Repeated deep-inspiration breath-hold CT scans at planning underestimate the actual motion between breath-holds at treatment for lung cancer and lymphoma patients.

PURPOSE/OBJECTIVE: Deep-inspiration breath-hold (DIBH) during radiotherapy may reduce dose to the lungs and heart compared to treatment in free breathing. However, intra-fractional target shifts between several breath-holds may decrease target coverage. We compared target shifts between four DIBHs at the planning-CT session with those measured on CBCT-scans obtained pre- and post-DIBH treatments. MATERIAL/METHODS: Twenty-nine lung cancer and nine lymphoma patients were treated in DIBH. An external gating block was used as surrogate for the DIBH-level with a window of 2 mm. Four DIBH CT-scans were acquired: one for planning (CTDIBH3) and three additional (CTDIBH1,2,4) to assess the intra-DIBH target shifts at scanning by registration to CTDIBH3. During treatment, pre-treatment (CBCTpre) and post-treatment (CBCTpost) scans were acquired. For each pair of CBCTpre/post, the target intra-DIBH shift was determined. For lung cancer, tumour (GTV-Tlung) and lymph nodes (GTV-Nlung) were analysed separately. Group mean (GM), systematic and random errors, and GM for the absolute maximum shifts (GMmax) were calculated for the shifts between CTDIBH1,2,3,4 and between CBCTpre/post. RESULTS: For GTV-Tlung, GMmax was larger at CBCT than CT in all directions. GMmax in cranio-caudal direction was 3.3 mm (CT)and 6.1 mm (CBCT). The standard deviations of the shifts in the left-right and cranio-caudal directions were larger at CBCT than CT. For GTV-Nlung and CTVlymphoma, no difference was found in GMmax or SD. CONCLUSION: Intra-DIBH shifts at planning-CT session are generally smaller than intra-DIBH shifts observed at CBCTpre/post and therefore underestimate the intra-fractional DIBH uncertainty during treatment. Lung tumours show larger intra-fractional variations than lymph nodes and lymphoma targets.

Radiation-Induced Sarcoma: A Retrospective Population-Based Study Over 34 Years in a Single Institution.

AIMS: About a half of all cancer patients receive radiotherapy as part of their oncological treatment. Because of the carcinogenic effect of ionising radiation, there is a rare, but definite, risk of developing secondary malignancies, including sarcomas. The aim of this retrospective study was to describe the prevalence, patient and tumour characteristics, as well as prognosis and outcome, of patients with radiation-induced sarcomas (RIS) in a cohort of patients treated in the Sarcoma Centre at Aarhus University Hospital over a period of 34 years. MATERIALS AND METHODS: All patients who fulfilled the criteria for RIS and were treated for RIS in the period 1979-2013 were included. Patient data were retrieved from the Aarhus Sarcoma Registry and the National Danish Sarcoma Database, crosschecked with the National Register of Pathology and validated using the patients' medical records. The primary end point was the effect of surgery and treatment intent on overall survival. Overall survival is reported using the Kaplan-Meier estimates and compared using the Log-rank test. Descriptive statistics are presented for patients, tumours and treatment characteristics. RESULTS: Of 2845 patients diagnosed with sarcoma between 1979 and 2013, 64 (2%) were diagnosed with RIS. The median interval from the original malignancy was 11 years. The most common histological type was undifferentiated pleomorphic sarcoma (33%). Curative treatment was intended for 45 patients. Fifty patients underwent surgery, of whom 80% had microscopically radical resection (R0). The 5-year overall survival for the whole cohort was 32%. Patients who underwent surgery had a significantly better overall survival compared with patients who were not treated with surgery. In the univariate Cox proportional hazard analyses, no metastases at diagnosis, surgery and R0 resection were favourable prognostics factors of survival. CONCLUSION: This study showed that RIS patients are unique in their epidemiology and tumour characteristics. They have a poor prognosis and need special research investigating new intensive treatment strategies to improve the outcome.

[Psychogeriatric management and sectorized psychiatry]. / Psychogeriatrische Versorgung und sektorisierte Psychiatrie.

Together with a general assessment of gerontopsychiatric care in the Federal Republic of Germany, the paper presents a model in hospitalised gerontopsychiatric treatment that has been tested at Hanover College of Medical Studies (Medizinische Hochschule Hanover). Results presented cover a wide range of divergent disorders, and appear to justify the employment of the model elsewhere.

[Depot neuroleptics in social psychiatric practice]. / Depotneuroleptika in der sozialpsychiatrischen Praxis.

In recent years, depot neuroleptics have gained in importance in the outpatient treatment of chronic schizophrenics. These neuroleptics make drug therapy safer than before, thus improving the prerequisites for socio-therapeutic and rehabilitative measures. The present study analyses the ranking and value of this kind of treatment in the management of outpatients. A random sample of 80 schizophrenics treated as outpatients, by a psychiatric university clinic working on a sectorial basis was examined for the purpose of this study. Treatment results, problems of indication, limitations of therapeutic possibilities using depot neuroleptics, as well as constellative conditions under which therapy was discontinued, are discussed.

[Fundamental problems of therapeutic teamwork in psychiatry (author's transl)]. / Grundfragen therapeutischer teamarbeit in der psychiatrie.

Certain institutional and organizational prerequisites are fundamental in present-day translation into reality of essential concepts of psychiatric therapy and rehabilitation. These include, for example, the basic structure of therapeutic co-operation and the form of such co-operation as practices by a multiprofessional team. The creation and shaping of facilities based on the principle of mutual therapeutic co-operation and joint working of team members engaged in therapy, are innovations and are representative of a development by which a specific style in psychiatry gradually takes shape and by which it becomes adequately conscious of its social tasks. As with all innovatory developments there is an inherent danger that individual elements of such innovations assume of life of their own and undergo mystification. The concept "team" in psychiatry form of co-operation can solve many more problems than it can cope with. Hence it is definitely useful to investigate critically into the structure of teamwork in psychiatry, into its possibilities and prerequisites and into the extent to which teams are superior to conventional forms of organization in meeting the specific demands made by treating the mentally diseased. It becomes evident that among the basic conditions of teamwork are significant attitudes to therapy and that the therapeutic approaches derived therefrom can be successful only on teamwork basis. At the same time, however, limitations become apparent beyond which teamwork - now no longer understood as a problem-related principle of co-operation, but as an ideology - threatens to become dysfunctional and anti-therapeutic, creating compulsions which are diametrically opposed to the very essence of therapy and also to the needs of the therapist group.

[Physician's group rounds in the psychiatric hospital as an element of inpatient therapy (author's transl)]. / Die Gruppenvisite als Element stationärer Therapie.

The conventional "round" during which the individual patient is seen by the physician and his assistants, has been replaced in many psychiatric hospitals by the so-called "group round". This is the result of the efforts made by therapists to reduce the distance and "gradients" between therapists and the patients they have to look after. In this respect, therefore, the "group round" is based on the principle of collective therapy, i.e. of the therapeutic community. The present article discusses the attitude and ideology forming part of the traditional round in hospitals. The form and organisation of the "group round" as practiced for the last decade in a sociopsychiatrically oriented University hospital are described. The article goes into details of the therapeutic value and advantages of this institutionalized interaction with the patient, basing on the author's experience, while pointing out the limitations of this method and the risks involved whenever it is employed without previous consideration of its aims and possibilities.