5-FU and once weekly cisplatin in locally advanced head and neck cancer

Purpose

In this study, the acute toxicity and long-term outcome of a hyperfractionated accelerated chemoradiation regimen with cisplatin/5-fluorouracil (5-FU) in patients with locally advanced squamous cell carcinomas of head and neck were evaluated.

Patients and methods

From 2000–2002, 38 patients with stage III (5.3?%) and stage IV (94.7?%) head and neck cancer were enrolled in a phase II study. Patients received hyperfractionated-accelerated radiotherapy with 72 Gy in 15 fractions of 2 Gy followed by 1.4 Gy twice daily with concurrent, continuous infusion 5-FU of 600 mg/m² on days 1–5 and 6 cycles of weekly cisplatin (30 mg/m²). Acute toxicities (CTCAEv2.0), locoregional control (LRC), metastases-free (MFS), and overall survival (OS) were analyzed and exploratively compared with the ARO 95-06 trial.

Results

Median follow-up was 11.4 years (95?% CI 8.6–14.2) and mean dose 71.6 Gy. Of the patients, 82?% had 6 (n?=?15) or 5 (n?=?16) cycles of cisplatin, 5 and 2 patients received 4 and 3 cycles, respectively. Grade 3 anemia, leukopenia, and thrombocytopenia were observed in 15.8, 15.8, and 2.6?%, respectively. Grade 3 mucositis in 50?%, grade 3 and 4 dysphagia in 55 and 13?%. The 2-, 5-, and 10-year LRC was 65, 53.6, and 48.2?%, the MFS was 77.5, 66.7, and 57.2?% and the OS 59.6, 29.2, and 15?%, respectively.

Conclusion

Chemoradiation with 5-FU and cisplatin seems feasible and superior in terms of LRC and OS to the ARO 95-06C-HART arm at 2 years. However, this did not persist at the 5- and 10-year follow-ups.     

Hypophysentumoren

Background and objectives

This article gives an overview of the most common tumors of the pituitary gland and the differential diagnostics with special emphasis on radiological diagnostic criteria.

Material and methods

A selective search of the literature in PubMed was carried out.

Results

Pituitary adenomas constitute 10–15?% of all intracranial tumors and are the most common tumors of the sellar region. Tumors smaller than 1 cm in diameter are called microadenomas while those larger than 1 cm in diameter are called macroadenomas. Approximately 65?% of pituitary gland adenomas secrete hormones whereby approximately 50?% secrete prolactin, 10?% secrete growth hormone (somatotropin) and 6?% secrete corticotropin. Other tumors located in the sella turcica can also cause endocrinological symptoms, such as an oversecretion of pituitary hormone or pituitary insufficiency by impinging on the pituitary gland or its stalk. When tumors spread into the space cranial to the sella turcica, they can impinge on the optic chiasm and cause visual disorders. A common differential diagnosis of a sellar tumor is a craniopharyngeoma. In children up to 10?% of all intracranial tumors are craniopharyngeomas. Other differential diagnoses for sellar tumors are metastases, meningiomas, epidermoids and in rare cases astrocytomas, germinomas or Rathke cleft cysts

Conclusion

As these tumors are located in an anatomically complex region of the skull base and are often very small, a highly focused imaging protocol is required. The currently favored modality is magnetic resonance imaging (MRI) with the administration of a contrast agent. The sellar region should be mapped in thin slices. In cases of suspected microadenoma the imaging protocol should also contain a sequence with dynamic contrast administration in order to assess the specific enhancement characteristics of the tumor and the pituitary gland.     

Moderately hypofractionated radiotherapy for localized prostate cancer

Purpose

To evaluate long-term outcome after dose-escalated, moderately hypofractionated radiotherapy for prostate cancer.

Methods

Since 2005, 150 consecutive patients were treated with primary radiotherapy for localized prostate cancer. Intensity modulated radiotherapy (IMRT) using the simultaneous integrated boost (SIB) technique was practiced in all patients and doses of 73.9 Gy (n?=?41) and 76.2 Gy (n?=?109) were delivered in 32 and 33 fractions, respectively. The pelvic lymph nodes were treated in 41 high-risk patients. Treatment was delivered using cone-beam CT based image-guided radiotherapy (IGRT). Toxicity was assessed prospectively using CTCAE 3.0; biochemical failure was defined according to the Phoenix definition of nadir +?2 ng/ml.

Results

Median follow-up of living patients was 50 months. Gastrointestinal (GI) toxicity was mild with >?80?% of the patients free from any GI toxicity during follow-up and no time trend to increased rates or to higher grade of GI toxicity. Two patients suffered from late grade 3 GI toxicity. Acute genitourinary (GU) toxicity grade 1–2 was observed in 85?% of the patients; most patients recovered quickly within 6 weeks after treatment. The rate of GU toxicity grade ≥?2 was <?10?% at 6–12 month but increased continuously to 22.4?% at 60 months; grade 3 GU toxicity remained below 5?% during follow-up. The 5-year freedom from biochemical failure (FFBF) was 82?% for all patients and 88, 80, and 78?% for low-, intermediate-, and high-risk disease.

Conclusion

Favorable FFBF with simultaneously low rates of toxicity was observed after moderately hypofractionated radiotherapy with 2 Gy-equivalent doses ≥?80 Gy. Conformal IMRT planning and accurate IGRT treatment delivery may have contributed to these results.