[A simple method for transposing MRI information to simulation films. Technical note]. / Eine einfache Methode zum Ubertragen von MR-Informationen auf Simulationsfilme. Ein technischer Hinweis.

BACKGROUND: The use of MRI information in the treatment planning process is still expensive and time consuming. Electro-optical devices or specially designed post-processing software in here the risk of picture distortion. PATIENTS AND METHODS: Between June 1998 and June 1999 in 48 patients with brain tumors and 11 patients with carcinoma of the prostate CT treatment planning and MRI were performed with identical patient positioning using the same devices as in the simulation. The transposition of organ and tumor volumes between MRI and simulation film takes place by overlying both on the brightening screen by using a grid. MRI and simulation films must be produced using an identical magnification factor. RESULTS: For 9 patients with brain tumors and 2 patients with a carcinoma of the prostate the transposition of MRI information on the simulation films showed the necessity of a modification of the shielding or the treatment portals. CONCLUSIONS: The simple method of direct transposition of MRI structures into simulation films allows to accomplish a verification of the portals and conformation which result of the treatment planning process. Moreover an individualized shielding can also directly be realized.

Vulvar carcinoma: a retrospective analysis of 80 patients.

We evaluated the files of 80 women who were treated for vulvar carcinoma. In 13 women radiotherapy was used as primary treatment, in 45 cases postoperatively and in 22 women because of local recurrence. Patients older than 60 years had a significantly worse 5-year survival rate (39%) than younger women (57%) (p = 0.02). The 5-year survival rate for patients with negative nodes was 72% versus 46% for the N1- and 47% for the N2-status, respectively (p = 0.027). The 5-year actuarial survival rate for patients with tumor manifestation in the clitoris was 77.9% versus 26.1% for patients with tumors in the labia majora (p = 0.0044). There was no difference in survival in patients who had been treated with radical vulvectomy and bilateral groin dissection plus local radiotherapy when compared with patients who had been irradiated (whole pelvis) after tumor resection alone. The 5-year survival rates and the median survival time were identical in both groups (61%/62 months).

Osseointegration of dental implants in patients with and without radiotherapy.

Between 1987 and 1997, 275 dental implants were inserted in the mandibles of 63 patients with squamous cell carcinoma of the lower oropharyngeal level following a radical surgical procedure. Thirty-five of these patients had been preirradiated with a complete dose of 60 Gy. In a retrospective analysis we have reviewed the data of these patients for age, sex, localization of the implants, irradiation, interval of implantation and interval of the abutment operation. Thus far, the median follow-up time is 65 months. The 5-year success rate for all implants was 97.9%. We found that radiotherapy, age, sex, localization of implantation or the interval between the end of the tumor therapy and the time of implantation did not have any significant influence on osseointegration or loss of osseointegration. Only the time interval between implantation and the abutment operation was recorded to be of any great significance (p = 0.0001). No augmentation in the osteoradionecrosis rate could be recorded after dental implantation (1.6%), which leads us to conclude that radiotherapy (60 Gy) in patients with head and neck cancers should not be regarded as a contraindication for dental implantation.

Combined modality treatment with accelerated radiotherapy and chemotherapy in patients with locally advanced inoperable carcinoma of the pancreas: results of a feasibility study.

Between July 1990 and September 1993, 32 patients with locally advanced irresectable adenocarcinoma of the pancreas, histologically proven by laparotomy, were involved in our study. Patients were treated with hyperfractionated, accelerated radiotherapy and simultaneous application of 5-fluorouracil and folinic acid. Chemotherapy was given on days 1,2 and 3. Determination of the target volume for radiotherapy was carried out by computerized axial tomography. The total tumour dose of 44.8 Gy was applied relative to the 90% isodose in two daily fractions of 1.6 Gy, resulting in ten fractions per week. On the first three days of radiotherapy, 600 mg m-3 of 5-fluorouracil and 300 mg m-3 of folinic acid were given i.v. According to response, chemotherapy was repeated in 4-week intervals. The median survival time for all patients was 12.7 months, compared with 3-7 months after palliative surgery (historical control). The median progression-free interval was 6.6 months. Toxicity and therapy-induced morbidity were recorded according to WHO criteria. Nausea and vomiting of WHO grade I and II occurred in 72.1% and of grade III and IV in 27.9% of the patients. WHO grade I and II diarrhoea was seen in 11 patients. The overall incidence of leucopenia and thrombocytopenia was 37.4%; severe side-effects (WHO III-IV) occurred in 9.3% of all patients. One patient experienced a severe mucositis (WHO III). This combined modality treatment consisting of accelerated hyperfractionated radiotherapy and chemotherapy turned out to be feasible for patients with locally advanced, irresectable pancreatic cancer. The therapy could be applied in a short period of time, approximately half the time used in conventional therapy schemes.

[The value of sequential scintigraphy of the liver in postactinic liver lesions]. / Wertigkeit der Lebersequenzszintigraphie bei postaktinischen Leberläsionen.

Dynamic hepatobiliary scintigraphy is the only method which enables non-invasive monitoring of regional function of liver parenchyma. It allows early detection of functional impairment due to radiation hepatitis. This method is simple and reproducible and is therefore suitable for follow-up of this disease.