[Postoperative, conventional fractionated radiotherapy for prevention of heterotopic ossification after total endoprosthesis of the hip joint]. / Die postoperative, konventionell fraktionierte Strahlentherapie zur Prävention heterotoper Ossifikationen nach TEP des Hüftgelenkes.

Radiotherapy is the only local means of treatment in the prevention of heterotopic bone formation. It is possible to reduce the incidence of HO following total hip arthroplasty from an average of 50% without further treatment to an average of 8% using different doses and fractionation schemes. In this retrospective clinical study 22 hips of 20 patients were treated with a conventional fractionated radiotherapy. Total doses of 12.0-20.0 Gy in daily fractionation of 200 cGy single doses were applied 18 hips were postoperatively irradiated as secondary prophylaxis against recurrence of HO. 4 hips were high-risk cases with contralateral HO after previous hip surgery. After 6-30 months observation periods the roentgenogramms were analyzed with a modified Brooker-Score. Patients with a score > II were classified as nonresponders. 95.5% of the treated hips showed satisfactory results, only one hip (4.5%) achieved a score IIIA. In this case radiotherapy was interrupted after 3 x 200 cGy. The high therapeutic efficiency of local irradiation in the prevention of heterotopic bone formation following total hip replacement could be proved. No considerable side effects were observed. Further prospective clinical investigations are necessary to optimize the doses and fractionation schemes.

Multimodality treatment in stage IV squamous cell carcinoma of the head and neck. A long-term follow-up.

We treated 114 patients with advanced inoperable head and neck cancer with a combined-modality protocol that included two cycles of chemotherapy followed by radiotherapy or three chemotherapy and in 18 patients with a radiosensitizing agent. At the beginning of the treatment all but one patient presented with a stage IV cancer. With a follow-up of 42-58 months, four patients are alive (three from the radiosensitizing group and one of the chemotherapy group). Complete response after the radiosensitizing agent correlated with superior prolonged disease-free survival in comparison to complete responses after chemotherapy at the level of p less than 0.009.

[Results of therapy in Hodgkin's disease]. / Therapieergebnisse beim Morbus Hodgkin.

The results of therapy in 239 patients (161 men, 78 women, median age 33 [13-80] years) who had been treated for Hodgkin's disease between 1972 and 1986 were evaluated retrospectively. The proportion of complete remissions depended on the stage of the disease and was 90% (35 out of 39 patients) for stage IA, 90% (9 out of 10) for stage IB, 84% (40 out of 48) for stage IIA, 88% (22 out of 25) for stage IIB and 86% (37 out of 43) for stage IIIA. At five and ten years, survival rates among patients in stages IA to IIB were 76 and 69%, respectively, and for patients in stage IIIA 81 and 52%, respectively. For patients who enjoyed complete remissions the probability of surviving for 5 or 10 years without recurrence was 62% or 54%, respectively, for stages IA to IIB, and 75 or 43%, respectively, for stage IIIA. There were no statistically significant differences between stages I, II and IIIA as regards remission rate, survival time or recurrence-free survival time. During these stages the patient's age proved to be the only prognostic factor of any statistical significance. For stages IIIB and for IVA and IVB the proportion of complete remissions achieved by combined chemotherapy with COPP was 62%. At 5 and 10 years the proportion of these patients in permanent remission was 63 and 53%, respectively, while survival rates in the entire series were 46% and 40%, respectively. A genuine cure--in the sense of at least 10 years' survival without recurrence after the first complete remission--can be expected in one third of patients in stages IIIB to IVB.

[Treatment of radiogenic colitis with a rectal foam containing cortisol. Clinical and pharmacologic data]. / Die Therapie der radiogenen Kolitis mit einem cortisolhaltigen Rektalschaum. Klinische und pharmakologische Daten.

20 patients with highly dosed irradiation of the small pelvis had been treated with Colifoam (hydrocortisone) in order to prove the therapeutic effect of radiation-induced proctitis. Over a period of three to six weeks starting in the third week of irradiation all patients received one applicator filling of rectal foam after bowel movement daily. The findings were verified by proctoscopy, histology and subjective personal well being. In ten patients we determined the daily cortisol profiles. Six months post irradiation ten patients underwent barium enema of the colon. During therapy no major complaints were recorded. The proctoscopic findings showed little changes concerning the submucous vascular walls. In none of the patients any kind of late lesion could be observed. The daily cortisol profile did not show any aberration of the physiological patterns. In conclusion the local therapy of Colifoam can be considered an additional treatment of radiation-induced colitis (proctitis).

Adjuvant chemotherapy in stage III and IV squamous cell carcinoma of the head and neck.

Initial combination drug regimen containing cisplatin in patients with stage III and IV head and neck cancer produced a high percentage of clinical response. This trial was initiated to assess the role of multimodality treatment (chemotherapy plus radiotherapy) versus chemotherapy alone. Ninety-six patients entered into this study; 80 patients were evaluable at time of analysis (Table I). Patients were randomized between chemotherapy and radiotherapy (group I) and chemotherapy alone (group II). The chemotherapy administered consisted of cisplatin, bleomycin and methotrexate and was given in 2 cycles over 35 days. Local radiotherapy followed. In group II 3 cycles of chemotherapy were given without radiotherapy. The overall tumour response after chemotherapy rose up to 75 per cent. After radiotherapy in group II the response rate sank to 59 per cent. In both regimes the remission duration was very short. Patients receiving only two cycles of chemotherapy do not have a statistically shorter survival than patients, who were treated by chemotherapy plus radiotherapy, or by a 3rd cycle of chemotherapy.

[Effectiveness of the radiosensitizer cisplatin. A pilot study]. / Zur Wirksamkeit des Radiosensitizers Cis-Platin. Eine Pilotstudie.

18 patients with advanced squamous cell carcinoma of the head and neck region were treated via chemotherapy and radio therapy. In this regimen cisplatinum was used as a radiosensitizer. The total remission rate was 94% while remission duration and survival could not be calculated. Severe clinical local toxicity occurred as a side effect.

[Chemotherapy of advanced head and neck tumors. A prospective randomized study comparing the effectiveness of chemotherapy alone to a chemo-radiotherapy procedure]. / Chemotherapie bei fortgeschrittenen Kopf-und Halstumoren. Eine prospektive randomisierte Studie zur Unterscheidung der Wirksamkeit einer Chemotherapie allein gegenüber einem chemo-radiotherapeutischen Vorgehen.

One of the most difficult problems of cancer treatment is the management of advanced squamous cell carcinomas of the upper respiratory tract. For several reasons the surgical resection of the primary lesion and the observed neck node metastases are limited to earlier tumour stages. Advanced and not resectable tumours of T3-4-N2-3-stages have very poor cure rates. Their treatment is based traditionally on radiotherapy and in recent years on combination chemotherapy programmes. 75 patients were entered into this prospective randomised study. 33 of these were treated with two cycles of chemotherapy followed by radiotherapy and 42 patients received three cycles of chemotherapy alone. Both therapy modalities induced tumour response rates of up to 75% but have done little to improve survival. The role of combined radiotherapy and chemotherapy in advanced squamous tumours is not yet well defined. In our group only patients who showed tumour response after chemotherapy actually benefited from radiotherapy.

[Chemotherapy or chemotherapy and radiotherapy in advanced head and neck tumors. A prospective, randomized study comparing the 2 therapeutic modalities]. / Chemotherapie oder Chemotherapie und Strahlentherapie bei weit fortgeschrittenen Kopf-Hals-Tumoren. Eine prospektive, randomisierte Studie zum Vergleich beider Therapiemodalitäten.

Initial combination drug regimens containing Cisplatin in patients with stage III and IV head and neck cancer produce a high percentage of clinical response. We initiated the current trial to assess the role of multimodality treatment (CT plus RT) versus CT alone in eliciting tumour response rates, and the duration of tumour free survival. Patients were randomised to CT followed by RT (arm A: 36 patients) or CT alone (arm B: 44 patients). Of 96 patients entered into this study 80 are evaluable at the time of analysis. There were 13 women and 67 men with a median age of 52 years and a median performance status of 90%. All of them presented measurable stage T4N0-3M0-1 or T3N2-3M0-1 carcinomas. The chemotherapy consisted of Cisplatinum, Bleomycin and Methotrexate and was given in 2 cycles over 35 days. Local radiotherapy with 6,000 rad followed. In arm B, 3 cycles of chemotherapy were given without radiotherapy. The overall tumour responses after CT were 75% in arm B, and 70% in arm A. After RT the tumour response fell to 59%. Median tumour remission was 4 months and median survival 11 months. Toxic effects were mild mainly consisting of alopecia, nausea and vomiting. Myelotoxicity was moderate, but significant renal or ototoxic side effects did not occur. 10 cases of Bleomycin related pulmonary fibrosis were found. Our main findings show that patients receiving 2 cycles of CT do not have a statistically shorter survival compared to those who were treated by CT plus RT.

[Endoscopic intraductal radiotherapy of high bile-duct carcinoma]. / Endoskopische, intraduktale Strahlentherapie hochsitzender Gallengangskarzinome.

A new method for palliative intraductal radiotherapy of high malignant bile duct occlusion was used in three patients. It consists of insertion of a 4 cm x 0,6 mm iridium-192 wire into the stenosis caused by the tumour. It uses a modified nasobiliary probe which is guided endoscopically retrograde transpapillary. A radiation output of 0.85 Gy/min (85 rd/min) and a requested therapeutic dosage of 60 Gy (6000 rd) at a distance of 0.5 cm lead to in situ position of the wire for about 70 hours. During that time bile flow is effected via the nasobiliary probe. The advantage over previously described methods (percutaneous transhepatic, surgical after installation of U-drainage) lies in a smaller complication rate and improved follow-up treatment as change of the endoprosthesis or repeat irradiation is not associated with renewed tissue trauma.