Low-dose radiation is sufficient for the noninvolved extended-field treatment in favorable early-stage Hodgkin's disease: long-term results of a randomized trial of radiotherapy alone.

PURPOSE: To show that radiotherapy (RT) dose to the noninvolved extended field (EF) can be reduced without loss of efficacy in patients with early-stage Hodgkin's disease (HD). PATIENTS AND METHODS: During 1988 to 1994, pathologically staged patients with stage I or II disease who were without risk factors (large mediastinal mass, extranodal lesions, massive splenic disease, elevated erythrocyte sedimentation rate, or three or more involved areas) were recruited from various centers. All patients received 40 Gy total fractionated dose to the involved field areas but were randomly assigned to receive either 40 Gy (arm A) or 30 Gy (arm B) total fractionated dose for the clinically noninvolved EF. No chemotherapy was given. RT films were prospectively reviewed for protocol violations and recurrences retrospectively related to the applied RT. RESULTS: Of 382 recruited patients, 376 were eligible for randomized comparison, 190 in arm A and 186 in arm B. Complete remission was attained in 98% of patients in each arm. With a median follow-up of 86 months, 7-year relapse-free survival (RFS) rates were 78% (arm A) and 83% (arm B) (P =.093). The upper 95% confidence limit for the possible inferiority of arm B in RFS was 4%. Corresponding overall survival rates were 91% (arm A) and 96% (arm B) (P =.16). The most common causes of death (n = 27) were cardiorespiratory disease/pulmonary embolisms (seven), second malignancy (six), and HD (five). Protocol violation was associated with significantly poorer RFS. Nonirradiated nodes were involved in 42 of 52 reviewed relapses, infield areas in 18, marginal areas in 17, and extranodal sites in 16. CONCLUSION: EF-RT alone attains good survival rates in favorable early-stage HD. The 30-Gy dose is adequate for clinically noninvolved areas. Protocol violation worsens the subsequent prognosis. Relapse patterns suggest that systemic therapy can reduce the 20% long-term relapse rate.

[Radiotherapy of induratio penis plastica]. / Strahlentherapie der Induratio penis plastica.

Radiation therapy of Peyronie's disease should be performed early, especially in young patients with pain. Patients with extensive fibrosis or calcifications should be excluded from radiation therapy. To avoid late sequelae, low single doses with a total dose of 20-32 Gy are recommended. Radiation therapy of Peyronie's disease is successful in up to 50-70% of all cases. In the majority of the remaining cases, at least progression can be positively influenced. Compared with other conservative therapeutical concepts, radiation therapy is immediately effective, shows almost no side-effects, and is inexpensive.

[Adjuvant postoperative radiotherapy of rectal cancer with special reference to the problem of local recurrence]. / Adjuvante postoperative Radiotherapie des Rektumkarzinoms unter besonderer Berücksichtigung der Lokalrezidivproblematik.

For a longer period of time the question of indication for adjuvant postoperative radiotherapy of the rectal cancer has been discussed and handled in practice with a lot of controversy. The lymphnode status plays a very important role as an prognostic indicator for the development of the disease. This already has been shown in large collections of patient data. According to our opinion, this evidence should lead to an increase of indication of the adjuvant postoperative radiotherapy. After the introduction of the computer-aided planned, small volume four-field-technique, the former problem of an additional significant damage through adjuvant postoperative radiotherapy are no longer of importance. The life quality of living of the patient with progressive disease often shows much earlier and decisive decrease by local failure comparing a metastatic disease to the liver and lung with few symptoms over a long period of time. Our radiation therapy on 135 patients in Dukes stage B2 to C2 has shown a rate of only 7.6% local failure and in Dukes stage B an even minimaly better outcome with 5.6% compared to stage Dukes C, which expectedly shows the worst result (12.7%). The median followup of 20.4 months corresponds about to the critical 2-years period. Comparing these excellent results with the literature, one has to notice that the 5-year survival rate according to the actuarial method of Kaplan-Meier in our group is as low as 27.6% (compared to the rate of about 60% in the literature). We explain this difference with the specific age structure and the relatively high rate of distant metastasis in our patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Primary adjuvant whole abdominal irradiation in ovarian carcinoma.

Eighty-four patients with an ovarian carcinoma Stage I-III received an adjuvant whole abdominal irradiation (WAI) with pelvic boost postoperatively. Surgery included a bilateral salpingo-oophorectomy, hysterectomy, and omentectomy in 59% of the patients; in 41% surgery was less radical. For the whole abdominal irradiation we used the moving-strip method on 43 patients. The open-field technique was used on the other patients. Median dose of WAI was 22.5 Gy and median pelvic dose was 45.5 Gy. After a median follow-up of 68.5 months, a 5-year survival rate of 64 +/- 5.7% was determined, as well as a 5-year NED rate of 61.2 +/- 5.7%. Five-year survival rate was 80.1 +/- 7.4% in Stage I, 64.1 +/- 9.7% in Stage II, and 35.4 +/- 11.6% in Stage III. Five-year survival depended on tumor rest significantly. There was a trend to better prognosis when surgery was complete and grade was G1 or G2. The risk factor according to Dembo proved to be the most reliable prognostic factor: the 5-year survival rates were 75.0 +/- 6.3% for patients with intermediate risk and 20.1 +/- 10.4% for those with high risk (p = 0.001). Side effects were generally well tolerated. We only saw one serious complication, a radiation-induced small bowel obstruction.

[Postoperative adjuvant whole abdomen irradiation in ovarian cancer]. / Die postoperative adjuvante Ganzabdomenbestrahlung beim Ovarialkarzinom.

Seventy-nine patients with ovarian carcinoma stage I-III postoperatively received a whole abdominal irradiation (median dose: 22.5 Gy) followed by pelvic boost irradiation (median pelvic dose: 45 Gy) as the sole adjuvant therapy. Surgery preceding the irradiation was radical only in 59 percent of the patients. Whole abdominal irradiation was performed either in the moving-strip-technique or the open-field-technique. The median follow-up time was 57 months. The overall and the progression-free five-year survival rate of the whole group is 66 +/- 6% and 63 +/- 6%, respectively. We have not seen a clear-cut dependence of the survival rates on the completeness of the surgery, on tumor histology or grading. In a statistically significant way, the survival rates depend on the stage, the presence of tumor rests, and, above all, on the risk group. The overall five-year survival rate for the intermediate-risk patients is 78 +/- 7% and 22 +/- 11% for high risk patients. There aren't any randomized studies concerning the optimal adjuvant therapy for intermediate-risk patients. Because of the reproduceable results and the infrequent toxicity, whole abdominal irradiation seems to be a treatment equivalent to other adjuvant therapies for these patients.

[The monitoring of gynecological radiotherapy using serial tumor marker determinations]. / Die Uberwachung der gynäkologischen Strahlentherapie durch serielle Tumormarkerbestimmungen.

In 149 collum and 45 corpus carcinomas tumor marker concentrations in serum have been measured before, during and sex to eight weeks after termination of radiotherapy. For the collum carcinomas (average of FIGO I to IV) the sensitivity of CEA was found to be 51%, SCC 67%, CEA +SCC 80%. In corpus carcinomas CEA had low sensitivity and could not readily be used for therapy monitoring. However, in a number of cases CA125 was a good substitute. Six to eight weeks after termination of radiotherapy the average tumor marker levels have been declined by comparison with the pretherapeutic values (100%): For the collum carcinoma CEA dropped to 39%, SCC to 57%; for the corpus carcinoma CEA to 72%, CA 125 to 81%. The highest diagnostic information was gained by comparison of post-therapeutical tumor-marker levels with cut off values obtained from healthy women of the same age group. After treatment in 29 of 106 collum carcinomas CEA and or SCC levels did still exceed these cut off values. In eleven cases this marker elevation was due to paraaortic lymph node metastases, in seven cases a local tumor residue was discovered and in six cases general metastases. In corpus carcinomas the main reason for post-therapeutic elevated CA125 values also were paraaortic lymph node metastases. Thus, the use of serial tumor marker determination for control of gynecological radiotherapy is a helpful tool in early detecting local tumor residues and metastases. The decision making for further radiotherapeutical measures will be much easier, if accompanying tumor marker determinations have been done during primary radiotherapy.