PubMed Health⌕ Search

Biomedical subjects

E Dühmke

Publications and source records attributed to E Dühmke.

At least 55 records · Page 3Linked to original sources
PubMed1996

[Total skin electron beam irradiation in cutaneous T-cell lymphoma].

PURPOSE: Patients with cutaneous T-cell lymphoma are treated in Germany mostly by dermatological local therapy like corticosteroids or PUVA-irradiation. Total skin electron beam irradiation is used rarely, even though it has a potentially curative character. We present an analysis of patients, who received a total skin electron beam irradiation after having progressive disease following other treatment modalities. PATIENTS AND METHODS: Twenty-one patients (mean age 58.9 years) in different stages were treated (stage IB and IIA n = 4, stage IIB n = 8, stage III n = 3, stage IV n = 6). All patients had progressive disease under other forms of local therapy. The irradiation was performed from 6 directions per hemibody using 2 axial fields which have each an 18 degree angle to the horizontal level. Six and 7 MeV fast electrons were used. Total dose was between 8 and 36 Gy in single dosis of 1 x 4 up to 5 x 2 Gy per week. In underdosed areas and areas of tumors of the skin boost irradiation with small fields was given. RESULTS: All patients had a good tumor regression (complete remission: n = 10, partial remission: n = 11). With the follow-up between 4 and 93 months total- and recurrence-free survival was 18 and 7 months (median). Patients in early stages with slow but complete remission of the symptoms had the best prognosis. Because of the small case number there was no significant difference between the groups. There were no severe side effects of the radiotherapy noted. CONCLUSION: Our analysis shows on a small patient number, that total skin electron beam irradiation has a good palliative effect on patients who have progressive disease following other types of treatment like PUVA or corticosteroids. The recurrence-free survival of 2 out of 4 patients with early stage disease (I-IIA) up to 93 month shows the potentially curative character of the treatment.

Adult↗
PubMed1996

[Adjuvant intraoperative radiotherapy of stomach carcinoma].

In order to evaluate the role of adjuvant IORT in the treatment of resectable gastric carcinoma, we carried out a randomized trial comparing surgery and surgery+adjuvant IORT. The study included 115 patients within a 74-month period, 51 of them received a single application of 28 Gy to the celiac axis. Patients were comparable with regard to age, sex, tumor stage and operative morbidity. The difference in mean survival time (IORT: 26.9 months vs. non-IORT, 30.8 months) and tumor-related death in the long-term course (mean follow-up period 29.2 months) with 29.4% (15/51) in the IORT-treated patients vs. 31.2% (20/64) in non-irradiated patients did not reach significance.

Combined Modality Therapy↗
PubMed1994

Use of surface markers for MR radiotherapy planning.

PURPOSE: For the precise planning of radiotherapy treatment ports, the delineation and control of their borders has to be performed with X-ray and other imaging procedures before and during the therapy. MATERIALS AND METHODS: Conventional planned therapy ports are checked with the help of MR-imaging with new gel-markers, as a further development to formerly used fluid filled tubes, on the skin of the patient in different regions. We describe the essentials of these gels and report about their first practical use. RESULTS: Principal considerations to the technique and practical applications are given with imaging examples. The essential physical qualities of the gels are introduced with separate NMR experiments. It turns out, that multiplanar MR-imaging in combination with field markers on the skin is a fast simple and useful help for the control and the improvement of treatment planning. CONCLUSION: MR-imaging with gel-markers on the skin in many cases can show the tumor and the field-ports in one picture. Thus the therapy planning is refined with simple means. On the one hand the target volume can be seized completely and on the other hand sensitive organs can better be protected.

Humans↗
PubMed1993

[A comparative consideration of para-aortic fields within the framework of the German Hodgkin's Disease Study].

In 33 patients of the multicenter German Hodgkin's Lymphoma Study Group the field borders of the paraaortic field were compared computer-assisted. It was seen that fields are chosen often too small or too large, though precise description of the fields is given in the protocol. In these patients the para-aortics were irradiated exclusively as extended field region. In addition to the above observation the clipping of the spleen pedicle provides the optimal help for correct positioning of this field. Overall a very low frequency of lymphatic clipping is observed, though clinical needs are obvious.

Aorta↗
PubMed1993

Quality control review for radiotherapy of small breast cancer: analysis of 708 patients in the GBSG I trial. German Breast Study Group (GBSG).

Within six years between November 1983 and December 1989 the German Breast Cancer Study Group (GBSG) conducted a prospective multicenter trial on the treatment of pT1 pN0 M0 breast carcinoma. Out of 1036 eligible patients from 69 hospitals, a total of 733 underwent breast preservation surgery and postoperative radiotherapy. A detailed quality control (QC) screening of 708 available radiotherapy records was performed by the radiotherapy reference center. The following quality control scoring system was used for all radiotherapy variables: Radiotherapy treatment "completely according to study protocol" (QC score = 0); "acceptable protocol deviations" (QC score = 1); "unacceptable protocol violations" (QC score = 2); the "overall QC score" was the worst judgement for any single quality control criterion, while the "total QC score" was the summation of all single quality control scores (range: 0 to 14). 292 (41.2%) patients were treated per protocol; 290 (41.0%) had acceptable protocol deviations; and 126 (17.8%) had unacceptable protocol violations. 107 (84.9%) single violations, 15 (11.9%) combinations of two, three (2.4%) combinations of three, and one (0.8%) combination of four unacceptable violations were observed. 564 (79.4%) patients achieved a total QC score of < or = 2, 124 (17.5%) of 3 to 5, and 20 (2.8%) of > or = 6. The criterion "radiotherapy treatment duration" had the highest rate of protocol violations, 67/708 (9.5%); other quality control criteria with protocol violations were "radiotherapy reference dose" (27 = 3.8%), "radiotherapy treatment initiation" (15 = 2.1%) and "other protocol violations" (33 = 4.7%). No protocol violations were observed for the criterion "target volume coverage". The protocol compliance improved slightly during the conduct of the study. Institutional differences in protocol compliance were observed depending upon the accrual rate, the institutional treatment preference and between academic and non-academic hospitals. After a short median follow-up of 48 months, differences in protocol compliance, i.e. protocol violations, have not resulted in a reduced disease-free survival; however, the final prognostic evaluation of the quality control review may require longer follow-up and eventually different treatment endpoints to be analyzed.

Breast Neoplasms↗
PubMed1993

[Diabetes insipidus and breast carcinoma--the importance of NMR tomography (MRT) in therapy planning].

In patients with advanced breast cancer the incidence of diabetes insipidus is between 0.1% and 0.9%. Satisfactory symptomatic relief can be obtained with Desmopressin-acetate. In the presence of this symptom complex magnetic resonance imaging (MRI) can aid in the detection of metastases to the posterior pituitary. By the use of magnetic resonance imaging, the incidence for and implementation of local radiotherapy can be firmly grounded.

Adult↗
PubMed1993

Radiation therapy verification in brachytherapy combining iron sulphate gel irradiation and magnetic resonance imaging (MRI).

We developed a verification method that allows the three-dimensional qualitative delineation of the dose inside an applicator during intracavitary brachytherapy using MRI of dose-dependent changes of iron sulphate. In addition to computer calculations, the verification of the dose distribution is depicted now within the applicator. Therefore one can get a qualitative information about the relative position of the applicator according to the tumor volume and the desired brachytherapy radiation volume.

Brachytherapy↗
PubMed1993

[Clinical and radiation physics studies on the influence of mandibular reconstruction plates on the dose distribution of ultrahard photons].

The effect of mandibular reconstruction plates on the dose distribution of megavoltage photons was analysed. All treated patients showed the normal reactions expected from radiation therapy regardless the modification of dose distribution by the metal plates. For dose estimation measurements were done in a phantom with photons of the energy 60Co to 42 MV and different material.

Alveolar Process↗
PubMed1992

Fast inversion recovery T1 contrast and chemical shift contrast in high-resolution snapshot FLASH MR images.

Fast MR imaging attracts the interest of both clinicians and physicists because new diagnostic information arises with reduced artifacts due to short investigational times. With the acceleration of the Snapshot FLASH MR sequence, the measurement of high-resolution images with 256 x 256 matrix is reported, together with contrasting prepulses that are applied to attain contrast in combination with higher in-plane resolution. Measuring times are in the range of a second. For whole-body imaging, a TR = 5.2 msec and a TE = 2.6 msec could be attained measuring omit 256 x 256 matrix images. Artifact-free images demonstrating T1 contrast and contrast from chemical shift are performed on moving organs (heart, intestine) in different experiments. These applications can easily be performed in a couple of minutes for clinical use. Especially in the lung, short TE and high resolution result in a new imaging quality of pulmonary and mediastinal vessels.

Abdomen↗
PubMed1992

[Case reports on the importance of the locoregional radiotherapy of Merkel cell tumor].

The Merkel cell tumor is becoming an increasingly diagnosed primary neoplasm of the skin. This subepidermal tumor is commonly located on the head and neck or extremities of elderly patients. Occasionally misinterpreted as cutaneous metastases, they show a high rate of local recurrence (27 to 52%) and distant metastatic spread (18 to 52%). The definitive diagnosis can be made with immunohistochemistry. Wide surgical excision with postoperative irradiation to the local site and regional lymphatics is the therapy of choice. In seven patients we describe management strategies and discuss their clinical results.

Adult↗
PubMed1991

[Aluminum, steel and tungsten portal film cassettes for the imaging verification of 60Co photon irradiation up to 42 MV in a clinical trial].

The movement of the patient lowers the contrast of the portals, because the exposition time is long and identical with the treatment time. To enhance the contrast in the portals, the first models of the cassettes were modified under the clinical tests by a rear sheet nearly free from backscattering. With the modified cassettes iodine contrast media are weakly seen on the portals in the laboratory tests, but not in the clinical routine.

Aluminum↗
PubMed1991

[The intracavity radiotherapy of cervical carcinoma with flexible applicators following the vesicovaginal interposition of the uterus].

Advantages of new flexible intracervical applicators treating cervical cancer with high dose rate afterloading brachytherapy are reported: The insertion of the flexible applicator is usually possible without anesthesia and dilation of the cervix. Therefore the treatment can be performed on an outpatient basis. The risks of perforation and infection are minimal. Dosimetry and documentation of the applicator geometry are possible, if the planning system allows the definition of individual curves of an individual applicator. We now prefer flexible applicators instead of rigid steel applicators treating cervix carcinoma.

Brachytherapy↗
PubMed1991

Definitive radiation therapy in the treatment of carcinoma of the uterine cervix. Treatment results and prognostic factors.

219 patients suffering from cervix carcinoma received definitive radiation therapy using moderate doses of external beam therapy and high dose-rate afterloading brachytherapy from 1979 to 1986. At five years, the actuarial survival (AS) for stage Ib patients was 81%, for stage IIa 53%, for stage IIb 56%, for stage IIIa 25%, for stage IIIb 33% and for stages IVa and IVb 0%. Significant prognostic factors for actuarial survival were FIGO stage, histological type, grading and, marginally, age of the patient at the time of diagnosis. The survival data censored for death caused by intercurrent disease (tumor related survival, TUS) at five years were: 90% (Ib), 66% (IIa), 63% (IIb), 50% (IIIa), 41% (IIIb) and 0% (IVa and IVb). The prognostic factors were stage and grading. Age and histology failed to be a significant prognostic factor. The disease-free survival (DFS) according to FIGO stage at five years were: Ib 84%, IIa 64%, IIb 59%, IIIa 50%, IIIb 38%, IVa and IVb 0%. Prognostic factors for disease-free survival were limited to FIGO stage and grading. The five-year local control results (LC) according to stage were 90% (Ib), 64% (IIa), 67% (IIb), 43% (IIIb) and 0% (IVa and IVb) with stage as prognostic factor. High dose-rate afterloading therapy for cervix carcinoma yields good results for local control and survival with a low ratio of severe side effects (6%). Radiation therapy eliminates the prognostic influence of histological type and grading of the tumor on local control. External beam and afterloading doses, however, are relevant factors for prognosis, if the patients are stratified by FIGO stage.

Adenocarcinoma↗
PubMed1990

Cardiac and vascular imaging with an MR snapshot technique.

Real-time vascular and cardiac magnetic resonance (MR) imaging has been reported only with echo-planar imaging. In this study, the fast low-angle shot (FLASH) MR imaging sequence was reduced to repetition times of 3 msec and echo times of less than 1.3 msec with use of an improved MR imaging system. The resulting 200-msec MR images (64 X 128 pixels) are called snapshot FLASH images. They allow measurements from dynamic series of MR images depicting processes such as relaxation behavior and the cardiac cycle in the absence of motion and flow artifacts. In animal studies (at 4.7 T) and in studies of human volunteers (at 2.0 T), vascular and cardiac snapshot FLASH images were obtained as a single shot, as reconstructed motion, and as real-time movies. The arbitrary and fast T1 contrast of these images and the reduction of motion artifacts result in favorable applications for the depiction of myocardial and great-vessel anatomy. These clinical applications can be performed on conventional MR imagers with minor technical modifications.

Animals↗