[The reaction of the heart to radiation. I. State of the knowledge based on animal experimental studies]. / Die Strahlenreaktion des Herzens. I. Erkenntnisstand aus tierexperimentellen Untersuchungen.

The aim of curative tumor therapy is healing without complications. Therefore the avoidance of undesirable side-effects in healthy tissue becomes more important to such a degree as the lifespan can be prolonged by therapy: In this review the experiences to cardiac reactions by ionizing radiations are represented from experiments on animals. The former conception of a marked radioresistance of the heart has to be revised to the hitherto presented investigations. Acute inflammatory reactions and late, often progressive alterations can develop in the heart like in other normal tissue. These late-effects especially are reflected at pericardium, myocardium and vessel system (microvessel system and coronaries) and not rarely cause functional injuries of the tissue. Actual investigations give special attention to pathogenesis of acute radioreaction. It is supposed that their explanation gives a better understanding for the process of independence and progress and with that a possibility for prophylactic or therapeutic measures.

[The reaction of the heart to radiation. II. Clinical studies]. / Die Strahlenreaktion des Herzens. II. Klinische Studien.

In a review the cardiac attendant reactions in tumor irradiation in thoracal area are represented by means of papers and experiences of our own. It is shown that the heart reacts differently on ionizing rays and in special cases it can become a critical organ for radiotherapy. The diagnostic practice and the phenomenon of pericardiac and myocardiac reactions are described in detail. Complications on coronary vessel system are not frequent but because of their clinical consequence always they have to take into consideration. Cardiac radioreactions can be transient or harmless but rarely can lead to vitally threatening situations. Therefore it is referred to symptoms, diagnostic proving and possible or necessary therapeutic measures. Because significant curative therapeutic results can be attained by radiotherapy in thoracal area and the chances for curing increase for many patients, a slight risk is justifiable for side-effects on healthy adjoining tissue. On the other hand undesirable side reactions can influence the life-quality of the tumor cured patients. Therefore a radiotherapy in intrathoracal tumors with the aim of healing without complications has to take into consideration the sensibility of heart in addition to those of lung and spinal marrow. Beside permanent development of physical-technical suppositions these biological aspects have a substantial influence on optimizing irradiation in thoracal area. Finally it is tried to formulate really existing possibilities reducing a risk for cardiac side-effects and to refer to prospective interesting problems.

[Radiation pneumonitis in the x-ray picture following megavoltage irradiation using the Neptune 10 p. linear accelerator]. / Die Strahlenpneumonitis im Röntgenbild nach Megavoltbestrahlung mit dem Linearbeschleunigter Neptun 10 p.

For 105 patients with healthy lungs (76 breast carcinomas, 29 testicular tumors) irradiated from 1981 to 1983 with the linear accelerator Neptune 10p. the pulmonary effects of irradiation were monitored over several years. The true dose applied for breast carcinomas was 46 Gy (2 Gy per fraction), for testicular tumors 40 Gy were applied in the mediastinal field. 9% of the patients showed excessive infiltrations, 18% radiation pneumonitis of medium degree. In 35% of the patients slight infiltrations were found. The course of the pneumonitis was, according to its stage, regular. After a latency period 30 days post irradiation the early stadium occurs. Florid pneumonitis develops between the 45th and 90th day after irradiation. Extended radiographic effects occur up to 10 days earlier. Through a period of pneumonitis with pronounced shrinkage fibrosis develops. By CT-based individual radiation planning the pulmonary radiation reaction can be significantly reduced. The differential diagnostics of radiation effects and metastases is discussed.

Remission of the newly diagnosed type 1 diabetes by radiation of the pancreas.

The process of autoaggression of the IDDM causes an "insulitis" leading to the destruction of the beta-cells. By photons (9 MV) in a total dose of 10 Gy, divided into 5 single doses at an interval of 2 days in each case we could get a total remission in 3 out of 4 diabetics, a partly remission in the fourth patient. The therapeutic effect lasts till now (1-6 months) without any further treatment. The combination of a radiation of 5 x 1 Gy with 1 mg methylprednisolon/kg body weight at the beginning of the treatment leads to a partly remission in 5 out of 7 patients lasting 3-7 months hitherto. Beside the antiinflammatory effect of the radiation on the "insulitis" an effect on the activated lymphocytes can be supposed. Side effects were not observed. They need not to be expected in a local therapy in a relatively small field size with a low radiation dose. Further research is necessary to confirm the results.

Advances in hypoxyradiotherapy.

Observations in animal experiments and in Phase I clinical trials on the effect of breathing 8-10% oxygen are summarized. The animal tests indicated that the hypoxia induced in this way for periods varying between 10-45 minutes had a radioprotective effect on normal tissues. Patients tolerated the hypoxic treatment given for 15 minutes without any acute or late complications. Phase II trials have been started to test the effect of hypoxic radiotherapy in administering a larger total tumor dose than in conventional radiotherapy.

[Place of triple diagnosis in the differential diagnosis of benign and malignant breast cancers (studies of 1819 women)]. / Stellenwert der Tripeldiagnostik bei der Differentialdiagnose gut- und bösartiger Mamma-Erkrankungen (Untersuchungen an 1819 Frauen).

In 1819 female patients, the diagnostic value of clinical examination, mammography, and fine needle biopsy separately as well as in combination (so-called triple diagnosis) has been investigated. Comparing the histological findings with each of the several examination procedures, the triple diagnosis proved to have a high diagnostic validity (sensitivity 0.98; specificity 0.99). If the result of all three findings is "benign" and the diameter of the tumour does not exceed 20 mm, the diagnostic extirpation of a mammary tumour will usually not be necessary. On the other hand, if the findings unanimously read "malignant" it is to be discussed whether a primary mammary amputation should be carried out. The examinations of the triple diagnosis can be made during a consultation and the risk is insignificant. They will only affect the patients very little and will leave no scars if repeated.

Clinical data for radiation embryology. Investigation programme 1967, report 1984.

In 1967 a prospective clinical study was started with the aim of providing optimum counselling for married couples who desire continuation of a pregnancy despite radiation exposure at an early stage as a result of X-ray diagnostics. Recommendations were devised as to whether an interruption of pregnancy should be applied for or not. These results were discussed repeatedly. Within the framework of the prospective study, embryological examinations were made in cases of interruption of pregnancy, and clinical and genetic examinations in cases of children who had been subject to radiation stress in utero. Up to July 1st 1984 nearly 200 cases of consultations have been or are being surveyed. The children were subjected to selected longterm examinations of up to 13 years. The results of cytogenetic, biochemical-genetic, clinical, and other examinations are considered and special characteristics of interesting cases are discussed. The conclusion was drawn that the recommendation to our patients to continue pregnancy in cases of exposure to radiation in utero below 0.1 Sv, was right. Furthermore the question arose of whether this dose limit could be increased. The study will be continued.