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Sarcomas are rare cancers with high heterogeneity in terms of type, location, and treatment. The health-related quality of life (HRQoL) of sarcoma patients has rarely been investigated and is the subject of this analysis. Adult sarcoma patients and survivors were assessed between September 2017 and February 2019 in 39 study centers in Germany using standardized, validated questionnaires (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30)). Associated factors were analyzed exploratively using multivariable linear regressions. Among 1113 patients, clinically important limitations and symptoms were most pronounced in emotional (63%, 95% CI 60–66%), physical (60%, 95% CI 57–62%), role functioning (51%, 95% CI 48–54%), and pain (56%, 95% CI 53–59%) and fatigue (51%, 95% CI 48–54%). HRQoL differed between tumor locations with lower extremities performing the worst and sarcoma types with bone sarcoma types being most affected. Additionally, female gender, higher age, lower socioeconomic status, recurrent disease, not being in retirement, comorbidities, and being in treatment were associated with lower HRQoL. Sarcoma patients are severely restricted in their HRQoL, especially in functioning scales. The heterogeneity of sarcomas with regard to type and location is reflected in HRQoL outcomes. During treatment and follow-up, close attention has to be paid to the reintegration of the patients into daily life as well as to their physical abilities and emotional distress.
Objective. We investigated the health-related quality of life (HRQoL) of patients with gastrointestinal stromal tumours (GIST). Methods: In the multicentre PROSa study, the HRQoL of adult GIST patients was assessed between 2017 and 2019 using the European Organisation for Research and Treatment of Cancer HRQoL questionnaire (EORTC QLQ-C30). We performed group comparisons and multivariate linear regressions. Results: Among 130 patients from 13 centres, the mean global HRQoL was 63.3 out of 100 points. Higher sores indicate better HRQoL. The highest restrictions were in emotional, social, role functioning, insomnia, fatigue, and pain. In multivariate linear regression, we found no significant differences between patients receiving tyrosine kinase inhibitor (TKI) treatment and those without TKI treatment as well as between patients treated with curative or with palliative intent. Patients who received multiple lines of TKI treatment had the most restrictions, notably in physical (unstandardized regression coefficient [B] = −15.7), role (B = −25.7), social (B = −18.4), and cognitive functioning (B = −19.7); fatigue (B = 15.93); general health (B = −14.23); and EORTC-sum score (B = −13.82) compared to all other patients. Conclusion: The highest HRQoL restrictions were in GIST patients receiving multiple lines of TKI therapy. Underlying causes need further investigation.
Background: Computed-tomography-guided interventions are attractive for tissue sampling of paediatric tumor lesions; however, it comes with exposure to ionizing radiation. The aim of this study was to analyse the radiation dose, accuracy and speed of CT-guided interventions in paediatric patient cohort.
Methods: We retrospectively reviewed CT-guided interventions over a 10 -year period in 65 children. The intervention site consisted of bones in 38, chest (lung) in 15 and abdomen (liver, lymph nodes) in 12 cases. Radiation dose and duration of the procedures were analysed. The statistical analysis was performed using dedicated statistical software (BiAS 8.3.6 software, Epsilon Verlag, North Hasted).
Results: All interventions were performed successfully. Mean target access path to lesion within the patients was 6.0 cm (min 3.5 cm, max 11.2 cm). Time duration to complete intervention was 25:15 min (min 17:03 min, max 43:00 min). The dose-length product (DLP) of intervention scan was 29.5 mGy · cm (min 6 mGy · cm, max 85 mGy · cm) with the lowest dose for biopsies in the region of the chest (p = 0.04).
Conclusions: With justified indications, CT-guided paediatric interventions are safe, effective and can be performed both, with short intervention times and low radiation exposure.
Background: To evaluate survival data and local tumor control after transarterial chemoembolization in two groups with different embolization protocols for the treatment of HCC patients.
Methods: Ninty-nine patients (mean age: 63.6 years), 78 male (78.8%) with HCC were repeatedly treated with chemoembolization in 4-week-intervals. Eighty-eight patients had BCLC-Stage-B and in 11 patients, chemoembolization was performed for bridging (BCLC-Stage-A). In total, 667 chemoembolization treatments were performed (mean 6.7 treatments/patient). The administered chemotherapeutic agent included mitomycin. For embolization, lipiodol only (n = 51;51.5%; mean age 63.8 years; 38 male), or lipiodol plus degradable starch microspheres (DSM) (n = 48; 48.5%; mean age 63.4 years; 40 male) were used. The local tumor response was assessed by MRI using Response Evaluation Criteria in Solid Tumors 1.1 (RECIST 1.1). Patient survival times were evaluated using Kaplan-Meier curves and log-rank tests.
Results: The local tumor control in the lipiodol-group was: PR (partial response) in 11 (21.6%), SD (stable disease) in 32 (62.7%) and PD (progressive disease) in 8 cases (15.7%). In the lipiodol-DSM-group, PR was seen in 14 (29.2%), SD in 22 (45.8%), and PD in 12 (25.0%) individuals (p = 0.211). The median survival of patients after chemoembolization with lipiodol was 25 months and in the lipiodol-DSM-group 28 months (p = 0.845).
Conclusion: Our data suggest a slight benefit of the use of lipiodol and DSM in comparison of using lipiodol only for chemoembolization of HCC in terms of local tumor control and survival data, this trend did not reach the level of significance.
The objective of this pilot clinical study was to assess the safety, technical feasibility, pharmacokinetic (PK) profile and tumour response of DC Bead™ with irinotecan (DEBIRI™) delivered by intra-arterial embolisation for the treatment of metastatic colorectal cancer. Eleven patients with unresectable liver metastases from CRC, tumour burden <30% of liver volume, adequate haematological, liver and renal function, performance status of <2 were included in this study. Patients received up to 4 sessions of TACE with DEBIRI at 3-week intervals. Feasibility of the procedure, safety and tumour response were assessed after each cycle. PK was measured after the first cycle. Patients were followed up to 24 weeks. Only mild to moderate adverse events were observed. DEBIRI is a technically feasibile procedure; no technical complications were observed. Average Cmax for irinotecan and SN-38 was 194 ng/ml and 16.7 ng/ml, respectively, with average t½ of 4.6 h and 12.4 h following administration of DEBIRI. Best overall response during the study showed disease control in 9 patients (2 patients with partial response and 7 with stable disease, overall response rate of 18%). Our study shows that transarterial chemoembolisation with irinotecan-loaded DC beads (DEBIRI) is safe, technically feasible and effective with a good PK profile.
Breitbandige Beamforming-Algorithmen zur Erfassung von Audiosignalen mit kompakten Mikrofon-Arrays
(2009)
Mikrofon-Arrays erlauben die selektive Erfassung und Trennung von Audiosignalen aus einer akustischen Umgebung. Typische Anwendungen sind z.B. die Ortung einzelner Schallquellen, die räumliche Kartierung eines Schallfeldes ("akustische Kamera") oder der gerichtete Empfang einer bestimmten Schallquelle bei gleichzeitiger Unterdrückung von Umgebungs- oder Störschallen. Vielkanalige Verfahren und Filter, die sich dieser Aufgabe widmen, werden als Beamforming bzw. Beamformer bezeichnet. In dieser Dissertation werden bekannte und eigene Beamforming-Ansätze im Hinblick auf ihre Eignung für die hochwertige Übertragung von Audiosignalen untersucht. Diese erfordert neben einer möglichst großen Abdeckung des relevanten Frequenzbereichs (Breitbandigkeit) auch die Frequenzunabhängigkeit der Richtcharakteristik, um spektrale Verzerrungen zu vermeiden. Es wird ein Algorithmus vorgestellt, der diese Anforderungen mit sehr kompakten Arrays erfüllt. Eine klassische Möglichkeit, eine frequenzinvariante Charakteristik (Beampattern) mithilfe eines Delay-and-Sum-Beamformers zu erhalten, ist eine frequenzabhängige Gewichtung der Mikrofone, welche die effektive Apertur des Arrays proportional zur Schallwellenlänge einstellt. Diese Methode funktioniert jedoch nur bei Wellenlängen, die kleiner sind als die Ausdehnung des Arrays, und erfordert bei Frequenzen unter 100Hz Arrays von mehreren Metern Größe. Ein gänzlich anderes Verhalten zeigen differentielle Mikrofonarrays, welche Differenzen aus Signalen benachbarter Mikrofone bilden: In Kombination mit Integratorfiltern erzeugen sie Beampattern, die auch bei sehr kleinen Frequenzen, d.h. bei Wellenlängen, die groß gegen das Array sind, unverändert bleiben (sog. Superdirektivität). Aus diesem Prinzip wurde in dieser Arbeit das Konzept des Multipol-Beamformers entwickelt, der ein gegebenes Soll-Beampattern durch eine Reihenentwicklung nach Sinus- und Kosinusfunktionen (zweidimensionaler Fall) oder Kugelflächenfunktionen (dreidimensionaler Fall) approximiert. Der Multipol-Beamformer erzielt eine hervorragende Richtwirkung bei kleinen Frequenzen, ist jedoch nur über einen sehr begrenzten Bereich frequenzinvariant und erweist sich insbesondere in drei Raumdimensionen als analytisch aufwändig. Flexibler und in zwei wie in drei Raumdimensionen gleichermaßen einfach in der Formulierung ist demgegenüber das in der Literatur zu findende Verfahren des modalen Subraum-Beamformings (Modal Subspace Decomposition, MSD). Dieser Ansatz bestimmt zu einer beliebigen Sensorgeometrie einen Satz orthogonaler Eigen-Beampattern, die dann zu einer Reihenentwicklung des Soll-Beampatterns herangezogen werden. Ähnlich dem erwähnten Delay-and-Sum-Beamformer jedoch erfordert auch dieser Ansatz bei großen Wellenlängen entsprechend groß dimensionierte Arrays und ist nicht superdirektiv. In dieser Arbeit wurde deshalb eine eigene, neue Ausprägung des MSD-Algorithmus formuliert, welche die Superdirektivität des Multipol-Beamformers mit der Flexibilität und Einfachheit des MSD-Verfahrens vereint. Diese als "superdirektives MSD-Beamforming" bezeichnete Methode besitzt - wie das bereits bekannte MSD-Verfahren auch - die interessante Eigenschaft, daß die Eigen-Beampattern für ein frei zu wählendes Entwurfs-Frequenzband berechnet werden, so daß das Verhalten des Beamformers über ein ganzes Frequenzintervall kontrolliert werden kann. Dies eröffnet auch die Möglichkeit eines sehr breitbandigen Beamformings durch Kombination mehrerer Beamformer, die individuell auf benachbarte Frequenzbänder abgestimmt werden. Mit beispielsweise einem hexagonalen Array von nur 6cm Durchmesser und sieben Mikrofonen erreicht der superdirektive Ansatz so ca. 20-30dB Störabstand über einen Frequenzbereich von 100Hz bis 6kHz, was für Sprache eine sehr hohe Übertragungsqualität darstellt. Zur experimentellen Verifikation der untersuchten Algorithmen wurde im Rahmen dieser Arbeit eine vielkanalige Echtzeit-Signalverarbeitungsumgebung unter Windows XP erstellt, welche die Erfassung, Verarbeitung, Analyse und Ausgabe vielkanaliger Audio-Daten erlaubt. Auch eine Simulation idealer Freifeldmessungen an Mikrofonarrays ist damit möglich, indem die Ausbreitung des Schalls von der Schallquelle zu den Mikrofonen durch zeitdiskrete Fractional-Delay-Filter simuliert wird. Dieser Filtertypus wurden im Rahmen dieser Arbeit ebenfalls eingehend untersucht: Für zwei aus der Literatur bekannte Entwurfsverfahren wurden Erweiterungen gefunden, die bei gleicher Filterordnung eine höhere nutzbare Bandbreite erzielen. Für Messungen an realen Arrays wurde die Akustik-Messkammer des Instituts durch zusätzliche Dämmauskleidung für Freifeld-Messungen nutzbar gemacht. Die Messergebnisse belegen, daß die untersuchten Algorithmen in der Praxis erwartungsgemäß funktionieren und daß der gefundene superdirektive MSD-Algorithmus mit sehr kompakten Arrays eine gute breitbandige Erfassung und Trennung von Audiosignalen ermöglicht.
Gene therapy (GT) is becoming a realistic treatment option for patients with haemophilia. Outside clinical trials, the complexity and potential complications of GT will pose unprecedented challenges to haemophilia care centres.AIM: To explore the potential use of electronic tools to improve the delivery of GT under real-world conditions.METHODS: Considering the hub-and-spoke model, the GTH working group on GT considered the entire patient pathway and reached consensus on requirements for an integrative software tool to secure documenting and sharing information between treaters, pharmacies and patients.RESULTS: Six steps of the gene therapy process were identified, each requiring completion of the previous step as a prerequisite for entry. The responsibilities of GT dosing and follow-up treatment centres, read/write access rules, and the minimum data set were outlined. Data contributed by patients through mobile devices was also considered.CONCLUSION: Important information needs to be shared between patients and treatment centres in a real-world GT hub-and-spoke model. Collecting and sharing this information in well-organised electronic applications will not only improve patient care but also enable national and international data collection in clinical registries...
Objectives: To evaluate the predictive value of volumetric bone mineral density (BMD) assessment of the lumbar spine derived from phantomless dual-energy CT (DECT)-based volumetric material decomposition as an indicator for the 2-year occurrence risk of osteoporosis-associated fractures. Methods: L1 of 92 patients (46 men, 46 women; mean age, 64 years, range, 19–103 years) who had undergone third-generation dual-source DECT between 01/2016 and 12/2018 was retrospectively analyzed. For phantomless BMD assessment, dedicated DECT postprocessing software using material decomposition was applied. Digital files of all patients were sighted for 2 years following DECT to obtain the incidence of osteoporotic fractures. Receiver operating characteristic (ROC) analysis was used to calculate cut-off values and logistic regression models were used to determine associations of BMD, sex, and age with the occurrence of osteoporotic fractures. Results: A DECT-derived BMD cut-off of 93.70 mg/cm3 yielded 85.45% sensitivity and 89.19% specificity for the prediction to sustain one or more osteoporosis-associated fractures within 2 years after BMD measurement. DECT-derived BMD was significantly associated with the occurrence of new fractures (odds ratio of 0.8710, 95% CI, 0.091–0.9375, p < .001), indicating a protective effect of increased DECT-derived BMD values. Overall AUC was 0.9373 (CI, 0.867–0.977, p < .001) for the differentiation of patients who sustained osteoporosis-associated fractures within 2 years of BMD assessment. Conclusions: Retrospective DECT-based volumetric BMD assessment can accurately predict the 2-year risk to sustain an osteoporosis-associated fracture in at-risk patients without requiring a calibration phantom. Lower DECT-based BMD values are strongly associated with an increased risk to sustain fragility fractures.
Key Points: Dual-energy CT–derived assessment of bone mineral density can identify patients at risk to sustain osteoporosis-associated fractures with a sensitivity of 85.45% and a specificity of 89.19%. The DECT-derived BMD threshold for identification of at-risk patients lies above the American College of Radiology (ACR) QCT guidelines for the identification of osteoporosis (93.70 mg/cm 3 vs 80 mg/cm 3 ).
Objectives: To investigate the diagnostic accuracy of color-coded contrast-enhanced dual-energy CT virtual noncalcium (VNCa) reconstructions for the assessment of lumbar disk herniation compared to unenhanced VNCa imaging.
Methods: A total of 91 patients were retrospectively evaluated (65 years ± 16; 43 women) who had undergone third-generation dual-source dual-energy CT and 3.0-T MRI within an examination interval up to 3 weeks between November 2019 and December 2020. Eight weeks after assessing unenhanced color-coded VNCa reconstructions for the presence and degree of lumbar disk herniation, corresponding contrast-enhanced portal venous phase color-coded VNCa reconstructions were independently analyzed by the same five radiologists. MRI series were additionally analyzed by one highly experienced musculoskeletal radiologist and served as reference standard.
Results: MRI depicted 210 herniated lumbar disks in 91 patients. VNCa reconstructions derived from contrast-enhanced CT scans showed similar high overall sensitivity (93% vs 95%), specificity (94% vs 95%), and accuracy (94% vs 95%) for the assessment of lumbar disk herniation compared to unenhanced VNCa images (all p > .05). Interrater agreement in VNCa imaging was excellent for both, unenhanced and contrast-enhanced CT (κ = 0.84 vs κ = 0.86; p > .05). Moreover, ratings for diagnostic confidence, image quality, and noise differed not significantly between unenhanced and contrast-enhanced VNCa series (all p > .05).
Conclusions: Color-coded VNCa reconstructions derived from contrast-enhanced dual-energy CT yield similar diagnostic accuracy for the depiction of lumbar disk herniation compared to unenhanced VNCa imaging and therefore may improve opportunistic retrospective lumbar disk herniation assessment, particularly in case of staging CT examinations.
Key Points
• Color-coded dual-source dual-energy CT virtual noncalcium (VNCa) reconstructions derived from portal venous phase yield similar high diagnostic accuracy for the assessment of lumbar disk herniation compared to unenhanced VNCa CT series (94% vs 95%) with MRI serving as a standard of reference.
• Diagnostic confidence, image quality, and noise levels differ not significantly between unenhanced and contrast-enhanced portal venous phase VNCa dual-energy CT series.
• Dual-source dual-energy CT might have the potential to improve opportunistic retrospective lumbar disk herniation assessment in CT examinations performed for other indications through reconstruction of VNCa images.
To analyze prospectively the interventional and clinical aspects of computed tomography-guided direct intratumoural injection of a novel chemotherapeutic administration and the parenchymal changes of tumour and necrosis in malignant liver tumours. Eight patients with 17 colorectal liver metastases were treated with a mean of 5.1 injections and nine patients with 13 hepatocellular carcinoma nodules with a mean of 3.1 treatments with computed tomography guided local applications of a novel cisplatin/epinephrine gel. This application provides a higher local and lower systemic drug concentration. Volumes of tumour and necrosis prior and after treatment were measured by computer generated volumetric analysis. Contrast enhanced studies verified pretherapeutic viable tumour volumes with a value of 77.4 ml in the metastases and 29.2 ml in the hepatocellular carcinoma nodules. Intratumoural drug application resulted in a significant increase of necrosis and a decrease in viable tumour volume to be 68.3 ml in metastases and 14.5 ml in hepatocellular carcinoma. Local therapy control rate for the follow up to 6 months was 38 and 71% for the group of metastases and hepatocellular carcinoma, respectively. Direct intratumoural injection of cisplatin/epinepthrine injectable gel is a feasible and good tolerated method and results in the development of a statistically significant increase in necrosis in malignant liver tumours. For hepatocellular carcinoma a higher local therapy control rate compared to colorectal metastases can be reported.