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Biomedical subjects

Jan J Battermann

Publications and source records attributed to Jan J Battermann.

13 recordsLinked to original sources
PubMed2005

Measurement of prostate rotation during insertion of needles for brachytherapy.

BACKGROUND AND PURPOSE: The purpose of this study is to investigate whether prostate rotation due to needle insertion for prostate brachytherapy is predictable and if so, to quantify this rotation, and to see whether locking needles reduce the magnitude of prostate rotation. PATIENTS AND METHODS: The measurements are done at the beginning of the procedure for brachytherapy with a Foley catheter in situ. After a needle is inserted into the prostate, a 3D ultrasound scan is made. Then the seeds are delivered using RAPID Strands (Oncura), and the needle is withdrawn. A second 3D scan is made. The needle and seed positions are determined in these scans. To determine the rotation of the prostate, the angle between the needle and the seed trajectory is calculated. RESULTS: The prostate rotations have been measured in 16 patients, eight without the use of locking needles and eight with locking needles. In total 62 needles were inserted. The maximum rotation was 13.8 degrees and occurred in the coronal plane when no locking needles were used with a significant correlation (P<0.01, R=0.637) between the place of insertion and rotation. It was shown that the method (with or without locking needles) had a significant (P<0.001) influence on the rotation in the coronal plane. Rotations in the sagittal plane ranged from -8.5 degrees to +10.2 degrees without correlation with the insertion point of the needle or the use of locking needles. CONCLUSIONS: This study showed that prostate rotation during needle insertion for prostate brachytherapy is relatively large and unpredictable. Locking needles reduce prostate rotation in the coronal plane, but not in the sagittal plane. Minimising this rotation is necessary for accurate seed delivery, especially when a robotic implantation technique is used.

Brachytherapy↗
PubMed2005

Quality of life of patients after permanent prostate brachytherapy in relation to dosimetry.

PURPOSE: To investigate changes in quality of life (QoL) after permanent prostate brachytherapy and to correlate these changes with postimplant dosimetry based on magnetic resonance (MR) images. METHODS AND MATERIALS: For this study, 127 patients with low-stage prostate cancer and treated with brachytherapy received a QoL questionnaire at five time points: before treatment and at 4 weeks, 6 months, 1 year, and 2 years after treatment. The questionnaire included the RAND-36 generic health survey, the cancer-specific European Organization for Research and Treatment of Cancer (EORTC) core questionnaire, the tumor-specific EORTC prostate cancer module, and the American Urological Association symptom index. Postimplant dosimetry was based on registered T1 spin echo transversal, T2 turbo spin echo transversal, and T2 turbo spin echo sagittal MR images and CT images taken 4 weeks after implantation of the iodine-125 seeds. Calculated parameters were prostate volume, prostate volume receiving 100% (V100) and 150% (V150) dose, dose to 90% of the prostate volume (D90), maximum dose in 1-, 2-, and 5-cm3 rectum volume, distance between prostate and anterior rectum wall, and the maximum dose in 1%, 2%, and 5% urethra volume. Analysis of variance for repeated measures was used for comparison of the means of all variables in the different questionnaires. Linear regression analysis (stepwise) was used to investigate the correlations between QoL parameters and dosimetry parameters. RESULTS: On average, only the QoL at 4 weeks after implant was significantly different from (worse than) the QoL at the other time points. Regression analysis showed a significant correlation between changes in bowel problems and the maximum dose in 2-cm3 rectum volume, between changes in urinary symptoms and prostate volume, and between changes in urinary problems and the D90 value of the prostate. CONCLUSIONS: The QoL for patients with permanent prostate implants was worse in the first months after treatment but returned to baseline values 1 year after implant. Significant correlations were found between dose distribution and QoL.

Analysis of Variance↗
PubMed2004

Treatment of stage III-IV nasopharyngeal carcinomas by external beam irradiation and local low doses of IL-2.

The therapeutic effect of intratumoural application of Interleukin-2 (IL-2) was studied in patients with stage III-IV nasopharyngeal carcinoma (NPC) that received radiotherapy. Patients with stage III-IV NPC receiving a standard treatment of 7,000 cGy external beam irradiation have a mean disease-free survival of about 1.5 years. In this paper, we describe ten of these patients who were treated with additional peritumoural and intratumoural injections with 3 x 10(4) U IL-2 on 5 days in weeks 2, 4, and 6 of the 7-weeks' irradiation period. This combined treatment group was compared with a historical group of patients treated with standard irradiation alone. Local IL-2 therapy showed a marked clinical and statistical significant improvement of disease-free survival. After 5 years, 63% of the IL-2 treated patients were disease-free versus 8% of the control patients. These results suggest that the therapeutic results of radiotherapy can be significantly improved by combining it with local IL-2 treatment. To our knowledge, this is the first clinical report showing that local IL-2 therapy is effective against an infiltrative and locally metastasizing tumour in human patients.

Adult↗
PubMed2004

Results of permanent prostate brachytherapy, 13 years of experience at a single institution.

BACKGROUND AND PURPOSE: To understand the influence of treatment techniques on the final outcome, as well as the relation of risk groups and of PSA nadir on the outcome, we reviewed our experience over more than 10 years. PATIENTS AND METHODS: Patients were treated in the period 1989 through 2000. Available for this evaluation are 351 patients. The distribution of cases by T stage was T1a, b (9%), T1c (49%), T2 (42%), and by grading G1 (58%), G2 (38%), G3 (1%) and Gx (3%). The technique of plantation of seeds varied over the years, starting with single seeds using a Mick applicator (104 patients), followed by Rapid strands without (70) and with pre-planning (177). Risk groups are categorised as low (iPSA <10 ng/ml, T1-2, grade 1), 116 patients; intermediate (iPSA 10-20 ng/ml, or grade 2-3), 114 patients; and high risk (both factors, or iPSA >20 ng/ml), 121 patients. The mean follow-up time was 50 months, median 48 and range 24-123 months. RESULTS: Overall actuarial survival at 5 and 7 years was 85 and 76%, respectively. Forty patients died, eight (2%) because of or with prostate cancer. Alive are 310 patients (88%), with 223 patients bNED (71%), 51 (16%) with PSA failure, 21 (7%) with local and 15 (5%) with distant recurrence. Total bNED was 72%. Although results are better since the introduction of Rapid strands, 79% bNED versus 54% bNED for single seeds (P = 0.14) also the increase in activity per cm(3) prostate volume accounts for this improvement. With pre-planning a significant better result (P < 0.03) is obtained as compared to single seeds or strands without planning. Categorisation into risk groups results in a significant difference (P < 0.007) of bNED with risk factors, respectively, 57% for the high, 75% for the intermediate and 89% for the low risk group. Also PSA nadir had a significant effect on outcome; patients who reach a nadir of < or =0.5 ng/ml have a 91% chance of cure. CONCLUSIONS: Results of permanent seed implantation improved with the introduction of strands, however, better staging and the increase in activity per cm(3) prostate volume also contributed to this improvement. A significant better result was obtained with pre-planning. Categorisation in risk groups corresponds very well with treatment outcome. Finally, a strong relation is found with PSA nadir.

Aged↗
PubMed2004

Loco-regional conformal radiotherapy of the breast: delineation of the regional lymph node clinical target volumes in treatment position.

BACKGROUND AND PURPOSE: As the location of the regional lymph nodes (LNs) of the breast varies largely between patients and may be dependant on the position of the arm, adequate localization of these nodes is mandatory in order to fully take advantage of optimized conformal radiotherapy. For this purpose, the anatomical boundaries of the regional lymph node (LN) clinical target volumes (CTVs) for delineation on transverse CT-slices, made in treatment position, were established. PATIENTS AND METHODS: Anatomical and surgical descriptions of the regional LNs of the breast, as well as a shoulder dissection, were studied. Axial slices of a human cadaver with one arm in abduction and the other in adduction were investigated, to assess the displacement of LNs by abduction of the arm into treatment position. Based on these findings, we defined the anatomical boundaries of the regional LN CTVs visible on transverse CT-slices. RESULTS: Standard anatomical and surgical descriptions appeared to be inadequate for determination of the boundaries of the regional LN CTVs in treatment position. With abduction of the arm, a change in position of all regional LNs, except for the medial supraclavicular LNs and internal mammary LNs, was observed in the anatomical cross-sections. This was also taken into account in our delineation protocol proposal. CONCLUSIONS: Anatomically based guidelines for delineation of the regional LN CTVs for loco-regional irradiation of the breast on transverse CT-slices, made in treatment position, have been developed in this study. These could be used as a basis for conformal radiotherapy.

Arm↗
PubMed2004

MRI-guided prostate brachytherapy with single needle method--a planning study.

BACKGROUND AND PURPOSE: Magnetic resonance image (MRI)-guided prostate brachytherapy with a conventional closed MR scanner is hampered by the limited access to the prostate. To handle this problem, we have designed a new implantation method, based on a patient lying in a closed MR scanner, a robotic device to be placed between patient's legs, and one needle with one insertion point. MATERIALS AND METHODS: The MRI-guided robotic system inserts the needle into the prostate to deliver the seeds. Each time, the needle will be retracted to the rotation point (in the body), and the insertion angle can be changed. The possible angles of the needle are limited by the geometry of the closed MR scanner and the presence of the symphysis, rectum and urethra. We have done a planning study to investigate the feasibility of this single needle method. RESULTS: The treatment plans made with the single needle method showed the possibility to cover the prostate with the prescribed dose without piercing the urethra or rectum and without pubic bone interference. The plans were comparable to the plans made for the multi parallel needle method, and the 144Gy isodose enclosed the prostate with a margin of about 2 mm. The planned angles of the needle were within the range of possible angles. CONCLUSIONS: This planning study has shown the feasibility of adequate prostate coverage with the divergent single needle method within the limited space inside the closed MR scanner.

Brachytherapy↗
PubMed2004

Quality of permanent prostate implants using automated delivery with seedSelectron versus manual insertion of RAPID Strands.

BACKGROUND AND PURPOSE: To compare the quality of manually inserted RAPID Strand implants with automatically inserted selectSeed implants using volumetric and dosimetric parameters. PATIENTS AND METHODS: Patients with T1 to T2 prostate carcinoma were treated with brachytherapy. The (125)I seeds were implanted in the prostate in three different ways: manual insertion of RAPID Strands (R); insertion of selectSeeds using the seedSelectron (S); a combination of both techniques: manual insertion of RAPID Strands in the left half of the prostate and insertion of selectSeeds with the seedSelectron in the right half of the prostate (RS). The comparison is based on implant and target specific parameters. The implant specific parameters, V(100), homogeneity index (HI), and natural dose ratio (NDR), were determined at the time of implantation and four weeks later. MR images taken four weeks after the implantation were used for the calculation of the target specific parameters: D(90), HI, external index (EI), and conformation number (CN). RESULTS: We found no significant difference between the groups of implants (R, S, RS) for the implant specific parameters V(100), HI, and NDR at t(0) and neither at t(4w). For each group, the V(100) values decreased significantly with time between t(0) and t(4w). The target specific parameters D(90), HI, EI and CN were not significantly different between the groups. For the group of patients with both RAPID Strands and selectSeeds, we found a significant difference in D(90) between both halves of the prostate. CONCLUSIONS: The dosimetry parameters of a newly introduced implant technique using an automatic seed afterloader were not significantly different from the parameters of a manual insertion technique using RAPID Strands. Since either technique has its advantages and disadvantages regarding seed migration, physics quality assurance, efficiency, logistics, and ease of use, it was decided to use both techniques and to continue evaluations.

Brachytherapy↗
PubMed2002

The mechanism of regression of solid SL2 lymphosarcoma after local IL-2 therapy.

Treatment of cancer by the administration of interleukin-2 (IL-2) at the tumour site is a very effective approach. The mechanism of this tumour regression is not clear, although it is generally assumed that it involves an IL-2-stimulated immune reaction. There are, however, no immune parameters that consistently correlate with the therapeutic effect. We have studied the histopathological events in a subcutaneously (s.c.) growing SL2 lymphosarcoma (transplantation of tumour cells at day 0) treated with peritumoural IL-2 injections at days 10-14. Most IL-2-treated tumours had already begun to regress from day 12 onwards, showing that local IL-2 therapy was also effective in the present study. The immediate reaction after local IL-2 administration is vascular leakage from the surrounding circulation, causing oedema within the tumour and in a broad zone surrounding it. The presence of oedema is always accompanied by markedly increased tumour necrosis. After a few days extensive angiogenesis occurs at the border between the oedematous area and the healthy connective tissue. Leucocytes, mainly macrophages, migrate via the newly formed blood vessels to gain access to the necrotising tumour site, where they form a granuloma. These macrophages phagocytose the dead tumour material. During growth, the SL-2 tumours infiltrate the surrounding tissue. The infiltrating tumour strands are apparently attacked by macrophages, as the tumour cells in close proximity to the latter are progressively destroyed. Therefore, the body of the tumour and the infiltrating tumour strands are attacked in different ways. The primary effect of IL-2 administration at the tumour site is vascular leakage that causes oedema in and around the tumour. This is followed by extensive angiogenesis, with the resulting migration of white cells from the circulation, which form a granuloma around the tumour. Both the oedema and the granuloma cause tumour regression.

Animals↗
PubMed2002

Biologically effective dose for permanent prostate brachytherapy taking into account postimplant edema.

PURPOSE: To study the influence of radiobiologic and physical parameters and parameters related to edema on the biologically effective dose (BED) for permanent prostate implants and to determine the optimal timing of seed reconstruction for BED calculation. METHODS AND MATERIALS: On the basis of the linear-quadratic model, an expression for the BED was derived, including the edema parameters. A set of parameter values was defined, and these parameter values were varied one at a time to examine the effect on the BED and the theoretically effective treatment time (t(eff)). A ratio epsilon was defined to investigate the optimal timing of seed reconstruction. RESULTS: The maximal BED decreases when the extent of lethal damage is smaller, the potential tumor doubling time is smaller, the half-life time of the seeds is shorter, and the magnitude of prostate volume increase is larger. For 125I, the optimal timing of seed reconstruction is 25 days after implantation. Seed reconstruction 1 day after the implantation results in an underestimation of the BED of at most 43%, depending on the magnitude and half-life of edema. An overestimation of the BED of at most 22% is calculated when seed reconstruction took place at the effective treatment time. CONCLUSION: The maximal BED depends strongly on the value of alpha, the potential tumor doubling time, and the choice of isotope. If prostate volume increase due to edema is not taken into account, the BED will be underestimated shortly after the implantation and overestimated if the calculations are based on images taken several months after implantation. The optimal timing of BED evaluation for 125I seed implants and typical prostate edema values is 25 days after implantation.

Algorithms↗
PubMed2002

Three-dimensional controlled interstitial hyperthermia combined with radiotherapy for locally advanced prostate carcinoma--a feasibility study.

PURPOSE: To perform a feasibility study of three-dimensional spatially controlled interstitial hyperthermia for locally advanced prostate cancer. METHODS AND MATERIALS: Twelve patients with prostate cancer (T3NxM0) were treated with conventional external beam radiotherapy and one interstitial hyperthermia treatment. Hyperthermia was delivered with the 27-MHz multielectrode current source (MECS) interstitial hyperthermia technique on an outpatient basis. Guided by transrectal ultrasonography, 12 catheters (range 7-16) were placed in the prostate through a template. Two electrodes per probe were inserted. Thermometry (average 100 sensors) was performed from within the probes for online temperature control. Additional thermometry was done in the prostate, rectum, urethra, and bladder. Reconstruction was done by sonography. Prostate perfusion was estimated from the thermal decay at the end of treatment. The full three-dimensional temperature distribution was calculated. RESULTS: No toxicities greater than Grade 2 were recorded. A learning curve for implantation, position verification, reconstruction, and temperature simulation was experienced. Perfusion was 47 mL/100 g/min (range 30-65). The average measured temperature was T(90) (90% of the prostate reached a temperature of at least:) 39.9 degrees C and T(50) 44.1 degrees C. The average calculated temperatures were lower: T(90), 39.4 degrees C and T(50), 41.8 degrees C, because the entire prostate was taken into account. The tumor temperatures were T(90), 40.7 degrees C and T(50), 43.0 degrees C. The bladder and rectal temperatures were below the safety limits. CONCLUSION: Multielectrode-current-source interstitial hyperthermia is technically feasible and well tolerated. It was not possible to achieve the goal temperature of 42-43 degrees C because of high perfusion and implantation limitations.

Aged↗
PubMed2002

Cataract after total body irradiation and bone marrow transplantation: degree of visual impairment.

PURPOSE: To assess the degree of visual impairment as a result of cataract formation after total body irradiation (TBI) for bone marrow transplantation. METHODS AND MATERIALS: The data from 93 patients who received TBI in 1 or 2 fractions as a part of their conditioning regimen for bone marrow transplantation were analyzed with respect to the degree of visual impairment as a result of cataract formation. The probability to develop severe visual impairment (SVI) was determined for all patients, and the degree of visual impairment was assessed for 56 patients with stabilized cataract, using three categories: no, mild, or severe. RESULTS: For all 93 patients, the probability of developing a cataract causing SVI was 0.44. For allogeneic patients, it was 0.33 without and 0.71 with steroid treatment (p <0.001). All SVI-free probability curves reached a plateau distinct from the cataract-free curves. Apparently, cataracts developing late in the follow-up period rarely cause SVI. Of the patients with stabilized cataract, 32% had no visual impairment, 16% had mild, and 52% severe impairment. No or mild visual impairment was present in 61% of all patients with stable cataract and no steroid treatment compared with only 13% of the patients treated with steroids (p = 0.035). CONCLUSION: SVI occurs in only some of the patients (52%) with stable cataract after TBI for bone marrow transplantation in 1 or 2 fractions. Steroid treatment markedly increases the probability of developing visual problems as result of a cataract after TBI.

Acute Disease↗
PubMed2002

Prostate perfusion in patients with locally advanced prostate carcinoma treated with different hyperthermia techniques.

PURPOSE: We determined prostate perfusion in 18 patients with locally advanced prostate carcinoma treated with a combination of external beam irradiation and regional (10) or interstitial (8) hyperthermia. MATERIALS AND METHODS: Perfusion values were calculated from temperature elevations due to constant applied power and from transient temperature measurements after a change in applied power. Student's t test was used for comparing perfusion values with time and in the 2 groups. RESULTS: At the start of regional hyperthermia treatment mean estimated perfusion plus or minus standard deviation was 10 +/- 8 ml./100 gm. per minute. At the end of treatment mean perfusion was increased to 14 +/- 2 ml./100 gm. per minute (p <0.01). Achieved thermal parameters were a mean temperature of at least 40.3C +/- 0.6C in 90% of the prostate, 40.9C +/- 0.6C in 50% and a mean maximum temperature of 41.6C +/- 0.6C. At the end of interstitial hyperthermia treatment estimated mean perfusion was 47 +/- 5 ml./100 gm. per minute, which was significantly different compared with the end of regional hyperthermia (p < 0(-7) ). Mean temperature was at least 39.4C +/- 0.9C in 90% of the prostate and 41.8C +/- 1.6C in 50%, while mean maximum temperature was 53.1C +/- 6.3C. Systemic temperature increased during regional hyperthermia up to 38.6C, whereas during interstitial hyperthermia body temperature was not elevated. CONCLUSIONS: During interstitial hyperthermia perfusion values are higher than during regional hyperthermia. Hyperthermia causes increased prostate perfusion.

Aged↗