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Biomedical subjects

R Greiner

Publications and source records attributed to R Greiner.

At least 55 records · Page 3Linked to original sources
PubMed1988

[Pion radiation therapy of non-resectable bone- and soft tissue sarcomas at the Swiss Institute for Nuclear Research].

A dynamic, tumor conforming treatment technique ("spot scan") for deep-seated tumors using pions (negative pi-mesons) has been in use at the Swiss Institute for Nuclear Research (SIN) since November 1981. This technique, with a favorable integral dose distribution, allows curative irradiation especially for large, unresectable tumors in the retroperitoneal and pelvic region. Between 1983 and 1986, 26 patients with sarcomas were treated: 18 had soft tissue sarcomas and 8 bone sarcomas. The tumor volumes ranged from 36 to 3400 cc. After previous therapy (23/26 patients) 14 out of 23 patients had progressive disease. In 20 fractions over 5 weeks a total dose of 30-36 Gy (90%-isodose) was administered. In a follow-up period of 9-50 months (median 14 months), the two year local control rate (Kaplan-Meier) for the soft tissue sarcomas was 93.3% and the two year survival rate 67.9%. Each of the 6 patients with bone sarcomas treated with curative intent showed clinically local tumor control. After a total dose of 30-36 Gy, no severe radiation induced morbidity was found.

Adolescent↗
PubMed1988

[Report on the conservative treatment of melanoma of the uvea at the Lausanne University Ophthalmologic Clinic].

A great number of techniques are currently available for the conservative treatment of uveal melanomas: ocular applicators emitting gamma rays 60Co, 125I) or high-energy beta rays (106Ru/106Rh), light photocoagulation, surgical excision, and accelerated proton beam irradiation. Life expectancy following conservative treatment is equal to or better than that following enucleation. This is demonstrated by nonrandomized comparative studies, and by the authors' own long-term results following the conservative treatment of melanomas by 60Co applicators: mortality due to metastases of small melanomas was 3% (V = smaller than 10 x 10 x 3 mm), with medium-size melanomas it was 12% (V = 10 x 10 x 3-15 x 15 x 5 mm), and with large melanomas 21% (V = larger than 15 x 15 x 5 mm). Accelerated proton beam irradiation of uveal melanomas is currently the method of choice for the conservative treatment of uveal melanomas. The sharp boundaries of the irradiated zone, the uniformly distributed irradiation dose, and beam-splitting are the main advantages of this technique. During the last three years, 310 cases of uveal melanoma have been treated in Switzerland with an accelerated proton beam. Of these, 214 were followed up for more than one year. Eight patients (3.9%) died of metastases. Visual acuity was identical or superior to initial visual acuity in 60.3% of the cases, while 39.6% exhibited a deterioration of vision or a functional loss. Favorable results achieved by conservative treatment of uveal melanomas considerably limited the indications for enucleation, which is now only performed in exceptional situations.

Brachytherapy↗
PubMed1988

[Pion radiotherapy of unresectable soft tissue sarcomas at the Swiss Institute for Nuclear Research].

The Swiss Institute for Nuclear Research SIN at Villigen is one of the three centres in the world (LAMPF, Los Alamos; TRIUMF, Vancouver) where pion therapy is possible. A dynamic, tumour conforming spot scan technique for the treatment of deep-seated tumours has been in use since November 1981. With this technique with a favorable integral dose distribution, curative irradiation also of advanced tumours in the retroperitoneum and pelvis is possible. Only at SIN, the treatment of non-resectable soft tissue sarcomas with pions is part of the clinical program. Between 1983 and 1985 totally nine patients were treated, 1/9 with three manifestations, 1/9 with palliative intent. In 20 fractions over five weeks (four fractions a week) total doses of 30 to 36 Gy (90% isodose) were applied. In a follow-up period of eleven to 43 months (median 18 months) only 1/10 tumour manifestations treated with greater than or equal to 30 Gy failed locally. The two-year survival rate (Kaplan-Meier) is 56%. Metastases were the cause of death in 3/5 patients, 1/5 heart disease, 1/5 local tumour progression. Even though 9/11 tumours were located in the retroperitoneum or pelvis, no radiogenic morbidity of the bowel was found. These preliminary results stimulate the intensification of this clinical program. 1986 the same number of patients with non-resectable soft tissue sarcomas was treated as in the whole period 1982 to 1985 before.

Adolescent↗
PubMed1988

[Radiotherapy of soft tissue sarcomas of the extremities].

Radiotherapy is fully integrated in the treatment of soft tissue sarcomas. Nonamputative limb salvage is combined with large-volume, high-dose (65 Gy), pre- or postoperative radiotherapy. The survival rate for the conservative, combined approach to tumors of the extremities is no worse than that of radical or amputative surgery alone. It is better for large tumors to receive irradiation preoperatively, as there is then a higher probability that the limb can be spared at surgery. For tumors less than 10 cm, at doses of greater than 64 Gy radiotherapy alone can attain a local control rate of as much as 50%. With neutron irradiation, half of the patients with nonresectable tumors can be successfully treated locally. Conformal and dynamic treatment techniques will increase the probability that local tumors can be controlled by irradiation alone. The pion treatment technique at SIN is described in some detail.

Combined Modality Therapy↗
PubMed1986

Combination of chemotherapy with methotrexate, bleomycin, and cis-platinum, and radiation therapy for locally advanced carcinoma of the cervix.

Sixteen non-pretreated patients with locally advanced cervical cancer (FIGO Stage IIIb) were treated with two 3-week cycles of platinum, bleomycin, and methotrexate (PBM), which were followed by radiation therapy. Response to both modalities was seen in 11 patients (69%), and three patients (19%) had a progression-free survival of more than 2 years. Radiation therapy was proven to be feasible after two cycles of PBM combination chemotherapy.

Adult↗
PubMed1985

[Autologous bone marrow transplantation--clinical experience in Berne].

Autologous bone marrow transplantation was performed in 28 pediatric and adult patients with various neoplasias. Long-term remissions were obtained in one patient with yolk sac tumor and in 9 patients with B-cell non-Hodgkin's lymphoma. The relapse rate was decreased in patients receiving in-vitro decontaminated marrow (anti-Y 29/55 and complement).

Adolescent↗
PubMed1985

[Polyneuropathy after cisplatin treatment].

Polyneuropathy developed in 7 of 87 women who had been treated with cis-platinum for ovarian carcinoma. Distal disturbances of sensitivity were clinically prominent, the emphasis being on disturbed vibratory perception and acrognosis. No relevant signs of motor dysfunction were noticed, neither clinically nor neurophysiologically. Sural biopsies taken from two women revealed a primary axonal degeneration, mostly affecting the myelinic fibres of large diameter. In 3 cases mild reversion was seen, and in 4 cases no definite reversion, of the disturbed functions - uncertain gait and clumsiness of the hands - during the follow-up period of 6 to 30 months.

Aged↗
PubMed1985

[Computed tomography of apical lung cancer].

CT was performed on 22 patients with carcinoma of the lung apex. CT provided reliable information concerning the local extent of the disease. Infiltration of the thoracic soft tissues was found in 91%, ribs in 87%, vertebral bodies in 61% and of the spinal canal and mediastinum in 22%. Metastases in the hilar and mediastinal lymph nodes were demonstrated in 38%. In eight patients, as a result of the CT, radiotherapy was performed, followed by resection of the tumour, and in 15 patients radiotherapy alone was used. The CT findings, by which operability or inoperability are judged, and the actual therapeutic procedures are discussed.

Adult↗
PubMed1985

[Chemotherapy as primary therapy in non-radically operated ovarian cancer].

Forthwith the results of chemotherapy on advanced ovarian carcinoma are summarized. The following conclusions can be drawn: stages Ia and Ib of low malignancy degrees should receive follow-up treatment. Stages II and I of high malignancy degrees should receive radiotherapy to the whole abdomen. The value of intensive chemotherapy is examined. Stage II with residual tumor should undergo combined cis-platin treatment for 4 to 6 months. Stage III with residual tumor should receive intensive chemotherapy followed by a second-look operation and radiotherapy to the whole abdomen. The prognosis of cases with large residual tumors is very unfavorable so that the value of radical therapy must be further investigated.

Antineoplastic Agents↗
PubMed1985

[Total abdominal irradiation following combination chemotherapy and second-look laparotomy in the treatment of advanced ovarian cancer].

From 1980 to 1984 fifty-four patients with advanced ovarian carcinoma after operation and concluding chemotherapy with alkeran (n = 7) or cis-platin/alkeran +/- hexamethylmelamine (n = 47) as well as second-look laparotomy received follow-up radiotherapy either with the moving-strip technique (n = 35) or later the open-field technique (n = 19). 32 patients in CR received radiation therapy. 15 patients in CR are without relapse after undergoing open-field radiation therapy and a mean observation period of 25 months. At this point of time 5 of 17 patients had relapses under the moving-strip radiation treatment. The frequency of the relapses is apparently due to the very long periods of radiation and numerous interruptions in treatment. If residual tumors were present at the begin of ray therapy, a CR could only be achieved in cases where the previous monotherapy was with alkeran.

Adenocarcinoma↗
PubMed1985

The treatment of ovarian cancer by a multimodality approach: remission induction with chemotherapy--hexa PAMP and PAMP regimens--followed by whole-abdominal radiation.

Seventy-six evaluable patients with ovarian carcinoma stages FIGO IIb, IIc, III, and IV, either received cis-platin (P) (80 mg/m2 iv. day 1), melphalan (PAM) (12 mg/m2 i.v. day 2) and hexamethylmelamine (HEXAPAMP) (135 mg/m2 orally days 8 to 21) or the same dose of cis-platin and melphalan but no hexamethylmelamine (PAMP) every four weeks. In 24 patients (32%) a surgically ascertained CR was achieved. 16 of these received follow-up radiation treatment to the whole abdomen. At present 19 patients are without relapse (average time 24 months). The trial has not been concluded. Particularly no predictions can be made on the value of follow-up radiation therapy in obtaining long-term remission rates.

Adult↗
PubMed1985

Review of the SIN and Los Alamos Pion Trials.

Negative pi mesons (pions) were used to treat 227 patients at the Los Alamos Meson Production Facility (LAMPF) between 1974 and 1981. Persisting local control values for 129 patients treated with pions alone in the following tumor sites were recorded at a minimum post-treatment observation interval of 2.5 years in the following tumor sites: cerebral gliomas 3/29; head and neck, 8/31; lung, 1/7; pancreas, 0/17; large bowel, 3/13; cervix, 2/45; bladder, 3/4; prostate, 18/20; miscellaneous sites, 0/4. Late severe sequelae ranged from none to 30% for major sites. A dose-response relationship was seen for late severe sequelae with a high probability following dose levels of 4750 cGy (max) in approximately 38 fractions. RBE values for pions appeared to lie in the range of 1.4-1.6 for both acute normal tissue reactions and late sequelae. At the Swiss Institute for Nuclear Research (SIN), 126 patients were treated in Phase I-II protocol studies between 1982 and 1984 with a new technique of scanning with a focused spot of pions. With minimum observation intervals of only 6 months, the local complete response values in 67 evaluable patients treated with pions alone to selected sites are gliomas 1/15 (9 months); pancreas, 3/11; cervix, 4/8; bladder, 18/26 (at 1 year, 9/22); sarcomas, 4/5; biliary tract, 3/4. Late severe sequelae ranged from none to 50% for major sites. A steep dose-response relationship is seen for late severe sequelae with high probability following doses exceeding 3800 cGy (max) in 20 fractions and very low probability with doses below 3500 cGy (max).

Brain Neoplasms↗
PubMed1985

Results of curative pion therapy at SIN.

The experiences of the treatment of bladder carcinoma indicated the direction in which the dose optimization program of intraabdominal tumours can be carried out. Small intraabdominal target volumes seem to tolerate doses from 31 to 33 Gy applied in 20 fractions. The best results with local tumour control and low complication rates have so far been reached in carcinoma of the cervix. It has not so far been organizationally possible at SIN to treat with pions on more than four days per week. This restricts changes to the fractionation scheme in the treatment of highly malignant gliomas. An improvement of results could be possible on the basis of experience to date. The significance of a postbiopsy preoperative radiotherapy, of the increase of target volume and the increase of the total dose will be tested in a study by the SAKK (Swiss Group for Clinical Cancer Research).

Elementary Particles↗
PubMed1984

[Adenocarcinoma of the kidney (hypernephroma)].

Adenocarcinomas of the kidney are rare tumors. This malignancy has been called the "internist's tumor" because of its often unusual presentation and systemic symptoms. The diagnosis is largely based on urography, sonography and CT-scan. Radical tumornephrectomy is the only treatment with curative potential. Interventional angiography with tumor embolization has become an important tool for palliation. On the other hand, the results of systemic treatment, such as hormone therapy, chemotherapy or immunotherapy, remain disappointing.

Androgens↗
PubMed1984

Autologous bone marrow transplantation in the treatment of children and adolescents with advanced malignant tumors.

Nineteen patients with advanced malignant tumors, less than 20 years old were treated with intensive chemotherapy (vincristine 2 mg/m2 i.v. and adriamycin 60 mg/m2 i.v. on day - 7; cyclophosphamide 45 mg/kg i.v. on days -6 to -3), total body irradiation (TBI, 600 rads on day -1) and autologous bone marrow transplantation (ABMT, day 0). Prior to this procedure induction of complete or partial remission by conventional therapy was attempted. Ten patients had intra-abdominal non-Hodgkin's lymphoma (NHL); three, yolk sac tumor; three, Ewing's sarcoma; and three, neuroblastoma. The supportive care included reverse isolation, immunoglobulin 400 mg/kg i.v. q 2 weeks, cotrimoxazole per os, and cell support as needed. No correlation between the bone marrow dose and the time of hematological reconstitution could be established. Five of seven patients with intra-abdominal NHL stage III (transplanted in first remission) are surviving disease-free for 5+, 5+, 20+, 23+, and 35+ months after ABMT. None of three patients with intra-abdominal NHL stage IV is surviving (two of them were transplanted in second remission). One of three patients with yolk sac tumor is surviving disease-free for 27+ months. There are no survivors among the patients with Ewing's sarcoma and neuroblastoma. Only one of 19 patients was lost due to therapeutic complications, while 12 died due to tumor. Regarding treatment results for advanced intra-abdominal NHL, the procedure described here is comparable to the best conventional regimens. In vitro methods for tumor cell eradication in the collected bone marrow might further improve the results of ABMT.

Adolescent↗
PubMed1984

Whole-abdomen radiation in patients with advanced ovarian carcinoma after surgery, chemotherapy, and second-look laparotomy.

Forty-three patients with ovarian carcinoma were treated with whole-abdomen radiation (moving strip +/- pelvic radiation), 15 patients had not received prior chemotherapy, and 28 patients were irradiated following chemotherapy and second-look laparotomy. Ten of these had been treated with a variety of chemotherapy regimens (L-PAM, CHAD, Hexa-CAF). Eighteen patients were treated in an ongoing prospective trial with combination chemotherapy consisting of melphalan, cis-platinum, and hexamethylmelamine++ (HexaPAMP). Thrombocytopenia was the limiting toxicity. A temporary pause in the radiation schedule allowing platelets to recover made it possible to complete treatment in 80% of the patients. The acute toxic effects, which included the expected side effects of radiation therapy on intestine, liver and lung, were not more frequent or more severe in the patients who had received prior chemotherapy than in those who had radiation therapy alone. Thirty-four of 43 patients (stage I, seven patients; stage II, seven patients; stage III, 27 patients; stage IV, two patients) are alive and without evidence of disease 26 + months (range 7 to 64 months) after entering the postsurgical treatment program.

Antineoplastic Combined Chemotherapy Protocols↗