Effectiveness and tolerability of radiotherapy for patients with indolent non-Hodgkin's lymphoma: a monocenter analysis

To analyze the effectiveness and toxicities of radiotherapy in indolent non-Hodgkin's lymphoma (iNHL) patients treated in our institution. Patients with iNHL treated with radiotherapy between 1999 and 2016 were included. The primary endpoint was progression-free survival (PFS). Secondary endpoints were local control (LC), overall survival (OS) and toxicities. PFS, LC, and OS were analyzed using Kaplan-Meier method. Log-rank test was used to investigate the differences between subgroups. Cox proportional hazard model was used for univariate continuous analysis. Seventy-five patients were identified in our institutional database between 1999 and 2016. Fifty-eight (77.3%) had stage I after Ann-Arbor and 17 patients (22.7%) had stage II. The median follow-up was 87~months (95% CI 72-102~months). Median single dose per fraction was 2.0~Gy (range 1.5-2~Gy) and median total dose was 30.6~Gy (range 16-45~Gy). Radiotherapy was performed in 2D (n = 10; 13.3%), 3D (n = 63; 84.0%) and VMAT (n = 2; 2.7%) techniques, respectively. The median PFS was 14.0~years (95% CI 8.3-19.7~years). The estimated PFS after 5 and 10~years were 73.0% and 65.5% in Kaplan-Meier analysis, respectively. The 5- and 10-year LC were 94.9% and 92.3%, respectively. The 5- and 10-year OS were 88.6% and 73.9%. In univariate analyses of PFS, younger patients (≤ 60~years old) had significantly superior PFS to those older than 60~years old (5-year PFS 81.9% vs. 65.1%, p = 0.021). Dose escalation > 36.0~Gy had no prognostic influence in term of PFS (p = 0.425). Extranodal involvement, stage and histology had no prognostic impact on PFS. Depending on the site of lymphomas, the most common acute side effects were: dermatitis CTCAE° I-II (8.0%), xerostomia CTC° I (8.0%), cataract CTC° I (12.0%) and dry eyes CTC° I-II (14.6%). No adverse event CTC° III was reported. Most acute side effects recovered at 3 to 6~months after radiotherapy except for CTC° I cataract and xerostomia. Local Radiotherapy was highly effective for treatment of early stage iNHL with no serious side effects in our cohort. The most acute CTCAE° I-II side effects recovered 3 to 6~months later. Technique advances seem to have further improved effectiveness and tolerability of radiotherapy.Trial registration: Local ethics committee of Ludwig-Maximilian-University (LMU) Munich approved this retrospective analysis on the May 7th, 2019 (Nr. 19-137)

MRI-based contrast clearance analysis shows high differentiation accuracy between radiation-induced reactions and progressive disease after cranial radiotherapy

BACKGROUND: Pseudoprogression (PsP) or radiation necrosis (RN) may frequently occur after cranial radiotherapy and show a similar imaging pattern compared with progressive disease (PD). We aimed to evaluate the diagnostic accuracy of magnetic resonance imaging-based contrast clearance analysis (CCA) in this clinical setting. PATIENTS AND METHODS: Patients with equivocal imaging findings after cranial radiotherapy were consecutively included into this monocentric prospective study. CCA was carried out by software-based automated subtraction of imaging features in late versus early T1-weighted sequences after contrast agent application. Two experienced neuroradiologists evaluated CCA with respect to PsP/RN and PD being blinded for histological findings. The radiological assessment was compared with the histopathological results, and its accuracy was calculated statistically. RESULTS: A total of 33 patients were included; 16 (48.5%) were treated because of a primary brain tumor (BT), and 17 (51.1%) because of a secondary BT. In one patient, CCA was technically infeasible. The accuracy of CCA in predicting the histological result was 0.84 [95% confidence interval (CI) 0.67-0.95; one-sided P = 0.051; n = 32]. Sensitivity and specificity of CCA were 0.93 (95% CI 0.66-1.00) and 0.78 (95% CI 0.52-0.94), respectively. The accuracy in patients with secondary BTs was 0.94 (95% CI 0.71-1.00) and nonsignificantly higher compared with patients with primary BT with an accuracy of 0.73 (95% CI 0.45-0.92), P = 0.16. CONCLUSIONS: In this study, CCA was a highly accurate, easy, and helpful method for distinguishing PsP or RN from PD after cranial radiotherapy, especially in patients with secondary tumors after radiosurgical treatment

Subject-specific lesson coaching during placements

Wiederholt wurde gezeigt, dass Unterrichtspraktika von Lehramtsstudierenden sehr geschätzt werden. Allerdings wissen wir wenig über die Wirkung unterschiedlicher Unterstützungsformen in Praktika auf das Lernen zukünftiger Lehrpersonen. Ein Modell zur Förderung von Praktikanten ist das fachspezifische Unterrichtscoaching. In einer quasi-experimentellen Interventionsstudie wurde dessen Wirksamkeit basierend auf Fragebogen, Videoaufzeichnungen und Interviews mit Dyaden von Praxislehrpersonen und ihren Praktikanten untersucht. Ergebnisse der Studie zeigen, dass in fachspezifischem Unterrichtscoaching weitergebildete Praxislehrpersonen (Interventionsgruppe, NIG = 16) wesentliche Elemente dieses Modells in ihr Handlungsrepertoire aufnahmen. Ihre Unterstützungspraxis unterscheidet sich signifikant von jener der Kontrollgruppe (NKG = 16), welche die Praktikanten auf traditionelle Weise unterstützen. Indikatoren für Lernen im Kontext von Unterrichtsbesprechungen belegen weiter, dass die Praktikanten der Interventionsgruppe signifikant mehr Lernerträge erzielten als die traditionell unterstützten Praktikanten. Auch die anhand von Videoaufnahmen vorgenommene Einschätzung der Unterrichtsqualität fiel für die Interventionsgruppe signifikant besser aus als für die Kontrollgruppe. It has been repeatedly shown that teaching placements are highly valued by student teachers. However, there is very little knowledge on the impact of different forms of support for placements on the learning of future teachers. One model to support placements is Content-Focused CoachingSM. In a quasi-experimental intervention study, we investigated the impact of this form of support using questionnaires, video recordings and interviews with dyads of practical teaching staff and their placement students. The results of the survey show that practical teaching staff trained in Content-Focused CoachingSM (intervention group NIG = 16) integrated basic elements of this model into their repertoire and that their teaching practice is significantly different to that in the control group (NKG = 16), which supports placement students in the traditional way. Indicators for learning in the context of lesson meetings, furthermore, give evidence that placement students in the intervention group achieve significantly better learning results than their counterparts supported in the traditional manner. The assessment of teaching quality, based on the video recordings, was also significantly better than for the control group