Biomedical subjects

C Nieder

Publications and source records attributed to C Nieder.

46 records · Page 3Linked to original sources

PubMed1996

Treatment of brain metastases from hypernephroma.

UNLABELLED: Considering the relative radioresistance of hypernephroma, the optimum treatment schedule for its metastases is a matter of debate. This study evaluated the effects of surgery as well as different irradiation schedules in cases with brain metastases from hypernephroma. Seven patients received surgery plus radiotherapy, 2 patients fractionated stereotactic radiotherapy, and 13 patients whole-brain irradiation in either conventional or accelerated fractionation to a total dose of 30 Gy. Local results, clinical course, and survival were most favorable in the group of patients who were treated with surgery plus radiotherapy. The patients treated by stereotactic radiotherapy had a better outcome than those treated by whole-brain irradiation to a total dose of 30 Gy. Accelerated fractionation was not associated with better local control or clinical improvement. Only 4/13 patients with whole-brain irradiation improved. CONCLUSION: In patients with brain metastases from hypernephroma standard palliative whole-brain irradiation led to unsatisfactory results. Stereotactic radiotherapy and surgery seem to be superior, but are not always available and/or indicated. Therefore, the use of higher total doses should be investigated for patients whose local disease extent makes whole-brain irradiation the treatment of choice.

Brain Neoplasms↗

PubMed1996

Risk factors and dose-effect relationship for osteoradionecrosis after hyperfractionated and conventionally fractionated radiotherapy for oral cancer.

A high frequency of osteoradionecrosis after hyperfractionated radiotherapy (RT) of head and neck tumours led to a detailed analysis of risk factors in the dental, surgical, and radiotherapeutic areas. 168 patients with oral cancer were analysed retrospectively. 19% of them had been irradiated primarily and 81% postoperatively. 116 patients received a total dose mostly ranging from 60 Gy to 70 Gy to the ICRU 29 reference point (daily single dose 2 Gy). 52 patients were treated hyperfractionally with two daily fractions of 1.2 Gy per day, 4 h minimum apart and a total dose 82.8 Gy. Dental findings could be evaluated in 126 patients. Factors were checked for prognostic significance for osteoradionecrosis (ORN). Dose dependency was computed using a PROBIT analysis. Dental status before radiotherapy was generally poor (mean 11/32 teeth present, of these 1 was dead, 2.4 carious, 2.4 loose, 0.3 destroyed). On average, six teeth (range 0-27 teeth) had to be extracted. In one-third of the patients bone surgery was necessary. ORN occurred in 8.6% of the patients treated conventionally but in 22.9% of those treated hyperfractionally (p = 0.029). Biologically effective dose (p = 0.032) and deep paradontitis (p = 0.034) proved to be significant risk factors for ORN. PROBIT analysis showed a steadily rising dose dependency of the ORN frequency after conventional radiotherapy. Using total doses up to 70 Gy the frequency of ORN was 8.6%. Dose escalation using hyperfractionation led to an intolerable ORN frequency (22.9%) where a short interfraction interval was a significant factor. The use of this dose fractionation was therefore discontinued in 1992.

Dose-Response Relationship, Radiation↗

PubMed1995

Relation between local result and total dose of radiotherapy for brain metastases.

PURPOSE: Some studies published recently focused on the improvement of the treatment results of patients with brain metastases who underwent radiation therapy. They evaluated survival as a measure for the expected improvement, but failed to demonstrate a significant benefit from an increased total dose of radiotherapy. This study was targeted to investigate the effect of dose escalation with a different endpoint, the local response. METHODS AND MATERIALS: As a first step, a retrospective analysis of 164 patients treated with a standard regimen of 10 x 3 Gy was performed to find factors correlating with the local result. All patients were systematically followed and underwent regular computed tomography (CT) examinations of the brain after irradiation. The second step was to compare, with respect to local control and survival, 39 patients treated with a total dose of 40-60 Gy with 39 patients treated with the standard regimen selected by means of a matched cohort pairs method. RESULTS: The retrospective analysis showed a dependence of the local result after irradiation on three parameters: diameter of brain metastases, primary tumor, and tumor histology. Small-cell and adenocarcinoma were found to be more radiosensitive than squamous-cell carcinoma. The highest radiosensitivity was found in breast cancer metastases. The matching procedure was performed with respect to those parameters and also the number of brain metastases and total cerebral tumor volume. The resulting groups were absolutely equivalent and differed only with regard to the total dose applied. The local response (complete or partial remission) was 48-52% after 30 Gy vs. 77% after 40-60 Gy (p < or = 0.05). Survival was not significantly different. A further analysis of the dose-response relationships showed the tendency of control probability to increase with total dose. CONCLUSION: This study suggests that there is a rationale for dose escalation in the treatment of brain metastases with radiotherapy, when local control is the aim. However, it seems questionable whether an improvement in survival results.

Brain Neoplasms↗

PubMed1995

[The outcome of surgery and radiotherapy in treatment of brain metastases of breast carcinoma].

In a group of 45 patients who had been conventionally irradiated, a multivariate analysis of prognostic factors was performed to find criteria for patient selection for surgery and radiotherapy or radiotherapy only. Nine patients underwent resection of metastases before irradiation. In most cases 10 x 3 Gy over 2 weeks were administered. 28 patients received concomitant hormonal treatment. Complete remission was seen in 30% of the non-operated cases (partial remission 25%). Symptomatic relief was seen in 67% of all cases. Median survival was 4 months (9.5 months after surgery) (p = 0.02). Survival of patients having had simultaneous extracerebral metastases and low Karnofsky performance status was disappointing. All long-time survivors received either hormonal treatment or chemotherapy. Karnofsky performance status and interval between the diagnosis of the primary tumour and the development of brain metastases were the most important prognostic factors. The influence of age and extracerebral metastases was less pronounced. In case of favourable prognostic factors and solitary metastases surgical treatment should be considered. Primary irradiation seems to be appropriate for the majority of patients. In any case an additional hormonal or chemotherapy must be considered. It seems to be questionable if patients with poor Karnofsky performance status and extracerebral metastases should be irradiated.

Adult↗

PubMed1995

[The results of the radiotherapy of brain metastases in patients at an advanced age].

BACKGROUND: To evaluate which patients older than 70 years will benefit by radiotherapy for their brain metastases. PATIENTS AND METHODS: The data of 35 patients in this age-group who were treated between 1983 and 1994 were retrospectively analyzed. All patients were previously untreated and received a whole-brain irradiation and concomitantly corticosteroids. The median total dose was 30 Gy (fractionation: 10 times 3 Gy in 2 weeks). Six patients each received lower or higher total doses with 50.4 Gy at maximum. RESULTS: Six patients failed to complete their prescribed treatment (17%). The median survival of all patients who completed their radiotherapy course was 67 days only. Patients with extracerebral metastases had a median survival of 31 days. Survival was not dependent on total dose of radiotherapy. In 56% of all cases the general condition of the patients improved or remained stable at a high level. Karnofsky-performance status was the most important prognostic factor. CONCLUSIONS: Advanced age is an unfavourable prognostic factor. Only patients in good general condition without extracerebral metastases had survival times which justify radiotherapy for their brain metastases. It seems to be extremely doubtful whether the other cases surviving 1 to 2 months should undergo radiotherapy. In each case a short and easily tolerable course of radiotherapy should be preferred.

Age Distribution↗

PubMed1995

[Tumor markers as prognostic factors in non-small-cell bronchial carcinoma].

PURPOSE: Considerations of different therapeutic approaches require a realistic estimation of the prognosis. The usefulness of tumor markers as prognostic indicators was evaluated by means of a multivariate analysis. PATIENTS AND METHODS: The data of 300 patients who had been irradiated for their primary tumor were analysed retrospectively. The serum concentrations of CEA, SCCA, NSE, and LDH were available before treatment and 3 months thereafter in a sufficient number of cases. The prognostic factors for survival and progression-free survival resulting from univariate tests were further evaluated by a Cox-proportional-hazards model. RESULTS: The serum levels of the particular tumor markers were pathologically elevated in 25 to 36.5% of the cases. Their values correlated with the stage of the disease and separately the N-stage too. A normalization of increased marker levels after irradiation occurred in 37.5 to 67% of the cases. Survival of patients with increased pretherapeutic values of CEA, SCCA, and LDH was significantly worse compared to those with normal values. In the case of a post-therapeutic return to normal levels, prognosis was significantly better than for those where the elevation persisted. However, after inclusion of all other parameters in multivariate analysis the tumor markers were meaningless. Karnofsky-performance status, total dose of radiotherapy, stage of the disease, and weight-loss evolved as independent prognostic factors for survival. For progression-free survival only stage of the disease was important. All subgroup analyses (restriction on patients with favorable prognosis) showed the same results. CONCLUSIONS: A prognostic importance of NSE could not be demonstrated. CEA, SCCA, and LDH were univariate predictors for survival and progression-free survival. But they proved to be dependent on the stage of the disease and were not confirmed as independent variables in the Cox-model. Their importance during the follow-up is diminished by the frequent lack of therapeutic approaches in the case of disease progression. Certainly a more favorable prognosis in case of a post-therapeutic normalization of previously elevated values was found.

Biomarkers, Tumor↗

PubMed1995

[Correlation of preoperative neuroradiologic with postoperative histologic diagnosis in pathological intracranial processes].

PURPOSE: To determine the accuracy of preoperative neuroradiological diagnosis of pathological intracranial processes in a prospective study. MATERIALS AND METHODS: A team of three neuroradiologists determined the diagnosis in CT, MR and angiography prior to stereotactic biopsy or operative resection (173 patients). Only one diagnosis was allowed, except in those cases with two equally probable diagnosis (24 patients). In 106 patients a resection of a brain tumor, in 67 cases a stereotactic biopsy was performed. According to the histological diagnosis the patients were subdivided into three groups: 1: complete agreement: the single diagnosis was correct. 2: conditional agreement: on of the 2 differential diagnosis was correct. 3: no agreement RESULTS: In 131 cases (76%) a complete agreement, in 24 cases (14%) a conditional agreement and in 18 patients (10%) no agreement were found. Assuming only stereotactic procedures the neuroradiological diagnosis was correct in 44 cases (66%) and incorrect in 10 cases (15%). In 13 patients (19%) one of the two differential diagnosis was correct. The specificity of the major tumors was calculated between 92% and 100%. The sensitivity for pituitary adenomas (n = 9) and neurinomas (n = 11) was 100%, the sensitivity for meningiomas (n = 32) was 94%. A sensitivity was calculated between 50% and 71% for astrocytomas (WHO I to WHO IV, n = 64) and metastases (n = 24). CONCLUSION: The accuracy was found to be higher than in the comparable retrospective studies.

Adolescent↗

PubMed1995

[Brain metastases of bronchial and breast carcinoma. Differences in metastatic behavior and prognosis].

Evaluation of 135 cases with brain metastases from non-small-cell lung cancer (group 1) compared with 51 cases from small-cell lung cancer (group 2) and 56 cases from breast cancer (group 3) showed that the frequency of solitary metastases was significantly higher in group 1 and 3. However, in group 2 lesions without surrounding edema occurred more frequently. The rate of patients with extracerebral metastases was significantly higher in groups 2 and 3. The longest median interval between primary tumor and brain metastases was observed in breast cancer patients. The highest local remission rate was seen in small-cell lung cancer if patients who received whole-brain irradiation of 30 Gy alone were compared (63% vs 45% in group 1 and 52% in group 3). However, with regard to clinical course no significant differences were recorded. Survival of lung cancer cases was similar, whereas breast cancer cases survived significantly longer, both after radiotherapy alone and after surgery plus radiotherapy. This might be caused by differences in the natural course of the two diseases as well as adjuvant treatment modalities like hormone and chemotherapy. In conclusion, because long-term survivors were observed only in the breast cancer group, these patients probably have the highest chance of profiting from a locally aggressive treatment approach.

Adult↗

PubMed1994

[The radiotherapy of brain metastases in bronchial carcinoma].

PURPOSE: The data of 132 patients who were treated between 1983 and 1992 because of cerebral metastases from lung cancer were retrospectively analysed, in order to find criteria for patients selection to radiotherapy with simultaneous application of corticosteroids. METHODS: Radiotherapy was given either in 10 fractions of 3 Gy over 2 weeks (97 patients) or in 20 fractions of 2 Gy over 4 weeks (35 patients), always in form of a whole-brain irradiation. Before and during radiotherapy dexamethasone was administered. RESULTS: The local remission rate was 56% for both treatment schedules. In cases with a complete remission median survival was significantly longer compared with partial remission or no change. The median survival of the whole group was 4 months. Patients with extracerebral metastases and a Karnofsky-score < 7 or brain metastases > or = 2.5 cm had a median survival of only 2 months, whereas patients with only brain metastases and a Karnofsky-score > or = 7 or brain metastases < 2.5 cm had a median survival of 6 months. 11% of the patients were asymptomatic. A symptomatic relief, additional to the effect of corticosteroid therapy, was found in 43% of cases, which was dependent on local remission and tendencially on dose of corticosteroids. In a multivariate analysis performance status, extracerebral metastases, and size of cerebral metastases were found to be prognostic parameters. CONCLUSION: Radiotherapy with 10 x 3 Gy seems to be appropriate for the majority of patients, when expense and hospitalisation time are compared with results and benefit. Selected patients may profile from a more aggressive treatment approach. In some cases radiotherapy may be an unsuitable overtreatment.

Adrenal Cortex Hormones↗

PubMedDate not supplied

Perspectives in the treatment of malignant gliomas in adults.

Over the last two decades, after establishing the role of postoperative radiotherapy for malignant gliomas, no definitive improvement in survival rate could be observed, despite advances in established treatment modalities such as radiotherapy and chemotherapy. Progress in exploration of the biology of these tumours allowed for translational research projects and the development of rational new approaches, such as gene therapy and immunotherapy, that could interfere with established treatment regimens or be used independently. Possible strategies include the restoration of defective cancer-inhibitory genes, cell transduction or transfection with antisense DNA corresponding to genes coding for growth factors and their receptors, or with the so-called 'suicide genes'. Several antiangiogenic approaches such as administration of thalidomide, protamine, or monoclonal antibodies against vascular endothelial growth factor have been developed, too. Further treatment possibilities include modulation of drug resistance, e.g. by P-glycoprotein antagonists or 06-alkyl-guanine-DNA-transferase inhibitors, inhibition of matrix metalloproteinases, inhibition of protein kinase C and administration of agents such as phenylbutyrate or valproic acid that showed promising antiproliferative effects in vitro. This review discusses the available laboratory and clinical data as well as recent advances in our knowledge about prognostic and predictive factors and their implications for the design of future clinical trials.

Adult↗