Prostate cancer and elective nodal radiation therapy for cN0 and pN0-a never ending story? : Recommendations from the prostate cancer expert panel of the German Society of Radiation Oncology (DEGRO).

For prostate cancer, the role of elective nodal irradiation (ENI) for cN0 or pN0 patients has been under discussion for years. Considering the recent publications of randomized controlled trials, the prostate cancer expert panel of the German Society of Radiation Oncology (DEGRO) aimed to discuss and summarize the current literature. Modern trials have been recently published for both treatment-naïve patients (POP-RT trial) and patients after surgery (SPPORT trial). Although there are more reliable data to date, we identified several limitations currently complicating the definitions of general recommendations. For patients with cN0 (conventional or PSMA-PET staging) undergoing definitive radiotherapy, only men with high-risk factors for nodal involvement (e.g., cT3a, GS ≥ 8, PSA ≥ 20 ng/ml) seem to benefit from ENI. For biochemical relapse in the postoperative situation (pN0) and no PSMA imaging, ENI may be added to patients with risk factors according to the SPPORT trial (e.g., GS ≥ 8; PSA > 0.7 ng/ml). If PSMA-PET/CT is negative, ENI may be offered for selected men with high-risk factors as an individual treatment approach.

Effects of zoledronate on the radiation-induced collagen breakdown: a prospective randomized clinical trial

Background: A negative side effect of therapeutic irradiation is the radiation-induced bone loss which can lead, in long term, to pathological fractures. Until today, the detailed mechanism is unknown. If osteoclasts would mainly contribute to the pathological bone loss, bisphosphonates could potentially counteract the osteolytic process and possibly help to prevent long-term complications. The aim of this study was to evaluate the effect of zoledronic acid on the early radiation-induced degradation of bone collagen fibrils by monitoring the urinary excretion of hydroxylysylpyridinoline and lysylpyridinoline under radiotherapy. Patients and methods: A total of 40 patients with skeletal metastases were assigned for a local radiotherapy and bisphosphonate treatment. The patients were prospectively randomized into two treatment groups: group A (n = 20) received the first zoledronate administration after and group B (n = 20) prior to the radiotherapy. Urine samples were collected from each patient on the first day, in the middle, and on the last day of the radiation therapy. Measurement of the bone metabolites hydroxylysylpyridinoline and lysylpyridinoline was performed by high-performance liquid chromatography. Statistical analysis was performed using the Mann–Whitney U test. Results: The hydroxylysylpyridinoline and lysylpyridinoline excretion decreased significantly in the combined bisphosphonate and radiotherapy group (p = 0.02, p = 0.08). No significant change of the hydroxylysylpyridinoline and lysylpyridinoline excretion was determined in the patients that received solely irradiation. Conclusion The results indicate the ability of zoledronate to prevent the early radiation-induced bone collagen degradation suggesting that the radiation-induced bone loss is mainly caused by osteoclastic bone resorption rather than by a direct radiation-induced damage (AU)

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On the interaction of water-soluble binders and nano silicon particles: alternative binder towards increased cycling stability at elevated temperatures.

Silicon based composites are among the most promising negative electrodes for lithium ion battery applications due to their high theoretical capacities. One major drawback of silicon based anodes are their large volume changes during lithiation and delithiation. Although many efforts have been made in view of new binder materials and improved electrolytes, the resulting battery cell suffers from severe capacity fading at ambient or elevated temperatures, respectively. The strong reactivity with the electrolyte is considered to be responsible for the reduced cycle life at elevated temperatures. In this work we introduce silicon composite anodes with a novel composition based on a gellan gum binder material that show an improved cycling performance at ambient temperature and at 60 °C. To elucidate the influence of the binder material, we investigated the structure of the silicon based composite anodes in order to understand the nature of the interaction of the gellan gum based binder polymers with the silicon particles in comparison with a common CMC binder. Also the influence of the choice of binder on the interactions at the interface between electrode surface and electrolyte were studied. A combination of powerful techniques including solid state NMR, TEM and EELS, XPS as well as FTIR were applied.

Effects of zoledronate on the radiation-induced collagen breakdown: a prospective randomized clinical trial.

BACKGROUND: A negative side effect of therapeutic irradiation is the radiation-induced bone loss which can lead, in long term, to pathological fractures. Until today, the detailed mechanism is unknown. If osteoclasts would mainly contribute to the pathological bone loss, bisphosphonates could potentially counteract the osteolytic process and possibly help to prevent long-term complications. The aim of this study was to evaluate the effect of zoledronic acid on the early radiation-induced degradation of bone collagen fibrils by monitoring the urinary excretion of hydroxylysylpyridinoline and lysylpyridinoline under radiotherapy. PATIENTS AND METHODS: A total of 40 patients with skeletal metastases were assigned for a local radiotherapy and bisphosphonate treatment. The patients were prospectively randomized into two treatment groups: group A (n = 20) received the first zoledronate administration after and group B (n = 20) prior to the radiotherapy. Urine samples were collected from each patient on the first day, in the middle, and on the last day of the radiation therapy. Measurement of the bone metabolites hydroxylysylpyridinoline and lysylpyridinoline was performed by high-performance liquid chromatography. Statistical analysis was performed using the Mann-Whitney U test. RESULTS: The hydroxylysylpyridinoline and lysylpyridinoline excretion decreased significantly in the combined bisphosphonate and radiotherapy group (p = 0.02, p = 0.08). No significant change of the hydroxylysylpyridinoline and lysylpyridinoline excretion was determined in the patients that received solely irradiation. CONCLUSION: The results indicate the ability of zoledronate to prevent the early radiation-induced bone collagen degradation suggesting that the radiation-induced bone loss is mainly caused by osteoclastic bone resorption rather than by a direct radiation-induced damage.

[The early development of brachytherapy of the prostate: a study on technique application in the development of urology]. / Zur frühen Entwicklung der Brachytherapie der Prostata : Eine Studie zur Technikanwendung in der Urologieentwicklung.

Within recent years brachytherapy of the prostate has become a treatment of choice. The treatment can be dated back up to the beginning of the twentieth century. It is interesting that the urological routes have never been explored directly by authors of articles and textbooks in the field of radiology and radiooncology.

The cytotoxic effects of three different bisphosphonates in-vitro on human gingival fibroblasts, osteoblasts and osteogenic sarcoma cells.

INTRODUCTION: Osteonecrosis of the jaw (ONJ) is an emerging condition in patients undergoing long-term administration of bisphosphonates (BP) for the treatment of osteoporosis and hypercalcaemia associated with malignancy, multiple myeloma, and metastatic breast and prostate cancers. This is a follow-up study, its purpose was to examine the effects in-vitro of intravenous zoledronic acid (ZOL) and pamidronate (PAM) and oral alendronate (FOS) on the human oral cavity using gingival fibroblasts and osteoblasts cells and, in addition, osteogenic sarcoma cells (SaOS-2-cells). MATERIALS AND METHODS: Human gingival fibroblasts, osteoblasts and SaOS-2-cells were seeded on multiple 6-well plates at a density of 5 × 10(5)cells in a 4-week cell culture. Four different concentrations (1, 5, 10, 20 µM) of each BP (ZOL, PAM, FOS) and pyrophosphate were used in this study. RESULTS: All BP decreased collagen production and lowered cell proliferation in-vitro. ZOL was the component with most inhibitory effect. CONCLUSION: The findings in this study suggest that ZOL, PAM and FOS generally diminish cell proliferation and collagen production of human gingival fibroblasts, osteoblasts and SaOS-2-cells. The present follow-up study shows that not only ZOL and PAM but also FOS have a strong inhibitory effect on collagen production and cell survival in-vitro.

Breast irradiation with brachytherapy: approved techniques and new concepts.

Among surgery and chemotherapy, radiotherapy has an important role in the treatment of breast cancer patients. But not only external beam radiotherapy (EBRT) treatment is an established method for treatment of breast cancer, also brachytherapy (BT) is an approved method. BT is well known for boost irradiation in combination with EBRT, but new indications as re-irradiation for local recurrences or partial breast irradiation offer new aspects in the field of BT for breast cancer treatment. Because of modern CT based 3-D treatment planning systems and the possibility of intensity modulated brachytherapy (IMBT) has getting more potential. In the future for selected patient's re-irradiation of the breast using IMBT after local relapse and second breast conserving surgery might be an alternative instead of mastectomy. Even partial breast BT following breast conservative operation as a new treatment option is getting more and more interesting and is widely investigated in several studies. Due to the approved techniques and the new indications BT is and will be an attractive alternative and extension in the field of breast cancer treatment. But we need five better ten years results for definite conclusions at least.

The accuracy of WinSmash delta-V estimates: the influence of vehicle type, stiffness, and impact mode.

The objective of this paper is to investigate the accuracy of WinSmash delta-V estimates as a function of crash mode, vehicle body type, and vehicle stiffness. The accuracy of WinSmash delta-V estimates was evaluated for 121 NASS/CDS 2000-2003 cases for which direct measurements of delta-V had been retrieved from an Event Data Recorder on the case vehicle. WinSmash was found to underestimate delta-V by 23% on average. WinSmash was found to be most accurate in crashes involving full frontal engagement of the vehicle structure. When using categorical stiffness coefficients, the accuracy of delta-V estimates was found to be a strong function of vehicle type. WinSmash underestimated delta-V for pickup trucks by only 3%, but underestimated delta-V for front-wheel drive cars by 31%. The use of vehicle-specific stiffness coefficients improved the accuracy of the longitudinal delta-V estimate. The single most important factor in improving WinSmash accuracy was the inclusion of restitution. After adjusting for restitution, WinSmash underestimated delta-V in frontal crashes by only 1% on average.

Topographic documentation of acute radiation morbidity.

BACKGROUND: The clinical knowledge on the frequency and severity of acute radiation morbidity is very sparse. With established morbidity recording, only severe side effects are revealed. The lower morbidity (I/II degree) as a major part of the data base is neglected. Another problem may be the lack of interdisciplinary and international compatibility in other systems. For these reasons, our intention was to create an easily acceptable, international and interdisciplinary compatible documentation form for routine use in radiotherapy. METHODS: A detailed topographic documentation sheet for each major topographic site of clinical radiation oncology has been developed (CNS, head and neck, thorax, female breast, abdomen, extremities). It is based upon existing toxicity codes and documentation systems (CTC[WHO], RTOG and EORTC, DEGRO, ADT, KIEL). Furthermore, basic oncological data like TNM, previous surgery or chemotherapy, drugs and more are included. For each topographic body site, one DIN A4 format is required for documentation of a 6 to 7-week treatment course. The toxicity prescription is coded according to the "DEGRO/RTOG Coding System for acute side effects" and to the "EORTC Acute Toxicity Code" to achieve optimal international and interdisciplinary compatibility. RESULTS: Complete documentation of toxicities level 0 to 4 is to be performed within 2 to 5 minutes per week/patient within preformed marks. The clinical performance has proven excellent. Not only level III/IV toxicities are recorded, but also level I/II morbidity. CONCLUSIONS: The topographic documentation system improves recording of acute morbidity in radiation oncology not only by time, but also in quality. Experimental, radiobiological and former clinical data may be proved for their actual plausibility.

Electronical recording and evaluation of acute radiation morbidity.

BACKGROUND: Relatively uniform documentation systems are used for recording of acute side effects in oncology. Object of this work is to illustrate the applicability of electronic data bases for registration and evaluation of acute side effects in radiation therapy. METHODS: Based on topographic documentation sheets, an electronic data base was developed for each major topographic site. Besides general patient related parameters (TNM, previous chemotherapy, surgical interventions, intercurrent diseases and more), the kind and the degree of acute radiation related side effects are documented for each week of radiation and for day 90 (RTOG) as the joint day between acute and subacute tissue reactions. RESULTS: The temporal expenditure for the recording of the general patient related parameters of a patient is less than a minute. The weekly documentation can be performed during the daily routine work and needs approximately 5 minutes per week. The structure of the data base enables for later analyses of acute radiation related morbidity. CONCLUSIONS: Electronic data bases enable a fast and systematic recording and evaluation of acute radiation related side effects. The development of particular registration entities for recording of acute side effects may be a possible application and demonstrates the needs of professional developments.

[Prevention and therapy of acute radiation-related morbidity of the skin and mucosa. II, Recommendations of the literature]. / Prophylaxe und Therapie akuter Strahlenfolgen an Haut und Schleimhaut. Teil II: Empfehlungen der Literatur.

BACKGROUND: In a German multicenter questionnaire, answered by 89 departments, we had examined the strategies to prevent or to treat the acute morbidity of the skin and mucosa associated to radiation therapy. In this work, the recommendations from the literature are compared to the results of the questionnaire. METHODS: An extensive research on common data information systems (Medline, Cancerlit, DIMDI and others) was performed. The criteria included the organ related morbidity and therapeutic strategies for its reduction. The obtained data were compared to the results from the questionnaire. RESULTS: The study data found by the research often demonstrate small patient numbers and little convincing results. However, as in the questionnaire, the joint principle seems to be the reduction of acute inflammatory tissue reaction by evasion of bacterial and mycotic overgrowth and reduction of exo- and endogenous toxins. CONCLUSIONS: Further studies with more convincing results are required.

[Prevention and therapy of acute radiation injuries of the skin and mucosa. I. Results of a German multicenter questionnaire]. / Prophylaxe und Therapie akuter Strahlenfolgen an Haut und Schleimhaut. Teil I: Ergebnisse einer bundesweiten Erhebung.

BACKGROUND: The acute radiation related morbidity is an essential factor for the patient's outcome in radiotherapy. The prophylactic and therapeutic management of acute side effects has a wide clinical range between different radiation oncology departments. In this work, it was to evaluate the remedies, which are used for prevention and therapeutic management of acute radiation related morbidity of the skin and mucosa (mouth, pharynx, esophagus, small and large bowel, rectum and vagina). METHODS: A questionnaire was sent to 130 radiotherapeutic departments in Germany in July 1995. The questionnaire had been designed with 22 open questions concerning the preventive and therapeutic management of acute radiation related morbidity of skin and mucosal sites. It has been correlated to the scoring system of the RTOG/EORTC and its German modification according to Seegenschmiedt and Sauer. The evaluation was performed anonymously. RESULTS: From 130 questionnaires, 89 (68.4%) were sent back till August 1995. All of them were evaluable. The recommendations showed a broad spectrum for each site. Especially the oral mucositis was treated in many different ways and combinations. The prevention and therapy of complicating superinfections seem to be the joint principle of most of the recommendations. CONCLUSIONS: The management of the acute radiation related morbidity has a wide clinical spectrum among different radiation therapy centers. Systematic prospectively designed investigations are necessary in order to achieve a further reduction in the radiation related acute morbidity. Therefore, a multicenter collaborative working group has been founded.