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Evaluation of remission rates after neoadjuvant chemotherapy alone or followed by preoperative radiotherapy.194 women with 198 biopsy-proven breast tumors were evaluated in this retrospective study. Of the 198 cases evaluated, 64 received neoadjuvant chemotherapy followed by surgery and adjuvant irradiation (CT group). In 134 cases, sequential preoperative chemo-/radiotherapy (CT-RT group) was given. In both groups, endocrine treatment was initiated in case of positive hormone receptor status after chemotherapy. The whole breast was homogeneously irradiated using 2-Gy fractions up to a total dose of 50 Gy, followed by a boost of 6-11 Gy to the tumor.A histologically proven complete remission (pCR) was achieved in 3% (2/64) in the CT and in 42% (56/134) in the CTRT group. The logistic regression analysis, including clinical tumor category (cT), lymph node (cN) and metastasis status (cM), grading (G), hormone receptor status (HRS), number of preoperative chemotherapy cycles, preoperative tumor volume, and preoperative radiotherapy, revealed that HRS (p = 0.0232) and radiotherapy (p0.0001) were significant factors for achieving pCR.Combination of neoadjuvant chemo-/radiotherapy results in significantly higher rates of complete remission than neoadjuvant chemotherapy alone. The significance for tumor-free and overall survival has to be evaluated.

Our objective was to investigate the effectiveness of hyperbaric oxygenation (HBO) in the treatment of radiation proctitis. The current literature was reviewed with regard to the necessary number of HBO treatments.Two patients with proctitis after pelvic irradiation were treated with 40 and 38 HBO treatments, respectively. Hyperbaric oxygenation was delivered at 240 kPa over 90 min.In one patient, proctosigmoidoscopy showed a significant improvement after 40 HBO sessions. The other patient interrupted therapy after 38 HBO treatments without subjective change. The reported number of HBO sessions for a successful treatment of radiation proctitis ranges from 12 to 90.HBO should be considered before more invasive treatment modalities are performed for radiation proctitis.

The aim of this protocol was to investigate breast conservation rates with and without flap-supported surgery after preoperative chemotherapy, radiotherapy and hyperthermia.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.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.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.

Neutron therapy should be beneficial to patients with tumor types which are resistant to photons but relatively sensitive to high-LET radiation. In this work the potential therapeutic gain of a clinical neutron beam is evaluated by quantifying the variations in radiosensitivity of different cell lines to neutrons and photons.Different cell lines were exposed in vitro to p(66)/Be neutrons or 60Co gamma-rays. Micronuclei frequencies in binucleated cells and surviving fractions were determined for each cell type.Following exposure to either 1 or 1.5 Gy neutrons, micronuclei frequencies were significantly correlated with that observed for 2 Gy photons. A weak but significant correlation between the variation in neutron RBE values, determined from survival curve inactivation parameters and the mean inactivation doses for photon exposures, was also established.It is concluded that although neutron and photon sensitivities are related, the use of this high energy neutron source may constitute a potential therapeutic gain for tumor types that can be identified as very resistant to photons. Considering that a definitive oxygen gain factor has been established for this neutron beam the observed therapeutic gain is expected to be further enhanced in tumors where hypoxia protects cells from conventional radiation damage.

Divergent opinions exist on the value of adjuvant treatment in endometrial cancer. This paper aims at clarifying the indications for adjuvant radiotherapy by reviewing the literature and presenting own data.For endometrial cancer 5-year survival data are analysed with respect to the value of adjuvant radiotherapy and/or chemo-/hormone therapy.Adjuvant radiotherapy in FIGO stage I and II tumors reduces pelvic recurrence rates from 15 to 20% to 1 to 5%. In high risk stage I patients the 5-year survival rate is increased by 30 to 40% using pre-operative high dose endocavitary brachytherapy or postoperative external beam therapy. In stage II disease the 5-year survival rate is increased to 60 to 80% when applying 50 to 60 Gy post surgery. In stage III and IV tumors primary radiotherapy results in 5-year survival rates of 16 to 40%.In stage I and II endometrial cancer primary treatment consists of surgery followed by radiotherapy in eligible cases. In stage III and IV tumors primary radiotherapy is generally advocated. No properly randomized trials are available to date on the value of adjuvant treatment. There is a great demand for such trials in order to confirm the available data. According to the extent of the disease and the discrimination of certain risk groups these trials should include external beam pelvic irradiation, brachytherapy, para-aortic irradiation as well as systemic chemo-or hormone therapy.

The triage of victims after radiation injury is complicated by missing dose values and the fact that most tissues react after a latency period.We evaluated 63 patients undergoing total body irradiation as conditioning regime before bone marrow transplantation in order to find a relation between prodromal symptoms and dose.Emesis after radiation exposure hints to doses greater than 1.5 Gy. A rise of body temperature above 37 degrees C up to five hours after exposure is related to doses exceeding 2.5 Gy, while an acute onset of diarrhoea is an indicator of a severe accident with more than 9 Gy.Besides blood counts and chromosome analyses a careful evaluation of prodromal symptoms can help to classify the severity of radiation accidents.

In the past decade the management of small cell lung cancer (SCLC) has undergone substantial changes with respect to surgery, chemo- und radiotherapy. Due to combined chemotherapy regimens survival rates increased and the role of radiotherapy has been reevaluated. Despite this, the majority of patients treated with chemotherapy alone failed at the primary site. Several randomized studies have shown that irradiation (35 to 40 Gy) following chemotherapy has increased locoregional control rates. There is no uniform opinion about the treatment volume, fractionation schedule or optimal dose of radiotherapy. Recent reports have demonstrated better local control rates with radiation doses in excess of 45 Gy. Prophylactic cranial irradiation with 20 to 40 Gy is widely used in patients with SCLC and generally accepted in patients with complete remission after chemotherapy. Randomized studies have proven that prophylactic cranial irradiation reduces central nervous system relapses, however, no author has reported so far a significant improvement in survival.

Between 1980 and 1988, 116 patients with invasive breast cancer were treated by limited surgery with axillary node dissection followed by radiation therapy. Radiotherapy was performed by individually computerized treatment planning. The target volume dose was 50 Gy to the whole breast followed by an electron boost of 10 Gy to the tumor bed. The median follow-up period was 59 months. The actuarial overall survival rate is 93%, and the disease-free survival 75.2%. Ten (8.6%) breast recurrences occurred. Analysis of clinical and pathological prognostic factors revealed that local control was impaired by young age, negative hormone receptors, G3-4 tumors and intraductal growth. The recurrence rate for T3- and T4-tumors was 12.5%.

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.

Among combined radiochemotherapy regimens of advanced head and neck tumors four modalities can be discriminated: 1. Induction chemotherapy, 2. simultaneous radiochemotherapy, 3. adjuvant chemotherapy, 4. accelerated hyperfractionated radiotherapy and chemotherapy. The results of the presently available randomized trials are as follows: 1. Induction chemotherapy has no influence on long-term recurrence-free survival. 2. With respect to simultaneous radiochemotherapy, recurrence-free survival has been unproved with 5-FU and Mitomycin C. 3. There is evidence that adjuvant cisplatin therapy improves recurrence-free survival. 4. No results are available to date using hyperfractionated accelerated radiotherapy regimens in combination with chemotherapy.

From 1990 to 1991 15 patients with advanced head and neck carcinomas underwent hyperfractionated accelerated radiotherapy (2 x 1.6 Gy/day, five days/week, total dose 64.0 to 67.2 Gy) and simultaneous intravenous application of Carboplatin (60 mg/m2, days 1 to 5 and 29 to 33) in a pilot study. Eleven patients had T4 and four had T3 tumours. At the end of treatment twelve patients had a complete tumour remission and in the others a partial tumour involution was seen. Although acute side-effects were more pronounced compared to conventional irradiation this treatment regimen is feasible and the initial complete remission rate of 80% is encouraging.

After preceding radiotherapy, chemotherapy and/or surgery the therapeutic options are limited in case of recurrence. In order to enhance the effect of a reduced radiation dose we have combined intravenous mitoxantrone and simultaneous irradiation. From 1988 to 1991 22 patients with recurrent head and neck carcinomas were treated with this combined regimen. 20 patients had already been irradiated with 50 to 70 Gy. The second treatment course was given with 19.8 to 56.0 Gy and simultaneous application of one to three courses of mitoxantrone. Eleven (50%) patients achieved a clinical complete remission. A partial remission was seen in nine patients.

From 1979 to 1988 63 patients with cancer of the colon received postoperative adjuvant radiotherapy. The mean age was 62 years and the median follow-up period was 71 months. Pathologic staging showed a B1-tumour in nine cases, B2 in 25, C1 in three and a C2-tumour in 26 cases according to the Astler and Coller modification of the Duke's classification. 53 patients received doses between 41 and 50 Gy. 47 patients were treated with a 60Co megavoltage unit and 16 cases with 8 MV photons. The overall five years survival rate is 65%. There was no significant difference between the survival rates for all stages. Only four patients with primary positive lymph nodes experienced a local relapse. 16 developed metastatic disease. In twelve cases (19%) liver metastases appeared: four patients (6%) developed intraperitoneal metastases, one patient had a metastasis in the abdominal wall and another showed pulmonary carcinosis. Acute and transient side effects were seen in 35% of our patients. Three patients underwent a second operation for radiation induced bowel stenosis. Compared with the results of surgery adjuvant radiotherapy yields improved five-year survival data in patients with C2 and G4 tumours.

Acute skin lesions following radiotherapy are uncomfortable and unacceptable side effects. They are observed predominantly after high surface doses as in conventional roentgen or electron beam therapy. To accelerate the wound healing we tested a bandage consisting of hydrocolloids and polymers, which is permeable for gas and water. Handling, compatibility and effectiveness of this plaster were tested in this study. According to the RTOG scoring system 19 irradiated fields with grade II to IV lesions were treated. Densitometric measurements of verification films with and without Biofilm showed no energy absorption. The bandage was comfortable for the patients and easy to handle.

The five-year follow-up results of 221 patients treated with neutrons or a neutron-boost at the West German Tumour Centre, Essen, are presented. 94 patients with gross tumour were treated with neutrons alone. 127 patients without gross tumour left behind post surgery were irradiated using a "mixed beam" schedule. The disease-free survival rate at five years is 62.6% for T1-, 71.5% for T2- and 28.7% for T3-tumours (p = 0.016). Significant differences were also found for various grades, i.e. 73.3% for G1-, 47.7% for G2- (p = 0.035) and 22.4% for G3-tumours (p = 0.024). Patients without microscopic tumour residue fared best with a survival rate of 86.6%, followed by patients with microscopic tumour (65.5%; p = 0.042) and patients with gross tumour (25.5%; p = 0.003) left behind. A functional limb was preserved in 86% of the patients with extremity lesions. The local control rate of patients with gross tumour was 76.5% compared with 53% in previous photon series. This finding underlines the potential biological advantage of neutrons in these tumours. Serious side effects ranged from 28% in the patients treated with neutrons for large volumes to 7% in patients treated with a neutron boost.

The poor prognosis of patients with unresectable pulmonary metastases of soft tissue sarcoma is well known. In order to evaluate the beneficial effect of radiotherapy, we have treated 44 patients with pulmonary metastases of grade 3 soft tissue sarcoma from 1980 to 1986. In 36 patients the treatment volume was restricted to the single metastases up to a dose of 50 to 60 (9 to 10 Gy/week). The survival rate at one year was 18% and at two years 6%. Eight patients were treated with a combined regimen, consisting of cisplatin and ifosfamide with simultaneous whole lung irradiation. Irradiation was performed with 8 or 16 MV photons at a hyperfractionation of 2 x 0.8 Gy/day (8 Gy/week). After a dose of 12 Gy, the single metastases were boosted up to 50 to 60 Gy, with a second course of chemotherapy. In six of eight patients complete remissions were achieved, one patient showed a partial remission. The survival rate at 27 months was 50%. The patients with partial remission died from pulmonary progression at 23 months. One patient died after twelve months from a loco-regional recurrence in the tonsillar fossa without evidence of pulmonary disease. Side effects included alopecia and moderate bone marrow suppression approximately twelve days after each chemotherapy cycle. Pulmonary fibrosis was observed only at the high dose volume without impairment of respiratory function. From these observations the conclusion is drawn that whole lung irradiation simultaneously with cisplatin and ifosfamide chemotherapy provides good palliative results without relevant morbidity in patients with high grade unresectable pulmonary metastases of soft tissue sarcomas.

This report reviews the treatment results of 111 patients with stage T3-4, N0-3, M0, biopsy proven squamous cell carcinoma of the oropharynx and oral cavity. All patients were treated by primary irradiation with 1.8 to 2 Gy per day for five days a week up to a target volume dose of 39.6 or 40 Gy. Simultaneously 20 mg/m2 cisplatin was given under hyperhydration and mannitol diuresis on days 1 to 5. In case of partial tumour regression radiotherapy was continued up to 70 Gy with another course of cisplatin. In case of minor response surgery was interposed followed by subsequent irradiation with 30 Gy and a second course of cisplatin. 67% of the patients showed an initial complete tumour involution and 27% a partial response. The five year actuarial survival rate with a minimum follow-up of two years is 47.6%. More than 96% of the long term survivors showed a complete response after the end of treatment. The results demonstrate that concomitant radiation and chemotherapy with cisplatin is a highly effective treatment in advanced head and neck carcinoma with tolerable toxicity. Carboplatin (CBDCA) is a second generation platinum analog and has shown comparable antitumour activity but less nephro- and neurotoxicity than cisplatin in head and neck cancer. In order to determine the feasibility and efficacy of simultaneous application of CBDCA and radiotherapy a phase I-II study is going on. Between September 1987 and March 1988 30 patients with advanced squamous carcinoma of the head and neck (T3-4, N0-3) have entered this trial. Patients were separated into three groups which received 60 mg/m2. 70 mg/m2 and 80 mg/m2 CBDCA from days 1 to 5 and 28 to 32. Radiotherapy was administered up to a target absorbed dose of 70 Gy. 5 X 2 Gy/week in shrinking field technique. The group which received 80 mg/m2 CBDCA reached the myelotoxicity limit so that subsequent patients were treated with 70 mg/m2. Among 30 patients who completed the treatment, 22 showed a complete (CR) and eight a partial remission (PR). Despite the short follow-up period the preliminary results appear to be comparable with those achieved after combined radiotherapy and cis-DDP application without any limitations for patients with renal or cardiovascular disorders.

A holding system is presented which allows a good, easy, and reproducible positioning of the patient in percutaneous head and neck radiotherapy. The patients are lying comfortably on a neck support and are fixed in such a way that they are not able to turn in a lateral or longitudinal direction. The distance chin-jugulum can be easily determined by an integrated measuring tape. Due to the use of UV ink and UV lamps, the field marking of the patient's skin cannot be seen in the spectrum of visible light.

A significant amelioration of treatment results is achieved by sequential chemotherapy and radiotherapy in patients with lymphogranulomatosis of stage IIb to IVb and in patients with non-Hodgkin's lymphomas in corresponding stages. Similar results will probably be obtained in patients with small cell bronchial carcinomas in a limited stage. Patients suffering from an initially inoperable ovarian cancer often reach an operable condition by sequential chemotherapy and radiotherapy. In the stages Dukes B2 and C of the rectum carcinoma, preoperative and/or postoperative irradiation significantly reduces the recurrence rates and increases the survival times. A considerable reduction of recurrence rates is obtained by postoperative radiotherapy in soft tissue sarcomas of the stages T1 to T3. Another improvement is anticipated by a neutron or neutron boost irradiation for stage T3 and by adjuvant chemotherapy for G3 tumors. In the osteosarcoma of adult persons, the results of the limb-sparing sequential therapy will not be worse than the results achieved by amputation. Retrospective analyses of the long-term results of radical mastectomy and conservative operation with postoperative irradiation in case of mammary carcinoma did not show any difference for the stages T1 to T3, N0 to N1.