Evaluation of the treatment outcome after radiosurgery (RS) alone or in combination with whole-brain radiotherapy (WBRT) with special attention to prescribed dose and its influence on local control ...and survival.
Between September 1984 and January 1997, 236 patients with 311 brain metastases treated with radiosurgery met the following inclusion criteria: one to three brain metastases per patient; no previous WBRT; and Kamofsky performance status (KPS) > or = 50%. One hundred fifty-eight patients treated only with RS received a median dose of 20 Gy prescribed to the 80% isodose line; 78 patients received RS with a median dose of 15 Gy/80% and an additional course of WBRT.
For the entire series, overall median survival was 5.5 months, with control of CNS disease achieved in 92% of the treated brain metastases; the results were not significantly different between patients treated by RS with or without WBRT. However, in patients without evidence of extracranial disease, median survival was increased for patients who received WBRT (15.4 vs 8.3 months; P=.08). Additionally, there was a suggestion that increased doses for patients treated with RS only resulted in improved outcome. Four lesions were suspicious for radiation necrosis by magnetic resonance imaging (MRI); in one of the four lesions, radiation necrosis was confirmed histologically. The incidence of transient low-grade toxicity was 18%; symptoms could be treated by the temporary administration of steroids.
RS is an effective, noninvasive means of controlling brain metastases when used alone or in combination with WBRT. There is a trend for superior local control and especially in patients without extracranial disease for superior survival when RS is used in conjunction with WBRT. Randomized trials would seem to be warranted, comparing the benefit of RS with or without additional WBRT.
Treatment techniques of increasing complexity such as dynamic/rotational techniques mandate digital management and increasingly image guidance. This constantly increases requirements for image ...management and archiving. This article discusses the current status of these requirements and will present potential image administration strategies.
Fundamentals of image administration and storage/archiving are presented (DICOM Standard, radiotherapy-specific issues) along the typical patient pathway (demographic data, radiotherapy treatment planning, signatures/approval of plan and image data, archiving of plan and image data). Different strategies for image management are presented (archiving centered on individual application vs. integral approach with central archiving in a DICOM-RT-PACS governed by a radiation oncology information system (ROCIS)). Infrastructural requirements depending on the amount of image data generated in the department are discussed.
Application-centered image management provides access to image data including all relevant RT-specific elements. This approach, however, is not migration-safe, requires significant administrative work to ensure a redundancy level that protects against data loss and does not provide datasets that are linked to respective therapeutic interventions. Therefore, centralized image management and archiving that links images to patients and individual steps in the treatment pathway within a standardized DICOM(-RT) environment is preferable despite occasional problems with visualization of specific data elements.
Zusammenfassung
Ziel und Methodik
Immer komplexere Bestrahlungstechniken wie z. B. dynamische Techniken sind nur noch digital und bildgesteuert sinnvoll einsetzbar. Dadurch erhöhen sich ständig die ...Anforderungen an die Bilddokumentation und -archivierung. Diese Arbeit soll detailliert die aktuellen Anforderungen an das Bildmanagement in der Radioonkologie und mögliche Bildadministrationsstrategien darstellen.
Ergebnisse
Es werden die Grundlagen der Bildspeicherung und -administration (DICOM-Standard, Besonderheiten in der Strahlentherapie) entlang des typischen Patientenpfads beschrieben (demografische Daten, Bestrahlungsplanung, Signatur/Approval und Archivierung von Plan- und Bildinformationen). Verschiedene Strategien des Bildmanagements werden konzeptionell gegenübergestellt (applikationsbezogene Bildarchivierung vs. integraler Ansatz mit zentraler Datenspeicherung in einem DICOM-RT-fähigen PACS unter Steuerung eines Radioonkologie-Informationssystems (ROKIS)). Anforderungen an die Infrastruktur (Speicherbedarf abhängig vom Bildaufkommen etc.) werden diskutiert.
Schlussfolgerung
Applikationsbezogenes Bildmanagement ermöglicht gegenwärtig jeweils unmittelbar den vollumfänglichen Zugriff auf Bilddaten einschließlich aller relevanten Zusätze. Dieser Ansatz ist aber aufgrund zu erwartender Systemmigrationen wenig zukunftssicher. Eine zentrale, patienten- und behandlungsschrittbezogene und primär applikationsunabhängige Bildarchivierung ist daher, trotz gelegentlicher Schwierigkeiten bei der Visualisierung bestimmter Datenelemente, vorzuziehen. Die Speicherung von Bilddaten im DICOM-Format ist unabdingbare Voraussetzung.
Purpose
In a retrospective analysis, adjuvant intensity-modulated radiation therapy (IMRT) combined with modern chemotherapy improved advanced gastric cancer survival rates compared to a combination ...of three-dimensional conformal radiation therapy (3D-CRT) and conventional chemotherapy. We report on the long-term outcomes of two consecutive patient cohorts that were treated with either IMRT and intensive chemotherapy, or 3D-CRT and conventional chemotherapy.
Patients and methods
Between 2001 and 2008, 65 consecutive gastric cancer patients received either 3D-CRT (n = 27) or IMRT (n = 38) following tumor resection. Chemotherapy comprised predominantly 5-fluorouracil/folinic acid (5-FU/FA) in the earlier cohort and capecitabine plus oxaliplatin (XELOX) in the latter. The primary endpoints were overall survival (OS) and disease-free survival (DFS).
Results
Median OS times were 18 and 43 months in the 3D-CRT and IMRT groups, respectively (p = 0.0602). Actuarial 5-year OS rates were 26 and 47 %, respectively. Within the IMRT group, XELOX gave better results than 5-FU/FA in terms of OS, but this difference was not statistically significant. The primary cause of death in both groups was distant metastasis. Median DFS times were 14 and 35 months in the 3D-CRT and IMRT groups, respectively (p = 0.0693). Actuarial 5-year DFS rates were 22 and 44 %, respectively. Among patients receiving 5-FU/FA, DFS tended to be better in the IMRT group, but this was not statistically significant. A similar analysis for the XELOX group was not possible as 3D-CRT was almost never used to treat these patients. No late toxicity exceeding grade 3 or secondary tumors were observed.
Conclusion
After a median follow-up period of over 5 years, OS and DFS were improved in the IMRT/XELOX treated patients compared to the 3D-CRT/5-FU/FA group. Long-term observation revealed no clinical indications of therapy-induced secondary tumors or renal toxicity.
Deregulated nuclear factor κB (NF-κB) activation plays an important role in inflammation and tumorigenesis. ABIN proteins have been characterized as negative regulators of NF-κB signaling. However, ...their mechanism of NF-κB inhibition remained unclear. With the help of a yeast two-hybrid screen, we identified ABIN proteins as novel ubiquitin-interacting proteins. The minimal ubiquitin-binding domain (UBD) corresponds to the ABIN homology domain 2 (AHD2) and is highly conserved in ABIN-1, ABIN-2 and ABIN-3. Moreover, this region is also present in NF-κB essential modulator/IκB kinase γ (NEMO/IKKγ) and the NEMO-like protein optineurin, and is therefore termed UBD in ABIN proteins and NEMO (UBAN). Nuclear magnetic resonance studies of the UBAN domain identify it as a novel type of UBD, with the binding surface on ubiquitin being significantly different from the binding surface of other UBDs. ABIN-1 specifically binds ubiquitinated NEMO via a bipartite interaction involving its UBAN and NEMO-binding domain. Mutations in the UBAN domain led to a loss of ubiquitin binding and impaired the NF-κB inhibitory potential of ABINs. Taken together, these data illustrate an important role for ubiquitin binding in the negative regulation of NF-κB signaling by ABINs and identify UBAN as a novel UBD.
Intracranial anaplastic ependymomas are a very rare entity within the group of adult CNS neoplasms. Thus, no standard adjuvant therapy after surgical resection has been defined so far. External ...radiotherapy is commonly administered, but the role of chemotherapy is still unclear in malignant ependymomas. The case of a 25-year-old female patient with multifocal recurrence of a supratentorial malignant ependymoma administered temozolomide as second-line therapy is reported. Currently, 5 months after initiation of temozolomide treatment, there is no evidence of radiographic progression. Temozolomide could constitute a promising approach to supratentorial recurrent and multifocal anaplastic ependymoma of adults.
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