[Problems of suitability laser's excision of pigmented dermal lesions: case report of minimal deviation melanoma]. / Problematika vhodnosti laserového odberu pigmentových kozních lézí: kazuistika minimálne deviovaného melanomu.

The paper describes a case of a 23-year-old woman, in whom an intradermal pigmented nevus was removed by an excision using a CO2 laser. In histological examination a minimal deviation melanoma (MDM) was found, occurring sparsely in the centre of the nevus. A sufficiently wide excision is important not only in terms of the pathologist who assesses the lesion but also, in particular, in terms of the prognosis to the patient. In problematic diagnoses where it is necessary to assess the extent of the lesion as well as its edges and base in particular, the sample taken by laser may be insufficient. The authors report widely used methods of nevus laser surgery and highlight the necessity of a sufficiently radical exstirpation of a nevus.

[Combined breast-preserving surgery, chemotherapy and radiotherapy in the treatment of breast carcinoma. Effect of the interval between surgery and the beginning of radiotherapy]. / Kombinierte brusterhaltende Chirurgie, Chemotherapie und Strahlentherapie bei der Behandlung des Mammakarzinoms. Der Einfluss des Intervalls zwischen Operation und Bestrahlungsbeginn.

BACKGROUND: The timing of breast conserving surgery, chemotherapy, and radiotherapy in breast cancer treatment has become the subject of increasing interest over the last years. PATIENTS AND METHOD: Seventy-four patients who underwent postoperative radiotherapy at our institution between 1985 and 1992 form the basis of this study. Median follow-up time was 5 years. Seventy-three percent of patients were pre- or perimenopausal. Almost all patients (91%) were UICC-stage II. Axillary lymph nodes were positive in 95% of cases. Complete gross resection was achieved in all patients, and in 65% final pathological margins were free of invasive or intraductal carcinoma. Postoperatively, 70% of patients received 6 cycles of polychemotherapy (predominantly CMF) before onset of irradiation. The radiation dose was in almost all cases 60 Gy including 10 Gy boost. RESULTS: Five years after start of treatment overall survival, disease-free survival, and local recurrence rates were 86% (95%-confidence limits, 76 to 93%), 73% (61 to 83%), and 8% (3 to 16%), respectively. For disease-free survival, the only significant prognostic factor was the number of involved lymph nodes: 0 to 3 = 86%, > or = 4 = 40% (p < 0.0001). The interval between surgery and radiation (< or = versus > 20 weeks) had no significant influence on disease-free survival or local tumor control. In contrast, there was a trend of increased regional and distant failure with shortening of the interval due to the delivery of less than 6 cycles chemotherapy before the onset of radiotherapy. CONCLUSIONS: In our experience, there was no negative impact of a delay of radiotherapy in order to deliver full course chemotherapy before initiation of radiotherapy. However, the low statistical power of this analysis due to the small number of patients must be considered. it appears possible that a less intense chemotherapy before starting radiation treatment correlates with enhanced distant failure and subsequently decreased disease-free survival rates. Therefore, for patients at increased risk for distant metastasis, we prefer to give 6 cycles polychemotherapy before irradiation.

[Local therapy measures in HIV-associated Kaposi's sarcoma with special reference to fractionation radiotherapy]. / Lokaltherapeutische Massnahmen beim HIV-assoziierten Kaposi-Sarkom mit besonderer Berücksichtigung der Röntgenweichstrahltherapie.

In 23 patients with HIV-associated Kaposi's sarcoma 53 tumor lesions were treated with fractioned radiotherapy. Indication for the radiotherapy were mostly cosmetic reasons in stigmatizing tumors, but also in several cases pain, oedema or functional deficits as a result of the tumor lesions. 21 patients received orthovoltage irradiation, the remaining four patients were treated with telecobalt therapy. A complete response was observed in 17%, a partial response in 76% and unchanged lesions in 4%. In two cases (4%), both were treated with telecobalt-therapy by large tumor masses, there occurred a further tumor progression inspite of the radiotherapy. In ten lesions, all with partial remission, we later observed a repeated tumor progression. Important side effects were signs of inflammation as mucositis and edema or hyperpigmentation. The occurrence of acute side effects can be reduced by fractionating of the radiotherapy.

[Rate of complications and dose rate in brachytherapy for carcinoma of the uterine cervix (author's transl)]. / Komplikationsrate and Dosisleistung bei der Brachytherapie des Kollumkarzinoms.

The results from 176 patients having undergone brachytherapy for carcinoma of the uterine cervix are reported, based on the evaluation of their case histories. Important complications in the course of the treatment are significantly more frequent after utilisation of an intra-uterine radium tube with 188.4 mg than after application of a 33-mg intra-uterine radium tube, whereas the rate of recurrences does not differ significantly, neither by the frequency nor by the site, after the application of differently loaded intra-uterine tubes. The problems of spatial and temporal dose distribution in brachytherapy are discussed considering especially the line of iso-effects and the influence of the angle of uterine inclination.