[Rectal carcinoma: preoperative irradiation improves the prognosis].
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Biomedical subjects
Publications and source records attributed to E Schnepper.
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The authors describe chordomas, i.e. relatively rare dysontogenetic tumors, their different localisations and the possibilities of radiologic diagnosis. Particular attention is paid to the therapy methods, namely operation, radiotherapy, and their combination, and to the problem of the high rates of local recurrences (36% on an average). The therapeutic problems of seven own cases are discussed and compared to those mentioned in literature. Surgery which should be performed as radically as possible and subsequent high dose radiotherapy (6000 rad) are stated to be at present the most promising therapy combination.
Endolymphatic radionuclide therapy (ELRT) produces not only a radiotherapeutic effect on the lymph nodes but makes possible also to judge of the lymph nodes being stained with labelled lipiodol UF. With the purpose of avoiding an eventual radiation exposure of the lung, or at least of confining it to a minimum, only limited quantities not exceeding 3.5 ml (5 mCi of 32P; 0.5 mCi of 131I) of the oily contrast medium for unilateral, or twice 3.5 ml (together 4 mCi of 32P; 0.5 mCi of 131I) for bilateral application. A retrospective analysis of 245 patients of the study group for endolymphatic radionuclide therapy, who suffered from malignant melanomas of the inferior limbs, revealed 77.5% of correct diagnoses. Most of the false-positive findings (44/70) seem to be due to the knowledge of the primary disease, as 77% of these cases had been described as "suspicious". False-negative findings turned out in 5% only. The findings which had been characterized as "surely positive" proved reliable in 90%. The good results of lymphography with smaller quantities of the contrast medium are, on the whole, comparable to those of primary diagnostic lymphography.
The authors are of the opinion that radiotherapy is always indicated for colorectal carcinoma patients: (1) Operable carcinomas should be given radiation treatment before operation; postoperative saturation of high-risk cases at the full tumor dose is recommended. (2) Inoperable or partially operated carcinomas should be treated with tumoricidal radiation dose. (3) Radiotherapy is also indicated for cases of local recurrence, especially in the floor of the pelvis, in view of the frequent lack of possible operative access. The necessary dose rate must take into account any prior radiation load. (4) The excellent palliative results are themselves a recommendation for radiotherapy.
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Sections of the body, being already an integral part of irradiation planning, can be obtained by ultrasonic instruments. This method is especially important for the representation of organs with a varying state of function or filling and for localization of contiguous tumors. After large surgical interventions involving an alteration of the anatomical situation, an ultrasonogram will be a valuable help for individual treatment planning.
Based upon 351 cases of malignant synovialoma from the literature and 12 own observations clinical and roentgenographic findings, differential diagnosis, therapy, and prognosis are discussed. Because of early recurrencies and metastases early diagnosis is most important for therapeutic results. By means of radical surgery and subsequent intensive irradiation of the previous tumor site and the draining lymphatics a 5-years survival rate of 30-50% can be achieved.
The results of highvoltage therapy in patients with malignant germinal tumors of the testicle are reported. The radiation technique applied is mentioned, and problems concerning the formation of metastases as well as the prognosis for seminomas and teratomas are considered.
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