Hermann Frommhold

Combined Cis-Platinum and Radiation Therapy in Patients with Stages PT3 and PT4 Bladder Cancer: A Pilot Study

A prospective study was done on 8 patients with advanced transitional cell carcinoma of the bladder to evaluate toxicity of an integrated treatment with cis-diamminedichloroplatinum (1.6 mg. per kg. body weight 3 times weekly) and 60 gray 60cobalt or 18 mev. photons. Local and systemic toxicity caused by this treatment schedule was minor. Late sequelae consisted of a contracted bladder in 1 patient. The rate of bladders free of tumor after a mean followup of 7.7 months was surprisingly high (6 of 8).

Multimodal therapy of small cell lung cancer in TNM stages I through IIIa

Since 1977, Innsbruck University Hospital has been employing a multimodal therapy concept for small cell bronchial carcinomas in stages I to IIIa. This concept includes all three treatment forms effective in this tumor, namely, chemotherapy, surgery, and radiotherapy. The therapy scheme is stage-dependent and begins in stages T1-3 N0-1 with lung resection and in stage N2 with chemotherapy. To date, 45 patients have been included in a prospective, nonrandomized (phase II) trial: 7 in TNM stage I, 11 in stage II, and 27 in stage IIIa (6 T3 and 21 N2). The actuarial 5-year survival rate of the entire group (including therapy-related lethality, early recurrences, and protocol violations) is 36%; it is 57% for those in stage I, 28% for those in stage II, and 34% for those in stage IIIa. Median survival time is 18 months. Patients with completed multimodal treatment have a 5-year survival rate of 56% regardless of disease stage. Three patients died of tumor-unrelated causes after 47, 52, and 54 months.

Hyperfractionated, accelerated radiotherapy and concurrent chemotherapy in locally advanced bladder cancer.

A prospective study was performed on 11 patients with locally advanced transitional cell carcinoma of the bladder to evaluate the toxicity of an integrated treatment with cis-platinum (70 mg/m2 body surface), doxorubicin (10 mg/m2 body surface) and 8 meV photons. Local and systemic toxicity caused by this treatment schedule was minor. Late sequelae consisted of reduced bladder capacity in 2 patients and proctitis in 1 patient. Complete clinical clearance of the local tumor could be achieved in 9 of 11 patients after a mean follow-up of 8.1 months.

Clivus Chordoma in A 9-Year-Old Child: Case Report and Review of the Literature

Chordomas are bone tumors of the axial skeleton. They arise from notochordal remnants. In children these tumors are extremely rare and are predominantly located in the skull base. The authors report on a clivus chordoma in a 9 7/12-year-old girl. It presented as a nasopharyngeal mass with destruction of the clivus and paralyses of the ninth, tenth, and eleventh cranial nerves on the right side. After incomplete resection by a transoral transclival route, high-dose radiotherapy was added. This treatment was effective as demonstrated by follow-up CAT scans. A short review of the current literature is given. The local recurrence rate is extremely high, and distant metastases may occur. Complete resection is rarely possible, and combined management with postoperative radiotherapy is propagated. Permanent cure is rare, and at the present time, chemotherapy appears to be of no value in the primary treatment of chordomas.

Influence of Local Radiotherapy of Breast Cancer Patients on the Frequency of Cytotoxic T Lymphocyte Precursor Cells

Alloantigen-specific cytotoxic T lymphocyte precursor (CTL-p) frequencies were analyzed in ten patients with histologically proven breast cancer receiving prophylactic RT. The frequency of CTL-p was assessed by limiting dilution (LD) analyses before, immediately after discontinuation of treatment and at various times following RT. The number of pbmnc, adherent cells and T cells was determined in parallel. Local RT led to a minor and transient reduction of CTL-p frequencies lasting approximately three months: on average a 25% decrease of CTL-p numbers was seen immediately after RT. Three months following treatment, a 20% reduction was still evident. Values subsequently returned to pretreatment levels. Moreover, these changes in the frequency of antigen-specific CTL were accompanied by a 25% to 39% decrease in the blood T cell counts lasting for more than 12 months. The reductions following local RT were less pronounced than those induced by immunosuppressive drugs in allograft recipients.

113. Der Stellenwert der Chirurgie in der Behandlung des kleinzelligen Bronchialcarcinoms

SummaryAs a result of strict cooperation between oncologists, surgeons and radiotherapists we developed a comprehensive combination therapy for small cell lung cancer (limited disease): Stage I, II: 1) radical tumour resection. 2) chemotherapy (Cohen). 3) cerebral radiation prophylaxis. 4) locoregional radiotherapy. Stage III: 1) Chemotherapy. 2) cerebral radiation prophylaxis. 3) lung resection in an extension required by the initial tumour. 4) radiotherapy (local). The preliminary results in 15 patients are encouraging.ZusammenfassungIn enger Kooperation von Chirurgen, Chemotherapeuten und Strahlentherapeuten wurde in den letzten 9 Jahren folgendes Therapiekonzept zur Behandlung des kleinzelligen Bronchialcarcinoms (limited disease) entwickelt. Stadium I, II: 1) Radikale Resektion. 2) Chemotherapie. 3) Cerebrale Bestrahlungsprophylaxe. 4) Lokale Radiotherapie. Stadium III: 1) Chemotherapie. 2) cerebrale Prophylaxe. 3) Radikale Operation im Ausmaß der ursprünglichen Tumorausdehnung. 4) Lokale Bestrahlung. Die bisherigen Ergebnisse bei 15 Patienten sind ermutigend.

Combined Radio-Chemotherapy in Advanced Bladder Cancer

Patients with locally advanced transitional cell carcinoma of the bladder treated by irradiation alone or in combination with transurethral resection of the exophytic tumor fail mostly because of local tumor persistence or development of new tumors elsewhere in the bladder. Only a few patients keep the bladder after definitive radiotherapy without the risk of future tumor recurrence. Therefore for further improvement of irradiation results additional treatment modalities are warranted.