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R Hünig

Publications and source records attributed to R Hünig.

At least 19 recordsLinked to original sources
PubMed1995

[Dose-volume histograms for optimization of radiotherapy planning based on the example of esophageal carcinoma].

PURPOSE: The tissue tolerance of a small radiation dose to a large tissue volume applied in small fractions is expected to be different from the tolerance of a high dose to a small volume given in large fractions. Corresponding criteria for judgment have to be worked out. METHODS: Using the example of oesophagus carcinoma, dose-volume histograms for diverse treatment techniques are calculated and judged by means of multiplanar isodose representations. RESULTS: The selected treatment plans are ranked with the aid of the dose-volume histograms. We distinguish the tissue inside and outside of the target volume. CONCLUSIONS: The description of the spatial dose distribution in dependence of the different volumes and the respective fractions of the tumor dose therein with the help of dose-volume histograms brings about a correlation between the physical parameters and the biological effects. In addition one has to bear in mind the consequences of measures that influence the reaction and the side-effects of radiotherapy (e.g. chemotherapy), i.e. the recuperation of the tissues that were irradiated intentionally or inevitably. Taking all that into account it is evident that the dose-volume histograms are a powerful tool for assessing the quality of treatment plans.

Esophageal Neoplasms↗
PubMed1992

The role of laminectomy in the combined treatment of metastatic spinal cord compression.

A retrospective analysis of clinical data concerning 140 patients with spinal cord compression is presented. Treatment consisted of a surgical decompressive laminectomy followed by radiation therapy in 127 cases. Primary radiation therapy supported by steroids was applied in only 26 cases. A dose of 30-40 Gy in 15-20 fractions was delivered to all patients. Treatment outcome was analyzed by comparing motor function (categories: no deficit, mild deficit ambulatory, paraparetic not ambulatory, paraplegic), sphincter function, and pain relief before and after treatment in both modalities. Following laminectomy and radiation therapy, 82% of paraparetic patients regained their ability to walk, sphincter function improved in 68%, pain relief was achieved in 88%. Following radiation therapy alone, 64% of paraparetic patients became ambulatory, 33% showed a normalization of sphincter function, and 72% became pain free. Our results indicate that laminectomy should play a major role in the treatment of patients with metastatic spinal cord compression. The decision as to the treatment of choice has to be made individually for each patient taking into consideration his general condition, life expectancy, and origin of the primary.

Adult↗
PubMed1992

[Diagnostic problems in local recurrence after breast saving treatment].

353 patients with stages pTis, pT1-2, pN0-1, cM0 breast cancer have been treated consecutively by breast conserving therapy in a prospective, nonrandomized study at the University Hospital Basel and the Women's Clinic Rheinfelden/Baden/Germany. The median age was 47 years, the median follow-up time 67 months, and 4% only of this collective were lost to follow-up after a median time of 42 months. In 79% of the cases the tumor was excised totally, while in 19% the resection margins were positive and in 2% only the margins were not available for histological judgement. The rate of local failure reached 8% with a median time interval of 53 months. 116 patients showed postactinic induration in the primary tumor region. 73 of these were given additional diagnostic examination: The postactinic induration was judget clinically suspicious in 51 cases and clinically nonsuspicious of local failure in 22 cases. All 73 patients received additional examination by mammography and biopsy. By comparison with the histological results the clinical results were correct in 59% and false in 41%, while the mammographic results were correct in 82% and false in 18% of the cases.

Biopsy↗
PubMed1991

[Health status and late complications following allogeneic bone marrow transplantation. A review].

Better results following bone marrow transplantation (BMT) have increased the number of patients in longterm follow-up. Health status and late effects are therefore of increasing interest. We discuss here the incidence and follow-up of late complications after allogenic BMT. Any conditioning regimen including TBI in postpubertal women introduces a postmenopausal status. In contrast, normal function is found after BMT without irradiation. In men, there is usually permanent azoospermia after TBI but not following chemotherapy alone. Thyroid dysfunction after BMT with TBI has been reported in about 40% of patients. In most of them compensated hypothyroidism with elevated TSH is found. BMT with TBI induces growth retardation in children. Decreased growth hormone levels are observed and substitution can induce normal height development. Interstitial pneumonitis (IP) is a major cause of death. It occurs on average three months after BMT but late onset IP's are increasingly reported. Cataracts are common after BMT. The risk of cataracts in patients given single dose TBI attains 80-100% after four years. Under treatment with cyclophosphamide alone, the risk of lens opacification is less than 20%. So far, patients treated with fractionated TBI have not developed more cataracts than those treated with chemotherapy alone. Impaired renal function is common early post-transplant. Risk factors include cyclosporine (CSA) nephrotoxic antibiotics and antifungal drugs. So far, few secondary malignancies have been reported in humans after BMT. However, actual observation time is still too short for final evaluation. Prevention or treatment is instituted for common complications. It is expected that other types of tissue damage will be recognized.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1989

Conservation therapy for breast cancers other than infiltrating ductal carcinoma.

Pathologic review of 861 Stage I and II breast cancers yielded 152 patients (18%) with histologic types other than invasive ductal carcinoma. All patients had been treated by breast-conserving surgery and radiotherapy, including supplemental radiation to the tumor bed. For 67 patients with predominantly lobular carcinomas, the actuarial overall 5-year survival was 100% and 77% for node-negative and node-positive patients, respectively. The actuarial probability of recurrence in the treated breast (13.5% at 5 years) appeared to be somewhat greater than that observed after treatment of invasive ductal cancers (8.8% at 5 years, P = 0.11). Of 12 mammary recurrences in patients with lobular carcinoma, four occurred at a considerable distance from the original primary and seven were multifocal, involving more than one quadrant in five patients. Of 47 patients with strictly in situ carcinomas, one patient whose axillary nodal status had not been determined subsequently developed distant metastases. Three additional patients developed mammary recurrence, two at the primary tumor site and one in another quadrant. The actuarial 5-year mammary recurrence and overall survival rates were 4% and 98%, respectively. For 27 patients with true medullary cancers, overall survival at 5 years was 90%. One localized mammary recurrence was observed at the site of the original primary. Actuarial mammary recurrence rate was 4% at 5 years. No relapse was observed in ten patients with colloid and one patient with adenoid cystic carcinoma. The authors conclude that, in addition to its well-established efficacy in the treatment of infiltrating ductal carcinomas, the combination of tumor excision and radiotherapy appears to provide adequate local control for other histologic types as well. However, patients with lobular cancer appear to be at somewhat greater risk of mammary failure, and recurrences in such patients tend to be multifocal and multicentric.

Adenocarcinoma, Mucinous↗
PubMed1989

[Breast saving therapy: diagnostic problems in after care].

From 1.1.1977 through 31.12.1985 two hundred seventy-five patients with stages pTis, pT1-2, pN0-1, cM0 breast cancer were treated by breast-conserving therapy. Six patients (2%) were lost to follow-up. Fifty-four patients developed significant subcutaneous or parenchymal induration in the treated breast. The induration was considered clinically suspicious for recurrence in 30/54 and non-suspicious in 24/54. Of the 30 suspicious indurations mammography was diagnostic or suggestive of recurrence in 12 (40%), and the diagnosis of recurrence could be confirmed microscopically in 16 (53%). Mammography showed no pathologic findings in 14/30 (42%) patients with suspicious indurations, and in 12/30 (40%) the impression of benignity was also confirmed microscopically. In patients whose mammograms were diagnostic or suggestive of tumor, malignancy was demonstrated by pathologic examination in all cases. In 21/24 (87.5%) clinically benign indurations no tumor could be found on microscopic examination. Twenty of these patients had a normal mammogram, and in only 1 of these was a recurrence discovered incidentally during a cosmetic operation. Four of the 24 patients with clinically benign indurations had pathologic mammograms, and in 2 of these the diagnosis of recurrence was established histologically. - The rate of agreement between suspicious clinical and mammographic or microscopic findings was about 50%, whereas the correlation for clinically benign indurations was greater than 80%.

Biopsy, Needle↗
PubMed1988

[Treatment of aggressive fibromatosis (desmoid). Reducing the rate of recurrence by postoperative irradiation].

Thirty-three patients with desmoid tumors were treated from 1 January 1970 through 31 December 1983 at the University Hospital in Basel. Twenty-nine patients were treated primarily by surgery in an attempt to cure. Sixty percent of these patients (17 of 29) suffered a subsequent recurrence. Of these 17 patients, 12 were treated with radiotherapy after a second operation. As a result, the recurrence rate was reduced to 25% (3 of 12). Following the initial tumor resection, 4 patients were treated by radiotherapy in an effort to cure. All 4 patients remain free of recurrence, with a median follow-up time of 56 months. The postoperative recurrence rate is dependent on age. No recurrences were observed in patients older than 40. In the younger patients, an increasing recurrence rate was observed the younger the patient. Radiotherapy can contribute to improved prognosis for desmoid tumors under the following circumstances: (1) when the tumor cannot be resected with histologically clear margins, or when resection margins are questionable; (2) when the patient is 30 years old or younger; (3) when the tumor is inoperable, or resectable only by means of a mutilating operation. For patients between 30 and 40 years of age, the question of postoperative radiotherapy should be discussed with the radiation oncologist, even following a microscopically complete resection.

Adolescent↗
PubMed1987

Para-articular ossification in total hip replacement: an indication for irradiation therapy.

The results of postoperative irradiation therapy after total hip replacement or resection of para-articular ossification in 25 patients are reported. The patients were kept under radiological observation for an average period of 26 months and clinical observation for an average period of 31 months after surgery. There were only two clinically relevant recurrences of para-articular ossification. The earlier radiotherapy with a total dose of 2000 rads (2000 cGy) was begun, the better was the effect. In this small population sample statistical significance could not be calculated. No side effects were detected.

Adult↗
PubMed1986

[Adverse effects of total body irradiation for bone marrow transplantation: prevention and therapy. Experience at Basel, July 1979-March 1986].

Acute toxicity, delayed complications and the incidence of interstitial pneumonitis (IP) after total body irradiation (TBI) are reviewed. Between July 1979 and March 1986 118 patients with hematological malignancies underwent bone marrow transplantation (BMT): all were conditioned with cyclophosphamide and TBI. 106 patients received single dose irradiation (18 with lung-shielding) and 12 had fractionated TBI. Except for mucositis all other symptoms of acute toxicity such as fever, vomiting, parotitis, headache and abdominal pain were usually of short duration. Fractionated TBI did not produce less acute side effects than single dose irradiation. Irradiation, and particularly the maximum lung dose, plays an important role in the multifactorial pathogenesis of IP. Delayed complications may appear several months or years after TBI. The majority of men suffer definitive sterility caused by azoospermia. In women primary ovarian failure and permanent sterility is a common sequela of BMT with TBI. The risk of developing cataracts after single dose TBI is about 80%, and surgical repair was necessary in 43% of these cases. Secondary tumors after TBI have been reported. So far we have observed no secondary malignancies in our patients after BMT. Rampant dental decay can be avoided by careful dental prophylaxis.

Adolescent↗
PubMed1986

Specific integral dose: a reconsideration of the integral dose concept.

The integral dose represents the total energy deposited by ionizing radiation within a body. Its distribution within normal tissues can be quite variable, depending upon beam energy and radiation technique. A close look at the concept of integral dose in its various forms should be helpful in quantifying the radiation burden borne by healthy tissues outside of the target volume. The integral dose, integral target dose and relative integral target dose will be reviewed, and the concept of specific integral dose will be introduced, using as examples the external irradiation of the urinary bladder employing various energies and techniques, as well as the intracavitary therapy of gynecological cancer using an afterloading apparatus.

Brachytherapy↗
PubMed1983

[Therapeutic breast-preserving measures in operable breast carcinoma].

Simple mastectomy with axillary clearance represents the standard therapy in operable breast cancer. In many cases no additional complex therapeutic measures have to be taken. For small tumors without clinical suspicion of lymphnode involvement in the axilla a combination of tumorectomy and axillary clearance followed by high voltage radiotherapy allows the conservation of a nearly normal breast. The survival figures available today show no difference between amputation and conservative treatment. An absolute condition for successful conservative treatment and follow-up is a consequent and continuous collaboration between the involved disciplines. If this is not the case, mastectomy with eventual later reconstruction has to be preferred.

Breast Neoplasms↗