34 results on '"Schmid, Maximilian P."'
Search Results
2. Association of persistent morbidity after radiotherapy with quality of life in locally advanced cervical cancer survivors
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Spampinato, Sofia, Tanderup, Kari, Lindegaard, Jacob C., Schmid, Maximilian P., Sturdza, Alina, Segedin, Barbara, Jürgenliemk-Schulz, Ina M., De Leeuw, Astrid, Bruheim, Kjersti, Mahantshetty, Umesh, Chargari, Cyrus, Rai, Bhavana, Cooper, Rachel, van der Steen-Banasik, Elzbieta, Sundset, Marit, Wiebe, Ericka, Villafranca, Elena, Van Limbergen, Erik, Pieters, Bradley R., Tee Tan, Li, Lutgens, Ludy C.H.W., Hoskin, Peter, Smet, Stéphanie, Pötter, Richard, Nout, Remi, Chopra, Supriya, and Kirchheiner, Kathrin
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- 2023
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3. Targeted muscle reinnervation at the time of amputation to prevent the development of neuropathic pain.
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Raasveld, Floris V., Mayrhofer-Schmid, Maximilian, Johnston, Benjamin R., Gomez-Eslava, Barbara, Hoftiezer, Yannick A.J., Liu, Wen-Chih, Valerio, Ian L., and Eberlin, Kyle R.
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Targeted muscle reinnervation (TMR) is an established modality for the surgical management of neuropathic pain. Although the preventive effect of primary (acute) TMR at the time of amputation has been demonstrated previously, it remains unclear how many and which patients benefit most. Therefore, this study investigated the proportion of patients achieving sustained pain prophylaxis following amputation, as well as factors associated with its efficacy. Primary patients who underwent TMR with a minimum follow-up of 6 months between 2018 and 2023 were enrolled. Pain outcomes (numeric rating scale [NRS], 0–10), comorbidities, and surgical factors were collected from chart review. Patients achieving sustained pain prophylaxis (NRS of ≤3 for ≥3 months until final follow-up) were identified. Multilevel mixed-effect models and multivariable regression were used to visualize pain courses and identify associated factors. Seventy-five patients who underwent primary TMR were included (median follow-up: 2.0 years), of whom 57.3% achieved sustained pain prophylaxis whereas 26.7% reported pain disappearance. Distal amputation levels (p = 0.036), a lower Elixhauser Comorbidity Index (p = 0.001), and the absence of psychiatric comorbidities (p = 0.039) were associated with pain prophylaxis. This study demonstrates that more than half of all patients undergoing primary TMR achieved sustained pain prophylaxis, and approximately a quarter of patients achieved sustained pain disappearance. Several factors associated with these favorable outcomes are described. These results will aid in preoperative counseling, managing patient expectations, and selecting patients who may benefit most from primary TMR surgery. IV – Therapeutic [ABSTRACT FROM AUTHOR]
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- 2024
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4. Vienna-II ring applicator for distal parametrial/pelvic wall disease in cervical cancer brachytherapy: An experience from two institutions: Clinical feasibility and outcome
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Mahantshetty, Umesh, Sturdza, Alina, Naga CH, Pushpa, Berger, Daniel, Fortin, Israel, Motisi, Laura, Schmid, Maximilian P., Aravindakshan, Dheera, Ghadi, Yogesh, Swamidas, Jamema V., Chopra, Supriya, Gurram, Lavanya, Nesvacil, Nicole, Kirisits, Christian, and Pötter, Richard
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- 2019
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5. Nodal failure after chemo-radiation and MRI guided brachytherapy in cervical cancer: Patterns of failure in the EMBRACE study cohort
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Nomden, Christel N., Pötter, Richard, de Leeuw, Astrid A.C., Tanderup, Kari, Lindegaard, Jacob C., Schmid, Maximilian P., Fortin, Israël, Haie-Meder, Christine, Mahantshetty, Umesh, Hoskin, Peter, Segedin, Barbara, Bruheim, Kjersti, Rai, Bhavana, Huang, Fleur, Cooper, Rachel, Van Der Steen Banasik, Elzbieta, Van Limbergen, Erik, and Jürgenliemk-Schulz, Ina M.
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- 2019
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6. 2293: Acute gastrointestinal toxicity of concurrent chemoradiation in cervix cancer: EMBRACE-II findings
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Charnalia, Mayuri S., Tanderup, Kari, Pötter, Richard, Chopra, Supriya, Pelizzola, Marta, Jurgenliemk-Schulz, Ina M., Schmid, Maximilian P., Bruheim, Kjersti, Segedin, Barbara, Westerveld, Henrike G., Wiebe, Ericka, Valgma, Margit, Velema, Laura A., Verhoef, Lia C.G., Tan, Li Tee, Lindegaard, Jacob C., Cooper, Rachel, Mathiesen, Hanne F., Kirisits, Christian, Serban, Monica, Jain, Jeevanshu, Kirchheiner, Kathrin, Nout, Remi A., and Spampinato, Sofia
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- 2024
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7. 890: Impact of cumulative cisplatin-dose on distant metastasis after chemoradiation of cervical cancer
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Knoth, Johannes, Nout, Remi, Mahantshetty, Umesh, Jürgenliemk-Schulz, Ina, Haie-Meder, Christine, Fokdal, Lars U., Sturdza, Alina, Hoskin, Peter, Segedin, Barbara, Bruheim, Kjersti, Huang, Fleur, Rai, Bhavana, Cooper, Rachel, van der Steen-Banasik, Elzbieta, van Limbergen, Erik, Pieters, Bradley R., Tan, Li T., Boryshchuk, Daniela, de Leeuw, Astrid A.C., Nesvacil, Nicole, Tanderup, Kari, Kirisits, Christian, Lindegaard, Jacob C., Pötter, Richard, and Schmid, Maximilian P.
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- 2024
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8. Learning radiation oncology in Europe: Results of the ESTRO multidisciplinary survey
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Bibault, Jean-Emmanuel, Franco, Pierfrancesco, Borst, Gerben R., Van Elmpt, Wouter, Thorwhart, Daniela, Schmid, Maximilian P., Rouschop, Kasper M.A., Spalek, Mateusz, Mullaney, Laura, Redalen, Kathrine Røe, Dubois, Ludwig, Verfaillie, Christine, and Eriksen, Jesper Grau
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- 2018
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9. Neural network-assisted automated image registration for MRI-guided adaptive brachytherapy in cervical cancer.
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Ecker, Stefan, Zimmermann, Lukas, Heilemann, Gerd, Niatsetski, Yury, Schmid, Maximilian, Sturdza, Alina Emiliana, Knoth, Johannes, Kirisits, Christian, and Nesvacil, Nicole
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In image-guided adaptive brachytherapy (IGABT) a quantitative evaluation of the dosimetric changes between fractions due to anatomical variations, can be implemented via rigid registration of images from subsequent fractions based on the applicator as a reference structure. With available treatment planning systems (TPS), this is a manual and time-consuming process. The aim of this retrospective study was to automate this process. A neural network (NN) was trained to predict the applicator structure from MR images. The resulting segmentation was used to automatically register MR-volumes. DICOM images and plans of 56 patients treated for cervical cancer with high dose-rate (HDR) brachytherapy were used in the study. A 2D and a 3D NN were trained to segment applicator structures on clinical T2-weighted MRI datasets. Different rigid registration algorithms were investigated and compared. To evaluate a fully automatic registration workflow, the NN-predicted applicator segmentations (AS) were used for rigid image registration with the best performing algorithm. The DICE coefficient and mean distance error between dwell positions (MDE) were used to evaluate segmentation and registration performance. The mean DICE coefficient for the predicted AS was 0.70 ± 0.07 and 0.58 ± 0.04 for the 3D NN and 2D NN, respectively. Registration algorithms achieved MDE errors from 8.1 ± 3.7 mm (worst) to 0.7 ± 0.5 mm (best), using ground-truth AS. Using the predicted AS from the 3D NN together with the best registration algorithm, an MDE of 2.7 ± 1.4 mm was achieved. Using a combination of deep learning models and state of the art image registration techniques has been demonstrated to be a promising solution for automatic image registration in IGABT. In combination with auto-contouring of organs at risk, the auto-registration workflow from this study could become part of an online-dosimetric interfraction evaluation workflow in the future. [ABSTRACT FROM AUTHOR]
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- 2022
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10. Evidence-Based Dose Planning Aims and Dose Prescription in Image-Guided Brachytherapy Combined With Radiochemotherapy in Locally Advanced Cervical Cancer.
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Tanderup, Kari, Nesvacil, Nicole, Kirchheiner, Kathrin, Serban, Monica, Spampinato, Sofia, Jensen, Nina Boje Kibsgaard, Schmid, Maximilian, Smet, Stephanie, Westerveld, Henrike, Ecker, Stefan, Mahantshetty, Umesh, Swamidas, Jamema, Chopra, Supriya, Nout, Remi, Tan, Li Tee, Fokdal, Lars, Sturdza, Alina, Jürgenliemk-Schulz, Ina, de Leeuw, Astrid, and Lindegaard, Jacob Christian
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The last 2 decades have witnessed the development and broad adoption of image-guided adaptive brachytherapy (IGABT) combined with radiochemotherapy in patients with locally advanced cervical cancer. A variety of brachytherapy techniques and dose/fractionation schedules have been applied, and until recently, there was no strong evidence available for preferring one approach to another. However, large volumes of data have now provided high level clinical evidence for dose-effect relations for both disease and morbidity endpoints. It is therefore now possible to apply evidence based dose planning aims and dose prescription protocols in IGABT for locally advanced cervical cancer. This review gives an overview of targets/organs-at-risk and disease/morbidity endpoints which are relevant in the context of treatment planning and dose prescription in IGABT. The dosimetric and clinical evidence is summarized to support the implementation of dose prescription protocols which include hard and soft constraints for targets and organs at risk. [ABSTRACT FROM AUTHOR]
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- 2020
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11. Recommendations from gynaecological (GYN) GEC-ESTRO working group – ACROP: Target concept for image guided adaptive brachytherapy in primary vaginal cancer.
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Schmid, Maximilian P., Fokdal, Lars, Westerveld, Henrike, Chargari, Cyrus, Rohl, Lisbeth, Morice, Philippe, Nesvacil, Nicole, Mazeron, Renaud, Haie-Meder, Christine, Pötter, Richard, and Nout, Remi A.
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VAGINAL cancer , *RADIOISOTOPE brachytherapy , *MAGNETIC resonance imaging , *CONCEPTS , *LYMPH nodes - Abstract
• Adaptive target volume concept for EBRT and brachytherapy in primary vaginal cancer. • MRI is the imaging modality of choice for target volume delineation in brachytherapy. • Common terminology will facilitate multicenter research. External beam radiotherapy (EBRT) combined with brachytherapy has an essential role in the curative treatment of primary vaginal cancer. EBRT is associated with significant tumour shrinkage, making primary vaginal cancer suitable for image guided adaptive brachytherapy (IGABT). The aim of these recommendations is to introduce an adaptive target volume concept for IGABT of primary vaginal cancer. In December 2013, a task group was initiated within GYN GEC-ESTRO with the purpose to introduce an IGABT target concept for primary vaginal cancer. All participants have broad experience in IGABT and vaginal cancer brachytherapy. The target concept was elaborated as consensus agreement based on an iterative process including target delineation and dose planning comparison, retrospective analysis of clinical data and expert opinions. Gynaecological examination and MR imaging are the modalities of choice for local tumour assessment. A specific template for standardised documentation with clinical drawings for vaginal cancer was developed. The adaptive target volume concept comprises different response-related target volumes. For EBRT these are related to the primary tumour and the lymph nodes, while for IGABT these are related to the primary tumour and are consisting of the residual gross tumour volume (GTV-T res) and the high-, and intermediate risk clinical target volumes (CTV-T HR , CTV-T IR). This target concept for IGABT of primary vaginal cancer defines adaptive target volumes for volumetric dose prescription and should improve comparability of different radiotherapy schedules of this rare disease. A prospective evaluation of the target volume concept within a multicentre study is planned. [ABSTRACT FROM AUTHOR]
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- 2020
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12. LDHA-Associated Lactic Acid Production Blunts Tumor Immunosurveillance by T and NK Cells.
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Brand, Almut, Singer, Katrin, Koehl, Gudrun E., Kolitzus, Marlene, Schoenhammer, Gabriele, Thiel, Annette, Matos, Carina, Bruss, Christina, Klobuch, Sebastian, Peter, Katrin, Kastenberger, Michael, Bogdan, Christian, Schleicher, Ulrike, Mackensen, Andreas, Ullrich, Evelyn, Fichtner-Feigl, Stefan, Kesselring, Rebecca, Mack, Matthias, Ritter, Uwe, and Schmid, Maximilian
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Summary Elevated lactate dehydrogenase A (LDHA) expression is associated with poor outcome in tumor patients. Here we show that LDHA-associated lactic acid accumulation in melanomas inhibits tumor surveillance by T and NK cells. In immunocompetent C57BL/6 mice, tumors with reduced lactic acid production (Ldha low ) developed significantly slower than control tumors and showed increased infiltration with IFN-γ-producing T and NK cells. However, in Rag2 –/– γc – / – mice, lacking lymphocytes and NK cells, and in Ifng –/– mice, Ldha low and control cells formed tumors at similar rates. Pathophysiological concentrations of lactic acid prevented upregulation of nuclear factor of activated T cells (NFAT) in T and NK cells, resulting in diminished IFN-γ production. Database analyses revealed negative correlations between LDHA expression and T cell activation markers in human melanoma patients. Our results demonstrate that lactic acid is a potent inhibitor of function and survival of T and NK cells leading to tumor immune escape. [ABSTRACT FROM AUTHOR]
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- 2016
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13. Combining transrectal ultrasound and CT for image-guided adaptive brachytherapy of cervical cancer: Proof of concept.
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Nesvacil, Nicole, Schmid, Maximilian P., Pötter, Richard, Kronreif, Gernot, and Kirisits, Christian
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CERVICAL cancer treatment , *ENDORECTAL ultrasonography , *IMAGE-guided radiation therapy , *RADIOISOTOPE brachytherapy , *RADIOTHERAPY treatment planning - Abstract
Purpose To investigate the feasibility of a treatment planning workflow for three-dimensional image-guided cervix cancer brachytherapy, combining volumetric transrectal ultrasound (TRUS) for target definition with CT for dose optimization to organs at risk (OARs), for settings with no access to MRI. Methods and Materials A workflow for TRUS/CT-based volumetric treatment planning was developed, based on a customized system including ultrasound probe, stepper unit, and software for image volume acquisition. A full TRUS/CT-based workflow was simulated in a clinical case and compared with MR- or CT-only delineation. High-risk clinical target volume was delineated on TRUS, and OARs were delineated on CT. Manually defined tandem/ring applicator positions on TRUS and CT were used as a reference for rigid registration of the image volumes. Treatment plan optimization for TRUS target and CT organ volumes was performed and compared to MRI and CT target contours. Results TRUS/CT-based contouring, applicator reconstruction, image fusion, and treatment planning were feasible, and the full workflow could be successfully demonstrated. The TRUS/CT plan fulfilled all clinical planning aims. Dose-volume histogram evaluation of the TRUS/CT-optimized plan (high-risk clinical target volume D 90 , OARs D 2cm³ for) on different image modalities showed good agreement between dose values reported for TRUS/CT and MRI-only reference contours and large deviations for CT-only target parameters. Conclusions A TRUS/CT-based workflow for full three-dimensional image-guided cervix brachytherapy treatment planning seems feasible and may be clinically comparable to MRI-based treatment planning. Further development to solve challenges with applicator definition in the TRUS volume is required before systematic applicability of this workflow. [ABSTRACT FROM AUTHOR]
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- 2016
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14. Transrectal ultrasound for image-guided adaptive brachytherapy in cervix cancer – An alternative to MRI for target definition?
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Schmid, Maximilian P., Nesvacil, Nicole, Pötter, Richard, Kronreif, Gernot, and Kirisits, Christian
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ENDORECTAL ultrasonography , *CERVICAL cancer diagnosis , *CERVICAL cancer treatment , *IMAGE-guided radiation therapy , *RADIOISOTOPE brachytherapy , *MAGNETIC resonance imaging - Abstract
Purpose To compare the maximum high risk clinical target volume (CTV HR ) dimensions and image quality between magnetic resonance imaging (MRI), transrectal ultrasound (TRUS) and computed tomography (CT) in image guided adaptive brachytherapy (IGABT) of locally advanced cervical cancer. Material and methods All patients with locally advanced cervical cancer treated with radiochemotherapy and IGABT between 09/2012-05/2013 were included in this study. T2-weighted MRI (1.5 tesla), TRUS and CT were performed before (MRI preBT , TRUS preBT ) and/or after (MRI BT , TRUS BT and CT BT ) insertion of the applicator. 3D TRUS image acquisition was done with a customized US stepper device and software. The HR CTV was defined on 3D image sequences acquired with different imaging modalities by one blinded observer, in accordance to the GEC-ESTRO recommendations for MRI-based target volume delineation, as the complete cervical mass including the tumour, any suspicious areas of parametrial involvement and the normal cervical stroma. Maximum HR CTV width and thickness were measured on transversal planes. Image quality was classified using the following scoring system: Grade 0: not depicted, Grade 1: inability to discriminate, margin not recognizable, Grade 2: fair discrimination, margin indistinct, Grade 3: excellent discrimination, margin distinct. Descriptive statistics, mean differences between the groups, with MRI BT as reference, and a paired t -test were calculated. Results Images from 19 patients (FIGO IB: 3, IIB: 9, IIIB: 5, IVB: 2) were available for analysis. The mean difference in maximum HR CTV width of TRUS BT, TRUS preBT, MRI preBT, CT BT to MRI BT was 0.0 mm ± 4.7 (n.s.), −1.1 mm ± 5.6 (n.s.), 0.7 mm ± 6.4 (n.s.) and 13.8 mm ± 6.7 ( p < 0.001). The mean difference in maximum HR CTV thickness of TRUS BT, TRUS preBT, MRI preBT, CT BT to MRI BT was -3.4 mm ± 5.9 ( p = 0.037), −3.4 mm ± 4.2 ( p < 0.001), 2.0 mm ± 6.1 (n.s.) and 13.9 mm ± 6.3 ( p < 0.001). Mean scores of image quality of the target volume was 2.9 for TRUS preBT , 2.3 for TRUS BT , 2.9 for MRI preBT , 2.7 for MRI BT and 2.1 for CT BT . Conclusion For the assessment of the HR CTV in IGABT of cervical cancer, TRUS is within the intraobserver variability of MRI. TRUS is superior to CT as it yields systematically smaller deviations from MRI, with good to excellent image quality. Small differences of TRUS HR CTV thickness are likely related to differences in image slice orientation and compression of the cervix by the TRUS probe before insertion of the brachytherapy applicator. [ABSTRACT FROM AUTHOR]
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- 2016
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15. Late gastrointestinal and urogenital side-effects after radiotherapy – Incidence and prevalence. Subgroup-analysis within the prospective Austrian–German phase II multicenter trial for localized prostate cancer
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Schmid, Maximilian P., Pötter, Richard, Bombosch, Valentin, Sljivic, Samir, Kirisits, Christian, Dörr, Wolfgang, and Goldner, Gregor
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PROSTATE cancer treatment , *CANCER radiotherapy complications , *RADIATION doses , *GASTROINTESTINAL system abnormalities , *LONGITUDINAL method , *COHORT analysis ,GENITOURINARY organ abnormalities - Abstract
Abstract: Purpose: In general late side-effects after prostate cancer radiotherapy are presented by the use of actuarial incidence rates. The aim of this analysis was to describe additional relevant aspects of late side effects after prostate cancer radiotherapy. Materials and methods: All 178 primary prostate-cancer patients were treated within the Austrian–German multicenter trial by three-dimensional radiotherapy up to a local dose of 70Gy (low/intermediate-risk) or 74Gy (high-risk), respectively. Late gastrointestinal/urogenital (GI/GU) side-effects were prospectively assessed by the use of EORTC/RTOG score. Maximum side-effects, actuarial incidence rate and prevalence rates, initial appearance and duration of ⩾grade 2 toxicity were evaluated. Results: Median follow-up was 74months. Late GI/GU side-effects ⩾grade 2 were detected in 15% (27/178) and 22% (40/178). The corresponding 5-year actuarial incidence rates for GI/GU side-effects were 19% and 23%, whereas the prevalence was 1–2% and 2–7% after 5years, respectively. Late side effects ⩾grade 2 appeared within 5years after radiotherapy in all patients with GI side-effects (27/27) and in 85% (34/40) of the patients with GU side-effects, respectively and lasted for less than 3years in 90% (GI) and 98% (GU). Conclusions: This study demonstrates that the majority of late GI and GU side effects after primary external beam radiotherapy for prostate cancer are transient. Using only actuarial incidence rates for reporting side effects may lead to misinterpretation or overestimation. The combination of incidence and prevalence rates provides a more comprehensive view on the complex issue of late side effects. [Copyright &y& Elsevier]
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- 2012
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16. Treatment of Locally Advanced Vaginal Cancer With Radiochemotherapy and Magnetic Resonance Image-Guided Adaptive Brachytherapy: Dose–Volume Parameters and First Clinical Results
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Dimopoulos, Johannes C.A., Schmid, Maximilian P., Fidarova, Elena, Berger, Daniel, Kirisits, Christian, and Pötter, Richard
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VAGINAL cancer , *CANCER radiotherapy , *CANCER chemotherapy , *MAGNETIC resonance imaging of cancer , *FEASIBILITY studies , *HEALTH outcome assessment - Abstract
Purpose: To investigate the clinical feasibility of magnetic resonance image-guided adaptive brachytherapy (IGABT) for patients with locally advanced vaginal cancer and to report treatment outcomes. Methods and Materials: Thirteen patients with vaginal cancer were treated with external beam radiotherapy (45–50.4 Gy) plus IGABT with or without chemotherapy. Distribution of International Federation of Gynecology and Obstetrics stages among patients were as follows: 4 patients had Stage II cancer, 5 patients had Stage III cancer, and 4 patients had Stage IV cancer. The concept of IGABT as developed for cervix cancer was transferred and adapted for vaginal cancer, with corresponding treatment planning and reporting. Doses were converted to the equivalent dose in 2 Gy, applying the linear quadratic model (α/β = 10 Gy for tumor; α/β = 3 for organs at risk). Endpoints studied were gross tumor volume (GTV), dose-volume parameters for high-risk clinical target volume (HRCTV), and organs at risk, local control (LC), adverse side effects, and survival. Results: The mean GTV (± 1 standard deviation) at diagnosis was 45.3 (±30) cm3, and the mean GTV at brachytherapy was 10 (±14) cm3. The mean D90 for the HRCTV was 86 (±13) Gy. The mean D2cc for bladder, urethra, rectum, and sigmoid colon were 80 (±20) Gy, 76 (±16) Gy, 70 (±9) Gy, and 60 (±9) Gy, respectively. After a median follow-up of 43 months (range, 19–87 months), one local recurrence and two distant metastases cases were observed. Actuarial LC and overall survival rates at 3 years were 92% and 85%. One patient with Stage IVA and 1 patient with Stage III disease experienced fistulas (one vesicovaginal, one rectovaginal), and 1 patient developed periurethral necrosis. Conclusions: The concept of IGABT, originally developed for treating cervix cancer, appears to be applicable to vaginal cancer treatment with only minor adaptations. Dose-volume parameters for HRCTV and organs at risk are in a comparable range. First clinical results indicate excellent LC. Further prospective multicenter studies are needed to establish this method and to confirm these results. [ABSTRACT FROM AUTHOR]
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- 2012
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17. Local recurrences in cervical cancer patients in the setting of image-guided brachytherapy: A comparison of spatial dose distribution within a matched-pair analysis
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Schmid, Maximilian P., Kirisits, Christian, Nesvacil, Nicole, Dimopoulos, Johannes C.A., Berger, Daniel, and Pötter, Richard
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CANCER relapse , *CERVICAL cancer , *RADIOISOTOPE brachytherapy , *CANCER chemotherapy , *MAGNETIC resonance imaging of cancer , *COMPARATIVE studies - Abstract
Abstract: Purpose: It has been shown that a cumulative dose of ⩾87Gy (EQD2) of external beam radiotherapy (EBRT) and image guided adaptive brachytherapy (IGABT) to the high risk clinical target volume (HR CTV) confer a local control rate >95% in locally advanced cervical cancer. This study examines the dose distribution within the HR CTV and intermediate (IR) CTV in patients with cervical cancer treated with definitive EBRT +/− concomitant chemotherapy and MRI-based IGABT between patients with local recurrence (LR) and patients in continuous complete local remission (CCLR). Material and methods: From 1998 to 2010, 265 patients were treated with definitive EBRT +/− concomitant chemotherapy and IGABT. Twenty-four LRs were documented. For the statistical analysis all patients with LR were matched to patients in CCLR from our database according to the following criteria: FIGO stage, histology, lymph node status, tumour size and chemotherapy. DVH parameters (D50, D90, D98, D100) were reported for HR CTV and IR CTV. In order to report the minimum dose in the region where the recurrence occurred, the HR CTV/IR CTV were divided into four quadrants on transversal planes. The minimum dose at the HR CTV/IR CTV contour was measured (within the corresponding quadrant closest to the LR) in the treatment planning system. A mean minimum point dose (MPD) was calculated by averaging these measurements on four consecutive slices at the level of the recurrence for each of the 4 brachytherapy fractions. EQD2 doses were calculated by summation of all BT and external beam therapy fractions. For each matched patient in the control group the measurements were performed on the same quadrant and at the same level. Results: Sufficient image data were available for 21 LRs. Eight central failures and 13 non-central failures were observed. The mean D90 and D100 for HR CTV were 77Gy and 61Gy for patients with LR and 95Gy and 71Gy for patients in CCLR, respectively (p <0.01). The MPD for HR CTV was 72Gy for patients in the LR arm and 99Gy for patients in the CCLR arm (p <0.01). In the LR arm seven patients had a D90 for HR CTV ⩾87Gy, however, in only three patients the MPD was ⩾87Gy. Conclusion: This study demonstrated significant differences in local outcome according to the delivered dose. In 85% of the LRs systematic low dose regions with less than 87Gy were found at HR CTV contour. Systematic low dose regions leading to local recurrence could be detected even if a D90 HR CTV ⩾87Gy was applied. In addition to DVH parameters, inspection of the spatial dose distribution remains a key point in dose prescription. [Copyright &y& Elsevier]
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- 2011
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18. High-tech image-guided therapy versus low-tech, simple, cheap gynecologic brachytherapy.
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Kirisits, Christian, Schmid, Maximilian P., Beriwal, Sushil, and Pötter, Richard
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RADIOISOTOPE brachytherapy , *GYNECOLOGIC care , *MEDICAL periodicals , *PERIODICAL publishing , *IMAGE-guided radiation therapy - Published
- 2015
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19. 2034: Morbidity profile of different lymph node management strategies in node positive cervical cancer.
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Zaharie, Alexandru-Teodor, Knoth, Johannes, Sturdza, Alina E., Pötter, Richard, Widder, Joachim, and Schmid, Maximilian P.
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CERVICAL cancer , *LYMPH nodes - Published
- 2024
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20. In response to the letter to the editor from Sylvia van Dyk et al. regarding our editorial “High-tech image-guided therapy vs. low-tech, simple, cheap gynecologic brachytherapy”.
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Kirisits, Christian, Schmid, Maximilian P., Beriwal, Sushil, and Pötter, Richard
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MEDICAL imaging systems , *GYNECOLOGIC care , *RADIOISOTOPE brachytherapy , *CANCER radiotherapy , *CERVICAL cancer patients - Published
- 2016
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21. Mean, lowest, and highest pulsatility index of the uterine artery and adverse pregnancy outcome in twin pregnancies.
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Klein, Katharina, Mailath-Pokorny, Mariella, Elhenicky, Marie, Schmid, Maximilian, Zeisler, Harald, and Worda, Christof
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UTERINE artery ,HEALTH outcome assessment ,MEDICAL screening ,PREECLAMPSIA ,ADVERSE health care events ,TWINS ,MEDICAL care - Abstract
Objective: The objective of the study was to assess the use of mean, lowest, and highest pulsatility index (PI) of the uterine arteries to screen for adverse pregnany outcome in twin pregnancies. Study Design: This was a screening study of 423 twin pregnancies. Relationship between PI at 20-22 weeks and adverse pregnancy outcome was evaluated. Results: Mean, lowest, and highest PI above the 95th centile were significant risk factors for preeclampsia and adverse pregnancy outcome in monochorionic and dichorionic twins. We calculated a sensitivity for preeclampsia for mean, highest, and lowest PI of 35%, 29%, and 27%, respectively. Conclusion: Increased mean, lowest, and highest PI is associated with a higher risk of preeclampsia and adverse pregnancy outcome in twins. We observed the highest sensitivity and specificity by using highest PI. The high incidence of preeclampsia in twins makes it attractive to use the PI of the uterine artery for risk stratification in twins. [ABSTRACT FROM AUTHOR]
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- 2011
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22. Severity and Persistency of Late Gastrointestinal Morbidity in Locally Advanced Cervical Cancer: Lessons Learned From EMBRACE-I and Implications for the Future.
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Spampinato, Sofia, Jensen, Nina B.K., Pötter, Richard, Fokdal, Lars U., Chargari, Cyrus, Lindegaard, Jacob C., Schmid, Maximilian P., Sturdza, Alina, Jürgenliemk-Schulz, Ina M., Mahantshetty, Umesh, Hoskin, Peter, Segedin, Barbara, Rai, Bhavana, Bruheim, Kjersti, Wiebe, Ericka, Van der Steen-Banasik, Elzbieta, Cooper, Rachel, Van Limbergen, Erik, Sundset, Marit, and Pieters, Bradley R.
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CERVICAL cancer , *EXTERNAL beam radiotherapy , *SMALL intestine , *GASTROINTESTINAL system , *UTERINE hemorrhage , *GASTROINTESTINAL hemorrhage , *SIGMOID colon - Abstract
Purpose: The purpose was to evaluate patient- and treatment-related risk factors for physician-assessed and patient-reported gastrointestinal (GI) symptoms after radio(chemo)therapy and image guided adaptive brachytherapy in locally advanced cervical cancer.Methods and Materials: Of 1416 patients from the EMBRACE-I study, 1199 and 1002 were prospectively evaluated using physician-assessed (Common Terminology Criteria for Adverse Events [CTCAE]) and patient-reported (European Organization for Research and Treatment of Cancer [EORTC]) GI symptoms, respectively. CTCAE severe grade (grade [G] ≥3) events were pooled according to the location in the GI tract (anus/rectum, sigmoid, and colon/small bowel). CTCAE G ≥2 and EORTC "very much" and "quite a bit" plus "very much" scores (≥ "quite a bit") were analyzed for individual symptoms with Cox regression. Logistic regression was used for persistent G ≥1 and EORTC ≥ "quite a bit" symptoms, defined if present in at least half of follow-ups.Results: The incidence of G ≥3 events was 2.8%, 1.8%, and 2.3% for G ≥3 anus/rectum, sigmoid, and colon/small bowel events, respectively. Among G ≥2 symptoms, diarrhea and flatulence were the most prevalent (8.5% and 9.9%, respectively). Among patient-related factors, baseline morbidity, increasing age, smoking status, and low body mass index were associated with GI symptoms to varying degrees. Among treatment-related factors, rectum D2cm3 and the International Commission on Radiation Units and Measurements recto-vaginal reference point (ICRU RV-RP) correlated with G ≥3 anus/rectum events and moderate/persistent diarrhea, proctitis, bleeding, abdominal cramps, and difficulty in bowel control. Bowel D2cm3 correlated with G ≥3 sigmoid and colon/small bowel events and moderate/persistent diarrhea and flatulence. For external beam radiation therapy (EBRT), prescription dose correlated with G ≥3 anus/rectum, diarrhea, and difficulty in bowel control. Patients with large lymph-node boost (V57Gy) were at higher risk for G ≥3 sigmoid events, moderate/persistent diarrhea, proctitis, and cramps.Conclusions: The analysis showed that both EBRT and image guided adaptive brachytherapy contribute to GI symptoms after locally advanced cervical cancer treatment. Rectum D2cm3, ICRU RV-RP , and bowel D2cm3 are risk factors for GI morbidity. The risk for various symptoms was lower with an EBRT prescription of 45 Gy than 50 Gy and increased with larger V57Gy. [ABSTRACT FROM AUTHOR]- Published
- 2022
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23. Impact of Vaginal Symptoms and Hormonal Replacement Therapy on Sexual Outcomes After Definitive Chemoradiotherapy in Patients With Locally Advanced Cervical Cancer: Results from the EMBRACE-I Study.
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Kirchheiner, Kathrin, Smet, Stéphanie, Jürgenliemk-Schulz, Ina M., Haie-Meder, Christine, Chargari, Cyrus, Lindegaard, Jacob C., Fokdal, Lars U., Spampinato, Sofia, Schmid, Maximilian P., Sturdza, Alina, Mahantshetty, Umesh, Segedin, Barbara, Bruheim, Kjersti, Rai, Bhavana, Cooper, Rachel, Van der Steen-Banasik, Elzbieta, Wiebe, Ericka, Sundset, Marit, van Limbergen, Erik, and Villafranca, Elena
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CERVICAL cancer , *HORMONE therapy , *SEXUAL intercourse , *SECONDARY prevention , *VULVODYNIA , *UTERINE hemorrhage , *RESEARCH , *HUMAN sexuality , *RESEARCH methodology , *EVALUATION research , *COMPARATIVE studies , *QUALITY of life , *QUESTIONNAIRES , *RADIOTHERAPY , *LONGITUDINAL method ,CERVIX uteri tumors - Abstract
Purpose: To evaluate patient-reported sexual outcomes after chemoradiation therapy and image-guided adaptive brachytherapy for locally advanced cervical cancer in the observational, prospective, multicenter EMBRACE-I study.Methods and Materials: Sexual outcomes were assessed prospectively with the European Organization for Research and Treatment of Cancer Qualify of Life Questionnaire (EORTC-QLQ-CX24) at baseline and follow-up. Crude incidence and prevalence rates of sexual activity, vaginal functioning problems (dryness, shortening, tightening, pain during intercourse), and sexual enjoyment were evaluated. Associations between pain during intercourse and vaginal functioning problems or sexual enjoyment were calculated, pooling observations over all follow-ups (Spearman correlation coefficient). In patients who were frequently sexually active (≥50% of follow-ups), the effects of regular hormonal replacement therapy (HRT) on vaginal functioning problems were evaluated (Pearson χ2).Results: The analysis involved 1045 patients with a median follow-up of 50 months. Sexual activity was reported by 22% of patients at baseline and by 40% to 47% of patients during follow-up (prevalence rates). Vaginal functioning problems in follow-up were dryness (18%-21%), shortening (15%-22%), tightening (16%-22%), pain during intercourse (9%-21%), and compromised enjoyment (37%-47%). Pain during intercourse was significantly associated with vaginal tightening (r = 0.544), shortening (r = 0.532), and dryness (r = 0.408) and negatively correlated with sexual enjoyment (r = -0.407). Regular HRT was associated with significantly less vaginal dryness (P = .015), shortening (P = .024), pain during intercourse (P = .003), and borderline higher sexual enjoyment (P = .062).Conclusions: Vaginal functioning problems are associated with pain and compromised sexual enjoyment. Further effort is required for the primary prevention of vaginal morbidity with dose optimization and adaptation. Secondary prevention strategies, including HRT for vaginal and sexual health after radiation therapy in locally advanced cervical cancer, should be considered and sexual rehabilitation programs should be developed further. [ABSTRACT FROM AUTHOR]- Published
- 2022
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24. Risk factors and dose-effects for bladder fistula, bleeding and cystitis after radiotherapy with imaged-guided adaptive brachytherapy for cervical cancer: An EMBRACE analysis.
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Spampinato, Sofia, Fokdal, Lars U., Pötter, Richard, Haie-Meder, Christine, Lindegaard, Jacob C., Schmid, Maximilian P., Sturdza, Alina, Jürgenliemk-Schulz, Ina M., Mahantshetty, Umesh, Segedin, Barbara, Bruheim, Kjersti, Hoskin, Peter, Rai, Bhavana, Huang, Fleur, Cooper, Rachel, van der Steen-Banasik, Elzbieta, Van Limbergen, Erik, Sundset, Marit, Westerveld, Henrike, and Nout, Remi A.
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BLADDER cancer , *INTERSTITIAL cystitis , *CERVICAL cancer , *CYSTITIS , *BLADDER , *FISTULA , *RADIOISOTOPE brachytherapy - Abstract
• Urinary morbidity after treatment of locally advanced cervical cancer is prevalent. • Bladder dose constraints based on a high level clinical evidence are not available. • EMBRACE I provides prospective morbidity data for analysis in a large cohort. • Individual physician and patient reported urinary endpoints were analysed in EMBRACE I. • Bladder fistula, bleeding and cystitis showed dose–effect with bladder D 2cm3. To identify patient- and treatment-related risk factors for fistula, bleeding, cystitis, pain and difficulty in voiding in locally advanced cervical cancer patients treated with radio(chemo)therapy and image-guided adaptive brachytherapy (IGABT). Morbidity within the EMBRACE-I study was prospectively reported for physician-assessed (CTCAE) fistula, bleeding and cystitis and patient-reported (EORTC) pain and difficulty in voiding. Analysis of risk factors was performed in patients without bladder infiltration. Risk factors were tested with Cox regression for grade (G) ≥ 3 cystitis, for G ≥ 2 fistula, bleeding and cystitis, and for EORTC "very much" and "quite a bit" or worse. Of 1416 patients enrolled, 1153 and 884 patients without bladder infiltration were evaluable for the analysis of CTCAE and EORTC items, respectively. Median follow-up was 48[3–120] months. Crude incidence rates for G ≥ 2 fistula, bleeding and cystitis were 0.7%, 2.7% and 8.8%, respectively, and 16% and 14% for "quite a bit" or worse pain and difficulty in voiding, respectively. Baseline urinary morbidity and overweight/obesity were significant risk factors for most endpoints. Bladder D 2cm3 correlated with G ≥ 2 fistula, bleeding and cystitis, while ICRU bladder point dose correlated with EORTC pain "quite a bit" or worse. An increase from 75 Gy to 80 Gy in bladder D 2cm3 resulted in an increase from 8% to 13% for 4-year actuarial estimate of G ≥ 2 cystitis. Clinical and treatment-related risk factors for bladder fistula, bleeding and cystitis were identified within a prospective and multi-institutional setting. A dose–effect was established with bladder D 2cm3 , reinforcing the importance of continued optimization during individualized IGABT planning. [ABSTRACT FROM AUTHOR]
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- 2021
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25. Importance of the ICRU bladder point dose on incidence and persistence of urinary frequency and incontinence in locally advanced cervical cancer: An EMBRACE analysis.
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Spampinato, Sofia, Fokdal, Lars U., Pötter, Richard, Haie-Meder, Christine, Lindegaard, Jacob C., Schmid, Maximilian P., Sturdza, Alina, Jürgenliemk-Schulz, Ina M., Mahantshetty, Umesh, Segedin, Barbara, Bruheim, Kjersti, Hoskin, Peter, Rai, Bhavana, Huang, Fleur, Cooper, Rachel, van der Steen-Banasik, Elzbieta, Van Limbergen, Erik, Sundset, Marit, Westerveld, Henrike, and Nout, Remi A.
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CERVICAL cancer , *BLADDER , *URINARY incontinence , *OVERACTIVE bladder , *OLDER patients , *FACTOR analysis , *CANCER radiotherapy - Abstract
• Urinary side effects after radiotherapy can rely on different bladder substructures. • EMBRACE I provides prospective morbidity data to study individual urinary symptoms. • Frequency and incontinence are frequent side effects in cervix cancer radiotherapy. • Limited clinical evidence supports the predictive value of ICRU Bladder point dose. • This analysis showed correlation of ICRU Bladder point dose with incontinence. To identify patient- and treatment-related risk factors and dose-effects for urinary frequency and incontinence in locally advanced cervical cancer (LACC) treated with radio(chemo)therapy and image-guided adaptive brachytherapy (IGABT). Physician-assessed (CTCAE) and patient-reported (EORTC) frequency and incontinence recorded in the EMBRACE-I study were analysed. Risk factors analysis was performed in patients without bladder infiltration and with baseline morbidity available. Cox regression was used for CTCAE grade (G) ≥ 3 and G ≥ 2 and for EORTC "very much" and "quite a bit" or worse. Logistic regression was used for late persistent morbidity defined when CTCAE G ≥ 1 or EORTC ≥ "quite a bit" were scored in at least half of follow-ups. Longitudinal data on 1153 and 884 patients were available for CTCAE and EORTC analysis, respectively. Median follow-up was 48[3-120] months. Crude incidence rates of G≥2 were 13% and 11% for frequency and incontinence, respectively. Baseline morbidity and overweight-obesity were risk factors for both symptoms. Elderly patients were at higher risk for incontinence. Patients receiving conformal-radiotherapy were at higher risk for frequency. ICRU bladder point (ICRU-BP) dose was a stronger predictor for incontinence than bladder D 2cm3. The 5-year actuarial estimate of G ≥ 2 incontinence increased from 11% to 20% with ICRU-BP doses > 75 Gy compared to ≤ 65 Gy. Frequency showed weaker associations with dose. ICRU-BP dose, in addition to clinical parameters, is a risk factor for urinary incontinence and shows a dose–effect after radio(chemo)therapy and IGABT. ICRU-BP dose should be monitored during treatment planning alongside volumetric parameters. Frequency seems associated with larger irradiated volumes. [ABSTRACT FROM AUTHOR]
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- 2021
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26. Results of image guided brachytherapy for stage IB cervical cancer in the RetroEMBRACE study.
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Petric, Primoz, Lindegaard, Jacob C., Sturdza, Alina, Fokdal, Lars, Kirchheiner, Kathrin, Tan, Li T., Schmid, Maximilian P., Haie-Meder, Christine, Jürgenliemk-Schulz, Ina M., van Limbergen, Erik, Hoskin, Peter, Gillham, Charles, Tharavichitkul, Ekkasit, Mahantshetty, Umesh, Villafranca, Elena, Tanderup, Kari, Kirisits, Christian, and Pötter, Richard
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CERVICAL cancer , *EXTERNAL beam radiotherapy , *ADJUVANT chemotherapy , *ONCOLOGIC surgery , *SQUAMOUS cell carcinoma , *TRACHELECTOMY - Abstract
• Local and pelvic control in FIGO 1994 stage IB were ≥95% with acceptable morbidity. • We found no isolated local relapse. Pelvic failure occurred in 3%. Most relapses were systemic. • Results of modern brachytherapy in early cervical cancer parallel those of modern surgery. Multiple treatment options are used in early local-stage cervical cancer, including combinations of surgery with neoadjuvant/adjuvant radiotherapy and chemotherapy. Our aim was to determine the outcome for definitive chemoradiation with image guided brachytherapy (IGBT). FIGO 1994 staging system was used in our study. We included 123 patients with stage IB cervical cancer, treated at 12 centers with external beam radiotherapy (EBRT) ± Chemotherapy and IGBT. Three- and 5-year actuarial local control (LC), pelvic control (PC), overall survival (OS), cancer-specific survival (CSS) and late morbidity (CTCAE v 3.0) were computed. Median age was 48 (23–82) years. FIGO 1994 stage distribution was: IB1 68% and IB2 32%; 41% of the entire cohort had nodal metastases and 73% squamous-cell carcinoma. MRI-based tumor size was >40 mm in 63%. Median EBRT dose was 45 (40–50) Gy; 84% received chemotherapy. At IGBT, mean CTV-HR D90 was 93 ± 17 Gy (EQD2 10). D2cc for bladder was 76 ± 14 Gy, rectum 66 ± 11 Gy, sigmoid 66 ± 10 Gy, bowel 67 ± 7 Gy (EQD2 3). At 43-months median follow-up, 9% of patients had systemic, 6% paraaortic, 3% pelvic-nodal and 2% local failure. Five-year LC was 98%, PC 96%, CSS 90%, OS 83%. Intestinal G3-–4 morbidity was 8%, urinary 7% and vaginal 0%. Chemoradiation with IGBT for FIGO 1994 stage IB cervical cancer leads to excellent loco-regional control with limited morbidity. In IB node-negative disease, it can be regarded equivalent to surgery in terms of oncologic outcome. In tumors with unfavorable pre-treatment characteristics, chemoradiation is the first choice to avoid combining surgery with adjuvant therapy. [ABSTRACT FROM AUTHOR]
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- 2021
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27. Dose-Volume Effects and Risk Factors for Late Diarrhea in Cervix Cancer Patients After Radiochemotherapy With Image Guided Adaptive Brachytherapy in the EMBRACE I Study.
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K. Jensen, Nina B., Pötter, Richard, Spampinato, Sofia, Fokdal, Lars U., Chargari, Cyrus, Lindegaard, Jacob C., Schmid, Maximilian P., Sturdza, Alina, Jürgenliemk-Schulz, Ina M., Mahantshetty, Umesh, Segedin, Barbara, Bruheim, Kjersti, Hoskin, Peter, Rai, Bhavana, Wiebe, Ericka, Cooper, Rachel, Van der Steen-Banasik, Elzbieta, Van Limbergen, Erik, Sundset, Marit, and Pieters, Bradley R.
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CERVICAL cancer , *RADIOTHERAPY , *DIARRHEA , *CHEMORADIOTHERAPY , *RADIOISOTOPE brachytherapy - Abstract
Purpose: To evaluate patient- and treatment-related risk factors associated with incidence and persistence of late diarrhea after radiochemotherapy and image guided adaptive brachytherapy (IGABT) in locally advanced cervical cancer.Materials and Methods: Of 1416 patients from the EMBRACE I study, 1199 were prospectively evaluated using physician-reported (Common Terminology Criteria for Adverse Events version 3 [CTCAEv3]) assessment for diarrhea; median follow-up 48 months. Patient-reported outcome (EORTC) was available in 900 patients. Incidence of CTCAE G≥2, G≥3, and EORTC "very much" diarrhea was analyzed with Cox proportional hazards regression. Binary logistic regression was used for analysis of persistent G≥1 and EORTC "quite a bit" - "very much" (≥"quite a bit") diarrhea, defined if present in at least half of all follow-ups.Results: Crude incidences of G≥2 and G≥3 diarrhea were 8.3% and 1.5%, respectively, and 8% of patients reported "very much" diarrhea. Persistent G≥1 and ≥"quite a bit" diarrhea was present in 16% and 7%, respectively. Patient-related risk factors were baseline diarrhea, smoking, and diabetes with hazard ratios of 1.4 to 7.3. Treatment-related risk factors included prescribed dose, V43 Gy, V57 Gy (lymph node boost), and para-aortic irradiation for external beam radiation therapy (EBRT). G≥2 diarrhea at 3 years increased from 9.5% to 19.9% with prescribed dose 45 Gy versus 50 Gy, 8.7% to 14.0% with V43 Gy <2500 cm3 versus >3000 cm3 and 9.4% to 19.0% with V57 Gy <165 cm3 versus ≥165 cm3. Brachytherapy-related bowel and rectum D2cm3 were also associated with diarrhea.Conclusion: Dose and volume effects have been established for late diarrhea after radiochemotherapy and IGABT in both CTCAE and EORTC reporting. The risk of diarrhea was lower with a pelvic EBRT prescription of 45 Gy, and higher with larger lymph node boosts volumes (ie, ≥165 cm3). The importance of EBRT volumes as determinants of late toxicity underline the need for continuous quality assurance of target contouring, dose planning, and conformity. The findings of brachytherapy dosimetric factors related to the intestines may become more important with highly conformal EBRT. [ABSTRACT FROM AUTHOR]- Published
- 2021
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28. Management of oligo-metastatic and oligo-recurrent cervical cancer: A pattern of care survey within the EMBRACE research network.
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Chopra, Supriya, Mangaj, Akshay, Sharma, Alisha, Tan, Li Tee, Sturdza, Alina, Jürgenliemk-Schulz, Ina, Han, Kathy, Huang, Fleur, Schmid, Maximilian P., Fokdal, Lars, Chargari, Cyrus, Diendorfer, Tamara, Tanderup, Kari, Potter, Richard, and Nout, Remi A
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CERVICAL cancer , *CANCER treatment , *ONCOLOGISTS , *RADIOTHERAPY , *CHEMORADIOTHERAPY , *RADIATION doses , *CERVIX uteri diseases - Abstract
• The survey results described in the manuscript captures the heterogeneity in the clinical practice of oligometastatic and oligorecurrent cervical cancer. • This survey will help to define the role of radiation therapy in oligometastatic and oligorecurrent cervical cancer. • This survey highlights the desire of radiation oncologists over the globe to practice stereotactic radiation therapy in oligometastatic disease and will help to plan future clinical trials. In the metastatic or recurrent cervical cancer, systemic chemotherapy constitutes the main treatment. Though there is an increasing use of high dose external radiation and brachytherapy in the metastatic setting, no consensus exists. A 17-item survey was designed with additional case-based questions to explore present management of oligo-metastatic and oligo-recurrent cervix cancer within EMBRACE research group participating sites. The questions were designed to elicit prevailing practices in the management of de-novo oligo-metastasis and oligo-recurrent setting after completing the primary treatment of cervix cancer. The survey was sent electronically with two rounds of email reminders to respond over a 2-week survey period. The online survey was designed such that it was mandatory to complete all questions. The responses were recorded and results were summarized as proportions and summary statistics were generated. Twenty-two centers responded to this survey. A majority (90%) of respondents reported a low incidence of de-novo oligo-metastatic cervical cancer in their practice (<5%), with a higher proportion of patients with oligo-recurrence after completing primary treatment (5–10%). All responding sites preferred to treat pelvic disease in the de-novo oligo-metastatic setting albeit with different fractionation regimens. While 68.2% of respondents recommended chemo-radiation and brachytherapy, 31.8% considered additional systemic therapy. Overall 77.3% centers recommended the use of stereotactic ablative radiation therapy to oligo-metastasis. For out-of-field nodal recurrences, 63.7% of respondents considered treating with curative intent, while 59% preferred treating in-field recurrence with palliative intent. A vast majority of the participating centers (90%) have stereotactic radiation therapy capacity and would consider a clinical trial addressing oligo-metastatic and oligo-recurrent cervical cancer. Although contemporary practice is variable, a substantial proportion of EMBRACE centers consider high dose radiation in de-novo metastatic and oligo-recurrence settings. However, there is clear need for a joint clinical protocol and prospective studies to address the role of high dose radiation within oligo-recurrent and oligo-metastatic scenarios. [ABSTRACT FROM AUTHOR]
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- 2021
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29. Initiatives for education, training, and dissemination of morbidity assessment and reporting in a multiinstitutional international context: Insights from the EMBRACE studies on cervical cancer.
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Kirchheiner, Kathrin, Smet, Stéphanie, Spampinato, Sofia, Jensen, Nina B.K., Vittrup, Anders Schwartz, Fokdal, Lars, Najjari-Jamal, Dina, Westerveld, Henrike G., Lindegaard, Jacob C., Kirisits, Christian, De Leeuw, Astrid, Schmid, Maximilian P., Tan, Li Tee, Nout, Remi A., Jürgenliemk-Schulz, Ina M., Pötter, Richard, and Tanderup, Kari
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REPORTING of diseases , *CERVICAL cancer , *RADIOISOTOPE brachytherapy , *CANCER education - Abstract
In 2008, the GEC ESTRO Gyn network launched the first multiinstitutional, observational, and prospective international study on MRI-guided brachytherapy in locally advanced cervical cancer patients (EMBRACE-I). EMBRACE-I was followed by EMBRACE-II from 2016 and ongoing. Among the aims of the EMBRACE studies are to benchmark morbidity outcomes and develop dose-volume effects and predictive models for morbidity. The EMBRACE studies collect both physician (CTCAE v.3) and patient (EORTC QLQ-C30/CX24) reported outcomes, including baseline information, in a regular follow-up schedule. The EMBRACE studies feature high numbers of patients (EMBRACE-I N = 1416, EMBRACE-II N = 1500 expected) enrolled from many institutions worldwide (EMBRACE-I n = 23, EMBRACE-II n = 45). This large-scale multiinstitutional approach offers a unique opportunity to investigate and develop new strategies for improving the quality of assessment and reporting of morbidity. This report presents an overview of the challenges and pitfalls regarding the assessment and reporting of morbidity encountered during more than a decade of development and research activities within the EMBRACE consortium. This includes the recognition and evaluation of inconsistencies in the morbidity assessment, and consequently, the provision of assistance and training in the scoring procedure to reduce systematic assessment bias. In parallel, a variety of methodological approaches were tested to comprehensively summarize morbidity outcomes, and a novel approach was developed to refine dose-effect models and risk factor analyses. The purpose of this report is to present an overview of these findings, describe the learning process, and the strategies that have consequently been implemented regarding educational activities, training, and dissemination. [ABSTRACT FROM AUTHOR]
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- 2020
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30. Definitive radiotherapy with image-guided adaptive brachytherapy for primary vaginal cancer.
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Westerveld, Henrike, Nesvacil, Nicole, Fokdal, Lars, Chargari, Cyrus, Schmid, Maximilian P, Milosevic, Michael, Mahantshetty, Umesh M, and Nout, Remi A
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VAGINAL cancer , *IMAGE-guided radiation therapy , *RADIOISOTOPE brachytherapy , *CONE beam computed tomography , *CERVICAL cancer , *CERVIX uteri diseases - Abstract
Primary vaginal cancer is a rare cancer and clinical evidence to support recommendations on its optimal management is insufficient. Because primary vaginal cancer resembles cervical cancer in many aspects, treatment strategies are mainly adopted from evidence in locally advanced cervical cancer. To date, the organ-sparing treatment of choice is definitive radiotherapy, consisting of external beam radiotherapy and brachytherapy, combined with concurrent chemotherapy. Brachytherapy is an important component of the treatment and its steep dose gradient enables the delivery of high doses of radiation to the primary tumour, while simultaneously sparing the surrounding organs at risk. The introduction of volumetric CT or MRI image-guided adaptive brachytherapy in cervical cancer has led to better pelvic control and survival, with decreased morbidity, than brachytherapy based on x-ray radiographs. MRI-based image-guided adaptive brachytherapy with superior soft-tissue contrast has also been adopted sporadically for primary vaginal cancer. This therapy has had promising results and is considered to be the state-of-the-art treatment for primary vaginal cancer in standard practice. [ABSTRACT FROM AUTHOR]
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- 2020
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31. Response to Yuce Sari et al.
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Spampinato, Sofia, Fokdal, Lars U., Pötter, Richard, Haie-Meder, Christine, Lindegaard, Jacob C., Schmid, Maximilian P., Sturdza, Alina, Jürgenliemk-Schulz, Ina M., Mahantshetty, Umesh, Segedin, Barbara, Bruheim, Kjersti, Hoskin, Peter, Rai, Bhavana, Huang, Fleur, Cooper, Rachel, van der Steen-Banasik, Elzbieta, Van Limbergen, Erik, Sundset, Marit, Westerveld, Henrike, and Nout, Remi A.
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SARIS , *CERVICAL cancer - Abstract
Cervical cancer, IGABT, Urinary morbidity, Risk factors, Dose-effect relationship, Clinical study. [Extracted from the article]
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- 2021
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32. Comparison between external beam radiotherapy (70Gy/74Gy) and permanent interstitial brachytherapy in 890 intermediate risk prostate cancer patients
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Goldner, Gregor, Pötter, Richard, Battermann, Jan J., Kirisits, Christian, Schmid, Maximilian P., Sljivic, Samir, and van Vulpen, Marco
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PROSTATE cancer treatment , *CANCER radiotherapy , *PROSTATE cancer patients , *FOLLOW-up studies (Medicine) , *MULTIVARIATE analysis , *MEDICAL statistics - Abstract
Abstract: Purpose: Aim of this analysis was to compare biochemical no evidence of disease (bNED) rates in intermediate-risk prostate-cancer patients treated at two centres of excellence using different approaches: permanent interstitial brachytherapy (BT) and external beam radiotherapy (EBRT). Materials and methods: A total of 890 intermediate-risk prostate-cancer patients, who were treated from 1998 to 2008, were identified in the two local databases. In Utrecht 601 patients received I-125 BT applying a dose of 144Gy. In Vienna 289 patients were treated by EBRT, applying a local dose of 70Gy in 105 patients and 74Gy in 184 patients. bNED-rates (Phoenix-definition) were assessed. Results: Median follow-up was 48months (1–150). 5-Year actuarial bNED-rates were 81% for BT-patients and 75% for EBRT-patients (67% for 70Gy and 82% for 74Gy), respectively. In univariate analysis no difference between BT and EBRT could be detected. In multivariate analysis including tumour-stage, GleasonScore, initial PSA, hormonal therapy and treatment-centre (BT vs. EBRT) only T-stage, GleasonScore and PSA were found to be significant. Additional analysis including radiation dose showed the same outcome. Conclusions: Intermediate-risk prostate cancer patients treated by permanent interstitial brachytherapy show biochemical tumour-control-rates which are comparable to EBRT of 74Gy. [Copyright &y& Elsevier]
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- 2012
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33. Clinical outcome of protocol based image (MRI) guided adaptive brachytherapy combined with 3D conformal radiotherapy with or without chemotherapy in patients with locally advanced cervical cancer
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Pötter, Richard, Georg, Petra, Dimopoulos, Johannes C.A., Grimm, Magdalena, Berger, Daniel, Nesvacil, Nicole, Georg, Dietmar, Schmid, Maximilian P., Reinthaller, Alexander, Sturdza, Alina, and Kirisits, Christian
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TREATMENT effectiveness , *MAGNETIC resonance imaging , *RADIOTHERAPY , *DRUG therapy , *CERVICAL cancer patients , *DRUG dosage , *CERVICAL cancer treatment , *HISTOLOGY , *SQUAMOUS cell carcinoma - Abstract
Abstract: Background: To analyse the overall clinical outcome and benefits by applying protocol based image guided adaptive brachytherapy combined with 3D conformal external beam radiotherapy (EBRT)±chemotherapy (ChT). Methods: Treatment schedule was EBRT with 45–50.4Gy±concomitant cisplatin chemotherapy plus 4×7Gy High Dose Rate (HDR) brachytherapy. Patients were treated in the “protocol period” (2001–2008) with the prospective application of the High Risk CTV concept (D90) and dose volume constraints for organs at risk including biological modelling. Dose volume adaptation was performed with the aim of dose escalation in large tumours (prescribed D90>85Gy), often with inserting additional interstitial needles. Dose volume constraints (D2cc) were 70–75Gy for rectum and sigmoid and 90Gy for bladder. Late morbidity was prospectively scored, using LENT/SOMA Score. Disease outcome and treatment related late morbidity were evaluated and compared using actuarial analysis. Findings: One hundred and fifty-six consecutive patients (median age 58years) with cervix cancer FIGO stages IB–IVA were treated with definitive radiotherapy in curative intent. Histology was squamous cell cancer in 134 patients (86%), tumour size was >5cm in 103 patients (66%), lymph node involvement in 75 patients (48%). Median follow-up was 42months for all patients. Interstitial techniques were used in addition to intracavitary brachytherapy in 69/156 (44%) patients. Total prescribed mean dose (D90) was 93±13Gy, D2cc 86±17Gy for bladder, 65±9Gy for rectum and 64±9Gy for sigmoid. Complete remission was achieved in 151/156 patients (97%). Overall local control at 3years was 95%; 98% for tumours 2–5cm, and 92% for tumours >5cm (p =0.04), 100% for IB, 96% for IIB, 86% for IIIB. Cancer specific survival at 3years was overall 74%, 83% for tumours 2–5cm, 70% for tumours >5cm, 83% for IB, 84% for IIB, 52% for IIIB. Overall survival at 3years was in total 68%, 72% for tumours 2–5cm, 65% for tumours >5cm, 74% for IB, 78% for IIB, 45% for IIIB. In regard to late morbidity in total 188 grade 1+2 and 11 grade 3+4 late events were observed in 143 patients. G1+2/G3+4 events for bladder were n =32/3, for rectum n =14/5, for bowel (including sigmoid) n =3/0, for vagina n =128/2, respectively. Interpretation: 3D conformal radiotherapy±chemotherapy plus image (MRI) guided adaptive intracavitary brachytherapy including needle insertion in advanced disease results in local control rates of 95–100% at 3years in limited/favourable (IB/IIB) and 85–90% in large/poor response (IIB/III/IV) cervix cancer patients associated with a moderate rate of treatment related morbidity. Compared to the historical Vienna series there is relative reduction in pelvic recurrence by 65–70% and reduction in major morbidity. The local control improvement seems to have impact on CSS and OS. Prospective clinical multi-centre studies are mandatory to evaluate these challenging mono-institutional findings. [Copyright &y& Elsevier]
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- 2011
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34. A Prospective Interobserver Study for Hybrid TRUS/CT Target Volume Contouring for Image-guided Brachytherapy of Cervical Cancer.
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Nesvacil, Nicole, Smet, Stephanie, Knoth, Johannes, Sturdza, Alina, Najjari-Jamal, Dina, Jelinek, Filip, Kronreif, Gernot, Pötter, Richard, Widder, Joachim, Kirisits, Christian, and Schmid, Maximilian P.
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RADIOISOTOPE brachytherapy , *CERVICAL cancer patients , *CERVICAL cancer diagnosis , *CANCER treatment , *COMPUTED tomography - Published
- 2018
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