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In breast cancer preoperative determination of the tumor size is important for planning breast-conserving operations. In 100 patients with breast cancer, the preoperative tumor size was measured using clinical, mammographic and sonographic examinations and correlated with the results of a subsequent histological examination. Using a high-resolution real-time system, 98 tumors were visible. It was possible to detect not only early tumors under 1 cm in diameter, but also intraductal tumor components. This contributed greatly to the accuracy of the diagnosis. The sonographic measurement of tumor size demonstrated a correlation coefficient of 0.91 and was thus superior to mammography (0.79) and palpation (0.77). Measurement of the total tumor spread, including 39 multicentric lesions, showed an overestimation of 5% for the mammographic measurements and an overestimation of 4% for the sonographic measurements. Tumor extension was underestimated in 33% of the mammograms but in only 3% using ultrasound examination. The results, along with those of other studies, highlight the role of sonography in the diagnosis of breast cancer.

From 1976 to 1985 151 recurrent carcinomas of the uterine cervix were diagnosed and in 118 cases they have been treated at the Gynaecological Centre of the University of Freiburg. The recurrences were divided according to the localisation scheme of Munnell and Bonney. 55 patients (47%) received radiotherapy, 22 (19%) surgery, 12 (10%) combined therapy of surgery and radiotherapy and 13 women (11%) chemotherapy or hormone therapy. 16 patients (13%) received a different type of therapy. We found most of the recurrences three or four years after the primary therapy. There was no correlation between the point of time of diagnosis of the recurrences and the prognosis. The distribution of the histology was no parameter for the OAS. The operative procedure demonstrates better results than the radiotherapy at recurrences in the centre of the pelvis--but there is no significance. The radiotherapy achieves significant better results than the operative treatment when we have large recurrences in the whole pelvis. If there is an answer of the tumour to the therapy, the OAS gets better--in these cases we should use, in spite of the risk of more side effects, the whole therapeutic range.

The increase in the occurrence of corpus carcinoma and the influence that special problems (accompanying diseases, age, histology, radiation technique) have on the survival of the patient make it necessary to reconsider indication and technique in radiation. Even though 80% of the cases are in stage I which indicates a favourable prognosis for surgical treatment, many new therapeutical questions have presented themselves and should not, in the future, need to be answered by the experience in clinics or in medical centers alone. Patients with corpus carcinoma should therefore not be treated on the basis of a fixed program, rather, through a flexible program suited to the individual patient's needs. Aside from the demands for precise histological diagnosis (including grading) and better grouping of the stages (pelvic and paraaortic lymphnode involvement in stage I at least 10%, in stage II 40%!) future analysis should be improved, resulting in a decision for higher grading or an increase of the dose in radiation therapy of the tumor in the 2. and 3. stages. In order to accomplish this, better techniques in radiation therapy and communication with the gynecologists and pathologists is necessary, so that a mutual concept for therapy, improving the chances of cure can be developed. Proof that this is entirely possible can be seen in statistics of the last years (Annual Report 1981, results from Department of Gynecology, Freiburg i. Br.).

An investigation was conducted in order to determine the effect of combined high voltage irradiation and the sensitizing drug misonidazole (Ro-07-0582) on human gynecologic carcinomas transplanted into nu/nu mice with thymic aplasia. Two carcinomas of the endometrium, two carcinomas of the ovaries, and one carcinoma of the cervix were submitted to Co-60 irradiation with and without misonidazole. The tumor growth was compared to that of control groups. The dosage and fractionation of the high voltage irradiation (2 x 5 Gy/week, total dose 60 Gy) were adapted to clinical data. Misonidazole (1 mg/kg body weight) was administered by intraperitoneal injection 15 minutes before the irradiation. Compared with the control animals, the locally irradiated tumors showed a slower growth or even a regression. The administration of misonidazole, however, did not produce significant differences in our five cases. Some reasons for this absence of the radiosensitizing effect of misonidazole are briefly discussed.

Eleven hundred rats with tumours were administered vitamin B6 (pyridoxine or pyridoxal-5-phosphate) before a single local irradiation of 10 Gy. No difference in the survival rate was found in comparison with control animals. Thus vitamin B6 in the dose used afforded no significant protection against local radiation in rats. The 24-hour-xanthurenic acid excretion in urine increased with growth of the tumor and was further elevated by local radiation (10 Gy). Radiation as well as the tumour itself induce in the rat metabolic changes typical of vitamin B6 deficiency.

Even today the therapeutic strategy in the treatment of breast cancer is governed by prognostic factors, such as the size and type of the tumor, histological grading, and the number of lymph node metastases. In addition to other criteria, a decision must also be made as to whether changes in the radiotherapy technique (dosage, means of boostering) might lead to better results in the treatment of carcinoma of the breast in patients in poor condition. Several studies indicate that the effectiveness of irradiation can be improved (even with respect to longterm results) by alterations in the technique and careful adaptation to the surgical procedure.

Not only the effect of cytostatic drugs and hormones, but also that of ionizing radiation can be tested after transplantation of human tumoral tissue into nu/nu mice with thymic aplasia. In this study, the effects of high voltage irradiations dosed up to 60 Gy (fractionation 2 X 5 Gy per week) to three carcinomas of the endometrium, three carcinomas of the cervix, three ovarian carcinomas, and one mammary metastasis of an immunoblastic sarcoma were observed during a period of 120 days. This irradiation plan could be performed without problems in eight cases, in two cases it had to be stopped after 50 Gy. Nine tumors decreased significantly in size, reaching sizes which were below those measured before irradiation. In six among the nine cases, the tumors grew again after different periods of observation. In case of rather long periods of observation, those points within the curves of development can be taken as efficacy indices which are representing the lowest or the initial values of tumor sizes. In another study, the effects of high voltage irradiation to tumors of the nude mouse are correlated to those found in the corresponding patients.

Methods of radiology, lymphography, and computer tomography included, are not used in all patients with ovarian cancer, neither in the preoperative phase nor in the search for the recurrence. Therefore these improved X-ray diagnostic possibilities are discussed. We describe the role of lymphography, sonography, and computer tomography in the diagnosis of ovarian cancer.

It is important to select the patients for irradiation treatment with great care. A review will be made of the existing data on the value of radiotherapy. The main factors which must be taken into consideration in order to improve radiation results are: type of radiation, modalities of treatment volume and radiation dose, biological parameters, and the combination of cytostatic agents and radiotherapy. Recent studies taking these factors into account have demonstrated a significant improvement in the results of radiotherapy of ovarian cancer.