Das Ziel der vorliegenden Studie war es, die von Earle et. al im Jahr 2005 aufgestellten Qualitätsindikatoren für die Versorgung am Lebensende bei Patienten mit fortgeschrittenen und metastasierten Kopf- Hals- Tumoren nach Inbetriebnahme der Palliativstation am UKW im November 2009 zu überprüfen. Es wurden klinische retrospektive Daten derjenigen Patienten analysiert, bei denen in der ersten Jahreshälfte von 2008- 2011 ein fortgeschrittener oder rezidivierender bzw. metastasierender KHT diagnostiziert worden war. Die Verläufe von 208 Patienten wurden ausgewertet.Im Vergleich der beiden Gruppen zeigte sich nach Eröffnung der Palliativstation im November 2009 keine Veränderungen in der Rate der Patienten mit Tumortherapie in den letzten 2 Lebenswochen (14% präPF vs. 16% postPF, p=0,707; 8,7% präRM vs. 21,4% postRM, p=0,201). Ein ähnliches Bild zeigte die Analyse der Therapieumstellungen im letzten Lebensmonat (10% präPF vs. 8% postPF, p=0,828; 4,3% präRM vs. 9% postRM, p=0,485). Der Anteil der Patienten, die im letzten Lebensmonat in einer Notaufnahme vorstellig wurden, änderte sich nicht signifikant (22% präPF vs. 29% postPF, p=0,087; 34,8% präRM vs. 34% postRM, p=0,986) wie auch der Anteil Patienten, die im letzten Lebensmonat auf einer Intensivstation behandelt wurden (12% präPF vs. 16,5% postPF, p=0,479; 8,7% präRM vs. 16% postRM, p=0,485). Im Kohortenvergleich hatte der Anteil der Erkrankten mit einem fortgeschrittenen KHT mit Palliativkontakt nach Inbetriebnahme der Palliativstation nicht zugenommen (30% präPF vs. 34% postPF, p=0,622). Der Anteil der Patienten mit Rezidiven oder Metastasen mit Palliativkontakt hatte signifikant zugenommen (39% präRM vs. 59% postRM, p=0.05). Diese retrospektive Studie ist als erster Schritt zu werten, die Auswirkungen des Ein-bezugs der spezialisierten Palliativversorgung bei fortgeschrittenen Kopf- Hals- Tumoren darzustellen. Insgesamt ist die Integration der Palliativmedizin insbesondere bei den primär metastasierten Patienten noch verbesserungswürdig. / The aim of this study was to review the quality indicators for end- of- life care provided by Earle et. al 2005 in patients with advanced and metastatic head and neck cancer. The analysis is based on retrospective clinical routine data from patients with recurrent or newly diagnosed head and neck cancer treated at the University Hospital Würzburg. 208 patients were included in this study. The patients were separated in two groups. In the comparison of the two groups, after the opening of the palliative care unit there were no changes in the tumor therapy performed during the last two weeks of life (14% präPF vs. 16% postPF, p=0,707; 8,7% präRM vs. 21,4% postRM, p=0,201). A new tumorspecific therapy in the last 30 days of life had a similar proportion of patients (10% präPF vs. 8% postPF, p=0,828; 4,3% präRM vs. 9% postRM, p=0,485). There was no significant change in the presentations in the emergency department during the last 30 days of life (22% präPF vs. 29% postPF, p=0,087; 34,8% präRM vs. 34% postRM, p=0,986). There was also no significant change in the proportion of patients treated in the last month of life in an intensive care unit (12% präPF vs. 16,5% postPF, p=0,479; 8,7% präRM vs. 16% postRM, p=0,485). The study shows that the proportions of patients with recurrent or metastases head and neck cancer with palliative contact had increased significantly (39% präRm vs. 59% postRM, p=0,05). This retrospective study is the first step in assessing the impact of specialized palliative care on advanced head- and neck tumors. Overall, the integration of palliative care, especially in advanced tumor patients, still needs improvement.

The subject of this work was to develop, implement, optimize and apply methods for quantitative MR imaging of tumors. In the context of functional and physiological characterization, this implied transferring techniques established in tumor model research to human subjects and assessing their feasibility for use in patients. In the context of the morphologic assessment and parameter imaging of tumors, novel concepts and techniques were developed, which facilitated the simultaneous quantification of multiple MR parameters, the generation of “synthetic” MR images with various contrasts, and the fast single-shot acquisition of purely T2-weighted images. / Gegenstand dieser Arbeit war die Entwicklung, Implementierung, Optimierung und Anwendung von Methoden für die quantitative MR-Bildgebung an Tumoren. In Bezug auf eine funktionelle und physiologische Charakterisierung wurden in der Forschung an Tumormodellen etablierte Verfahren für den Einsatz am Menschen adaptiert und ihre Anwendbarkeit zur Untersuchung von Tumoren wurde an Patienten erforscht. Im Bereich der morphologischen Untersuchung und Parameterbildgebung an Tumoren wurden neue Konzepte und Verfahren entwickelt, welche die simultane Quantifizierung mehrerer MR-Parameter, die Generierung "synthetischer" MR-Bilder mit unterschiedlichen Kontrasten, sowie die schnelle "Single-Shot"-Akquisition rein T2-gewichteter Bilder ermöglichen.

Glioma is one of the most challenging types of brain tumors to be treated or controlled locally. One of the main problems is to determine which areas of the apparently normal brain contain glioma cells, as gliomas are known to infiltrate several centimetres beyond the clinically apparent lesion that is visualized on standard CT or MRI. To ensure that radiation treatment encompasses the whole tumor, including the cancerous cells not revealed by MRI, doctors treat the volume of brain that extends 2cm out from the margin of the visible tumor. This approach does not consider varying tumor-growth dynamics in different brain tissues, thus it may result in killing some healthy cells while leaving cancerous cells alive in other areas. These cells may cause recurrence of the tumor later in time which limits the effectiveness of the therapy. In this thesis, we propose two models to define the tumor invasion margin based on the fact that glioma cells preferentially spread along nerve fibers. The first model is an anisotropic reaction-diffusion type tumor growth model that prioritizes diffusion along nerve fibers, as given by DW-MRI data. The second proposed approach computes the tumor invasion margin using a geodesic distance defined on the Riemannian manifold of brain bers. Both mathematical models result in Partial Differential Equations (PDEs) that have to be numerically solved. Numerical methods used for solving differential equations should be chosen with great care. A part of this thesis is dedicated to discuss in detail, the numerical aspects such as stability and consistency of different finite difference methods used to solve these PDEs. We review the stability issues of several 2D methods that discretize the anisotropic diffusion equation and we propose an extension of one 2D stable method to 3D. We also analyze the stability issues of the geodesic model. In comparison, the geodesic model is numerically more stable than the anisotropic diffusion model since it results in a rst-order PDE. Finally, we evaluate both models on actual DTI data from patients with glioma by comparing our predicted growth with follow-up MRI scans. Results show improvement in predicting the invasion margin when using the geodesic distance model as opposed to the 2cm conventional Euclidean distance.

No description available.

Thesis (Ph.D.)--Kent State University, 2008. / Title from PDF t.p. (viewed Jan. 26, 2010). Advisor: Bansidhar Datta. Keywords: p67, ERK1, ERK2, oncogenic KRasV12, tumor suppressor. Includes bibliographical references (p. 143-160).

Thesis (Ph. D.)--University of Hong Kong, 2010. / Includes bibliographical references (leaves 121-150). Also available in print.

Habilitation - Universität, Lübeck, 1997.

Thesis (Ph. D.)--University of Queensland, 2002. / Includes bibliographical references.

A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine. / Significance: Contrast‐enhanced (CE) and Fluid attenuation inversion recovery (FLAIR) MRI are current standard of care tools for delineating radiation treatment targets in high‐grade glioma (HGG) patients. However, in the setting of retreatment, tumor regrowth and non‐tumor therapy‐related inflammation, known as post‐treatment radiation effect (PTRE), have identical MRI appearances. As a result, FLAIR MRI can be an unreliable tool for treatment planning. Surgical biopsy can definitively distinguish recurrent tumors from PTRE but has many disadvantages, namely operative risk and cost. Dynamic Susceptibility‐weighted Contrast‐ Enhanced (DSC) MRI Perfusion can non‐invasively detect distinct characteristics of tumor and PTRE through measurements of relative cerebral blood volume (rCBV). PTRE exhibits decreased microvascular density, whereas tumor recurrence displays angiogenesis and microvascular proliferation. Thus, DSC‐MRI affords the opportunity to better define tumor burden within and possibly outside of these nonspecific regions. Objective: To assess the extent with which rCBV maps correlate with re‐radiation treatment plans in patients with recurrent tumor in order to identify potential differences in treatment planning. Design: This study enrolled 8 previously treated HGG patients presenting for re‐irradiation of suspected recurrent tumor at a single hospital on an IRB‐approved trial. All patients underwent DSC‐MRI and routine MRI imaging prior to re‐irradiation treatment planning, and underwent treatment as per routine clinical protocol. Following therapy, rCBV and radiation dose maps were overlaid on conventional MR to delineate differences in identified tumor burden. Results: Of the 8 patients, four rCBV images showed evidence of tumor outside of the RT planning volumes, while the other 4 showed fully treated tumor but with large volumes of uninvolved brain receiving radiation. Conclusion: DSC‐MRI better identified unique regions of potential tumor burden in recurrent HGG patients compared to conventional MRI and could be used to improve radiation treatment planning in re‐radiated patients.

No description available.