[The inhalation versus systemic prevention of pneumonitis during thoracic irradiation]. / Inhalative versus systemische Pneumonitisprophylaxe bei Thoraxbestrahlungen.

BACKGROUND: Pneumonitis is a typical subacute reaction of healthy bronchial tissue to thoracic irradiation. The purpose of the present trial was to show whether prophylactic application of steroids in the course of and following radiotherapy would reduce the incidence of pneumonitis. PATIENTS AND METHODS: Fifty-seven patients receiving thoracic irradiation for bronchial carcinoma were assigned to 2 therapeutic groups; half of the patients were given 10 mg of oral prednisolone per day, while the other half received daily inhalative beclomethasone. All patients were evaluated for radiographic signs of pneumonitis. Thirty-two patients received additional investigations for pulmonary diffusion capacity of carbon monoxide. RESULTS: The overall incidence of pneumonitis was 17.6% (10/57 patients). Neither total radiation dose nor mode of fractionation did significantly contribute to the incidence of pneumonitis. Those patients showing a pulmonary diffusion capacity for carbon monoxide of less than 60% prior to radiotherapy had a significantly higher risk of developing pneumonitis (4/7) than patients with a higher diffusion capacity (3/25, p = 0.026). In follow-up period we did not see significant changes in diffusion capacity neither with patients who developed pneumonitis nor with those patients showing no evidence of pulmonary injury. Comparing the chest X-ray there were less radiographic changes consistent with pneumonitis in the inhalative beclomethasone (2/28) than in the oral prednisolone group (8/29, p = 0.045). DISCUSSION: In order to reduce the incidence of pneumonitis in patients receiving thoracic irradiation we support a continuous application of steroids in the course of and following radiotherapy. The inhalative use of beclomethasone has proved to be superior to oral prednisolone due to better local efficacy and decreased unwanted side effects.

[The vaginal stump recurrence rate in endometrial carcinoma in relation to the target volume of postoperative HDR-afterloading brachytherapy]. / Die Vaginalstumpf-Rezidivrate beim Endometriumkarzinom in Abhängigkeit des Zielvolumens der postoperativen HDR-Afterloading-Brachytherapie.

BACKGROUND: Basis for adjuvant strategies for patients with endometrial carcinoma is a postoperative staging including criteria such as myometrial tumor infiltration and histological grading. Such adjuvant strategies include afterloading therapy of the vagina as a long-established therapeutic concept. Our aim was to investigate the influence of the target volume on treatment results (i.e. local tumor control, side effects) in these patients. PATIENTS AND METHOD: At Jena University, Department of Radiotherapy, from 1981 to 1990 108 patients with endometrial carcinoma were postoperatively treated with high dose radiation brachytherapy of the vagina without additional percutaneous radiotherapy. Histology showed more or less differentiated adenocarcinoma in 90% of all patients, all patients were postoperatively stage I or II without proven lymphatic metastases. Dependent on individual figures patients were distributed to 3 different groups: group A: 4 x 10 Gy, tissue-thickness of 1 cm (vaginal apex) respectively 0.5 cm (lower vaginal walls); group B: 4 x 10 Gy, tissue thickness of 1 cm (upper vaginal wall); group C: 4 x 10 Gy, tissue-thickness of 0.5 cm (both excluding the lower vaginal walls). RESULTS: Both 3-year survival rates (group A: 96.6%, group B: 96.9%, group C: 97.7%) and tumor relapse rates of the vaginal apex (group A: 0, group B: 3.1%, group C: 2.2%) don't show significant differences. No case of local tumor recurrence was seen in the upper 2/3 of the vagina and the pelvic walls. Late side effects concerning bladder and rectum (grade III to IV, EORTC/RTOG) could be minimized by reducing the treatment volume (group A: 6.8%/12.6%, group B: 6.2%/3.1%, group C: 2.2%/0). CONCLUSIONS: Our results show the value of postoperative afterloading brachytherapy in patients with endometrial carcinoma, the brachytherapy of the upper vaginal wall is a sufficient therapeutic concept. Radiotherapy of the lower vaginal walls does not contribute to better tumor control, while it does significantly increase the number of unwanted side-effects in our investigation.

[Shielded vaginal applicators for line-shaped 192Ir sources for use in the irradiation of cervix cancer]. / Abgeschirmte Vaginalapplikatoren für "linienförmige" 192Ir-Quellen zur Bestrahlung des Zervixkarzinoms.

The possibility is investigated to use shielded vaginal applicators for "line-shaped" 192Ir-sources to irradiate cervical carcinoma. Using segment-shaped absorbers of heavy metal the dose can be reduced in ventro-dorsal direction in area of rectum and bladder with irradiation of cervical carcinoma up to a factor of 2 in dependence of rectum and bladder position. Selecting a suitable source position and source standing time a dose reduction can be realized in cranial direction up to two centimetres from the portio.

[Possibilities of isodose distribution in afterloading contact therapy of non-operated uterine cancer using an applicator tube and a point-shaped radiation source]. / Möglichkeiten der Isodosengestaltung bei der Afterloading-Kontakttherapie von nichtoperierten Uteruskarzinomen mit einem Applikatorrohr und "punktförmiger" Strahlenquelle.

For the contact radiotherapy according to the afterloading-procedure of patients with cervical and endometrial carcinomas isodose plans are represented, that are standardized to the lengths of uterus probes and adapted to tumor stages and are determined by an applicator tube lying centrally within the uterine cavity. By an additional lead screening of the vaginal applicator a dose reduction can be attained by the factor 1.6 or 1.4 in the critical organs bladder and rectum, which are relevant for this therapeutic form. An uncritical inclusion of the vagina into the target volume of contact therapy, that is not justified by tumor invasion, should not be carried out, knowing the higher complication rate at the critical organs.

[Results of therapy of endometrial carcinoma and analysis of risk factors in comparison with a control group]. / Therapieergebnisse beim Endometriumkarzinom und Risikofaktorenanalyse im Vergleich mit einer Kontrollgruppe.

Overall 1,021 patients with endometrial carcinoma were treated between 1965 and 1982 at the Department of Obstetrics and Gynecology and the Department of Radiology, Friedrich-Schiller-University, Jena. The 5-year-survival rate of all patients amounted to 63%. The 5-year-survival probability with primary surgery was 76.1%, with primary irradiation 34.4%. The frequency of risk factors in the patient group was compared with an age adjusted group of patients who underwent a D & C due to irregular bleeding of benign causes. Overweight and infertility were evaluated as significantly more frequent risk factors in cancer patients. There was no significant difference between the two groups concerning the factors hypertension, diabetes, heart-diseases, irregular bleeding and history of carcinoma in the family.

[Dosimetric studies of 192Ir line sources and the mathematical presentation of the dose distribution]. / Dosimetrische Untersuchungen der "linienförmigen" 192Ir-Quelle und die mathematische Darstellung der Dosisverteilung.

The dose distribution of a "line-shaped" 192Ir-source was measured in 1,152 measuring points in a water phantom. Using regression analysis the analytical description of dose distribution was obtained. Accomplished comparison measurings with a solid phantom of miramide in 45 measuring points show that the dose distribution can be reproduced well by solid phantom measurings. Taking an ideal line source distribution as a basis, the r-dependence of correction factor, obtained by regression analysis, refers to a dispersion effect. The angle-dependent deviation of dose distribution from the ideal line source can be described by cos-terms with the single and double angle between line source axis and measuring point.

[A comparison between the dose distribution from 192Ir point and line sources in the afterloading therapy of gynecologic neoplasms]. / Vergleich der Dosisverteilung zwischen "punkförmigen" "linienförmigen" 192Ir-Quellen in der Afterloadingtherapie gynäkologischer Tumoren.

For different fields of application in irradiation of gynecological tumors a comparison of isodose distribution is done with "point-shaped" and "line-shaped" 192Ir-source. With the oblateness of dose efficiency distribution towards the axis of source with the "line-shaped" 192Ir-source an improvement of dose distribution occurs in intracavitary irradiation with the lower and more balanced exposure of fundus uteri, especially in irradiation of the endometrial carcinoma. On the other hand the irradiation of vaginal stump renders problematic. In pure vaginal irradiation no differences are found in medically interesting range.

[A prospective randomized study on the fractionation of afterloading therapy of cancer of the cervix and endometrium]. / Prospektive randomisierte Studie zur Fraktionierung der Afterloading-Therapie von Zervix- und Endometriumkarzinomen.

A prospective randomized clinical study is made on patients with uterine cervix and endometrium carcinomas treated only by radiotherapy. The fractionation schemes of 4 times 10 Gy, and 5 times 8 Gy, and 8 times 5 Gy at the reference points A and My, respectively, of a short-term afterloading therapy combined with percutaneous telecobalt therapy with 45 Gy at the pelvic wall are investigated. A tendency is shown towards better tumor control and less radiogenic effects with an increased number of fractions. The results are discussed on the basis of the NSD and LQ models. The problems caused by the equipment type and dosage specificity hampering the applicability of the results on other afterloading therapy units are pointed out.

[Dose-time optimization in fractionated radiotherapy]. / Zur Dosis-Zeit-Optimierung in der fraktionierten Strahlentherapie.

On the basis of an evaluation of different isoeffect correlations for normal tissue reactions supported by a clinical study, a number of correlations for the dose-time optimization of irradiations with equal fractionation intervals are derived from a simple approach for the survival rate of irradiated tumor cells based on a linear quadratic dose-effect function for an exponential cell proliferation. This allows to determine optimum single doses for every given fractionation interval which, applied with the number of fractions tolerated by normal tissue, lead to a maximum reduction of tumor cells. The values of these optimum fractionation parameters depend from cell proliferation and radiosensitivity of the tumoral tissue and vary with respect to a normal tissue tolerance for early and late reactions. The results are described for several fractionation examples. It is shown that, within the tolerance limits of normal tissue, a greater tumor remission is achieved by hyper-fractionated irradiation than by a small number of high-dose irradiations.

[Results of percutaneous radiotherapy of bladder cancer using 1 and 2 series of irradiation]. / Ergebnisse der perkutanen Strahlentherapie bei Harnblasenkarzinomen mit Einserien- und Zweiserienbestrahlung.

In a randomized prospective clinical study, the authors investigate the results of percutaneous radiotherapy (telecobalt) with two rhythms of fractionation in patients with vesical carcinomas. A one-series irradiation with 1.5 Gy daily (except the weekends) up to a total dose of 60 Gy is compared to a two-series irradiation (in the first series 3 Gy three days per week up to 30 Gy, then irradiation-free interval of four weeks, in the second series 1.5 Gy daily up to a total focal dose of 60 Gy). The five-year survival rates are 52% after one-series irradiation and 39% after two-series irradiation. The surgical treatment consisted in a most radical resection of the vesical tumor by TUTUR, partial resection of the wall, of transvesical tumor resection.

[Results of radiotherapeutic optimization within the scope of combined operative-radiologic therapy of urinary bladder cancer]. / Ergebnisse strahlentherapeutischer Optimierung im Rahmen der kombinierten operativ-radiologischen Therapie des Harnblasenkarzinoms.

The results of a prospective randomized clinical study for the comparison of a uniserial irradiation with a biserial irradiation are demonstrated. The investigations were performed on altogether 191 patients. Patients after cystectomy and supravesical by-pass of the urine were excluded. The operative treatment consisted of TUTUR, transvesical tumour resection or partial resection of the urinary bladder. According to the life table method the uniserial irradiation a survival rate of 52% and for the biserial irradiation of 39% after 54 months was calculated.

[Clinical aspects and results of therapy of endometrial cancer at the Department of Medicine of the Friedrich Schiller University in Jena 1964-76. II: Results of primary radiotherapy]. / Klinik und Therapieergebnisse beim Endometriumkarzinom am Bereich Medizin der Friedrich-Schiller-Universität Jena in den Jahren 1964-1976. II. Mitteilung: Ergebnisse der primären Strahlentherapie.

In this paper results of irradiation only at 235 patients are reported and discussed, different treatment methods are applicated. The 5-year-survival rate of all cases amounted 35.7 per cent, the rate of complications 6.2 per cent. Measures of improvement of therapeutic results are investigated.

[Clinical aspects and results of therapy in endometrial cancer at the Department of Medicine of the Friedrich Schiller University in Jena 1964-76. I: Evaluation of primarily surgically treated endometrium cancer]. / Klinik und Therapieergebnisse beim Endometriumkarzinom am Bereich Medizin der Friedrich-Schiller-Universität Jena in den Jahren 1964-1976. I. Mitteilung: Wertung der primär operativ behandelten Endometriumkarzinome.

In this paper therapeutic results are reported obtained from 444 patients with endometrial cancer which were operated on. In 260 patients the primary operation was completed by a different radiation therapy. The 5-years-survival rates are 75,9% Surgical and radiological therapeutic measures are demonstrated with regard to their development and to side effects.

[Therapy and treatment results of cervical cancer in the Medical School of the Friedrich Schiller University of Jena from 1965 to 1976 (report on 1453 cases)]. / Therapie und Behandlungsergebnisse beim Zervixkarzinom am Bereich Medizin der Friedrich-Schiller-Universität Jena in den Jahren 1965 bis 1976 (Bericht über 1453 Fälle).

In this paper, therapeutic results of 1,453 cervical cancer patients stage T1-T4 who have been treated at the Gynaecological Hospital and the Radiological Hospital of Jena University are reported. The overall Five-Year Survival Rate amounted to 68.4 per cent. Surgical and radiological therapeutic measures are demonstrated with regard to their development and to side effects between 1965 and 1983. As a consequence of the results obtained the necessity for treating cervical cancer patients in a cancer center has to be stressed.

[Results of treatment of cervical malignancies at the Medical Department of the Friedrich Schiller University in Jena 1965-1976. III. Comparison of results of telecobalt postoperative radiotherapy with conventional roentgen irradiation]. / Ergebnisse der Behandlung des Zervixmalignoms am Bereich Medizin der Friedrich-Schiller-Universität Jena in den Jahren 1965-1976. III. Mitteilung: Vergleich der Ergebnisse der postoperativen Strahlentherapie mit Telekobalt und konventioneller Röntgenstrahlung.

Results and secondary effects of postoperative radiation therapy by telecobalt and conventional x-rays at 589 female patients with malignoma of the cervix are discussed. Advantages and disadvantages of both methods are analysed critically. The 5-years-survival rates are 78,6% respectively 87,0%.