[Neoadjuvant and adjuvant radiochemotherapy for rectal carcinoma]. / Neoadjuvante/adjuvante Radio(chemo)therapie beim Rektumkarzinom. Welche Konzepte den grössten Erfolg versprechen.

The current standard treatment for resectable tumours in clinical stages II and III is neoadjuvant radio(chemo)therapy. Improved radiation techniques and chemotherapy (CT) with continuous infusion of 5-FU during adjuvant radiotherapy (RT) has led to an additional improvement of adjuvant therapeutic results. The efficacy of new cytostatic drugs and antibodies is presently being clinically tested for perioperative therapy.

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 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.

[Radiation therapy for Morbus Ledderhose -- indication and clinical results]. / Strahlentherapie beim Morbus Ledderhose-Indikation und klinische Ergebnisse.

BACKGROUND: Morbus Ledderhose (ML) is a rare hyperproliferative disorder of the plantar aponeurosis which is similar in its clinical course to Morbus Dupuytren (MD). We examined whether radiotherapy (RT) can effect symptoms and prevent disease progression. PATIENTS AND METHODS: From June 1996 to December 2001, 25 patients (12 female/13 male) aged 9-76 (median: 56) years had radiotherapy (RT) for symptomatic ML. Follow-up (FU) was at least 1 year. 36 feet (16 right/20 left) were treated, as eleven patients had bilateral disease. Twelve (48%) patients had MD. There were 63 nodules (with 0,5-6,5 cm diameter) on all feet and 20 cords (with 1-4 cm length) on 13 (52%) feet prior to RT. 21 (84%) patients had one or more signs: 14 (56%) severe local pain, eight (32%) walking difficulties, twelve (48%) other symptoms, pressure or tension sensation. The RT field involved all nodules and cords plus safety margin. Two RT-series were applied (each 5 3 Gy in 1 week) separated by 8-12 weeks up to a total dose of 30 Gy. Evaluation was performed at the end of RT, after 3 and 12 months FU and in December 2002. The primary endpoint was prevention of disease progression and avoidance of surgery. Secondary endpoints were objective changes of morphological and functional parameters and patient's satisfaction measured on a visual analogue scale (VAS). RESULTS: With a median FU of 38 (12-67) months no patient experienced progression or underwent surgery: 11 of 36 (44%) feet had a reduced number (overall: -16) or size of nodules, 7 of 13 (54%) feet had a reduced number (overall: -9) or length of cords; gait was improved in six of twelve (50%) feet; pain was reduced or had completely disappeared in 9 of 15 (60%) feet, and other symptoms disappeared in 8 of 18 (44%) symptomatic feet. 20 (80%) patients regarded 28 of 36 (78%) treated feet as improved and 8 (22%) in stable condition. The median relative improvement stated by patients on the VAS was 50% (0-100%). Treatment side effects were minimal: During and within 3 months of the RT course only a slight erythema (CTC 1 degrees ) was seen in five treated lesions, while dry skin changes within the RT portal were observed in three cases (11%) in long term FU (> 12 months). CONCLUSIONS: Radiotherapy is effective in treating ML and may prevent otherwise necessary surgical interventions. Nodules, cords and symptoms regress, but long-term outcome of at least 5 years has to be awaited. Prospective phase III studies should confirm these results.

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.

[Radiotherapy of keloids. Patterns of care study -- results]. / Strahlentherapie des Keloids in Deutschland Patterns-of-Care-Studie -- Ergebnisse einer Umfrage.

BACKGROUND: Keloids are benign diseases of the skin. Because of the high rate of relapses after operation often postoperative irradiation is used. Treatment modalities must be collected by Patterns of Care Studies before therapy advice may be given from DEGRO. PATIENTS AND METHOD: Dates of investigations with questionnaire on mail of 250 radiotherapy institutions in Germany in 1997/2000 were collected to know therapy modalities, results and side effects. Keloids were irradiated in 101 institutions. During a time up to 35 years 1672 patients were irradiated, 880 patients had a follow-up. RESULTS: Mostly radiotherapy was applied soon postoperatively with kilovoltage radiotherapy or electrons 4-12 MeV fractionated 3-5 times a week and single doses of 2-3 Gy up to total doses of 10-20 Gy. 101 relapses were seen, the frequency of 11.4% is in the range of literature. Relapses were seen in the interval of some weeks up to 2 years after therapy. Side effects of irradiation were low, no malignant transformation was reported. CONCLUSION: Postoperative radiotherapy for keloids is applied in Germany mostly under equal conditions. This therapy offers effective relapse prophylaxis with nearly no side effects. A follow-up for 2 years is necessary to see outcome and relapses of irradiation.