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Biomedical subjects

R Engenhart-Cabillic

Publications and source records attributed to R Engenhart-Cabillic.

At least 19 recordsLinked to original sources
PubMed2003

Brain metastases following interleukin-2 plus interferon-alpha-2a therapy: a follow-up study in 94 stage IV melanoma patients.

This study analyses the frequency and therapy of brain metastases in 94 stage IV melanoma patients after treatment with high-dose interleukin-2 (IL-2) and interferon-alpha (IFN-alpha) within three subsequent trials between 1990 and 1995. Central nervous system (CNS) metastases occurred in 28 patients (30%) during the potential follow-up period of 6 years. Time to occurrence of brain metastases varied between 1 and 53 months, with a median of 10 months. Of 28 patients, 19 had < 5 metastases, which were treated with stereotactic radiosurgery (SR) in 9 patients. In 2 patients, SR was followed by resection. 9 patients had multiple metastases, of which 4 received whole brain irradiation (WBI). Median survival after the detection of CNS metastases was 6 months (95% Confidence Interval (CI) 1-11 months). SR plus resection was associated with a prolonged survival of 34 and 35 months in 2 patients, 1 patient survived for 41 months after WBI, demonstrating the efficacy of these therapeutic strategies.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed2002

[Function and responsibility of an interdisciplinary tumor center. Need for a "cancer center" for multimodal therapy concepts].

BACKGROUND AND OBJECTIVE: Cancer will be the leading cause of death in industrialized countries within the next few years. A successful treatment represents a great challenge within the next years and requires multimodality treatment approaches. An multidisciplinary tumour center is essential for coordination and communication between different departments and institutions and is important to maintain standards in diagnostic and therapeutic procedures. METHODS: Two years ago, a cancer center was founded in Marburg. The central facility of its work is a twice weekly tumour conference, where patients requiring multimodality treatment approaches are presented and treatment procedures are fixed and documented. Furthermore, guidelines for diagnosis and treatment of the various cancer diseases will be established and the transfer of clinical and experimental research to the actual patient treatment is intended. RESULTS: A total of 407 patients were discussed within the first year. Leading cancer entities were lung cancer, colorectal cancer and tumours of the upper GI-tract. The tumour conference has improved the communication between all involved disciplines. The process of standardisation of diagnostic and therapeutic procedures is ongoing. The next step will be the documentation of the further follow up of all patients discussed in the tumour conference. CONCLUSIONS: In the communication between all disciplines involved in cancer patient care, success, be it a survival benefit or an improvement in quality of life, is most likely. All the described tasks are best organized within a cancer center.

Adolescent↗
PubMed2001

High efficacy of fractionated stereotactic radiotherapy of large base-of-skull meningiomas: long-term results.

PURPOSE: Large skull-base meningiomas are difficult to treat due to their proximity or adherence to critical structures. We analyzed the long-term results of patients with skull-base meningiomas treated by a new approach with high-precision fractionated stereotactic radiotherapy. PATIENTS AND METHODS: One hundred eighty-nine patients with benign meningiomas were treated with conformal fractionated stereotactic radiotherapy between 1985 and 1998. Patients were undergoing a course of radiotherapy either as primary treatment, following subtotal resection, or for recurrent disease. The median target volume was 52.5 mL (range, 5.2 to 370 mL). The mean radiation dose was 56.8 Gy (+/- 4.4 Gy). Follow-up examinations, including magnetic resonance imaging, were performed at 6-month intervals thereafter. RESULTS: The median follow-up period was 35 months (range, 3 months to 12 years). Overall actuarial survival for patients with World Health Organization (WHO) grade I meningiomas was 97% after 5 years and 96% after 10 years. Local tumor failure was observed in three of 180 patients with WHO grade I tumors and was significantly higher in two of nine patients with WHO grade II tumors. A volume reduction of more than 50% was observed in 26 patients (14%). Preexisting cranial nerve symptoms resolved completely in 28% of the patients. Clinically significant treatment-induced toxicity was seen in 1.6% of the patients. No treatment-related deaths occurred. CONCLUSION: The results of this study demonstrate that fractionated stereotactic radiotherapy is safe and effective in the therapy of subtotally resected or unresectable meningiomas. The overall morbidity and incidence subacute and late side effects of this conformal radiotherapy approach were low.

Adolescent↗
PubMed2001

Acute toxicity and changes in quality of life during a combined radio-chemotherapy of glioblastomas with topotecan (Hycamtin).

BACKGROUND: Because of the pronounced radioresistance of glioblastoma multiforme the prognosis of this disease remains poor. Therefore, we investigated the impact of an additional simultaneous chemotherapy with the topoisomerase-I inhibitor topotecan (Hycamtin) on the quality of life and toxicity of radiotherapy. PATIENTS AND METHODS: In this multicenter trial patients with histologically proven glioblastoma multiforme underwent a simultaneous radio-chemotherapy. Including pilot phase 60 patients, 41 male and 19 female, were treated. Age ranged from 26 to 76 years, the mean was 57 years. Conventional fractionated conformal radiotherapy was performed with daily doses of 2.0 Gy to a total dose of 60 Gy. 1 hour prior to irradiation 0.5 mg (absolute dose) of topotecan were administered intravenously resulting in a cumulative dose of 15 mg. Besides hematologic and non-hematologic toxicity, quality of life was assessed by Karnofsky index and Spitzer index. Additionally local control and survival time were recorded. RESULTS: 57 patients completed the combined therapy. Median administered dose of radiation was 60 Gy (16-76 Gy). Median cumulative topotecan dose was 15 mg (7.5-18.5 mg). Grade-III toxicity was found in six cases (two hematologic, two motoric disorder, one infection, one nausea) and grade-IV toxicity in three cases (one esophagitis, one motoric disorder, one mental disorder). Two patients died of septic disease most likely caused by steroid induced immunosuppression. Mean Karnofsky index and Spitzer index initially, at the end of therapy and 6 weeks after therapy showed values of 87%, 81% and 80% and 19 points, 18 points and 19 points, respectively. Median survival time was 15 months. CONCLUSION: This multimodal approach for patients with glioblastoma multiforme is well tolerated. Quality of life remains preserved and outpatient treatment is possible. The relatively long median survival time even for patients bearing macroscopic tumors is promising.

Adult↗
PubMed2001

Radiotherapy for advanced adenoid cystic carcinoma: neutrons, photons or mixed beam?

PURPOSE: To compare retrospectively radiotherapy with neutrons, photons, and a photon/neutron mixed beam in patients with advanced adenoid cystic carcinoma of the head and neck. Local control, survival, distant failure, and complications were analyzed. MATERIALS AND METHODS: Between 1983 and 1995, 75 patients with inoperable, recurrent, or incompletely resected adenoid cystic carcinoma of the head and neck received radiotherapy that consisted of either fast 14.1 MV DT neutrons (median dose 16 neutron Gy), linac-based photon irradiation (median dose 64 photon Gy), or both (median dose 8 neutron Gy and 32 photon Gy). Follow-up ranged from 1 to 160 months (median 51 months), and the surviving patients had a minimum follow-up of 3 years at the time of analysis. RESULTS: The actuarial 5-year local control was 75% for neutrons, and 32% for both mixed beam and photons (P = 0.015, log-rank). This advantage for neutrons in local control was not transferred to significant differences in survival (P > 0.1). The survival is dictated by the tumor diseases due to distant metastases occurring in 29 (39%) of the 75 patients. Positive lymph nodes were the only significant factor (P = 0.001) associated with the development of distant metastases although negative lymph nodes did not predict absence of distant metastases, but predicted a delay of occurrence. In multivariate analysis postoperative radiotherapy (P = 0.003) and small tumor size (P = 0.01) were associated with high local control, while primary therapy (P = 0.006) and negative lymph nodes (P = 0.01) were associated with longer survival. While acute toxicity was similar in all three radiotherapy groups, severe late grade 3 and 4 toxicity tended to be more prevalent (P > 0.1) with neutrons (19%) than with mixed beam (10%) and photons (4%). CONCLUSION: Fast neutron radiotherapy provides higher local control rates than a mixed beam and photons in advanced, recurrent or not completely resected adenoid cystic carcinoma of the major and minor salivary glands. Neutron radiotherapy can be recommended in patients with bad prognosis with gross residual disease (R2), with unresectable tumors, or inoperable tumors. The type of radiation does not impact survival, which is dominated by the high number of distant metastases.

Adult↗
PubMed2000

Conventionally fractionated stereotactic radiotherapy (FSRT) for acoustic neuromas.

PURPOSE: Analysis of local tumor control and functional outcome following conventionally fractionated stereotactic radiotherapy (FSRT) for acoustic neuromas. PATIENTS AND METHODS: From 11/1989 to 9/1999 51 patients with acoustic neuromas have been treated by FSRT. Mean total dose was 57.6 +/- 2.5 Gy. Forty-two patients have been followed for at least 12 months and were subject of an outcome analysis. Mean follow-up was 42 months. We analyzed local control, hearing preservation, and facial and trigeminal nerve functional preservation. We evaluated influences of tumor size, age, and association with neurofibromatosis Type 2 (NF2) on outcome and treatment related toxicity. RESULTS: Actuarial 2- and 5-year tumor control rates were 100% and 97.7%, respectively. Actuarial useful hearing preservation rate was 85% at 2 and 5 years. New hearing loss was diagnosed in 4 NF2 patients. Pretreatment normal facial nerve function was preserved in all cases. Two cases of new or impaired trigeminal nerve dysesthesia required medication. No other cranial nerve deficit was observed. In Patients without NF2 tumor size or age had no influence on tumor control and cranial nerve toxicity. Diagnosis of NF2 was associated with higher risk of hearing impairment (p = 0.0002), the hearing preservation rate in this subgroup was 60%. CONCLUSION: FSRT has been shown to be an effective means of local tumor control. Excellent hearing preservation rates and 5th and 7th nerve functional preservation rates were achieved. The results support the conclusion that FSRT can be recommended to patients with acoustic neuromas where special attention has to be taken to preserve useful hearing and normal cranial nerve function. For NF2 patients, FSRT may be the treatment of choice with superior functional outcome compared to treatment alternatives.

Actuarial Analysis↗
PubMed2000

Expectations and quality of life of cancer patients undergoing radiotherapy.

Expectations, real or false, affect the way patients respond to their illnesses. We assessed therapy-related expectations in relation to global quality of life in 55 cancer patients before and after radiotherapy. Factor analysis indicated that therapy-related expectations come into three broad categories--pain/emotional control, healing and tumour/symptom control. 35 patients expected 'healing' even though curative treatment was intended in only 19 and all patients had been fully informed. The expectation of healing was associated with high quality of life, and the same was true of perception of healing after radiotherapy. In the group as a whole, quality of life was little altered by radiotherapy, but it became substantially worse in those patients who had expected healing but perceived that this had failed, even though physician-assessed Karnofsky status did not change. These findings indicate that the expectation of healing, in cancer patients, is a component of a good global quality of life, whereas more limited expectations (pain control, tumour control) relate to lower quality of life. Patients' expectations deserve further study as a novel approach to improving care.

Analysis of Variance↗
PubMed1999

Radiotherapy for stages I and IIA/B testicular seminoma.

Radiotherapy is generally accepted as a standard treatment for early-stage testicular seminoma. Relapse rates of 2% to 5% in clinical stage I and 10% to 20% in stage IIA/B (according to the Royal Marsden classification) can be achieved. Disease-specific survival reaches 100%. With such excellent cure rates, treatment-related side effects gain particular importance. Therefore, a prospective multicenter trial was initiated for radiotherapy of testicular seminoma with limited treatment portals and low total doses of irradiation. In clinical stage I, 483 patients were treated with 26 Gy to the para-aortic region only. In stage IIA, 42 patients and, in stage IIB, 18 patients received irradiation to the para-aortic and high iliac lymph nodes with 30 and 36 Gy, respectively. With a median time to follow-up of 55 months for stage I and 55.5 months for stage IIA/B, there were 18 (3.7%) and 4 (6.7%) cases of relapse in both treatment groups. Disease-specific survival was 99.6% in stage I and 100% in stage IIA/B. Acute toxicity was dominated by moderate gastro-intestinal side effects. No major late toxicity has been observed to date. Limited volume pure para-aortic treatment for stage I and para-aortic/high iliac irradiation for stage IIA/B with 26, 30 and 36 Gy, respectively, yields excellent cure rates with only moderate acute toxicity and is therefore recommended as standard treatment.

Adolescent↗
PubMed1999

The role of high-LET radiotherapy compared to conformal photon radiotherapy in adenoid cystic carcinoma.

Tumors of the base of skull represent a challenging radiooncological target due to their close proximity to dose limiting critical normal tissue structures. A critical review of the literature provides evidence that high-LET radiotherapy offers a therapeutic gain factor compared to low-LET radiation and should be the treatment of choice in advanced salivary gland malignancies, which are inoperable or not completely resected, and in recurrent disease. Modern techniques of conformal high LET radiotherapy, e.g. heavy ion beam radiotherapy, will help to reduce the long and the short term toxicity of radiotherapy.

Carcinoma, Adenoid Cystic↗
PubMed1999

Prevention of heterotopic bone formation after total hip arthroplasty: a prospective randomised study comparing postoperative radiation therapy with indomethacin medication.

Heterotopic ossification (HO) after total hip arthroplasty is known to be a major complication with an impact on the functional outcome. Efforts have been made to prevent the occurrence of HO by means of either radiation therapy or pharmacotherapy. To date, there are no data available regarding the relative benefit of radiation versus medication with non-steroidal anti-inflammatory drugs. The objective of this study was to compare single-dose 600-cGy radiation therapy with indomethacin medication for their effect on the prevention of heterotopic bone formation after total hip arthroplasty. In all, 154 patients were included in the study. All patients underwent primary total hip arthroplasty due to osteoarthritis. Patients were randomly assigned to three different therapeutic groups. (a) The radiation group received a single radiation dose of 600 cGy between the 2nd and 4th postoperative day. (b) The indomethacin group received an oral application of indomethacin 2 x 50 mg per day from the 1st to 42nd postoperative day. (c) The control group received neither radiation nor indomethacin medication. There were significant group differences (P < 0.001). A least significant difference test (LSD) revealed that the mean of the control group was significantly different from that of the radiation and indomethacin groups. The 13 patients (8.4%) classified Brooker 3 or 4 were all in the control group. Again, this effect was statistically significant (chi-square, P < 0.001). In conclusion, this study demonstrated that both radiation and indomethacin therapy are effective in the prevention of postoperative HO. The choice for either one of the treatments has to be based on availability, contraindications, side-effects, practicability, standardisation and cost. Based on these considerations together with the results of this study, we currently use postoperative radiation with 600 cGy for all patients undergoing primary total hip arthroplasty.

Administration, Oral↗
PubMed1998

Neutron therapy in malignant salivary gland tumors: results at European centers.

Malignant salivary gland tumors are relatively rare and account for only 3%-4% of all head and neck cancers. Especially in adenoid cystic carcinoma, the incidence of local recurrence and distant metastases is influenced by the perineural spread of tumor. In advanced salivary gland tumors, surgery alone has a high incidence of local failure. The results of conventional radiotherapy are suboptimal in inoperable or not completely resected salivary gland tumors and in recurrent disease. The pooled data of some international series for low linear energy transfer radiation show a local control of only 28%. Especially in advanced salivary gland tumors, neutron therapy can improve local control. In Europe at least 570 patients with salivary gland tumors have been treated with neutrons alone or with combined modalities. The clinical data of different centers in Europe and the United States result in a similar local control rate of 67% in gross disease. An analysis of different European series shows on average a complication rate of 10.6% for severe radiation-related morbidity. Modern neutron machines and the use of three-dimensional treatment planning systems are now available in a few institutions and may further reduce side effects.

Aged↗
PubMed1998

European results of neutron therapy in soft tissue sarcomas.

The purpose of this publication is to review the data of European neutron therapy facilities in the treatment of soft tissue sarcoma. In the past locally advanced soft tissue sarcoma was a common indication for neutron therapy in several European centers. Data from 1171 patients treated at 11 centers were analysed on the basis of published data or personal communication. Neutron therapy was of benefit especially for patients with primary radiotherapy of inoperable tumors, and with macroscopic disease after surgery. Local control was about 50% in these patients. These results are superior to those from photon therapy from the literature. Results for postoperative neutron therapy after R0- and R1-resection are similar to those from photon therapy. The incidence of late side effects was considerably high in some neutron series. This is influenced by the treatment of most patients with first-generation machines of limited technical standard, and that in most cases large treatment volumes were irradiated.

Humans↗
PubMed1998

Use of neutron therapy in the management of locally advanced nonresectable primary or recurrent rectal cancer.

Inoperable locally advanced or inoperable recurrent rectal cancer is a difficult problem. Tenesmus, discharge, bleeding and pelvic pain are frequently present and often are associated with infiltration of the sacral plexus. The value of radiotherapy in managing such patients is being appreciated, although up to 40% of the treated patients have no symptomatic response. Improvement in tumor response and control has been scored through efforts to overcome the radio resistance of the hypoxic tumor cells by neutron irradiation. This article is an account of the activity of neutron radiotherapy in such patients. Over 350 patients were entered in studies comparing neutrons used alone and neutrons used in a mixed-beam treatment schedule. At present no therapeutic gain for long-lasting survival has been achieved; however, local control and pain improvement seems to be better with neutrons than with photons.

Humans↗
PubMed1998

[The radiosurgery of glioblastoma multiforme in cases of recurrence. The Heidelberg experiences compared to the literature].

AIM: To describe the clinical results a prospective phase II study of radiosurgically treated patients with recurrent glioblastoma multiforme. PATIENTS AND METHOD: Since 1986, 62 patients were irradiated stereotactically. Including criteria were residual tumor < or = 5 cm and Karnofsky performance score > or = 70. Twenty-seven patients (mean age 50 years) were treated for recurrent tumor. The planning target volume was defined by the contrast enhancing region demonstrated by magnetic resonance imaging (MRI) scans which were performed in treatment position. A safety margin of 2 to 5 mm was added. The mean dose was 17 Gy. The median interval from the time of initial diagnosis and therapy to radiosurgery for recurrent tumor was 9.6 months. Initial therapy consisted of surgery and irradiation (60 Gy). Survival curves were calculated according to the Kaplan Meier method. Quality of life was evaluated using objective criteria such as neurological findings, frequency of seizures and steroid medication. RESULTS: The median survival calculated from the time of diagnosis was 18 months, calculated from the time of radiosurgery 9 months. 4.5 months after therapy, 50% of the patients showed improved or stable quality of life. CONCLUSION: Radiosurgery demonstrates efficacy in selected patients suffering from recurrent glioblastoma multiforme.

Adult↗
PubMed1998

[Value of radiosurgery in first-line therapy of glioblastoma multiforme. The Heidelberg experience and review of the literature].

AIM: To describe the clinical results and the feasibility of a phase II dose escalation study of small boost target volumes with a radiosurgical technique in patients with positive early postoperative MRI scans. PATIENTS AND METHOD: Since 1986, 35 patients were treated within a concept for first line therapy. Including criteria were residual tumor < or = 5 cm and Karnofsky performance score > or = 70. The mean age was 54.5 years. The treatment concept included an operation for reduction of tumor volume and a postoperative irradiation. The postoperative irradiation was divided in 2 parts: first, a hyperfractionated (1.8 Gy single dose twice a day, 54 Gy total dose) irradiation was performed containing the tumor and the edema with a 2 cm safety margin. Secondly, a radiosurgical boost dose was delivered. The target volume of this radiosurgery was the contrast enhancing residual tumor in early postoperative MRI scans. The median boost dose was 15 Gy. Survival curves were calculated according to the Kaplan-Meier method. Quality of life was evaluated using objective criteria such as neurological findings, frequency of seizures and steroid medication. RESULTS: The median survival calculated from the time of diagnosis was 10.1 months. The 1- and 2-year survival rate were 35% and 6%, respectively. Young age tended to longer survival, patients younger than 53 years had a median survival of 10.4 months whereas patients older than 53 years showed a median survival of 9.2 months. The mean value of the boost volume was 22 cm3. Patients with smaller volumes had a median survival of 10.1 months and patients with bigger volumes showed a median survival of 9.9 months, 4.5 months after therapy, 75% of the patients showed improved or stable quality of life. CONCLUSION: The feasibility of a radiosurgically delivered boost dose after postoperative irradiation could be demonstrated. The observed survival rate is comparable to the survival rates reported in the literature. Whether or not the radiosurgery after postoperative irradiation is able to prolong survival can only be evaluated in a randomized phase III trial.

Adult↗