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N Willich

Publications and source records attributed to N Willich.

At least 37 records · Page 2Linked to original sources
PubMed2000

[Intraoperative radiotherapy as multimodal therapy approach in epithelial tumors of the gastrointestinal system].

Surgery alone often fails to achieve local control in advanced gastrointestinal tumors. With multimodal therapy approaches, both local tumor control and long-term survival appear to be improved. Intraoperative radiation therapy (IORT) is an attempt to achieve higher doses of irradiation while dose-limiting structures are surgically displaced. It has been shown previously that both local tumor control and long-term survival are improved in patients undergoing surgery combined with IORT for both primary and recurrent rectal carcinoma. In advanced gastric carcinoma, IORT has achieved optimistic survival results in a few studies. In locally advanced pancreatic cancer, an apparent improvement in local control has been noted with IORT, but survival has not been prolonged because of a high incidence of both liver and peritoneal metastases. The data concerning IORT for esophageal carcinoma are not yet sufficient to allow judgement.

Animals↗
PubMed2000

Results of prophylactic irradiation in patients with resected keloids--a retrospective analysis.

The data of 139 patients with 166 keloids treated postoperatively between 1962 and 1996 were evaluated for prognostic factors and outcomes. Treatment commenced within 48 h after surgery. Radiotherapy was carried out as brachytherapy, using an integrated radionuclide 90 Sr-90Y surface applicator. The median dose delivered to the subcutis amounted to 14 Gy (range 7.5-28.5 Gy). The overall recurrence-free response rate was calculated to be 80% for all keloids. Response rates differed significantly (p < 0.001) between the different anatomical regions. The recurrence rate was lowest (2%) with keloids of the face and neck and highest with keloids of the thorax (49%). Outcome also differed significantly, depending on the etiology. Keloids following burns had a poorer success rate than those developing after surgery or mechanical trauma (p < 0.001). We were unable to demonstrate any significance in outcome related to gender, age or size. No direct correlation was found between total doses and response rates. In our patients there were no signs of secondary malignancies in the irradiation area within a median follow-up period of 12 years. Two new prognostic factors have been identified: keloid etiology and localization of the disorder.

Adult↗
PubMed2000

Simultaneous radiochemotherapy versus concomitant boost radiation for advanced inoperable head and neck cancer.

In this prospective, non-randomized study we compare the results of simultaneous radiochemotherapy (RCT) with those of concomitant boost treatment (CBT) in advanced head and neck cancer. From January 1993 to March 1999, 77 patients were treated with cisplatin, 5-FU, and 70.2 Gy (accelerated split-course); from January 1995 to March 1999, a further 33 patients received CBT to a total dose of 72 Gy. Toxicities were prospectively recorded according to RTOG/EORTC criteria. Acute and subacute reactions did not differ significantly. Severe late effects (III/IV) remained anecdotal (one fistula). Therapy-associated mortalities were 3%(RCT) vs. 0% (CBT), most tumors responding well to therapy (CR + PR: RCT: 72%, CBT: 63%). The 2-year probabilities for freedom from locoregional progression amounted to 42% (RCT) and 31% (CBT); p > 0.05. Tumor-specific 2-year survival amounted to 40% (RCT) and 34% (CBT); p > 0.05. Both of the treatment concepts yield high remission rates with moderate toxicities. Nevertheless, median time to recurrence is still fairly short. We could not find any differences for local control and survival. For patients who are not able to complete the full three courses of radiochemotherapy, the concomitant boost schedule presents a good alternative.

Adult↗
PubMed2000

Radiation therapy approach in gliomatosis cerebri--case reports and literature review.

Gliomatosis cerebri is defined as a remarkably diffuse glioma, characterized by widespread infiltration of the central nervous system. Clinicopathologic characteristics and imaging findings have been published but valid classification remains controversial. Few reports exist regarding therapeutic options in gliomatosis cerebri. Here we review data on 17 patients treated with radiation therapy extracted from the literature, in which we focus our attention on available details of irradiation and clinical outcome and present the results of three additional patients treated at our two institutions. Radiologic-pathologic correlation in gliomatosis cerebri indicates that tumor delineation should be based on T2-weighted MRI. Radiation therapy in gliomatosis cerebri is associated with a temporary improvement in or stabilization of clinical symptoms in the majority of cases. Duration of improvement was > or = 6 months in 50% of treated patients. Survival from onset of symptoms was 23.8 months (range 8-42). Considerable variation in the natural course of the disease precludes conclusions regarding the impact of radiation therapy on survival.

Adolescent↗
PubMed2000

Recurrent head and neck cancer: retreatment of previously irradiated areas with combined chemotherapy and radiation therapy-results of a prospective study.

PURPOSE: To prospectively test the effectiveness of combined chemotherapy and radiation therapy for recurrent head and neck cancer. MATERIALS AND METHODS: In 32 patients, external-beam radiation therapy (2 Gy/d) was administered as a 5-day course with simultaneous hydroxyurea (1.5 g/d orally) and 5-fluorouracil (300 mg/m(2)/d bolus), followed by 9 days of rest. This cycle was repeated until a cumulative soft-tissue radiation dose of 110 Gy (including prior radiation therapy) was reached. RESULTS: At a median follow-up of 18 months, three patients were alive, and 29 had died. The overall 1-year survival rate was 39%. The overall response rate was 41% (13 patients). Acute toxicity was low. According to World Health Organization and Radiation Therapy Oncology Group criteria, there were three cases of grade 3 mucositis or dermatitis and three cases of grade 3 or 4 neutropenia. Three patients had grade 3 late effects: one oral trismus, one jugular venous thrombosis, and one cerebral stroke. CONCLUSION: The combination of simultaneous 5-fluorouracil and hydroxyurea infusion and local reirradiation is feasible for retreatment of recurrent head and neck tumors. This regimen provides short-term tumor control in most patients and long-term control in a few patients.

Aged↗
PubMed2000

Long-term follow-up results of irradiation alone or combined with surgery in stage I-IV carcinoma of the uterine cervix.

OBJECTIVE: Evaluation of side effects and prognostic factors for survival in cervical carcinoma treated with radiation therapy +/- surgery. MATERIAL AND METHODS: From January 1986 to June 1995 277 female patients with cervical carcinoma were treated by irradiation in the Department of Radiation Oncology of the University of Münster. Out of them 224 patients were evaluable for clinical features. 20 of them did not undergo complete radiation series and 14 patients received irradiation for recurrent disease, therefore 190 patients (n = 103 pts. with primary irradiation, n = 87 pts. with postoperative irradiation) were analyzed for survival/therapeutic features. RESULTS: 5-year-disease-free survival rates after primary irradiation: (FIGO I number of patients too small); FIGO II (n = 33 pts.) 52%; FIGO III (n = 44 pts.) 39.5%; FIGO IV (n = 18 pts.) 26%. 5-year-survival rates after postoperative irradiation: pT1 (n = 43 pts.) 87.4%; pT2 (n = 37 pts.) 47%. As significant prognostic factors for disease specific survival after irradiation alone the hemoglobin bloodlevel at the beginning of radiation therapy, tumor stage according to FIGO, tumor size and irradiation of the paraaortic region were revealed. As significant prognostic factors for disease free survival after postoperative irradiation were seen: interval between surgery and the beginning of radiation therapy, tumor invasion of parametria, postoperative stage, involvement of lymph nodes and lymph-/hemangiosis. The documented side effects among all patients corresponded to data found in literature. CONCLUSIONS: Prognostic factors for disease free survival in our patients corresponded to the results of other studies. Acute and chronic side effects after irradiation were within the usual range. Especially in case of additional irradiation of the paraaortic region we could not find an accumulation of side effects. An elevation of disease free survival rates in patients with cervical carcinoma probably could be obtained by improving positional techniques for irradiation or changing fractionation schedules.

Adenocarcinoma↗
PubMed1999

Radiotherapy for intracranial and spinal ependymomas. A retrospective analysis.

BACKGROUND: The low incidence of ependymomas results in limited treatment experience. While standard therapy consists of surgery and postoperative radiotherapy, irradiation techniques are still subject to discussion. We report the experience from Münster over the last 35 years. PATIENTS AND METHODS: Since 1961, 25 evaluable patients with ependymoma were irradiated in Münster: 17 intracranial and 8 spinal tumors. Fourteen of 25 patients underwent subtotal resection. Fifteen of 25 patients were treated by local irradiation, 10 of 25 with large-field techniques (whole-brain/cranio-spinal irradiation) and an additional tumor boost. The median tumor dose amounted to 50 Gy (16 to 65 Gy). Sites of recurrence were analyzed and correlated with the irradiated region. RESULTS: Twelve recurrences were observed. Six of 12 could be exactly related to the irradiation portals and were found well inside the local or boost fields. The remaining 6 tumors also recurred locally; whether they were in-field or field margin recurrences was not to be discerned by the imaging available at the time. No out-field recurrences or spinal seeding were observed. For 8 of 17 locally irradiated patients with intracranial ependymomas, 5 local recurrences were recorded. In 9 of 17 patients receiving whole-brain or cranio-spinal irradiation, 6 local recurrences were found. Two of 8 spinal tumors recurred locally. CONCLUSIONS: All tumors recurred within the former tumor bed. In the remaining cranio-spinal axis no recurrences or metastases were found. Similar results are reported from current literature. The value of large-field techniques (whole brain/spinal irradiation) is to be questioned. Modern methods like IORT or stereotactic radiotherapy might be able to deliver a higher tumor dose without increasing toxicity.

Adolescent↗
PubMed1999

HIT '91 (prospective, co-operative study for the treatment of malignant brain tumors in childhood): accuracy and acute toxicity of the irradiation of the craniospinal axis. Results of the quality assurance program.

BACKGROUND: It was the aim of the quality control program of the randomized trial HIT '91 (intensive chemotherapy before irradiation versus maintenance chemotherapy after irradiation) to assess prospectively the quality of neuroaxis irradiation with respect to the protocol guidelines and to evaluate acute toxicity with respect to treatment arm. PATIENTS, MATERIALS AND METHODS: Data of 134 patients undergoing irradiation of the craniospinal axis were available. Positioning aids, shielding techniques, treatment machines, choice of energy, total dose and fractionation were evaluated. A total of 651 simulation and verification films were analyzed to assess the coverage of the clinical target volume (whole brain, posterior fossa, sacral nerve roots) and deviations of field alignment between simulation and verification of first treatment. Field matching between whole brain and adjacent cranial spinal fields was analyzed with respect to site and width of junction. Acute maximal side effects were evaluated according to a modified WHO score for neurotoxicity, infections, skin, mucosa and myelotoxicity. RESULTS: In 91.3% of patients contemporary positioning aids and individualized shielding techniques were used to assure a reproducible treatment. In 98 patients (73.1%) linear accelerators and in 36 patients (26.8%) Cobalt machines were used. Single and total dose were administered according to the protocol guidelines in more than 90% of patients. In 20.2% of patients the cribriform plate, in 1.4% the middle cranial fossa and in 21.1% the posterior fossa and in 4.5% the 2nd sacral segment were incompletely encompassed by the treatment portals. Ninety-five percent of deviations of field alignment were less than 13.0 mm (whole brain) and 12 mm (cranial spinal field) with a random error between 4.9 and 7.6 mm (whole brain) and 6.9 mm and 9.9 mm (spinal canal), respectively. In 77.5% of patients the junctions between whole brain and cranial spinal fields were placed without a gap. A gap between 5 and 10 mm was left in 15 patients (18.7%), exceeding 10 mm in 3 patients. Acute neurotoxicity and skin reactions were mild, the rate of infections was low in both treatment arms. However, myelotoxicity resulted in interruptions of radiotherapy in 31.9% after intensive chemotherapy as compared to 20.0% without preceding chemotherapy. CONCLUSIONS: In the HIT '91 trial a precise radiotherapy of craniospinal axis has been performed in the majority of patients. Our findings indicate that the high quality is possibly an important contributing factor for the therapeutic outcome. However, preceding intensive chemotherapy caused marked toxicity of subsequent irradiation leading to a high rate of interruptions. Our database is subject to a future analysis of recurrences.

Brain Neoplasms↗
PubMed1999

Results of fast neutron therapy of adenoid cystic carcinoma of the salivary glands.

INTRODUCTION: Patients with adenoid cystic carcinoma (ACC) of the salivary glands in the head and neck region have been reported to benefit from neutron radiotherapy according to significant clinical experience. A prospective clinical trial on the efficacy and treatment related morbidity of fast neutron radiotherapy was performed between 1986 and 1995 at the (d + T) 14 MeV neutron generator in Münster. MATERIAL AND METHODS: 72 consecutive patients with ACC were treated with fast neutrons, 66 after surgery, 6 for primarily unresectable disease, 43/66 for macroscopic residual disease, 23/66 for unresectable recurrent disease. 45/72 tumors were localized in the minor, 27 in the major salivary glands. T-stage was in 13 pts T2, in 33 T3, in 26 T4; positive nodes were in 10 pts, M+ in 15 pts. Mean tumor volume was 89 cm3. Neutron therapy was 15.03 Gy in 3 weeks with 1.67 Gy per fraction three times per week. Individual computer assisted treatment planning was performed based on CT and/or MRI, using bolus material if necessary. Target volume was the macroscopic tumor volume with a generous safety margin. RESULTS: Complete response was achieved in 28 pts, partial response in 35 pts. Local control was observed in 73.4% after a mean observation period of 36 months. Overall and recurrence free survival was 85%/81% at two years, and 58%/53% at 5 years (Kaplan-Meier). In univariate analysis tumor volume (> 100 cm3), distant metastases, histologic subtype (solid) and neutron dose (< 15 Gy) turned out to be significant parameters for predicting outcome, in multivariate analysis tumor volume and histologic subtype remained the only significant parameters. Acute morbidity was grade III/IV (EORTC/RTOG) in 6% for skin (desquamation), in 4% for mucosa (ulceration), late morbidity (grade III/IV) in one patient with local temporal brain necrosis. CONCLUSION: According to this experience and taking into account the so far collected experience, fast neutron radio-therapy remains the treatment of choice for large and unresectable primary and recurrent ACC, and residual disease after surgery.

Adolescent↗
PubMed1999

Treatment results of fast neutron irradiation in soft tissue sarcomas.

PURPOSE: Surgery is the standard treatment of soft-tissue sarcomas. Adjuvant radiotherapy with photons after less radical resection can improve local control. The rate of tumor control achieved in patients with G1 and G2 soft tissue sarcomas incompletely resected and treated postoperatively with neutron irradiation is similar to that seen in patients undergoing complete tumor resection and adjuvant photon irradiation. PATIENTS AND METHODS: At the Department of Radiotherapy and Radiation Oncology of the University of Münster, 61 patients with soft tissue sarcomas were irradiated postoperatively with fast neutrons. Mainly tumors of low or intermediate malignancy (R0; 27%; R1, 21%; R2, 52%) were treated. Malignant fibrous histiocytoma, liposarcoma, and neurogenic sarcomas dominated. 46 patients were irradiated with fast neutrons alone, and 15 patients were treated with mixed beam therapy (photons and neutrons). RESULTS: The median follow-up period was 44 months. Overall five-year survival probability analysed by Kaplan-Meyer method was 42.5%. The local control rate was 57.7%. 15 patients showed complete remission, 18 patients had a partial remission. Only 11% of the patients showed grade III and IV side effects during neutron irradiation. CONCLUSION: Neutron irradiation is efficocious in treating highly and intermediately differentiated soft tissue sarcomas. The result of surgical resection seems to be a very important prognostic factor for patients with soft tissue sarcomas.

Adult↗
PubMed1999

Analysis of failures after whole abdominal irradiation in gastrointestinal lymphomas. Is prophylactic irradiation of inguinal lymph nodes required? German Multicenter Study Group on GI-NHL, University of Muenster.

BACKGROUND: To evaluate failures and to investigate the need for prophylactic inclusion of the inguinal lymph nodes in case of whole abdominal irradiation in gastrointestinal lymphoma. PATIENTS AND METHOD: In October 1992 a prospective study on primary gastrointestinal lymphoma was initiated to evaluate management strategies. Treatment consisted either of conservative management comprehending radiotherapy +/- chemotherapy or radio-/chemotherapy sequential to primary surgery, depending on the physician's decision. Until November 1996, 382 patients were enrolled. Out of them we analyzed 92 patients who received a whole abdominal irradiation, in 21 cases with prophylactic inclusion, in 71 cases without inclusion of inguinal lymph nodes. RESULTS: After a median follow-up time of 36 months in 92 patients with whole abdominal irradiation 9 patients developed relapse of gastrointestinal lymphoma (8 local failures, 1 distant failure). In these cases the analysis of radiation therapy shows low tumor doses or small field sizes. No significant difference in the relapse rates is shown between the 21 patients with inclusion of the inguinal lymph nodes in the abdominal radiation fields (3 recurrences approximately equal to 14.3%) and the 71 patients without enclosure of the inguinal lymph nodes (6 recurrences approximately equal to 8.5%). CONCLUSION: General prophylactic enclosure of the inguinal lymph nodes in the case of whole abdominal irradiation in gastrointestinal lymphoma seems to be unnecessary.

Abdomen↗
PubMed1999

Radiation-induced esophageal carcinoma 30 years after mediastinal irradiation: case report and review of the literature.

A 54-year-old man who had been irradiated in 1964 for cervical involvement by Hodgkin's disease was admitted in December 1994 to our clinic with strong complaints of dysphagia. The reason was a moderately differentiated squamous cell carcinoma of the proximal esophagus in the previously irradiated region. The patient had no risk factors (abuse of nicotine or alcohol) for the developement of esophageal carcinoma. A reirradiation was performed, but the disease progressed locally and two weeks after the beginning of the therapy the patient developed two tracheoesophagocutaneous fistulae. The radiation therapy was discontinued and the tumor stenosis was bridged by a tube closing the fistulae. A retrospective dose analysis to evaluate the applied doses will be performed. Furthermore, an overview of 66 cases of the literature with radiation-induced esophageal carcinoma analysed concerning applied dose and latent interval will be given. In conclusion the reported case fits the criteria for radiation-induced malignancies (Chudecki Br J Radiol 1972;45:303-4) known from literature: (1) a history of previous irradiation, (2) a cancer occurring within the irradiated area, (3) gross tissue damage due to an excessive dose of radiation, and (4) a long latent interval between irradiation and development of cancer. Esophageal carcinomas belong to the rare secondary malignancies after the therapeutic use of ionizing radiation. Nevertheless in patients with dysphagia they should be suspected as a differential diagnosis even many years after mediastinal irradiation. The treatment of these tumors is very difficult and is associated with a poor prognosis.

Carcinoma, Squamous Cell↗
PubMed1999

Trimodality therapy in stage III non-small cell lung cancer: prediction of recurrence by assessment of p185neu.

In a trimodality treatment approach for stage III non-small cell lung cancer the prognostic impact of pretherapeutic p185neu assessment was evaluated. Fifty-four patients were admitted to chemotherapy followed by twice-daily radiation with concomittant low-dose chemotherapy and subsequent surgery. Immunohistochemical assessment of p185neu expression was performed in paraffin-embedded mediastinal lymph node metastases, by mediastinoscopy biopsy prior to therapy. Paraffin-embedded biopsies of mediastinal lymph node metastases were available in 33 cases. Seven out of eight patients with positive p185neu staining developed distant metastases, in contrast to seven out of 25 negative cases. Expression of p185neu in mediastinal lymph node metastases was a significant predictor for progression-free survival (p=0.047) and resulted mainly from significant differences in metastases-free survival (p185neu-positive versus p185neu-negative: median, 11 versus 19 months; 2- and 3-yr rates, 13% and 0% versus 40% and 32%; p=0.04). On the basis of these preliminary results it was concluded that further evaluation of p185neu expression in trials on neoadjuvant and adjuvant therapy is warranted. When the prognostic impact of p185neu in such trials with larger patient numbers is confirmed, this may contribute to the identification of stratification variables for future treatment approaches of non-small cell lung cancer.

Adult↗
PubMed1999

Impact of preoperative bimodality induction including twice-daily radiation on tumor regression and survival in stage III non-small-cell lung cancer.

PURPOSE: The objective of this prospective study was to assess the feasibility, toxicity, and efficacy of an intensive trimodality approach in stage III non-small-cell lung cancer (NSCLC). PATIENTS AND METHODS: Fifty-four patients with NSCLC and biopsy-proven N2 nodes (IIIA; n = 25) or N3 nodes or T4 lesions (IIIB; n = 29) were administered two initial cycles of ifosfamide, carboplatin, and etoposide; subsequent radiotherapy (45 Gy, twice-daily 1.5 Gy) with concurrent carboplatin and vindesine; and surgery if the patient's disease was resectable or conventional radiotherapy (16 Gy, 2 Gy/d) if the patient's disease was not resectable or incompletely resectable. RESULTS: Thirty-seven patients (69%) responded to preoperative induction. Forty of 54 patients (74%) had disease that was resectable, with 34 (63%) complete resections (R0). A substantial pathologic response (tumor regression [TR] > 90%) was achieved in 27 of 54 patients (50%) and is revealed as an independent predictor for long-term survival after surgery. Five treatment-related deaths (9%) occurred. With a median follow-up period of 44 months, calculated survival rates at 3 years were 35% for patients with stage IIIA disease, 26% for patients with stage IIIB disease, and 56% for patients with R0 disease and TR > 90%. CONCLUSION: This trimodality approach is feasible and results in encouraging 3-year survival rates in prognostically unfavorable patients with stage III NSCLC. Patients experiencing a 90% degree of pathologic TR were most likely to achieve long-term survival.

Adult↗