TY  - JOUR
A1  - Pinkawa, Michael
A1  - Aebersold, Daniel M.
A1  - Böhmer, Dirk
A1  - Flentje, Michael
A1  - Ghadjar, Pirus
A1  - Schmidt-Hegemann, Nina-Sophie
A1  - Höcht, Stefan
A1  - Hölscher, Tobias
A1  - Müller, Arndt-Christian
A1  - Niehoff, Peter
A1  - Sedlmayer, Felix
A1  - Wolf, Frank
A1  - Zamboglou, Constantinos
A1  - Zips, Daniel
A1  - Wiegel, Thomas
T1  - Radiotherapy in nodal oligorecurrent prostate cancer
JF  - Strahlentherapie und Onkologie
N2  - Objective
The current article encompasses a literature review and recommendations for radiotherapy in nodal oligorecurrent prostate cancer.

Materials and methods
A literature review focused on studies comparing metastasis-directed stereotactic ablative radiotherapy (SABR) vs. external elective nodal radiotherapy (ENRT) and studies analyzing recurrence patterns after local nodal treatment was performed. The DEGRO Prostate Cancer Expert Panel discussed the results and developed treatment recommendations.

Results
Metastasis-directed radiotherapy results in high local control (often > 90% within a follow-up of 1–2 years) and can be used to improve progression-free survival or defer androgen deprivation therapy (ADT) according to prospective randomized phase II data. Distant progression after involved-node SABR only occurs within a few months in the majority of patients. ENRT improves metastases-free survival rates with increased toxicity in comparison to SABR according to retrospective comparative studies. The majority of nodal recurrences after initial local treatment of pelvic nodal metastasis are detected within the true pelvis and common iliac vessels.

Conclusion
ENRT with or without a boost should be preferred to SABR in pelvic nodal recurrences. In oligometastatic prostate cancer with distant (extrapelvic) nodal recurrences, SABR alone can be performed in selected cases. Application of additional systemic treatments should be based on current guidelines, with ADT as first-line treatment for hormone-sensitive prostate cancer. Only in carefully selected patients can radiotherapy be initially used without additional ADT outside of the current standard recommendations. Results of (randomized) prospective studies are needed for definitive recommendations.
KW  - prostate cancer
KW  - oligorecurrence
KW  - metastasis-directed therapy
KW  - radiation therapy
KW  - androgen deprivation therapy
KW  - stereotactic body radiotherapy
KW  - oligmometastases
KW  - lymph node metastases
Y1  - 2021
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-307763
SN  - 0179-7158
SN  - 1439-099X
VL  - 197
IS  - 7
ER  - 
TY  - JOUR
A1  - Merzenich, Hiltrud
A1  - Baaken, Dan
A1  - Schmidt, Marcus
A1  - Bekes, Inga
A1  - Schwentner, Lukas
A1  - Janni, Wolfgang
A1  - Woeckel, Achim
A1  - Bartkowiak, Detlef
A1  - Wiegel, Thomas
A1  - Blettner, Maria
A1  - Wollschläger, Daniel
A1  - Schmidberger, Heinz
T1  - Cardiac late effects after modern 3D-conformal radiotherapy in breast cancer patients: a retrospective cohort study in Germany (ESCaRa)
JF  - Breast Cancer Research and Treatment
N2  - Purpose
Radiotherapy (RT) was identified as a risk factor for long-term cardiac effects in breast cancer patients treated until the 1990s. However, modern techniques reduce radiation exposure of the heart, but some exposure remains unavoidable. In a retrospective cohort study, we investigated cardiac mortality and morbidity of breast cancer survivors treated with recent RT in Germany.

Methods
A total of 11,982 breast cancer patients treated between 1998 and 2008 were included. A mortality follow-up was conducted until 06/2018. In order to assess cardiac morbidity occurring after breast cancer treatment, a questionnaire was sent out in 2014 and 2019. The effect of breast cancer laterality on cardiac mortality and morbidity was investigated as a proxy for radiation exposure. We used Cox Proportional Hazards regression analysis, taking potential confounders into account.

Results
After a median follow-up time of 11.1 years, there was no significant association of tumor laterality with cardiac mortality in irradiated patients (hazard ratio (HR) for left-sided versus right-sided tumor 1.09; 95% confidence interval (CI) 0.85–1.41). Furthermore, tumor laterality was not identified as a significant risk factor for cardiac morbidity (HR = 1.05; 95%CI 0.88–1.25).

Conclusions
Even though RT for left-sided breast cancer on average incurs higher radiation dose to the heart than RT for right-sided tumors, we found no evidence that laterality is a strong risk factor for cardiac disease after contemporary RT. However, larger sample sizes, longer follow-up, detailed information on individual risk factors and heart dose are needed to assess clinically manifest late effects of current cancer therapy.
KW  - breast cancer
KW  - 3D-conformal radiotherapy
KW  - cardiac mortality
KW  - cardiac morbidity
KW  - cohort study
KW  - survival
Y1  - 2022
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-308606
SN  - 0167-6806
SN  - 1573-7217
VL  - 191
IS  - 1
ER  -