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V Budach

Publications and source records attributed to V Budach.

At least 55 records · Page 3Linked to original sources
PubMed1998

[Virtual simulation. First clinical results in patients with prostate cancer].

AIM: Investigation of options of virtual simulation in patients with localized prostate cancer. PATIENTS AND METHODS: Twenty-four patients suffering from prostate cancer were virtual simulated. The clinical target volume was contoured and the planning target volume was defined after CT scan. The isocenter of the planning target volume was determined and marked at patient's skin. The precision of patients marking was controlled with conventional simulation after physical radiation treatment planning. RESULTS: Mean differences of the patient's mark revealed between the 2 simulations in all room axes around 1 mm. The organs at risk were visualized in the digital reconstructed radiographs. CONCLUSIONS: The precise patient's mark of the isocentre by virtual simulation allows to skip the conventional simulation. The visualisation of organs at risk leeds to an unnecessarily of an application of contrast medium and to a further relieve of the patient. The personal requirement is not higher in virtual simulation than in conventional CT based radiation treatment planning.

Aged↗
PubMed1998

Combined treatment of inoperable carcinomas of the uterine cervix with radiotherapy and regional hyperthermia. Results of a phase II trial.

AIM: The disappointing results for inoperable, advanced tumors of the uterine cervix after conventional radiotherapy alone necessitates improving of radiation therapy. Simultaneous chemotherapy or altered radiation fractionation, such as accelerated regimen, increase acute toxicity and treatment is often difficult to deliver in the planned manner. The purpose of this phase II study was to investigate the toxicity and effectiveness of a combined approach with radiotherapy and regional hyperthermia. PATIENTS AND METHODS: From January 1994 to October 1995 18 patients with advanced carcinomas of the uterine cervix were treated in combination with radiotherapy and hyperthermia. The patients were treated with 6 to 20 MV photons delivered by a linear accelerator in a 4-field-box technique to a total dose of 50.4 Gy in 28 fractions. In the first and fourth week 2 regional hyperthermia treatments were each applied with the Sigma-60 applicator from a BSD-2000 unit. After this a boost to the primary tumor was given with high-dose-rate iridium-192 brachytherapy by an afterloading technique with 4 x 5 Gy at point A to a total of 20 Gy and for the involved parametrium anterioposterior-posterioanterior to 9 Gy in 5 fractions. RESULTS: The acute toxicity was low and similar to an external radiotherapy alone treatment. No Grade III/IV acute toxicity was found. The median age was 47 years (range 34 to 67 years). In 16 of 18 patients a rapid tumor regression was observed during combined thermo-radiotherapy, which allowed the use of intracavitary high-dose-rate brachytherapy in these cases. Complete and partial remission were observed in 13 and 4 cases, respectively. One patient did not respond to the treatment. The median follow-up was 24 months (range 17 to 36 months). The local tumor control rate was 48% at 2 years. Median T20, T50 and T90 values were 41.7 degrees C (range 40.3 to 43.2 degrees C), 41.1 degrees C (range 39.2 to 42.5 degrees C) and 39.9 degrees C (range 37.7 to 41.9 degrees C), respectively. Cumulative minutes of T90 > 40 degrees C (Cum40T90) and cumulative minutes, which were isoeffective to 43 degrees C, were calculated (CEM43T90, CEM43T50, CEM43T20). CEM43T90 was found to be a significant parameter in terms of local tumor control for the 4 hyperthermia treatments (p = 0.019). CONCLUSIONS: This treatment modality has proved to be feasible and well tolerable. The rapid tumor shrinkage in the combined approach of radiotherapy with hyperthermia before beginning brachytherapy seems to be a good prerequisite for improving of the disappointing results in cure of advanced cancer of the uterine cervix.

Adult↗
PubMed1998

[Hyperfractionated accelerated simultaneous radiochemotherapy in advanced hypopharyngeal carcinomas. Survival rate, retained function quality of life in a phase II study].

Forty-one patients with locally advanced hypopharyngeal carcinomas were followed for at least 3 years (median, 60 months) after simultaneous radiochemotherapy. Conventionally fractionated radiotherapy was administered as 5 x 2 Gy/week to a total dose of 30 Gy within 3 weeks. From the fourth week an accelerated hyperfractionated schedule was used as 2 x 1.4 Gy/day five days weekly given exclusively to the first order target volume of macroscopic tumor (adding up to a total dose of 72 Gy in six weeks). The second and third order target volumes received conventional fractionation only to 60 Gy and 50 Gy, respectively. The moderate acceleration of the concomitant boost scheme in the second half was counterbalanced during the first week by the introduction of a 5-fluorouracil bolus of 350 mg/M2 with 200 mg/M2 folinic acid and a subsequent continuous infusion using the same dose each 24 h for 5 days. Additionally, a Mitomycin-C bolus of 10 mg/M2 was infused at the fifth day and on the first day of the sixth week. Six weeks after treatment the patients were restaged. In cases with residual carcinoma salvage surgery was performed (11 patients). Late effects of therapy were analyzed according to the Lent-Soma index and life quality according to the European Organisation for Research and Treatment of Cancer-Module. Late effects of treatment were tolerable and were controlled locally. The 3-year-survival rate was 39%, with a local-regional recurrence-free control rate of 71%. Fifty-two percent of all cases of death were caused by distant metastases, secondary carcinomas or other diseases not related to tumor recurrence. The poor prognosis of hypopharyngeal carcinomas despite acceptable local tumor control may be due to specific biological factors present in affected patients.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1998

High-dose rate interstitial with external beam irradiation for localized prostate cancer--results of a prospective trial.

PURPOSE: A prospective phase II trial was carried out to test the feasibility and effectiveness of a combined interstitial with external beam radiotherapy approach for localized prostate cancer. MATERIALS AND METHODS: Between October 1992 and December 1994, 82 evaluable patients were treated. T2 and T3 tumours, according to the AJCC classification system of 1992, were found in 21 and 61 cases, respectively. The median follow-up was 24 months; three patients were lost during follow-up. All of the patients were pathologically proven to be node-negative by laparoscopic node dissection of the fossa obturatoria region. A dose of 9 Gy a week was prescribed during the first and second weeks of treatment (10 Gy each week from October 1992 to December 1993) interstitially with high-dose rate Iridium-192 brachytherapy to the prostate and tumour extension beyond the capsule. External beam four-field box irradiation was then given to the prostate to a dose of 45 Gy/25 fractions (40 Gy/20 fractions from October 1992 to December 1993). RESULTS: Before starting treatment, a PSA value of > or =10 ng/ml was found in 64.6% (53/82) of patients with a median PSA of 14.0 ng/ml. The median PSA 3, 12 and 24 months after completion of therapy was 1.20, 0.78 and 0.70 ng/ml, respectively. The PSA value was < 1.0 ng/ ml in 52.9% of patients at 2 years. Negative punch biopsies 12 and 24 months after therapy were observed in 69.8% (44/63) and 73. 1% (38/ 52) of patients, respectively. A positive biopsy combined with a PSA value of > 1.0 ng/ml was considered as local failure. The local tumour control rate was 79.5% at 2 years. Acute side-effects were not increased relative to external beam irradiation alone. Severe side-effects were observed in three patients (two of the three patients had additional risk factors (colitis ulcerosa and diabetes mellitus)); they developed rectourethral fistulae requiring colostomy after biopsies from the anterior rectal wall. CONCLUSION: The described method is feasible and well tolerable. The three complications observed were not caused by irradiation alone. Biopsies from the anterior rectal wall after definitive high-dose radiotherapy for prostate cancer have to be seen as obsolete. The rate of negative prostate biopsies of 73.1% after 24 months represents an encouraging result.

Adenocarcinoma↗
PubMed1998

Preoperative chemotherapy followed by concurrent chemoradiation therapy based on hyperfractionated accelerated radiotherapy and definitive surgery in locally advanced non-small-cell lung cancer: mature results of a phase II trial.

PURPOSE: To evaluate the feasibility and efficacy of an intensive multimodality approach with combination chemotherapy, hyperfractionated accelerated chemoradiotherapy, and definitive surgery in prognostically unfavorable subgroups of locally advanced non-small-cell lung cancer stages IIIA and IIIB (LAD-NSCLC). PATIENTS AND METHODS: Following staging, including mediastinoscopy, 94 patients with inoperable LAD-NSCLC were treated preoperatively with chemotherapy (three courses of split-dose cisplatin and etoposide [PE]) followed by concurrent chemoradiotherapy (one course of PE combined with 45 Gy hyperfractionated accelerated radiotherapy). After repeat mediastinoscopy, patients underwent surgery 4 weeks postradiation. RESULTS: Of 94 consecutive patients (52 stage IIIA [> or = two lymph node levels involved] and 42 stage IIIB [no pleural effusion, no supraclavicular nodes]), 62 (66%) completed induction and underwent surgery. Complete resection (R0) was achieved in 50 (53% of all patients) and pathologic complete response (PCR) in 24 (26%). After a median follow-up of 43 months, the median survival time was 20 months for IIIA, 18 months for IIIB, and 42 months for R0 patients. Calculated survival rates at 4 years were 31%, 26%, and 46%. Two patients died of sepsis preoperatively and four died postoperatively of pleural empyema (n = 1), stump insufficiency (n = 2), and cardiac failure (n = 1). Other toxicities were acceptable-mainly hematologic during chemotherapy or chemoradiotherapy and esophagitis during chemoradiotherapy. CONCLUSION: This intensive multimodality treatment is feasible and demonstrates high efficacy in prognostically unfavorable LAD-NSCLC subgroups with high R0 rates and improved long-term survival compared with historical controls

Adult↗
PubMed1998

Comparison of conventional and virtual simulation for radiation treatment planning of malignant lymphoma.

PURPOSE: The exact coverage of the lymph nodes and optimal shielding of the organs at risk are necessary for patients with Hodgkin's disease or malignant lymphoma to guarantee a high cure rate and a low rate of late effects for normal tissue. The purpose of this study was to compare conventional simulation and blocking with virtual simulation in terms of coverage of the target volume and shielding of the organs at risk in this highly curative patient group. PATIENTS AND METHODS: In 10 patients diagnosed with Hodgkin's disease and 5 patients with a Non-Hodgkin lymphoma radiation treatment planning for a mantle field or para-aortic field with inclusion of the spleen was performed in a conventional manner and with virtual simulation. With conventional technique, irradiation portals were defined during fluoroscopy and shielding of the organs at risk was drawn onto the simulation films, based on the information from previous X-ray films, CT or MRI scans. For virtual simulation, contouring of the target volumes and organs at risk (e.g. the kidneys) and the definition of the irradiation portals were performed with the AcQSim software package on a VoxelQ workstation (Picker Inc.) This was done in a beam's eye view environment on a currently driven CT scan in the treatment position. Both irradiation portals were compared in terms of coverage of the target volume and shielding of the organs at risk. RESULTS: Planning of a mantle field in the conventional way resulted in an incomplete coverage of the right hilus in 4/15 cases and of the left in 1/15 cases, respectively. The spleen and the spleen hilus were not covered completely in 5/15 and 6/15 cases, respectively. The left kidney was adequately shielded in only two thirds (10/15) of the conventionally planned fields. The planning time required for virtual simulation was reduced for the patient, but was increased for the physician because of the more time consuming contouring procedure compared to conventional simulation. CONCLUSIONS: Virtual simulation based on CT scans for radiation treatment planning of malignant lymphoma gives more information about soft tissue structures than conventional treatment planning. Therefore, it allows a more precise coverage of the target volumes and better shielding of the organs at risk. However, the time required for the whole procedure is increased. This is justified because of the often highly curative intention when treating this group of patients.

Feasibility Studies↗
PubMed1998

Verification of set-up deviations in patients with breast cancer using portal imaging in clinical practice.

AIM: The aim of this study was to determine set-up deviations during irradiation of patients with breast cancer using Electronic Portal Imaging (EPI). PATIENTS AND METHOD: In order to monitor the intrafractional set-up deviations multiple portal image readings were carried out on 5 patients with breast cancer. Moreover interfractional set-up deviations were determined by the acquisition of daily EPIs in a total of 20 patients. RESULTS: The results of intrafractional set-up deviation based on 130 EPIs revealed a maximum lateral and longitudinal (cranio-caudal) deviation of 2 mm (range:-10 mm to 8 mm) as well as 1 degree in rotation (range: -2 degree to 2 degrees). The interfractional set-up deviations in 20 breast cancer patients during a treatment series of 25 fractions showed mean standard deviations of 5 mm in lateral and longitudinal direction, respectively. Only in few cases deviations up to maximally 24 mm were observed. The mean standard deviation of the rotational error was 2 degrees and reached a maximum of 6.5 degrees. CONCLUSION: These results show that intrafractional set-up deviations in breast cancer patients are negligible in clinical practice. They can be attributed to random errors due to patient movement and breathing. The set-up deviations during a treatment series can be differentiated in systematic and random errors. Patient fixation and immobilization is crucial in minimizing random errors. Taking into account 10 mm safety margins as used in our department around the "clinical target volume" (CTV), set-up errors outside of this volume (PTV) were exceptional. The enlarged PTV definition of 15 mm for lateral and cranio-caudal field margins, respectively as used in this study covers 99% of the CTV in all patients.

Breast Neoplasms↗
PubMed1998

Radiotherapy-induced emesis. An overview.

BACKGROUND: A significant number of patients receiving radiotherapy experience the distressing side effects of emesis and nausea. These symptoms are some of the most distressing problems for the patients influencing their quality of life. METHODS: International study results concerning radiotherapy-induced emesis are demonstrated. A German multicenter questionnaire examining the strategies to prevent or to treat radiotherapy-induced nausea and emesis is presented. An international analysis concerning incidence of emesis and nausea in fractionated radiotherapy patients is discussed. Finally the consensus of the consensus conference on antiemetic therapy from the Perugia International Cancer Conference V is introduced. RESULTS: Untreated emesis can lead to complications like electrolyte disorders, dehydration, metabolic disturbances and nutrition problems with weight loss. Prophylactic antiemetics are often given to patients receiving single high-dose radiotherapy to the abdomen. A survey has revealed that antiemetic prophylaxis is not routinely offered to the patients receiving fractionated radiotherapy. However, there is a need for an effective treatment of emesis for use in this group of patients, too. In 20% of patients nausea and emesis can cause a treatment interruption because of an inadequate control of symptoms. Like in chemotherapy strategies there exists high, moderate, and low emetogenic treatment regimens in radiotherapy as well. The most emetogenic potential has the total body irradiation followed by radiotherapy to the abdomen. Radiotherapy induced emesis can be treated effectively with conventional antiemetics up to 50%. CONCLUSION: Studies with total body irradiation, fractionated treatment and high-dose single exposures have clearly demonstrated the value of 5-HT3-receptor antagonist antiemetics. There is a response between 60 and 97%. There is no difference in the efficacy of the different 5-HT3-antagonists. High-risk patients should be prophylactic treated with 5-HT3-antagonists. The additional administration of glucocorticoids and benzodiazepins can optimize the response.

Antiemetics↗
PubMed1997

[Combined iridium 192 afterloading therapy of prostate carcinoma].

The goal of radiation therapy is to deliver a high dose to the tumor while preserving normal surrounding tissue. For early-stage prostate cancer, the ultimate conformal irradiation is to place radioactive sources directly into the gland as permanent or temporary seeds. Contemporary prostate brachytherapy incorporates advances in computer analysis, imaging technology, and delivery apparatus, allowing exact and reproducible results. Accurate comparison of brachytherapy to surgery and external beam irradiation requires a randomized study. Comparisons of retrospective studies are fraught with the problems of the heterogeneous nature of early-stage prostate cancer. Pretreatment PSA and grade appear to be more sensitive variables than stage in predicting failure after irradiation. The treatment results based on biopsy are promising for the first two years. Brachytherapy may be considered as a therapeutic option: as monotherapy for early-stage disease and also as a boost following moderate doses of external beam irradiation for locally advanced disease.

Brachytherapy↗
PubMed1997

Correlation between primary chemo- and radiation sensitivity in a panel of highly malignant human soft tissue sarcoma xenografts.

BACKGROUND AND PURPOSE: Sensitivity to radiation and sensitivity to cytotoxic drugs have been proposed to be independent properties of tumour cells. However, very few clinical or experimental studies have tested this hypothesis. Therefore, we evaluated the response to ionizing radiation and to four cytotoxic drugs in a panel of 12 human soft tissue sarcoma cell lines using the xenograft system. MATERIAL AND METHODS: NMRI-nu/nu nude mice with subcutaneous tumours received at a tumour volume of 120-200 mm3 either single dose, single agent chemotherapy with 350 mg/kg ifosfamide, 200 mg/kg dacarbazine, 10 mg/kg doxorubicin, 6.6 mg/kg cisplatin, or 24 Gy local tumour irradiation under acutely hypoxic conditions from a cobalt-60 source. Tumour response to radiotherapy and chemotherapy was measured as specific growth delay (SGD). RESULTS: A significant correlation was found between SGD after radiotherapy and SGD after decarbazine (P < 0.001) and doxorubicin (P = 0.05), whereas no correlation could be demonstrated for cisplatin. For ifosfamide, the correlation reached borderline significance. The maximal response to any of the four tested chemotherapeutic drugs correlated very well with the response to radiotherapy (P < 0.001). CONCLUSION: The results suggest that radiation sensitivity and chemosensitivity are not independent properties of soft tissue sarcoma cell lines.

Animals↗
PubMed1997

Temporary tracheobronchial stenting in malignant stenoses.

Endobronchial stent implantation has been successfully employed in malignant stenoses. The aim of this prospective study was to investigate the temporary use of tracheobronchial stents combined with tumour-specific therapy. All patients received stents for primary palliation of dyspnoea followed by radio- or chemotherapy with the aim of stent removal after reduction of the stenosis. In 22 patients suffering from severe malignant strictures, 34 endobronchial stents (29 Strecker-, 3 Dumon-, 1 Orlowski-, 1 Dynamic-Y-stents) were implanted (in 9 patients, 2 stents were necessary). Patients were treated by irradiation (n = 18) or chemotherapy (n = 4) after stent implantation. Significant improvement of dyspnoea (P < 0.001) and partial oxygen pressure (P < 0.01) was observed. In 11 out of 22 cases (50%), the stents could be removed after successful tumour-specific therapy which led to reduction of stenosis after a mean interval of 31.7 (6-104) days (temporary stenting). During the period of tumour-specific therapy, 9 patients died after a mean interval of 132 (13-347) days (definite stenting). In two cases, stents had to be removed after stent compression, stent dislocation and severe cough. The results suggest that temporary stenting, characterised by subsequent successful tumour-specific therapy, is a new valuable therapeutic strategy. It can "bridge the gap" before tumour-specific therapy can take effect. If tumour-specific therapy is ineffective, definite stenting is the palliative method of choice in severe dyspnoea in bronchial carcinoma.

Adult↗
PubMed1997

Chemo-radiotherapy for locally advanced head and neck cancer--long-term results of a phase II trial.

The feasibility and effectiveness of a combined chemo-radiotherapy treatment modality for locally advanced head and neck cancer was tested in a phase II trial. Between 1990 and 1993, 74 patients (20 female/54 male) with head and neck cancer stage III (n = 12) and IV (n = 62) were treated with accelerated radiotherapy (72 Gy) and simultaneous chemotherapy (5-FU, folinic acid, mitomycin C). The median follow-up time was 43 months (1-72). Complete remission (CR) was absent in 76% (56/74) of patients and, after subsequent resection of residual lymph nodes, another 8 patients achieved CR. The cumulative local control rate was 72% and disease-specific survival rate was 59% at 4 years. Two patients died with treatment-related conditions (pancytopenia, larynx oedema). By multivariate analysis, only lymph node status was an independent parameter for local control (P = 0.04). This treatment was feasible and toxicity was not a treatment-limiting factor. As a consequence, a German multicentre phase III trial was initiated in 1995.

Adult↗
PubMed1997

High-dose rate iridium192 afterloading therapy in combination with external beam irradiation for localized prostate cancer.

Development of afterloading techniques in combination with external radiotherapy allows for curative therapy modality for stage C prostate cancer. Between 10/92 and 12/95 128 patients were treated. Stage B and C tumors were found in 36 and 89 cases, respectively. All patients were pathologically proven to be node-negative by laparoscopic node dissection of the fossa obturatoria region. 9 Gy a week was applied during the first and second weeks of treatment (10/92-12/93: 10 Gy each week) interstitially with high-dose rate iridium192 brachytherapy to the prostate. After this, a four-field box of external beam radiation therapy was given to the prostate to a dose of 45 Gy/25 fractions (10/92-12/93: 40 Gy/20 fractions). Before starting treatment median PSA was 13.8 ng/ml. The median PSA 3, 12, and 24 months after completion of therapy was 1.2, 0.78, and 0.75 ng/ml, respectively. Negative biopsies 12 and 24 months after therapy were observed in 56% (49/87) and 72% (31/43), respectively.

Adenocarcinoma↗
PubMed1996

Preoperative and postoperative radiotherapy in rectal carcinoma.

Surgery is the initial treatment of choice for most patients with rectal neoplasms. The objectives are to remove of tumor and drain the primary nodes. In stage I disease the surgical approach is though to be sufficiently effective. However, at least in the case of abdominoperineal resection, this causes considerable morbidity. Therefore, at the present time, there are efforts to reduce the extent of the resection by applying other treatment modalities in stage I disease. After curative resection in stage II/III disease a considerable number of patients suffer from local recurrence or distant metastases. In these patients adjuvant therapy is currently recommended. In locally advanced disease, primary resection is not feasible. Different treatment settings which apply combinations of all treatment modalities are possible. The article reviews the literature and shows future directions.

Combined Modality Therapy↗
PubMed1996

Results of radiotherapy for 230 patients with stage I-II seminomas.

PURPOSE: The outcome of treatment of testicular seminoma in 230 patients with stage I and II disease was retrospectively evaluated in regard of survival, pattern of failure, radiation dose, treatment volume, acute and chronic side effects. PATIENTS AND METHODS: From 1978 to 1992, 230 male patients with the diagnosis of pure seminoma of the testis were treated by postoperative radiotherapy at the University of Essen. According to the Royal Marsden Staging System, 188 patients were presenting with stage I disease, 24 with stage IIA, 13 with stage IIB and 5 with stage IIC disease. All patients received irradiation to the paraaortic lymph nodes (median dose: 36 Gy). In 154 patients the ipsilateral iliac lymph nodes were additionally irradiated with or without inguinal lymph nodes and in 66 patients the contralateral pelvic nodes were included. Since 1987, the total dose was reduced to 26 Gy for microscopic disease. A mediastinal irradiation (median dose: 30 Gy) was performed in 22 patients. Eight patients with stage IIB and IIC disease were additionally treated with chemotherapy. RESULTS: Overall actuarial survival (Kaplan-Meier method) for all patients was 97.8% at 5 years and 96.5% at 10 years. Ten-year survival corrected for intercurrent mortality (n = 8) was 100%. In 5 patients recurrent disease (n = 5) was observed, in 6 patients seminoma occurred in the contralateral testis. For stage I seminoma the disease-free survival was 96.8%. For the whole group of stage II seminoma the DFS was 88.1%, for stage IIA 91.7% and for stage IIB 76.9%. In stage IIC no recurrences occurred. In general, the radiation therapy was well tolerated with minor side effects only. CONCLUSIONS: Postoperative radiotherapy for seminoma stage I, IIA and IIB alone offers excellent control and survival rates with tolerable side effects.

Adult↗