[3d ultrasound in prenatal diagnosis]

Three-dimensional sonography is a logical development of conventional sonography, and is a consequence of the fact that every examiner tries to imagine the three-dimensional appearance of an organ on the basis of the tomographic images of it. In a long development process starting with the first 3D images in 1986/87 and lasting until today, we succeeded in developing a 3D system suitable for routine examinations, which the manufacturer is now marketing commercially. With a 3D transducer a coordinated sequence of tomograms is obtained; all the images are then computed transparently and subsequently imaged three-dimensionally as a crystalline volume. Movement of the 3D image on the computer screen is important for three-dimensional identification. The volume thus computed can then be bisected in longitudinal, transverse and horizontal planes and thus examined in real-time without any interference such as fetal movements. The horizontal sections cannot be obtained by conventional sonography. On the basis of more than 600 patients examined by this new method it was established that 3D imaging of malformations improves diagnosis and assessment, that examinations deliver accurate and reproducible results, and that section analysis can substantially facilitate diagnosis of fetal malformations.

[Diagnosis of tubal function using intraluminal ultrasound--initial results]

The extremely small ultrasound transducers of the intraluminal ultrasound instruments, introduced via catheters, enable diagnosis to be made inside hollow organs. In order to test the possible uses and indications for this new method in gynaecology, we conducted preliminary examinations in the diagnosis of the uterus and tubes. We employed an intraluminal instrument supplied by Dornier. The intraluminal transducers of this instrument have a diameter of 3.5 and 5 F. Following in-vitro examinations, hysteroscopy and laparoscopy/laparotomy were performed in 15 patients during which the transducer was pushed up via the cervix uteri to the tubes with full vision. This was successful in all 15 patients; in 9 cases the transducer could be pushed as far as the distal end. The tubal walls were examined in detail by this method and for the first time it became possible to achieve functional diagnosis of the motility of the tubes. Strictures can be visualised. The endometrium of the uterus, however, cannot as yet be diagnosed exactly by the present-day state of examination technique. If image quality can be further improved, this method will be the first to enable a functional diagnosis of the tubes and the uterus.

[Ultrasound diagnosis of blood flow in benign and malignant breast tumors]

Malignant tumours can be differentiated from the benign ones by their vascular blood supply. We employed three methods to analyse the blood flow: the angiodynograph, the duplex system, and the continuous-wave Doppler method, and measured the blood flow in 151 patients on the preoperative day. Histology revealed a malignoma in 92 cases and a benign tumour in 59 cases. It was found, that in more than 90% of the malignomas, a high blood flow was identified in or around the tumour by means of the colour method (angiodynography), which could be quantified by the pulsed-wave Doppler. A significantly lower blood flow was evident in the benign tumours with a markedly increased resistance index (by 80%) established by means of the pulsed-wave Doppler. Continuous-wave (CW) Doppler showed a significantly higher blood flow with almost all malignomas in the entire breast, than was the case with benign changes. Our studies showed, that the enhanced blood flow in and around malignant tumours can be visualised by means of update technology, angiodynography being particularly suitable for demonstrating the flow by the B-mode. Quantification, however, is, at present, only possible by employing the duplex method with pulsed-wave Doppler. CW Doppler is suitable only for blood flow diagnosis of the entire organ, but it requires great precision of working method and is time consuming; tumour blood flow cannot be visualised on-target by this method.

[Palliative laser therapy in gynecologic oncology]

Local recurrences of carcinomas of the breast and genitals are a severe psychic and physical strain on the patients. Continuous confrontation with an often visible and generally painful tumour manifestation is an indication for palliative treatment, if other oncological therapies can no longer be employed. In these cases, the possibility of laser use represents a new therapeutic approach. In a pilot study at the University of Heidelberg, Department of Obstetrics and Gynaecology, a palliative laser therapy was performed on 45 patients with locally recurrent carcinomas of the breast (n = 29) and genitals (n = 16). Carbon dioxide and Nd:YAG lasers were utilized for tumour resection, vaporisation and coagulation. This new concept, the combined application of both wavelengths has been proved to be most efficient.

Ultrasound scanning for the diagnosis of meniscal lesions of the knee joint

We report on the efficacy of ultrasound scanning as a noninvasive method of the preoperative diagnosis of meniscal lesions of the knee joint, using the 7.5-Hz head of a real-time scanner. In studies on cadaveric knee joints we found a high efficacy in diagnosing meniscal lesions using ultrasound. Comparative clinical studies on 51 patients who had undergone preoperative ultrasound scanning showed a strong correlation of ultrasound diagnosis with intraoperative findings. Arthrography was performed in 24 of the 51 patients, yet ultrasound studies proved to be more effective than arthrography in diagnosing meniscal lesions. Consequently, we believe that ultrasonic scanning as a noninvasive method of diagnosis is more helpful in identifying meniscal lesions of the knee joint.

[Ultrasound diagnosis of fetal lung maturity]

Until now, it has been possible to determine fetal pulmonary maturity only by amniocentesis. Since the functional changes of the fetal lung leading to maturity are also morphologically apparent, pulmonary maturity can be demonstrated sonographically. Obtaining a uniform value for maturity is a problem, since the position of the fetus, the mother's constitution and the instrument setting all influence assessment. The fetal liver was therefore used as a reference organ, since it is subject to the same influences. By frequency analysis of both organs and calculation of the ratio between the frequencies obtained, a mathematical value can be calculated by which pregnancies can be compared and which, as our studies showed, represents a measure of pulmonary maturity. This was documented in 348 patients. It was shown by amniocentesis in 32 patients and the postpartal condition of 25 premature births that a value of 1.11 for this ratio between lung and liver represents the borderline between pulmonary immaturity and maturity. Lower values indicate maturity. If these results are confirmed by further studies on larger groups of patients, it will in future be possible to determine fetal pulmonary maturity very easily and non-invasively.

Diagnosis of fetal lung maturity by ultrasound: a new method and first results

The first results are presented of a method to determine the maturity of fetal lung by sonography. By comparing the frequency characteristics of lung echoes to those from the fetal liver as a reference organ, we avoid the known pitfalls which previously made it impossible to standardize fetal lung changes with gestation. We examined 222 patients between 27 and 39 completed weeks of gestation. In one ultrasound section we depicted fetal lung and liver simultaneously. Switching to A-mode we registered the frequencies contained in the video envelope in both organs. The registered frequencies were entered digitally in to a computer and checked for mean frequency, maximum frequency and minimum frequency. Afterwards, the ratio of the frequencies of the lung and liver were obtained. For all weeks of gestation, the mean value and standard deviation were calculated. We found the liver to be an adequate reference organ, since there is no change of the reflection pattern between the different weeks of gestation, while significant changes were registered in the fetal lungs. A quotient of Q(mean) lower than 1.1 suggests lung maturity, while values over 1.1 point to immaturity. This appeared to be confirmed in 13 patients who had agreement between amniotic fluid lecithin values and Q(mean). Further comparisons with amniotic fluid results will have to validate these findings.

[Three-dimensional ultrasonic diagnosis in gynecology and obstetrics]

Three-dimensional reconstruction of an organ requires a coordinated sequence of cross-sectional scans. In ultrasound this can be solved by rotating the scan plane horizontally or vertically. Two scan heads have been built, one to rotate the plane around a horizontal, the second around a vertical axis. There are two ways to reconstruct the scans taken by ultrasound into a three-dimensional image: --to contour the surface of the organ in each scan and to reconstruct these contours to a ring-shaped structure. This procedure needs a lot of time; moreover, contouring must be performed via cursor on the screen. --calculate a transparent image of the organ. To obtain the best spatial image by the "transparent method", the image must be moved on the screen. Both methods of reconstruction are shown and compared in this paper. First experiences show that they can be applied in tumour diagnostic and in the diagnosis of malformations in early pregnancy. Further clinical studies will have to prove this.

[Comparison of duplex systems and simple Doppler equipment in obstetric diagnosis]

Duplex systems are normally used in obstretric Doppler sonography. The fact that these systems are technically complex and very costly to some extent contradicts the use of Doppler sonography as a screening method. This study examines whether simplex Doppler systems without tomographic imaging and not involving costly technology, such as frequency analysis, are as suitable for Doppler examination in pregnancy as the costly duplex systems. Examinations of 83 patients between GW 32 and 42 showed that both the umbilical and uterine arteries can be reliably identified using the simplex Doppler unit. A comparison of Doppler curves obtained with duplex and simplex Doppler systems showed that the two devices produced the same results. The Doppler curves were compared both as regards their geometry, according to the score described by Fendel et al. (1988), as well as on the basis of calculated parameters. The scores were correlated to delivery mode and birth weight. However, the fetal aorta cannot be reliably located with the simplex Doppler unit unless it has been tomographically imaged beforehand. Doppler examination of the umbilical and uterine arteries provides the best information for selection of high-risk pregnancies. It therefore appears sufficient to screen patients with the simplex Doppler described here and to perform more detailed diagnostic investigations with a duplex systems in the event of pathologic findings.

Current evaluation of sonography of the meniscus. Results of a comparative study of sonographic and arthroscopic findings

Sonography of the knee has gained in significance in the diagnosis of the meniscus; experimental and clinical studies have demonstrated that the normal and pathological anatomy of the meniscus can be visualized on a sonogram. The aim of this comparative investigation is to evaluate sonographic lesion diagnosis in comparison with arthroscopic findings, using a standardized examination method. Two hundred and six knee joints were first scanned sonographically using a 7.5 MHz sector transducer. The examining doctor had neither anamnestic nor clinical information in advance. On the following day, the joints were examined arthroscopically, without the findings of the day before being available to the examiner. When the findings were compared, the sensitivity of sonographic diagnosis of lesions was found to be 82.2% and its specificity 87.6%. The patients were of varying ages and had varying anamneses. The results show that sonography of the meniscus is a valuable diagnostic help when the knee-joint symptoms are not clear, given that the correct technical equipment and sufficient experience with this form of examination are at hand. The advantage of sonography is that, in contrast to arthroscopy, it is noninvasive and easily available.

[Transvaginal sonography: the differential diagnostic significance of the secondary vitelline sac in early pregnancy]

In the study reported here, yolk sac size and vertex-breech length were determined by transvaginal sonography, in addition to other parameters relevant to early pregnancy. Vital pregnancy was found without abortion symptoms in 72 cases, and with these symptoms in 35 cases; in 29 cases a missed abortion was found. The secondary yolk sac, which was detectable and measurable in 95 of 107 vital early pregnancies, showed constant growth from the fifth (diameter 3.9 mm) to the twelfth completed gestational week p.m. (diameter 6.5 mm). From the tenth completed gestational week p.m. onward, the yolk sac was not always detectable. Of the yolks sacs in the group of missed abortions, seven were found to be too small and 15 rudimentary. The correlation coefficients determined between yolk sac size and gestational age on the one hand and vertex-breech length on the other indicate that there is a significant relationship between the development of the yolk sac and that of the embryo up to the tenth completed gestational week p.m. Where a normally developed secondary vitelline sac is sonographically detected up to the tenth gestational week, the prognosis may be regarded as good. However, any finding which deviates from the norm must be verified, and the prognosis must be considered poor even when a living embryo is detected.

[Prerequisites for the clinical application of 3-dimensional ultrasonic imaging]

After satisfactory experimental results with three-dimensional data acquisition and presentation of the kidney in vitro, we wanted to show how our technique could be used for medical application in vivo, such as ultrasonic 3D reconstruction of organs. The sector scans were taken by rotating the scan head 10 degrees in any direction around the length of the axis. The organ was scanned with 18 images and reconstructed. The digital images, using the organ contours, allowed 3D reconstruction of the original organ, relying on the computer memory. The first results in reconstructing uteri show how this scan head can be used in combination with the computer programs for medical application. For the first time, it has become possible to present computer-generated views of an organ cross-section that has been impossible to obtain by means of traditional ultrasound techniques. Recent experiments using this method show new ways of diagnosing tumors.

[3-dimensional organ representation with ultrasound. Experimental studies--computer simulation]

This is the first report on the 3-dimensional representation of organs with US. The prerequisite for this was a coordinated transducer movement, in such a manner that the organ under examination was represented by US sections differing in only one of the space coordinates. Such transducer movement was made possible by 2 devices. In the first instance, longitudinal movement of the transducer resulted in the production of parallel sections of the organ while, in the other instance, rotation of the transducer head permitted sections arranged around a fixed center-point. Using a special computer program, the sections were contoured in such a manner that only the surface of the organ was represented. These sections were then arranged in space. The 3-dimensional representation can be effected both by binary image representation and by representation with closed (intact) body surface. The advantage of the binary image representation is the fact that the organ surfaces "extracted" from the original US sections are directly incorporated within the 3-dimensional image build-up, with no further computer manipulations. It can be seen that the rotation of the transducer head represents the practicable possibility for the use in the clinical setting.

[Clinical application of 3-dimensional ultrasound display. Initial results]

Using a newly developed ultrasound transducer and a corresponding computer program, it proved possible to construct a three-dimensional (3-D) display--at 7, 9, 11 and 13 weeks of pregnancy, respectively--of three structures lying one inside the other: embryo, amniotic sac and uterus. By means of a special computer technique the three structures could be displayed both in relation to one another and singly. Spatial rotations of the reconstructed body can be displayed on the video screen as can the individual bodies in different cross-sections. With narrow angles between individual sections this method may become important in the intra-uterine diagnosis of malformations and also of neoplasms.

[Effect of parity on the venous system of the leg]

Pregnancy is known to be an important aetiological factor of varicose veins. How much this can be attributed to gestation is still controversially discussed. This problem was investigated using three non-invasive methods--Ultrasonography, Venous-Occlusion Plethysmography (VOP) and Light-Reflexion-Rheography (LPR). We found no significant differences between the group of primipara and multipara with relation to the venous morphology and the venous function in the legs. Only the distensibility of the venous wall of the multipara group was slightly increased in comparison to the group of the primipara. These results were found by VOP and LRR simultaneously. Varicosis is therefore caused mainly by the first pregnancy, whereas the subsequent pregnancies do not show remarkable changes of the status quo. Concerning the sensitivity of the methods mentioned above, ultrasonography alone can give easy and quick information. In the case of pathological findings, the indication for more complex investigations (VOP and LRR) can be established.

[Three-dimensional imaging in ultrasonic diagnosis. Initial results]

A new method of three-dimensional (3-D) reconstruction of 2-D ultrasound images of the kidney is described. It is based on a coordinated spatial reconstruction of sequential cross-sectional images. The ultrasound head is moved longitudinally between two rails (parallel sections) and rotated. With a suitable computer program and contouring of each cross-section (so that the organ limits are defined for the computer) these cross-sectional pictures can be reconstructed into 3-D organ images. The kidney can then be presented spatially either as a binary picture or with closed surface. Ultrasound investigators are still unaccustomed to colour reproduction of 3-D reconstructed organs. It remains to be seen whether the method is valuable in routine clinical use.

[Initial studies of 3-dimensional imaging using ultrasound]

In the study reported here three-dimensional sonographic imaging of organs was achieved for the first time. To make this possible it was first necessary to ensure, by appropriate guidance of the probe, that the sequence of sonographic sections was coordinated in their spatial arrangement. This was accomplished by constructing a probe guide with which parallel sonographic sections could be demonstrated. The distance between these sections was known, so that with the aid of suitable computer programs three-dimensional reconstruction of a kidney examined in a water bath was possible. Since, however, due to the uneven surface of the body, it will hardly be possible to obtain parallel sonographic sections of an organ, a new solution had to be found to ensure the necessary coordinated sequence of sections. The solution lay in rotating the probe. A further device was constructed in which the probe could be rotated farther, by known angles, from section to section. The pivotal point was at the center of the probe tip. The computer knew the angular distance between these sections and reconstruction to a three-dimensional image was therefore possible. Prior the three-dimensional reconstruction the ultrasonographic sections had to be contoured, since only the surface of the organ was available for three-dimensional image construction. Three-dimensional imaging of an organ can be achieved on the one hand by binary representation and on the other with a continuous organ surface. The advantage of binary representation is that the original sonographic data are incorporated in the image-producing process without any computer manipulation; with a continuous surface the distance between the individual sections has to be interpolated.(ABSTRACT TRUNCATED AT 250 WORDS)

[Involution-induced changes in arterial uterine blood flow]

The change of resistance in the uterine arteries was studied in 20 patients showing a normal involution on five consecutive days. A uterine artery was examined by Doppler sonography, the Doppler profile evaluated, and the quotient, Fmean, resistance index, and pulsatility index were calculated from the systole and diastole. These parameters, which provided information on vascular resistance independently of the angle between the Doppler beam and the vessel, indicated a continuous increase during the puerperium; the differences in values for different days were significant. The changes in the Doppler profiles in the puerperial period pointed to an increasing vascular resistance. In one-half of the patients this was shown only by an increasing slope to the systolic peak, a sharp drop to early diastole, and a clear distinction between systole and diastole. In the other half of the patients the Doppler curves were like those found in pregnant patients with EPH gestosis. This indicated that the pathologic mechanisms leading to increased resistance in the uterine vessels were the same in both groups. One cause of this may be contraction and compression of the blood vessels, the other, and probably principal, cause was reduction of the vascular system due to histolysis, as in the puerperium, or insufficient development of the vascular system, as in EPH gestosis. That is to say, functional and morphological changes occur in both cases. No decrease in resistance in the uterine vascular bed was detected in cases of puerperial subinvolution of the uterus.

[Non-invasive diagnosis of pre- and postpartum urination disorders]

Postpartal disorders of urinary discharge due to birth trauma are frequently the cause of rising infections of the urinary tract during the puerperium. In diagnosis, noninvasive methods should be preferred. Bladder-emptying function was checked by means of uroflowmetry and sonographic measurement of residual urine in 83 patients at the Department of Gynecology and Obstetrics at the RWTH, Aachen, in the third trimester and post partum. A considerable restriction of urine flow was found both prepartally as well as on the third day post partum. In contrast, there was practically no disturbance of bladder emptying on the sixth day post partum. This function is restored more quickly in cases of cesarean section than in cases of vaginal delivery. As early as the third day post partum no further influence of subpartal analgesia could be demonstrated. The findings failed to show any difference between the group with vaginal/surgical delivery and that with spontaneous birth. Generous use of these noninvasive diagnostic methods to identify postpartal micturition disorders can be recommended.

[Fetal functional atrioventricular blocks in pregnancies at risk]

Because antepartal and subpartal CTG monitoring is now widespread, fetal cardiac arrhythmias are being diagnosed ever more frequently. In a high-risk group of 148 pregnancies with placental insufficiency and preterm births, 14 CTGs manifested a rigid rectangular pattern, with alternating normal-frequency and slightly bradycardial cycles. The change in frequency occurred suddenly. All the children of the high-risk group were delivered by cesarean section and weighed less than 2500 g at birth. There is no description in the literature of similar CTG curves with sligthly bradycardial phases. However, there are some descriptions of cases of fetal AV blocks with severe bradycardias. These frequently occur in combination with fetal cardiac abnormalities and collagenoses of the mother. In the present authors' group these underlying conditions were not diagnosed. The fixed numerical ratio of the output frequency to slight bradycardia in the CTGs described here supports the tentative diagnosis of an atrioventricular conduction disorder, with relatively high conduction from the atrium to the ventricle. Since the arrhythmias did not continue in the newborns post partum it may be assumed that they were functional events. Birthweight, Apgar score, and the placental weight of the 14 births with the rectangular CTG curve described were lower than in the control group, i.e., the other 134 births. The CTG patterns described appear to have been caused by a chronic supply deficiency, resulting in functional AV conduction disorders. This CTG course should therefore be reason enough for intensive fetal monitoring.

[The renal artery and uterine circulation in normal and toxemic pregnancies]

The renal and uterine arteries of 52 patients with normal course of pregnancy and 12 patients with EPH gestosis were examined by Doppler sonography between the 35th and 38th weeks of gestation post menstruationem. Doppler curves of renal arteries were recorded in a further 31 nonpregnant subjects. A significant difference in arterial vessel resistance was found between patients with normal course of pregnancy and those with EPH gestosis. There was also a significant difference in the circulation parameters in the renal vessels between patients with normal courses of pregnancy and the nonpregnant controls. However, there were no differences in this vessel segment between the patients with EPH gestosis and the nonpregnant controls. Among patients with EPH gestosis the renal increase in resistance was relatively more pronounced than the uterine increase. In addition to the calculated flow parameters there were also marked differences in the Doppler curves of these two groups. There is evidently a considerable increase in renal circulation in normal pregnancies. This is in agreement with findings described in the literature, obtained by invasive methods. On the other hand, a clear limitation of renal and uterine resistance was seen in the patients with EPH gestosis. This ties in with the well-known morphologic changes in the kidneys in cases of EPH gestosis. A larger patient sample will have to be studied to determine whether the renal vascular changes described here may represent an early sign of EPH gestosis. If this is confirmed it would make sense to include Doppler sonography of the renal vessels in routine diagnostic procedure.

[Comparative studies of the venous system of the arm and leg before and after delivery]

Venous occlusion plethysmographic measurements were performed on the legs of ten non-pregnant subjects on ten consecutive days, in order to demonstrate the reproducibility of this method. In the third trimester of gestation and on the seventh day post partum, venous occlusion plethysmographic studies and vein caliber measurements were performed on arms and legs of 20 patients. A significant reduction in leg vein diameter following delivery was found. There were no differences in the diameters of arm veins measured in the third trimester and post partum. The results of venous occlusion plethysmography, as an indicator of venous function, revealed no differences between the third trimester and post partum in either the arm or the leg. Since hormonal changes during gestation must affect the entire venous system, i.e., also the arms and legs, mechanical displacement of the blood drainage pathways by the gravid uterus is most probably responsible for the significant dilatation of leg veins in the third trimester. A displacement of the higher sections of the femoral vein was demonstrated by Doppler sonography. Increased distensibility of the veins in the third trimester, continuing post partum, is probably the measurable basis of the much higher incidence of varicosis among women who have had children. It appears possible to detect extreme dilatations of leg veins sonographically, and to counter the increased risk of thrombosis and perhaps also to reduce the risk of later varicosis by timely compression treatment.

[Changes in uterine circulation in relation to body position in pregnancy]

The present paper reports on studies to determine the influence of body position on uterine blood flow. In ten pregnant patients (around the 35th week of gestation), over 700 measurements of systolic/diastolic action in the uterine vessels were made by Doppler sonography with the patients in various positions: lying down, standing, and sitting on the couch and the balance-variable chair; from the relationship between the systolic and diastolic levels conclusions were then drawn about the uterine blood flow in various body positions. It was found that it was best when the patient was lying down or sitting on the special chair without angling the hips; in contrast, diastole was lower in relation to systole with the patient standing and sitting on the examination couch. This means an increase in resistance or a reduction in blood flow. It appears reasonable to conclude that sitting on the balance-variable chair can be recommended to pregnant patients with signs of deficient fetal blood supply, in addition to bedrest, which is customarily advised. Apart from this, it is wise to use Doppler sonography to establish the body position in which uterine blood flow is best.

[Doppler studies of arterial uterofetoplacental blood flow before and during labor]

The encouraging results obtained using pulsed Doppler sonography for antepartal diagnosis gave cause to use the method during labor. For this purpose a group with normal course of pregnancy was examined by Doppler sonography. This group was compared with a similar group examined by the same method at onset of labor with the cervix beginning to dilate, or with premature rupture. A comparison of the usual Doppler parameters, uterine arteries, umbilical artery and fetal aorta, recorded in contraction-free phases, showed no differences between the two groups. A third group was examined by Doppler sonography during labor with average or late cervix dilatation. In this case the Doppler parameters for the contraction phases were compared with those for the contraction-free phases. With adequate utero-placental supply during labor, the changes in the Doppler parameters for the uterine arteries due to contraction indicate a reduction in blood flow. The blood flow in the umbilical artery remains unaffected during normal labor. In the fetal aorta the blood flow velocity drops significantly due to contractions, while the peripheral resistance is unchanged. The elimination of the end-diastolic shift in frequency in the fetal aorta during labor indicates a fetal supply deficiency, as shown by Doppler measurements during birth in cases with pathologic cardiotokograms.

[Meniscus sonography--alternative to invasive meniscus diagnosis?]

Sonographic visualization of the meniscus as well as the detection and evaluation of its lesions presupposes use of the 7.5 MHz transducer of a sector scan. All lesions applied by means of a scalpel to cadaver knees could be pictured and evaluated in this way. In a clinical study, there was agreement between sonographic and surgical findings in 86 out of 91 patients (94%). The arthrography carried out in addition in 50 of these patients had a lower precision (88%) than sonography (98%). Agreement between the results of sonography and arthrography was found in 87 out of 98 patients (89%). The complete freedom from risk and high precision support the application of sonography in diagnosis of meniscus lesions. It can thus replace arthrography in this indication.

Comparison of 32P therapy and sequential hemibody irradiation (HBI) for bony metastases as methods of whole body irradiation

We report a retrospective study of 15 patients with prostate carcinoma and diffuse bone metastases treated with sodium 32P for palliation of pain at Downstate Medical Center and Kings County Hospital from 1973 to 1978. The response rates, duration of response, and toxicities are compared with those of other series of patients treated with 32P and with sequential hemibody irradiation. The response rates and duration of response are similar with both modalities ranging from 58 to 95% with a duration of 3.3 to 6 months with 32P and from 75 to 86% with a median duration of 5.5 months with hemibody irradiation. There are significant differences in the patterns of response and in the toxicities of the two treatment methods. Both methods cause significant bone marrow depression. Acute radiation syndrome, radiation pneumonitis, and alopecia are seen with sequential hemibody irradiation and not with 32P, but their incidence can be reduced by careful treatment planning. Hemibody irradiation can provide pain relief within 24 to 48 h, while 32P may produce an initial exacerbation of pain. Lower hemibody irradiation alone is less toxic than either upper hemibody irradiation or 32P treatment.