[Optimizing radiotherapy for carcinomas of the tongue and floor of the mouth. Measurement of oncoradiogenic enzyme peaks of GPI]. / Optimierung der Strahlentherapie von Zungen- und Mundbodenkarzinomen. Messung des onkoradiogenen Enzympeaks der GPI.

After a first irradiation with 2 and 5 Gy blood samples were collected at 30 minutes' intervals for 24 hours in 19 tongue cancer patients to assess the activity of the glycosis enzyme glucose-6-phosphate isomerase (GPI) and the creatine kinase (CK). In all patients the GPI activity exhibited peaks at reproducible points in time. Observed for the very first time, this GPI peak had a height at 15 to 18 hours following radiation that correlated with the tumor volume and the irradiation dose. We refer to it as the oncoradiogenic enzyme peak. The frequency of the appearance of a late enzyme peak is significantly related to the presence of regional lymph node metastases. The radiobiological considerations regarding the potential causes for such post-irradiation increases in enzyme activity are discussed. The impact of demonstrating oncoradiogenic GPI peaks for optimizing radiotherapy is outlined.

[Detection of early tumor reactions in irradiation of tumors of the gastrointestinal tract by measuring the onco-radiogenic enzyme peak of glucosephosphate isomerase]. / Nachweis früher Tumorreaktionen bei Bestrahlung von Tumoren des Magen-Darm-Traktes durch Messung des onkoradiogenen Enzympeaks der GPI.

In 43 patients with oesophageal, pancreatic and rectal carcinoma blood samples were taken after the first irradiation and the activity of the glycolytic enzyme glucose-6-phosphate isomerase was measured. In all patients GPI peaks occurred at reproducible time intervals. The height of the enzyme peak occurring 15.5 to 19.5 hours p.irr. was significantly dependent on tumour size and irradiation dose. The frequency of a late occurring enzyme peak was dependent on the presence of regional lymph node metastases. Possible sources of the enzyme peaks are discussed from a radiobiological point of view and the meaning of such enzyme peaks for the optimization of radiation therapy is pointed out.

[Possibilities for optimizing radiotherapy of cervix cancers by measuring the enzyme peak of GPI after initial irradiation]. / Möglichkeiten der Optimierung der Strahlentherapie von Zervixkarzinomen durch Messung des Enzympeaks der GPI nach der ersten Bestrahlung.

Following the first irradiation with a dose of 1.6 respectively 2 Gy we determined the activity of glucose-6-phosphate isomerase (GPI) and of creatine kinase in intervals of 30 minutes for 24 hours. In all patients we could observe peaks of GPI-activity 15.5 to 19.5 hours after irradiation corresponding to tumour volume and grading. Frequency depends on present lymph node metastases detected by lymphography and/or computed tomography. Possible reasons have been discussed by the viewpoint of radiation biology and the meaning with respect to an optimal radiation treatment.

[Possibilities for optimizing radiotherapy of cancers of the ENT area by measuring oncoradiogenic enzyme peaks of glucose-6-phosphate isomerase]. / Möglichkeiten der Optimierung der Strahlentherapie von Karzinomen im HNO-Bereich durch die Messung des onkoradiogenen Enzympeaks der Glukose-6-Phosphat-Isomerase (GPI).

Blood samples were taken from 39 patients with head and neck carcinomas after the initial irradiation, and the activity of the glycolytic enzyme glucose-6-phosphate isomerase (GPI) was measured. All patients showed GPI peaks at reproducible times. The height of the enzyme peak occurring 15.5-19.5 h after irradiation, was significantly correlated with tumour size and histological tumour differentiation. A late enzyme peak was associated with regional lymph node metastases. Possible sources of the enzyme peaks are discussed from a radiobiological point of view, and the value of such enzyme peaks for the optimization of radiation therapy is pointed out.

[Possibilities for optimization of radiotherapy of esophageal carcinoma through measurement of the oncoradiogenic enzyme peak of glucosephosphate isomerase]. / Möglichkeiten der Optimierung der Strahlentherapie von Oesophaguskarzinomen durch die Messung des onkoradiogenen Enzympeaks der GPI.

In 20 patients with oesophageal carcinoma blood samples were taken after the first irradiation and the activity of the glycolytic enzyme glucose-6-phosphate isomerase was measured. In all patients there occur GPI peaks at reproducible times. The height of the enzyme peak occurring 15.5 to 19.5 hours p.irr. expresses a significant dependence on tumour size and irradiation dose. The frequency of a late occurring enzyme peak depends on the appearance of regional lymph node metastases. Possible sources of the enzyme peaks are discussed from a radiobiological point of view and the meaning of such enzyme peaks for the optimization of radiation therapy is pointed out.

[A comparison of systemic radiotherapy, chemotherapy or local radiotherapy in the treatment of extensive small-cell bronchial carcinoma. Results of a randomized series]. / Vergleich zwischen systemischer Strahlentherapie, Chemotherapie oder lokaler Strahlentherapie bei der Behandlung des ausgedehnten kleinzelligen Bronchialkarzinoms. Ergebnisse einer randomisierten Serie.

Between 1982 and 1987 we carried out a prospective randomized study to compare the effectiveness of high-dose half-body irradiation (HBI) (A), intensive combined chemotherapy (B), and local or locoregional radiotherapy (C) in the therapy of extended small cell lung carcinoma (SCLC). 99 patients with a histologically proved SCLC were assigned to the three therapeutic groups of series: A = 31 patients, B = 37 patients, C = 31 patients. The median survival period showed a statistically significant advantage (p less than 0.01) for the chemotherapy group (B = 46 weeks) versus the two radiotherapy groups (A = 19 weeks, C = 23 weeks). The survival after half a year, one year, and two years also gave a clear advantage for the chemotherapy group. No difference was found between the radiotherapy groups A and C. The high-dose HBI gave no improvement of the sad therapeutic situation for the extended SCLC.

A randomized clinical trial comparing systemic radiotherapy versus chemotherapy versus local radiotherapy in small cell lung cancer.

Between 1982 and 1987 a prospectively randomized trial of sequential hemibody irradiation (SHBI) (A), a non-cross-resistant chemotherapy drug combination (B) and local and/or locoregional radiotherapy (C) in small cell lung cancer (SCLC) was conducted. Previously untreated patients with extensive SCLC were randomized into three arms: A = 31 patients, B = 37, C = 31. In the chemotherapy combination, the following were used: etoposide, doxorubicin, methotrexate (VAM) and procarbacine, vincristine, cyclophosphamide, lomustine (POCC) and prophylactic cranial irradiation (30 Gy). The results show that the median survival was significantly (P less than 0.01) better in chemotherapy (44 weeks) compared with 17 and 20 weeks in arms A and C, respectively. One year and 2 year survival rates were better for the chemotherapy arm. No differences were found between groups A and C. In comparing the total hospitalization time expressed as a percentage of overall survival, an advantage for group B was shown. In conclusion, high dose SHBI cannot be recommended as a standard therapy for extensive SCLC.

[Lumpectomy with axillary lymph node excision and subsequent irradiation of the small breast cancer]. / Die Lumpektomie mit axillärer Lymphonodektomie und Nachbestrahlung beim kleinen Mammakarzinom.

The technique of lumpectomy with axillary lymphonodectomy and postoperative irradiation is discussed in this paper and is compared to quadrantectomy or bilaterally restricted subcutaneous mastectomy in cases of small-size mammary carcinoma. A critical appraisal is made of the authors' own concept of indication, with reference being also made to the problem of the non-invasive form.

[Pre- and postoperative irradiation of gastrointestinal tumors]. / Zur prä- und postoperativen Bestrahlung gastrointestinaler Tumoren.

Evidence has been produced to the effect that the radiation doses sufficient to manage occult malignoma offsprings or metastases are much lower than those required to cope with primary tumours. This seems to support the assumption that five-day or twelve-day preoperative irradiation, using doses between 20 Gy and 30 Gy, is possible of a target area large enough to include adjacent lymph nodes, without any impairment of the operation proper and for much better rates of healing. This should apply particularly to rectum, stomach, and pancreas carcinomas. Preoperative irradiation should be preferred to postoperative irradiation, provided secured diagnosis, since radiosensitivity of tumour cells was found to decline and that of normal tissue to rise after surgery. Hence, therapeutic effectiveness of postoperative irradiation must be expected to decrease after each recurrence. Consultation with a radiotherapist, therefore, is recommended, prior to a recurrent operation. To improve therapeutic results, concentration at adequately furnished centres is demanded for patients with oesophagus, pancreas, and anal carcinomas.

[Use of CT in the staging and follow-up of small-cell bronchial cancer]. / Einsatz der CT beim Staging und Verlauf des kleinzelligen Bronchialkarzinoms.

In 54 patients with small-cell bronchial carcinoma, investigated with conventional X-ray technique and computer tomography, CT afforded a considerable extension of findings in regard to mediastinal tumor and metastatic spread, as well as in the detection of supraclavicular and pleural metastases. Also, the process of remission and renewed tumor growth could be observed better. Thus, CT constitutes quite an acquisition to therapy planning. The investigations carried out simultaneously in the brain region did not appreciably add to the findings in comparison to scintigraphy. In contrast, in the abdominal region, we have discovered liver metastases, subrenal metastases and lymph-node metastases both at first investigations and at controls. At post-mortem, however, we found kidney metastases that were not described in the CT but which may possibly have arisen prefinally. Altogether, thoracal and abdominal investigations with CT prior to onset of therapy and subsequent control are a valuable addition to therapy planning.

Results of neutron therapy of soft-tissue sarcomas.

82 radioresistant mesenchymal sarcomas localized mainly at the trunk and the extremities have been irradiated with fast neutrons. In all three tumor dose ranges applied (6 to 9.6, 10 to 12.6, and 13 to 19 Gy) alike with 90% of the tumors either complete (congruent to 50%) or partial (congruent to 40%) regressions were observed; only 10% were unresponsive. Further 53 soft tissue sarcomas, showing a spontaneous recurrence rate following local extirpation up to 50%, underwent postoperative prophylactic irradiation with tumor doses of about 10 Gy. In 45 cases surveyed for at least two years, there developed seven (15%) recurrences in the irradiation field. The high regression rate and the good prophylactic effect against recurrences with doses well tolerable, render neutron radiation especially suitable for the treatment of soft tissue sarcomas.