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Development of afterloading techniques in combination with external radiotherapy allows for curative therapy modality for stage C prostate cancer. Between 10/92 and 12/95 128 patients were treated. Stage B and C tumors were found in 36 and 89 cases, respectively. All patients were pathologically proven to be node-negative by laparoscopic node dissection of the fossa obturatoria region. 9 Gy a week was applied during the first and second weeks of treatment (10/92-12/93: 10 Gy each week) interstitially with high-dose rate iridium192 brachytherapy to the prostate. After this, a four-field box of external beam radiation therapy was given to the prostate to a dose of 45 Gy/25 fractions (10/92-12/93: 40 Gy/20 fractions). Before starting treatment median PSA was 13.8 ng/ml. The median PSA 3, 12, and 24 months after completion of therapy was 1.2, 0.78, and 0.75 ng/ml, respectively. Negative biopsies 12 and 24 months after therapy were observed in 56% (49/87) and 72% (31/43), respectively.

Radiation therapy (RT) following radical prostatectomy (RP) in locally progressed prostate carcinoma has become increasingly important in the last few years as both adjuvant therapy and treatment for a PSA increase in local recurrence of disease. The background for this is the knowledge gained by using PSA that up to 50% of the patients with pathologically confirmed pT3/4 tumors are systemically and/or locally progressive after 3-5 years if only surgical or radiation therapy was performed. A number of retrospective studies substantiated a significantly higher local tumor control by RT after RR. This holds true for adjuvant therapy as well as with a PSA increase from the "zero" range, whereby it must be taken into consideration that a certain percentage of treated patients among those with histologically proven local recurrence actually do not need further therapy. Lengthening the survival time has, however, not yet been proven. With an increase in the PSA from the "zero range" after RP, there are indications that systemic metastatic spread already occurs with values higher than 2.5-4 ng/ml and the RT no longer has any curative intention. A total of three prospective randomized studies on the question of adjuvant radiation therapy are presently being conducted. There are only very little, although interesting, data on the question of radiation therapy in combination with simultaneous systemic hormonal therapy (HT).

Background: Radiation therapy following radical prostatectomy in locally progressed prostate carcinoma has become increasingly important in the last few years as both adjuvant therapy in patients with pT3-tumors with or without positive margins and treatment for a PSA increase in local recurrence of disease. The background for this is the knowledge gained by using PSA that up to 60% of the patients with histopathologically confirmed pT3/4 tumors or involvement of the lymph nodes are systemically and/or locally progressive after 3 to 5 years if only surgical or radiation therapy was performed., Results: A number of studies, albeit exclusively retrospective, substantiated a significantly high local tumor control by radiotherapy after radical prostatectomy. This holds true for adjuvant therapy with a PSA in the "zero range" as well as with a PSA increase from the "zero range", whereby it must be taken into consideration that a certain percentage of treated patients with a PSA in the "zero-range" with or without positive margins actually do not need further therapy. Two retrospective studies demonstrated a significant better lengthening of "freedom from treatment failure" that is local and systemic progression of disease. Lengthening the survival time has, however, not yet been proven. With an increase in the PSA from the "zero range" after radical prostatectomy, there are indications that systemic metastatic spread already occurs with values higher than 2.5 to 4 ng/ml and the radiotherapy no longer has any curative intention., Conclusions: Adjuvant RT following radical prostatectomy gives better local control rates and probably better rates of "freedom from treatment failure" in patients with locally advanced prostate cancer with positive margins and probably in patients with negative margins. However, in retrospective studies no advantage in overall survival was shown.

Although not an AIDS-defining malignancy, anal cancer is an evolving problem in HIV-infected patients. Treatment-tolerance to radiotherapy as well as to chemotherapy is supposed to be reduced in patients with HIV-infection. From January 1995 to January 1997, four patients with epidermoid cancer of the anal canal and a long history of HIV-infection but without symptoms of AIDS or repeated severe infections were treated with radiotherapy (n = 1) or radiochemotherapy (n = 3). External beam radiotherapy with 45 Gy to the tumor and pelvic as well as inguinal lymphatic drainage was administered. In tumors larger than T2 N0 lesions an additional boost of 9 Gy was given. Chemotherapy consisted of 5-fluorouracil 1000 mg/m2/24 h, d 1-4 two cycles and Mitomycin C either 1 x 15 mg/m2, d 1 in the first, or 2 x 10 mg/m2, d 1, in the first and fifth week of radiotherapy. Acute reactions were mild to moderate in all patients and all but one treatment could be given as scheduled (1 patient with a delay of 4 days). No excessive acute reactions were seen. Because of the short follow-up, late reactions and local control are not yet evaluable.

A 15 year old patient presenting with a lumbar Ewing's Sarcoma was treated according to the EICESS-92 pilot study (EVAIA branch). Local therapy consisted of definitive irradiation given simultaneously to chemotherapy courses 5 to 7. Close to the end of treatment the patient developed progressive peripheral neurologic deficits. Such combined toxic treatment side effects are unique and unforeseen in the study protocol.

In a prospective investigation Eustachian tube function was tested before and after surgery and irradiation of patients suffering from carcinoma of the larynx or hypopharynx. Passive and active tubal parameters were determined using the dual-impedance method in a pressure chamber. In this test, passive tubal function is described by the spontaneous opening and closing characteristics of the tube by an overpressure in the middle ear. Active tubal parameters are determined by the facility of the tube to equalize an over- and underpressure in the middle ear by swallowing. Statistic evaluation was performed with Student's t-test. There were no significant alterations of passive or active tubal function after neck dissection with or without surgery of the primary tumour. On the other hand we observed significant deterioration of all tubal parameters immediately after a series of fractionated percutaneous telecobalt therapy (60 Gy). 2 out of 18 patients developed unilateral middle ear effusion during irradiation which was reversible within 6 months. In most patients we observed a total or at least partial restitution of passive tubal parameters during this time, which was statistically significant. The active tubal function was of minor reversibility. Whereas the facility to equalize a positive pressure in the middle ear was quite good after 6 months, only few patients were able to equalize a negative pressure. The temporary deterioration of passive tubal function may be caused by a marginal implication of the tube at the edge of the irradiation field and by increased lymphatic pressure in tubal tissue following a radiogenic swelling of the lymphatic vessels of the neck.(ABSTRACT TRUNCATED AT 250 WORDS)

A case of leiomyosarcoma of the spinal leptomeninges is presented, with clinical, radiological, light microscopic and immunohistochemical data. The probable origin of the tumor from a pluripotent mesenchymal cell is discussed.

The early reactions of the eye to radiation are conjunctivitis and, with higher doses, corneal damage. The inflammatory reactions are transient and remit within a few weeks after the end of radiotherapy. Doses above 60 Gy can produce corneal ulcerations with the risk of perforation and loss of the eye. The most frequent late reaction of the eye is cataract of the lens. The tolerance dose (about 5 Gy) is extremely low and the latent period varies from 6 months to 3 years. The lens in children has a much lower tolerance. The increasing potential for optical support and ophthalmic surgery over recent decades has reduced the fear of this complication. The most severe late complications are retinopathy (RR) and neuropathy of the optic nerve (RON), both of which are caused by radiation-induced microangiopathy. Visual loss is very frequent and complete blindness is seen with high doses in the range of 50-60 Gy. The latent period of these injuries varies widely from 1 month to 15 years, but they usually occur within 3 years of treatment. Conflicting frequencies are reported in the literature. Beyond 30 Gy, usually no RR is seen. However, the lowest recorded dose producing RR is 11 Gy. In the high dose range of 60-70 Gy RR and RON are found in 10%-100% of patients. There is a great need for prospective trials to estimate the true risk to patients with nasopharyngeal, maxillo-ethmoidal, and orbital tumors, pituitary adenomas, and tumors of the salivary glands. To minimize complications of radiotherapy to the eyes daily fractions should be reduced to 1.7-1.8Gy.(ABSTRACT TRUNCATED AT 250 WORDS)

Compared to surgery alone, postoperative radiotherapy leads with glioblastomas (grade IV gliomas) to a significant improvement of the therapeutic results. The prolongation of survival time, however, is to a large extent compensated by the therapy itself (it normally implicates hospitalisation). Therefore, we tested the efficiency of rapid course irradiation with high fractions. 70 patients were treated daily with individual fractions of 3.5 Gy, 4 to 6 fractions per week. The entire dose amounted to 31.5 to 38.5 Gy. The average survival time was 33.5 weeks corresponding to the survival time known from the combined surgical and radiotherapy treatment of glioblastomas. An effective increase in therapy-free survival time seems possible, especially when the entire focal dose does not exceed 35 Gy. It is remarkable that the patients with the maximum exposure did not have the longest survival times and rates. Living conditions for the patients were similar to those with conventional fractionation , or even better. Rapid course irradiation with high fractions and a limited total dose (35 Gy) presently is - apart from the accelerated superfractionation - a successful measure to prolong the therapy-free survival time for patients with grade IV gliomas.

The authors investigated the influence of a preoperative irradiation on the rate of successful implantations and the growth behavior of human hypernephromas implanted into nude mice. No successful implantation was observed in hypernephromas preirradiated with a dose of 2000 rd, which was also confirmed by histologic examinations. The rate of successful implantation of 17 non-preirradiated hypernephromas (10/17) is below that of the total group, and the rate of successful implantation in serial passage (6/17 = 35%) is markedly inferior. The clinical observation that the incidence of local recurrences is reduced by a preoperative irradiation is explained by our experimental findings.

A group of 36 patients who received mantle field irradiation for Hodgkin's disease (35 pts) or non-Hodgkin lymphoma (1 pt) were prospectively examined by plain film radiography and computed tomography (CT) for evaluation of the pulmonary reaction at the beginning and the end of the course of irradiation, and at 12 weeks, 17 weeks, and 37 weeks after the start of the mantle field irradiation. A total of 173 plain chest radiographs (p.a. and lateral view), and 167 CTs were reviewed. As in chest radiography, the pulmonary reaction to radiation seen in CT took a characteristic course with different distinguishable stages. The radiation-induced changes typically seen on on CT were reducible to three basic patterns of opacification, which sometimes appeared in combination, and had a characteristic spatial distribution. Comparison of the two imaging modalities suggest that CT should be used in special cases, while conventional plain film radiography of the chest, with the possibility of short-term controls, is still the mainstay of follow-up for patients with Hodgkin's disease.

Simulator method and computed tomography use different pictures for measurements of the tumor volume for therapy planning: X-ray pictures taken from two different directions can only show the indirect volume of the tumor, while CT pictures give information of the real size of the tumor. For estimation of the value of the two methods therapy planning was performed by the simulator method in 34 patients with carcinoma of the prostate (T1-T3) and the results were added to CT pictures. Comparison of the two methods resulted in equivalent consequences. Therefore economic aspects should be taken into account for selection of a special method of radiation therapy planning.

Significant modifications in tissues, even death of cells, are caused by hyperthermia of few degrees centigrade. The extent of these modifications depends on the temperature applied. In a whole-body treatment, only not directly cytotoxic temperatures can be tolerated. The authors compare the methods of induction of whole-body hyperthermia with respect to expenditure, temperature applied, and side effects. Total-body hyperthermia aims at a reinforcement of other tumoricide therapies (radiotherapy, chemotherapy). - A pilot study performed with patients suffering from microcellular bronchial carcinomas, extensive disease, showed that the results of ACO and total-body hyperthermia (41 degrees C) are encouraging as compared with single ACO therapy: complete remission 8/15, partial remission 5/15, no change and progressive disease 2/15, 53-week survival rate 0,5, one-year survival rate 0,53, two-year survival rate 0,18.

Disorders of the skeleton in the thoracic area after percutaneous irradiation of malignant lymphomas are relatively rare. The most common site for pathologic changes is the clavicula. Local overdosage and, in case of malignant alterations, an additional chemotherapy might be the reasons. Among our patients seven lesions occurred, three of them were malignant: two osteogenic sarcomas and one chondrosarcoma.

Nine patients suffering from non oat cell carcinoma bronchial carcinomas were treated with extended-field irradiations. The treatment was executed under the conditions of whole-body hyperthermia. All patients had inoperable but not yet disseminated carcinomas, seven among them a squamous cell carcinoma and two an undifferentiated carcinoma. The hyperthermia was produced by a Siemens cabin (chamber of Pomp) with preheated air of 55 to 60 degrees C and a radio frequency of 27 MHz, 400 W. A temperature of body cavities of 40 to 40.5 degrees C was reached within 40 to 60 minutes. Fifteen minutes after having reached this temperature, the patient was irradiated. The nominal standard dose of 18 to 18.5 Gy was fractioned into three times three Gy per week. Three to thirteen single doses were combined with whole-body hyperthermia. The initial tumor regression seemed increased. One patient became operable; he was submitted to pneumonectomy. All patients showed partial remissions. Compared to radiotherapy alone, there is no improvement of remission period and survival time until now. Better results could possibly be reached by an additional systemic chemotherapy.