[Radiotherapy treatment of lymphoma]. / Radioterapija u lijecenju limfoma.

Radiotherapy and/or chemotherapy are primary treatment modalities in the therapy of lymphoma. The treatment depends on the lymphoma type, stage of disease and patients general condition. Radiation therapy is applied with curative or palliative intent, either as a single or combined modality treatment. In patients with stage I and stage IIA Hodgkin's lymphoma (HL) and no adverse risk factors, radiotherapy is applied as a single modality treatment. Moreover, treatment modalities in early-stage HL (I and IIA) consisting of either chemotherapy alone or combined with radiotherapy are the subject of ongoing clinical trials. In addition to the region/s with clinically involved lymph nodes, the target volume of radiation therapy applied as a primary radical treatment modality (stages I and IIA) also includes non-involved lymph nodes of adjacent regions aimed at their prophylactic irradiation. Such extended radiation fields are, for instance, the "mantle-field" and the "inverted-Y" field. On the other hand, with radiation therapy applied in combination with chemotherapy, the target volume depends on both the stage of the disease and the number of chemotherapy cycles. Likewise, the combined treatment is dependent on whether the role of radiotherapy is only the control of clinically involved regions, or of regions with potential subclinical disease too. Chemotherapy is the most frequently applied treatment modality in the management of non-Hodgkin's lymphoma (NHL). Radiation therapy as a single modality treatment with curative intent is applied in patients with, according to the histopathologic classification of the disease, the indolent NHL type and pathological stages I and II in continuation. The target radiation volume includes the clinically involved region, and possibly other adjacent clinically non-involved regions. In higher stages of disease or other, more aggressive NHL chemotherapy is applied either alone or in combination with adjuvant radiotherapy.

[Pain therapy with implanted medication pumps for chronic pain.]. / Schmerztherapie mit implantierten Medikamentenpumpen bei chronischen Schmerzen.

Epidural or intrathecal opiate analgesia, combined with bupivacain by means of an implanted pump, represents a possibility for providing good pain management for cancer patients as well as other chronic pain patients. Several indications, for implantation of a percutanously refillable pump are demonstrated in 27 patients. Twenty-four patients were treated with epidural and 3 with intrathecal catheters. Nineteen patients were suffering from chronic pain, and 8 had pain because of cancer. Four patients with chronic pain have been treated with continuous epidural opiate analgesia by means of an implanted pump for more than 2 years and 1 patient for more than 5 years. In the course of 2 years there has been no significant increase in the daily dose of buprenorphin given epidurally to patients with chronic pain. There were no addiction problems with opiates given epidurally or intrathecally by means of implanted pumps. Because of a 13% complication rate, pumps and epidural or intrathecal catheters should only be implanted by an experienced team.