[Preoperative irradiation and interstitial radiotherapy-hyperthermia boost in breast tumors > or = 3 cm. The Düsseldorf experience]. / Präoperative Bestrahlung mit interstitiellem Radio-hyperthermie-Boost bei Mammatumoren > or = 3 cm. Düsseldorfer Ergebnisse.

AIM: The aim of this protocol was to investigate breast conservation rates with and without flap-supported surgery after preoperative chemotherapy, radiotherapy and hyperthermia. PATIENTS AND METHODS: One hundred and fifty-eight patients with stage IIA-IV breast cancers were initially treated with chemotherapy, radiotherapy and hyperthermia. Radiation treatment consisted of an interstitial boost of 10 Gy 192Ir-afterloading therapy and a course of external beam radiotherapy of 50 Gy, using 5 x 2 Gy/week. Local hyperthermia with 43.5-44.5 degrees C over 60 minutes was delivered immediately before interstitial radiotherapy. RESULTS: One hundred and forty-two patients underwent salvage surgery. A breast-conserving approach was possible in 74 patients (52%). Fifty-three patients (37%) underwent flap-supported surgery. After a median follow-up of 20 months, one patient developed isolated local recurrence. In 14 cases, locoregional recurrences occurred in combination with distant metastases. CONCLUSION: In about 50%, breast conservation was achieved by chemotherapy, radiotherapy and hyperthermia. The low isolated local recurrence rate of 0.6% (1/158) has to be substantiated by further follow-up.

[An absent correlation between antioxidant blood concentrations and the remission response of preoperatively treated breast carcinomas]. / Fehlende Korrelation zwischen Antioxidanzienkonzentrationen im Blut und Remissionsverhalten präoperativ behandelter Mammakarzinome.

PURPOSE: Deleterious effects of ionizing radiation and some chemotherapeutic agents are predominantly caused by reactive oxygen agents which are detoxified by antioxidants. This study was designed to evaluate the modifying effects of vitamin A-, vitamin E- and selenium serum concentrations and glutathione peroxidase activity on preoperative radio- and chemotherapy of breast cancer. PATIENTS AND METHODS: Tumor volume, vitamin A-, vitamin E-, selenium serum concentrations and glutathione peroxidase activity in circulating erythrocytes were determined in 40 patients with breast cancer before treatment. Interstitial radiohyperthermia was given initially using a single dose of 10 Gy (HDR) combined with hyperthermia between 43.5 to 44.5 degrees C over 60 minutes followed by external beam radiotherapy with 50 Gy in 5 weeks. All patients received anthracyline or anthrachinone containing chemotherapy. Tumor response was determined by histopathological examination. Patients with complete and incomplete remissions were compared using the Wilcoxon test. Pre- and posttreatment tumor-volume differences were correlated with antioxidant concentrations (Spearman correlation coefficient). RESULTS: Twenty patients (50%) achieved a complete histopathologic tumor regression. This high complete remission rate was not related to the antioxidants under investigation (vitamin A: p = 0.32, vitamin E: p = 0.44, selenium: p = 0.68, glutathione peroxidase: p = 0.3). There was no correlation to pre- and posttreatment tumor-volume-differences either (vitamin A: p = 0.89, vitamin E: p = 0.67, selenium: p = 0.41, glutathione peroxidase: p = 0.87). CONCLUSIONS: In this study serum concentrations of antioxidants had no modifying influence on tumor response in breast cancer patients following induction radio-chemotherapy and subsequent surgery. Further studies measuring tissue levels could clarify if there is any modifying influence of antioxidants on tumor remission.

Intraarterial 5-FU-infusion and simultaneous radiotherapy as palliative treatment of recurrent rectal cancer.

Palliative treatment of recurrent rectal cancer remains to be a challenge. From 1989 to 1991 13 patients with recurrent rectal cancer were treated with intraarterial infusion of 5-Fluorouracil and simultaneous radiotherapy in a palliative intent. Seven patients had received postoperative adjuvant radiotherapy with 56 to 60 Gy. Three patients had been treated with systemic chemotherapy. Radiotherapy of the recurrence was performed with 19.8 to 30.6 Gy in the pre-irradiated patients and with 50.4 to 59.4 Gy in the others. One complete remission, three partial remissions and nine minor responses were observed. Three patients had complete pain relief after the treatment, in the remaining patients major pain reduction was achieved. Palliation lasted from three to twelve months (median: five months). Our results indicate that locoregional chemo- and radiotherapy are a effective modality in recurrent rectal cancer.