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H Kucera

Publications and source records attributed to H Kucera.

At least 55 records · Page 3Linked to original sources
PubMed1990

[Effect of inguinal lymph node irradiation on the treatment result of vulvar cancer with different risk factors].

The clinical data from 101 patients with invasive squamous cell cancers of the vulva with less than 10 mm stromal invasion in depth, treated between 1972 and 1983, were studied. 43 of these patients underwent merely a radical vulvectomy, the remaining 58 patients underwent a combination therapy of vulvectomy and irradiation of inguinal lymph nodes. Although the majority of risk factors, like clinically suspicious nodes, stromal invasion of more than 5 mm, tumour expansion of more than 2 cm and clitoral location, occurred more frequently (p<0,001) in the combination therapy group. There was no statistical significance in the five-year survival rate between our two therapy groups (88,4% versus 79,3%). In stage I and II cases inguinal relapses occurred in the group with vulvectomy alone in 9.3%, in the group with adjuvant external irradiation of the inguinal fields in 2.6%. We believe, the data presented show the important role of radiotherapy of inguinal nodes in the curative management of vulvar cancer.

Adult↗
PubMed1990

[Value of irradiation alone of generally inoperable endometrial cancer with high dose rate iridium 192].

Surgery should be an integral part of the management of the patient suffering from endometrial cancer. Only patients with severe internal diseases should be treated with radiation therapy alone. Although radiation therapy alone can cure endometrial cancer, the survival figures are poorer than for the operation. At the University of Vienna (1st Department of Gynaecology), 267 patients with endometrial cancer were treated by radiation therapy alone (Afterloading iridium192 technique). 5-year survival (life table method) for all patients was 65.2%. In stage I, 5-year survival was 66.9%, and in stage II 46.7%, respectively. For up to 69 years of age the survival was 76.6%, for 70 years and more 61.8%, for grading I 78.8%, for grading II and III only 55.4%, respectively. With radium226 technique, the survival rate was only 56%, while 65.2% were reached with the Iridium technique. All differences are significant. External irradiation (cobalt60) was employed as combined treatment in only 9.4% of the cases. Intrauterine and intravaginal applications were performed without anaesthesia and the hospitalisation time was only one day per week. The relapse rate in stage I/b was 14.8% and in stage II 30%, respectively. Therefore, the dose of intracavitary treatment should be changed and external irradiation used more often.

Aged↗
PubMed1989

[Results of electrosurgical vulvectomy with postoperative irradiation of the inguinal lymph nodes in vulvar cancer].

Clinical data on 669 patients with invasive squamous cell carcinoma of the vulva were seen between 1952 and 1982. All of these patients were available for 5-year evaluation. The crude survival for these patients was 62%, and the "cleaned" 5-year survival for 585 patients was 70%. All patients were treated with radical vulvectomy using the warm knife and open-wound technique. Treatment of the regional lymph nodes was performed by irradiation alone. This simple surgical technique in combination with radiotherapy applied only to the inguinal lymph nodes gives an excellent result without the complications associated with aggressive surgery.

Aged↗
PubMed1989

Influence of brachytherapy (192Ir afterloading) on cell-mediated immune reactions in patients with stage I endometrial cancer.

The influence of radiation therapy on cell-mediated immune reactions in cancer patients seems to depend on source, dose, and area of irradiation, as well as on the variables reflected by the patient population investigated. In the present study we demonstrated that brachytherapy (192Ir afterloading), applied to patients with inoperable stage I endometrial cancer, has no immediate or sustained effect on lymphocyte function. Both lymphocyte mitogen response and natural killer cell (NK) activity are not significantly changed in terms of baseline values compared with test results during and after therapy. Brachytherapy, as used in this study, has no influence on cell-mediated immunity in patients with endometrial cancer stage I.

Aged↗
PubMed1989

[The value of postoperative irradiation in endometrial cancer of pathohistologic stage I].

In a prospective therapeutic study, 571 cases of endometrial cancer in pathological stage I were treated initially with total hysterectomy and received 6 weeks after surgery double high-dose-rate iridium 192 irradiation of the vagina (afterloading technique). The single dose was 700 cGY (at 2 cm distance from the applicator axis). Postoperative treatment planning was based on the prognosticators of depth of myometrial invasion and tumor grading with subtypes. External irradiation was prescribed only for patients with poor prognostic factors (Cobalt-60,5600 cGY on the pelvis wall, 30 fractions). At the time of this report, the patients had been followed up for 6 to 96 months after their original therapy. Survival was calculated by the life table method. 327 cases with slight tumor infiltration, independent of the tumor morphology, received postoperative vaginal irradiation only. Survival rate was 90.6%. 27 cases with tumor infiltration of the middle third of the myometrium and grade 1 tumors, received also only vaginal irradiation. Survival rate was 100%. 101 cases with tumor infiltration of the middle third of the myometrium and grade 2 and 3 tumors, received vaginal irradiation plus external irradiation. Survival rate was 89.9%. 116 cases with tumor infiltration of the external third of the mymetrium and any tumor grade, received vaginal irradiation plus also external irradiation. In these patients with poor prognosis, the survival rate was 85%. Differences between groups are not significant. Considering the treatment group with good prognosis and the group with poorer prognosis and the additional external irradiation, the survival figures were quite similar (90.6% and 87.9% respectively). In spite of the unfavorable situation of patients with poor prognosticators, treatment results after the additional external irradiation were rather similar to those cases with good prognosticators and without external irradiation. The value of external irradiation in cases of endometrial cancer in stage I with unfavorable prognosticators seems to be quite clear. This therapy improvement was all the better, because side effects of external irradiation were low (0.2% rectovaginal fistulas) and in case of irradiation of the vagina only, no severe side effects occurred. Relapse rate for the treatment group with good prognosis and vaginal irradiation only was 0.6% (2 from 354) and for the group with poor prognosis and additional external irradiation 2.8% (6 from 217) respectively.

Adult↗
PubMed1989

[The value of primary irradiation of invasive adenocarcinoma of the uterine cervix].

Of 1484 patients with invasive carcinoma of the cervix who underwent primary radiotherapy, 65 (4.4%) were found to have adenocarcinoma. These adenocarcinoma patients were matched with squamous cell carcinoma patients on the basis of age, stage and 5-year survival rates. In 703 patients with squamous cell carcinoma, there was no difference in age and stage compared to those patients, who had an adenocarcinoma of the cervix. The cumulative 5-year survival rates for 65 patients in the adenocarcinoma group (30.7%) were not significantly different, but were remarkably lower with the squamous cell control subjects (42.7%). Only the 5-year survival results for patients with FIGO stage 2 disease were significantly less than those of our control group. For patients with stage 3 disease there were nearly the same results (30%) in both groups. Our results underline the importance of radiotherapy for the treatment of inoperable patients with invasive adenocarcinoma of the uterine cervix.

Adenocarcinoma↗
PubMed1989

[The development of postoperative radiotherapy].

After a short review of the development of radiotherapy a prospective study is presented which indicates the benefit of postoperative external irradiation in cases of endometrial cancer, stage I. 327 cases with good prognosis received only vaginal irradiation (group A). 217 cases with bad prognosis (deep infiltration, grading 2.3) had additional external irradiation (group B). 5-year-survival (Kaplan-Meier) was 90.6% in group A and 87.9% in group B, respectively. The benefit of external irradiation in patients with a poor prognosis is evident.

Austria↗
PubMed1988

The electrosurgical operation of vulvar carcinoma with postoperative irradiation of inguinal lymph nodes.

The results of treatment in the department of 607 patients with invasive squamous cell carcinoma of the vulva between 1952 and 1980 is described and analyzed. The absolute 5-year cure rate in these patients was 60.3%. Particular attention was given to lymph node status (TNM system) in the analysis of the last 141 patients treated. The absolute 5-year survival rate was 67% for the N0-N1 patients and 43% for the N2-N3 patients. Patients were treated uniformly by means of electrosurgical operation and postactinic irradiation of the inguinal lymph nodes. Operative lymphadenectomy was performed only in 5% of cases when the diameter of inguinal lymph nodes was greater than 2 cm. This simple surgical technique, in combination with irradiation of inguinal lymph nodes, gives excellent results and avoids the complications associated with inguinofemoral lymphadenectomy. Owing to its combination of electrosurgical operation of the vulva and irradiation of the inguinal regions as a standard procedure, the treatment involves extremely low strain on the patient and is almost free of complications. This seems to be particularly important as the results of our treatment are not less satisfactory than those of more aggressive procedures.

Aged↗
PubMed1988

[Postoperative irradiation of carcinoma of the corpus uteri using the iridium afterloading technic].

From 1981 to 1986 a prospective study was conducted of University of Vienna, 1st gynecology department, for 708 patients with operated and postoperatively irradiated endometrial cancer. These patients were treated by total hysterectomy, bilateral salpingo-oophorectomy and postoperative vaginal irradiation with high-dose-afterloading (iridium 192). A percutaneous irradiation (cobalt 60) was done in stage I cases only when myometrial infiltration was deep. Highly differentiated tumors with infiltration of the first and second third of the myometrium were treated by vaginal irradiation alone. Poorly differentiated tumors (G2, G3) with infiltration of the second and third third of the myometrium were treated by vaginal and percutaneous irradiation. A group of 125 cases with good prognosis (infiltration 1/3, G1) and with postoperative vaginal irradiation alone had the same five-year-survival of 83% as a group of 152 cases with bad prognosis (infiltration 2/3 and 3/3, G2 or G3) treated by vaginal and percutaneous irradiation. This result shows clearly the importance of additional irradiation of the pelvis in cases with bad prognosis factors. The incidence of radiation side effect in all 708 cases was: cystitis 4.6%, proctitis 5.2%, vaginal or rectal ulcers 1.4% and fistulas 0.2%. Cases with vaginal irradiation alone and with the optimal intravaginal fraction dose of 700 cGy (twice) had the lowest level of side effects: cystitis 3.8%, proctitis 2.1%, vaginal necrosis 0.7%, no further severe complications. None of the patients with postoperative vaginal irradiation alone had a vaginal recurrence. The incidence of recurrences in 708 patients was 1.6%. All recurrence cases in stage I (0.7%) had bad prognosis factors and were treated with vaginal and percutaneous irradiation. It is concluded that primary surgery of endometrial cancer should be followed by postoperative vaginal radiation. It appears that the remote afterloading treatment for vaginal radiation produces minimally complications and gives complete protection from radiation exposure to the medical staff. With additional external radiation in high-risk cases the same good result can be achieved as in cases with low-risk and vaginal radiation alone.

Adult↗
PubMed1988

[Treatment of inoperable endometrial carcinoma with intracavitary high-dose rate iridium irradiation].

Surgery should be an integral part of the management of the patient with endometrial cancer. Only patients with severe medical conditions should be treated with radiation therapy alone. Although radiation therapy alone often can cure endometrial cancer, five-year-survival figures are poorer than for operation. At the University of Vienna, I. Department of Gynecology, 198 patients with endometrial cancer were treated by radiation therapy alone. Using the afterloading-iridium-192-technique, the three-year-survival-rate was 76%, five-year-survival 60%. A comparable group of 185 cases treated by intracavitary radium-226 had five-year-survival of only 40% (p less than 0.001). With afterloading high-dose irradiation younger patients had five-year-survival of 75%, older patients (70 years and more) 51%; when tumor grading was one survival figures reached 76%, with tumor grading 2 and 3 only 41%. Severe radiation side effects did not occur with the optimal intrauterine single dose of 850 cGy (four times) and 700 cGy intravaginal (once), nor could any severe complications be observed when the total rectal dose did not exceed 500 cGy. In only 8% of the cases the treatment was combined with external irradiation (Cobalt-60). Intrauterine and intravaginal applications were performed without anaesthesia and the hospitalisation time was very short.

Age Factors↗
PubMed1987

The influence of nicotine abuse and diabetes mellitus on the results of primary irradiation in the treatment of carcinoma of the cervix.

References in the literature to the frequent occurrence of cervix carcinoma accompanied by nicotine abuse led us to investigate the effects of cigarette smoking on the results of treatment in primary irradiation of cervix carcinoma. As not only nicotine abuse but also diabetes mellitus can lead to angiopathy, we also investigated the influence of diabetes mellitus on the results of treatment. Of 410 nonsmokers with carcinoma of the cervix in Stages I and II, 260 (63.4%) reached the 5-year limit, but only 62 of 115 smokers survived (53.9%). In Stages III and IV there were significantly less favorable rates of cure in patients with nicotine abuse. Of 626 nonsmokers with cervix carcinoma in Stages III and IV, 212 survived (33.9%); but of 153 smokers, only 31 (20.1%) could be cured (P less than 0.01). The frequency of side effects of primary irradiation was distinctly higher in smokers than in nonsmokers. Reversible complications occurred in 17.5% of the smokers and 15.5% of the nonsmokers. Severe irreversible changes occurred in 28% of the smokers versus 15.2% of the comparative group of nonsmokers (P less than 0.01). The injuries caused by smoking not only reduce the biologic effectiveness of ionizing radiation but also increase the rate of side effects due to the deficient capacity for regeneration of the tissue surrounding the tumor. With diabetes as a complication, however, no significant changes in frequency of side effects were noted. Five-year survival in diabetic patients was affected in Stage I and II, but not in the advanced stages.

Diabetes Complications↗
PubMed1987

[Imaging of endometrial cancer with vaginosonography].

Besides the grading parameters, another decisive criterion of prognosis for the 5 year survival rate of the endometrium carcinoma is the depth of infiltration of the carcinoma. It is possible to detect by vaginal sonography an invasion of the myometrium even in women who subjected to primary irradiation. In 8 out of 25 women the histological findings showed an adenocarcinoma type Ib, G2, where the degrees of infiltration of the myometrium that were diagnosed sonographically, varied from one-third to three-thirds. Using vaginal sonography it is possible to provide a criterion of indication for additional irradiation with telecobalt in patients undergoing primary irradiation.

Aged↗
PubMed1987

Radiation dose and leukemia risk in patients treated for cancer of the cervix.

To quantify the risk of radiation-induced leukemia and provide further information on the nature of the relationship between dose and response, a case-control study was undertaken in a cohort of over 150,000 women with invasive cancer of the uterine cervix. The cases either were reported to one of 17 population-based cancer registries or were treated in any of 16 oncologic clinics in Canada, Europe, and the United States. Four controls were individually matched to each of 195 cases of leukemia on the basis of age and calendar year when diagnosed with cervical cancer and survival time. Leukemia diagnoses were verified by one hematologist. Radiation dose to active bone marrow was estimated by medical physicists on the basis of the original radiotherapy records of study subjects. The risk of chronic lymphocytic leukemia, one of the few malignancies without evidence for an association with ionizing radiation, was not increased [relative risk (RR) = 1.03; n = 52]. However, for all other forms of leukemia taken together (n = 143), a twofold risk was evident (RR = 2.0; 90% confidence interval = 1.0-4.2). Risk increased with increasing radiation dose until average doses of about 400 rad (4 Gy) were reached and then decreased at higher doses. This pattern is consistent with experimental data for which the down-turn in risk at high doses has been interpreted as due to killing of potentially leukemic cells. The dose-response information was modeled with various RR functions, accounting for the nonhomogeneous distribution of radiation dose during radiotherapy. The local radiation doses to each of 14 bone marrow compartments for each patient were incorporated in the models, and the corresponding risks were summed. A good fit to the observed data was obtained with a linear-exponential function, which included a positive linear induction term and a negative exponential term. The estimate of the excess RR per rad was 0.9%, and the estimated RR at 100 rad (1 Gy) was 1.7. The model proposed in this study of risk proportional to mass exposed and of risk to an individual given by the sum of incremental risks to anatomic sites appears to be applicable to a wide range of dose distributions. Furthermore, the pattern of leukemia incidence associated with different levels of radiation dose is consistent with a model postulating increasing risk with increasing exposure, modified at high doses by increased frequency of cell death, which reduces risk.

Adult↗