David Feltl

Accelerated radiotherapy with concomitant boost technique (69.5 Gy/5 weeks) : an alternative in the treatment of locally advanced head and neck cancer.

Background and PurposeTo present the feasibility and results of accelerated radiotherapy with concomitant boost technique (69.5 Gy/5 weeks) in the treatment of locally advanced head and neck cancer.Patients and MethodsA total of 65 patients were treated between June 2006 and August 2009. The distribution of clinical stages was as follows: II 11%, III 23%, IV 61%, and not defined 5%.ResultsThe median follow-up was 30.5 months. The treatment plan was completed in 94% of patients. Patients were treated using the conformal or intensity-modulated radiotherapy (IMRT) technique. The median overall treatment time was 37 days (13–45 days). The mean radiotherapy dose was 68.4 Gy (16–74 Gy). Overall survival was 69% after 2 years. Disease-free survival was 62% after 2 years. Acute toxicity ≥ grade 3(RTOG scale) included mucositis (grade 3: 42.6%), pharynx (grade 3: 42.3%), skin (grade 3: 9.5%), larynx (grade 3: 4%), while late toxicity affected skin (grade 3: 6.25%) and salivary glands (grade 3: 3.7%).ConclusionAccelerated radiotherapy with concomitant boost technique is feasible in patients with locally advanced head and neck cancer, has an acceptable toxicity profile, and yields promising treatment results.Hintergrund und ZielPräsentation von Durchführbarkeit und Ergebnissen der Strahlentherapie mit Concomitant-Boost-Technik (69,5 Gy/5 Wochen) bei der Behandlung von lokal fortgeschrittenen Kopf-Hals-Tumoren.Patienten und MethodikIm Zeitraum 6/06 bis 8/09 wurden 65 Patienten behandelt. Stadienverteilung: II in 11%, III in 23%, IV in 61% und undefinierbar in 5% der Fälle.ErgebnisseMediane Beoachtungszeit: 30,5 Monate. Die geplante Therapie ließ sich bei 94% der Patienten durchführen. Die Patienten wurden mit 3D-konformaler oder IMRT-Technik bestrahlt. Der Median der Bestrahlungsdauer betrug 37 Tage (13–45 Tage). Die applizierte durchschnittliche Dosis betrug 68,4 Gy (16–74 Gy). Das gesamte 2-Jahres-Überleben betrug 69%, Das krankheitsfreie 2-Jahres-Überleben 62%. Akuttoxizitäten von mindestens Grad 3 (RTOG Skala) betrafen Mukositis (Grad 3: 42%), Pharynx (Grad 3: 42,3%) Haut (Grad 3: 9,5%) und Kehlkopf (Grad 3: 4%). Die Spättoxizitäten betrafen Haut (Grad 3: 9,5%) und Speicheldrüsen (Grad 3: 3,7%).SchlussfolgerungDie akzelerierte Strahlentherapie mit der Concomitant-Boost-Technik ist bei Patienten mit Kopf- und Halstumoren durchführbar. Diese Technik hat ein akzeptables Toxizitätsprofil und gute Heilungsergebnisse.

Accelerated radiotherapy with concomitant boost technique (69.5 Gy/5 weeks)

Background and PurposeTo present the feasibility and results of accelerated radiotherapy with concomitant boost technique (69.5 Gy/5 weeks) in the treatment of locally advanced head and neck cancer.Patients and MethodsA total of 65 patients were treated between June 2006 and August 2009. The distribution of clinical stages was as follows: II 11%, III 23%, IV 61%, and not defined 5%.ResultsThe median follow-up was 30.5 months. The treatment plan was completed in 94% of patients. Patients were treated using the conformal or intensity-modulated radiotherapy (IMRT) technique. The median overall treatment time was 37 days (13–45 days). The mean radiotherapy dose was 68.4 Gy (16–74 Gy). Overall survival was 69% after 2 years. Disease-free survival was 62% after 2 years. Acute toxicity ≥ grade 3(RTOG scale) included mucositis (grade 3: 42.6%), pharynx (grade 3: 42.3%), skin (grade 3: 9.5%), larynx (grade 3: 4%), while late toxicity affected skin (grade 3: 6.25%) and salivary glands (grade 3: 3.7%).ConclusionAccelerated radiotherapy with concomitant boost technique is feasible in patients with locally advanced head and neck cancer, has an acceptable toxicity profile, and yields promising treatment results.Hintergrund und ZielPräsentation von Durchführbarkeit und Ergebnissen der Strahlentherapie mit Concomitant-Boost-Technik (69,5 Gy/5 Wochen) bei der Behandlung von lokal fortgeschrittenen Kopf-Hals-Tumoren.Patienten und MethodikIm Zeitraum 6/06 bis 8/09 wurden 65 Patienten behandelt. Stadienverteilung: II in 11%, III in 23%, IV in 61% und undefinierbar in 5% der Fälle.ErgebnisseMediane Beoachtungszeit: 30,5 Monate. Die geplante Therapie ließ sich bei 94% der Patienten durchführen. Die Patienten wurden mit 3D-konformaler oder IMRT-Technik bestrahlt. Der Median der Bestrahlungsdauer betrug 37 Tage (13–45 Tage). Die applizierte durchschnittliche Dosis betrug 68,4 Gy (16–74 Gy). Das gesamte 2-Jahres-Überleben betrug 69%, Das krankheitsfreie 2-Jahres-Überleben 62%. Akuttoxizitäten von mindestens Grad 3 (RTOG Skala) betrafen Mukositis (Grad 3: 42%), Pharynx (Grad 3: 42,3%) Haut (Grad 3: 9,5%) und Kehlkopf (Grad 3: 4%). Die Spättoxizitäten betrafen Haut (Grad 3: 9,5%) und Speicheldrüsen (Grad 3: 3,7%).SchlussfolgerungDie akzelerierte Strahlentherapie mit der Concomitant-Boost-Technik ist bei Patienten mit Kopf- und Halstumoren durchführbar. Diese Technik hat ein akzeptables Toxizitätsprofil und gute Heilungsergebnisse.

Plasma levels of vascular endothelial growth factor during and after radiotherapy in combination with celecoxib in patients with advanced head and neck cancer

Celebrex and radiotherapy in advanced head and neck cancer. This phase I dose-escalation study seeks to determine the phase II recommended dose of cyclooxygenase type 2 (COX-2) inhibitor in patients with locally advanced squamous cell head and neck (H&N) cancer, treated with accelerated radiotherapy. Anti-vasculogenic effect of this treatment on serum vascular endothelial growth factor (VEGF) is examined. Patients were irradiated with curative intent (72Gy in 6weeks). Celecoxib was administered throughout the radiotherapy course. Serum VEGF level were tested during radiotherapy and in follow-up. Tumor specimens were stained to quantify the COX-2 expression. Thirty-two patients completed the treatment. The dose of celecoxib was escalated (200, 400 and 800mg bid, then de-escalated to 600mg bid). The acute toxicity related to the treatment in the first and second cohort did not reach grade III; in the third cohort three patients had grade III radiation toxicity and one had celecoxib-related toxicity. In the last fourth cohort the toxicity was acceptable. Significant VEGF level drop (p=0.011) was found between radiation day 1 and post-treatment visit. Significant decrease (p=0.022) of the VEGF level was shown in patients with high COX-2 expression in the tumor. Phase II recommended dose of celecoxib combined with accelerated radiotherapy in advanced H&N cancer was 600mg bid. A significant decrease of the post-treatment serum VEGF level compared to the initial level was noticed only in patients with high COX-2 expression in tumors.

Estimating the number of colorectal cancer patients treated with anti-tumour therapy in 2015: the analysis of the Czech National Cancer Registry

BackgroundColorectal cancer (CRC) represents a serious health care problem in the Czech Republic, introducing a need for a prospective modelling of the incidence and prevalence rates. The prevalence of patients requiring anti-tumour therapy is also of great importance, as it is directly associated with planning of health care resources.MethodsThis work proposes a population-based model for the estimation of stage-specific prevalence of CRC patients who will require active anti-tumour therapy in a given year. Its applicability is documented on records of the Czech National Cancer Registry (CNCR), which is used to estimate the number of patients potentially treated with anti-tumour therapy in the Czech Republic in 2015.ResultsSeveral scenarios are adopted to cover the plausible development of the incidence and survival rates, and the probability of an anti-tumour therapy initiation. Based on the scenarios, the model predicts an increase in CRC prevalence from 13% to 30% in comparison with the situation in 2008. Moreover, the model predicts that 10,074 to 11,440 CRC patients will be indicated for anti-tumour therapy in the Czech Republic in 2015. Considering all patients with terminal cancer recurrence and all patients primarily diagnosed in stage IV, it is predicted that 3,485 to 4,469 CRC patients will be treated for the metastatic disease in 2015, which accounts for more than one third (34-40%) of all CRC patients treated this year.ConclusionsA new model for the estimation of the number of CRC patients requiring active anti-tumour therapy is proposed in this paper. The model respects the clinical stage as the primary stratification factor and utilizes solely the population-based cancer registry data. Thus, no specific hospital data records are needed in the proposed approach. Regarding the short-term prediction of the CRC burden in the Czech Republic, the model confirms a continuous increase in the burden that must be accounted for in the future planning of health care in the Czech Republic.

Chromoendoscopy to Detect Early Synchronous Second Primary Esophageal Carcinoma in Patients with Squamous Cell Carcinomas of the Head and Neck

Objective. To evaluate the use of flexible esophagoscopy and chromoendoscopy with Lugols solution in the detection of early esophageal carcinomas (second primary carcinomas) in patients with squamous cell carcinoma of the head and neck (HNSCC). Methods. All patients with newly diagnosed HNSCC underwent office-based Lugols chromoendoscopy. After flexible esophagoscopy with white light, 3.0% Lugols iodine solution was sprayed over the entire esophageal mucosa. Areas with less-intense staining (LVLs) were evaluated and biopsies taken. Results. 132 patients with HNSCC were enrolled in this study. The most frequent primary tumors were oropharyngeal (49/132), tumors of the oral cavity (36/132), and larynx (35/132). The majority of subjects (107/132 patients, 81.1%) had advanced HNSCC carcinomas (stages III and IV). Multiple LVLs were discovered in 24 subjects (18.2%) and no LVLs in 108 (81.8%) subjects. Fifty-five LVL biopsy specimens were obtained and assessed. Squamous cell carcinomas were detected in two patients, peptic esophagitis in 11 patients, gastric heterotopic mucosa in two patients, hyperplasia in two patients, and low- and high-grade dysplasia in three patients. Conclusion. Although only two patients with synchronous primary carcinomas were found among the patients, esophagoscopy should be recommended after detection of HNSCC to exclude secondary esophageal carcinoma or dysplasia.

Stereotactic Body Radiotherapy of Prostate Cancer – Effectiveness and Toxicity

BACKGROUND Prostate cancer is the most prevalent cancer in males and its incidence is steadily increasing. Most cases of prostate cancer are diagnosed during the early asymptomatic period, in which case the prognosis is very good. Therapies differ widely in their efficacies and toxicities, and this is an important consideration when it comes to deciding which treatment is optimal for a particular patient. One treatment method for early stage prostate cancer is stereotactic body radiotherapy (SBRT). We present the first results obtained using this modality at our institution. PATIENTS AND METHODS A total of 261 patients with low or intermediate risk prostate cancer were treated with SBRT between August 2010 and July 2012. Patients received a total dose of 36.25 Gy in five fractions of 7.25 Gy every other day. The toxicity of the treatment was evaluated according to RTOG criteria. For assessment of quality of life, patients filled out a modified EPIC questionnaire (Expanded Prostate Composite index). RESULTS Overall survival (OS) in this study was 93.1%. Biochemical relapse free survival (bRFS) was 97.7%. As expected, OS and bRFS were worse in the group of patients with an intermediate risk of recurrence. Acute and chronic urinary and gastrointestinal RTOG toxicity was very low. Quality of life after treatment, as determined using the EPIC questionnaire, was slightly reduced immediately after treatment but returned to baseline or even improved during long term follow-up. CONCLUSION SBRT is an effective therapeutic modality for early prostate cancer and has acceptable rates of acute and low late toxicity.Key words: prostate cancer - stereotactic body radiotherapy - quality of life The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study. The Editorial Board declares that the manuscript met the ICMJE recommendation for biomedical papers.Submitted: 5. 1. 2017Accepted: 1. 2. 2017.

Intensity Modulated Hyperfractionated Accelerated Radiotherapy to Treat Advanced Head and Neck Cancer – Predictive Factors of Overall Survival

AIM The aim of this study was to evaluate overall survival (OS) and prognostic factors in patients ineligible for chemotherapy who were treated with a hyperfractionated accelerated schedule with simultaneous integrated boost. MATERIAL AND METHODS From May, 2008, to April, 2013, 122 patients with locally advanced nonmetastatic squamous laryngeal (14%), hypopharyngeal (30%), oropharyngeal (30%), and oral cavity (27%) cancer were treated at our institution. The median age, Karnofsky Performance Status (KPS), and gross tumor volume (GTV) of the patients were 63 years (range, 46-87 years), 80% (range, 50-100%), and 46 ml (range, 5-250 ml), resp. The median total dose of radiotherapy was 72.6 Gy (range, 62-77 Gy) at 1.4-1.5 Gy per fraction, and 55 Gy at 1.1 Gy per fraction was delivered for GTV (primary and lymphadenopathy) with a margin of 0.7 cm and regional lymphatic areas with a margin of 0.3 cm. The dose was delivered 2× a day, with a 6-8 hour interval between doses, via a 6 MeV linear accelerator. OS was estimated using the Kaplan-Meier method, and predictors of OS were analyzed using Cox proportional hazards regression. RESULTS The median duration of the radiotherapy series was 37 days (range, 32-45 days). The incidence of grade 3 acute toxicity was 62% for mucosa (oral cavity and/or pharynx) and 0% for skin. Confluent mucositis cleared in all cases within 21 days. No grade 4 or 5 toxicities were recorded. PEG was introduced before treatment in 55 patients (45%). The 1-and 2-year OS was 65% and 32%, resp. KPS less than 80% (RR 2.4, 95% CI 1.3-4.2; p = 0.004), cancers other than oropharyngeal or laryngeal cancer (RR 2.0, 95% CI 1.1-3.5; p = 0.016), and capacity of high GTV (RR 1.006, 95% CI 1.001-1.011; p = 0.017) were found to be negative prognostic factors for OS. CONCLUSION More than 30% of patients with poor prognosis survived for longer than 2 years. KPS before treatment was the strongest prognostic factor for better OS.Key words: head and neck cancer - radiotherapy dose fractionation - survival analysis - acceleration - hyperfractionation This work was supported by RVO-FNOs/2016 (HPV status as predictive and prognostic factor for primary and secondary head and neck cancer). The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study. The Editorial Board declares that the manuscript met the ICMJE recommendation for biomedical papers.Submitted: 9. 3. 2017Accepted: 19. 4. 2017.

Is there an intermediate risk group of nonseminoma

323 Background: To evaluate predictive factors of testicular nonseminoma cancer. METHODS Between 2000 and 2012, 189 patients with testicular nonseminoma cancer were evaluated. Stages according to TNM classification were I, II, and III for 84 patients (60%), 49 (26%), and 56 (30%). The median age of the patients was 31 years (range 18-77 years). Treatment was based on orchiectomy plus chemotherapy (bleomycine/etoposide/cisplatin and vinblastine/ifosfamide/cisplatin) and retroperitoneal lymphadenectomy in residual disease. Treatment protocol was updated regularly according to international standards. Overall survival (OS) was evaluated according to the stage, Karnofsky index (KI), and dose intensity of chemotherapy with the Kaplan-Meier method at 5% significance level. RESULTS There was a significant difference between OS in patient with the different stages (log-rank test, p=0.000), however, detailed analysis revealed that there is significantly worse survival in stage IIIC only (10-years OS for IIIC vs. IIIA+B, 35% vs. 88%, p=0.001) while the difference among IIIB and lower stages was not significant (p=0.383) and 10-years OS was 94%. Dose intensity of chemotherapy proved to be a significant predictive factor for OS in stage IIIA+B patients. Patients with no dose reduction had a significantly higher OS than those with any kind of dose reduction (10-years OS 96% vs. 0%, log-rank test, p=0,000). In stage IIIC, however, the dose intensity had no influence on OS (log-rank test, p=0.167). Unlike dose intensity, in stage III disease KI had no prognostic significance for OS (KI<80 versus KI≥80, Log-rank test, p=0,627) and this is true both for stages IIIA+B and for stage IIIC. CONCLUSIONS Standard of care in testicular nonseminoma cancer offers excellent prognosis with no significant differences in OS for good and intermediate risk groups. On the other hand, outcomes for stage IIIC are poor and further intensification of treatment is warranted. We have found no impact of performance status on OS neither for stage IIIA+IIIB nor stage IIIC. Reduction of chemotherapy dose has a negative impact on OS in patients with stage IIIA+IIIB and should be avoided if possible.

Accelerated radiotherapy with concomitant boost technique (69.5 Gy/5 weeks)Akzelerierte Strahlentherapie in Concomitant-Boost-Technik (69,5 Gy/5 Wochen) als Therapiealternative für lokal fortgeschrittene Kopf-Hals-Tumoren

Background and PurposeTo present the feasibility and results of accelerated radiotherapy with concomitant boost technique (69.5 Gy/5 weeks) in the treatment of locally advanced head and neck cancer.Patients and MethodsA total of 65 patients were treated between June 2006 and August 2009. The distribution of clinical stages was as follows: II 11%, III 23%, IV 61%, and not defined 5%.ResultsThe median follow-up was 30.5 months. The treatment plan was completed in 94% of patients. Patients were treated using the conformal or intensity-modulated radiotherapy (IMRT) technique. The median overall treatment time was 37 days (13–45 days). The mean radiotherapy dose was 68.4 Gy (16–74 Gy). Overall survival was 69% after 2 years. Disease-free survival was 62% after 2 years. Acute toxicity ≥ grade 3(RTOG scale) included mucositis (grade 3: 42.6%), pharynx (grade 3: 42.3%), skin (grade 3: 9.5%), larynx (grade 3: 4%), while late toxicity affected skin (grade 3: 6.25%) and salivary glands (grade 3: 3.7%).ConclusionAccelerated radiotherapy with concomitant boost technique is feasible in patients with locally advanced head and neck cancer, has an acceptable toxicity profile, and yields promising treatment results.Hintergrund und ZielPräsentation von Durchführbarkeit und Ergebnissen der Strahlentherapie mit Concomitant-Boost-Technik (69,5 Gy/5 Wochen) bei der Behandlung von lokal fortgeschrittenen Kopf-Hals-Tumoren.Patienten und MethodikIm Zeitraum 6/06 bis 8/09 wurden 65 Patienten behandelt. Stadienverteilung: II in 11%, III in 23%, IV in 61% und undefinierbar in 5% der Fälle.ErgebnisseMediane Beoachtungszeit: 30,5 Monate. Die geplante Therapie ließ sich bei 94% der Patienten durchführen. Die Patienten wurden mit 3D-konformaler oder IMRT-Technik bestrahlt. Der Median der Bestrahlungsdauer betrug 37 Tage (13–45 Tage). Die applizierte durchschnittliche Dosis betrug 68,4 Gy (16–74 Gy). Das gesamte 2-Jahres-Überleben betrug 69%, Das krankheitsfreie 2-Jahres-Überleben 62%. Akuttoxizitäten von mindestens Grad 3 (RTOG Skala) betrafen Mukositis (Grad 3: 42%), Pharynx (Grad 3: 42,3%) Haut (Grad 3: 9,5%) und Kehlkopf (Grad 3: 4%). Die Spättoxizitäten betrafen Haut (Grad 3: 9,5%) und Speicheldrüsen (Grad 3: 3,7%).SchlussfolgerungDie akzelerierte Strahlentherapie mit der Concomitant-Boost-Technik ist bei Patienten mit Kopf- und Halstumoren durchführbar. Diese Technik hat ein akzeptables Toxizitätsprofil und gute Heilungsergebnisse.

Accelerated radiotherapy with concomitant boost technique (69.5 Gy/5 weeks)@@@Akzelerierte Strahlentherapie in Concomitant-Boost-Technik (69,5 Gy/5 Wochen) als Therapiealternative für lokal fortgeschrittene Kopf-Hals-Tumoren: An alternative in the treatment of locally advanced head and neck cancer

Background and PurposeTo present the feasibility and results of accelerated radiotherapy with concomitant boost technique (69.5 Gy/5 weeks) in the treatment of locally advanced head and neck cancer.Patients and MethodsA total of 65 patients were treated between June 2006 and August 2009. The distribution of clinical stages was as follows: II 11%, III 23%, IV 61%, and not defined 5%.ResultsThe median follow-up was 30.5 months. The treatment plan was completed in 94% of patients. Patients were treated using the conformal or intensity-modulated radiotherapy (IMRT) technique. The median overall treatment time was 37 days (13–45 days). The mean radiotherapy dose was 68.4 Gy (16–74 Gy). Overall survival was 69% after 2 years. Disease-free survival was 62% after 2 years. Acute toxicity ≥ grade 3(RTOG scale) included mucositis (grade 3: 42.6%), pharynx (grade 3: 42.3%), skin (grade 3: 9.5%), larynx (grade 3: 4%), while late toxicity affected skin (grade 3: 6.25%) and salivary glands (grade 3: 3.7%).ConclusionAccelerated radiotherapy with concomitant boost technique is feasible in patients with locally advanced head and neck cancer, has an acceptable toxicity profile, and yields promising treatment results.Hintergrund und ZielPräsentation von Durchführbarkeit und Ergebnissen der Strahlentherapie mit Concomitant-Boost-Technik (69,5 Gy/5 Wochen) bei der Behandlung von lokal fortgeschrittenen Kopf-Hals-Tumoren.Patienten und MethodikIm Zeitraum 6/06 bis 8/09 wurden 65 Patienten behandelt. Stadienverteilung: II in 11%, III in 23%, IV in 61% und undefinierbar in 5% der Fälle.ErgebnisseMediane Beoachtungszeit: 30,5 Monate. Die geplante Therapie ließ sich bei 94% der Patienten durchführen. Die Patienten wurden mit 3D-konformaler oder IMRT-Technik bestrahlt. Der Median der Bestrahlungsdauer betrug 37 Tage (13–45 Tage). Die applizierte durchschnittliche Dosis betrug 68,4 Gy (16–74 Gy). Das gesamte 2-Jahres-Überleben betrug 69%, Das krankheitsfreie 2-Jahres-Überleben 62%. Akuttoxizitäten von mindestens Grad 3 (RTOG Skala) betrafen Mukositis (Grad 3: 42%), Pharynx (Grad 3: 42,3%) Haut (Grad 3: 9,5%) und Kehlkopf (Grad 3: 4%). Die Spättoxizitäten betrafen Haut (Grad 3: 9,5%) und Speicheldrüsen (Grad 3: 3,7%).SchlussfolgerungDie akzelerierte Strahlentherapie mit der Concomitant-Boost-Technik ist bei Patienten mit Kopf- und Halstumoren durchführbar. Diese Technik hat ein akzeptables Toxizitätsprofil und gute Heilungsergebnisse.