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Biomedical subjects

R Sauer

Publications and source records attributed to R Sauer.

At least 199 records · Page 11Linked to original sources
PubMed1991

[Interstitial and percutaneous radiotherapy after limited surgery in carcinoma of the oral cavity].

From 1.1. 1986 to 31.12. 1990 50 patients with epidermoid carcinoma of the floor of the mouth and the mobile tongue (stage T1 18, stage T2 20, stage T3 eight and stage T4 four patients) were treated by surgery, 192-iridium implantation using the plastic tube technique and percutaneous irradiation. Surgery was performed as enoral resection (35 patients) or en bloc tumour resection with part of the mandible and flap reconstruction (15 patients). Interstitial therapy was considered as a boost to primary tumour region, the dose given ranged between 16 and 33 Gy. 50 to 60 Gy were applied with external beam radiotherapy. Management of the neck consisted of elective or radical neck dissection followed by external beam radiotherapy (50 to 60 Gy). At 2/1991 median follow-up was 17 (three to 53) months. 35 patients are alive and tumour-free, one patient lives with tumour. 14 patients died, eight patients tumour-related, four patients of intercurrent disease and two patients because of a second primary. Primary local control was 18/18 patients for stage T1, 19/20 patients for stage T2, 7/8 patients T3, 3/4 patients for stage T4. Three patients suffered from nodal recurrences, four patients from distant metastases. Complication rate was acceptable. Soft tissue necrosis occurred in 4/18 patients (T1); 5/20 patients (T2); 3/8 patients (T3) and 1/4 patients (T4). Three patients developed osteoradionecrosis. Our results show that combined modality treatment for tumours of the oral cavity yields high local control with acceptable complication rate.

Adult↗
PubMed1991

[Ovariopexy and the treatment of Hodgkin's disease].

Between 1979 and 1989 a total of 113 women underwent treatment for Hodgkin's disease at the Department of Radiation Oncology of the University of Erlangen-Nürnberg. Only 17 female patients of child bearing age received total lymphoid irradiation including pelvic and inguinal nodes. 15/17 patients underwent prophylactic bilateral oophoropexy during staging laparotomy: ten had lateral, five had midline ovarian transposition. Reproductive and ovarian function was investigated in 13 patients--all in complete remission after a minimum follow-up of three years--by menstrual history and serum levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), prolactin (PRL), testosterone, dehydroepiandrosteronsulfate (DHEAS), androstendion, estradiol, progesterone, 17-OH progesterone, sexual hormone binding globulin (SHBG), free androgen index (FAI). Thyroid function was assessed by measuring thyroxine (T4), triiodothyronine (T3), thyroxine stimulating hormone (TSH) and thyroxine binding globulin (TBG). Normal cyclic ovarian activity was found in seven out of nine patients following lateral oophoropexy (including one pregnancy), but only in one out of four cases after midline fixation. Median calculated dose was 325 cGy (range 260 to 500 cGy) to the laterally fixed ovaries and 490 cGy (range 390 to 500 cGy) for midline transposition. We conclude, if ovarian protection is required prior to pelvic radiation, lateral oophoropexy should be preferred.

Adolescent↗
PubMed1990

c-erbB2 expression in correlation to other biological parameters of breast cancer.

On the prognostic value of c-erbB2-encoded protein p185 in breast cancer there are controversal opinions. With the outlook of an evaluation of the prognostic value of p185 expression in breast cancer the relationships between p185 expression and known prognosis factors were investigated. Using polyclonal antibody against p185 33% out of 163 primary breast carcinomas are p185-positive. Within the various histological types of tumors the percentage of p185 expression differs. It is suggested that p185 indicates a certain type of biological behavior and plays a role in the pathogenesis of breast cancer. Thus the determination of p185 could allow definition of biological subclasses. A statistically significant correlation between expression of p185 and the presence of lymph node metastases or tumor size can not be proved. Nevertheless p185 expression is increased in cases with more than three positive lymph nodes. Expression of p185 correlates statistically significantly positively with histological grade and epidermal growth factor receptor, and negatively with steroid receptor status. Furthermore, high-proliferating tumors are more common in p185-positive cases than in p185-negative cases. It is concluded that p185 may be associated with an increased malignancy and proliferation activity of tumors.

Breast Neoplasms↗
PubMed1990

Radiotherapy with and without cisplatin in bladder cancer.

From October 1985 to December 1988, 67 patients with invasive bladder carcinoma T1-4 N0-2 M0 were treated with irradiation (50.4 Gy in 28 fractions in 6 weeks) and simultaneous cisplatin (25 mg/m2 per day on 5 consecutive days in the first and fifth irradiation week). After transurethral resection and irradiation plus cisplatin, complete remissions were achieved in 8/11 T1-, 14/16 T2-, 27/36 T3- and 1/4 T4-tumors. The complete remission rate 6 weeks after treatment according to the extent of preceeding transurethral surgery (TUR) was: R0: 67% (8/12); R1: 83% (20/24); R2: 70% (21/30); Rx: 1/1. In patients with incomplete TUR (R1-2), the complete remission rate was 76% (41/54). This was superior to the results of a historical control (76% vs. 45%, p less than 0.01). The estimated 3-year survival according to T-stage was: T1: 73%, T2-3: 68%, T4: 25%. The overall 3-year survival was unchanged as compared to our historical control (66% each). Severe complications have not been observed. We conclude that cisplatin will likely increase the local control rate after incomplete transurethral surgery. An improvement of survival seems unlikely.

Aged↗
PubMed1990

Initial results of phase I/II interstitial thermoradiotherapy for primary advanced and local recurrent tumors.

Since January 1986 in a phase I/II study, 45 lesions (30 head and neck, 11 pelvic, and 4 other lesions) in 44 patients (24 men, 20 women; age 18-81 years) received a combination of interstitial Ir-192 radiotherapy (IRT) and interstitial 915 MHz MW hyperthermia (IHT) supplemented by external radiation (ERT). In June 1989, evaluation was performed for lesions with minimum follow-up (FU) of 6 months and FU periods between 6 and 39 months (mean: 16 months, SD +/- 9). The tumors comprised 21 advanced primary (AP) lesions without prior ERT, 18 local recurrent (LR) and 6 local metastatic (LM) lesions with variable prior treatment modes; 24 lesions had received prior ERT between 40 and 70 Gy, 23 chemotherapy and 30 prior surgery. The mean dimensions of 42 lesions were 4.5 X 4.0 X 3.0 (cm3) with tumor volumes ranging from 12 to 135 cm3 (mean: 54 cm3, SD +/- 35); 3 lesions had extensive tumor volumes greater than 225 cm3. IHT was applied immediately prior to and/or after low-dose Ir-192 IRT (20-30 Gy) for 60 min at temperatures between 41 and 44 degrees C. ERT (40-50 Gy) was always given for AP and LM lesions, but variably applied for previously irradiated LR lesions, thereby avoiding the cumulative radiation dose exceeding 110 Gy per site. IRT doses ranged from 17-48 Gy (mean: 26.8 Gy, SD +/- 8) at a dose rate of 25-70 cGy/h (mean: 42 cGy/h, SD +/- 12). Thirty-three lesions received additional ERT of 30-56 Gy (mean: 46.5 Gy, SD +/- 9). Total radiation dose (IRT + ERT dose) ranged from 31 to 82 Gy (mean: 61 Gy, SD +/- 18). The hyperthermia systems of Lund/Buchler 4010 and Clini-Therm Mark VI/IX with thermistor or fiber-optic thermometry devices were employed. Initial response at 3 months FU showed 31 (69%) lesions complete response (CR), 10 (22%) partial response (PR), and 4 (9%) no change (NC). Long-term response of 30 lesions at 12 months FU revealed a total of 27 (90%) with local control (LC) and 3 (10%) in-field recurrences. Six patients died prior to 12 months FU, three with LC and three with progressive disease. So far 10 (22%) patients have developed distant metastases. Acute side-effects occurred in 15 lesions (33%) resulting in 12 (27%) long-term complications with 3 lesions (7%) requiring surgery.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1990

Primary advanced and local recurrent head and neck tumors: effective management with interstitial thermal radiation therapy.

Thirty-seven patients with 18 primary advanced or persistent, 16 local recurrent, and three local metastatic tumors of the head and neck were treated with a combination of interstitial low-dose iridium-192 radiation therapy and interstitial 915-MHz microwave hyperthermia supplemented by external radiation therapy. Twenty-eight lesions received an additional external radiation dose of 21-61 Gy. Interstitial hyperthermia was applied immediately before Ir-192 was placed and after its removal for 45-60 minutes at 41 degrees C-44 degrees C. Follow-up ranged from 4 to 45 months. At 3 months, complete remission occurred in 25 lesions (68%); partial remission, in nine (24%); and no change or progressive disease, in three (8%). At 12 months of follow-up in 32 lesions, local control was achieved in 23 (72%), with the patients alive, and in four (12%), with the patients dead. There were five local recurrences, one of which occurred after complete response. Lesion type, tumor volume, radiation dose, and thermal quality at high minimum temperature were identified as prognostic factors influencing complete remission. The combined treatment was well tolerated.

Adolescent↗
PubMed1990

[Radiotherapy of malignant soft tissue tumors].

The treatment of choice for small low-grade lesions in soft tissues may well be wide or radical surgical resection alone. For all other lesions (UICC stage IIa and larger), multimodal treatment is recommended. Pre- or postoperative radiotherapy reduces the local failure rate to 5%-10%. A re-resection should be performed after non-oncologic resections. Irradiation offers an entirely credible alternative to radical surgery for desmoid tumors which are not resectable.

Combined Modality Therapy↗
PubMed1990

[The role of radio-oncology in the treatment of bronchial cancer].

The treatment results obtained in patients with both small and non small cell lung cancer have remained stagnant for years. Therefore, in order to select patients who will have a profit from radiotherapy the indication has to take into account prognostic factors such as tumor stage, extent of resection, patient's age, lymph node status, weight loss and the patient's performance status. Non small cell lung cancer: Postoperative radiotherapy seems to benefit only in patients with hilar or mediastinal lymph node involvement, where a five-year survival rate of up to 30% of cases can be achieved. Postoperative irradiation should not be applied following curative resection and negative lymph node status (R0 N0). In inoperable cases conventional fractionated radiotherapy may definitively have a favourable effect on the patient's survival time, even when the treatment was originally intended to be merely palliative. Only those patients will live five years, who received more than 50 Gy to the hilar and mediastinal nodes and at least 60 Gy to the primary lesion. The volume to be irradiated must include the primary tumor, the ipsilateral and contralateral hilum, the mediastinum, and both supraclavicular regions. If a Pancoast tumor is present, radiotherapy alone obtains a similar result as preoperative irradiation followed by resection. Small cell lung cancer: Radiation treatment of the primary tumor region and the lymph drainage area increases the remission rate by roughly 20% compared with chemotherapy alone, considerably reduces the incidence of local recurrences and exerts a beneficial effect on the survival of the patients. Recently, this has been confirmed by prospectively randomised protocols. Prophylactic brain irradiation has been found to decrease the risk of cerebral metastases to 4-6% in patients affected by limited disease and complete tumor remission under chemotherapy, and to improve the quality of life without, however, showing the benefit on survival time. Future efforts in radiotherapy should be aimed not only at increasing dose intensities but also at developing less toxic treatment modalities to the benefit of the quality of life.

Brachytherapy↗
PubMed1990

Interstitial thermoradiotherapy: review on technical and clinical aspects.

Interstitial hyperthermia (IHT) combined with brachycurietherapy (thermoradiotherapy) has gained increasing popularity among radiation oncologists due to its potential as an effective radio- and chemosensitizer. IHT offers considerable advantages over percutaneous methods: confined treatment volume, better sparing of normal tissue, accessibility of deeper tumors, more homogeneous therapeutic temperature distribution, and better control and evaluation of thermal parameters using extensive "thermal mapping" procedures. This article addresses technical principles and clinical applications of IHT methods, radiofrequency (RF), microwave (MW), and hot source (HS) hyperthermia. Clinical phase I/II studies have used IHT palliatively for primary advanced, persistent, or local recurrent tumors, which have responded poorly to conventional treatment. The preliminary clinical data on greater than 500 patients treated with interstitial thermoradiotherapy are extremely promising despite the broad variation among the different treatment approaches. The observed complete response (CR) rate in various clinical trials ranges between 11 and 74%. The differences between the various techniques are minor, with a CR of 57% for interstitial RF hyperthermia (169 of 299 patients) and 60% for interstitial MW hyperthermia (130 of 215 patients). Despite extensive pretreatment, the total observed compliation rate of 22% for RF hyperthermia (67 of 299) and 21% for MW hyperthermia (45 of 215) is acceptable. The prognostic treatment factors identified are tumor volume, applied radiation dose, sufficiently high minimum tumor temperatures, and good thermal parameters, i.e., good quality of the hyperthermia treatment sessions. Technical innovations may facilitate and improve clinical applications and should allow broad clinical implementations of IHT, e.g., intraoperative hyperthermia, and even intracavitary hyperthermia. From these experiences it would appear that IHT 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↗
PubMed1989

Therapy of early breast cancer: preliminary results of the German Breast Cancer Study.

The German Breast Cancer Study Group has a large, homogeneous patient population with pT1 pN0 breast cancers who have undergone a detailed pathohistological work-up and uniform treatment. Seventy institutions take part in this study, mostly community hospitals. All pathologic specimens are reviewed by the Pathology Reference Center. Moreover, in order to improve the quality of radiation therapy, all dosimetric data, radiation protocols, and localization, and verification films are reviewed by the Radiotherapeutic Study Centre. By January 31, 1988, 762 patients had been recruited. At the moment, after an admittedly short follow-up period for the majority of our patients, there is no evidence of differences between the two treatment arms concerning the incidence of local and distant recurrences, contralateral breast cancers, and other malignancies. However, the study demonstrates several unresolved problems, mainly the collection of follow-up data which can arise when many institutions especially community hospitals and general practitioners, are involved in a prospective trial.

Breast Neoplasms↗
PubMed1989

Neuro-rhinosurgical treatment of aesthesioneuroblastoma.

The results of a combined neuro-rhinosurgical procedure in eight cases of aesthesioneuroblastoma are presented. All patients were suffering from tumours in the advanced stage (stage C according to Kadish). Diagnosis was established by the clinical history, neuro-radiological imaging and by endoscopic endonasal biopsy. Contrary to most reports in the literature the authors performed a one step operative removal of the whole tumour mass by a combined transcranial-transbasal approach alone. A second transfacial operation was unnecessary in all our cases. To the best of our knowledge only Loew (see Jakumeit 1971) already in the 1960ties used a comparable one step transcranial approach for tumour removal. The long-term survival rate in our patients is 50%, a result comparable to reported series in the literature. Mortality is due to early recurrences and metastases within a few months after the initial treatment including post-operative irradiation. Four patients are living without evidence of tumour recurrence 1.5 to 5 years after treatment. The authors surgical technique is presented in detail and compared with the results of other treatment modalities.

Adolescent↗
PubMed1989

Effect of iodine disinfection products on higher plants.

Iodine is used to disinfect potable water on United States spacecraft. Iodinated potable water will likely be used to grow plants in space. Little is known about the effects of iodine disinfection products on plants. Seeds of select higher plants were germinated in water iodinated using the Shuttle Microbial Check Valve, and water to which measured amounts of iodide was added. Percent germination was decreased in seeds of most species germinated in iodinated water. Beans were most affected. Germination rates, determined from germination half-times, were decreased for beans germinated in iodinated water, and water to which iodide was added. Development was retarded and rootlets were conspicuously absent in bean and several other plant species germinated in iodinated water. Iodide alone did not elicit these responses. Clearly iodine disinfection products can affect higher plants. These effects must be carefully considered for plant experimentation and cultivation in space, and in design and testing of closed environmental life support systems.

Brassica↗
PubMed1989

Superficial chest wall recurrences of breast cancer: prognostic treatment factors for combined radiation therapy and hyperthermia.

Forty-nine patients with chest wall recurrences of breast carcinoma received radiation therapy and 915-MHz microwave hyperthermia for 95 lesions. Follow-up ranged from 3 to 39 months, with five patients dying before 6 months follow-up. At 1 month follow-up, 49 (52%) of 95 lesions showed complete response; 28 (29%), partial response; and 18 (19%), no change. At 6 or more months follow-up, 54 (67%) of 81 lesions demonstrated local control; 10 (12%), partial response; six (7%), no change; and 11 (14%), local-regional recurrences. Superficial blisters occurred in 24 (25%) of 95 lesions, whereas long-term complications (deep necrosis, subcutaneous burns) occurred in seven (7%) lesions. Relapse occurred in 16 (17%) lesions, seven after initial complete response and nine after partial response. Several prognostic treatment factors were identified: applied radiation dose (greater than 30 Gy, P less than .01), size of tumor (less than 6 cm diameter, P less than .001), minimum tumor temperature (greater than 41 degrees C, P less than .001), and status of disease (M0 or M1 vs M2, P less than .001). Treatment complications were correlated with maximum temperatures (greater than 45 degrees C, P less than .001). In summary the palliative treatment concept proved to be safe and effective.

Adult↗
PubMed1989

[Results of temporary interstitial iridium 192 implantation in head and neck tumors].

In order to improve local tumor control in advanced head and neck tumors, a temporary interstitial iridium-192 implantation (40 to 50 cGy/h) was performed as a boost therapy (20 to 30 Gy at the surface of the target volume). This treatment was part of a multimodal therapy conception for primary tumors (N = 55) as well as for recurrences (N = 22). Local control was achieved in 89% (49/55) of patients treated for primary tumors. Complications appeared in the form of soft tissue necroses in 55% (30/55) and in the form of osteoradionecrosis of the mandible in 7% (4/55) of the patients. The authors discuss as possible reasons for this high complication rate: implantation volume too large or total activity too high, activities of the individual iridium-192 seeds to high, setting of radiation sources too close together, total dose too high, disturbed reparation capacity of sound tissues due to preceding operation and chemotherapy, premature test biopsies in the area of implantation, lacking oral hygiene and dental care by uncooperative patients. A local control rate of 50% was achieved by the treatment of recurrences, but this has no importance for the course of this tumor disease which is fatefully determined by the formation of remote metastases.

Adult↗