TY - THES A1 - Huflage, Henner T1 - Die stereotaktische Bestrahlung von Lungenmetastasen am Universitätsklinikum Würzburg im Zeitraum von November 1997 bis September 2012 T1 - Stereotacitc body radiation therapy of lung metastases at Würzburg University Hospital between November 1997 and September 2012 N2 - Die vorliegende Arbeit untersucht die stereotaktische Bestrahlung von Lungenmetastasen am Universitätsklinikum Würzburg im Zeitraum von 1997 bis 2012. In diesem Zeitraum wurden am Institut für Strahlentherapie der Universitätsklinik Würzburg 102 Patienten bestrahlt. Es sollen Einflussfaktoren auf die wesentlichen Endpunkte lokale Kontrolle, systemische Kontrolle und das Überleben identifiziert werden. Die Arbeit zeigt, dass die stereotaktische Bestrahlung eine nebenwirkungsarme und effektive Therapie von Lungenmetastasen darstellt und soll einen Beitrag dazu leisten, die Einflüsse und Ergebnisse der stereotaktischen Bestrahlung zu objektivieren und zusätzliches Datenmaterial für zukünftige Studien liefern. Das untersuchte Kollektiv der Universitätsklinik Würzburg gehört zum Zeitpunkt der Studie zu den größten in den auf diesem Gebiet durchgeführten Single-Center-Studien. N2 - The study examines the stereotactic body radiation therapy of lung metastases at the University Hospital of Würzburg in the period from 1997 to 2012. 102 patients were treated at the Institute for Radiotherapy of the University Hospital of Würzburg during this period. Factors influencing the essential endpoints of local control, systemic control and overall survival are to be identified. This study shows that SBRT is an effective therapy for lung metastases with few side effects and should contribute to objectifying the influences and results of stereotactic radiation and provide additional data material for future studies. At the time of the study, the investigated collective of the University Hospital of Würzburg is one of the largest single-centre studies conducted in this field. KW - Strahlentherapie KW - Lungenmetastase KW - SBRT Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-257620 ER - TY - JOUR A1 - Roesch, J. A1 - Panje, C. A1 - Sterzing, F. A1 - Mantel, F. A1 - Nestle, U. A1 - Andratschke, N. A1 - Guckenberger, M. T1 - SBRT for centrally localized NSCLC - What is too central? JF - Radiation Oncology N2 - Purpose Current guidelines recommend stereotactic body radiotherapy (SBRT) for stage I non-small-cell lung cancer (NSCLC) in medically inoperable patients. There are excellent outcome and toxicity data for SBRT of peripheral lung tumors. However, the discussion on SBRT for centrally located tumors is controversial. This study evaluated current clinical practice regarding SBRT of centrally located lung tumors, to identify common fractionation schedules and commonly accepted contraindications for SBRT. Methods A questionnaire consisting of two parts was introduced at the annual meeting of the DEGRO working group on stereotactic radiotherapy, representing centers in Germany and Switzerland. The first part of the questionnaire covered general information about the centers, whereas the second part specifically addressed SBRT of centrally located lung tumors, using case examples of nine primary NSCLC patients. Reconstructions of a contrast enhanced CT, as well as PET-Imaging for each case were demonstrated to the participants. Results Twenty-six centers participated in the meeting. The majority was academic (73%), participated in interdisciplinary thoracic oncology tumorboards (88%) and offered SBRT for lung tumors (96%). Two centers questioned the indication of SBRT for central lung tumors because of lack of evidence. The majority of centers had experience in SBRT for central lung tumors (88%) and half of the centers reported more than ten cases treated during a median period of five years. Most fractionation schedules used PTV encompassing doses of 48–60 Gy in eight fractions with maximum doses of 125–150%. A clear indication for SBRT treatment was seen by more than 85% of centers in three of the nine patients in whom tumors were small and not closer than 2 cm to the main bronchus. Prior pneumonectomy or immediate adjacency to hilar/mediastinal structures were not considered as contraindications for SBRT. In cases where the tumor exceeded 4 cm in diameter or was located closer than 4 cm to the carina 50–80% of centers saw an indication for SBRT. One case, with a 7 cm tumor reaching to the carina would have been treated with SBRT only by one center. Conclusion Within DEGRO working group on stereotactic radiotherapy, SBRT for small (<4 cm) early stage NSCLC is a common indication, if the minimal distance to the main bronchi is at least 2 cm. The controversy on the treatment of larger and more central tumors will hopefully be solved by ongoing prospective clinical trials. KW - SBRT KW - SABR KW - NSCLC KW - central lung KW - pulmonary toxicity Y1 - 2016 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-167459 VL - 11 IS - 157 ER - TY - THES A1 - Schindler, Paul T1 - Stellenwert der Strahlentherapie beim fortgeschrittenen adrenokortikalen Karzinom T1 - Value of radiation therapy in advanced adrenocortical carcinoma N2 - Das adrenokortikale Karzinom (ACC) ist eine seltene Tumorerkrankung der Nebennierenrinde. Die Prognose ist im Allgemeinen ungünstig und vom Tumorstadium sowie von weiteren tumor- und patientenspezifischen Faktoren abhängig. Die chirurgische Komplettresektion stellt das bisher einzige kurative Behandlungsverfahren dar. Dabei gibt es bisher für sonstige Lokaltherapien beim fortgeschrittenen bzw. rezidivierten ACC kaum umfangreiche Daten, welche die entsprechende lokale Wirksamkeit belegen. Neben der Operation stellt die Strahlentherapie eine bisher effektive Therapieoption bei verschiedenen anderen Tumorerkrankungen hinsichtlich Tumorkontrolle, Verträglichkeit und Zugänglichkeit dar. Allerdings ist diese Option in der Behandlung des fortgeschrittenen ACC als Lokaltherapie bislang nicht mit zufriedenstellenden Datensätzen umfänglich untersucht. Ziel dieser Studie war es, anhand einer retrospektiven Datenanalyse aus dem European Network for the Study of Adrenal Tumours (ENSAT) den Stellenwert der Strahlentherapie als Lokaltherapie beim fortgeschrittenen bzw. rezidivierten ACC zu untersuchen. Es wurden insgesamt 132 Fälle hinsichtlich strahlentherapeutischer Dosis, Lokalkontrolle, progressionsfreiem Überleben, Gesamtüberleben, objektivem Ansprechen, Verträglichkeit und Risikofaktoren untersucht. Hierbei konnte gezeigt werden, dass die Anwendung einer hohen biologischen Effektivdosis mit einer verbesserten lokalen Tumorkontrolle einhergeht. Insgesamt zeigte sich eine gute Verträglichkeit der strahlentherapeutischen Behandlung. Die Ergebnisse dieser Arbeit legen nahe, dass wahrscheinlich weitere Risikofaktoren mit Rezidiven dieser Tumorart einhergehen, allerdings weitere Untersuchungen (z.B. randomisierte prospektive Studien) erfordern. Letztendlich stellt diese Arbeit auch die angewandten Dosis- und Fraktionierungskonzepte der vergangenen Jahrzente bei der Behandlung des ACC dar. N2 - Adrenocortical carcinoma (ACC) is a rare malignancy of the adrenal cortex. The prognosis is generally poor and depends on the tumour stage but also on other tumour- and patient-specific factors. Complete surgical resection might be the only curative treatment option so far. Currently there is no data in a satisfactory extent, proving the local effectiveness for other local therapies in advanced ACC. In addition to surgery, radiotherapy has been described as an effective treatment option for various tumor diseases in terms of tumour control, tolerability and accessibility. However, this option as local therapy in the treatment of advanced ACC has not yet been investigated with satisfactory comprehensive data sets. The aim of this study was a retrospective data analysis from the European Network for the Study of Adrenal Tumors (ENSAT) to investigate the role of radiotherapy as a local therapy in advanced or relapsed ACC. A total of 132 cases were examined with regard to radiotherapy treatment dose, local control, progression free survival, overall survival, objective response, tolerability and other risk factors. It has been shown that the use of a high biological effective dose is associated with improved local tumour control. Overall, the radiotherapy treatment was well tolerated. The results of this study suggest that additional risk factors are probably associated with tumour recurrences but require further investigation (e.g. randomized prospective studies). Finally, this work also presents the dosage and fractionation concepts used over the past decades in the treatment of ACC. KW - Nebennierenrindenkrebs KW - adrenokortikales Karzinom KW - Endokrine Onkologie KW - Stereotaktische Strahlentherapie KW - SBRT KW - Strahlentherapie KW - Endokrinologie KW - Radiochirurgie Y1 - 2024 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-349304 ER -