[The observation of edema in the substantia alba during postoperative brain irradiation. The role of computed tomographic studies]

BACKGROUND

The aim of our study was to determine on CT whether a relation exists between a radiation-induced brain edema, treated with diuretics and its corresponding Houndsfield Units (HU).

PATIENTS AND METHODS

Seventy-five patients (age 20 to 65 years, suffering from headaches but without hypertension brain tumors or cerebral arteriosclerosis were examined as a reference group. Three slices with 8 mm thickness, 24 mm apart in the upper, middle and lower third of the brain were obtained to measure the HU of the white matter. The second group consisted of 20 patients with brain tumors, which underwent brain surgery. HU of the white matter were measured before radiation and after 10, 20, 30, 40 and 50 Gy. If a reduction in density was detected, diuretic therapy with 40 mg furosemide per o.s. was initiated. If no increase in density was found on follow-up additional therapy with glycerine (4.5 g/kg body weight) was started. In this cases follow-up was on day 4 after initiation of diuretics. If clinical symptoms suggested an increasing in intracranial pressure, CT-examination was performed immediately. Therapy was started according to measurement results. The third group consisted of 64 patients with brain tumors, that underwent postsurgical radiation therapy. Prior to radiation therapy 40 mg furosemide per o.s. were given. CT-examinations, intensified diuretic therapy and follow-up examinations were performed as in group 2. If, despite therapy, the HU decreased, infusion of mannites was added. The second and third group of patients received radiation therapy with telecobalt and/or a linear accelerator (6 and 9 MeV X-ray).

RESULTS

In the first group white matter density was > 30 HU. In the second group white matter density was between 25 and 29 HU prior to diuretic therapy. Under 25 HU a continuous headache, vertigo and confusion ensued. Diuretic therapy was intensified until the measured values reached 25 to 29 HU. Forty-seven of 64 patients in the third group had 25 to 29 HU prior to radiation therapy. Despite prophylactic diuretic therapy in 28 cases density decreased to 20 to 24 HU. Improvement was achieved with an additional glycerine per o.s. The measured values reached again 25 to 29 HU. In 1 case the values dropped under 20 HU. Additional mannite infusion was necessary. In 17 of 64 patients white matter density was > 30 HU prior to radiation therapy, dropping to 25 to 29 HU during radiation. Prophylactic diuretic administration kept the values in this range. A correlation between age of the patient, radiation source, total dose, tumor histology and degree of change in HU was not found.

CONCLUSION

Measurements of HU can serve as a good indicator for spontaneous or diuretic induced changes of a white matter edema during radiation therapy.

[Volume changes to the neck lymph node metastases in head-neck tumors. The evaluation of radiotherapeutic treatment success]

AIM

This work is engaged with the volume change of neck lymph node metastasis of malignant tumors in the head-neck region during radiotherapy.

PATIENTS AND METHOD

In 54 patients with head and neck tumors, the volume of neck lymph nodes before and after radiation was measured. The volumetry was done with CT planimetry. The total dose was 66 Gy (2 Gy/d) telecobalt from 2 lateral opponated fields. The time of volume change could be defined with measuring of the half-time and the doubling-time by the help of Schwartz formula.

RESULTS

After 10 Gy the volume diminution was about 20% and half-time 24 to 26 days. Afterwards the time of volume diminution picked up speed and finally achieved 60 to 72%. Meanwhile the half-time decreased to the half value. The result was independent of the site of primary tumor, the patient's sex and age.

CONCLUSION

In our opinion the effectivity of radiotherapy can best be judged with defining of the volume change of lymph nodes of the neck.

[Lymphoepithelial carcinoma of the nasolacrimal duct--a case report]

PATIENT

A 59-year-old patient with an extremely rare lymphoepithelioma of the nasolacrimal duct was treated with radiation therapy and chemotherapy.

RESULTS

A complete remission was achieved. Serious side effects and late effects have, until now, not been observed. The patient has been free of tumor for two and a half years.

CONCLUSIONS

With this case report, the authors wish to draw the attention of otorhinolaryngologists to this unusual tumorsite. They emphasize that good results can be achieved with a combination of radiation therapy and chemotherapy, if surgery is not possible.

[Preoperative low-dose-rate versus high-dose-rate brachytherapy in stage IB cervix cancer. An efficacy study]

In women with stage IB (FIGO) carcinoma of the cervix, the authors investigated the efficacy of the manual low-dose rate (LDR) and afterloading high-dose rate (HDR) technique in terms of local freedom from tumor. It was found that in the 194 patients treated with the low-dose rate LDR-technique (computed dose point A 23.5 GY; point B 4.7 Gy), the surgical specimen was free of tumor in 37%. Among the 161 patients treated with the high-dose rate technique (point A11 Gy; point B 2 Gy), 41% of the surgical specimens were free of tumor. Follow-up examinations in the group receiving LDR-brachytherapy were carried out within a period of between ten and 90 months after treatment (average: 30.76 months). In 84% of the cases, NED was established. In the patient group treated with HDR-brachytherapy, follow-up examinations performed within a period of between six and 42 months after treatment (average 17.17 months), NED was found in 90%.

[Difficulties in recognition and treatment of lethal midline granuloma and otolaryngologic and radiotherapeutic practice]

The authors report on two cases of a "lethal midline granuloma". The first patient was treated by irradiation and chemotherapy. He lives for the last three and a half years in complete remission. The established diabetes did not affect the healing process. In the second case only a palliative irradiation was practicable because of the extreme tumour propagation, but the result was nevertheless good.

[The brachytherapy of carcinoma of the external auditory canal]

Brachytherapy is advantageous in the initial carcinomas of external auditory canal. The radiation charge of the surrounding tissues is much lower in spite of millivoltage irradiation because of its higher dosage gradient. It is stated according to the recent experiences and results on seven treated patients, that with LDR treatment of 5 x 10 Gy on consecutive days and with HDR treatment of 6 x 6 Gy on weekly interruptions (in both cases the dose means a depth of 5 mm). It is impossible to give the analysis because of the small number of cases. On base of our own patients it could be proved that lasting recovery of bone involving tumours is due to radical surgery and postoperative millivoltage irradiation.