Grit Welzel

Volumetric modulated arc therapy (VMAT) vs. serial tomotherapy, step-and-shoot IMRT and 3D-conformal RT for treatment of prostate cancer

INTRODUCTION Volumetric modulated arc therapy (VMAT), a complex treatment strategy for intensity-modulated radiation therapy, may increase treatment efficiency and has recently been established clinically. This analysis compares VMAT against established IMRT and 3D-conformal radiation therapy (3D-CRT) delivery techniques. METHODS Based on CT datasets of 9 patients treated for prostate cancer step-and-shoot IMRT, serial tomotherapy (MIMiC), 3D-CRT and VMAT were compared with regard to plan quality and treatment efficiency. Two VMAT approaches (one rotation (VMAT1x) and one rotation plus a second 200 degrees rotation (VMAT2x)) were calculated for the plan comparison. Plan quality was assessed by calculating homogeneity and conformity index (HI and CI), dose to normal tissue (non-target) and D(95%) (dose encompassing 95% of the target volume). For plan efficiency evaluation, treatment time and number of monitor units (MU) were considered. RESULTS For MIMiC/IMRT(MLC)/VMAT2x/VMAT1x/3D-CRT, mean CI was 1.5/1.23/1.45/1.51/1.46 and HI was 1.19/1.1/1.09/1.11/1.04. For a prescribed dose of 76 Gy, mean doses to organs-at-risk (OAR) were 50.69 Gy/53.99 Gy/60.29 Gy/61.59 Gy/66.33 Gy for the anterior half of the rectum and 31.85 Gy/34.89 Gy/38.75 Gy/38.57 Gy/55.43 Gy for the posterior rectum. Volumes of non-target normal tissue receiving > or =70% of prescribed dose (53 Gy) were 337 ml/284 ml/482 ml/505 ml/414 ml, for > or =50% (38 Gy) 869 ml/933 ml/1155 ml/1231 ml/1993 ml and for > or =30% (23 Gy) 2819 ml/3414 ml/3340 ml/3438 ml /3061 ml. D(95%) was 69.79 Gy/70.51 Gy/71,7 Gy/71.59 Gy/73.42 Gy. Mean treatment time was 12 min/6 min/3.7 min/1.8 min/2.5 min. CONCLUSION All approaches yield treatment plans of improved quality when compared to 3D-conformal treatments, with serial tomotherapy providing best OAR sparing and VMAT being the most efficient treatment option in our comparison. Plans which were calculated with 3D-CRT provided good target coverage but resulted in higher dose to the rectum.

Memory Function Before and After Whole Brain Radiotherapy in Patients With and Without Brain Metastases

PURPOSE To prospectively compare the effect of prophylactic and therapeutic whole brain radiotherapy (WBRT) on memory function in patients with and without brain metastases. METHODS AND MATERIALS Adult patients with and without brain metastases (n = 44) were prospectively evaluated with serial cognitive testing, before RT (T0), after starting RT (T1), at the end of RT (T2), and 6-8 weeks (T3) after RT completion. Data were obtained from small-cell lung cancer patients treated with prophylactic cranial irradiation, patients with brain metastases treated with therapeutic cranial irradiation (TCI), and breast cancer patients treated with RT to the breast. RESULTS Before therapy, prophylactic cranial irradiation patients performed worse than TCI patients or than controls on most test scores. During and after WBRT, verbal memory function was influenced by pretreatment cognitive status (p < 0.001) and to a lesser extent by WBRT. Acute (T1) radiation effects on verbal memory function were only observed in TCI patients (p = 0.031). Subacute (T3) radiation effects on verbal memory function were observed in both TCI and prophylactic cranial irradiation patients (p = 0.006). These effects were more pronounced in patients with above-average performance at baseline. Visual memory and attention were not influenced by WBRT. CONCLUSIONS The results of our study have shown that WBRT causes cognitive dysfunction immediately after the beginning of RT in patients with brain metastases only. At 6-8 weeks after the end of WBRT, cognitive dysfunction was seen in patients with and without brain metastases. Because cognitive dysfunction after WBRT is restricted to verbal memory, patients should not avoid WBRT because of a fear of neurocognitive side effects.

Intraoperative radiotherapy as a boost during breast-conserving surgery using low-kilovoltage X-rays: the first 5 years of experience with a novel approach.

PURPOSE Intraoperative radiotherapy (IORT) during breast-conserving surgery (BCS) has been recently introduced using different devices. We report the first 5 years of a single-center experience after introduction of a novel approach to deliver IORT as a tumor bed boost during BCS for breast cancer. METHODS AND MATERIALS A total of 155 breast cancers in 154 women (median age, 63 years; range, 30-83 years; T1/T2 = 100/55; N0/N+ = 108/47) were treated between February 2002 and December 2007 at the University Medical Center Mannheim, in whom IORT as tumor bed boost was applied using 50-kV X-rays (20 Gy) followed by 46-50 Gy whole-breast external-beam radiotherapy (EBRT). Chemotherapy, if indicated, was given before EBRT. The median interval between BCS plus IORT and EBRT was 40 days. Median follow-up was 34 months (maximum 80 months, 1 patient lost to follow-up). Overall survival and local relapse-free survival were calculated at 5 years using the Kaplan-Meier method. Seventy-nine patients were evaluated at 3-year follow-up for late toxicity according to the Late Effects in Normal Tissues-Subjective, Objective, Management, and Analytic system. RESULTS Ten patients died, 2 had in-breast relapse, and 8 developed distant metastases (5-year overall survival = 87.0%; 5-year local relapse-free survival = 98.5%). Grade 3 fibroses of the tumor bed were detected in 5% of the patients after 3 years. Skin toxicity was mild (telangiectases and hyperpigmentations in approximately 6% each). CONCLUSIONS Intraoperative radiotherapy as a tumor bed boost during BCS for breast cancer using low-kilovoltage X-rays followed by EBRT yields low recurrence and toxicity rates.

Reduced rectal toxicity with ultrasound-based image guided radiotherapy using BAT™ (B-mode acquisition and targeting system) for prostate cancer

PurposeTo evaluate the effect of image guided radiotherapy with stereotactic ultrasound BAT (B-mode acquisition and targeting system) on rectal toxicity in conformal radiotherapy of prostate cancer.Patients and Methods42 sequential patients with prostate cancer undergoing radiotherapy before and after the introduction of BAT were included. Planning computed tomography (CT) was performed with empty rectum and moderately filled bladder. The planning target volume (PTV) included the prostate and seminal vesicles with a safety margin of 1.5 cm in anterior and lateral direction. In posterior direction the anterior 1/3 of the rectum circumference were included. Total dose was 66 Gy and a boost of 4 Gy excluding the seminal vesicles.22 patients (BAT group) were treated with daily stereotactic ultrasound positioning, for the other 20 patients (NoBAT group) an EPID (electronic portal imaging device) was performed once a week. Acute and late genito-urinary (GU) and rectal toxicity and PSA values were evaluated after 1.5, 3, 6, 9 and 12 months. The total median follow up of toxicity was 3 years in the BAT group and 4 years in the NoBAT group.ResultsIn the NoBAT group significant more rectal toxicity occurred, while in GU toxicity no difference was seen. Two patients in the NoBAT group showed late rectal toxicity grade 3, no toxicity > grade 2 occurred in the BAT group. There was no significant difference in PSA reduction between the groups.ConclusionWithout BAT significant more acute and a trend to more late rectal toxicity was found. With regard to dose escalation this aspect is currently evaluated with a larger number of patients using intensity-modulated radiotherapy (IMRT).ZusammenfassungHintergrundZiel dieser Auswertung war es, den Effekt der bildgebungsgestützen Strahlentherapie mittels stereotaktischem Ultraschall-BAT (B-mode Acqusition and Targeting-System) auf die Akut- und Spättoxizität am Rektum sowie auf den Verlauf der PSA-Werte zu ermitteln.Patienten und Methodik42 Patienten mit Prostatakarzinom wurden in die Auswertung eingeschlossen (Tabelle 1). Die Planung erfolgte standardisiert mit entleertem Rektum und moderat gefüllter Blase. Es wurde ein Planungszielvolumen (PTV) unter Einschluss der Prostata und Samenblasen mit einem Sicherheitsabstand lateral und anterior von 1,5 cm definiert. Posterior wurde maximal das vordere Rektumdrittel eingeschlossen. Die Gesamtdosis betrug 66 Gy mit einem Boost unter Ausschluss der Samenblasen mit nochmals 4 Gy.Bei 22 Patienten erfolgte die tägliche Lagerungskontrolle mit stereotaktischem Ultraschall (BAT-Gruppe), bei den restlichen 20 (NoBAT-Gruppe) wurde einmal wöchentlich eine Verifikationsaufnahme (EPID) zur Lagerungskontrolle durchgeführt. Die Akuttoxizität und Spättoxizität an der Blase und am Rektum sowie der Verlauf der PSA-Werte nach 1,5, 3, 6, 9 und 12 Monaten wurden ermittelt. Der Beobachtungszeitraum der Patienten ohne BAT war 3–4 Jahre und mit BAT 2–3 Jahre.ErgebnisseIn der NoBAT-Gruppe trat signifikant häufiger eine höhergradige Rektumtoxizität auf (Abbildungen 1 und 2), während sich bei der Blasentoxizität kein wesentlicher Unterschied in beiden Gruppen zeigte. Zwei Patienten aus der NoBAT-Gruppe hatten als Spättoxizität eine persistierende rektale Blutung. In der BAT-Gruppe fand sich keine Spättoxizität > Grad 2. Der Verlauf der PSA-Werte zeigte keinen relevanten Unterschied (Abbildung 3).SchlussfolgerungOhne BAT trat signifikant mehr Akuttoxizität und tendenziell mehr Spättoxizität am Rektum auf. Dieser Aspekt wird insbesondere im Hinblick auf eine Dosiseskalation an einer größeren Patientengruppe mit intensitätsmodulierter Strahlentherapie (IMRT) evaluiert.

Acute neurocognitive impairment during cranial radiation therapy in patients with intracranial tumors

Background and PurposeThe objective of the current study was to evaluate the acute effects of cranial radiation therapy (CNS-RT) using different radiation doses (0, 1.8, 2, 3, ≥ 20 Gy) on cognitive function with special emphasis on memory. We assessed patients with and without intracranial tumors to distinguish between direct and indirect radiation effects on brain tissue.Materials and MethodsEighty-two patients were evaluated with neuropsychological testing before and acutely after radiotherapy (RT). Sixty-four patients received RT to the brain (55 with, 9 without intracranial tumor). Eighteen patients treated with RT to the breast served as controls.ResultsPatients with intracranial tumor demonstrated attention (19–38th percentile) and verbal memory scores (34–46th percentile) below the population average at baseline. The average Verbal Memory score was significantly different between patients with intracranial tumor and controls both at baseline (38th vs. 58th percentile) and after irradiation (27th vs. 52th percentile). Patients with preexisting peritumoral edema performed worse than patients without edema and controls. Radiation dose-related deficits were seen for working memory performance in patients with intracranial tumor.ConclusionOur data indicate no measurable impairment of cognitive functioning acutely after prophylactic cranial irradiation. Patients with intracranial tumor show a deterioration of almost all memory functions with a dose-dependent impairment in working memory. Patients with preexisting peritumoral brain edema show the strongest deterioration.ZusammenfassungHintergrund und ZielDie vorliegende Arbeit untersucht Akuteffekte der kraniellen Strahlentherapie (ZNS-RT) nach unterschiedlichen Bestrahlungsdosen (0, 1.8, 2, 3, ≥ 20 Gy) auf die kognitive Funktion unter besonderer Berücksichtigung des verbalen Gedächtnisses. Wir haben Patienten mit und ohne Hirntumor untersucht, um zwischen direkten und indirekten Bestrahlungseffekten auf das Hirngewebe zu unterscheiden.Patienten und Methodik82 Patienten wurden vor und unmittelbar nach Beginn der Radiotherapie (RT) neuropsychologisch untersucht. 64 Patienten wurden am ZNS bestrahlt (55 mit, 9 ohne Hirntumor). 18 Patientinnen, die an der Mamma bestrahlt wurden, dienten als Kontrollgruppe.ErgebnisseVor RT-Beginn lagen Aufmerksamkeitsleistungen (Prozentränge von 19–38) und verbale Gedächtnisleistungen (Prozentränge von 34–46) der Patienten mit Hirntumor unterhalb des Mittelwertes für die Normalbevölkerung (Tabellen 4, 5). Die durchschnittliche verbale Gedächtnisleistung der Patienten mit Hirntumor unterschied sich vor (Prozentrang 38 vs. 58) und nach RT (Prozentrang 27 vs. 52) signifikant von der der Kontrollgruppe (Abbildung 1). Patienten mit einem peritumoralen Hirnödem vor ZNS-RT zeigen schlechtere Leistungen als Patienten ohne Hirnödem und Kontrollpatienten (Abbildung 3). Bestrahlungsdosisabhängige Effekte wurden für das Arbeitsgedächtnis bei Patienten mit ZNS-Tumor beobachtet (Abbildung 2).SchlussfolgerungUnsere Daten zeigen keine messbaren kognitiven Beeinträchtigungen unmittelbar nach Beginn einer prophylaktischen Ganzhirnbestrahlung. Patienten mit Hirntumor zeigen eine Verschlechterung der verbalen Gedächtnisfunktionen und eine dosisabhängige Beeinträchtigung im Arbeitsgedächtnis. Patienten mit einem peritumoralen Hirnödem vor ZNS-RT zeigen die größten Veränderungen.

Quality of life outcomes in patients with anal cancer after combined radiochemotherapy.

Purpose:To assess self-reported quality of life (QoL) experienced by anal cancer patients after radiochemotherapy, and to identify patient- and disease-related factors associated with QoL.Patients and Methods:A total of 88 patients treated for anal cancer at our institution between 1990 and 2006 were identified from our database. Of these, 15 patients had died, and 4 were lost to follow-up. QoL was assessed using the EORTC QLQ-C30 questionnaire (cancer-specific QoL) and the colorectal cancer module QLQ-CR38 (site-specific QoL); 52 responses were received. The median follow-up was 36 months (range, 5–137 months).Results:As for cancer-specific QoL, global health QoL score (mean 60.4) was similar to the general German population, whereas most of the function and symptom scale scores were considerably lower/higher in anal cancer patients. The most prominent mean score differences were observed in role functioning (–21.8 points), emotional functioning (–20.7 points), social functioning (–28.9 points), diarrhea (+34.6 points), and financial difficulties (+26.9 points; p < 0.001). As for site-specific QoL, the mean function scale scores ranged from 22.1 (sexual function) to 63.2 (body image), and the mean symptom scale scores from 14.7 (weight loss) to 69.0 (stoma-related problems, 4 patients) and 67.9 (male sexual dysfunction), respectively. Most of the QoL scores were not affected by late toxicity, patient- or disease-related factors. Fatigue (+18.2 points) emerged as the strongest predictor of impaired QoL.Conclusion:The global health QoL of anal cancer patients is comparable with that of the general German population, but there are specific limitations, e.g., sexual dysfunction, urological/gastrointestinal complaints, financial difficulties, fatigue, and a reduction in emotional and social well-being.ZusammenfassungZiel:Untersuchung der Lebensqualität (LQ) von Analkarzinompatienten nach kombinierter Radiochemotherapie (RChT), und Identifikation von Patienten- und Krankheitsbezogenen Faktoren, die mit der LQ zusammenhängen.Patienten und Methodik:Nach Aktendurchsicht wurden 88 Patienten an unserer Klinik zwischen 1990 und 2006 mit einer kombinierten RChT behandelt. 15 Patienten waren verstorben, 4 Patienten waren lost to follow up. Die LQ wurde mit dem EORTC QLQ-C30 Fragebogen (tumorspezifische LQ) und dem Zusatzmodul für kolorektale Tumoren QLQ-CR38 (organspezifische LQ) erfasst. 52 Patienten beantworteten den Fragebogen. Das mediane Follow-up lag bei 36 Monaten (range 5–137; siehe Tabelle 1).Ergebnisse:Tumorspezifische LQ: Die globale, gesundheitsbezogene LQ (Mittelwert: 60,4) war vergleichbar mit der der deutschen Normalbevölkerung, allerdings waren die meisten Funktions- und Symptomwerte der Analkarzinompatienten im Mittel deutlich niedriger/höher. Die höchsten Belastungen wurden in den Bereichen Rollenfunktion (–21,8 Punkte), emotionale Funktion (–20,7 Punkte), soziale Funktion (–28,9 Punkte), Diarrhoe (+34,6 Punkte), und finanzielle Belastungen (+26,9 Punkte; p < 0,001) ge-funden (siehe Abbildung 1). Organspezifische LQ: Die mittleren Funktionswerte lagen zwischen 22,1 (sexuelle Funktion) und 63,2 (Körperbild) und die mittleren Symptomwerte zwischen 14,7 (Gewichtsverlust) und 69,0 (Probleme mit dem Stoma, 4 Patienten) sowie 67,9 (sexuelle Dysfunktion, Männer; siehe Tabelle 2). Die meisten LQ Werte wurden nicht durch Spättoxizität, patienten- oder krankheitsbezogene Faktoren beeinflusst (siehe Tabellen 3–5). Fatigue (+18,2 Punkte) hatte den stärksten Einfluss auf die LQ.Schlussfolgerung:Die globale, gesundheitsbezogene LQ von Analkarzinompatienten entspricht nach kombinierter RChT der der deutschen Allgemeinbevölkerung, allerdings gibt es spezifische Beeinträchtigungen wie sexuelle Dysfunktion, urologische/gastro-intestinale Beschwerden, finanzielle Belastungen, Fatigue und negative Effekte auf die emotionale und soziale Funktionsfähigkeit.

Early initiation of external beam radiotherapy (EBRT) may increase the risk of long-term toxicity in patients undergoing intraoperative radiotherapy (IORT) as a boost for breast cancer

BACKGROUND Intraoperative radiotherapy (IORT) during breast-conserving surgery is increasingly used. We analyzed the influence of the interval between an IORT boost and external beam radiotherapy (EBRT) on late toxicity. METHODS Forty-eight patients received 20 Gy IORT (50 kV X-rays (Intrabeam, Carl Zeiss, Oberkochen, Germany) followed by 46-50 Gy EBRT with a median interval of 36 days (14-197). Late toxicity was assessed with the modified LENT SOMA score after a median of 36 months. RESULTS Twelve patients developed a higher grade fibrosis ( degrees II-III), three teleangiectases, one a breast edema grade degrees II, six retractions, four hyperpigmentations and five pain ( degrees II-III). The median interval between IORT and EBRT was significantly shorter in these patients (n=18) compared to the 30 patients without higher grade toxicity (29.5 days vs. 39.5 days, p=0.023, Mann-Whitney U-test). CONCLUSION Starting EBRT about 5-6 weeks after IORT appears to be associated with a decreased risk of chronic late toxicity compared with a shorter interval. The impact on local recurrence of prolonged gaps between IORT and EBRT is not known.

A comparison of several modulated radiotherapy techniques for head and neck cancer and dosimetric validation of VMAT

PURPOSE Volumetric modulated arc therapy (VMAT) has the potential to shorten treatment times for fluence modulated radiotherapy. We compared dose distributions of VMAT, step-and-shoot IMRT and serial tomotherapy for typical head and neck (H&N) planning target volumes (PTV) with sparing of one parotid, a complex paradigm and a situation often encountered in H&N radiotherapy. Finally, we validated the dosimetric accuracy of VMAT delivery. MATERIAL AND METHODS Based on CT datasets of 10 patients treated for H&N cancer (PTV1:60 Gy/PTV2:56 Gy) with IMRT (7/9 fields), serial tomotherapy (MIMiC) and VMAT were compared with regard to plan quality and treatment efficiency. Plan quality was assessed by calculating homogeneity/conformity index (HI/CI), mean dose to parotid and brain stem and the maximum dose to the spinal cord. For plan efficiency evaluation, total treatment time (TTT) and number of monitor units (MU) were considered. A dosimetric evaluation of VMAT was performed using radiosensitive film, ion chamber and 2D-array. RESULTS For MIMiC/IMRT(7F)/IMRT(9F)/VMAT, mean CI was 1.98/2.23/2.23/1.82, HI(PTV1) was 1.12/1.20/1.20/1.11 and HI(PTV2) was 1.11/1.15/1.13/1.12. Mean doses to the shielded parotid were 19.5 Gy/14.1 Gy/13.9 Gy/14.9 Gy and the spinal cord received maximum doses of 43.6 Gy/40.8 Gy/41.6 Gy/42.6 Gy. The mean MUs were 2551/945/925/521 and the mean TTT was 12.8 min/7.6 min/8.5 min/4.32 min. The ion chamber measurements showed an absolute deviation of 0.08 ± 1.10% and 98.45 ± 3.25% pixels passed γ-analyses for 3%/3mm and 99.95 ± 0.09% for 5%/5mm for films. 2D-array measurements reported an agreement for 3%/3mm of 95.65 ± 2.47%-98.33 ± 0.65% and for 5%/5mm 99.79 ± 0.24%-99.92 ± 0.09% depending on the measurement protocol. CONCLUSION All treatment paradigms produced plans of excellent quality and dosimetric accuracy with IMRT providing best OAR sparing and VMAT being the most efficient treatment option in our comparison of treatment plans with high complexity.

Can the Radiation Dose to CT-Enlarged but FDG-PET-Negative Inguinal Lymph Nodes in Anal Cancer Be Reduced?

Purpose:To investigate whether a dose reduction to CT-enlarged but FDG-PET-negative (([18F]-fluoro-2-deoxy-D-glucose positron emission tomography) inguinal lymph nodes in radiochemotherapy of anal cancer is safe.Patients and Methods:39 sequential patients with anal cancer (mean age 59 years [range: 37–86 years], median follow-up 26 months [range: 3–51 months]) receiving pretherapeutic FDG-PET were included. All patients were treated with combined radiochemotherapy including elective radiation of the inguinal lymph nodes with 36 Gy. In case of involvement (FDG-PET positivity defined as normalized SUV [standard uptake value] above Δ > 2.5 higher than blood pool), radiation dose was increased up to 50–54 Gy. Planning CT and PET results were compared for detectability and localization of lymph nodes. In addition, local control and freedom from metastases were analyzed regarding the lymph node status as determined by FDG-PET.Results:In the planning CTs, a total of 162 inguinal lymph nodes were detected with 16 in nine patients being suspicious. Only three of these lymph nodes in three patients were PET-positive receiving 50.4–54 Gy, whereas all other patients only received elective inguinal nodal irradiation. No recurrence in inguinal lymph nodes occurred, especially not in patients with CT-enlarged inguinal lymph nodes and elective irradiation only. Patients with PET-positive nodal disease had a higher risk of developing distant metastases (p = 0.045).Conclusion:Reduction of the irradiation dose to CT-enlarged but PET-negative inguinal lymph nodes in anal cancer seems not to result in increased failure rates.Ziel:Untersucht wurde, ob eine Reduktion der Bestrahlungsdosis auf im CT vergrößerte, aber PET-negative (Positronenemissionstomographie) inguinale Lymphknoten bei der kombinierten Radiochemotherapie des Analkarzinoms ohne Verschlechterung der Prognose möglich ist.Patienten und Methodik:39 Patienten mit Analkarzinom (median Alter 59 Jahre [37–86 Jahre]), mittlerer Nachsorgezeitraum 26 Monate [3–51 Monate]) mit einer prätherapeutischen PET-Untersuchung wurden in die Auswertung eingeschlossen (Tabelle 1). Alle Patienten erhielten eine kombinierte Radiochemotherapie einschließlich einer elektiven Bestrahlung der inguinalen Lymphknoten bis zu einer Dosis von 36 Gy, bei Befall (PET-positiv: normalisierter Uptakewert mehr als das 2,5fache höher als der gemessene Wert im Blutpool) wurde die Dosis auf 50–54 Gy aufgesättigt. Das Bestrahlungsplanungs-CT und die PET-Untersuchung wurden in Bezug auf Nachweisbarkeit und Lokalisation der Lymphknoten verglichen. Zusätzlich wurden die lokale Kontrolle und das metastasenfreie Überleben in Abhängigkeit vom im PET erhobenen Lymphknotenstatus ermittelt.Ergebnisse:In den Bestrahlungsplanungs-CTs wurden insgesamt 162 inguinale Lymphknoten detektiert; davon wurden 16 bei neun Patienten als suspekt eingestuft. Nur drei dieser suspekten inguinalen Lymphknoten bei drei Patienten waren PET-positiv und wurden mit 50,4–54 Gy bestrahlt (Abbildungen 1a und 1b), während alle anderen Patienten nur eine elektive Bestrahlung der Leisten mit 36 Gy erhielten (Tabellen 2a bis 2c). Keiner der Patienten entwickelte ein Rezidiv im Bereich der inguinalen Lymphknoten, insbesondere auch nicht die Patienten, die bei im CT vergrößerten Lymphknoten nur elektiv in den Leisten bestrahlt wurden. Patienten mit PET-positiven Lymphknoten hatten ein erhöhtes Risiko für Fernmetastasen (p = 0,045; Abbildung 2).Schlussfolgerung:Eine Reduktion der Bestrahlungsdosis bei im CT vergrößerten, aber PET-negativen inguinalen Lymphknoten scheint nicht mit einem erhöhten Rezidivrisiko einherzugehen.

Neuropsychological outcome after fractionated stereotactic radiotherapy (FSRT) for base of skull meningiomas: a prospective 1-year follow-up

PURPOSE The purpose of this study was to evaluate the cognitive outcome after fractionated stereotactic radiotherapy (FSRT) in patients with base of skull meningiomas. METHODS AND MATERIAL A total of 40 patients with base of skull meningiomas were neuropsychologically evaluated before, after the first fraction (1.8 Gy), at the end of FSRT (n=37), 6 weeks (n=24), 6 (n=18) and 12 months (n=14) after FSRT. A comprehensive test battery including assessment of general intelligence, attention and memory functions was used. Alternate forms were used and current mood state was controlled. RESULTS After the first fraction a transient decline in memory function and simultaneous improvements in attention functions were observed. No cognitive deteriorations were seen during further follow-up, but increases in attention and memory functions were observed. Mood state improved after the first fraction, at the end of radiotherapy and 6 weeks after radiotherapy. CONCLUSION The present data support the conclusion that the probability for the development of permanent cognitive dysfunctions appears to be very low after FSRT. The transient memory impairments on day 1 are interpreted as most likely related to an increase of a preexisting peritumoral edema, whereas the significant acute improvements in attention functions are interpreted as practice effects. An analysis of localization specific effects of radiation failed to show clear hemisphere specific cognitive changes.