R.W.M. van der Maazen

A randomized controlled clinical trial on the efficacy of radiation therapy in the control of subfoveal choroidal neovascularization in age-related macular degeneration : Radiation versus observation

Abstractu2002· Background: The results of several pilot studies concerning radiation therapy for age-related subfoveal choroidal neovascularization (CNV) have been published recently. Although positive treatment results have been described, it is not known whether this therapy alters the natural course of eyes with neovascular age-related macular degeneration (AMD). A randomized controlled clinical trial was conducted in which radiation therapy was compared with observation in patients with subfoveal neovascular AMD. · Methods: Seventy-four patients with a recent drop in central vision due to subfoveal age-related CNV were randomized to either radiation treatment or observation. Patients with either classic, occult or mixed type CNV were included. Eyes in the treatment group received a radiation dose of 24 Gy in four fractions of 6 Gy. Evaluation of data concerning visual acuity (VA) and fluorescein angiography occurred at 3, 6 and 12 months after inclusion.u2002· Results: At 12 months of follow-up 52.2% of the observation group versus 32.0% of the irradiation group had lost 3 or more lines of VA (P=0.03, log rank test). More severe visual decline, 6 lines or more, was observed in 40.9% of the observation versus 8.8% in the irradiation group (P=0.002 using log rank test). At 12 months 39.6% of the observation group and 20.0% of the treatment group had VA of less than 0.1 (P=0.08, log rank test). The size of the CNV membrane doubled in 25.2% of eyes in the observation group versus 20.0% in the treatment group at 12 months (P=0.5, log rank test). No side effects were observed. · Conclusion: Preservation of VA was significantly better in the treatment group compared with the control group at 12 months. Nevertheless we noted a drop in central vision of 3 or more lines in a substantial proportion of the treatment group. Radiation therapy does not prevent visual loss in all patients with age-related subfoveal CNV, and whether the treatment benefit at 12 months will persist has to be awaited.

Combined modality treatment is the treatment of choice for stage I/IE intermediate and high grade non-Hodgkin's lymphomas

BACKGROUND AND PURPOSEnIn a retrospective study, the efficacy of radiotherapy alone was compared with combined modality treatment in patients with stage I/IE non-Hodgkins lymphoma (NHL).nnnPATIENTS AND METHODSnBetween 1980 and 1994, 296 patients with stage I/IE non-Hodgkins lymphoma of intermediate or high grade malignancy (according to the Working Formulation) were treated in four different institutions. All patients were included except patients that presented with NHLs localized in the central nervous system, testis or skin. Two hundred two patients were treated with radiation therapy alone and 94 patients were treated with combined modality treatment.nnnRESULTSnIncreasing age and radiation as a single treatment (versus combined modality treatment) were highly significant adverse prognostic factors by multivariate analysis. The actuarial 10-year rates for progression-free and overall survival were 83 and 70%, respectively, for the patients treated with combined modality treatment and 47 and 43%, respectively, for the patients treated with radiation therapy alone.nnnCONCLUSIONnCombined modality treatment is the treatment of choice for patients with stage I/IE intermediate and high grade non-Hodgkins lymphomas.

Intracranial radiosurgery in the Netherlands. A planning comparison of available systems with regard to physical aspects and workload.

Different planning and treatment systems for intracranial stereotactic radiosurgery available in the Netherlands are compared. The systems for intracranial radiosurgery include: Gamma Knife, Cyberknife, Novalis, and Tomotherapy. Electronic data of 5 patients was transferred to all participating centres and treatment plans were generated according to 2 different prescription protocols. For this study, plans were also generated for a conventional linac. Even systems with a high resolution (Gammaknife and Novalis) have conformity indices in violation with RTOG guidelines (CI > 2.5) when target volumes of <0.5 cc are treated. For medium sized targets (0.5–1 cc) all systems performed reasonably well, but for the different systems a large range of conformity indices was seen (1.1 to 3.7). The differences are partly system dependent but depend also on specific planning choices made. For larger target volumes (>1 cc), all systems perform well. The workload of the different techniques was comparable although the treatment times were usually longer for Gamma Knife radiosurgery. We conclude that small targets should be treated by dedicated systems, larger volumes (>0.5–1 cc) can also be treated using conventional treatment systems equipped with a MLC.

Gem-(R)CHOP versus (R)CHOP: a randomized phase II study of gemcitabine combined with (R)CHOP in untreated aggressive non-Hodgkin's lymphoma--EORTC lymphoma group protocol 20021 (EudraCT number 2004-004635-54).

Background:u2002 Despite recent improvements, many patients with aggressive non‐Hodgkin’s lymphoma (NHL) ultimately succumb to their disease. Therefore, improvements in front‐line chemotherapy of aggressive NHL are needed. Gemcitabine is active in lymphoma.

Development and Evaluation of an Educational E-Tool to Help Patients With Non-Hodgkin's Lymphoma Manage Their Personal Care Pathway

Background An overload of health-related information is available for patients on numerous websites, guidelines, and information leaflets. However, the increasing need for personalized health-related information is currently unmet. Objective This study evaluates an educational e-tool for patients with non-Hodgkin’s lymphoma (NHL) designed to meet patient needs with respect to personalized and complete health-related information provision. The e-tool aims to help NHL patients manage and understand their personal care pathway, by providing them with insight into their own care pathway, the possibility to keep a diary, and structured health-related information. Methods Together with a multidisciplinary NHL expert panel, we developed an e-tool consisting of two sections: (1) a personal section for patients’ own care pathway and their experiences, and (2) an informative section including information on NHL. We developed an ideal NHL care pathway based on the available (inter)national guidelines. The ideal care pathway, including date of first consultation, diagnosis, and therapy start, was used to set up the personal care pathway. The informative section was developed in collaboration with the patient association, Hematon. Regarding participants, 14 patients and 6 laymen were asked to evaluate the e-tool. The 24-item questionnaire used discussed issues concerning layout (6 questions), user convenience (3 questions), menu clarity (3 questions), information clarity (5 questions), and general impression (7 questions). In addition, the panel members were asked to give their feedback by email. Results A comprehensive overview of diagnostics, treatments, and aftercare can be established by patients completing the questions from the personal section. The informative section consisted of NHL information regarding NHL in general, diagnostics, therapy, aftercare, and waiting times. Regarding participants, 6 patients and 6 laymen completed the questionnaire. Overall, the feedback was positive, with at least 75% satisfaction on each feedback item. Important strengths mentioned were the use of a low health-literacy level, the opportunity to document the personal care pathway and experiences, and the clear overview of the information provided. The added value of the e-tool in general was pointed out as very useful for preparing the consultation with one’s doctor and for providing all information on one website, including the opportunity for a personalized care pathway and diary. The majority of the revisions concerned wording and clarity. In addition, more explicit information on immunotherapy, experimental therapy, and psychosocial support was added. Conclusions We have developed a personal care management e-tool for NHL patients. This tool contains a unique way to help patients manage their personal care pathway and give them insight into their NHL by providing health-related information and a personal diary. This evaluation showed that our e-tool meets patients’ needs concerning personalized health-related information, which might serve as a good example for other oncologic diseases. Future research should focus on the possible impact of the e-tool on doctor-patient communication during consultations.

Trends in quality of non-Hodgkin’s lymphoma care: is it getting better?

This study outlines trends in quality of delivered non-Hodgkin’s lymphoma (NHL) care in the Netherlands between 2007 and 2011 and to what extend this was influenced by the national Visible Care program, which aimed at increasing transparency by providing insight into the quality of healthcare. We analyzed data collected from medical records in two observational studies, combined into 20 validated quality indicators (QIs) of which 6 were included in the national program. A random sample of 771 patients, diagnosed with NHL in 26 Dutch hospitals, was examined. Multilevel regression analyses were used to assess differences in quality of NHL care and to provide insight into the effect of the national program. We reported improved adherence to only 3 out of 6 QIs involved in the national program and none of the other 14 validated QIs. Improvement was shown for performance of all recommended staging techniques (from 26u2009 to u200943xa0%), assessment of International Prognostic Index (from 21u2009 to u200943xa0%), and multidisciplinary discussion of patients (from 23u2009 to u200941xa0%). We found limited improvement in quality of NHL care between 2007 and 2011; improvement potential (<80xa0% adherence) was still present for 13 QIs. The national program seems to have a small positive effect, but has not influenced all 20 indicators which represent the most important, measurable parts in quality of NHL care. These results illustrate the need for tailored implementation and quality improvement initiatives.

OC-0268: A Dutch nationwide survivorship care programme for (non-) Hodgkin lymphoma survivors

T2; and N stage was: 25 Nx, 65 N0, 26 N1, 1 N3. Mastectomy was performed in 17 and wide local excision in 100. Axillary dissection was done in 67 and sentinel node dissection in 33 with a median number of 13 (1-24) lymph nodes excised. 52 received chemotherapy and 72 endocrine therapy. All received radiotherapy (1 neoand 116 adjuvant) with 67 breast/chest wall alone and 40 breast/chest wall and regional nodal irradiation. The median time to onset of LE from the completion of radiotherapy was 0.5 y (0.1 to 7.8). LEs included: 38 truncal and/or breast pain; 24 arm lymphedema; 16 breast inflammation; 16 breast lymphedema; 14 neck, truncal, breast fibrosis; 9 tissue ulcer/necrosis; 2 brachial plexopathy 2; and 11 other. Following LE consultation, 90 received pharmacologic (18 anti-inflammatory, 60 anti-oxidant, 12 pentoxifylline or 4 other) and/or non-pharmacologic management (33 selflymphatic massage). Transient mild toxicities were observed in 8 (9%) (4 GI, 2 MSK, 2 pre-syncope). No major toxicities from LE treatment occurred. Moderate to significant improvement was observed in 78 (87%) with12 patients demonstrating no improvement. Conclusions: Following completion of therapy, acute toxicities may persistent or late toxicities arise. For women with these toxicities, current interventions appear to have a meaningful impact upon LEs with minimal side effects. Recognition of the potential to manage persistent acute effects and LEs is important and needs to be better incorporated within breast cancer survivorship to best improve aftercare.

SU‐E‐T‐580: Does Arc Therapy Have the Potential to Improve Radiation Treatment of Hodgkin's Lymphoma Patients?

PURPOSEnTo evaluate whether arc therapy (helical Tomotherapy and volumetric arc therapy; VMAT) is superior to step and shoot IMRT regarding sparing of lungs while maintaining adequate planning target volume (PTV) coverage in Hodgkins lymphoma patients .nnnMETHODSnRadiation treatment plans for eleven Hodgkins lymphoma patients were created employing the following techniques: coplanar and noncoplanar Step & Shoot IMRT, VMAT and Tomotherapy, i.e., for every patient 4 different treatment plans were created. The IMRT and VMAT planning was performed with Pinnacle software (v. 8 and 9, Philips) suitable for delivery with an Elekta linear accelerator, Tomotherapy plans were calculated with Tomotherapy planning software (v. 3.4). Four patients received a single prescription dose of 30 or 36 Gy, and 7 patients received a simultaneous integrated boost (30 Gy/36 Gy). Treatment plans were optimized such that the normal tissue constraints for the lung [volume receiving more than 20 Gy (V20) is less than 30% and mean lung dose (MLD) is less than 14 Gy] were met, even if PTV coverage (V95%=99%) had to be sacrificed.nnnRESULTSnAll 4 techniques delivered clinically acceptable treatment plans. Tomotherapy achieved the highest dose homogeneity in the PTV and highest dose coverage of the boost volume (on average 98% versus 96% for the other 3 techniques). Since lung sparing was the first planning objective, all techniques scored equally well for V20 en MLD.nnnCONCLUSIONSnThe strength of arc therapy lies in the large number of beamlets entering the patient from a high number of angles. For Hodgkins lymphoma patients this does not automatically translate into a superior treatment due to the high weight on the lung objectives limiting the number of beamlets allowed to pass through the lung. This means that for Hodgkins lymphoma arc therapy has no added value for sparing of the lungs.

Long-Term Results of Radiotherapy for Age-Related Macular Degeneration

As laser photocoagulation therapy leads to immediate and permanent visual loss in eyes with subfoveal choroidal neovascularisation (CNV) in age-related macular degeneration (ARMD), other treatment options are under investigation, including photo-dynamic therapy, pharmacological therapy, surgical therapy and radiotherapy.