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Biomedical subjects

A Hackl

Publications and source records attributed to A Hackl.

At least 19 recordsLinked to original sources
PubMed1992

Reduction of the dose to the lens in prophylactic cranial irradiation: a comparison of three different treatment techniques and two different beam qualities.

Three treatment techniques using two beam qualities have been compared on the basis of dose to the lens in prophylactic cranial irradiation. The dose to the lens and the globe was measured with thermoluminescent crystals in an anthropomorphic phantom and calculated by a computer-assisted planning system. A comparison was made of large field and small field techniques using 60Co and 8 MV photons. Modifications to the basic techniques studied included angulation of the gantry, angulation of the couch, and placement of an additional eye block close to the surface. The dose to the lens could be reduced to four percent of the midplane dose by applying the small-field technique combined with the use of 8 MV energy photons, by placing an additional block close to the surface, and by five degree occipitally angling the gantry, as well as rotating the treatment couch to account for the divergence of the beam. The use of 60Co produced an underdosage of the posterior segment of the globe in angled treatment techniques.

Cataract↗
PubMed1992

[Metallic mesh endoprosthesis and intraluminal high dose rate 192Ir brachytherapy in the palliative treatment of malignant bile duct obstruction. Initial results].

Since December 1989, 9 patients with inoperable malignant biliary tract obstruction were treated palliatively by a combined modality treatment consisting of placement of a permanent biliary endoprosthesis followed by intraluminal high dose-rate 192Ir brachytherapy. A dose of 10 Gy was delivered in a hyperfractionated schedule at the point of reference in a distance of 7.5 mm of centre of the source. External small field radiotherapy (50.4 Gy, 1.8 Gy per day, 5 fractions per week) was also given in six cases (M/O, Karnofsky greater than 60%). In 9/9 cases an unrestrained bile flow and an interruption of pruritus was achieved, in 78% (7/9) of cases the duration of palliation was as long as the survival time (median survival time 7.5 months).

Adenocarcinoma↗
PubMed1992

Surgical and non-surgical treatment of cancer of the oesophagus and the oesophagogastric junction: results of 200 consecutive cases.

200 consecutive, unselected patients with cancer of the oesophagus or the oesophagogastric junction (89 squamous, 110 adenocarcinoma or undifferentiated, 1 oat cell) between 1984 and 1987 were reviewed. Resection with postoperative adjuvant irradiation in the cases of squamous cell cancer, was carried out in 51 patients and non-surgical treatment [57 combined dilation and Nd-YAG-laser, 64 iridium 192 high-dose rate brachytherapy with or without 60 Gy external beam irradiation (EBR); 28 endoprostheses] was performed in the remaining 149 patients. The overall 5 year-survival rate was 9.2% (resections: 17.9%, non-resected: 5.2%). Resected nodal negative T1 or T2 patients had the best prognosis (45.8% 5-year survival). The median survival following dilation and laser was 3.4 months for all T-stages. Endoprostheses yielded a median survival of 1.7 months. Intracavitary brachytherapy gave the best palliative result with 6.5 months median survival, whereby only T1 and T2 patients benefitted from additional EBR. Histological subtype, age, sex or tumour localization did not influence survival. Multivariate analysis showed that in M0 patients the choice of treatment had a significant impact on prognosis.

Adenocarcinoma↗
PubMed1991

[Magnetic resonance tomographic screening studies of the bone marrow with gradient echo sequences: (I) the contrast relations of phase-identical and phase-shifted gradient echo sequences. Studies on probands and pathological-anatomical preparations].

Anatomical specimens and normal persons were studied by gradient echo MR imaging to determine the influence of different echo times (TE) on bone marrow contrast. First of all, six normal persons were studied to determine specific echo times for in-phase and opposed-phase states. Using different sequences bone marrow contrast in isolated femoral bones was determined and compared to results of pathological exams. Red bone marrow had no signal on opposed-phase images; contrast between red and yellow marrow was higher on opposed-phase than on in-phase images. Bone marrow lesions can be expected to be visualised with high signal on opposed-phase images; this technique should be especially suited for MR imaging of bone marrow.

Adult↗
PubMed1991

Consolidation radiotherapy following carboplatin-based chemotherapy in radically operated advanced ovarian cancer. A pilot study.

Adjuvant chemoradiotherapy was administered to 26 patients with stage Ic-IV ovarian cancer after radical cytoreductive surgery. All patients received six cycles of carboplatin, epirubicin, and prednimustine and had no evidence of disease after completion of chemotherapy. They received whole-abdominal radiation and radiation to the retroperitoneal lymph nodes. Five (23%) of the patients were discontinued on this protocol because of myelosuppression, progressive disease, or withdrawal. One patient had a small bowel obstruction due to intraperitoneal adhesions. The survival of 10 Stage III ovarian cancer patients who received chemoradiotherapy and were evaluable for assessment of treatment efficacy was retrospectively compared with the survival of 11 Stage III patients who received chemotherapy only. At 36 months, a slight advantage of the chemoradiotherapy versus the chemotherapy-only group was observed (p = 0.11). These preliminary results suggest that adjuvant chemoradiotherapy may prolong the "no evidence of disease" interval of radically operated ovarian cancer patients. Toxicity is acceptable when second-look surgery is avoided and when subsequent radiotherapy is limited to patients with no clinical evidence of disease.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1991

Bladder and rectal dose of gynecologic high-dose-rate implants: comparison of orthogonal radiographic measurements with in vivo and CT-assisted measurements.

Bladder and rectal doses were retrospectively reviewed in 281 patients who underwent implantation of 575 gynecologic iridium-192 high-dose-rate devices. Dose measurements obtained with orthogonal radiography, in vivo thermoluminescent dosimetry, and computed tomography (CT)-assisted planning were compared. Measurements of bladder dose derived from radiographs revealed a significant difference between bladder neck dose and bladder base dose (P less than .0001). In 17% of cases, the dose to the bladder base was at least double the dose to the bladder neck. The mean dose to the rectum calculated from radiographs was 85.9% (cervix) and 90.2% (vaginal vault) of the prescribed fraction dose. The correlation coefficient factor between doses determined with orthogonal radiographs and doses determined with in vivo measurements was .9694. The dose to the bladder neck and to four rectal points determined with corresponding CT images revealed a deviation of 4% and 7%, respectively. However, calculations at the rectal wall cephalic to the specified rectal points showed higher doses to the rectum, with a ratio of 1-1.6. CT-assisted calculations at the bladder base also revealed doses that were higher than those obtained with radiographs alone by a ratio of 1.4-2.2. CT-assisted dosimetry is the method of choice.

Brachytherapy↗
PubMed1991

[Evaluation of irradiation techniques in breast carcinoma using dose-volume histograms. Comparison of the heart and lung exposure].

For irradiation of the internal mammary lymph nodes (IMN), together with irradiation of the breast the commonly used treatment techniques are of three types: 1. two tangential opposed fields, 2. three field plans with a separate "straight on" IMN-field, or 3. with a separate "angled" IMN-field. To determine lung and heart volumes and doses for these techniques, dose-volume-histograms in 30 patients were analyzed. The optimum dose distribution was achieved with the "angled" field technique and an appropriate combination of electrons and 60Co gamma radiation for the IMN-field. (The beam mixture used was 40% 60Co beam and 60% electron beam.) The least possible dose to the lung was obtained with the "straight-on" field technique and the least possible dose to the heart with the separate "angled" IMN-field technique.

Breast Neoplasms↗
PubMed1991

[Interstitial Ir-192 afterloading therapy with sequential warm-water hyperthermia].

For selective heating of superficially located or easily accessible tumors interstitial hyperthermia has become an increasing popular method in combination with interstitial radioactive implants. At our institution the hyperthermia treatment is performed utilizing the warm water system KHS-9, which is adapted to our Ir-192 high-dose-rate afterloading device, so that the same hollow needles for the interstitial radiation can be used for the heating procedure. So far, this technique has been applied for the treatment of primary and carcinomas, gynecological recurrences, and metastases of malignant melanomas after preceding in vitro measurements of temperature distribution. As a result both, in vitro and in vivo investigations showed good homogeneity of the temperature throughout the heated volume. Analysing the temperature data of in vivo measurements the maximum deviation of temperature was found to be 1.5 degrees C. When using a needle spacing of 8 mm, the temperature required for clinical application (42.5 degrees C) could be maintained in all heat treatments with a preselected water temperature of 46 degrees C to 49.5 degrees C.

Anus Neoplasms↗
PubMed1990

Radiation therapy in stage III ovarian cancer following surgery and chemotherapy: prognostic factors, patterns of relapse, and toxicity: a preliminary report.

Twenty patients with FIGO stage III epithelial ovarian cancer who had undergone maximum cytoreductive surgery (including pelvic and paraaortic lymph node dissection) and combination chemotherapy (4-10 cycles, median 6) were treated with irradiation to the abdomen and pelvis with 30 Gy followed by diaphragmatic/paraaortic and pelvis boost fields to 42 and 51.6 Gy, respectively. Second-look laparotomy was not performed. Seventeen of 20 patients completed the planned course of radiation. In 2 cases, failure to complete treatment was related to acute hematologic toxicity, and 1 patient refused further treatment. Five patients (29%) required treatment breaks ranging from 8 to 16 days (median, 12 days) due to pancytopenia. Actuarial overall survival and relapse-free survival at 3 years for the 17 patients who completed radiation was 69 and 47%, respectively, with follow-up ranging from 19 to 53 months (median: 24, mean: 27.6 months). Seven patients (41%) relapsed within the abdomen alone and 2 patients developed extraabdominal lymph node metastasis as their sole site of failure. The prognostic factors evaluated for correlation with relapse-free survival included histologic subtype, grade, amount of residual disease at the time of surgery, and nodal involvement; only residual tumor at surgery (none vs less than or equal to 2 cm or greater than 2 cm) was found to be statistically significant (P less than 0.01). Three-year overall survival correlated with amount of residual disease following the initial cytoreductive surgery. It was 100% for patients with no residual disease, 66.7% for less than or equal to 2 cm, and 26.7% for those with greater than 2 cm residual disease, respectively. Radiation treatment was well tolerated, with only one patient developing treatment-related bowel obstruction 7 months after radiation therapy. The results of this planned trimodality treatment approach compare favorably with those reported following surgery and chemotherapy, particularly in patients who have been maximally cytoreduced.

Adult↗
PubMed1990

Intraoperative radiation therapy combined with external irradiation in nonresectable non-small-cell lung cancer: preliminary report.

Twenty-one patients with nonresectable non-small-cell lung cancer (15 squamous-cell, 4 adeno, 2 large-cell; T1-T3, N0-N2, all M0) underwent lymph node dissection and intraoperative irradiation of the tumor (IORT) with doses between 10 and 20 Gy (energies: 7 to 20 MeV electron beam). Postoperatively, 46-56 Gy external beam irradiation (8 or 23 MeV photon beam) were delivered to the mediastinum and 46 Gy to the tumor bearing area. Fifteen patients were available for follow-up investigations. The CT-scan tumor volumetry 4 weeks postoperatively showed a significant overall decrease (Wilcoxon test: p less than 0.05) with eight minor responses (MR) (tumor regressions between 4 and 45%) and six partial responses (PR) (between 50 and 84%). One case was not evaluable. A second volumetry after external irradiation was done in 14 patients, 18 weeks after IORT, showing 3 complete responses, 10 partial responses (62 to 84%), and 1 minor response (28%). The recent volumetries (10 patients) between 4.5 and 16.5 months after IORT showed 7 complete responses and 3 partial responses (63 to 94%). One patient died from intrabronchial hemorrhage at 7 weeks. Three others died from unrelated causes, 6, 12 and 14 months, respectively, after IORT and in one further case the cause of death at 15 months was local tumor regrowth. Within the median time elapsed since IORT (12 months) only this one case of local regrowth and one further case of distant spread were observed.

Aged↗
PubMed1990

Intraoperative radiation with external irradiation: an alternative for nonresectable non-small-cell lung cancer?

In 15 patients with nonresectable non-small-cell lung carcinoma (NSCLC) (10 squamous, 1 large cell, 4 adenocarcinomas; T1-T3, N0-N2, all M0), lymph node dissection and intraoperative irradiation of the tumour (IORT) with doses between 10 and 20 Gy (11-20 MeV electron beam) was performed. Four weeks postoperatively 46-56 Gy external irradiation (8 or 23 MeV photons) was delivered to the mediastinum and 46 Gy to the tumour-bearing area. Four weeks postoperatively, 8 minor responses (MR, tumour regression between 4% and 45%) and 6 partial responses (PR, 50%-84%) were found. In 1 case, CT was inconclusive. Eighteen weeks after IORT, volumetry showed 3 CR, 9 PR (62% to 94%) and 1 28% MR. One patient died from intrabronchial hemorrhage 7 weeks after IORT (50% PR). Two others (both CR) died from unrelated causes, 6 and 12 months, respectively, after IORT. One patient (62% PR) died after 14 months from an unknown cause. Another patient died at 15 months from local relapse after CR. The latest CT volume assessment between 7.5 and 21.5 months, respectively, yielded 8 CR, and 1 63% PR. One further case of local CR has developed contralateral pulmonary metastasis after 10 months. All these patients are alive and well. The median time elapsed since IORT is 12.5 months, 10 patients have survived more than 12 months.

Aged↗
PubMed1990

[Treatment of primary cancer of the fallopian tube].

33 patients treated since 1970 at the Medical School of the University of Graz, were classified using the FIGO system for ovarian carcinoma, fourteen were in stage I, 8 stage II, 8 stage III and 3 stage IV. In 17 patients, surgery consisted of total abdominal or vaginal hysterectomy with bilateral salpingo-oophorectomy; 12 patients underwent additional pelvic +/- paraaortic lymph node extirpation and in 4 the tumour excision was incomplete. Treatment in 6 patients was surgery alone (2/stage I, 4 with advanced disease) (Group A). Adjuvant radiotherapy was performed in 14 patients (Group B); the remaining patients were treated with single (2/13) or multiple agent chemotherapy (11/13) (Group C). The 3-year survival rate was 55% for stage I, 42% for stage II; 10/11 of the stage III/IV patients died within 26 months. The 4-year actuarial survival rate for group B was 68%, for group C 11%. There was no difference between the short-time results of stage II tumours when comparing radiotherapy against chemotherapy. The tumour progression rate was 60%, indicating the need for radical surgery as well as for more aggressive adjuvant treatment. Surgery alone is recommended for stage I disease confined to the mucosa. More advanced disease (extension to the serosa, stage Ic, stage II) requires whole abdominal irradiation with a boost to the pelvic lymph nodes. For stage III/IV tumours a multi-modality treatment is recommended. Chemotherapy (cis-platinum, cyclophosphamide) for recurrent disease resulted in remission in some cases.

Adenocarcinoma↗
PubMed1990

[A therapeutic concept for the treatment of inoperable esophageal carcinoma].

From 1/87 to 12/88, 20 patients with anatomically or functionally inoperable carcinomas of the esophagus (cT1-3/N0-2/M0-1) were treated by endoluminal Ir-192 HDR brachytherapy (1-3 sessions, each 5-7 Gy) and percutaneous irradiation (50-70 Gy/2 Gy). In 10 cases a bouginage or combined dilatation and retrograde Nd-Yag-laser debulking was done before irradiation. The response of the treatment was documented by endoscopy (degree of stenoses) and symptoms (dysphagia score according to De Meester). In 95% of all cases the degree of stenoses was diminished and an improvement of dysphagia was found in 100%. The mean duration of oral uptake of properly chewed food could be prolonged to 308 days.

Brachytherapy↗
PubMed1990

[Intraoperative radiotherapy (IORT) at the Graz University Clinics: development and dosimetry of an applicator system].

The use of high energy electron beams for intraoperative radiotherapy necessitates special technical adjustments of the conventional megavolt equipment. At the University Clinic of Radiology, Division of Radiotherapy in Graz, an applicator system for electron energies up to 20 MeV and cone diameters up to 14 cm was developed. A self modified commercial operating table was used instead of the treatment couch to guarantee optimum mobility for the docking maneuver. The technical set-up of this adaptor system as well as the dosimetric considerations and calculations will be presented in detail.

Austria↗
PubMed1990

[Intraoperative radiotherapy (IORT) at the Graz University Clinics: results of a pilot study on non-small cell lung carcinoma].

A pilot study was undertaken during which 15 patients with non-small cell pulmonary carcinomas were exposed to an intraoperative irradiation; twelve out of them were submitted to an additional percutaneous photon therapy. The criteria used to select these patients were functional inoperability, exclusion of remote metastases, and a Karnofsky index greater than 70. Central and peripheral tumors of the stages T1-3, N0-2 were included into the study after histological confirmation of the diagnosis. The local regression rate of the primary tumor can be assessed quite well despite the short follow-up time of 4.5 to 16 months (10 months on an average) which does not yet allow to make a conclusion as to a prolongation of the disease-free survival time. Already two months after the end of external irradiation, a complete remission (CR) was seen in three patients (25%), a partial remission (PR) in seven patients (67%), and a minor remission (MR) in one patient. In the course of further follow-up, the number of complete remissions increased to six (50%). We are encouraged by the small morbidity and a therapeutic response higher than average to continue with this therapy method in patients who, for the time being, are still selected according to strict criteria.

Aged↗
PubMed1989

[Abdominal fibromatosis in a 58-year-old male patient].

We report on a 58 year-old male patient, in whom abdominal fibromatosis occurred 3 years after laparotomy and irradiation on account of rectal cancer. Abdominal fibromatosis are very rare tumour-like fibrous lesions of the anterior muscular abdominal wall, mainly affecting fertile females. Men, however, are only rarely affected and without age preponderance. A hereditary or mutant generalized defect of growth regulation of fibrous tissue is considered to be the cause of this disease; moreover, trauma, hormonal effects and pregnancies often play a role as cofactors. Interestingly, there is a high correlation between abdominal fibromatoses and osseous lesions of the femur, mandible and thoracic, as well as lumbar spine. In our case thoraco-lumbar Scheuermann's disease was detected.

Abdominal Muscles↗