Angelika Rahn

Stellenwert der18F-Fluordeoxyglucose-Positronen-emissionstomographie in der Radiotherapieplanung von Kopf-Hals-Tumoren

ZusammenfassungHintergrundEine exakte Ausbreitungsdiagnostik ist Voraussetzung für die individualisierte Bestrahlungsplanung bei Patienten mit Kopf-Hals-Tumoren. Trotz hoher Zuverlässigkeit der in der Routine eingesetzten Verfahren Computer-und Kernspintomographie ist die sichere Diagnostik eines lymphonodalen Tumorbefalls oft nicht möglich. Wir untersuchten im Rahmen einer Studie, ob die zusätzliche Durchführung einer18F-Fluordeoxyglucose-Positronenemissionstomographie (FDG-PET) hier einen für die Radiotherapieplanung relevanten Informationsgewinn erbringt.Patienten und MethodeUntersucht wurden Daten von 34 Patienten mit Plattenepitheltumoren der HNO-Region, bei denen im Rahmen des Staging vor Radiotherapieplanung zusätzlich zu Sonographie, MRT, CT und Panendoskopie eine FDG-PET durchgeführt wurde. Ausgewertet wurde, wie häufig und in welchem Ausmaß das Ergebnis der PET eine Änderung des geplanten Bestrahlungsfeldes bzw. des Behandlungskonzeptes erforderte.ErgebnisseBei 7/12 der Rezidive und 9/22 der Primärtumoren wurde durch die FDG-PET ein konventionell nicht festgestellter Tumorbefall diagnostiziert. In allen Fällen war eine Änderung des Therapiekonzeptes oder des Bestrahlungsvolumens erforderlich. Überdurchschnittlich häufig waren therapierelevante PET-Befunde bei Rezidivtumoren, großen Primärtumoren (T3 und T4) und bei Primärtumoren mit ausgedehntem Lymphknotenbefall (N2 und N3).SchlußfolgerungBesonders bei Rezidivtumoren und fortgeschrittenen Kopf-Hals-Tumoren erbringt die FDG-PET einen Gewinn an diagnostischer Information für die Radiotherapieplanung. Bei dieser Patientengruppe sowie bei unklarer Befundlage sollte die FDG-PET als zusätzliches diagnostisches Verfahren im prätherapeutischen Staging vor der Entscheidung über Therapiestrategie und Bestrahlungsplanung hinzugezogen werden.AbstractPurposeAn individualized radiation treatment planning in patients with head and neck tumors requires an exact definition of tumorspread. Despite of high reliability of methods like computed tomography, sonography or magnetic resonance imaging used in daily routine, the correct diagnosis of lymphonodal tumor infiltration is often not possible. In a prospective trial, we examined whether an additional FDG-PET gives a relevant gain of information for radiation treatment planning.Patients and MethodsWe studied data of 34 patients with histologically confirmed squamous cell carcinoma of the head and neck who received a FDG-PET prior to treatment planning additionally to conventional staging procedures. The extent of changes of treatment strategy or target volume due to additional FDG-PET finding were analyzed.ResultsIn 9/22 of patients with primary tumors and in 7/12 of patients with recurrent disease, FDG-PET detected additional tumor manifestations. In all cases, changes of treatment strategy or target volume were necessary. Regarding patients with primary tumors, the percentage of treatment modifications was highest in patients with large tumors (T3 and T4) and patients with advanced lymph node involvement (N2 and N3).ConclusionsEspecially in patients with recurrent disease and patients with advanced tumor stages, FDG-PET is able to give clinically relevant information compared to conventional staging procedures. Therefore, in these group of patients a FDG-PET study prior to radiotherapy planning should be considered.PURPOSE An individualized radiation treatment planning in patients with head and neck tumors requires an exact definition of tumorspread. Despite of high reliability of methods like computed tomography, sonography or magnetic resonance imaging used in daily routine, the correct diagnosis of lymphonodal tumor infiltration is often not possible. In a prospective trial, we examined whether an additional FDG-PET gives a relevant gain of information for radiation treatment planning. PATIENTS AND METHODS We studied data of 34 patients with histologically confirmed squamous cell carcinoma of the head and neck who received a FDG-PET prior to treatment planning additionally to conventional staging procedures. The extent of changes of treatment strategy or target volume due to additional FDG-PET findings were analyzed. RESULTS In 9/22 of patients with primary tumors and in 7/12 of patients with recurrent disease, FDG-PET detected additional tumor manifestations. In all cases, changes of treatment strategy or target volume were necessary. Regarding patients with primary tumors, the percentage of treatment modifications was highest in patients with large tumors (T3 and T4) and patients with advanced lymph node involvement (N2 and N3). CONCLUSIONS Especially in patients with recurrent disease and patients with advanced tumor stages, FDG-PET is able to give clinically relevant information compared to conventional staging procedures. Therefore, in these group of patients a FDG-PET study prior to radiotherapy planning should be considered.

Improving dose homogeneity in large breasts by IMRT: efficacy and dosimetric accuracy of different techniques.

Purpose:Evaluation of a simplified intensity-modulated irradiation (IMRT), a three-field (MFT), and a conventional two-tangential-field technique regarding dose homogeneity, target coverage, feasibility and, for the first time, dosimetric reliability in patients with large breasts treated postoperatively for breast cancer on a low-energy linac.Material and Methods:CT datasets of ten patients with relatively large breast volumes treated for breast cancer were selected. For each patient, four treatment plans were created: low-energy conventional (C-LE), high-energy conventional (C-HE), three-field (MFT), and a two-field aperture-based IMRT technique. Apertures for the IMRT and MFT were created with the aid of a three-dimensional dose display. Dosimetric accuracy of each technique was evaluated in an anthropomorphic thorax/breast phantom.Results:The mean of planning target volumes receiving < 95% or > 105% of the prescribed total dose was reduced from 16.0% to 13.9% to 10.4% to 8.9% in the C-LE, C-HE, MFT, and IMRT plans, respectively. Phantom dose measurements agreed well with the calculated dose within the breast tissue.Conclusion:Aperture-based IMRT using two tangential incident beam directions, as well as a three-field technique with inverse optimization, provide a better alternative to the standard wedged tangential beams for patients with large breasts treated on low-energy linacs while maintaining the efficiency of the treatment-planning and delivery process.Ziel:Evaluation einer einfachen tangentialen intensitätsmodulierten Bestrahlungs-(IMRT-)Technik, einer Drei-Felder-Technik (MFT) und der konventionellen tangentialen Technik im Hinblick auf Dosishomogenität, Erfassung des Zielvolumens, Durchführbarkeit und – erstmalig – dosimetrische Reproduzierbarkeit bei der postoperativen Mammabestrahlung von Patientinnen mit großem Mammavolumen an einem Linac mit niedriger Energie.Material und Methodik:CT-Datensätze von zehn Patientinnen mit relativ großem Mammavolumen, bei denen eine postoperative Radiotherapie wegen Mammakarzinoms durchgeführt worden war, wurden für diese Untersuchung verwendet. Für jede Patientin wurden vier Bestrahlungspläne generiert: Niedrigenergie konventionell (C-LE), Hochenergie konventionell (C-HE), Drei-Felder-Plan (MFT) und eine aperturbasierte Zwei-Felder-IMRT-Technik. Aperturen (Segmente) für die IMRT und MFT wurden mit Hilfe eines dreidimensionalen Dosisdisplays generiert. Die dosimetrische Reproduzierbarkeit der generierten Pläne wurde in einem anthropomorphen Thorax/Mamma-Phantom evaluiert.Ergebnisse:Das mittlere Volumen des Planungszielvolumens, das < 95% oder > 105% der Verschreibungsdosis erhielt, wurde von 16,0% (C-LE) auf 13,9% (C-HE) auf 10,4% (MFT) bzw. 8,9% (IMRT) reduziert. Die gemessene Dosis stimmte für alle Pläne im Bereich der Mamma gut mit der berechneten Dosis überein.Schlussfolgerung:Die aperturbasierte IMRT mit zwei tangentialen Primäreinstrahlrichtungen und die Drei-Felder-Technik mit inverser Optimierung verbessern die Planqualität bei der postoperativen Bestrahlung voluminöser Mammae an Linacs mit niedriger Energie bei hervorragender Behandlungsökonomie.

Influence of irradiation on therapy-associated psychological distress in breast carcinoma patients

PURPOSE To confirm our assumptions regarding factors that apparently cause psychological distress related to adjuvant radiotherapy in breast cancer patients and to evaluate variables that can predict therapy-associated distress. METHODS AND MATERIALS Between January 1997 and April 1998, 111 women (33-84 years) with early-stage breast cancer were irradiated (56 Gy) after breast-conserving surgery. Patients were given self-assessment questionnaires on the first and last day of radiotherapy. Statistical analysis was performed using the structural equation model LISREL, variance analysis, and regression analysis. RESULTS The internal subject-related factors (coping, radiation-related anxiety, physical distress, psychological distress) reciprocally influenced each other, whereas external radiotherapy-specific factors (environmental influence, confidence in the medical staff) were causally related to coping, anxiety, and distress. Fifty-three percent of the women felt distressed because cancer affected the breast; 48% were initially afraid of radiotherapy. For 36%, anxiety was not reduced during treatment. Highly distressed women were identified by the following parameters: < or =58 years; initial anxiety; they were affected by having breast cancer, were negatively affected by environmental factors, and did not find distraction helpful. CONCLUSION Despite considerable individual variability in breast cancer patients, it seems possible to identify women who run a high risk of therapy-associated distress. In these patients, psychosocial support is necessary to reduce treatment-related anxiety and to stabilize confidence in the medical staff.

VerstÄrkung der radiotherapeutischen wirkung auf HeLa-Zellen durch gemcitabine

HintergrundDas difluorierte Deoxycytidinderivat Gemcitabine (dFdC) ist ein neues Nukleosidanalogon, das in vivo und in vitro bei soliden Tumoren zytotoxisch wirkt. In Untersuchungen mit Pankreas- und Kolonkarzinomzellinien wurde ein radiosensibilisierender Effekt von dFdC beschrieben. Ziel unserer Untersuchung war die überprüfung dieses Effekts an Plattenepithelkarzinomzellen der Zervix (HeLa-Zellen, ATCC CCL-2).Material und MethodenUnter standardisierten Bedingungen wurden HeLa-Zellen in Monolayer-Kulturen mit dFdC in unterschiedlicher Konzentration (0,003, 0,01 und 0,03 umol/1) und Expositionszeit (vier bis 24 Stunden) inkubiert. Die nachfolgende Bestrahlung erfolgte mit 2 bis 6 Gy unmittelbar bzw. zwölf Stunden nach durchgeführter Gemcitabine-Exposition. Das Zellüberleben wurde im Koloniebildungstest evaluiert. Die Zeilüberlebenskurven wurden nach Korrektur der chemotherapeutischen ZytotoxizitÄt unter Anwendung des linearquadratischen Modells erstellt, um die mittlere Inaktivierungsdosis (MID) berechnen zu können. Eine RadiotherapieverstÄrkung war definiert als VerhÄltnis MIDRT(=Kontrolle)/MIDRT+dFdc > 1.ErgebnisseNach vier-bzw. achtstündiger Gemcitabine-Exposition und unmittelbar nachfolgender Bestrahlung errechnet sich bei einer dFdC-Dosis von 0,01 und 0,03 Μmol/l eine VerstÄrkung der radiotherapeutischen Wirkung um den Faktor 1,07 und 1,14 bzw. 1,04 und 1,22. Bei einer 16-bzw. 24stündigen dFdC-Exposition zeigt sich eine weitere Steigerung des Bestrahlungseffekts bereits für dFdC-Konzentrationen von > - 0,003 bis 0,03 umol/1 (Faktor 1,08 bis 2,0 bzw. 1,08 bis 2,48). Wird erst zwölf Stunden nach einer 24stündigen dFdC-Exposition (0,01 bzw. 0,03 umol/1) bestrahlt, betrÄgt der VerstÄrkungsfaktor 1,18 bzw. 1,7.Schlu\folgerungenDie In-vitro-Untersuchungen an HeLa-Zellen weisen dFdC als potenten Radiosensitizer aus. Die Wirkung der auf die Gemcitabine-Exposition nachfolgenden Radiotherapie wird durch die nicht bzw. kaum zytotoxischen dFdC-Konzentrationen dosis- und zeitabhÄngig verstÄrkt.AbstractBackgroundGemcitabine (21).21-difluorodeoxycytidine; dFdC) is a new nucleoside analog with promising activity in different solid tumors in vivo and in vitro. As published up to now, combined with irradiation dFdC demonstrates a radio-sensitizing effect on pancreas and colon carcinoma cell lines. We investigated the influence of dFdC on the radiosensitization of human squamous carcinoma cells of the cervix (HeLa-cells, ATCC CCL-2).Material and MethodsUnder standardized conditions monolayer cultures of HeLa-cells were incubated in medium with dFdC for different times (4 to 24 hours) and exposed to different concentrations (0.003, 0.01 and 0.03 umol/1). Irradiation (2 to 6 Gy, electron beam) followed immediately or 12 hours after dFdC-exposure. Cell survival was determined by colony forming assay. Using the linear-quadratic model cell survival curves were fit after correction for drug-induced cytotoxicity and the mean inactivation dose (MID) was calculated. Radiation enhancement was defined as the ratio MIDRT(=Control)/MIDRT+dFdC > 1.ResultsExposed to gemcitabine for 4 and 8 hours and followed by immediate irradiation the radiation enhancement ratio (Table 1) is 1.07 to 1.14 and 1.04 to 1.22, respectively, if dFdC concentration is > 0.01 to 0.03 umol/1. Further increase of the irradiation effect is demonstrated in cells exposed to > 0.003 to 0.03 imol/l dFdC for 16 and 24 hours (radiation enhancement ratio 1.08 to 2.0 and 1.08 to 2.48, respectively) (Figure 3). If irradiation is applied 12 hours after 24-hour-exposure (0.01 and 0.03 umol/1) the enhancement ratio was 1.18 and 1.7, respectively (Figure 4).ConclusionsIn cell cultures the assays combining irradiation with dFdC demonstrate that dFdC is a potent radiation sensitizer of HeLa-cells. The effect of irradiation on cells pre-treated with non- and hardly cytotoxic concentrations of dFdC is increased in dependence of dose and time of exposure.

Radiation enhancement by gemcitabine-mediated cell cycle modulations.

The purpose of this study was to investigate the exact dose dependency and time dependency of the radiation-enhancing effect of gemcitabine (2′,2′difluoro desoxycytidine [dFdC]) in in vitro experiments (HeLa cells: cancer of the uterine cervix, #4197 cells: oropharyngeal squamous cell carcinoma), and to correlate this effect with the underlying changes in cell cycle distribution. Cell viability was determined fluorometrically after exposure to dFdC (0–20.0 &mgr;mol/l), irradiation (0–37.5 Gy), and both modalities. Combining both therapies, cells were exposed to dFdC (0–10.0 &mgr;mol/l) for 24 hours before further treatment and irradiated (0–30 Gy) immediately afterwards with or without removal of dFdC. For cell cycle analysis by flow cytometry, cells were irradiated (0–40 Gy) or treated with dFdC (0.012–1.0 &mgr;mol/l, 24–48 hours). Additionally, cells were exposed to dFdC (2.0 &mgr;mol/l, 0–4 hours). Cell cycle kinetics were evaluated using bromodeoxyuridine (BrdU) (10 &mgr;mol/l) S-phase labeling, given either 30 minutes before or in the last hour of dFdC treatment (2.0 &mgr;mol/l, 0–6 hours). The fluorometric assay revealed that dFdC enhances radiation-induced cytotoxicity at marginally toxic or nontoxic concentrations (<37 nmol/l). Radiation resulted in the anticipated G2/M arrest already at 2 Gy. DFdC induced concentration and exposure time-dependent cell cycle changes that were better resolved using BrdU, demonstrating a pronounced S-phase arrest already at 12 nmol/l. BrdU-pulse labeling revealed that the cell cycle block occurred at the G1/S boundary. Our data reconfirm the already known radiation enhancement, the S-phase specific activities of dFdC, and the relevance of the synchronized progression of cells through the S-phase with regard to the radiosensitizing properties of low-dose dFdC. However, we could demonstrate that before progressing in the S-phase, cells were blocked and partially synchronized at the more radiosensitive G1/S boundary. Furthermore, cells progressing past the block might accumulate proapoptotic signals caused by both radiation and dFdC, which will also results in cell death.

Einfluß der adjuvanten radiotherapie auf das psychische befinden von patientinnen mit einem brusterhaltend operierten mammakarzinom

ZusammenfassungHintergrundIn der Literatur finden sich wenig Informationen über den Einfluß der adjuvanten postoperativen Radiotherapie auf die psychische Belastung brusterhaltend operierter Brustkrebspatientinnen. In der täglichen Praxis kann jedoch Sorge und Angst im Zusammenhang mit der Bestrahlung beobachtet werden. Ziel unserer Untersuchung war es, den allgemeinen und den situationsspezifischen Einfluß der Radiotherapie auf das psychische Befinden der Patientinnen zu evaluieren.Patienten und MethodeZwischen Oktober 1995 und Juni 1996 wurde bei 48 Frauen (Alter: 31 bis 76 Jahre) eine postoperative Radiotherapie mit oder ohne Chemo-/Hormontherapie durchgeführt. Die Patientinnen erhielten am ersten und letzten Behandlungstag einen mit Psychologen erarbeiteten Fragebogen. Dieser erfaßt unterschiedliche Situationsvariablen, wobei sich die Konstruktion der Items an Faktoren orientierte, die einen möglichen Einfluß auf Belastungen und Empfindungen im Zusammenhang mit der Radiotherapie haben.ErgebnisseNahezu alle Frauen (92%) fühlten sich über die Radiotherapie gut aufgeklärt und bemühten sich aktiv um zusätzliche Information (83%). Andererseits versuchten 56%, nicht an die Bestrahlung zu denken und/oder sich abzulenken (81%). Angst vor der Radiotherapie äußerten 40%. Am Ende der Behandlung gaben 77% an, nur anfänglich bzw. nie Angst gehabt zu haben; 19% hatten meist/immer Angst. 35% sorgten sich um das kosmetische Resultat; nur 30% beobachteten letztlich radiogene Änderungen im ästhetischen Erscheinungsbild. Der Kontakt zum medizinischen Personal erleichterte es allen Patientinnen, die Radiotherapie durchzustehen (100%).SchlußfolgerungenTrotz theoretischer Vorüberlegungen haben unsere Ergebnisse einen eher explorativen Charakter. Folgende Punkte erscheinen jedoch bedeutsam: 1. Es besteht ein großes Informationsbedürfnis über die Radiotherapie. 2. Die Erfahrungen mit der Bestrahlung waren für die Patientinnen positiver als anfänglich von ihnen erwartet. 3. Situationsbedingte Ängste verringerten sich im Verlauf der Behandlung, wobei sich die psychosoziale Betreuung durch das medizinische Personal als wichtiger angstreduzierender Faktor herausstellen läßt.AbstractBackgroundIn literature there are only few informations about the influence of postoperative irradiation on the psychological health of breast cancer patients treated by breast conserving surgery. However, psychological distress and anxiety related to irradiation are often observed. Purpose of our study was the evaluation of the influence of radiotherapy-induced distress in these patients.Patients and MethodsBetween October 1995 and June 1996 in 48 breast cancer patients (31 to 76 years old) treated by breast conserving surgery adjuvant irradiation with or without systemic therapy was applicated. On the first and the last day of radiotherapy they were given a questionnaire (Table 1) which was designed together with psychologists. Covering different situations related to radiotherapy the construction of items are determined by factors with possible influence on psychological distress and perception with regard to irradiation.ResultsMost of the women (92%) stated to be well informed about the irradiation and tried to obtain further information about this treatment (83%). 56% tried not to think about radiotherapy and/or to distract themselves (81%). 40% were anxious about the fact to undergo irradiation. In the end of treatment 77% reported to have been anxious only initially or never; only 19% were anxious almost or most of the time. 35% were worried about the expected cosmetic alterations of their breast; only 30% observed acute cosmetic changes. With regard to situation-related distress all patients (100%) stated that the communication with the medical staff made it easier to stand the irradiation treatment.ConclusionsIn spite of theoretical considerations our results are explorative in character. However, following statements seem to be important: 1. A large requirement exists to get information about radiotherapy. 2. The patients experience irradiation treatment more positive than initially expected by themselves. 3. With regard to radiotherapy anxiety is reduced during the course of treatment. Here the psychosocial care of the medical staff is an important support for reduction of anxiety.BACKGROUND In literature there are only few informations about the influence of postoperative irradiation on the psychological health of breast cancer patients treated by breast-conserving surgery. However, psychological distress and anxiety related to irradiation are often observed. Purpose of our study was the evaluation of the influence of radiotherapy-induced distress in these patients. PATIENTS AND METHODS Between October 1995 and June 1996 in 48 breast cancer patients (31 to 76 years old) treated by breast-conserving surgery adjuvant irradiation with or without systemic therapy was applied. On the first and the last day of radiotherapy they were given a questionnaire (Table 1) which was designed together with psychologists. Covering different situations related to radiotherapy the construction of items are determined by factors with possible influence on psychological distress and perception with regard to irradiation. RESULTS Most of the women (92%) stated to be well informed about the irradiation and tried to obtain further information about this treatment (83%). 56% tried not to think about radiotherapy and/or to distract themselves (81%). 40% were anxious about the fact to undergo irradiation. In the end of treatment 77% reported to have been anxious only initially or never; only 19% were anxious almost or most of the time. 35% were worried about the expected cosmetic alterations of their breast; only 30% observed acute cosmetic changes. With regard to situation-related distress all patients (100%) stated that the communication with the medical staff made it easier to stand the irradiation treatment. CONCLUSIONS In spite of theoretical considerations our results are explorative in character. However, following statements seem to be important: 1. A large requirement exists to get information about radiotherapy. 2. The patients experience irradiation treatment more positive than initially expected by themselves. 3. With regard to radiotherapy anxiety is reduced during the course of treatment. Here the psychosocial care of the medical staff is an important support for reduction of anxiety.

Palliative Radiochemotherapie mit Bendamustin bei fortgeschrittenen Tumorrezidiven im HNO-Bereich

Hintergrund: Bei Tumorrezidiven im HNO-Bereich sind die therapeutischen Möglichkeiten durch intensive Vortherapie und durch den Allgemeinzustand der Patienten eingeschränkt. In der palliativen Situation erfordern schmerztherapeutische, kosmetische und pflegerische Probleme eine Behandlung, die bei der limitierten Gesamtprognose dem betroffenen Patienten im Hinblick auf Benefit, Behandlungsdauer und Nebenwirkungsprofil gerecht werden muss. Überprüft werden sollte die Wirksamkeit und Durchführbarkeit eines palliativen Radiochemotherapiekonzepts. Patienten und Methodik: Behandelt wurden 14 Patienten mit Plattenepitheltumorrezidiven im Kopf-Hals-Bereich (13 Männer, eine Frau). Das mittlere Alter lag bei 56,1 Jahren (Altersspanne 42–76 Jahre). Vortherapie: Radiatio n = 14 (42–71,3 Gy), Operation n = 10, Chemotherapie n = 13. Behandelt wurde mit 100–150 mg Bendamustin pro m2 Körperoberfläche (Tag 1 und 2) sowie 15 Gy Radiation (3 Gy/d, Tag 1–5). Erfasst wurden Nebenwirkungen, Remissionsstatus und -dauer, Symptomkontrolle und Überlebenszeit. Ergebnis: Ansprechen: komplette Remission n = 4, partielle Remission n = 10, deutliche Besserung von 70% der Tumorsymptome. Die Zeit bis zum erneuten Progress betrug 2–104 Wochen. Aufgetretene Nebenwirkungen: Toxizität CTC-Grad 3 und 4 bei zwei Patienten (14%). Schlussfolgerung: Das vorgestellt Therapieschema ermöglicht auch bei intensiv vorbehandelten Patienten mit fortgeschrittenen inkurablen Tumorrezidiven eine wirkungsvolle palliative Intervention. Das Nebenwirkungsprofil ist günstig und erlaubt auch eine Behandlung von Patienten mit reduziertem Allgemeinzustand.Background: In case of recurrent carcinoma of the head and neck region therapeutic options are often limited due to intensive prior therapy and/or reduced physical condition of the patient. Nevertheless there is a need for palliative treatment to control symptoms like pain, obstruction of the airways, dysphagia and for hygienic and cosmetic reasons. Side effects, treatment time and achievable results have to be adjusted to the needs of this patient subgroup. Patients and Method: 14 patients (13 male, one female) with recurrent squamous cell carcinoma of the head and neck region were studied. Average age was 56.1 years (range 42–76 years) (Table 1). Prior therapy: radiotherapy n = 14 (42–71.3 Gy), surgery: n = 10, chemotherapy: n = 13 (Table 2). Our patients received 100–150 mg/m2 Bendamustin iv. (day 1 and 2) and involved field irradiation 15 Gy (daily dose 3 Gy, day 1–5) (Figure 1). Remission status, time to progression, side effects and survival were documented. Results: Ten patients showed partial remissions, four patients had complete remissions of the treated lesion (Figure 2), amelioration of 70% of tumor symptoms was documented (Figure 3). Time to progression was 2–104 weeks. Side effects: 71% of patients had no significant side effects, CTC Grade 3 to 4 toxicity was seen in two patients (14%). Conclusion: The reported therapy regimen allows successful palliative treatment of intensively pretreated patients with progressive recurrent tumors of the head and neck. Side effects are tolerable even in patients with reduced physical condition.

Klinische und pharmakokinetische Ergebnisse intrapleuraler Epirubicin-Applikation

Eine 71j~ihrige, abladierte und chemotherapierte Patientin mit linksseitigem, invasiv-duktalem Mammakarzinom (Stadium pT2 pN1 cM0, G3) sollte wegen diffuser oss~irer Metastasierung und Thoraxwandrezidiv sowie Lymphangiosis carcinomatosa pulmonum nach dem EC-Protokoll (Epirubicin, Cyclophosphamid [1, 2]) behandelt werden. Ein subkutanes, intraven0ses Infusionssystem (ChemoSite| war in die rechte Vena cephalica implantiert und r6ntgenologisch kontrolliert worden.

190 TLD-measurements of the increase of surface dose due to wound dressings during percutaneous irradiation

Objective Since any prolongation of overall radiotherapy time mayaffect the outcome of treatment, skin protection promises to improve the results of percutaneous irradiation. Different non-irritant dressing materials have been tested in the treatment of radio induced skin lesions. However, the increase of skin dose caused by wound dressings may enhance skin reaction. Therefore we measured the dose due to different wound dressings. Material and methods Dose increase at the skin covered by wound dressings was measured during therapeutic irradiation. The investigated materials were a silicon-coated polyamide net (Mepitel, Molnlycke), a hydrocolloid dressing (Varihesive, Merck&Co.) and an alginate dressing (Kaltostat, Convatec). Measurements were carried out by thermoluminescent dosimetry during irradiation with electrons (5 MeV to 40 MeV) and photons (6MV and Co60). Results Dose increase depended on quality and energy of beam and on the beam arrangement. For electrons absolute values at the surface were relatively high for all materials (85–96%), but there was only a small dose increase (5–10% compared to uncovered skin). For photons dose increase depended also on the material. The lowest dose increase was measured for Mepitel, the thinnest coating. During irradiation with a single stationary field perpendicularly to the skin dose values of 32% (6MV) and 43% (Co) related to the maximum dose and a dose increase of 39% and 65% were measured. For tangential fields (e.g. irradiation of the breast, head and neck) absolute dose values were higher (up to 60% (6MV) and 75% (Co)), but dose increase was much lower (up to 20%). The other coatings caused dose increase up to 156% related to the uncovered skin. Dose values of 85% of the maximum dose (Co) are possible. Conclusions Wound dressings need not be removed during irradiation with electrons, thin dressings like Mepitel need not be removed during irradiation with photons, but thicker coatings like Varihesive or Kaltostat should be taken away during photon therapy.