Strahlentherapie最新文献

The contact irradiation in the region of pharynx and mouth with an afterloading unit is presented. Twelve patients with recurrent carcinomas of the squamous cell epithelium have been treated. A stable and reproducible positioning of the source probes in the tumor region is made possible by special applicator prostheses which are adapted to the post-operative situation. The irradiation scheme is based on the transformation of the source co-ordinates from the stereoradiographic localization system into the co-ordinate system of the computed tomogram. At least three fixed metal points which are inserted in the applicator prostheses and visualized by stereoradiography as well as by computed tomography serve as mutual reference points for both co-ordinate systems. The source positioning in the tumor region is optimized by CT irradiation planning. Three cases are presented in order to describe the principles of the method. Preliminary results are discussed.

Between January 1973 and April 1982 66 evaluable patients with advanced inoperable orofacial tumours underwent intraarterial Bleomycin and Methotrexate with simultaneous radiotherapy in a prospective study. 32 patients had no previous treatment, 34 patients had initial surgery, radiotherapy and/or chemotherapy. 15 mg Bleomycin were administered through a catheter into the arteria externa carotis daily in the morning. 25 mg Methotrexate were given in the same way at night followed by 3 mg Calcium-Leucovorin i.m. every 8 hours. The cumulative dose was 300 mg Bleomycin and 500 mg Methotrexate. Four hours after the administration of Bleomycin the target volume was irradiated (single fraction 2 Gy, total dose 60 to 65 Gy). The overall response rate was 65% containing 17% complete and 48% partial remission. Destruction of the bone appeared to be the most important index at the start of the therapy. Further prognostic determinants as previous treatment, localisation of the primary tumours (maxilla and mandibula respectively oral cavity and oropharynx) and local regional lymphnode stage missed statistically significance in the survival time, may be due to a possible radiosensitizing effect of the simultaneous chemotherapy. Complete remission turned out to be the most important prognostic factor after the end of treatment. Patients responding with complete remission show a median disease free survival of 56+ months and a median survival time of 82 months. Acute reactions were reversible. Only in 14% of the patients the treatment could not be finished. Better results could be obtained by electron-affinic radiosensitizers and high LET radiation.

A retrospective study of primary irradiated carcinomas of the uterine cervix was made in order to compare the effect of radium with the effect of a 192Ir afterloading therapy with high dose rate which had been introduced 2 1/2 years before. A group of 31 patients treated with iridium was opposed to a historical control group of 24 patients treated with radium. Both groups were submitted to the same method of simultaneous percutaneous irradiation. All consecutively treated patients exposed to a percutaneous focal dose of greater than 45 Gy were evaluated. The iridium and radium doses applied as well as the values measured in intestine and bladder are presented. The iridium group had the same or a slightly less favorable prognosis (prognostic factors compared: stage, percutaneous dose, histology, age) than the radium group. The remission rates were identical for both therapy methods. Patients treated with iridium have a slightly better curve of recurrence-free interval and survival time, even taking into consideration the shorter observation period. Two out of the patients treated with iridium and four out of those treated with radium presented severe long-term side effects with formation of fistulas (average incidence 12,5 months and 12,7 months after the beginning of therapy, respectively).

In sixteen patients who had been treated 42 months before on an average for malignant melanomas of the lower extremity (stage I) by a unilateral endolymphatic therapy with 32P/131J-Lipiodol UF, bipedal lymphography with oily contrast medium was performed. In consequence of the high-dosed intralymphatic radiotherapy the lymph nodes of the treated side are markedly reduced in size and number; fourteen out of the sixteen patients, however, showed lymph nodes of normal size and structure which had not been coloured during ELRT. On the basis of this phenomenon, a possible mechanism of formation of metastases in previously treated lymph nodes is discussed. The presentation and extent of radiogenic reactions in the lymph vessels correspond to the changes known for percutaneous irradiation.

Between 1970 and 1980, 339 patients with Hodgkin's disease in stages IA to IIIB were treated at the Department of Radiotherapy, University of Essen, FRG. 65 patients (group A) were irradiated using a multiple-field-technique with cobalt-60, 110 patients (group B) with mantle fields, inverted Y or paraaortic extended fields given with 5.7 MeV photons. There were no significant differences between the cumulative survival times, local and marginal recurrences. However, the recurrence rates of unirradiated lymph node regions were different, mainly due to absent or given paraaortic treatment. The presence of initially normal blood parameters (BSR, relatively lymphocyte count, haptoglobin, copper, iron) is of high prognostic value. Combined, they allow a correct prognosis as to the five year recurrence rate in up to 98% of cases. The prognostic precision of initially pathologic values was considerably reduced, even if a normalization had occurred after one year from the initiation of treatment.

Report on the incidence of recurrences, the time necessary for complete remission, and the sites of recurrences in 333 patients with demonstrated lymphogranulomatosis. Suggestion of an examination scheme considering clinical data and laboratory findings for early diagnosis of recurrences. Among the image-producing methods, sonography and CT are of special importance besides thorax examination, lymphography, and bone scintigraphy.

The combination of polychemotherapy and large-field radiotherapy essentially promoted the improved total results achieved during the period of 1976 and 1982 in 272 patients with non-Hodgkin's lymphomas (NHL) of low and high malignancy. In case of centroblastic-centrocytic (cb/cc) NHL of stages II A/III A, the recurrence-free survival after radiotherapy (n = 21) could be increased by the combined method (n = 25) from 17% to 60%, and the probability of seven-year survival could be improved from 70% to 90%. All of the ten initially irradiated patients in the stages I A/II A/III A of centrocytic (cc) NHL suffered from a recurrence, whereas the development seems to be more favorable in the five patients submitted to combined treatment who had only one recurrence. The recurrence-free seven-year survival of the highly malignant NHL in stage I A/II A increased from 40% after unique radiotherapy (n = 15) to 70% after combined therapy (n = 39), the survival probability increased from 55% to 75%. Despite the partly insufficient therapy results after unique radiotherapy and polychemotherapy, the combined method has largely contributed to achieve after eight years the total survival rates of 76% for cb/cc NHL (n = 123) and of 55% for the highly malignant immunoblastic NHL (n = 57), centroblastic NHL (n = 35) and NHL with uncertain classification, whereas the cc-NHL (n = 36) hitherto has a relatively unfavorable prognosis with only 29%.

The authors present seven typical cases chosen from a group of thirty patients with recurrent Hodgkin's disease. One out of these patients suffered from two recurrences, five patients from three recurrences each, and one patient from six recurrences. The observation period, beginning with the primary treatment, was between five and 16 years. None of the patients was exclusively irradiated or only treated by cytostatic drugs. Therefore after primary radiotherapy in the stages I to III A, later recurrences could often be successfully treated by an alternating application of cytostatic drugs and repeated radiotherapy. After primary chemotherapy of the advanced primary stages III B to IV B, too, a remission of the second and third recurrence could often be achieved by radiotherapy. Furthermore, the application of alternative schemes such as Holoxan-Vepesid has to be taken into account in the treatment of recurrences. The repeated application of C-MOPP after an interval of at least twelve months also produces good rates of response. The present results allow to make the conclusion that a successful treatment of the second and third and even of further recurrences is possible by a combined application of irradiation and cytostatic therapy.

The conception of etiology and pathophysiology of lymphogranulomatosis has essentially changed since the first description made by Hodgkin in 1832. In former communications, this disease was initially regarded as a tuberculosis of the lymphatic system with a pseudoleukemic course, then as an inflammatory disease, then as an intermediate state between cancer and tuberculosis, and finally as a chronic autoimmune process accompanied by interactions between neoplastic and normal lymphoid cells. Today the symptomatology is defined as a malignant disease of the lymphoreticular system beginning in a single lymph node, then expanding to other lymph nodes and spreading out by hematogenic propagation into the parenchymatous organs. The histologic examination of granulomatous tissue shows Hodgkin cells with one nucleus and Sternberg-Reed giant cells with several nuclei. The origin of Hodgkin cells is not yet clear, however, there are some hints resulting from investigations with monoclonal antibodies that the precursor cells possess some characteristics of granulopoietic cells, but also of antigens which are recognized by specific monoclonal antibodies. The immune system shows some modifications, above all with regard to the cellular immunity. The evolution of the disease is probably determined by some correlations with troubles of the cellular immune system. The treatment modalities depend on the stage which is classified according to the Ann Arbor Conference. The diagnosis should be established under rational aspects and with the aid of the most recent image-producing methods.

Esophago-gastro-duodenoscopies with multiple mucosa biopsies were performed before and after irradiation of the mantle field or the spleen pedicle in 13 patients with Hodgkin's disease in stage I and II. For the irradiation the photons of a 4 MeV linear accelerator were applied with focal doses of 40 to 44 Gy. Contrast simulator radiographs were made in order to verify the position within the irradiation field of the organs from which biopsies were taken. In 0/10 patients examined before the irradiation, 0/5 patients examined less than 15 weeks after the irradiation, and 0/12 patients examined 15 weeks or later after the irradiation, histomorphologic investigation of the mucosa of the esophagus showed no pathologic findings. With the same intervals of examination related to irradiation, the gastric mucosa showed a pathologic histomorphology in 1/13, 7/9, and 5/9 patients, respectively, and the duodenal mucosa in 0/13, 5/9, and 2/9 patients, respectively. With the exception of one ulcer in the duodenal bulb the histopathologic findings as well as the macroscopic findings were neither significant nor characteristic, i.e. not radiospecific. Most of these findings were inflammatory alterations of the mucosa, erosions, and capillarectasies.