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Purpose To investigate whether combined-modality treatment (CMT) with two cycles of doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) followed by extended-field radiotherapy (EF-RT) is superior to EF-RT alone in patients with early favorable Hodgkin's lymphoma (HL). Patients and Methods Between 1993 and 1998, 650 patients with newly diagnosed, histology-proven HL in clinical stages IA to IIB without risk factors were enrolled onto this multicenter study and randomly assigned to receive 30 Gy EF-RT plus 10 Gy to the involved field (arm A) or two cycles of ABVD followed by the same radiotherapy (arm B). Results At a median observation time of 87 months, there was no difference between treatment arms in terms of complete response rate (arm A, 95%; arm B, 94%) and overall survival (at 7 years: arm A, 92%; arm B, 94%; P = .43). However, freedom from treatment failure was significantly different, with 7-year rates of 67% in arm A (95% CI, 61% to 73%) and 88% in arm B (95% CI, 84% to 92%; P ≤ .0001). This was due mainly to significantly more relapses after EF-RT only (arm A, 22%; arm B, 3%). No patient treated with CMT experienced relapse before year 3. Relapses were treated mainly with bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone, or with the combination cyclophosphamide, vincristine, procarbazine, and prednisone/ABVD; treatment of relapse was significantly more successful in arm A than in arm B (P = .017). In total, there were 39 second malignancies, with 21 in arm A and 18 in arm B, respectively. The incidence was approximately 0.8% per year during years 2 to 9 and was highest in older patients (P < .0001) and those with “B” symptoms (P = .012). Conclusion CMT consisting of two cycles of ABVD plus EF-RT is more effective than EF-RT alone.

Background: The optimal treatment of elderly patients with Hodgkin’s lymphoma (HL) is still a matter of debate. Since many of these patients receive combined modality treatment, we evaluated the impact of different radiation field sizes, that is extended-field (EF) or involved-field (IF) technique when given after four cycles of chemotherapy. Patients and methods: In the multicenter HD8 study of the German Hodgkin Study Group, 1204 patients with early-stage unfavorable HL were randomized to receive four cycles of chemotherapy followed by either radiotherapy (RT) of 30 Gy EF + 10 Gy to bulky disease (arm A) or 30 Gy IF + 10 Gy to bulky disease (arm B). A total of 1064 patients were assessable for the analysis. Of these, 89 patients (8.4%) were 60 years or older. Results: Elderly patients had a poorer risk profile. Acute toxicity from RT was more pronounced in elderly patients receiving EF-RT compared with IF-RT [World Health Organization (WHO) grade 3/4: 26.5% versus 8.6%)]. Freedom from treatment failure (FFTF, 64% versus 87%) and overall survival (OS, 70% versus 94%) after 5 years was lower in elderly patients compared with younger patients. Importantly, elderly patients had poorer outcome when treated with EF-RT compared with IF-RT in terms of FFTF (58% versus 70%; P = 0.034) and OS (59% versus 81%; P = 0.008). Conclusion: Elderly patients with early-stage unfavorable HL generally have a poorer risk profile and outcome when compared with younger patients. Treatment with EF-RT instead of IF-RT after chemotherapy has a negative impact on survival of elderly patients and should be avoided.

Photofrin II has been demonstrated to serve as a specific and selective radiosensitizing agent in in vitro and in vivo tumor models. We aimed to investigate the feasibility of a clinical application of Photofrin II.12 patients were included in the study (7 unresectable solid tumors of the pelvic region, 3 malignant gliomas, 1 recurrent oropharyngeal cancer, 1 recurrent adenocarcinoma of the sphenoid sinus). The dose of ionizing irradiation was 30-50.4 Gy; a boost irradiation of 14 Gy was added for the pelvic region. All patients were intravenously injected with 1 mg/kg Photofrin II 24 h prior to the commencement of radiotherapy. Magnetic resonance imaging (MRI) controls and in some cases positron emission tomography (PET) were performed in short intervals. The mean follow-up was 12.9 months.No major adverse events were noted. Minor adverse events consisted of mild diarrhea, nausea and skin reactions. A complete remission was observed in 4/12 patients. A reduction in local tumor volume of45% was achieved in 4/12 patients. Stable disease was observed in 4/12 patients. 1 patient showed local disease progression after 5 months.The early follow- up results are encouraging regarding the feasibility of the application of Photofrin II as a radiosensitizing agent.

Background and Purpose: In spite of major advances in cancer treatment, the prognosis of patients with oesophageal carcinoma remains poor. Squamous cell carcinoma and adenocarcinoma account for 95% of all oesophageal tumors, although other histological subtypes are occasionally seen. We aimed to evaluate whether Photofrin II can enhance the effect of ionizing radiation on oesophageal cancer in an in vitro tumor model. Material and Methods: A human oesophageal squamous cancer cell line (OE-21) and a human oesophageal adenocarcinoma cell line (OE-33) were evaluated with and without incubation with Photofrin II. Cells were irradiated using doses ranging from 0 to 8 Gy. The response rate of the cells to irradiation was evaluated by a tetrazolium-based colorimetric assay, similar to the MTT test, with the aim to determine the efficiency of Photofrin II as a radiation sensitizer in comparison to irradiation alone. Results: The OE-21 cell line demonstrated a significantly reduced cellular survival rate, when irradiated in the presence of Photofrin, as compared to a control group irradiated in the absence of Photofrin II. For the OE-33 cell line, no significant differences were found between the group treated with Photofrin II and the control group. Conclusion: Our results demonstrate in an in vitro model that Photofrin II may act as a radio-sensitizer in squamous cell oesophageal cancer, but not in oesophageal adenocarcinoma.

Radiosensitizers represent an enticing concept in tumor therapy. As ionizing radiation affects both neoplastic and normal tissues, its effects are generally non-specific. The aim of applying a radiosensitizing agent is to achieve a maximum effect on tumor tissue, while minimizing the damage to normal tissues. A variety of parameters such as the oxygen supply and the state in the cell cycle, need to be taken into account when evaluating a potential radiosensitizer. Most of the previously known radiosensitizers are neither selective nor tumor specific. In this article, we review the properties and radiosensitizing potential of Photofrin II® . Photofrin II® is wellknown as a photosensitizing agent in photodynamic therapy. In recent years, a radiosensitizing potential of the substance has been demonstrated, specifically increasing the sensitivity of solid tumor tissues, especially of radio-resistant, hypoxic tumor cells, to radiation. This radiosensitizing effect has been demonstrated both by in vitro studies and by animal experiments. Several studies with tissue cultures have demonstrated a radiosensitizing effect of Photofrin II® in glioblastoma (U-373MG) and bladder cancer cell lines (RT-4). No effect was noted in colon carcinoma cell lines (HT-29). Unpublished data of additional cell lines will be mentioned in the review. Animal experiments with Lewis sarcoma and with bladder cancer have moreover demonstrated an in vivo effect of Photofrin II® as a radiosensitizer. The mechanism of this radiosensitizing effect is not completely understood. In vitro data, however, support the hypothesis that the radiosensitizing action involves OH-radicals in addition to a potential impairment of repair mechanisms after sublethal damage of ionizing radiation. Moreover, early results of a phase I trial are available and document the potential feasibility of the application of Phototofrin II® as a radiosensitizing agent in clinical practice.

In contrast to younger patients, the prognosis of elderly patients with advanced Hodgkin's disease (HD) has not improved substantially over the last 20 years. We thus carried out a prospectively randomized study (HD9(elderly)) to compare the BEACOPP regimen in this setting against standard COPP-ABVD. Between February 1993 and 1998, 75 patients aged 66-75 years with newly diagnosed HD in advanced stages were recruited into the HD9 trial as a separate stratum (HD9(elderly)). Patients were assigned to eight alternating cycles of COPP and ABVD or eight cycles of BEACOPP in baseline doses. Radiotherapy was given to initial bulky or residual disease. In total, 68 of 75 registered patients were assessable: 26 were treated with COPP-ABVD and 42 with BEACOPP baseline. There were no significant differences between COPP-ABVD and BEACOPP in terms of complete remission (76%), overall survival (50%) and freedom from treatment failure (FFTF) (46%) at 5 years. At a median follow-up of 80 months, a total of 37 patients died: 14/26 patients (54%) treated with COPP-ABVD and 23/42 patients (55%) with BEACOPP. Two patients (8%) treated with COPP-ABVD and nine patients (21%) treated with BEACOPP died of acute toxicity. Hodgkin-specific FFTF at 5 years was 55% after COPP-ABVD and 74% after BEACOPP (P=0.13). Thus, there are no differences in survival between these regimens in elderly patients.

Hintergund: Ziel dieser Pilotstudie war es, die Durchfuhrbarkeit und Toxizitat einer Chemotherapie mit Vinorelbin und Mitomycin C in Kombination mit einer simultanen Strahlentherapie (RT) bei Patienten mit lokal fortgeschrittenen Kopf-Hals-Tumoren zu evaluieren. Patienten und Methoden: Zwischen Januar 2003 und Marz 2004 wurden 15 Patienten mit T4/N2-3 Plattenepithelkarzinomen (12/15) oder mit zervikalen N3-Lymphknotenmetastasen bei unbekanntem Primartumor (3/15) einer Chemotherapie und einer akzelerierten RT unterzogen. Ergebnisse: Bei 11 Patienten konnte die Radiochemotherapie ohne Unterbrechung oder Reduktion der Zielvolumendosis durchgefuhrt werden. Eine akute Grad 3-4 Mukositis war bei 9/15 Patienten, eine hamatologische Toxizitat Grad 4 bei 6/15 Patienten nachweisbar. Im medianen Beobachtungszeitraum von 7,5 Monaten waren 2 Patienten an Begleiterkrankungen verstorben und 2 entwickelten ein Lokalrezidiv. 5 Patienten zeigten eine anhaltende komplette

Radiation adaptive response in terms of induced radioresistance or hyperradiosensitivity, has been studied in HCV29 (human bladder epithelium) and RT4 (human bladder carcinoma) cell lines. After pre-irradiation doses of 0.05 Gy or 0.1 Gy, HCV29 cells showed induced radioresistance, whereas after pre-irradiation doses of 0.05 Gy, 0.1 Gy, 0.2 Gy, and 0.5 Gy, the RT4 cells clearly showed hyperradiosensitivity. On the basis of these results, an approach has been developed that may lead to a concept for a new radiotherapeutic regimen of bladder cancer that includes protection of normal cells, on the one hand, and the potential of tumor cell damage, on the other hand. These findings need to be confirmed in further studies for the benefit of the patients.

Purpose To analyze, in a prospective clinical trial, the efficacy and toxicity of concurrent radiotherapy and chemotherapy with gemcitabine and cisplatin in patients with incompletely (R1) resected pancreatic cancer. Methods and materials Between 2000 and 2002, a total of 30 pancreatic cancer patients were treated. Radiotherapy was performed in 15 patients up to a total dose of 45.0 Gy. An additional 15 patients received a total dose of 50.0 Gy according to the International Commission on Radiation Units and Measurements (ICRU) Report 50 reference point (equivalent to 45.0 Gy at the isodose, including 90% covering the former tumor area and local lymph nodes). Concurrent with radiotherapy, four applications of gemcitabine (300 mg/m 2 ) and cisplatin (30 mg/m 2 ) were administered. After chemoradiotherapy, patients received four additional courses of gemcitabine (1000 mg/m 2 ) and cisplatin (50 mg/m 2 ) on Days 1 and 15 in a 4-week cycle. Results The median progression-free survival was 10.6 months, and the median overall survival was 22.8 months. The 1-, 2-, and 3-year survival rate was 81%, 43%, and 26%, respectively. After completion of chemoradiotherapy, distant metastasis was observed in 14 patients during a median follow-up of 15.0 months (range, 4.6–30.0). One patient developed both local recurrence and distant metastases. Hematologic toxicities were the most prominent side effects (leukopenia Grade 3 and 4 in 53% and 7% and thrombocytopenia Grade 3 and 4 in 33% and 7% of patients, respectively). Grade 3 and 4 GI toxicity was not observed. Conclusion Postoperative chemoradiotherapy with gemcitabine and cisplatin after incomplete (R1) resection of pancreatic carcinoma is safe and feasible. A prolonged progression-free survival suggests high local efficacy, translating into a benefit of overall survival. On the basis of the favorable outcome of patients receiving gemcitabine/cisplatin-based chemoradiotherapy, testing this combined treatment strategy appears warranted in a comparative trial.

Even today patients who suffer from mantle cell lymphoma have a poor prognosis, especially when the CNS is involved. To confirm the diagnosis of meningeosis lymphomatosa, asservation of the liquor cerebrospinalis is necessary. During this procedure, intrathecal chemotherapy may be given if there is clinical evidence of meningeosis. If lumbar puncture cannot be performed, a lateral suboccipital puncture may be an alternative approach.We report the case of a 65-year-old patient who suffered from mantle cell lymphoma stage IV. The patient presented with symptoms of progressive paraparesis of both legs and incontinence, with tumor mass intradural from the 12th thoracic vertebra to the level of S1. During irradiation, the patient developed symptoms of diffuse meningiosis lymphomatosa. The conventional lumbar puncture was impossible, because of tumor present in the thoracico-lumbar junction.A suboccipital puncture was performed for both collecting cerebrospinal fluid and application of chemotherapy (cytosine arabinoside/dexamethasone). This lead to remarkable improvement of the patient's clinical symptoms.The suboccipital cervical puncture was performed without complications. A variation of the intrathecal approach is described, which may serve as alternative when conventional lumbar puncture is not possible.

The biological effects of radiation affect both neoplastic and normal tissues. The nature and extent of such effects, however, depend on selected biological parameters (e.g., oxygen supply, cell cycle) and can be modified by chemical agents such as radiosensitizers, radioprotectors and chemotherapeutic agents. A precise control of the mode of action of the radiation is important in order to achieve the maximum effect on tumor tissue, while minimizing the effect on normal tissues. Most of the known and routinely used radiosensitizers are neither selective nor tumor specific. This article reviews a new selective and specific modality that increases the sensitivity of solid tumor tissue, especially of radio resistant, hypoxic tumor cells, to radiation. This modality is currently under early clinical evaluation and encompasses the application of Photofrin II, which is already used as a photosensitizer in photodynamic therapy (PDT) at predetermined times prior to irradiation.

Die strahlentherapeutische Behandlung von Tumorpatienten ist haufig mit starken psychosozialen Belastungen verbunden, fur deren Erfassung es bisher keinen spezifischen Fragebogen gibt. Mit dem Stress Index RadioOnkologie (SIRO), der auf den Analyseergebnissen umfangreicher Voruntersuchungen beruht, soll erstmals ein Screening-Instrument zur Verfugung gestellt werden, mit dem die psychosozialen Belastungen von Tumorpatienten, einschlieslich der durch Strahlentherapie induzierten, erfasst werden konnen. Ziel dieser Studie ist, die Fragebogen-Vorform psychometrisch zu evaluieren und in die endgultige Fragebogenversion (SIRO) zu uberfuhren. Daruber hinaus sollen Informationen uber das psychosoziale Belastungsprofil radioonkologischer Patienten zu Beginn einer Strahlentherapie gewonnen werden. Patienten und Methoden: 104 Tumorpatienten (18–85 Jahre) mit unterschiedlichen Diagnosen wurden in die Studie aufgenommen. Die Patientendaten wurden mit der SIRO-Vorform, der Hospital Anxiety and Depression Scale (HADS), der European Organization for Research and Treatment of Cancer Study Group Quality of Life Questionnaire (EORTC QLQ-C30) und der Lebenssituation (LS) erfasst. Mit 25 Patienten wurden halb standardisierte Interviews durchgefuhrt. Ergebnisse: Die Anforderungen an die Gutekriterien (Reliabilitat, Validitat) des SIRO wurden erfullt bzw. ubertroffen. In der untersuchten Patientenstichprobe traten die hochsten Belastungswerte in der Skala “Psychophysische Belastungen” auf, gefolgt von den Skalen “Partnerschaftliche Probleme”, “Strahlentherapeutische Belastungen” und “Informationsdefizite”. Entsprechend waren auf Itemebene die hochsten Belastungen bei den Leistungseinschrankungen und Angsten zu beobachten. Bei den strahlentherapeutischen Items waren die Patienten am starksten durch die Angst vor Nebenwirkungen der Strahlentherapie und die Tatsache, dass sie bestrahlt werden, belastet. Patienten mit palliativer Behandlungsoption waren starker als solche mit kurativer belastet. Schlussfolgerungen: Die Fragebogen-Vorform hat sich als reliabel, valide und praktikabel erwiesen und kann unverandert als neuer Selbstberichts-Fragebogen (SIRO) zur Erfassung der psychosozialen Belastung radioonkologischer Patienten ubernommen werden.

The aim of this study was to investigate stress in tumor patients by means of a cancer-specific questionnaire in the course of radiotherapy. Material and Methods: Disease-specific aspects of psychosocial stress (Herschbach's Questionnaire on Stress in Cancer Patients, QSC) were self-assessed by patients with different tumor types before radiotherapy (ti1), after radiotherapy (ti2), and 6 weeks after the end of radiotherapy (ti3). We investigated 265 of 446 patients (157 male, 108 female; median age 58.6 years) with complete data of ti1–ti3. Results: In the course of investigation, the most prominent stress scale of the patients proved to be physical efficiency, without significant changes during treatment and after therapy. Significant increases in stress were observed for anxiety, pain, and information at ti3 (p < 0.001, p = 0.001, p = 0.035). Women showed significantly higher stress from ti1 to ti3, younger patients displayed a decrease in anxiety, whereas elderly patients demonstrated an increase (p = 0.016). Breast cancer patients had the highest stress levels. The probability of correctly predicting increase in stress (sensitivity) was 78% and the specificity 67%. The relevant predictor variables were tumor stage, addiction to alcohol or nicotine, metabolic disorder, marital status, and age. Conclusion: Patients who experienced stress at the beginning of radiotherapy also had the same or increased levels of stress during and shortly after treatment and needed permanent psychosocial support to improve quality of life. The identification of patients with high stress levels at the beginning of therapy could be helpful.

Die simultane Radiochemotherapie unter Verwendung von Gemcitabin scheint bei der Behandlung des Pankreaskarzinoms ein hoffnungsvoller Ansatz, da Gemcitabin als Monosubstanz oder in Kombination mit anderen Zytostatika eine verbesserte Wirksamkeit beim (metastasierten) Pankreaskarzinom im Vergleich zu 5-FU-haltigen Therapieschemata zeigt und zudem strahlensensibilisierendes Potential besitzt. In der vorliegenden Arbeit werden die Pilotdaten einer sequentiellen und simultanen Radiochemotherapie unter Verwendung von Gemcitabin und Cisplatin vorgestellt. Patienten und Methode: 57 Patienten (w/m 23/34) mit Pankreaskarzinom wurden insgesamt behandelt, davon 33 Patienten mit inoperablem Tumor, 19 Patienten nach Tumorresektion (R1-Resektion und/oder pN+) sowie funf Patienten mit Lokalrezidiv. Die Strahlentherapie wurde in konventioneller Fraktionierung bis zu einer Dosis von 45,0 Gy im Referenzpunkt nach ICRU (50 Patienten 1,8 Gy ED) bzw. 50,0 Gy im Zielvolumen I. Ordnung (sieben Patienten, 45,0 Gy im ZV II. Ordnung, 1,8/2,0 Gy ED) durchgefuhrt. Simultan zur Bestrahlung wurden Cisplatin 30 mg/m2 und Gemcitabin 300 mg/m2 an den Tagen 1, 8, 22 und 29 verabreicht. Nach Abschluss der simultanen Radiochemotherapie wurden sequentiell zwei Zyklen Gemcitabin/Cisplatin (1000 mg/m2/50 mg/m2 d 1, 15) verabreicht. Ergebnisse: Bei einer medianen Nachbeobachtungszeit von 8,2 Monaten betragt die aktuelle mediane Uberlebenszeit 14,8 Monate (inoperable Patienten 10,3 Monate, postoperative Patienten 15,1 Monate). Bei 19 bzw. vier der 33 inoperablen Patienten trat eine partielle bzw. komplette Remission auf. Insgesamt konnten 14 Patienten sekundar operiert werden. Die Hamatotoxizitat war die gravierendste Nebenwirkung (Leukopenie Grad III und IV bei 29 und funf Patienten, Thrombopenie Grad III und IV bei 21 und acht Patienten), jedoch nur mit geringer klinischer Relevanz (ein neutropenischer Infekt, eine Hb-wirksame Epistaxis). Schlussfolgerung: Das von uns vorgestellt Therapieschema mit Gemcitabin und Cisplatin sequentiell und simultan zur Bestrahlung ist mit vertretbaren Nebenwirkungen durchfuhrbar. Zur Evaluation der hoffnungsvollen Remissions- und Uberlebensraten sind randomisierte Studien zur neoadjuvanten und primaren Radiochemotherapie gestartet.

Aim: We wanted to understand coping strategies specific to different phases up to two years after radiotherapy, to identify patients who are at higher risk of mood disturbances and to characterise the association between coping strategies and psychosocial adaptation. Patients and Methods: From 1997 to 2001, 2,169 patients with different diagnoses were screened (27.8% refused to participate). Data of 276 patients from the beginning of radiotherapy (ti1) and 5 follow-up investigations (ti6/2 years) could be analysed. With the FKV (Freiburg Questionnaire Coping with Disease) cancer-specific coping aspects were assessed. The association between coping styles and psychosocial adaptation was evaluated using the Questionnaire on Stress in Cancer Patients (QSC) and the questionnaire on Functional Assessment of Cancer Treatment (FACT-G). Results: ‘Active problem-orientated’ coping and ‘distractions’ are the most important coping strategies. Only ‘active problemorientated’ and ‘depressive’ coping showed a significant decrease. We observed higher means on the scales of the FKV in women. Marital status (single, married, divorced/widowed) had a significant influence on active problem-orientated coping and spirituality. Age, children, education, T/M status and curative/ palliative intention of treatment had no influence on coping styles. Breast cancer patients and lymphoma patients demonstrated the highest use of coping strategies after radiotherapy with a significant decrease of ‘active problem-orientated coping’. Depressive coping and minimizing importance at ti1 were associated with high psychosocial distress and low quality of life (QoL) at ti6. Conclusion: The correlation of coping mechanisms at the beginning of radiotherapy with low QoL and high psychosocial stress at 2 years could help to identify patients at risk for low psychosocial adaptation. Psychooncologically trained teams of physicians would best correspond to this profile of needs and would contribute significantly to an ameliorated adaptation of patients to cancer which could lead to higher life satisfaction.

Background: the effect of ionizing radiation on tumour tissues can be optimised by adding radiosensitising agents to enhance tumour inactivation. Photofrin II has been approved as a photosensitising agent for the photodynamic therapy (PDT) of selected solid tumours. At present, no chemical modifier has been found to act as a selective radiosensitiser. We report here the first use of Photofrin II as a radiosensitising agent to enhance radiation therapy. Patients: two patients, one female with unresectable bladder cancer and one male with recurrent inoperable bladder cancer, were treated with radiation therapy (44.8 Gy + 14 Gy boost) of the pelvic region. 24 hours before initiation of therapy the patients were intravenously injected with 1 mg kg−1 Photofrin II (Axcan, Canada). Results: magnetic resonance imaging of the pelvis with a standardized protocol demonstrated a reduction in tumour volume of approximately 40% in the female patient and 35% in the male patient. The female patient was operated upon after conclusion of radiotherapy, the male patient refused the operation. No severe side effects were observed. Conclusion: Photofrin II is a promising radiosensitising agent in the treatment of patients with advanced solid tumours.

Psychosocial factors influence patient compliance and have an effect on survival. Identifying patients at risk of decreased quality of life (QOL) with no extra expenditure in terms of hospital staff time or resources is mandatory to plan psychosocial support.Between 1997 and 2000, 242 patients with head-and-neck cancer (30% pharyngeal, 29% oropharyngeal, and 13% laryngeal cancer) were screened. Of these, 28.5% refused to participate and 19.0% were excluded (Karnofsky performance score50, language and cognitive deficits, death, or noncompliance). A total of 124 patients were assessed with the Functional Assessment of Cancer Therapy-General (FACT-G) questionnaire at ti1 (beginning of radiotherapy [RT]). Eighty-three patients from this group were examined, with complete data from ti1 to ti3 (6 weeks after RT).The QOL did not change during RT. In logistic regression analysis, medical information, in contrast to sociodemographic variables, turned out to have no influence on the ability to predict low QOL (sensitivity 80% vs. 32%). Four sociodemographic variables were entered in the regression model (children, currently employment, ethanol abuse, level of secondary education) and accounted for 26% of variance in QOL at ti3.By routinely obtaining clinical information from the patient's history, patients at risk of low QOL after RT can be identified and could benefit from early psychosocial support.

The standard therapy for patients with clinically resectable rectal cancer is generally considered to be surgery. If the patient is diagnosed with advanced disease, postoperative radio-chemotherapy (RCT) is usually recommended. In our study we aimed to investigate and analyze the effectiveness and toxicity of preoperative pelvic radiotherapy in combination with 5-fluorouracil (5-FU) in locally advanced rectal cancer.From June 1999 to September 2001 we evaluated 50 consecutive patients [37 male and 13 female; average age 65.1 (range 46-79.5) years] with locally advanced rectal carcinoma. 32 patients were staged as uT3, 14 as uT4, and 4 as uT2. Regarding N-staging, 22 patients were diagnosed as uN0. 2 patients had distant metastases, with liver metastases in both instances. Conformal irradiation was performed with a box technique (4-field technique) with a dose of 45 Gy (5 x 1.8 Gy per week for a total of 25 sessions). From days 1-5 and 29-33, all patients received 5-FU (500 mg/m(2 ) per day, as a continuous i.v. injection).Remission was observed in 28 patients (56%), with down-staging of at least one T-stage. A better success rate was achieved for patients with deep-seated tumors (64% of the patients in this group). Complete remission was observed in 4 patients (8.0%) and progression in 3 (6.0%). 15 patients had no detectable change in tumor staging (30.0%). A surgical R0 resection could be achieved in 43 patients, an R1 resection (minimal margin) in 7. Side effects and toxicity (common toxicity criteria) of RCT included grade I-II dysuria in 5 patients (10%), grade I-II diarrhea in 20 patients (40%), and severe diarrhea in 2 patients (4.0%). Grade I-II skin reaction was noticed in 22 patients (44.0%), severe skin reaction only in 1 patient. Regarding acute postoperative morbidity, abscess and fistula formation was noted in 8 patients (16.0%), with anastomosis leakage in 7 (14%).Preoperative radiotherapy appears to be a feasible therapeutic approach with moderate toxicity and the potential to induce down-staging. The data presented in this study confirm the preliminary reports on this neoadjuvant treatment.

Die Radiotherapie bringt Tumorpatienten in eine besondere Lebenssituation, in der sie einer Reihe von unterschiedlichen Faktoren ausgesetzt werden, deren Auspragung weitgehend unbekannt ist. Intention dieser Querschnittsstudie war es, erstmals systematisch die spezifischen Belastungen von Tumorpatienten zu Beginn einer Strahlentherapie aufzuzeigen und einen belastungsunabhangigen Betreuungswunsch zu erheben mit dem Ziel einer Belastungsreduktion und Verbesserung von Lebensqualitat und Compliance wahrend einer radioonkologischen Behandlung.

PURPOSE: To show that radiotherapy (RT) dose to the noninvolved extended field (EF) can be reduced without loss of efficacy in patients with early-stage Hodgkin’s disease (HD). PATIENTS AND METHODS: During 1988 to 1994, pathologically staged patients with stage I or II disease who were without risk factors (large mediastinal mass, extranodal lesions, massive splenic disease, elevated erythrocyte sedimentation rate, or three or more involved areas) were recruited from various centers. All patients received 40 Gy total fractionated dose to the involved field areas but were randomly assigned to receive either 40 Gy (arm A) or 30 Gy (arm B) total fractionated dose for the clinically noninvolved EF. No chemotherapy was given. RT films were prospectively reviewed for protocol violations and recurrences retrospectively related to the applied RT. RESULTS: Of 382 recruited patients, 376 were eligible for randomized comparison, 190 in arm A and 186 in arm B. Complete remission was attained in 98% of patients in each arm. With a median follow-up of 86 months, 7-year relapse-free survival (RFS) rates were 78% (arm A) and 83% (arm B) (P = .093). The upper 95% confidence limit for the possible inferiority of arm B in RFS was 4%. Corresponding overall survival rates were 91% (arm A) and 96% (arm B) (P = .16). The most common causes of death (n = 27) were cardiorespiratory disease/pulmonary embolisms (seven), second malignancy (six), and HD (five). Protocol violation was associated with significantly poorer RFS. Nonirradiated nodes were involved in 42 of 52 reviewed relapses, infield areas in 18, marginal areas in 17, and extranodal sites in 16. CONCLUSION: EF-RT alone attains good survival rates in favorable early-stage HD. The 30-Gy dose is adequate for clinically noninvolved areas. Protocol violation worsens the subsequent prognosis. Relapse patterns suggest that systemic therapy can reduce the 20% long-term relapse rate.

The use of ionizing irradiation as radiation therapy (RT) for tumor treatment represents a well-established method. The use of photodynamic therapy (PDT), especially with Photofrin II, for tumor treatment is also known. Chemical modifiers enhancing the action of radiation therapy are well known and widely used in medicine. None of these compounds, however, is a selective radiosensitizer.Several series of animal experiments were performed. The highly differentiated human bladder cancer cell line RT4 was implanted subcutaneously in nude mice. The mice were injected 10 mg/kg Photofrin II and irradiated with 5 Gy.Photofrin II has proved to be a chemical modifier of ionizing irradiation, enhancing the tumor doubling time (tumor growth) from 6.2 to 10.9 days in the control group with the use of irradiation and injection of porphyrin.Photofrin II shows a high activity as radiosensitizer and, in the future, can be used as a selective radiosensitizer for tumor treatment with ionizing radiation.

Background and objective: Ionizing radiation therapy by way of various beams such as electron, photon and neutron is an established method in tumor treatment. The side effects caused by this treatment such as ulcer, painful mastitis and delay of wound healing are well known, too. Biomodulation by low level laser therapy (LLLT) has become popular as a therapeutic modality for the acceleration of wound healing and the treatment of inflammation. Evidence for this kind of application, however, is not fully understood yet. This study intends to demonstrate the response of biomodulative laser treatment on the side effects caused by ionizing radiation by means of magnetic resonance imaging (MRI). Study design/patients and methods: Six female patients suffering from painful mastitis after breast ionizing irradiation and one man suffering from radiogenic ulcer were treated with λ =780 nm diode laser irradiation at a fluence rate of 5 J/cm 2 . LLLT was performed for a period of 4–6 weeks (mean sessions: 25 per patient, range 19–35). The tissue response was determined by means of MRI after laser treatment in comparison to MRI prior to the beginning of the LLLT. Results: All patients showed complete clinical remission. The time-dependent contrast enhancement curve obtained by the evaluation of MR images demonstrated a significant decrease of enhancement features typical for inflammation in the affected area. Conclusion: Biomodulation by LLLT seems to be a promising treatment modality for side effects induced by ionizing radiation.

Background & Aims: Appropriate management of primary gastric lymphoma is controversial. This prospective, multicenter study aimed to evaluate the accuracy of endoscopic biopsy diagnosis and clinical staging procedures and assess a treatment strategy based on Helicobacter pylori status and tumor stage and grade. Methods: Of 266 patients with primary gastric B-cell lymphoma, 236 with stages EI (n = 151) or EII (n = 85) were included in an intention-to-treat analysis. Patients with H. pylori –positive stage EI low-grade lymphoma underwent eradication therapy. Nonresponders and patients with stage EII low-grade lymphoma underwent gastric surgery. Depending on the residual tumor status and predefined risk factors, patients received either radiotherapy or no further treatment. Patients with high-grade lymphoma underwent surgery and chemotherapy at stages EI/EII, complemented by radiation in case of incomplete resection. Results: Endoscopic-bioptic typing and grading and clinical staging were accurate to 73% and 70%, respectively, based on the histopathology of resected specimens. The overall 2-year survival rates for low-grade lymphoma did not differ in the risk-adjusted treatment groups, ranging from 89% to 96%. In high-grade lymphoma, patients with complete resection or microscopic tumor residuals had significantly better survival rates (88% for EI and 83% for EII) than those with macroscopic tumor residues (53%; P Conclusions: There is a considerable need for improvement in clinical diagnostic and staging procedures, especially with a view toward nonsurgical treatment. With the exception of eradication therapy in H. pylori –positive low-grade lymphoma of stage EI and the subgroup of locally advanced high-grade lymphoma, resection remains the treatment of choice. However, because there is an increasing trend toward stomach-conserving therapy, a randomized trial comparing cure of disease and quality of life with surgical and conservative treatment is needed. GASTROENTEROLOGY 2000;119:1191-1202

Therapeutic modalities for incompletely resected pancreatic carcinoma are rare. Effective treatment must not only prolong the period of palliation but also limit the adverse sequelae of the Whipple procedure so as not to compromise the quality of the remaining life span. New treatments include the use of gemcitabine and type I interferons. We treated a patient with incomplete resection of a pancreatic tumor with two cycles of gemcitabine (1000 mg/m2) and cisplatinum (50 mg/m2) followed by radiotherapy (45 Gy/5 weeks) combined with interferon-beta (three times a week/5 x 10(6) IU). Two small liver metastases occurred subsequently. In all, four cycles of gemcitabine/cisplatinum were delivered. The patient lived at least 9 months with stable metastatic liver disease and local control. He had no acute toxic reactions except for a decrease in the leukocyte count, no long-term side effects, and a satisfactory quality of life. A regimen of sequential gemcitabine/cisplatinum and radiotherapy in combination with interferon-beta deserves further consideration as therapy for pancreatic carcinoma.

Summary Background: Comparison of accelerated radiochemotherapy (aRCT) and standard radiotherapy (sRT) in postoperative treatment after macroscopica

The occurrence of second malignancies (SM) is an important late event following the treatment of Hodgkin's disease (HD). We sought to determine the incidence, the risk factors, and the prognosis of SM in our population of patients with HD. A total of 1120 patients diagnosed with HD were registered at six participating institutions in Munich (calendar period 1974-1994). The mean follow-up for the development of SM was 9.1 years. A cumulative treatment score was calculated for both radio- and chemotherapy. The relative and absolute risks of SM were established. All SM were investigated for response to treatment and outcome. We observed 85 SM [eight leukemias, 22 non-Hodgkin's lymphomas (NHL), two plasma cell neoplasias, and 53 solid tumors]. Five patients developed third malignancies. The relative risk of developing a second neoplasm was compared with that within the normal population and was 3.1-fold. The risk varied according to the category of SM. Higher relative risks (20.5 and 25.9-fold), but lower absolute risks were observed for leukemias and non-Hodgkin's lymphomas. Solid tumors had lower relative risks (1.8-fold). Splenectomy increased the risk of SM (relative risk 4.4-fold versus 2.7-fold). The risk of SM did not correlate with the initial treatment (radio- or chemotherapy) and did not decrease with prolonged follow-up. The cumulative intensity of radiotherapy, chemotherapy, or the two modalities combined correlated with the risk of SM. Since some cases occurred early after diagnosis, not all second neoplasms can be considered treatment-associated. After 15 years, an actuarial risk of 11.7% was calculated for all SM, of 1.0% for leukemias, of 3.0% for NHL, and of 7.7% for solid tumors. The prognosis of SM varied between good (thyroid cancer, melanoma: median survival 5+ years), average (breast cancer, NHL), and poor (acute myeloid leukemias, lung cancers: median survival 9 months). With the exception of NHL, second cancers often occurred in topographic relation to the field of previous radiotherapy. Taken together, in our patient population, we observed all three categories of SM (solid tumors, leukemias, NHL). The risk for second leukemias is lower than in previous studies, whereas the risk of second NHL is somewhat higher. We confirm that splenectomy is a possible risk factor for SM. Even after correction for the age-specific cancer incidence, treatment intensity is associated with the development of second malignant tumors. Continued follow-up is mandatory after treatment for HD. Since the prognosis of most SM is unfavorable, early recognition and prevention are of the utmost importance.

Hintergrund Bei multimodalen Therapiekonzepten in der Strahlentherapie werden wiederholt therapiebedingte Leukopenien mit entsprechenden Folgen beobachtet. Bei fehlender Zulassung wurde in der Strahlentherapie dennoch unter individuellen Gesichtspunkten G-CSF (granulocyte-colony-stimulating-factor) mit Erfolg appliziert. In kleineren Patientenkollektiven konnten diese Ergebnisse in der Therapie von Leukopenien bestatigt werden. In dieser Arbeit sollten die Ergebnisse fruherer Studien bei einem groseren Kollektiv uberpruft, die postulierten unerwunschten Wirkungen verifiziert und insbesondere ein kosteneffektiver Einsatz des Wachstumfaktors (Neupogen®) aufgezeigt werden.

The BEACOPP chemotherapy regimen for advanced Hodgkin's disease employs a rearranged schedule permitting a shortened three-week cycle. With haematological growth factor support, the dosages of cyclophosphamide, etoposide and adriamycin could be moderately escalated. The 3-armed multicentre HD9 trial (recruitment 1993-1998; 1300 patients randomised) aimed to compare BEACOPP with the standard COPP/ABVD chemotherapy and to detect and measure the gain in efficacy, if any, due to moderate dose escalation of BEACOPP. Eight cycles were given, followed by local irradiation. The most recent interim analysis, with 689 evaluable patients, circa 40% of all expected events and a median observation time of 27 months, showed significant differences in progression rate (P) and in two-year freedom from treatment failure (F) between the treatment arms, with escalated BEACOPP (P = 2%, F = 89%) better than baseline BEACOPP (P = 9%, F = 81%) better than COPP/ABVD (P = 13%, F = 72%). Survival was not significantly different. Acute toxicity was more severe due to dose escalation, but remained manageable. These preliminary results suggest that BEACOPP improves efficacy. Moderate dose escalation is feasible with G-CSF support and appears likely to make a worthwhile improvement in the cure rate. The results must await confirmation (or otherwise) by the final analysis including all randomised patients and sufficiently mature data.

The influence of light emitted from a diode laser centred at lambda = 805 nm was investigated on murine skeletal myotubes (C2), normal urothelial cells (HCV29), human squamous carcinoma cells of the gingival mucosa (ZMK) and urothelial carcinoma cells (J82) in a computer-controlled irradiation chamber. Cells were treated with varying fluences between 0 and 20 J cm-2. The response was tested by analysis of the mitotic index using single cell counting after Orcein staining and proliferation index based on BrdU incorporation during DNA synthesis. While the mitotic index of C2, HCV29 and J82 cells increased at a fluence of 4 J cm-2, irradiation with fluences of 20 J cm-2 resulted in a slight decrease. ZMK tumor cells showed a decrease of the mitotic index with both fluences. No significant differences could be determined when using irradiances between 10 mW cm-2 and 150 mW cm-2. The BrdU test after irradiation showed no significant effects compared to the controls in each cell line.

Background: This investigation is done to evaluate the extent of β-Interferon-induced radiosensitization and the underlying mechanisms by which β-Interferon alters the radiation response of two different human tumours in vitro. Material and Methods: Two human tumors were studied in vitro. One was the second passage of a human squamous cell carcinoma of the head and neck (ZMK-1), the other was the breast cancer cell line MCF-7. Cells were cultured by standard methods. β-Interferon was used in concentrations from 10 to 1,000 IE/ml medium, incubation times were 3 h (pulse) or for the remainder of the incubation for colony formation (continuous). Cells were either attached to their flasks or in suspension. The cells were irradiated with 200-kV X-rays at dose levels from 2 to 10 Gy. Evaluation was done by colony assay. Results: For MCF-7 cells we found an antiproliferative effect caused by β-Interferon depending on concentrations and incubation times. When combined with X-radiation we found no additional effects of β-Interferon for both kinds of cells irradiated in suspension. When the cells were irradiated attached to their flasks, β-Interferon caused a slight radiosensibilization with respect to the MCF-7 cells and a pronounced effect with respect to the ZMK-1 cells, the isoeffect enhancement ratio being 1.5, determined at the 10% survival level. Conclusion: These results demonstrate that under the influence of β-Interferon repair of sublethal radiation damage of MCF-7 and ZMK-1 cells is decreased by a short preirradiation incubation time. Additionally, lethal radiation of ZMK-1 cells is increased by β-Interferon.

Background: Due to the increasingly common use of endocrine therapy in adjuvant and palliative therapy of breast cancer, a significant number of patients will be treated with radiation therapy and Tam

Background: High-dose-rate (HDR) remote afterloading intracavitary brachy-therapy has been widely used and is important for the treatment of carcinoma of the uterine cervix. Material and Methods: Experiences with a new flexible intracervical applicator after 56 afterloading treatments for carcinoma of the cervix in 17 patients are reported. Results: There where no complications due to the applicator or the technical system. The insertion of the flexible applicator was possible without dilatation of the cervix in all cases and without anesthesia in 19/56 applications (34%). Risk of perforation is minimal. Conclusion: We conclude that the use of flexible applicators instead of rigid steel applicators improves the technique for the delivery of high-dose-rate afterloading intracavitary brachytherapy for carcinoma of the cervix and can improve the quality of life of these patients.

Hodgkin’s disease is curable by radio- and/or chemotherapy. In limited stages most patients are treated with radiotherapy alone, which results in a high cure rate. In intermediate stages a combination

Porphyrin metabolism disorders, known as porphyria, represent inherited or acquired diseases. The development of porphyria due to light sensibility occurs especially with exposure to wavelengths in the range of 300-700 nm. Skin reactions and neurovisceral dysfunctions are known side effects of ionizing irradiation. It can be postulated that during or after ionizing irradiation treatment of patients affected with tumor and porphyria, severe side effects might appear, in contrast to patients without porphyria. This paper describes the treatment of 2 patients affected with tumor and concomitant porphyria.One female patient suffering from intermittent porphyria and breast cancer and one male patient suffering from porphyria cutanea tarda and bladder cancer were treated with ionizing irradiation (electrons and photons). No abnormalities nor any severe general or local side effects could be observed.Radiation therapy is not a 'stimulating' factor in activating porphyria symptoms.

Purpose With improved prognosis for patients with Hodgkin's lymphoma (HL), interest increasingly focuses on high-risk groups such as elderly patients. We thus performed a retrospective analysis using the German Hodgkin's Study Group (GHSG) database to determine clinical risk factors, course of treatment, and outcome in elderly HL patients in comparison with younger adults. Patients and Methods A total of 4,251 patients included in the GHSG studies HD5 to HD9 were analyzed, of whom 372 (8.8%) were 60 years or older and 3,879 (91.2%) were younger than 60 years. Patient characteristics, treatment results, toxicity, freedom from treatment failure (FFTF), and overall survival (OS) were compared. Results Elderly patients more often had mixed cellularity subtype, “B” symptoms, elevated erythrocyte sedimentation rate, and poorer performance status. Less frequently observed were nodular sclerosis subtype, large mediastinal mass, and bulky disease. Acute toxicity during chemotherapy was generally higher in elderly patients. This was most obvious for severe infections (grade 3 or 4; 15% v 6%) correlating with more severe leukopenia in elderly patients (grade 4; 38% v 23%). As a result, significantly fewer elderly patients received the intended full chemotherapy dose (75% v 91%). The survival analysis showed a significantly poorer treatment outcome for elderly patients in terms of 5-year OS (65% v 90%), FFTF (60% v 80%), and HL-specific FFTF (73% v 82%). Conclusion Elderly patients have a poorer risk profile compared with younger HL patients and experience more severe treatment-associated toxicity. Higher mortality during treatment as well as lower dose-intensity are the major factors explaining the poorer overall outcome of elderly HL patients.

Review of the role of chemoradiotherapy in the treatment of locally advanced pancreatic cancer with a specific focus on the technical feasibility and the integration of chemoradiotherapy into multimodal treatment concepts. Combined chemoradiotherapy of pancreatic cancer is a safe treatment with an acceptable profile of side effects when applied with modern planning and radiation techniques as well as considering tissue tolerance. Conventionally fractionated radiation regimens with total doses of 45-50 Gy and small-volume boost radiation with 5.4 Gy have found the greatest acceptance. Locoregional lymphatic drainage should be included in the planning of target volumes because the risk of tumor involvement and local or loco-regional recurrence is high. Up to now, 5-fluorouracil has been considered the "standard" agent for concurrent chemoradiotherapy. The role of gemcitabine given concurrently with radiation has not yet been defined, since high local efficacy may also be accompanied by enhanced toxicities. In addition, no dose or administration form has been determined to be "standard" up to now. The focus of presently ongoing research is to define an effective and feasible regimen of concurrent chemoradiotherapy. While preliminary results indicate promising results using gemcitabine-based chemoradiotherapy, reliable data derived from mature phase III trials are greatly needed. Intensity-modulated radiotherapy has been developed to improve target-specific radiation and to reduce organ toxicity. Its clinical relevance still needs to be defined.

Because late vessel failure has been speculated as a possible limitation of vascular brachytherapy, we conducted a prospective clinical evaluation at 6, 12, 24, and 36 months of follow-up after irradiation with strontium-90/yttrium-90 for in-stent restenosis, regardless of the patient's symptomatic status. We report complete 3-year follow-up data for 106 consecutive patients. The cumulative rate of death at 6, 12, 24, and 36 months was 0.9%, 0.9%, 0.9%, and 1.9% respectively. The corresponding rates for acute ST-elevation myocardial infarction were 2.8%, 4.7%, 4.7%, and 4.7%, respectively. The cumulative rate of late thrombotic occlusion at 6, 12, 24, and 36 months was 3.8%, 4.7%, 4.7%, and 4.7%, respectively. The corresponding rates of target lesion revascularization and target vessel revascularization were 8.5% and 12.3% (p = 0.046), 14.2% (p = 0.157) and 18.0% (p = 0.046), 12.3% and 18.9% (p = 0.008), and 21.7% (p = 0.083) and 29.2% (p = 0.005), respectively. The cumulative rate of all major adverse cardiovascular events at 6, 12, 24, and 36 months was 16.1%, 24.5% (p = 0.003), 27.4% (p = 0.083), and 35.8% (p = 0.003), respectively. In conclusion, these results indicate a delayed and, even in the third year after the index procedure, continued restenotic process after beta irradiation of in-stent restenotic lesions.

In-stent restenosis (ISR) represents the major limitation of stent implantation. Treatment, although of relative technical ease, is unsatisfactory due to a high incidence of recurrent restenosis. Vascular brachytherapy (VBT) has emerged as a powerful adjunct therapeutic modality to treat ISR. Inhibition of neointima formation has been regarded as the relevant mechanism of action. Yet, positive remodelling has been suspected as another contributing factor. Since only very few precise analyses of the extent, distribution and time course of the respective mechanims exist, the goal of the present study was to describe the changes of the vessel geometry at the target lesion and at the reference site following angioplasty and VBT of ISR in 42 patients by means of quantitative coronary angiography (QCA) and intravascular ultrasound (IVUS) before and after the index procedure and at the 3 and 6 month follow-up. By QCA the acute lumen gain measured 2.2+/-0.8 mm, the late lumen loss at 3 months was 0.1+/-0.5 mm and at 6 months 0.4+/-0.7 mm. By IVUS luminal cross-sectional area increased from 1.5+/-1.2 mm(2) to 7.9+/-1.9 mm(2) (p

The aim of this study was to prospectively evaluate the impact of different degrees of vessel barotrauma on the acute and 1-year clinical and angiographic outcomes of percutaneous coronary intervention (PCI) and adjunctive vascular brachytherapy (VBT) with 90Sr/90Y for in-stent restenotic lesions (ISR) in 118 patients.Sixty consecutive patients were treated according to an aggressive PCI strategy (group 1); fifty-eight were treated non-aggressively (group 2). Irradiation was performed with a manual afterloader. Clinical and angiographic baseline characteristics did not differ between groups. Group 1 yielded a higher acute lumen gain (2.3 +/- 1.2 mm versus 1.7 +/- 1.3 mm; p=0.005) and a higher prevalence of additional stent implantation (48.3% versus 22.4%; p=0.003). At follow-up, net gain (1.8 +/- 0.7 mm versus 1.4 +/- 0.8 mm; p=0.102) was equalized by a higher late loss in group 1 (0.6 +/- 0.8 mm versus 0.3 +/- 0.7 mm; p=0.036). Remaining target vessel late loss, due to edge effects, was considerably higher in group 1 than in group 2 (0.5 +/- 0.8 mm versus 0.2 +/- 0.5 mm; p0.001), leading to a higher rate of binary angiographic restenosis (23.3% versus 6.9%; p=0.013) and target vessel revascularization (16.7% versus 5.2%; p=0.046). After excluding patients who received additional stents, the angiographic differences between groups were attenuated.Our study does not support the use of oversized balloons and high inflation pressures for the treatment of ISR when combined with VBT. Additional stent implantation combined with VBT carries a high risk of repeat revascularization in the setting of ISR and should be avoided.

Patients with head and neck cancer are extraordinarily susceptible to depressive traits. Thus, a general screening of these patients at their first admission to the ital is desirable.From 1997-2001, 133 patients with head and neck tumors filled in the Self-Rating-Depression-Scale (SDS) at the beginning and end of radiotherapy (ti1/ti2), 6 weeks, and 6 months after radiotherapy (ti3/ti4). RESULTS.: The SDS index increased significantly from 46.44 (ti1) to 48.91(ti2) (p =.025) and then remained stable. The subdomain "somatic-eating-related symptoms" at ti1 was significantly lower than ti2 (p.001). In contrast to inpatients, outpatients and those with conventional instead of hyperfractionated-accelerated radiotherapy were less impaired by eating-related symptoms. Patients with higher education showed a lower SDS index and cognitive scale. Marital status, tumor stage, histologic grading, and substance abuse had no influence.Patients with a higher risk of depression should receive long-term monitoring during and after the end of radiotherapy, and prompt intervention strategies should be applied.

The purpose of this study was to determine the feasibility of a custom-made, modified bellyboard to reduce radiotherapy side effects on small bowel, bladder, skin, and male gonads. Two groups of 10 consecutive patients each were treated from January 2003 through April 2003 with neoadjuvant (45 Gy) or adjuvant (54 Gy) radio(chemo)therapy in single fractions of 5 days a week 1.8 Gy for rectal carcinoma, using a photon energy of 15 MV. One group was positioned in a prone position without an immobilization device, the other group was positioned on our bellyboard. Treatment planning was calculated by using a 4- and a 3-field box technique. Differences in the dose of organs of risk were calculated. For 1 male patient, a gonadal shielding was developed and integrated. All patients examined with the bellyboard demonstrated an anterior and cranial dislocation of the small bowel. Using a 4-field box, the mean dose to the small bowel of patients treated on our bellyboard was 56.5% as compared to 63.1% when treated without the bellyboard. When a 3-field box was used, the mean dose to the small bowel was 52.4% when the bellyboard was used, as compared to a mean dose of 63.1% without the bellyboard. Regarding the dose volume effects to the bladder, the mean dose for patients treated with a 4-field box was about 14.5% higher as compared to patients treated with a 3-field box. The mean dose to the hip joints and skin also depended on the radiation technique. The patient who received gonadal shielding received a maximal total gonadal dose of about 75.0 cGy in single fractions of maximal 3.0 cGy (TL-dosimeters). Daily setup variations evaluated by a beam’s-eye view were similar in both groups and ranged from 0.5 cm 1.0 cm. For daily use, our bellyboard appears to be an ideal compromise due to effectiveness, its easy handling, and reproductive positioning; moreover, it can also be used in combination with gonadal shielding.

Chemical modifiers (radiosensitizers) are used in order to increase the efficacy of radiotherapy. The use of Photodynamic Therapy for tumor treatment, especially with Photofrin II, is also known. At present, no chemical modifier has been found to act as a selective radiosensitizer. Experiments using several series of cell lines were performed; human bladder cancer cell line (RT4), colon adenocarcinoma cells (HT-29), and the glioblastoma cells (U-373 MG) were investigated, with and without incubation with Photofrin II, before irradiation. The irradiation was performed using doses ranging from 0 to 8 Gy. Colony forming tests were applied to determine the efficiency of Photofrin II as a radiation sensitizer in comparison to irradiation alone. Two of the cell lines tested, cultures of the RT4 and U-373 MG, treated with Photofrin II prior to radiation, showed cell survival lower than cultures untreated with Photofrin II but irradiated under identical conditions. For the HT-29 cells, the results did not differ between the two groups (with and without Photofrin). The results of this study showed that Photofrin II can act, under certain conditions as a tumor radiosensitizer.

The aim of this study was to investigate the time course of angiographic restenosis rate and late loss after successful percutaneous coronary intervention and vascular brachytherapy with beta-irradiation using strontium-90/yttrium-90 in 98 patients who were prospectively enrolled into a quantitative angiographic and clinical follow-up protocol at 6, 12, and 24 months after the index procedure, regardless of their symptom status. Actuarial restenosis rates measured 11.2 +/- 5% at 6 months of follow-up, 24.5 +/- 5% at 12 months, and 28.5 +/- 6% at 24 months, respectively. Late loss of the stent segment during the first 6 months measured 0.38 +/- 0.40 mm (6 to 12 months: 0.25 +/- 0.38 mm; 12 to 24 months: 0.16 +/- 0.32 mm), of the injured segment 0.27 +/- 0.21 mm (6 to 12 months: 0.21 +/- 0.26 mm; 12 to 24 months: 0.13 +/- 0.24 mm), of the irradiated segment 0.18 +/- 0.29 mm (6 to 12 months: 0.19 +/- 0.31 mm; 12 to 24 months: 0.11 +/- 0.27 mm), and of the analysis segment 0.18 +/- 0.36 mm (6 to 12 months: 0.17 +/- 0.29 mm; 12 to 24 months: 0.11 +/- 0.20 mm). Restenosis after angioplasty and beta-irradiation of in-stent restenotic lesions is not complete within 6 months but is sustained with a gradual decrease over 24 months.

Purpose: To investigate whether radiotherapy can be reduced without loss of efficacy from extended field (EF) to involved field (IF) after four cycles of chemotherapy. Patients and Methods: Between 1993 and 1998, patients with newly diagnosed early-stage unfavorable HD were enrolled onto this multicenter study. Patients were randomly assigned to receive cyclophosphamide, vincristine, procarbazine, and prednisone (COPP) + doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) for two cycles followed by radiotherapy of 30 Gy EF + 10 Gy to bulky disease (arm A) or 30 Gy IF + 10 Gy to bulky disease (arm B). Results: Of 1,204 patients randomly assigned to treatment, 1,064 patients were informative and eligible for the arm comparison (532 patients in arm A; 532 patients in arm B). The median observation time was 54 months. Five years after random assignment, the overall survival (OSran) for all eligible patients was 91% and freedom from treatment failure (FFTFran) was 83%. Survival rates at 5 years after start of radiotherapy revealed no differences for arms A and B, respectively, in terms of FFTF (85.8% and 84.2%) and OS at 5 years (90.8% and 92.4%). There also were no differences between arms A and B, respectively, in terms of complete remission (98.5% and 97.2%), progressive disease (0.8% and 1.9%), relapse (6.4% and 7.7%), death (8.1% and 6.4%), and secondary neoplasia (4.5% and 2.8%). In contrast, acute side effects including leukopenia, thrombocytopenia, nausea, gastrointestinal toxicity, and pharyngeal toxicity were more frequent in the EF arm. Conclusion: Radiotherapy volume size reduction from EF to IF after COPP + ABVD chemotherapy for two cycles produces similar results and less toxicity in patients with early-stage unfavorable HD.