Dental status, dental treatment procedures and radiotherapy as risk factors for infected osteoradionecrosis (IORN) in patients with oral cancer – a comparison of two 10 years’ observation periods

OBJECTIVES: Dental status, dental treatment procedures and radiotherapy dosage as potential risk factors for an infected osteoradionecrosis (IORN) in patients with oral cancers: Retrospective evaluation of 204 patients treated in two observation periods of approximately ten years each. PATIENTS AND METHODS: In group A, 90 patients were treated in the years 1993-2003, in group B 114 patients in the years 1983-1992 (data in brackets). All patients had histopathologically proven squamous cell cancers, mainly UICC stages III and IV. 70% (85%, n.s.) had undergone surgery before radiotherapy. All patients were referred to the oral and maxillofacial surgeon for dental rehabilitation before further treatment. Radiotherapy was performed using a 3D-conformal technique with 4-6MV photons of a linear accelerator (Co-60 device up to 1987). The majority of patients were treated using conventional fractionation with total doses of 60-70 Gy in daily fractions of 2 Gy. Additionally, in group A, hyperfractionation was used applying a total dose of 72 Gy in fractions of 1.2 Gy twice daily (time interval > 6 hours). In group B, a similar schedule was used up to a total dose of 82.8 Gy (time interval 4-6 hours). 14 (0) patients had radiochemotherapy simultaneously. After therapy, the patients were seen regularly by the radiooncologist and – if necessary – by the oral and maxillofacial surgeon. The duration of follow-up was 3.64 years (5 years, p = 0.004). RESULTS: Before radiotherapy, the dental health status was very poor. On average, 21.5 (21.2, n.s.) teeth were missing. Further 2.04 teeth (2.33, n.s.) were carious, 1.4 (0.3, p = 0.002) destroyed. Extractions were necessary in 3.6 teeth (5.8, p = 0.008), conserving treatment in 0.4 (0.1, p = 0.008) teeth. After dental treatment, 6.30 (4.8, n.s.) teeth remained. IORN was diagnosed after conventionally fractionated radiotherapy in 15% (11%, n.s.), after hyperfractionation in 0% (34%, p = 0.01). CONCLUSION: Within more than 20 years there was no improvement in dental status of oral cancer patients. Extensive dental treatment procedures remained necessary. There was an impressive reduction of the IORN frequency in patients treated in a hyperfractionated manner probably resulting from a dose reduction and an extension of the interfraction time

ArthroRad trial: multicentric prospective and randomized single-blinded trial on the effect of low-dose radiotherapy for painful osteoarthritis depending on the dose-results after 3 months' follow-up

Purpose Randomized comparison of the effect of radiotherapy on painful osteoarthritis (OA) applying a standard-dose vs. a very-low-dose regime Patients and methods Patients with OA of the hand and knee joints were included. Further inclusion criteria: symptoms for more than 3 months, favorable general health status, age above 40 years. Patients with prior local radiotherapy, trauma, rheumatoid arthritis, or vascular diseases were excluded. After randomization (every joint was randomized separately), the following protocols were applied: standard arm: total dose 3.0 Gy, single fractions of 0.5 Gy twice weekly; experimental arm: total dose 0.3 Gy, single fractions of 0.05 Gy twice weekly. The dosage was not known to the patients. The patients were examined 3 and 12 months after radiotherapy. Scores like VAS (visual analogue scale), KOOS-SF (the knee injugy and osteoarthritis outcome score), SF-SACRAH (short form score for the assessment and quantification of chronic rheumatic affections of the hands), and SF-12 (short form 12) were used. Results A total of 64 knees and 172 hands were randomized. 3.0 Gy was applied to 87 hands and 34 knees, 0.3 Gy was given to 85 hands and 30 knees. After 3 months, we observed good pain relief after 3 Gy and after 0.3 Gy, there was no statistically significant difference. Side effects were not recorded. The trial was closed prematurely due to slow recruitment. Conclusion We found favorable pain relief and a limited response in the functional and quality of life scores in both arms. The effect of low doses such as 0.3 Gy on pain is widely unknown. Further trials are necessary to compare a conventional dose to placebo and to further explore the effect of low doses on inflammatory disorders

New clinical and biological insights from the international TARGIT-A randomised trial of targeted intraoperative radiotherapy during lumpectomy for breast cancer

BACKGROUND: The TARGIT-A trial reported risk-adapted targeted intraoperative radiotherapy (TARGIT-IORT) during lumpectomy for breast cancer to be as effective as whole-breast external beam radiotherapy (EBRT). Here, we present further detailed analyses. METHODS: In total, 2298 women (≥45 years, invasive ductal carcinoma ≤3.5 cm, cN0-N1) were randomised. We investigated the impact of tumour size, grade, ER, PgR, HER2 and lymph node status on local recurrence-free survival, and of local recurrence on distant relapse and mortality. We analysed the predictive factors for recommending supplemental EBRT after TARGIT-IORT as part of the risk-adapted approach, using regression modelling. Non-breast cancer mortality was compared between TARGIT-IORT plus EBRT vs. EBRT. RESULTS: Local recurrence-free survival was no different between TARGIT-IORT and EBRT, in every tumour subgroup. Unlike in the EBRT arm, local recurrence in the TARGIT-IORT arm was not a predictor of a higher risk of distant relapse or death. Our new predictive tool for recommending supplemental EBRT after TARGIT-IORT is at https://targit.org.uk/addrt . Non-breast cancer mortality was significantly lower in the TARGIT-IORT arm, even when patients received supplemental EBRT, HR 0.38 (95% CI 0.17-0.88) P = 0.0091. CONCLUSION: TARGIT-IORT is as effective as EBRT in all subgroups. Local recurrence after TARGIT-IORT, unlike after EBRT, has a good prognosis. TARGIT-IORT might have a beneficial abscopal effect. TRIAL REGISTRATION: ISRCTN34086741 (21/7/2004), NCT00983684 (24/9/2009)

Long-term results of radiotherapy for periarthritis of the shoulder: a retrospective evaluation

<p>Abstract</p> <p>Background</p> <p>To evaluate retrospectively the results of radiotherapy for periarthritis of the shoulder</p> <p>Methods</p> <p>In 1983–2004, 141 patients were treated, all had attended at least one follow-up examination. 19% had had pain for several weeks, 66% for months and 14% for years. Shoulder motility was impaired in 137/140 patients. Nearly all patients had taken oral analgesics, 81% had undergone physiotherapy, five patients had been operated on, and six had been irradiated. Radiotherapy was applied using regular anterior-posterior opposing portals and Co-60 gamma rays or 4 MV photons. 89% of the patients received a total dose of 6 Gy (dose/fraction of 1 Gy twice weekly, the others had total doses ranging from 4 to 8 Gy. The patients and the referring doctors were given written questionnaires in order to obtain long-term results. The mean duration of follow-up was 6.9 years [0–20 years].</p> <p>Results</p> <p>During the first follow-up examination at the end of radiotherapy 56% of the patients reported pain relief and improvement of motility. After in median 4.5 months the values were 69 and 89%, after 3.9 years 73% and 73%, respectively. There were virtually no side effects. In the questionnaires, 69% of the patients reported pain relief directly after radiotherapy, 31% up to 12 weeks after radiotherapy. 56% of the patients stated that pain relief had lasted for "years", in further 12% at least for "months".</p> <p>Conclusion</p> <p>Low-dose radiotherapy for periarthropathy of the shoulder was highly effective and yielded long-lasting improvement of pain and motility without side effects.</p

Die Integration eines computerbasierten Anatomie-Lernprogramms im Curriculum der Ausbildung Medizinisch-technischer Assistenten der Fachrichtung Radiologie [The integration of a computer-based tutorial in anatomy into an educational curriculum for student radiographers/technicians]

[english] Purpose: Anatomy is an important subject in the education of radiographers and radiotherapy technicians. The enormous amount of information may render efficient learning more difficult and lead to sub-optimal results. The purpose of this study was to test whether the introduction of a computer-based tutorial enhances learning success in anatomy. Methods: A commercially available tutorial in anatomy especially adapted to the requirements of the education of radiographers and which facilitated and structured the frequent repetition of the material was introduced into the conventional curriculum. The tutorial was used during normal lessons, and work with it was obligatory. The students could learn anatomical structures and landmarks repeatedly as well as test themselves. The scores obtained in the final examinations two years prior to introduction of this tutorial were compared with those obtained two years after introduction. Results: Students’ knowledge in anatomy could be markedly improved. Conclusion: An efficient and time-saving method of learning became possible. It was important to integrate the tutorial into the normal curriculum. The test results show the feasibility of this educational concept. <br>[german] Zielsetzung: In der MTA-Ausbildung nimmt Anatomie einen wichtigen Platz ein. Die große Stofffülle erschwert jedoch ein effizientes zeitsparendes Lernen und führt auch bei motivierten Schülern oft zu mangelndem Lernerfolg. Es sollte geprüft werden, ob dieser durch Einführung computerbasierten Lernens verbessert werden kann. Methodik: Ein auf die Erfordernisse der MTRA-Ausbildung von den Autoren angepasstes kommerzielles Anatomie-Lernprogramm, das den Schülern das notwendige häufige Wiederholen des Materials erleichtert und strukturiert, wurde im Rahmen des Pflichtunterrichtes den Schülern zur Verfügung gestellt. Diese konnten damit anatomische Sachverhalte sich einprägen, beliebig oft wiederholen und ihr Wissen testen. Die Examensergebnisse jeweils zweier Jahrgänge vor und nach der Einführung des Programms wurden verglichen. Ergebnisse: Durch die Einführung des Programms konnten die Anatomiekenntnisse von MTA-Schülern bei gleichem Zeitaufwand deutlich verbessert werden. Schlussfolgerung: Durch gezieltes Üben derjenigen Elemente, die noch nicht ausreichend im Langzeitgedächtnis verankert sind, war eine effiziente und zeitsparende Art des Lernens möglich. Wichtig ist eine Einbettung des eLearning-Tools in den normalen Unterrichtsablauf. Die deutlich besseren Examensergebnisse nach Einführung unserer Anatomie-Lernplattform sprechen für die Richtigkeit des Konzeptes

Die Integration eines computerbasierten Anatomie-Lernprogramms im Curriculum der Ausbildung Medizinisch-technischer Assistenten der Fachrichtung Radiologie [The integration of a computer-based tutorial in anatomy into an educational curriculum for student radiographers/technicians]

[english] Purpose: Anatomy is an important subject in the education of radiographers and radiotherapy technicians. The enormous amount of information may render efficient learning more difficult and lead to sub-optimal results. The purpose of this study was to test whether the introduction of a computer-based tutorial enhances learning success in anatomy. Methods: A commercially available tutorial in anatomy especially adapted to the requirements of the education of radiographers and which facilitated and structured the frequent repetition of the material was introduced into the conventional curriculum. The tutorial was used during normal lessons, and work with it was obligatory. The students could learn anatomical structures and landmarks repeatedly as well as test themselves. The scores obtained in the final examinations two years prior to introduction of this tutorial were compared with those obtained two years after introduction. Results: Students’ knowledge in anatomy could be markedly improved. Conclusion: An efficient and time-saving method of learning became possible. It was important to integrate the tutorial into the normal curriculum. The test results show the feasibility of this educational concept. <br>[german] Zielsetzung: In der MTA-Ausbildung nimmt Anatomie einen wichtigen Platz ein. Die große Stofffülle erschwert jedoch ein effizientes zeitsparendes Lernen und führt auch bei motivierten Schülern oft zu mangelndem Lernerfolg. Es sollte geprüft werden, ob dieser durch Einführung computerbasierten Lernens verbessert werden kann. Methodik: Ein auf die Erfordernisse der MTRA-Ausbildung von den Autoren angepasstes kommerzielles Anatomie-Lernprogramm, das den Schülern das notwendige häufige Wiederholen des Materials erleichtert und strukturiert, wurde im Rahmen des Pflichtunterrichtes den Schülern zur Verfügung gestellt. Diese konnten damit anatomische Sachverhalte sich einprägen, beliebig oft wiederholen und ihr Wissen testen. Die Examensergebnisse jeweils zweier Jahrgänge vor und nach der Einführung des Programms wurden verglichen. Ergebnisse: Durch die Einführung des Programms konnten die Anatomiekenntnisse von MTA-Schülern bei gleichem Zeitaufwand deutlich verbessert werden. Schlussfolgerung: Durch gezieltes Üben derjenigen Elemente, die noch nicht ausreichend im Langzeitgedächtnis verankert sind, war eine effiziente und zeitsparende Art des Lernens möglich. Wichtig ist eine Einbettung des eLearning-Tools in den normalen Unterrichtsablauf. Die deutlich besseren Examensergebnisse nach Einführung unserer Anatomie-Lernplattform sprechen für die Richtigkeit des Konzeptes

Radiotherapy of painful heel spur with two fractionation regimens

Background In this randomized multicenter trial, we compared the effect of a lower single dose of 0.5 Gy vs. a standard single dose of 1 Gy concerning pain relief and quality of life, while maintaining a uniform total dose of 6 Gy. On the basis of laboratory observations, the lower single dose would be expected to be more effective. Patients and methods A total of 127 patients suffering from painful heel spur were randomized: Patients in the standard group were treated with single fractions of 6 x 1 Gy twice a week, while the experimental group was treated with single fractions of 12 x 0.5 Gy three times a week. Patients who did not show satisfactory pain relief after 12 weeks were offered re-irradiation with the standard dose. The study's primary endpoints were pain relief and quality of life. Therapy results were evaluated and compared based on follow-up examinations after 12 and 48 weeks. Results The data of 117 patients could be evaluated. There was no significant difference between the groups concerning the results of a visual analogue scale (VAS), Calcaneodynia Score (CS), and the somatic scale of the 12-Item Short-Form Health Survey(SF-12). Patients undergoing re-irradiation showed a significant benefit concerning pain relief. Their total outcome was comparable to patients showing a good response from the beginning. No relevant acute or chronic side effects were recorded. Conclusion Both patient groups showed good results concerning pain relief. A fractionation schedule of 12 x 0.5 Gy was not superior to the current standard dose of 6 x 1 Gy. Further trials are necessary to explore the best fractionation schedule