Combined External Beam and Intraluminal Radiotherapy for Irresectable Klatskin Tumors

Background: In most cases of proximal cholangiocarcinoma, curative surgery is not possible. Radiotherapy can be used for palliative treatment. We report our experience with combined external beam and intraluminal radiotherapy of advanced Klatskin's tumors. Patients and Methods: 30 patients were treated for extrahepatic proximal bile duct cancer. Our schedule consisted of external beam radiotherapy (median dose 30 Gy) and a high-dose-rate brachytherapy boost (median dose 40 Gy) delivered in four of five fractions, which could be applied completely in twelve of our patients. 15 patients in the brachytherapy and nine patients in the non-brachytherapy group received additional low-dose chemotherapy with 5-fluorouracil. Results: The brachytherapy boost dose improved the effect of external beam radiotherapy by increasing survival from a median of 3.9 months in the non-brachytherapy group to 9.1 months in the brachytherapy group. The effect was obvious in patients receiving a brachytherapy dose above 30 Gy, and in those without jaundice at the beginning of radiotherapy (p < 0.05). Conclusions: The poor prognosis in patients with advanced Klatskin's tumors may be improved by combination therapy, with the role of brachytherapy and chemotherapy still to be defined. Our results suggest that patients without jaundice should be offered brachytherapy, and that a full dose of more than 30 Gy should be applied. Hintergrund: Bei den meisten Patienten mit proximalen Cholangiokarzinomen ist eine kurative Operation nicht mehr möglich. Im Rahmen der Palliativbehandlung kann die Strahlentherapie eingesetzt werden. Wir berichten über unsere Erfahrungen mit der Kombination aus perkutaner und intraluminaler Strahlentherapie fortgeschrittener Klatskin-Tumoren. Patienten und Methode: 30 Patienten wurden wegen extrahepatischer proximaler Gallengangskarzinome behandelt. Unser Therapieschema umfasste eine perkutane Strahlentherapie (mediane Dosis: 30 Gy) sowie einen Brachytherapie-Boost im High-Dose-Rate-Afterloadingverfahren (mediane Dosis: 40 Gy), der in vier oder fünf Fraktionen appliziert wurde. Dieses konnte bei zwölf Patienten vollständig durchgeführt werden. 15 Patienten aus der Gruppe mit und neun Patienten aus der Gruppe ohne Brachytherapie erhielten parallel zur Radiotherapie eine niedrig dosierte Chemotherapie mit 5-Fluorouracil (vgl. Tabelle 1). Ergebnisse: Der Brachytherapie-Boost verbesserte die Wirkung der perkutanen Strahlentherapie und erhöhte die Überlebenszeit von median 3,9 Monaten in der Gruppe ohne Brachytherapie auf 9,1 Monate in der Gruppe mit Brachytherapie (vgl. Abbildung 1). Dieser Effekt zeigte sich bei Patienten, die eine Brachytherapiedosis von mehr als 30 Gy erhielten, sowie bei Patienten, die zu Beginn der Radiotherapie bereits anikterisch waren (p < 0,05). Schlussfolgerung: Die schlechte Prognose von Patienten mit fortgeschrittenen Klatskin-Tumoren kann durch die Kombinationsbehandlung verbessert werden, wobei die Rolle von Brachytherapie und Chemotherapie noch diskutiert wird. Unsere Ergebnisse sprechen dafür, die Brachytherapie bei anikterischen Patienten in das Behandlungskonzept einzubeziehen, wobei eine Dosis von mehr als 30 Gy appliziert werden sollte.     

Combined Fractionated External Beam Radiotherapy and Low-Dose-Rate Iodine-125 Seeds in an Experimental Tumor System

Background: To quantify the effect of implanted low-dose-rate iodine seeds combined with fractionated external beam radiation on local control rates in an experimental tumor system. Materials and Methods: Experiments were done on the rhabdomyosarcoma R1H of the rat transplanted s. c. into the back of male WAG/Raj albino rats. Tumors were irradiated with 200 kVp X-rays with 2 Gy/fraction 5 times weekly. The total dose of the external beam irradiation varied between 60 and 98 Gy for external beam radiotherapy alone and 10 Gy to 82 Gy for combined external beam radiotherapy and iodine seeds. One to 4 iodine seeds with a median activity of 21.05 MBq were permanently implanted 3 days before the start of external radiotherapy or 6 and 7 iodine seeds alone were used. The median tumor volume at the start of treatment was 0.12 cm³. Local tumor control rates were determined and TCD_37% values were calculated applying the maximum likelihood method. Results: With increasing number of implanted iodine seeds the TCD_37% (of external beam irradiation) decreased. With external beam radiotherapy alone the TCD_37% amounted to 103.2 Gy (95% CI, 101.3 to 105.1 Gy) decreasing to (externally applied doses) 69.7 Gy (63.7 to 74.7 Gy) after 1 implanted iodine seed and further to 31.6 Gy (25.6 to 37.6 Gy) after 4 implanted iodine seeds. The effective dose (equivalent to external dose) per iodine seed decreased with increasing number of implanted iodine seeds. One iodine seed gave an effective dose of 33.5 Gy (28.5 to 39.5 Gy) decreasing to 17.9 Gy (16.4 to 19.4 Gy) after 4 iodine seeds. Conclusions: The combined treatment of tumors with implanted low-dose-rate iodine seeds and external beam irradiation can decrease the total dose of the external beam irradiation and, hence, offer the possibility of considerable dose sparing of normal tissues without compromising local tumor control rates. Hintergrund: Prüfung des Effekts der Kombination von permanent implantierten Low-Dose-Rate-Jod-125-Seeds und fraktionierter externer Bestrahlung auf die lokalen Tumorkontrollraten in einem experimentellen Tumorsystem. Material und Methoden: Die Experimente wurden am Rhabdomyosarkom R1H der Ratte durchgeführt, welches subkutan auf den Rücken von WAG/Raj-Albinoratten transplantiert wurde. Die Tumoren wurden mit 200 kVp Röntgenstrahlen mit 2 Gy/Fraktion fünfmal wöchentlich bestrahlt. Die Gesamtdosen der externen Bestrahlung variierten zwischen 60 und 98 Gy für alleinige externe Bestrahlung und 10 und 82 Gy für die Kombination aus externer Bestrahlung und implantierten Jod-Seeds. Ein bis vier Jod-Seeds mit einer medianen Aktivität von 21,05 Mbq wurden drei Tage vor Beginn der externen Bestrahlung permanent in die Tumoren implantiert; als Kontrollen wurden Tumoren mit sechs bis sieben Jod-Seeds permanent implantiert ohne zusätzliche externe Bestrahlung. Das mediane Tumorvolumen zu Behandlungsbeginn betrug 0,12 cm³. Die lokalen Tumorkontrollraten wurden ermittelt, und die TCD_37%-Werte wurden nach der Maximum-Likelihood-Methode berechnet. Ergebnisse: Mit steigender Anzahl implantierter Jod-Seeds nahm die TCD_37% (der externen Bestrahlung) ab. Nach alleiniger externer Bestrahlung betrug die TCD_37% 103,2 Gy (95%-Vertrauensbereich 101,3 bis 105,1 Gy) und nahm nach Implantation eines Jod-Seeds auf 69,7 Gy (63,7 bis 74,7 Gy) ab bzw. 31,6 Gy (25,6 bis 37,6 Gy) nach vier implantierten Jod-Seeds. Die effektive Dosis (äquivalent einer externen Dosis) pro Jod-Seed nahm mit der Anzahl implantierter Jod-Seeds ab. Nach Implantation eines Jod-Seeds betrug die effektive Dosis 33,5 Gy (95%-Vertrauensbereich 28,5 bis 39,5 Gy) und nahm nach vier Jod-Seeds auf 17,9 Gy (16,4 bis 19,4 Gy) ab. Schlussfolgerung: Die Kombination von externer Bestrahlung und Implantation von Jod-Seeds in Tumoren ermöglicht eine erhebliche Verringerung der extern applizierten Dosis und damit auch eine Verringerung der Belastung von Normalgeweben ohne Gefahr niedriger Tumorkontrollraten.     

Dose Escalated External Beam Radiotherapy versus Neoadjuvant Androgen Deprivation Therapy and Conventional Dose External Beam Radiotherapy for Clinically Localized Prostate Cancer: Do we Need Both?

Strahlentherapie und Onkologie - Several randomized trials have demonstrated that men with localized prostate cancer benefit from the use of short-term neoadjuvant androgen deprivation therapy...     

Chemoradiation in Cervical Cancer with Cisplatin and High-Dose Rate Brachytherapy Combined with External Beam Radiotherapy Results of a Phase-II Study

BACKGROUND: In 1999, five randomized studies demonstrated that chemoradiation with cisplatin and low-dose rate (LDR) brachytherapy has a benefit in locally advanced cervical cancer and for surgically treated patients in high-risk situations. We evaluated the safety and efficacy of concomitant chemoradiation with cisplatin and high-dose rate (HDR) brachytherapy in patients with cervical cancer. PATIENTS AND METHODS: 27 patients were included in our phase-II trial: 13 locally advanced cases (group A) and 14 adjuvant-therapy patients in high-risk situations (group B). A definitive radiotherapy was performed with 25 fractions of external beam therapy (1.8 Gy per fraction/middle shielded after eleven fractions). Brachytherapy was delivered at HDR schedules with 7 Gy in point A per fraction (total dose 35 Gy) in FIGO Stages IIB-IIIB. The total dose of external and brachytherapy was 70 Gy in point A and 52-54 Gy in point B. All patients in stage IVA were treated without brachytherapy. Adjuvant radiotherapy was performed with external beam radiotherapy of the pelvis with 1.8 Gy single-dose up to 50.4 Gy. Brachytherapy was delivered at HDR schedules with two fractions of 5 Gy only in patients with tumor-positive margins or tumor involvement of the upper vagina. The chemotherapeutic treatment schedule provided six courses of cisplatin 40 mg/m2 weekly recommended in the randomized studies GOG-120 and -123. RESULTS: A total of 18/27 patients (66.7%) completed all six courses of chemotherapy. Discontinuation of radiotherapy due to therapy-related morbidity was not necessary in the whole study group. G3 leukopenia (29.6%) was the only relevant acute toxicity. There were no differences in toxicity between group A and B. Serious late morbidity occurred in 2/27 patients (7.4%). 12/13 patients (92.3%) with IIB-IVA cervical cancer showed a complete response (CR). 13/14 adjuvant cases (92.8%) are free of recurrence (median follow up: 19.1 months). CONCLUSION: Concomitant chemoradiation with cisplatin 40 mg/m2 weekly x 6 using HDR brachytherapy represents a promising treatment of cervical cancer with an acceptable toxicity.     

High-Dose Rate Brachytherapy of Prostatic Adenocarcinoma in Combination with External Beam Radiotherapy

AIM: To report the long-term follow-up of 50 patients with prostatic adenocarcinoma (PAC) treated by high-dose rate brachytherapy in combination with external beam radiotherapy. PATIENTS AND METHODS: Between 1988 and 1995, 50 patients were treated with external beam radiotherapy delivered in 2 Gy fractions to a total dose of 50 Gy. Brachytherapy was delivered in two 10 Gy fractions. The mean follow-up time was 7.2 years. RESULTS: 42 patients are alive and four patients have deceased of prostatic adenocarcinoma. Of the remaining patients, 40 have a PSA < 1 ng/l. 41 patients were interviewed during the year 2000 and 91% of these were satisfied with the treatment. Four (8%) patients reported grade III/IV side effects. Ten of the 41 patients reported that they still had an erection allowing intercourse. Half of those who developed an erectile dysfunction did so in direct connection with the treatment. In the others erectile dysfunction developed gradually during the first 48 months after the treatment. CONCLUSION: The combined treatment gave an exceptionally good local control (86%). The method represents a promising curative treatment, but the effect can be double edged. The small number of patients in this study restricts a more conclusive statement concerning this treatment modality.     

PSA Kinetics after External Beam Radiotherapy Alone or Combined with an Iridium Brachytherapy Boost to Deliver 85 Grays to Prostatic Adenocarcinoma

PURPOSE: Increasing the dose to prostatic adenocarcinoma in conformal external beam therapy (EBT) has resulted in increased levels of PSA normalization and increased percentage of biochemical disease-free survival rates. However technical problems due to prostate motion inside the pelvis or patients' set-up make difficult the realization of the EBT boost fields above 72 Gy. Brachytherapy which overcomes these problems was investigated to deliver the boost dose to achieve 85 Gy. PSA nadir which has been identified as the strongest independent predictor of any failure in many studies has been used as the end point for early evaluation of this work. PATIENTS AND METHODS: In a retrospective way we report on 163 patients' PSA kinetics after EBT alone to 68 Gy or EBT first and a brachytherapy boost up to 75 or 85 Gy. RESULTS: At 12 months follow-up, PSA nadirs percentage < or = 0.5 or < or = 1 ng/ml increased from 7.5 and 20.7% after 68 Gy EBT to 49.8 and 71.2% after a brachytherapy boost to deliver 85 Gy (p < 0.0001). In the Cox PH model analysis, the total dose remained the most important factor for predicting PSA normalization. CONCLUSIONS: These results are in accordance with the most recent results published after conformal EBT at the same 80 Gy level of dose. If confirmed on a higher number of patients they could place brachytherapy among the most accurate methods of boosting in the radiation treatment of prostatic carcinoma.     

PSA Kinetics after External Beam Radiotherapy Alone or Combined with an Iridium Brachytherapy Boost to Deliver 85 Grays to Prostatic Adenocarcinoma

Purpose: Increasing the dose to prostatic adenocarcinoma in conformal external beam therapy (EBT) has resulted in increased levels of PSA normalization and increased percentage of biochemical disease-free survival rates. However technical problems due to prostate motion inside the pelvis or patients' set-up make difficult the realization of the EBT boost fields above 72 Gy. Brachytherapy which overcomes these problems was investigated to deliver the boost dose to achieve 85 Gy. PSA nadir which has been identified as the strongest independent predictor of any failure in many studies has been used as the end point for early evaluation of this work. Patients and Methods: In a retrospective way we report on 163 patients' PSA kinetics after EBT alone to 68 Gy or EBT first and a brachytherapy boost up to 75 or 85 Gy. Results: At 12 months follow-up, PSA nadirs percentage h 0.5 or h 1 ng/ml increased from 7.5 and 20.7% after 68 Gy EBT to 49.8 and 71.2% after a brachytherapy boost to deliver 85 Gy (p < 0.0001). In the Cox PH model analysis, the total dose remained the most important factor for predicting PSA normalization. Conclusions: These results are in accordance with the most recent results published after conformal EBT at the same 80 Gy level of dose. If confirmed on a higher number of patients they could place brachytherapy among the most accurate methods of boosting in the radiation treatment of prostatic carcinoma. Hintergrund: Bei der perkutanen Konformationsbestrahlung des Adenokarzinoms der Prostata hat eine Erhöhung der Dosis zu einer erhöhten PSA-Normalisierung und einer erhöhten Rate biochemischer Krankheitsfreiheit geführt. Technische Probleme aufgrund der Beweglichkeit der Prostata innerhalb des Beckens oder der Patientenlagerung lassen eine Eskalation der perkutanen Bestrahlungsdosis über 72 Gy jedoch kritisch erscheinen. Daher wurde ein Brachytherapie-Boost bis zu einer Gesamtdosis von 85 Gy untersucht. Als Endpunkt für eine frühe Auswertung wurde der PSA-Nadir verwendet, der als wichtigster unabhängiger prädiktiver Faktor für das Therapieversagen in vielen Studien identifiziert worden war. Patienten und Methode: Wir berichten in einer retrospektiven Analyse über 163 Patienten. Die PSA-Kinetik wurde entweder nach alleiniger Bestrahlung bis 68 Gy oder nach zunächst perkutaner Bestrahlung und anschließendem Brachytherapie-Boost bis 75 oder 85 Gy verfolgt. Ergebnisse: Nach einem medianen Follow-up von zwölf Monaten zeigte sich, dass ein PSA-Nadir h 0,5 bzw. h 1 ng/ml von 7,5 bzw. 20,7% nach alleiniger perkutaner Radiotherapie bis 68 Gy auf 49,8 bzw. 71,2% nach zusätzlichem Brachytherapie-Boost bis 85 Gy beobachtet werden konnte (p < 0,0001). Die Gesamtdosis war der wichtigste prädiktive Faktor für eine PSA-Normalisierung in einer Cox-PH-Modellanalyse. Schlussfolgerung: Diese Resultate stimmen mit den kürzlich publizierten Daten nach konformaler perkutaner Radiotherapie bis zu einem Dosislevel von 80 Gy überein. Wenn sich diese Daten bei einer höheren Patientenzahl bestätigen, könnte sich die Brachytherapie-Boost-Technik in der radiotherapeutischen Behandlung des Prostatakarzinoms etablieren.     

Hypofractionated Stereotactic Radiotherapy for Primary and Secondary Intrapulmonary Tumors

PURPOSE: To evaluate the feasibility, efficacy, and side effects of dose escalation in hypofractionated stereotactic radiotherapy (hfSRT) for intrapulmonary tumors with the Novalis system (BrainLAB AG, Heimstetten, Germany). PATIENTS AND METHODS: From 07/2003 to 01/2005, 21 patients/39 tumors were treated with 5 x 7 Gy (n = 21; total dose 35 Gy) or 5 x 8 Gy (n = 18; total dose 40 Gy). There were three cases of primary lung cancer, the remainder were metastases. Median gross tumor volume (GTV) and planning target volume (PTV) were 2.89 cm(3) (range, 0.15-67.94 cm(3)) and 25.75 cm(3) (range, 7.18-124.04 cm(3)), respectively. RESULTS: Rates of complete remission, partial remission, no change, and progressive disease were 51%, 33%, 3%, and 13%, respectively. No grade 4 toxicity occurred, nearly all patients had grade 1 initially. One grade 3 toxicity, i.e., dyspnea, was documented for a period of 6 months after therapy. Radiosurgery quality assurance guidelines could be met. CONCLUSION: hfSRT of primary and secondary lung tumors using a schedule of five fractions at 7-8 Gy each was well tolerated. Further dose escalation is planned.     

脑干肿瘤的放射治疗及预后分析

 目的 回顾性分析20例脑干肿瘤放射治疗效果,探讨影响放疗效果的因素。方法 20例患者均接受单纯8mV-X线放疗,放射剂量40～60 Gy／(4～7)周。Kaplan-Meier法计算生存率并绘制生存曲线。结果 1 a生存14例,3 a生存5例,5 a生存2例,中位生存期为22.4个月。就诊前症状持续时间长及首发无颅神经损害者预后好。结论 就诊前症状持续时间及首发有无颅神经损害可能是影响脑干肿瘤预后的重要因素。建议肿瘤靶区放射剂量至少为50 Gy。     

Second Primary Tumors after Radiotherapy for Malignancies Treatment-Related Parameters

PURPOSE: The aim of the present analysis was to identify radiotherapy-related parameters that influence the development of second malignancies. PATIENTS AND METHODS: Between 1969 and 1989, about 31,000 patients were treated in Dresden with low voltage (< or = 180 kV X-rays) or telecobalt radiotherapy or a combination of both. Of these 203 were readmitted after earlier radiotherapy, for radiotherapy of a newly developed malignancy. Based on definitive diagnosis of a secondary tumor and completeness of documentation 53 patients were selected for further analysis. This included the spatial relation between the new tumor and the primary treatment fields, and the incidence in relation to the dose at the site of origin. The material does not allow for risk estimation. RESULTS: Primary malignancies comprised breast and gynecological tumors in female, and tumors of prostate, head and neck and lymphomas in male patients. Second tumors developed mainly in corpus uteri, respiratory, gastrointestinal and urinary tract. The high incidence of 9.9% second primary corpus/cervix uteri tumors in patients with primary breast cancers suggests a common etiology. The majority of second tumors was observed within the margin of the planning target volume (PTV), which was defined as the volume 2.5 cm inside to 5 cm outside the field margin proper. Inside the PTV developed < 10%, outside 11% of the second tumors. With regard to dose the majority of second tumors was observed in the region receiving < 6 Gy. CONCLUSIONS: A significant number of second primary tumors is found in the volume receiving < or = 6 Gy, i.e. at the margins of the PTV. This should be considered for multiple field radiotherapy and IMRT, where the relevant volumes may be substantially increased.     

Radiotherapy and High-Dose Chemotherapy in Advanced Ewing's Tumors

BACKGROUND: Ewing's tumors are sensitive to radio- and chemotherapy. Patients with multifocal disease suffer a poor prognosis. Patients presenting primary bone marrow involvement or bone metastases at diagnosis herald a 3-year disease-free survival below 15%. The European Intergroup Cooperative Ewing's Sarcoma Study (EICESS) has established the following indications for high-dose therapy in advanced Ewing's tumors: Patients with primary multifocal bone disease, patients with early (< 2 years after diagnosis) or multifocal relapse. PATIENTS AND METHOD: As of 1987, 83 patients have been treated in the EICESS group, 39 of them at the transplant center in Düsseldorf, who have been analyzed here. All individuals received 4 courses of induction chemotherapy with EVAJA and stem cell collection after course 3 and 4. Consolidation radiotherapy of the involved bone compartments was administered in a hyperfractionated regimen 2 times 1.6 Gy per day, up to 22.4 Gy simultaneously to course 5 and 22.4 Gy to course 6 of chemotherapy. The myeloablative chemotherapy consisted of melphalan and etoposide (ME) in combination with 12 Gy TBI (Hyper-ME) or Double-ME with whole lung irradiation up to 18 Gy (without TBI). RESULTS: The survival probability at 40 months was 31% (44% DOD; 15% DOC). Pelvic infiltration did not reach prognostic relevance in this cohort. Radiotherapy encompassed 75% of the bone marrow at maximum (average 20%). Engraftment was not affected by radiotherapy. CONCLUSION: High-dose chemotherapy can improve outcome in poor prognostic advanced Ewing's tumors. The disease itself remains the main problem. The expected engraftment problems after intensive radiotherapy in large volumes of bone marrow can be overcome by stem cell reinfusion.     

Radiotherapy and High-Dose Chemotherapy in Advanced Ewing's Tumors

Background: Ewing's tumors are sensitive to radio- and chemotherapy. Patients with multifocal disease suffer a poor prognosis. Patients presenting primary bone marrow involvement or bone metastases at diagnosis herald a 3-year disease-free survival below 15%. The European Intergroup Cooperative Ewing's Sarcoma Study (EICESS) has established the following indications for high-dose therapy in advanced Ewing's tumors: Patients with primary multifocal bone disease, patients with early (<2 years after diagnosis) or multifocal relapse. Patients and Method: As of 1987, 83 patients have been treated in the EICESS group, 39 of them at the transplant center in Düsseldorf, who have been analyzed here. All individuals received 4 courses of induction chemotherapy with EVAJA and stem cello collection after course 3 and 4. Consolidation radiotherapy of the involved bone compartments was administered in a hyperfractionated regimen 2 times 1.6 Gy per day, up to 22.4 Gy simultaneously to course 5 and 22.4 Gy to course 6 of chemotherapy. The myeloablative chemotherapy consisted of melphalan and etaposide (ME) in combination with 12 Gy TBI (Hyper-ME) or Double-ME with whole lung irradiation up to 18 Gy (without TBI). Results: The survival probability at 40 months was 31% (44% DOD; 15% DOC). Pelvic infiltration did not reach prognostic relevance in this cohort. Radiotherapy encompassed 75% of the bone marrow at maximum (average 20%). Engraftment was not affected by radiotherapy. Conclusion: High-dose chemotherapy can improve outcome in poor prognostic advanced Ewing's tumors. The disease itself remains the main problem. The expected engraftment problems after intensive radiotherapy in large volumes of bone marrow can be overcome by stem cell reinfusion. Hintergrund: Ewing-Tumoren sind radio- und chemosensibel. Im metastasierten Stadium ist die Prognose schlecht. Patienten mit Knochen- oder Knochenmarkinfiltration haben nach drei Jahren eine erkrankungsfreie Überlebenswahrscheinlichkeit von weniger als 15%. Die EICESS-Gruppe hat folgende Indikationen für die Hochdosistherapie bei fortgeschrittenen Ewing-Tumoren etabliert: Patienten mit primären multifokalen Knochenmetastasen und Patienten mit einem frühen (<2 Jahren) oder multifokalen Rezidiv. Patienten und Methode: Seit 1987 wurden 83 Patienten in der EICESS-Gruppe behandelt, 39 von ihnen in Düsseldorf, deren Analyse hier vorgestellt werden soll. Alle Patienten erhielten vier Kurse einer Induktionschemotherapie mit EVAJA und nachfolgender Stammzellasservation. Anschließend erfolgte eine konsolidierende Bestrahlung aller befallenen Knochenkompartimente, hyperfraktioniert, 2mal 1,6 Gy pro Tag bis zu einer Zielvolumendosis von 22,4 Gy simultan zu Kurs 5 und 6 der Chemotherapie, entsprechend 44,8 Gy Gesamtdosis. Die myeloablative Therapie bestand aus Melphalan und Etoposid (ME) und 12 Gy TBI (Hyper-ME) oder bei zusätzlichem Lungenbefall aus zwei Kursen ME und Ganzlungenbestrahlung bis 18 Gy (Double-ME). Ergebnisse: Die Überlebenswahrscheinlichkeit nach 40 Monaten betrug 31% (44% starben am Tumor und 15% an Komplikationen). Beckentumoren hatten in dieser Gruppe keine prognostische Relevanz. Im Durchschnitt wurden 20% des Knochenmarkvolumens (maximal 75%) bestrahlt. Das Engraftment wurde durch die Bestrahlung nicht beeinflußt. Schlußfolgerung: Die Prognose bei multifokalen, fortgeschrittenen Ewing-Tumoren kann durch die Hochdosistherapie verbessert werden. Das Hauptproblem bleibt die Krankheit selbst. Die nach intensiver Strahlentherapie großer Knochenmarkvolumia erwarteten Engraftment-Probleme können durch Stammzellreinfusion überwunden werden.     

Combined Systemic Therapy and Radiotherapy for Bladder Cancer

Strahlentherapie und Onkologie -     

Comparison of Intratumor and Intraluminal Temperatures During Locoregional Deep Hyperthermia of Pelvic Tumors

PURPOSE: To investigate whether intraluminal thermometry provides sufficient information to apply high quality deep hyperthermia in pelvic tumors. PATIENTS AND METHODS: The intratumor and intraluminal temperatures of 48 patients were analyzed per cancer type: rectum (21 male, 14 female), cervix (n=8), and bladder (n=5). Temperature-dose parameters were calculated, temperature curves within each treatment session were compared, and correlation between intratumor and intraluminal temperatures was analyzed. RESULTS: Intratumor and intraluminal temperatures at the same time points during individual treatments were highly correlated (mean correlation coefficient: 0.93). However, the quantitative level differed from 0.1 to 1.1 degrees C and the differences of the time-temperature graphs varied per tumor group. Average intratumor and intraluminal temperatures were not different in the four groups. Intratumor thermometry was found not superior over intraluminal thermometry to improve tumor temperature level and homogeneity by SAR steering. CONCLUSION: Intraluminal thermometry provides sufficient information to apply deep hyperthermia to individual patients with centrally located rectum, cervix or bladder cancer.     

Comparative Planning Study for Proton Radiotherapy of Benign Brain Tumors

PURPOSE: A comparative study of different systems for proton-based radiotherapy was conducted. MATERIAL AND METHODS: The Paul Scherrer Institute method for spot scanning was compared with the systems for passive scattering from the Helax-TMS and the Varian Eclipse. Twelve cases of "benign" brain tumors were considered (meningiomas, neurinomas, and hypophyseal adenomas). Organs at risk included chiasm, brainstem, eyes and optic nerves as well as the not otherwise specified healthy brain tissue in view of long-term toxicity. RESULTS: The results showed that high target coverage was achievable (V(90) > 98% for all systems). Plans designed with the spot-scanning technique presented the minimum involvement of healthy tissue (e. g., the lowest maximum significant dose to healthy brain [25.6 Gy] or the lowest conformity index [CI(95) = 1.3], between 38% and 46% lower than for the other techniques). CONCLUSION: In this study, no definitive indication of superiority of any technique can be drawn but spot scanning can better conform dose distributions and minimize the irradiation of healthy volumes at medium to low dose levels, a factor of interest when long life expectancy is considered.