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AbstractAbstract
[en] In radiation therapy, photon beams are mainly used in addition to electrons which at energies of more than 10 MeV lead to activation of the air they passed through. There are the (γ,n) reactions resulting in the formation of the positrons emitters O-15 and N-13, whose contribution to the radiation exposure of the operating personnel is subject to monitoring. In addition, the discharge of radioactivity into the ambient air is to be monitored. If one assumes a uniform distribution of the radionuclides in the atmosphere, in both cases it is not the positron radiation itself but, because of its greater range, the positron annihilation radiation that determines the maximum permissible concentrations of radioactivity in the air. Two techniques for the measurement of induced airborne activity are presented and are compared with each other: the direct activity measurement in irradiated air samples and measurements in activated solid specimens of Imidazol and urea. Scintillation counters can be used for measurements of solid specimens because of the high activity density. The air samples are measured with the Geiger-Mueller counter. Activity measurements were carried out with the two techniques at different linear accelerators and betatron devices. In a model computation, the airborne activity induced in an irradiation room is derived from the measured results and is compared with the limiting values set by the Radiation Protection Ordinance. Even cautious assumptions do not reveal any airborne activity densities exceeding permissible levels valid for occupationally exposed persons of category B. In the case of an undiluted discharge of activated room air into the environment, unfavourable conditions are possible that will lead to discharges exceeding the maximum permissible values. (orig./HP)
[de]
In der Strahlentherapie werden neben Elektronen vorwiegend Photonen-Strahlen eingesetzt, die ab einer Energie von 10 MeV zu einer Aktivierung der durchstrahlten Luft fuehren. Die ueber (γ,n)-Reaktionen entstehenden Positronenstrahler O-15 und N-13 liefern einen kontrollbeduerftigen Beitrag zur Strahlenexposition des Bedienungspersonals, andererseits muss die Ableitung radioaktiver Stoffe in die Umgebungsluft beachtet werden. Nimmt man eine gleichmaessige Verteilung der Radionuklide in der Atmosphaere an, so bestimmt in beiden Faellen nicht die Positronenstrahlung selbst, sondern wegen der groesseren Reichweite die Positronen-Vernichtungsstrahlung die maximal zulaessigen Konzentrationen radioaktiver Stoffe in Luft. Zwei Verfahren zur Messung der induzierten Luftaktivitaet werden vorgestellt und miteinander verglichen: die direkte Aktivitaetsmessung an einer bestrahlten Luftprobe und an aktivierten Feststoffproben aus Imidazol und Harnstoff. Fuer Messungen an Feststoffproben koennen wegen der hohen Aktivitaetsdichte Szintillationszaehler benutzt werden. Die Luftproben werden mit einem Geiger-Mueller-Zaehler gemessen. Nach beiden Verfahren wurden an verschiedenen Linearbeschleunigern und Betatronanlagen Akvititaetsmessungen durchgefuehrt. In einer Modellrechnung wird aus den Messergebnissen die in einem Bestrahlungsraum induzierte Luftaktivitaet bstimmt und mit den in der Strahlenschutzverordnung festgelegten Grenzwerten verglichen. Auch unter vorsichtigen Annahmen wird die fuer beruflich strahlenexponierte Personen der Kategorie B zulaessige Luftaktivitaetsdichte nicht ueberschritten. Bei der unverduennten Ableitung der aktivierten Raumluft ins Freie koennen in unguenstigen Faellen die Grenzwerte ueberschritten werden. (orig./HP)Original Title
Untersuchung der Luftaktivierung durch medizinisch genutzte Beschleuniger mittels Messungen an Luft-, Imidazol- und Harnstoffproben
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5 Dec 1988; 48 p; Copy held by UB/TIB Hannover; Diss. (Dr.med.).
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Miscellaneous
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Thesis/Dissertation
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ACCELERATORS, BEAMS, BETA DECAY RADIOISOTOPES, BETA-PLUS DECAY RADIOISOTOPES, CHARGED PARTICLE DETECTION, CYCLIC ACCELERATORS, DETECTION, ELECTROMAGNETIC RADIATION, ELECTRON CAPTURE RADIOISOTOPES, ENERGY RANGE, EVEN-ODD NUCLEI, FLUIDS, GASES, INTERACTIONS, ISOTOPES, LEPTON BEAMS, LIGHT NUCLEI, MEDICINE, MEV RANGE, MINUTES LIVING RADIOISOTOPES, NITROGEN ISOTOPES, NUCLEI, ODD-EVEN NUCLEI, OXYGEN ISOTOPES, PARTICLE BEAMS, PARTICLE INTERACTIONS, PARTICLE SOURCES, PERSONNEL, RADIATION DETECTION, RADIATION SOURCES, RADIATIONS, RADIOISOTOPES, SAFETY STANDARDS, THERAPY
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AbstractAbstract
[en] Purpose/Objective: To assess the prognostic factors and treatment results of thymoma with emphasis on surgery and radiotherapy. Materials and Methods: Thymoma patients treated at Duesseldorf University Hospital from 1954 to 1991 were studied in this retrospective analysis. Depending on stage and residual disease, treatment was surgery (sternotomy or thoracotomy) with and without radiotherapy and chemotherapy (Holoxan, Endoxan, Vinblastin, Adriamycin, Bleomycin, CDDP, Vepesid). 70 patients (38f, 32m) were enrolled in this study. The mean age was 46,5 years. At presentation the median Karnofsky's index was 90%. In 19% thymoma was accidentally diagnosed, 81% presented symptoms at diagnosis. Masaoka's staging system was used (I: intact capsule; II: invasion of the capsule; III: invasion of neighboring organs; IV: dissemination). Stage at presentation was I:21%; II: 26%; III: 43%; IV: 10%. All histologic slices were peer reviewed. Histologic classification according to Lewis (predominantly lymphocytic: 36%; predominantly epithelial: 23%; mixed type: 33%, spindle cell thymoma: 9%) was applied. All available paraffin embedded specimens (36) were studied with DNA cytometric analysis after Feulgen staining. Occasionally thymoma was accompanied by Myasthenia gravis (23%) or other paraneoplastic syndromes (19%). Statistical analysis was performed using the Kaplan-Meier method and logrank-tests. Multivariate analysis was also performed. Results: From 70 patients treated surgically, 68% were radically resected (R0), 26% incompletely resected (R1,2) and 6% had biopsy only. The median cause specific survival (CSS) was 132 months. All patients with localized disease (stage I and II) were completely resected and received no further therapy, whereas only 50% (15 pat) in stage III and 0% in stage IV were amenable to radical resection. 36% (25 pat) received an additional therapy (CMT): 31% (22 pat) postoperative irradiation and 4% (3 pat) combined radio-chemotherapy. The radiation dose ranged from 40 Gy to 58 Gy. 50% (21 pat) of the completely resected patients without additional CMT relapsed (by stage: I= 7%, II= 62%, III= 86%), but only 1 (20%) of the 5 completely resected patients with CMT. 66% ((8(12))) of the incompletely resected patients with CMT relapsed, 27% within the irradiated volume. In stage III the CSS was 85 mo. after incomplete surgery and CMT versus 115 mo. after radical resection alone (p=0.72, n.s.). The DFS accounted to 45.7 vs. 44.9 mo. (p=0.36, n.s.). In addition Karnofsky's index did not significantly influence the overall survival (OS). Depending on histology the DFS was significantly better for lymphocytic type in comparison to the epithelial type (p<0.01). Myasthenia gravis did not influence the OS and DFS. DNA index was correlated with stage and DFS, but not with OS. Conclusions: The most important prognostic factor (PF) was stage according to Masaoka's staging system. CSS and DFS were both significantly influenced. The traditional histologic subtyping according to Lewis proved to correlate with DFS, with spindle cell type bearing the most favorable prognosis. The impact of CMT on treatment outcome is demonstrated in stage III, where incomplete resection plus CMT achieves long-term results comparable to radical surgery alone
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S0360301697809182; Copyright (c) 1997 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; Country of input: International Atomic Energy Agency (IAEA)
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Journal Article
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International Journal of Radiation Oncology, Biology and Physics; ISSN 0360-3016; ; CODEN IOBPD3; v. 39(2,suppl.1); p. 316
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ALKALOIDS, ALKYLATING AGENTS, ANTIBIOTICS, ANTI-INFECTIVE AGENTS, ANTIMITOTIC DRUGS, ANTINEOPLASTIC DRUGS, AROMATICS, AZAARENES, AZOLES, BODY, DISEASES, DOSES, DRUGS, HETEROCYCLIC COMPOUNDS, IMMUNOSUPPRESSIVE DRUGS, INDOLES, LYMPHATIC SYSTEM, MEDICINE, NUCLEAR MEDICINE, ORGANIC COMPOUNDS, ORGANIC NITROGEN COMPOUNDS, ORGANS, PYRROLES, RADIOLOGY, THERAPY
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[en] Short communication
Original Title
Wachstumsstoerung nach Radiotherapie im Kindesalter bei Morbus Hodgkin
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Journal Article
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RoeFo - Fortschritte auf dem Gebiete der Roentgenstrahlen und der Neuen Bildgebenden Verfahren; ISSN 0936-6652; ; CODEN RFGVEF; v. 163(6); p. 536-537
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[en] Purpose: To investigate the applicability of doped optical fiber radiation sensors in clinical dosimetry. Methods: Ionizing radiation causes a dose depending discoloring in silica. When proper impurities (doping agents) are added, the radiation sensitivity may be increased to a range suited for clinical dosimetry. We performed in-vivo-measurements using a lead doped silica fiber (d< 1mm). The fiber was coiled and the flat ring (diameter15mm, total fiber length L= 0.6m) was positioned on the closed eye lid. During orbital irradiation we studied the surface dose (SD) due to scattered radiation in order to estimate the dose at the eye lens. For irradiations 8-MV photons (Linac) were used. Measurements were also performed with a human phantom (AldersonTM) in comparison to thermoluminescence detectors (TLDs). Results: The scattered radiation is easily detected with this sensor fiber. In contrast to TLDs the dose and doserate values are obtained immediately and setup errors can be recognized before irradiation is completed. The SD clearly depends on setup modifications due to the extent of disease. Other doping agents (GeP) provide better tissue equivalence and less energy dependence. Conclusions: Optical fibers are suitable for in vivo dosimetry purposes. Fiber sensors provide real time dose values, and the readout procedure is much easier compared to TLDs. These features may gain significance in quality assurance, conformal therapy, and intraoperative radiotherapy (IORT)
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Source
016781409680627X; Copyright (c) 1995 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; Country of input: International Atomic Energy Agency (IAEA)
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[en] The authors compare two different methods to determine the activity of the air induced by the bremsstrahlung of medical accelerators. The activities of the air resulting from maximum photon energies of 16 to 42 MeV are measured with proportional counter tube ('direct measurement') and by means of activation analyses of imidazole, triazole, malonic acid, and urea specimens ('indirect measurement'). The results are compared. (orig.)
[de]
Zwei unterschiedliche Methoden zur Bestimmung der durch Bremsstrahlung medizinischer Beschleuniger induzierten Luftaktivitaet werden verglichen. Fuer maximale Photonenenergien zwischen 16 und 42 MeV werden Luftaktivitaetsmessungen mit einem Proportionalzaehlrohr ('direkte Messung') und Aktivierungsanlaysen von Imidazol-, Triazol, Malonsaeure- und Harnstoffproben ('indirekte Messung') einander gegenuebergestellt. (orig.)Original Title
Der Vergleich zweier Methoden zur Bestimmung der photoneninduzierten Luftaktivitaet an medizinischen Beschleunigern
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ACCELERATORS, BETA DECAY RADIOISOTOPES, BETA-PLUS DECAY RADIOISOTOPES, CHARGED PARTICLE DETECTION, CHEMICAL ANALYSIS, CYCLIC ACCELERATORS, DETECTION, ELECTROMAGNETIC RADIATION, ELECTRON CAPTURE RADIOISOTOPES, ENERGY RANGE, EVEN-ODD NUCLEI, FLUIDS, GASES, ISOTOPES, LIGHT NUCLEI, MEASURING INSTRUMENTS, MEDICINE, MEV RANGE, MINUTES LIVING RADIOISOTOPES, NITROGEN ISOTOPES, NONDESTRUCTIVE ANALYSIS, NUCLEI, ODD-EVEN NUCLEI, OXYGEN ISOTOPES, RADIATION DETECTION, RADIATION DETECTORS, RADIATIONS, RADIOISOTOPES, THERAPY
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[en] Background: Radiotherapy is commonly used in Grave's ophthalmopathy. The target volume encompasses the ocular muscles and the orbital tissue. The result of conventional simulation can be examined by means of CT simulation. Patients and methods: Twenty-five planning CTs with Grave's ophthalmopathy were studied. The conventional simulation of 4x4 cm2 lateral portals confined anteriorly by the fleshy canthus was performed on a CT-simulator using the observer's eye view (OEV) and digitally reconstructed radiographs (DRR). The coverage of the target volume and sparing of the eye lenses were studied on axial CT slices and multiplanar reconstructions (MPR). The distances between the apex of the orbita and cornea, fleshy canthus, and bony canthus were measured as well as the distance between cornea and posterior face of the lens. Results: The pituitary gland and the ocular lenses were spared in each case (25/25). The orbita was entirely covered in 24 cases (96%). However, anterior parts of the external eye muscles were not completely encompassed in 7 cases (28%). The distance from the apex of the orbita to the corena was 54.6 mm (53.3 to 55.8 mm, 95% confidence interval), to the fleshy canthus 40.3 mm (39.4 to 41.2 mm), and to the bony canthus 31.4 mm (30.2 to 32.5 mm). The distance between cornea and posterior face of the lens was 8.3 mm (7.9 to 8.7 mm). The distance between cornea and canthus differed signficantly from normal eyes while the distance between cornea and posterior face of the lens was very similar to normal eyes. Conclusions: Conventional simulation of orbital irradiation with lateral fields confined anteriorly by the fleshy canthus ensures protection of the ocular lenses and the pituitary gland. However, anterior parts of the eye muscles may occasionally not completely be covered. The fleshy canthus and the cornea are more reliable landmarks as compared to the bony canthus. (orig.)
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Hintergrund: Zur Therapie der endokrinen Orbitopathie wird die Bestrahlung der Retrobulbaerraeume eingesetzt. Das Zielvolumen umschliesst die Orbita und die aeusseren Augenmuskeln. Mit der CT-Simulation laesst sich das Ergebnis der konventionellen Simulation ueberpruefen. Patienten und Methodik: 25 Planungs-CT mit endokriner Orbitopathie wurden untersucht. Die konventionelle Simulation mit lateralen 4x4 cm2 grossen, ventral am Lidwinkel ausgerichteten Feldern wurde im 'Observer's Eye View' (OEV) und mit digital rekonstruierten Radiographien (DRR) durchgefuehrt. Die Zielvolumenerfassung und Schonung der Augenlinsen wurden in axialen Schichten und multiplanaren Rekonstruktionen (MPR) ueberprueft. Der Abstand der Orbitaspitze zu Kornea, Lidwinkel und Kanthus sowie der Kornea zur Linsenrueckflaeche wurde gemessen. Ergebnisse: In alle 25 Faellen wurden Hypophyse und Linse geschont. In 24 Faellen (96%) wurde die Orbita in kraniokaudaler bzw. sagittaler Richtung vollstaendig erfasst. Die aeusseren Augenmuskeln wurden in sieben Faellen (28%) im ventralen Anteil nicht vollstaendig erfasst. Der Abstand der Orbitaspitze zur Kornea betrug 54,6 mm (53,3 bis 55,8 mm, 95%-Konfidenzintervall), zum Lidwinkel 40,3 mm (39,4 bis 41,2 mm), zum lateralen Kanthus 31,4 mm (30,2 bis 32,5 mm), der Abstand zwischen Kornea und Linsenrueckflaeche 8,3 mm (7,9 bis 8,7 mm). Der Vergleich mit Normalwerten ergab eine deutliche Abweichung des Abstands Kornea-Kanthus, waehrend der Abstand Kornea-Linsenrueckflaeche mit den Normalwerten uebereinstimmte. Schlussfolgerung: Die konventionelle Simulation der Retrobulbaerbestrahlung mit seitlichen, am Lidwinkel ausgerichteten Feldern gewaehrleistet eine sichere Schonung der Augenlinsen und Hypophyse. Die bulbusnahen Anteile der aeusseren Augenmuskeln werden dagegen in einigen Faellen nicht vollstaendig erfasst. Der Lidwinkel oder die Kornea sind als Orientierungspunkte fuer die ventrale Feldgrenze besser geeignet als der laterale Kanthus. (orig.)Original Title
Konventionelle und virtuelle Simulation bei der Retrobulbaerbestrahlung
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[en] Ionizing radiation may cause discolouring of glass by creation of colour centers. So radiation induced optical damping may be a measure of absorbed dose. Using a lead doped glass fiber (silica fiber, 60 Wt-% PbO2, diameter < 0.1 mm, length < 100 mm) a small volume optical dosimeter with high spatial resolution for clinical purposes has been tested with different photon fields (Cs-137, Co-60, 12 and 18 MV photons of an electron linac) in dependence on temperature, energy dose and dose rate. In a wide dose range (0 to 112 Gy) 0.04 Gy may be detected and with a reproducibility at 1 Gy of about 4%. Fading may be compensated during irradiation using a phenomenological model. Therefore, in contrast to TLD glass fiber provides real time dosimetry and may be appropriate for in vivo dosimetry in radiotherapy. (HP)
[de]
Ionisierende Strahlung erhoeht die Lichtabsorption geeigneter Glaeser durch Erzeugung von Farbzentren. Die induzierte optische Daempfung kann als Messgroesse fuer die absorbierte Dosis dienen. Mit einer bleidotierten Glasfaser (Silikatfaser, 60 Wt-% PbO2, Durchmesser < 0.5 mm, Laenge < 100 mm) wurde ein kleinvolumiges Dosimeter mit hoher Ortsaufloesung fuer klinische Anwendungen untersucht in verschiedenen Photonenfeldern (Cs-137, Co-60, 12- und 18 MV-Photonen eines Elektronenlinearbeschleunigers) in Abhaengigkeit von Temperatur, Energiedosis und Dosisleistung. Die untere Nachweisgrenze liegt in der Groessenordnung von 0.04 Gy, die Reproduzierbarkeit bei einer Dosis von 1 Gy betraegt ca. 4%. Das Fading kann mit Hilfe eines phaenomenologischen Modells waehrend der Bestrahlung kompensiert werden. Das Glasfaserdosimeter ermoeglicht im Gegensatz zu TLD dadurch Dosismessungen waehrend der Bestrahlung und scheint fuer in-vivo-Anwendungen in der Strahlentherapie geeignet. (HP)Original Title
Dosimetrische Untersuchungen mit Glasfasern
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Journal Article
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[en] The aim of this protocol was to investigate breast conservation rates with and without flap-supported surgery after preoperative chemotherapy, radiotherapy and hyperthermia. One hundred and fifty-eight patients with stage IIA-IV breast cancers were initially treated with chemotherapy, radiotherapy and hyperthermia. Radiation treatment consisted of an interstitial boost of 10 Gy 192Ir-afterloading therapy and a course of external beam radiotherapy of 50 Gy, using 5x2 Gy/week. Local hyperthermia with 43.5-44.5 C over 60 minutes was delivered immediately before interstitial radiotherapy. One hundred and forty-two patients underwent salvage surgery. A breast-conserving approach was possible in 74 patients (52%). Fifty-three patients (37%) underwent flap-supported surgery. After a median follow-up of 20 months, one patient developed isolated local recurrence. In 14 cases, locoregional recurrences occurred in combination with distant metastases. (orig.)
[de]
Untersucht wurde die Brusterhaltungsrate mit und ohne Myokutanlappenunterstuetzung nach praeoperativer Chemotherapie, Radiotherapie und Hyperthermie. 158 Patientinnen im Stadium IIA-IV wurden praeoperativ mit Chemotherapie, Radiotherapie und Hyperthermie behandelt. Die Radiotherapie bestand aus einem primaeren interstitiellen Boost des palpablen Tumors von 10 Gy 192Ir-HDR-Afterloading-Therapie sowie einer perkutanen Brustbestrahlung von 50 Gy in einer Fraktionierung von 5x2 Gy pro Woche. Die Hyperthermiebehandlung mit 43,5 bis 44,5 C ueber 60 Minuten erfolgte unmittelbar vor der interstitiellen Bestrahlung. Es wurden insgesamt 142 Patientinnen einer Sanierungsoperation unterzogen. 74 Patientinnen (52%) wurden brusterhaltend operiert. In 53 Faellen (37%) wurden Myokutanlappen verwendet. Nach einer medianen Beobachtungszeit von 20 Monaten entwickelte eine Patientin ein isoliertes Thoraxwandrezidiv. 14 weitere lokoregionaere Rezidive traten in Kombination mit Fernmetastasen auf. (orig.)Original Title
Praeoperative Bestrahlung mit interstitiellem Radiohyperthermie-Boost bei Mammatumoren ≥ 3 cm
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ANIMALS, BETA DECAY RADIOISOTOPES, BETA-MINUS DECAY RADIOISOTOPES, BODY, BODY TEMPERATURE, DAYS LIVING RADIOISOTOPES, DISEASES, ELECTRON CAPTURE RADIOISOTOPES, GLANDS, HEAVY NUCLEI, INTERNAL CONVERSION RADIOISOTOPES, IRIDIUM ISOTOPES, IRRADIATION, ISOMERIC TRANSITION ISOTOPES, ISOTOPES, MAMMALS, MAN, MEDICINE, MINUTES LIVING RADIOISOTOPES, NEOPLASMS, NUCLEI, ODD-ODD NUCLEI, ORGANS, PRIMATES, RADIOISOTOPES, RADIOTHERAPY, THERAPY, VERTEBRATES, YEARS LIVING RADIOISOTOPES
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[en] Background: incidental irradiation of the prostate may affect serum prostate-specific antigen (PSA). However, scarce data exist on PSA changes after irradiation of noncancerous prostatic tissue. This is an update of a study on PSA after pelvic irradiation. Material and methods: from 1997 to 2007, blood samples of 38 men were examined who had undergone pelvic irradiation for rectal or anal cancer. The planning target volume included the prostate in all cases. No patient had clinical evidence of prostatic disease. Radiotherapy was applied in fractions of 1.8-2 Gy up to 40-50 Gy (n = 3), 50-60 Gy (n = 21), and 60-65 Gy (n = 2). Seven patients received 5 x 5 Gy. Serum PSA was measured before, during, and after radiotherapy periodically. Median log (PSA) changes were calculated according to elapsed time from starting radiotherapy. The significance was tested with χ2-test. Results: 18 patients died during follow-up. For 15 patients, long-term PSA data with a median follow-up of 9 years (2,546-3,528 days) are available. PSA levels rose during the first weeks of irradiation peaking at 2-4 weeks with a significant 2.7-fold increase (p < 0.01). 1 year after radiation therapy, PSA declined below (90%) the preirradiation level, but this difference was not significant (p = 0.36). On further follow-up PSA did not change up to 8.9 years after radiotherapy (p 0.36). Conclusion: irradiation of the prostate causes transient increase of serum PSA. By 1 year, PSA has returned near the preirradiation value and stays there for at least 9 years. A major interference with prostate cancer screening or surveillance after radiotherapy is therefore unlikely. (orig.)
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[en] 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 Duesseldorf, 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) oder 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. (orig.)
[de]
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 Ueberlebenswahrscheinlichkeit von weniger als 15%. Die EICESS-Gruppe hat folgende Indikationen fuer die Hochdosistherapie bei fortgeschrittenen Ewing-Tumoren etabliert: Patienten mit primaeren multifokalen Knochenmetastasen und Patienten mit einem fruehen (<2 Jahren) oder multifokalen Rezidiv. Patienten und Methode: Seit 1987 wurden 83 Patienten in der EICESS-Gruppe behandelt, 39 von ihnen in Duesseldorf, 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 zusaetzlichem Lungenbefall aus zwei Kursen ME und Ganzlungenbestrahlung bis 18 Gy (Double-ME). Ergebnisse: Die Ueberlebenswahrscheinlichkeit von 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 koennen durch Stammzellreinfusion ueberwunden werden. (orig.)Primary Subject
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