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P Wust

Publications and source records attributed to P Wust.

At least 19 recordsLinked to original sources
PubMed2006

123I-IMT SPECT for evaluation of the response to radiation therapy in high grade gliomas: a feasibility study.

Assessing response to radiation therapy in patients with high grade gliomas is needed upon making decisions toward further therapy strategies. Currently used standard imaging tools such as CT and MRI are not sensitive enough to detect early therapy effects. We prospectively investigated if single photon emission computed tomography (SPECT) using radiolabelled amino acid derivate (123)I-methyltyrosine (IMT) would be useful for this aim. 10 patients with histologically proven high grade gliomas, who were candidates for radiation therapy, were enrolled in this investigation. All patients were examined by IMT SPECT before radiation therapy and 4 weeks after the initiation of the hypofractionated application of 40 Gy. Patients were followed up for 39 months; the tumours to background ratios (T/B) for IMT under/before radiation therapy were correlated to survival times. Initially, SPECT depicted an abnormal intratumoural IMT uptake in all patients (mean T/B ratios 1.37-1.87). In four out of 10 patients, the mean T/B ratios decreased by more than 10% under radiation therapy. In six other patients, the BQ decreased by less than 10% or increased. There were no significant correlations between the degree of changes in T/B and survival (r = -0.1, p = 0.973). Serial IMT SPECT measurements allow detection of changes in amino acid accumulation in high-grade gliomas under radiation therapy. However, these changes seem to possess no prognostic value in respect to survival prediction.

Adult↗
PubMed2006

Corrections of arterial input function for dynamic H215O PET to assess perfusion of pelvic tumours: arterial blood sampling versus image extraction.

Assessment of perfusion with 15O-labelled water (H215O) requires measurement of the arterial input function (AIF). The arterial time activity curve (TAC) measured using the peripheral sampling scheme requires corrections for delay and dispersion. In this study, parametrizations with and without arterial spillover correction for fitting of the tissue curve are evaluated. Additionally, a completely noninvasive method for generation of the AIF from a dynamic positron emission tomography (PET) acquisition is applied to assess perfusion of pelvic tumours. This method uses a volume of interest (VOI) to extract the TAC from the femoral artery. The VOI TAC is corrected for spillover using a separate tissue TAC and for recovery by determining the recovery coefficient on a coregistered CT data set. The techniques were applied in five patients with pelvic tumours who underwent a total of 11 examinations. Delay and dispersion correction of the blood TAC without arterial spillover correction yielded in seven examinations solutions inconsistent with physiology. Correction of arterial spillover increased the fitting accuracy and yielded consistent results in all patients. Generation of an AIF from PET image data was investigated as an alternative to arterial blood sampling and was shown to have an intrinsic potential to determine the AIF noninvasively and reproducibly. The AIF extracted from a VOI in a dynamic PET scan was similar in shape to the blood AIF but yielded significantly higher tissue perfusion values (mean of 104.0 +/- 52.0%) and lower partition coefficients (-31.6 +/- 24.2%). The perfusion values and partition coefficients determined with the VOI technique have to be corrected in order to compare the results with those of studies using a blood AIF.

Femoral Artery↗
PubMed2006

[Radiation dose of the radiologist and the assistant in transarterial hepatic chemoembolization--comparison with the dose limits].

PURPOSE: To determine the values of effective dose and partial body dose for the radiologist and the assistant during transarterial chemoembolization (TACE) of hepatocellular carcinoma (HCC) und to compare the doses with the dose limits. MATERIALS AND METHODS: In 65 TACE of HCC cases, values of various surface doses for the radiologist and the assistant were measured. The measurements were performed with the help of thermoluminescence dosemeters (TLD) that were attached to the eyebrows, over the lobes of the thyroid gland, to the breasts, abdomen and symphysis, and to the hands and the lower legs. The measured surface dose values were used as indicators of the exposure of the organs and tissues located near the surface, i. e. eye lens, thyroid gland, breast, testes and tibia. They were also seen as conservative estimations of tissues deep inside the body and the extremities. RESULTS: The highest surface dose for the radiologist was measured at the lower leg (0.58 +/- 0.28 mSv) and the highest surface dose for the assistant was measured at the right lower leg (0.24 +/- 0.20 mSv) since it was closer to the tube than the left side, followed by the dose values at the also unprotected areas of the eyebrows, lobes of the thyroid gland and the hands. The estimated value of the effective dose was 0.06 +/- 0.03 mSv for the radiologist and 0.04 +/- 0.01 mSv for the assistant. With regard to the relationship between the dose limits according to the German X-ray regulation and the measured values and with regard to the maximum possible number of interventions per year, the partial body dose of the red bone marrow in the lower leg provided the greatest limitation, followed by the partial body dose of the muscle in the lower leg and the effective dose. CONCLUSION: In order to meet the dose limits, especially the lower leg should be protected, and the effective dose should also be reduced.

Allied Health Occupations↗
PubMed2006

Influence of neoadjuvant radiochemotherapy combined with hyperthermia on the quality of life in rectum cancer patients.

PURPOSE: The present study compares quality of life (QoL) after neoadjuvant radiochemotherapy with or without hyperthermia in patients with advanced rectal cancer. METHODS: Between April 1994 and May 1999, 137 patients were treated by neoadjuvant radiochemotherapy with (69 patients (50.4%)) or without (68 patients (49.6%)) hyperthermia. Forty-six patients (33.6%) filled-out a 'Gastrointestinal Quality of Life Index' (GIQLI) questionnaire at four time points (before and after neoadjuvant therapy, early after surgery and after long-term follow-up) and were included in the present study. RESULTS: There were no statistically significant differences in the global GIQLI index between patients treated with neoadjuvant radiochemotherapy with and without hyperthermia at any time point. The longitudinal analysis of GIQLI values in both treatment groups showed specific profiles that were identical in both treatment groups. Occurrence of severe toxicity during the neoadjuvant therapy in both arms lead to a significant temporary reduction of QoL scores at TP2 without any detrimental long-term effects. Patients with sphincter preservation and patients with sphincter resection reported similar QoL scores during long-term follow-up. CONCLUSION: Neoadjuvant radiochemotherapy with and without hyperthermia has similar effects on the QoL of patients with locally advanced rectal cancer. The addition of hyperthermia during the neoadjuvant therapy with the potentially associated inconveniences has no negative effects on QoL.

Adult↗
PubMed2006

Glioma assessment using quantitative blood volume maps generated by T1-weighted dynamic contrast-enhanced magnetic resonance imaging: a receiver operating characteristic study.

PURPOSE: To investigate the use of blood volume maps in the non-invasive separation of glioma grades. MATERIAL AND METHODS: T1-weighted quantitative dynamic contrast-enhanced magnetic resonance imaging was used to quantify the fractional intratumoral blood volume of 41 gliomas (World Health Organization (WHO) grades II-IV). Two methods, mean fractional intratumoral blood volume determination and a system based on thresholds for extracting the tumor pixels with the highest vascularization from the blood volume maps, were investigated by means of receiver operating characteristic (ROC) analysis. The thresholds were adjusted using the ROC curve area calculated using the trapezoid method. RESULTS: The ability to separate grade II (WHO) gliomas from grades III-IV was nearly the same for both methods (ROC curve area 0.941 (threshold) versus 0.932 (mean value)) and significantly greater than the ability to separate grade IV (WHO) gliomas from grades II-III (ROC curve area 0.792 (threshold) versus 0.787 (mean value)). The best correspondence with WHO glioma grading was achieved using thresholds corresponding to only the 5.2% of tumor voxels with the largest blood volume for separating grade II gliomas and 4% for separating grade IV gliomas. CONCLUSION: Use of the optimized threshold resulted in matching with the WHO grading system in 74% of cases.

Adolescent↗
PubMed2006

Comparison of MR-thermography and planning calculations in phantoms.

A systematic comparison of three-dimensional MR (magnetic resonance) thermography and planning calculations in phantoms for the hyperthermia (HT) SIGMA-Eye applicator. We performed 2 x 6 experiments in a homogeneous cylindrical and a heterogeneous elliptical phantom by adjusting 82 different patterns with different phase control inside an MR tomograph (Siemens Magnetom Symphony, 1.5 Tesla). For MR thermography, we employed the proton resonance frequency shift method with a drift correction based on silicon tubes. For the planning calculations, we used the finite-difference time-domain (FDTD) method and, in addition, modeled the antennas and the transforming network. We generated regions according to a segmentation of bones and tissue, and used an interpolation technique with a subgrid of 0.5 cm size at the interfaces. A Gauss-Newton solver has been developed to adapt phases and amplitudes. A qualitative agreement between the planning program and measurements was obtained, including a correct prediction of hot spot locations. The final deviation between planning and measurement is in the range of 2-3 W/kg, i.e., below 10%. Additional HT phase and amplitude adaptation, as well as position correction of the phantom in the SIGMA-Eye, further improve the results. HT phase corrections in the range of 30-40 degrees and HT amplitude corrections of +/- 20-30% are required for the best agreement. The deviation /MR-FDTD/, and the HT phase/amplitude corrections depend on the type of phantom, certain channel groups, pattern steering, and the positioning error. Appropriate agreement between three-dimensional specific absorption rate distributions measured by MR-thermography and planning calculations is achieved, if the correct position and adapted feed point parameters are considered. As long as feed-point parameters are uncertain (i.e., cannot be directly measured during therapy), a prospective planning will remain difficult. However, we can use the information of MR thermography to better predict the patterns in the future even without the knowledge of feed-point parameters.

Algorithms↗
PubMed2006

Radiation risks for the radiologist performing transjugular intrahepatic portosystemic shunt (TIPS).

The aim of this study is to evaluate the radiation dose to the interventional radiologist in transjugular intrahepatic portosystemic shunt (TIPS) concerning the risk of cancer and deterministic radiation effects and the relation to recommended dose limits. In 18 TIPS interventions radiation doses were measured with thermoluminescence dosemeters (TLD) fixed at the eyebrow, thyroid and hand of the radiologist without special lead shielding of these body parts and at the chest, abdomen and testes under the lead apron. The doses of the eye lens, thyroid gland and hand were assumed to be equal to the corresponding surface doses. The dose at the abdomen under the lead apron was used as an estimation of the ovarian dose. Effective dose equivalent was estimated by Webster's method. The estimated effective dose equivalent was 0.087 mSv and the effective dose 0.110 mSv. The risk of fatal cancer was of 10(-6) and the risk of severe genetic defect of 10(-7) for one single intervention. The maximum permissible number of TIPS interventions was 181, otherwise the dose limit for effective dose would be exceeded. When the radiologist performed more than 372 TIPS procedures per year for many years, the dose to the lens of the eye could exceed the threshold for cataract. If the interventionist performs a large number of TIPS procedures in a year, the risk of fatal cancer and developing cataracts becomes relatively high.

Female↗
PubMed2005

Comparison of CT, MRI and FDG-PET in response prediction of patients with locally advanced rectal cancer after multimodal preoperative therapy: is there a benefit in using functional imaging?

The aim of this study was to compare CT, MRI and FDG-PET in the prediction of outcome of neoadjuvant radiochemotherapy in patients with locally advanced primary rectal cancer. A total of 23 patients with T3/4 rectal cancer underwent a preoperative radiochemotherapy combined with regional hyperthermia. Staging was performed using four-slice CT (n=23), 1.5-T MRI (n=10), and (18)F-FDG-PET (n=23) before and 2-4 weeks after completion of neoadjuvant treatment. Response criteria were a change in T category and tumour volume for CT and MRI and a change in glucose uptake (standard uptake value) within the tumour for FDG-PET. Imaging results were compared with those of pretherapy endorectal ultrasound and histopathological findings. Histopathology showed a response to neoadjuvant therapy in 13 patients whereas 10 patients were classified as nonresponders. The mean SUV reduction in responders (60+/-14%) was significantly higher than in nonresponders (37+/-31%; P=0.030). The sensitivity and specificity of FDG-PET in identifying response was 100% (CT 54%, MRI 71%) and 60% (CT 80%, MRT 67%). Positive and negative predictive values were 77% (CT 78%, MRI 83%) and 100% (CT 57%, MRI 50%) (PET P=0.002, CT P=0.197, MRI P=0.500). These results suggest that FDG-PET is superior to CT and MRI in predicting response to preoperative multimodal treatment of locally advanced primary rectal cancer.

Adenocarcinoma↗
PubMed2005

[Comparison of radiation dose and image quality of Siremobil-IsoC(3D) with a 16-slice spiral CT for diagnosis and intervention in the human pelvic bone].

PURPOSE: To compare the image quality of 16-slice computed tomography with the image quality of Siremobil-IsoC (3D) of the pelvic region and to measure simultaneously the radiation dose before and after implantation of a sacroiliac screw (SI-screw) MATERIALS AND METHODS: The pelvic region of 8 human cadavers was examined in the Siremobil-IsoC (3D) at five different levels. We used a standard protocol for the 16-slice CT of the complete pelvic region before and after insertion of a pelvic screw, followed by stepwise reduction of the tube current to find the tube current that equalizes the image quality of both modalities. We controlled the image quality by judging important structures such as neuroforamen, nerves, sacroiliacal joint space, intervertebral space, osteophytes, iliopsoas muscle, acetabular surface, fovea centralis, hip joint and os pubis. The image quality was judged by three radiologists and three trauma surgeons using a ranking from 1 to 5. The dose was measured with an endorectally placed NOMEX Dosimeter, to obtain the gonadal dose. RESULTS: The medium score for all viewers of the Siremobil-IsoC (3D) examinations was between 3 and 4.3. The medium score for all CT-examinations with a tube current of 250 mA was between 1.3 and 2.2. The reduction of tube current down to 80 mA hardly influenced the marks for the analyzed structures. Under 80 mA, bony structures, even after implantation of a SI-screw, were still marked as good, but soft tissue differentiation was getting worse. For the examination of the pelvis, the average dose-length product for the IsoC (3D) was 41.2 mGy x cm. The medium dose-length product for CT was 389 mGy x cm for 250 mA, 125 mGy x cm for 80 mA and 82 mGy x cm for 60 mA. CONCLUSION: The Siremobil-IsoC (3D) is sufficient for therapeutic intraoperative purpose, but the image quality is not sufficient for diagnostic purpose. The higher dose-length product of a CT examination is justifiable because of a better overview, shorter examination time and qualitative superiority. An advantage of the Siremobil-IsoC (3D) is the intraoperative availability with acceptable 3D image quality compared to conventional fluoroscopy.

Bone Screws↗
PubMed2005

Current status of radiant whole-body hyperthermia at temperatures >41.5 degrees C and practical guidelines for the treatment of adults. The German 'Interdisciplinary Working Group on Hyperthermia'.

The term 'extreme' whole-body hyperthermia (WBH) describes the procedure of raising a patients' body-core temperature to 41.5-42.0 degrees C for 60 min. WBH represents the only hyperthermia technique that enables systemic heat treatment in patients with disseminated malignancies and is, therefore, usually combined with systemic chemotherapy. Up to now, several WBH-approaches have proved to be safe and associated with acceptable toxicity rates when radiant heat devices are employed. Until the late 1990s, the use of radiant WBH was restricted to a few specialized treatment centres worldwide. During the last 5 years, a larger number of WBH-devices were put into operation particularly in Germany. As a result, a novel generation on phase II trials on chemotherapy and adjunctive WBH in patients with various malignancies has been completed. Based on the promising results observed herein, first multi-centric phase III-trials on chemotherapy +/- WBH have been initiated, with a considerable number of patients treated at German institutions. The authors are members of the 'Interdisciplinary Working Group for Hyperthermia' ('Interdisziplinäre Arbeitsgruppe Hyperthermie'), a sub-group of the German Cancer Society. They formulated these guidelines in order to standardize the WBH treatment procedure and supportive measures, to provide some uniformity in the selection of patients to be treated and to define criteria of a successful WBH-treatment. These recommendations may be helpful to ensure the quality of WBH performed at different institutions.

Chemotherapy, Adjuvant↗
PubMed2005

Methods and potentials of magnetic resonance imaging for monitoring radiofrequency hyperthermia in a hybrid system.

INTRODUCTION: Non-invasive thermometry (NIT) is a valuable and probably indispensable tool for further development of radiofrequency (RF) hyperthermia. A hybridization of an MRI scanner with a hyperthermia system is necessary for a real-time NIT. The selection of the best thermographic method is difficult, because many parameters and attributes have to be considered. METHODS: In the hybrid system (Siemens Symphony/BSD-2000-3D) the standard methods for NIT were tested such as T1, diffusion (ADC: apparent diffusion coefficient) and proton-resonance-frequency shift (PFS) method. A series of three-dimensional datasets was acquired with different gradient-echo sequences, diffusion-weighted EPI spin-echo sequences and calculated MR-temperatures in the software platform AMIRA-HyperPlan. In particular for the PFS-method, corrective methods were developed and tested with respect to drift and other disturbances. Experiments were performed in phantoms and the results compared with direct temperature measurements. Then the procedures were transferred to clinical applications in patients with larger tumours of the lower extremity or the pelvis. RESULTS: Heating experiments and MR-thermography in a homogeneous cylindrical phantom give an excellent survey over the potentials of the methods. Under clinical conditions all these methods have difficulties due to motion, physiological changes, inhomogeneous composition and susceptibility variations in human tissues. The PFS-method is most stable in patients yielding reasonable MR temperature distributions and time curves for pelvic and lower extremity tumours over realistic treatment times of 60-90 min. Pooled data exist for rectal tumour recurrencies and soft tissue sarcomas. The fat tissue can be used for drift correction in these patients. T1 and diffusion-dependent methods appear less suitable for these patients. The standard methods have different sensitivities with respect to the various error sources. The advantages and pitfalls of every method are discussed with respect to the literature and illustrated by the phantom and patient measurements. CONCLUSIONS: MR-controlled RF hyperthermia in a hybrid system is well established in phantoms and already feasible for patients in the pelvic and lower extremity region. Under optimal conditions the temperature accuracy might be in the range of 0.5 degrees C. However a variety of developments, especially sequences and post-processing modules, are still required for the clinical routine.

Humans↗
PubMed2005

Clinical hyperthermia of prostate cancer using magnetic nanoparticles: presentation of a new interstitial technique.

The aim of this pilot study was to evaluate whether the technique of magnetic fluid hyperthermia can be used for minimally invasive treatment of prostate cancer. This paper presents the first clinical application of interstitial hyperthermia using magnetic nanoparticles in locally recurrent prostate cancer. Treatment planning was carried out using computerized tomography (CT) of the prostate. Based on the individual anatomy of the prostate and the estimated specific absorption rate (SAR) of magnetic fluids in prostatic tissue, the number and position of magnetic fluid depots required for sufficient heat deposition was calculated while rectum and urethra were spared. Nanoparticle suspensions were injected transperineally into the prostate under transrectal ultrasound and flouroscopy guidance. Treatments were delivered in the first magnetic field applicator for use in humans, using an alternating current magnetic field with a frequency of 100 kHz and variable field strength (0-18 kA m(-1)). Invasive thermometry of the prostate was carried out in the first and last of six weekly hyperthermia sessions of 60 min duration. CT-scans of the prostate were repeated following the first and last hyperthermia treatment to document magnetic nanoparticle distribution and the position of the thermometry probes in the prostate. Nanoparticles were retained in the prostate during the treatment interval of 6 weeks. Using appropriate software (AMIRA), a non-invasive estimation of temperature values in the prostate, based on intra-tumoural distribution of magnetic nanoparticles, can be performed and correlated with invasively measured intra-prostatic temperatures. Using a specially designed cooling device, treatment was well tolerated without anaesthesia. In the first patient treated, maximum and minimum intra-prostatic temperatures measured at a field strength of 4.0-5.0 kA m(-1) were 48.5 degrees C and 40.0 degrees C during the 1st treatment and 42.5 degrees C and 39.4 degrees C during the 6th treatment, respectively. These first clinical experiences prompted us to initiate a phase I study to evaluate feasibility, toxicity and quality of life during hyperthermia using magnetic nanoparticles in patients with biopsy-proven local recurrence of prostate cancer following radiotherapy with curative intent. To the authors' knowledge, this is the first report on clinical application of interstitial hyperthermia using magnetic nanoparticles in the treatment of human cancer.

Aged↗
PubMed2004

[CT-guided interstitial brachytherapy of lung malignancies. Technique and first results].

CT-guided interstitial brachytherapy of lung malignancies is a novel technique combining (192)Iridium brachytherapy with modern CT guidance for applicator positioning and 3D dosimetry. Initially, this technique has been developed for the treatment of liver malignancies. In the following we describe this novel technique as well as initial results for the treatment of lung malignancies.

Brachytherapy↗
PubMed2004

[Part-body hyperthermia with a radiofrequency multiantenna applicator under online control in a 1.5 T MR-tomograph].

Objective of this study is the integration of a multiantenna applicator for part-body hyperthermia (BSD 2000/3D) in a 1.5 T MR-tomograph (Siemens Magnetom Symphony) in order to perform noninvasive MR monitoring in real time to increase safety and effectiveness of heat treatments. The positioning unit is mechanically coupled to the MR gantry from the back side and the body coil is utilised for imaging. For that purpose, the hyperthermia antenna system (100 MHz, 1.500 W) and the MR receiver (63.9 MHs) have to be decoupled in terms of high frequency (filter) and electromagnetically (emc). The processing of MR data sets is performed in a hyperthermia planning system. A simultaneous operation of radiofrequency hyperthermia and MR system is possible at clinically relevant power levels. MR imaging is used for tumor-diagnostics (standard spin echo sequences), for hyperthermia planning (T1-weighted gradient echo sequences in equal- and opposed-phase techniques), and for temperature measurements according to the proton resonance frequency method (PRF method, phase evaluation registration using a gradient echo sequence with long echo time). In 33 patients with advanced pelvic and abdominal tumors we performed 150 heat sessions under MR monitoring. For 70% of these patients a visualisation of temperature sensitive data during treatment was possible. The evaluated difference images represent a superposition of real temperature -increase and a (temperature-induced) perfusion elevation. The -hybrid approach renders development of part body hyperthermia possible as an MR-controlled intervention in radiology.

Abdominal Neoplasms↗
PubMed2004

Whole-body hyperthermia in the scope of von Ardenne's systemic cancer multistep therapy (sCMT) combined with chemotherapy in patients with metastatic colorectal cancer: a phase I/II study.

This phase I/II study evaluated the feasibility, toxicity and response rates of von Ardenne's systemic cancer multistep therapy (sCMT) when applied as an adjunct to cytostatic therapy in patients with metastatic colorectal cancer. sCMT consists of whole-body hyperthermia (WBH) at 41.8-42.1 degrees C, hyperglycaemia and hyperoxaemia. All patients who entered the trial first received three monthly courses of chemotherapy (folinic acid, 50 mg, days 1-5; 5-fluorouracil, 425 mg/m2, days 1-5; mitomycin 8 mg/m2, day 1), followed by response evaluation according World Health Organization (WHO) criteria. Responders (partial/complete remission) were assigned to three further courses of chemotherapy, whereas non-responders (stable/progressive disease) were allocated to additional sCMT on day 1 of every subsequent chemotherapy course. The WBH procedure was administered under general anaesthesia employing the Iratherm-2000 radiant heat device. Of 28 patients enrolled, 19 received more than three treatment courses. Eight of these 19 patients had responded to chemotherapy (PR) and thus obtained three further courses of chemotherapy alone. In 10 of 19 patients who had not responded (SD, PD), three additional courses of chemotherapy were combined with sCMT (with 25 sCMT applications). One patient who did not respond to initial treatment declined sCMT and was continued with chemotherapy alone. It was found that sCMT was feasible, but associated with a specific spectrum of grade III/IV toxicity (skin 20%, pain 16%, peripheral nerves 8% of treatment courses). The fact that three patients who did not respond to initial chemotherapy achieved a PR after additional sCMT suggests that sCMT may enhance the effect of chemotherapy in patients with colorectal cancer.

Adult↗
PubMed2004

Regional pelvic hyperthermia as an adjunct to chemotherapy (oxaliplatin, folinic acid, 5-fluorouracil) in pre-irradiated patients with locally recurrent rectal cancer: a pilot study.

The aim of this study was to evaluate the feasibility and toxicity of a novel hyperthermic chemotherapy approach for patients with locally recurrent adenocarcinoma of the rectum. All patients were pre-irradiated (> or = 45 Gy) and had histologically proven pelvic recurrence. Hyperthermic chemotherapy was applied according to a modified 'OFF'-schedule with weekly infusions of 43 mg/m2 of oxaliplatin (i.v., 120 min), 500 mg/m2 of folinic acid (i.v., 120 min) and 2.6 g/m2 of continuous infusional 5-fluorouracil (24 h) for 6 consecutive weeks. Oxaliplatin was started in parallel to pelvic radiofrequency hyperthermia that was provided by the BSD 2000-system. A total of 67 applications were administered to nine patients and were well tolerated. A total of 55/67 (82%) chemotherapy courses were applied without dose-reduction. In 62/67 (93%) hyperthermia sessions, a treatment time of > 60 min was maintained. Tolerated power levels were on average 600 W and, thus, slightly lower than those described in curative pelvic hyperthermia schedules. Eight out of 10 episodes of severe (WHO III degrees) toxicity represented typical side-effects of the chemotherapy given (nausea n = 4, diarrhoea n = 3, neuropathy n = 1). Two severe adverse events were firstly attributable to hyperthermia (haematuria, n = 1; deterioration of a decubital ulcer, n = 1). No patient suffered WHO-disease progression during the treatment period. Two patients achieved a partial remission. It is concluded that hyperthermic chemotherapy with oxaliplatin, folinic acid and 5-FU is feasible on an outpatient basis. Overall toxicity was moderate, although hyperthermia may add side-effects to this approach. Results, moreover, suggest a relevant palliative effect in patients with pre-irradiated pelvic recurrence of rectal cancer.

Adenocarcinoma↗
PubMed2004

Role of F18-FDG PET for monitoring of radiochemotherapy -- estimation of detectable number of tumour cells.

BACKGROUND: FDG-PET has been proven to be useful for the diagnosis of pancreatic cancer. However, no quantitative data exist concerning its sensitivity for treatment monitoring or early diagnosis. CASE REPORT: We report on a 61-year-old patient with locally advanced cancer of the pancreas head who received sequential radiochemotherapy including gemcitabine and 5-FU/FA. Under this regimen, MR and CT showed a partial remission with a residual mass which seemed to allow surgical treatment for this patient. A pre-operative FDG-PETScan displayed a count rate close to the detection limit of vital residual tumour. An R0 resection was performed successfully. However, histopathology revealed residual tumour at the core of the resected mass that had gone undetected by all imaging modalities. CONCLUSION: The number of vital tumour cells within this specimen was estimated to be 10(6)-10(7). The detection threshold for FDG-PET in pancreatic carcinoma appears to be within this range.

Cell Count↗