Arne Gruen

Dosimetric comparison of different treatment modalities for stereotactic radiosurgery of meningioma

The original version of this article unfortunately contained mistakes. The name of Constantin Tulaesca is misspelled, it should be Constantin Tuleasca. The correct affiliation of C. Tuleasca and M. Levivier should be: Lausanne University Hospital, Neurosurgery Service and Gamma Knife Center; University of Lausanne, Faculty of Biology and Medicine On the third page, Subtitle “Patient population”, lines 18 and 19: “Gamma Knife planning and optimalisation was performed by Thierry Gevaert” should be: “Gamma Knife planning and optimalisation was performed by Marc Levivier”.

Adjuvant chemoradiation after laparoscopically assisted vaginal radical hysterectomy (LARVH) in patients with cervical cancer

Purpose:Compared to laparotomic surgery, laparoscopically assisted radical vaginal hysterectomy (LARVH) offers decreased blood loss during surgery and faster convalescence of the patient postoperatively, while at the same time delivering similar oncologic results. However, there is no data on outcome and toxicity of LARVH followed by (chemo)radiation.Patients and Methods:A total of 55 patients (range 28–78 years) with cervical cancer on FIGO stages IB1–IIIA (Tables 1 and 2) with risk factors were submitted to either external beam radiotherapy alone [EBRT, n = 8 (14%), including paraaortic irradiation, n = 4 (2.2%); EBRT and brachytherapy (BT), n = 33 (60%); BT alone, n = 14 (25.5%)] or chemoradiation after LARVH.Results:At a median follow-up of 4.4 years, the 5-year disease-free survival (DFS) was 81.8% with 84.5% overall survival (OS). Acute grade 3 side effects were seen in 4 patients. These were mainly gastrointestinal (GI) and genitourinary (GU) symptoms. Grade 4 side effects were not observed.Conclusion:With similar oncologic outcome data and mostly mild side effects, LARVH followed by (chemo)radiation is a valid alternative in the treatment of cervical cancer patients.Ziel:Die laparoskopisch assistierte radikale Hysterektomie (LAVRH) bietet gegenüber offenen Verfahren bei Patientinnen mit gynäkologischen Tumoren die Vorteile eines geringeren Blutverlusts und einer schnelleren Rekonvaleszenz bei onkologisch gleichwertigen Ergebnissen. Bisher existieren keine Daten zu onkologischen Ergebnissen und Toxizität nach LARVH und adjuvanter Radio(chemo)therapie.Patienten und Methodik:55 Patientinnen (28–78 Jahre) mit Zervixkarzinomen (FIGO IB1 bis IIIA), (Tabellen 1, 2) wurden ausgewertet. Die Patientinnen wurden nach LARVH aufgrund von Risikofaktoren einer postoperativen perkutanen Strahlentherapie [EBRT: n = 8 (14%), inklusive Paraaortalfeld (EFRT): n = 4 (2,2%), einer EBRT und Brachytherapie (BT): n = 33 (60%), einer alleinigen BT: n = 14 (25,5%)] bzw. kombinierten Radiochemotherapie zugeführt.Ergebnisse:Nach 4,4 Jahren mittlerer Nachbeobachtungszeit ergab sich ein krankheitsfreies Überleben (DFS) nach 5 Jahren von 81,8% bei einem Gesamtüberleben (OS) von 85,4%. Grad-3-Akutnebenwirkungen entwickelten 4 Patientinnen. Grad-4-Nebenwirkungen wurden nicht beobachtet.Schlussfolgerung:Bei insgesamt sehr niedrigen Raten gastrointestinaler (GI) und urogenitaler (GU) Toxizität stellt die LARVH im Kontext mit der adjuvanten Radio(chemo)- bzw. Brachytherapie eine valide Alternative zu offenen Verfahren in der Behandlung von Patientinnen mit Zervixkarzinomen dar.

The impact of patient compliance with adjuvant radiotherapy: a comprehensive cohort study

Postoperative radiotherapy (RT) is the standard of care for early stage breast cancer. It reduces the risk for local recurrence and prolongs survival. We assessed whether, the omission of RT because of patients preference may influence the prognosis and, thus, the quality of cancer care. Detailed information from a prospectively collected database of a breast cancer center was analyzed. Multiple regression analysis and univariate and multivariate analysis for risk factors for recurrence were performed. The entire cohort of primary breast cancer patients in a given time period was analyzed. Data from 1903 patients undergoing treatment at breast cancer center between 2003 and 2008 were used. All patient underwent breast conserving surgery and RT was performed for all patients of the cohort. Local tumor control and disease‐free survival were calculated. After a median follow‐up of 2.18 years (maximum 6.39 years), 5.5% of patients did not follow guideline‐based recommendations for RT. There was a significant correlation between noncompliance and patients age, adjuvant hormonal therapy (97.0%), and adjuvant chemotherapy (96.8%). Seventy local recurrences occurred that corresponds to a local recurrence rate of 3.9%. The difference in regard to local recurrence‐free 5‐year survival between the compliant patients and the noncompliant patients is absolute 17.9 (93.3% and 75.4%). Noncompliant patients had suffered a 5.02‐fold increased risk of local recurrence than compliant patients. The omission of RT after breast‐conserving surgery results in a higher local failure rate and significantly worsens clinical outcome. Age may play an important role because of the comorbidities of aged patients or the assumed low RT tolerance in this group. On a clinical level, this data suggests that improvement is needed to correct this situation, and the question remains as to how best to improve RT compliance.

Adjuvant chemoradiation after laparoscopically assisted vaginal radical hysterectomy (LARVH) in patients with cervical cancer: oncologic outcome and morbidity.

Purpose:Compared to laparotomic surgery, laparoscopically assisted radical vaginal hysterectomy (LARVH) offers decreased blood loss during surgery and faster convalescence of the patient postoperatively, while at the same time delivering similar oncologic results. However, there is no data on outcome and toxicity of LARVH followed by (chemo)radiation.Patients and Methods:A total of 55 patients (range 28–78 years) with cervical cancer on FIGO stages IB1–IIIA (Tables 1 and 2) with risk factors were submitted to either external beam radiotherapy alone [EBRT, n = 8 (14%), including paraaortic irradiation, n = 4 (2.2%); EBRT and brachytherapy (BT), n = 33 (60%); BT alone, n = 14 (25.5%)] or chemoradiation after LARVH.Results:At a median follow-up of 4.4 years, the 5-year disease-free survival (DFS) was 81.8% with 84.5% overall survival (OS). Acute grade 3 side effects were seen in 4 patients. These were mainly gastrointestinal (GI) and genitourinary (GU) symptoms. Grade 4 side effects were not observed.Conclusion:With similar oncologic outcome data and mostly mild side effects, LARVH followed by (chemo)radiation is a valid alternative in the treatment of cervical cancer patients.Ziel:Die laparoskopisch assistierte radikale Hysterektomie (LAVRH) bietet gegenüber offenen Verfahren bei Patientinnen mit gynäkologischen Tumoren die Vorteile eines geringeren Blutverlusts und einer schnelleren Rekonvaleszenz bei onkologisch gleichwertigen Ergebnissen. Bisher existieren keine Daten zu onkologischen Ergebnissen und Toxizität nach LARVH und adjuvanter Radio(chemo)therapie.Patienten und Methodik:55 Patientinnen (28–78 Jahre) mit Zervixkarzinomen (FIGO IB1 bis IIIA), (Tabellen 1, 2) wurden ausgewertet. Die Patientinnen wurden nach LARVH aufgrund von Risikofaktoren einer postoperativen perkutanen Strahlentherapie [EBRT: n = 8 (14%), inklusive Paraaortalfeld (EFRT): n = 4 (2,2%), einer EBRT und Brachytherapie (BT): n = 33 (60%), einer alleinigen BT: n = 14 (25,5%)] bzw. kombinierten Radiochemotherapie zugeführt.Ergebnisse:Nach 4,4 Jahren mittlerer Nachbeobachtungszeit ergab sich ein krankheitsfreies Überleben (DFS) nach 5 Jahren von 81,8% bei einem Gesamtüberleben (OS) von 85,4%. Grad-3-Akutnebenwirkungen entwickelten 4 Patientinnen. Grad-4-Nebenwirkungen wurden nicht beobachtet.Schlussfolgerung:Bei insgesamt sehr niedrigen Raten gastrointestinaler (GI) und urogenitaler (GU) Toxizität stellt die LARVH im Kontext mit der adjuvanten Radio(chemo)- bzw. Brachytherapie eine valide Alternative zu offenen Verfahren in der Behandlung von Patientinnen mit Zervixkarzinomen dar.

Re‐irradiation of recurrent gliomas: pooled analysis and validation of an established prognostic score—report of the Radiation Oncology Group (ROG) of the German Cancer Consortium (DKTK)

The heterogeneity of high‐grade glioma recurrences remains an ongoing challenge for the interdisciplinary neurooncology team. Response to re‐irradiation (re‐RT) is heterogeneous, and survival data depend on prognostic factors such as tumor volume, primary histology, age, the possibility of reresection, or time between primary diagnosis and initial RT and re‐RT. In the present pooled analysis, we gathered data from radiooncology centers of the DKTK Consortium and used it to validate the established prognostic score by Combs et al. and its modification by Kessel et al. Data consisted of a large independent, multicenter cohort of 565 high‐grade glioma patients treated with re‐RT from 1997 to 2016 and a median dose of 36 Gy. Primary RT was between 1986 and 2015 with a median dose of 60 Gy. Median age was 54 years; median follow‐up was 7.1 months. Median OS after re‐RT was 7.5, 9.5, and 13.8 months for WHO IV, III, and I/II gliomas, respectively. All six prognostic factors were tested for their significance on OS. Aside from the time from primary RT to re‐RT (P = 0.074) and the reresection status (P = 0.101), all factors (primary histology, age, KPS, and tumor volume) were significant. Both the original and new score showed a highly significant influence on survival with P < 0.001. Both prognostic scores successfully predict survival after re‐RT and can easily be applied in the routine clinical workflow. Now, further prognostic features need to be found to even improve treatment decisions regarding neurooncological interventions for recurrent glioma patients.

Adjuvant chemoradiation after laparoscopically assisted vaginal radical hysterectomy (LARVH) in patients with cervical cancer@@@Adjuvante Radiochemotherapie nach laproskopisch assistierter vaginaler radikaler Hysterektomie (LARVH) bei Patientinnen mit Zervixkarzinom. Onkologische Ergebnisse und Morbidität: Oncologic outcome and morbidity

Purpose:Compared to laparotomic surgery, laparoscopically assisted radical vaginal hysterectomy (LARVH) offers decreased blood loss during surgery and faster convalescence of the patient postoperatively, while at the same time delivering similar oncologic results. However, there is no data on outcome and toxicity of LARVH followed by (chemo)radiation.Patients and Methods:A total of 55 patients (range 28–78 years) with cervical cancer on FIGO stages IB1–IIIA (Tables 1 and 2) with risk factors were submitted to either external beam radiotherapy alone [EBRT, n = 8 (14%), including paraaortic irradiation, n = 4 (2.2%); EBRT and brachytherapy (BT), n = 33 (60%); BT alone, n = 14 (25.5%)] or chemoradiation after LARVH.Results:At a median follow-up of 4.4 years, the 5-year disease-free survival (DFS) was 81.8% with 84.5% overall survival (OS). Acute grade 3 side effects were seen in 4 patients. These were mainly gastrointestinal (GI) and genitourinary (GU) symptoms. Grade 4 side effects were not observed.Conclusion:With similar oncologic outcome data and mostly mild side effects, LARVH followed by (chemo)radiation is a valid alternative in the treatment of cervical cancer patients.Ziel:Die laparoskopisch assistierte radikale Hysterektomie (LAVRH) bietet gegenüber offenen Verfahren bei Patientinnen mit gynäkologischen Tumoren die Vorteile eines geringeren Blutverlusts und einer schnelleren Rekonvaleszenz bei onkologisch gleichwertigen Ergebnissen. Bisher existieren keine Daten zu onkologischen Ergebnissen und Toxizität nach LARVH und adjuvanter Radio(chemo)therapie.Patienten und Methodik:55 Patientinnen (28–78 Jahre) mit Zervixkarzinomen (FIGO IB1 bis IIIA), (Tabellen 1, 2) wurden ausgewertet. Die Patientinnen wurden nach LARVH aufgrund von Risikofaktoren einer postoperativen perkutanen Strahlentherapie [EBRT: n = 8 (14%), inklusive Paraaortalfeld (EFRT): n = 4 (2,2%), einer EBRT und Brachytherapie (BT): n = 33 (60%), einer alleinigen BT: n = 14 (25,5%)] bzw. kombinierten Radiochemotherapie zugeführt.Ergebnisse:Nach 4,4 Jahren mittlerer Nachbeobachtungszeit ergab sich ein krankheitsfreies Überleben (DFS) nach 5 Jahren von 81,8% bei einem Gesamtüberleben (OS) von 85,4%. Grad-3-Akutnebenwirkungen entwickelten 4 Patientinnen. Grad-4-Nebenwirkungen wurden nicht beobachtet.Schlussfolgerung:Bei insgesamt sehr niedrigen Raten gastrointestinaler (GI) und urogenitaler (GU) Toxizität stellt die LARVH im Kontext mit der adjuvanten Radio(chemo)- bzw. Brachytherapie eine valide Alternative zu offenen Verfahren in der Behandlung von Patientinnen mit Zervixkarzinomen dar.