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Biomedical subjects

H von Lieven

Publications and source records attributed to H von Lieven.

At least 19 recordsLinked to original sources
PubMed2001

Postoperative radiotherapy of NSCLC--outcome after 3-D treatment planning.

AIM: To evaluate the benefit of postoperative radiotherapy depending on lymph node involvement in non-small-cell lung cancer (NSCLC). PATIENTS AND METHOD: Retrospective analysis of patients with NSCLC, who have been treated at the University of Giessen between 1986 and 1996 by surgery (n = 437) or surgery and 3-D planned postoperative radiotherapy with 50-60 Gy (n = 115). Evaluation of survival rates and risk of death depending on postoperative radiotherapy taking into account N-category, tumor stage, completeness of resection and performance status. RESULTS: With individually 3-D planned postoperative radiotherapy there was a lower risk of death in all stages with lymph node metastases. The relative risks of death and the 95% CI were in pN1 0.64 (0.39-1.03), in pN2 0.31 (0.18-0.56) and in pN3 0.25 (0.10-0.64). CONCLUSION: Our results suggest that the risk of death in NSCLC with lymph node involvement can be reduced by individually 3-D planned postoperative radiotherapy.

Adult↗
PubMed2001

Patterns of failure following CT-based 3-D irradiation for malignant glioma.

BACKGROUND: This retrospective study was undertaken to analyze the patterns of failure in patients with malignant glioma after localized irradiation. PATIENTS AND MATERIALS: Recurrence patterns of 46 patients with malignant glioma (glioblastoma: 24, anaplastic astrocytoma: 15, anaplastic oligodendroglioma: 5, unclassified malignant glioma: 2) were studied using CT/MR scans and radiotherapy plan-plots. All patients were operated before and a total dose of 5,940 cGy was given after CT assisted and individually configurated 3-D planning using 7-15 slices at an in between distance of 5 mm. The target volume included a 2-3 cm margin beyond the tumor indicated by preoperative CT scan. The following parameters were analyzed: tumor size and type, size of perifocal edema and whether the edema was fully included into treatment volume and finally the location of the recurrent tumor. The maximal distance between primary tumor and recurrent tumor was measured and also the distance from the border of the primary tumor to the distant border of edema for a visual analysis. RESULTS: Local limited volume irradiation was sufficient since 73.9% of recurrences occurred within 2 cm distance from primary tumor and 93.5% of recurrences occurred completely within 3 cm distance from primary tumor. Regarding the distance between primary tumor and recurrent tumor and the time interval until appearance of recurrent tumor it was not of importance if perifocal edema was included completely into treatment volume or not. CONCLUSION: Limited volume irradiation of malignant glioma with a target volume 3 cm beyond that indicated by preoperative CT scan seems to be sufficient, since 93.5% of recurrences were completely within 3 cm distance from the margin of the tumor. Improvement of the results with larger treatment volumes are unlikely. Complete irradiation of perifocal edema was not found to be necessary.

Adolescent↗
PubMed2000

[Therapy-resistant ventricular tachycardia in a woman with primary cardiac non-Hodgkin lymphoma].

HISTORY: A 65-year-old woman had suffered from relapsing ventricular tachycardias (VT) since 1996. FINDINGS: Physical examination was normal. An arrhythmogenic substrate was found in the right ventricular outflow tract by electrophysiological examination. Nuclear magnetic resonance imaging (MRI) showed an infiltration of the right heart. Myocardial biopsy revealed a high-grade centroblastic non Hodgkin lymphoma. The patient was now transferred to our hospital for further treatment. Lactate dehydrogenase was elevated (2,030 U/l). Echocardiography showed a thickened and more reflecting right ventricular myocardium. Bone marrow aspiration and MRI/computed tomography of abdomen and thorax excluded a generalized stage. Ventricular tachycardias were caused by a primary cardiac lymphoma. TREATMENT AND COURSE: Combined radio-chemotherapy succeeded in complete remission. High-frequency ablation and amiodarone failed. Although MRI showed no more vital lymphoma after the combined radio-chemotherapy the patient suffered from spontaneous and symptomatic relapses of VT. Therefore this patient with primary cardiac lymphoma was the first in literature to get a defibrillator (ICD). The incidence of VT decreased and up to now the patient showed no relapse of the non Hodgkin lymphoma (follow-up 23 months).

Aged↗
PubMed1996

Comparison of two strategies for the treatment of radiogenic leukopenia using granulocyte colony stimulating factor.

PURPOSE: Radiation-induced leukopenia can cause a delay or discontinuation of radiotherapy. This complication can be overcome with the use of granulocyte colony-stimulating factor (G-CSF). However, an uncertainty exists regarding the mode of application of G-CSF in patients treated with radiotherapy. For this reason, the efficacy of two strategies for the administration of G-CSF in irradiated patients was compared in a prospective randomized clinical study. METHODS AND MATERIALS: Forty-one patients who developed leukopenia (< 2.5 x 10(9) per liter) while undergoing radiotherapy were treated with G-CSF at a daily dose of 5 microg/kg. The first group received single injections of G-CSF as required (n = 21). The second group received G-CSF on at least 3 consecutive days (n = 20). An analysis was made of the changes in leukocyte counts, the number of days on which radiotherapy had to be interrupted, and the side effects of growth-factor treatment. RESULTS: An increase in leukocyte values in the peripheral blood was observed in all patients treated with G-CSF. In the group which received G-CSF when required, two injections (range: 1-8) were administered in most cases. In the second group, most of the patients received three injections (range: 3-9). The average duration of therapy interruptions due to leukopenia was 4.8 days (0-28) in the first therapy arm and 2.5 (0-20) in the second arm. The variance in the duration of therapy interruptions between the two groups was not significant (p = 0.2). Radiotherapy had to be terminated in two patients due to thrombocytopenia but the application of G-CSF did not seem to be a reason of decreasing platelet counts. CONCLUSIONS: Our results reveal that G-CSF is safe and effective in the treatment of radiation-induced leukopenia regardless of the mode of application. Because the calculated difference related to radiation treatment interruptions has no clinical relevance, both approaches examined in our study appear reasonable.

Adult↗
PubMed1996

[Water-filtered infrared-A-hyperthermia combined with radiotherapy in advanced and recurrent tumors. Initial results of a multicenter phase I-II study].

BACKGROUND: Water-filtered infrared-A-radiation (IR/A-HT) can be used to heat superficial malignant tumors. A prospective multicenter phase I-II study was conducted to evaluate toxicity and efficacy of IR/A-HT combined with external beam radiotherapy (RT). PATIENTS, MATERIAL AND METHODS: From December 1991 to June 1994, a total of 53 patients with 58 malignant lesions were entered in the study. There were 14 primary, 36 recurrent and 8 metastatic tumors which were located in the head and neck region (14), chest wall (31), abdominal wall (2) and the extremities (11). The mean tumor volume was 100 cm3. IR/A-HT was applied 1 to 2 times per week with up to 3 IR/A-HT-radiators directly before or after external RT for 1 hour at 40.5 to 44 degrees C. Temperatures were controlled at various locations at the skin surface and invasively at depth. RESULTS: IR/A-HT was well tolerated: in 31 (53%) lesions acute (pain, pulse or blood pressure changes, increased skin reaction etc.) and in 25 (43%) chronic side-effects (atrophy, telangiectasis, fibrosis etc.) were noted; usually the toxicity was minor and temporary. At 3 months FU, 32 (55%) lesions achieved a local CR and 19 (35%) a PR; at 12 months FU, 25 (43%) had persistent CR; 16 patients (18 lesions) were deceased and 3 (4 lesions) not yet in FU. In univariate analysis the following prognostic factors for CR at 3 or 12 months FU were found: Karnofsky, metastatic status, tumor size, total RT-dose, thermal parameters T min(av) and T mean. For acute toxicity maximum temperature Tmax(av) was prognostically decisive. Significant differences were also found when considering the "quality of the HT-application". The microwave technique was superior to the infrared-A-HT-technique with regard to the penetration depth of energy deposition. CONCLUSIONS: Water-filtered infrared-A-radiation can be safely and effectively applied to heat localized superficial tumors (up to 1 cm depth). To increase the area of HT application multiple infrared-A-radiators have to be combined. A multi-element-system is in progress.

Abdominal Muscles↗
PubMed1988

[Temperature distribution in interstitial hyperthermia].

The temperature distribution during the application of interstitial hyperthermia was measured in a static and a dynamic phantom. Despite the temperature-controlled release of energy over six electrodes, there were considerable temperature heterogeneities in the target volume. The temperatures measured in partial volumes were largely dependent on the regional perfusion.

Humans↗
PubMed1985

[The tumor markers CEA, TPA and CA 19-9 and ferritin and osteocalcin in follow-up studies in breast cancer].

Radioimmunological determinations of the tumour markers CEA, TPA, CA 19-9, ferritin and also osteocalcin were carried out in 250 patients with ablatio mammae for breast cancer over a follow-up period of at least 1 year. Metastases were detected in 49 of the 250 patients. The normal control group comprised 193 healthy persons. CEA proved to be the most valuable tumour marker, but TPA and ferritin were also significantly elevated in metastatic breast cancer. Combined determination of all 3 parameters gave the best results. Additional measurement of CA 19-9 was helpful in only one of the 49 patients with metastases in whom the 3 other parameter were negative throughout. Hence, determination of CA 19-9 appears unnecessary in breast cancer. In progressive disease the markers generally increased and fell again following successful therapy. In a few cases the opposite was found or no changes were observed. Cases with small local recurrence or an additional carcinoma at an early stage did not exhibit increased marker values as compared to patients without metastases. Not infrequently the increase in markers preceded the manifestation of metastases by several months. Very high concentrations of tumour markers signify a poor prognosis. Osteocalcin was elevated in patients with bone metastases, but not soft tissue metastases. In general, however, it paralleled the serum alkaline phosphatase level.

Adult↗
PubMed1983

[Bone marrow transplantation in adults in acute leukemia, aplastic anemia and paroxysmal nocturnal hemoglobinuria. Results of the Medical Clinic IIi of LMU (Ludwig-Maximilians University) Munich].

Eleven adults have been transplanted for various reasons between July 1979 and July 1982: 2 with aplastic anemia (AA), 1 with paroxysmal nocturnal hemoglobinuria (PNH), 8 with acute leukemia (AL). Four patients suffered from acute lymphocytic leukemia (ALL) and four from acute non-lymphocytic leukemia (ANLL). Two of them were transplanted in relapse, 1 in a partial remission, and 5 in complete remission. All patients were in their late stage of disease. The PNH-patient had an identical twin, 8 patients had an HLA- and MLC compatible sib, 1 an unrelated donor, and 1 was transplanted from his father. Four patients are alive, 2 more than 3 years: 1 with AA and 1 with ALL who was transplanted in relapse. Six patients died of infectious complications (4 of interstitial pneumonia, 1 of a candida sepsis, 1 of acute toxoplasmosis). Patients living more than 3 weeks had a take. Acute graft-versus-host (GvH) disease did not present a major problem. All patients received methotrexate for GvH-prophylaxis, in three instances the marrow was additionally pre-incubated with anti-T-cell globulin.

Acute Disease↗
PubMed1981

[Bone marrow transplantation for aplastic anaemia (author's transl)].

From March 1975 until May 1980 twelve patients with severe aplastic anemia were grafted with bone marrow from HLA-identical siblings by the Munich Cooperative Group for Bone Marrow Transplantation. Six patients are alive between 10 months and more than 5 years after grafting with normal blood values and marrow. One patient is treated as an out patient for chronic localized graft-versus-host disease (GvHD), five patients are well and without treatment. Six patients have died, one patient with a cerebral hemorrhage the day before transplantation, three patients following rejection of grafts 32, 40 and 55 days after grafting, one patient with severe GvHD 85 days after grafting and one patient, probably with interstitial pneumonia, following cerebral hemorrhage. Three of 6 patients who were conditioned with Cyclophosphamide (CY) only died following rejection of the graft. Two adults who were conditioned with CY and "total lymphoid irradiation" and three children, who wer given unirradiated leukocyte concentrates from the marrow donor after grafting, did not reject their grafts. The results of the Munich-Cooperative Group for Bone Marrow Transplantation are comparable to those of large, specialized centers for bone marrow transplantation, they indicate possibilities of cure of severe aplastic anemia by marrow grafts from HLA-identical siblings. They confirm that better results are obtained with earlier transplantation in the course of the disease.

Adolescent↗
PubMed1981

[Radiation therapy of tumors of the hypopharynx (author's transl)].

A follow-up study of 69 patients with malignant tumors of the hypopharynx is reported. They were treated either with Cobalt-60-gamma-rays or with 19 MeV Betatron X-rays mainly up to a dose of 60 Gy over a 6 week period. 53 of the 67 patients with carcinomas had very large tumors (T3 and/or N3). The 3-year survival rate in group N0 was 15%, and in group N1--3 7%. These rates could not be improved on by radical operations prior to radiotherapy. 51 of the 67 patients with carcinomas died due to local or regional disease. 7 patients developed distant metastases. These results could not be improved on by increasing the dose to 70,0 Gy.

Carcinoma↗
PubMed1981

[Bone scintigraphy in the diagnosis and follow up care of malignant head and neck neoplasms].

In diagnosis and localisation of malignant tumors with destruction of the bone, scintigraphy has its special importance in diagnosis as an addition to X-ray tomography. When carcinoma are localized in the middle or dorsal part of the base of the skull scintigraphy may help to calculate the chance for an operation. The exact knowledge of the dimension of the tumor is a valuable help in radiotherapy. In primary diagnosis of destructions of the base of the skull scintigraphy might give an earlier information than X-ray. Malignant tumors of the ear however are sufficiently detected by means of X-rays alone. The main field of scintigraphy is the observation of irradiated and operated malignoma. We recommend 6 or 12 months controls in combination with a clinical observation and with tomographic controls. Scintigraphy became a most valuable tool in the search and diagnosis of metastases in primary malignoma of the mammae, the lungs or the kidneys. In case of metastases in the skull scintigraphy is most helpful to detect them often earlier than by means of X-rays.

Adult↗
PubMed1980

[Radiation therapy of the renal tumor in children (author's transl)].

Close cooperation of pediatric surgeons and pediatric oncologists with radiotherapists, using coordinated treatment schedules conformable to the stage of the disease, and combining tumor nephrectomy, postoperative irradiation and the treatment with AMD and Vincristine, has increased the 3-year survival rate from 27% (13 of 49) up to 67% (14 of 21) for children with Wilm's tumor.

Child↗