Palliative radiotherapy in recurrent head-and-neck tumors by a percutaneous superfractionated treatment schedule.

PURPOSE: A frequent problem in treatment of patients with head-and-neck tumors is recurrence in pre-irradiated areas, thus limiting dose for another full-course radiotherapy. We present our experience with a percutaneous superfractionated short-term radiotherapy regimen that may be useful for palliative irradiation. METHODS AND MATERIALS: Twenty-three patients with head-and-neck tumor recurrence after radiotherapy or extensive tumor growth have been treated by a superfractionated regimen. At each of two subsequent days, eight fractions of 1 Gy were applied with an interfraction interval of 1 h, resulting in a total dose of 16 Gy. Time between the last fraction of the first day and the first fraction of the second day was 17 h. RESULTS: In 16 of 23 patients (70%), our irradiation schedule could achieve a palliative effect such as tumor necrosis or reduction of swelling or pain. Seven patients showed erythema (WHO I) at the end of the second day. Neither mucositis nor late effects of treatment were observed. CONCLUSIONS: Our superfractionated schedule is feasible without severe acute side reactions and can achieve a palliative effect in advanced or recurrent head-and-neck cancer.

Intraoperative radiotherapy for pre-irradiated head and neck cancer.

BACKGROUND AND PURPOSE: Radiotherapy of recurrent head and neck tumours is limited in dose due to pre-treatment up to normal tissue tolerance doses. Surgery alone is limited by the problems related to pre-surgery, post-radiation fibrosis, and infiltration of tumours into nerves and vessels too closely to be completely removed. Our aim was to evaluate the possible role of intraoperative radiotherapy (IORT) in such tumours treated with palliative intent. METHODS: In the last 10 years, we performed 113 intraoperative irradiations in a total of 84 pre-irradiated patients with head and neck cancer. The patient data were evaluated with regard to palliative effect, complications of treatment, recurrence and survival after IORT. RESULTS: Palliation of symptoms, as assessed by clinical evaluation, was achieved in 88% of symptomatic patients, often just by removal of large exophytic or exulcerating tumours, with IORT preventing their immediate recurrence after surgery. The complication rate did not exceed that expected after surgery alone. The median survival after IORT was 6.8 months, with a median time to local tumour recurrence or progression of 3.7 months. CONCLUSION: Intraoperative irradiation can be used as a palliative treatment option in pre-treated head and neck tumours with satisfactory results. With large and infiltrating tumours, however, recurrences or tumour progression occur close to the IORT portals, thus rendering this method unsuitable for achieving long-term control in such extended tumours.

Mode of breast cancer detection: a study from the German part of the Maas-Rhine-EUREGIO.

Cancer screening programmes differ throughout the European Union with regard to their content as well as their acceptance by the population. In Germany, mammography is not yet part of the recommended screening programme, although its routine use is recommended by several national and international institutions. We were interested in the present methods of breast cancer detection and the correlation to tumour stage, histology and prognosis. Patients with breast cancer, presenting in our department between January 1990 and December 1994 (1,050 cases), were asked whether the suspicious finding was first detected by themselves, their physician, or in routine mammography. Seventy-two per cent of tumours were detected by patients themselves, 12% by the physician at routine cancer screening or for other reasons, and 16% were found in mammography performed without clinical suspicion of cancer. Tumours found by physicians or by mammography were treated much sooner than those first recognized by the patient and, thus, were of lower T and N stages. Surgery could more often be breast-conserving in these cases. Of the T2 stages, as far as can be determined after the short follow-up, patients with tumours detected by screening showed a better survival rate. In spite of the introduction of cancer screening programmes most breast carcinomas are still detected by patients themselves. Therapy is often started after a great delay, so that the tumours are found to be at more advanced stages and show a worse prognosis than those detected by clinical examination or mammography.

[Detection of breast carcinoma: a statistical-epidemiological study of the current situation]. / Entdeckung des Mammakarzinoms--Statistisch-epidemiologische Untersuchung zum derzeitigen Stand.

PURPOSE: Within the framework of the discussed introduction of mammography for breast cancer screening in Germany, we were interested in the actual status of breast cancer detection. PATIENTS AND METHOD: From 1990-1994, 1019 breast cancer patients with 1050 carcinomas were inquired during primary anamnesis whether the suspicious finding was first discovered by themselves, their physician at routine examination or in routine mammography. RESULTS: In 71.14% of the cases, breast changes were first recognised by the patient, in 12.48% palpated by the physician and 16.38% were first seen at routine mammography. Cancers discovered by physicians or mammography were in statistically significant lower tumour and lymph node stages than those found by the patient and could more often be treated by breast-conserving regimes. CONCLUSION: However, most breast cancers are still first discovered by the patient and are diagnosed at higher stages than those discovered by clinical examination or mammography.

[Radioprotection of human endothelial cells by sodium selenite]. / Radioprotektion humaner Endothelzellen durch Natriumselenit.

BACKGROUND: Sodium selenite is applied in tumor patients during chemo- or radiotherapy due to its cytoprotective effects. Aim of our study was to evaluate the effect of exposure with sodium selenite on proliferation of human endothelial and tumor cells after irradiation. MATERIALS AND METHODS: We studied the proliferative activity of human umbilical vein endothelial cells in comparison to tumor cells of the HeLa, MIA Paca-2 and SiHa cell line after single-dose irradiation with 2 or 10 Gy and controls without irradiation. All cells had been exposed to different concentrations of sodium selenite prior to irradiation. Evaluation was done by BrdU-ELISA. RESULTS: Exposure of human endothelial cells with sodium selenite concentrations > or = 100 micrograms/l led to an increase of BrdU proliferation index. This effect was markedly weaker in HeLa cells and not found in SiHa and MIA Paca-2. CONCLUSIONS: High concentrations of sodium selenite can counteract the decrease of proliferative activity caused by irradiation in human endothelial cells and thus exert a radioprotective effect on these cells. This effect was observed by far stronger in endothelial cells than in tumor cells, implying the possible clinical use of sodium selenite as a protective agent for normal tissue in radiotherapy.

[Bone marrow recovery after irradiation of the spine]. / Knochenmarkregeneration nach Bestrahlung der Wirbelsäule.

BACKGROUND: Imaging of bone marrow by radio labeled antibodies against NCA-95 antigen of human granulocytes offers the possibility to visualize granulopoietic activity. After radiotherapy, a reduced uptake delineates the radiation field. Aim of our investigation was the study of strength and duration of this effect. PATIENTS AND METHODS: We analyzed 80 cases of patients irradiated for different primary or metastatic malignancies including parts of the spine who received a bone marrow scan for re-staging or during follow-up. Activity uptake of vertebrae inside and outside the irradiation portal was evaluated by ROI and the ratio was taken as measure of bone marrow suppression. RESULTS: A depression of granulopoietic bone marrow activity was seen even after a few fractions of 1.8 or 2 Gy (Figure 1). Depending on time since irradiation (Figure 2), we found a bone marrow recovery. In patients without bone metastasis, regeneration could be complete, whereas in patients treated for metastases, it was incomplete in all cases (Figure 3). CONCLUSIONS: For a certain time after irradiation, radioimmunoimaging delineates the irradiation portal by showing depression of granulopoiesis. Later on, it also shows bone marrow regeneration after radiotherapy. This may be helpful in reconstruction of radiation portals or in toxicity estimation during multimodal cancer therapy.

[Combined treatment of localized prostate cancer with HDR-Iridium 192 remote brachytherapy and external beam irradiation]. / Die kombinierte Behandlung des lokal begrenzten Prostatakarzinoms mit HDR-Iridium-192-Nachlade-Brachytherapie und perkutaner Bestrahlung.

BACKGROUND: The localized prostate cancer can be treated curatively by radiation therapy. The combined treatment of external beam irradiation and HDR-Iridium 192 remote brachytherapy allows higher radiation doses within the tumor without increasing radiation sequelae. PATIENTS AND METHODS: Patients of our clinic have been treated with this combined procedure since 1991. Between 1991 and 1994 15 patients received 2 x 9 Gy of high-dose-rate brachytherapy, followed by 36 Gy external beam irradiation (group A). Because of the frequent local failures in group A, the reference dose of external beam irradiation was increased to 50.4 Gy after brachytherapy between 1994 and 1996. RESULTS: Seven of 15 patients (47%) in group A developed a local recurrence after a median of 17 (13 to 30) months. In group B (20 patients) local failure occurred in 3 patients (15%) after 11, 16 and 32 months. CONCLUSION: The combined radiation therapy of localized prostate cancer cannot substitute radical prostatectomy completely, but it is a promising alternative in the curative treatment in selected patients.

Radioprotection of human endothelial cells with amifostine.

MATERIALS AND METHODS: We studied the effect of amifostine on radiation sensitivity of human endothelial cells and several tumor cell lines (HeLa, MIA PaCa-2 and BxPC-3). The cells were incubated in medium with a concentration of 1 microgram/microliter amifostine and after 1 hour irradiated with 10 or 20 Gy single dose. Proliferation index was measured by BrdU assay after another 8 and 24 hours. RESULTS: The results show a higher proliferation rate of endothelial cells following radiation plus amifostine, compared with radiation alone. Amifostine induced an increase of proliferation in the control/non-irradiated human endothelial cells. After irradiation with 10 Gy single dose the proliferation of amifostine treated human endothelial cells was still higher. Amifostine exerts no apparent proliferative effect on the tumor cells. CONCLUSIONS: The results presented indicate that amifostine acts as an activation of proliferation of the human endothelial cells in a simple in-vitro system and indicate that amifostine supplementation prior to radiation therapy might exert a radioprotective effect to healthy tissue without spurring tumor growth.

[Radiation therapy of occult choroidal neovascularisation (CNV) in age-related macular degeneration (AMD)]. / Strahlentherapie okkulter choroidaler Neovaskularisationen (CNV) bei altersabhängiger Makuladegeneration (AMD).

BACKGROUND: Occult choroidal neovascularisation secondary to age-related macular degeneration cause severe visual loss due to exsudation, hemorrhage and fibrovascular scarring. So far, no efficient treatment of this condition could be established. Recently, some publications described an improved prognosis after low-dose radiation therapy of the neovascular membranes. PATIENTS AND METHODS: Patients with occult choroidal neovascularisation as defined by the Macular Photocoagulation Study were inclosed in our study. Irradiation with Photons (10 to 12 MeV) in fractions of 5 x 2 Gy were administered. At three-month follow-up intervals visual acuity a complete ophthalmological examination including visual acuity, fluorescein- and ICG-angiography as well as fundus photography was performed. RESULTS: In our study 64 patients (74 +/- 7 years) with occult CNV secondary to AMD were included. Follow-up was between 3 and 39 months (14.5 +/- 10). Compared to studies who investigated the natural history of this disease, the visual acuity measured in our study did not differ significantly from the natural course. CONCLUSIONS: Our results do not support the general use of radiation therapy in patients with occult choroidal neovascularisation secondary to AMD. However, the controlled multicenter studies might provide a better basis for a general recommendations.