Radiation therapy of breast cancer in the Nahe Breast Center: first results of an analysis in the context of health services research

BACKGROUND

The first evaluation of radiotherapy results in patients with breast cancer treated as part of a multimodal oncologic therapy in the Nahe Breast Center is presented. Analysis of the results was performed using an in-practice registry.

PATIENTS AND METHODS

From September 2016 to December 2017, 138 patients (median age 62.5 years; range 36-94 years) with breast cancer (right side, n = 67; left side, n = 71) received adjuvant radiation therapy. Of these, 103 patients received gyneco-oncologic care at the Nahe Breast Center, and 35 were referred from outside breast centers. The distribution into stages was as follows: stage I, n = 48; stage II, n = 68; stage III, n = 19; stage IV, n = 3. Neoadjuvant chemotherapy was given to 19 and adjuvant chemotherapy to 50 patients. Endocrine treatment was given to 120 patients. Both 3D conformal (n = 103) and intensity-modulated (n = 35) radiotherapy were performed with a modern linear accelerator.

RESULTS

With a median follow-up of 60 months (1-67), local recurrence occurred in 4/138 (2.9%) and distant metastasis in 8/138 (5.8%) patients; 7/138 (5.1%) patients died of their tumors during the follow-up period. The actuarial 5‑year local recurrence-free survival of all patients was 97.1%, and the actuarial 5‑year overall survival of all patients was 94.9%. We observed no grade 3 or 4 radiogenic side effects.

CONCLUSION

The results of radiotherapy for breast carcinoma at the Nahe Breast Center are comparable to published national and international results. In particular, the local recurrence rates in our study, determined absolutely and actuarially, are excellent, and demonstrate the usefulness of radiotherapy.

Counseling on Complementary Methods in the Treatment of Side Effects of Oncological Therapies: A Project of the Breast and Bowel Center Nahe at the Hospital Sankt Marienwoerth Bad Kreuznach

BACKGROUND

Increasingly, patients with cancer are asking for additional, complementary therapy options for treating the side effects of oncological therapy. Thus, the members of the Breast and Bowel Center Nahe at the Sankt Marienwörth Hospital Bad Kreuznach decided to define the content of this type of counseling for patients before treatment.

METHODS

In 2018, a team of internal oncologists, gynecological oncologists, radio-oncologists, nutritionists, psycho-oncologists, and study nurses met several times to define the content of counseling. To inform the team, an intensive literature review was conducted.

RESULTS

Counseling content was determined for complementary treatment options for the most frequent side effects of oncological therapies. Counseling sessions were formulated as frontal lectures (slide presentations), given at regular intervals for patients and relatives. These lectures were highly appreciated by patients.

CONCLUSION

These counseling sessions increased patient understanding of both useful complementary measures and harmful measures they should not use.

[Follow-up of Crohn's disease: can hydro-MRI replace fractionated gastrointestinal passage examination?]

PURPOSE

To compare the value of hydro-MRI with follow-through examinations in the follow-up of Crohn's disease.

METHOD

22 patients known to be suffering from Crohn's disease were examined via 1.5 T-MR system; an oral contrast examination using 1000 ml of a 2.5% mannitol solution was performed in all patients. T2-weighted TSE sequences and T1-weighted SE sequences were performed before and after the intravenous injection of Gd-DTPA. To reduce movement artifacts caused by peristalsis of the gut, intravenous injection of 40 mg Buscopan was given. The findings of hydro-MRI were compared with the follow-through examinations.

RESULTS

In the upper gastrointestinal tract, the follow-through examination showed clear advantages compared with hydro-MRI for the demonstration of inflammatory changes in the gut; Hydro-MRI was, however, somewhat more reliable in the ileum and colon. It was also more sensitive than the follow-through for the demonstration of enteric fistulae (four as compared with two cases), and in demonstration extraluminal changes (free fluid in six against zero, and inflammatory adherent loops (four against zero)). Amongst the 22 patients, hydro-MRI was equal (in 10) or better (in 8) than the follow-through examination for demonstrating the intestinal manifestations of Crohn's disease, and follow-through was better in only four.

CONCLUSION

For follow-up of Crohn's disease, hydro-MRI is at least as good as follow-through examination, and is even preferable, because of the absence of radiation exposure of the usually young patients.

[Results of radiologic follow-up of patients with automatic implantable cardioverter-defibrillators]

In the follow-up of patients with automatic implanted cardioverter defibrillators (AICD), the serial radiographs give us important information concerning the cardiac function, signs of cardiac insufficiency may be a first sign of a dysfunction of the implanted aggregate or of the system of electrodes. Not only the short term but also the radiographs over a long period of time are important. The estimation of the correct positions of the electrodes is important too, for dislocation or disconnection of the electrodes lead to a misfunction of the AICD. On the other hand a kinging or a disconnection of the marker-stripe of plain-surfaced electrodes needs no correction for they do not lead to a misfunctioning AICD. Beside the serial radiographs, radioscopy is important because a disconnection of the electrodes often is not visible except by radiography.

[Adenocarcinoma of the lobus v. azygos, characteristics of lymphogenous and hematogenous metastasis]

A tumor originating in a lobus v. azygos is very seldom. We report here on a patient with a poorly differentiated adenocarcinoma of the lobus v. azygos which exhibits a very aggressive growth. Depending on the tumor localization, the metastasis is typical and can be recognized by computertomography (CT). In spite of the large number of treatment strategies, the prognosis is poor.

[The palliative radiotherapy of Kaposi's sarcomas in AIDS patients]

BACKGROUND

Follow-up of patients, who were irradiated because of AIDS-related Kaposi's sarcomas.

PATIENTS AND METHODS

From 1983 to 1994 17 patients were irradiated because they suffered from AIDS-related neoplasms. Fifteen of these were irradiated because of Kaposi's sarcomas. The radiation fields were as small as possible, the total dose that was given was 30 Gy in the average, given 5 x 2 Gy or 4 x 2.5 Gy per week.

RESULTS

The results concerning the cosmetic benefits were good, the pain could be reduced very well. In two patients the radiation therapy was cancelled: 1 patient suffered from a general tumor progression and 1 did not allow any further therapy. The remission rate was 3 to 4 months in the average, 3 patients did not show local progression for 4 respectively, 5 months now. One patient was in remission for 8 months.

CONCLUSIONS

The radiation therapy is a local, but very effective method to treat patients with AIDS-related Kaposi's sarcomas. Whereas the side-effects are very little, we found quite a long remission rate.

[Quantitative determination of cerebral perfusion using digital subtraction angiography (DSA)]

In a search for a reliable and relatively non-invasive method for quantifying cerebral perfusion, we examined the possible role of DSA. By using special software, it is possible to demonstrate vascular morphology and obtain functional data concerning blood flow. Regions of interest are used for obtaining time-density curves and these are evaluated by a formula designed by Meier and Zierler. Perfusion through the arterial territory in both cerebral hemispheres was correlated with the clinical symptoms of the patients and with the morphological findings. Difficulties and problems are described and discussed.