Die postoperative Strahlentherapie beim Endometriumkarzinom Eine retrospektive Analyse von 541 Patienten

PURPOSE: This retrospective study was designed to evaluate the role of adjuvant radiotherapy for surgically treated endometrial carcinoma. PATIENTS AND METHODS: From 1980 through 1988, 541 patients were treated with either intravaginal cuff irradiation with a high-dose-rate (HDR) Iridium-192 remote afterloading technique (n = 294) or with combined HDR-brachytherapy and additional external pelvic irradiation to 54 Gy (n = 247) after surgery for endometrial cancer. Afterloading irradiation was administered in 4 fractions 4 to 6 weeks after surgery. A dose of 30 Gy was delivered at a depth of 0.5 cm from the vaginal mucosa. RESULTS: Patients with HDR-brachytherapy alone showed a 5-year survival of 94.3% for Stage I and 73.6% for Stage II (p = 0.0007). Patients who received both brachytherapy and additional external pelvic irradiation had a 5-year survival of 94.1% for Stage I, 81.1% for Stage II, 70.4% for Stage III and 46.9% for Stage IV (p = 0.0001). The main predictors for survival in a multivariate analysis were stage and grading. Patients with combined radiotherapy had a local recurrence rate of 3.2%, whereas patients with brachytherapy alone who were better selected and had more favorable prognostic factors showed a recurrence rate of 2%. Low-risk patients (Stage I, Grade 1, low infiltration) in the HDR-brachytherapy group had 6 relapses, mainly caused by insufficient treatment on the basis of papillary histology. High-risk patients with poorly differentiated tumors, which infiltrate more than half the myometrial wall might benefit from additional external radiotherapy in terms of reduction of local recurrence and better survival. Five-year actuarial survival rate was 93.6% after combined radiotherapy vs 86.7% after brachytherapy alone. Complications were graded according to the RTOG scoring system. Severe late complications were fistulas of bladder and/or bowel, which occurred in 2.8% in the combined radiotherapy group, and 0.7% in the HDR brachytherapy group. CONCLUSIONS: Low-risk patients should be generally treated postoperative with HDR-brachytherapy alone. Combined radiotherapy decreased pelvic relapses for high-risk patients with overall low complication rates. We conclude that an individually adjusted postoperative radiotherapy allows a well tolerated treatment with excellent results.     

Radiotherapy of epidermoid anal canal cancer

Forty-eight patients with anal canal cancers were treated with surgery and irradiation or irradiation alone during the period 1970-1982. All cases were treated by external megavoltage equipment. The overall 5-year survival was 50%, and the local recurrence rate 33%. According to the therapy, four major groups were analysed: radical surgery followed by post-operative irradiation (5-year survival 43%, local recurrence rate 38%), incomplete major surgery and post-operative irradiation with very inferior prognosis (none of the patients surviving beyond 52 months). Two groups of patients had sphincter-saving procedures: local surgery followed by irradiation (5-year survival 78%, local recurrence rate 22%) and primary irradiation (5-year survival 57%, local recurrence rate 14%). Lymph node positive patients showed a median survival of 24.5 months against 52 months in N0 cases (5-year survival 21% against 50%). Side-effects of radiotherapy were transient and mild, and no late severe sequelae were seen. The data indicate that post-operative external radiotherapy seems insufficient and unable to decrease the local recurrence rate, especially when surgery is incomplete. Both spincter-saving surgery and radiotherapy, as well as primary irradiation, are effective treatment modalities. These data are analysed and future aspects considering combined radiochemotherapy are discussed.     

Peripheral soft tissue sarcomas. A retrospective study on 90 primary treatment patients

Between 1960 and 1982, 90 patients treated primarily for peripheral soft tissue sarcomas received a postoperative irradiation at the Irradiation Department of the St?dtische Krankenhaus Passau. Five patients (6%) were inoperable for internistic reasons and were treated only by radiotherapy. The local recurrence rate after combined therapy was 26%. 44% of the patients (40/90) developed metastases, preponderantly in the lung and within the first year (70% each). The age-corrected survival rate was 63% after five years and 43% after ten years in 79 patients with complete postoperative irradiation. Important prognostic factors are the degree of malignancy (five-year survival times of 57 patients: almost 90% for G1 tumors, 50% for G2 tumors, and 17% for G3 tumors, statistically significant) as well as the completeness of surgery. It is shown by the available results that conservative surgical interventions combined with radiotherapy are not less effective than more radical operations.     

Endometrial carcinoma in patients aged 75 years or older: outcome and complications after postoperative radiotherapy or radiotherapy alone.

A retrospective analysis is reported of 89 patients at least 75 years old (median age 79 years) treated with irradiation for endometrial carcinoma between 1972 and 1989, the median follow-up being 39 months. In 66 patients radiotherapy was given postoperatively and in one case preoperatively, 22 patients were treated with radiotherapy alone: intravaginal insertions exclusively in 22 patients (median dose 60 Gy to the mucosa) and combined with external radiotherapy in 53 patients (median external target dose 45 Gy; three or four fields, all treated daily, 1.8 to 2.0 Gy per fraction, five fractions per week; 30 Gy to the vaginal mucosa with low-dose rate). A few patients were treated with external radiotherapy or intrauterine insertions only. 65% of the patients treated with radiotherapy alone and 34% of the patients receiving postoperative radiotherapy had FIGO stage II or III disease. Five-year actuarial overall survival and disease-free survival for all patients with adenocarcinomas treated with curative intent was 47.5% and 57.2%, respectively. In 48 patients with surgical stages I and II, treated with postoperative adjuvant radiotherapy, overall actuarial survival is 58.2% and disease-free survived 65.5% at five years. After postoperative vaginal insertions only, no vaginal recurrence occurred. With combined external and intravaginal radiotherapy in surgical stage I and II, 4/36 patients (11%) showed a recurrence in the vagina only, the abdominal and pelvic recurrence rate being 8.3%. Grade 3 to 4 late toxicity was observed in 6/53 patients (11.3%) treated with external and intravaginal radiotherapy. However, in patients receiving external radiotherapy less than 45 Gy and intravaginal radiotherapy 30 to 40 Gy, as is standard postoperative adjuvant treatment today, only one grade 3 late toxicity was observed in 17 patients (5.9%). We conclude, that treatment of elderly patients with adenocarcinoma of the uterus should follow the same pattern as in younger patients, the acute side-effects and late toxicity of radiotherapy being similar.     

Results of interstitial curietherapy and combined transcutaneous radiotherapy-curietherapy in 150 patients with carcinoma of the tongue and/or mouth floor

The authors report their experience on the treatment of carcinoma of the oral tongue and floor of the mouth with interstitial brachytherapy, alone or in combination with external irradiation. One hundred and fifty patients were treated; among these, 116 with brachytherapy alone, 34 with combined treatment. The five years local control in those patients treated with brachytherapy alone was 72.5% in T1, 61.2% in T2 and 35% in T3; in those patients treated with external irradiation and brachytherapy the global five years control was 42.5%. The global five years survival was 64% in the patients treated with brachytherapy alone and 48% in the patients treated with combined therapy.     

Effect of misonidazole in preoperative irradiation for bladder cancer followed by total cystectomy

Between 1980 and 1984, 44 patients were treated for bladder cancer by preoperative irradiation of 40 Gy to the pelvic region followed by total cystectomy. These patients were prospectively divided into two groups at random. In 23 cases, 500 mg of misonidazole (MISO) was administered four hours prior to irradiation. Twenty-one patients were preoperatively treated by radiation alone. Most patients had histopathological grading of G3-4, and the distribution of T-factors in the two groups was comparable. Thirty-seven patients out of 44 underwent total cystectomy within three weeks after irradiation. pT-factors were carefully examined in resected specimens. Survival rates were calculated by the Kaplan-Meier method. The 5 year survival rate for T3 patients in the group treated by MISO combined with radiotherapy was 59%, while that for T3 patients in the radiation only group was 43%. A reduction in T-factors was observed in 9 of 17 T3 cases treated by MISO combined with radiation, and in one of 14 T3 cases treated by radiation alone. This finding was significant on chi-square test (p = 0.02). Since the survival rate of T3 patients with a reduction in T-factors by preoperative irradiation was superior to that of cases without reduction (70% vs. 43%), the combined use of MISO in preoperative irradiation seems to be useful for the treatment of T3 bladder cancer.     

Die kombinierte Behandlung des lokal begrenzten Prostatakarzinoms mit HDR-Iridium-192-Nachlade-Brachytherapie und perkutaner Bestrahlung

BACKGROUND: The localized prostate cancer can be treated curatively by radiation therapy. The combined treatment of external beam irradiation and HDR-Iridium 192 remote brachytherapy allows higher radiation doses within the tumor without increasing radiation sequelae. PATIENTS AND METHODS: Patients of our clinic have been treated with this combined procedure since 1991. Between 1991 and 1994 15 patients received 2 x 9 Gy of high-dose-rate brachytherapy, followed by 36 Gy external beam irradiation (group A). Because of the frequent local failures in group A, the reference dose of external beam irradiation was increased to 50.4 Gy after brachytherapy between 1994 and 1996. RESULTS: Seven of 15 patients (47%) in group A developed a local recurrence after a median of 17 (13 to 30) months. In group B (20 patients) local failure occurred in 3 patients (15%) after 11, 16 and 32 months. CONCLUSION: The combined radiation therapy of localized prostate cancer cannot substitute radical prostatectomy completely, but it is a promising alternative in the curative treatment in selected patients.     

铜蒸气脉冲激光治疗慢性胃炎42例临床观察

本组将激光加药物治疗各种慢性胃炎与单服药物治疗进行比较,前者总有效率约为90.5％,后者约为35.0％,二者有效率相差55.5％,尤其对慢性萎缩性胃炎也有较好的效果。经观察激光加药物治疗组的复发率(23.8％)较单服药物组的复发率(55.0％)明显降低。     

The results of treatment of carcinoma of the uterine cervix using a linear vaginal source and 4 MV X rays

Between 1960 and 1976, 1645 women with carcinoma of the uterine cervix were treated in the Radiotherapy Department, Edinburgh. In the earlier years the majority of patients were treated using a partially afterloaded radium line source system, combined with 4 MV external irradiation. The radium was later replaced by caesium which, from 1972, was used in a fully afterloaded line source intracavitary applicator. In recent years a computer program has been used to calculate the dose distribution, resulting in improved pelvic dosimetry and a decline in the frequency and severity of radiation reactions. Actuarial survival rates are reported by stage for a 20-year period. The 5-year survival rate for patients with Stage I disease treated by the Edinburgh method was 74.7% (71.5% for the whole group). For patients with Stage II disease, the rates were 57.1% and 51.3% and for those with Stage III disease, the rates were 40.1% and 28.0%.     

A retrospective analysis of the use of brachytherapy in relation to early stage squamous cell carcinoma of the oropharynx and its relationship to second primary respiratory and upper digestive tract cancers

The purpose of this study was to retrospectively evaluate brachytherapy for early stage squamous cell carcinoma of the oropharynx (SCO) in relation to second primary respiratory and upper digestive tract cancers (RUDT). Between 1976 and 2001, 111 previously untreated patients with stage I or II SCO were treated with Au-198 seed brachytherapy alone (36 cases) or Au-198 seed brachytherapy plus external irradiation (75 cases). Of the 111 patients, 28 patients had stage I disease and 83 patients had stage II disease. Each patient was evaluated for therapeutic efficacy, post-treatment quality of life (QOL) and a second cancer. The 5-year and 10-year cause-specific actuarial survival rates for stage I and II SCO were 87% and 86%, respectively. We found that the 5-year and 10-year survival rates for all SCOs combined with second primary RUDT cancers were 71% and 45%, respectively. 51 second primary RUDT cancers occurred successively in 41 patients following treatment for early stage oropharyngeal cancer and this was the sole prognostic factor by the multivariate analysis. Au-198 seed brachytherapy with or without ipsilateral external irradiation of up to 30 Gy was associated with fewer late complications in the oral cavity and salivary gland. We concluded that our treatment policy of brachytherapy with or without external irradiation for patients with early stage SCO was effective and acceptable from the standpoint of tumour control and post-treatment QOL.     

Intraarterial chemotherapy of head and neck tumors

Forty-one patients with advanced recurrent or untreated and neck tumors were treated with intraarterial short-term (1-1 1/2 hr) infusion of cisplatin into the external carotid artery, achieving an immediate tumor response rate of 29.3%. Tumor extent within or beyond the territory of a single external carotid artery was the only significant factor identified affecting the tumor response rate (57.1% vs. 14.8%). Treatment with intraarterial chemotherapy using superselective catheterization before irradiation or surgery is beneficial in some patients.     

Radiotherapy of carcinoma of the uterine cervix--high dose rate intracavitary irradiation using a linear source arrangement

We analyzed the records of 339 patients with squamous cell carcinoma of the uterine cervix. The patients were treated by irradiation alone in the period of 1973-1985 with external and high-dose rate intracavitary irradiation using linear source arrangement. The reason for using the linear source arrangement was to ensure the position of source as well as to simplify the technique of intracavitary irradiation. First, external irradiation was performed mainly with a dosage of 50Gy/25f four times a week or 50.4Gy/28f five times a week. Intracavitary irradiation was then carried out mainly with a dose of 30Gy/6f two times a week or 35Gy/7f two times a week and dose was indicated at point A. The 5-year survival rate of all 330 patients were 51.4%, and 55.1% for stage I (N = 19), 66.7% for stage II (N = 88), 47.1% for stage III (N = 212), 33.7% for stage IV (N = 20). Of the patients followed up for 24 months and found to have recurrence, 21.8% (39/179) had a recurrence in the pelvis and 22.1% (39/175) were found to have a distant metastasis. Of the patients followed up for over 24 months, 21.5% 932/149) developed intestinal complications and 12.2% (18/149) developed bladder complications. However complications Grade 2-4 were 5.4% for intestinal complications and 2.0% for bladder complications. From these results high-dose-rate intracavitary irradiation using a linear source arrangement was considered to be an effective treatment of carcinoma of the uterine cervix and to produce a standard results of treatment.(ABSTRACT TRUNCATED AT 250 WORDS)     

Langzeitergebnisse der postoperativen Strahlentherapie des Endometriumkarzinoms im Stadium I

BACKGROUND: Surgical resection is the primary treatment in stage I endometrial carcinoma. Retrospective analyses support the value of local vaginal irradiation to avoid vaginal recurrences to be relatively proven. The impact of an additional external beam irradiation of the pelvis considering different prognostic criteria is still unclear. PATIENTS AND METHODS: From January 1986 to December 1995 a total of 128 patients with a stage I endometrial carcinoma were treated in our clinic with postoperative radiotherapy. Depending on the prognostic factors from literature, 68 patients received an HDR-brachytherapy and 60 patients a combined treatment with external beam irradiation and HDR-brachytherapy. The median follow-up was 62.1 months. The statistical analysis was performed as a retrospective cohort study. RESULTS: Depth of tumor invasion and grading could be identified as statistically significant prognostic factors for local recurrence-free and tumor-specific survival. It could be shown that an additional external beam irradiation is indicated with a tumor invasion of more than 50% of the myometrium. In the majority of cases grade I and II radiation-associated side effects were observed. Chronic side effects grade 3 and 4 at the bowel and the rectum occurred in less than 4% of cases in the combined treatment group. CONCLUSIONS: The addition of external beam irradiation to intravaginal brachytherapy is useful in tumors with more than 50% infiltration of the myometrium. Severe side effects were seen in less than 4% in combination treatment.     

Surgical and radiotherapeutic treatment in stage I endometrial adenocarcinoma. Retrospective analysis of 218 patients

From April 1977 through April 1985, 218 stage I endometrial carcinomas were treated with radiosurgery or radiotherapy alone. Postoperative irradiation was external (60Co) in 131 and curietherapy in 27 patients. Twenty patients underwent preoperative curietherapy and 40 patients radiotherapy alone. Median follow-up was 5.6 years (range 3-11). The overall 5-year actuarial survival (Kaplan-Meier method) was 86.1% +/- 2.5. The 5-year D.F. actuarial survival was 95% +/- 4.9, 93.1% +/- 4.7, 88.4% +/- 2.9, respectively, for preoperative radiotherapy, postoperative curietherapy and postoperative external irradiation groups. The 5-year actuarial survival was 69.8% +/- 7.7 in the radiotherapy alone group. There was difference in survival among patients treated with radiotherapy alone as compared to those radiosurgically treated (P less than 0.001). Local and general recurrence rate was 8.2%; vaginal recurrences 2/218 (0.9%); pelvic recurrences 7/218 (3.3%); distant metastases 9/218 (4.1%). Overall side effects were observed in 20/218 patients (9.1%): grade I and II in 8.6% of cases, grade III in 0.9% of cases. The authors conclude that good results can be achieved with adjuvant radiotherapy both in high risk cases and in low risk cases, with minimal side effects.     

有限内固定结合外固定支架治疗复杂胫骨平台骨折的疗效分析

目的探讨有限内固定结合外固定支架治疗复杂胫骨平台骨折的临床效果。方法选择2010年1月~2013年6月在新疆维吾尔自治区人民医院米东医院外科收治的复杂胫骨平台骨折患者92例(SchatzkerⅣ型41例,Ⅴ型25例,Ⅵ型26例),男性61例,女性31例;年龄31~77岁,平均54.2岁。所有患者均为开放性骨折(Gustilo分型:Ⅰ型38例,Ⅱ型26例,Ⅲ28例),按照随机数字表法分为观察组和对照组,各46例。观察组采用有限内固定结合外固定支架治疗,对照组采用单纯钢板内固定传统手术治疗。对比两组手术情况、术后骨折愈合情况以及关节炎发生率,并对伤膝关节功能进行评估。结果观察组手术时间、术中出血量、术后愈合时间以及微动移位分别为(183.09±26.47)min、(304.75±51.47)mL、(0.57±0.11)周、(0.14±0.03)mm,均显著低于对照组的(213.47±34.23)min、(361.37±56.83)mL、(0.74±0.15)周、(0.31±0.07)mm;观察组术后膝关节评定优良率以及术后愈合率分别为97.83%(45/46)和93.48%(43/46),均显著高于对照组82.61%(38/46)和78.26%(36/46),而术后关节炎发生率观察组2.17%(1/46)低于对照组13.04%(6/46),上述差异均有统计学意义(P0.05)。结论有限内固定结合外固定支架治疗复杂胫骨平台骨折对患者造成的创伤小,术后恢复快,并且愈合程度高、关节炎发生率低,适合临床推广应用。     

内固定结合铰链式外固定支架治疗复杂肘关节骨折

目的探讨铰链式外固定支架结合内固定治疗复杂肘关节骨折的疗效。方法回顾性分析2010年5月~2015年3月收治的复杂肘关节骨折患者46例,26例行内固定结合外固定支架治疗(外固定支架组),其中肘关节"恐怖三联征"12例,后孟氏骨折6例,经鹰嘴骨折脱位8例;20例行内固定结合可调节支具外固定治疗(可调节支具组),其中肘关节"恐怖三联征"10例,后孟氏骨折5例,经鹰嘴骨折脱位5例。所有患者均行切开复位内固定术,外固定支架组结合铰链式外固定支架固定,可调节支具组术后采用可调节支具外固定。末次随访时采用Mayo肘关节功能评分(MEPS)评定肘关节功能。结果所有患者获得术后10~24个月(平均16.8个月)随访,所有患者骨折均获骨性愈合,外固定支架组愈合时间为(12.6±2.4)周,可调节支具组愈合时间(13.8±3.6)周,差异无统计学意义(P0.05)。外固定支架组肘关节平均屈伸范围为129.98°±12.59°,前臂平均旋转范围为142.15°±15.35°,MEPS评分平均为91分(58~96分),优21例,良2例,可2例,差1例,优良率为88.5%。可调节支具组肘关节平均屈伸范围为106.98°±10.36°,前臂平均旋转范围为121.32°±17.67°,MEPS评分平均为82分(55~92分),优10例,良4例,可2例,差4例,优良率为70.0%,差异有统计学意义(P0.05)。结论内固定结合铰链式外固定架可以使肘关节获得更好的功能恢复。     

乳腺癌保乳术后放射治疗的疗效观察

目的观察乳腺癌保乳术后放射治疗的疗效和美观效果。方法109例保乳术后在我科接受全乳外照射和瘤床加量(boost)放疗,79例应用高剂量率插植技术,T1肿瘤用单排插植,针距为1.5cm,T2以上肿瘤用双排或三排插植。针距间单次剂量(DB)10～12Gy,靶区周边剂量为85%DB。30例采用电子线常规外照射15Gy。全乳照射应用6MV直线加速器,采用双切线半野照射技术,靶区剂量为45～52Gy(平均48.6Gy)。采用医生评分与患者问卷方法评价美观效果。结果全组109例应用KaplanMeier方法统计5年实际生存率为93.8%。局部复发率为6.5%。全组无放射性溃疡发生,5例出现位于插植针孔周围急性皮肤炎症。在经临床随访体检的75例中,医生打分和患者自评满意度为优的比例分别为87%和81%,无统计学意义(P>0.05)。48例经组织间插植加量放疗;27例经电子线外照加量放疗。两组满意度医生总评为优的患者比例分别为81.2%和85.2%,差异无统计学意义(P>0.05)。结论乳腺癌保乳术后放疗可降低局部复发率,并发症少。不同的瘤床加量放疗方法不影响美观效果。     

Intraluminal irradiation for T2M0 esophageal cancer: effect of patient selection on prognosis.

The contribution of intraluminal irradiation to the prognosis of T2M0 esophageal cancer was examined with reference to patient selection. To determine the effect of patient selection, we used esophagrams to assess the potential difficulty of inserting a tube for intraluminal irradiation in 39 patients who were treated with external irradiation prior to 1982. Twenty-two patients were assessed as likely to have been able to undergo intraluminal irradiation (group 1) while 17 were assessed as unlikely to have been able to undergo the procedure (group 2). Of 36 patients treated after 1983, 19 patients were treated with a combination of intraluminal irradiation and external beam therapy (group 3) and 17 by external irradiation alone (group 4). The median survival times of groups 1, 2, 3, and 4 were 10.8, 6.4, 12.0, and 8.5 months, respectively. The prognosis of patients treated with combination therapy (group 3) was superior to that of those treated before 1982 (groups 1 + 2). However, there was no improvement in the prognosis of T2M0 esophageal cancer treated by radiotherapy after the introduction of intraluminal irradiation, and the difference between the survival curves of patients treated by combination therapy (group 3) and with a wide esophageal lumen (group 1) was not significant. Our study thus showed that the selection of patients according to the insertability of the intraluminal therapy tube affected the prognosis.     

立体定向放射治疗肺癌的临床探讨

30例肺癌患者，鳞癌26例，腺癌4例；立体照射单次剂量5～10Gy，隔日一次，共4～8次，5～6个弧形或非共面适形固定野照射，总量26～42Gy。放疗后2～3个月复查CT，PR8例、PR18例、NR4例，总有效率为86.7%，中位生存期12个月，1年局控率86.7%。Kaplan-Meier生存率计算，1年和两年生存率分别为84.6%和61.92%。结果提示，立体定向放射治疗肺癌可起到良好的姑息或根治性治疗作用。配合常规处照射，在不增加近期放疗反应和并发症的同时，可增加靶区剂量，缩短疗程，提高肿瘤控制和近期疗效。     

CT引导下经皮乙酸注射联合肝动脉化疗栓塞治疗原发性肝癌

目的 研究经导管肝动脉化疗栓塞(TACE)联合经皮乙酸注射(PAI)治疗原发性肝癌的疗效.方法 选择52例肝癌患者,分为TACE联合PAI治疗组(26例)和单纯TACE组(26例),比较两组治疗效果.结果 联合组与单纯TACE组AFP下降率为78.3%和50.0%,肿瘤体积缩小有效率分别为65.4%(17/26)和38.5%(10/26),1、2年生存率分别为73.1%(19/26)、38.5%(10/20)和57.7%(15/26)、19.2%(5/26),差异有统计学意义(P＜0.05).结论 TACE联合PAI治疗原发性肝癌效果明显优于单纯TACE组.