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Diagnostik und Therapie von Hirngliomen

Anca‑L. Grosu
2018 Der Onkologe  
-L. Grosu gibt an, dass kein Interessenkonflikt besteht. Diagnostik: • Klinische neurologische Untersuchung • CT • MRT, eventuell PET (PET/CT, PET/MRT) • Eventuell PET, eventuell PET/CT 1.  ... 
doi:10.1007/s00761-018-0505-x fatcat:zbor6zv7b5gh5ehv2iea4lgjee

Single punch, double biopsy

Malte Krönig, Norbert Nanko, Vanessa Drendel, Martin Werner, Wolfgang Schultze-Seemann, Anca L. Grosu, A. Cordula Jilg
2016 SpringerPlus  
Objective: In lethal primary metastatic prostate cancer, biopsy material is often the only accessible cancer tissue. Lack of tissue quantity limited the use of biopsy cores for analyzing higher numbers of molecular markers and standard histopathologic evaluation for clinical diagnosis simultaneously. Recent advances in single cell analytics have paved the way to characterize a tumor in more depth from minute input material such as biopsies. We therefore aimed to develop a biopsy needle, which
more » ... nerates two cores side by side from the same punch: one for standard histopathologic analysis to allow for routine diagnostics and the second one for single cell analytics. Methods: On the basis of a conventional punch biopsy needle we have milled two parallel longitudinal rifts into the needles shat which are separated by a 100 µm thick metal sheet. Each rift can harbor a single tissue core. Results: Two cores from the same punch were generated reproducibly from a radical prostatectomy specimen and showed congruent results in histopathologic analysis. Both cores yielded equally sufficient material for standard H&E staining and histopathological evaluation. Conclusion: Our modified biopsy system will allow for simultaneous acquisition of tissue cores for diagnostic and scientific analysis from solid tumors or metastatic sites. which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. MK designed and planned the project and wrote the manuscript, NN constructed the modified needle, VD and MW performed the histologic analysis, AG wrote the manuscript, WS and CJ performed radical prostatectomies. All authors read and approved the final manuscript.
doi:10.1186/s40064-016-3141-1 pmid:27652032 fatcat:6afzn7lf5fcdxnryd4mnlb74zu

Stereotactic radiosurgery (SRS) for brain metastases: a systematic review

Carsten Nieder, Anca L Grosu, Laurie E Gaspar
2014 Radiation Oncology  
In many patients with brain metastases, the primary therapeutic aim is symptom palliation and maintenance of neurologic function, but in a subgroup, long-term survival is possible. Local control in the brain, and absent or controlled extracranial sites of disease are prerequisites for favorable survival. Stereotactic radiosurgery (SRS) is a focal, highly precise treatment option with a long track record. Its clinical development and implementation by several pioneering institutions eventually
more » ... ndered possible cooperative group randomized trials. A systematic review of those studies and other landmark studies was undertaken. Most clinicians are aware of the potential benefits of SRS such as a short treatment time, a high probability of treated-lesion control and, when adhering to typical dose/volume recommendations, a low normal tissue complication probability. However, SRS as sole first-line treatment carries a risk of failure in non-treated brain regions, which has resulted in controversy around when to add whole-brain radiotherapy (WBRT). SRS might also be prescribed as salvage treatment in patients relapsing despite previous SRS and/or WBRT. An optimal balance between intracranial control and side effects requires continued research efforts.
doi:10.1186/1748-717x-9-155 pmid:25016309 pmcid:PMC4107473 fatcat:f2hmduc5k5f63a2d4ifnkzvg3a

Leopoldina und die Rolle der Medizin

Wolfram H. Knapp, Anca-L. Grosu
2020 Der Radiologe (Berlin. Print)  
-L. Grosu) Vizepräsident die Klasse Medizin. Weiter gehören dem Präsidium jeweils 1 Sekre- tar der Klassen an. Sekretar der Klasse Medizin ist derzeit (Stand 2020) Hans- Peter Zenner (Tübingen).  ... 
doi:10.1007/s00117-020-00771-6 pmid:33226443 pmcid:PMC7681187 fatcat:dinjxx6uifampdzg5du6yivzgm

Development of a Score Predicting Survival after Palliative Reirradiation

Carsten Nieder, Nicolaus Andratschke, Kent Angelo, Ellinor Haukland, Anca L. Grosu
2014 Journal of Oncology  
Elevated but less than 30 mg/L 12.6 Elevated 30-60 mg/L 5.3 Elevated >60 mg/L 2.6 Thrombocyte count Low 12.7 0.038 n.s.  ...  27 31 Elevated 30-60 mg/L 14 16 Elevated >60 mg/L 17 20 Missing information 9 10 Thrombocyte count 1 Low 2 11 13 Normal 45 52 High 19 22 Missing information 12 14 Table 1 :  ... 
doi:10.1155/2014/128240 pmid:25332718 pmcid:PMC4190136 fatcat:do7kz2pcw5f6vbf2g5i7uy72qa

The challenge of durable brain control in patients with brain-only metastases from breast cancer

Carsten Nieder, Oliver Oehlke, Mandy Hintz, Anca L. Grosu
2015 SpringerPlus  
The vast majority of patients with brain metastases from breast cancer have extracranial metastases, e.g., in the liver, lungs or bones, with serious impact on prognosis. Limited research has been performed on patients with brain-only disease. We analyzed patterns of treatment, brain control and survival in uni-and multivariate analyses. All 25 patients with brain-only disease were treated with radiotherapy (whole-brain radiotherapy (WBRT) with or without stereotactic radiotherapy/radiosurgery
more » ... SRS) or surgical resection) and most patients with systemic treatment later during the disease trajectory. Only a minority of patients remained free from brain progression at 1 year after their initial therapy, regardless of initial treatment approach (median brain progression-free survival 6.2 months). However, overall survival was significantly better after initial surgical resection/SRS as compared to upfront WBRT (median 24.1 and 5.2 months, respectively). For all patients combined, median survival was 11.7 months (2-year survival rate 28 %). Several prognostic factors for shorter survival were identified in multivariate regression analysis: lower KPS, triple-negative tumor, coordination deficit, older age, lack of upfront surgical resection or SRS, and lack of endocrine or HER2-directed therapy after brain metastases treatment. Although durable brain control and long-term survival beyond 5 years could be achieved in a subset of patients (largely after successful salvage), progression of brain metastases during the first year after diagnosis was common. Prognosis was influenced by patient-, disease-and treatment-related factors. which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
doi:10.1186/s40064-015-1384-x pmid:26543720 pmcid:PMC4627995 fatcat:6msmbmxw7bfpfol473rfb3wfl4

Scientific impact of studies published in temporarily available radiation oncology journals: a citation analysis

Carsten Nieder, Hans Geinitz, Nicolaus H Andratschke, Anca L Grosu
2015 SpringerPlus  
The purpose of this study was to review all articles published in two temporarily available radiation oncology journals (Radiation Oncology Investigations, Journal of Radiosurgery) in order to evaluate their scientific impact. From several potential measures of impact and relevance of research, we selected article citation rate because landmark or practice-changing research is likely to be cited frequently. The citation database Scopus was used to analyse number of citations. During the time
more » ... iod 1996-1999 the journal Radiation Oncology Investigations published 205 articles, which achieved a median number of 6 citations (range 0-116). However, the most frequently cited article in the first 4 volumes achieved only 23 citations. The Journal of Radiosurgery published only 31 articles, all in the year 1999, which achieved a median number of 1 citation (range 0-11). No prospective randomized studies or phase I-II collaborative group trials were published in these journals. Apparently, the Journal of Radiosurgery acquired relatively few manuscripts that were interesting and important enough to impact clinical practice. Radiation Oncology Investigations' citation pattern was better and closer related to that reported in several previous studies focusing on the field of radiation oncology. The vast majority of articles published in temporarily available radiation oncology journals had limited clinical impact and achieved few citations. Highly influential research was unlikely to be submitted during the initial phase of establishing new radiation oncology journals.
doi:10.1186/s40064-015-0885-y pmid:25763304 pmcid:PMC4348359 fatcat:zaf2ooakgfg3fnz3ufietczrfe

Preserving the legacy of reirradiation: A narrative review of historical publications

Carsten Nieder, Johannes A. Langendijk, Matthias Guckenberger, Anca L. Grosu
2017 Advances in Radiation Oncology  
Purpose: The purpose of this study is to illustrate the historical development of reirradiation during several decades of the 20th century, in particular between 1920 and 1960. Methods and materials: We chose the format of a narrative review because the historical articles are heterogeneous. No systematic extraction of baseline data, treatment details, or follow-up care was possible in many cases. Results: Both hematological malignancies and solid tumors were treated with a second course of
more » ... ation therapy, and indications included local relapse, regional nodal recurrence, and second primary tumors developing in a previously treated region. The literature consists of retrospective single-institution analyses describing treatment approaches that included external beam radiation therapy, brachytherapy, or combinations thereof. Data on toxicities and survival were often provided. Breast cancer and gynecological, head and neck, brain, and skin tumors are among the entities included in this review. Conclusions: The leading pioneers in the field are fully aware of many of the challenges we continue to debate today. These include the process of late tissue changes and development of personalized treatment approaches and better ways to select patients who are likely to benefit from a second course of radiation therapy.
doi:10.1016/j.adro.2017.02.005 pmid:28740929 pmcid:PMC5514242 fatcat:rmrjdukadve7xk5pk6a7tfuq5i

Integration of chemotherapy into current treatment strategies for brain metastases from solid tumors

Carsten Nieder, Anca L Grosu, Sabrina Astner, Reinhard Thamm, Michael Molls
2006 Radiation Oncology  
Patients with brain metastases represent a heterogeneous group where selection of the most appropriate treatment depends on many patient- and disease-related factors. Eventually, a considerable proportion of patients are treated with palliative approaches such as whole-brain radiotherapy. Whole-brain radiotherapy in combination with chemotherapy has recently gained increasing attention and is hoped to augment the palliative effect of whole-brain radiotherapy alone and to extend survival in
more » ... in subsets of patients with controlled extracranial disease and good performance status. The randomized trials of whole-brain radiotherapy vs. whole-brain radiotherapy plus chemotherapy suggest that this concept deserves further study, although they failed to improve survival. However, survival might not be the most relevant endpoint in a condition, where most patients die from extracranial progression. Sometimes, the question arises whether patients with newly detected brain metastases and the indication for systemic treatment of extracranial disease can undergo standard systemic chemotherapy with the option of deferred rather than immediate radiotherapy to the brain. The literature contains numerous small reports on this issue, mainly in malignant melanoma, breast cancer, lung cancer and ovarian cancer, but very few sufficiently powered randomized trials. With chemotherapy alone, response rates were mostly in the order of 20-40%. The choice of chemotherapy regimen is often complicated by previous systemic treatment and takes into account the activity of the drugs in extracranial metastatic disease. Because the blood-brain barrier is partially disrupted in most macroscopic metastases, systemically administered agents can gain access to such tumor sites. Our systematic literature review suggests that both chemotherapy and radiochemotherapy for newly diagnosed brain metastases need further critical evaluation before standard clinical implementation. A potential chemotherapy indication might exist as palliative option for patients who have progressive disease after radiotherapy.
doi:10.1186/1748-717x-1-19 pmid:16800900 pmcid:PMC1523351 fatcat:yn4byx7qyffzdlatq63a2wnlh4

Validation of the graded prognostic assessment for gastrointestinal cancers with brain metastases (GI-GPA)

Carsten Nieder, Mandy Hintz, Ilinca Popp, Angelika Bilger, Anca L. Grosu
2020 Radiation Oncology  
The purpose of this study was to validate a new prognostic model (GI-GPA) originally derived from a multi-center database (USA, Canada, Japan). This retrospective study included 92 German and Norwegian patients treated with individualized approaches, always including brain radiotherapy. Information about age, extracranial spread, number of brain metastases, performance status and other variables was collected. The GI-GPA score was calculated as described by Sperduto et al. RESULTS: Median
more » ... al was 4 months. The corresponding figures for the 4 different prognostic strata were 2.3, 4.4, 9.4 and 12.7 months, respectively (p = 0.0001). Patients whose management included surgical resection had longer median survival than those who were treated with other approaches (median 11.9 versus 3.0 months, p = 0.002). Comparable results were seen for additional systemic therapy (median 8.5 versus 3.5 months, p = 0.01). These results confirm the validity of the GI-GPA in an independent dataset from a different geographical region, despite the fact that overall survival was shorter in all prognostic strata, compared to Sperduto et al. Potential explanations include differences in molecular tumor characteristics and treatment selection, both brain metastases-directed and extracranially. Long-term survival beyond 5 years is possible in a small minority of patients.
doi:10.1186/s13014-020-1484-9 pmid:32054485 fatcat:fw543b7lz5ewloz6mgms63lbmy

Normal tissue studies in radiation oncology: A systematic review of highly cited articles and citation patterns

CARSTEN NIEDER, NICOLAUS H. ANDRATSCHKE, ANCA L. GROSU
2014 Oncology Letters  
Radiation therapy is one of the cornerstones of modern multidisciplinary cancer treatment. Normal tissue tolerance is critical as radiation-induced side effects may compromise organ function and quality of life. The importance of normal tissue research is reflected by the large number of scientific articles, which have been published between 2006 and 2010. The present study identified important areas of research as well as seminal publications. The article citation rate is among the potential
more » ... dicators of scientific impact. Highly cited articles, arbitrarily defined as those with 15 citations, were identified via a systematic search of the citation database, Scopus. Up to 608 articles per year were published between 2006 and 2010, however, <10% of publications in each year accumulated 15 citations. This figure is notably low, when compared with other oncology studies. A large variety of preclinical and clinical topics, including toxicity prediction, the dose-volume relationship and radioprotectors, accumulated 15 citations. However, clinical prevention or mitigation studies were underrepresented. The following conclusion may be drawn from the present study; despite the improved technology that has resulted in superior dose distribution, clinical prevention or mitigation studies are critical and must receive higher priority, funding and attention. Abstract. Radiation therapy is one of the cornerstones of modern multidisciplinary cancer treatment. Normal tissue tolerance is critical as radiation-induced side effects may compromise organ function and quality of life. The importance of normal tissue research is reflected by the large number of scientific articles, which have been published between 2006 and 2010. The present study identified important areas of research as well as seminal publications. The article citation rate is among the potential indicators of scientific impact. Highly cited articles, arbitrarily defined as those with ≥15 citations, were identified via a systematic search of the citation database, Scopus. Up to 608 articles per year were published between 2006 and 2010, however, <10% of publications in each year accumulated ≥15 citations. This figure is notably low, when compared with other oncology studies. A large variety of preclinical and clinical topics, including toxicity prediction, the dose-volume relationship and radioprotectors, accumulated ≥15 citations. However, clinical prevention or mitigation studies were underrepresented. The following conclusion may be drawn from the present study; despite the improved technology that has resulted in superior dose distribution, clinical prevention or mitigation studies are critical and must receive higher priority, funding and attention.
doi:10.3892/ol.2014.2252 pmid:25120644 pmcid:PMC4114634 fatcat:i34hrlal2fddxdzcnvbvnfgfba

Brain Metastases Research 1990–2010: Pattern of Citation and Systematic Review of Highly Cited Articles

Carsten Nieder, Anca L. Grosu, Minesh P. Mehta
2012 The Scientific World Journal  
L. Grosu have no conflict of interests. M.  ... 
doi:10.1100/2012/721598 pmid:23028253 pmcid:PMC3458272 fatcat:mhk3r6yxabffpmrmj5x4s3hsjm

Validation of the graded prognostic assessment for lung cancer with brain metastases using molecular markers (lung-molGPA)

Carsten Nieder, Mandy Hintz, Oliver Oehlke, Angelika Bilger, Anca L. Grosu
2017 Radiation Oncology  
Many patients with brain metastases from non-small cell lung cancer have limited survival, while others survive for several years, depending on patterns of spread, EGFR and ALK alterations, among others. The purpose of this study was to validate a new prognostic model (Lung-molGPA) originally derived from a North American database. Patients and methods: This retrospective study included 269 German and Norwegian patients treated with individualized approaches, always including brain
more » ... Information about age, extracranial spread, number of brain metastases, performance status, histology, EGFR and ALK alterations was collected. The Lung-molGPA score was calculated as described by Sperduto et al. Results: Median survival was 5.4 months. The score predicted survival in patients with adenocarcinoma histology and those with other types. For example, median survival was 3.0, 6.2, 14.7 and 25.0 months in the 4 different prognostic strata for adenocarcinoma. The corresponding figures were 2.4, 5.5 and 12.5 months in the 3 different prognostic strata for non-adenocarcinoma. Conclusions: These results confirm the validity of the Lung-molGPA in an independent dataset from a different geographical region. However, median survival was shorter in 6 of 7 prognostic strata. Potential explanations include lead time bias and differences in treatment selection, both brain metastases-directed and systemically.
doi:10.1186/s13014-017-0844-6 pmid:28651600 pmcid:PMC5483956 fatcat:ssbelqgzyrbyzle43hynb2ghq4

Increasing frequency of reirradiation studies in radiation oncology: systematic review of highly cited articles

Carsten Nieder, Nicolaus H Andratschke, Anca L Grosu
2013 American Journal of Cancer Research  
90-05 radiosurgery study 27 312 Iwamoto et al. 2009 [17] Glioblastoma 26 70 Maier-Hauff et al. 2007 [22] Glioblastoma 24 111 Schulz-Ertner et al. 2004 [31] Carbon ion radiotherapy 19 149 Grosu  ... 
pmid:23593538 pmcid:PMC3623835 fatcat:4rebs4d4bfb7vfuwlfx6v4wdge

Gastrin-Releasing Peptide Receptor Antagonist [68Ga]RM2 PET/CT for Staging of Pre-Treated, Metastasized Breast Cancer

Kerstin Michalski, Lars Kemna, Jasmin Asberger, Anca L. Grosu, Philipp T. Meyer, Juri Ruf, Tanja Sprave
2021 Cancers  
Positron emission tomography (PET)/computed tomography (CT) using the gastrin-releasing peptide receptor antagonist [68Ga]RM2 has shown to be a promising imaging method for primary breast cancer (BC) with positive estrogen receptor (ER) status. This study assessed tumor visualization by [68Ga]RM2 PET/CT in patients with pre-treated ER-positive BC and suspected metastases. Methods: This retrospective pilot study included eight female patients with initial ER-positive, pre-treated BC who
more » ... [68Ga]RM2 PET/CT. Most of these patients (seven out of eight; 88%) were still being treated with or had received endocrine therapy. [68Ga]RM2 PET/CTs were visually analyzed by two nuclear medicine specialists in consensus. Tumor manifestations were rated qualitatively (i.e., RM2-positive or RM2-negative) and quantitatively using the maximum standardized uptake value (SUVmax). SUVmax values were compared between the two subgroups (RM2-positive vs. RM2-negative). Results: Strong RM2 binding was found in all metastatic lesions of six patients (75%), whereas tracer uptake in all metastases of two patients (25%) was rated negative. Mean SUVmax of RM2-positive metastases with the highest SUVmax per patient (in lymph node and bone metastases; 15.8 ± 15.1 range: 3.7–47.8) was higher than mean SUVmax of the RM2-negative metastases with the highest SUVmax per patient (in bone metastases; 1.6 ± 0.1, range 1.5–1.7). Conclusions: Our data suggest that RM2 binding is maintained in the majority of patients with advanced disease stage of pre-treated ER-positive BC. Thus, [68Ga]RM2 PET/CT could support treatment decision in these patients, radiotherapy planning in oligometastatic patients or selection of patients for RM2 radioligand therapy. Further studies with larger patient cohorts are warranted to confirm these findings.
doi:10.3390/cancers13236106 pmid:34885214 fatcat:oyaqhroqwvgb5gfnnwge5opk2e
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