Biomedical subjects

Klaus Bratengeier

Publications and source records attributed to Klaus Bratengeier.

8 recordsLinked to original sources

PubMed2006

3-D conformal treatment of prostate cancer to 74 Gy vs. high-dose-rate brachytherapy boost: a cross-sectional quality-of-life survey.

The effects of two modalities of dose-escalated radiotherapy on health-related quality of life (HRQOL) were compared. Forty-one consecutive patients were treated with a 3-D conformal (3-DC) boost to 74 Gy, and 43 with high-dose rate (HDR) brachytherapy boost (2x9 Gy), following 3-D conformal treatment to 46 Gy. Median age was 70 years in both groups, median initial PSA was 7.9 microg/l in 3-DC boost patients and 8.1 microg/l in HDR boost patients. Stage was or=7 in 52% and 47%, respectively. HRQOL was assessed cross-sectionally using EORTC QLQ-C30 and organ-specific PR25 modules 3--32 (median 19) and 4--25 (median 14) months after treatment, respectively. Questionnaires were completed by 93% and 97% of patients, respectively. Diarrhea and insomnia scores were significantly increased in both groups. In the PR25 module, scores of 3-DC boost and HDR boost patients for urinary, bowel and treatment-related symptoms were similar. Among responders, 34% of 3-DC boost patients and 86% of HDR boost patients had severe erectile problems. Dose escalation in prostate cancer by either 3-DC boost to 74 Gy or HDR brachytherapy boost appears to result in similar HRQOL profiles.

Brachytherapy↗

PubMed2005

Hypofractionated stereotactic re-irradiation: treatment option in recurrent malignant glioma.

BACKGROUND: Hypofractionated stereotactic radiotherapy (HFSRT) is one salvage treatment option in previously irradiated patients with recurrent malignant glioma. We analyzed the results of HFSRT and prognostic factors in a single-institution series. METHODS: Between 1997 and 2003, 19 patients with recurrent malignant glioma (14 glioblastoma on most recent histology, 5 anaplastic astrocytoma) were treated with HFSRT. The median interval from post-operative radiotherapy to HFSRT was 19 (range 3-116) months, the median daily single dose 5 (4-10) Gy, the median total dose 30 (20-30) Gy and the median planning target volume 15 (4-70) ml. RESULTS: The median overall survival (OS) was 9.3 (1.9-77.6+) months from the time of HFSRT, 15.4 months for grade III and 7.9 months for grade IV tumors (p = 0.029, log-rank test). Two patients were alive at 34.6 and 77.6 months. OS was longer after a total dose of 30 Gy (11.1 months) than after total doses of <30 Gy (7.4 months; p = 0.051). Of five (26%) reoperations, none was performed for presumed or histologically predominant radiation necrosis. Median time to tumor progression after HFSRT on imaging was 4.9 months (1.3 to 37.3) months. CONCLUSION: HFSRT with conservative total doses of no more than 30 Gy is safe and leads to similar OS times as more aggressive treatment schemes. In individual patients, HFSRT in combination with other salvage treatment modalities, was associated with long-term survival.

Antineoplastic Agents↗

PubMed2005

Radiotherapy of prostate cancer with multileaf collimators (MLCs) optimization of the undulating dose distribution at the MLC edge.

BACKGROUND AND PURPOSE: A technical modification for radiotherapy of prostate cancer is presented to smooth the scalloped dose pattern that occurs at treatment field edge, when a multileaf collimator (MLC) has been used. MATERIAL AND METHODS: Ten patients with prostate cancer receiving postoperative, adjuvant irradiation were studied prospectively. By a three-dimensional planning system (TMS, Helax 6.1B) the irradiation was planned for an 18-MV linear accelerator (Primus 1, Siemens). The volumes of interest (VOI) were the planning target volume (PTV; the region of the prostate including the seminal vesicles), the volume of rectum (V(rectum)) and urinary bladder (V(bladder)). Two four-field techniques (0 degrees , 90 degrees , 180 degrees , 270 degrees ) were planned using "beam's eye view" for setting the leaf position of the MLC. For technique A the MLC was adapted to the PTV using a 0 degrees collimator angle for the lateral fields. For technique B the collimator angle of the lateral fields was optimized to compensate the cascade field shape. Dose-volume histograms of PTV, V(rectum) and V(bladder) were analyzed. The dose was prescribed for the reference point according to ICRU 50. Film dosimetry was used to show the dose pattern at the field edge produced by the two techniques. RESULTS: Dose to PTV did not differ between technique A and B. Median dose to V(rectum) was 82.6% for technique A and 77.3% for technique B (p < 0.001). Technique A irradiates a larger V(rectum) than technique B being significant for all isodose levels tested. Median dose to V(bladder) did not differ for technique A and B (p > 0.05). CONCLUSION: The presented technical modification is an effective method to blur the staggered dose distribution that results, when the MLC is conventionally stepped to adapt to the dorsal, irregular PTV border in irradiation of prostate. Especially for irradiation to escalated dose levels, this modification may reduce the dose to the rectum and thus the rectal side effects in comparison to the conventional MLC fields.

Algorithms↗

PubMed2005

2-Step IMAT and 2-Step IMRT: a geometrical approach.

The purpose of this paper is to develop a method that reduces the number of segments for intensity modulated arc therapy (IMAT) and intensity modulated radiotherapy (IMRT) for concave target volumes (TV). The aim was to utilize no more than two intensity levels per organ at risk (OAR) and to derive both optimal segment widths and weights from geometric considerations. Brahme's model of an annular target surrounding a circular OAR was used as test model. Brahme's solution was substituted by a single segment added to a simple field blocking the OAR. Width and weight of the segment were the free parameters to optimize. The objective function to minimize was the root mean square (rms) error of the dose in the target volume. One boundary condition was--neglecting scatter--"zero-dose" to the OAR. The resulting rules for width and weight of the additive segment are referred to as "optimized 2-Step IMAT" and "2-Step IMRT." The recommendations were applied to some simplified plans representing clinical cases using a commercial planning system. Optimized 2-Step IMAT improved the rms by a factor of 4 with respect to techniques simply blocking the OAR. The additional segment reduced the rms below 3% for cases with gaps between OAR and TV larger than 8% of the TV diameter. The results for 2-Step IMAT are applicable to IMRT and aperture modulated arc therapy (AMAT). 2-Step IMAT can be utilized for noncylindrical cases and for more than one OAR. A geometrical and topological approach to IMAT and IMRT can be useful to understand fluence profiles. The results could be applied to ameliorate other topology-based procedures used in some planning systems. Basic mechanisms of 2-Step IMAT can assist with the creation of rules for adaptive IMRT to compensate for patient motion.

Algorithms↗

PubMed2005

2-Step IMAT and 2-Step IMRT in three dimensions.

In two dimensions, 2-Step Intensity Modulated Arc Therapy (2-Step IMAT) and 2-Step Intensity Modulated Radiation Therapy (IMRT) were shown to be powerful methods for the optimization of plans with organs at risk (OAR) (partially) surrounded by a target volume (PTV). In three dimensions, some additional boundary conditions have to be considered to establish 2-Step IMAT as an optimization method. A further aim was to create rules for ad hoc adaptations of an IMRT plan to a daily changing PTV-OAR constellation. As a test model, a cylindrically symmetric PTV-OAR combination was used. The centrally placed OAR can adapt arbitrary diameters with different gap widths toward the PTV. Along the rotation axis the OAR diameter can vary, the OAR can even vanish at some axis positions, leaving a circular PTV. The width and weight of the second segment were the free parameters to optimize. The objective function f to minimize was the root of the integral of the squared difference of the dose in the target volume and a reference dose. For the problem, two local minima exist. Therefore, as a secondary criteria, the magnitude of hot and cold spots were taken into account. As a result, the solution with a larger segment width was recommended. From plane to plane for varying radii of PTV and OAR and for different gaps between them, different sets of weights and widths were optimal. Because only one weight for one segment shall be used for all planes (respectively leaf pairs), a strategy for complex three-dimensional (3-D) cases was established to choose a global weight. In a second step, a suitable segment width was chosen, minimizing f for this global weight. The concept was demonstrated in a planning study for a cylindrically symmetric example with a large range of different radii of an OAR along the patient axis. The method is discussed for some classes of tumor/organ at risk combinations. Noncylindrically symmetric cases were treated exemplarily. The product of width and weight of the additional segment as well as the integral across the segment profile was demonstrated to be an important value. This product was up to a factor of 3 larger than in the 2-D case. Even in three dimensions, the optimized 2-Step IMAT increased the homogeneity of the dose distribution in the PTV profoundly. Rules for adaptation to varying target-OAR combinations were deduced. It can be concluded that 2-Step IMAT and 2-Step IMRT are also applicable in three dimensions. In the majority of cases, weights between 0.5 and 2 will occur for the additional segment. The width-weight product of the second segment is always smaller than the normalized radius of the OAR. The width-weight product of the additional segment is strictly connected to the relevant diameter of the organ at risk and the target volume. The derived formulas can be helpful to adapt an IMRT plan to altering target shapes.

Algorithms↗

PubMed2004

A table top suited for CT and radiotherapy.

A radiotherapy table top was to be designed and manufactured, suitable for computer tomography in the same room. The aim was a distortion of the dose distribution by the table top of not more than 4% in small subunits of the target volume (TV) and less than 2% for the mean dose in the TV. Only negligible artifacts in the CT slices should occur in order to assure the exact relocalization of the TV. The table top manufactured of carbon fiber reinforced plastic was constructed by means of finite-element-algorithms. The trapezoidal shaped sandwich plate is supported with tapered beams. The small side of the table can penetrate a 60 cm CT-gantry. When turned, the table top allows large ap-pa opposed fields without irradiating through the beams. Transmission measurements were performed with an ionization chamber under different irradiation angles to determine the influence of the beams and the covering plate. Additionally, a portal imaging device (PID) was used for comparison. It was found that the deflection and torsion of the carbon fiber table top was smaller than for the original. The transmission of the sandwich plate was 97.5% (18 MV) and 96.5% (6 MV photons) respectively. If the irradiation of the beam walls can not be avoided the transmission is not in a critical range. The CT-slices show only minor artifacts along the side walls of the beams. The localization of the tumor or the TV is not restricted.

Artifacts↗

PubMed2003

Induction chemotherapy with paclitaxel and cisplatin and CT-based 3D radiotherapy in patients with advanced laryngeal and hypopharyngeal carcinomas--a possibility for organ preservation.

BACKGROUND: To evaluate the effect of paclitaxel/cisplatin induction chemotherapy (ICHT) and CT-based radiotherapy (RT) on larynx preservation, tumor control, and survival in patients with larynx/hypopharynx carcinoma eligible for total laryngectomy (TL) or TL plus partial pharyngectomy (TLPP). PATIENTS AND METHODS: Fifty patients eligible for TL or TLPP were enrolled onto a prospective study and treated with ICHT (200 mg/m(2) paclitaxel, 100 mg/m(2) cisplatin; day 1, 22). In patients with complete or partial tumor response RT (69.9 Gy in 5.5 weeks at the gross tumor, 50.4 Gy in the lymphatic drainage; single dose: 1.8 Gy, concomitant boost: 1.5 Gy) was applied. Non-responders had TL/TLPP and RT with total doses adapted to the radicality of tumor resection (56-70 Gy). RESULTS: The response rate to ICHT was 88% (10% complete, 78% partial response). At a median follow-up period of 25 months the larynx preservation rate was 84%. The 2-year local-regional control rate was 91% and the 2-year overall survival rate was 72.3%. The 3-year estimate to survive with functional larynx is 60%. CONCLUSION: In a large portion of patients eligible for TL or TLPP the larynx was preserved by paclitaxel/cisplatin ICHT and 3D RT.

Adult↗

PubMed2002

Homogeneous Ir-192 afterloading-flab-irradiation of plane surfaces.

Homogeneous irradiation of plane targets by Ir-192 afterloading flabs made by a parallel series of linear applicators can be time-consuming even with modern planning systems. The aim of the present study was to develop an algorithm that supplies homogeneous dose distributions in an arbitrary given plane in parallel to the equipped plane of a flab. The edge and corner positions of the flab are of particular importance. The identity of the dose in the optimisation distance above the flab centre, corners, and middle of the flab edges, leads to a strict relation of the respective dwell weights. Formulas can be derived that allow the calculation of the dwell times. The dimensioning of the flab can be rapidly adapted to new conditions. A comparison with the results of Nucletron PLATO-BPS for applicator-applicator distances and step sizes of 1 cm at optimisation distances of 10, 20, 30, and 40 mm and various flab sizes (3 x 3, 9 x 9, and 15 x 15 cm2) shows the following results: The standard deviation of the proposed algorithm is sometimes slightly higher than the results of the commercial planning system, whereas the underdosage at the flab edges is usually smaller. The effort for planning and preparation of the irradiation, for example using a Nucletron HDR, is below 5 minutes--a considerable reduction of planning time.

Calibration↗