PubMed Health⌕ Search

Biomedical subjects

M Niewald

Publications and source records attributed to M Niewald.

At least 37 records · Page 2Linked to original sources
PubMed1996

Rapid course radiation therapy vs. more standard treatment: a randomized trial for bone metastases.

PURPOSE: In a prospective randomized trial we examined whether radiotherapy of painful bone metastases can be shortened using larger single doses without impairing effectivity. METHODS AND MATERIALS: One hundred patients with painful bone metastases having no prior surgical intervention or treatment with x-ray therapy and had a median follow-up of 12 months were analyzed. The primary tumor was located in the breast in 43%, in the lung in 24%, and in the prostate in 14%. The most frequent sites of metastases were the pelvis (31%), the vertebral column (30%), and the ribs (20%). Further percentages of sites were: lower extremity 11%, upper extremity 6%, and skull 2%. Fifty-one patients received a short course radiotherapy with a total dose of 20 Gy in 1 week (daily dose 4 Gy), and 49 patients received 30 Gy in 3 weeks (daily dose 2 Gy). RESULTS: There were no significant differences in frequency, duration of pain relief, improvement of mobility, recalcification, frequency of pathologic fractures nor survival. There was a light trend favoring 30 Gy in frequency of pain relief and recalcification. Survival was mostly influenced by primary tumor site, Karnofsky performance status, and possibly by the response to radiotherapy (pain relief). CONCLUSIONS: Because of the very short life expectancy of patients with metastatic bone disease, we now use 20 Gy in 1 week as our standard to reduce hospital stay.

Adult↗
PubMed1996

A palliative accelerated irradiation regimen (PAIR) for advanced non-small-cell lung cancer (NSCLC).

In order to avoid overtreatment in advanced NSCLC we developed a palliative accelerated irradiation regimen (PAIR) applying a total dose of 32 Gy in 10 days with two daily fractions of 2 Gy. This paper reports on a 1-year pilot study carried out in preparation of a randomised trial. Data for the 34 patients receiving PAIR were compared to 179 conventionally irradiated historical controls selected from a pre-existing database according to identical inclusion criteria. Statistical analysis showed that PAIR patients had a significantly longer survival than controls (P = 0.0029). Median survival was 11.8 and 5.8 months, respectively, while 1-year survival was 45.6% vs. 21.2%. Compared to the subgroup of controls who had received the full planned dose of 60 Gy (n = 104) PAIR patients showed no significant difference in survival. In order to adjust for possible imbalances we used a comprehensive blinded prognostic rating design creating one score value per patient out of several known prognostic factors. After adjustment for the resulting prognostic score by means of the Cox proportional hazards model PAIR patients still showed significantly longer survival. We conclude that in advanced NSCLC survival after a palliative short-term regimen appears to be at least equivalent to that following conventional high-dose irradiation.

Carcinoma, Non-Small-Cell Lung↗
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

Low-dose radiotherapy for stage I seminoma: early results.

One hundred and one patients with stage I seminoma were irradiated with total doses of 30, 25.5 and 20 Gy to gradually reduced target volumes (paraaortic, pelvic, and inguinal regions to paraaortic only). Low doses and small target volumes resulted in excellent survival and freedom of recurrence but in more frequent nausea.

Adult↗
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

Significant reversibility of alcoholic brain shrinkage within 3 weeks of abstinence.

Chronic alcoholism is often associated with brain shrinkage or atrophy. During recent years, it has been demonstrated that this shrinkage is, at least in part, reversible when abstinence is maintained. There are different hypotheses concerning the mechanisms for this reversibility, but many questions are still open. Especially the time conditions for these reversible changes are subject of discussion. Twenty-eight male patients with severe alcohol dependence were investigated in a computed tomographic study at the beginning of abstinence and 3 weeks later. Planimetric evaluation of 5 selected slices revealed a significant decrease in liquor areas and an increase of brain volume. The densitometric analysis showed an increase in brain tissue density. In a multiple regression approach it was shown that the reversibility was mostly influenced by the age of the patients. Our results support neither the hypothesis of an increase in brain water as the most important principle for reversibility in alcoholic brain shrinkage nor the hypothesis of augmented dendritic growth. Other mechanisms like reduced (during chronic intoxication) and normalized (during abstinence) cerebral hemoperfusion have to be considered as possible mechanisms for the reversibility of alcoholic brain shrinkage.

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

[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↗
PubMed1990

[A simple method for positioning and fixing the extremities during the radiotherapy of soft-tissue sarcomas].

The exact and reproducible radiotherapy of malignant tumours in the extremities is aided by reliable positioning of the involved limb. In our department individually-formed casts and circular fix up made of two-component polyurethane foam (NEOFRAKT, supplied by Schumacher, Krefeld, FRG) are used. These allow the maintenance of any bending, stretching and torsional positions. The fields to be applied are cut out of the casts, thus preventing any influence on the depth dose of the radiation involved.

Arm↗
PubMed1988

Plastic material used to optimize radiotherapy of head and neck tumors and the mammary carcinoma.

In order to improve head and neck tumor therapy, face masks were developed. The physical and mechanical properties of 11 apparently suitable materials were tested using a phantom. According to our studies "HEXCELITE" (supplied by Medimex, Hamburg, F.R.G.) proved to be the best material. Plastic breast molds were made to optimize the dose distribution for radiation therapy with fast electrons of post-mastectomy breast tumors. Here too the mechanical and physical properties of nine different materials were tested. The most suitable of these proved to be the gel mat "PRIMAMED" (supplied by Schülke and Mayr, Norderstedt, F.R.G.). The two materials mentioned have been well tolerated by more than 200 patients.

Bandages↗
PubMed1988

[A simple device for positioning and fixing the head in radiotherapy of brain tumors in frontal and lateral position].

In radiotherapy of cerebral tumors in the occipital, central, and parietal area it can be favourable to fix the patient's head in frontal or lateral position. It is true that this problem can be solved by manufacturing individual face masks of PVC with the vacuum deep-drawing method, but this method is very time- and cost-consuming. The present study suggests a simplified method using the thermoplastic polyester "Orfit". Such a mask provides a good immobilization and can be manufactured in 10 to 15 minutes without bothering much the patient. Simulation and computed tomography are not substantially affected by the material.

Brain Neoplasms↗