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G Goldner

Publications and source records attributed to G Goldner.

7 recordsLinked to original sources
PubMed2001

Rectal sequelae after conformal radiotherapy of prostate cancer: dose-volume histograms as predictive factors.

PURPOSE: To identify clinically relevant parameters predictive of late rectal bleeding derived from cumulative dose-volume histograms (DVHs) of the rectum after conformal radiotherapy of prostate cancer. MATERIALS AND METHODS: One hundred and nine patients treated with 3D conformal radiotherapy between 1/1994 and 1/1996 for localized prostate cancer (clinical stage T1-T3) were available for analysis. All patients received a total dose of 66 Gy/2 Gy per fraction (specified at the International Commission on Radiation Units and Measurements ICRU reference point). DVHs of the contoured rectum were analyzed by defining the absolute (aV) and relative (rV) rectum volume that received more than 30% (V30), 50% (V50), 70% (V70), 80% (V80), 90% (V90) and 100% (V100) of the prescribed dose. Additionally, a new aspect of DVH analysis was investigated by calculation of the area under the DVH-curve between several dose levels (area under the curve (AUC)-DVH). DVH-variables were correlated with radiation side effects evaluated in 3-6 months intervals and graded according to the EORTC/RTOG score. The median follow-up was 30 months (12-60 months). RESULTS: Univariate and multivariate stepwise Cox-Regression analysis including age, PTV, rectum size, rV100, rV90, rV80, rV70, rV50 rV30 and aV30 to aV100 were calculated. Late rectal bleeding (EORTC/RTOG grade 2) was significantly correlated with the percentage of rectum volume receiving > or = 90% of the prescribed dose (rV90) (P = 0.007) and inversely correlated in a significant way with the size of contoured rectum (P = 0.006) in multivariate analysis. In our series, a proportion of the rectum volume > or = 57% were included in the 90%-isodose (rV90 > or = 57%) in one half of the patients, with an actuarial incidence of 31% of late rectal bleeding at 3 years. In the other half of the patients, when rV90 < 57%, the 3-year actuarial incidence was 11% (P < 0.03). CONCLUSION: Our data demonstrate a dose-volume relationship at the reference dose of 60 Gy ( approximately 90% of the prescribed dose) with respect to late rectal toxicity. The rV90 seems to be the most useful and easily obtained parameter when comparing treatment plans to evaluate the risk of rectal morbidity.

Aged↗
PubMed2000

Endoscopic scoring of late rectal mucosal damage after conformal radiotherapy for prostatic carcinoma.

PURPOSE: To describe rectal mucosal damage in an endoscopic study after conformal radiotherapy of prostate cancer and to correlate this with clinical outcome. MATERIALS AND METHODS: Flexible rectosigmoidoscopy was performed on 44 patients who voluntarily accepted the examination. The median follow-up was 29 months (20-41 months) after 3-D-planned conformal radiotherapy of prostate cancer (66 Gy at the ICRU Reference point, 2 Gy per fraction). To enable a systematic topographic description of endoscopic findings the rectum was divided into four sections. Additionally we differentiated between anterior, posterior, right and left lateral rectal wall. Due to the lack of an existing valid graduation system for radiation induced proctitis, we introduced a six-scaled rectoscopy score for describing and reporting endoscopic findings based on the standardization of the endoscopic terminology published by the ESGE (European Society for Gastrointestinal Endoscopy). Endoscopic findings were compared to the EORTC/RTOG morbidity score. In addition, since 3-D dose distribution of organs at risks was available, a correlation could be made between the location of the rectal lesions and the absorbed dose at that level. RESULTS: In general, endoscopic findings increased from the proximal rectum to the anorectal transition, as well as from the posterior to the anterior rectum wall. Telangiectasia grade 1 and 2 were observed at the whole circumference, only telangiectasia grade 3 were limited to the high dose region at the anterior rectum wall. Similar results were found for congested mucosa (reddening and edematous mucosa). Correlation with symptoms, 7/9 patients who suffered from intermittent rectal bleeding (EORTC/RTOG grade 2) had multiple telangiectasia grade 2-3 and/or congested mucosa grade 3 and microulcerations. However, the same extent of mucosal damage (rectoscopy score 2-3) was found in seven out of 35 patients who have never developed a period of macroscopic rectal bleeding. CONCLUSION: Rectoscopy offers the possibility of detecting signs of tissue dysfunction below the level of subjective symptoms. Systematic analytic examinations such as rectoscopy, in addition to clinical examinations, as already foreseen in the LENT-SOMA-score, will be necessary due to the fact that even telangiectatic lesions have been observed for asymptomatic patients. For the opportunity of sharing and comparing data collected from endoscopy after radiotherapy a graduation system as proposed based on a standardisation of the endoscopic terminology will be necessary.

Aged↗
PubMed1999

[Significance of a rectal balloon as internal immobilization device in conformal radiotherapy of prostatic carcinoma].

BACKGROUND: As known from the literature, prostate motion depends on different bladder and/or rectum fillings. The aim of this study was to analyze the influence of a rectum balloon catheter, used as an internal immobilization device, on prostate and rectum motion during the treatment course. Moreover we have analyzed if the balloon enables an increase of the distance between the prostate and the posterior rectum wall. PATIENTS AND METHODS: Ten patients with localized prostate cancer (T1 to T3) underwent computed tomographic examinations with and without rectal balloon (filled with 40 ml air) at 3 times during treatment course (at the start, middle and end of treatment). Edges of prostate, rectum and bladder were measured in relation to bony reference structures and compared for both examination series (with and without balloon). RESULTS: An increase of the distance between the prostate and the posterior rectal wall of 8 mm was observed at the base of the prostate when using the rectum balloon (Figures 1a,b and 2). Moreover prostate motion in the ventrodorsal direction > or = 4 mm (1 SD) was reduced from 6/10 patients (60%) to 1/10 patients (10%) using the rectal balloon (Table 3, Figure 3). In general, deviations in the latero-lateral and cranio-caudal directions were less (mean < or = 2 mm, 1 SD), no difference between both examination series (with and without balloon) was observed. CONCLUSION: Rectal balloon catheter offers a possibility to reduce prostate motion and rectum filling variations during treatment course. In addition it enables an increase in the distance between prostate and posterior rectal wall, which could enable an improved protection of the posterior rectal wall.

Catheterization↗
PubMed1999

Three dimensional conformal photon radiotherapy at a moderate dose level of 66 Gy for prostate carcinoma: early results.

BACKGROUND: The therapeutic outcome and toxicity of 3-D conformal photon external beam therapy of prostate cancer is well documented in the literature. Progress is still in work for optimization of treatment strategies by risk-adapted dose escalation studies to improve local tumor control without increase of radiation side effects. PATIENTS AND METHODS: We present our experience of 291 patients treated between January 1994 and August 1997 with a 3-D planned four-field box technique and a central dose of 66 Gy. Biochemical response of patients with radiotherapy alone (group 1, n = 72 pts.) has been analyzed in detail. Acute radiation side effects are given for all patients (n = 291), late radiation side effects are given for patients treated between Jan 1994 and Jan 1996 with a median follow-up of 22 months (n = 115 pts.). RESULTS: We have observed a biochemical response (nadir PSA < 1 after 12 months, < 2 after 6 months) for patients treated with radiotherapy alone without hormone manipulation in 67%. Incidence of late rectal and bladder morbidity (grade 2 and 3) was 9.4% and 4%, respectively. CONCLUSION: Compared to other reports our results indicate a high rate of local tumor control (early biochemical response) and a low rate of late morbidity. Nevertheless, we will start a risk-adapted dose escalation study up to 74 Gy for unfavorable subgroups (G2-3, Gleason Score > 7, PSA > 10) to improve treatment outcome.

Follow-Up Studies↗