DEGRO practical guideline for central nervous system radiation necrosis part 1: classification and a multistep approach for diagnosis.

Bevacizumab Central Nervous System Humans Necrosis Radiation Injuries / diagnosis Radiation Oncology
Bevacizumab Brain metastases Glioma Radioation necrosis Reirradiation

Journal

Strahlentherapie und Onkologie : Organ der Deutschen Rontgengesellschaft ... [et al]
ISSN: 1439-099X
Titre abrégé: Strahlenther Onkol
Pays: Germany
ID NLM: 8603469

Informations de publication

Date de publication:
10 2022
Historique:
received: 09 06 2022
accepted: 19 07 2022
pubmed: 30 8 2022
medline: 30 9 2022
entrez: 29 8 2022
Statut: ppublish

Résumé

The Working Group for Neuro-Oncology of the German Society for Radiation Oncology in cooperation with members of the Neuro-Oncology Working Group of the German Cancer Society aimed to define a practical guideline for the diagnosis and treatment of radiation-induced necrosis (RN) of the central nervous system (CNS). Panel members of the DEGRO working group invited experts, participated in a series of conferences, supplemented their clinical experience, performed a literature review, and formulated recommendations for medical treatment of RN including bevacizumab in clinical routine. Diagnosis and treatment of RN requires multidisciplinary structures of care and defined processes. Diagnosis has to be made on an interdisciplinary level with the joint knowledge of a neuroradiologist, radiation oncologist, neurosurgeon, neuropathologist, and neuro-oncologist. A multistep approach as an opportunity to review as many characteristics as possible to improve diagnostic confidence is recommended. Additional information about radiotherapy (RT) techniques is crucial for the diagnosis of RN. Misdiagnosis of untreated and progressive RN can lead to severe neurological deficits. In this practice guideline, we propose a detailed nomenclature of treatment-related changes and a multistep approach for their diagnosis.

Identifiants

DOI: 10.1007/s00066-022-01994-3 PMID: 36038669 PMC: PMC9515024
pubmed: 36038669
doi: 10.1007/s00066-022-01994-3
pii: 10.1007/s00066-022-01994-3
pmc: PMC9515024
doi:

Substances chimiques

Bevacizumab 2S9ZZM9Q9V

Types de publication

Journal Article Review

Langues

eng

Sous-ensembles de citation

IM

Pagination

873-883

Informations de copyright

© 2022. The Author(s).

Références

Mahajan A et al (2017) Post-operative stereotactic radiosurgery versus observation for completely resected brain metastases: A single-centre, randomised, controlled, phase 3 trial. Lancet Oncol 18:1040–1048
pubmed: 28687375 pmcid: 5560102 doi: 10.1016/S1470-2045(17)30414-X
Yamamoto M et al (2014) Stereotactic radiosurgery for patients with multiple brain metastases (JLGK0901): A multi-institutional prospective observational study. Lancet Oncol 15:387–395
pubmed: 24621620 doi: 10.1016/S1470-2045(14)70061-0
Rusthoven CG et al (2020) Evaluation of first-line radiosurgery vs whole-brain radiotherapy for small cell lung cancer brain metastases: The FIRE-SCLC cohort study. JAMA Oncol 6:1028–1037
pubmed: 32496550 pmcid: 7273318 doi: 10.1001/jamaoncol.2020.1271
Wick W et al (2019) N2M2 (NOA-20) phase I/II trial of molecularly matched targeted therapies plus radiotherapy in patients with newly diagnosed non-MGMT hypermethylated glioblastoma. Neuro Oncol 21:95–105
pubmed: 30277538 doi: 10.1093/neuonc/noy161
Combs SE et al (2010) Randomized phase II study evaluating a carbon ion boost applied after combined radiochemotherapy with temozolomide versus a proton boost after radiochemotherapy with temozolomide in patients with primary glioblastoma: The CLEOPATRA Trial. BMC Cancer. https://doi.org/10.1186/1471-2407-10-478
doi: 10.1186/1471-2407-10-478 pubmed: 21062428 pmcid: 2996393
Straube C et al (2018) Adjuvant stereotactic fractionated radiotherapy to the resection cavity in recurrent glioblastoma—the GlioCave study (NOA 17—ARO 2016/3—DKTK ROG trial). BMC Cancer. https://doi.org/10.1186/s12885-017-3928-7
doi: 10.1186/s12885-017-3928-7 pubmed: 30241469 pmcid: 6151028
Dixit KS et al (2021) A multi-center prospective study of re-irradiation with bevacizumab and temozolomide in patients with bevacizumab refractory recurrent high-grade gliomas. J Neurooncol. https://doi.org/10.1007/S11060-021-03875-8
doi: 10.1007/S11060-021-03875-8 pubmed: 34689306
Brandsma D, Stalpers L, Taal W, Sminia P, van den Bent MJ (2008) Clinical features, mechanisms, and management of pseudoprogression in malignant gliomas. Lancet Oncol 9:453–461
pubmed: 18452856 doi: 10.1016/S1470-2045(08)70125-6
Brandsma D, Van Den Bent MJ (2009) Pseudoprogression and pseudoresponse in the treatment of gliomas. Curr Opin Neurol 22:633–638
pubmed: 19770760 doi: 10.1097/WCO.0b013e328332363e
Chao ST et al (2013) Challenges with the diagnosis and treatment of cerebral radiation necrosis. Int J Radiat Oncol Biol Phys 87:449–457
pubmed: 23790775 doi: 10.1016/j.ijrobp.2013.05.015
Leitlinienprogramm Onkologie (Deutsche Krebsgesellschaft, Deutsche Krebshilfe, AWMF): Supportive Therapie bei onkologischen PatientInnen – Langversion 1.3, 2020,AWMF Registernummer: 032/054OL
Nabors LB et al (2020) Central nervous system cancers, version 3.2020, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw 18:1537–1570
pubmed: 33152694 doi: 10.6004/jnccn.2020.0052
Bernhardt D et al (2020) DEGRO Positionspapier Radionekrose. https://www.degro.org/wp-content/uploads/2020/11/20201125_Positionspapier-Bevacizumab.pdf . Accessed 13.02.2022
Ruben JD et al (2006) Cerebral radiation necrosis: incidence, outcomes, and risk factors with emphasis on radiation parameters and chemotherapy. Int J Radiat Oncol Biol Phys 65:499–508
pubmed: 16517093 doi: 10.1016/j.ijrobp.2005.12.002
Zhuang H, Shi S, Yuan Z, Chang JY (2019) Bevacizumab treatment for radiation brain necrosis: Mechanism, efficacy and issues. Mol Cancer. https://doi.org/10.1186/s12943-019-0950-1
doi: 10.1186/s12943-019-0950-1 pubmed: 31349837 pmcid: 6659280
Zhuang H, Yuan X, Yuan Z, Wang P (2017) Indication of Bevacizumab for cerebral radiation necrosis. Recent Pat Anticancer Drug Discov. https://doi.org/10.2174/1574892812666170425124430
doi: 10.2174/1574892812666170425124430 pubmed: 28443515
Melguizo-Gavilanes I, Bruner JM, Guha-Thakurta N, Hess KR, Puduvalli VK (2015) Characterization of pseudoprogression in patients with glioblastoma: is histology the gold standard? J Neurooncol 123:141–150
pubmed: 25894594 pmcid: 4780341 doi: 10.1007/s11060-015-1774-5
Lawrence YR et al (2010) Radiation dose-volume effects in the brain. Int J Radiat Oncol Biol Phys. https://doi.org/10.1016/j.ijrobp.2009.02.091
doi: 10.1016/j.ijrobp.2009.02.091 pubmed: 21095630 pmcid: 2946486
Rahmathulla G, Marko NF, Weil RJ (2013) Cerebral radiation necrosis: A review of the pathobiology, diagnosis and management considerations. J Clin Neurosci 20:485–502
pubmed: 23416129 doi: 10.1016/j.jocn.2012.09.011
Gonzalez J, Kumar AJ, Conrad CA, Levin VA (2007) Effect of bevacizumab on radiation necrosis of the brain. Int J Radiat Oncol Biol Phys 67:323–326
pubmed: 17236958 doi: 10.1016/j.ijrobp.2006.10.010
Emami B et al (1991) Tolerance of normal tissue to therapeutic irradiation. Int J Radiat Oncol Biol Phys 21:109–122
pubmed: 2032882 doi: 10.1016/0360-3016(91)90171-Y
Marks LB et al (2010) Use of normal tissue complication probability models in the clinic. Int J Radiat Oncol Biol Phys 76:S10–S19
pubmed: 20171502 pmcid: 4041542 doi: 10.1016/j.ijrobp.2009.07.1754
Bentzen SM et al (2010) Quantitative Analyses of Normal Tissue Effects in the Clinic (QUANTEC): An introduction to the scientific issues. Int J Radiat Oncol Biol Phys 76:S3–S9
pubmed: 20171515 pmcid: 3431964 doi: 10.1016/j.ijrobp.2009.09.040
Berberich A et al (2018) Nonmeasurable speckled contrast-enhancing lesions appearing during course of disease are associated with IDH mutation in high-grade astrocytoma patients. Int J Radiat Oncol Biol Phys 102:1472–1480
pubmed: 30071292 doi: 10.1016/j.ijrobp.2018.07.2004
Yuan T et al (2021) New enhancement beyond radiation field improves survival prediction in patients with post-treatment high-grade glioma. J Oncol 9437090:2021
Held T et al (2019) Clinical management of blood-brain barrier disruptions after active raster-scanned carbon ion re-radiotherapy in patients with recurrent head-and-neck cancer. Cancers (Basel) 11(3):383
doi: 10.3390/cancers11030383
Minniti G et al (2011) Stereotactic radiosurgery for brain metastases: Analysis of outcome and risk of brain radionecrosis. Radiat Oncol. https://doi.org/10.1186/1748-717x-6-48
doi: 10.1186/1748-717x-6-48 pubmed: 22136376 pmcid: 3275813
Mayer R, Sminia P (2008) Reirradiation tolerance of the human brain. Int J Radiat Oncol Biol Phys 70:1350–1360
pubmed: 18037587 doi: 10.1016/j.ijrobp.2007.08.015
Campos B et al (2020) Analysis of a surgical series of 21 cerebral radiation necroses. World Neurosurg 137:e462–e469
pubmed: 32058117 doi: 10.1016/j.wneu.2020.02.005
Chambless LB, Angel FB, Abel TW, Xia F, Weaver KD (2010) Delayed cerebral radiation necrosis following treatment for a plasmacytoma of the skull. Surg Neurol Int 1:65
pubmed: 21125009 pmcid: 2980905 doi: 10.4103/2152-7806.71984
Furuse M, Nonoguchi N, Kawabata S, Miyatake SI, Kuroiwa T (2015) Delayed brain radiation necrosis: Pathological review and new molecular targets for treatment. Med Mol Morphol 48:183–190
pubmed: 26462915 doi: 10.1007/s00795-015-0123-2
Connor M et al (2016) Dose-dependent white matter damage after brain radiotherapy. Radiother Oncol 121:209
pubmed: 27776747 pmcid: 5136508 doi: 10.1016/j.radonc.2016.10.003
Walker AJ et al (2014) Postradiation imaging changes in the CNS: How can we differentiate between treatment effect and disease progression? Future Oncol 10:1277
pubmed: 24947265 doi: 10.2217/fon.13.271
Raschke F et al (2020) Dose dependent cerebellar atrophy in glioma patients after radio(chemo)therapy. Radiother Oncol 150:262–267
pubmed: 32739316 doi: 10.1016/j.radonc.2020.07.044
Holdhoff M et al (2019) The consistency of neuropathological diagnoses in patients undergoing surgery for suspected recurrence of glioblastoma. J Neurooncol 141:347–354
pubmed: 30414096 doi: 10.1007/s11060-018-03037-3
Garcia GCTE, Dhermain F (2020) Pseudoprogression in gliomas: The use of advanced MRI for treatment decisions. Curr Treat Options Neurol 22:1–9
doi: 10.1007/s11940-020-00630-8
van Dijken BRJ, van Laar PJ, Holtman GA, van der Hoorn A (2017) Diagnostic accuracy of magnetic resonance imaging techniques for treatment response evaluation in patients with high-grade glioma, a systematic review and meta-analysis. Eur Radiol 27:4129–4144
pubmed: 28332014 pmcid: 5579204 doi: 10.1007/s00330-017-4789-9
Rowe LS et al (2018) Differentiating pseudoprogression from true progression: analysis of radiographic, biologic, and clinical clues in GBM. J Neurooncol 139:145–152
pubmed: 29767308 pmcid: 7983158 doi: 10.1007/s11060-018-2855-z
Kessler AT, Bhatt AA (2018) Brain tumour post-treatment imaging and treatment-related complications. Insights Imaging 9:1057
pubmed: 30411280 pmcid: 6269328 doi: 10.1007/s13244-018-0661-y
Thust SC, van den Bent MJ, Smits M (2018) Pseudoprogression of brain tumors. J Magn Reson Imaging 48:571
pmcid: 6175399 doi: 10.1002/jmri.26171
Sawlani V et al (2012) Magnetic resonance spectroscopy for differentiating pseudo-progression from true progression in GBM on concurrent chemoradiotherapy. Neuroradiol J 25:575–586
pubmed: 24029093 doi: 10.1177/197140091202500511
Okada H et al (2015) Immunotherapy Response Assessment in Neuro-Oncology (iRANO): A report of theRANO working group. Lancet Oncol 16:e534
pubmed: 26545842 pmcid: 4638131 doi: 10.1016/S1470-2045(15)00088-1
Wen PY et al (2010) Updated response assessment criteria for high-grade gliomas: Response assessment in neuro-oncology working group. J Clin Oncol 28:1963–1972
pubmed: 20231676 doi: 10.1200/JCO.2009.26.3541
Brandes AA et al (2008) Disease progression or pseudoprogression after concomitant radiochemotherapy treatment: Pitfalls in neurooncology. Neuro Oncol 10:361
pubmed: 18401015 pmcid: 2563059 doi: 10.1215/15228517-2008-008
Kowalski ES et al (2020) Immune checkpoint inhibition in patients treated with stereotactic radiation for brain metastases. Radiat Oncol 15:1–10
doi: 10.1186/s13014-020-01644-x
Galldiks N et al (2020) Imaging challenges of immunotherapy and targeted therapy in patients with brain metastases: Response, progression, and pseudoprogression. Neuro Oncol 22:17–20
pubmed: 31437274 doi: 10.1093/neuonc/noz147
Niyazi M et al (2011) FET-PET for malignant glioma treatment planning. Radiother Oncol 99:44–48
pubmed: 21458093 doi: 10.1016/j.radonc.2011.03.001
Munck Af Rosenschold P et al (2015) Impact of [18F]-fluoro-ethyl-tyrosine PET imaging on target definition for radiation therapy of high-grade glioma. Neuro Oncol 17:757–763
pubmed: 25537018 doi: 10.1093/neuonc/nou316
Langen KJ, Galldiks N, Hattingen E, Shah NJ (2017) Advances in neuro-oncology imaging. Nat Rev Neurol 13:279–289
pubmed: 28387340 doi: 10.1038/nrneurol.2017.44
Langen KJ, Watts C (2016) Amino acid PET for brain tumours—Ready for the clinic? Nat Rev Neurol 12:375–376
pubmed: 27282652 doi: 10.1038/nrneurol.2016.80
Galldiks N et al (2015) The use of dynamic O‑(2-18F-fluoroethyl)-l-tyrosine PET in the diagnosis of patients with progressive and recurrent glioma. Neuro Oncol 17:1293–1300
pubmed: 26008606 pmcid: 4588758
Unterrainer M et al (2020) Recent advances of PET imaging in clinical radiation oncology. Radiat Oncol. https://doi.org/10.1186/s13014-020-01519-1
doi: 10.1186/s13014-020-01519-1 pubmed: 32317029 pmcid: 7171749
Albert NL et al (2016) Response Assessment in Neuro-Oncology working group and European Association for Neuro-Oncology recommendations for the clinical use of PET imaging in gliomas. Neuro Oncol 18:1199–1208
pubmed: 27106405 pmcid: 4999003 doi: 10.1093/neuonc/now058
Pyka T et al (2018) Diagnosis of glioma recurrence using multiparametric dynamic 18F-fluoroethyl-tyrosine PET-MRI. Eur J Radiol 103:32–37
pubmed: 29803382 doi: 10.1016/j.ejrad.2018.04.003
Werner JM et al (2019) Differentiation of treatment-related changes from tumour progression: A direct comparison between dynamic FET PET and ADC values obtained from DWI MRI. Eur J Nucl Med Mol Imaging 46:1889–1901
pubmed: 31203420 doi: 10.1007/s00259-019-04384-7
Galldiks N et al (2015) Diagnosis of pseudoprogression in patients with glioblastoma using O‑(2-[18F]fluoroethyl)-L-tyrosine PET. Eur J Nucl Med Mol Imaging 42:685–695
pubmed: 25411133 doi: 10.1007/s00259-014-2959-4
Mihovilovic MI et al (2019) O‑(2-( 18 F)fluoroethyl)-L-tyrosine PET for the differentiation of tumour recurrence from late pseudoprogression in glioblastoma. J Neurol Neurosurg Psychiatry 90:238–239
pubmed: 29705720 doi: 10.1136/jnnp-2017-317155
Law I et al (2019) Joint EANM/EANO/RANO practice guidelines/SNMMI procedure standards for imaging of gliomas using PET with radiolabelled amino acids and [18 F]FDG: version 1.0. Eur J Nucl Med Mol Imaging 46:540–557
pubmed: 30519867 doi: 10.1007/s00259-018-4207-9
Galldiks N et al (2019) PET imaging in patients with brain metastasis-report of the RANO/PET group. Neuro Oncol 21:584–595
doi: 10.1093/neuonc/noz003
Romagna A et al (2016) Suspected recurrence of brain metastases after focused high dose radiotherapy: can [18F]FET- PET overcome diagnostic uncertainties? Radiat Oncol. https://doi.org/10.1186/s13014-016-0713-8
doi: 10.1186/s13014-016-0713-8 pubmed: 27769279 pmcid: 5073742
Lohmann P et al (2018) Combined FET PET/MRI radiomics differentiates radiation injury from recurrent brain metastasis. Neuroimage 20:537
pubmed: 30175040 pmcid: 6118093 doi: 10.1016/j.nicl.2018.08.024
Galldiks N et al (2012) Role of O‑(2-(18)F-fluoroethyl)-L-tyrosine PET for differentiation of local recurrent brain metastasis from radiation necrosis. J Nucl Med 53:1367–1374
pubmed: 22872742 doi: 10.2967/jnumed.112.103325
El Shafie RA et al (2019) Pre-operative versus post-operative radiosurgery of brain metastases—Volumetric and dosimetric impact of treatment sequence and margin concept. Cancers (Basel) 11(3):294
doi: 10.3390/cancers11030294
Brown PD et al (2017) Postoperative stereotactic radiosurgery compared with whole brain radiotherapy for resected metastatic brain disease (NCCTG N107C/CEC·3): a multicentre, randomised, controlled, phase 3 trial. Lancet Oncol 18:1049–1060
pubmed: 28687377 pmcid: 5568757 doi: 10.1016/S1470-2045(17)30441-2
Steidl E et al (2021) Sequential implementation of DSC-MR perfusion and dynamic [ 18 F]FET PET allows efficient differentiation of glioma progression from treatment-related changes. Eur J Nucl Med Mol Imaging 48:1956–1965
pubmed: 33241456 doi: 10.1007/s00259-020-05114-0
Paprottka KJ et al (2021) Fully automated analysis combining [ 18 F]-FET-PET and multiparametric MRI including DSC perfusion and APTw imaging: a promising tool for objective evaluation of glioma progression. Eur J Nucl Med Mol Imaging 48:4445–4455
pubmed: 34173008 pmcid: 8566389 doi: 10.1007/s00259-021-05427-8
Iuchi T et al (2011) Para-ventricular radiation necrosis after radiation therapy for malignant astrocytomas. Int J Radiat Oncol Biol Phys 81:274
doi: 10.1016/j.ijrobp.2011.06.472
Carceller F, Mandeville H, Mackinnon AD, Saran F (2017) Facing pseudoprogression after radiotherapy in low grade gliomas. Transl Cancer Res 6(S2):S254–S258
doi: 10.21037/tcr.2017.03.46
Harrabi SB et al (2022) Radiation induced contrast enhancement after proton beam therapy in patients with low grade glioma—How safe are protons? Radiother Oncol 167:211–218
pubmed: 34973277 doi: 10.1016/j.radonc.2021.12.035
Bahn E et al (2020) Late contrast enhancing brain lesions in proton-treated patients with low-grade glioma: Clinical evidence for increased periventricular sensitivity and variable RBE. Int J Radiat Oncol Biol Phys 107:571–578
pubmed: 32234554 doi: 10.1016/j.ijrobp.2020.03.013
Bauer J et al (2021) How can scanned proton beam treatment planning for low-grade glioma cope with increased distal RBE and locally increased radiosensitivity for late MR-detected brain lesions? Med Phys 48:1497–1507
pubmed: 33506555 doi: 10.1002/mp.14739
Shah R et al (2012) Radiation necrosis in the brain: imaging features and differentiation from tumor recurrence. Radiographics 32:1343–1359
pubmed: 22977022 doi: 10.1148/rg.325125002
McDonald MW, Linton OR, Calley CSJ (2015) Dose-volume relationships associated with temporal lobe radiation necrosis after skull base proton beam therapy. Int J Radiat Oncol Biol Phys 91:261–267
pubmed: 25636754 doi: 10.1016/j.ijrobp.2014.10.011
Uhl M et al (2014) Highly effective treatment of skull base chordoma with carbon ion irradiation using a raster scan technique in 155 patients: First long-term results. Cancer 120:3410–3417
pubmed: 24948519 doi: 10.1002/cncr.28877
Liermann J et al (2018) Advanced radiation techniques in the treatment of esthesioneuroblastoma: a 7‑year single-institution’s clinical experience. Cancers (Basel) 10(11):457
doi: 10.3390/cancers10110457
Seidensaal K, Harrabi SB, Uhl M, Debus J (2020) Re-irradiation with protons or heavy ions with focus on head and neck, skull base and brain malignancies. Br J Radiol 93(1107):20190516
pubmed: 31647306 pmcid: 7066969 doi: 10.1259/bjr.20190516
Kitpanit S et al (2020) Temporal lobe necrosis in head and neck cancer patients after proton therapy to the skull base. Int J Part Ther 6:17
pubmed: 32582816 pmcid: 7302730 doi: 10.14338/IJPT-20-00014.1
Wu VWC, Tam SY (2020) Radiation induced temporal lobe necrosis in nasopharyngeal cancer patients after radical external beam radiotherapy. Radiat Oncol 15:112
pubmed: 32414378 pmcid: 7227265 doi: 10.1186/s13014-020-01560-0
Wang J et al (2019) Development and validation of a model for temporal lobe necrosis for nasopharyngeal carcinoma patients with intensity modulated radiation therapy. Radiat Oncol 14:1–7
pubmed: 30621744 pmcid: 6323842 doi: 10.1186/s13014-019-1250-z
Pehlivan B et al (2012) Temporal lobe toxicity analysis after proton radiation therapy for skull base tumors. Int J Radiat Oncol Biol Phys 83:1432–1440
pubmed: 22349042 doi: 10.1016/j.ijrobp.2011.10.042
Held T et al (2019) Dose-limiting organs at risk in carbon ion re-irradiation of head and neck malignancies: An individual risk-benefit tradeoff. Cancers (Basel) 11(12):2016
doi: 10.3390/cancers11122016
Xu Y et al (2018) Bevacizumab monotherapy reduces radiation-induced brain necrosis in nasopharyngeal carcinoma patients: A randomized controlled trial. Int J Radiat Oncol Biol Phys 101:1087–1095
pubmed: 29885994 doi: 10.1016/j.ijrobp.2018.04.068
Chen L et al (2018) Concurrent immune checkpoint inhibitors and stereotactic radiosurgery for brain metastases in non-small cell lung cancer, melanoma, and renal cell carcinoma. Int J Radiat Oncol Biol Phys 100:916–925
pubmed: 29485071 doi: 10.1016/j.ijrobp.2017.11.041
Martin AM et al (2018) Immunotherapy and symptomatic radiation necrosis in patients with brain metastases treated with stereotactic radiation. JAMA Oncol 4:1123–1124
pubmed: 29327059 pmcid: 5885198 doi: 10.1001/jamaoncol.2017.3993
Kim PH et al (2021) Immune checkpoint inhibitor therapy may increase the incidence of treatment-related necrosis after stereotactic radiosurgery for brain metastases: a systematic review and meta-analysis. Eur Radiol 31:4114–4129
pubmed: 33241519 doi: 10.1007/s00330-020-07514-0

Auteurs

Denise Bernhardt (D)

Klinik und Poliklinik für Radioonkologie und Strahlentherapie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Germany. denise.bernhardt@mri.tum.de.
Partner Sites Munich, Freiburg and Heidelberg, Deutsches Konsortium für Translationale Krebsforschung (DKTK), Heidelberg, Germany. denise.bernhardt@mri.tum.de.
ORCID: 0000-0001-5231-9097

Laila König (L)

Klinik für Radioonkologie und Strahlentherapie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
Heidelberger Ionenstrahltherapie-Zentrum (HIT), Im Neuenheimer Feld 450, 69120, Heidelberg, Germany.
Heidelberg Institute of Radiation Oncology (HIRO), Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany.
National Center for Tumor diseases (NCT), Heidelberg, Germany.

Anca Grosu (A)

Partner Sites Munich, Freiburg and Heidelberg, Deutsches Konsortium für Translationale Krebsforschung (DKTK), Heidelberg, Germany.
Department of Radiation Oncology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Robert-Koch-Str. 3, 79106, Freiburg, Germany.

Benedikt Wiestler (B)

Department of Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University Munich, Munich, Germany.

Stefan Rieken (S)

Clinic of Radiotherapy and Radiation Oncology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany.

Wolfgang Wick (W)

Clinical Cooperation Unit Neurooncology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany.
Department of Neurology and Neurooncology Program, National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany.

Jens Gempt (J)

Department of Neurosurgery, School of Medicine, Klinikum rechts der Isar, Technical University Munich, Munich, Germany.

Sandro M Krieg (SM)

Department of Neurosurgery, School of Medicine, Klinikum rechts der Isar, Technical University Munich, Munich, Germany.

Friederike Schmidt-Graf (F)

Department of Neurology, School of Medicine, Klinikum rechts der Isar, Technical University Munich, Munich, Germany.

Felix Sahm (F)

Department of Neuropathology, University Hospital Heidelberg and CCU Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany.

Bernhard Meyer (B)

Department of Neurosurgery, School of Medicine, Klinikum rechts der Isar, Technical University Munich, Munich, Germany.

Bernd J Krause (BJ)

Department of Nuclear Medicine, Rostock University Medical Centre, Rostock, Germany.

Cordula Petersen (C)

Department of Radiotherapy and Radiation Oncology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.

Rainer Fietkau (R)

Department of Radiation Oncology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.
Comprehensive Cancer Center Erlangen-European Metropolitan Region of Nuremberg (CCC ER-EMN), Erlangen, Germany.

Michael Thomas (M)

Department of Thoracic Oncology, Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany.
Member of the German Center for Lung Research (DZL), Translational Lung Research Center Heidelberg (TLRC-H), Heidelberg, Germany.

Frank Giordano (F)

Department of Radiation Oncology, University Hospital Bonn, Bonn, Germany.

Andrea Wittig-Sauerwein (A)

Department of Radiotherapy and Radiation Oncology, University Hospital Jena, Bachstr. 18, 07743, Jena, Germany.

Jürgen Debus (J)

Partner Sites Munich, Freiburg and Heidelberg, Deutsches Konsortium für Translationale Krebsforschung (DKTK), Heidelberg, Germany.
Klinik für Radioonkologie und Strahlentherapie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
Heidelberger Ionenstrahltherapie-Zentrum (HIT), Im Neuenheimer Feld 450, 69120, Heidelberg, Germany.
Heidelberg Institute of Radiation Oncology (HIRO), Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany.
National Center for Tumor diseases (NCT), Heidelberg, Germany.

Ghazaleh Tabatabai (G)

Department of Neurosurgery, University Hospital Tuebingen, Eberhard Karls University Tuebingen, Tuebingen, Germany.
Center for Neuro-Oncology, Comprehensive Cancer Center Tuebingen Stuttgart, University Hospital Tuebingen, Eberhard Karls University of Tuebingen, Tuebingen, Germany.
Department of Neurology, Eberhard Karls University of Tuebingen, Tuebingen, Germany.
Department Interdisciplinary Neuro-Oncology, Eberhard Karls University of Tuebingen, Tuebingen, Germany.

Peter Hau (P)

Wilhelm Sander-NeuroOncology Unit and Department of Neurology, University Hospital Regensburg, 93053, Regensburg, Germany.

Joachim Steinbach (J)

Dr Senckenberg Institute of Neurooncology, University Hospital, Frankfurt am Main, Germany.

Stephanie E Combs (SE)

Klinik und Poliklinik für Radioonkologie und Strahlentherapie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Germany.
Institute of Radiation Medicine (IRM), Department of Radiation Sciences (DRS), Helmholtz Zentrum München (HMGU), Ingolstädter Landstr. 1, 85764, Oberschleißheim, Germany.
Partner Sites Munich, Freiburg and Heidelberg, Deutsches Konsortium für Translationale Krebsforschung (DKTK), Heidelberg, Germany.

Articles similaires

[Redispensing of expensive oral anticancer medicines: a practical application].

Lisanne N van Merendonk, Kübra Akgöl, Bastiaan Nuijen
1.00
Humans Antineoplastic Agents Administration, Oral Drug Costs Counterfeit Drugs

Smoking Cessation and Incident Cardiovascular Disease.

Jun Hwan Cho, Seung Yong Shin, Hoseob Kim et al.
1.00
Humans Male Smoking Cessation Cardiovascular Diseases Female

Evaluation of Low-Value Services Across Major Medicare Advantage Insurers and Traditional Medicare.

Ciara Duggan, Adam L Beckman, Ishani Ganguli et al.
1.00
Humans United States Aged Cross-Sectional Studies Medicare Part C

Effectiveness of Virtual Yoga for Chronic Low Back Pain: A Randomized Clinical Trial.

Hallie Tankha, Devyn Gaskins, Amanda Shallcross et al.
1.00
Humans Yoga Low Back Pain Female Male

Classifications MeSH

questionsmedicales.fr › Acides aminés, peptides et protéines › Protéines › Globulines › Sérum-globulines › Immunoglobulines › Anticorps › Anticorps monoclonaux › Anticorps monoclonaux humanisés › Bévacizumab › DEGRO practical guideline for central nervous...
questionsmedicales.fr › Système nerveux › Système nerveux central › DEGRO practical guideline for central nervous...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › DEGRO practical guideline for central nervous...
questionsmedicales.fr › États, signes et symptômes pathologiques › Processus pathologiques › Nécrose › DEGRO practical guideline for central nervous...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Hygiène radiologique › Effets des rayonnements › Lésions radiques › DEGRO practical guideline for central nervous...
questionsmedicales.fr › Professions de santé › Médecine › Radiologie › Radio-oncologie › DEGRO practical guideline for central nervous...