[Indications and methods of megavolt therapy in prostatic cancer--evaluation of 98 cases]. / Zur Indikation und Methodik der Megavolttherapie des Prostatakarzinoms--Auswertung von 98 Fällen.

A report is given on 98 unselected cases of carcinoma of the prostate, treated at the University Department of Radiotherapy and Radiobiology of Vienna from January 1974 till December 1979. 85% of the patients were over 60 years old. More than the half of them had been subjected to surgery or had undergone hormone therapy before starting radiotherapy. Moreover, more than 50% of the patients showed advanced disease (stages C or D). Local control was achieved in about 95% of cases. Long-term side effects such as irradiation damage to bladder or gut occurred in about 5% patients only. Survival rate was 75.5% after 3 years, 66.7% after 5 years and 46.7% after 7 years. Recommendations as to the management of such an unselected patient group are given. Our modified radiation technique is presented.

[Optimization of dose distribution by use of lead wedge filters in combined electron and photon therapy]. / Optimierung der Dosisverteilung bei kombinierter Elektronen- und Photonentherapie durch Anwendung von Blei-Keilfiltern.

A significantly improved isodose distribution has been reached by the combined application of high-energy photons and electrons, however, there are still problems with respect to the critical organs. It was demonstrated that a considerable progress is possible by the use of lead wedge filters within the frame of this irradiation technique. Recommendations for clinical application are given on the basis of the authors' own practical experiences.

[Interstitial radiotherapy for malignant melanoma of the choroid: implantation of radioactive gold grains by means of a gun-shaped applicator]. / Interstitielle Radiotherapie maligner Aderhautmelanome: Spickung mit dem Goldkorn-Applikator nach Hodt.

Four years after enucleation of one eye of a 49-year-old patient because of malignant melanoma of the choroid, the same kind of tumor developed in the remaining eye. The size of the melanoma and its location close to the pole prompted an unconventional therapeutic approach. After external beam radiation a radioactive gold seed sheathed with platinum was deposited directly above the tumor through the hollow needle of a pistol-shaped applicator, thus increasing the radiation dose to the required 8500 rad, which is considered sufficient for reliable destruction of malignant melanoma. After a one-year period of observation the patient is still in good health, the melanoma having been replaced by a flat chorioretinal scar; the surrounding retina, as well as the optic nerve and the lens lack any sign of radiation damage. Visual acuity of 0.8/Jg I has been preserved. The technique and possible indications for treatment by this method are described.

[Treatment of advanced ovarian cancer as an interdisciplinary task: surgery, histopathology, radiotherapy, and chemotherapy]. / Die Behandlung fortgeschrittener Ovarialkarzinome als interdisziplinäre Aufgabe: Chirurgie, Histopathologie, Strahlentherapie, Chemotherapie.

From February 1977 to February 1981 we treated 55 patients with ovarian cancer (45 stage III and 10 stage IV) with simultaneous radio-chemotherapy; 34 of these patients underwent a therapeutic second-look operation. The overall response rate was 94%, comprising 63% complete and 31% partial remissions. In the group with residual tumours exceeding 2 cm in diameter after primary operation 52% complete remissions were observed. In the stage III group there were 74% complete and 26% partial remissions. Cytoreductive surgery to less than 2 cm was achieved by means of an early second-look operation in 74% of these cases. These patients have as good a prognosis as those with an equivalent residual tumour after primary resection. Unlike the cases with tumour spread to the retroperitoneal area, macroscopic tumour spread to the surface of the liver or diaphragm indicated a worse prognosis. The survival time of patients who prove to be tumour-free at the time of the diagnostic operation is significantly longer than of those with residual tumours. Neither the age of the patients nor the histological findings after primary operation have any significant influence on survival time. Late intestinal complications made us change the therapeutic strategy employed since March 1981 to sequential radio-chemotherapy. Possible cure for stage III patients can be achieved only by way of interdisciplinary cooperation. In stage IV patients the prognosis is so bad that local therapy is possible only in selected cases.

[Percutaneous radiotherapy of thyroid malignancies. Analysis of 54 cases]. / Zur perkutanen Strahlentherapie des Schilddrüsenmalignoms. Analyse von 54 Fällen.

A report is given on 54 cases of thyroid malignancy treated at the University Department of Radiotherapy and Radiobiology of Vienna from January 1970 till September 1977. These cases are analysed according to local control of disease and survival time. The 5-year disease-free survival rate for all histological types was found to be 48%. Local recurrence occurred in 13% of cases. Combined external irradiation and radioiodine therapy is critically discussed.

[Sonographic location of the prostate gland by perineal-tomography (author's transl)]. / Sonographische Lokalisation der Prostata durch perineale Schnittführung.

The concept of radiation therapy of carcinoma of the prostate includes radiation of the primary tumour via a perineal field, besides ventral and dorsal irradiation fields. Therapy planning adapted to the individual anatomical conditions in the minor pelvis led to location of the prostate via perineal, sagittal ultrasonic tomography. Sonographic examination was conducted in 10 patients with carcinoma of the prostate, in 5 patients with benign enlargements of the organ and in 5 patients with urologically normal findings, taking the positioning of the patient during irradiation into consideration. In 18 of these 20 patients it was possible to determine the anatomical parameters relevant to therapeutic planning. Choice of the field dimensions, focal depth and angle of inclination of the central beam were greatly facilitated by this easy examination method which can be conducted as a routine measure.

[The role of radiotherapy in the treatment of the pancreas carcinoma (author's transl)]. / Rolle der Strahlentherapie in der Behandlung des Pankreaskarzinoms.

Although diagnosis of the pancreas carcinoma is only possible in an advanced stage, it is recommendable to try a radiotherapy as long as there are no remote metastases. If the patients are adequately selected, further if the target volume is exactly localized and charged with a high dose, it should be possible to reach considerably longer survival times. Different irradiation methods with ultrahard photons and high energy electrons are compared with regard to their therapeutic value.

[Therapeutic results in ovarian cancer after replacement of conventional radiotherapy by Co-60 irradiation (author's transl)]. / Veränderung des Behandlungsergebnisses beim Ovarialkarzinom nach Ersatz der konventionellen Röntgentherapie durch 60Kobalt-Bestrahlung.

The use of Co-60 screen and pendular irradiation instead of conventional radiotherapy has brought about an improvement in the 5-year survival rate in patients with more advanced stages of ovarian cancer. Although the general side effects of Co-60 irradiation are considered to be more unpleasant than those of X-ray and radium therapy, severe, reversible or irreversible damage to the urogenital tract and intestinal organs was diminished by accurate planning of Co-60 therapy, so that these complications occurred less frequently than with conventional radiotherapy.

[Radiotherapy of para-aortal lymphomas with Co 60 gamma radiation (author's transl)]. / Strahlenbehandlung von paraaortalen Lymphomen mit Co-60-Gammastrahlen.

With regard to 16 cases of testicle tumors and Hodgkin disease which are well proved by X-ray diagnosis, the mono-axial and bisectorial pendulum movement over 100 degrees is submitted to a critical consideration. The authors resume that the big lymph nodes are not always covered in an optimal manner, however, the radiation exposure of the kidneys is often relatively high. The values of different alternative methods are discussed on the basis of computer isodoses relating to a constant phantom cross-section. In view of tumor covering as well as kidney and spinal marrow exposure, the most favourable dose distribution is reached by a mono-axial and bisectorial pendulum movement combined with a contralaterial irradiation method. This method seems to be specially suited for the routine therapy of lymphomas requiring an irradiation with 5,000 rd or more because of their bigness or their low radiosensitivity.

[Bisectorial small-angle pendulum irradiation alternatively to other methods of 60Co-teletherapy: valence and volume doses (author's transl)]. / Die bisektorale Kleinwinkelpendelung als Alternative zu anderen Methoden der 60Co-Teletherapie. Wertigkeit und Volumsdosen.

A comparison is made between five irradiation methods, the dose distribution and volume doses of which had been ascertained by means of two phantoms presupposed differently large. Of the two methods of small-angle pendulum irradiation, the bisectorial monaxial pendulum technique turns out to be a practicalbe alternative to fixed-field and rotation irradiations. Similarly to fixed-field irradiation with two opposed fields, to which, after all, this technique is superior in every respect, it makes possible a relatively simple spatial irradiation planning. In this regard it is also more favorable than the rotation irradiations, though they give security of a more homogeneous load to axially parallel focuses; but an oblique position of the focal axis can be compensated only by an extension of the target volume and consequently augmentation of the volume dose. The necessity of confining to a certain extent the sum of absorbed energy is accentuated.

[Methodologic studies on the optimization of the 60Co-teletherapy in combination with high dosage brachytherapy of cervix carcinoma]. / Methodologische Untersuchungen zur Optimierung der 60Co-Teletherapie in Kombination mit hochdosierter Brachytherapie beim Kollumkarzinoma

After dosimetric recording of the radium implants being in use at the radiological department of the gynecological clinics at Vienna, an attempt is made for the adaptation of cobalt-60 teletherapy to brachytherapy generally applied here and utilizing relatively high dosage. A biaxial, bisegmental small-angle rotation about two cranially convergent axes, combined with the radium doses, yields a relatively well equilibrated load on the parametrial tissue and on the essential areas of the lymph flow. The dose distribution is shown by transversal as well as by frontal sectional planes. If deviations of the position of the radium implants, always possible in an individual case, are verified by localization imaging, asymmetrical dose distributions can be calculated by a computer and compensated by means of different loads to the axes of rotation.

[Radiotherapy of ovarian carcinoma (author's transl)]. / Die Strahlentherapie des Ovarialkarzinoms

The difficulties of early diagnosis and therapeutic management of ovarian carcinoma are discussed. Large-field irradiation of the abdomen in stage II and III cases with Co-60 screen and pendular irradiation significantly improves the survival rate of the patients. In these cases radical operation combined with intensive postoperative irradiation with Co-60 gamma-rays is considered to be the treatment of choice. Above all, a focal dose of 6000 rad, which can be attained during inpatient treatment, leads to a marked improvement in the results.