Aims: Stereotactic arrhythmia radiotherapy (STAR) is suggested as potentially effective and safe treatment for patients with therapy-refractory ventricular tachycardia (VT). However, the current... Show moreAims: Stereotactic arrhythmia radiotherapy (STAR) is suggested as potentially effective and safe treatment for patients with therapy-refractory ventricular tachycardia (VT). However, the current prospective knowledge base and experience with STAR is limited. In this study we aimed to prospectively evaluate the efficacy and safety of STAR. Methods and results: The StereoTactic Arrhythmia Radiotherapy in the Netherlands no.1 was a pre-post intervention study to prospectively evaluate efficacy and safety of STAR. In patients with therapy-refractory VT, the pro-arrhythmic region was treated with a 25 Gy single radiotherapy fraction. The main efficacy measure was a reduction in the number of treated VT-episodes by >= 50%, comparing the 12 months before and after treatment (or end of follow-up, excluding a 6-week blanking period). The study was deemed positive when >= 50% of patients would meet this criterion. Safety evaluation included left ventricular ejection fraction, pulmonary function, and adverse events. Six male patients with an ischaemic cardiomyopathy were enrolled, and median age was 73 years (range 54-83). Median left ventricular ejection fraction was 38% (range 24-52). The median planning target volume was 187 mL (range 93-372). Four (67%) patients completed the 12-month follow-up, and two patients died (not STAR related) during follow-up. The main efficacy measure of >= 50% reduction in treated VT-episodes at the end of follow-up was achieved in four patients (67%). The median number of treated VT-episodes was reduced by 87%. No reduction in left ventricular ejection fraction or pulmonary function was observed. No treatment related serious adverse events occurred. Conclusions: STAR resulted in a >= 50% reduction in treated VT-episodes in 4/6 (67%) patients. No reduction in cardiac and pulmonary function nor treatment-related serious adverse events were observed during follow-up. Show less
We aimed to expand our knowledge about the level of neurocognitive functioning (NCF) and health-related quality of life (HRQoL) in patients with primary and secondary brain tumors during the... Show moreWe aimed to expand our knowledge about the level of neurocognitive functioning (NCF) and health-related quality of life (HRQoL) in patients with primary and secondary brain tumors during the disease course. We found that the tumor itself has the largest negative impact on NCF and HRQoL. At group level, treatment (surgery, radiotherapy and/or chemotherapy) did not seem to have a large extra detrimental effect on the short term. However, subgroups of patients, e.g. patients with tumors in the non-dominant hemisphere and long-term survivors, appeared to be vulnerable for cognitive decline after treatment. At the individual patient level, HRQoL varied to a large degree in the first months after treatment, confirming this is a multidimensional concept and that the impact of treatment differs for the different aspects. With the results from the studies described in this thesis, treatment and individual patient care can be optimized by minimizing the negative impact of treatment, e.g. by intraoperative monitoring of cognition during awake surgery, and by counseling and rehabilitation of patients. Besides, investigators should pay attention to methodological challenges in reporting of neurocognitive outcomes in research, as reporting of these outcomes is currently not sufficient, while evidence can be of value in clinical decision-making. Show less
This thesis consists of studies on stereotactic radiotherapy (SRT) of intracranial tumors aiming at optimizing the treatment technique and improving the patients__ outcome. We compared two... Show moreThis thesis consists of studies on stereotactic radiotherapy (SRT) of intracranial tumors aiming at optimizing the treatment technique and improving the patients__ outcome. We compared two treatment planning techniques (dynamic conformal arc and intensity-modulated radiotherapy) and concluded that for most patients optimal plans were possible with both techniques. We also found that patient fixation during SRT could be improved by adding a vacuum mouthpiece to the standard stereotactic frame. Five chapters deal with treatment results of SRT in patients with brain metastases. From our own results and a literature review we concluded that single fraction SRT produces excellent local control results in patients with small brain metastases, but insufficient local control rates in patients with large metastases. The higher biologically equivalent doses needed for improved local control rates in large brain metastases can be administered with fractionated SRT. Finally, we studied the clinical problem of lesion growth after SRT of brain metastases. The cause can be real tumor progression or pseudo-progression (radiation toxicity). We found that symptomatic pseudo-progression is serious radiation toxicity of the normal brain tissue surrounding the metastasis. Reduction of pseudo-progression rates is possible by limiting the volume of normal brain tissue that receives high radiation doses. Show less
Wiggenraad, R.; Verbeek-de Kanter, A.; Mast, M.; Molenaar, R.; Kal, H.B.; Nijeholt, G.L.A.; ... ; Struikmans, H. 2012
