Biomedical subjects
Publications and source records attributed to M L Sautter-Bihl.
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The international consensus conference from St. Gallen concerning the treatment of early breast cancer concluded in 2003, that sentinel node biopsy was now accepted as method allowing axillary staging in breast cancer. This procedure may avoid complete lymph node dissection in appropriate cases. Since numerous questions associated with the technique are still not defined and the procedure itself is not yet standardized, the German Society of Senology defined the conditions for the routine clinical use of sentinel node biopsy in an interdisciplinary consensus meeting.
BACKGROUND: In Hodgkin disease (HD), accurate assessment of the extent of disease is essential because it provides the basis for different treatment strategies. In addition to conventional imaging methods (CIM), positron emission tomography with fluorine-18-fluorodeoxyglucose (FDG-PET) may permit reliable differentiation between lymphoma and nonmalignant tissue and thus improve determination of the stage of the disease. The aim of the current study was to assess the clinical value of FDG-PET for primary staging, treatment monitoring, and assessment in a suspected case of recurrent HD. METHODS: Eighty-one patients with HD underwent 106 FDG-PET studies using a dedicated whole body PET ring scanner. In 25 patients PET was part of the primary staging, 63 PET studies were undertaken for treatment monitoring after the completion of treatment, and in 18 patients PET was performed in cases of suspected recurrence of HD. PET scans were compared with CIM and verified histologically and/or by follow-up evaluation (mean follow-up duration, 20.4 months). RESULTS: With regard to primary staging, in a patient to patient analysis, both PET scans and CIM were positive (i.e., showed pathologic foci indicative of HD) in 24 of 25 cases. In a staging-relevant lesion to lesion analysis, accuracy in the determination of the stage of disease was 96% for PET versus 56% for CIM. PET led to a lower stage classification in 28% and a higher stage classification in 12% of cases, compared with the stage assumed with CIM. With regard to treatment monitoring, PET showed an accuracy of 91% compared with 62% for CIM. The negative predictive value of PET was 96%. With regard to suspected recurrence, PET findings were true-positive in 10 of 12 PET scans and true-negative in 5 of 6 PET scans, resulting in accuracy of 83%, which compares favorably with the accuracy rate of 56% for CIM. CONCLUSIONS: It may be concluded that FDG-PET is capable of determining the stage of HD with great accuracy and is capable of correctly detecting manifestations of HD in treatment monitoring and cases of suspected recurrence, in which CIM occasionally result in equivocal findings. The results of the current study suggest that FDG-PET should become a routine tool in the staging/restaging of HD.
BACKGROUND: Differentiated thyroid cancer (DTC) is a rare tumor entity with excellent prognosis. Thus, assessment of the efficacy of different treatment modalities requires follow-up for such a long period that the validity of the conclusion may be limited because diagnostic and therapeutic standards have changed substantially. Accordingly, the indication for external radiotherapy is still controversial. The aim of the present retrospective study is to evaluate prognostic factors and the influence of treatment on outcome of differentiated thyroid cancer from a large data base. PATIENTS AND METHODS: Records of 441 patients (317 females, 124 males; mean age 46 years) with 270 follicular and 171 papillary thyroid carcinomas (pT1-4, pN0-3) were reviewed. Treatment was surgery in 440, radioiodine therapy in 338, postoperative external radiotherapy (50-60 Gy) in 223 patients. In 182 cases the three modalities were combined. RESULTS: The 5-year actuarial survival rate of the whole study population was 95%, 10-year survival 92%. 10-year survival was significantly influenced by: tumor stage (pT1: 100%, pT2: 94%, pT3: 94%, pT4: 79%; p = 0.0005), age (< 40 years: 100%, 41-60 years: 91%, > 60 years: 79%; p = 0.0001) and the presence of lymph node metastases in the follicular subtype (pN0: 96%, pN1-3: 81%; p = 0.02). No significant differences in survival were found according to gender or histological subtype. External radiotherapy yielded a non-significant (p = 0.06) increase in the 10-year survival rate (87% vs 46%; p = 0.06) in patients with pT4 tumors (n = 60). CONCLUSION: Prognostic factors predominantly confirmed those reported in the literature. Further clinical studies should clarify, if the trend towards better survival in irradiated patients with pT4 tumors can be confirmed in larger patient groups.
BACKGROUND: In Hodgkin's disease accurate restaging is important to assess treatment results and may eventually provide a basis for further therapeutic strategies. A typical dilemma after treatment of Hodgkin's disease with radiographically persistent lymphoma is the differentiation between sterilized residual mass and viable tumor. Positron emission tomography (PET) has been described as a reliable tool to identify active lymphoma. Aim of the present study was to assess the accuracy and clinical relevance of PET for treatment control and in the situation of a suspected relapse of Hodgkin's disease. PATIENTS AND METHODS: 63 patients (32 men, 31 women, mean age 41.5 years) with Hodgkin's disease were investigated with FDG-PET. In 51 patients 63 PET studies were performed as a treatment control (group 1) after primary therapy. 17 patients (5 of whom preexamined in group 1) underwent 18 PET scans for confirmation of suspected relapse (group 2). PET was performed with a dedicated whole-body ring scanner. In a retrospective analysis, all FDG-PET scans were compared with conventional imaging methods and related to the final diagnosis obtained by histology and/or clinical follow-up (mean 22.4 months). RESULTS: Group 1: FDG-PET showed an accuracy of 91%, whereas the accuracy of conventional imaging was 62%. Group 2: The accuracy for PET was 83% and 56% for conventional imaging. CONCLUSION: The present data suggest that PET is a sensitive and reliable tool for detection of involved areas of active Hodgkin's disease. The accuracy of PET for restaging purpose seems to be superior than conventional imaging.
BACKGROUND: Leptomeningeal carcinomatosis occurs in about 5% of solid tumors and may seriously compromise quality of life. Aim of the present study was to evaluate the feasibility of craniospinal irradiation with and without intrathecal chemotherapy and its efficacy with regard to symptom palliation and survival. PATIENTS AND METHODS: 16 patients (mean age 46 years; nine breast cancers, five lung cancers, one renal cell cancer, one tumor of unknown primary site) with leptomeningeal carcinomatosis occurring after a median interval from primary tumor diagnosis of 5 months (0-300 months) received craniospinal irradiation between October 1995 and May 2000. The median total dose was 36 Gy (à 1.6-2.0 Gy). Ten patients were additionally treated with intrathecal methotrexate (15 mg per cycle, 2-8 cycles). RESULTS: Median survival was 12 weeks, 8 weeks after radiotherapy alone, 16 weeks after combined modality treatment. 14 patients died from disease. Eleven patients (68%) experienced regression of their neurological symptoms during or soon after completion of radiotherapy. Seven patients regained their ability to walk, six had pain reduction, three regression of bladder and bowel incontinence. In three patients symptom progression and in two patients no change occurred. Side effects were: myelosuppression (CTC) Grade I: n = 2, Grade II: n = 4, Grade III: n = 4 patients and Grade IV: n = 1. Nine patients had dysphagia, seven mucositis, three suffered from nausea. No late toxicity was observed. CONCLUSION: Craniospinal radiotherapy is feasible and effective for palliative treatment of leptomeningeal carcinomatosis. As far as the small patient number permits any definite conclusions, combined modality treatment seems superior to irradiation alone.
BACKGROUND: Heterotopic ossifications occur in about 20% of patients with spinal cord injury and may seriously compromise the rehabilitation process. Aim of the present study was to evaluate if radiotherapy administered early in the course of the disease prevents the manifestation of heterotopic ossification and if in patients whose bone formations have been resected recurrence can be avoided. PATIENTS AND METHODS: 52 patients (44 males, eight females, median age 33 years) and 75 joints were irradiated between December 1989 and March 2000. 49 patients (70 joints, 65 hips, three knees, one shoulder, one elbow) were evaluable. Median follow-up was 11 months. In 58 joints radiotherapy was performed as a primary treatment in the inflammatory phase of soft tissue swelling that precedes manifestation of heterotopic ossifications. Twelve joints were treated after resection of manifest heterotopic bone, two patients had primary and postoperative irradiation in different joints. The dose was 10 Gy in single fractions of 2-2.5 Gy in 34 joints and 7.5-20 Gy in six joints. From July 1996 on, 30 joints received single-dose irradiation with 8 Gy. RESULTS: 50/70 joints (71%) remained free from progression. This was the case for 47/65 (72%) hips, whereas in 18 hips (27%) the Brooker score increased for 1-2 grades and caused a moderate decrease of mobility in five joints. Out of the other five joints, two knees developed progression. No relevant side effects occurred. CONCLUSION: The present results suggest that radiotherapy is an effective local treatment option for spinal cord injured patients with heterotopic ossifications.
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OBJECTIVE: Heterotopic ossifications (HO) occur in about 20% of patients with spinal cord injury and may seriously compromise the rehabilitation process. The aim of the present study was to ascertain whether radiotherapy (RT) administered early in the course of the disease prevents the manifestation of HO and whether in patients, whose HO have been resected, recurrence can be avoided. METHODS: Thirty-six patients (46 joints) were irradiated; 33 patients were evaluable. Mean follow up was 23.6 months. In 27 patients RT was performed as primary treatment in the inflammatory phase of soft tissue swelling that precedes manifest HO. Eleven patients were treated after resection of manifest HO, while two had primary and postoperative RT in different joints. The dose was 10 Gy in fractions of 2-2.5 Gy in 25 patients. Four patients were treated with total doses between 7.5 and 20 Gy. Seven patients received single dose irradiation with 8 Gy. RT was performed with 8 MV photons after simulation on the basis of CT scans. RESULTS: The mean duration of follow up was 23.6 months. Thirty of the 36 irradiated patients showed no progression of HO. In three patients reossifications after therapy caused a moderate decrease in joint mobility. No relevant adverse effects were observed. CONCLUSION: These results suggest that RT is a safe and effective local treatment option for spinal cord injury patients with HO.
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PURPOSE: Treatment planning for breast cancer is often performed using a conventional computed tomography (CT), which does not allow patient positioning in the treatment set-up. Using a simulator with CT option the scanning procedure can be performed in an identical position as the treatment. Aim of the present study was to investigate feasibility and accuracy of a simulator with CT option compared to treatment planning with a conventional CT for breast irradiation. PATIENTS AND METHODS: Twenty patients submitted for radiotherapy after breast conserving surgery underwent simulation with the SLS-CT (Elekta Oncology Systems, EOS). Additionally, a planning CT with a diagnostic CT scanner (Somatom Plus, Siemens,) was performed. All the patients were scanned with both modalities and had 3 to 5 slices. For Somatom-CT patients lay flat, for SLS-CT they rested on a breast angle board. The target volume was delineated in the CT scans obtained with both modalities, the planning procedure was carried out using the 3-D planning system Helax-TMS. RESULTS: The median values for SLS-CT (1) and Somatom (2) were: Target volume: 679 cm3 (1) and 670 cm3 (2) for all patients and 1,025 cm3 (1) and 1,100 cm3 (2) for large breasts. Maximal dose in the dose-volume histogram (DVH): 109.3% (1) and 109.7% (2). Lung volume in the 20% isodose: 119 cm3 (1) and 123 cm3 (2). The distance between entrance and exit point in the central axis: 13.8 (1) and 14.6 cm (2). CONCLUSION: Treatment planning with a CT option is feasible, the simulation procedure can be performed with 1 single device and under identical set-up conditions as the treatment itself. Our data show a tendency towards sparing of irradiated volume with SLS-CT, the clinical relevance cannot yet be determined.
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PURPOSE: With regard to the poor prognosis of patients with glioblastoma multiforme, the aspect of life quality with a minimal treatment time becomes essential. The purpose of the present study is to evaluate whether the results of a radiotherapy schedule using increased single fractions applied over a shortened treatment time is feasible without compromising treatment efficiency or providing more side effects than a conventionally fractionated treatment. PATIENTS AND METHODS: A total of 38 patients (f = 21, m = 17, mean age 58 years) with histologically proven glioblastoma multiforme were irradiated after (partial) resection (n = 29) or stereotactic surgery (n = 9) with single doses of 3.5 Gy (ICRU) 5 fractions a week up to a total dose of 42 Gy following individual treatment planning. RESULTS: Median survival was 45.7 weeks, survival rate after 6 months was 80.9% and decreased to 34.2% after 12 months. Radiotherapy was tolerated without any important acute toxicity or any late side effects during the follow-up period. CONCLUSIONS: The increase of the dose per fraction using a fraction size of 3.5 Gy enhanced neither acute nor late toxicity. The survival rate compared well to those described in the literature. Thus the shortened treatment schedule seems as efficient as conventional radiotherapy. Moreover, it seems preferable with regard to quality of life.
BACKGROUND: Chronic pancreatitis is a severe inflammatory process leading to destruction of exocrine tissue, fibrosis and a sometimes fatal pancreatic necrosis. Therapeutic options are poor and restricted to an exclusively symptomatic treatment. In this situation any additional treatment option is welcome. CASE REPORT: The present paper reports the successful irradiation of a patient with severe chronic pancreatitis resistant to any pretreatment. Pain relief was stated one week after beginning of the irradiation. Total dose was 7 Gy, applied with opposing ap/pa fields using 8 MV photons. Three years after treatment the patient has remained free from symptoms. He has gained 14 kg of weight and is working regularly.