Why validation of prognostic models matters?

Publication date: Available online 26 March 2018
Source:Radiotherapy and Oncology
Author(s): Alex Zwanenburg, Steffen Löck
Prognostic models are powerful tools for treatment personalisation. However, not all proposed models work well when validated using new data, despite impressive results being reported initially. Here, we will use a hands-on approach to highlight important aspects of prognostic modelling, as well as to demonstrate methods to generate generalisable models.



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Clinical outcome after high-precision radiotherapy for skull base meningiomas: Pooled data from three large German centers for radiation oncology

Publication date: Available online 26 March 2018
Source:Radiotherapy and Oncology
Author(s): Stephanie E. Combs, Mostafa Farzin, Julia Boehmer, Oliver Oehlke, Michael Molls, Jürgen Debus, Anca-Ligia Grosu
PurposeTo evaluate outcome in patients with base of skull meningiomas treated with modern high precision radiation therapy (RT) techniques.Patients and methods927 patients from three centers were treated with either radiosurgery or fractionated high-precision RT for meningiomas. Treatment planning was based on CT and MRI following institutional guidelines. For radiosurgery, a median dose of 13 Gy was applied, for fractionated treatments, a median dose of 54 Gy in 1.8 Gy single fractions was prescribed. Follow-up included a clinical examination as well as contrast-enhanced imaging. All patients were followed up prospectively after radiotherapy in the three departments within a strict follow-up regimen. The median follow-up time was 81 months (range 1–348 months).ResultsMedian local control was 79 months (range 1–348 months). Local control (LC) was 98% at 1 year, 94% at 3 years, 92% at 5 years and 86% at 10 years. There was no difference between radiosurgery and fractionated RT. We analyzed the influence of higher doses on LC and could show that dose did not impact LC. Moreover, there was no difference between 54 Gy and 57.6 Gy in the fractionated group. Side effects were below 5% in both groups without any severe treatment-related complications.DiscussionBased on the pooled data analysis this manuscript provides a large series of meningiomas of the skull base treated with modern high precision RT demonstrating excellent local control and low rates of side effects. Such data support the recommendation of RT for skull base meningiomas in the interdisciplinary tumor board discussions. The strong role of RT must influence treatment recommendations keeping in mind the individual risk–benefit profile of treatment alternatives.



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Clinical outcome after high-precision radiotherapy for skull base meningiomas: Pooled data from three large German centers for radiation oncology

Publication date: Available online 26 March 2018
Source:Radiotherapy and Oncology
Author(s): Stephanie E. Combs, Mostafa Farzin, Julia Boehmer, Oliver Oehlke, Michael Molls, Jürgen Debus, Anca-Ligia Grosu
PurposeTo evaluate outcome in patients with base of skull meningiomas treated with modern high precision radiation therapy (RT) techniques.Patients and methods927 patients from three centers were treated with either radiosurgery or fractionated high-precision RT for meningiomas. Treatment planning was based on CT and MRI following institutional guidelines. For radiosurgery, a median dose of 13 Gy was applied, for fractionated treatments, a median dose of 54 Gy in 1.8 Gy single fractions was prescribed. Follow-up included a clinical examination as well as contrast-enhanced imaging. All patients were followed up prospectively after radiotherapy in the three departments within a strict follow-up regimen. The median follow-up time was 81 months (range 1–348 months).ResultsMedian local control was 79 months (range 1–348 months). Local control (LC) was 98% at 1 year, 94% at 3 years, 92% at 5 years and 86% at 10 years. There was no difference between radiosurgery and fractionated RT. We analyzed the influence of higher doses on LC and could show that dose did not impact LC. Moreover, there was no difference between 54 Gy and 57.6 Gy in the fractionated group. Side effects were below 5% in both groups without any severe treatment-related complications.DiscussionBased on the pooled data analysis this manuscript provides a large series of meningiomas of the skull base treated with modern high precision RT demonstrating excellent local control and low rates of side effects. Such data support the recommendation of RT for skull base meningiomas in the interdisciplinary tumor board discussions. The strong role of RT must influence treatment recommendations keeping in mind the individual risk–benefit profile of treatment alternatives.



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Blindness after facial trauma: epidemiology, incidence and risk factors. a 27-year cohort study of 5708 patients.

This is a 27-year study of a cohort of 5708 patients who sustained maxillofacial fractures. Our purpose is to present the aetiology, mechanism of trauma, site and concomitant injuries that led to visual loss. We hypothesize that fractures caused by high energy impact of the midface may be associated with blindness. A discussion of the treatment approaches is also included.

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Demographics and referral patterns of a university-based oral maxillofacial radiology clinic over a 20 year period

– The aim of this study was to review the referral patterns, distribution of interpretations, and type of diagnostic imaging used in a university based oral maxillofacial radiology clinic for patients referred for consultation from both dental and non-dental clinicians.

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Management update of potentially premalignant oral epithelial lesions

The term oral potentially malignant disorders (OPMD) previously defined at the World Health Organisation (W.H.O) workshop in 2005 has now been redefined as potentially premalignant oral epithelial lesions (PPOELs). It is important to differentiate PPOEL's which are a broad term to define a wide variety of clinical lesions from oral epithelial dysplasia which should be reserved specifically for lesions with biopsy proven foci of dysplasia. Unfortunately, the nomenclature is not consistent and many times both terms PPOEL and dysplasia are used interchangeably which adds to confusion in the literature.

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Clinical outcome after high-precision radiotherapy for skull base meningiomas: Pooled data from three large German centers for radiation oncology

To evaluate outcome in patients with base of skull meningiomas treated with modern high precision radiation therapy (RT) techniques.

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