Strahlentherapie最新文献

The authors present 99 patients irradiated for a tonsillar carcinoma. 41 patients were primarily irradiated and 52 patients postoperatively. Radiotherapy was combined with cytostatic chemotherapy in six cases. Most of the cases treated were advanced tumors: 76 patients with T3/T4 tumors. 52% out of the 23 patients with T1/T2 tumors survived five years and 45% ten years; only 26% of the patients with T3 tumors and 15% of those with T4 tumors survived five years. The prognosis was significantly influenced by the lymph node state: whereas 75% of the patients with N0 tumors survived five years, this rate is reduced to 21% in case of lymph node state N3. 22 out of the 34 recurrences were situated in the tumor region, 12 in lymph nodes. 94% of recurrences became evident during the first two years after the end of treatment.

With a rate of 87.7% of exact diagnoses, sonography is a proven method to find intraperitoneal and retroperitoneal manifestations of malignant system diseases. It is not stressing or invasive and can be frequently repeated; needing less expenditure and involving no risks, it can bear comparison with lymphographic methods and is important in the classification of stages of lymphatic system diseases. During one examination, enlarged organs and infiltrations in form of focuses in the parenchymatous organs can be diagnosed, and vessels and formations of lymphomas can be seen within their topographic connection. Independently from their drainage ways, all enlarged lymph nodes, also those situated in areas not accessible by lymphography like the hilus of liver, spleen, kidney, and retrohepatic, mesenteric, and intraperitoneal regions, can be visualized even without administration of a contrast medium. The method offers the possibility of frequent control examinations during radiotherapy or chemotherapy; possible recurrences can be early detected. However, manifestations of a malignant system disease in the lymph nodes can be hardly discerned from metastases of a primary tumor localized in another region. Despite this disadvantage, sonography keeps the first rank in the gradual application of image-producing diagnostic methods (sonography, CT, lymphography).

The status of radiotherapy of Hodgkin's disease is no longer determined by the staging alone but also by some special risk factors. So a marked improvement of curative radiotherapy becomes possible by close co-operation with chemotherapy, above all in patients with Bulky disease or with constellations having hitherto a considerably deteriorated prognosis in case of exclusive application of radiotherapy. The present study describes the different risk factors and submits the modified therapeutic procedure depending on the different stages.

Some of the useful clinical radiation characteristics required for treatment planning using the 6,9,13,17, and 20 Me V scanning electron beams obtainable in a CGR Therac-20 Me V Saturne linear accelerator are outlined.

A significant reduction of mortality after lethal irradiation (7,8 and 9 Gy X-ray total-body irradiation) was achieved by continuous therapeutic subcutaneous application of the biologic inducers PIND-AVI and PIND-ORF. This was obtained by a stimulation of the investigated spleen parameters and a stimulation of leucocytes and phagocytosis. The inducers had no significant influence on the radiogenic reduction of blood cells and bone marrow cells, of the relative spleen and thymus weight and of the DNA and protein level of spleen and thymus. The regeneration of blood leucocytes (preponderantly by PIND-AVI) and of the spleen (preponderantly by PIND-ORF) was accelerated, but not the thymus regeneration which was already rather low. The leucocyte phagocytosis which increased generally after irradiation was markedly stimulated by paramunization. This stimulation was also observed after a latent time in animals submitted to sham irradiation. Its temporal appearance and its quantitative and qualitative properties corresponded to the effects of inducers after X-ray irradiation. Both inducers were found to be harmless in all experiments.

In many problems of modern radiotherapy such as multifractionation, interstitial and intracavitary therapy with implanats the NSD-formula is hardly applicable. Serious difficulties arise, when this formula is used for an estimation of late responses of tissues, because it mainly appreciates acute effects. On the basis of the linear-quadratic survival model S = exp (-alpha D - beta D2) the TDF-problem is investigated with the help of kinetic principles.

During the establishment of a new radiooncologic department in a general hospital, a clinical tumor register has been developed for internal patient documentation. The authors describe the general requirements which had to be fulfilled by this tumor register as well as the reasons leading to the purchase of a commercial program package adapted to an irradiation planning system. The structure of the programs and the specification of characteristics are defined. Finally some aspects of organisation regarding the use of the register are mentioned.

The radiation reactions in the normal tissues of the vagina, rectum and bladder were studied in 166 patients receiving prophylactic vaginal high dose-rate intracavitary irradiation. Most reactions were observed in the vaginal mucosa included in the intracavitary target and only a few in the rectum and bladder in close proximity to the same target. The influence of the total dose, the dose per fraction and the overall treatment time, summarized as the Cumulative Radiation Effect (CRE), correlated well to the rate of reactions after a correction of the formula for late effects.

Hitherto, the objective of chemotherapy in case of the non-small cell bronchial carcinoma is only of a palliative nature. Thus a critical indication is necessary. This is confirmed by our investigations with the combinations of cis-platinum and ifosfamide (80 patients, remission rate 35%, median survival time of patients with remission 11,5 months), cis-platinum and vindesine (29 patients, remission rate 28%, median survival time of patients with remission 14,5 months), and ifosfamide and vepeside (63 patients, remission rate 27%, median survival time of patients with remission 12 months). The combination ifosfamide-vepeside was much better tolerated by the patients and, with its comparable remission rates and survival times, was superior to the cis-platine combinations. For the chemotherapy of the non-small cell bronchial carcinoma it has to be considered that the treatment result may be more influenced by tumor stage and activity index of the patient than by the therapy method.

From 1963 to 1978 119 patients with a carcinoma of the tonsillar fossa received cobalt-60-therapy from 60 to 70 Gy to the primary lesion and the lymph nodes. The 5-year-survival-rate was 34%, with a combined therapy of surgery and irradiation it was 43.6%. For 44 patients with a sarcoma of the tonsillar fossa the 5-year-survival was 32%. For the patients with a carcinoma chemotherapy was only given for palliation.