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  • 1. Beskow, Catharina
    et al.
    Ågren-Cronqvist, Anna-Karin
    Lewensohn, Rolf
    Toma-Dasu, Iuliana
    Stockholms universitet, Naturvetenskapliga fakulteten, Fysikum.
    Biological effective dose evaluation and assessment of rectal and bladder complications for cervical cancer treated with radiotherapy and surgery2012Ingår i: Journal of Contemporary Brachytherapy, ISSN 1689-832X, E-ISSN 2081-2841, Vol. 4, nr 4, s. 205-212Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose: This study aims to retrospectively evaluate dosimetric parameters calculated as biological effective dose in relation to outcome in patients with cervical cancer treated with various treatment approaches including radiotherapy, with and without surgery.

    Methods and Materials: Calculations of biological effective dose (BED) were performed on data from a retrospective analysis of 171 patients with cervical carcinoma stages IB-IIB treated with curative intent between January 1989 and December 1991. 43 patients were treated only with radiotherapy and 128 patients were treated with a combination of radiotherapy and surgery. External beam radiotherapy was delivered with 6-21 MV photons from linear accelerators. Brachytherapy was delivered either with a manual radium technique or with a remote afterloading technique. The treatment outcome was evaluated at 5 years.

    Results: The disease-specific survival rate was 87% for stage IB, 75% for stage IIA and 54% for stage IIB, while the overall survival rates were 84% for stage IB, 68% for stage IIA and 43% for stage IIB. Patients treated only with radiotherapy had a local control rate of 77% which was comparable to that for radiotherapy and surgery patients (78%). Late complications were recorded in 25 patients (15%). Among patients treated with radiotherapy and surgery, differences in radiation dose calculated as BED10 did not seem to influence survival. For patients treated with radiotherapy only, a higher BED10 was correlated to a higher overall survival (p=0.0075). The dose response parameters found based on biological effective dose calculations were D50=85.2 Gy10 and γ=1.62 for survival and D50=61.6 Gy10 and γ=0.92 for local control.

    Conclusions: The outcome correlates with biological effective dose for patients treated with radiation therapy alone, but not for patients treated with radiotherapy and surgery. No correlations were found between BED and late toxicity from bladder and rectum.

  • 2.
    Johansson, Bengt
    et al.
    Region Örebro län. Department of Oncology.
    Karlsson, Leif
    Örebro universitet, Hälsoakademin. Department of Medical Physics, Örebro University Hospital, Örebro, Sweden; Örebro University, Örebro, Sweden.
    Hardell, Lennart
    Örebro universitet, Hälsoakademin. Department of Medical Physics, Örebro University Hospital, Örebro, Sweden.
    Persliden, Jan
    Örebro universitet, Hälsoakademin. Department of Medical Physics, Örebro University Hospital, Örebro, Sweden.
    Long term results of PDR brachytherapy for lip cancer2011Ingår i: Journal of Contemporary Brachytherapy, ISSN 1689-832X, E-ISSN 2081-2841, Vol. 3, nr 2, s. 65-69Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose: To evaluate the long time outcome with regard to local tumour control and side effects of a pulsed dose rate (PDR) monobrachytherapy of primary or recurrent cancer of the lip.

    Material and methods: Between 1995 and 2007 we treated 43 patients with primary or recurrent clinical T1-T3N0 lip cancers. There were 22 T1 patients (51%), 16 T2 (37%) and 5 T3 cases (12%). A median dose of 60 (55-66) Gy was given, depending on the tumour volume. The PDR treatment was delivered with 0.83 Gy/pulse every second hour for 5.5-6.5 days. The patients were followed for a median of 55 (1-158) months.

    Results: The 2-, 5- and 10-year rates of actuarial local control were 97.6%, 94.5% and 94.5%, overall survival 88.0%, 58.9% and 39.1%, disease free survival 92.7%, 86.4% and 86.4% respectively. The regional control rate was 93%. One patient (2%) developed distant metastases. A dosimetrical analysis showed a mean treated volume of 14.9 (3.0-56.2) cm(3). Long-term side effects were mild and the cosmetic outcome excellent, except for 1 case (2%) of soft tissue necrosis and 1 case (2%) of osteoradionecrosis.

    Conclusions: Local outcome is excellent and similar to other published studies of continuous low dose rate (cLDR) brachytherapy.

  • 3.
    Johansson, Bengt
    et al.
    Örebro universitet, Hälsoakademin. Region Örebro län. Department of Oncology, Head and Neck Oncology Center.
    Karlsson, Leif
    Head and Neck Oncology Center, Örebro University Hospital, Örebro, Sweden.
    Reizenstein, Johan
    Department of Oncology, Örebro University Hospital, Örebro University, Örebro, Sweden; Head and Neck Oncology Center, Örebro University Hospital, Örebro University, Sweden .
    von Beckerath, Mathias
    Örebro universitet, Hälsoakademin. Region Örebro län. Department of Otolaryngology, Head and Neck Oncology Center.
    Hardell, Lennart
    Department of Oncology, Örebro University Hospital, Örebro, Sweden.
    Persliden, Jan
    Department of Medical Physics, Örebro University Hospital, Örebro, Sweden.
    Pulsed dose rate brachytherapy as the boost in combination with external beam irradiation in base of tongue cancer: Long-term results from a uniform clinical series2011Ingår i: Journal of Contemporary Brachytherapy, ISSN 1689-832X, E-ISSN 2081-2841, Vol. 3, nr 1, s. 11-17Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose: To evaluate long time outcome with regard to local tumour control, side effects and quality of life of combined pulsed dose rate (PDR) boost and hyperfractionated accelerated external beam radiotherapy (EBRT) for primary base of tongue (BOT) cancers.

    Material and methods: Between 1994 and 2007, the number of 83 patients were treated with primary T1-T4 BOT cancers. Seven patients (8%) were T1-2N0 (AJCC stage I-II) and 76 (92%) patients were T1-2N+ or T3-4N0-2 (AJCC stage III-IV). The mean estimated primary tumour volume was 15.4 (1-75) cm(3). EBRT was given with 1.7 Gy bid to 40.8 Gy to primary tumour and bilateral neck lymph nodes in 2.5 weeks. PDR boost of 35 Gy and a neck dissection in clinical node positive case was performed 2-3 weeks later. The patients were followed for a median of 54 (2-168) months.

    Results: The 2-, 5- and 10-years rates of actuarial local control were 91%, 89% and 85%, overall survival 85%, 65% and 44%, disease free survival 86%, 80% and 76%, respectively. The regional control rate was 95%. Six patients (7%) developed distant metastases. A dosimetric analysis showed a mean of 100% isodose volume of 58.2 (16.7-134) cm(3). In a review of late complications 11 cases of minor (13%) and 5 of major soft tissue necroses (6%), as well as 6 cases of osteoradionecroses (7%) were found. The patients median subjective SOMA/LENT scoring at last follow up was as follow: grade 0 for pain and trismus, grade 1 for dysphagia and taste alteration, and grade 2 for xerostomia. Global visual-analogue-scale (VAS) scoring of quality of life was 8.

    Conclusion: Local and regional tumour control rate was excellent in this treatment protocol. The data shows the PDR boost as at least as effective as published continuous low dose rate (CLDR) results.

  • 4.
    Karlsson, Leif
    et al.
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Department of Medical Physics, Örebro University Hospital, Örebro, Sweden.
    Thunberg, Per
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Region Örebro län. Department of Medical Physics, Örebro University Hospital, Örebro, Sweden.
    Johansson, Bengt
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Region Örebro län. Department of Oncology, Örebro University Hospital, Örebro, Sweden.
    Persliden, Jan
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Region Örebro län. Department of Medical Physics, Örebro University Hospital, Örebro, Sweden.
    The impact of activating source dwell positions outside the CTV on the dose to treated normal tissue volumes in TRUS guided 3D conformal interstitial HDR brachytherapy of prostate cancer2014Ingår i: Journal of Contemporary Brachytherapy, ISSN 1689-832X, E-ISSN 2081-2841, Vol. 6, nr 3, s. 282-288Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose: Dose coverage is crucial for successful treatment in mono-brachytherapy. Since few and very high dose fractions are used, there is an important balance between dwell positioning outside the clinical target volume (CTV) and possible damage on adjacent normal tissue. The purpose of this study was to evaluate the possibility of having dwell positions close to the CTV surface, while maintaining an acceptable dose distribution, and to investigate the robustness in terms of known geometrical uncertainties of the implant.

    Material and methods: This study included 37 patients who had received brachytherapy for prostate cancer as a monotherapy with the following schedules: 2 x 14 Gy or 3 x 11 Gy, each fraction separated by two weeks. The source dwell positions were activated 5 mm outside CTV. New optimizations were simulated for dwell positions at 3, 2, 1, and 0 mm. Inverse and graphical optimization were applied according to the relative dose constraints: V-100 CTV >= 97%, D-max,D- urethra <= 110%, and D-10 rectal mucosa <= 65%. The V-100 normal tissue outside CTV was used to evaluate dose variations caused by different dwell positions. Prostate geometries and dose distributions for the different dwell positions outside the CTV were used to investigate the impact on the CTV dose distribution due to geometrical uncertainties.

    Results: Both V-100,V- CTV, and V-100,V- normal tissue decreased, 98.6% to 92.2%, and 17 cm(3) to 9.0 cm(3), for dwell activation from 5 rum to 0 mm. The evaluation of both simulated longitudinal geometrical uncertainties and different source dwell activations implied that V-100,V- CTV ranged from 98.6% to 86.3%.

    Conclusions: It is possible to reduce the V-100,V- normal tissue by decreasing the source dwell positions outside the CTV from 5 to 3 mm, while maintaining dose constraints. In combination with the estimated geometrical uncertainties, however, the source dwell positions need to be 5 mm from the surface in order to maintain a robust implant.

  • 5.
    Karlsson, Leif
    et al.
    School of Health and Medical Sciences, Örebro University, Örebro, Sweden; Department of Medical Physics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Thunberg, Per
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Medical Physics, Örebro University Hospital, Örebro, Sweden.
    With, Anders
    Department of Medical Physics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Mordhorst, Louise Bohr
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Oncology, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Persliden, Jan
    Region Örebro län. School of Health and Medical Sciences, Örebro University, Örebro, Sweden; Department of Medical Physics, Örebro University Hospital, Örebro, Sweden.
    3D image-based adapted high-dose-rate brachytherapy in cervical cancer with and without interstitial needles: measurement of applicator shift between imaging and dose delivery2017Ingår i: Journal of Contemporary Brachytherapy, ISSN 1689-832X, E-ISSN 2081-2841, Vol. 9, nr 1, s. 52-58Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose: Using 3D image-guided adaptive brachytherapy for cervical cancer treatment, it often means that patients are transported and moved during the treatment procedure. The purpose of this study was to determine the intra-fractional longitudinal applicator shift in relation to the high risk clinical target volume (HR-CTV) by comparing geometries at imaging and dose delivery for patients with and without needles.

    Material and methods: Measurements were performed in 33 patients (71 fractions), where 25 fractions were without and 46 were with interstitial needles. Gold markers were placed in the lower part of the cervix as a surrogate for HR-CTV, enabling distance measurements between HR-CTV and the ring applicator. Shifts of the applicator relative to the markers were determined using planning computed tomography (CT) images used for planning, and the radiographs obtained at dose delivery. Differences in the physical D-90 for HR-CTV due to applicator shifts were simulated individually in the treatment planning system to provide the relative dose variation.

    Results: The maximum distances of the applicator shifts, in relation to the markers, were 3.6 mm (caudal), and-2.5 mm (cranial). There was a significant displacement of-0.7 mm (SD = 0.9 mm) without needles, while with needles there was no significant shift. The relative dose variation showed a significant increase in D-90 HR-CTV of 1.6% (SD = 2.6%) when not using needles, and no significant dose variation was found when using needles.

    Conclusions: The results from this study showed that there was a small longitudinal displacement of the ring applicator and a significant difference in displacement between using interstitial needles or not.

  • 6.
    Tagliaferri, Luca
    et al.
    Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.
    Budrukkar, Ashwini
    Tata Memorial Centre, Mumbai, India.
    Lenkowicz, Jacopo
    Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy.
    Cambeiro, Mauricio
    Clìnica Universidad de Navarra, Navarra, Spain.
    Bussu, Francesco
    Head of the Otolaryngology Division, Azienda Ospedaliero-Universitaria di Sassari, Italy.
    Guinot, Jose Luis
    Department of Radiation Oncology, Fundacion Instituto Valenciano de Oncologia, Valencia, Spain.
    Hildebrandt, Guido
    University Hospital Radiotherapy Department, University of Rostock, Rostock, Germany.
    Johansson, Bengt
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Oncology.
    Meyer, Jens E.
    Head & Neck Surgery Department, AK St. George Hospital, Hamburg, Germany.
    Niehoff, Peter
    Department of Radiotherapy, Sana Hospital Offenbach, Offenbach, Germany.
    Rovirosa, Angeles
    Hospital Clinic I Universitaria, Barcelona, Spain.
    Takacsi-Nagy, Zoltan
    National Cancer Institute, Budapest, Hungary.
    Boldrini, Luca
    Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy.
    Dinapoli, Nicola
    Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.
    Lanzotti, Vito
    Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.
    Damiani, Andrea
    Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy.
    Gatta, Roberto
    Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.
    Fionda, Bruno
    Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.
    Lancellotta, Valentina
    Radiation Oncology Section, Department of Surgical and Biomedical Science, University of Perugia and Perugia General Hospital, Perugia, Italy.
    Soror, Tamer
    Interdisciplinary Brachytherapy Unit, University of Lübeck – University Hospital S-H, Campus Lübeck, Germany.
    Monge, Rafael Martinez
    Clìnica Universidad de Navarra, Navarra, Spain.
    Valentini, Vincenzo
    Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy.
    Kovacs, Gyoergy
    Interdisciplinary Brachytherapy Unit, University of Lübeck – University Hospital S-H, Campus Lübeck, Germany.
    ENT COBRA ONTOLOGY: the covariates classification system proposed by the Head & Neck and Skin GEC-ESTRO Working Group for interdisciplinary standardized data collection in head and neck patient cohorts treated with interventional radiotherapy (brachytherapy)2018Ingår i: Journal of Contemporary Brachytherapy, ISSN 1689-832X, E-ISSN 2081-2841, Vol. 10, nr 3, s. 260-266Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    Purpose: Clinical data collecting is expensive in terms of time and human resources. Data can be collected in different ways; therefore, performing multicentric research based on previously stored data is often difficult. The primary objective of the ENT COBRA (COnsortium for BRachytherapy data Analysis) ontology is to define a specific terminological system to standardized data collection for head and neck (H&N) cancer patients treated with interventional radiotherapy.

    Material and methods: ENT-COBRA is a consortium for standardized data collection for H&N patients treated with interventional radiotherapy. It is linked to H&N and Skin GEC-ESTRO Working Group and includes 11 centers from 6 countries. Its ontology was firstly defined by a multicentric working group, then evaluated by the consortium followed by a multi-professional technical commission involving a mathematician, an engineer, a physician with experience in data storage, a programmer, and a software expert.

    Results: Two hundred and forty variables were defined on 13 input forms. There are 3 levels, each offering a specific type of analysis: 1. Registry level (epidemiology analysis); 2. Procedures level (standard oncology analysis); 3. Research level (radiomics analysis). The ontology was approved by the consortium and technical commission; an ad-hoc software architecture ("broker") remaps the data present in already existing storage systems of the various centers according to the shared terminology system. The first data sharing was successfully performed using COBRA software and the ENT COBRA Ontology, automatically collecting data directly from 3 different hospital databases (Lubeck, Navarra, and Rome) in November 2017.

    Conclusions: The COBRA Ontology is a good response to the multi-dimensional criticalities of data collection, retrieval, and usability. It allows to create a software for large multicentric databases with implementation of specific remapping functions wherever necessary. This approach is well-received by all involved parties, primarily because it does not change a single center's storing technologies, procedures, and habits.

  • 7.
    Tagliaferri, Luca
    et al.
    Department of Radiation Oncology – Gemelli-ART, Università Cattolica del Sacro Cuore, Milano, Italy.
    Kovacs, Gyoergy
    Interdisciplinary Brachytherapy Unit, Universitätsklinikum Schleswig-Holstein, University of Lübeck, Lübeck, Germany.
    Autorino, Rosa
    Department of Radiation Oncology – Gemelli-ART, Università Cattolica del Sacro Cuore, Milano, Italy.
    Budrukkar, Ashwini
    Tata Memorial Centre, Mumbai, India.
    Luis Guinot, Jose
    Department of Radiation Oncology, Fundacion Instituto Valenciano de Oncologia, Valencia, Spain.
    Hildebrand, Guido
    University Hospital Radiotherapy Department, University of Rostock, Rostock, Germany.
    Johansson, Bengt
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Oncology, Örebro University Hospital, Örebro, Sweden.
    Martinez Monge, Rafael
    Clìnica Universidad de Navarra, Navarra, Spain.
    Meyer, Jens E.
    Head & Neck Surgery Department, AK St. George Hospital, Hamburg, Germany.
    Niehoff, Peter
    University Witten Herdecke, Cologne, Germany.
    Rovirosa, Angeles
    Hospital Clinic I Universitari, Barcelona, Spain.
    Takocsi-Nagy, Zoltan
    National Cancer Institute, Budapest, Hungary.
    Dinapoli, Nicola
    Department of Radiation Oncology – Gemelli-ART, Università Cattolica del Sacro Cuore, Milano, Italy.
    Lanzotti, Vito
    KBO-Labs – Gemelli-ART, Università Cattolica del Sacro Cuore, Milano, Italy.
    Damiani, Andrea
    KBO-Labs – Gemelli-ART, Università Cattolica del Sacro Cuore, Milano, Italy.
    Soror, Tamer
    Interdisciplinary Brachytherapy Unit, Universitätsklinikum Schleswig-Holstein, University of Lübeck, Lübeck, Germany.
    Valentini, Vincenzo
    Department of Radiation Oncology – Gemelli-ART, Università Cattolica del Sacro Cuore, Milano, Italy.
    ENT COBRA (Consortium for Brachytherapy Data Analysis): interdisciplinary standardized data collection system for head and neck patients treated with interventional radiotherapy (brachytherapy)2016Ingår i: Journal of Contemporary Brachytherapy, ISSN 1689-832X, E-ISSN 2081-2841, Vol. 8, nr 4, s. 336-343Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    Purpose: Aim of the COBRA (Consortium for Brachytherapy Data Analysis) project is to create a multicenter group (consortium) and a web-based system for standardized data collection.

    Material and methods: GEC-ESTRO (Groupe Europeen de Curietherapie - European Society for Radiotherapy & Oncology) Head and Neck (H&N) Working Group participated in the project and in the implementation of the consortium agreement, the ontology (data-set) and the necessary COBRA software services as well as the peer reviewing of the general anatomic site-specific COBRA protocol. The ontology was defined by a multicenter task-group.

    Results: Eleven centers from 6 countries signed an agreement and the consortium approved the ontology. We identified 3 tiers for the data set: Registry (epidemiology analysis), Procedures (prediction models and DSS), and Research (radiomics). The COBRA-Storage System (C-SS) is not time-consuming as, thanks to the use of "brokers", data can be extracted directly from the single center's storage systems through a connection with "structured query language database" (SQL-DB), Microsoft Access, FileMaker Pro, or Microsoft Excel. The system is also structured to perform automatic archiving directly from the treatment planning system or afterloading machine. The architecture is based on the concept of "on-purpose data projection". The C-SS architecture is privacy protecting because it will never make visible data that could identify an individual patient. This C-SS can also benefit from the so called "distributed learning" approaches, in which data never leave the collecting institution, while learning algorithms and proposed predictive models are commonly shared.

    Conclusions: Setting up a consortium is a feasible and practicable tool in the creation of an international and multi-system data sharing system. COBRA C-SS seems to be well accepted by all involved parties, primarily because it does not influence the center's own data storing technologies, procedures, and habits. Furthermore, the method preserves the privacy of all patients.

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