Combined chemoradiotherapy with gemcitabine in patients with locally advanced inoperable transitional cell carcinoma of the urinary bladder and/or in patients ineligible for surgery: a phase I trial.

BACKGROUND: We conducted a phase I trial of gemcitabine (gem) with concurrent radiotherapy in patients with muscle-invasive bladder cancer (BC) ineligible for surgery or cisplatin or refusing organ loss. PATIENTS AND METHODS: Patients with urothelial cancer, cT2-T4, cN0-1, M0, ineligible for surgery due to local tumor extension, PS, age or co-morbidities or who refused surgery were included. After maximal transurethral resection, the treatment schedule included: twice-weekly i.v. infusion of gem [dose levels (DL) 1-6: 20, 27, 30, 33, 50 and 40 mg/m(2), respectively] for 30 min and concurrent radiotherapy (RT) to the bladder with 55.5 Gy. The primary end point was to determine the maximum-tolerated dose (MTD) and the dose recommended (RD) for further studies of this gem schedule. The secondary end point was late toxicity. The MTD was defined by dose-limiting toxicity (DLT) in 2 or more of 6 patients, discontinuation of RT and/or gem for >1 week in 2 or more of 6 patients due to grade (G) 3/4 acute and/or late toxicity in more than 2 of 18 patients. RESULTS: Thirty-five of 44 patients were assessable for toxicity and thus the primary end point. DLTs occurred in two of five patients at dose level 5: one G3 alanine aminotransferase elevation and one G3 fatigue. The MTD, therefore, was 50 mg/m(2) gem twice weekly. At DL 6 with 40 mg/m(2), the RD was established: only one of six patients developed G3 fatigue and diarrhea. Late toxicity was rare and of low grade (only G1-2). The 2-year locoregional failure rate was 32% (9/28); 10 of 28 patients (38%) were alive with an intact bladder and no evidence of recurrent disease, 9 patients developed distant metastases and 6 died of their disease. CONCLUSIONS: Gemcitabine in combination with RT is well tolerated in BC patients ineligible for surgery and/or cisplatin. The RD of gemcitabine for subsequent trials is 40 mg/m(2) twice weekly with concurrent radiation.

Do radiation oncologists talk about sexual health and dysfunction with their cancer patients? Results of the igls-vienna-sexmed-survey.

BACKGROUND AND PURPOSE: The aim of this survey was to invite radiation oncologists to self-assess whether sexual health care and sexual dysfunction are an issue in daily routine. MATERIALS AND METHODS: At the annual congress of the Austrian Society of Radiation Oncology in 2017 doctors were asked about their care for sexual health in cancer patients by using questionnaires. No exclusion criteria were employed. Forty-one questionnaires were answered and statistically analysed so 44.5% of doctors participated. RESULTS: Only 4.9% of the participants self-assessed to routinely explore sexual health issues in 61-80% of their patients. Thirty-one point seven percent of the doctors suspected sexual problems in about half of their patients but did not raise the issue. The most common reason for not raising sexual issues by the patients was assumed by the doctors "other problems are more important" (73.2%), followed by "lack of time" (36.6%). Participants were also asked about additional medical qualifications: none of the physicians had training in sexual medicine. CONCLUSION: The main reason for not talking about sexual problems was the impression of the participating doctors that other problems were more important for the patients. Another reason for not bringing up the topic of sexual issues by the patients was assumed by the doctors: lack of time. As doctor shortage is a problem in the observed country other kind of networks and counselling possibilities should be evaluated. An interesting finding was that survey participants show a higher awareness for male sexual problems than for female issues.

High-resolution computed tomography of the lungs in irradiated breast cancer patients.

Fifty-five breast cancer patients underwent high-resolution computed tomography (HRCT) of the lungs before, 8-12 weeks, 6, 9 and 12 months after adjuvant radiotherapy. During the follow-up time, 17 of them (30%) were found to develop minimal parenchymal alterations in the irradiated lung volume by HRCT evidence. The parenchymal alterations were classified by five scores. Scores 1-4 described chronic radiologic changes, score 5 acute radiologic changes. Three patients presented with acute radiologic changes (alveolar filling) within the first 3 months after radiotherapy. Two did not show any abnormalities at later follow-ups. Chronic radiologic fibrosis (15 patients) was not seen before the sixth month post irradiation except in 2 cases. There was no correlation between acute changes and chronic fibrosis. None of these changes were seen at a lung dose of less than 40 Gy. The appearance of interstitial pulmonary lesions secondary to breast irradiation was comparable to that of other interstitial diseases of the lungs. Chest radiographs were normal in all patients. None of the 55 patients presented with clinical symptoms.

[High-resolution CT of the lung versus thoracic radiography after adjuvant radiotherapy in breast carcinoma]. / HR-CT der Lunge versus Thoraxübersichtsaufnahme nach adjuvanter Strahlentherapie beim Mammakarzinom.

We examined the lungs of 35 women following postoperative radiotherapy for breast cancer by using high-resolution computed tomography (HR-CT). Radiotherapy was performed on a cobalt 60 unit using a five-field technique. The average interval between the end of radiotherapy and HR-CT examinations was 23.8 months. HR-CT was limited to those lung areas that were at risk for radiation-induced changes. In 40% of patients minimal interstitial damage (e.g. thickened septal lines, curvilinear densities) invisible on chest x-ray was demonstrated by HR-CT. Massive fibrosis as reported by others was not seen in our study. We conclude that in case lung involvement is suspected clinically during or after radiotherapy, HR-CT is the method of choice for demonstrating these morphological changes.

[Native radiologic staging of osteoporosis--CT densitometry of lumbar vertebral spongiosa. A correlation study]. / Nativradiologisches Osteoporosestaging--CT-Densitometrie der Wirbelkörperspongiosa. Eine Korrelationsstudie.

Lumbar spine radiographs in 47 patients with manifest or clinically suspected osteoporosis were evaluated, using a staging system, and correlated to quantitative computed tomography (QCT) of lumbar vertebrae. The accuracy of osteoporosis assessment, obtained with plain film analysis, was 60%, the sensitivity 67%, the specificity 56%. Statistical correlation showed high standard deviation of each of the QCT-mean values according to the respective stage groups, and altogether poor linear correlation between increasing morphological stages of osteoporosis and decreasing QCT-values. As our results show plain film differentiation of normal from reduced trabecular bone mineral content is unreliable, even by use of a staging system. The diagnostic value of spine radiographs therefore remains limited to demonstration of advanced osteoporotic changes.

[The foramen sternale: a minor anomaly--great relevance]. / Foramen sternale: kleine Anomalie--grosse Relevanz.

PURPOSE: Evaluation of the incidence of a midline sternal foramen, as a developmental anomaly, in order to avoid fatal complications following sternal puncture of sternal acupuncture treatment. MATERIAL AND METHODS: 100 chest computed tomograms were evaluated in reference to the incidence of this anomaly and its various features. RESULTS: The variety of CT aspects ranged from very incomplete types with only sandglass-like retraction of sternal cortex, to a complete foraminal defect. The incidence of midline sternal foramen in a feature bearing a risk of complication, is approximately 6%. CONCLUSION: We conclude that--if sternal acupuncture is planned in the region of corpus--previous radiographs should be done to rule out this anomaly. Furthermore, we strongly recommend the acupuncture technique of the "Wiener Schule", which prescribes a safe superficial-oblique approach to the sternum.

[First clinical experiences with the radiosensitizer MTDQ in advanced primary and recurrent tumors]. / Erste klinische Erfahrungen mit dem Radiosensitizer MTDQ bei fortgeschrittenen Erst- und Rezidivtumoren.

Between April 1981 and February 1983 55 patients with advanced tumours or recurrences in preirradiated fields with different localizations and histology underwent radiotherapy in a pilot I study with MTDQ, a radiosensitizer developed in Hungary, at the University Clinic for Radiotherapy and Radiobiology of Vienna. The prognostically unfavourable group with recurrences following complete irradiation of the target volume shows the same response rate and frequency of complete remissions as the prognostically favourable group without pretreatment (73% versus 61% and 27% versus 29%). The best results are noted in epithelial and mesenchymal tumours of head and neck and in gynaecological malignancies. Furthermore, the side-effects of the drug MTDQ, which are clinically acceptable, are comprehensively described and discussed. The authors have come to the conclusion that MTDQ accomplishes the clinical prerequisites of a radiosensitizer, and propose a prospective randomized study for head and neck tumours.

[Hormones and tumor therapy: current clinical status and future developments in endocrine therapy of breast cancer]. / Hormone und Tumortherapie: Klinischer Stand und Entwicklung der endokrinen Therapie beim Mammakarzinom.

Postoperative adjuvant hormone therapy and hormone therapy in disseminated breast cancer will be discussed systematically. The classical ablative and additive endocrine therapeutic measures--with the exception of ovarectomy and gestagen therapy--are increasingly being replaced by antagonists. Individual chapters discuss recent experience with combined hormone-radiotherapy or hormone-chemotherapy. In addition, a successful therapy scheme for the treatment of disseminated breast cancer will be presented.

[Hormones and tumor therapy: the rational basis of endocrine therapy in breast cancer]. / Hormone und Tumortherapie: die rationalen Grundlagen der endokrinen Therapie beim Mammakarzinom.

Since endocrine therapy has gained great importance in curative and palliative radiotherapy, the hormone-therapy of breast cancer owing to the relevance of the receptor contents in the tumour, has had to be reconsidered over the past decade. Accordingly, this paper deals with endocrine pathophysiology both in relation to the central and cellular mechanisms of hormone action; in addition it presents recent findings on biosynthesis of the different hormones. Furthermore, important treatment criteria with regard to patient selection will be listed. The discussion of these criteria is based both on clinical findings ("empirical criteria") and on the receptor status ("objective criteria") with a view to a better assessment of risk and prognosis at the time of surgery.

[Treatment of advanced ovarian cancer as an interdisciplinary task: surgery, histopathology, radiotherapy, and chemotherapy]. / Die Behandlung fortgeschrittener Ovarialkarzinome als interdisziplinäre Aufgabe: Chirurgie, Histopathologie, Strahlentherapie, Chemotherapie.

From February 1977 to February 1981 we treated 55 patients with ovarian cancer (45 stage III and 10 stage IV) with simultaneous radio-chemotherapy; 34 of these patients underwent a therapeutic second-look operation. The overall response rate was 94%, comprising 63% complete and 31% partial remissions. In the group with residual tumours exceeding 2 cm in diameter after primary operation 52% complete remissions were observed. In the stage III group there were 74% complete and 26% partial remissions. Cytoreductive surgery to less than 2 cm was achieved by means of an early second-look operation in 74% of these cases. These patients have as good a prognosis as those with an equivalent residual tumour after primary resection. Unlike the cases with tumour spread to the retroperitoneal area, macroscopic tumour spread to the surface of the liver or diaphragm indicated a worse prognosis. The survival time of patients who prove to be tumour-free at the time of the diagnostic operation is significantly longer than of those with residual tumours. Neither the age of the patients nor the histological findings after primary operation have any significant influence on survival time. Late intestinal complications made us change the therapeutic strategy employed since March 1981 to sequential radio-chemotherapy. Possible cure for stage III patients can be achieved only by way of interdisciplinary cooperation. In stage IV patients the prognosis is so bad that local therapy is possible only in selected cases.

[Determination of therapy management in rectal carcinoma by staging with 18-FDG-PET]. / Bestimmung des Therapiemanagements beim Rectumcarcinom durch Staging mittels 18-FDG-PET.

The curative treatment of carcinoma of the rectum in the early stage of the disease is radical local surgery. If there is a solitary liver metastasis, resection is also a curative treatment. This report describes a female patient with rectal carcinoma, in whom a solitary liver metastasis in the left lobe was diagnosed only by FDG-PET and verified at surgery. This case report demonstrates the potential role of FDG-PET even for primary staging in detecting occult hepatic and extrahepatic metastases, thus significantly influencing the therapeutic management and prognosis of these patients.

Chemoradiotherapy with 5-fluorouracil/leucovorin, surgery and adjuvant chemotherapy for locally advanced rectal cancer.

The aim of this study was to demonstrate a pathologic complete response (pCR) rate of at least 10% with an acceptable toxicity achieved by preoperative chemoradiotherapy with 5-fluorouracil (5-FU)/leucovorin in patients with locally advanced rectal cancer. Patients were treated by radiotherapy targeting 50 Gy and 5-FU/leucovorin intravenously during the 1st, 4th and 7th week after start of radiotherapy followed by surgery and adjuvant chemotherapy. In 71 evaluable patients, the pCR rate was 14.1% (95% CI, 6.0-22.2); the local relapse rate, 6.1%; the 5-year disease-free survival, 54% and the overall 5-year survival, 68%. The most severe adverse events were neutropenia (17%), diarrhoea (17%), infection (8%) and fatal cardiovascular function (1%). This therapy yielded a high rate of pCR, a low rate of local relapse and a long disease-free and overall survival. To increase its feasibility, radiation dose reduction to 45 Gy and administration of only two preoperative cycles of chemotherapy is recommended.

[Value of transrectal sonography in irradiation planning and oncological follow-up in prostatic cancer]. / Die Wertigkeit der transrektalen Sonographie für die Bestrahlungsplanung und onkologische Nachsorge des Prostatakarzinoms.

Transrectal ultrasonic scanning of the prostate is a simple, cheap, easily employed examination method which requires no preparation. In radiation therapy of prostatic carcinoma it allows in staging and follow-up during and after therapy, an exact imaging of shape, size, capsule infiltration and structure of the prostate, thus permitting a more exact evaluation of the treatment response than with usual methods of examination. The analysis of the acoustic characterisation allows an early recognition of recurrences.

[Therapy monitoring and after care of irradiated anorectal cancer using transrectal sonography]. / Therapie-Monitoring und Nachsorge bestrahlter anorektaler Karzinome mittels Transrektalsonographie.

Pretherapeutic staging before radiotherapy and peri- and posttherapeutic endosonographic screening was carried out on 33 patients with anorectal carcinoma. The results showed the transrectal endosonography to be essential for staging and for the differential diagnosis of tumor recurrence/post irradiation changes during follow up. The sonomorphological criteria of tumor recurrences and post irradiation bowel wall changes are discussed.

[The cobalt-60 irradiation of skeletal metastases--conventional fractionation versus accelerated hyperfractionation]. / Kobalt-60-Bestrahlung von Skelettmetastasen--konventionelle Fraktionierung versus akzelerierte Hyperfraktionierung.

Purpose of this study was to compare the results of two different modalities of palliative radiation i.e. conventional fractionated (group I: 35 patients) vs. hyperfractionated radiation (group II: 20 patients). Group I received 1.8 to 2.3 Gy one time a day (total dose 30 to 40 Gy), with an average treatment duration of 20 days. Group II received 1.8 to 2 Gy two times a day (total dose 25 to 35 Gy), with an average treatment duration of ten days. Regression of complaints occurred in 80% of group I, with an average of twelve days, and in 95% of group II, with an average onset of four days after beginning of treatment. Neither acute nor long term complications did occur in any group. The advantages of the hyperfractionated radiation modality therefore are on one hand a higher regression-rate of subjective complaints, with equal good recovery of clinical and radiological findings and lack of side-effects especially those of the myelon, and on the other hand are resulting in a shortening of hospitalisation.

Three years experience in the development of a dynamic quality management concept in a digitized radiotherapy department.

BACKGROUND: This article addresses general procedures for dynamic quality management and offers some practical suggestions to control an electronic radiotherapy system. The review of data takes place additionally to and completely independent of visual opportunities such as the approval of port images. MATERIAL AND METHODS: The radiotherapy procedure was split up into individual processes, all steps were analyzed with respect to their potential of being influenced by human mistakes or system malfunction. RESULTS: Relating the mistakes to the absolute number of treated fields, we can show that the percentage of fields that is related to an error was 0.22% in 1997 and could be decreased to 0.18% in 1999. For an average number of about 90-100 patients per day the time to verify the electronic data were: 6-8 h for the routine weekly control, 4 h/week to check the first treatments and manually calculated treatment fields, 6 h/week for physicists to check the 3D plans and 12 h/week for senior oncologists to check the 3D plans and data approval in the verification system. CONCLUSIONS: Meticulous monitoring and the currently available level of automation ensure that even clinically irrelevant errors and mistakes can be detected so that patients can be offered patient-oriented efficient radiotherapy in a routine hospital setting.

Endoscopic ultrasonography versus computed tomography in the differential diagnosis of perianorectal complications in Crohn's disease.

In this prospective study the performance of transrectal or transvaginal endoscopic ultrasonography (EUS) was compared with that of computed tomography (CT) in the diagnosis of perirectal fistulae, abscesses and diffuse inflammatory changes in the lower pelvis in 25 patients with Crohn's disease. Results were verified by surgery in eight patients and by correlation with findings on endoscopy, barium radiography and fistulography, and the clinical course in all other patients. EUS was superior to CT in diagnosing fistulae (14 vs 4 correct diagnoses) and inflammatory infiltration of the lower pelvic muscles (11 vs 2 correct diagnoses). The methods were equivalent in diagnosing perianorectal abscesses. CT was superior in the detection of inflammatory changes in the pararectal fasciae and fatty tissue which could not be detected by EUS. It is concluded that EUS should be used as the primary method for diagnosing perianorectal changes in patients with Crohn's disease especially in the case of fistulae and abscesses, having the added advantage of lack of radiation for the patient.