[Endourethral brachytherapy for the prevention of recurrent strictures following internal urethrotomy]. / Endoluminale Brachytherapie zur Vorbeugung von rezidivierenden Strikturen nach Urethrotomia interna.

METHODS AND MATERIALS: Between November 2000 and December 2002 endoscopic incision or transurethral scar resection was followed by endourethral brachytherapy (BT) which was performed in patients with recurrent bulbar strictures ( n=9), bladder neck stenosis after transurethral prostatectomy (TUR-P) ( n=3), anastomotic stricture after radical prostatectomy ( n=2) or penile urethral stricture ( n=1). High dose rate (HDR) iridium-192 BT started on the day of the endoscopic incision or resection and continued for the following 3 days. The BT fractionation scheme was 4x3 Gy in the first three patients (until first relapse) and 4x4 Gy in all following patients. The dose was calculated at 3 mm tissue depth using 3-dimensional CT-planning. As of February 2004, the median follow-up of all patients reached 22 months. RESULTS: Seven of 15 patients (46%) are recurrence free. In two patients (13.3%), recurrent strictures developed 12 month later, outside of the region of initial treatment. In six patients (40%) the treatment was considered to be unsuccessful as recurrent strictures were found between 2 and 12 months after the initial or second course of treatment. CONCLUSION: Endourethral brachytherapy after endoscopic incision or resection is a promising treatment for the prevention of recurrent strictures of the urethra, bladder neck or vesicourethral anastomosis. The initial results have been very good, but with longer follow-up recurrence occurred in the irradiated area in 40% of patients. Prospective randomized studies in patients with a strictly defined type of recurrent stricture, or even after the first internal urethrotomy, should be done in the future.

[Radiotherapy for basal cell carcinoma. Local control and cosmetic outcome]. / Strahlentherapie des Basalzellkarzinoms. Lokale Kontrolle und kosmetisches Ergebnis.

BACKGROUND: The basal cell carcinoma which is often occurring in the elderly can be well treated by surgery. For large and recurrent lesions and in cosmetically difficult locations external beam radiotherapy provides an equally effective treatment alternative. PATIENTS AND METHODS: From 1986 to 1999, 60 females and 39 males received primary radiotherapy for a total of 127 histologically verified basal cell carcinoma lesions. Tumors were mostly localized in the face at the temple, nose and forehead. Radiotherapy was applied with orthovoltage equipment and energies of up to 100 kV. Single doses ranged from 2 to 5 Gy related to the 80%-isodose depth. Weekly doses ranged from 8 to 25 Gy and total doses from 25 to 60 Gy. The mean follow-up period was 36 +/- 21 months. The acute sequelae were scored according to CTC criteria. Radiogenic late effects as single events were related to the radiation portal. RESULTS: 3 months after treatment all besides one patient (99%) experienced complete tumor remission (CR). In all cases, acute radiation reaction occurred within the radiation portal: CTC Grade 1 in 100%, CTC Grade 2 in 54% and CTC Grade 3 in 30% of the cases. All side effects regressed under simple local measures without further complications. Late sequelae were observed in three cases. Overall cosmetic outcome was good to excellent in almost all patients (98%). In two cases (2%) a local recurrence was observed 6 and 20 months after radiotherapy. CONCLUSION: External beam (orthovoltage) radiotherapy is very effective and yields high tumor control rates and good cosmetic results in long-term follow-up. Former dermatological treatment concepts should be replaced by an ICRU-based radiophysical dose prescription and should respect the newer radiobiological fractionation principles.

[Optimization of radiotherapy in Dupuytren's disease. Initial results of a controlled trial]. / Optimierung der Radiotherapie bei Morbus Dupuytren. Erste Ergebnisse einer kontrollierten Studie.

PURPOSE: Radiotherapy prevents progression of Dupuytren's contracture. Herein, 1-year results of a prospective randomized trial comparing 2 different dose concepts are presented. PATIENTS AND METHODS: 129 patients (67 males, 62 females) were included in the study with a minimum 1-year follow-up: 69 had bilateral and 60 unilateral involvement of Dupyutren's disease accounting for 198 irradiated hands. According to Tubiana, 73 hands had Stage N, 61 Stage N/I (< or = 10 degrees flexion deformity), 59 Stage I (11 to 45 degrees) and 5 Stage II disease (46 to 90 degrees). Radiotherapy was randomly delivered: group A (63 patients/95 hands) received 10 times 3 Gy (total: 30 Gy) in 2 series (each 5 times 3 Gy) separated by 8 weeks; group B (66 patients/103 hands) received 7 times 3 Gy (total: 21 Gy) within 2 weeks. Orthovoltage radiotherapy (120 kV) with 40 cm standard cones and individual shielding was applied. Patient and disease parameters were equally distributed in both groups. Evaluation (toxicity, efficacy) was performed at 3 and 12 months with regard to subjective (patient's opinion) and objective parameters (palpation, measurements, comparative photographs--physician). RESULTS: Acute toxicity was minimal: 76 (38%) hands had skin reactions CTC Grade 1, 12 (6%) CTC Grade 2. Chronic side effects (dryness, skin atrophy, change of sensation, LENT Grade 1) occurred in 9 (5%) hands without differences between treatment groups. At 3 and 12 months follow-up, subjective symptoms and objective signs, nodules and cords, were reduced in both groups (p < 0.01) with no differences between groups: a total of 110 (55%) hands (group A: 55, group B: 55) regressed, 74 (37%) hands (group A: 35; group B: 39) were stable. Overall and mean number of nodules, cords and skin changes decreased at 3 and 12 months. 16 of 198 (8%) hands (group A: 7; group B: 9) progressed at 12 months follow-up ("treatment failure"); at 1 year, 7 of 60 patients with unilateral Dupyutren's disease required prophylactic radiotherapy for the contralateral hand due to disease progression. CONCLUSIONS: Prophylactic radiotherapy reduces symptoms and prevents disease progression in early-stage Dupyutren's disease. Both treatment concepts are well-tolerated and equally effective. Acute toxicity is slightly increased with treatment concept B (7 times 3 Gy), while chronic sequelae are low in both treatment groups. Long-term evaluation with follow-up of more than 5 years has to be awaited to recommend one or the other dose concept.

Radiotherapy optimization in early-stage Dupuytren's contracture: first results of a randomized clinical study.

PURPOSE: Radiotherapy (RT) can prevent progression of Dupuytren's contracture (DC). It is unknown whether there is a dose response and which dose is sufficient. Herein, the 1-year results of a prospective randomized trial are presented which compared two different RT dose concepts with each other. METHODS: 129 patients (67 males; 62 females) were entered in this study: 69 had bilateral and 60 uni-lateral involvement of DC accounting for 198 irradiated hands. According to Tubiana's classification, 73 hands had Stage N (nodules/cords, no extension deficit = flexion deformity), 61 had Stage N/I (< or = 10 degrees deficit), 59 had Stage I (11-45 degrees deficit), and 5 had Stage II (46-90 degrees deficit) DC. Prophylactic RT was randomly delivered; in Group A, 63 patients (95 hands) received 10 x 3 Gy (total dose, 30 Gy) in 2 series (5 x 3Gy) separated by 8 weeks; in Group B, 66 patients (103 hands) received 7 x 3 Gy (total dose, 21 Gy) in 1 series within 2 weeks. Orthovoltage RT (120 kV) was applied using standard cones and individual shielding of uninvolved areas of the palm. Relevant patient and disease parameters were equally distributed in both groups. Evaluation (toxicity, efficacy) was performed at 3 and 12 months after RT. Subjective (patient's opinion) and objective parameters (palpation, measurements, and comparative photographs) were applied to assess treatment response. Minimum follow-up (FU) was 1 year. RESULTS: Acute toxicity was minimal, but slightly more pronounced in Group B. Seventy-six (38%) hands developed skin reactions CTC 1 degrees (A, 30; B, 46); and 12 (6%) had skin reactions CTC 2 degrees (A, 4; B, 8). Chronic side effects were limited to dryness, desquamation, skin atrophy, and change of sensation (LENT 1 degrees ) in 9 (5%) sites without differences between the two groups. At 3 and 12 months after RT, subjective and objective reduction of symptoms, nodules, and cords occurred in both groups (p < 0.01) with no differences between the groups: in Group A, 55 (56%) sites regressed, 35 (37%) remained stable, and 7 (7%) progressed, whereas in Group B, 55 (53%) regressed, 39 (38%) remained stable, and 9 (9%) progressed at 12 months FU (NS). Overall and mean number of nodules, cords, and skin changes decreased at 3 and 12 months. The "treatment failure" rate at 1 year was 16 of 198 (8%), but only 4 (2%) sites required hand surgery for disease progression. Seven of 60 patients with unilateral DC received prophylactic RT for the initially uninvolved, contralateral hand due to progression of DC. CONCLUSION: Both prophylactic RT concepts have been well accepted and tolerated by patients. Within the first year, they were equally effective to prevent further disease progression of DC and obtain considerable symptomatic improvement. Although 1-year results suggest similar response rates for both treatment groups, long-term FU of > 5 years has to be awaited for final assessment and recommendation of an optimized RT treatment schedule.

[Radiotherapy in rectal carcinoma. Indications, side effects and after-care]. / Strahlentherapie beim Rektum-Ca. Indikationen, Nebenwirkungen und Nachsorge.

In patients at a high risk of developing a local recurrence or distant metastases, external beam radiotherapy used in combination with chemotherapy with 5-FU is indispensable. Adjuvant treatment is indicated for stage II and stage III rectal carcinoma, following tearing or cutting of the tumor, and/or following an R1 or R2 tumor resection. The neoadjuvant strategy comprises preoperative radiochemotherapy in the case of inoperable tumors or local recurrence, with the aim of enabling radical surgery. Radiation is applied to all sites likely to develop a recurrence. The fractionated radiation dose is 1.8-2 Gy/day, applied 5 times a week, for a total dose of 50 Gy at the dose reference point in the pelvis. Side effects include diarrhea, skin erosions and urological affections. Aftercare is provided on an interdisciplinary basis, initially at 6-week intervals, after 6 months at 3-month intervals, after one year every 6 months, and after 3 years once yearly.

[Location and morphology of plaque of the carotid artery and femoral artery in the B-scan image in employees of the Düsseldorf public officials: value of screening study]. / Untersuchung zu Plaquelokalisation und -morphologie an Aa. carotides und Aa. femorales im B-Scan-Bild bei Angestellten der Düsseldorfer Landesbehörden: Wertigkeit als Screeninguntersuchung.

With the help of high-resolution real-time sonography, we examined the carotid and femoral arteries in 3,500 asymptomatic persons to assess early states of atherosclerosis an to prove the utility of B-Scan-Sonography in this aim. We found 384 people having plaques, totally 769 pl. 68 p.c. of all plaques we were found in the femoral arteries, 32 p.c. in the carotid arteries, in each case with preference of the bifurcation and the pre-bifurcation-region. This seems to confirm earlier studies on this theme. As regards to the morphology, we found 67 p.c. (of all plaques) being faintly-echogenic ("fatty-streaks" or intermediär type). 73 p.c. of all plaques showed a smooth or faintly irregular surface-character. More than 75% of all plaques had a volume less than 0.3 ccm. Altogether, the results verify the assessment of mostly early states of atherosclerosis with the help of real-time-ultrasound and underline this method being a good and sufficient non-invasive-technique for screening-examinations on an asymptomatic collective.

[Prevention of arterial and venous vascular diseases, especially the correlation between risk factors and arteriosclerosis]. / Studie zur Prävention von arteriellen und venösen Gefässerkrankungen, insbesondere Korrelation zwischen Risikofaktoren und Arteriosklerose.

In a epidemiological study 3840 clerks of state of North Rhein Westfalia were investigated concerning the frequency of atherosklerotic leasions of the carotid and femoral arteries in duplex scanning. 17% of all investigated showed independency to age, sex and risk factors alterations of the vessel walls. Men had twice as much plaques as women and male subjects with multiple risk factors had four times more plaques than those without.

[Imaging real-time sonography (B-scan) of peripheral veins--possibilities for use with reference to secondary prevention]. / Bildgebende Echtzeitsonographie (B-Scan) peripherer Venen--Anwendungsmöglichkeiten hinsichtlich sekundärer Prävention.

In 2400 male and 1400 female persons the proximal femoral and saphenal venous vessels have been monitored and measured with a Ultramark 4, build by ATL, by use of 7.5 megacycle/s. transducer. Moreover, we took the venous calibers at the junction of the saphenous veins into femoral veins. In patients with marked varices or less symptomatic patients as well as clinically asymptomatic persons with positive family history there could be found significantly bigger dilatation of vessel calibers in those patients laying than those standing up, in contrast to healthy persons. B-Scan ultrasound consequently in future offers a new range of diagnostic values in examination of venous vessels, that is to say a non-invasive, reproducible and haemodynamically tolerable method which helps to improve secondary prevention.