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.

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.

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.

Short-time splenic irradiation for splenomegaly.

BACKGROUND: Splenic irradiation is routinely used in the supportive treatment of lymphoepithelial and hemopoietic diseases associated with splenomegaly. A new short-time irradiation schedule with conventional dosage (Group A: 2 Gy/fract.) was compared retrospectively with low-dose prolonged treatment schedules (Group B: < or = 1 Gy/fract.) to establish its tolerance and its efficacy in terms of relieving splenomegaly-associated symptoms. PATIENTS AND METHOD: Between 12/1996 and 3/2002 49 patients (6 with CLL, 14 with CML, 6 with NHL, 16 with MPD, 6 with OMF and 1 with AML) underwent 85 treatment courses (13 courses low-dose prolonged treatment and 72 courses short-time treatment).The spleens had been exposed to pretreatment doses of 3-70 Gy (mean 20.75 Gy). Splenic size was 12-35 cm (mean 22.76 cm). One treatment was done with 60Co. 9-20 MeV electron beams were used in 23 treatments and 6 MV photons in 61 treatments. Blood counts were monitored daily. Clinical improvement (pain relief, improvement of splenomegaly-associated symptoms), spleen volume reduction and effects on blood counts were evaluated and documented at the end of the treatment. RESULTS: Of the 85 treated patients, 55 (Group A: 47/72, Group B: 8/13) showed a > 10% reduction of spleen volume and 62 (Group A: 57/72, Group B: 5/13) clinical improvement. 15 of 49 patients underwent multiple irradiation (2-8 courses) without clinical or hematologic complications. The intervals between the courses were 2-19 months. Rapid response in terms of reduction in splenic size in 23 patients permitted field reduction during treatment. Significant hematologic abnormalities were absent throughout. CONCLUSION: The short-time treatment schedule ensured a rapid response with relief of pain and improvement of gastrointestinal and pulmonary symptoms at an overall treatment time shorter than that of low-dose prolonged treatment schedules. No differences in terms of hematologic abnormalities were found between single doses of 2 Gy and < or = 1 Gy.

[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.

Improvement of skin care during radiotherapy.

BACKGROUND: State-of-the-art radiotherapy, new insights into pharmacology and novel operating techniques require patient-oriented adaptation of care. PATIENTS AND METHOD: At the Radio-oncology Department of the Kaiser Franz Josef Spital, Vienna, a new skin care concept for patients undergoing radiotherapy was introduced in March 1999. This concept has subsequently been applied in all cases regardless of the diagnosis prompting referral (79 ENT, 305 breast, 134 prostate, 89 colorectal cancer and 751 other patients). Radiotherapy consisted of photon and/or electron radiation on the linear accelerator. The energy ranges were between 6 and 15 MV for photon therapy and between 6 and 12 MeV for electron radiation. Patients received an average total radiation dose of 50-66 Gy at single fractional doses of 1.8-2 Gy 5 times a week. Powdering of the skin was replaced by a moist skin care program. Patients were allowed to take cool whole-body showers without soap, including the irradiated skin areas, 3 times a week. RESULTS: With the new skin care program dryness of the skin and resultant allergic skin reactions became less common. Broken skin an epitheliolysis were clearly reduced and superinfections were prevented. CONCLUSION: Moist care of irradiated skin areas during radiotherapy thus improved radiation tolerance and patient acceptance.

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.

Treatment of unresectable, locally advanced pancreatic adenocarcinoma with combined radiochemotherapy with 5-fluorouracil, leucovorin and cisplatin.

The aim of the study was to evaluate the effectiveness and safety of a combined treatment modality including systemic chemotherapy with 5-fluorouracil (FU), leucovorin, cisplatin and external beam radiotherapy in patients with locally advanced pancreatic cancer. Systemic chemotherapy consisted of FU 400 mg m(-2) and leucovorin 20 mg m(-2) both given as intravenous bolus injection on days 1-4, plus cisplatin 20 mg m(-2) administered as 90-min infusion on days 1-4. Treatment courses were repeated every 4 weeks x 6 unless prior evidence of progressive disease. Radiation therapy using megavolt irradiation of > or = 6 MV photons with a 3- or 4-field technique was delivered during the second and third chemotherapy course, that was reduced in dose by 25%. Between October 1994 and July 1996, a total of 38 patients were entered onto this trial, all of whom were assessable for toxicity and survival. Eighteen of these (47%) had objective remissions to combined radiochemotherapy, including four CR (11%), 13 (34%) had stable disease and seven patients (18%) showed tumour progression during treatment. The median progression-free interval of the entire study population was 10 months (range 3-32), and median overall survival was 14.0 months (range 3-45+ months); 53% of all patients were alive at 12 months, and 18% of patients were alive at 24 months respectively. Severe haematological side-effects comprised neutropenia in 18%, thrombocytopenia in 8% and anaemia in 11%. The most frequent non-haematological side-effects were nausea/vomiting (WHO grade 3: 18%), and diarrhoea (grade 3: 13%). This combined radiochemotherapy regimen was tolerable and effective in patients with locally advanced pancreatic cancer. Since therapeutic results, in fact, compare favourably with other series, including surgical treatment of potentially resectable tumours, further evaluation of combined treatment modalities in the neoadjuvant setting seems warranted.

[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.

Effective radiochemotherapy with cisplatin and etoposide for the management of patients with locally inoperable and metastatic esophageal carcinoma.

BACKGROUND: The limited therapeutic value of available chemotherapeutic drug combinations in patients with advanced esophageal carcinoma, the documented synergistic activity of etoposide and cisplatin, which might be further enhanced by simultaneous radiotherapy, and promising though only preliminary therapeutic results with this combination regimen have stimulated the present Phase II trial. The specific aim of the study was to determine the efficacy and tolerance of this combined treatment approach in previously untreated patients with either local regional unresectable or metastatic esophageal carcinoma. METHODS: Thirty patients with Stage IIIB or IV squamous cell or adenocarcinoma of the esophagus were entered in this study between October 1992 and November 1994. Chemotherapy was comprised of cisplatin, 30 mg/m2, combined with etoposide, 120 mg/m2, both given intravenously on 4 consecutive days. Treatment courses were repeated every 4 weeks. Radiation therapy (total dose, 5000 centigray) was administered concurrently during the 2nd and 3rd chemotherapy course, during which both drugs were given with a 25% dose reduction. RESULTS: After a median of 4 chemotherapeutic treatment courses (range, 1 to 6 courses), 3 patients had a complete response for 5, 8, and 11.5 months, and 9 patients had a partial response lasting for a median duration of 5.3 months (range, 2.5 to 7.5 months), yielding an overall response rate of 40% (95% confidence interval, 23-59%). The response rates tended to be higher for squamous cell carcinomas (11 of 23; 48%) than for adenocarcinomas (1 of 7), as well as for locoregional disease (7 of 13; 54%) than for patients with disseminated disease (5 of 17; 29%). For the entire study population, median time to progression was 5.4 months (range, 1.5 to 13.5 months), and median survival was 9.2 months (range, 1.5 to 28 months), with 4 patients still alive at the time of this report. Clinically, the most important toxic effect was myelosuppression. Grade 3-4 granulocytopenia occurred in 16 patients (53%), severe thrombocytopenia in 11 (37%), and Grade 3 anemia in 5 (17%). There were four hospitalizations among three patients for the management of fever during neutropenia. Other nonhematologic side effects were generally mild or modest, and most commonly included nausea/emesis (40%), mucositis and/or esophagitis during simultaneous radiotherapy (40%), and alopecia (43%). CONCLUSIONS: Combined radiochemotherapy with cisplatin and etoposide is active against advanced esophageal carcinoma, but can be associated with significant hematotoxicity. Although the therapeutic potential of this regimen appears to be comparable to other, conventional fluorouracil/cisplatin-based chemotherapy, less toxic and more effective regimens need to be identified.

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.

[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.

Endosonographic features of the lower pelvic region in Crohn's disease.

Anorectal complications in long-term Crohn's disease are frequent and evaluation of inflammatory changes in the lower pelvic region is difficult. Abnormalities are fistulas and abscesses which can be demonstrated rapidly and easily by endosonographic measures. Further topographical localization of the abnormalities is possible. Over a period of 2 yr, 55 patients with anorectal complications were examined. Using endosonography, 46 fistulas were found in 36 patients. Forty patients presented inflammatory changes. Abscesses were demonstrated in four cases. Our findings were verified by surgery, fistulography, and correlation with clinical course of illness. Limiting factor of the examination procedure proved to be painful and strictures in male patients, whereas in female patients the alternative of performing the examination via vagina was given. Our results demonstrate that endosonography is an excellent screening method for detecting and evaluating fistulas and abscesses in Crohn patients. Omitting radiation exposure is a further advantage of endosonography.

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.

[Transrectal sonographic (TRUS) prostatic volumetry in assessing tumor response to radiation]. / Transrektal sonographische (TRUS-) Prostatavolumetrie zur Beurteilung des Tumoransprechens auf Radiatio.

The aim of this study was to document the grading-related response of carcinoma of the prostate to radiotherapy, especially in views of the fact that the PSA values of hormonal therapy are not evaluable if hormonal therapy is done prior to radiotherapy or in patients with high likelihood of metastatic spread. Controls were done on 55 patients before, during and after primary external radiotherapy of carcinoma of the prostate with volumetric analysis of transrectal ultrasound (TRUS) of the prostate. There were significant differences between G1 and G2 tumors on the one hand and G3 tumors on the other hand. The latter had a much larger volume to start with and their volume reduced more rapidly after therapy.

[The prevention of mucosal lesions during oropharyngeal irradiation with a dental-filling shield]. / Prävention lokaler Schleimhautläsionen während Oropharynx-Bestrahlung durch einen Plombenschutz.

In patients with metallic dental fillings radiation therapy to the oral cavity can cause mucous membrane lesions, which are more severe than expected. They appear as circumscribed erosions, opposite to metallic fillings and are caused by an increase in radiation dose through secondary radiation due to the higher density and atomic number of the filling material. This dose increase can be directly measured with 0.1 mm thin sheets of graphite-loaded TLD's (LiF, Vinten). For Co-60 gamma rays a commercial amalgam filling caused a dose increase by a factor of 1.7. The half value layer for this additional radiation was measured to be approximately 0.4 mm tissue. In order to avoid painful mucous membrane ulcerations which are even more a problem if hyperfractionated treatment schedules are used, we constructed individual dental shields for each patient. As shielding material we used a dental impression material (Optosil P+1 Bayer). This method was tested in 35 patients, in all of them circumscribed mucous membrane ulcerations could be avoided. The method proved to be fast and simple and was very well tolerated by all patients.

[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.