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1.
Phys Med Biol ; 67(15)2022 07 29.
Article in English | MEDLINE | ID: mdl-35830817

ABSTRACT

Objective.Due to the radiosensitizing effect of biocompatible noble metal nanoparticles (NPs), their administration is considered to potentially increase tumor control in radiotherapy. The underlying physical, chemical and biological mechanisms of the NPs' radiosensitivity especially when interacting with proton radiation is not conclusive. In the following work, the energy deposition of protons in matter containing platinum nanoparticles (PtNPs) is experimentally investigated.Approach.Surfactant-free monomodal PtNPs with a mean diameter of (40 ± 10) nm and a concentration of 300 µg ml-1, demonstrably leading to a substantial production of reactive oxygen species (ROS), were homogeneously dispersed into cubic gelatin samples serving as tissue-like phantoms. Gelatin samples without PtNPs were used as control. The samples' dimensions and contrast of the PtNPs were verified in a clinical computed tomography scanner. Fields from a clinical proton machine were used for depth dose and stopping power measurements downstream of both samples types. These experiments were performed with a variety of detectors at a pencil beam scanning beam line as well as a passive beam line with proton energies from about 56-200 MeV.Main results.The samples' water equivalent ratios in terms of proton stopping as well as the mean proton energy deposition downstream of the samples with ROS-producing PtNPs compared to the samples without PtNPs showed no differences within the experimental uncertainties of about 2%.Significance.This study serves as experimental proof that the radiosensitizing effect of biocompatible PtNPs is not due to a macroscopically increased proton energy deposition, but is more likely caused by a catalytic effect of the PtNPs. Thus, these experiments provide a contribution to the highly discussed radiobiological question of the proton therapy efficiency with noble metal NPs and facilitate initial evidence that the dose calculation in treatment planning is straightforward and not affected by the presence of sensitizing PtNPs.


Subject(s)
Metal Nanoparticles , Proton Therapy , Radiation-Sensitizing Agents , Gelatin , Metal Nanoparticles/therapeutic use , Platinum/pharmacology , Proton Therapy/methods , Protons , Radiation-Sensitizing Agents/pharmacology , Reactive Oxygen Species
2.
Phys Med Biol ; 66(21)2021 10 26.
Article in English | MEDLINE | ID: mdl-34534971

ABSTRACT

Objective. The aim of the phantom study was to validate and to improve the computed tomography (CT) images used for the dose computation in proton therapy. It was tested, if the joint reconstruction of activity and attenuation images of time-of-flight PET (ToF-PET) scans could improve the estimation of the proton stopping-power.Approach. The attenuation images, i.e. CT images with 511 keV gamma-rays (γCTs), were jointly reconstructed with activity maps from ToF-PET scans. Theß+activity was produced with FDG and in a separate experiment with proton-induced radioactivation. The phantoms contained slabs of tissue substitutes. The use of theγCTs for the prediction of the beam stopping in proton therapy was based on a linear relationship between theγ-ray attenuation, the electron density, and the stopping-power of fast protons.Main results. The FDG based experiment showed sufficient linearity to detect a bias of bony tissue in the heuristic look-up table, which maps between x-ray CT images and proton stopping-power.γCTs can be used for dose computation, if the electron density of one type of tissue is provided as a scaling factor. A possible limitation is imposed by the spatial resolution, which is inferior by a factor of 2.5 compared to the one of the x-ray CT.γCTs can also be derived from off-line, ToF-PET scans subsequent to the application of a proton field with a hypofractionated dose level.Significance. γCTs are a viable tool to support the estimation of proton stopping with radiotracer-based ToF-PET data from diagnosis or staging. This could be of higher potential relevance in MRI-guided proton therapy.γCTs could form an alternative approach to make use of in-beam or off-line PET scans of proton-inducedß+activity with possible clinical limitations due to the low number of coincidence counts.


Subject(s)
Proton Therapy , Algorithms , Fluorodeoxyglucose F18 , Image Processing, Computer-Assisted/methods , Phantoms, Imaging , Positron-Emission Tomography/methods , Protons
3.
Acta Oncol ; 60(11): 1392-1398, 2021 Nov.
Article in English | MEDLINE | ID: mdl-34213401

ABSTRACT

BACKGROUND: Survivors of pediatric brain tumors are susceptible to neurovascular disease after radiotherapy, with dose to the chiasm or Circle of Willis (CW) as risk factors. The aims of this study were to develop a delineation atlas of neurovascular structures, to investigate the doses to these structures in relation to tumor location and to investigate potential dose surrogates for the CW dose. MATERIAL AND METHODS: An atlas of the CW, the large intracranial arteries and the suprasellar cistern (SC) was developed and validated. Thirty proton plans from previously treated pediatric brain tumor patients were retrieved and grouped according to tumor site: 10 central, 10 lateralized, and 10 posterior fossa tumors. Based on the atlas, neurovascular structures were delineated and dose metrics (mean dose (Dmean) and maximal dose (Dmax)) to these structures and the already delineated chiasm were evaluated. The agreement between dose metrics to the CW vs. chiasm/SC was investigated. The minimal Hausdorff distance (HDmin) between the target and SC was correlated with the SC Dmean. RESULTS: The median Dmean/Dmax to the CW were 53 Gy(RBE)/55 Gy(RBE) in the central tumors, 18 Gy(RBE)/25 Gy(RBE) in the lateralized tumors and 30 Gy(RBE)/49 Gy(RBE) in the posterior fossa tumors. There was a good agreement between the Dmax/Dmean to the CW and the SC for all cases (R2=0.99), while in the posterior fossa group, the CW Dmax was underestimated when using the chiasm as surrogate (R2=0.76). Across all patients, cases with HDmin < 10 mm between the target and the SC received the highest SC Dmean. CONCLUSION: The pattern of dose to neurovascular structures varied with the tumor location. For all locations, SC doses could be used as a surrogate for CW doses. A minimal distance larger than 10 mm between the target and the SC indicated a potential for neurovascular dose sparing.


Subject(s)
Brain Neoplasms , Proton Therapy , Radiotherapy, Intensity-Modulated , Brain Neoplasms/radiotherapy , Child , Circle of Willis , Humans , Organs at Risk , Radiotherapy Dosage , Radiotherapy Planning, Computer-Assisted
4.
Clin Oncol (R Coll Radiol) ; 33(7): e295-e304, 2021 07.
Article in English | MEDLINE | ID: mdl-33820696

ABSTRACT

AIMS: Proton beam therapy (PBT) has increasingly been applied for the treatment of young children when radiotherapy is needed. The treatment requires intensive multimodality care and is logistically demanding. In this analysis, we evaluated our experiences in treating infants with tumours of the central nervous system with PBT. MATERIALS AND METHODS: Children younger than 2 years of age treated with PBT for central nervous system tumours enrolled in the prospective registry study KiProReg were retrospectively analysed. Information on patient characteristics, treatment, toxicities and outcome were evaluated. Adverse events were classified according to the National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE V4.0) before, during and after PBT. RESULTS: Between September 2013 and June 2018, 51 infants were eligible. The median age was 19 months (range 11-23 months) at the time of PBT. Tumour entities were ependymoma (51.0%), atypical teratoid rhabdoid tumour (39.0%), high-grade glioma (6.0%), pineoblastoma (2.0%) and medulloblastoma (2.0%). The prescribed median total dose was 54.0 Gy (range 45.0-59.4 Gy). Most received local radiotherapy. In four patients, craniospinal irradiation followed by a boost to the local tumour bed was applied. The median follow-up time was 42.0 months (range 7.3-86.2 months). The estimated 3-year local control, progression-free survival and overall survival rates for all patients were 62.7, 47.1 and 76.5%, respectively. During radiotherapy, 24 events of higher-grade (CTCAE ≥ °III) toxicities were reported. Interruption of radiotherapy for more than 2 days was due to infection (n = 3) or shunt complication (n = 2). Unexpected hospitalisation during radiotherapy affected 12 patients. Late adverse events attributable to radiotherapy included endocrinopathy (CTCAE °II; 7.8%), new onset of hearing loss (CTCAE °III; 5.8%) and visual impairment (CTCAE °IV; 1.9%). Transient radiation-induced imaging changes occurred in five patients (9.8%). CONCLUSIONS: Our study indicates that PBT is feasible for very young children with central nervous system tumours, at least in the short term. However, it requires challenging interdisciplinary medical care and high logistical effort. For evaluation of late effects, longer follow-up and evaluation of neurocognitive outcome are desirable. More data have to be gathered to further define the role of radiotherapy in infants over time.


Subject(s)
Brain Neoplasms , Cerebellar Neoplasms , Proton Therapy , Brain Neoplasms/radiotherapy , Child , Child, Preschool , Feasibility Studies , Humans , Infant , Proton Therapy/adverse effects , Registries , Retrospective Studies
5.
Med Phys ; 48(2): 831-840, 2021 Feb.
Article in English | MEDLINE | ID: mdl-33368345

ABSTRACT

OBJECTIVE: Side effects of radiation therapy may include skin damage. The surface dose is of great interest and contains the buildup effect. In particular, the proton therapy community requires further experimental data to quantify doses in the surface region. This specification includes the skin dose, which is defined according to ICRU Report No. 39 at 70 µm water equivalent depth. The aim of this study is to gather more knowledge of the skin dose by varying key parameters defined by the patient treatment plan. This consists of clinical aspects such as the influence of the air gap, the application of a range shifter (RS), or the proton delivery technique. MATERIAL/METHODS: Skin doses were determined with a PTW 23391 extrapolation chamber with three thin Kapton® entrance windows operated as a conventional ionization chamber. The impact on the skin dose for quasi-monoenergetic pencil beam scanning (PBS) proton beams was evaluated for clinical air gaps between 3.5 and 51.1 cm. The differences in skin dose were assessed by irradiating equivalent fields with an RS of 51 mm water equivalent thickness (RS51) and without. Furthermore, the delivery techniques PBS, uniform scanning (US), and double scattering (DS) were compared by defining a spread-out Bragg peak (SOBP). TOPAS (V.3.1.2) was used to model an IBA nozzle with PBS and to score dose to water at the surface of a water phantom. RESULTS: For the monoenergetic fields without the application of the RS the skin dose was constant down to an air gap of 6.2 cm. A lower air gap of 3.5 cm showed a variation in skin dose by up to 2.4% compared to the results obtained with larger air gaps. With the inserted RS51 an increase in the skin dose was found for air gaps smaller than 11.3 cm. Experimentally, a dose difference of 1.4% was recorded for an air gap of 6.2 cm by inserting an RS and none. With the Monte Carlo calculations the largest dose increase was observed at the air gap of 3.5 cm with 1.7% and 4.0% relative to the skin dose results without the RS and to the largest evaluated air gap of 51.1 cm, respectively. The SOBP comparison of the beam modalities at the measuring plane at the isocenter revealed higher skin doses without RS (including RS) by up to +1.9% (+1.5%) for DS and +1.3% (+1.1%) for US compared to PBS. For all three techniques an approx. 2% rise in skin dose was observed for the largest evaluated air gap of 37.7 cm to an air gap of 6.2 cm when using an RS51. CONCLUSION: The study investigated aspects of skin dose of a water equivalent phantom by varying key parameters of a proton treatment plan. Parameters like the RS, the air gap, and the delivery modality have an impact on the order of 4.0% for the skin dose at the depth of 70 µm. The increases in skin dose are the effects of the contribution of the increased electron fluence at small air gaps and the emitted hadronic particles produced by the RS.


Subject(s)
Proton Therapy , Humans , Monte Carlo Method , Phantoms, Imaging , Protons , Radiotherapy Dosage , Radiotherapy Planning, Computer-Assisted
6.
Med Phys ; 47(5): 2277-2288, 2020 Jun.
Article in English | MEDLINE | ID: mdl-32037577

ABSTRACT

PURPOSE/OBJECTIVE: Quantification of surface dose within the first few hundred water equivalent µm is challenging. Nevertheless, it is of large interest for the proton therapy community to study dose effects in the skin. The experimental determination is affected by the detector properties, such as the detector volume and material. The International Commission on Radiation Units and Measurements in its report 39 recommends assessing the skin dose at a depth of 0.07 mm. The aim of this study is the estimation of the absorbed dose at and around a depth of 70 µm. We used various dosimetric approaches in conjunction with proton pencil beam scanning delivery to determine the skin dose in a clinical setting. MATERIAL/METHODS: Five different detectors were tested for determining the surface dose in water: EBT3 and HD-V2 GAFCHROMIC™ radiochromic film, LiF:Mg,Ti thermoluminescent dosimeter, IBA PPC05 plane-parallel ionization chamber, and PTW 23391 extrapolation chamber. The irradiation setup consisted of quasi-monoenergetic scanned proton pencil beams with kinetic energies of 100, 150, and 226.7 MeV, respectively. Radiochromic films were placed within a vertical stack and in wedge geometry and were analyzed with FilmQA Pro™ adopting triple channel dosimetry. The extrapolation chamber PTW 23391, which served as a reference in the current work, was used in a conventional ionization chamber setup with a fixed electrode gap of 2 mm. Three Kapton® entrance windows with thicknesses of 25, 50, and 75 µm were employed. Thermoluminescent dosimeters were provided as powder and were pressed onto a sheet of aluminum. Furthermore, the Monte Carlo code TOol for PArticle Simulation (TOPAS) in version 3.1.p2 was used to model an IBA pencil beam scanning nozzle and score dose to water in a water phantom. RESULTS: The resulting depth dose curves were normalized to their 100% dose at the reference depth of 3 cm. We obtained the skin doses with the extrapolation chamber and with TOPAS. For the experimental approach this resulted in 79.7 ± 0.3%, 86.0 ± 0.6%, and 87.1 ± 0.1% for the proton energies 100, 150, and 226.7 MeV, respectively. The results for TOPAS were 80.1 ± 0.2% (100 MeV), 87.1 ± 0.5% (150 MeV), and 86.9 ± 0.4% (226.7 MeV), respectively. Based on the experimental results of the skin dose, we provided a clinically relevant surface extrapolation factor for the common measurement methods. This allows the result of the first measurement depth of a detector to be scaled to the dose at the skin depth. Most practical would be the use of the surface extrapolation factor for the PPC05 chamber, due to its direct reading, the wide availability in clinics and the low uncertainties. The calculated factors were 0.986 ± 0.004 for 100 MeV, 0.961 ± 0.008 for 150 MeV, and 0.963 ± 0.003 for 226.7 MeV. CONCLUSIONS: In this study, dissimilar experimental approaches were evaluated with respect to measurements at depths close to the surface. The experimental depth dose curves are in good agreement with the simulation with TOPAS Monte Carlo. To the author's knowledge this was the first experimental determination of the skin dose according to the International Commission on Radiation Units and Measurements 39 definition in proton pencil beam scanning.


Subject(s)
Proton Therapy/methods , Radiation Dosage , Film Dosimetry , Radiotherapy Dosage
7.
Phys Med Biol ; 64(15): 155003, 2019 08 01.
Article in English | MEDLINE | ID: mdl-31216523

ABSTRACT

Some clinical indications require small fields with sharp lateral dose gradients, which is technically challenging in proton beam therapy. This holds especially true for low-range fields applied with the spot scanning technique, where large beam profiles entering from the beam-line or the insertion of range shifting blocks lead to large lateral gradients. We regard the latter case and solve it by shifting the range shifting block far upstream in conjunction with a collimating aperture close to the patient. The experiments of the current work are based on a commercial proton therapy treatment head designed for several delivery modes. In a research environment of the spot-scanning delivery mode a range shifter is inserted downstream of the scanning magnets in a slot which is usually employed only in a scattering delivery mode. This configuration is motivated by equations assuming a simple model of proton transport. In the experiments lateral dose planes are acquired with a scintillation screen and radiochromic films. Dose distributions are calculated with the Monte Carlo dose engine of the RayStation treatment planning system. We demonstrate that proton fields with 80%-20% lateral dose fall-off values between 1.4 mm and 4.0 mm can be achieved for water equivalent depths between 0 cm and 10 cm. The simulated lateral dose profiles agree with the experimental dose profiles. The sharpening of the field edges is set off by a broadening of the proton spots towards the center of the fields. This limits the clinical application mainly to small fields for which the distal and proximal conformality is of minor importance.


Subject(s)
Proton Therapy/methods , Radiotherapy Planning, Computer-Assisted/methods , Stereotaxic Techniques , Humans , Monte Carlo Method , Phantoms, Imaging , Radiotherapy Dosage
8.
Phys Med Biol ; 63(8): 085020, 2018 04 20.
Article in English | MEDLINE | ID: mdl-29553047

ABSTRACT

To assess if apertures shall be mounted upstream or downstream of a range shifting block if these field-shaping devices are combined with the pencil-beam scanning delivery technique (PBS). The lateral dose fall-off served as a benchmark parameter. Both options realizing PBS-with-apertures were compared to the uniform scanning mode. We also evaluated the difference regarding the out-of-field dose caused by interactions of protons in beam-shaping devices. The potential benefit of the downstream configuration over the upstream configuration was estimated analytically. Guided by this theoretical evaluation a mechanical adapter was developed which transforms the upstream configuration provided by the proton machine vendor to a downstream configuration. Transversal dose profiles were calculated with the Monte-Carlo based dose engine of the commercial treatment planning system RayStation 6. Two-dimensional dose planes were measured with an ionization chamber array and a scintillation detector at different depths and compared to the calculation. Additionally, a clinical example for the irradiation of the orbit was compared for both PBS options and a uniform scanning treatment plan. Assuming the same air gap the lateral dose fall-off at the field edge at a few centimeter depth is 20% smaller for the aperture-downstream configuration than for the upstream one. For both options of PBS-with-apertures the dose fall-off is larger than in uniform scanning delivery mode if the minimum accelerator energy is 100 MeV. The RayStation treatment planning system calculated the width of the lateral dose fall-off with an accuracy of typically 0.1 mm-0.3 mm. Although experiments and calculations indicate a ranking of the three delivery options regarding lateral dose fall-off, there seems to be a limited impact on a multi-field treatment plan.


Subject(s)
Proton Therapy/methods , Humans , Monte Carlo Method , Proton Therapy/instrumentation , Radionuclide Imaging , Radiotherapy Dosage , Radiotherapy Planning, Computer-Assisted
9.
Phys Med ; 43: 15-24, 2017 Nov.
Article in English | MEDLINE | ID: mdl-29195558

ABSTRACT

PURPOSE: To commission the treatment planning system (TPS) RayStation for proton therapy including beam models for spot scanning and for uniform scanning. METHODS: Tests consist of procedures from ESTRO booklet number 7, the German DIN for constancy checks of TPSs, and extra tests checking the dose perturbation function. The dose distributions within patients were verified in silico by a comparison of 65 clinical treatment plans with the TPS XiO. Dose-volume parameters, dose differences, and three-dimensional gamma-indices serve as measures of similarity. The monthly constancy checks of Raystation have been automatized with a script. RESULTS: The basic functionality of the software complies with ESTRO booklet number 7. For a few features minor enhancements are suggested. The dose distribution in RayStation agrees with the calculation in XiO. This is supported by a gamma-index (3mm/3%) pass rate of >98.9% (median over 59 plans) for the volume within the 20% isodose line and a difference of <0.3% of V95 of the PTV (median over 59 plans). If spot scanning is used together with a range shifter, the dose level calculated by RayStation can be off by a few percent. CONCLUSIONS: RayStation can be used for the creation of clinical proton treatment plans. Compared to XiO RayStation has an improved modelling of the lateral dose fall-off in passively delivered fields. For spot scanning fields with range shifter blocks an empirical adjustment of monitor units is required. The computation of perturbed doses also allows the evaluation of the robustness of a treatment plan.


Subject(s)
Proton Therapy , Radiotherapy Planning, Computer-Assisted/methods , Computer Simulation , Humans , Quality Control
10.
Phys Med Biol ; 53(15): 4031-47, 2008 Aug 07.
Article in English | MEDLINE | ID: mdl-18612175

ABSTRACT

Theoretical considerations predicted the feasibility of K-edge x-ray computed tomography (CT) imaging using energy discriminating detectors with more than two energy bins. This technique enables material-specific imaging in CT, which in combination with high-Z element based contrast agents, opens up possibilities for new medical applications. In this paper, we present a CT system with energy detection capabilities, which was used to demonstrate the feasibility of quantitative K-edge CT imaging experimentally. A phantom was imaged containing PMMA, calcium-hydroxyapatite, water and two contrast agents based on iodine and gadolinium, respectively. Separate images of the attenuation by photoelectric absorption and Compton scattering were reconstructed from energy-resolved projection data using maximum-likelihood basis-component decomposition. The data analysis further enabled the display of images of the individual contrast agents and their concentrations, separated from the anatomical background. Measured concentrations of iodine and gadolinium were in good agreement with the actual concentrations. Prior to the tomographic measurements, the detector response functions for monochromatic illumination using synchrotron radiation were determined in the energy range 25 keV-60 keV. These data were used to calibrate the detector and derive a phenomenological model for the detector response and the energy bin sensitivities.


Subject(s)
Photons , Tomography, X-Ray Computed/methods , Calibration , Feasibility Studies , Image Processing, Computer-Assisted , Phantoms, Imaging , Synchrotrons
11.
Klin Monbl Augenheilkd ; 224(10): 780-6, 2007 Oct.
Article in German | MEDLINE | ID: mdl-17952822

ABSTRACT

BACKGROUND: The aim of this study was to provide a description of the spatial distortions and temporal instability in amblyopic vision, and to attempt to define a cortical substrate of the spatial distortions in strabismic amblyopia. MATERIAL AND METHODS: The perceptual distortions and instabilities occurring in amblyopic vision were investigated psychophysically, by asking 17 subjects to describe and sketch their percepts. This was then visualised with an animated computer programme and validated by the subjects. In a second experiment, the cortical responses of normal observers to patterns corresponding to the spatial distortions reported by amblyopic subjects were investigated using functional magnetic resonance imaging. RESULTS: Spatial distortions were more marked in strabismic than in anisometropic amblyopes or in strabismic subjects with alternating fixation. Temporal instability occurred mainly in strabismic amblyopes and affected mainly patterns with higher spatial frequencies. Experiments with functional magnetic resonance imaging showed that the patterns with the highest spatial distortions yield increased activation in the primary visual cortex of normally-sighted observers. CONCLUSIONS: The results of the imaging experiment suggest that the occurrence of spatial distortions might explain the higher activation in the primary visual cortex of some amblyopic subjects. The occurrence of temporal instability in strabismic amblyopia suggests an involvement of higher-order, extrastriate visual areas of the dorsal, "where" visual pathway in amblyopia, in addition to the known deficits in the ventral, "what" visual pathway.


Subject(s)
Amblyopia/physiopathology , Depth Perception/physiology , Orientation/physiology , Perceptual Disorders/physiopathology , Perceptual Distortion/physiology , Visual Cortex/physiopathology , Adult , Amblyopia/diagnosis , Brain Mapping , Color Perception/physiology , Discrimination Learning/physiology , Female , Humans , Image Processing, Computer-Assisted , Imaging, Three-Dimensional , Magnetic Resonance Imaging , Male , Middle Aged , Motion Perception/physiology , Optical Illusions/physiology , Perceptual Disorders/diagnosis , Photic Stimulation , Psychomotor Performance/physiology , Psychophysics , Reference Values , Strabismus/diagnosis , Strabismus/physiopathology , Visual Pathways/physiopathology
12.
Phys Rev Lett ; 97(6): 062502, 2006 Aug 11.
Article in English | MEDLINE | ID: mdl-17026166

ABSTRACT

A new experimental approach to the famous problem of the anomalously slow Gamow-Teller (GT) transitions in the beta decay of the A=14 multiplet is presented. The GT strength distributions to excited states in 14C and 14O were studied in high-resolution (d,2He) and (3He,t) charge-exchange reactions on 14N. No-core shell-model calculations capable of reproducing the suppression of the beta decays predict a selective excitation of Jpi=2+ states. The experimental confirmation represents a validation of the assumptions about the underlying structure of the 14N ground state wave function. However, the fragmentation of the GT strength over three 2+ final states remains a fundamental issue not explained by the present no-core shell model using a 6homega model space, suggesting possibly the need to include cluster structure in these light nuclei in a consistent way.

13.
Acta Neurochir (Wien) ; 148(8): 831-8; discussion 838, 2006 Aug.
Article in English | MEDLINE | ID: mdl-16791439

ABSTRACT

BACKGROUND: We present outcome data of a cohort of 164 immunocompetent PCNSL patients uniformly diagnosed at a single center for stereotactic neurosurgery, and evaluate the acceptance and impact of combination radiotherapy (RT) and chemotherapy (CHT) with high-dose methotrexate (HD-MTX) over time. METHOD: We assessed choice of treatment and patient survival in a series of 164 PCNSL cases diagnosed from 1989 to 2001, and performed a re-evaluation of histopathology and pre-operative clinical data. FINDINGS: From 1989 to 1993, RT was the predominant therapy, and additional CHT did not improve survival. After 1994, the use of combination CHT/RT increased continuously, consistently contained MTX, and was associated with longer survival than RT only: median survival was 14 months after CHT/RT (2-year survival 35.7%) and 10 months (2-year survival 26.2%) after RT only (not significant). Overall median survival remained poor, increasing from six (1989-1993) to nine months (1994-2001) (p = 0.008). Survival was variable, with a few patients surviving >4 years after diagnosis in the CHT/RT as well as in the RT only group. CONCLUSIONS: Despite considerable improvement of PCNSL therapy, the overall benefit of combined CHT/RT versus RT only was lower than that expected from previous phase II clinical trials. The striking variability of survival in either treatment group may suggest a yet undefined biological heterogeneity of PCNSL, which may also include a more aggressive PCNSL subtype in the group of patients with rapidly progressive disease and not eligible for standard therapy.


Subject(s)
Brain Neoplasms/drug therapy , Brain Neoplasms/radiotherapy , Drug Therapy/statistics & numerical data , Lymphoma/drug therapy , Lymphoma/radiotherapy , Radiotherapy/statistics & numerical data , Adult , Aged , Aged, 80 and over , Antimetabolites, Antineoplastic/therapeutic use , Biopsy/methods , Brain Neoplasms/diagnosis , Cohort Studies , Drug Therapy/standards , Drug Therapy/trends , Early Diagnosis , Female , Humans , Immunocompetence/immunology , Lymphoma/diagnosis , Male , Methotrexate/therapeutic use , Middle Aged , Radiotherapy/standards , Radiotherapy/trends , Retrospective Studies , Stereotaxic Techniques , Survival Rate/trends , Treatment Outcome
14.
J Exp Biol ; 207(Pt 25): 4393-405, 2004 Dec.
Article in English | MEDLINE | ID: mdl-15557025

ABSTRACT

Oxygen transport processes in millimetre-sized animals can be very complex, because oxygen molecules do not exclusively follow the pathway predetermined by the circulating fluid but may also simultaneously move from the respiratory surfaces to the tissues along different paths by diffusion. The present study made use of the oxygen-sensitive phosphorescence probe Oxyphor R2 to analyze the internal oxygen pathway in the transparent microcrustacean Daphnia magna. Oxyphor R2 was injected into the circulatory system and the distribution of oxygen partial pressure (P(O(2))) in the haemolymph was measured by phosphorescence lifetime imaging in the P(O(2)) range 0-6 kPa (0-30% air saturation). There were substantial differences in the shape of the two-dimensional P(O(2)) profiles depending on the concentration of haemoglobin (Hb) in the haemolymph. A steep global gradient, from posterior to anterior, occurred in animals with low concentrations of Hb (90-167 micromol l(-1) haem). In contrast, animals with a five- to sixfold higher concentration of Hb showed flat internal P(O(2)) gradients which, however, were only present under reduced ambient oxygen tensions (P(O(2)amb)=3-1 kPa), when Hb was maximally involved in oxygen transport. Under these conditions, the presence of Hb at high concentrations stabilized the unloading P(O(2)) in the central body to 0.9-0.4 kPa. Independent of Hb concentration and body size, the loading P(O(2)) was always 0.5 kPa below the P(O(2)amb). From these P(O(2)) profiles, it was possible (i) to follow the track of oxygen within the animal, and (ii) to visualize the shift from a diffusion-dominated to a convection-dominated transport as a result of increased Hb concentration.


Subject(s)
Cardiovascular Physiological Phenomena , Daphnia/metabolism , Hemoglobins/metabolism , Hemolymph/metabolism , Oxygen/metabolism , Analysis of Variance , Animals , Biological Transport/physiology , Daphnia/physiology , Female , Heart Rate , Metalloporphyrins/blood , Microinjections , Oxygen/blood , Partial Pressure
15.
J Comp Physiol B ; 172(4): 275-85, 2002 May.
Article in English | MEDLINE | ID: mdl-12037590

ABSTRACT

To determine the contribution of circulatory convection to tissue oxygen supply in animals of Daphnia magna, heart rate ( f(H)), in-vivo Hb oxygen-saturation ( S(Hb)) and NADH fluorescence intensity ( I(NADH)) as a measure of the tissue oxygenation state were simultaneously measured using digital motion analysis, microabsorption spectroscopy and fluorescence microscopy. In addition, the relationship between stroke volume and body size was established. Groups of differently sized animals (small: 1.4-1.6 mm, medium: 2.7-2.9 mm, large: 3.3 mm) with either low (Hb-poor) or high Hb concentration (Hb-rich) in the hemolymph were exposed to a gradual decrease in ambient oxygen partial pressure ( P(O2amb)) between normoxia and anoxia. In all groups, f(H) increased in response to progressive hypoxia. The hypoxic maximum in f(H) was highest in medium-sized Hb-poor animals, whereas perfusion rate increased continuously with increasing body size in Hb-poor and Hb-rich animals. The P(O2amb) at which Hb in the heart region was half-saturated (in-vivo P(50)) was higher in medium-sized (Hb-poor: 3.2 kPa, Hb-rich: 2.0 kPa) than in small (Hb-poor: 2.1 kPa, Hb-rich: 1.5 kPa) and large animals (Hb-poor: 1.9 kPa). The in-vivo P(50) was always lower in Hb-rich than in Hb-poor animals. The I(NADH) indicated an impairment of tissue oxygenation starting at higher critical P(O2amb) with increasing body size and with lower Hb concentration. Model calculations suggest that at the respective critical P(O2amb), circulatory convection delivers less than half of the oxygen demand in Hb-poor animals. In contrast, in Hb-rich animals, the contribution of circulatory convection to tissue oxygen supply at respective critical P(O2amb) was much greater due to the higher concentration of Hb.


Subject(s)
Daphnia/physiology , Hemoglobins/physiology , Oxygen/physiology , Animals , Body Constitution , Heart/physiology , Heart Rate/physiology , Hemolymph/physiology , NAD/analysis
16.
J Exp Biol ; 204(Pt 20): 3425-41, 2001 Oct.
Article in English | MEDLINE | ID: mdl-11707494

ABSTRACT

To determine the contribution of haemoglobin (Hb) to the hypoxia-tolerance of Daphnia magna, we exposed Hb-poor and Hb-rich individuals (2.4-2.8 mm long) to a stepwise decrease in ambient oxygen partial pressure (P(O(2)amb)) over a period of 51 min from normoxia (20.56 kPa) to anoxia (<0.27 kPa) and looked for differences in their physiological performance. The haem-based concentrations of Hb in the haemolymph were 49 micromol l(-1) in Hb-poor and 337 micromol l(-1) in Hb-rich animals, respectively. The experimental apparatus made simultaneous measurement of appendage beating rate (fA), NADH fluorescence intensity (I(NADH)) of the appendage muscles, heart rate (fH) and in vivo Hb oxygen-saturation possible. In response to progressive, moderate hypoxia, both groups showed pronounced tachycardia and a slight decrease in fA. The fA and fH of Hb-rich animals were generally 4-6 % lower than those of Hb-poor animals. In addition, Hb-rich animals showed a significant decrease in the P(O(2)amb) at which the Hb in the heart region was half-saturated and a striking reduction in the critical P(O(2)amb) of appendage-related variables. In Hb-poor animals, the I(NADH) signal indicated that the oxygen supply to the limb muscle tissue started to become impeded at a critical P(O(2)amb) of 4.75 kPa, although the high level of fA was largely maintained until 1.77 kPa. The obvious discrepancy between these two critical P(O(2)amb) values suggested an anaerobic supplementation of energy provision in the range 4.75-1.77 kPa. The fact that I(NADH) of Hb-rich animals did not rise until P(O(2)amb) fell below 1.32 kPa strongly suggests that the extra Hb available to Hb-rich animals ensured an adequate oxygen supply to the limb muscle tissue in the P(O(2)amb) range 4.75-1.32 kPa. This finding illustrates the physiological benefit of Hb in enabling the animal to sustain its aerobic metabolism as the energetically most efficient mode of fuel utilization under conditions of reduced oxygen availability.


Subject(s)
Daphnia/physiology , Hemoglobins/physiology , Oxygen/administration & dosage , Animals , Extremities , Heart Rate , Hemoglobins/analysis , Hemolymph/chemistry , Microscopy, Fluorescence , Muscles/chemistry , NAD/analysis , Oxygen/blood
17.
Physiol Biochem Zool ; 73(1): 77-85, 2000.
Article in English | MEDLINE | ID: mdl-10685909

ABSTRACT

The mayfly larvae Epeorus sylvicola and Ecdyonurus torrentis inhabit either fast-flowing or, for the latter species, calm zones of running water. We studied (1) mechanisms and limitations of oxygen transport in single individuals (oxygen consumption rate, occurrence and rate of gill movements, and heartbeats) in running water of different oxygen concentrations and (2) capacities for anaerobiosis (L-lactate production). Our aim was to look for specific adaptations in the two species to slightly different microhabitats. Epeorus sylvicola, whose immovable gills are not able to generate ventilatory convection, proved to be an oxyconformer at both test temperatures (11 degrees and 15 degrees C). Ecdyonurus torrentis showed a progressively stronger oxyregulatory behavior at higher temperatures. In this species an onset of gill beating was found at moderate hypoxia (below 16 kPa). Ventilating individuals reached maximum rates (300 min-1) of 5-14 kPa. In the case of a further reduction of oxygen partial pressure, the ventilatory rate started to decrease. Ventilatory activity, however, was maintained down to very low oxygen concentrations. Neither in E. sylvicola nor in E. torrentis was experimental evidence found to confirm the hypothesis of a respiratory function of hindgut movements. During hypoxia, the heart rate was constant in both species (E. sylvicola: 80 min-1; E. torrentis: 60 min-1): bradycardia occurred either below 1.5 kPa or below 4 kPa. Anaerobiosis, that is, lactate production, was not detected in either species.


Subject(s)
Adaptation, Physiological , Insecta/physiology , Respiration , Water Movements , Animals , Heart Rate , Lactic Acid/blood
18.
Z Orthop Ihre Grenzgeb ; 133(1): 84-91, 1995.
Article in German | MEDLINE | ID: mdl-7887008

ABSTRACT

In the literature a good reliability of isokinetic measurements is reported. In spite of these reports high variations of the peak torque and work values were registered when testing 24 patients with low back pain, using a CYBEX TR isokinetic trunk rotation apparatus. After a 3 week's training the patients force (peak torque) increased in the average between 10.7 p.c. (SD +/- 26.4) and 23.2 p.c. (SD +/- 63.8), corresponding to the test-velocity. Seven of the 24 patients improved or deteriorated more than 30 p.c. Analysing the parameters which could interfere with the results there was found a discrepancy between the original CYBEX software and the German Iso-Kin 4.0 software. The Isokin 4.0 does not warm up and calibrate the isokinetic apparatus daily. Investigations with definite weights showed that the values for peak torque are 40-50 m higher when using the Iso-Kin 4.0 software in comparison to the original CYBEX software. Furthermore there are a lot of other parameters such as acceleration of the body, psychological alterations, pain, motivation, learning effects, and artificial oscillations of the registered curve, which can affect the results even when using the original CYBEX software.


Subject(s)
Low Back Pain/physiopathology , Physical and Rehabilitation Medicine/methods , Software , Adult , Biomechanical Phenomena , Body Weight , Calibration , Diagnostic Errors , Humans , Middle Aged , Movement , Physical and Rehabilitation Medicine/instrumentation
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