Biomedical subjects

U M Lütolf

Publications and source records attributed to U M Lütolf.

At least 37 records · Page 2Linked to original sources

PubMed1993

[Questions and aspects of radiotherapy of adult patients with localized supradiaphragmatic stage (CS I/II) Hodgkin's disease. 1. Questions and aspects on indications for primary and adjuvant radiotherapy].

Important studies of the therapy in patients with early stages of Hodgkin's disease aim at reducing the long-term risks, yet maintaining the high cure rate. Several prospective studies and two large meta-analyses did not observe a significant difference of the ten- or 15-year survival rate after radiotherapy or combined radio- and chemotherapy in the total group of patients with CS I/II A Hodgkin's disease, not withstanding a significant reduction of the recurrence risk after combined therapy. There is some evidence but no proof, that certain subgroups of patients with early stage, have a higher survival after combined therapy compared to that after radiotherapy alone. Most studies of therapy in Hodgkin's disease have a statistical power much too low, in order to demonstrate significant differences of the survival rate in the order of 10 to 15%. Randomized studies of chemo- versus radiotherapy in patients with PS I/II A and some PS III A have shown conflicting results. Patients with supradiaphragmatic Hodgkin's disease and CS I/II can be subdivided according to the recurrence risk after primary radiotherapy in the following subgroups: 1. Patients with a very low or a low recurrence risk of approximately 10 to 20%: patients less than 40 years old and CS I/II A NS/LP with less than three involved regions and no bulky mediastinal mass and an ESR below 30 mm. If there is only unilateral suprahyoidal lymph node involvement, primary radiotherapy of the involved region or a mini-mantle or a mantle field is acceptable and achieves a recurrence free survival of 90% or higher. If there is only non bulky mediastinal involvement, mantle field radiotherapy is acceptable and achieves a recurrence-free survival of at least 90%. In the other patients, primary irradiation of an extended mantle field without a staging laparotomy is an acceptable primary treatment, achieving a recurrence-free survival rate of approximately 80%. Another option is a staging laparotomy with splenectomy and a mantle radiotherapy for PS I/II. Few groups prefer primary chemotherapy alone or some type of a reduced chemotherapy with lesser toxicity combined with localized radiotherapy and long-term observations of a larger group of patients after the last type of treatment have to confirm the excellent early results. 2. Patients with an intermediate recurrence risk of approximately 20 to 40%: patients, who do not belong to group one or group 3.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗

PubMed1993

[Radiotherapy in treatment of breast cancer].

Surgery and radiation therapy are the basic therapies for local tumor control in breast cancer. The role of radiation therapy has been established in a number of prospective studies during the past years. Technical advances (computerized treatment planning, linear accelerators) and knowledge of tolerance in normal tissues have practically eliminated the severe side effects of former radiation therapies. Radiation is able to prevent local recurrences in postoperative situations (breast-conserving therapies, in high-risk situations after mastectomy, after excision of chest wall recurrences). If a tumor cannot be removed or a gross tumor is left after excision, radiation will be necessary to achieve local tumor control. Radiation has an important role in palliation in metastatic disease. The current paper summarizes the role of modern radiation therapy in the treatment of breast cancer and points to problems in the referral of patients in current practice.

Breast Neoplasms↗

PubMed1992

[Papillary and follicular thyroid carcinoma: long-term course in 339 patients of the Zurich University Hospital 1960 to 1988 and review].

Survival rates, tumor control and complications in 339 patients with follicular or papillary carcinoma of the thyroid treated at the clinics of radio-oncology and nuclear medicine during the period 1960-1988 were analyzed. Operable tumors were treated by subtotal thyroidectomy or various modes of uni- or bilateral subtotal resection combined with eradication of remaining thyroid tissue with iodine 131 or percutaneous irradiation, the latter limited in the seventies to patients with local or regional tumor extension. Further 131I was administered when iodine-incorporating tissue was detected. Mortality due to tumor was under 5% in patients younger than 40, 2-20% in older patients with tumor stages T1-3 N0-1 M0 or T2-3 N0 M0, 53 to 74% in various groups T4 N0-2 M0 and over 40, and more than 85% in patients over 40 with distant metastasis. When the total activity of 131I was limited to 1 Ci (37 Gbq), an increased incidence of leukemias or cancer of the bladder was not observed. These observations are discussed and compared with data from published reports. A scheme for treatment and follow-up is presented.

Adenocarcinoma↗

PubMed1992

Endometrial carcinoma in patients aged 75 years or older: outcome and complications after postoperative radiotherapy or radiotherapy alone.

A retrospective analysis is reported of 89 patients at least 75 years old (median age 79 years) treated with irradiation for endometrial carcinoma between 1972 and 1989, the median follow-up being 39 months. In 66 patients radiotherapy was given postoperatively and in one case preoperatively, 22 patients were treated with radiotherapy alone: intravaginal insertions exclusively in 22 patients (median dose 60 Gy to the mucosa) and combined with external radiotherapy in 53 patients (median external target dose 45 Gy; three or four fields, all treated daily, 1.8 to 2.0 Gy per fraction, five fractions per week; 30 Gy to the vaginal mucosa with low-dose rate). A few patients were treated with external radiotherapy or intrauterine insertions only. 65% of the patients treated with radiotherapy alone and 34% of the patients receiving postoperative radiotherapy had FIGO stage II or III disease. Five-year actuarial overall survival and disease-free survival for all patients with adenocarcinomas treated with curative intent was 47.5% and 57.2%, respectively. In 48 patients with surgical stages I and II, treated with postoperative adjuvant radiotherapy, overall actuarial survival is 58.2% and disease-free survived 65.5% at five years. After postoperative vaginal insertions only, no vaginal recurrence occurred. With combined external and intravaginal radiotherapy in surgical stage I and II, 4/36 patients (11%) showed a recurrence in the vagina only, the abdominal and pelvic recurrence rate being 8.3%. Grade 3 to 4 late toxicity was observed in 6/53 patients (11.3%) treated with external and intravaginal radiotherapy. However, in patients receiving external radiotherapy less than 45 Gy and intravaginal radiotherapy 30 to 40 Gy, as is standard postoperative adjuvant treatment today, only one grade 3 late toxicity was observed in 17 patients (5.9%). We conclude, that treatment of elderly patients with adenocarcinoma of the uterus should follow the same pattern as in younger patients, the acute side-effects and late toxicity of radiotherapy being similar.

Actuarial Analysis↗

PubMed1992

Follow-up data of our pilot study on concomitant hyperfractionated radiotherapy and cisplatinum (CDDP) in patients with advanced cancer of the head and neck.

Since 1988, 52 patients with stage III/IV squamous cell cancer of the head and neck have been treated by concomitant irradiation with 2 x 1.2 Gy/d on five days per week up to a total dose between 72 and 76.8 Gy without split and 5 x 20 mg/m2 cisplatinum (CDDP) as short infusion finished approximately 30 min before the second session on five days of the first and the fifth week of radiotherapy. Radiotherapy has been suspended after 30 and 50 Gy in three patients for insufficient response. In all other patients, radiotherapy has been completed. Due to a slow haematologic recovery, 34% of the patients received only one cycle of CDDP Grade 3 mucositis, occurring during radiotherapy in all patients, healed in a couple of weeks after radiotherapy. Three patients have a persisting ulcer between eight and 36 months after radiotherapy with biopsies negative for tumour and also no other signs of tumour. The ulcers are situated in the region of the former primary tumour with an extensive destruction of tissue already before radiotherapy (cumulative risk of this complication after three years 8%). There were no other major complication. Cumulative local control after three years was 67% (75% including salvage surgery in two patients) with a plateau after twelve months. Total survival after three years was 62%. For the whole follow-up period, local control in the region of the primary tumour after radiotherapy was: 19/29 (T4), 10/15 (T3), 7/10 (T1 + 2, including salvage surgery: 8/10). Local control in the region of the nodal metastasis after radiotherapy was: 5/14 (N3, including salvage surgery: 6/14). 18/21 (N2) and 6/8 (N1).

Adult↗

PubMed1992

Long-term follow-up of 92 patients with locally advanced follicular or papillary thyroid cancer after combined treatment.

Between 1960 and 1988, 92 patients with a locally advanced follicular or papillary thyroid cancer have been treated with surgery and radiotherapy consisting of iodine-131 or external (ext RT) radiotherapy or both. Locoregional control in patients less than 38 years of age at diagnosis and in older patients with a papillary cancer and a macroscopically complete resection was 100% with or without ext RT. Locoregional control in patients 38 years of age or older and without palpable postsurgical residual mass was 89% with ext RT and 60% without. In patients with a palpable residual mass, one of ten treated with iodine-131 alone had a permanent local control compared to six of 14 treated with addition of ext RT. Published data concerning iodine-131 and ext RT in the treatment of locally advanced follicular or papillary thyroid cancer are discussed. Routine surgery in our region consists of a near total thyroid resection, followed by iodine-131 ablation of the remnant thyroid. In younger patients with a limited T4 tumour and complete resection, we do not use ext RT. In all older patients with a T4 tumour as well as in younger patients with an extensive T4 tumour, ext RT is added.

Adenocarcinoma↗

PubMed1991

[Radiotherapy as an emergency measure].

An emergency in radiotherapy is a case calling for such urgent treatment that the usual stages of planning are abbreviated and radiation is started within a few hours. After a short summary of the biological effects of radiotherapy, we will discuss the emergency situations one has to deal with. Most frequent are those in the course of malignant disease. Yet, in the context of increasingly practised transfusion- and transplantation-techniques, the number of other emergencies is rising.

Airway Obstruction↗

PubMed1991

Long-term morbidity of adjuvant infradiaphragmatic irradiation in patients with testicular cancer and implications for the treatment of stage I seminoma.

Long-term abdominal or urological morbidity and second malignancies in 289 surviving patients with infradiaphragmatic adjuvant radiotherapy (RT) for testicular cancer between 1950 and 1988 are analysed by retrospective chart review. After RT with single doses between 1.5 and 2.0 Gy and a total dose between 30 and 35 Gy, we did not observe any peptic ulcer nor other abdominal or urological long-term morbidity, except second tumours. The cumulative incidence of 16 second extratesticular malignancy was (in years after RT): 0.4% (4 years), 1.3% (9 years), 4.5% (14 years), 6.3% (19 years), 7.5% (24 years), 15.6% (29 years) and 23.6% (35 years). The ratio of observed to expected incidence of extratesticular malignancies did not differ significantly from unity; only the frequency of penile cancer (n = 2) was somewhat higher than expected. The cumulative risk of bilateral testicular cancer was 4.8% with no difference between patients with seminoma or non-seminomatous germ cell tumours. In a recent group of 128 patients with a stage I seminoma staged and treated between 1978 and 1988 by modern standard, there was no recurrence.

Diaphragm↗

PubMed1990

[Long-term results following radioiodine treatment of patients with metastasizing follicular and papillary thyroid carcinoma].

From 1963 to 1988, 94 patients with mediastinal and/or distant metastasis of follicular or papillary thyroid cancer have been treated in our department by subtotal or near total thyroidectomy, 131-iodine ablation of the thyroid recurrent thyroid hormone and 131-iodine applications. Patients with locally advanced tumours had also percutaneous irradiation. Some patients had also surgical excision and percutaneous irradiation of the metastasis. Rates of complete and permanent remissions were: 53% (all pap.), 7% (all foll.), 75% (lung and/or mediastinal metastasis), 100% (miliary or micronodular lung metastasis and small mediastinal nodes), 6% (bone metastasis). Tumor specific survival rates were: 95% and 90% 10 and 20 years in patients less than 40 years old at the beginning of the treatment, 65% (5 years), 40% (10 years), 25% (15 years) and 18% (20 years) in patients at least 40 years old. Serious complications due to radioiodine were observed in three patients (one acute leukemia, one macroscopic haematuria with irradiation cystitis and one cancer of the bladder). Furthermore five patients suffered from grade III/IV thrombocytopenia: these patients had also multiple bone metastasis and percutaneous irradiation of various bone regions.

Adenocarcinoma↗

PubMed1990

[Hyperfractionated irradiation with simultaneous cisplatin chemotherapy in patients with far-advanced carcinoma of the head and neck].

From January 1988 to April 1989, 22 of 28 patients with advanced carcinomata of the head and neck have been treated by hyperfractionated radiotherapy (2 x 1.2 Gy/day, five days/week, total dose 74.4 to 79.2 Gy) and simultaneous application of Cisplatinum (20 mg/m2 day, i.v., five days in the first and fifth week of the radiotherapy). In 68% of the patients the treatment could be applied in full dose. All eight patients with primary application of a gastrostomy could be irradiated without split, whereas five of 14 patients without a gastrostomy had a split of greater than or equal to 2 weeks. The mucositis healed in all patients after the end of the irradiation. Up to now, no serious complications have been seen. One year cumulative locoregional control rate is 65%. This study serves as a pilot study for a randomized trial. According to the acute and subacute toxicity the applied treatment is feasible.

Carcinoma↗

PubMed1989

[Radiation-induced vascular damage and its treatment using percutaneous transluminal angioplasty and local thrombolysis].

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Adolescent↗

PubMed1988

[Radio-oncology--advances and integration of the last few years].

Progress in radiation oncology can be ascribed to better staging (diagnostic procedures such as CT and MRI), improved pathological classification, innovations in treatment planning (CT, computerized planning systems, patient fixation) and modern accelerators. These various contributions are demonstrated in detail taking radiation therapy of prostate cancer as an example. The importance of these (largely technological) advances is discussed, together with ways of balancing the technical and human aspects.

Diagnostic Imaging↗

PubMed1986

[Tumor scintigraphy with cobalt bleomycin in ORL tumors].

Our experiences with cobalt bleomycin scintigraphy in the treatment planning of ORL tumors are described. 142 scintigrams taken from 127 patients have been examined. As is shown by our investigation, cobalt bleomycin scintigraphy is a good examination method, however, too much expenditure is needed to have the necessary data for therapy planning. To our opinion, the information obtained in oto-rhino-laryngology by an exact clinical examination is as good as that of cobalt bleomycin scintigraphy. Our treatment schemes had only to be revised in some exceptional cases.

Bleomycin↗

PubMed1985

[Locoregional recurrence in breast cancer--what should be done?].

Recurrence is a quite common problem in breast cancer. Strictly local recurrence seems to be not much different from an early breast cancer situation with minimal tumor load, and surgical removal may be adequate. If recurrence with multiple local tumors and/or regional nodes is present, most patients will develop metastatic disease. Treatment of loco-regional recurrence depends on prognostic factors; where long survival may be expected, surgical excision and radiation therapy with normal fractionation schedules should be planned. Current controlled studies are expected to determine the value of adjuvant hormone/cytotoxic therapy. With poor prognostic signs only systemic treatment is expected to influence survival, whereas local treatment (surgery/radiation-therapy) should be given as palliative treatment.

Breast Neoplasms↗

PubMed1985

[Therapeutic results in spinal tumor metastases involving neurologic deficit].

Between 1976 and 1982 primary or secondary intraspinal malignant lymphomas and metastases of solid tumours with neurologic defects were found in 118 hospitalised patients. A total of 126 episodes of spinal and caudal compressions were observed. Nearly half of all tumour diagnoses were breast and prostatic carcinomas. Segments Th 3-6 were mainly involved. Symptoms of compression were the first objective hints of malignant disease in every third patient. Local and (or) radicular pains were reported as first symptoms by 80% of patients. Therapeutic success was considered satisfactory (group A) if patients were able to walk freely 3 months after initiation of treatment or isolated loss of sensitivity or defects of urination or defaecation could not be demonstrated any longer. Results were classified as unsatisfactory (group B) if the above-mentioned aims of treatment could not be achieved within this time. After individualised carefully monitored treatment, survival of patients of group A was significantly longer after 12 and 24 months than in patients of group B. Probability of survival is mainly influenced by rapid response to treatment, by tumour histology, by severity of neurologic defects and by the chosen treatment regime.

Aged↗

PubMed1984

[Radiation resistance: a concept in need of review or a stubborn problem for radio-oncology?].

Many tumors are considered to be radio-resistant. Reviewing recent literature on clinical results, this notion of radio resistance needs to be revised. With new technics and improved dosimetry it has become possible to control locally even well differentiated carcinomas and achieve clear survival benefits. Three examples illustrate the importance of radiation therapy of prostatic cancer as a well established procedure. It would seem that radiation therapy in colorectal tumors of certain stages is becoming part of initial treatment. A case is made out for meningeoma, where surgery undoubtedly remains the first approach; after incomplete removal or in locally inoperable patients, radiation therapy may be of value.

Aged↗

PubMed1983

[Ovarian cancers--a solution within reach?].

The overall 5-year survival rate for ovarian malignant tumors is approximately 25-30%. Ovarian cancer is usually recognized and diagnosed too late. Malignant ovarian tumors show a variety of biological and clinical features, as well as a wide spectrum of histiogenesis and histologic findings. The present study deals with epithelial ovarian tumors (80% of all malignant ovarian tumors): serous, mucinous, endometrioid and undifferentiated carcinoma. The incidence of malignant ovarian tumors varies between 2.5 in Japan and 15.1 in Sweden. The aim of surgical treatment lies in the radical removal of tumor masses without producing higher morbidity or mortality figures. Whenever possible the surgical treatment consists of median laparotomy, cytologic, anatomical and histologic staging, as radical as possible tumorectomy, hysterectomy with bilateral adnexectomy, omentectomy, and appendectomy. The prognosis of ovarian cancer depends on histologic findings, and also on the modalities of primary treatment. Further important prognostic factors are residual tumor masses after surgical treatment, the patient's age, the degree of differentiation and the extent of the tumor. Diagnosis, monitoring of patients and follow-up are directly influenced by dissemination of the tumor. Second-look laparotomy is the only reliable method of obtaining data in follow-up of the disease. Clinical assessment is important but insufficient in considering further treatment. Adjuvants to radical surgical treatment are chemotherapy and radiotherapy, for which the indications and therapy schedule are described.(ABSTRACT TRUNCATED AT 250 WORDS)

Antineoplastic Combined Chemotherapy Protocols↗

PubMed1980

Postexercise changes in ejection fraction associated with coronary artery disease.

Radionuclide measurement of left ventricular ejection fraction (LVEF) response to exercise has been proposed as a way to help identify patients with coronary artery disease (CAD). Previous studies were done using an exercise bicycle or a treadmill and showed that patients with CAD do not increase ejection fraction (EF) to the same extent as normal (control) subjects. The present studies were done using a coaxial Gamma Cor cardiac probe. Because radiocardiograms (RCG) obtained with the cardiac probe require 1/10 the dose required for a scintillation camera, serial measurements could be made before, during and following exercise. Although 3 of our 9 patients showed an unchanged and 3 showed a decreased EF at the time of maximal exercise, 3 others were able to increase their EF, and in 2 this increase occurred concomitantly with angina. Thus, not all the CAD patients could be identified by failure to increase EF in response to exercise. However, looking at the period just following exercise, one can see that most of our patients with CAD maintain or increase LVEF during the first 6 to 9 min after stopping exercise; normal (control) subjects rapidly return to the preexercise value. The normal pattern is an increase in EF during exercise followed by a prompt return toward normal after cessation of exercise. Changes of this normal pattern of EF increase and decrease occurred in all except 1 patient with CAD, and consequently provided a better indication of the presence of significant disease than the response during exercise alone.

Adult↗