Prostate bed irradiation with alternative radio-oncological approaches (PAROS) - a prospective, multicenter and randomized phase III trial

Background: For patients with treatment-naïve carcinoma of the prostate, hypofractionated irradiation becomes more and more popular. Due to the low α/β value of prostate cancer, increased single dose leading to a shortened treatment period seems to be safe and feasible. However, reliable data is lacking for post-prostatectomy patients so far. Further, the role of proton therapy is still under debate. Two prospective phase II trials with both, hypofractionated photon and proton therapy, provided promising results. Methods/design: The PAROS trial is a prospective, multicenter and randomized phase III trial for men with localized prostate carcinoma after surgery. Post-prostatectomy patients will be randomized to either normofractionated radiotherapy (nRT) with photons (70.0/ 2.0 Gy), or hypofractionated radiotherapy (hRT) with photons (57.0/ 3.0 Gy) or hRT with protons (57.0/ 3.0 Gy relative biological effectiveness [RBE]). Block randomization is stratified by Gleason Score (≤ 7 vs. > 7) and treatment indication (adjuvant vs. salvage). The trial is planned to enroll 897 patients. The primary objective is to show an improvement in the bowel-score according to EORTC QLQ-PR25 after proton therapy compared to photon irradiation (week 12 vs. baseline). Secondary aims are non-inferiority of hRT compared to nRT with regard to biochemical progression-free survival (bPFS), overall survival (OS), quality of life and toxicity. Discussion: The present study aims to evaluate the role of hypofractionated radiotherapy to the prostate bed with photons and protons leading to significant impact on future management of operated men with prostate cancer. Trial registration: Deutsches Register klinischer Studien DRKS00015231; registered 27 September 2018

PSMA-PET/CT-guided salvage radiotherapy in recurrent or persistent prostate cancer and PSA < 0.2 ng/ml.

PURPOSE The purpose of this retrospective, multicenter study was to assess efficacy of PSMA-PET/CT-guided salvage radiotherapy (sRT) in patients with recurrent or persistent PSA after primary surgery and PSA levels < 0.2 ng/ml. METHODS The study included patients from a pooled cohort (n = 1223) of 11 centers from 6 countries. Patients with PSA levels > 0.2 ng/ml prior to sRT or without sRT to the prostatic fossa were excluded. The primary study endpoint was biochemical recurrence-free survival (BRFS) and BR was defined as PSA nadir after sRT + 0.2 ng/ml. Cox regression analysis was performed to assess the impact of clinical parameters on BRFS. Recurrence patterns after sRT were analyzed. RESULTS The final cohort consisted of 273 patients; 78/273 (28.6%) and 48/273 (17.6%) patients had local or nodal recurrence on PET/CT. The most frequently applied sRT dose to the prostatic fossa was 66-70 Gy (n = 143/273, 52.4%). SRT to pelvic lymphatics was delivered in 87/273 (31.9%) patients and androgen deprivation therapy was given to 36/273 (13.2%) patients. After a median follow-up time of 31.1 months (IQR: 20-44), 60/273 (22%) patients had biochemical recurrence. The 2- and 3-year BRFS was 90.1% and 79.2%, respectively. The presence of seminal vesicle invasion in surgery (p = 0.019) and local recurrences in PET/CT (p = 0.039) had a significant impact on BR in multivariate analysis. In 16 patients, information on recurrence patterns on PSMA-PET/CT after sRT was available and one had recurrent disease inside the RT field. CONCLUSION This multicenter analysis suggests that implementation of PSMA-PET/CT imaging for sRT guidance might be of benefit for patients with very low PSA levels after surgery due to promising BRFS rates and a low number of relapses within the sRT field

Development and Validation of a Multi-institutional Nomogram of Outcomes for PSMA-PET-Based Salvage Radiotherapy for Recurrent Prostate Cancer.

IMPORTANCE Prostate-specific antigen membrane positron-emission tomography (PSMA-PET) is increasingly used to guide salvage radiotherapy (sRT) after radical prostatectomy for patients with recurrent or persistent prostate cancer. OBJECTIVE To develop and validate a nomogram for prediction of freedom from biochemical failure (FFBF) after PSMA-PET-based sRT. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study included 1029 patients with prostate cancer treated between July 1, 2013, and June 30, 2020, at 11 centers from 5 countries. The initial database consisted of 1221 patients. All patients had a PSMA-PET scan prior to sRT. Data were analyzed in November 2022. EXPOSURES Patients with a detectable post-radical prostatectomy prostate-specific antigen (PSA) level treated with sRT to the prostatic fossa with or without additional sRT to pelvic lymphatics or concurrent androgen deprivation therapy (ADT) were eligible. MAIN OUTCOMES AND MEASURES The FFBF rate was estimated, and a predictive nomogram was generated and validated. Biochemical relapse was defined as a PSA nadir of 0.2 ng/mL after sRT. RESULTS In the nomogram creation and validation process, 1029 patients (median age at sRT, 70 years [IQR, 64-74 years]) were included and further divided into a training set (n = 708), internal validation set (n = 271), and external outlier validation set (n = 50). The median follow-up was 32 months (IQR, 21-45 months). Based on the PSMA-PET scan prior to sRT, 437 patients (42.5%) had local recurrences and 313 patients (30.4%) had nodal recurrences. Pelvic lymphatics were electively irradiated for 395 patients (38.4%). All patients received sRT to the prostatic fossa: 103 (10.0%) received a dose of less than 66 Gy, 551 (53.5%) received a dose of 66 to 70 Gy, and 375 (36.5%) received a dose of more than 70 Gy. Androgen deprivation therapy was given to 325 (31.6%) patients. On multivariable Cox proportional hazards regression analysis, pre-sRT PSA level (hazard ratio [HR], 1.80 [95% CI, 1.41-2.31]), International Society of Urological Pathology grade in surgery specimen (grade 5 vs 1+2: HR, 2.39 [95% CI, 1.63-3.50], pT stage (pT3b+pT4 vs pT2: HR, 1.91 [95% CI, 1.39-2.67]), surgical margins (R0 vs R1+R2+Rx: HR, 0.60 [95% CI, 0.48-0.78]), ADT use (HR, 0.49 [95% CI, 0.37-0.65]), sRT dose (>70 vs ≤66 Gy: HR, 0.44 [95% CI, 0.29-0.67]), and nodal recurrence detected on PSMA-PET scans (HR, 1.42 [95% CI, 1.09-1.85]) were associated with FFBF. The mean (SD) nomogram concordance index for FFBF was 0.72 (0.06) for the internal validation cohort and 0.67 (0.11) in the external outlier validation cohort. CONCLUSIONS AND RELEVANCE This cohort study of patients with prostate cancer presents an internally and externally validated nomogram that estimated individual patient outcomes after PSMA-PET-guided sRT

Head-to-head intra-individual comparison of biodistribution and tumor uptake of 68Ga-FAPI and 18F-FDG PET/CT in cancer patients

PURPOSE : FAPI ligands (fibroblast activation protein inhibitor), a novel class of radiotracers for PET/CT imaging, demonstrated in previous studies rapid and high tumor uptake. The purpose of this study is the head-to-head intra-individual comparison of 68Ga- FAPI versus standard-of-care 18F-FDG in PET/CT in organ biodistribution and tumor uptake in patients with various cancers. MARERILA AND METHODS : This international retrospective multicenter analysis included PET/CT data from 71 patients from 6 centers who underwent both 68Ga-FAPI and 18F-FDG PET/CT within a median time interval of 10 days (range 1–89 days). Volumes of interest (VOIs) were manually drawn in normal organs and tumor lesions to quantify tracer uptake by SUVmax and SUVmean. Furthermore, tumor-to-background ratios (TBR) were generated (SUVmax tumor/ SUVmax organ). RESULTS : A total of 71 patients were studied of, which 28 were female and 43 male (median age 60). In 41 of 71 patients, the primary tumor was present. Forty-three of 71 patients exhibited 162 metastatic lesions. 68Ga-FAPI uptake in primary tumors and metastases was comparable to 18F-FDG in most cases. The SUVmax was significantly lower for 68Ga-FAPI than 18F-FDG in background tissues such as the brain, oral mucosa, myocardium, blood pool, liver, pancreas, and colon. Thus, 68Ga-FAPI TBRs were significantly higher than 18F-FDG TBRs in some sites, including liver and bone metastases. CONCLUSION : Quantitative tumor uptake is comparable between 68Ga-FAPI and 18F-FDG, but lower background uptake in most normal organs results in equal or higher TBRs for 68Ga-FAPI. Thus, 68Ga-FAPI PET/CT may yield improved diagnostic information in various cancers and especially in tumor locations with high physiological 18F-FDG uptake.Open Access funding by Projekt DEAL.http://link.springer.com/journal/259am2022Nuclear Medicin

Spagat mit Kopftuch Essays zur Deutsch-Tuerkischen Sommerakademie

In diesem Band praesentiert die Hamburger Koerber-Stiftung Essays ihrer Deutsch-Tuerkischen Sommerakademien, die dazu beitragen sollen, den nicht immer einfachen deutsch-tuerkischen Dialog zu verbessern. Seit 1994 haben junge deutsche und tuerkische Studierende und Graduierte zu unterschiedlichen Aspekten der bilateralen Beziehungen geforscht und sich kennengelernt. (Autorenreferat) Inhalt: 1. Zur Geschichte und Gegenwart der deutsch-tuerkischen Beziehungen (Imago Turci). U. Kural: Antiosmanische Propaganda, aufgezeigt an deutschsprachigen Flugblaettern des 16. Jahrhunderts; A. Hoefert: Vom Antichrist zum Menschen: Der Wandel des westeuropaeischen Tuerkenbildes in der fruehen Neuzeit anhand des 'Traktats ueber die Sitten, die Lebensverhaeltnisse und die Arglist der Tuerken' des Georg von Ungarn; O. Schnekenburger: Die Tuerkeipolitik des Deutschen Reichs in der Bismarckzeit; S. Zahlmann: Tuerken? Find ich gut. Auslaendische Maenner in deutschen Werbeanzeigen seit der Jahrhundertwende; I. Schoenberger: Gedanken zur tuerkischen Kleidung. Vom historischen Blickwinkel auf die Tuerkei zur heutigen Situation der Tuerken in Deutschland; S. Kara: Die zweite Eroberung Istanbuls - Erhaltung und Geschichtsbewusstsein in der Tuerkei; N. Yuece: Die Funktion der jungen tuerkischen Rueckwanderer im Tourismus. 2. Die Tuerkei in Europa. O. Ernst: Die Diskussion um Menschenrechte und Demokratie in der Tuerkei; C. Ispir: Die Tuerkei zwischen Morgenland und Abendland; N. Kilinc: Tuerkei vor der Zollunion. Ein Land zwischen zwei Zivilisationen; S. Voglrieder: Abkehr der EU von der Tuerkei? 3. Beitraege zur Migrationsproblematik. M. Oezdemir: Anmerkungen zur Situation der in Deutschland lebenden Tuerken; H. Uslucan: Die Resistenz der Ehre; O. Schaefer: Paedagogische Aspekte der tuerkischen Arbeitsmigration; S. Kirim: Wanderer zwischen zwei Welten. Ueber den Wandel der Lebensbedingungen der tuerkischen Arbeitermigranten in Deutschland. 4. Generation und Integration. A.-M. Nohl: Intergenerationelle Verhaeltnisse. Diskurse junger Tuerken ueber die Beziehung zu ihren Eltern; Ue. Oeztoprak: Werteorientierung tuerkischer Jugendlicher im Generationen und Kulturvergleich. Eine empirische Studie; Y. Sarikaya: Schulische Integration tuerkischer Jugendlicher zweiter Generation; F. Woelk: Spagat mit Kopftuch -Muslimische Maedchen im deutschen Sportunterricht. 5. Tuerkisch-deutsche Literatur und persoenliche Erfahrung. K. Yesilada: Schreiben mit spitzer Feder - die Satiren der tuerkisch-deutschen Migrationsliteratur; J. Mayr: Sprache und Kulturwechsel in tuerkisch-deutscher Literatur: Emine Sevgi Oezdamar 'Mutterzunge'; G. Oner: Deutsch? Tuerkisch? Oder Mutterzunge?; E. Molla: Das Janusgessicht des Heimatlandes. (efms LITDOC)SIGLEAvailable from efms-Bibliothek / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekDEGerman

Malignant pleural mesothelioma – Pleural cavity irradiation after decortication with helical tomotherapy

BackgroundMalignant pleural mesothelioma (MPM) is a rare and aggressive disease that poses a treatment challenge in spite of recent technical developments. The aim of this retrospective analysis is to assess the feasibility of administering intensity-modulated radiotherapy (IMRT) to the pleural cavity using helical tomotherapy in patients who had undergone pleurectomy/decortication (P/D) and also the resulting toxicity levels.Patients and methodsTen patients who had MPM and had undergone P/D were treated with pleural cavity irradiation that included a median dose of 52.2[[ce:hsp sp="0.25"/]]Gy using helical tomotherapy. The median age of the patients was 53 years (31–74). In addition to clinical and diagnostic findings from regular follow-up examinations, we evaluated the dose distribution for other organs at risk to assess treatment in relation to toxicity, with special regard for the underlying intact lung.ResultsThe mean lung dose on the treatment site was 32.8[[ce:hsp sp="0.25"/]]Gy (±6.8). The V20[[ce:hsp sp="0.25"/]]Gy was 71.7% (±17.2). No treatment-related toxicity that exceeded grade III according to common toxicity criteria (CTC) was observed. Median progression-free survival (PFS) was 13 months with a median overall survival (OAS) of 19 months.ConclusionThe findings of this analysis provide data indicating that sparing the underlying lung in patients with MPM after P/D is not only feasible with helical tomotherapy, but that this treatment also causes reasonably few side effects

Data publication : Tailoring crosstalk between localized 1D spin-wave nanochannels using focused ion beams

This dataset contains raw data (SEM images, AFM, FMR, BLS, TetraX) used to study the dynamical edge modes in closely spaced permalloy microstrips

Advanced diagnostic imaging in children and adolescents with solid tumors Staging, risk stratification, and response assessment

Background The spectrum of solid tumors in children and adolescents as well as the concepts of treatment (e.g., bone marrow transplants in solid tumors) differ from those in adults. Almost all children with cancer are included in studies of national and international oncological societies and treated in pediatric oncological centers. Pediatric radiology takes on essential tasks, especially in therapeutic risk stratification and therapy control. Materials and methods Based on a selective literature search in the PubMed database, recent guidelines, and study protocols of the national and international pediatric oncology societies, the imaging standards and the latest developments for selected solid tumor entities were described. The authors who work in pediatric oncology centers discuss embryonic tumors, lymphomas, brain tumors, and tumor predisposition syndromes. Conclusion Both performing and reading of imaging in children with solid tumors are already relatively standardized. Experienced radiologists in certified centers should primarily be involved in this task. In particular, further functional imaging innovations suggest that imaging biomarkers may be used as target parameters in future treatment studies