Proton and carbon ion beam treatment with active raster scanning method in 147 patients with skull base chordoma at the Heidelberg Ion Beam Therapy Center-a single-center experience.

BACKGROUND: This study aimed to compare the results of irradiation with protons versus irradiation with carbon ions in a raster scan technique in patients with skull base chordomas and to identify risk factors that may compromise treatment results. METHODS: A total of 147 patients (85 men, 62 women) were irradiated with carbon ions (111 patients) or protons (36 patients) with a median dose of 66 Gy (RBE (Relative biological effectiveness); carbon ions) in 4 weeks or 74 Gy (RBE; protons) in 7 weeks at the Heidelberg Ion Beam Therapy Center (HIT) in Heidelberg, Germany. The median follow-up time was 49.3 months. All patients had gross residual disease at the beginning of RT. Compression of the brainstem was present in 38%, contact without compression in 18%, and no contact but less than 3 mm distance in 16%. Local control and overall survival were evaluated using the Kaplan-Meier Method based on scheduled treatment (protons vs. carbon ions) and compared via the log rank test. Subgroup analyses were performed to identify possible prognostic factors. RESULTS: During the follow-up, 41 patients (27.9%) developed a local recurrence. The median follow-up time was 49.3 months (95% CI: 40.8-53.8; reverse Kaplan-Meier median follow-up time 56.3 months, 95% CI: 51.9-60.7). No significant differences between protons and carbon ions were observed regarding LC, OS, or overall toxicity. The 1­year, 3­year, and 5­year LC rates were 97%, 80%, and 61% (protons) and 96%, 80%, and 65% (carbon ions), respectively. The corresponding OS rates were 100%, 92%, and 92% (protons) and 99%, 91%, and 83% (carbon ions). No significant prognostic factors for LC or OS could be determined regarding the whole cohort; however, a significantly improved LC could be observed if the tumor was > 3 mm distant from the brainstem in patients presenting in a primary situation. CONCLUSION: Outcomes of proton and carbon ion treatment of skull base chordomas seem similar regarding tumor control, survival, and toxicity. Close proximity to the brainstem might be a negative prognostic factor, at least in patients presenting in a primary situation.

Aqueous Gold Overgrowth of Silver Nanoparticles: Merging the Plasmonic Properties of Silver with the Functionality of Gold.

To date, it has not been possible to combine the high optical quality of silver particles with the good chemical stability and synthetic convenience in a fully aqueous system, while simultaneously allowing chemical surface functionalization. We present a synthetic pathway for future developments in information, energy and medical technology where strong optical/electronic properties are crucial. Therefore, the advantages inherent to gold are fused with the plasmonic properties of silver in a fully aqueous Au/Ag/Au core-shell shell system. These nanoparticles inherit low dispersity from their masked gold cores, yet simultaneously exhibit the strong plasmonic properties of silver. Protecting the silver surface with a thin gold layer enables oxidant stability and functionality without altering the Ag-controlled optical properties. This combines both worlds-optical quality and chemical stability-and is not limited to a specific particle shape.

Quantitative imaging of the magnetic configuration of modulated nanostructures by electron holography.

By means of off-axis electron holography the local distribution of the magnetic induction within and around a poly-crystalline Permalloy (Ni81Fe19) thin film is studied. In addition the stray field above the sample is measured by magnetic force microscopy on a larger area. The film is deposited on a periodically nanostructured (rippled) Si substrate, which was formed by Xe(+) ion beam erosion. This introduces the periodical ripple shape to the Permalloy film. The created ripple morphology is expected to modify the magnetization distribution within the Permalloy and to induce dipolar stray fields. These stray fields play an important role in spinwave dynamics of periodic nanostructures like magnonic crystals. Micromagnetic simulations estimate those stray fields in the order of only 10 mT. Consequently, their experimental determination at nanometer spatial resolution is highly demanding and requires advanced acquisition and reconstruction techniques such as electron holography. The reconstructed magnetic phase images show the magnetized thin film, in which the magnetization direction follows mainly the given morphology. Furthermore, a closer look to the Permalloy/carbon interface reveals stray fields at the detection limit of the method in the order of 10 mT, which is in qualitative agreement with the micromagnetic simulations.

7 Tesla imaging of cerebral radiation necrosis after arteriovenous malformations treatment using amide proton transfer (APT) imaging.

Arteriovenous malformations (AVM) can be treated with stereotactic radiosurgery. An infrequent, but important complication of this treatment is radionecrosis, which can be detected by MRI. However, the imaging characteristics of necrosis are unspecific in conventional MRI. Here, we report a case of necrosis after radiotherapy of an AVM to illustrate the potential of 7 Tesla MRI including amide proton transfer (APT) for necrosis imaging.

Megavoltage CT in helical tomotherapy - clinical advantages and limitations of special physical characteristics.

Helical tomotherapy is a form of image-guided intensity-modulated radiotherapy that introduces the ring gantry concept into radiation oncology. The system is a combination of a therapeutic linear accelerator and a megavoltage CT-scanner. This work describes the clinical experience with megavoltage CT with 456 patients in more than 11000 fractions. It also provides a review of the current literature of the possibilities and limitations of megavoltage CT. Between July 2006 and October 2008 456 patients were treated with helical tomotherapy and a pretreatment megavoltage CT was performed in 98.1% of the 11821 fractions to perform position control and correction. CT image acquisition was done with 3.5 MV x-rays in the helical tomotherapy machine. MVCT was used for dose recalculations to quantify doses distributions in cases of changing geometry, tumor shrinkage or presence of metal implants. Inverse treatment planning for prostate cancer patients with bilateral hip replacements was performed based upon an MVCT. A mean 3D-correction vector of 7.1mm with a considerable variation was detected and immediately corrected. Mean shifts were lateral 0.9mm (sd 5.0mm), mean longitudinal shift 1.0mm (sd 5.1mm) and mean vertical shift 3.2mm (sd 5.2mm). The MVCT enables imaging of anatomical structures in the presence of dental metal or orthopedic implants. Especially in these cases, dose recomputations can increase the precision of dose calculations. Due to a mean 3d correction vector of more than 7mm and a variation of corrections of more than 5mm daily image-guidance is recommended to achieve a precise dose application. The MVCT shows evident advantages in cases with metal implants but has limitations due to a reduced soft tissue contrast. Compared with megavoltage cone-beam-CT the tomotherapy fan beam CT adds less extra dose fore the patient and has a better soft tissue contrast.

Model-based magnetization retrieval from holographic phase images.

The phase shift of the electron wave is a useful measure for the projected magnetic flux density of magnetic objects at the nanometer scale. More important for materials science, however, is the knowledge about the magnetization in a magnetic nano-structure. As demonstrated here, a dominating presence of stray fields prohibits a direct interpretation of the phase in terms of magnetization modulus and direction. We therefore present a model-based approach for retrieving the magnetization by considering the projected shape of the nano-structure and assuming a homogeneous magnetization therein. We apply this method to FePt nano-islands epitaxially grown on a SrTiO3 substrate, which indicates an inclination of their magnetization direction relative to the structural easy magnetic [001] axis. By means of this real-world example, we discuss prospects and limits of this approach.

Realization of a tilted reference wave for electron holography by means of a condenser biprism.

As proposed recently, a tilted reference wave in off-axis electron holography is expected to be useful for aberration measurement and correction. Furthermore, in dark-field electron holography, it is considered to replace the reference wave, which is conventionally diffracted in an unstrained object area, by a well-defined object-independent reference wave. Here, we first realize a tilted reference wave by employing a biprism placed in the condenser system above three condenser lenses producing a relative tilt magnitude up to 20/nm at the object plane (300kV). Paraxial ray-tracing predicts condenser settings for a parallel illumination at the object plane, where only one half of the round illumination disc is tilted relative to the optical axis without displacement. Holographic measurements verify the kink-like phase modulation of the incident beam and return the interference fringe contrast as a function of the relative tilt between both parts of the illumination. Contrast transfer theory including condenser aberrations and biprism instabilities was applied to explain the fringe contrast measurement. A first dark-field hologram with a tilted - object-free - reference wave was acquired and reconstructed. A new application for bright/dark-field imaging is presented.

Intensity modulated radiation therapy (IMRT) for sinonasal tumors: a single center long-term clinical analysis.

BACKGROUND: Radiotherapy has a central role in the treatment of sinonasal malignancies, either as postoperative or as primary therapy. To study the efficacy and safety of intensity modulated radiotherapy (IMRT) for sinonasal tumors a single center retrospective evaluation focusing on survival and therapy related toxicity was performed. METHODS: One hundred twenty two patients with primary (n = 82) or recurrent (n = 40) malignant sinonasal tumors were treated with intensity modulated radiotherapy between 1999 and 2009 at the University Clinic of Heidelberg and the German Cancer Research Center and retrospectively analyzed. Most patients had adenoid cystic carcinomas (n = 47) or squamous cell carcinoma (n = 26). 99 patients received postoperative radiotherapy. The median total dose was 64 Gy in conventional fractionation (1.8-2 Gy). Overall survival (OS), progression free survival (PFS) and local recurrence free survival (LRFS) rates were calculated using the Kaplan-Meier method. The log-rank test and Fishers Exact test were applied for univariate analysis, Cox-regression was used for multivariate analysis. RESULTS: Median follow up was 36 months. 1-, 3- and 5-year estimated overall survival rates were 90, 70 and 54 % respectively. Median progression free survival and local recurrence free survival was 45 and 63 months respectively. Progression free survival and local recurrence free survival at 1, 3 and 5 years were 76, 57 and 47, and 79, 60 and 51 % respectively. 19 patients (15.5 %) were diagnosed with distant metastases. Univariate analysis revealed significantly improved OS and LRFS for treatment of tumors after primary diagnosis, first series of irradiation and radiation dose ≥60 Gy. Multivariate analysis revealed only treatment in primary situation as an independent prognostic factor for OS and LRFS. Acute CTC grade III mucositis was seen in 5 patients (4.1 %) and CTC grade II dysgeusia in 19 patients (15.6 %). Dysgeusia, dysosmia and ocular toxicity were the most common late adverse events. CONCLUSIONS: Our data support the results of previous studies and indicate that intensity modulated radiation therapy (IMRT) represents an effective and safe treatment approach for patients with sinonasal carcinomas.

Semiclassical TEM image formation in phase space.

Current developments in TEM such as high-resolution imaging at low acceleration voltages and large fields of view, the ever larger capabilities of hardware aberration correction and the systematic shaping of electron beams require accurate descriptions of TEM imaging in terms of wave optics. Since full quantum mechanic solutions have not yet been established for, e.g., the theory of aberrations, we are exploring semiclassical image formation in the TEM from the perspective of quantum mechanical phase space, here. Firstly, we use two well-known semiclassical approximations, Miller's semiclassical algebra and the frozen Gaussian method, for describing the wave optical generalization of arbitrary geometric aberrations, including nonisoplanatic and slope aberrations. Secondly, we demonstrate that the Wigner function representation of phase space is well suited to also describe incoherent aberrations as well as the ramifications of partial coherence due to the emission process at the electron source. We identify a close relationship between classical phase space and Wigner function distortions due to aberrations as well as classical brightness and quantum mechanical purity.

A proposal for the holographic correction of incoherent aberrations by tilted reference waves.

The recently derived general transfer theory for off-axis electron holography provides a new approach for reconstructing the electron wave beyond the conventional sideband information limit. Limited ensemble coherence of the electron beam between object and reference area leads to an attenuation of spatial frequencies of the object exit wave in the presence of aberrations of the objective lens. Concerted tilts of the reference wave under the condition of an invariant object exit wave are proposed to diminish the aberration impact on spatial frequencies even beyond the sideband information limit allowing its transfer with maximum possible contrast. In addition to the theoretical considerations outlined in detail, an experimental proof-of-principle is presented. A fully controlled tilt of the reference wave, however, remains as a promising task for the future. The use of a hologram series with varying reference wave tilt is considered for linearly synthesizing an effective aperture for the transfer into the sideband with broader bandwidth compared to conventional off-axis electron holography allowing us to correct the incoherent aberrations in transmission electron microscopy. Furthermore, tilting a reference wave with respect to a plane wave is expected to be an alternative way for measuring the coherent and incoherent aberrations of a transmission electron microscope. The capability of tilting the reference wave is expected to be beneficial for improving the signal-to-noise ratio in dark-field off-axis electron holography as well.

Development of splitting convergent beam electron diffraction (SCBED).

Using a combination of condenser electrostatic biprism with dedicated electron optic conditions for sample illumination, we were able to split a convergent beam electron probe focused on the sample in two half focused probes without introducing any tilt between them. As a consequence, a combined convergent beam electron diffraction pattern is obtained in the back focal plane of the objective lens arising from two different sample areas, which could be analyzed in a single pattern. This splitting convergent beam electron diffraction (SCBED) pattern has been tested first on a well-characterized test sample of Si/SiGe multilayers epitaxially grown on a Si substrate. The SCBED pattern contains information from the strained area, which exhibits HOLZ lines broadening induced by surface relaxation, with fine HOLZ lines observed in the unstrained reference part of the sample. These patterns have been analyzed quantitatively using both parts of the SCBED transmitted disk. The fine HOLZ line positions are used to determine the precise acceleration voltage of the microscope while the perturbed HOLZ rocking curves in the stained area are compared to dynamical simulated ones. The combination of these two information leads to a precise evaluation of the sample strain state. Finally, several SCBED setups are proposed to tackle fundamental physics questions as well as applied materials science ones and demonstrate how SCBED has the potential to greatly expand the range of applications of electron diffraction and electron holography.

Direct Depth- and Lateral- Imaging of Nanoscale Magnets Generated by Ion Impact.

Nanomagnets form the building blocks for a variety of spin-transport, spin-wave and data storage devices. In this work we generated nanoscale magnets by exploiting the phenomenon of disorder-induced ferromagnetism; disorder was induced locally on a chemically ordered, initially non-ferromagnetic, Fe60Al40 precursor film using nm diameter beam of Ne(+) ions at 25 keV energy. The beam of energetic ions randomized the atomic arrangement locally, leading to the formation of ferromagnetism in the ion-affected regime. The interaction of a penetrating ion with host atoms is known to be spatially inhomogeneous, raising questions on the magnetic homogeneity of nanostructures caused by ion-induced collision cascades. Direct holographic observations of the flux-lines emergent from the disorder-induced magnetic nanostructures were made in order to measure the depth- and lateral- magnetization variation at ferromagnetic/non-ferromagnetic interfaces. Our results suggest that high-resolution nanomagnets of practically any desired 2-dimensional geometry can be directly written onto selected alloy thin films using a nano-focussed ion-beam stylus, thus enabling the rapid prototyping and testing of novel magnetization configurations for their magneto-coupling and spin-wave properties.

Cholesterol levels linked to abnormal plasma thiol concentrations and thiol/disulfide redox status in hyperlipidemic subjects.

Treatment of hyperlipidemic patients with the thiol compound N-acetylcysteine (NAC) was previously shown to cause a significant dose-related increase in the high-density lipoprotein (HDL)-cholesterol serum level, suggesting the possibility that its disease-related decrease may result from a diminished thiol concentration and/or thiol/disulfide redox status (REDST) in the plasma. We therefore investigated plasma thiol levels and REDST in normo-/hyperlipidemic subjects with and without coronary heart disease (CHD). The thiol level, REDST, and amino acid concentrations in the plasma and intracellular REDST of peripheral blood mononuclear cells (PBMC) have been determined in 62 normo- and hyperlipidemic subjects. Thirty-three of these subjects underwent coronary angiography, because of clinical symptoms of CHD. All groups of hyperlipidemic patients under test and those normolipidemic individuals with documented coronary stenoses showed a marked decrease in plasma thiol concentrations, plasma and intracellular REDST of PBMCs, and a marked increase in plasma taurine levels. Individual plasma thiol concentrations and plasma REDST were strongly negatively correlated with the serum LDL-cholesterol and positively correlated with the serum HDL-cholesterol level. Together with the earlier report about the effect of NAC on the HDL-cholesterol serum level, our findings suggest strongly that lower HDL-cholesterol serum levels may result from a decrease in plasma thiol level and/or REDST possibly through an excessive cysteine catabolism into taurine.

Transfer and reconstruction of the density matrix in off-axis electron holography.

The reduced density matrix completely describes the quantum state of an electron scattered by an object in transmission electron microscopy. However, the detection process restricts access to the diagonal elements only. The off-diagonal elements, determining the coherence of the scattered electron, may be obtained from electron holography. In order to extract the influence of the object from the off-diagonals, however, a rigorous consideration of the electron microscope influences like aberrations of the objective lens and the Möllenstedt biprism in the presence of partial coherence is required. Here, we derive a holographic transfer theory based on the generalization of the transmission cross-coefficient including all known holographic phenomena. We furthermore apply a particular simplification of the theory to the experimental analysis of aloof beam electrons scattered by plane silicon surfaces.

Noise estimation for off-axis electron holography.

Off-axis electron holography provides access to the phase of the elastically scattered wave in a transmission electron microscope at scales ranging from several hundreds of nanometres down to 0.1nm. In many cases the reconstructed phase shift is directly proportional to projected electric and magnetic potentials rendering electron holography a useful and established characterisation method for materials science. However, quantitative interpretation of experimental phase shifts requires quantitative knowledge about the noise, which has been previously established for some limiting cases only. Here, we present a general noise transfer formalism for off-axis electron holography allowing to compute the covariance (noise) of reconstructed amplitude and phase from characteristic detector functions and general properties of the reconstruction process. Experimentally, we verify the presented noise transfer formulas for two different cameras with and without objects within the errors given by the experimental noise determination.

Interconnection of nanoparticles within 2D superlattices of PbS/oleic acid thin films.

Make it connected! 2D close-packed layers of inorganic nanoparticles are interconnected by organic fibrils of oleic acid as clearly visualized by electron holography. These fibrils can be mineralised by PbS to transform an organic-inorganic framework to a completely interconnected inorganic semiconducting 2D array.

Randomized phase II trial of hypofractionated proton versus carbon ion radiation therapy in patients with sacrococcygeal chordoma-the ISAC trial protocol.

BACKGROUND: Chordomas are relatively rare lesions of the bones. About 30% occur in the sacrococcygeal region. Surgical resection is still the standard treatment. Due to the size, proximity to neurovascular structures and the complex anatomy of the pelvis, a complete resection with adequate safety margin is difficult to perform. A radical resection with safety margins often leads to the loss of bladder and rectal function as well as motoric/sensoric dysfunction. The recurrence rate after surgery alone is comparatively high, such that adjuvant radiation therapy is very important for improving local control rates. Proton therapy is still the international standard in the treatment of chordomas. High-LET beams such as carbon ions theoretically offer biologic advantages in slow-growing tumors. Data of a Japanese study of patients with unresectable sacral chordoma showed comparable high control rates after hypofractionated carbon ion therapy only. METHODS AND DESIGN: This clinical study is a prospective randomized, monocentric phase II trial. Patients with histologically confirmed sacrococcygeal chordoma will be randomized to either proton or carbon ion radiation therapy stratified regarding the clinical target volume. Target volume delineation will be carried out based on CT and MRI data. In each arm the PTV will receive 64 GyE in 16 fractions. The primary objective of this trial is safety and feasibility of hypofractionated irradiation in patients with sacrococygeal chordoma using protons or carbon ions in raster scan technique for primary or additive treatment after R2 resection. The evaluation is therefore based on the proportion of treatments without Grade 3-5 toxicity (CTCAE, version 4.0) up to 12 months after treatment and/or discontinuation of the treatment for any reason as primary endpoint. Local-progression free survival, overall survival and quality of life will be analyzed as secondary end points. DISCUSSION: The aim of this study is to confirm the toxicity results of the Japanese data in raster scan technique and to compare it with the toxicity analysis of proton therapy given in the same fractionation. Using this data, a further randomized phase III trial is planned, comparing hypofractionated proton and carbon ion irradiation. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01811394.

Intraoperative electron radiation therapy (IOERT) in patients with locally recurrent renal cell carcinoma.

BACKGROUND: To analyze our experience with intraoperative electron radiation therapy (IOERT) followed by moderate doses of external beam radiation therapy (EBRT) in patients with locally recurrent renal cell carcinoma. METHODS: From 1992 to 2010, 17 patients with histologically proven, locally recurrent renal cell carcinoma (median tumor size 7 cm) were treated by surgery and IOERT with a median dose of 15 Gy. All patients met the premise of curative intent including 7 patients with oligometastases at the time of recurrent surgery, which were resected and/or irradiated. The median time interval from primary surgery to local recurrence was 26 months. Eleven patients received additional 3D-conformal EBRT with a median dose of 40 Gy. RESULTS: Surgery resulted in free but close margins in 6 patients (R0), while 9 patients suffered from microscopic (R1) and 2 patients from macroscopic (R2) residual disease. After a median follow-up of 18 months, two local recurrences were observed, resulting in an actuarial 2-year local control rate of 91%. Eight patients developed distant failures, predominantly to liver and bone, resulting in an actuarial 2-year progression free survival of 32%. An improved PFS rate was found in patients with a larger time interval between initial surgery and recurrence (> 26 months). The actuarial 2-year overall survival rate was 73%. Lower histological grading (G1/2) was the only factor associated with improved overall survival. Perioperative complications were found in 4 patients. No IOERT specific late toxicities were observed. CONCLUSIONS: Combination of surgery, IOERT and EBRT resulted in high local control rates with low toxicity in patients with locally recurrent renal cell cancer despite an unfavorable surgical outcome in the majority of patients. However, progression-free and overall survival were still limited due to a high distant failure rate, indicating the need for intensified systemic treatment especially in patients with high tumor grading and short interval to recurrence.

Electron holography for fields in solids: problems and progress.

Electron holography initially was invented by Dennis Gabor for solving the problems raised by the aberrations of electron lenses in Transmission Electron Microscopy. Nowadays, after hardware correction of aberrations allows true atomic resolution of the structure, for comprehensive understanding of solids, determination of electric and magnetic nanofields is the most challenging task. Since fields are phase objects in the TEM, electron holography is the unrivaled method of choice. After more than 40 years of experimental realization and steady improvement, holography is increasingly contributing to these highly sophisticated and essential questions in materials science, as well to the understanding of electron waves and their interaction with matter.

A new linear transfer theory and characterization method for image detectors. Part I: theory.

A new generalized linear transfer theory describing the signal and noise transfer in image detectors is presented, which can be applied to calculate the pixelwise first and second statistical moment of arbitrary experimental images including correlation between pixels. Similar to the existing notion of a point spread function describing the transfer of the first statistical moment (the average), a noise spread function is introduced to characterize the spatially resolved transfer and generation of noise (second central moment, covariance). It is also shown that previously used noise characteristics like the noise power spectrum and detection quantum efficiency, derived from plainly illuminated images, contain only partial information of the complete noise transfer.