Rapid course radiation therapy vs. more standard treatment: a randomized trial for bone metastases.

PURPOSE: In a prospective randomized trial we examined whether radiotherapy of painful bone metastases can be shortened using larger single doses without impairing effectivity. METHODS AND MATERIALS: One hundred patients with painful bone metastases having no prior surgical intervention or treatment with x-ray therapy and had a median follow-up of 12 months were analyzed. The primary tumor was located in the breast in 43%, in the lung in 24%, and in the prostate in 14%. The most frequent sites of metastases were the pelvis (31%), the vertebral column (30%), and the ribs (20%). Further percentages of sites were: lower extremity 11%, upper extremity 6%, and skull 2%. Fifty-one patients received a short course radiotherapy with a total dose of 20 Gy in 1 week (daily dose 4 Gy), and 49 patients received 30 Gy in 3 weeks (daily dose 2 Gy). RESULTS: There were no significant differences in frequency, duration of pain relief, improvement of mobility, recalcification, frequency of pathologic fractures nor survival. There was a light trend favoring 30 Gy in frequency of pain relief and recalcification. Survival was mostly influenced by primary tumor site, Karnofsky performance status, and possibly by the response to radiotherapy (pain relief). CONCLUSIONS: Because of the very short life expectancy of patients with metastatic bone disease, we now use 20 Gy in 1 week as our standard to reduce hospital stay.

[Hyperfractionated irradiation of esophageal cancer. Initial results of a pilot study]. / Hyperfraktionierte Bestrahlung von Osophaguskarzinomen. Erste Ergebnisse einer Pilotstudie.

A group of 21 patients with esophagus carcinomas was submitted to hyperfractionated irradiation with a total reference dose of 65 Gy, applied in 50 fractions over five weeks. Generally, the irradiation was well tolerated. About 49% of the patients are alive one year later.

[Treatment of radiation pneumonitis with curative intent--a review]. / Die Behandlung der Strahlenpneumonitis mit kurativer Intention--ein Uberblick.

Therapeutic assays with medicaments intended for the healing of radiopneumonitis have a long tradition. Numerous medicaments have been assayed in men and animals during the last thirty years without having reached any lasting positive results. In the end, the fibrotic stage of this radiogenic side effect has always been refractory. It was, however, possible with some medicaments to relieve the symptoms of the early exudative phase. This study is supposed to give a general survey of the present state of knowledge in this field.

[Hyperfractionated irradiation of bronchial cancer. Results of a pilot study]. / Hyperfraktionierte Bestrahlung beim Bronchialkarzinom. Ergebnisse einer Pilotstudie.

The results achieved during recent years in experimental radiotherapy of malignant tumors show more and more the benefit provided by the small individual doses applied in fractionated irradiation. The effects and side effects of a hyperfractionated therapy of the bronchial carcinoma were investigated in a not randomized comparative study. The data of 100 patients were available for evaluation; they showed a tendency to local superiority of hyperfractionated irradiation. The value of hyperfractionation shall be examined in detail in a randomized prospective study.

[Chest wall moulages for radiotherapy of resected breast cancer with fast electrons: comparative tests of different materials]. / Moulagen der Brustwand in der Strahlentherapie des operierten Mammakarzinoms mit schnellen Elektronen: vergleichende Testung verschiedener Materialien.

Irradiation of the thoracic wall with high-speed electrons is one of the standard methods of prophylaxis and therapy of local recurrences and cutaneous metastases of an operated mammary carcinoma. The surface dose, however, is only 85% of the maximum dose, due to the depth dose curve of the electron beams with the preponderantly applied energy of 7MeV. This is a poor value, since most of all recurrences appear near to the surface and so the risk of giving an insufficient dose is involved. The dose distribution could be essentially improved by the use of moulages on the chest. These moulages were made of different materials which were tested and compared with respect to their suitability for radiotherapeutic purposes. The best materials proved to be "Urgo-Plastan" (manufacturer: Holphar, Sulzbach) and "Orthoplast" (manufacturer: Johnson & Johnson, Düsseldorf). Both materials are synthetic substances which after heating can easily be adapted to the body shape and which offer a good stability, little inconvenience for the patient and a relative easy handling. With these moulage materials, the surface dose is increased to 98% ("Urgo-Plastan") and 99% ("Orthoplast") of the maximum dose.

[Irradiation of grades III and IV astrocytomas with new types of radiation]. / Bestrahlung von Astrozytomen Grad III und IV mit neuen Strahlenarten.

Until 1983, more than 300 astrocytomas of degree III and IV have been irradiated all over the world with new types of radiation such as neutrons, protons, alpha particles, heavy ions, and pions. Up to now a therapeutic progress could not be achieved. Radiobiologic experimentations suggest that the dense ionisation is unfavorable in the irradiation of malignant cerebral tumors. The clinical radiotherapy research with protons should therefore be intensified and hyperfractionation should be critically reviewed.

Tumoral calcinosis. Observations during six years.

Findings of a 56 year old woman suffering from tumoral calcinosis, who was treated for 6 years, are presented. Under conditions known to lead to negative calcium-phosphorus balance, a reduction in tumor size was seen. Transient hypercalcemia was attributed to immobilization. The process of tumor reduction was not definitely accelerated by treatment with ethane-hydroxy-diphosphonate (EHDP; 500 mg/day for 20 months). Nephrotic syndrome as a consequence of amyloidosis developed. Amyloidosis seems to have resulted from the aseptic histiocytic inflammatory process in the tumors. The possible importance of high cholesterol in very low density lipoproteins in the serum of the patient is discussed.

[Therapy in cancer of the male breast (author's transl)]. / Zur Therapie des mämmlichen Mammakarzinoms.

Six patients with carcinomas of the breast are reported. Bienergetic pendulum irradiation with electrons is applied following surgical treatment in the same manner as with female patients. The possibilities of metastasition treatment are discussed.

[The period of time between operation and irradiation of a mamma carcinoma and its cytostatic treatment (author's transl)]. / Uber den Zeitpunkt der zytostatischen Behandlung nach operietem und bestrahltem Mammakarzinom.

The critical attitude towards the additional chemotherapy of the mamma carcinoma is justified by the results of 453 patients submitted to post-operative irradiations. With the indication corresponding to their stade, 43 patients were treated by chemotherapy according to Ward. The remission rate was 70%.

[Kidney stress in percutaneous abdominal radiotherapy]. / Zur Nierenbelastung bei perkutaner abdomineller Strahlenbehandlung

Percutaneous abdominal radiotherapy leads to an obligatory simultaneous stress of the kidneys. This partial stress of the kidneys can be reduced to a bearable minimum if the medicophysical irradiation planning methods, already developed nowadays. are used. The improved irradiation technique basing on these methods was examined, by administering abdominal irradiation, in a corresponding collective of patients. Clinical, laboratory-chemical, roentgenologic, and nucleo-medical examinations were carried out in different intervals. The significant control results certified the kidney protecting method of our radiotherapy.