[Adequate performance of a pectoral implanted defibrillator after high-dose radiation therapy for thyroid cancer]. / Regelrechte Funktion eines implantierten Defibrillators nach hochdosierter Strahlentherapie unter Einbeziehung der Defibrillator-Loge.

The interference of implanted defibrillators (ICD) from electronic appliances is small. There is scant knowledge about the effects of radiation therapy on defibrillator function. Existing data commonly derive from in vitro tests of the devices. We report on a 60-year old male patient with a left pectoral implanted ICD, who received radiation therapy for treatment of thyroid cancer. The patient suffered from coronary heart disease with severely impaired left ventricular function, and had to be resuscitated from ventricular fibrillation in December 1997. A defibrillator (Medtronic Jewel 7219 C) was implanted in a left pectoral pocket. In January 2000, a carcinoma of the thyroid gland was diagnosed and treated surgically. The operation was followed by a radiation therapy with curative intention. The patient received a local dosage of 64 Gray (32 sessions in 51 days). The ICD was covered by individually sized metal blocks, and was affected by 10 Gray at maximum. The ICD was inactivated during the radiation applications to avoid inadequate therapy due to electromagnetic interference. The pace-sense parameters during 8 months of follow-up were regular. Three episodes of ventricular fibrillation were terminated adequately by the ICD. Therefore, we assumed a correct ICD funtion after radiation therapy. Radiation-induced damage of the ICD was possible. A surgical transfer of the generator out of the radiation area was rejected on ethical grounds. In the short follow-up period, the ICD function was correct. For our opinion it seems to be justified primarily to control the spontaneous outcome and ICD function at short intervals, especially in view of the poor prognosis of cancer patients.

[Treatment of stage IIIB loco-regionally advanced non-small-cell bronchial carcinomas with radiation and interferon-beta. Preliminary results of a phase II study]. / Behandlung lokoregionär fortgeschrittener nichtkleinzelliger Bronchialkarzinome im Stadium IIIB mit Bestrahlung und Interferon beta. Vorläufige Ergebnisse einer Phase-II-Studie.

BACKGROUND: In-vitro and in-vivo studies demonstrated the radiosensitizing effect of interferon beta on malignant tumor tissue as well as simultaneously a radioprotective effect on normal lung tissue. In this phase II study the outcome of combining radiotherapy with interferon beta in patients with advanced non-small cell lung cancer was evaluated. PATIENTS AND METHOD: From February 1994 until November 1996 14 patients with non-small cell lung cancer, stage IIIB were treated with locoregional radiation up to 59.4 Gy, with daily doses of 1.8 Gy and 5 fractions per week. Five million units of interferon beta (Fiblaferon) were given intravenously immediately preceding radiotherapy on the first 3 days of week 1, 3 and 5. RESULTS: Four of 14 patients (28.6%) showed complete response and 7 patients (50%) partial response, resulting in an overall response rate of 78.6%. After a mean follow-up time of 23.3 months the 1-, 2- and 3-year survival rates were 56.3%, 37.5% and 37.5%, respectively. The median survival time was 13 months. Three of 14 patients (21.4%) suffered from 7 Grade-3 acute side effects and 2 patients (14.3%) from 1 Grade-3 late toxicity in each case. One further patient, whose right lung was resected 3 months after completion of radiotherapy, developed as a consequence of this operation 2 Grade-4 complications. CONCLUSION: Considering the toxicity and the preliminary results of combining irradiation and interferon beta in the treatment of locally advanced non-small cell lung cancer it seems, that this procedure is worth to be tested in a phase III study.

[Possibilities and limits of radiotherapy in the treatment of pelvic tumors in childhood]. / Möglichkeiten und Grenzen der Strahlentherapie in der Behandlung von Beckentumoren im Kindesalter.

1. The most frequently occurring malignant tumours of the pelvis in childhood are germ cell tumours, soft-tissue sarcomas and osseous sarcomas. 2. Of the embryonal carcinomas, the dysgerminomas are regularly cured by radiotherapy alone. The other embryonal carcinomas are also radiosensitive. However, in view of the very high success rate of surgery and chemotherapy, radiotherapy is really not necessary. 3. Of the soft-tissue sarcomas, local radiotherapy is necessary only if complete remission of the tumour has not been achieved by surgery and aggressive chemotherapy in the following tumours: embryonal rhabdomyosarcomas, undifferentiated sarcomas and extraosseous Ewing's sarcomas. On the other hand, radiotherapy is necessary for reducing the local relapse rate in the rare types of soft-tissue sarcomas such as alveolar rhabdomyosarcomas and synovial sarcomas. These tumours show a similarly characteristic behaviour as the soft-tissue sarcomas in adults. 4. Of the osseous sarcomas, Ewing's sarcoma of the pelvis always requires aggressive local therapy (surgery and/or irradiation) besides intensive drug therapy.

Radiation myelopathy of the mouse spinal cord--isoeffect correlations after fractionated radiation.

A one cm long segment of the lower thoracic upper lumbar spinal cord of mice was irradiated using one, two, three, five, seven, ten, 15, 20 and 25 daily fractions. The animals were checked for paraparesis of the hind legs over their entire life span up to two years. The ED 50-values for radiation myelopathy for intervals of 250 up to 550 days were calculated. The resulting isoeffect curves follow an upward bending course being flat for one to five fractions and then getting steeper up to 25 fractions with a slope of 0.27 to 0.30. For intervals between 250 and 550 days the isoeffect curves run a parallel course. Only ED 50-values for intervals of 550 days post radiation omitting data above 6 Gy/fraction fit the linear quadratic cell survival (LQ) model with an alpha/beta value of 6.5 Gy which is relatively high compared to alpha/beta-values for late damage of normal tissues. Incomplete repair between fractions or overlapping effects of the cell systems responsible for radiation myelopathy (oligodendrocytes and endothelial cells) might account for failure of the other isoeffect data to fit the LQ-model. There are important differences of the isoeffect correlations of rat and mouse radiation myelopathy probably due to different repair characteristics and kinetics between the involved cells. On the other hand similarities of isoeffect correlations of man, rat and mouse are observed. Therefore the model of mouse radiation myelopathy presented in this paper might be used to test new treatment strategies.

[Results of combination treatment of medulloblastoma at the Charlottenburg Hospital of the Berlin Free University (1951 to 1980)]. / Ergebnisse kombinierter Behandlung von Medulloblastomen im Klinikum Charlottenburg der Freien Universität Berlin (1951 bis 1980).

Between 1951 and 1980 34 patients, mainly children, were treated for medulloblastoma in Klinikum Charlottenburg of the Free University of Berlin. Between 1951 and 1970 in 14 patients only the posterior fossa was irradiated (group A), between 1971 and 1976 the whole CNS was irradiated with varying techniques in eight patients while between 1976 and 1980 the whole CNS was radiated in a new standardized fashion in twelve patients (group C). Since 1972 16 of the 20 patients of groups B and C were treated by additional chemotherapy, which in six cases was given postoperatively prior to radiation. While no patient in group A survived more than three years two patients of group B (25%) and eleven patients of group C (92%) are relapse-free after five years. It seems that improvement of diagnostic procedures (CT), introduction of microsurgical techniques as well as more subtle radiation techniques and intensified chemotherapy account for the good results.

Cranial computed tomography of 64 children in continuous complete remission of leukemia I: relations to therapy in modalities.

64 children with acute lymphoblastic leukemia and non Hodgkin's lymphoma in continuous complete remission were studied by cranial computed tomography two months to 7 years after cessation of antileukemic treatment. 17 (27%) patients showed abnormal widening (grade 2) of external cerebrospinal fluid spaces, 20 (31%) minimal widening (grade 1). A significant correlation between grade 2 abnormalities and the duration of maintenance therapy and single cranial radiation dose was found, whereas the correlations with total radiation dose and with intensity of induction protocols were not significant. Widening of external cerebrospinal fluid spaces after cessation of therapy persisted.

Cranial computed tomography of 64 children in continuous complete remission of leukemia II: relations to patient data and neurological complications.

Abnormal widening of cortical sulci as seen in posttherapeutic cranial computed tomography (CCT) of 64 children in complete continuous remission (CCR) of acute lymphoblastic leucemia (ALL)/non Hodgkin's lymphoma (NHL) was related to patient data and neurological complications during the application of West Berlin treatment protocol. Age and neurological/neurodevelopmental findings of the patients at diagnosis of their disease positively and significantly correlated with CCT abnormalities. Abnormal pre- and intratherapeutic electroencephalographic (EEG) recordings, the development of a severe polyneuropathy syndrome and/or a considerable loss of weight during treatment were frequently associated with an abnormal widening of cortical sulci. Occurrence of transient early encephalopathy syndrome, development of radiation induced blood brain barrier disturbance and somnolence syndrome were not correlated with these CCT changes. Possible explanations of these abnormalities are discussed.

Effective radiotherapy in one case of dermatofibrosarcoma protuberans.

A case of dermatofibrosarcoma protuberans is presented where radiotherapy had been part of the management of multiple recurrent lesions. Over a course of 46 years, complete response occurred in 2 out of 3 lesions after medium-and high-dose radiation therapy and in 1 out of 5 lesions after interstitial therapy. Regression of the lesions took several months. In the literature, 5 additional cases of local control and 2 of partial control after high-dose radiotherapy are reported. When failure of radiotherapy was reported, the dose had been low and the observation time short in many cases. High-dose radiotherapy used with patience might be tried in selected cases.

[Medulloblastoma study of the German Society for Pediatric Oncology, a first report]. / Medulloblastomstudie der Gesellschaft für Pädiatrische Onkologie, ein Zwischenbericht.

The principle of giving intensive polychemotherapy in the time between operation and irradiation was applied in a cooperative phase-2-study in children with medulloblastoma of the posterior fossa. A first evaluation of 33 of 47 registered patients was attempted after the study existing now for 1 year and 10 months. In the majority of patients the chemotherapy protocol could be fully realized without any deductions. Side effects including two therapy related fatalities were analysed. In all patients irradiation was not delayed and could be started about 11 weeks after operation and could be carried through without any major draw-backs. Analysis of survival can only be preliminary due to the short duration of the study, but patients' survival is compatible with other reported studies. The therapeutic principle presented here shall be compared in a randomized and extended fashion with a conventional therapeutic approach.

Prognostic factors in pyriform sinus carcinoma.

In the 48-month survival analysis of 76 evaluable pyriform sinus carcinoma cases, nodal stage and size played the most significant prognosis-affecting roles. N3 stage and node greater than 3 cm decreased the survival fourfold and threefold, respectively, at statistically significant levels. The difference between the 35 per cent preoperative radiation therapy and 3 per cent radical radiation therapy cumulative 48-mouth survivals was significant at p less than 0.01. Complication rates were 6 per cent with radical radiation, 35 per cent with preoperative radiation and 43 per cent with curative surgery.

Radiation therapy of malignant melanoma: experience with high individual treatment doses.

Reports of the existence of a large shoulder on the radiation survival curve of cultured mouse and human malignant melanoma cells prompted a clinical trial of radiation therapy using high individual-dose-fractionation schedules. Typically, individual doses of larger than or equal to 600 rads were delivered once or twice weekly. The most clear-cut effect was against skin metastases. Twenty-nine of 33 lesions showed partial or complete regression when treated in this manner. None of 11 lesions responded that were treated with individual treatment doses of 200 to 500 rads, although in some cases the total doses were greater than 5000 rads. Some of the possible roles for an effective radiation regimen in the overall management of this complex disease are discussed.