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R Sauer

Publications and source records attributed to R Sauer.

At least 37 records · Page 2Linked to original sources
PubMed1995

[Preoperative radiochemotherapy in primary non-resectable rectal cancer].

PURPOSE: In a pilot-study patients with primarily non-resectable rectal cancer received a pre-operative radiochemotherapy to assess the tolerance and efficacy of this treatment protocol. PATIENTS AND METHOD: Twenty patients with non-resectable rectal cancer (Mason CS III-IV) have been irradiated from September 1989 through February 1994. The total dose, calculated at the isocenter, was 50.4 Gy with 5 fractions of 1.8 Gy per week with a small volume boost in selected cases. Chemotherapy was administered on 5 consecutive days in week 1 and 5 with 1000 mg/m2 5-FU per day as continuous infusion over 120 hours. RESULTS: The treatment was well tolerated. Acute toxicity included 1 grade III-dermatitis, 7 grade II-enteritis, 1 grade III- and 3 grade II-leucopenia. Seventeen out of 20 patients were resected 6 weeks after radiochemotherapy, 3 patients had no surgery (1 toxic death due to septicemia, 1 refusal of surgery after complete remission, 1 thrombocytopenia due to liver cirrhosis), all 3 had at least partial remission of their tumors. Fourteen out of 17 (82%) resections were curative (R0) with 1 additional R1- and 2 R2-resections. Ten out of 14 (71%) curative resected patients had no lymph node metastasis. A detailed histological examination showed regression in 15/16 tumors with fibrosis and vascular wall changes. Nine out of 16 patients had only minimal residual tumor. CONCLUSIONS: In this pilot study, pre-operative radiochemotherapy was well tolerated. The relatively high rate of curative resections and marked histological tumor regressions of this approach requires further investigations in a randomized trial.

Adenocarcinoma↗
PubMed1995

[Simultaneous radiochemotherapy in recurrent and metastatic breast neoplasm. Clinical experience].

BACKGROUND: To improve the quality of life for patients with recurrent and metastatic breast cancer, palliation of pain, skin and soft tissue metastases and complicating lymph node relapses are mandatory. Toxicity and efficacy of 2 simultaneous radiochemotherapy regimens was tested in this study. PATIENTS AND METHODS: From October 1989 to March 1993, 48 patients with locoregional relapse of breast carcinoma after primary mastectomy and no option for curative resection were entered in the study. Seventeen patients had additional distant metastases. Two different radiochemotherapy regimens were applied: Group A (28 patients) received a "split course" radiotherapy within 10 weeks (1.8 to 2 Gy single dose) on day 1 to 12, 29 to 40 and 57 to 68 up to a total dose of 54 Gy. Chemotherapy with 5-FU, methotrexate and cyclophosphamide was applied simultaneously with radiation. After the second and fourth week the treatment was interrupted for 2 weeks. Group B (20 patients) received "conventional" radiotherapy over 6 weeks with 1.8 to 2 Gy single and 54 Gy total dose. 5-FU and mitomycin C was applied in the first and fifth week of radiotherapy. Treatment toxicity was analyzed in 48 patients, while treatment efficacy was assessed in 44 patients with a minimum follow-up of at least 1 year. RESULTS: Overall treatment response (CR+PR) was 82% in group A (CR 21%). Five of 28 patients developed toxicities of grade 3 to 4 (EORTC/RTOG/WHO). The overall response rate in group B was 87% (CR 19%). In this group 6 of 20 patients experienced toxicities of grade 3 to 4. In both groups, the local response rate was remarkably reduced in patients with additional visceral metastases. CONCLUSIONS: Both treatment concepts achieved similar response rates. Group B patients experienced a higher toxicity rate, but treatment duration was considerably shorter. The local response rate correlated well with the extent of systemic metastatic disease.

Antibiotics, Antineoplastic↗
PubMed1994

Organ-sparing treatment of advanced bladder cancer: a 10-year experience.

PURPOSE: Radical cystectomy is considered as standard therapy for muscle-invasive bladder cancer. We present 10-year results of bladder-sparing treatment by conservative surgery and radiotherapy +/- chemotherapy. METHODS AND MATERIALS: From 1982 through 1991, 245 consecutive patients, mean age 66 years, with invasive bladder cancer (T2-3 or poor prognostic T1, no distant metastases) entered a prospective protocol with the objective of bladder preservation. Treatment consisted of transurethral resection (complete, if possible) and definitive radiotherapy with 56 Gy maximum dose (50.4 Gy minimum target dose) in 28 fractions. Since 1985, 139 patients received a simultaneous chemotherapy on 5 days in the first and fifth treatment week with either 25 mg/m2 cisplatin daily (79 patients) or 65 mg/m2 carboplatin (60 patients). Cystectomy was performed as salvage treatment for residual or recurrent invasive disease. The median follow-up at the date of analysis (12-31-92) was 5.9 years. RESULTS: The overall survival was 47% after 5 years and 26% after 10 years. The 5-year survival according to the initial T-category was 60% for T1 (44 patients), 64% for T2 (47 patients), 43% for T3 (127 patients), and 16% for T4 (23 patients). The most important single prognostic factor was the amount of residual tumor after TUR (5-year survival 80% after R0, 53% after R1, and 31% after R2 resection, p < 0.01). Chemotherapy increased the rate of complete remission, but had no impact on 5-year survival (52% vs. 50%). Fifty-three salvage cystectomies were performed, all without severe complications, and 192 patients (79%) maintained a normal functioning bladder. The bladder preservation rate in 5-year survivors was 83%. CONCLUSIONS: Organ-sparing treatment of advanced bladder cancer by transurethral surgery and definitive radiotherapy or radiochemotherapy is feasible and effective. The survival in this series is as good as in any comparable cystectomy series. Eighty-three percent of long-term survivors maintained their functioning bladders.

Aged↗
PubMed1994

Preoperative versus postoperative radiotherapy for prevention of heterotopic ossification (HO): first results of a randomized trial in high-risk patients.

PURPOSE: In vivo data support the effectiveness of pre- and postoperative radiotherapy in suppressing the development of heterotopic ossification after hip surgery. In June 1992 a prospectively randomized trial was initiated to assess the comparative efficacy of pre- vs. postoperative prophylactic radiotherapy in patients with high risk to develop heterotopic ossification after hip surgery. METHODS AND MATERIAL: Between June 1992 and September 1993 a total of 84 eligible patients with high risk profile for the development of heterotopic ossification were entered in the study. They were randomized to receive radiotherapy either preoperatively (< 4 h before surgery) or according to a "standard protocol" postoperatively (< 72 h after surgery). A single 7 Gy fraction was administered to the preoperative group, while the postoperative group received a previously tested scheme of five fractions of 3.5 Gy (total dose 17.5 Gy). The treatment portal encompassed the soft tissues between the periacetabular region of the pelvis and the intertrochanteric portion of the femur. Important patient variables (age, sex, prior surgery) and predisposing risk factors were equally distributed between both treatment arms. X rays of the irradiated hips were obtained prior and immediately after surgery as well as at 6 months after surgery. The modified Brooker grading was used to score the extent of heterotopic ossification. The Harris score was applied to judge the overall functional status of the hip. If the Brooker grade and Harris score decreased from the immediate postoperative or preoperative status respectively to the follow-up situation, the case was considered as a "treatment failure." RESULTS: At a minimum 6 months follow-up after hip surgery 44 patients were available for evaluation. Effective prophylaxis was achieved in 41 (93%) hips. Two "radiological failures" were observed in the preoperative group and one in the postoperative group. Neither the pre- nor the postoperative interval affected the prophylactic efficacy. There were no increased intra- and postoperative complications seen in the preoperative group. The interval of partial strain (50% body weight) to the operated hip was longer in the preoperative group (19 days +/- 27) as compared to the postoperative group (8 days +/- 13), however the interval to full strain (100% body weight) was equal in both groups. The functional status (Harris Score change) of the operated hip decreased only in two (5%) patients ("functional failures"). The overall change was better in the postoperative group (42.7 +/- 17.1) as compared to the preoperative group (34.3 +/- 13.7) (p = 0.08, NS) as well as with regard to the criteria "limp" (p = 0.05) and "use of walking support" (p = 0.10, NS). In in all other aspects no differences were observed between both treatment arms. Therefore, the preliminary results for preoperative radiotherapy are similar to historical results obtained with postoperative radiotherapy regimens. CONCLUSION: Preoperative radiotherapy of the operative site applied within 4 h prior to elective hip surgery and total hip arthroplasty appears to be equally effective to currently accepted postoperative radiotherapy regimens in prevention of clinically significant heterotopic ossification about the hip. Improved patient comfort, ease of treatment management, and avoidance of possible postoperative complications associated with moving and positioning the patient in the immediate postoperative period are the major advantages of the preoperative radiotherapy concept.

Adult↗
PubMed1994

Multivariate analysis of prognostic parameters using interstitial thermoradiotherapy (IHT-IRT): tumor and treatment variables predict outcome.

PURPOSE: From January 1986 to October 1991, 90 patients with localized tumors were treated in a Phase I/II trial using low-dose 192Ir brachytherapy (IRT) plus interstitial 915 MHz microwave (MW) hyperthermia (IHT) and external beam radiotherapy (ERT). Tumors were classified as locally advanced primary (class 1: 27), recurrent (class 2: 40), metastatic (class 3: 10) and persistent (class 4: 13) lesions. The treatment sites included tumors of the head and neck (62), pelvis (26), and others (2). The mean cuboidal tumor volume was 63 cm3 (range: 8-288 cm3). Most recurrent and metastatic lesions (48) had received prior treatment including ERT. METHODS AND MATERIALS: The treatment protocol prescribed two heating sessions (each 60 min) at 41-44 degrees C before and after IRT. One hundred sixty-one IHT sessions were evaluated. Invasive thermal data were recorded at an average of 18 sites throughout the implant volume. Several thermal variables were analyzed (e.g., averaged parameters: Tmaxav, Tmean, Tminav; index parameters: T10, T50, T90). The study was evaluated with a minimum follow up (FU) of one year. Median follow-up was 19 months. RESULTS: At 3 months FU, a complete response (CR) was observed in 59 of 90 (66%) patients. At 12 months FU, local control (LC) was achieved in 54 of 84 (64%) evaluable patients. Ten patients developed a local and 14 a regional recurrence (REC) after achieving a CR and/or LC. At last FU, a total of 31 (34%) patients were still alive and 28 (31%) patients had relapse-free survival. For all 90 patients, the median overall survival was 20 months and the median relapse-free survival was 17 months. Overall and relapse-free survival was significantly longer for primary and persistent lesions as compared to recurrent and metastatic lesions (p = 0.002; p < 0.001). Totally 22 (24%) patients experienced acute or subacute side-effects (Grade 1: 12 patients; Grade 2: eight patients; Grade 3: two patients). CONCLUSION: Univariate logistic regression analysis revealed significant dependencies of CR, LC and REC upon tumor parameters as well as radiation and thermal parameters. The overall and relapse free survival was associated with tumor and radiation parameters. The multivariate analysis revealed two independent predictors of CR: tumor volume and minimum tumor temperature variables. We conclude, that IHT-IRT is a safe and effective treatment. The results provide important implications for planning HT-RT studies and for defining quality assurance (QA) criteria and thermal performance standards in HT studies.

Adolescent↗
PubMed1994

[Hypoxic radiotherapy. The radioprotective effect of acute hypoxia in the radiotherapy of tumors in the abdominal area].

AIM: We tested, whether inhalation a of gas mixture containing 8.0 to 8.5% O2 reduces the radiosensitivity of healthy tissue in order to deliver higher tumor doses without increasing the side effects of radiation therapy. PATIENTS AND METHODS: In this study 165 patients were treated in the Clinic of Radiation Oncology Erlangen (Germany) and in the Institute of Oncology in Brno (Czech Republic) in the period of January 1986 to December 1993. In 108 patients external irradiation was applied using acute hypoxia (group A--hypoxyradiotherapy). This group was compared with a conventional therapy group of 57 patients (group B). The majority of the patients had advanced tumor of cervix uteri or of rectum. In 89% of patients of group A and in 61% patients of group B external irradiation was applied with portals > 20 x 15 cm2 (p < 0.01). The mean dose in the group A was increased about 30% compared to the mean dose of group B (55.2 Gy vs. 43.6 Gy; p < 0.01). RESULTS: Despite this increase in dose and large-field irradiation in most cases in group A no differences were found between group A and B concerning acute or late effects of radiation therapy. CONCLUSION: The aerogen acute hypoxia (hypoxyradiotherapy) is so far not only the simplest, but also one of the most effective selective radioprotective methods.

Abdominal Neoplasms↗
PubMed1994

[Prevention of para-articular ossifications after endoprosthetic hip joint replacement by postoperative irradiation].

In a prospectively randomized study, 137 patients with 141 hips at high risk for heterotopic ossification (HO) received prophylactic radiation therapy (RT). Patients were randomly assigned to a low-dose regimen of five fractions of 2 Gy each (n = 73) or a high-dose regimen of either 10 fractions of 2 Gy each (n = 7) or five fractions of 3.5 Gy each (n = 61). Treatment outcome was assessed by comparing immediately postoperative radiographs with radiographs obtained at least 6 months after hip surgery (Brooker grading score). Positive responses (ie, effective prophylaxis of HO) were seen in 129 (91.5%) hips. Treatment failures were observed in 12 (8.5%). Use of a nonsteroidal antiinflammatory drug (NSAID) lowered the failure rate in both groups. High RT dose with a short duration (< or = 9 days) and use of an NSAID was significantly (p = 0.009) correlated with treatment success. RT delivered within a few days after hip surgery is effective in preventing HO, even in high-risk patients, and provides an alternative of at least equal value for patients with contraindications to long-term medication with either NSAIDs or corticosteroids.

Adult↗
PubMed1994

[Problems of radiotherapy in Germany after the recent events in Hamburg].

BACKGROUND: During the 3rd Symposium on "Experimental Radiotherapy and Clinical Radiobiology" (Hamburg, March 1994) the consequences of the recent events in the Department of Radiotherapy of the University-Hospital in Hamburg for daily radiotherapy practice in Germany were discussed. The following topics were covered: information of the patient, choice of therapy, development of new treatment modalities, ethics committee, follow-up and role of radiobiology. DISCUSSION AND RESULTS: Information of the patient: Due to the insecure juridical situation in Germany there is a tendency to inform patients excessively, which is rather confusing for them. Adequate information of patients is a difficult task for physicians considering their daily workload. Choice of therapy: Unfortunately in Germany radiotherapists are often not initially involved in planning of the overall treatment strategy for individual cancer patients. The recent events in Hamburg led to a decreased referral of cancer patients for radiotherapy. This might even hold for tumor entities where radiotherapy is an essential part of therapy. Another problem is that dose might be reduced inadequately. This would reduce complications but also significantly increase local failure. Development of new treatment modalities: There are no special juridical problems with the conduction of clinical studies for optimization of radiation treatments. Ethics committee: Ethics committees are not only meant to safeguard patients but also protect physicians and institutions from the consequences of questionable research. FOLLOW-UP: Only radio-oncologists are adequately trained for follow-up after radiation treatment. Nevertheless, because of administrative, financial, legal and political problems many patients in Germany are not regularly seen by the radiation oncologist after end of radiation treatment. Always when new treatment strategies are established, careful follow-up is of special concern. Role of radiobiology: The main obligation of clinical radiobiology is to introduce radiobiological knowledge into clinical practice. This may be best promoted by a period of radiobiological research during residency. However, close collaboration between radiotherapists and radiobiologists is only possible at very few centres in Germany, because the institutes of radiobiology are dismantled systemically.

Aftercare↗
PubMed1994

[Hypoxia-radiotherapy: the changes in selected physiological parameters of healthy tissue during the breathing of a hypoxic gas mixture].

BACKGROUND: Chronic hypoxia in tumors is generally accepted to be one of the most important factors concerning sensibility to irradiation. The principle of hypoxyradiotherapy is to achieve a limited (maximal 30 min) radioresistance of the healthy (actually euoxic) tissue by acute aerogen hypoxia, without protecting effects in the average chronic hypoxic tissue of the tumor. This study investigates changes in selected physiological parameters in vivo during acute aerogen hypoxia. PATIENTS AND METHODS: In 31 persons (group A) we documented changes in blood-gas-analysis, ECG-parameters, blood pressure and pulse during acute hypoxia lasting 5 minutes. During 30 minutes of acute hypoxia we determined in another 10 persons (group B) the relations between different phosphoryl-metabolites by means of 31-phosphorus magnetic resonance spectroscopy (31P-MRS). The 31P-MRS of the Musculus triceps surae was performed on our 1.5 T imaging system (Magnetom, Siemens) using a 8 cm diameter surface coil. To achieve the hypoxic condition in the persons tested, a gas-mixture with 8.2% O2 was used. RESULTS: In group A the acute hypoxia led to significant changes in O2-pressure, the blood O2-saturation and pulse frequency. The pO2-values drop in the 5th minute to about 50% of the initial value. Concerning group B the relations of the phosphoryl metabolites show no significant changes during acute hypoxia. CONCLUSIONS: The results show an excellent tolerability of breathing of the hypoxic gas-mixture, and confirm that this mixture containing 8.2% of O2 ensures a decrease in the pO2-levels of more than 50%. This is necessary to achieve a dose modifying factor (DMF) of at least 1.15 to 1.2. The changes in relations of phosphoryl metabolites seem to reflect the ability of healthy tissue to adapt to hypoxic conditions starting after 10 minutes and leading to the loss of the radioprotective effect after 30 minutes.

Acute Disease↗
PubMed1994

[The characterization of semirigid coaxial antennae for interstitial and endocavitary microwave hyperthermia].

PURPOSE: The increased dissemination of interstitial hyperthermia techniques requires suitable action in quality assurance for the used applicators. This work presents physical-technical methods for complete characterisation of interstitial and endocavitary coaxial antennas used for microwave hyperthermia. METHODS: After a short introduction about the antennas' physical principle 2 fundamental experiments for acquisition of specific absorption rate (SAR) are described: There are the thermometric method, especially the power pulse technique, using a static solid state phantom and the direct measurement of the amplitude square of emitted electric field using miniaturized E-field probes in a fluid phantom. Principal problems occurring during E-field measurements in the near field zone of insulated antennas in media (phantom fluid) are discussed in detail. RESULTS: Characteristic relative SAR profiles were found for each tested applicator design. The profiles were described using the following parameters: depths of SAR maximum, effective heating lengths and lengths of the dead end of the antennas relative to the 50%-iso-SAR-surface. Antenna designs for endocavitary and interstitial purposes were measured at variable insertion depths. The changing SAR-patterns were discussed regarding the found measurement data. Additionally measurements of parallel and inclined antenna arrays consisting of 4 interstitial applicators are described. CONCLUSION: The final discussion give future perspectives to forthcoming developments for interstitial and endocavitary microwave hyperthermia.

Equipment Design↗
PubMed1994

[The adjuvant therapy of rectal carcinoma: its current status].

BACKGROUND: Adjuvant therapy of rectal cancer has been investigated in randomized trials during the past 20 years. The actual data allow to draw some principle conclusions. RESULTS: Adequate surgical treatment is the basis for any adjuvant therapy. However, even in case of optimal surgery local recurrence rates of 20 to 30% are to be expected for stage II/III patients with 5-year survival figures in the range of 40 to 60%. In some series, e.g. the results of the Surgical Department of the University of Erlangen, a significant correlation between local control and survival exists. Postoperative radiotherapy decreases the risk of local recurrence but has--as postoperative chemotherapy--only marginal impact on survival. Combined adjuvant treatment (radiotherapy plus 5-FU-chemotherapy) has significantly increased the 5-year survival figures by 10 to 15% in 2 randomized trials and is considered as standard adjuvant treatment. From a radio-oncological point of view, most studies may be criticized at least in part because of low pre-operative doses, inadequate technique without individual treatment planning and shielding, unfavourable fractionation, or dose reductions of radiotherapy in case of chemotherapy. Further improvement of local efficacy of radiotherapy and reduction of therapy-related toxicity seems therefore possible. Innovative approaches in radiation oncology mainly include pre-operative strategies. CONCLUSIONS: Postoperative radiochemotherapy (locoregional irradiation with 50 Gy, small volume boost, 6 courses with 5-FU) is recommended as standard adjuvant treatment outside clinical trials for stage II/III patients after curative surgery. Prospective studies should mainly focus on neoadjuvant treatment concepts.

Carcinoma↗
PubMed1994

[Radiotherapy of esophageal cancer. Results following radiotherapy alone and simultaneous radiochemotherapy and intracavitary irradiation].

PURPOSE: The records of 52 patients with inoperable but localized squamous cell carcinomas of the esophagus were reviewed to determine the influence of different treatment modalities on survival, dysphagia and sites of recurrence. PATIENTS AND METHODS: 22 patients were treated by concurrent radio-chemotherapy with cis-platin/5-FU or carboplatin/5-FU; 19 patients by radiotherapy alone; six patients by chemotherapy followed by irradiation and five patients by concurrent radio-chemotherapy with various drugs. External beam radiotherapy consisted of treating the primary lesion (mean dose 53 Gy) and the lymphatic areas (mean dose 31 +/- 26 Gy) at the rate of 2 Gy/day for five days/week. Additional intraluminal high-dose-rate radiotherapy was performed in 13 patients with single fractions of 6 Gy as a boost. Minimum follow-up was twelve months, median follow-up 4.3 years. RESULTS: For the whole population a remission rate of 65% (34/52 patients) was achieved (complete remission 18/52 patients = 35%; partial remission 16/52 patients = 31%). Relief of dysphagia accompanied tumor regression. Median survival was eleven months; three-year survival rate 23%; five-year survival rate 7.6%. The analysis of recurrence revealed a high rate of local failures (26/52 patients = 50%) and distant metastases (9/52 patients = 18%). Comparing the different modalities the best results were achieved by concurrent radio-chemotherapy with cis-platin/5-FU or carboplatin/5-FU: Complete remission could be determined in 46% and median survival was 14.9 months. Additional intracavitary radiotherapy resulted in a slightly better local control rate (54% vs. 46%) and three-year-survival rate (30% vs. 20%) compared to external beam irradiation alone. CONCLUSIONS: Concurrent radio-chemotherapy with cis-platin/5-FU is superior to other treatment modalities in inoperable carcinoma of the esophagus. Additional intraluminal radiotherapy may increase local control rate.

Brachytherapy↗
PubMed1994

[Radiotherapy of esthesioneuroblastoma].

AIM: To evaluate the radiocurability of esthesioneuroblastoma, we have retrospectively analyzed the results of radiation therapy in this tumor in our clinic. PATIENTS AND METHODS: From 1985 through 1990, twelve patients with esthesioneuroblastoma have been treated at the Department of Radiotherapy at the University of Erlangen. Two had Kadish stage A, one stage B, and nine stage C. There were seven males and five females with a mean age of 43 years. Eleven patients had combined transcranial-transbasal surgery prior to radiotherapy (five R0-, four R1-, and two patients R2-resections) and one received radiotherapy only. The dose was 12 to 60 Gy (mean 54 Gy) in 1.8 Gy to 2 Gy per fraction. RESULTS: 8/12 patients (67%) were locally controlled. One had progressive disease during radiotherapy after partial resection and died. Three had local recurrences, one in-field and two marginal. One patient with a local recurrence developed cervical lymph node metastases, and one locally controlled patient developed bone metastases but is alive eight years after chemotherapy plus radiotherapy for metastatic disease. The five-year-overall and recurrence-free survival was 72% and 55%, respectively. CONCLUSIONS: Sophisticated surgery plus radiotherapy may cure a reasonable number of patients with esthesioneuroblastoma.

Adolescent↗
PubMed1994

[Supportive therapy during radiochemotherapy--prevention and therapy of infections].

BACKGROUND: In current radiooncology the consistent use of best supportive care during aggressive combined treatment protocols is indispensible. Presently the optimal management of fever in granulocytopenic patients is controversially discussed. MATERIAL AND METHODS: Based on own clinical experiences and a literature review we report about empiric antibiotic and antifungal therapy in febrile patients with granulocytopenia. Particular consideration is given to the new antifungal agent fluconazole (compared to amphotericin B) and the beta-lactamase inhibitor sulbactam. We also discuss the use of hematopoietic growth factors and selective gastrointestinal decontamination. RESULTS: In fever of unknown origin the use of a two drug antibiotic combination containing an ureidopenicillin (acyl-penicillin) and an aminoglycoside is recommended. After five days of persisting fever additional antimycotic therapy is initiated. Fluconazole shows a high response rate with only few side effects in the treatment of infections with candida albicans and cryptococcus neoformans. In the early empiric antifungal therapy it is more and more replacing amphotericin B. With encouraging results sulbactam can be combined with piperacillin or mezlocillin during radiochemotherapy. Concerning G-CSF there are no general recommendations allowed. We prefer a calculated prophylaxis for patients who receive a myelotoxic chemotherapy and have a high individual risk for severe neutropenia. During the second day of reverse isolation we start a selective decontamination of the digestive tract until white-blood-cell-count increases to more than 1000 to 1500 granulocytes/mm3. CONCLUSION: The radiooncologist should be able to completely manage prevention and treatment of infectious diseases to provide an optimal use of all new options in combined modality treatment in radiooncology.

Anti-Infective Agents↗
PubMed1994

[Pre- and postoperative radiotherapy to prevent heterotopic ossification of the hip joint].

BACKGROUND: In-vivo experimental data indicate that both pre- and postoperative radiotherapy can prevent heterotopic ossification after hip surgery. This comparison was clinically tested in a randomized study. PATIENTS AND METHODS: From June 1992 to September 1993, 84 patients with high risk for the development of heterotopic ossification were randomized. The treatment concept consisted either of preoperative radiotherapy within four hours prior to surgery (arm A) or postoperative radiotherapy within 72 hours following hip surgery (arm B). Preoperative radiotherapy was given in one fraction of 7 Gy, while the postoperative radiotherapy was delivered in five fractions of each 3.5 Gy (total 17.5 Gy). All patient variables (age, sex, prior surgery) and predisposing risk factors were comparable in both treatment arms. For the radiological assessment of heterotopic ossification according to (Brooker-Score) X-rays of the pelvis or hip were evaluated which had been taken immediately pre- and postoperatively as well as at least six months following surgery and prophylactic irradiation. The functional hip status was evaluated pre- and postoperatively using the Harris-Score. Cases in which the Brooker- and/or Harris-Score worsened during the postoperative follow-up as compared to the pre- and immediate postoperative situations were considered as treatment failures. RESULTS: Of 44 patients with at least six months follow-up 41 (93%) experienced a successful prophylaxis. Two failures were observed in the preoperative and one in the postoperative group. The prophylactic efficacy was not influenced if the pre- or postoperative interval was longer than prescribed. All intra- and postoperative complications were comparable for both treatment groups. The mean interval to partial strain (50% body weight) of the operated hip was longer in the preoperative group (mean 19 +/- 27 days) as compared to the postoperative group (mean 8 +/- 13 days). With respect to full strain (100% body weight), the results were equal in both groups. The functional hip status decreased in two patients. Again the mean overall improvement in the postoperative group was larger (mean 42.7 +/- 17.1 points) as compared to the preoperative group (mean 34.3 +/- 13.7 points). CONCLUSIONS: Preoperative and postoperative radiotherapy have equal prophylactic efficacy to prevent heterotopic ossification following hip surgery. The main advantage of preoperative radiotherapy are the simple management of the patient, the reduction of possible complications associated with transport and positioning of the patient in the postoperative period as well as excellent acceptance of this treatment concept by patients, nurses and staff.

Aged↗