Strahlentherapie最新文献

Two patients with lung metastases are presented who were submitted to a combined low-dose radiotherapy and adriamycin monotherapy with good palliative results. The mode of action as well as the experimental examination results are discussed. The ineffectiveness of single low-dose chemotherapy is demonstrated by the non-response of lung metastases beyond the irradiation fields (heart block, diaphragm). Both patients were resistant to chemotherapy.

During combined treatment of hamster kidney cells with cisplatin and irradiation under aerobic conditions, there appear interactions between the two treatment modalities. The presence of cisplatin during irradiation leads to an increased bending, pretreatment or posttreatment with cisplatin to a gradual adaption of the shape of the survival curve to a straight line. Simultaneous treatment of hamster kidney cells with cisplatin and irradiation in hypoxia does not change the survival curve in contrast to simultaneous treatment under aerobic conditions.

The occurrence of different symptoms and signs and their relation to prognosis were studied in a series of 324 cases of renal adenocarcinoma. The most common symptoms were gross haematuria and loss of weight, but 17% of the patients were asymptomatic at presentation. The incidence of asymptomatic patients had doubled in ten years. Of the symptoms and signs studied in a multivariate survival analysis, only erythrocyte sedimentation rate had prognostic significance independently of other factors.

In this paper we describe the comparative study concerning the immobilization during radiotherapy for cancer of the larynx and pharynx with or without shell and fixing device. Immobilization was continuously monitored by semi-conductor detector. Reproducibility was investigated by means of verification film. The result significantly indicated that better immobilization was obtained in the patients treated with use of the shell (p much less than 0.001). Reproducibility of the field arrangement was also sufficient throughout the course of radiotherapy.

A microprocessor-system is described which utilizes videocameras and a digital image recorder in order to facilitate and to improve the accuracy of patient positioning in radiation therapy.

Twenty-seven patients with operable squamous cell cancer of head and neck were randomized into the study. Twelve patients received Prospidin combined to preoperative radiotherapy and fourteen patients were treated with preoperative radiotherapy alone. The daily dose of the drug was from 0.70 mg/kg to 2 mg/kg and the total dose during preoperative radiotherapy was between 1800 mg and 2250 mg with a mean of 2073 mg. The recurrence rate was in patients receiving Prospidin three out of twelve and in patients treated with irradiation alone four out of fourteen during the observation time of 33 months. In the present study Prospidin combined with preoperative radiotherapy had no advantage as compared to irradiation alone.

The data published about the healing chances of Hodgkin's disease cannot reflect reality since the evaluation includes also the technically preventable marginal recurrences. The analysis of 63 own cases furnishes the same result as far as only one true recurrence was found in the irradiated regions. Only in two patients we have seen a progression of the disease in lymph nodes beyond the extended field. The evaluation of our recurrences shows a clear pattern: in the individual cases, progression during radiotherapy and recurrences are very probably due to an understaging or to a problem concerning the dose.

Between May 1964 and December 1976, 370 patients with Hodgkin's disease (CS/PSIn = 41 [11.2%], CS/PSIIn = 148 [40.2%], CS/PSIII n = 148 [40.2%], CS/PSIV n = 31 [8.4%] with different diagnoses were treated by different therapies, 250 out of them (67.5%) only by radiotherapy (local, extended, and total lymphoid irradiation), 115 (31%) by radiotherapy and chemotherapy, and five patients in stage IV (1.5%) only by chemotherapy. The first treatment divides the patients into three subgroups with significantly different prognoses: 1. a subgroup with complete remission assessed half a year after the end of therapy (n = 206 [58%]) and a healing rate of 96.2%; 2. a subgroup with partial remission (n = 62 [17.5%]) and a healing rate of 51.6%; 3. a subgroup without remission (n = 87 [24.5%]) and a healing rate of 4.2%. In case of recurrence after complete or partial remission, another complete and durable remission is achieved by subsequent therapy in about 85% of patients with preceding complete remission and statistically about 50% of patients with preceding partial remission. The overall five-year survival rate is 73.1%; a constant level of 67.3% (statistical healing rate) is observed after seven years. The following risk factors for remission have been found: the histologic manifestation lymphocytic depletion, parts of stage III, especially of type B, stage IV, and an age above 40 years and even more above 50 years.

The total group of patients with Hodgkin's disease submitted to primary treatment from May 1964 till December 1976 is divided with respect to diagnostics and therapy into a preponderantly clinically assessed group (CS) treated during the years of 1964 to 1971 (n = 190) and a preponderantly surgically assessed group (PS) treated during the years of 1972 to 1976 (n = 180). The first subgroup was treated with differently large irradiation fields and, in case of combined therapy, mostly with cyclophosphamide. The second subgroup was treated with extended fields, even until total lymphoid irradiation and, in case of drug administration, with primary combined chemotherapy (MOPP). The overall five-year remission rates of both subgroups (stages I to IV) have improved from 35.4% to 54.8% (P less than or equal to 0.001) and the five-year survival rates from 67.2% to 78.2% (P less than or equal to 0.001). If a complete remission was achieved, this was obtained, as far as judgeable, already at an earlier moment in the individual groups: e.g., in stage I with 95.5% after one year as against 94.1% after five years and in stage II with 91.3% after four years as against 72.9% after seven years. The prognostic differences of stages I and II and the histologic manifestations: lymphocytic predominance, nodular sclerosis, and mixed cellularity were equalized under the therapeutic measures of the intensive treatment period.

The post-therapeutic pregnancy data of 122/244 women aged until 40 years who had been treated primarily in Freiburg i. Br. for Hodgkin's disease between 1949 and 1981 were obtained by an inquiry based on questionnaires. All of the 122 patients of the questionnaire group were in remission. 39 out of them (32%) became pregnant one or more times; 38/94 (40%) of these had been irradiated down to the promontory and 1/17 (6%) had been submitted to an irradiation including the pelvis with ovariopexy. The resulting 63 post-therapeutic pregnancies leaded to 41 normal births (65%), three premature infants (5%), two viable children suffering from malformations (3%) and five spontaneous abortions (8%). An interruption was performed in twelve cases (19%). There were no significant divergences from distributions of normal populations with regard to the percentages of normal births and negative variants, even under consideration of comparable literature reports. Neither in the questionnaire group nor in the group of 122 patients whose gynecologic data could only be evaluated by means of the medical records available, there was any indication suggesting an increased risk of morbidity or mortality.