Nikolaos Zamboglou

3-D conformal HDR brachytherapy as monotherapy for localized prostate cancer. A pilot study.

Purpose:Pilot study to evaluate feasibility, acute toxicity and conformal quality of three-dimensional (3-D) conformal high-dose- rate (HDR) brachytherapy as monotherapy for localized prostate cancer using intraoperative real-time planning.Patients and Methods:Between 05/2002 and 05/2003, 52 patients with prostate cancer, prostate-specific antigen (PSA) ≤ 10 ng/ml, Gleason score ≤ 7 and clinical stage ≤ T2a were treated. Median PSA was 6.4 ng/ml and median Gleason score 5. 24/52 patients had stage T1c and 28/52 stage T2a. For transrectal ultrasound-(TRUS-)guided transperineal implantation of flexible plastic needles into the prostate, the real-time HDR planning system SWIFT® was used. After implantation, CT-based 3-D postplanning was performed. All patients received one implant for four fractions of HDR brachytherapy in 48 h using a reference dose (Dref) of 9.5 Gy to a total dose of 38.0 Gy. Dose-volume histograms (DVHs) were analyzed to evaluate the conformal quality of each implant using D90, D10 urethra, and D10 rectum. Acute toxicity was evaluated using the CTC (Common Toxicity Criteria) scales.Results:Median D90 was 106% of Dref (range: 93–115%), median D10 urethra 159% of Dref (range: 127–192%), and median D10 rectum 55% of Dref (range: 35–68%). Median follow-up is currently 8 months. In 2/52 patients acute grade 3 genitourinary toxicity was observed. No gastrointestinal toxicity > grade 1 occurred.Conclusion:3-D conformal HDR brachytherapy as monotherapy using intraoperative real-time planning is a feasible and highly conformal treatment for localized prostate cancer associated with minimal acute toxicity. Longer follow-up is needed to evaluate late toxicity and biochemical control.Ziel:Pilotstudie zur Evaluation der Praktikabilität, Akuttoxizität und konformalen Qualität der konformalen dreidimensionalen (3-D) High-Dose-Rate-(HDR-)Brachytherapie als Monotherapie beim lokal begrenzten Prostatakarzinom unter Einsatz intraoperativer Real-Time-Planung.Patienten und Methodik:Zwischen 05/2002 und 05/2003 wurden 52 Patienten mit einem Prostatakarzinom, PSA-Wert (prostataspezifisches Antigen) ≤ 10 ng/ml, Gleason-Score ≤ 7 und klinischem Stadium ≤ T2a behandelt. Der mediane PSA-Wert betrug 6,4 ng/ml und der mediane Gleason-Score 5. 24/52 Patienten waren im Stadium T1c und 28/52 im Stadium T2a. Für die TRUS-gesteuerte (transrektaler Ultraschall) transperineale Implantation von flexiblen Plastiknadeln in die Prostata kam das Real-Time- HDR-Planungssystem SWIFT® zum Einsatz. Nach der Implantation wurde ein CT-basiertes 3-D-Postplanning durchgeführt. Alle Patienten erhielten ein Implantat für vier Fraktionen HDR-Brachytherapie in 48 h mit einer Referenzdosis (Dref) von 9,5 Gy bis zu einer Gesamtdosis von 38,0 Gy. Dosis-Volumen-Histogramme (DVH) wurden analysiert, um die konformale Qualität der Implantate mit Berechnung der D90, D10 Urethra und D10 Rektum zu bestimmen. Akuttoxizitäten wurden unter Verwendung der CTC-Skalen (Common Toxicity Criteria) evaluiert.Ergebnisse:Die mediane D90 betrug 106% von Dref (Range: 93–115%), die mediane D10 Urethra 159% von Dref (Range: 127–192%), die mediane D10 Rektum 55% von Dref (Range: 35–68%). Die mediane Nachbeobachtungszeit beträgt gegenwärtig 8 Monate. Bei 2/52 Patienten wurden akute urogenitale Grad-3-Toxizitäten beobachtet. Gastrointestinale Toxizitäten > Grad 1 traten nicht auf.Schlussfolgerung:Die konformale 3-D-HDR-Brachytherapie als Monotherapie unter Einsatz intraoperativer Real-Time-Planung erweist sich als praktikable und hochkonformale Behandlung mit minimalen akuten Nebenwirkungen beim lokal begrenzten Prostatakarzinom. Eine längere Nachbeobachtungszeit ist zur Beurteilung von Spättoxizitäten und biochemischer Kontrolle notwendig.

High-Dose-Rate Interstitial Brachytherapy as Monotherapy for Clinically Localized Prostate Cancer: Treatment Evolution and Mature Results

PURPOSE To report the clinical outcome of high-dose-rate (HDR) interstitial (IRT) brachytherapy (BRT) as sole treatment (monotherapy) for clinically localized prostate cancer. METHODS AND MATERIALS Between January 2002 and December 2009, 718 consecutive patients with clinically localized prostate cancer were treated with transrectal ultrasound (TRUS)-guided HDR monotherapy. Three treatment protocols were applied; 141 patients received 38.0 Gy using one implant in 4 fractions of 9.5 Gy with computed tomography-based treatment planning; 351 patients received 38.0 Gy in 4 fractions of 9.5 Gy, using 2 implants (2 weeks apart) and intraoperative TRUS real-time treatment planning; and 226 patients received 34.5 Gy, using 3 single-fraction implants of 11.5 Gy (3 weeks apart) and intraoperative TRUS real-time treatment planning. Biochemical failure was defined according to the Phoenix consensus, and toxicity was evaluated using Common Toxicity Criteria for Adverse Events version 3. RESULTS The median follow-up time was 52.8 months. The 36-, 60-, and 96-month biochemical control and metastasis-free survival rates for the entire cohort were 97%, 94%, and 90% and 99%, 98%, and 97%, respectively. Toxicity was scored per event, with 5.4% acute grade 3 genitourinary and 0.2% acute grade 3 gastrointestinal toxicity. Late grade 3 genitourinary and gastrointestinal toxicities were 3.5% and 1.6%, respectively. Two patients developed grade 4 incontinence. No other instance of grade 4 or greater acute or late toxicity was reported. CONCLUSION Our results confirm IRT-HDR-BRT is safe and effective as monotherapy for clinically localized prostate cancer.

3-D Conformal HDR Brachytherapy as Monotherapy for Localized Prostate Cancer

Purpose:Pilot study to evaluate feasibility, acute toxicity and conformal quality of three-dimensional (3-D) conformal high-dose- rate (HDR) brachytherapy as monotherapy for localized prostate cancer using intraoperative real-time planning.Patients and Methods:Between 05/2002 and 05/2003, 52 patients with prostate cancer, prostate-specific antigen (PSA) ≤ 10 ng/ml, Gleason score ≤ 7 and clinical stage ≤ T2a were treated. Median PSA was 6.4 ng/ml and median Gleason score 5. 24/52 patients had stage T1c and 28/52 stage T2a. For transrectal ultrasound-(TRUS-)guided transperineal implantation of flexible plastic needles into the prostate, the real-time HDR planning system SWIFT® was used. After implantation, CT-based 3-D postplanning was performed. All patients received one implant for four fractions of HDR brachytherapy in 48 h using a reference dose (Dref) of 9.5 Gy to a total dose of 38.0 Gy. Dose-volume histograms (DVHs) were analyzed to evaluate the conformal quality of each implant using D90, D10 urethra, and D10 rectum. Acute toxicity was evaluated using the CTC (Common Toxicity Criteria) scales.Results:Median D90 was 106% of Dref (range: 93–115%), median D10 urethra 159% of Dref (range: 127–192%), and median D10 rectum 55% of Dref (range: 35–68%). Median follow-up is currently 8 months. In 2/52 patients acute grade 3 genitourinary toxicity was observed. No gastrointestinal toxicity > grade 1 occurred.Conclusion:3-D conformal HDR brachytherapy as monotherapy using intraoperative real-time planning is a feasible and highly conformal treatment for localized prostate cancer associated with minimal acute toxicity. Longer follow-up is needed to evaluate late toxicity and biochemical control.Ziel:Pilotstudie zur Evaluation der Praktikabilität, Akuttoxizität und konformalen Qualität der konformalen dreidimensionalen (3-D) High-Dose-Rate-(HDR-)Brachytherapie als Monotherapie beim lokal begrenzten Prostatakarzinom unter Einsatz intraoperativer Real-Time-Planung.Patienten und Methodik:Zwischen 05/2002 und 05/2003 wurden 52 Patienten mit einem Prostatakarzinom, PSA-Wert (prostataspezifisches Antigen) ≤ 10 ng/ml, Gleason-Score ≤ 7 und klinischem Stadium ≤ T2a behandelt. Der mediane PSA-Wert betrug 6,4 ng/ml und der mediane Gleason-Score 5. 24/52 Patienten waren im Stadium T1c und 28/52 im Stadium T2a. Für die TRUS-gesteuerte (transrektaler Ultraschall) transperineale Implantation von flexiblen Plastiknadeln in die Prostata kam das Real-Time- HDR-Planungssystem SWIFT® zum Einsatz. Nach der Implantation wurde ein CT-basiertes 3-D-Postplanning durchgeführt. Alle Patienten erhielten ein Implantat für vier Fraktionen HDR-Brachytherapie in 48 h mit einer Referenzdosis (Dref) von 9,5 Gy bis zu einer Gesamtdosis von 38,0 Gy. Dosis-Volumen-Histogramme (DVH) wurden analysiert, um die konformale Qualität der Implantate mit Berechnung der D90, D10 Urethra und D10 Rektum zu bestimmen. Akuttoxizitäten wurden unter Verwendung der CTC-Skalen (Common Toxicity Criteria) evaluiert.Ergebnisse:Die mediane D90 betrug 106% von Dref (Range: 93–115%), die mediane D10 Urethra 159% von Dref (Range: 127–192%), die mediane D10 Rektum 55% von Dref (Range: 35–68%). Die mediane Nachbeobachtungszeit beträgt gegenwärtig 8 Monate. Bei 2/52 Patienten wurden akute urogenitale Grad-3-Toxizitäten beobachtet. Gastrointestinale Toxizitäten > Grad 1 traten nicht auf.Schlussfolgerung:Die konformale 3-D-HDR-Brachytherapie als Monotherapie unter Einsatz intraoperativer Real-Time-Planung erweist sich als praktikable und hochkonformale Behandlung mit minimalen akuten Nebenwirkungen beim lokal begrenzten Prostatakarzinom. Eine längere Nachbeobachtungszeit ist zur Beurteilung von Spättoxizitäten und biochemischer Kontrolle notwendig.

Randomized comparison of early versus late hyperfractionated thoracic irradiation concurrently with chemotherapy in limited disease small-cell lung cancer: A randomized phase II study of the Hellenic Cooperative Oncology Group (HeCOG)

BACKGROUND Concurrent platinum etoposide chemotherapy given in combination with hyperfractionated thoracic radiation therapy (HTRT) in limited disease (LD) small cell lung cancer (SCLC) is associated with a high response rate and significant prolongation of survival. Given these results, the Hellenic Cooperative Oncology Group (HeCOG) performed a multicenter randomized phase II study in patients with LD SCLC to evaluate the timing of HTRT (early vs. late) when given concurrently with chemotherapy. PATIENTS AND METHODS To be eligible for the study, patients were required to have histologically or cytologically proven LD SCLC, confined to one hemithorax and/or ipsilateral mediastinal or supraclavicular lymphnodes and absence of pleural effusion or controlateral supraclavicular lymphnode involvement. Moreover, patients had to have a good performance status and adequate haematological, liver and renal function. Patients with LD SCLC were randomized to receive HTRT either concurrently with the first (Group A) or with the fourth (Group B) cycle of chemotherapy. Chemotherapy consisted of carboplatin administered at an AUC of six given as an i.v. 1-hour-infusion immediately followed by etoposide at a dose of 100 mg/m2 i.v. as a two-hour infusion for three consecutive days every three weeks up to a total of six cycles. Prophylactic cranial irradiation was also given to patients achieving a complete response. RESULTS 42 and 39 patients, were eligible for efficacy evaluation in group A and B respectively. The overall response rate was 76% in group A and 92.5% in group B (P = 0.07) with a complete response rate of 40.5% and 56.5%, respectively. After a median follow-up of 35 months, time to progression was 9.5 months in group A and 10.5 in group B (NS) while overall median survival was 17.5 and 17 months respectively (NS). The 2-year survival was 36% in group A and 29% in group B (NS) and the 3-year survival 22% and 13%, respectively (NS). The distant relapse rate was 38% in group A and 61% in group B (P = 0.046). Severe grade 3 4 anemia was recorded in 19% of group A and 12.5% of group B (NS), while severe leucopenia was recorded in 35.5% and 20.5% (P = 0.09) and neutropenic fever in 5% and 2.5% (NS), respectively. Severe thrombocytopenia did not differ significantly between the two treatment groups being 21.5% and 23%, respectively. Severe grade 2-3 esophageal toxicity was 19% in group A and 23% in group B (NS), while grade 3 lung toxicity was 5% and 7.5% (NS), respectively. No toxicity-related deaths were recorded. CONCLUSION Concurrent administration of HTRT with carboplatin etoposide is associated with a high response and survival rate. Although a trend for higher response rate was recorded in the group of patients who received late HTRT, the overall median, 2-year and 3-year survival rates did not differ significantly between the two treatment groups. The toxicity of this promising therapeutic approach was acceptable. Comparative phase III studies with an adequate number of patients are recommended in order to answer this question.

Anatomy-based three-dimensional dose optimization in brachytherapy using multiobjective genetic algorithms.

In conventional dose optimization algorithms, in brachytherapy, multiple objectives are expressed in terms of an aggregating function which combines individual objective values into a single utility value, making the problem single objective, prior to optimization. A multiobjective genetic algorithm (MOGA) was developed for dose optimization based on an a posteriori approach, leaving the decision-making process to a planner and offering a representative trade-off surface of the various objectives. The MOGA provides a flexible search engine which provides the maximum of information for a decision maker. Tests performed with various treatment plans in brachytherapy have shown that MOGA gives solutions which are superior to those of traditional dose optimization algorithms. Objectives were proposed in terms of the COIN distribution and differential volume histograms, taking into account patient anatomy in the optimization process.

CT-Based Interstitial HDR Brachytherapy

Purpose: Development, application and evaluation of a CT-guided implantation technique and a fully CT-based treatment planning procedure for brachytherapy. Methods and Materials: A brachytherapy procedure based on CT-guided implantation technique and CT-based treatment planning has been developed and clinical evaluated. For this purpose a software system (PROMETHEUS) for the 3D reconstruction of brachytherapy catheters and patient anatomy using only CT scans has been developed. An interface for the Nucletron PLATO BPS treatment planning system for optimization and calculation of dose distribution has been devised. The planning target volume(s) are defined as sets of points using contouring tools and are used for optimization of the 3D dose distribution. Dose-volume histogram based analysis of the dose distribution (COIN analysis) enables a clinically realistic evaluation of the brachytherapy application to be made. The CT-guided implantation of catheters and the CT-based treatment planning procedure has been performed for interstitial brachytherapy and for different tumor sites in 197 patients between 1996 and 1997. Results: The accuracy of the CT reconstruction was tested using first a quality assurance phantom and second, a simulated interstitial implant of 12 needles. These were compared with the results of reconstruction using radiographs. Both methods gave comparable results with regard to accuracy, but the CT based reconstruction was faster. Clinical feasibility was proved in pre-irradiated recurrences of brain tumors, in pretreated recurrences or metastatic disease, and in breast carcinomas. The tumor volumes treated were in the range 5.1 to 2,741 cm3. Analysis of implant quality showed a slightly significant lower COIN value for the bone implants, but no differences with respect to the planning target volume. Conclusions: The Offenbach system, incorporating the PROMETHEUS software for interstitial HDR brachytherapy has proved to be extremely valuable in routine clinical practice for many tumor sites. Our CT-guided implantation technique together with a fully CT-based planning system has enabled conformal brachytherapy treatment to become routine.Ziel: Entwicklung, Anwendung und Evaluierung einer CT-gesteuerten Implantationstechnik und einer vollständig CT-gestützten Behandlungsplanung für Brachytherapie. Material und Methoden: Es wurde ein Brachytherapieverfahren, basierend auf einer CT-gesteuerten Implantationstechnik und CT-gestützter Bestrahlungsplanung, entwickelt und klinisch evaluiert. Für diese Zielsetzung wurde ein Softwaresystem (PROMETHEUS) zur 3D-Rekonstruktion der Applikatoren und der individuellen anatomischen Verhältnisse unter ausschließlicher Verwendung von CT-Schnittbildern entwickelt. Hierzu wurde ein Interface für das Nucletron-PLATO-BPS-Planungssystem zur Optimierung und Berechnung der Dosisverteilung realisiert. Das Zielvolumen (PTV) wird definiert und zur Optimierung der dreidimensionalen Dosisverteilung verwendet. Die Analyse der Dosisverteilung mittels Dosisvolumenhistogrammen (COIN) ermöglicht eine klinische Bewertung des Brachytherapieverfahrens. Die CT-gesteuerte Katheterimplantation und die CT-gestützte Bestrahlungsplanung zur Behandlung unterschiedlicher Tumoren in verschiedenen anatomischen Regionen wurden bei 197 Patienten in dem Zeitraum 1996 bis 1997 durchgeführt. Ergebnisse: Die Genauigkeit der CT-Rekonstruktion wurde mit Hilfe eines Brachytherapie-QA-Phantoms und eines Implantats mit zwölf Nadeln überprüft. Die Ergebnisse wurden mit denen der konventionellen Rekonstruktion aus Röntgenaufnahmen verglichen. Beide Methoden ergaben vergleichbare Ergebnisse in Hinblick auf die Rekonstruktionsgenauigkeit. Die CT-gestützte Rekonstruktion war jedoch schneller. In der klinischen Anwendung wurden Tumorvolumina zwischen 5,1 und 2 741 cm3 behandelt. Die Auswertung der Bestrahlungspläne ergab einen geringfügig signifikant geringeren COIN-Wert für die Knochenimplantate, aber keine Unterschiede hinsichtlich des Tumorvolumens. Schlußfolgerung: Die entwickelte Offenbacher Methode hat sich in der klinischen Routine zur Durchführung einer CT-gestützten Brachytherapie in unterschiedlichen Tumorlokalisationen bewährt. Unsere CT-gesteuerte Implantationstechnik zusammen mit dem CT-gestützten Planungssystem ermöglicht uns eine konformale Brachytherapiebehandlung.

Concomitant Radiochemotherapy vs Radiotherapy Alone in Patients with Head and Neck Cancer

The primary objective of the present randomized phase III trial was to compare the 3-yr survival rate of patients treated with standard fractionated radiotherapy (RT) alone or with the same RT concomitantly with cisplatin (DDP) or carboplatin (Cb). From January 1995 until July 1999, 124 patients with histologically proven locally advanced non-nasopharyngeal head and neck cancer (HNC) were randomized to receive either RT monotherapy (70Gy, Group A) or the same RT concomitantly with DDP (100 mg/m2 on d 2, 22, 42, Group B) or Cb (7 AUC on d 2, 22, 42, Group C). There were no significant differences in complete response rates between patients treated with RT alone or combined chemoradiotherapy. However, median time to progression (TTP) and overall survival (OS) were significantly longer in patients treated with concomitant chemoradiotherapy. Thus, median TTP was 6.3, 45.2, and 17.7 mo in groups A, B, and C respectively (p=0.0002). Similarly, median OS was 12.2, 48.6, and 24.5 mo, respectively (p=0.0003). At 3 yr follow-up, 17.5% of patients in group A were alive compared to 52% in group B and 42% in group C (p<0.001). Patients treated with concomitant chemoradiotherapy experienced more frequently severe hematological toxicity. Also, severe nausea/vomiting was more pronounced in group B, as expected. The present study clearly demonstrated that concomitant chemoradiotherapy with platinum analogs significantly prolongs 3-yr survival and median OS in patients with locally advanced HNC compared to conventional RT alone.

Radiation therapy for painful heel spurs: results of a prospective randomized study.

Purpose:To evaluate the efficacy of two different dose-fractionation schedules for radiation therapy (RT) in patients with painful heel spurs.Patients and Methods:130 patients were randomized into two groups: the low-dose (LD) group (n = 65 heels) received a total dose of 3.0 Gy given in two weekly fractions of 0.5 Gy; in the high-dose (HD) group (n = 65 heels), two weekly fractions of 1.0 Gy were applied over 3 weeks (total dose 6.0 Gy). In 24 sites of the HD group and 17 sites of the LD group, a second RT course was given. The results were assessed using a five-level function score which was documented before RT, at the end of each RT course, and at 6 weeks and 6 months thereafter.Results:At 6-month follow-up, RT led to a highly significant reduction of symptoms in both groups. In the HD group, 31 sites were classified as excellent (score: 90–100), 13 as good (score: 70–85), twelve as moderate (score: 45–65), and nine as poor (score: 0–40). In the LD group, 35 sites were classified as excellent, eight as good, ten as moderate, and twelve as poor. The comparison of the difference of the sum score and the single criteria before RT and at 6 months after RT using the Wilcoxon-Mann-Whitney U-test revealed no statistically significant difference of response to RT between both groups.Conclusion:RT is an effective treatment option for the management of inflammatory heel spurs. The dose for an RT course should not exceed 3.0 Gy.Ziel:Prospektiv-randomisierte Untersuchung der Effektivität zweier verschiedener Dosisregime für die Strahlentherapie von Patienten mit schmerzhaften Fersenspornen.Patienten und Methodik:130 Patienten wurden in zwei Gruppen randomisiert: Die Gruppe mit niedriger Dosis (LD-Gruppe, n = 65) wurde mit 2 × 0,5 Gy pro Woche bis zu einer Gesamtdosis von 3,0 Gy pro Serie bestrahlt, die Gruppe mit höherer Dosis (HD-Gruppe, n = 65) erhielt zwei wöchentliche Fraktionen à 1,0 Gy bis zu einer Gesamtdosis von 6,0 Gy/Serie. 24 Fälle der HD-Gruppe und 17 der LD-Gruppe erhielten eine zweite Bestrahlungsserie. Die Evaluierung der Ergebnisse erfolgte anhand eines Funktionsscores vor Bestrahlungsbeginn, am Ende jeder Serie sowie 6 Wochen und 6 Monate nach der Therapie.Ergebnisse:6 Monate nach der Bestrahlung fand sich in beiden Gruppen eine hochsignifikante Verbesserung des Scores. In der HD-Gruppe wurden 31 Patienten als exzellent (Score: 90–100), 13 als gut (Score: 70–85), zwölf als zufriedenstellend (Score: 45–65) und neun als schlecht (Score: 0–40) eingestuft. In der LD-Gruppe wurden 35 Patienten als exzellent, acht als gut, 10 als zufriedenstellend und 12 als schlecht bewertet. Der Vergleich des Summenscores und Einzelkriterien mittels des Wilcoxon-Mann-Whitney-U-Tests zeigte keinen statistisch signifikanten Unterschied zwischen beiden Gruppen.Schlussfolgerung:Die Strahlentherapie ist eine effektive Therapieoption für die Behandlung entzündlicher Fersensporne. Die Gesamtdosis von 3,0 Gy pro Serie erwies sich als ausreichend.

A hybrid evolutionary algorithm for multi-objective anatomy-based dose optimization in high-dose-rate brachytherapy

Multiple objectives must be considered in anatomy-based dose optimization for high-dose-rate brachytherapy and a large number of parameters must be optimized to satisfy often competing objectives. For objectives expressed solely in terms of dose variances, deterministic gradient-based algorithms can be applied and a weighted sum approach is able to produce a representative set of non-dominated solutions. As the number of objectives increases, or non-convex objectives are used, local minima can be present and deterministic or stochastic algorithms such as simulated annealing either cannot be used or are not efficient. In this case we employ a modified hybrid version of the multi-objective optimization algorithm NSGA-II. This, in combination with the deterministic optimization algorithm, produces a representative sample of the Pareto set. This algorithm can be used with any kind of objectives, including non-convex, and does not require artificial importance factors. A representation of the trade-off surface can be obtained with more than 1000 non-dominated solutions in 2-5 min. An analysis of the solutions provides information on the possibilities available using these objectives. Simple decision making tools allow the selection of a solution that provides a best fit for the clinical goals. We show an example with a prostate implant and compare results obtained by variance and dose-volume histogram (DVH) based objectives.

Usefulness of Tumor Volumetry as a Prognostic Factor of Survival in Head and Neck Cancer

Background: The TNM classification system of tumor stage does not always reflect the actual tumor mass present at diagnosis. This study aimed at evaluating the prognostic value of volumetric data regarding survival in head and neck cancer patients being treated with either cisplatin or carboplatin administered concomitantly with radiotherapy. Patients and Methods: We retrospectively analyzed 107 patients suffering from squamous cell carcinoma of the head and neck in a Greek-German cooperational study (see Table 1). All patients were treated by radiotherapy and concomitant chemotherapy. 65 patients received chemotherapy with carboplatin and 42 with cisplatin. More than 6,200 CT scans were analyzed by digitalization of contours which subsequently led to the computation of the tumor volume (primary and macroscopic lymph node metastases). Results: Median follow-up was 43 months and median survival 30 months. Median initial tumor volume was 32.5 ml (range 2.1–220.1 ml) in the carboplatin and 44.4 ml (range 3.2–202.5 ml) in the cisplatin group (see Figure 1). After treatment, tumor volumes did not differ significantly (median of 3.1 ml [range 0.0–167.1 ml] and 3.5 ml [range 0.0–166.0 ml], respectively). 41 patients (63.1%) died in the carboplatin group and 22 patients (52.4%) in the cisplatin group (see Figure 2). Pretherapeutic tumor volume was prognostic with respect to survival while TNM classification and age were not. Pretherapeutic tumor volume was negatively and percent decrease in tumor volume positively associated with survival (see Tables 2 and 3). Conclusion: Knowledge of the initial tumor volume adds valuable information in terms of prognosis. Initial tumor volume should be included in all future clinical trials regarding head and neck cancer patients.Hintergrund: Das TNM-Tumorklassifikationssystem repräsentiert nicht immer die tatsächliche Tumormasse bei Diagnose. Diese Studie hatte die Überprüfung der prognostischen Wertigkeit volumetrischer Analysen bezüglich des Überlebens bei Patienten mit Kopf-Hals-Tumoren, die radiotherapeutisch und mit begleitender Chemotherapie (Cisplatin oder Carboplatin) behandelt wurden, zur Zielsetzung. Patienten und Methodik: Wir analysierten retrospektiv 107 Patienten mit Kopf-Hals-Tumoren im Rahmen einer griechisch-deutschen Kooperationsstudie (s. Tabelle 1). Alle Patienten erhielten eine Radiotherapie, 65 Patienten zusätzlich eine Carboplatin-, 42 Patienten eine Cisplatin-Chemotherapie. Mehr als 6 200 CT-Bilder wurden mittels Digitalisierung der Konturen bearbeitet, sodass daraus das Tumorvolumen (Primarius inkl. makroskopischer Lymphknotenmetastasen) berechnet werden konnte. Ergebnisse: Das mediane Follow-up betrug 43 Monate, das mediane Überleben 30 Monate. Das mediane initiale Tumorvolumen betrug 32,5 ml (2,1–220,1 ml) in der Carboplatin- und 44,4 ml (3,2–202,5 ml) in der Cisplatin-Gruppe (s. Abbildung 1). Nach Beendigung der Therapie unterschieden sich die Tumorvolumina nicht signifikant (Median von 3,1 ml [0,0–167,1 ml] bzw. 3,5 ml [0,0–166,0 ml]). In der Carboplatin-Gruppe starben 41 (63,1%) der Patienten, in der Cisplatin-Gruppe 22 (52,4%) (s. Abbildung 2). Das prätherapeutische Tumorvolumen war im Gegensatz zur TNM-Klassifikation prognostisch bezüglich des Überlebens. Das prätherapeutische Tumorvolumen war negativ, die prozentuale Abnahme des Tumorvolumens positiv mit dem Überleben assoziiert (s. Tabellen 2 und 3). Schlussfolgerung: Das initiale Tumorvolumen ist ein wichtiger Prognostikator des Überlebens und sollte in alle zukünftigen Studien bezüglich Kopf-Hals-Tumoren inkludiert werden.