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R Sauer

Publications and source records attributed to R Sauer.

At least 19 recordsLinked to original sources
PubMed1992

[Organ-preserving therapy in invasive bladder carcinoma].

With the aim of organ preservation, transurethral resection with subsequent radiotherapy (until 1985) or combined radio- and chemotherapy (since 1986) was undertaken as part of a prospective trial in 175 consecutive patients (137 men, 38 women; mean age 65 [31-90] years) with invasive bladder carcinoma, tumour stage T1-4 N0-3 M0. All patients had a transurethral resection, followed 2-6 weeks later by definitive radiotherapy at a dose of 50.4 Gy to the bladder in 28 fractions. 85 patients simultaneously with the radiotherapy received chemotherapy with cisplatin (25 mg/m2 daily) or carboplatin (65-75 mg/m2 daily) in the first and fifth weeks of radiotherapy. The 5-year survival rate for the whole group (including inoperable cases) was 50%. The survival rate as related to the T category was 53% for T1 (n = 26), 68% for T2 (n = 34), 45% for T3 (n = 94) and 22% for T4 (n = 17). 139 patients (79%) were left with a normally functioning bladder. Cystectomy was performed in 36 patients because of remaining tumour or recurrence after radiotherapy. Combined radio- and chemotherapy improved the histological remission rate, compared with an earlier control group with radiotherapy only, but it did not affect the survival rate. These data indicate that in advanced bladder carcinoma organ-preserving treatment with transurethral resection and definitive radiotherapy or combined radio- and chemotherapy can be successful.

Adult↗
PubMed1992

Hodgkin's disease.

Explore the source record for details and available documents.

Combined Modality Therapy↗
PubMed1992

Combined radiation and chemotherapy for epidermoid carcinoma of the anal canal.

Between 1985 and 1992, 46 patients with epidermoid carcinoma of the anal canal were treated prospectively by a protocol of combined radiation and chemotherapy with 5-Fluorouracil and Mitomycin C. The survival rate, NED-survival rate and local tumour control rate were 84%, 71% and 83% at 5 years. Anorectal function was retained in 33 of 41 patients (80%). We observed severe acute toxicity including three deaths, but very little late morbidity. The only marginally significant prognostic factor (P = 0.06) for local tumour control was T-stage. NED-survival was significantly affected (P = 0.02) by reduction of chemotherapy during the second course.

Adult↗
PubMed1992

Therapy of small breast cancer: a prospective study on 1036 patients with special emphasis on prognostic factors.

In 1983, The German Breast Cancer Study Group, sponsored by the Federal Ministry of Research and Technology, started a prospective multicenter trial on the treatment of early breast cancer pT1 pN0 M0. Treatment consisted of initial tumorectomy with microscopically free margins and lower axillary dissection. After conformation of a pT1 pN0-stage, additional treatment was either mastectomy or adjuvant radiotherapy (50 Gy in 25 fractions to the entire breast plus 12 Gy electron boost). In medially located tumors, the parasternal and supraclavicular area was also irradiated with 50 Gy. A randomization between both treatment modalities was initially planned but was not feasible and abandoned. Nearly all patients were treated according to their own choice. From November 1983 through December 1989, 1119 patients were recruited. Eighty-three were excluded from the protocol. Out of the remaining 1036 patients, 733 (71%) underwent breast preservation and 303 (29%) mastectomy. A detailed pathohistological examination of all tumorectomy specimens was performed in a pathologic reference center. Oncogen overexpression was evaluated by immunohistological detection of the transmembrane protein p-185 (corresponding to c-erb-B2) in 425 cases. After a median follow-up of 48 months, the frequency of local recurrences (4.7%), regional recurrences (1%), and distant metastases (5.4%) was the same in the breast preservation group and the mastectomy group. The 3-year disease-free survival was 90% after breast preservation and 88% after mastectomy (p = 0.21). In the breast preserving group, 24 patients with microscopically involved margins had a poorer disease-free survival than the study group (75% vs 90% after 3 years). The width of the margins had no impact on prognosis. Other prognostic factors in an univariate and multivariate analysis were tumor size and tumor grade. Age, menopausal status, hormone receptor status, histological tumor type, and treatment (mastectomy vs breast preservation) were not significant. P-185-expression was dependent on tumor grade and was the strongest prognostic factor in an univariate and multivariate analysis (p less than 0.001). The results emphasize the central role of tumor grade for prognosis and suggest the independent prognostic significance of the c-erb-B2 oncogen (corresponding to p-185) in pN0-patients.

Adenocarcinoma↗
PubMed1992

Interstitial thermal radiation therapy: five-year experience with head and neck tumors.

Sixty-two patients with 24 primary advanced, six persistent, 28 locally recurrent, and four metastatic tumors of the head and neck were treated with combined interstitial low-dose iridium-192 radiation therapy, interstitial 915-MHz microwave hyperthermia (IHT), and external-beam radiation therapy. Diagnoses were squamous cell carcinoma in 56, adenocarcinoma in three, and soft-tissue sarcoma in three lesions. IHT was applied immediately before Ir-192 was placed and after its removal for 45-60 minutes at 41 degrees C-44 degrees C. At 3 months, complete remission had occurred in 39 lesions; partial remission, in 18; and no change or progressive disease, in five. At 12-month follow-up, local control was achieved in 29 of 50 patients; seven other patients had slow ongoing tumor regression with an unclear residual mass at computed tomography or magnetic resonance imaging. Lesion type, tumor volume, total radiation dose, and thermal parameters with "good quality of heating" at high minimum tumor temperature were identified as statistically significant (P less than .05) prognostic factors influencing initial and long-term tumor response. There was no prognostic factor for acute or late thermal damage.

Adolescent↗
PubMed1992

[Prognostic factors and results after the combined surgical and radiotherapy treatment of ependymomas].

Between 1978 and 1991, 31 patients with primary (n = 28) and recurrent (n = 3) ependymoma received external radiation after initial surgery. There were 26 cases of intracranial and five cases of spinal ependymoma. Histological grading revealed low-grade in 23 and high-grade tumors in eight patients. Craniospinal irradiation was given to 13 of 28 patients, whole cranial radiation with boost to posterior fossa in three and local treatment to twelve patients. Six of 28 patients received chemotherapy. Dose to the primary, tumor localisation, grading and extend of surgery did not significantly impact on survival and relapse-free survival. Age was a marginally significant prognostic factor for survival. In patients with intracranial ependymoma (n = 24) survival and relapse-free survival at five years were 54% and 42%, respectively. Patterns of recurrence showed a local recurrence alone in eight, a CNS-relapse with local recurrence in four and local recurrence with distant metastases in one case. Spinal seeding occurred in two of 13 after craniospinal irradiation and two of twelve patients after local treatment. The main problem in the treatment of ependymoma remains local control, the use of spinal irradiation does not seem to improve treatment results.

Adolescent↗
PubMed1992

[Prevention of periarticular ossification following endoprosthetic hip replacement using postoperative irradiation].

The development of heterotopic ossification (HO) after total hip replacement or other surgical hip procedures can considerably impair the functional result and quality of life in up to 73% of all patients. Predisposing high risk factors for heterotopic ossification are severe pre-intra- and/or postoperative hip trauma, previous development of ipsi- and/or contralateral heterotopic ossification, hypertrophic osteoarthritis, active rheumatoid spondylarthritis as well as male sex. Over the past two decades a variety of surgical, pharmaceutical and radiotherapeutic prophylactic measurements have been proposed and tested in clinical trials. Since June 1988, we have treated 77 patients or 80 hips respectively with prophylactic irradiation. Individual risk factors included severe coxarthrosis grade IV, ipsi- or contralateral heterotopic ossification and severe hip trauma. As of July 1991 60 patients with a minimum follow-up of six months could be analyzed using clinical and radiological scoring systems. The patients had been prospectively randomized in two different treatment arms: 32 patients were treated with low dose (LD), five times 2 Gy daily fractions to a total dose of 10 Gy, whereas 28 patients were treated with high dose (HD), ten times 2 Gy (eight patients) or five times 3.5 Gy (20 patients). Operative procedures and individual risk factors were equally distributed in both groups. 23 patients (38% received indometacin three times 25 mg for six weeks, 19 patients (32%) diphosphonate EHDP 20 mg/kg body weight and 18 patients (30%) had no additional medication. 56/60 (93%) patients developed no significant heterotopic ossification and/or remained without impairment of their postoperative radiological and clinical hip status according to the applied Brooker and Harris Scores. Only 4/60 (7%) patients demonstrated treatment failures developing postoperative worsening one grade of Brooker score in two patients and two and three grades of Brooker score in the two others. Only 1/49 patients experienced a treatment failure, when radiotherapy had been initiated before and at postoperative day 4 compared to 3/11 patients initiated after postoperative day 4 (p less than 0.001). 3/32 patients (9.4%) in the LD group and 1/28 (3.6%) in the HD group were scored as treatment failures (nonsignificant). Radiotherapy treatment duration and additional medication had no impact on the outcome. In conclusion postoperative radiotherapy has shown high efficacy in prevention of heterotopic ossification as long as the treatment is initiated within the first four days after surgery. With respect to acute toxicity postoperative radiotherapy seems to be without any competition compared to surgical and pharmaceutical approaches including corticoid, diphosphonate and nonsteroid antiphlogistic drugs.

Adult↗
PubMed1992

The current role of interstitial thermo-radiotherapy.

Internal methods of thermotherapy such as interstitial, endocavitary and perfusional hyperthermia in combination with high- (HDR) or low-dose rate (LDR) brachytherapy have gained increasing interest among oncologists due to the known radio- and chemosensitizing potential of heat. Interstitial techniques offer several advantages over percutaneous heating techniques: confined treatment volume with improved sparing of normal tissue; accessibility of deeper tumors in various sites; more homogeneous distribution of therapeutic temperatures; and better control and evaluation of thermal parameters, when using extensive "thermal mapping" procedures. Currently several promising techniques are investigated such as radiofrequency (RF), microwave (MW) and hot source (HS) techniques. In phase 1 to 2 studies interstitial hyperthermia (IHT) has been mostly applied in the head and neck and brain, the chest wall, the pelvic region and the extremities for primary advanced, persistent or local recurrent tumors, which have responded poorly to conventional treatment approaches. Preliminary data on 600 patients treated with interstitial thermo-radiotherapy (IHT-IRT) are extremely promising despite broad variations among the technical and clinical treatment parameters. The tumor response rate in various clinical trials ranges between 11% and 74% CR, and with respect of extensive pre-treatment approaches, the overall complication rate of 20% appears acceptable. So far several prognostic treatment factors have been identified: tumor volume; radiation dose; high minimum tumor temperatures and sufficiently good thermal quality of the hyperthermia treatment. Future technical innovations should broaden clinical implementations of interventional hyperthermia such as intraoperative hyperthermia and intracavitary hyperthermia. It would appear from these experiences, that interstitial hyperthermia is an effective and safe treatment modality, especially when combined with radiotherapy for tumor palliation. Prospective randomized multicentric studies have already been initiated to investigate its role in palliative and adjuvant tumor therapy.

Brachytherapy↗
PubMed1992

Breast preservation versus mastectomy in early breast cancer--1991 update of the GBSG 1--protocol and prognostic factors. The German Breast Cancer Study Group.

In 1983, the German Breast Cancer Study Group (GBSG), sponsored by the Federal Ministry of Research and Technology, started a prospective multicenter trial on the treatment of early breast cancer (pT1 pN0 M0). This was preceded by a three-year reviewing period because of some novelties of medical, juristical and ethical problems in the FRG. University and, in the majority, community hospitals participated, combining all together 69 different institutions. From 11/1983 to 12/1989, 1112 patients were recruited. From 1036 patients, 733 underwent breast preservation (71%) and 303 mastectomy (29%). The randomization rate was only 6%. In 268 patients (26%) the tumor size was less than or equal to 10 mm, in 765 patients (74%) 11 to 22 mm. In 129 cases, we subdivided the tumor grading II[3] into IIa and IIb. Moreover, the immunohistochemical detection of the transmembrane proteins EGFR, p-185 and p-148 by oncogene overexpression and c-myc oncogene were undertaken in 425 breast cancers. After tumorectomy (or wide excision) and a lower axillary dissection (at least eight lymph nodes) the breast was irradiated up to 50 Gy in 25 fractions. A boost of 12 Gy was given to the tumor bed. The medial located lymph nodes were also irradiated in case of medially or centrally tumors. Quality control was performed by pathological, radiotherapeutic and methodical reference centers. Significant correlations could be demonstrated between receptor status and tumor grading, patient age and grading, and tumor size and grading. The results emphasize the central role of tumor grading among the prognostic factors. Especially the differentiation of the Bloom and Richardson score II into IIa and IIb seems to play an important role. After a median follow-up of 41 months, the frequency of local recurrences (4.4%), regional recurrences (1%) and distant metastases (4.6%) was exactly the same in both treatment groups. In multivariate analysis, only tumor size and tumor grading had a significant impact on disease-free survival. 23 patients with tumor-involved margins had a higher recurrence rate (DFS 62% versus 85% after five years). Without any impact on DFS were the other conventionally evaluated prognostic factors: age, menopausal status, hormone receptor status, histological tumor type, tumor localisation, degree of differentiation, pleomorphism, mitotic index and degree of dissociation. Among the transmembrane proteins EGFR, p-185, p-148 and c-myc, only the impact of p-185 and EGRF positivity on DSF is significant.(ABSTRACT TRUNCATED AT 400 WORDS)

Breast↗
PubMed1992

[Initial results of the Project of the German Breast Cancer Study Group on "Breast saving therapy of the small breast cancer"].

In the German Breast Cancer Study Group (GBSG) multicenter trial "Breast preservation in small breast cancer" 1119 patients were accrued over a period of six years. The study was originally designed as a randomized trial which had to be changed into a prospective observation study. A high therapeutic standard was guaranteed by quality control. The univariate analysis of prognostic variables was the first step to a valid treatment comparison. Those factors determined as being significant were combined with the treatment effects in a multivariate analysis. The published results were obtained after a median observation time of four years.

Breast Neoplasms↗
PubMed1992

[The potentials and limits of the radiotherapy of laryngeal carcinoma].

Early stage glottic carcinoma can be treated with primary radiotherapy reaching equally good results compared to primary surgery; for supraglottic carcinoma surgery offers only slight advantages over primary radiotherapy. Tumor control for recurrences is considerably improved by salvage surgery. The use of primary radiotherapy allows improved or at least preserved voice and reduced rates of acute complications and late treatment sequelae. However, treatment duration is longer and probably more expensive compared to function preservation microlaryngoscopic surgery. Which treatment approach is chosen, depends on individual patient factors and specific conditions in the clinical setting. In any case, primary radiotherapy deserves a stronger say in the early stage tumor situation. In our institution early stage supraglottic carcinomas undergo primary surgery. Advanced carcinomas (T2b and more) are rarely suited for primary radiotherapy with the exception of some very confined T3 tumors. Surgical approaches should be favoured, since they provide a detailed pathohistological tumor staging including R-classification, which would be lacking using primary radiotherapy. There are clear reasons to treat the lymph nodes for glottic carcinomas stage T2b and more and for all supraglottic carcinomas with radiotherapy. Specific risk factors are: tumor at the margins of the incision (R1), infiltration of the cartilage and pre-epiglottic space, paratracheal and subglottic extension of more than 1 cm, perineural invasion, grade III and IV as well as emergency tracheostomy. Postoperative radiotherapy should be given to the lymph nodes for all positive neck-dissections. New therapeutic approaches are on the horizon, which may improve the results of radiotherapy even for advanced larynx carcinomas, like hyperfractionation radiotherapy and simultaneous radio-chemotherapy combined enoral resection and postoperative radiotherapy may yield larynx preservation even for advanced stages. New imaging techniques allow an improved staging and predictive radiobiological assays may play a major role in tumor prognosis.

Carcinoma↗
PubMed1991

Radiation therapy as local treatment in Ewing's sarcoma. Results of the Cooperative Ewing's Sarcoma Studies CESS 81 and CESS 86.

The Cooperative Ewing's Sarcoma Studies, CESS 81 and CESS 86, are multiinstitutional trials with more than 80 participating institutions from Germany, the Netherlands, Austria, and Switzerland. Treatment consists of four courses of multiagent chemotherapy and local therapy. Local therapy was not randomized and was either radical surgery or resection plus postoperative irradiation or definitive radiation therapy. Here results according to local therapy have been analyzed for 93 protocol patients with localized Ewing's sarcoma (ES) who have been recruited in CESS 81 from January 1981 to February 1985 and 122 protocol patients recruited in CESS 86 from January 1986 to November 1989. The 3-year relapse-free survival (RFS) was 55% in CESS 81 and 62% in CESS 86. In CESS 81, the RFS was better for surgically treated than for irradiated patients. In this study there was an extremely high incidence of local failures (50%) after definitive irradiation. In CESS 86, however, the results after radiation therapy have been improved markedly (3-year RFS 67% after radiation therapy, 65% after surgery, and 62% after resection plus irradiation). Possible explanations for the improvement of radiotherapeutic results are as follows: selections for patients for radiation therapy, start of local therapy, and quality of radiation therapy. In CESS 86, irradiated patients were randomized to receive either conventionally fractionated irradiation with less intense chemotherapy or hyperfractionated irradiation with simultaneous chemotherapy. There was no difference in treatment results at the time of analysis. The authors conclude that selection of patients for local treatment modalities and quality of treatment performance has an impact on local and overall treatment results in ES.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1991

Percutaneous endoscopically guided gastrostomy in patients with head and neck cancer.

In 212 patients with tumors in the head and neck region the nutritional status prior to, during, and following radiotherapy, was determined by body measurements and biochemical and immunological parameters. In 165 orally fed patients the nutritional parameters deteriorated rapidly under radiation and afterwards recovered only slowly and incompletely, 31 patients requiring PEG during radiotherapy. By contrast, 47 patients with a poor initial status who had a prospectively performed percutaneous endoscopically guided gastrostomy (PEG) experienced an amelioration of their nutritional status even before radiotherapy ended. The subjective status of the patients was assessed using the Padilla quality of life index. Here, too, the PEG patients had significantly worse initial values than the orally fed patients. As with the objective indicators of nutritional status a significant deterioration was seen in the orally fed patients during radiotherapy, while the scores of the PEG patients remained constant. We consider early institution of a carefully monitored enteral feeding by PEG useful for stabilizing the nutritional status of patients with tumors in the head and neck region, and therefore recommend, when aggressive multimodal therapy is planned-and particularly if primary malnutrition is already obvious-prophylactic performance of PEG prior to the start of therapy.

Adult↗
PubMed1991

Future prospects of radiotherapy in pancreatic cancer.

To clarify the role of radiation therapy in the treatment of carcinoma of the pancreas studies with radiotherapy alone, combined interventional or concurrent radio-chemotherapy are reviewed. It is shown that in the case of inoperable tumour radiotherapy alone is inadequate, but by the means of a combination of chemotherapy, external beam or interventional (intra-operative, interstitial) irradiation, improvements in local control rates and median survival can be achieved. Following so-called curative resection, a number of studies have shown that adjuvant radio-chemotherapy or interventional treatments possibly prolong survival.

Combined Modality Therapy↗
PubMed1991

[Simultaneous radiotherapy and chemotherapy with cisplatin and 5-fluorouracil in advanced head and neck tumors].

Between 1.1. 1987 and 31.12. 1988 47 patients with locally advanced head- and neck tumours (UICC-stage II: one patient, stage III: 16 patients, stage IV: 30 patients) were treated with simultaneous radio-chemotherapy. Localisations were hypopharynx (23 = 49%), oropharynx (16 = 34%) and other sites (8 = 17%). Radiation therapy consisted of 60 Gy (primary region, N+) or 50 Gy (N0) in daily fractions of 2 Gy each over six weeks. During week 1 and 5 of radiotherapy two courses of chemotherapy with 5-FU (600 mg/m2/day, i.v. continuous infusion for five days) and cis-platin (25 mg/m2/day i.v. bolus for five days) were administered. 43/47 patients (91%) responded to therapy. 34/47 (72%) patients achieved a complete remission, 9/47 (19%) a partial remission, and 4/47 (9%) no change. With a minimum follow-up of 26 months 17/47 patients (36%) are alive and NED, 4/47 (9%) are alive with tumour. 18 patients (38%) died of cancer, eight patients (17%) died of second tumours, intercurrent diseases and of unknown reasons. Actuarial four-year survival is 45% (stage III: 56%, stage IV: 42%), four-year NED survival is 35% (stage III: 68%, stage IV: 18%). There were no loco-regional recurrences after additional surgical treatment of the primary and the neck following complete remission. In contrast after RCT alone and complete remission local recurrences in 6/21 patients (29%) and regional recurrences in 5/24 patients (21%) occurred. We conclude that simultaneous RCT is a new very effective treatment modality of locally advanced head and neck tumours producing superior loco-regional control compared to conventional management.

Adult↗
PubMed1991

[Testicular seminoma--goal volume, dosage and technique of external radiotherapy].

External radiation in stage I (Royal Marsden system) seminoma is given to para-aortic lymphnodes with total doses between 26 and 30 Gy. In stage IIa/IIb additional treatment of ipsilateral iliac nodes up to 30 Gy (stage IIa) and 36 Gy (stage IIb) is recommended. In patients with bulky abdominal disease (stage IIc) whole abdominal irradiation with doses between 25 and 30 Gy followed by a small field to encompass residual masses (15-20 Gy) can be offered as primary treatment. Prophylactic supradiaphragmatic irradiation is not advocated.

Combined Modality Therapy↗