The aim of this study was to evaluate interobserver agreement (IOA) on target volume definition for pancreatic cancer (PACA) within the Radiosurgery and Stereotactic Radiotherapy Working Group of the German Society of Radiation Oncology (DEGRO) and to identify the influence of imaging modalities on the definition of the target volumes. Two cases of locally advanced PACA and one local recurrence were selected from a large SBRT database. Delineation was based on either a planning 4D CT with or without (w/wo) IV contrast, w/wo PET/CT, and w/wo diagnostic MRI. Novel compared to other studies, a combination of four metrics was used to integrate several aspects of target volume segmentation: the Dice coefficient (DSC), the Hausdorff distance (HD), the probabilistic distance (PBD), and the volumetric similarity (VS). For all three GTVs, the median DSC was 0.75 (range 0.17–0.95), the median HD 15 (range 3.22–67.11) mm, the median PBD 0.33 (range 0.06–4.86), and the median VS was 0.88 (range 0.31–1). For ITVs and PTVs the results were similar. When comparing the imaging modalities for delineation, the best agreement for the GTV was achieved using PET/CT, and for the ITV and PTV using 4D PET/CT, in treatment position with abdominal compression. Overall, there was good GTV agreement (DSC). Combined metrics appeared to allow a more valid detection of interobserver variation. For SBRT, either 4D PET/CT or 3D PET/CT in treatment position with abdominal compression leads to better agreement and should be considered as a very useful imaging modality for the definition of treatment volumes in pancreatic SBRT. Contouring does not appear to be the weakest link in the treatment planning chain of SBRT for PACA.

Objective: The purpose of this pilot study was to evaluate the feasibility and toxicity of concurrent chemotherapy with vinorelbine and mitomycin C in combination with accelerated radiotherapy (RT) in patients with locally advanced cancer of the head and neck. Patients and Methods: Between January 2003 and March 2004, 15 patients with T4/N2-3 squamous cell carcinoma (12/15) and with N3 cervical lymph node metastases of carcinoma of unknown primary (3/15) were treated with chemotherapy and simultaneous accelerated RT. Results: 11 patients completed therapy without interruption or dose reduction. Grade 3 - 4 acute mucosal toxicity was observed in 9/15 patients, grade 4 hematologic toxicity in 6/15 patients. At a median follow-up of 7.5 months, 2 patients have died of intercurrent disease, 2 patients have experienced local relapse; 5 patients are alive with no evidence of disease at the primary tumor site. Discussion: The described regimen is highly effective, but led to remarkable side effects.

Background: Even today patients who suffer from mantle cell lymphoma have a poor prognosis, especially when the CNS is involved. To confirm the diagnosis of meningeosis lymphomatosa, asservation of the liquor cerebrospinalis is necessary. During this procedure, intrathecal chemotherapy may be given if there is clinical evidence of meningeosis. If lumbar puncture cannot be performed, a lateral suboccipital puncture may be an alternative approach. Patient and Methods: We report the case of a 65-year-old patient who suffered from mantle cell lymphoma stage IV. The patient presented with symptoms of progressive paraparesis of both legs and incontinence, with tumor mass intradural from the 12th thoracic vertebra to the level of S1. During irradiation, the patient developed symptoms of diffuse meningiosis lymphomatosa. The conventional lumbar puncture was impossible, because of tumor present in the thoracico-lumbar junction. Results: A suboccipital puncture was performed for both collecting cerebrospinal fluid and application of chemotherapy ( cytosine arabinoside/dexamethasone). This lead to remarkable improvement of the patient's clinical symptoms. Conclusion: The suboccipital cervical puncture was performed without complications. A variation of the intrathecal approach is described, which may serve as alternative when conventional lumbar puncture is not possible.

Besonders vielversprechend ist die Kombination mit Gemcitabin und Oxaliplatin (GEMOX), berichtete Dr. Peter Harper, Guy’s and St. Thomas Hospital, London. Beide Substanzen sind bereits als Monotherapie bei verschiedenen Tumoren aktiv; kombiniert zeigen sie aufgrund ihrer unterschiedlichen Ansatzpunkte in der Tumorzelle einen synergistischen Effekt (Tab. 1). Phase-Iund II-Studien sprechen zudem für eine geringe Toxizität der Kombination, die auch von älteren Patienten mit niedrigem Performance-Status gut vertragen wird. Aufgrund positiver Studiendaten gilt GEMOX mittlerweile als neue Hoffnung beim Pankreaskarzinom. Palliative Standardtherapie ist derzeit noch Gemcitabin, mit dem eine 1-Jahres-Überlebensrate von 18% erreicht wird. Die hohe Aktivität von GEMOX bei diesem nur sehr schwer therapierbaren Tumor wurde in einer französischen Phase-II-Studie an 64 Patienten mit lokal fortgeschrittenem (n = 30) oder metastasiertem Pankreaskarzinom (n = 34) deutlich, die Gemcitabin (1000 mg/m2 i.v.) an Tag 1 und Oxaliplatin (100 mg/m2 i.v.) an Tag 2 in zweiwöchigen Zyklen erhielten. Median wurden 9 Therapiezyklen verabreicht, d.h. die Hälfte der Patienten wurde mindestens 18 Wochen lang behandelt. Tumorschrumpfung bei einem Drittel der Patienten