The role of STIR MRI sequence in the evaluation of the breast following conservative surgery and radiotherapy.

The purpose of the study was to define the value of fat suppressed STIR sequence in the MRI of the conserved breast. To our knowledge, this study is the first clinical evaluation of STIR sequence in post-therapy conditions. Forty patients with early (T1-2, N0-1) invasive breast cancer underwent conservative surgery and postoperative radiotherapy. Routine follow-up examinations, including physical examination and mammography were supplemented with breast MRI in all cases 6-166 months (mean 27.6) after initial treatments. Three patients had bilateral cancer. Including follow-up (9 patients) MRI examinations, altogether 53 MRIs were available for analysis. An 0.5 T MRI (Elscint, Haifa, Israel) was used with double breast coil. Axial T1 and T2 weighted spin echo, STIR and 3D gradient echo dynamic sequences were performed. Pre- and postcontrast slices underwent serial subtraction. Twenty-eight circumscribed lesions were identified. All were well visualised on STIR sequence, regardless of histologic nature of lesions. One low grade DCIS was not detected by any sequence. Differential diagnosis between benign and malignant lesions was not possible by STIR sequence alone. STIR sequence was found to be more sensitive in the detection of treatment related breast edema and fluid collection, than T2 SE (spin-echo) sequence. Even the patients who were not good candidates for subtracted contrast enhanced dynamic studies - because of motion artefacts - could have been examined with satisfactory results. STIR is a very sensitive sequence for depicting circumscribed lesions and post-therapy complications, but not suitable for differentiation. It is a useful tool in the follow-up of patients with conserved breast subjected to radiotherapy.

In vitro evaluation of a new rotational thrombectomy device: the Straub Rotarex catheter.

PURPOSE: To evaluate the efficacy of a new rotational thrombectomy device, and the procedure-related risk of particle embolization. METHODS: The experiments were performed in transparent silicone tubes. The conditions of flow were as close as possible to physiological parameters. Distal embolization was detected by a mesh of nylon filters. RESULTS: The Straub Rotarex catheter was able to remove all clots. The mean number of migrating particles larger than 1000 microm was 0.17 (+/- 0.38), the mean number of 400-1000 microm migrating particles was 1.08 (+/- 1.04). The mean intervention time was 67 (+/- 37) sec. The mean volume of collected liquid was 96.6 (+/- 24.7) ml. CONCLUSION: The in vitro results suggest that the Straub Rotarex catheter is able to remove large volumes of thrombus with a limited risk of embolization. The main limitation of our model is the absence of adhesion of the clot to the tube.

CT-image-based conformal brachytherapy of breast cancer. The significance of semi-3-D and 3-D treatment planning.

PURPOSE: To compare the conventional 2-D, the simulator-guided semi-3-D and the recently developed CT-guided 3-D brachytherapy treatment planning in the interstitial radiotherapy of breast cancer. PATIENTS AND METHODS: In 103 patients with T1-2, N0-1 breast cancer the tumor bed was clipped during breast conserving surgery. Fifty-two of them received boost brachytherapy after 46 to 50 Gy teletherapy and 51 patients were treated with brachytherapy alone via flexible implant tubes. Single, double and triple plane implant was used in 6, 89 and 8 cases, respectively. The dose of boost brachytherapy and sole brachytherapy prescribed to dose reference points was 3 times 4.75 Gy and 7 times 5.2 Gy, respectively. The positions of dose reference points varied according to the level (2-D, semi-3-D and 3-D) of treatment planning performed. The treatment planning was based on the 3-D reconstruction of the surgical clips, implant tubes and skin points. In all cases the implantations were planned with a semi-3-D technique aided by simulator. In 10 cases a recently developed CT-guided 3-D planning system was used. The semi-3-D and 3-D treatment plans were compared to hypothetical 2-D plans using dose-volume histograms and dose non-uniformity ratios. The values of mean central dose, mean skin dose, minimal clip dose, proportion of underdosaged clips and mean target surface dose were evaluated. The accuracy of tumor bed localization and the conformity of planning target volume and treated volume were also analyzed in each technique. RESULTS: With the help of conformal semi-3-D and 3-D brachytherapy planning we could define reference dose points, active source positions and dwell times individually. This technique decreased the mean skin dose with 22.2% and reduced the possibility of geographical miss. We could achieve the best conformity between the planning target volume and the treated volume with the CT-image based 3-D treatment planning, at the cost of worse dose homogeneity. The mean treated volume was reduced by 25.1% with semi-3-D planning, however, it was increased by 16.2% with 3-D planning, compared to the 2-D planning. CONCLUSION: The application of clips into the tumor bed and the conformal (semi-3-D and 3-D) planning help to avoid geographical miss. CT is suitable for 3-D brachytherapy planning. Better local control with less side effects might be achieved with these new techniques. Conformal 3-D brachytherapy calls for new treatment planning concepts, taking the irregular 3-D shape of the target volume into account. The routine clinical application of image-based 3-D brachytherapy is a real aim in the very close future.

[Radiologic follow-up after breast-conserving surgery: value of MRI examination of the breast]. / Posztoperatív sugárkezelés okozta mellékhatások radiológiai követése emlömegtartó mütét után: az emlö MR-vizsgálatának értéke.

The aim of the study was to establish an objective method for evaluation the extent, topography and quantity of skin and soft tissue side effects after tele- and/or brachyradiotherapy of the conserved breast and to compare the sequales of different radiation methods. 26 patients operated on for T1-2 N0-1 breast cancer underwent the following kinds of postoperative radiotherapy: 1. 46-50 Gy whole breast teletherapy + 10-16 Gy electron boost (5 patients), 2. 46-50 Gy teletherapy + 10-15 Gy HDR brachytherapy boost (12 patients), 3. 46-50 Gy teletherapy (6 patients), 4. 36,4 Gy sole HDR brachytherapy of the tumour bed (5 patients). The postirradiation side effects were examined by MRI, mammogram, US and physical examination, as well. MRI was performed on a 0.5 T, double breast coil, with SE-T1, SE-T2 and 3D-GE sequences. The findings of MRI and mammography were compared to physically detectable side effects using the RTOG/EORTC late radiation morbidity scoring scheme. US is useful in the measurement of skin thickening and in the diagnosis of fat necrosis. Mammography and physical examination are very subjective and low specificity methods to evaluate postirradiation side effects. MRI is a suitable and more objective method to detect the real extent and quantity of skin thickening and fibrosis. The incidence of > or = G2 side effects of skin and breast parenchyma were 64.5 and 32.2%, respectively. The differences between the side effects of whole breast irradiation and sole brachytherapy of the tumour bed are also clearly demonstrated. Brachytherapy alone is feasible without compromising cosmetic results. The authors established the MRI criteria for categorization the extent and grade of skin thickening and fibrosis (focal vs diffuse, grade 1-4). Breast MRI is an objective tool for assisting to the evaluation of the side effects of postoperative radiotherapy.

Sole brachytherapy of the tumor bed after breast conserving surgery: a new radiotherapeutic strategy for patients at low risk of local relapse.

The aim of the study was to test the hypothesis, if there were subgroups of early breast cancer patients in which sole brachytherapy (BT) of the tumor bed was a feasible and safe treatment option after breast conserving surgery (BCS). Forty four prospectively selected patients with Stage I-II breast cancer were entered into a protocol of postoperative tumor bed irradiation using interstitial high dose rate (HDR) implants. The HDR fractionation schedules were calculated according to the linear quadratic model. In 8 patients 7 x 4.33 Gy, in the other 36 patients 7 x 5.2 Gy were delivered to the tumor bed with 2 cm margin. The treatment planning was based on the 3 dimensional (3D) reconstruction of the clipped excision cavity, catheters and skin points. A conformal semi-3D dose planning was used. The side effects were assessed by mammograms, MRI- and clinical examinations. At a median follow up of 20 (7-36) months 1 (2.3%) local and 1 (2.3%) regional failure was observed. Distant metastasis did not occur. The cosmetic results were judged to be excellent in each case. G2 radiation side effects were observed in 2 (4.5%) cases. Postoperative sole BT of the tumor bed with careful patient selection and adequate quality assurance seems to be a feasible alternative to whole breast radiotherapy after BCS. Sole BT shortens the time of radiotherapy from 5-6 weeks to 5 days, and reduces the costs of treatment. The skin and volume sparing effect of interstitial irradiation may decrease the side effects of radiotherapy. A randomized study is in progress to define which subgroups of patients should be candidates for BT alone after BCS.

[Brachytherapy of the tumor bed after breast conserving surgery: new radiotherapeutic option in the management of early breast cancer]. / A tumorágy egyedüli brachyterápiája emlömegtartó mütét után: új sugárterápiás lehetöség a korai emlörák kezelésében.

PURPOSE: To initiate fractionated, interstitial high dose rate brachytherapy of the tumour bed as the sole radiation modality after breast conserving surgery. PATIENTS AND METHODS: In 41 cases of selected stage I-II breast cancer the tumour bed was marked with titanium clips during breast conserving surgery. The tumour bed was implanted with flexible plastic catheters to deliver postoperative radiotherapy. In 8 cases 7 x 4.33 Gy (30.3 Gy), in 33 cases 7 x 5.2 Gy (36.4 Gy) interstitial 192Ir high dose rate brachytherapy was given to the clipped area. Irradiation of the whole conserved breast was omitted. The radiation side effects were assessed by mammograms and MRI-examinations. RESULTS: At a median follow up of 17 (4-36) months neither distant nor regional failure was observed. Local recurrence was detected in 1/41 (2.4%) case. G2 radiation side effects were observed in 2/21 (9.5%). CONCLUSIONS: Postoperative sole brachytherapy of the tumour bed with careful patient selection and adequate quality assurance seems to be a feasible alternative to whole breast teletherapy. Sole brachytherapy shortens the time of radiotherapy from 5-6 weeks to 5 days, and reduces the costs of treatment. The skin and volume sparing effect of interstitial irradiation may decrease the side effects of radiotherapy.

[Spiral CT: new clinical indications and special artifacts]. / Spirál CT: új klinikai indikációk és sajátos mütermékek.

Authors describe the technical principles of volumetric CT, in comparison with the conventional method. New, quick data acquisition related artifacts are demonstrated in the different organs in order to avoid diagnostical faults. Details are given about the special examination parameter settings which are used for searching for particular pathological processes. Advantages, disadvantages, physiological and technical limitations are discussed. Authors present the new clinical applications, especially in the field of vascular and musculoskeletal imaging.

[A new, more invasive approach in the radiation diagnosis of breast cancer]. / A korai emlörák legújabb szemléletü, fokozottan invazív radiológiai diagnosztikája.

The authors discuss the state-of-the-art techniques and the increasingly invasive approach to the diagnosis of breast diseases and also summarise their own experiences. Special attention is called to the nonpalpable, preclinical stage of breast cancers. The newest techniques like MR-mammography, stereo-taxic and ultrasound directed cytology and core biopsy are demonstrated, as well as the present place of traditional breast imaging methods: mammography and diagnostic ultrasound. The preoperative localisation of nonpalpable cancers improves the safety of surgical procedures. The authors emphasize the importance of the detection of early breast cancer, for the sake of a more favourable prognosis compared to that of the palpable, advanced cases. The results of mass screening is detailed, based on statistical data.

[Incidence of osteoporosis and aseptic femur head necrosis following complex therapy of germ cell testicular tumors]. / Osteoporosis és asepticus combfejnecrosis elöfordulása csírasejtes heredaganatok komplex kezelését követöen.

Between the period of 1981 and 1991 at the National Institute of Oncology 1300 patients suffering from non-seminoma testicular cancer were treated by chemotherapy. Among them 19 cases of femoral head necrosis, one side or bilateral, were observed. Authors collected and compared the data of 16 patients of osteonecrosis and 28 without it. The aim of the study was the determination of the causes of osteonecrosis and searching for possible relation between antineoplastic therapy and osteoporosis. High alcohol consumption was found in 15 cases in the osteonecrotic group, versus one among the others. Bone mineral content measurement was performed by quantitative computed tomography. Average ages at the time of densitometry: osteonecrotic group 39.17, patients without osteonecrosis 33.91. The relative bone mineral content was found 65.94% in the osteonecrosis (A) group and 77.92% in the group without osteonecrosis. A significant difference was found in the level of serum calcium and the steroid dose applied during chemotherapy.

The age dependence of gustatory habits--a family study.

The authors continued their earlier studies in the field of human food favoritism. They collected family samples from two Hungarian towns. For the comparison of food choices of adults and children a quantity called Adults' Food Preference Score (AFPS) was constructed which seemed to be suitable to discriminate the gustatory habits. A family analysis has shown that the food preferences of mothers and children are much more connected than those of fathers and children.

Laryngeal lipoma.

We present a rare case of an intrinsic lipoma of the left false vocal cord in a 62-year-old man. The tumor was a manifestation of generalized lipomatosis. Successful endolaryngeal removal was accomplished.

Taste sensitivity to phenylthiocarbamide in a sample of Hungarian Gipsies.

PTC sensitivity in Gipsy and non-Gipsy populations of Hungary was evaluated. A significantly high difference was observed between the proportions of non-tasters among the Gipsies (39.3 per cent) and the non-Gipsies (26.4 per cent). These results are regarded as a probable confirmation of the Indian origin of the Gipsies, as the percentage of non-tasters in the majority of the different Indian tribes is higher than that of the European populations.

Sneezy twins.

A curious monozygous pair of twins producing sudden and vehement nose blowing and/or sneezing during/after eating and drinking, when their stomach had achieved a certain stage of fullness, has been observed. The sneezing reflex could be registered in 4 male members of the family. Since there were neither neurological disorders nor significant alterations in their electroencephalographic activity, the phenomenon may be regarded as a special type of hereditary vegetative sensitivity. The trait seems to follow either an autosomal dominant or perhaps a Y-linked mode of inheritance.

On the food favoritism of twins.

In the present study, there is a continuation of the authors' earlier investigations concerning food preference/refusal patterns in a group of Hungarian adult MZ and DZ twin pairs. A "Food Like/Dislike Chart" (FLDC), adapted to local nutritional habits, was applied. In order to characterize the degree of intra-pair concordance referring to the food favoritism, the concept of the "Taste Concordance Point" (TCP) was introduced. On the basis of the comparison of the TCP values obtained for the MZ and DZ pairs the conclusion can be drawn that gustatory habits are presumably influenced also by genetic factors. The results allow the possibility of applying TCP to testing zygosity.

Taste perception for phenylthiocarbamide and food choice--a Hungarian twin study.

A total of 98 MZ and 67 like sexed DZ adult twin pairs were studied for taste sensitivity to P.T.C. The MZ pairs were also tested for their food favoritism. A P.T.C. screening test showed a concordance in "tasting" or "non-tasting", within the MZ versus the DZ pairs. For the comparison of food choices of the P.T.C. tasters and non-tasters (members of MZ pairs) a quantity called "Tastership Test Point" (TTP) was constructed. Based on an analysis of the TTP values it may be suggested that taste sensitivity to P.T.C. and food preferences are not completely unrelated characters. These results serve as a contribution to the authors' previous findings obtained in Hungarian adolescents.