Effect of irradiation on thromboxane and platelet sensitivity in-vivo in patients with cervical cancer.
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Adult↗
Biomedical subjects
H Kucera
Publications and source records attributed to H Kucera.
[Effect of ozone and ionizing radiation on an in vitro model--a pilot study of 4 gynecologic tumors].
In order to investigate the sensibility of cultured tumor cells to ozone and irradiation primary tissue cultures from one undifferentiated non-classified ovarian carcinoma, two solid adenocarcinomas of the ovary and one endometrial carcinoma were established. Cultivation was performed according to standard techniques involving the stem cell assay in soft agar as well as the monolayer technique in liquid nutrient media. The type of culture system did not influence the sensitivity of the culture cells to ozone and/or irradiation. Ozone treatment was performed with three different Ozone concentrations (0.03 ppm, 0.1 ppm, 0.3 ppm). Irradiation was done with 100 rd Ra226, Ir192 or Co60. A control experiment showed that the proliferative tendency of benign cells (skin fibroblasts) was not inhibited by the three ozone concentrations used in this study. Ra226 and even the combination of ozone and Radium did not influence the proliferative activity of these benign cells. Ir192 and Co60 were cytotoxic to benign as well as to carcinoma cells. Cultivated cells from endometrial carcinoma resisted to ozone treatment as well as to Ra226 (but they were destroyed by Ir119 and Co60). After pretreatment with ozone (0.1 ppm), Ra226 treatment of endometrial carcinoma cells induced a cytostatic effect implying that no cell divisions were observed after irradiation and the cells lysed within two weeks after irradiation. For the three ovarian carcinoma cell lines analysed in this study ozone treatment had a cytostatic effect even at the lowest concentration (0.03 ppm), with the two higher ozone concentrations a cytotoxic effect could be induced in ovarian carcinoma cells. Exclusive treatment with Ra226 induced a cytostatic effect, but it was cytotoxic after combination with ozone treatment of the lowest concentration (Ir192 and Co60 were cytotoxic in all cases). Our investigation confirmed the radiosensitizing effect of ozone treatment. Furthermore it was shown that exclusive ozone treatment even without combined irradiation displayed a selective cytotoxic action at the ovarian carcinoma cells.
Cells, Cultured↗
[Value of postoperative irradiation of cases of cervix cancer of histologic stage I/b with extensive infiltration (stage I/c)].
The separation of FIGO stage I b cervical carcinoma into a new histological stage I b1 and a stage I c (deep infiltration confined to the cervix) leads to an essential difference in therapeutic results. 5-year survival of 152 cases consigned to the new stage I b1 was 92%, whereas that of 95 cases of the new stage I c was only 77%. Hence, 5-year survival of stage I c patients is lower than of FIGO stage II a (83%). Contrary to our earlier practice, since 1976 all stage I c cases have received postoperative irradiation (Cobalt60). 5-year survival of 75 stage I c cases without lymph node metastasis was 83% when treated by surgery alone; 5-year survival of 22 similar cases treated by surgery and postoperative irradiation was 82%. There is no benefit of postoperative irradiation in cases of stage I c cervical carcinoma when the lymph nodes are not affected.
Combined Modality Therapy↗
[Effect of nicotine abuse on treatment results in primary irradiated cervical cancer].
In view of the fact that frequent occurrence of cervical carcinoma in smokers is referred in literature, the authors examined the effects of cigarette smoking on primary irradiation therapy results in cervical carcinoma. Whereas of 410 patients with cervical carcinoma of stage I and II, 260 (63.4%) attained the 5-year limit, out of 115 smokers only 62 survived (53.9%). In the advanced cases of stage III and IV, on the other hand, the rates of cure achieved in patients who were habitual smokers were significantly poorer. Of 626 non-smokers with cervical carcinoma in stages III and IV, 212 survived (33.9%), whereas of 153 smokers only 31 (20.3%) were cured (p less than 0.01). The incidence of side effects of primary irradiation was also distinctly higher in smokers than in non-smokers. Reversible complications occurred in 17.5% of the smokers and in 15.5% of the non-smokers. Severe irreversible changes occurred in 28% of smokers but in only 15.2% of the comparative group of non-smokers (p less than 0.01). The noxious effects of smoking not only impaired the biological effectiveness of ionising radiation but also increased the incidence of side effects owing to deterioration of the regenerative capacity of the tissue surrounding the tumour.
Adult↗
[Afterloading short-term irradiation of the vagina following radical surgery of uterine cancer].
A report is given of results and complications following postoperative irradiation in endometrial carcinoma via monitored high-dose afterloading therapy (iridium 192). Intravaginal irradiation was performed in all operated cases. In advanced cases or in cases with poor prognosis (deep infiltration of the myometrium, tumour grading 1-2) percutaneous irradiation (cobalt 60) was employed additionally. 327 patients with endometrial carcinoma were treated by postoperative irradiation between 1981 to 1985 and could then be followed up for at least 12 months to 5 years. Evaluation was done with regard to recurrence-free survival rate and side effects. With the postoperative afterloading iridium 192 technique, the 3-year recurrence-free rates were 91% in stage I and 78% in advanced stages. All of the patients in stage I with a control time of 5 years survived. The incidence of radiation side effects in the overall group was: cystitis 4%, proctitis 7% and fistulas 0.6%. No further severe complications occurred with the optimal intravaginal fraction dose of 700 cGy (twice). The afterloading therapy with high dose rates and remote control monitoring reduces the risk of radiation exposure of the medical staff and also places less strain on the patients because of the short-term irradiation. Intravaginal applications were performed without anaesthesia or any drugs, and treatment on an outpatient basis was possible in almost all of the cases.
Aged↗
[Prognosis of primary radiotherapy of cervix cancer in younger females].
Between 1970 and 1979 202 women of 40 years of age or younger were treated for invasive cervical cancer at the 1st Department of Obstetrics and Gynaecology of the University of Vienna. 77 patients received primary irradiation therapy (radium and cobalt-60), 125 underwent surgery. These cases were compared with 1586 patients of all ages who received primary radiation therapy. Of the women under 40 receiving only radiation therapy, the survivors were divided into the following categories: stage I:84.6% of 13 cases stage II:69.2% of 13 cases stage III:35.1% of 37 cases stage IV: 0% of 14 cases. The survival rate for all age groups receiving primary radiation therapy was: stage I:76.0% of 225 cases stage II:52.9% of 429 cases stage III:42.9% of 801 cases stage IV:11.4% of 131 cases. There was no significant difference in the 5-year survival rate between the older and younger women. However, a more promising trend for the younger women receiving primary radiation therapy may be expected. The younger women were observed to have irreversible complications (fistulas) at a rate of 7.7%, whereas the rate of comparable patients receiving radiation therapy was 0.6%. The younger women having stage III and IV cancer were found to develop fistulas at a rate of 17.6%, while both groups together had a rate of only 3.2%. Hence, primary radiation therapy for younger women must be considered as involving a relatively high rate of complications. For younger women with stage I cancer the survival rate after radical surgery was 88.8% (98 cases), after radiation therapy 84.6.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
[Afterloading short-term irradiation of inoperable uterine cancer].
Irradiation using the afterloading therapy equipment enabling monitored short-term high-dose radiation, not only reduces exposure of the medical staff to radiation, but also places less strain on the patients. 94 patients with endometrial carcinoma were treated by irradiation alone between 1980-1985 and could be followed up for at least 12 months up to 5 years. Evaluation was performed with regard to a recurrence-free survival rate and radiation side effects. The 5-year survival rates with radiation alone are compared with a previously recorded control group. Before the afterloading technique had become available, the 5-year survival for endometrial carcinoma treated by intracavitary radium-226 was 50%. Using the afterloading iridium-192 technique, the 3-year recurrence-free rate was 81% and the 5-year survival rate 70%. There was no difference between younger (50-69 years of age) and older (70-85 years of age) patients, nor was there any difference between highly and less differentiated tumours. Incidence of severe damage caused by radiation in the overall group: 2 cases of ileus, 1 case of rectovaginal fistula, 3 cases of rectal ulcers and 1 case of severe vaginal necrosis. Severe complications did not occur with the optimal intrauterine fraction dose of 850 cGy (4 times) and 700 cGy intravaginal (once), nor could any complications be observed when the total rectal dose did not exceed 500 cGy. In only 5% of the patients the treatment was combined with percutaneous telecobalt irradiation (stage II). Intrauterine and intravaginal applications were performed without anaesthesia or sedation, and outpatient treatment was possible in almost all cases.
Brachytherapy↗
[Surgical gynecologic interventions in females over 75 years of age].
In a retrospective analysis of 181 gynaecological operations performed in women older than 75 years the authors examined whether surgery had been meaningful and useful. Malignancy was established histologically in 50.3% of the cases, whereas in 49.7% benign diseases had led to an operation. Postoperative morbidity was 7.73% and depended on the magnitude of the procedure as well as on the diagnosed status of the histological findings. The mortality was 0.55%. Because of this low complication rate under appropriate internal and intensive care, surgery is recommended even in elderly women, if medical indication necessitates an invasive diagnostic or therapeutic procedure.
Aged↗
[Electrosurgical radical operation of vulvar cancer with postoperative irradiation of the inguinal lymph nodes].
Clinical data on 607 patients with invasive squamous cell carcinoma of the vulva seen between 1952-1980 are reported. All of these patients were eligible for 5-year evaluation. The crude survival for these patients was 60.3%, and the cleaned 5-year survival for 530 patients was 69% (stage I [n = 158]: 87.3%, stage II [n = 118]: 83%, stage III [n = 182]: 66.5%, stage IV [n = 72]: 12.5%). A series of 141 patients with vulvar squamous cell carcinoma was analysed with regard to treatment of the inguinal lymph nodes. Crude survival for N0-N1 patients was 67%, for N2-N3 cases 43%. All patients were treated with radical vulvectomy using 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 complications associated with aggressive surgery. Lymph node dissection was performed in 5% of cases only, if lymph nodes were more than 2 cm. The combination therapy of electrosurgery and irradiation of the inguinal lymph nodes and renunciation of groin dissection gave rise to few complications only. This factor must be interpreted as very important, in particular since our 5-year survival rate compared with other reports was not low and the median age of our patients was very high.
Aged↗
[Does radiosterilization of the vagina occur through therapeutic radiation dosages?].
The endogenous genital flora is a major source of infections of the female genital tract, especially in patients with cervical or endometrial cancer. Until recently the "radiosterilisation of the vagina", respectively a prophylactic and/or therapeutic effect of irradiation (external high voltage as well as intracavitary-radium) concerning infections was postulated in the literature. This theory was disproved in a prospective clinical and bacteriological study covering 48 patients with advanced cervical cancer undergoing primary intracavitary radium-irradiation and 38 patients with inoperable endometrical cancer, undergoing primary Iridium-192-afterloading. Following intracavitary radium for cervical cancer some typical nosocomial pathogens like Streptococcus faecalis, Enterobacter, Klebsiella, Proteus and Pseudomonas were isolated significantly more frequently than before treatment. Likewise, the mean number of aerobic bacterial species increased significantly after irradiation. Also primary Ir-192 (afterloading) irradiation did not alter the frequency of isolation of the resident flora in endometrial cancer patients. Therefore, "radiosterilisation" of the vagina as result of radiotherapy does not exist.
Adenocarcinoma↗
[Side effects of postoperative irradiation of uterine cancer with high dose rate iridium and low dose rate radium].
A report is given about reversible and irreversible complications following postoperative irradiation in cases of endometrial carcinoma. Intravaginal brachytherapy was performed. In advanced cases or in cases with poor prognosis (tumor grading) percutaneous irradiation was added (Co60). In 156 cases low-dose-rate irradiation (Ra226) and in 143 cases high-dose-rate irradiation (Ir192) was applied intravaginally. Reversible complications (cystitis, proctitis) could be observed following Radium in 7%, following Iridium in 14%. Irreversible complications (fistulas, stenoses): 1.9% following Radium and 3.5% following Iridium. When high-dose-rate irradiation was combined with percutaneous Co60 therapy, reversible complications occurred in 22.8%. After changing the Iridium-therapy scheme (reduction of dose from 10 to 7 Gy and irradiation only of the upper two thirds of the vagina) complications only could be observed in the same level as in Radium-therapy. High-dose-rate irradiation does not need hospitalization of the patients.
Brachytherapy↗
Radiotherapy of primary carcinoma of the vagina: management and results of different therapy schemes.
Three hundred and sixty-two cases of primary vaginal carcinoma were treated at the Irradiation Department of the University Clinic for Obstetrics and Gynecology, Vienna, from 1950 to 1977. As the method of choice an individually dosed, fractioned, and protracted radium-telecobalt therapy was employed. Comparing the last period analyzed (1971-1977) with another period 20 years earlier (1951-1956), a marked increase of advanced stages and older patients can be observed. These changes are reflected in the 5-year remission rate: in the total population it was 39.8%, as compared to 32% for the period from 1971 to 1977. For a group of 99 patients, who were treated between 1971 and 1977, the therapeutic effect of different therapy schemes is reported. The benefit of teletherapy is remarkable for advanced states, whereas for stages I and II an intrauterine application may be of importance. The complication rate amounted to 8% recto- or vesicovaginal fistulas and 41% and 43% cystitis and proctitis. The central importance of gynecological screening, especially for older women, is emphasized.
Adult↗
[Postoperative radiotherapy of epithelial ovarian cancers].
The importance of postoperative radiotherapy in patients with epithelial ovarian carcinomas was examined critically by means of our own results and the experiences published in international literature. 220 (36.2%) patients out of 608, whose inner genital tract could at least be partially removed, survived after irradiation therapy only without any chemotherapy. In FIGO stages I to III, without consideration of residual tumour mass, a survival rate of 73% after one year, 56% after two years, 47% after three years, 42% after four years and of 40% after five years after only postoperative irradiation therapy has been attained in the course of the last few years. To arrive at a useful comparison, several prognostic factors have to be considered in the estimation of therapeutic results of ovarian cancer. These prognostic factors are the non-resectable residual tumour mass, histology (cell type and grading), age of the patient and tumour stage (diagnosis, surgical technique, completeness of operation). Although our abdominal pelvic irradiation technique with 60-cobalt merely seems to be a compromise, we attained a remission rate and cure rate comparable to the results after postoperative chemotherapy. Our abdominal pelvic irradiation technique was well tolerated. The most frequent complication was an ileus (5.6%), whereas fistulas developed in 1.6% of all cases. According to the results of former randomised studies, postoperative irradiation is effective only in patients with residual tumour mass smaller than 2 cm, if an adequate irradiation technique could be performed. Hence, prospective chemotherapeutic studies should include a therapeutic arm with irradiation therapy alone or in combination with chemotherapy to clarify the importance of postoperative irradiation therapy in ovarian carcinomas.
Adult↗
[Optimal therapy of uterine cancer in a geriatric patient sample (operation versus irradiation)].
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Aged↗
[Postoperative radiotherapy of cervical cancer: complications and implications for the surgical indications].
In a retrospective study the incidence was determined of reversible and irreversible complications in 176 cases of cervical cancer stages I and II treated by operation and postoperative irradiation, in 329 cases of cervical cancer stages III and IV treated by irradiation alone. Severe, irreversible complications (fistulae) occurred in a significantly higher percentage of patients in the group given combined treatment (7.4%) compared with the group treated by irradiations alone (0.6%); p=0.01). The incidence of fistulae was even twice as high in the group of operated and irradiated patients with cervical cancer stages I and II than in the group of patients with cervical cancer stages III and IV treated by irradiation alone (3.2%). Hence, postoperative radiotherapy appears to be rather dangerous. Since primary irradiation achieves the same 5-year survival rate, but is connected with significantly fewer complications, it is pointed out that those cases of cervical cancer which seem to be technically operable, but will probably have to undergo postoperative irradiation, should better be treated by irradiation alone.
Adolescent↗
Radiation therapy for primary carcinoma of the female urethra: a survey over 25 years.
Sixty-two patients with primary carcinoma of the female urethra were treated with a combined radiation therapy (high-dose intracavitary vaginal radium and external beam). Treatment was strictly individualized, but an administered tumor dose of 5500-7000 rad (55-70 Gy) was always attempted. Forty-two patients (67.7%) had tumors of the anterior urethra, and in 20 women (32.3%) the posterior urethra was involved. In 19 patients (30.6%) the clinical diagnosis of lymph node involvement was made. The overall 5-year-survival rate was 64.5%. Patients with anterior urethral carcinoma had a higher 5-year-survival rate (71.4%) than patients with posterior carcinoma (50.0%). The favorable results underline the substantial role of radiation therapy for this malignancy.
Adult↗
[Experiences with second-look curettage following irradiated primary endometrial cancer. Consequences for tumor follow-up].
A report is given about 207 second-look curettages 9-12 months after radiotherapy of carcinoma endometrii. In 22.7% of the cases clinical symptoms of a recurrent disease already have been observed. In 18.4% second-look curettage could not be performed because of complete obliteration of the cervical canal. Perforations occurred in 5.3%. A positive histologic result was found in 17.2%. Only 64% of all recurrent diseases 24 months after primary irradiation were detected by means of second-look curettage. Most interesting are the cases with obliteration of the cervical canal: 37 out of 38 patients showed local recidivation in the following 5 years. Regular intrauterine exfoliation smears in tumour follow-up of primary irradiated endometrial carcinomas are suggested. If this is not possible because of an obliterated cervical canal, second-look curettage must be performed. In this manner not only recidivation can be detected, but obliterations of the cervical canal with consecutive recurrent disease can also be prevented.
Adult↗
[Complications of postoperative radiotherapy in uterine cancer].
A report is given about reversible and irreversible complications following postoperative irradiation in cases of endometrial carcinomas. Intravaginal brachytherapy (Ra226, vaginal cylinder applicator) is given. In advanced cases or in cases with poor prognosis (tumor grading) percutaneous irradiation was added (Co60). Reversible complications (cystitis, proctitis) could be observed in 7%, irreversible complications (fistulas, stenosis) in 1.9% of the cases, respectively. The rate of radiation side effects after primary operation is lower than after primary irradiation of endometrial carcinoma. This is contrary to the results in postoperative irradiation of cervical carcinoma with a markedly higher rate of irradiation side effects. After postoperative intravaginal brachytherapy (Ra226) alone, only in 5.9% of the cases reversible and in 0.8% irreversible complications were observed.
Adult↗