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Influence of the Radiation Dose to Salivary Glands on Xerostomia in Patients with Head and Neck Carcinomas

Journal of Cancer Therapy 2013年第1期4卷 188-194页

作者： Andre Buchali Christina Schroder Dietrich Sidow eyck blank Department of Radiation Oncology Ruppiner Kliniken GmbHNeuruppinGermany.

Purpose: Investigation of the influence of radiation dose to salivary glands on xerostomia in patients with head and neck cancers. Methods: From October 2002 to December 2011, 548 patients with head and neck carcinomas were treated in our department using intensity modulated radiotherapy (IMRT). 325 patients were eligible for analysis more than 1 year after irradiation. Xerostomia was evaluated according to the criteria of Radiation Therapy and Oncology Group (RTOG) and xerostomia related questionnaire. For statistical analysis grade 1 and 2 were recorded as mild and grade 3 and 4 as severe xerostomia. The dosimetric values for absolute mean dose, biological equivalent mean dose (EQD2), the relative organ volume not exceeding 20 Gy, 25 Gy and 30 Gy (V20, V25, V30) for all 4 major salivary glands or for both parotid glands only were used for analysis. V20 revealed the best discrimination between both patient groups (with vs. without xerostomia), compared to parameters V25 and V30. Therefore the volume of the salivary glands receiving less than 20 Gy (V 20Gy) was analyzed additionally. Mann-Whitney-U-test, Kruskal-Wallis-test and logistic regression were used in statistical analysis. Results: A TD 50 can be determined for the occurrence of xerostomia more than one year after radiotherapy for both parotid glands of 19.3 Gy for the mean dose absolute, 11.2 Gy for the mean dose EQD2, 38.2% for V20, 26.8% for V25, 18.7% for V30, 34.9 ml for V 20Gy. For all major salivary glands theses values were 25.7 Gy for the mean dose absolute, 15.6 Gy for the mean dose EQD2, 51.3% for V20, 41.1% for V25, 33.9% for V30 and 34.8 ml for V 20Gy. Conclusions: The identification of a tolerance dose for the salivary glands for treatment planning appears to be difficult, as the dose-response correlation only shows a flat slope. Additionally, a large interindividual variability seems to exist. We could not found any threshold dose for development of xerostomia.

关键词： Xerostomia Salivary Glands Tolerance Dose Irradiation

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Is There a Future for 74 Gy Radiation Treatment of NSCLC after RTOG 0617?A Comparison of the RTOG Study Results with Our Own Department’s 74 Gy NSCLC Cohort

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Journal of Cancer Therapy 2015年第8期6卷 642-647页

作者： Christina Schroder eyck blank Dietrich Sidow Rita Engenhart-Cabillic Andre Buchali Departement of Radiooncology Ruppiner Kliniken GmbHNeuruppinGermany Departement of Radiooncology University HospitalJustus Liebig UniversityGiessen and MarburgGermany

Background and Purpose: There have been a number of different efforts trying to improve the outcome of NSCLC patients treated with radiotherapy (RT). Contrary to most expectations, the long awaiting results of the RTOG 0617 trial didn’t show any benefit of dose escalation to 74 Gy. In this unicentric retrospective analysis we compare the RTOG 0617 result with the outcome of our own 74-Gy-NSCLC cohort. Methods and Material: Since October 2009, 80 patients with NSCLC were treated with 74 Gy in 37 fractions, of which 69 patients were eligible for a retrospective analysis of local and distant failure, survival time and treatment related toxicity. A subgroup analysis was done for patients with a possible follow-up of at least 18 month. Results: Complete local remission could be achieved in 18 patients (26.1%);26 patients (37.7%) had a partial remission and 3 patients (4.4%) a stable local disease. Local failure occurred in 12 patients (17.3%). Distant failure occurred in 27 patients (39.1%). The median survival time was 43.7 weeks (95% CI: 25.2 - 62.3 weeks). 5 patients (6.3%) developed RT induced side effects. As for the analyzed subgroup, a complete or partial local remission could be achieved in 29 patients (61.7%). Local failure occurred in 11 patients (23.4%) and 20 patients (42.6%) developed distant metastases. The 18-month overall survival was 38.3% and the median survival time was 51.7 weeks (95% CI: 27.2 - 76.3 weeks). Conclusion: The results of this retrospective analysis indicate that 74 Gy total radiation dose might not lead to results as bad as indicated by the RTOG 0617 trial. It might therefore be a suitable treatment concept for people with NSCLC.

关键词： Lung Cancer Dose Escalation Local Remission Survival Side Effects

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Correlation between the Changes in Lung Function and Lung Density Changes in Patients Following Radio- (Chemo-) Therapy for Thoracic Carcinomas

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Journal of Cancer Therapy 2019年第3期10卷 257-267页

作者： Christina Schroeder Rita Engenhart-Cabillic Sven Kirschner eyck blank André Buchali Clinic for Radiotherapy and Radiation Oncology University Clinic Giessen and Marburg Marburg Germany Clinic for Radiation Oncology Universitatsspital Zürich Zürich Switzerland Clinic for Radiotherapy and Radiation Oncology Ruppiner Kliniken GmbH Neuruppin Germany

Purpose: In this analysis we focused on the correlation of patients’ lung function (PFT) data and lung density changes (ΔHU) detected in follow-up CTs. Material and Methods: PFT and lung function data were available for 58 patients 12 weeks and 47 patients 6 months after radio- (chemo-) therapy for thoracic carcinomas (NSCLC, SCLC and esophageal carcinoma). The follow-up CT scans were matched with the planning CT scans of each patient and then subtracted to calculate ΔHU for each voxel using customized research software. PFT data regarding e.g. vital capacity (VC), total lung capacity (TLC) and diffusion capacity for carbon monoxide (DLCO) were collected before and at several follow-up appointments after treatment. Results: 12 weeks after therapy there was a statistically significant correlation between difference in DLCO and the maximum ΔHU as well as the difference in TLC and the minimum ΔHU. 6 months after treatment there was a significant correlation between the difference in VC and DLCO with numerous lung density parameters, e.g. the mean and median lung density changes and the 75th percentile of ΔHU. There was no significant correlation between the PFT parameters FEV1, pCO2 and pO2 and any lung density parameter at any follow-up appointment. Conclusion: There is a significant correlation between DLCO and ΔHU 6 months after treatment that most likely reflects the underlying pathological mechanisms in terms of the development of fibrotic lung tissue after RT. The relevance of the significant correlations 12 weeks after RT is questionable.

关键词： Lung Thoracic Neoplasms Radiation Injuries Pulmonary Fibrosis Lung Function

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The Survival of Head and Neck Carcinoma Patients Depends on Secondary Causes of Death

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Journal of Cancer Therapy 2017年第13期8卷 1187-1193页

作者： André Buchali Winfried Huhnt Ina Maekelburg Sophia Rohrberg Dietrich Sidow eyck blank Christina Schroeder Achim Franzen Department of Radiooncology Ruppiner Kliniken Neuruppin Germany Medical University Theodor Fontane Neuruppin Germany Justus Liebig University Giessen Germany Department of Otorhinolaryngology Head and Neck Surgery Ruppiner Kliniken Neuruppin Germany

Purpose: The study aimed to analyse causes of death and differential survival after multimodal treatment of head and neck carcinoma patients. Methods and Materials: Between September 2000 and December 2015, 935 patients received a multimodal treatment of head and neck carcinoma. Of these, 562 patients (60.1%) underwent a resection of the primary tumour and a postoperative radio- or radiochemotherapy and 373 patients (39.9%) received definitive radio- or radiochemotherapy. The median follow-up was 21.0 months (0.5 - 175.4 months). Results: At the endpoint of the investigation, 465 patients (49.7%) were alive. The median survival of all patients was 44.8 months (0.5 - 164.3 months). A total of 470 patients (50.3%) died. The causes of death were divided into five groups: 22 patients (2.4%) died of therapy-associated complications with a median of 2.2 months (1.6 - 3.3 months). The 160 patients (17.1%) with intercurrent death, 117 patients (12.5%) with deaths from locoregional progression with or without metastasis, and 86 patients (9.2%) with deaths from metastasis without locoregional recurrence showed comparable survival curves with a median survival of 13.3 months, 13.6 months, and 14.4 months. Eighty-five patients (9.1%) died from second malignant diseases and controlled treated head and neck carcinomas with a median survival of 34.5 months (P < 0.001). Conclusion: Despite a locoregional control and metastasis-free survival of 78.3% patients, only 49.7% of the patients were alive, due to a high rate of intercurrent and second malignant diseases. The short median survival rate is mainly due to the tumours (locoregional and or distant progression) and intercurrent causes of death, with the second malignant diseases leading to death later on.

关键词： Head and Neck Carcinoma Radiochemotherapy Causes of Death

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索诺兰景观实验室

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景观设计 2010年第5期 12-17页

作者： Christy Ton eyck 李沐菲

该项目隶属于美国亚利桑那大学的建筑与景观学院（CALA）．这个新增设的场所旨在创造一个综合环境，为三个设计学科（建筑、景观设计以及规划）的学生营造个能够并肩学习和实践的机会。该场所同时也将作为一个可供长期使用的实验室，以... 详细信息

该项目隶属于美国亚利桑那大学的建筑与景观学院（CALA）．这个新增设的场所旨在创造一个综合环境，为三个设计学科（建筑、景观设计以及规划）的学生营造个能够并肩学习和实践的机会。该场所同时也将作为一个可供长期使用的实验室，以及对西南旱区进行可持续性设计的示范区域。三个学科的学生们可共同使用综合工作室并讨论交流学业，这个拥有世界一流设施的实验室可让学生们通过亲手实践去研究新材料和学习设计。

关键词：景观设计实验室亚利桑那大学可持续性设计综合环境设计学学生示范区

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俾斯麦与德意志帝国

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作者： (英)埃里克·埃克(Erich eyck)

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