Publications by authors named "Max Dahele"

Background: Free-breathing expiration-gating (EG) is a non-invasive technique used to manage respiratory-induced tumor motion. This study explores the effectiveness of EG stereotactic body radiotherapy (SBRT) for lung tumors using 10MV FFF VMAT.

Methods And Materials: The study included 41 patients (50 targets) treated with EG lung SBRT between September 2019 and February 2023.

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  • - Osteogenesis Imperfecta (OI), or "brittle bone disease," is a rare genetic disorder that causes fragile bones and potential deformities due to defects in collagen type I, requiring comprehensive care throughout a patient's life stages.
  • - Treatment primarily focuses on supportive measures, including medications like bisphosphonates and various orthopedic surgeries, which have shown positive results, especially in children, but there is a notable lack of guidelines for adults transitioning from pediatric care.
  • - A systematic review of existing literature emphasizes the need for a multifaceted approach by various medical specialists to enhance the transition from pediatric to adult care for OI patients, stressing the importance of education, personalized plans, and ongoing follow-up.
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Background: High-energy transmission beams (TBs) are currently the main delivery method for proton pencil beam scanning ultrahigh dose-rate (UHDR) FLASH radiotherapy. TBs place the Bragg-peaks behind the target, outside the patient, making delivery practical and achievement of high dose-rates more likely. However, they lead to higher integral dose compared to conventional intensity-modulated proton therapy (IMPT), in which Bragg-peaks are placed within the tumor.

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  • Chemoradiotherapy followed by surgical resection is the standard treatment for superior sulcus tumors (SST), which invade the chest wall and often require complex surgical techniques.
  • The surgery for SST is challenging due to higher risks of complications, the tumor's anatomical location, and potential variations in surgical approach, highlighting the importance of careful patient selection and multidisciplinary care.
  • Advancements in surgical techniques, including minimally invasive options and 3D imaging, are evolving to enhance recovery and reduce morbidity, while chest wall reconstruction, when needed, should use appropriate materials for structural support.
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  • The study assessed the outcomes of trimodality therapy (induction concurrent chemoradiotherapy followed by surgical resection) for patients with superior sulcus tumors (SSTs) of the lung that invaded the spine, revealing significant treatment challenges.
  • Eighteen patients were analyzed, with 94% achieving complete surgical resection and a median follow-up of 30 months, while postoperative morbidity was noted at 44% but with no related mortality.
  • Results indicated a 5-year overall survival rate of 55% and disease-free survival of 40%, highlighting the need for further research on improving distant disease control.
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  • Stage IV adrenocortical carcinoma (mACC) has a historically poor prognosis, but results from a 2012 trial led to the recommendation of the first-line treatment EDP-M, which includes multiple chemotherapy agents.
  • Analysis of data from 167 mACC patients in the Netherlands showed that while EDP-M appeared to improve overall survival (OS) numerically, the results were not statistically significant; patients receiving mitotane alone had the best long-term survival rates.
  • Overall survival for mACC patients in the Netherlands has improved since 2014, with factors like palliative adrenalectomy and local treatment contributing to better outcomes, but EDP-M did not show a significant impact on OS.
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Background: Pulmonary metastasectomy and stereotactic ablative radiotherapy (SABR) are both guideline-recommended treatments for selected patients with oligometastatic colorectal pulmonary metastases. However, there is limited evidence comparing these local treatment modalities in similar patient groups.

Methods: We retrospectively reviewed records of consecutive patients treated for colorectal pulmonary metastases with surgical metastasectomy or SABR from 2012 to 2019 at two Dutch referral hospitals that had different approaches toward the local treatment of colorectal pulmonary metastases, one preferring surgery, the other preferring SABR.

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Purpose: A three-dimensional deep generative adversarial network (GAN) was used to predict dose distributions for locally advanced head and neck cancer radiotherapy. Given the labor- and time-intensive nature of manual planning target volume (PTV) and organ-at-risk (OAR) segmentation, we investigated whether dose distributions could be predicted without the need for fully segmented datasets.

Materials And Methods: GANs were trained/validated/tested using 320/30/35 previously segmented CT datasets and treatment plans.

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Purpose: Spine stereotactic body radiation therapy (SBRT) requires high positioning accuracy and a stable patient to maximize target coverage and reduce excessive irradiation to organs at risk. Positional verification during spine SBRT delivery helps to ensure accurate positioning for all patients. We report our experience with noninvasive 3-dimensional target position monitoring during volumetric modulated arc therapy of spine metastases in nonimmobilized patients positioned using only a thin mattress and simple arm and knee supports.

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  • Local control for colorectal pulmonary metastases after stereotactic ablative radiotherapy (SABR) is lower compared to other tumors, but salvage surgery can be effective.
  • The study involved 17 patients who underwent 20 salvage surgeries, with 14 being minimally invasive, demonstrating a median overall survival of 71 months post-surgery.
  • Despite some complications (20% had significant issues), the results suggest that salvage resection is a viable option with favorable outcomes for selected patients.
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Background: Radiotherapy (RT) is involved in about 50% of all cancer patients, making it a very important treatment modality. The most common type of RT is external beam RT, which consists of delivering the radiation to the tumor from outside the body. One novel treatment delivery method is volumetric modulated arc therapy (VMAT), where the gantry continuously rotates around the patient during the radiation delivery.

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  • - The study explores the use of FLASH radiotherapy, which delivers high dose rates (≥40 Gy/s), for whole breast irradiation (WBI), aiming to minimize damage to healthy tissue often found in the treatment area.
  • - Various treatment plans were tested using ultra-high dose rate proton beams, assessing both standard five-fraction treatments and hypothetical shorter schedules of two or one fraction to enhance efficiency and effectiveness.
  • - Results showed that while achieving high FLASH doses was challenging with clinically available equipment, optimizing beam configurations improved plan quality and FLASH delivery, achieving about 50% FLASH-dose in practical cases.
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Background: Clinical data used to train deep learning models are often not clean data. They can contain imperfections in both the imaging data and the corresponding segmentations.

Purpose: This study investigates the influence of data imperfections on the performance of deep learning models for parotid gland segmentation.

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Progress in biological cancer characterization, targeted systemic therapies and multimodality treatment strategies have shifted the goals of radiotherapy for spinal metastases from short-term palliation to long-term symptom control and prevention of compilations. This article gives an overview of the spine stereotactic body radiotherapy (SBRT) methodology and clinical results of SBRT in cancer patients with painful vertebral metastases, metastatic spinal cord compression, oligometastatic disease and in a reirradiation situation. Outcomes after dose-intensified SBRT are compared with results of conventional radiotherapy and patient selection criteria will be discussed.

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Introduction: Pre-invasive squamous lesions of the central airways can progress into invasive lung cancers. Identifying these high-risk patients could enable detection of invasive lung cancers at an early stage. In this study, we investigated the value of F-fluorodeoxyglucose ( F-FDG) positron emission tomography (PET) scans in predicting progression in patients with pre-invasive squamous endobronchial lesions.

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Depending on the clinical situation, different combinations of lymph node (LN) levels define the elective LN target volume in head-and-neck cancer (HNC) radiotherapy. The accurate auto-contouring of individual LN levels could reduce the burden and variability of manual segmentation and be used regardless of the primary tumor location. We evaluated three deep learning approaches for the segmenting individual LN levels I−V, which were manually contoured on CT scans from 70 HNC patients.

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Radiotherapy (RT) is one of the primary treatment modalities for cancer patients. The clinical use of RT requires a balance to be struck between tumor effect and the risk of toxicity. Sparing normal tissue is the cornerstone of reducing toxicity.

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Objectives: Healthcare is required to be effectively organised to ensure that growing, aging and medically more complex populations have timely access to high-quality, affordable care. Cardiac surgery is no exception to this, especially due to the competition for and demand on hospital resources, such as operating rooms and intensive care capacity. This is challenged more since the COVID-19 pandemic led to postponed care and prolonged waiting lists.

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Knowledge-based planning solutions have brought significant improvements in treatment planning. However, the performance of a proton-specific knowledge-based planning model in creating knowledge-based plans (KBPs) with beam angles differing from those used to train the model remains unexplored. We used a previously validated RapidPlanPT model and scripting to create nine KBPs, one with default and eight with altered beam angles, for 10 recent oropharynx cancer patients.

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Purpose: Research suggests that in addition to the dose-rate, a dose threshold is also important for the reduction in normal tissue toxicity with similar tumor control after ultrahigh dose-rate radiation therapy (UHDR-RT). In this analysis we aimed to identify factors that might limit the ability to achieve this "FLASH"-effect in a scenario attractive for UHDR-RT (high fractional beam dose, small target, few organs-at-risk): single-fraction 34 Gy lung stereotactic body radiation therapy.

Methods And Materials: Clinical volumetric-modulated arc therapy (VMAT) plans, intensity modulated proton therapy (IMPT) plans and transmission beam (TB) plans were compared for 6 small and 1 large lung lesion.

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Concurrent chemoradiotherapy (cCRT) is the preferred treatment for stage III NSCLC because surgery containing multimodality treatment is often not appropriate. Alternatives, often for less fit patients, include sequential CRT and RT alone. Many reports describing the relationship between overall survival (OS), toxicity, and dosimetry are based on clinical trials, with strict criteria for patient selection.

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Article Synopsis
  • Chemoradiotherapy (CRT) is the standard treatment for Stage IIIA non-small cell lung cancer (NSCLC), but trimodality treatment (TT) has shown promising results for some patients with operable tumors.
  • A study analyzed outcomes from 257 patients with Stage IIIA NSCLC, finding that those receiving TT generally had better progression-free survival (PFS) and overall survival (OS) compared to those treated with CRT alone.
  • Specifically, patients with large tumors (>120 cc) and those with adenocarcinoma saw improved outcomes when treated with TT, highlighting factors that may help in decision-making for treatment options.
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