Low-Dose Radiotherapy of Painful Heel Spur/Plantar Fasciitis as an Example of Treatment Effects in Benign Diseases

Degenerative changes in the plantar fascia may cause the so‐called “painful heel” with typical projections of tenderness. This condition is often associated with a plantar heel spur. Radiotherapy with low doses (LD‐EBRT) has been well known for its anti‐inflammatory potential. In the recent years, several microbiological mechanisms were elucidated to explain immunomodulation by LD‐EBRT. Furthermore, a randomized study proved the clinical efficacy of this therapy in plantar fasciitis. Two other trials defined a fractionation schedule of 6 × 0.5 Gy twice weekly as the new standard therapy. Taken together, LD‐EBRT is an effective and safe therapeutic option for patients over 30 years of age and after exclusion of pregnancy. In case of an insufficient response, a second course can be offered to the patient. There are still open questions concerning target volume definition and fractionation of LD‐EBRT. Furthermore, studies randomizing LD‐EBRT with other conservative therapeutic approaches are missing

Cardiac Toxicity after Radiotherapy for Breast Cancer: Myths and Facts

Radiotherapy is an important component in the multidisciplinary treatment of breast cancer. In recent years, the cardiac risks of radiation have been discussed several times. This problem has long been known and resolved from the radiotherapeutic point of view. The current data is briefly described here

Emerging Role of Hypofractionated Radiotherapy with Simultaneous Integrated Boost in Modern Radiotherapy of Breast Cancer

Hypofractionated radiotherapy for breast cancer is becoming increasingly important. The scientific background of this development as well as the introduction of the simultaneous integrated boost to the primary tumor region in this context are discussed here

Prospective Evaluation of Low-Dose External Beam Radiotherapy (LD-EBRT) for Painful Trapeziometacarpal Osteoarthritis (Rhizarthrosis) on Pain, Function, and Quality of Life to Calculate the Required Number of Patients for a Prospective Randomized Study

Background: Retrospective studies have described the effectiveness of low-dose radiotherapy (LD-EBRT) in painful arthrosis of small finger joints, but two recent prospective studies have yielded ambiguous results. To generate accurate data for the planning of a trial, we conducted a prospective, monocentric, observational study to describe the effects of LD-EBRT as precisely as possible. Methods: Twenty-five consecutive patients with symptomatic trapeziometacarpal (TMC) arthrosis were irradiated with 6 × 0.5 Gy. Before, 3, and 12 months after LD-EBRT, we assessed subjective endpoints (modified “von-Pannewitz score”, 10-point visual analogue scale (VAS), “patient-rated wrist evaluation” (PRWE)), and objective measurements (“active range of motion” (AROM), Kapandji index, grip strength, pinch grip). Results: At 3/12 months, 80%/57% reported partial and 4%/18% complete remission according to the “von-Pannewitz” score. VAS “overall pain” significantly decreased from a median of seven (IQR 4) at baseline to three (IQR 6; p = 0.046) and to two (IQR 2; p = 0.013). Similar results were obtained for VAS “pain during exercise”, VAS “pain during daytime”, and VAS “function”. “PRWE overall score” was reduced from 0.5 at baseline (SD 0.19) to 0.36 (SD 0.24, p = 0.05) and to 0.27 (SD 0.18, p = 0.0009). We found no improvements of the objective endpoints (AROM, Kapandji, grip strength) except for flexion, which increased from 64° (SD 12°) at baseline to 73° (SD 9.7°, p = 0.046) at 12 months. Conclusions: We recommend the PRWE score as a useful endpoint for further studies for this indication. To prove a 15% superiority over sham irradiation, we calculated that 750 patients need to be prospectively randomized

No supra-additive effects of goserelin and radiotherapy on clonogenic survival of prostate carcinoma cells in vitro

<p>Abstract</p> <p>Background</p> <p>Oncological results of radiotherapy for locally advanced prostate cancer (PC) are significantly improved by simultaneous application of LHRH analoga (e.g. goserelin). As 85% of PC express LHRH receptors, we investigated the interaction of goserelin incubation with radiotherapy under androgen-deprived conditions in vitro.</p> <p>Methods</p> <p>LNCaP and PC-3 cells were stained for LHRH receptors. Downstream the LHRH receptor, changes in protein expression of c-fos, phosphorylated p38 and phosphorylated ERK1/2 were analyzed by means of Western blotting after incubation with goserelin and irradiation with 4 Gy. Both cell lines were incubated with different concentrations of goserelin in hormone-free medium. 12 h later cells were irradiated (0 – 4 Gy) and after 12 h goserelin was withdrawn. Endpoints were clonogenic survival and cell viability (12 h, 36 h and 60 h after irradiation).</p> <p>Results</p> <p>Both tested cell lines expressed LHRH-receptors. Changes in protein expression demonstrated the functional activity of goserelin in the tested cell lines. Neither in LNCaP nor in PC-3 any significant effects of additional goserelin incubation on clonogenic survival or cell viability for all tested concentrations in comparison to radiation alone were seen.</p> <p>Conclusion</p> <p>The clinically observed increase in tumor control after combination of goserelin with radiotherapy in PC cannot be attributed to an increase in radiosensitivity of PC cells by goserelin in vitro.</p

Prostate-Specific Membrane Antigen PET/CT: False-Positive Results due to Sarcoidosis?

We report on a 72-year-old male patient who developed sarcoidosis of the mediastinal lymph nodes, the liver, and the prostate 11 years ago. Seven years later, he underwent transurethral resection of the prostate by laser due to hematuria. Pathology of the resected chips showed a ‘granulomatous prostatitis with epitheloid cells’. Malignancy was histologically excluded at that time. Four years later, he was diagnosed with an undifferentiated prostate carcinoma, with a Gleason score of 5 + 4 = 9. After initiation of antihormonal therapy, he underwent radical prostatectomy and pelvic lymphadenectomy, which revealed a pT3b pN1 carcinoma with infiltrated resection margins. Three months later, the prostate-specific antigen level was 1.4 ng/ml, and a local recurrence was suspected by ultrasound; consequently, a 68Ga-prostate-specific membrane antigen (PSMA) PET/CT was performed. This examination seemed to confirm the local recurrence, a right pelvic lymph node metastasis, and a hepatic metastasis. However, ultrasound with contrast medium could not confirm the metastatic spread to the liver. In palliative intention, radiotherapy of the pelvis was done. After 50 Gy, the supposed recurrence had markedly shrunk, and an additional boost dose with 16.2 Gy was applied. Two years later, the patient is still free of disease. Due to this clinical development, we doubt the diagnosis of a fulminant progression of the prostate cancer as suspected by PSMA-PET/CT. Instead, we suspect a recurrence of the previously proven sarcoidosis leading to false-positive results. Our focus in this report is on the interaction between PSMA-PET/CT and sarcoidosis. Another report on a case of sarcoidosis of the spleen seems to confirm this possibility [Kobe et al: Clin Nucl Med 2015;40: 897–898]

Three Simple Software Extensions for Automatic Presentation of Radiation Induced Toxicity, Sequelae and Treatment Outcomes, for Increasing Safety in Daily Therapeutic Routine, and for Enhancing Patient Comfort

Background: Simple software extensions to already existing software-infrastructure can monitor treatment results, increase patient safety and enhance patient comfort in a very cost-effective way. This is of particular interest due to the increasing implementation of quality management in radiotherapeutic treatment sites as well as due to the external cooperation in cancer centers. In this article, we present three different tools.Results: First, “ToxReview” is a program extension to “MOSAIQ” 02.10. It correlates automatically radiation induced toxicity and treatment outcomes with therapeutic concepts (target volumes, radiation doses etc.). Data are shown in a simple tabular form.Second, “Patient&nbsp; Recognition”&nbsp; is&nbsp; a&nbsp; JAVA&nbsp; based&nbsp; program&nbsp; extension&nbsp; that&nbsp; aims&nbsp; to&nbsp; minimize&nbsp; the risk of mix-ups between patients. It does not need a MOSAIQ license. It identifies the actual patient uploaded in the treatment control station. On a monitor next to the treatment room entrance a portrait and the name of this patient is shown, enabling the assistance staff and the patient himself to check that his specific data are uploaded.Third,&nbsp; the&nbsp; add-on&nbsp; “Jukebox”&nbsp; enables&nbsp; to&nbsp; play&nbsp; patient&nbsp; individualized&nbsp; music&nbsp; and&nbsp; entertainment programs in the radiation room during treatment. No additional efforts are necessary for the assistance staff. Conclusion: We present customer programmable software extensions with high value in daily clinical practice, to expand the possibilities of the pre-existing IT infrastructure.Quality management,patient safety and patient satisfaction are substantially increased. </p

CT Scanner Based Virtual Simulation of Radiotherapy Treatment by the PICTOR 3D® System Does not Increase Efficacy in Daily Routine Radiation Therapy

Exact reproduction of patient position is crucial in radiotherapy. We evaluated the reproducibility of&nbsp; a&nbsp; CT&nbsp; based&nbsp; treatment&nbsp; simulation&nbsp; with&nbsp; the&nbsp; PICTOR&nbsp; 3D ® system&nbsp; (LAP,&nbsp; Lüneburg,&nbsp; Germany)&nbsp; and examined its influence on workflow in daily routine.Ulterior motive to introduce such a simulation system is to save time at the radiation treatment machine (LINAC). Normally, treatment simulations are directly done at the LINAC (so called „virtual simulation“). However, this procedure is time consuming, and opportunity costs are much higher for the LINAC than for the treatment planning CT scanner. This explains the efforts to switch the simulation process from the LINAC to the planning CT.In 31 patients the isocenter marks were drawn at the planning CT with laser projections, and afterwards controlled at the LINAC based imaging system. The mean offsets between both simulations were 2.7 ± 2.4 mm in lateral, 2.3 ± 2.2 mm in longitudinal, and 1.9 ± 1.7 mm in sagittal direction.In 14 patients (45%) the deviation was ≥5mm in at least one direction. In both separately evaluated anatomical regions (thorax, pelvis) and all age groups significant offsets were seen. The time span for a virtual simulation with the PICTOR 3D ® system was 18 ± 2 min (ranging from 15 to 23min).The LINAC based virtual simulation cannot be replaced by the CT based simulation with PICTOR 3D ®, as the latter is lacking an option to verify the laser projected isocenter at the CT scanner. The daily workflow is not improved by this system, it is dispensable in daily clinical routine.</p