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@ARTICLE{Held:143360,
      author       = {T. Held and S. Akbaba and K. Lang and S. Harrabi$^*$ and D.
                      Bernhardt and C. Freudlsperger and S. Kargus and P. Plinkert
                      and S. Rieken and K. Herfarth and J. Debus$^*$ and S.
                      Adeberg$^*$},
      title        = {{C}linical {M}anagement of {B}lood⁻{B}rain {B}arrier
                      {D}isruptions after {A}ctive {R}aster-{S}canned {C}arbon
                      {I}on {R}e-{R}adiotherapy in {P}atients with {R}ecurrent
                      {H}ead-and-{N}eck {C}ancer.},
      journal      = {Cancers},
      volume       = {11},
      number       = {3},
      issn         = {2072-6694},
      address      = {Basel},
      publisher    = {MDPI},
      reportid     = {DKFZ-2019-00948},
      pages        = {383},
      year         = {2019},
      abstract     = {Purpose: The aim of the current evaluation was to assess
                      central nervous system necrosis (CNSN) after re-irradiation
                      with carbon ions (CR) in two-hundred seventeen (n = 217)
                      patients with recurrent head-and-neck cancer (HNC). Methods:
                      Thirty-six (n = 36) patients with CNSN were assessed
                      retrospectively regarding clinical symptoms and radiographic
                      response. Results: CNSN were classified according to
                      clinical management in line with the Common Terminology
                      Criteria for Adverse Events (CTCAE) v5.0. At a median
                      follow-up of 25.3 months (range 3.3⁻79.9 months), the
                      median time interval until occurrence of grade I, II, and
                      III CNSN was 9.2 months (range 2.8⁻75.0 months), 10.2
                      months (range 2.3⁻60.5 months), and 16.6 months (range
                      8.7⁻32.5 months), respectively. In one patient with an
                      adenocarcinoma infiltrating the frontal lobe, an extensive
                      CNSN grade IV was suspected but the patient declined
                      surgical intervention. Radiographic response after treatment
                      of CNSN grade I, II, and III, defined as $≥25\%$ reduction
                      of the T2 alteration on Magnetic Resonance Imaging (MRI),
                      was observed in 4 $(16.0\%),$ 5 $(29.4\%),$ and 4 $(80\%)$
                      patients, respectively. Conclusion: CNSN occurred late and
                      frequent after re-irradiation with carbon ions in patients
                      with HNC infiltrating the base of skull. The clinical
                      outcome with adequate treatment was encouraging but correct
                      diagnosis of CNSN remains challenging.},
      cin          = {E050 / L101},
      ddc          = {610},
      cid          = {I:(DE-He78)E050-20160331 / I:(DE-He78)L101-20160331},
      pnm          = {315 - Imaging and radiooncology (POF3-315)},
      pid          = {G:(DE-HGF)POF3-315},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:30893824},
      doi          = {10.3390/cancers11030383},
      url          = {https://inrepo02.dkfz.de/record/143360},
}