Publications

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2014
Reis, T., E. Sperk, Y. Abo-Madyan, M. Ehmann, F. Bludau, and F. Wenz, "Targeted Intraoperative Radiotherapy in Oncology - Other Applications of INTRABEAM®", Targeted Intraoperative Radiotherapy in Oncology: Springer Berlin Heidelberg, pp. 93–104, 2014. Abstractiort-intrabeam_springer.pdf

Intraoperative radiotherapy (IORT) permits the delivery of a high radiation dose directly to the residual tumour or tumour bed while sparing nearby normal tissues. In most cases, IORT with the INTRABEAM® system is employed as a part of multimodal treatment, with the aim of providing an additional benefit in terms of prevention of local recurrence. IORT is used to treat many tumours, the most common being:

locally advanced or recurrent colorectal cancer

soft tissue sarcomas

stomach and pancreatic cancers

primary or recurrent gynaecological cancers

head and neck tumours

New fields of application are the treatment of symptomatic vertebral metastases, for which purpose IORT is employed in combination with balloon kyphoplasty (“kypho-IORT”), and intravaginal X-ray brachytherapy. A variety of applicators have been designed for the different treatments

Abo-Madyan, Y., H. Wertz, S. Mai, and F. Wenz, "Advantage of ultrasound-based over CT-based image guidance in the treatment of mesenteric NHL: a case report", STRAHLENTHERAPIE UND ONKOLOGIE, vol. 190: URBAN & VOGEL NEUMARKTER STRASSE 43, D-81673 MUNICH, GERMANY, pp. 96–96, 2014. Abstract
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Abo-Madyan, Y., M. M. Aly, L. Jahnke, F. Wenz, and G. Glatting, "Breast Radiation Therapy (RT) Using Simultaneous Integrated Boost (SIB): Which Is the Optimal Intensity Modulated RT (IMRT) Technique?", International Journal of Radiation Oncology• Biology• Physics, vol. 90, no. 1: Elsevier, pp. S227–S228, 2014. Abstract
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Aboumadian, A. Y., O. Aldabbas, M. Polednik, G. Welzel, and F. Wenz, "Cosmetic Differences after Hypofractionated & Normofractionated Intensity Modulated Radiotherapy in Breast Cancer Patients: An Interim Analysis of the Phase II KOSIMA-Trial (ARO 2010-3)", ONCOLOGY RESEARCH AND TREATMENT, vol. 37: KARGER ALLSCHWILERSTRASSE 10, CH-4009 BASEL, SWITZERLAND, pp. 15–15, 2014. Abstract
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Chandrasekaran, J., L. Jahnke, G. Glatting, F. Wenz, and Y. Abo-Madyan, "Image guided tangential IMRT for breast cancer radiotherapy: An analysis of different cone-beam-CT matching strategies and their possible effect on the dose distribution", STRAHLENTHERAPIE UND ONKOLOGIE, vol. 190: URBAN & VOGEL NEUMARKTER STRASSE 43, D-81673 MUNICH, GERMANY, pp. 55–55, 2014. Abstract
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Giordano, F. A., S. Brehmer, F. Schneider, S. Clausen, G. Welzel, M. Seitz-Rosenhagen, P. Schmiedek, Y. Abo-Madyan, and F. Wenz, "INTRAGO-Intraoperative Radiotherapy for Glioblastoma-a phase I/II study", ONCOLOGY RESEARCH AND TREATMENT, vol. 37: KARGER ALLSCHWILERSTRASSE 10, CH-4009 BASEL, SWITZERLAND, pp. 25–25, 2014. Abstract
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Giordano, F. A., S. Brehmer, Y. Abo-Madyan, G. Welzel, E. Sperk, A. Keller, F. Schneider, S. Clausen, C. Herskind, P. Schmiedek, et al., "INTRAGO: intraoperative radiotherapy in glioblastoma multiforme-a Phase I/II dose escalation study", BMC cancer, vol. 14, no. 1: BioMed Central Ltd, pp. 992, 2014. Abstract
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Giordano, F. A., Y. Abo-Madyan, S. Brehmer, C. Herskind, and F. Wenz, "Intraoperative radiotherapy (IORT)—a resurrected option for treating glioblastoma?", Translational Cancer Research, vol. 3, no. 1: Pioneer Bioscience Publishing Company, pp. 94–105, 2014. Abstract
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Schneider, F., S. Clausen, J. Thölking, F. Wenz, and Y. Abo-Madyan, "A novel approach for superficial intraoperative radiotherapy (IORT) using a 50 kV X-ray source: a technical and case report", Journal of Applied Clinical Medical Physics, vol. 15, no. 1, 2014. Abstract
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Lohr, F., D. Georg, L. Cozzi, H. T. Eich, D. C. Weber, J. Koeck, B. Knäusl, K. Dieckmann, Y. Abo-Madyan, C. Fiandra, et al., "Novel radiotherapy techniques for involved-field and involved-node treatment of mediastinal Hodgkin lymphoma", Strahlentherapie und Onkologie, vol. 190, no. 10: Springer Berlin Heidelberg, pp. 864–871, 2014. Abstract
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Abo-Madyan, Y., M. H. Aziz, M. M. O. M. Aly, F. Schneider, E. Sperk, S. Clausen, F. A. Giordano, C. Herskind, V. Steil, F. Wenz, et al., "Second cancer risk after 3D-CRT, IMRT and VMAT for breast cancer", Radiotherapy and Oncology, vol. 110, no. 3: Elsevier, pp. 471–476, 2014. Abstract
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Aly, M. M. O. M., G. Glatting, L. Jahnke, F. Wenz, and Y. Abo-Madyan, "Simultaneous integrated boost for breast cancer radiotherapy: a planning study comparing different IMRT techniques", STRAHLENTHERAPIE UND ONKOLOGIE, vol. 190: URBAN & VOGEL NEUMARKTER STRASSE 43, D-81673 MUNICH, GERMANY, pp. 114–114, 2014. Abstract
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2013
Shelan, M., Y. Abo-Madyan, G. Welzel, C. Bolenz, J. Kosakowski, N. Behnam, F. Wenz, and F. Lohr, "Dose-escalated salvage radiotherapy after radical prostatectomy in high risk prostate cancer patients without hormone therapy: outcome, prognostic factors and late toxicity", Radiation Oncology, vol. 8, no. 1: BioMed Central Ltd, pp. 276, 2013. AbstractWebsite

Purpose

Evaluation of dose escalated salvage radiotherapy (SRT) in patients after radical prostatectomy (RP) who had never received antihormonal therapy. To investigate prognostic factors of the outcome of SRT and to analyze which patient subsets benefit most from dose escalation.

Materials and methods

Between 2002 and 2008, 76 patients were treated in three different dose-groups: an earlier cohort treated with 66 Gy irrespective of pre-RT-characteristics and two later cohorts treated with 70 Gy or 75 Gy depending on pre-RT-characteristics. Biochemical-relapse-free-survival (bRFS), clinical-relapse-free-survival (cRFS) and late toxicity were evaluated.

Results

Four-year bRFS and cRFS were 62.5% and 85%. Gleason score <8, positive surgical resection margin (PSRM) and low PSA (≤0.5 ng/ml) before SRT resulted in higher bRFS. Analysis of the whole group showed no clear dose-outcome relationship. Patients with PSRM, however, had improved bRFS when escalating >66 Gy. While > 70 Gy did not improve the overall results, 4-year bRFS for patients with manifest local recurrence in the high-dose group was still comparable to those without manifest local recurrences. No grade 4 and minimal grade 3 gastrointestinal and urinary toxicity were observed.

Conclusions

Dose-escalated SRT achieves high biochemical control. The data strongly support the application of at least 70 Gy rather than 66 Gy. They do not prove positive effects of doses >70 Gy but do not disprove them as these doses were only applied to an unfavorable patients selection.

Keywords:
Radical prostatectomy; Salvage radiotherapy; Dose escalation

Harth, S., Y. Abo-Madyan, L. Zheng, K. Siebenlist, C. Herskind, F. Wenz, and F. A. Giordano, "Estimation of intracranial failure risk following hippocampal-sparing whole brain radiotherapy", Radiotherapy and Oncology, vol. 109, no. 1: Elsevier, pp. 152–158, 2013. AbstractWebsite

Purpose

To estimate the risk of undertreatment in hippocampal-sparing whole brain radiotherapy (HS-WBRT).

Methods

Eight hundred and fifty six metastases were contoured together with the hippocampi in cranial MRIs of 100 patients. For each metastasis, the distance to the closest hippocampus was calculated. Treatment plans for 10 patients were calculated and linear dose profiles were established. For SCLC and NSCLC, dose–response curves were created based on data from studies on prophylactic cranial irradiation, allowing estimating the risk for intracranial failure.

Results

Only 0.4% of metastases were located inside a hippocampus in 3% of all patients. SCLC showed a relatively high rate of hippocampal metastasis (18.2% of all SCLC patients) and HS-WBRT in a commonly applied fractionation scheme would increase the risk for brain relapse by ∼4% compared to conventional WBRT. NSCLC showed a lower rate of brain metastasis in the hippocampi (2.8%) and HS-WBRT would account for a slightly increased absolute risk of 0.2%.

Conclusions

Prophylactic or therapeutic HS-WBRT is expected to be associated with a low risk of undertreatment. For SCLC, it bears a minimally elevated risk of failure compared to standard WBRT. In NSCLC, HS-WBRT is most likely not associated with a clinically relevant increase in risk of failure.

Keywords

Brain metastasis;
Hippocampal-sparing whole brain radiotherapy;
Whole brain radiotherapy;
Prophylactic cranial irradiation

1 These authors contributed equally to this work.

Abo-Madyan, Y., O. Aldabbas, M. Polednik, G. Welzel, and F. Wenz, "Vergleich des kosmetischen Ergebnisses von hypofraktionierter (HF) und normofraktionierter (NF) intensitätsmodulierte Bestrahlung (IMRT) beim Mammakarzinom (KOSIMA Studie)", Senologie-Zeitschrift für Mammadiagnostik und-therapie, vol. 10, no. 02, Munich, pp. A1, 2013. Abstract

Fragestellung: Zwischenbericht und erste Ergebnisse aus einer Prospektivstudie 1 und 6 Wochen nach Bestrahlungsende.

Methoden: 80 Brustkrebs-Patientinnen ≥60 Jahre wurden in zwei Gruppen stratifiziert: n=43 wurden mit 40Gy/2,67Gy in 3 Wochen bei rechtsseitigem Mamma-Ca und n=37 mit 50Gy/2Gy in 5 Wochen bei linksseitigem Mamma-Ca behandelt. Alle Bestrahlungen wurden als tangentiale IMRT (tIMRT) durchgeführt. Für Patientinnen ≤70 Jahre wurde ein 16Gy/2Gy Tumorbettboost appliziert. Basierend auf CTC-AEv3 und LENT-SOMA Skalen wurden Nebenwirkungen prospektiv dokumentiert.

Ergebnisse:
Medianes Alter: 69 Jahre, durchschnittliche Brustgröße: 1105ccm (HF) vs. 1147ccm (NF), Chemotherapie: 14% (HF) vs. 11% (NF). Die Inzidenz für eine akute Grad 2 Dermatitis lag in Woche 1 bei 12% (HF) vs. 11% (NF). In Woche 6 wurden nur Grad 1 Dermatitiden beobachtet: 20% (HF) vs. 16% (NF). Hyperpigmentierungen und Brustödeme waren weniger häufig nach HF als NF (40% vs. 57% bzw. 23% vs. 32%). Retraktionen der behandelten Mamma nahmen von 8% vor Behandlungsbeginn auf 21% (HF) und 16% (NF) in Woche 1 zu; in Woche 6 lag die Rate bei 16% (HF) vs. 19% (NF). Brustschmerzen Grad 2 wurden in Woche 1 bei 12% und in Woche 6 bei 6% der Patientinnen in beiden Gruppen beobachtet. Grad 3 Brustschmerzen wurden bei jeweils einer Patientin dokumentiert.

Fazit: Die tIMRT als Teil der brusterhaltenden Therapie ist mit geringen akuten Nebenwirkungen verbunden. In der frühen posttherapeutischen Phase war die hypofraktionierte Behandlung im Vergleich zur normofraktionierten Behandlung tendenziell besser verträglich.

Abo-Madyan, Y., O. Aldabbas, M. Polednik, G. Welzel, and F. Wenz, "Cosmetic Outcome of Hypofractionated Breast Cancer Intensity Modulated Radiation Therapy: A Preliminary Report of a Prospective Trial", International Journal of Radiation Oncology* Biology* Physics, vol. 87, no. 2: Elsevier, pp. S213–S213, 2013. Abstract
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Abo-Madyan, Y., U. Goessler, J. Vent, C. Nwankwo, F. Schneider, K. Hoermann, and F. Wenz, "Intraoperative radiotherapy (IORT) for recurrent head and neck squamous cell carcinoma (SCC) using a mobile 50 kilovoltage (KV) mini-accelerator", STRAHLENTHERAPIE UND ONKOLOGIE, vol. 189: URBAN & VOGEL NEUMARKTER STRASSE 43, D-81673 MUNICH, GERMANY, pp. 99–100, 2013. Abstract
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Harth, S., L. Zheng, Y. Abo-Madyan, F. Wenz, and F. A. Giordano, "Mapping of Brain Metastases to Evaluate the Risk of Hippocampus-Sparing Prophylactic and Therapeutic Cranial Irradiation", International Journal of Radiation Oncology, Biology, Physics, vol. 87, no. 2 Supplement: Elsevier Science, pp. S103–S104, 2013. Abstract
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Harth, S., L. Zheng, Y. Abo-Madyan, J. Hesser, F. Wenz, and F. A. Giordano, "Mapping of Brain metastasis to estimate the Risk of a Hippocampus conservation for prophylactic and therapeutic Entire Brain Irradiation", STRAHLENTHERAPIE UND ONKOLOGIE, vol. 189: URBAN & VOGEL NEUMARKTER STRASSE 43, D-81673 MUNICH, GERMANY, pp. 24–24, 2013. Abstract
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Abo-Madyan, Y., M. H. Aziz, F. Schneider, E. Sperk, S. Clausen, C. Herskind, V. Steil, M. Afzal, F. Wenz, and G. Glatting, "Second Cancer Risk in Breast Cancer after Treatment with 3DCRT, IMRT and VMAT", STRAHLENTHERAPIE UND ONKOLOGIE, vol. 189: URBAN & VOGEL NEUMARKTER STRASSE 43, D-81673 MUNICH, GERMANY, pp. 139–139, 2013. Abstract
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2012
Giordano, F. A., G. Welzel, Y. Abo-Madyan, and F. Wenz, "Potential toxicities of prophylactic cranial irradiation", Translational Lung Cancer Research, vol. 1, no. 4, pp. 254–262, 2012. AbstractWebsite

Prophylactic cranial irradiation (PCI) with total doses of 20-30 Gy reduces the incidence of brain metastasis (BM) and increases survival of patients with limited and extensive-disease small-cell lung cancer (SCLC) that showed any response to chemotherapy. PCI is currently not applied in non-small-cell lung cancer (NSCLC) since it has not proven to significantly improve OS rates in stage IIIA/B, although novel data suggest that subgroups that could benefit may exist.
Here we briefly review potential toxicities of PCI which have to be considered before prescribing PCI. They are mostly difficult to delineate from pre-existing risk factors which include preceding chemotherapy, patient age, paraneoplasia, as well as smoking or atherosclerosis. On the long run, this will force radiation oncologists to evaluate each patient separately and to estimate the individual risk. Where PCI is then considered to be of benefit, novel concepts, such as intensity-modulated radiotherapy and/or neuroprotective drugs with potential to lower the rates of side effects will eventually be superior to conventional therapy. This in turn will lead to a re-evaluation whether benefits might then outweigh the (lowered) risks.

Koeck, J., Y. Abo-Madyan, F. Lohr, F. Stieler, J. Kriz, R. - P. Mueller, F. Wenz, and H. T. Eich, "Radiotherapy for early mediastinal Hodgkin lymphoma according to the German Hodgkin Study Group (GHSG): the roles of intensity-modulated radiotherapy and involved-node radiotherapy", International Journal of Radiation Oncology* Biology* Physics, vol. 83, no. 1: Elsevier, pp. 268–276, 2012. AbstractWebsite

Purpose

Cure rates of early Hodgkin lymphoma (HL) are high, and avoidance of late complications and second malignancies have become increasingly important. This comparative treatment planning study analyzes to what extent target volume reduction to involved-node (IN) and intensity-modulated (IM) radiotherapy (RT), compared with involved-field (IF) and three-dimensional (3D) RT, can reduce doses to organs at risk (OAR).

Methods and Materials

Based on 20 computed tomography (CT) datasets of patients with early unfavorable mediastinal HL, we created treatment plans for 3D-RT and IMRT for both the IF and IN according to the guidelines of the German Hodgkin Study Group (GHSG). As OAR, we defined heart, lung, breasts, and spinal cord. Dose–volume histograms (DVHs) were evaluated for planning target volumes (PTVs) and OAR.

Results

Average IF-PTV and IN-PTV were 1705 cm3 and 1015 cm3, respectively. Mean doses to the PTVs were almost identical for all plans. For IF-PTV/IN-PTV, conformity was better with IMRT and homogeneity was better with 3D-RT. Mean doses to the heart (17.94/9.19 Gy for 3D-RT and 13.76/7.42 Gy for IMRT) and spinal cord (23.93/13.78 Gy for 3D-RT and 19.16/11.55 Gy for IMRT) were reduced by IMRT, whereas mean doses to lung (10.62/8.57 Gy for 3D-RT and 12.77/9.64 Gy for IMRT) and breasts (left 4.37/3.42 Gy for 3D-RT and 6.04/4.59 Gy for IMRT, and right 2.30/1.63 Gy for 3D-RT and 5.37/3.53 Gy for IMRT) were increased. Volume exposed to high doses was smaller for IMRT, whereas volume exposed to low doses was smaller for 3D-RT. Pronounced benefits of IMRT were observed for patients with lymph nodes anterior to the heart. IN-RT achieved substantially better values than IF-RT for almost all OAR parameters, i.e., dose reduction of 20% to 50%, regardless of radiation technique.

Conclusions

Reduction of target volume to IN most effectively improves OAR sparing, but is still considered investigational. For the time being, IMRT should be considered for large PTVs especially when the anterior mediastinum is involved.

Keywords

Hodgkin lymphoma;
Intensity-modulated radiotherapy;
Involved-node;
Involved-field;
Mediastinum

J.K. and Y.A. contributed equally to this article.

Wenz, F., Y. Abo-Madyan, G. Welzel, and F. A. Giordano, "ABVD vs. radiotherapy in early stage Hodgkin’s lymphoma", Strahlentherapie und Onkologie, vol. 188, no. 8: Urban & Vogel, pp. 649, 2012. Abstract
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Koeck, J., Y. Abo-Madyan, H. T. Eich, F. Stieler, J. Fleckenstein, J. Kriz, R. - P. Mueller, F. Wenz, and F. Lohr, "Clinical relevance of different dose calculation strategies for mediastinal IMRT in Hodgkin’s disease", Strahlentherapie und Onkologie, vol. 188, no. 8: Springer, pp. 653–659, 2012. Abstract
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Simeonova, A., Y. Abo-Madyan, M. El-Haddad, G. Welzel, M. Polednik, R. Boggula, F. Wenz, and F. Lohr, "Comparison of anisotropic aperture based intensity modulated radiotherapy with 3D-conformal radiotherapy for the treatment of large lung tumors", Radiotherapy and Oncology, vol. 102, no. 2: Elsevier, pp. 268–273, 2012. Abstract
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