[New method of radiotherapy of lung neoplasms - radiotherapy with inhalation of 95% oxygen plus 5% carbon dioxide].
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The authors report the clinical and histopathologic factors of oral candidiasis in patients treated with irradiation for head and neck cancer and predisposing antimycotic related treatments.
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Combined radiotherapy of patients with cervical carcinoma of stages IIb and IIIb was conducted. Hypoxia (8.0-8.5% of O2 in the respiratory mixture) was used in microfractionated (2 Gy) irradiation of metastatic spreading zones. When irradiating under conditions of hypoxia, the number of fractions was brought up to 28 as compared to 20 in control. Despite a 40%-increase of the dose, seriousness of radiation reactions and remote injuries remained at the same level. It is found that patients endure well the respiratory mixture for 6 min. necessary for irradiation.
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Radiotherapy--predominantly with soft x-rays--is, besides plastic surgery and cryosurgery, suitable for the treatment of facial malignancies for which operation would be undesirable in consideration of tumour size and the patient's general health, age and internal diseases. Operation should be preferred for smaller tumours that can be operated on with primary wound closure; tumours that grow into the mouth angle or into the cartilaginous folds of the ear; for patients under 50 years of age; for facial malignancies that have already caused a defect; for patients with nevoid basal cell epithelioma syndrome or xeroderma pigmentosum; for melanomas and sarcomas (except lentigo maligna). Optimal results are achieved by exact limitation of the irradiated area (with a safety margin) and a ray hardness that corresponds to the individual tumour thickness. Due to mechanical irritation, unusually high sun exposure, allergies, pyodermas and local treatment with corticosteroids ulceration may develop in the radioderma remaining after radiotherapy. Radiation-induced tumours occurring in radiodermas are extremely rare if irradiation was applied for a facial malignancy according to the rules and after the 50th year of age.
Long-term observations were made for the development of secondary neoplasms following radiotherapy of animal tumors. Experimental tumors were 3rd generation isotransplants of a mammary carcinoma which arose spontaneously in a C3Hf/He mouse. A single dose of TCD20-TCD98 was followed by weekly observations. Most recurrences were observed in the first 150 days, while only a few were seen in the subsequent 150 days. Secondary neoplasms developed frequently following this period, i.e., 41 out of 67 animals surviving more than 300 days developed secondary neoplasms. They were osteogenic and soft tissue sarcomas, and half the new tumors were found within 490 days after radiotherapy. The results obtained were compared with literature reports of secondary neoplasms following postoperative radiotherapy for carcinoma of the breast and treatment of retinoblastomas. Most of these secondary human neoplasms were nonepithelial sarcomas as in the present study. Secondary carcinomas have been reported following radiotherapy of carcinoma in other locations, i.e., the cervix or head and neck; however, only a limited number of studies have been reported.
Neoplasm therapy is restricted by the haematological side effects of tumour-destructive therapy, requiring expensive supportive care to some extent to overcome and treat leucopenia and its consequences. An effective and very cost-effective alternative for treating neutropenia is to administer lithium carbonate. Lithium leads to a release of hematopoietic growth factors (CSF) and therefore to proliferation of neutrophil granulocytes. Normally, recombinant CSF is only administered when there are indications of severe neutropenia because of the high costs involved, all the more evident in the long-term treatment of persistent leucocytopenia. On the other hand, CSF and leucocytes play an essential role in tumour immunology and with regard to response rates to cytostatic drugs. Lithium salts have shown that they can increase the number of neutrophil granulocytes quite significantly and, to a lesser extent, the number of eosinophil granulocytes and lymphocytes as well. The average number of erythrocytes does not change significantly. Patient tolerability to lithium carbonate therapy is very good. It can be used to treat patients with chronic leucopenia following chemotherapy or radiotherapy extremely cost-effectively. Unfortunately this treatment has not won acceptance in clinical oncology in the face of highly cost-intensive treatment with recombinant CSF.