Evaluation of treatment-associated eye toxicity after irradiation in childhood and adolescence-results from the Registry of the Evaluation of Side Effects after Radiotherapy in Childhood and Adolescence (RiSK).

PURPOSE: The aim of the study is to evaluate treatment-related acute and late eye toxicity associated with radiation therapy in childhood and adolescence as correlated with RT (radiotherapy) doses. METHODS: From 2001 to 2016, a total of 1725 children and adolescents undergoing radiation therapy were prospectively documented in the Registry of the Evaluation of Side Effects after Radiotherapy in Childhood and Adolescence (RiSK). The RTOG/EORTC criteria were used to classify ocular acute and late effects. Uni- and multivariate analyses were carried out to evaluate the impact of patient age, pre-existing impairments, and radiation dose on ocular toxicity. RESULTS: Of all documented patients, 593 received dose to the eye and formed the basis of this analysis. In 435 patients, information on acute reaction was available and graded 1, 2, 3, and 4 in 49, 17, 0, and 2 patients, respectively. Information on late toxicity was available in 268 patients and graded 1, 2, 3, and 4 in 15, 11, 11, and 5 patients, respectively. The acute toxicity rate was significantly higher in children who received a maximum dose > 50 Gy to the eye (p < 0.001) and who had a pre-existing eye impairment (p < 0.001 in multivariate analysis). The development of late toxicity was significantly higher for patients experiencing acute toxicity and having received a radiation dose > 50 Gy. CONCLUSION: Acute and late toxicity both correlate with high radiation dose to the eye (> 50 Gy) and acute toxicity additionally with pre-existing eye impairments.

Are women more afraid than men? Fear of recurrence in couples with cancer - predictors and sex-role-specific differences.

PURPOSE: Although fear of cancer recurrence (FoR) is one of the major concerns in cancer patients and their partners with approximately 49% reporting moderate to high FoR, few studies investigated predictors and sex-role-specific differences. The aim of the current study was to investigate FoR in couples with different types of cancer and to gain a deeper understanding of sex and role-specific differences and predictors of FoR in patients and partners. DESIGN: Cross-sectional study in Germany. Sample: N = 188 couples with prostate (PC; n=52), laryngeal (LC; n=21) or breast cancer (BC; n=115) participated. All PC and LC patients were males, all BC patients were females. METHODS: Fear of recurrence, depression, and relationship satisfaction were measured with validated questionnaires (Fear of Progression Questionnaire, Patient Health Questionnaire, Hospital Anxiety and Depression Scale, Quality of Marriage Index) in couples with PC, LC, or BC. FINDINGS: Results indicated sex-role-specific differences. For women, FoR was higher for patients (M = 35.76) than for caregivers (M = 27.11). For males, spouses of women with BC (M = 30.1) showed higher FoR than male PC or LC patients (M = 24.9). Moreover, in couples there was a correlation between the FoR of one and the other (PC: r = .51, BC: r = .31, LC: r = .41). Depression was as a significant predictor, with a positive relationship to FoR. Moreover, in men with PC and LC besides depression, age emerged as significant predictor with a negative relationship to FoR. The Actor-Partner-Interdependence-Model showed for couples with PC or LC significant actor effects, both for patients and partners. Moreover, a significant partner effect emerged for patients' depression on partners' FoR. For couples with BC only significant actor effects occurred. CONCLUSIONS: FoR remains a major concern for both cancer patients and their partners. Implications for Psychosocial Providers or Policy: FoR should be considered both in cancer patients and their spouses. In addition, sex and role effects should be taken into account in treatment of FoR.

Quality of life in patients with limited (1-3) brain metastases undergoing stereotactic or whole brain radiotherapy : A prospective study of the DEGRO QoL working group.

PURPOSE: Published results of quality of life (QoL) studies mostly concern whole brain radiotherapy for limited or multiple brain metastases. This prospective multicentre study was designed to compare the QoL of patients with limited (1-3) brain metastases treated with either whole brain (WBRT) or stereotactic radiotherapy (SRT). METHODS: From 01/2007-03/2011, 90 limited brain metastases patients who were previously untreated (n = 77) or had undergone primary surgery (n = 13) were recruited at 14 centres in Germany and Austria. QoL was measured with the EORTC-QLQ-C15-PAL and BN20 brain modules before the start of radiotherapy and after 3 months. RESULTS: Fifty-two patients (58%) received WBRT and 38 (42%) received SRT. At 3 months, 67 patients (74%) were still living, and 92.6% of the 3­month survivors completed the second set of questionnaires. Analysis of the QLQ-C15-PAL and BN20 scales revealed significant deterioration in patients treated with WBRT and SRT in physical function (p < 0.001 and p = 0.007), fatigue (p < 0.001 and p = 0.036), nausea (p = 0.003 and p = 0.002), appetite loss (p < 0.001 and p = 0.025), drowsiness (p < 0.001 and p = 0.011), hair loss (p = 0.019 and p = 0.023) and itchy skin (p = 0.030 and p = 0.018). Motor dysfunction (p < 0.001), communication deficits (p = 0.002) and leg weakness (p < 0.001) declined significantly only in patients treated with WBRT. Comparing the two radiotherapy techniques over time, the results showed significant differences in symptom scores for future uncertainty, fatigue and appetite loss. CONCLUSIONS: QoL data as an outcome of the paper should be considered in decision making on the irradiation technique in patients with small number of brain metastases. Larger studies are required to verify the results according to subgroups.

Body image in men with prostate or laryngeal cancer and their female partners.

Objectives: The study examines body image of male cancer patients and their female partners as well as factors influencing body image. Methods: N = 73 heterosexual couples in which the male partner was diagnosed with prostate (PC; n = 52) or laryngeal cancer (LC; n = 21) completed questionnaires on body image acceptance (Self Image Scale), relationship satisfaction (Quality of Marriage Questionnaire), and cancer-related distress (Questionnaire on Stress in Cancer Patients). The body image was assessed from two perspectives: self-acceptance (which measures a person's satisfaction or acceptance of the body) and partner-acceptance (which assesses a person's perception of the partners' appraisals of the body). Results: No differences occurred in body image acceptance between men with PC or LC. Patients with PC rated the perceived partner-acceptance lower than did their female partners. In couples with LC, women rated the self-acceptance of their partners higher than did the patients themselves. Multiple regression analysis revealed that for survivors of PC, cancer-related distress, relationship satisfaction and partner-acceptance emerged as significant predictors of self-acceptance. The only significant predictor of partner-acceptance was men's self-acceptance. Conclusions: The dissatisfaction with physical appearance is found in PK and LK patients and seems to persist for a long time. Impairment of patients' body image should be identified and addressed to prevent the negative effects on psychosocial stress for patients and relationship satisfaction.

Hepatotoxicity after liver irradiation in children and adolescents : results from the RiSK.

AIM: The aim of this study was to evaluate acute and late radiotherapy-associated hepatotoxicity in consideration of dose-volume effects and liver function in childhood and adolescence. PATIENTS AND METHODS: Since 2001, irradiated children and adolescents in Germany have been prospectively documented in the "Register of Treatment-Associated Late Effects After Radiotherapy of Malignant Diseases in Childhood and Adolescence (RiSK)" using standardized forms. Toxicity was graded according to the Radiation Therapy Oncology Group (RTOG) criteria. RESULTS: Until April 2012, 1,392 children and adolescents from 62 radiotherapy centers were recruited. In all, 216 patients underwent irradiation of the liver (median age 9 years, range 1-18 years, 70 patients with total-body irradiation, TBI). For 75 % of patients without TBI, information on acute toxicity of the liver was available: 24 patients had acute toxicity of grade 1-4 (grade 1, 2, and 4, in 20, 3, and 1 patient, respectively), including five patients receiving simultaneous hepatotoxic chemotherapy. Information on late toxicity was documented in 465 forms from 216 patients, with a median follow-up of 2 years. A maximum grade of toxicity of ≥ 0 occurred in 18 patients over time (with grade 1, 2, and 3 toxicity occurring in 15, 2, and 1 patient, respectively), including three patients (17 %) with TBI. One of them received simultaneous hepatotoxic chemotherapy. In multivariable analysis, volume-dose correlations showed no statistically noticeable effect on acute or chronic toxicity. CONCLUSION: Only low hepatotoxicity developed in children after irradiation of various abdominal and thoracic tumors. Due to the low radiation doses to the liver (median liver dose = 5 Gy) and the low toxicities that were consecutively observed, dose-volume curves for liver toxicity could not be established. These findings reflect the cautious attitude of radiation oncologists in terms of attributable liver doses in the treatment of the investigated tumor entities. It offers the option of increasing these conservative doses if tumor control is necessary.

Distress, anxiety and depression in patients with brain metastases before and after radiotherapy.

BACKGROUND: Many patients with cancer suffer from distress, anxiety and depression. However, studies on patients with brain metastases are lacking. In this exploratory study we prospectively assessed distress, anxiety and depression in patients with brain metastases from different solid primary tumour treated with radiotherapy to the brain. METHODS: Patients were recruited between May 2008 and December 2010. Distress, anxiety and depression were subjectively evaluated before radiotherapy, 6 weeks, 3 months and 6 months after radiotherapy using the validated National Comprehensive Cancer Network Distress Thermometer (DT) and the Hospital Anxiety and Depression Scale (HADS). The treatment group consisted of adult patients (n = 67) with brain metastases who were treated with whole-brain radiotherapy (n = 40) or hypofractionated stereotactic radiotherapy (n = 27). The control group comprised of patients (n = 32) diagnosed with breast cancer without cranial involvement who received adjuvant whole breast radiotherapy. Forty-six patients (24 in the treatment group) completed the study after six months. RESULTS: Before radiotherapy, the treatment group experienced higher distress than the control group (p = 0.029). Using a cut-off ≥ 5, 70% of the treatment group were suffering from significant distress (66% of the control group). No significant time-by-group interaction on distress, anxiety and depression was observed. At all time points, a high proportion of patients reported psychological stress which featured more prominently than most of the somatic problems. Global distress correlated strongly with the Hospital Anxiety score before radiotherapy, but only moderately or weakly with both HADS scores after radiotherapy with the weakest association 6 months after radiotherapy. CONCLUSION: In conclusion, the course of distress, anxiety and depression does not differ significantly between patients with brain metastases and breast cancer patients without cranial involvement. This finding suggests that both groups need similar psychological support during their treatment. Both screening instruments should be used as they cover different facets of distress.

Evaluation of quality of life in lung cancer patients receiving radiation and Viscum album L.: a real-world data study.

BACKGROUND: Lung cancer (LC) is associated with high mortality and poor quality of life (QoL). The disease as well as oncological treatments such as radiation and chemotherapy with adverse effects can impair the QoL of patients. Add-on treatment with extracts of Viscum album L. (white-berry European mistletoe, VA) has been shown to be feasible and safe and to improve the QoL of cancer patients. The aim of this study was to analyze the changes in QoL of LC patients being treated with radiation according to oncological guidelines and add-on VA treatment in a real-world setting. METHODS: A real-world data study was conducted using registry data. Self-reported QoL was assessed by the evaluation of the European Organization of Research and Treatment Health-Related Quality of Life Core Questionnaire scale (EORTC QLQ-C30). Adjusted multivariate linear regression analyses were performed to analyze factors associated with changes in QoL at 12 months. RESULTS: A total of 112 primary LC patients (all stages, 92% non-small-cell lung cancer, median age 70 (ICR: 63-75)), answered the questionnaires at first diagnosis and 12 months later. Assessment of 12 months changes in QoL revealed significant improvement of 27 points for pain (p = 0.006) and 17 points for nausea/vomiting (p = 0.005) in patients who received combined radiation and VA. In addition, significant improvements of 15 to 21 points for role (p = 0.03), physical (p = 0.02), cognitive (p = 0.04), and social functioning (p = 0.04) were observed in guideline treated patients receiving no radiation but add-on VA. CONCLUSIONS: Add-on VA therapy reveals supportive effects for the QoL of LC patients. Particularly in combination with radiation a significant reduction in pain and nausea/ vomiting has been observed. Trial registration The study received ethics approval and was retrospectively registered (DRKS00013335 on 27/11/2017).

Prevention and Treatment of Chemotherapy-Induced Peripheral Neuropathy (CIPN) with Non-Pharmacological Interventions: Clinical Recommendations from a Systematic Scoping Review and an Expert Consensus Process.

Background: Most individuals affected by cancer who are treated with certain chemotherapies suffer of CIPN. Therefore, there is a high patient and provider interest in complementary non-pharmacological therapies, but its evidence base has not yet been clearly pointed out in the context of CIPN. Methods: The results of a scoping review overviewing the published clinical evidence on the application of complementary therapies for improving the complex CIPN symptomatology are synthesized with the recommendations of an expert consensus process aiming to draw attention to supportive strategies for CIPN. The scoping review, registered at PROSPERO 2020 (CRD 42020165851), followed the PRISMA-ScR and JBI guidelines. Relevant studies published in Pubmed/MEDLINE, PsycINFO, PEDro, Cochrane CENTRAL, and CINAHL between 2000 and 2021 were included. CASP was used to evaluate the methodologic quality of the studies. Results: Seventy-five studies with mixed study quality met the inclusion criteria. Manipulative therapies (including massage, reflexology, therapeutic touch), rhythmical embrocations, movement and mind-body therapies, acupuncture/acupressure, and TENS/Scrambler therapy were the most frequently analyzed in research and may be effective treatment options for CIPN. The expert panel approved 17 supportive interventions, most of them were phytotherapeutic interventions including external applications and cryotherapy, hydrotherapy, and tactile stimulation. More than two-thirds of the consented interventions were rated with moderate to high perceived clinical effectiveness in therapeutic use. Conclusions: The evidence of both the review and the expert panel supports a variety of complementary procedures regarding the supportive treatment of CIPN; however, the application on patients should be individually weighed in each case. Based on this meta-synthesis, interprofessional healthcare teams may open up a dialogue with patients interested in non-pharmacological treatment options to tailor complementary counselling and treatments to their needs.

Hypofractionated stereotactic radiotherapy of limited brain metastases: a single-centre individualized treatment approach.

BACKGROUND: We retrospectively report treatment results of our single-centre experience with hypofractionated stereotactic radiotherapy (hfSRT) of limited brain metastases in primary and recurrence disease situations. Our aim was to find the most effective and safe dose concept. METHODS: From 04/2006 to 12/2010, 75 patients, with 108 intracranial metastases, were treated with hfSRT. 52 newly diagnosed metastases (48%), without up-front whole brain radiotherapy (WBRT), received hfSRT as a primary treatment. 56 metastases (52%) received a prior WBRT and were treated in this study in a recurrence situation. Main fractionation concepts used for primary hfSRT were 6-7x5 Gy (61.5%) and 5x6 Gy (19.2%), for recurrent hfSRT 7-10x4 Gy (33.9%) and 5-6x5 Gy (33.9%). RESULTS: Median overall survival (OS) of all patients summed up to 9.1 months, actuarial 6-and 12-month-OS was 59% and 35%, respectively. Median local brain control (LC) was 11.9 months, median distant brain control (DC) 3.9 months and intracranial control (IC) 3.4 months, respectively. Variables with significant influence on OS were Gross Tumour Volume (GTV) (p = 0.019), the biological eqivalent dose (calculated on a 2 Gy single dose, EQD2, α/ß = 10) < and ≥ median of 39 Gy (p = 0.012), extracerebral activity of the primary tumour (p < 0.001) and the steroid uptake during hfSRT (p = 0.03). LC was significantly influenced by the EQD2, ≤ and > 35 Gy (p = 0.004) in both uni- and multivariate Cox regression analysis. Median LC was 14.9 months for EQD2 >35 Gy and 3.4 months for doses ≤35 Gy, respectively. Early treatment related side effects were usually mild. Nevertheless, patients with a EQD2 >35 Gy had higher rates of toxicity (31%) than ≤35 Gy (8.3%, p=0.026). CONCLUSION: Comparing different dose concepts in hfSRT, a cumulative EQD2 of ≥35 Gy seems to be the most effective concept in patients with primary or recurrent limited brain metastases. Despite higher rates of only mild toxicity, this concept represents a safe treatment option.

Prospective evaluation of quality of life effects in patients undergoing palliative radiotherapy for brain metastases.

BACKGROUND: Recently published results of quality of life (QoL) studies indicated different outcomes of palliative radiotherapy for brain metastases. This prospective multi-center QoL study of patients with brain metastases was designed to investigate which QoL domains improve or worsen after palliative radiotherapy and which might provide prognostic information. METHODS: From 01/2007-01/2009, n=151 patients with previously untreated brain metastases were recruited at 14 centers in Germany and Austria. Most patients (82 %) received whole-brain radiotherapy. QoL was measured with the EORTC-QLQ-C15-PAL and brain module BN20 before the start of radiotherapy and after 3 months. RESULTS: At 3 months, 88/142 (62 %) survived. Nine patients were not able to be followed up. 62 patients (70.5 % of 3-month survivors) completed the second set of questionnaires. Three months after the start of radiotherapy QoL deteriorated significantly in the areas of global QoL, physical function, fatigue, nausea, pain, appetite loss, hair loss, drowsiness, motor dysfunction, communication deficit and weakness of legs. Although the use of corticosteroid at 3 months could be reduced compared to pre-treatment (63 % vs. 37 %), the score for headaches remained stable. Initial QoL at the start of treatment was better in those alive than in those deceased at 3 months, significantly for physical function, motor dysfunction and the symptom scales fatigue, pain, appetite loss and weakness of legs. In a multivariate model, lower Karnofsky performance score, higher age and higher pain ratings before radiotherapy were prognostic of 3-month survival. CONCLUSIONS: Moderate deterioration in several QoL domains was predominantly observed three months after start of palliative radiotherapy for brain metastases. Future studies will need to address the individual subjective benefit or burden from such treatment. Baseline QoL scores before palliative radiotherapy for brain metastases may contain prognostic information.

Effect of Traumeel S on pain and discomfort in radiation-induced oral mucositis: a preliminary observational study.

CONTEXT: Painful oral mucositis is an almost inevitable side effect of radiotherapy of head and neck tumors that simultaneous chemotherapy intensifies and that is notoriously difficult to treat. In a previous study, chemotherapy-induced stomatitis in children undergoing bone marrow transplantation responded well to the homeopathic complex remedy Traumeel S. OBJECTIVE: To evaluate the efficacy of Traumeel S in the management of radiation-induced oral mucositis in patients with head and neck tumors. DESIGN: The research team designed a nonrandomized, prospective, observational study with matched pairs. SETTING: The research team performed the study in a tertiary cancer-care center at the Institute of Radiotherapy and Special Oncology, Medical School Hanover, Germany. PARTICIPANTS: The participants were 20 patients who were receiving radiotherapy or radiochemotherapy for head and neck tumors. INTERVENTION: Five times per day during the observational period, participants self-administered daily mouth rinses with either sage tea (Salvia officinalis, control group) or Traumeel S solution (intervention group). OUTCOME MEASURES: Two independent physicians determined the grade of oral mucositis at least once per week, and the research team derived the degree of oral pain from diaries that participants kept. RESULTS: Both groups were comparable in terms of tumor and treatment characteristics. The research team could not confirm any appreciable specific effect of Traumeel S on the primary endpoints; the limited reduction in pain for the intervention group compared to the control group was not significant, and the more frequent analgesia in the Traumeel S group most likely explained that reduction. Among the secondary endpoints, loss of taste and swallowing difficulty responded to Traumeel S to some extent. CONCLUSIONS: Traumeel S may have some potential in the treatment of radiation-induced oral mucositis, but its possible effects need confirmation by further studies. This article discusses some methodological requirements.

Cisplatin Versus Carboplatin and Paclitaxel in Radiochemotherapy for Patients With Locally Advanced Head and Neck Squamous Cell Carcinoma.

BACKGROUND/AIM: The implementation of a platinum-containing regimen is recommended for definitive and adjuvant therapy of patients with locally advanced head and neck tumour. We compared the conditions for the use of cisplatin or carboplatin/paclitaxel or for changing between these two regimens on a clinic-specific basis. PATIENTS AND METHODS: We evaluated 150 patients with advanced head and neck squamous cell carcinoma who received simultaneous radiochemotherapy at our institution between 2012 and 2017. Chemotherapy with weekly doses of cisplatin (40 mg/m2, group 1) or, in cases of impaired renal and/or cardiac function, with weekly doses of carboplatin AUC2 and paclitaxel (45 mg/m2, group 2), was performed as a first-choice therapy. If toxicities occurred in group 1, treatment was switched to the carboplatin/paclitaxel regimen (group 3). Patient- and therapy-related parameters, toxicity and survival data were compared across groups. RESULTS: We examined 99, 30, and 21 patients in each group who received at least 1 course of chemotherapy. Group 3 patients switched from cisplatin to carboplatin/paclitaxel after a median of 3 courses due to nephrotoxicity (95.2%). The target of at least 5 chemotherapy courses was most frequently achieved by patients in group 1 (69.7%), followed by group 3 (61.9%) and then group 2 (40.0%). Multivariate analysis revealed that patients who switched groups were more likely to be over 60 years old (p=0.021), undergo definitive radiochemotherapy (p=0.049) and develop higher nephrotoxicity (p=0.036) than group 1 patients. Outcomes did not differ between groups. CONCLUSION: When cisplatin application is contraindicated due to renal- or cardiotoxicity, carboplatin/paclitaxel is an appropriate option.

Effects of an Interdisciplinary Integrative Oncology Group-Based Program to Strengthen Resilience and Improve Quality of Life in Cancer Patients: Results of a Prospective Longitudinal Single-Center Study.

BACKGROUND: Patients with cancer receiving oncological treatment often suffer from a reduced quality of life (QoL) and resilience. OBJECTIVES: The aim of this study was to evaluate the effect of an interdisciplinary integrative oncology group-based program on resilience and quality of life in patients with cancer during or after conventional oncological therapy. METHODS: This prospective longitudinal single-center study evaluated the resilience (Resilience Scale), quality of life (EORTC-QLQ C30), anxiety, depression (Hospital Anxiety and Depression Scale), and distress levels (Distress Thermometer) of 60 patients with cancer who participated in a 10-week interdisciplinary integrative oncology group-based program during or after cancer treatment in outpatient clinics. An average of 12 (range 11-13) patients participated in each 10-week group. The program included recommendations for diet, stress management, relaxation, and exercise, as well as naturopathic self-help strategies and psychosocial support. RESULTS: There were slight increases in global quality of life scores (week 0: 58.05 ± 20.05 vs week 10: 63.13 ± 18.51, n = 59, P = .063, d = -.25) and resilience scores (week 0: 63.50 ± 13.14 vs week 10: 66.15 ± 10.17, n = 52, P = .222, d = -.17) after the group program compared to before; however, these changes were not statistically significant and had small effect sizes. Patients with at least moderate anxiety symptoms (P = .022, d = .42) and low resilience (P = .006, d = -.54) benefited most from the program. The patients reported no relevant side effects or adverse events from the program. CONCLUSIONS: No significant effects on global quality of life or resilience were found in the general sample; notably, patients with anxiety and low initial resilience benefited the most from the program.

Nursing Procedures for the Prevention and Treatment of Mucositis Induced by Cancer Therapies: Clinical Practice Guideline Based on an Interdisciplinary Consensus Process and a Systematic Literature Search.

BACKGROUND: Patients with cancer receiving tumor therapy often suffer from oral mucositis. OBJECTIVES: The aim of this project was to summarize experiences with nursing procedures by experts in integrative oncology and to establish recommendations for nursing interventions that can prevent or cure mucositis. METHODS: The study design was an interdisciplinary consensus process based on a systematic literature search. RESULTS: The panel discussed and agreed on 19 nursing procedures, which included mouthwashes, such as teas, supplements, oil applications, and different kinds of ice cubes to suck, as well as flaxseed solution, propolis, and mare milk. Twelve interventions were classified as effective, with effectiveness for OraLife, propolis, sea buckthorn pulp oil, marshmallow root tea also for xerostomia, Helago chamomile oil, mare milk, and Saliva Natura rated as highly effective in clinical experience. In the systematic literature search, a total of 12 out of 329 randomized controlled trials and meta-analyses on chamomile (n = 3), Calendula (n = 1) and sage (n = 1), propolis (n = 2), and sucking ice cubes (cryotherapy; n = 5) met all inclusion criteria. Trial evidence for effectiveness in oral mucositis was revealed for propolis and cryotherapy. CONCLUSIONS: The current evidence supports the use of some nursing procedures (f.e. propolis for 2 and 3 grade mucositis) for improving oral mucositis during cancer therapies. There is still a need to define general clinical practice guidelines for the supportive treatment of mucositis, as well as for more interdisciplinary research in this area.

Radiation therapy and internet - what can patients expect? homepage analysis of german radiotherapy institutions.

BACKGROUND: the internet as a source of medical information has emerged during the last years. There is a confusing amount of medical websites with a great diversity of quality. Websites of radiotherapy institutions could offer a safe and an easy-to-control way to assist patients' requests. MATERIAL AND METHODS: 205 internet appearances of German radiotherapy institutions were analyzed in June 2009 (nonuniversity hospitals n = 108, medical practices n = 62, university hospitals n = 35). For the evaluation of each homepage verifiable criteria concerning basic information, service and medical issues were used. RESULTS: the quality of information published via internet by different radiotherapy institutions showed a large variety. Basic information like telephone numbers, operating hours, and direction guidance were provided in 96.7%, 40%, and 50.7%, respectively. 85% of the websites introduced the staff, 50.2% supplied photos and 14% further information on the attending physicians. The mean amount of continuative links to other websites was 5.4, the mean amount of articles supplying medical information for patients summed up to 4.6. Medical practices and university hospitals had statistically significant more informative articles and links to other websites than nonuniversity hospitals. No statistically significant differences could be found in most other categories like service issues and basic information. CONCLUSION: internet presences of radiotherapy institutions hold the chance to supply patients with professional and individualized medical information. While some websites are already using this opportunity, others show a lack of basic information or of user-friendliness.

Chemoradiotherapy with weekly cisplatin 40 mg/m(2) in 103 head-and-neck cancer patients: a cumulative dose-effect analysis.

BACKGROUND AND PURPOSE: In patients with head-and-neck cancer treated with chemoradiotherapy (CRT), a cisplatin-based regimen is often used. Several treatment schedules are accepted with a cumulative cisplatin dose of 200 mg/m(2) (CisCD200) given during radiotherapy. The aim of this analysis was to investigate feasibility and efficacy of a weekly cisplatin 40 mg/m(2) regimen. PATIENTS AND METHODS: During 08/2001 and 12/2006, 103 patients with squamous head-and-neck cancer received concurrent CRT with intended weekly cisplatin 40 mg/m(2) and were analyzed retrospectively. CRT was definitive for a newly diagnosed primary in 62, postoperative in 16, and for recurrence in 25 patients. Most patients had carcinoma of the hypo- and oropharynx (81%). Patients received a median total dose of 70 Gy (range, 42-71.2 Gy). RESULTS: Only 42 patients (41%) received a CisCD200 predominantly due to hematotoxicity. Actuarial 12- and 18-month overall survival (OS) for patients with and without CisCD200 was 83.3% versus 72.1% (p = 0.19) and 66.7% versus 67.2% (p = 0.86), the 12- and 18-month locoregional control (LRC) 66.7% versus 78.7% (p = 0.325) and 59.5% versus 78.7% (p = 0.109), respectively. Multivariate analysis revealed only type of CRT (definitive vs. recurrent) and T-classification as significant variables predicting OS and LRC. CONCLUSION: Feasibility and efficacy of CRT with weekly cisplatin 40 mg/m2 were suboptimal in this analysis. However, the prospects of weekly cisplatin may be its more suitable integration into emerging trimodality concepts combining CRT with molecularly targeted agents.

Effects of radiotherapy for brain metastases on quality of life (QoL). Prospective pilot study of the DEGRO QoL working party.

BACKGROUND: Prospective data on quality-of-life (QoL) effects of radiotherapy for brain metastases are currently lacking, but would be of great interest to guide therapeutic decisions. PATIENTS AND METHODS: From 01/2007 to 08/2007, 46 patients with previously untreated brain metastases were recruited at eight centers. QoL was measured at start of treatment (T(0)) and at 3 months (T(3mo)). In the pilot study, two combinations of QoL instruments could be used at the discretion of the centers (A: EORTC QLQ-C30 and B: EORTC QLQ-C15-PAL both with brain module BN20, assessment by proxies with A: Palliative Care Outcome Scale, B: self-constructed brain-specific instrument). RESULTS: All patients received whole-brain radiotherapy, four with an additional boost irradiation. At T(3mo), 26/46 patients (56.5%) had died. 17/20 survivors (85%) completed the questionnaires. In 3-month survivors, QoL deteriorated in most domains, significant in drowsiness, hair loss and weakness of legs. The scores for headaches and seizures were slightly better after 3 months. Assessment by proxies also suggested worsening of QoL. Initial QoL at T(0) was better in those alive than in those deceased at T(3mo), significant for physical function and for the symptom scales of fatigue and pain, motor dysfunction, communication deficit and weakness of legs. CONCLUSION: Practicability and compliance appeared better with the (shorter) version B. This version is now used in the ongoing main phase of the study with additional centers. First results indicate a moderate worsening of QoL during the first 3 months after start of palliative radiotherapy for brain metastases. QoL at initiation of radiotherapy may be prognostic for survival.

Frequency and risk factors for arm lymphedema after multimodal breast-conserving treatment of nodal positive breast Cancer - a long-term observation.

BACKGROUND: Arm-lymphedema is a major complication after breast cancer. Recent studies demonstrate the validity of predicting Breast Cancer Related Lymphedema (BCRL) by self-reports. We aimed to investigate the rate of BCRL and its risk factors in the long-term using self-reported symptoms. METHODS: Data was collected from 385 patients who underwent multimodal therapy for nodal positive breast cancer, including breast conserving surgery, axillary dissection, and local or locoregional radiotherapy. Two validated questionnaires were used for the survey of BCRL (i.e. LBCQ-D and SDBC-D). These were analysed collectively with retrospective data of our medical records. RESULTS: 23.5% (n = 43) suffered a permanent BCRL (stage II-III) after a median follow-up time of 10.1 years (4.9-15.9 years); further 11.5% (n = 23) reported at least one episode of reversible BCRL (Stage 0-I) during the follow-up time. 87.1% of the patients with lymphedema developed this condition in the first two years. Adjuvant chemotherapy was a significant risk factor for the appearance of BCRL (p = 0.001; 95%-CI 7.7-10.2). CONCLUSIONS: Breast cancer survivors face a high risk of BCRL, particularly if axillary dissection was carried out. Almost 90% of BCRL occurred during the first two years after radiotherapy. Self-report of symptoms seems to be a suitable instrument of early detection of BCRL.