Effect of dose and dose-distribution in damage to the kidney following abdominal radiotherapy.

PURPOSE: To define the effects of abdominal radiotherapy on the kidney with regard to dose-distribution parameters. MATERIALS AND METHODS: Ninety-one patients with abdominal radiotherapy were included in the study, and the minimum follow-up was 1 year. Conventional fractionation, 5 x 1.8-2.0 Gy week(-1) to total doses of 30.6-62.5 Gy, was employed. Assessment of organ function was performed before, immediately after, and at 6 months and 1 year after radiotherapy. In cases with a significant radiation response at 1 year, subsequent follow-ups were done at 6-month intervals. Documented parameters included clinical examination, static and sequential scintigraphy of the kidneys, abdominal computed tomography, and sonography. RESULTS: Twenty-one patients (23%) developed a reduction in kidney function detected by static scintigraphy. Only in 15 of these patients was impairment of renal function observed by sequential scintigraphy. The contribution of the irradiated kidney to overall renal function decreased progressively to 34-40% by the third year after treatment. Hypertension was seen in two patients. No changes were found in laboratory parameters. ED(50) for scintigraphic changes decreased from 27 Gy for 10% of the volume to 7.6 Gy for 100%. ED(5) were in the range of 3-6 Gy, and this was independent of volume. CONCLUSIONS: Sophisticated imaging techniques allow the identification of radiation effects in partial volumes of the kidneys. A dose-response relationship in relation to the volume of kidney irradiated can thus be established for scintigraphic changes. As in a number of other organs, such changes do not relate directly to loss of renal function due to the reserve capacity of unirradiated kidney tissue.

[D-xylose test of resorption as a method to determine radiation side effects in the small intestine]. / D-Xylose-Resorptionstest als Methode zur Erfassung der Strahlenreaktion des Darms.

BACKGROUND: The D-xylose test is the most important method to determine a disorder of carbohydrates resorption in proximal small intestine. The application is based on an impaired resorption due to pathological change of small intestine surface, leading to a decreased blood level or decreased excretion in urine. PATIENTS AND METHOD: D-xylose test was applied in 91 patients before, shortly after, 1/2 and 1 year after radiotherapy. All patients received an abdominal radiotherapy. We determined the blood level of D-xylose by a capillary blood sample 1 hour after oral D-xylose administration. RESULTS: A significant decrease of the mean blood level of D-xylose to 1.88 mmol/l was determined after radiotherapy in comparison with 2.17 mmol/l before radiotherapy. Half a year after radiotherapy the mean blood level of D-xylose returned to normal. Regarding a threshold value of D-xylose blood level of 1.70 mmol/l 29 patients (32%) showed a pathologically decreased D-xylose resorption after radiotherapy. Twenty out of the 29 patients already showed a normal resorption half a year after the determination of the resorption disorder, 5 patients after 1 year and 4 patients after 1 1/2 years. There was no correlation between the detection of a disorder of D-xylose resorption and of a loss of body weight. The acute clinical side effects seemed to be more marked in connection with a disorder of D-xylose resorption, but this correlation is not significant. Eleven or 14 of the 29 patients, respectively, with pathologically decreased D-xylose resorption only had complaints of lower or upper gastrointestinal tract, respectively, and 10 patients did not have abdominal complaints at all. CONCLUSIONS: The D-xylose test is an important and simple method for determination of radiogen induced carbohydrate malabsorption in proximal small intestine. By means of it radiation side effects on small intestine can also be determined in patients who are otherwise free of complaints.

[Radiation effects in the left kidney after irradiation of the spleen]. / Strahlenfolgen an der linken Niere nach Milzbestrahlung.

BACKGROUND: An important component of treatment of malignant lymphoma is the radiotherapy. If the spleen has to be included in the irradiation field, the left kidney has to be considered as a risk organ. PATIENTS AND METHOD: In 25 patients, splenic pedicle or spleen was included in the irradiation field. These patients were followed up at 6-monthly intervals clinically and by renal scintigram. For 21 out of 25 patients, a volume-dose-histogram of the kidneys was made. RESULTS: A decreased uptake of activity by the left kidney was found in the static renal scintigram of 13 out of the 25 patients and was seen 6 months to 1 year after radiotherapy for the first time at a moderate intensity. The decreased uptake improved in 1 patient, but was progressive in 8 patients until a storage defect or a shrinking of the whole left kidney appeared. The volume-dose-histogram showed that a decreased uptake was seen in the upper half or whole left kidney respectively if at least 40% of the volume or the whole organ was irradiated with at least 20 Gy. 40% of the volume of the left kidney were exposed to at least 20 Gy in only for 3 out of the 12 patients with no decreased uptake. By means of the renal sequence scintigram a reduced function of the left kidney was determined for 11 out of 13 patients. The functional contribution of the left kidney deteriorated to 16 to 37% of the total function of the 2 kidneys. One patient developed a hypertension 1 1/2 years after radiotherapy; all other patients showed no clinical symptoms. Retention of substances in blood was not observed. CONCLUSIONS: The static renal scintigram enables defined radiation-induced lesions of parenchyma of the left kidney to be determined after irradiation of the splenic pedicle or spleen. The changes are predominantly subclinical but possible long-term effects are unknown. In the treatment planning all possibilities should be used to minimize the irradiation volume of the left kidney. Furthermore, all patients should be followed up at regular intervals on a long-term basis.

[CT-guided manual afterloading with 198-gold seeds in intracerebral tumors]. / CT-gestütztes manuelles Afterloading mit 198-Gold-Seeds bei intrazerebralen Tumoren.

Interstitial brachytherapy of intracerebral tumours was stimulated through the introduction of computed tomography and afterloading technique. Biopsies for their histologic verification as well as the stereotactic implantation of plastic tubes and adjusted to the extent of the tumour can be carried out with a high degree of exactitude by means of CT-supported localization and puncture. The small-sized 198-gold seeds are then introduced according to the manual afterloading technique and remain in situ until the planned dose in the target volume of 50 Gy is achieved. Report on our manual afterloading brachytherapy in high-grade astrocytomas III and IV and in adenomas of the hypophysis. Indications of the diagnostic and therapeutic procedure, irradiation planning, calculation of the dose and discussion of our tentative clinical experience are explained.

[Radiation load of kidneys in telecobalt irradiation of aortic lymph nodes]. / Untersuchungen zur Strahlenbelastung der Nieren bei der Telekobaltbestrahlung der aortalen Lymphknoten.

The kidneys of 117 patients were examined before and after (immediately until several weeks) a telecobalt irradiation of the aortal lymph nodes. In 36 out of them, another control examination could be performed after 1 1/2 years. In 17 patients, the early examinations showed functional troubles of the kidneys which regressed in nine cases. The late examinations showed in 19 cases functional restrictions which have to be considered to be irreversible. The conclusion must be drawn that it is necessary to examine the kidneys before and until several years after a radiotherapy of the aortal lymph nodes and that the dose distribution has to be optimized with respect to a conservation of the kidneys, as far as this is oncologically possible.

[Diagnosis of infectious spondylitis following urological interventions]. / Zur Diagnostik der Spondylitis infectiosa nach urologischen Eingriffen.

Spread of infection to the spine following urological surgery is extremely rare. The diagnosis is therefore often made at a late stage resulting in delayed treatment. Four patients observed by the authors are described and the diagnosis is discussed.

[The erysipelas as complication of a lymph oedema after therapy of mastocarcinomas (author's transl)]. / Das Erysipel als Komplikation bei Lymphödem nach Therapie des Mammakarzinoms.

1812 patients with mastocarcinomas were submitted to a combined therapy (surgery and radiotherapy); 34.2% of them developed an oedema. This inflammation is a complicating factor because it may increase the oedematous tendency. The authors discuss the correlations between a disturbed defluxion and an erysipelas tendency as well as the risks of a chronic stasis. These correlations necessitate an immediate and intensive treatment of the erysipelas.

[Radiotherapy of the juvenile xanthogranuloma of the iris (author's transl)]. / Zur Strahlentherapie des juvenilen Xanthogranuloms der Iris.

A report is given on an eight months old child with a juvenile xanthogranuloma of the iris and a secondary glaucoma. After radiotherapy with 6 X 0,5 Gy under conventional deep therapy conditions, a soon regression of the increased intraocular pressure was observed. In case of a juvenile xanthogranuloma of the iris, this secondary glaucoma represents in any case an acute danger to the eye, so it must be treated immediately. Radiotherapy has to be considered as the method of choice; it is also discussed with regard to the risk and the avoidance of a radiation cataract which, however, has to be tolerated in certain cases in order to prevent greater troubles.

[Problems in juvenile xanthogranuloma of the anterior uvea (author's transl)]. / Zum Problem des juvenilen Xanthogranuloms der vorderen Uvea.

With reference to a case of juvenile xanthogranuloma localized in the anterior uvea the authors describe the clinical signs, differential diagnosis, morphology and treatment of this disease. If the juvenile xanthogranuloma is located in the anterior uvea, the eye may be severely affected. Spontaneous hyphema in infants is characteristic. At present radiation is the most successful treatment for preserving the bulbus and visual function. The earlier the disease is discovered the better the chances of successful treatment.

[Intervention radiology for guided needle aspiration biopsy (author's transl)]. / Interventionsradiologische Möglichkeiten zur gezielten Punktions-Zytodiagnostik.

Aspiration of material on the basis of radiological examination is a well suited method of intervention radiology. This is demonstrated by lesions of the breast, thyroid gland, lungs, mediastinal masses, lymph nodes, skeleton and kidney. Intervention radiology represents the combination of tumour localization and guided cytological diagnosis without additional risks for the patient.