[The radiation-sensitizing effect of isometronidazole following its intravesical application in bladder carcinoma. A clinical phase-II study]. / Die strahlensensibilisierende Wirkung von iso-Metronidazol nach intravesikaler Applikation beim Harnblasenkarzinom. Eine klinische Phase-II-Studie.

The radiosensitizing efficacy of iso-metronidazole, a 4-nitroimidazole derivative, was evaluated in a prospective clinical phase-II study. The results of combined radiotherapy of 25 patients with bladder cancer were compared with those of a control group of 25 patients treated with radiotherapy only. Tumor regression six months after radiotherapy was used as an endpoint. The surgical procedure was performed as double TUR. Evaluating the local tumor control after additional application of iso-metronidazole a gain factor of 1.2 is obtained.

[Shielded vaginal applicators for line-shaped 192Ir sources for use in the irradiation of cervix cancer]. / Abgeschirmte Vaginalapplikatoren für "linienförmige" 192Ir-Quellen zur Bestrahlung des Zervixkarzinoms.

The possibility is investigated to use shielded vaginal applicators for "line-shaped" 192Ir-sources to irradiate cervical carcinoma. Using segment-shaped absorbers of heavy metal the dose can be reduced in ventro-dorsal direction in area of rectum and bladder with irradiation of cervical carcinoma up to a factor of 2 in dependence of rectum and bladder position. Selecting a suitable source position and source standing time a dose reduction can be realized in cranial direction up to two centimetres from the portio.

[Autopsy results in surgical-radiotherapeutic treatment of bladder carcinoma--conclusions for optimal radiologic therapy]. / Obduktionsbefunde beim operativ-strahlentherapeutisch behandelten Harnblasenkarzinom--Schlussfolgerungen für die radiologische Therapieoptimierung.

With 282 autopsied patients with bladder carcinoma, that were treated by combined operation and radiotherapy, conclusions are given for tendency in tumor spreading as well as for complications and late-effects of radiotherapy. In 24.5% of the cases tumor tissue was found within the bladder and in 30.5% of the cases within the minor pelvis. Metastases were found in 24.1% in iliac lymph-nodes, in 21.3% of the autopsy cases in abdominal lymph-nodes. Liver, lungs, bones, and kidneys are main organs for hematological metastasizing. Little or undifferentiated carcinomas and squamous cell carcinomas show a greater tendency to metastasize than highly and medium-differentiated ureteral carcinomas. The least radiotherapeutical complications and late-effects were found in a fractionation with daily 1.5 Gy and a total dose of 60 Gy (necrotising urocystitis 17.9%, proctitis 3.6%).

Status of allogeneic bone marrow transplantation in childhood in the GDR.

Of 25 HLA-identical, MLC negative transplants 10 patients had acute lymphoblastic leukaemia (ALL), 8 acute nonlymphoblastic leukaemia (ANLL), 3 severe aplastic anaemia, 2 malignant histiocytosis, 1 patients neuroblastoma and 1 Fanconi anaemia. 3 HLA nonidentical, MLC positive transplants were performed, two children had malignant infantile osteopetrosis and 1 child had a severe combined immunodeficiency disease. Patients with ALL and ANLL received cyclophosphamide and single dose total body irradiation. 3 patients received fractionated TBI. The results for the allogeneic group overall indicate that the actuarial disease free survival rate is 0.62. 16 of 25 patients are in continuous complete remission (CCR) periods of 3-78 months posttransplant. All three transplanted children with severe aplastic anaemia alive disease-free for periods of 21-81 months. 10 patients with ALL were transplanted (2 in first remission for high risk ALL, 8 in second remission). 7 of 10 patients are alive and disease-free (CCR rate 0.67). 8 patients underwent BMT for ANNL while in first remission in 7 patients and in third partial remission in 1 patient. 4 of 8 patients are alive and disease-free for periods of 25-56 months (CCR rate 0.50). 1 patient with neuroblastoma stage IV survives 24 months, 1 child with Fanconi anemia died on day +25 of GVHD and septicaemia. 1 of the 2 patients transplanted for malignant histiocytosis relapsed 3 months posttransplant, 1 patient is alive and disease-free 5 months posttransplant. In none of the HLA-nonidentical and MLC positive transplantations T-cell depleted marrow engrafted.

Transplantation of major AB0-incompatible bone marrow: removal of red cells by dextrane sedimentation.

The elimination of erythrocytes by dextran sedimentation is a useful method to prevent haemolytic complications after AB0-incompatible bone marrow transplantation. The procedure presented here lasts only 1.5-2 hours, is high reproducible and safe in respect of infections. The mean recovery of nucleated cells amounted to 94%. The contamination with erythrocytes is low (recovery 1.1%). We have never seen haemolytic reactions during 7 AB0-incompatible bone marrow transplantations.

Cryopreservation of marrow, purging and autologous bone marrow transplantation in childhood.

Since 1984 bone marrow from 42 children with acute lymphoblastic leukaemia, non Hodgkin's lymphoma and neuroblastoma was cryopreserved. In 5 cases (c-ALL, NHL and B type) the marrow was purged by using a cocktail of three monoclonal antibodies (VIL A1, VIB C5, VIB-E3). Up to now 13 children (ALL/10, neuroblastoma/3) were autografted (one of them after purging) after supralethal chemoradiotherapy. Except one child with early death all patients had engraftment: a level of 1.0.10(9)/l leukocytes was reached at days 10-33 (median, 19); platelet level over 60.10(9)/l at days 32-60 (median, 41). 2 children died on treatment related complications, one on infection after full haematological restitution, 2 patients alive with relapse, 8/13 alive in CCR and well.

[Dosimetric studies of 192Ir line sources and the mathematical presentation of the dose distribution]. / Dosimetrische Untersuchungen der "linienförmigen" 192Ir-Quelle und die mathematische Darstellung der Dosisverteilung.

The dose distribution of a "line-shaped" 192Ir-source was measured in 1,152 measuring points in a water phantom. Using regression analysis the analytical description of dose distribution was obtained. Accomplished comparison measurings with a solid phantom of miramide in 45 measuring points show that the dose distribution can be reproduced well by solid phantom measurings. Taking an ideal line source distribution as a basis, the r-dependence of correction factor, obtained by regression analysis, refers to a dispersion effect. The angle-dependent deviation of dose distribution from the ideal line source can be described by cos-terms with the single and double angle between line source axis and measuring point.

[A comparison between the dose distribution from 192Ir point and line sources in the afterloading therapy of gynecologic neoplasms]. / Vergleich der Dosisverteilung zwischen "punkförmigen" "linienförmigen" 192Ir-Quellen in der Afterloadingtherapie gynäkologischer Tumoren.

For different fields of application in irradiation of gynecological tumors a comparison of isodose distribution is done with "point-shaped" and "line-shaped" 192Ir-source. With the oblateness of dose efficiency distribution towards the axis of source with the "line-shaped" 192Ir-source an improvement of dose distribution occurs in intracavitary irradiation with the lower and more balanced exposure of fundus uteri, especially in irradiation of the endometrial carcinoma. On the other hand the irradiation of vaginal stump renders problematic. In pure vaginal irradiation no differences are found in medically interesting range.

[The value of hyperfractionated irradiation from the viewpoint of radiobiological model findings]. / Zur Wertigkeit hyperfraktionierter Bestrahlungen aus der Sicht strahlenbiologischer Modellansätze.

From radiobiological model investigations it is deduced that hyperfractionated irradiation can render possible a better tumor regression than conventional fractionation with the same complication rate in tumors growing not too quick.

[The place of radiotherapy in pharyngeal cancer]. / Zum Stellenwert der Strahlentherapie bei Pharynxkarzinomen.

In a summary representation the therapeutic principles are shown applying radiotherapy in epithelial tumors of epi-, meso-, and hypopharynx on base of actual references in literature and own results. Especially by combination therapy a trend indicates improvement of therapeutic results.

[Results of combined operative-radiologic therapy of bladder cancer from the viewpoint of optimizing the physical-technical irradiation planning]. / Ergebnisse der kombinierten operativ-radiologischen Therapie des Harnblasenkarzinoms unter dem Gesichtspunkt der Optimierung der physikalisch-technischen Bestrahlungsplanung.

In 294 patients with bladder carcinoma, in which after transurethral or transvesical operation a high-voltage irradiation with daily 1.5 Gy and a total target dose of 60 Gy (four fields cross firing technique) was done, the influence of quality of physical-technical irradiation planning is studied on survival rates, portion of recurrences, side-, and late effects. The group of patients with individually computer-based optimizing of irradiation parameters based on a patient's cross-section, ascertained on therapy simulator, significantly shows better results with regard to above-mentioned criteria than the groups of patients with standard irradiation technique without and with definition of bladder topography.

[Studies of the relevance of the tumor marker neopterin for therapeutic decisions and follow-up of breast cancer]. / Untersuchungen zur Relevanz des Tumormarkers Neopterin für die Therapieentscheidung und Verlaufskontrolle bei Mammakarzinom.

The value of serum neopterin as tumour marker was verified on 104 breast cancer patients. Based on the results, neopterin cannot be recommended either for deciding treatment after primary therapy or for monitoring of breast cancer.

[Results of the surgical-radiologic treatment strategy used in laryngeal cancer in Jena patient material from 1964 to 1981]. / Ergebnisse der operativ-radiologischen Behandlungsstrategie bei Larynxkarzinomen im Jenaer Patientenmaterial von 1964 bis 1981.

The retrospective analysis of a radiotherapeutical material includes 452 patients with laryngeal carcinoma of the University Jena during the period from 1964 to 1981. The primary radiotherapy was done according to therapeutic protocol exclusively in glottal tumors of stage T1 and T2, exceptionally refusers of operation or inoperables. The portion of total laryngectomy is accordingly high with 47.6% of all patients. The 5-years-survival of all patients is 48% (217 of 452 patients). The results are compared with results of other therapeutic statements.

[Possibilities of isodose distribution in afterloading contact therapy of non-operated uterine cancer using an applicator tube and a point-shaped radiation source]. / Möglichkeiten der Isodosengestaltung bei der Afterloading-Kontakttherapie von nichtoperierten Uteruskarzinomen mit einem Applikatorrohr und "punktförmiger" Strahlenquelle.

For the contact radiotherapy according to the afterloading-procedure of patients with cervical and endometrial carcinomas isodose plans are represented, that are standardized to the lengths of uterus probes and adapted to tumor stages and are determined by an applicator tube lying centrally within the uterine cavity. By an additional lead screening of the vaginal applicator a dose reduction can be attained by the factor 1.6 or 1.4 in the critical organs bladder and rectum, which are relevant for this therapeutic form. An uncritical inclusion of the vagina into the target volume of contact therapy, that is not justified by tumor invasion, should not be carried out, knowing the higher complication rate at the critical organs.

[Results of therapy of endometrial carcinoma and analysis of risk factors in comparison with a control group]. / Therapieergebnisse beim Endometriumkarzinom und Risikofaktorenanalyse im Vergleich mit einer Kontrollgruppe.

Overall 1,021 patients with endometrial carcinoma were treated between 1965 and 1982 at the Department of Obstetrics and Gynecology and the Department of Radiology, Friedrich-Schiller-University, Jena. The 5-year-survival rate of all patients amounted to 63%. The 5-year-survival probability with primary surgery was 76.1%, with primary irradiation 34.4%. The frequency of risk factors in the patient group was compared with an age adjusted group of patients who underwent a D & C due to irregular bleeding of benign causes. Overweight and infertility were evaluated as significantly more frequent risk factors in cancer patients. There was no significant difference between the two groups concerning the factors hypertension, diabetes, heart-diseases, irregular bleeding and history of carcinoma in the family.

[A prospective randomized study on the fractionation of afterloading therapy of cancer of the cervix and endometrium]. / Prospektive randomisierte Studie zur Fraktionierung der Afterloading-Therapie von Zervix- und Endometriumkarzinomen.

A prospective randomized clinical study is made on patients with uterine cervix and endometrium carcinomas treated only by radiotherapy. The fractionation schemes of 4 times 10 Gy, and 5 times 8 Gy, and 8 times 5 Gy at the reference points A and My, respectively, of a short-term afterloading therapy combined with percutaneous telecobalt therapy with 45 Gy at the pelvic wall are investigated. A tendency is shown towards better tumor control and less radiogenic effects with an increased number of fractions. The results are discussed on the basis of the NSD and LQ models. The problems caused by the equipment type and dosage specificity hampering the applicability of the results on other afterloading therapy units are pointed out.

[Dose-time optimization in fractionated radiotherapy]. / Zur Dosis-Zeit-Optimierung in der fraktionierten Strahlentherapie.

On the basis of an evaluation of different isoeffect correlations for normal tissue reactions supported by a clinical study, a number of correlations for the dose-time optimization of irradiations with equal fractionation intervals are derived from a simple approach for the survival rate of irradiated tumor cells based on a linear quadratic dose-effect function for an exponential cell proliferation. This allows to determine optimum single doses for every given fractionation interval which, applied with the number of fractions tolerated by normal tissue, lead to a maximum reduction of tumor cells. The values of these optimum fractionation parameters depend from cell proliferation and radiosensitivity of the tumoral tissue and vary with respect to a normal tissue tolerance for early and late reactions. The results are described for several fractionation examples. It is shown that, within the tolerance limits of normal tissue, a greater tumor remission is achieved by hyper-fractionated irradiation than by a small number of high-dose irradiations.

[Information concerning radiation-induced sarcomas. Report on 2 cases]. / Zur Kenntnis strahlenbedingter Sarkome. Mitteilung über 2 Beobachtungen.

Two cases of radiation-induced sarcomas are presented. Osteosarcomas developed in the frontal bone after a latency period of 36 years following operation for brain tumor with post-operative irradiation (48 Gy) in one patient and in the region of the right sacro-iliac joint after ablation of testis for seminoma with post-operative irradiation (60 Gy) in another patient. In the literature, the risk of developing an irradiation-induced sarcoma is considered to be low (0.05-0.2%). Both cases, however, underline the necessity of an exact indication for irradiation to avoid such complications.