Jürgen Debus

HPV16 DNA status is a strong prognosticator of loco-regional control after postoperative radiochemotherapy of locally advanced oropharyngeal carcinoma: Results from a multicentre explorative study of the German Cancer Consortium Radiation Oncology Group (DKTK-ROG)

OBJECTIVEnTo investigate the impact of HPV status in patients with locally advanced head and neck squamous cell carcinoma (HNSCC), who received surgery and cisplatin-based postoperative radiochemotherapy.nnnMATERIALS AND METHODSnFor 221 patients with locally advanced squamous cell carcinoma of the hypopharynx, oropharynx or oral cavity treated at the 8 partner sites of the German Cancer Consortium, the impact of HPV DNA, p16 overexpression and p53 expression on outcome were retrospectively analysed. The primary endpoint was loco-regional tumour control; secondary endpoints were distant metastases and overall survival.nnnRESULTSnIn the total patient population, univariate analyses revealed a significant impact of HPV16 DNA positivity, p16 overexpression, p53 positivity and tumour site on loco-regional tumour control. Multivariate analysis stratified for tumour site showed that positive HPV 16 DNA status correlated with loco-regional tumour control in patients with oropharyngeal carcinoma (p=0.02) but not in the oral cavity carcinoma group. Multivariate evaluation of the secondary endpoints in the total population revealed a significant association of HPV16 DNA positivity with overall survival (p<0.01) but not with distant metastases.nnnCONCLUSIONSnHPV16 DNA status appears to be a strong prognosticator of loco-regional tumour control after postoperative cisplatin-based radiochemotherapy of locally advanced oropharyngeal carcinoma and is now being explored in a prospective validation trial.

Heavy Ion Radiation for Chordomas and Chondrosarcomas

Abstract Protons are currently the most frequently used ions in the radiation treatment of chordomas and chondrosarcomas. Because of their biological and physical advantages, carbon ions promise further improvement in tumor control compared with photons and protons. Carbon ions have an emerging role especially for patients with chordomas and chondrosarcomas. In this chapter, the physical and biological characteristics of carbon ions compared with those of protons and photons will be described. Furthermore, indications, technique, and results of carbon ion treatment in patients with chordomas and chondrosarcomas will be discussed.

Evaluation of Dosimetric Robustness of Carbon Ion Boost Therapy for Anal Carcinoma

PurposenThe radiation therapy treatment outcome of human papillomavirus-negative anal carcinoma may be improved by the biological effectiveness of carbon ions. However, abdominal tissue motion can compromise the precision of carbon ion therapy. This work aims to evaluate the dosimetric feasibility of carbon ion boost (CIB) therapy for anal carcinoma.nnnMaterials and MethodsnAn algorithm to generate computed tomographies based on daily magnetic resonance imaging data and deformable image registration was developed. By means of this algorithm, fractional computed tomography data for 54 treatment fractions for 3 different patients with anal carcinoma were derived. The dose for a sequential CIB (CIBseq) treatment plan was recalculated on the fractional computed tomography data and accumulated over the number of fractions. The resulting dose distributions were compared to standard intensity-modulated radiation therapy treatment with an integrated photon boost.nnnResultsnFor the investigated patient cases, similar dosimetric results for CIBseq treatment and for intensity-modulated radiation therapy with an integrated photon boost were found. For CIBseq treatment, bladder-filling variation had the strongest influence on the dose distribution. However, the detrimental effects on the mean target dose remained below 1 Gy (RBE) as compared to photon therapy.nnnConclusionnThis study shows the dosimetric feasibility of CIB therapy for anal carcinoma for the first time and gives reason for clinical exploitation of the enhanced biological effect of carbon ions for patients with human papillomavirus-negative anal cancer.

Future Directions in Ion Beam Therapy

There is a growing interest in ion beam therapy (IBT) worldwide which has led to an increasing number of new treatment facilities. This development is accompanied by intensive radiobiological, physical and clinical research of both proton therapy (PT) and carbon ion radiotherapy (CIRT). Current developments in IBT with high impact for future challenges will be summarized in this chapter.

Krebserkrankungen als Folge ionisierender Strahlung

Neben der naturlichen Strahlenbelastung gibt es eine Reihe anderer erwunschter und unerwunschter Strahlenquellen. Berufllich exponierte Personen, die in der uberwiegenden Mehrzahl im medizinischen Bereich tatig sind, stellen eine der grosten Gruppen der potenziell strahlenexponierten Personen dar.