Patients characteristic.

<p>Patients characteristic.</p

Validation of an established prognostic score after re-irradiation of recurrent glioma

<p><b>Background:</b> Re-irradiation (Re-RT) is offered widely in clinical routine, and has been established as a key element in the treatment of recurrent gliomas. At our center, generally re-resection is performed widely by an experienced neurosurgical team. Thus, Re-RT mostly offered to patients with macroscopic residuals or irresectable lesions, is applied later compared to other centers. Therefore, we sought to validate the Combs Prognostic Score developed in 2012 using our independent patient cohort.</p> <p><b>Patients and methods:</b> We included 199 patients treated from 2002 until April 2016 for recurrent glioma at the Department of Radiation Oncology at the Klinikum Rechts der Isar, Munich. Different concepts of Re-RT were applied.</p> <p><b>Results:</b> Median follow-up after Re-RT was 2.5 months. Median overall survival (OS) after Re-RT was 7.9 months for WHO IV gliomas, 11.3 months for WHO III gliomas, and 13.6 months for low-grade gliomas (WHO I/II). Univariate analyses confirmed the prognostic factors primary histology (p = 0.001), age (p = 0.002), and time between primary radiotherapy and Re-RT (p < 0.001). We also tested Karnofsky Performance Score (KPS), gender, and neurological symptoms before Re-RT as well as planning target volume and found only KPS also significant at p < 0.001. Comparing the prognostic score groups, the outcome was highly statistically significant at p < 0.001.</p> <p><b>Conclusion:</b> In our analysis, we validated the Combs Prognostic Score. Validation in this independent large patient cohort confirms the significance of the score for glioma recurrences. Thus, the role of the Combs Prognostic Score might be an essential component of future clinical decision making and patient stratification.</p

Treatment tolerance of particle therapy in pediatric patients

<p>Curative treatment of pediatric cancer not only focuses on long-term survival, but also on reducing treatment-related side effects. Advantages of particle therapy are mainly due to their physical ability of significantly reducing integral dose.</p> <p><b>Methods.</b> Between January 2009 and December 2012, we treated 83 pediatric patients (aged 21 and younger) at the Heidelberg Ion Therapy Center at University Hospital of Heidelberg (HIT). In total 56 patients (67%) received proton irradiation, while 25 (30%) patients were treated with carbon ions (C12). Two patients received both treatments (3%). Treatment toxicity was analyzed retrospectively and documented according to the CTCAE/RTOG classification. In a second step, treatment toxicity from ion therapy was analyzed in comparison to treatment toxicity during photon irradiation of a comparable historical group of 19 pediatric patients.</p> <p><b>Results.</b> In all patients, particle therapy was tolerated well (median follow-up time 3.7 months), children (20 patients) with at least two follow-up visits showed a median follow-up time of 10.2 months. During the first two months patients mainly suffered from radiogenic skin reaction (63%), mucositis (30%), headache and dizziness (35%) as well as nausea and vomiting (13%). Severe toxicity reaction (grade II–IV) was only seen in patients who had intensive simultaneous chemotherapy or who had undergone several operations in the irradiated area before radiotherapy (18%). Treatment toxicity during ion therapy was comparable to treatment toxicity from photon irradiation of a historical group.</p> <p><b>Conclusions.</b> In comparison to conventional therapy, patients with particle therapy do not suffer from increased acute treatment-related toxicity during the first months. More experience with particle therapy will be needed during the next years to help to thoroughly evaluate the high potential of ion therapy.</p

New prognostic score: Median OS and life table.

<p>New prognostic score: Median OS and life table.</p

Scoring scheme of the new prognostic score (modification of the original scoring scheme by Combs et al. [1]).

<p>Scoring scheme of the new prognostic score (modification of the original scoring scheme by Combs et al. [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0180457#pone.0180457.ref001" target="_blank">1</a>]).</p

OS after according to the new prognostic score (p < .001).

<p>OS after according to the new prognostic score (p < .001).</p

Results of the univariate and multivariate analyses of the prognostic factors.

<p>Results of the univariate and multivariate analyses of the prognostic factors.</p

Patients characteristic.

<p>Patients characteristic.</p

User rate of CAM.

<p>User rate of CAM during and before therapy. The percentage for all are calculated with n = 171; for the different units, the percentage of n = 26 / n = 56 are displayed for during and before therapy respectively.</p

User motives.

<p>Motives of oncological patients to use CAM (n = 171).</p