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Biomedical subjects

N Willich

Publications and source records attributed to N Willich.

At least 91 records · Page 5Linked to original sources
PubMed1995

[Endoluminal HDR brachytherapy in the palliative treatment of patients with the recurrence of a non-small-cell bronchial carcinoma after prior radiotherapy].

PURPOSE: The preferred primary treatment in non-small cell lung cancer is surgical resection. In fact, only less than 25% of patients are resectable with curative intent. The remaining patients are primarily treated with radiation therapy or combined radiochemotherapy, achieving remission rates up to 60% but 5-year survival rates of only about 5%. Therefore an effective palliative treatment is important. The aim of our study was to show that using intraluminal HDR brachytherapy, tumor-induced bronchial obstruction and its symptoms can be relieved in the majority of cases. PATIENTS AND METHODS: Sixteen patients with recurrent previously irradiated non-small cell lung cancer were treated with intraluminal high dose rate iridium-192 afterloading irradiation at the Department of Radiotherapy and Radiation Oncology of the University of Münster between 1989 and 1993. There were 15 men and 1 woman with a median age of 61 years. As a primary treatment, 50 to 60 Gy had been delivered percutaneously. The recurrences were treated with HDR brachytherapy using 2 to 4 applications of 5 Gy to 6 Gy each to a tissue depth of 0.5 cm. RESULTS: In 13 of 16 patients dyspnoea could be improved and in 15 of 16 patients atelectasis could be dissolved. Nine of 16 patients achieved a partial or complete remission evaluated by bronchoscopic criteria. The median period of remission was 4 months. The median survival time, measured from the start of therapy and analysed using the Kaplan-Meier method, was only 9 months. As side effects, 1 pneumothorax and 1 tracheomediastinal fistula occurred, the latter presumably related to tumor progression. CONCLUSION: Our results show the importance of intraluminal HDR brachytherapy in the palliative treatment of patients with recurrent non-small cell lung cancer.

Adenocarcinoma↗
PubMed1994

[Treatment results of soft tissue sarcomas in adults].

PURPOSE: An appropriate therapeutical concept for soft tissue sarcomas is unknown particularly since that our knowledge about these neoplasms is considerably incomplete partly resulting from a low incidental rate distributed to many subentities. Children and adolescents were aggressively and multimodally treated. The standard therapy of the adults is an resection as radical as possible followed by adjuvant radiotherapy. The aim of our study was to show the treatment results of our clinic and to investigate survival rates, local tumor control and prognostic factors. PATIENTS AND METHODS: Between 1965 and 1989, a total of 51 male and 49 female were treated for soft tissue sarcoma at the University Hospital of Münster. RESULTS: The overall five-year survival rate (actuarial survival) was 43.1%. 27% of the patients developed a local recurrence, 45% distant metastases. Lymph node metastases occurred in 4% of the patients. Tumor size was a prognostic factor for the five-year survival rates (T1 = 59.8%, T2 = 44.0%, T3 = 26.0%). The best results were achieved after combined treatment using surgery (wide resection) and postoperative high dose radiotherapy. Compared to wide resection alone, the combined treatment had a significantly higher five-year survival rate (59.7% vs. 26%). There was no significant improvement using adjuvant postoperative chemotherapy. CONCLUSION: In our study we could show a remarkable improvement of the five-year survival rate by adjuvant radiotherapy after surgical resection versus surgery alone and demonstrate the importance of radiotherapy in the treatment of soft tissue sarcoma.

Adolescent↗
PubMed1993

[Radiotherapy of invasive breast cancer in the female].

In curative treatments irradiation following breast-conserving operations reduces the local recurrence rate. Stage-adapted regional lymphatic irradiation remains controversial and is recommended only for advanced cases. Combination with adjuvant systemic treatment is possible. Following modified radical mastectomy irradiation reduces locoregional recurrences and improves recurrence-free survival. Inflammatory breast cancer is treated by chemotherapy, irradiation and mastectomy. The prognosis regarding local recurrence after breast-conserving treatment is better than after modified radical mastectomy. In palliative treatments irradiation improves quality of life.

Breast Neoplasms↗
PubMed1993

[A comparative consideration of para-aortic fields within the framework of the German Hodgkin's Disease Study].

In 33 patients of the multicenter German Hodgkin's Lymphoma Study Group the field borders of the paraaortic field were compared computer-assisted. It was seen that fields are chosen often too small or too large, though precise description of the fields is given in the protocol. In these patients the para-aortics were irradiated exclusively as extended field region. In addition to the above observation the clipping of the spleen pedicle provides the optimal help for correct positioning of this field. Overall a very low frequency of lymphatic clipping is observed, though clinical needs are obvious.

Aorta↗
PubMed1992

[Assessing the quality of the speaking voice after therapy of T1 and T2 vocal cord cancers].

All studies which analysed voice quality after T1 and T2 glottic cancer employed sustained vowels for evaluation. Sustained vowels can often be produced more clearly than expected in a severe degree of hoarseness in running speech. In this investigation voice quality was analysed by measuring the signal-to-noise-ratio (SNRc) in running speech. For evaluation these data were correlated to the scores from an auditive evaluation and from a clinical examination of the larynx considering functional parameters. 39 patients were examined after different therapies (primary radiation, chordectomy, frontolateral partial resection). The grading of the three different methods for characterisation of the voice quality correlated well. Therefore the SNRc is presumed to be a valuable additional method to the psychoacoustic voice evaluation. Comparison of voice quality after different therapies provided no significant difference between radiotherapy and chordectomy. The functional results after frontolateral partial resection were significantly less satisfying as expected.

Aged↗
PubMed1992

[Secondary lymphedema of the arm following primary therapy of breast carcinoma].

1107 cases of lymphedema of the ipsilateral arm (27%) were found in 4011 female breast cancer patients suffered from 4101 breast cancer, seen in the Bad Trissl hospital between 1972 and 1990. The right arm was affected in 47.5%, the left in 52.5%. Primary treatment had consisted of operation alone in 1630 patients with a consecutive rate of edema of 20.3%. Additional irradiation increased this rate up to 31.4% (n = 2471). The rate of edema after radical mastectomy (n = 731), modified radical mastectomy (n = 3149) and breast preserving operation (n = 221) were 39.2% and 9.5% respectively. Adjuvant radiotherapy increased the edema rate of each the surgical procedures (radical mastectomy alone 22.7%, with irradiation 44.7%, modified radical mastectomy alone 19.9%, with irradiation 29.3%, breast preserving operation alone 6.9%, with irradiation 10.4%). During the observation time from 1972 to 1990, the edema rate was reduced from 38% to 18%, reflecting the change of the chosen therapy modalities (radical surgery and conventional irradiation from the 50th's to the early 70th's, breast preserving techniques with modern megavoltage irradiation in the late 80th's). A further reduction of the lymphedema rates by minimization of the aggressiveness of the treatment seems to be possible and should be taken into account for preserving an optimal quality of life.

Arm↗
PubMed1990

[Postoperative adjuvant whole abdomen irradiation in ovarian cancer].

Seventy-nine patients with ovarian carcinoma stage I-III postoperatively received a whole abdominal irradiation (median dose: 22.5 Gy) followed by pelvic boost irradiation (median pelvic dose: 45 Gy) as the sole adjuvant therapy. Surgery preceding the irradiation was radical only in 59 percent of the patients. Whole abdominal irradiation was performed either in the moving-strip-technique or the open-field-technique. The median follow-up time was 57 months. The overall and the progression-free five-year survival rate of the whole group is 66 +/- 6% and 63 +/- 6%, respectively. We have not seen a clear-cut dependence of the survival rates on the completeness of the surgery, on tumor histology or grading. In a statistically significant way, the survival rates depend on the stage, the presence of tumor rests, and, above all, on the risk group. The overall five-year survival rate for the intermediate-risk patients is 78 +/- 7% and 22 +/- 11% for high risk patients. There aren't any randomized studies concerning the optimal adjuvant therapy for intermediate-risk patients. Because of the reproduceable results and the infrequent toxicity, whole abdominal irradiation seems to be a treatment equivalent to other adjuvant therapies for these patients.

Adult↗
PubMed1990

Increased serum amylase in patients after radiotherapy as a probable bioindicator for radiation exposure.

The radiation-induced increase of serum amylase is investigated in 41 patients following either whole body irradiation or irradiation of the head- and neck-region. The radiation treatment caused a dose-independent serum amylase increase up to 80 times of the preirradiation measured in controls. This increase can only be induced if the salivary glands are within the radiation field. An isoenzyme analysis differentiated between salivary and pancreatic amylase. It was shown that also in case of whole body irradiation pancreatic proteins either contribute only to a small extent to the increase or show no recognizable change. Although great variations in radiation response remain, the increase of serum amylase produced by salivary glands is highly significant and serves as a bioindicator for radiation exposures.

Amylases↗
PubMed1990

[Current status of radiotherapy in treatment of esophageal cancer].

An improvement of the quality of life by alleviating pain, improving swallowing and increasing weight is achieved in about 80% of patients with esophageal cancer. With survival rates of 41%, 21% and 11% after 1, 2 and 5 years, respectively the curative potential of radiotherapy is considered low. Survival is significantly better in patients with small tumors than with large tumors. Radiochemotherapy must still be considered an experimental modality. Afterloading may be helpful for palliation. Postoperative and postradiation results are relatively positive due to improved local control and patient selection.

Combined Modality Therapy↗
PubMed1990

[Development of special electron applicators for intraoperative radiotherapy at the Grosshadern Clinic].

A specialized applicator system for intraoperative radiation therapy using high energy electrons of a linear accelerator has been developed and manufactured, regarding the specific situation that there is no dedicated linear accelerator available at the surgery facility. Additionally, long lasting interruptions of the daily routine irradiations are hardly tolerable. A significant improvement of the procedure could be achieved developing applicators, which are divided into two halves. Positioning the lower part of the applicator into the patient at the operating room already, the transportation and the irradiation of the closed patient is possible. Adapted to the linear accelerator in use, a Siemens Mevatron KD having electron energies in the range from 6 to 21 MeV, the dosimetric properties of the system have been optimized by iteration. Excess dose values near the applicator walls could be avoided completely. A rapid decrease of the leakage dose could be realized.

Electrons↗
PubMed1990

[Radiotherapeutic quality assurance in the Hodgkin's disease study HD4 supported by the BMFT (Bundesministerium für Forschung und Technologie)].

In the German Hodgkin Study Group a radiotherapy assurance program is being carried out at the radiotherapeutic reference centre in Göttingen since April 1988: 74 patients were entered from 27 radiotherapeutic institutions. 18 of them participated in a quality assurance program and submitted the data of 29 patients: In 21 of the 29 patients the protocol was followed correctly. Physical aspects of quality control showed two major deviations from the protocol: one center used photon energies of more than 15 MVX without mould; another had a anterior-posterior loading of 3:1. The radiation oncology assessment detected six inadequate treatments: The safety margin was inappropriate in three of 26 mantle fields. Another center used a multiple field technique, and in two patients the paraaortic region was not irradiated.

Cobalt Radioisotopes↗
PubMed1989

Time-effect relationship of chromosome aberrations in peripheral lymphocytes after radiation therapy for seminoma.

The time-effect relationship of dicentrics and cells containing unstable chromosome abnormalities (Cu cells) was studied in peripheral lymphocytes of 40 blood samples from 23 patients suffering from seminoma during a time period of 0-1720 days after radiation therapy. Nine patients were studied before treatment. Since the half-time for the disappearance of damaged cells from circulating blood is an increasing function of post-exposure time it can only be expressed as a differential value. The present model discriminates between the mean lifetime m for lymphocytes and a parameter q which is the differential half-time for the decline of damaged cells immediately after exposure (t = 0). If the time t is short compared with m the decline is asymptotically time-hyperbolic rather than exponential and can be described by q only. According to recalculations of previous data, comprising 30 years post exposure, m approximates 10 years. Differential half-times can be derived for any time post treatment within the analysed time period for the decline of the incidence of dicentrics. For example at the end of therapy (t = 0) the differential half-time was calculated to be 0.4 years and at 1720 days post exposure 3.6 years resulted. The corresponding values for the percentage of Cu cells cannot be derived for t = 0; at 1720 days 3.9 years resulted.

Adult↗
PubMed1989

Changes in oligosaccharides of human blood cells measured by tritium- and FITC-labeled lectins after in vitro- and in vivo-irradiation--lectin binding as a 'biological dosemeter'?

The lectin-binding system has been described previously as a biological dosimeter, by revealing induced changes in oligosaccharides of the cell membrane. The measurements were performed by binding [3H]concanavalin A to blood cells. Our results on human blood cells irradiated in vitro with doses in the range 0.5-5 Gy indicate great difficulties in using radioactive labeled Con-A for an accurate quantitative analysis of radiation effects on cell membranes. It appears nearly impossible to differentiate between only a few damaged cells and the remaining undamaged cells. Using fluorescein-labeled Con-A and wheat germ agglutinin, single-cell measurements of fluorescence intensity by flow cytometry revealed enhanced lectin-binding to platelets, lymphocytes and monocytes in the dose range 0.5-5 Gy after in vitro irradiation. But even by this method it was impossible to discriminate irradiations in either partial or whole-body irradiated patients. There were no significant or reproducible changes in the binding capacities of the blood-cell membranes of these patients. Therefore, the suitability of lectin binding as a 'biological indicator' for irradiation could not be confirmed.

Adult↗
PubMed1989

Combination chemotherapy with vinblastine, ifosfamide and cisplatin in bulky seminoma.

Since 1982, 24 patients with bulky seminoma were treated with the VIP-regimen consisting of vinblastine 6 mg/m2 days 1+2, ifosfamide 1.5 g/m2 days 1-5, cisplatin 20 mg/m2 days 1-5. One patient showed primary progression, another patient partial remission, and one patient died during the first cycle. All the other patients had complete remission (21/24 = 87%), which was documented histologically in 9 patients. One patient relapsed but obtained complete remission after repeated treatment. Thus 21 patients are currently living without disease after a median observation time of 30+ months. Bone marrow toxicity was severe, leading to dose reduction in more than 50% of the patients. No other severe side effects were observed. We conclude that the regimen is highly effective in bulky seminoma. Reduction of the vinblastine dose is recommended because of bone marrow toxicity.

Adult↗