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Biomedical subjects

R Sauer

Publications and source records attributed to R Sauer.

At least 217 records · Page 12Linked to original sources
PubMed1989

[Anal canal carcinoma: diagnosis--therapy--prognosis].

78 patients with anal canal carcinoma were treated between 1970 and 1988 at the University Hospital Erlangen. 48 patients (35 women, 13 men) were treated by surgery alone, 44/48 by abdominoperineal resection, 4/48 by local excision. Median age was 63 years, median follow-up 8.5 years. The overall local recurrence rate was 16.7%, the overall five-year-survival was 51%. 30 patients received a combined radio-chemotherapy. The small pelvis was treated with a.-p./p.-a. fields up to a total dose between 42 and 50 Gy. Two courses of chemotherapy consisting of 5-FU (800 to 1000 mg/m2 days 1 to 4 and 29 to 32) and Mitomycin C (10 mg/m2 days 1 and 29) were administered. Two months after completion of treatment 83% had a biopsy proven complete remission. After a median follow-up of 15 months 87% are alive with NED, 74% are continent. The combined regimen of radio-chemotherapy is considered as the treatment of the choice for anal canal carcinoma. Abdominoperineal resection is only performed in patients with non response or local recurrent disease.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1989

[Comparison between oral nutrition and enteral nutrition using a percutaneous endoscopically guided gastrostomy (PEG) in patients undergoing radiotherapy for head and neck tumors].

The nutritional state of 99 patients with tumors in the head and neck area was determined prior to, during and after radiotherapy by anthropometric, laboratory-chemical and immunological parameters. In 73 orally nourished patients, the nutritional parameters deteriorated very quickly during radiotherapy and recovered slowly and incompletely after radiotherapy. In 26 patients treated prospectively by percutaneous endoscopically guided gastrostomy (PEG), however, an improved nutritional state was achieved already during the irradiation in spite of a less favorable starting point. The subjective feeling of patients was questioned by means of the "quality of life" index according to Padilla et al. (1983). The preliminary results show an identical deterioration of the subjective feeling in both groups, but - as opposed to the other patients - force and working capacity did not decrease during radiotherapy in the enterally nourished patients. This corresponds to the objective nutritional parameters. However, an improvement of the subjective feeling after the end of radiotherapy was observed only in the orally nourished patients. Possible reasons are discussed. We have the opinion that an early and constant enteral nutrition by PEG can stabilize the nutritional state of patients with tumors in the head and neck area. Therefore we recommend to establish a prophylactic, pretherapeutic PEG if an aggressive multimodal therapy is planned, especially in case of apparent primary malnutrition.

Body Mass Index↗
PubMed1989

[A new multi-channel LDR/MDR-afterloading-system (Inter-Pal-C38)].

The methods of temporary interstitial implantation of iridium-192 seed chains have been applied in Erlangen for two years in many cases of squamous cell carcinoma in the head and neck area, the cervix uteri or the anal duct. The afterloading procedure which at the beginning had to be performed manually involved partially considerable radiation-exposures of medical and nursing staff. Therefore we have developed a 38-canal machine for remote control afterloading with iridium-192 seed chains in LDR and MDR therapy which is working in a similar way as the already established methods of remote control afterloading in HDR therapy. Special technical features are the automatic afterloading procedure, the disconnecting of patient and machine for any length of time, the possibility to use the machine for several succeeding patients, and the modern computer control by an IBM PC with color monitor and alpha-numerical keyboard. The new machine is fast and easy to handle, protects the staff completely against radiation and, due to the possibility of disconnection and free mobility, makes it easier and more comfortable for the patient to stay within the radioprotection room.

Anus Neoplasms↗
PubMed1989

[Methods and clinical results of interstitial thermoradiotherapy].

Besides percutaneous hyperthermia techniques, some new interstitial procedures have been developed and included into the arsenal of radiotherapists. As compared to percutaneous techniques, considerable benefits are offered by interstitial methods: a more homogeneous distribution of therapeutical temperatures, a better sparing of normal tissue, the possibility to treat deep tumors, and better therapy control and evaluation by extensive "thermal mapping" within the target volume. This study presents the technical principles and the clinical possibilities of the interstitial hyperthermia methods developed hitherto: resistive radiofrequency hyperthermia, radiative microwave hyperthermia, inductive ferromagnetic seed hyperthermia, and conductive hot-water perfusion hyperthermia. Until now, interstitial thermo-radiotherapy was only performed during some phase I/II studies. It was applied for palliative reasons in persisting and recurrent tumors accessible for implantation and situated in superficial to semi-deep locations with no or insufficient response to differently combined treatment modalities (surgery, radiotherapy, or chemotherapy). The preliminary clinical results obtained in almost 300 patients are quite promising: complete remission rates up to 70% have been achieved. Interstitial hyperthermia represents an effective and safe therapy modality, especially when combined with radiotherapy in palliative tumor therapy. At present, several prospective randomized multicentric studies are conducted to investigate its value as adjuvant therapy modality.

Brachytherapy↗
PubMed1989

[DNA impulse cytophotometry measurements in head and neck tumors. Initial results of a correlation with clinical stage, therapeutic response and pattern of recurrence].

The DNA index and proliferation rate (percentage of S-phase cells) of 52 head and neck tumours were analysed by flow cytometry. Thirty-one (60%) of these tumours were aneuploid, 21 (40%) diploid. The distribution of aneuploid tumours was nearly equal in all T-stages. In contrast, the number of aneuploid tumours increased with higher N-stages. Locoregional recurrences developed more often (69%) in aneuploid tumours than in diploid tumours (54%). Furthermore, recurrence presented earlier (median 5 months) than in the latter (median 11 months). Regional recurrences were mainly observed in aneuploid tumours, local recurrences in diploid tumours.

DNA, Neoplasm↗
PubMed1989

[Flow cytophotometric measurements before and during radiotherapy of head and neck tumors].

The DNA index and proliferation activities were determined by flow cytophotometry in 59 tumors of the head and neck area. 35 tumors (59%) were aneuploid, 24 (41%) were diploid. Aneuploid tumors showed a tendency to increased formation of lymph node metastases, an increased risk of relapse as well as a shorter relapse-free interval. No correlation was found between the primary tumor stage and the incidence of aneuploid tumors. Whereas aneuploid tumors developed frequently regional recurrences, only local recurrences were observed in diploid tumors. A number of biopsies was additionally performed during radiotherapy in twelve tumors. After 10 or 20 Gy, aneuploid tumors showed a considerably increased number of S and S2 + M phase cells. In diploid tumors, substantial modifications of the cell cycle phases were not found, because it is not possible in these cases to distinguish between normal cells and tumor cells.

Aneuploidy↗
PubMed1988

Multidisciplinary treatment of primary Ewing's sarcoma of bone. A 6-year experience of a European Cooperative Trial.

The German Society of Pediatric Oncology in 1981 initiated the Cooperative Ewing's Sarcoma Study (CESS 81) using a four-drug combination of chemotherapy prior to definitive local control with surgery and/or radiation. From January 1, 1981 until February 28, 1985, 93 patients were registered at the trial office from 54 participating institutions in West Germany, Austria, Switzerland, and the Netherlands. On February 1, 1987, 54 of 93 patients were disease-free. Using the Kaplan-Meier life table analysis, the estimated disease-free survival (DFS) rate was 60% at 36 months and 55% at 69 months. The median period of observation was 29 months, ranging from 22 months to 69 months. Twenty-one of 93 patients (23%) had local failure, 18 of 93 patients (19%) developed systemic metastases. The local failure rate was particularly high in patients treated with radiation and was reduced when radiation planning was centralized within the study based upon the extent of disease at diagnosis. Cox regression analysis of prognostic factors showed that tumor volume was a significant factor influencing prognosis. The estimated 3-year DFS rate was 80% for patients with small tumors (volume less than 100 ml) compared to 31% for patients with large tumors (volume greater than or equal to 100 ml). In patients who had surgery for local control, the histologic response to chemotherapy was analyzed on the surgical specimen and had a strong influence on survival: 79% DFS at 3 years for patients with less than 10% viable tumor (good responders) compared to 31% DFS for patients with more than 10% viable tumor (poor responders). Tumor load and responsiveness to chemotherapy are the two major factors influencing prognosis in patients with primary Ewing's sarcoma of bone.

Adolescent↗
PubMed1988

Malnutrition and the role of nutritional support for radiation therapy patients.

The nutritional status of a tumor patient can be negatively influenced by the local and systemic effects of the malignant tumor (tumor cachexia, anorexia, difficult oral food intake), by the effects of the various antitumoral therapy modalities (surgery, radiotherapy, chemotherapy), and by the complications associated with such modalities (anorexia, nausea, vomiting, mucositis, xerostomia, alterations of the smell and taste sensations, odynophagia, dysphagia, maldigestion, malabsorption, diarrhea, steatorrhea, conditioned aversions, radiogenic late effects), as well as by the psychological reactions of the patient to the real or feared existence of his tumor. The radiation-induced nutritional disorders depend on the tumor localization, the region irradiated, the dose and length of radiotherapy, the fractionation, the volume irradiated, and the combination with other therapeutic modalities ("combined modality therapy"). The acute radiation-induced reactions are usually of limited duration and for this reason tend to interfere with the nutritional status to a lesser extent than the permanent chronic consequences of irradiation. Weight loss and malnutrition tend to develop particularly in patients in whom segments of the gastrointestinal tract are subjected to irradiation. The incidence and severity of deficient nutrition depend not only on the region irradiated (head-neck region, thorax, abdomen, pelvis) but also, and most particularly, on the volume of the digestive tract irradiated. Chemotherapy and radiotherapy combined act very strongly on rapidly proliferating cell populations (skin, mucosa, epithelium of the gastrointestinal tract). In this context, actinomycin D and adriamycin act like real sensitizers, whereas the majority of the other drugs are likely to produce only an additive effect. The first named cytostatics give rise to the so-called recall phenomenon, i.e., the reactivation of latent radiation effects in response to the subsequent administration of the drug. Malnutrition impairs organ function and ultimately results in increased morbidity and mortality. For this reason it has proven mandatory and reasonable that the organism of all tumor patients suffering from malnutrition is provided with the missing essential nutrients (especially amino acids for protein synthesis). This tends to clearly improve the Karnofsky performance status, with a positive effect on response rates, toxicity, and survival rates in retrospective studies.(ABSTRACT TRUNCATED AT 400 WORDS)

Abdominal Neoplasms↗
PubMed1988

Preliminary results of treatment of invasive bladder carcinoma with radiotherapy and cisplatin.

From October 1985 to February 1988, 41 patients with invasive bladder cancers were treated with transurethral resection (TUR) and radiotherapy with simultaneous cisplatin chemotherapy at the University Hospital in Erlangen. Radiotherapy was performed as primary treatment in case of macroscopic residual tumor after TUR (n = 22) or as adjuvant treatment in patients with macroscopically complete transurethral resection (n = 19). Age ranged from 44 to 77 years. Radiotherapy was given in daily fractions of 1.8 Gy. The pelvis was treated with a box up to 41.4 Gy and the bladder was boosted up to 50.4 Gy by a rotation technique. Cisplatin was administered in the first and fifth treatment week on five consecutive days with 25 mg cisplatin/m2 per day as short infusion. Pathohistologic response was examined by control cystoscopy with biopsies from the deep layers 6 weeks after completing radiochemotherapy. Maximum follow-up is 24 months after control cystoscopy. After TUR plus radiochemotherapy, histologically confirmed complete remission rates according to T-stage were: 7/8 T1-, 26/31 T2-3-, and 2/2 T4-tumors. In patients with macroscopic tumor prior to radiochemotherapy, histological and cytological complete remission was achieved in 2/3 T1-, 14/18 T2-3-, and 1/1 T4-cancers with an overall complete response rate of 77%. In complete responders, 3 isolated local recurrences (2 T1- and one T3-recurrence) and two local recurrences with distant metastases have occurred until now. Six patients had only partial response. Mild to moderate side effects occurred frequently, but overall treatment tolerance was good even in older patients. Complications did not occur. So far, 7 cystectomies have been performed, 6 were a result of persistent or recurrent tumor and one a result of a contracted bladder after multiple TURs. Thirty-four of forty-one patients (83%!) maintained their bladder and normal bladder function. In conclusion, moderate dose radiation therapy (50 Gy) in combination with simultaneous cisplatin chemotherapy is a well-tolerated treatment and highly effective for controlling local disease and preservation of bladder function in invasive bladder cancers.

Aged↗
PubMed1988

[Design, goals and preliminary results of the first national breast cancer study--the Federal Ministry of Research and Technology study of "small breast cancer"].

In the multicentre trial sponsored by the Federal Ministry for Research and Technology (= BMFT), mastectomy is compared with breast preservation in patients with pT1 NO MO breast cancer. On the basis of that protocol breast preservation can also be performed by smaller institutions thus implementing the health policy programme of effecting new treatment modalities on a broad basis. We can already recognise a substantial improvement in treatment standards applied by the different disciplines in the hospitals involved in the study. Special emphasis is placed on an optimal patient information about the possible treatment modalities involving the patients in the treatment decision. The evaluation of various prognostic factors will result in additional information on the biology of breast cancer. As a consequence, the definition of the group of patients suitable for breast preservation therapy can be clarified further.

Breast Neoplasms↗
PubMed1988

[Histochemical and ultrastructural studies on the anti-edema and radiation-protective effects of 0-(beta-hydroxyethyl)-rutosides in the rat brain after single-dose irradiation. 1. Electron microscopy study of terminal blood circulation].

The changes in the terminal blood stream appeared with and without protection by 0-(beta-hydroxyethyl)-rutoside (HR) were studied in irradiated rat brains by means of the electron and light microscope. Thirty minutes before irradiating the animals with doses of 1, 5, 10, and 20 Gy, they were given simultaneous i.p. and s.c. doses of 250 mg each of HR per kg of body weight or, as a control, of physiologic NaCl solution. 2, 6, 9, and 14 days after the irradiation, small tissue specimens from the parasagittal parietal cortex were examined according to the following criteria: 1. number of widely open, i.e. well perfused capillaries and small vessels, 2. number and size of perivascular, optically unstructured "light haloes" which are signs of intracellular oedemas of the perivascular astrocyte processes, 3. incidence of hyperchromic, partly shrunken neurons. The control animals not pretreated with HR showed a collapse of most capillaries and an increase in number and size of "light haloes" around capillaries, arterioles and venules. In the electron microscope, these haloes corresponded to the strongly swollen parts of the perivascular neuropile consisting mainly of oedematous astrocyte processes. These severe perivascular cell alterations were prevented for all dose ranges by the pretreatment with HR. Thus our findings do not only demonstrate a clear antiedematous effect of HR on the radiogenic cell oedema of the perivascular neuropile, they support moreover the working hypotheses with regard to the mode of action of this substance as a "membrane protector".

Animals↗
PubMed1988

[Histochemical and ultrastructural studies on anti-edematous and radiation-protective action of 0-(beta-hydroxyethyl)-rutosides on the rat brain after single irradiation. 2. Histochemical study on carbohydrate metabolism and acid phosphatase activation].

The disturbances of the carbohydrate metabolism and the activation of acid phosphatases with and without protection by O-(beta-hydroxyethyl)-rutoside (HR) were studied in irradiated rat brains by means of the light microscope. The histochemically demonstrable deposition of glycogen and acid mucopolysaccharides serves as a criterion for a reversible lesion of the irradiated cerebral tissue. The extent of local activation of repair processes following to irradiation can be determined by the quantity of acid phosphatases in the lysosomes. For the dose range of 1 to 5 Gy, HR seems to exert a protective effect on the cellular metabolism of the irradiated cerebral tissue shown by a slight decrease of glycogen and mucopolysaccharide deposits compared to the untreated animals. However, when exceeding a threshold dose of 10 Gy, the deposition of carbohydrates in the HR group is strongly increased. A slightly increased activity of acid phosphatases induced by HR can be supposed at best for the dose range of 5 to 7.5 Gy. If the dose is even more increased, the reverse effect found in the carbohydrate metabolism, too, and an increased activation of acid phosphatases in the control group will be observed. This unexpected reversion of the protective effect could be related to the assumed inhibitory effect of HR on the ATPases and thus on the anaerobic part of glycolysis or to a breakdown of the cell interaction system of endothelial cells, glia cells, and neurons.

Acid Phosphatase↗
PubMed1988

[Individual collimators as an aid in improving the accuracy of positioning, the reproducibility of irradiation and the sparing of critical organs].

Despite the technical progress regarding radiotherapeutic facilities, the positioning and fixation of the patient and the reproduction of the daily irradiation geometry is still the critical point in planning and performance of radiotherapy treatments. Besides the use of irradiation masks, an improved adjustment precision and reproducibility as well as an individualization of the target volume is achieved above all by individual collimators. The use of individual absorbers offers a precise and fast adjustment of irradiation fields at the therapy unit, an optimum adaptation of the irradiation volumes to the anatomical features of the patient and the loco-regional tumor extent as well as a selective protection of radiosensitive structures. The historical method of field-shaping by standard absorbers should be abandoned.

Humans↗
PubMed1988

[Induction of malignancies by radiotherapy: a retrospective study of 454 tumors].

On the basis of 98 case reports compiled from the literature of the years 1902 to 1984, a retrospective study was conducted on 454 tumors developed after radiotherapy within the irradiation field. 226 patients (49.8%) were treated for a benign primary disease and 222 (49.6%) for a malignant primary disease. In six cases the primary diagnosis was unknown. The histologic investigation of the tumors showed sarcomas in 52% of the cases, carcinomas in 38%, and leukemias in 8.5%. Cerebral tumors were described in two cases. The average latency was 7.1 years in leukemia, 12.1 years in sarcomas, and 19 years in carcinomas. Carcinomas were preponderantly found after a focal dose up to 30 Gy, sarcomas after higher doses up to 70 Gy. In leukemia, a dose-effect correlation was not evident. The influence of surgery, chemotherapy, the age of the patients at the moment of radiotherapy, as well as the dignity of the primary disease on latency and histology of the radiogenic tumor was also investigated.

Adolescent↗
PubMed1988

[Cervical lymph node metastases from an unknown primary tumor].

From 1978 through August 1986, 32 patients with lymph node metastases of the neck and unknown primary tumor were treated at the Radiotherapeutic Hospital of the University Erlangen-Nürnberg. Most of the cases were large metastases from squamous cell carcinomas or anaplastic carcinomas. The patients were treated by surgery and postsurgical radiotherapy or radiotherapy alone. In nearly all patients the target volume comprised both sides of the neck including the median structures as well as the base of the tongue and the nasopharynx. A dose of at least 50 Gy was aimed at, which was given within five weeks by individual doses of 2 Gy each. The survival at three years is 70% and at five years 52%. Out of twenty patients irradiated with more than 50 Gy following lymph node extirpation or radical excision of the lymph nodes of the neck, sixteen are tumor-free. The five year survival of this group is 80%. The results of radiotherapy alone are unsatisfactory, because only two out of nine patients are alive with follow-up periods of less than one year. Two primary tumors were found after the end of treatment. Both were situated within the ORL areas beyond the ancient irradiation fields, and both were developed by patients who at first had only been treated by local irradiation. Half of the patients with lymph node metastases of the neck and unknown primary tumors can be cured by complete tumor excision and postsurgical irradiation. The target volume of radiotherapy comprises both sides of the lymph drainage area of the neck as well as the mucous membranes of the ORL region including nasopharynx and base of the tongue. The dose is at least 50 Gy which is given after surgery with conventional fractionation.

Adult↗