[Biological basis of radiochemotherapy] / A radiokemoterápia biológiai alapjai.

The tumor biological and radiobiological aspects, the mechanism of actions and general considerations of clinical application of radiochemotherapy are discussed. The aims of radiochemotherapy are to prolong the patient's survival by improving local tumor control and decreasing distant metastases. The goal of radiochemotherapy is to enhance the therapeutic effect of radiation with tolerable and controllable local and systemic side effects. The mechanism of action of the most frequently used drugs are also discussed.

[Effectiveness of radiochemotherapy in esophageal cancers]. / Radiokemoterápia hatásosságának vizsgálata nyelócsórákokban.

AIM: Simultaneous radio-chemotherapy of the inoperable or irresectable oesophagus cancer. METHOD: Thirteen patients with inoperable oesophagus cancer were treated between 1995-98. The therapy was started with intraluminal HDR AL irradiation for the recanalisation of the oesophagus (Dose 8 Gy in 0.5 cm deep, two-three times, one week interval repeated) followed by the percutem megavolt irradiation one week after the last HDR AL session (50 Gy total dose, 5 x 2 Gy/week fractions in 5 week). The chemotherapy was started simultaneously with the percutem megavolt irradiation (three courses Cisplatin-5-Fluorouracil combination, repeated in four weeks intervals). RESULTS: The swallow function has been improved in 7/13 patients with 1-3 Units (Deutsche Gesellschaft für Radio-Onkologie Dysphagical Classification) remained unchanged in 4/13 and it got worse in 2/13 patients 1 and 3 Units, respectively. Side effects: Oesophagitis of different degree occurred in all patients, consecutive transitory dysphagia developed in 9/27 (33.3%) patients. Follow up time: average 14 month (minimum 3 months, maximum 39 month). The duration of the swallow function improvement: average 13 month (minimum 3 month, maximum 39 month). CONCLUSION: The initial results refer to the favourable effect of the palliative radio-chemotherapy at the inoperable oesophageal cancer.

Radiotherapy for lung metastases in a patient with ewing sarcoma.

UNLABELLED: Purpose. To assess the benefit of therapy for multiple lung metastases in a young female patient previously treated with operation, local radiotherapy and chemotherapy. PATIENT: Lung metastases occurred in a young female patient 13 months after finishing combined treatment of a Ewing sarcoma of the left eleventh rib. Primary treatment had included surgical removal, 51 Gy local radiotherapy and chemotherapy.Method. 20 Gy total dose was applied to the lungs of both sides in two courses with an additional 15 Gy to the mediastinum.Results and Discussion. Complete radiological regression was achieved at the end of therapy which was maintained during the follow-up period of 16 months.

[Combination of high dose after-loading radiation therapy and percutaneous irradiation in the management of tumors of the major airways]. / Endobronchialis magas dózisú afterloading sugárkezelés és percutan besugárzás kombinációja nagylégúti daganatok kezelésében.

17 patients with malignant main airway tumours were treated with combined high dose rate afterloading and external beam irradiation. The improvement of the general conditions of the patients and that of the leading symptoms (dyspnoe, cough) were observed in all cases. First experiences corresponding with those of others suggest that this method should be integrated routinely in the management of main airway malignancies with endoluminal exophytic involvement.

Bone marrow (reticuloendothelial system) scintigraphy for haematological follow-up of radiochemotherapy-treated patients.

To assess the bone marrow capacity before a new treatment decision, 99mTc-human serum albumin bone marrow scintigraphy (with qualitative and quantitative evaluation) was performed in 32 patients with solid tumours or malignant lymphomas previously treated with radiochemotherapy. In the group with a normal bone marrow capacity, the blood counts were normal (14/16 cases) or became normal (2/16 cases) in the follow-up period, and the examined marrow samples exhibited normal haemopoiesis. In the group with a reduced bone marrow capacity, one or more blood counts were low in 14/16 cases. Decreased haemopoiesis was observed in only 4 of 8 examined marrow samples. The following conclusions were drawn. (1) A scintigraphically normal bone marrow capacity relates to normal haematological parameters, and therefore treatment plans could be decided on. (2) Although a reduced bone marrow capacity indicates pathological haematological conditions in the majority of cases, further studies are needed to evaluate its precise significance. (3) Application of this non-invasive, inexpensive, repeatable, non-immunizing method is recommended before a therapeutic plan is decided on for patients at considerable haematological risk.

Neutron radiotherapy in adenoidcystic carcinoma: preliminary experience at the Münster neutron facility.

In adenoidcystic carcinoma macroscopic residual disease after surgery, inoperable and recurrent tumors are characterized by relapse rates up to 70% if treated according to conventional treatment strategies including photon radiotherapy. By neutron therapy a tumor control rate of 70% has been reported. At the d,T-generator (14 MeV) in Münster nine patients with adenoidcystic carcinoma of the salivary glands in locally advanced stage have been treated since 1/86. A combined modality schedule (30 Gy photon/5 to 10 Gy neutrons) used in the beginning has been replaced by a definitive neutron therapy (15 Gy) with single fractions of 1.0 to 1.3 Gy in five to six weeks. Treatment planning included CT/MRI as well as computer assisted dose calculations based on a specific software for neutron therapy. The volume reduction by neutron radiotherapy was 82% for advanced disease. Continuous remission was achieved in seven of nine patients in a short follow-up period of medium 15 months (from six to 28 months). The two recurrences occurred at the field edge. Based on this preliminary experience and on a survey of the literature the main issues for neutron therapy in salivary glands tumors in particular adenoidcystic carcinomas are discussed: histology, stage, tumor size, location, surgery, treatment planning and delivery, dose, and side effects. A long term evaluation of neutron therapy within a controlled clinical multicenter trial is proposed.

[Neutron therapy for adenoid cystic carcinoma]. / Neutronentherapie bei adenoidzystischen Karzinomen. Erste Erfahrungen am DT-Neutronengenerator in Münster mit Literaturübersicht.

In the treatment of adenoid cystic carcinomas, certain situations such as inoperable tumors, macroscopic tumor residues following surgery and recurrences occurring with the previous therapeutic strategies (surgery and/or photon radiotherapy) are afflicted with frequent local recurrences. In these situations the use of radiotherapy with fast neutrons (densely ionizing radiation with high energy transfer) results in absence of recurrences in approx. 70% of the cases, according to data in the literature. The advantage of using neutrons lies in their greater biological effect on slowly growing tumors. In the Hospital for Radiotherapy of the Münster University neutron therapy has been applied since 1986 for these indications using a DT neutron generator (14 MeV). Based on the results obtained in the treatment of 8 patients and a review of the literature, indications for, treatment planning and implementing of neutron therapy is illustrated. Particular consideration is given to CT and MRT. Neutron therapy offers an alternative to previously existing treatment methods for locally advanced adenoid cystic carcinomas or highly differentiated malignomas of the salivary glands. Its effectiveness should be verified by studies involving larger numbers of patients and longer observation periods.

[Role of radiotherapy in esthesioneuroblastoma]. / Zur Rolle der Strahlentherapie beim Asthesioneuroblastom.

A case report on a locally advanced inoperable esthesioneuroblastoma in a patient of 65 years of age is presented. Chemotherapy (CYVADIC) resulted in a slight reduction of tumour mass and was followed by rapid tumour regrowth. By megavoltage radiotherapy (65 Gy) with shrinking field technique a clinically complete remission was achieved. The role of radiotherapy in long-term local tumour control in combination with surgery is discussed, taking into account the few date reported in literature. Depending on the tumour stage at diagnosis, a graduated strategy combining surgery and radiotherapy is recommended as the treatment of choice. The value of adjuvant chemotherapy has not yet been clearly established, not even in locally progressing or advanced stages of tumours or in metastasizing tumours.

[Therapy result of malignant tumors of the paranasal sinuses in patients treated at the metropolitan onco-radiologic centre of Budapest. Period under review: 1946-1974 (author's transl)]. / Behandlungsergebnisse bei bösartigen Nasennebenhöhlentumoren. patientengut des Hauptstädtischen Onkoradiologischen Zentrums Budapest Berichtszeitraum 1946-1974.

A report is given on the therapy results of 301 patients with ethmoidomaxillary tumors treated at the Metropolitan Onco-Radiologic Centre of Budapest between 1946 und 1974. Most of these patients were in an advanced stage when the first diagnosis was established. The five-year survival rate of all stages was 27%, which does not strongly differ from the average value of 30% mentioned in literature. The five-year survival rate of the patients submitted to a combined surgical and radiologic treatment was 33%, that of the patients treated by irradiations only was 16%. 81 patients received an intracavitary brachycurietherapy after having undergone a non-radical operation. The five-year survival rate of this group was 38%. The intracavitary brachycurietherapy is most favorable and should always be applied in case of this not very radiosensible, often even radioresistant tumor.

[Individual treatment planning with computed tomography for extended ethmoidomaxillary tumors (author's transl)]. / Individuelle Bestrahlungsplanung basierend auf Computertomographie bei ausgedehnten ethmoidomaxillären Tumoren.

Individual computer-assisted treatment planning using CT was performed in 10 patients with advanced ethmoidomaxillary tumors. Immediate and good exploration of the pterygopalatine fossa and of the para- and retropharyngeal cavities can be accomplished by means of computed tomography. The target volume was defined more exactly with the help of computed tomography, and the choice of the optimal adjustment thus was possible.

New primary malignant tumors in patients treated for carcinoma of the uterine cervix or corpus.

Subsequent primary malignancy was revealed in 1.8 per cent of 2, 689 cases with cervical and in 1.7 per cent of 773 cases with corpus carcinoma. In the cervical carcinoma series the most frequent new primary sites were the skin, breast and recto-sigmoid. Of the cases with cervical and corpus carcinoma 18.8 and 30.7 per cent, respectively, had a family history of malignant disease.

[Changes in treatment results of 5279 cervix tumor patients between 1946 and 1972]. / Die Veränderungen der Behandlungsergebnisse von 5279 Zervixtumorpatientinnen zwischen 1946 und 1972.

Results of the treatment of 5279 cervix tumour patients between 1946--1972 are reported. The assessment was performed by computer analysis of the material. There was a parallel rise in the 5 years survival of patients with the growth of radiotherapeutical equipment, mainly in extensive cases. Regarding all stages, the 5 years survival was 44,36%.

[Therapeutic results achieved in 1366 patients with corpus uteri carcinomas treated between 1946 and 1972]. / Therapieergebnisse der zwischen 1946 und 1972 behandelten 1366 Korpuskarzinompatientinnen.

A report is given on 1366 patients with tumour of the uterine body. A computer was used for evaluation purposes. The 5-year survival rate relating to all stages of the disease was 62.37%. The best results were obtained when surgery was combined with irradiation therapy.