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Biomedical subjects

U M Carl

Publications and source records attributed to U M Carl.

35 records · Page 2Linked to original sources
PubMed1995

Adjuvant radiotherapy following radical prostatectomy--results of 56 patients.

Patients with adenocarcinoma of the prostate with positive surgical margins and/or seminal vesicle invasion after radical prostatectomy (RP) have a high risk of local recurrence or distant spread of disease. Several investigators reported increased local control rates following adjuvant radiotherapy (RT). However, it is unclear whether this procedure, with or without hormonal therapy (HT), improves the outcome. From 1975 to 1987, 56 patients with adenocarcinoma of the prostate underwent adjuvant RT following RP (pathological stage C1, n = 19; stage C2, n = 17; stage D1, n = 20). In 27 of 56 patients an additional immediate orchiectomy was performed. 48 patients received 4000-5000 cGy to the pelvic lymphatics, including the prostatic fossa, followed by a boost to the prostatic fossa to complete 6400-7000 cGy, whereas 8 patients were treated to the prostatic fossa only. With a median follow-up of 89 months, the overall survival rate of patients with stages C1, C2 and D1 did not differ significantly (10-year overall survival rate 84, 74 and 71, respectively). The local control rate for 5- and 10-years was 96 and 90%, respectively. A significant advantage in overall survival (5- and 10-year rate: 92 versus 93% and 92 versus 63%; P < 0.05, respectively) and clinical disease-free survival (5- and 10-year rate: 92 versus 72% and 92 versus 49%; P < 0.05, respectively) was seen in 27 patients with orchiectomy compared with 29 patients without HT. A total of 15 patients (26%) developed at least one form of late toxicity, in most cases a mild proctitis, cystitis, or penile or leg oedema. However, 6 patients (11%) had severe grade 3 or 4 side-effects that necessitated a cystectomy in 2 cases as well as a colostomy in 2 cases. In all patients with grade 3 or 4 side-effects, 70 Gy as a tumour-encompassing isodose were applied. Adjuvant RT, following RP in stage C and D1 prostate cancer with positive surgical margins and/or seminal vesicle invasion increases local control. Whether immediate HT influences the outcome, as seen in this study, should be proven in prospective clinical trials.

Adenocarcinoma↗
PubMed1995

The value of a postoperative radiation therapy in FIGO stage I and II endometrial cancers.

PURPOSE: The incidence of endometrial cancer has increased considerably within the last decades. Due to early symptoms more than 88% of all patients present initially with FIGO stage I or II disease. PATIENTS AND METHODS: One hundred and forty-four patients out of 192 patients with stage I endometrial cancers received surgical treatment alone. Like the remaining 48 patients 39 out of 65 patients with stage II tumors received adjuvant radiation therapy with 50 Gy to the true pelvis. RESULTS: Independent on the chosen treatment results in stage I were influenced by the depth of myometrial invasion (p = 0.023). With a crude 5-year survival rate of 88% patients with less than 33% reached life expectation of matched healthy women. With deeper infiltration crude survival rates were as low as 77%. In stage II tumors 5-year crude survival was elevated 60 to 80% independent on the depth of myometrial infiltration by adjuvant radiation therapy (p = 0.11). CONCLUSIONS: Despite its potential curability and the general knowledge that the prognosis of endometrial carcinomas is governed by a number of factors there are no generally accepted standard treatment modalities available Thus there is great demand for randomized clinical trials.

Adult↗
PubMed1994

The role of adjuvant treatment in endometrial cancer.

PURPOSE: Divergent opinions exist on the value of adjuvant treatment in endometrial cancer. This paper aims at clarifying the indications for adjuvant radiotherapy by reviewing the literature and presenting own data. METHODS: For endometrial cancer 5-year survival data are analysed with respect to the value of adjuvant radiotherapy and/or chemo-/hormone therapy. RESULTS: Adjuvant radiotherapy in FIGO stage I and II tumors reduces pelvic recurrence rates from 15 to 20% to 1 to 5%. In high risk stage I patients the 5-year survival rate is increased by 30 to 40% using pre-operative high dose endocavitary brachytherapy or postoperative external beam therapy. In stage II disease the 5-year survival rate is increased to 60 to 80% when applying 50 to 60 Gy post surgery. In stage III and IV tumors primary radiotherapy results in 5-year survival rates of 16 to 40%. CONCLUSIONS: In stage I and II endometrial cancer primary treatment consists of surgery followed by radiotherapy in eligible cases. In stage III and IV tumors primary radiotherapy is generally advocated. No properly randomized trials are available to date on the value of adjuvant treatment. There is a great demand for such trials in order to confirm the available data. According to the extent of the disease and the discrimination of certain risk groups these trials should include external beam pelvic irradiation, brachytherapy, para-aortic irradiation as well as systemic chemo-or hormone therapy.

Endometrial Neoplasms↗
PubMed1994

Radiation-induced cell cycle delay measured in two mouse tumors in vivo using bromodeoxyuridine.

The magnitude of the delay of cells in the phases of the cell cycle after irradiation may be related to the radioresponsiveness of tumor cell populations. In this study we have quantified division delay in two mouse tumors in vivo after single and fractionated doses of X rays and single doses of neutrons. The incorporation of bromodeoxyuridine and flow cytometry provided a sensitive and quantitative method to detect cell cycle perturbations after radiation treatment. The more rapidly growing SAF tumor showed less G2-phase delay per gray than a more slowly proliferating tumor, the Rh (0.9 vs 1.8 h). In addition, the SAF tumor failed to show any G1/S-phase delay while the Rh tumor experienced a longer G1-phase delay than that measured for G2 phase (3.1 vs 1.8 h). There was a trend in both tumors for lower doses to be more effective in producing cell cycle delays. Neutrons caused longer G2-phase delays on a unit dose basis, 2.5 and 5.4 h for the SAF and Rh tumors, respectively. The RBE for neutrons for division delay was found to be 2.9 and 2.8 for the SAF and Rh tumors, while the RBE for growth delay was 3.4 and 3.5. Fractionation of the X-ray dose caused a reduction in division delay at higher total doses (10 or 12 Gy) but was without effect at the lower dose studied (6 Gy). These studies show the feasibility of measuring cell cycle delays in vivo, and future developments are suggested for a possible predictive test in patients receiving radiotherapy.

Animals↗
PubMed1993

Radiation therapy of para-aortic lymph nodes in cancer of the uterine cervix.

From 1965 to 1986, 173 patients with gynaecological cancer received para-aortic radiation treatment using a biaxial-four-segmental-rotating field technique. Seventy-five patients with cervical cancer and proven lymph node involvement were eligible for analysis. Crude survival and disease-free survival in 37 patients with FIGO III and 15 patients with FIGO IVA, receiving initial para-aortic treatment were compared with the corresponding data from patients in whom para-aortic treatment was secondary applied when para-aortic metastases became clinically symptomatic. Five-year survival rates of 37.5% (FIGO III) and 27.3% (FIGO IVA) were encouraging as none of the patients in the secondary group survived for more than 16 months. The number of complications induced by the described method of survived for more than 16 months. The number of complications induced by the described method of para-aortic irradiation appears to be substantially lower than with other methods using equal doses. Five cases of severe but not life-threatening side-effects were observed among 173 treated patients.

Adolescent↗
PubMed1993

[The mixed fractionated radiotherapy of R1H tumors in the rat using neutrons and photons].

A number of experimental investigations has demonstrated, that tumor growth delay due to a mixed fractionated treatment schedule with photons and neutrons can be prolonged compared to pure photon treatment. That question after the mechanisms remains undissolved. In the presented study of the R1H tumor of the rat 30 fractions using 2 Gy of photons in 39 days are compared to results of mixed fractionated treatment schedules with neutrons and photons. Neither a prolonged net growth delay (NGD) was found nor does the sequence in which neutrons and photons are given influence the outcome when replacing photons by neutrons in twelve of 30 fractions (RBE 2.5). In contrast, hypofractionated schedules (five fractions/total dose 40 Gy/four days) have a considerable longer NGD when replacing two fractions of photons by neutrons (RBE 2.5) (p < 0.01). This could be explained if 8 Gy photons/fraction destroyed all euoxic tumor cells, a 24 hour interval was too short for reoxygenation and thus make hypoxia to a major problem in 8 Gy/fraction photon treatment.

Animals↗
PubMed1993

Long-term observation of the rat skin after fractionated local X irradiation: development of secondary tumors.

Data from previous animal experiments were analyzed retrospectively with a view to the induction of secondary tumors. The skin of 86 rats was exposed locally to multiple fractions of 200 kV p X rays at doses of 60 to 82 Gy applied in 30 or 35 fractions in 6 weeks, i.e., in the clinically relevant range of 1.9 to 2.7 Gy per fraction. The course of the early skin reaction was scored and compared to the late carcinogenic effects of the treatment using Kaplan-Meier data analysis. With increasing total dose the median duration of the early skin reaction increased, while median latency of tumor induction in the irradiated area of skin decreased from 381 days after 60 Gy to 274 days after 82 Gy. Independent of the total dose, number of fractions, and operative intervention, 84 to 100% of the animals cured by irradiation developed a secondary neoplasm inside the treated area. The majority of induced tumors were squamous cell carcinomas. In the skin covering the thorax, which had received a dose of 15 Gy in 10 fractions for elective irradiation of the lungs, no tumors were induced.

Animals↗
PubMed1993

[Therapeutic consequences of early detection of locoregional recurrences in breast cancer].

The value of follow-up investigations depends on the therapeutic consequences of early detection of recurrences and metastatic disease. After breast conservation early detection of recurrent disease by physical and apparative examinations has to be aimed for due to a possible curation by salvage surgery. Also in recurrences of the chest wall a great deal of local controls can be achieved when detected early and at smaller sizes. While axillary recurrences can be controlled by surgery and radiation therapy the prognosis is poor in the case of a supraclavicular and retrosternal lymph node involvement. Diagnostic and therapeutic options will be discussed for these five types of recurrences.

Breast Neoplasms↗
PubMed1992

Proliferative changes in two murine tumours in response to single or fractionated doses of X-rays.

Studies were carried out to investigate proliferative changes in two murine experimental tumours in response to radiation. Results were generated using bromodeoxyuridine labelling and flow cytometry. This study demonstrates the possible ambiguity of previous studies using tritiated thymidine in which inability to discriminate normal and tumour cell components in murine tumours may lead to different values for cell kinetic parameters. In particular, the sarcoma F appeared to have a growth fraction of 0.62 when all cells were considered; in reality the growth fraction of the tumour cells only (based on DNA content discrimination) was close to unity. Radiation, administered either as single or fractionated doses, caused little change in the proliferative characteristics of the sarcoma F tumour but had profound effects on the adenocarcinoma Rhodesia tumour. Major changes were the accumulation of cells in G2 for several days after the end of the radiation treatment in both tumours and a dramatic drop in labelling index of the Rhodesia tumour. In neither tumour was there any evidence to suggest an increase in tumour cell proliferation during or after the irradiations. The diploid cells within the sarcoma F tumour showed an initial depression of labelling index followed by a rapid increase overshooting the control labelling index at higher radiation doses. Much of the effects could be attributed to cell cycle delays.

Adenocarcinoma↗
PubMed1992

Radiation therapy of para-aortic lymph nodes in gynaecologic cancers: techniques, results and complications.

From 1965 to 1986 the para-aortic lymph nodes of 141 patients with gynaecologic cancers were irradiated directly after initial treatment of the primary site was completed. Another 32 patients only received para-aortic radiation treatment when para-aortic metastases became clinically apparent some time later. Radiation therapy was performed using a biaxial-four-segmental-rotating-field-technique. Crude survival of the group with initial para-aortic radiation treatment is far better than of the second group. Only five cases of severe complications due to para-aortic treatment were reported. In order to analyze the reason for such a low number of complications, CT-treatment planning for a typical patient was performed for different methods as they have been described in the literature, also referring to treatment data such as success, total dose and dose-distribution, thus influencing the complication rate. Obviously, the biaxial-four-segmental-rotating-field-technique is a method allowing to deposit a certain dose into the target volume without considerably damaging tissues in the vicinity.

Adolescent↗
PubMed1990

Radiotherapy of the rhabdomyosarcoma R1H of the rat: postoperative radiotherapy.

Rhabdomyosarcoma R1H of the rat was excised aiming for a complete macroscopic local excision. Adjuvant radiotherapy was performed from the third postoperative day on. Former tumor sites were locally irradiated with 200 kVp X rays 4 times per week over a period of 6 weeks. Total doses of 0, 15, 30, 45 and 60 Gy were applied. The tumor volume was measured and the time to regrow to initial volume was assessed. The results were compared to the effect of a standard radiotherapy alone with 30 fractions of 2 Gy applied within 6 weeks. All tumors recurred despite of the irradiation treatment. At high total doses (greater than 30 Gy), adjuvant radiotherapy was found to improve short term tumor response considerably, whereas no positive effect was seen at low doses. After a total dose of 60 Gy and long time intervals after start of treatment, radiotherapy alone and a combination of surgery and radiotherapy seem to be isoeffective in our tumor system.

Animals↗
PubMed1989

[Split-course neutron and photon irradiation of experimental tumors: the importance of the sequence and interval lengths].

In a split course mixed beam experiment we have investigated the influence of the interval and beam-quality on tumour growth delay. Fast growing sarcomas (SaF) in grey CBA-mice were irradiated with different sequences of neutrons (N) and photons (X) varying the length of time interval from 0 up to 300 minutes between two doses. The tumours were treated with isoeffective doses of X-rays and/or neutrons (XX, NN, NX, XN). In order to achieve a homogeneous radiosensitive cell population, tumours were reversibly made hypoxic by clamping ten minutes prior and during irradiation. Tumour growth delay is dependent on the sequence and on the interval. As expected the growth delay in tumours treated with neutrons only was less dependent on the interval than after pure photon irradiation. Beyond an interval of 30 minutes in the mixed beam schedules the one giving neutrons first was more effective than the one giving photons first.

Animals↗
PubMed1987

The effect of mixed fractionation with X rays and neutrons on tumour growth delay and skin reactions in mice.

We have compared the effects of mixed fractionation schedules with X rays and neutrons on growth delay of a murine tumour and skin reactions in mice. The schedules were five daily fractions of X rays, neutrons or mixtures (NNXXX, XXXNN or NXXXN). For clamped tumours or skin all three mixed schedules had the same effect. In contrast, for unclamped tumours giving the neutrons first (NNXXX) was more effective than the other two mixed schedules. This represented a true therapeutic gain and implies that if neutrons are used clinically as only part of a course of fractionated radiotherapy, they should be given at the beginning rather than at the end of treatment.

Animals↗
PubMedDate not supplied

Dual-energy CT-scan quantification of recalcification in osteolyses of the vertebral body due to mammary carcinomas in the course of antineoplastic treatment.

Recalcification of osteolyses can be determined by the use of dual-energy CT-scanning. Quantitative CT-scans have been performed in a group of 11 female patients with osteolytic metastatic spread of mammary carcinomas under systemic antineoplastic treatment. During their treatment with either chemotherapy or hormones these patients have been investigated every two weeks in a total observation period of three months. Additional to every CT-scan (n = 77) a conventional radiograph was taken. In the course of treatment it was possible to give reliable statements with regard to the response to therapy up to 8 weeks earlier by the use of quantitative CT-scans compared to conventional radiographs.

Adult↗
PubMedDate not supplied

The influence of inspiratory hyperoxia on ischemia-reperfusion-induced tumour growth delay.

We investigated the ischemia-reperfusion-induced tumour growth delay as a function of ischemic time, tumour temperature, and the amount of inspired oxygen during reperfusion. The rhabdomyosarcoma R1H growing on the right flank of male WAG/Rij rats was clamped for 2 or 4 h at 20 degrees C or 37 degrees C. Five minutes prior to and 10 min during reperfusion the animals respired air, pure oxygen or carbogen (95% O2, 5% CO2). Comparison of single treatment modalities with untreated controls revealed significant tumour growth delays after clamping times of 4 h at 37 degrees C for air and pure oxygen, but not for carbogen.

Animals↗