The Development Of Gynecological Radiotherapy/Oncology In Sweden

The development of gynecological radiotherapy and oncology during this century has changed the methods of diagnosis and treatment of cancer and given better results. From the beginning the gynecologist could only palpate and inspect. Later on roentgen examination was introduced and later still microscopic diagnosis, more advanced diagnostic methods, e.g. endoscopy, ultrasound, isotope examination, advanced microscopic diagnosis and computerized tomography. In parallel with the development in diagnosis, treatment has developed. To start with surgery was the only method available. Later on intracavitary radiation, low energy radiation, endocrine therapy, chemotherapy and high energy treatment became available along with some experimental therapies. Today we have a broad range of therapeutic tools to use. In the future we might use profylaxis more than we do today to prevent cancer and when cancer is already there we might enhance the immune defense or introduce specific immunotherapy with clonal antibodies, specially made for the actual tumour, and consequently surgery, radiotherapy and chemotherapy will be often less used.

It is, of course, impossible in a short paper to review fully the development of gynecological radiotherapy/oncology in Sweden. The following is a short review based on my personal selection of some important and interesting developments in the field of gynecological radiotherapy/oncology, especially treatment of cancer of the cervix uteri (1).     

Organization Of Radiotherapy And Clinical Oncology In Sweden A Historical Review

The organization of radiotherapy and oncology in Sweden is described, from the first small pioneer roentgen institutes, via the early Radiumhemmet and King Gustaf V's Jubilee Clinics, up to the present organization with its regional coordinating oncologic centres and Department of oncology and radiotherapy at the regional hospitals, as well as at some large central county hospitals. The great importance of Gosta Forssell's early organizing work and foresight for this development is underlined.     

Development Of Clinical Radiotherapy Since 1896

From the discovery of x-rays in November 1895 and the first publication in December 1895 it did not take long for the first x-ray therapy of cancer in January 1896. The first 25 years in the history of radiotherapy was not a very flattering period for the discipline. During the following 25 years, however, important developments in clinical radiotherapy occurred and in some countries the specialty of radiotherapy was established in the 1930s. In the last 50 years gradual changes have taken place and now modern radiotherapy is an established curative method in the treatment of cancer. The scientific background of radiotherapy is solid, and the understanding of cancer biology and radiobiology has improved drastically. The radiotherapists of today are cancer specialists, oncologists. The technical development has been enormous. The future of radiation oncology looks very promising, with local cancer treatment being shown to be most effective.     

Transrectal Ultrasonically-Guided Core Biopsies In The Assessment Of Local Cure Of Prostatic Cancer After Radical External Beam Radiotherapy

Fifty-five patients were included in an extended follow-up after radical radiation therapy (RRT) for localized prostatic cancer (T1-3, Nx, MO). Local cure was assessed by a combination of digital rectal examination (DRE), transrectal ultrasound (TRUS) and systematic 'mapping' with TRUS-guided core biopsies (TGCB). After a mean follow-up of 6.8 years, 33% (18/55) of the patients were locally free of tumour, while in 67% (37/55) of cases residual cancer was demonstrated in the biopsies. Endocrine treatment did not influence the local cure rate, nor did the T stage of tumour grade at diagnosis or the cumulative radiation effect (CRE) values within the range of the present study. The sensitivity of DRE and TRUS was low; 37% and 20% respectively, while the specificity of the DRE and TRUS methods was 83% and 94% respectively. The conclusion of the study is that residual tumour was found in the high proportion of biopsied patients nearly 7 years after RRT and that multiple, TRUS-guided core biopsies are mandatory in the assessment of local cure in patients irradiated for prostatic cancer; both DRE and TRUS on their own are less reliable.     

The Impact Of Lymph Node Metastases On The Results Of Treatment By Primary Radiotherapy And Secondary Surgery In Oropharyngeal Cancer

The prognostic significance of lymph node metastases was evaluated in an unselected material of 427 oropharyngeal cancer patients treated primarily with radiotherapy. At first referral, palpable lymph node metastases were present in 60% of the patients. After irradiation, 60% of all palpable nodes had disappeared. As many as 50% of the nodes initially palpable in N3 patients vanished after irradiation. Recurrences were significantly increased in patients primarily with lymph node metastases (N1-3) compared with No. patients; recurrences in the primary tumour site were (56% vs. 43%) in neck lymph nodes (40% vs. 9%) and in distant metastases (14% vs. 5%). Surgery was performed in 98 of 256 patients (38%) with recurrent or metastatic disease. The 5-year disease-free survival rate after radiotherapy for NO patients was an improvement (44%) on that of Nl-3 patients (23%). The N-stage is an important prognostic factor for oropharyngeal canter patients.     

The Challenges of Using MRI During Radiotherapy

In this article we aim to introduce the main considerations in integrating magnetic resonance imaging (MRI) into the radiotherapy workflow. We will cover the use of MRI for improved delineation, considerations regarding MRI-only workflows, and the potential of functional imaging techniques. The challenges of implementing each of these will be discussed to ensure safe usage in radiotherapy.     

Resources and Productivity in Radiation Oncology in Denmark, Finland, Iceland, Norway and Sweden During 1987

Data concerning megavoltage equipment and use of mega-voltage external beams in cancer management during 1987 in Denmark, Finland, Iceland, Norway, and Sweden were collected from all 37 centres serving a population of 23 million in these countries. Population per Linear Accelerator Equivalent (LAE) unit ranged from 0.30 million/LAE unit (Denmark) to 0.19 million/LAE unit (Sweden). the number of field treatments were 227 548 (Denmark), 259 917 (Finland), 10 426 (Iceland), 147 960 (Norway) and 490 126 (Sweden). the number of field treatments per million population per year ranged from 35 229 (Norway) to 58 438 (Sweden). the number of field treatments per LAE unit/year ranged from 13 192 (Denmark) to 9 546 (Norway). the fraction of cancer patients receiving megavoltage radiotherapy in 1987 out of all newly diagnosed cancer patients during 1987 was 24% in Denmark, 37% in Iceland, 25% in Norway, and 34% in Finland and Sweden. We conclude that Denmark and Norway probably did not provide adequate levels of radiotherapy for their cancer patients during 1987.     

HPLC测定细胞中阿霉素及其在筛选耐药逆转剂中的应用

 阿霉素(简称ADM)是肿瘤化疗中常用的药物。 本文介绍一种用高效液相色谱(HPLC)测定耐药细胞中ADM的方法, 该方法处理简单、灵敏度高, 仪器的最低检出量为8.621pmol, 在20～344.8pmol范围内呈现良好的浓度一峰高线性关系, 并利用该方法时行ADM耐药逆转剂的筛选研究, 认为潘生丁、环抱菌素A可作为ADM耐药的逆转剂。     

The Doses Received by the Breast During Mantle Radiotherapy

Purpose: To accurately measure the dose received by the breast during mantle radiotherapy.Methods and Materials: A phantom containing lung-equivalent material was used to measure the doses received by the breast during mantle radiotherapy given by anterior and posterior opposing fields. These were measured using thermoluminescent dosimeters and compared with point dose calculations obtained by computer planning.Results: Most of the breast lies under the lung shields or inferior to the mantle field, but the upper outer quadrant of the breast remains unshielded. In the unshielded areas of the breast, the average dose measured was nearly 13% higher than the dose prescribed at the central axis. In the shielded parts of the breast, the average measured dose was nearly 10% of the dose prescribed at the central axes, decreasing from 18% superiorly to 4% inferiorly. The posterior field contributed 45% to the dose in the breast, even though doses were prescribed at the midplane. The computer calculations systematically varied from measured doses by up to 35%, becoming less accurate towards the inferior edge of the field.Conclusions: In a conventional course of mantle radiotherapy (for example, 36 Gy in 20 fractions), most of the breast is shielded but will receive a dose of 3–4 Gy, higher than expected largely due to internally scattered radiation passing through the lungs from the posterior field. Computer dose calculations may poorly reflect actual off-axis doses in large fields with complex shielding, containing inhomogeneous tissue.     

On The Use Of Bradykinin In Arteriography Of The Arm

Bradykinin injected intra-arterially immediately prior to arteriography of the arm increases the contrast filling of both arteries and veins of the arm and hand, if the vessels still have a capacity for dilatation. If an appropriate dose is used in relation to the size and location of the examination area, no side-effects are obtained.     

生活质量量表在肿瘤内科中的应用

生活质量是一个多维的概念,包括躯体的、心理的、社会的以及很多主观层面的内容.生活质量量表的种类较多,临床可根据需要选择合适的量表,评估癌症患者的生活质量,以协助选择合适的治疗方案,并评价疗效及预后.