Radiotherapy of Langerhans' Cell Histiocytosis : Results and Implications of a National Patterns-of-Care Study.

PURPOSE: This patterns-of-care study was performed to define the current clinical experience with radiotherapy of Langerhans' cell histiocytosis in adults in Germany and to define open questions resulting from this study. MATERIAL AND METHODS: A standardized questionnaire was sent to 198 German radiotherapy institutions. Data about patient characteristics, stage of disease, practice and fractionation of radiotherapy, outcome of therapy, etc. were systematically evaluated. 123 of 198 institutions answered the complete questionnaire (62.1%). RESULTS: Only 23 of the 123 institutions (18.7%) reported experience with radiotherapy of Langerhans' cell histiocytosis of adults. 18 institutions with 98 patients were evaluable. The majority of patients (72 of 98) was treated on a linear accelerator. The median single dose of radiotherapy was 2 Gy, while the median total dose was 24 Gy. 81 of 89 evaluable patients (91%) reached a local control of the treated lesion(s), 69 of those had a complete remission. Eight of 89 patients (9%) developed an in-field recurrence. 87.8% of patients experienced no acute and 97% of patients no late side effects of radiotherapy. CONCLUSION: Clinical experience with radiotherapy of Langerhans' cell histiocytosis in adults in Germany is still very limited. Nevertheless, the clinical results-with high remission and local control rates-confirm the effectiveness of radiotherapy in the multidisciplinary treatment of this disease. Due to the small number of patients in this study despite higher incidence rates, the knowledge of this disease has to be multiplied in Germany. Future patients should be systematically included into a prospective radiotherapy registry.

[Radiotherapy of basal cell carcinoma of the face and head: Importance of low dose per fraction on long-term outcome]. / Radiotherapie des Basalzellkarzinoms im Gesichts-/Kopfbereich: Bedeutung einer niedrigen Einzeldosis für das Langzeitsergebnis.

BACKGROUND: Radiotherapy plays an important role in the treatment of basal cell carcinoma of the face and head and achieves cure rates of 92-96 %. Different fractionation concepts of radiotherapy have been described. This study investigates the efficacy, as well as acute and chronic toxicity, of a slightly hypo-fractionated radiotherapy schedule. PATIENTS AND METHODS: 85 patients with 104 tumors underwent radiotherapy for basal cell carcinoma of the face and head. The radiotherapy schedule was 5 x 3 Gray/week up to a total dose of 57 Gray in 95 % of patients. Acute and late radiotherapy toxicity and cosmetic outcome were evaluated in long-term follow-up. RESULTS: No recurrence was observed. In 87 % of tumors, only low acute toxicity occurred at the end of radiotherapy. Late toxicity, if observed, was low in most patients. "Excellent" or "good" cosmesis was achieved in 94 % of tumors at last follow-up. CONCLUSIONS: Our radiotherapy schedule achieves a very high local control rate and very good cosmetic and functional results. This fractionation can be recommended as a standardized radiotherapy treatment for basal cell carcinoma of the face and head.

Radiotherapy for bony manifestations of Langerhans cell histiocytosis. Review and proposal for an international registry.

PURPOSE: To examine the role of radiotherapy (RT) in adult Langerhans cell histiocytosis (LCH) for osseous manifestations, to define open questions regarding RT, and to develop recommendations for the clinical decision-making and problem-solving process. MATERIAL AND METHODS: A literature review using different medical databases was conducted including the last 3 decades, and resulting questions regarding the use of ionizing radiation were systematically compiled. RESULTS: The literature review revealed a local control rate of 96% (93% complete remissions) in patients with osseous single-system disease and of 92% (76% complete remissions) in patients with bony involvement in multi-system disease. To increase our knowledge, a prospective registry has been developed to allow a differentiated analysis of RT outcome and definition of potential prognostic factors. CONCLUSION: Ionizing radiation can be successfully applied as a single treatment or in combination with other therapies for osseous manifestations of LCH. It leads to high remission and local control rates. Nevertheless, many open questions still exist. A prospective clinical registry is proposed to define the exact role of RT in this disease and to develop future interdisciplinary treatment guidelines.

Endourethral brachytherapy for prevention of recurrent urethral stricture following internal urethrotomy--first clinical experiences and results.

PURPOSE: To evaluate the therapeutic effect of endourethral brachytherapy for prevention of recurrent urethral stricture after internal urethrotomy. MATERIALS AND METHODS: Endourethral high-dose-rate (HDR) brachytherapy was performed in 10 male patients with recurrent urethral strictures after radical prostatectomy or transurethral resection of prostatic adenoma. Brachytherapy commenced on the day of the actual intervention and continued over 3 days; the radiotherapy dose was 4 x 3 = 12 Gy for the first 3 patients and 4 x 4 Gy = 16 Gy for the following 7 patients. RESULTS: During follow-up (range: 8-27 months, mean: 14.8 months), 9 of 10 patients remained relapse-free, i.e., without recurrent strictures or requiring another urethrotomy. In 1 patient with a restricture after endourethral brachytherapy, a second brachytherapy course was performed; nevertheless, he experienced a further restricture 12 months after the second intervention. No radiation-induced acute toxicity occurred, but 1 patient developed incontinence after the current urethrotomy. Overall, patient satisfaction and compliance with the therapeutic procedures was high. CONCLUSIONS: Endourethral HDR brachytherapy proved to be a safe method that can reduce urethral restricture. Further follow-up is needed to prove long-term efficacy of this treatment. Further investigations are planned to evaluate the adequate fractionation and possible late treatment sequelae.