Etwa 20% der Patienten mit kleinzelligem Lungenkarzinom (SCLC) sind bei Diagnosestellung noch im lokal beschränkten Stadium. Aufgrund der dennoch meist systemischen Erkrankung bzw. raschen Metastasierung ist immer eine systemische Chemotherapie indiziert. Die lokale Kontrolle ist dennoch sowohl für die Symptomatik des Patienten, das Lokalrezidiv und die Gesamtprognose entscheidend. Deshalb sollte früh zusätzlich zur Chemotherapie eine thorakale Strahlentherapie erfolgen. Zumindest bei gutem Ansprechen auf die Chemotherapie und thorakale Strahlentherapie ist eine prophylaktische Ganzhirnbestrahlung zu empfehlen, die das Auftreten von Hirnmetastasen reduziert und auch das Überleben etwas verlängert.

About 20% of the patients with small cell lung cancer (SCLC) are still in a limited stage at the time of diagnosis. As nevertheless small cell lung cancer is usually a systemic disease and due to the tendency of this tumour for rapid metastasis systemic chemotherapy is always indicated. Local control is nevertheless important for the symptoms of the patient, the local recurrence and overall prognosis. Therefore thoracic radiotherapy should be applied early during chemotherapy. At least in patients with a good response to chemotherapy and thoracic radiotherapy prophylactic cranial irradiation is recommended, which reduces the occurrence of cerebral metastases and to some extent prolongs survival of these patients.

In-stent restenosis (ISR) represents the major limitation of stent implantation. Treatment, although of relative technical ease, is unsatisfactory due to a high incidence of recurrent restenosis. Vascular brachytherapy (VBT) has emerged as a powerful adjunct therapeutic modality to treat ISR. Inhibition of neointima formation has been regarded as the relevant mechanism of action. Yet, positive remodelling has been suspected as another contributing factor. Since only very few precise analyses of the extent, distribution and time course of the respective mechanims exist, the goal of the present study was to describe the changes of the vessel geometry at the target lesion and at the reference site following angioplasty and VBT of ISR in 42 patients by means of quantitative coronary angiography (QCA) and intravascular ultrasound (IVUS) before and after the index procedure and at the 3 and 6 month follow-up.

Supratentorial primitive neuroectodermal tumors (stPNETs) are malignant tumors. We saw within three years six children with stPNETs. In four of the six children radical resection could be achieved. All had craniospinal irradiation and chemotherapy according to the HIT-91 protocol. The two children with incomplete resection died due to tumor progression after 7 and 10 months. Two of the 4 children with complete tumor resection had local relapses 8 months after diagnosis and died after 14 and 18 months. One child had a diffuse meningeal relapse 12 months after diagnosis. Despite (high-dose) systemic chemotherapy and intraventricular mafosfamide, lie died 21 months after diagnosis due to tumor although remission could be achieved. Only one child is still in remission 86 months after diagnosis.

Patienten mit nichtkleinzelligem Lungenkarzinom im lokal fortgeschrittenen inoperablen Stadium erreichen durch die Kombination aus Strahlentherapie und Chemotherapie bessere Ansprechraten und besseres Überleben. Die Auswirkungen auf die Lebensqualität sind noch nicht ausreichend untersucht.

Supratentorial primitive neuroectodermal tumors (stPNETs) are malignant tumors. We saw within three years six children with stPNETs. In four of the six children radical resection could be achieved. All had craniospinal irradiation and chemotherapy according to the HIT-91 protocol. The two children with incomplete resection died due to tumor progression after 7 and 10 months. Two of the 4 children with complete tumor resection had local relapses 8 months after diagnosis and died after 14 and 18 months. One child had a diffuse meningeal relapse 12 months after diagnosis. Despite (high-dose) systemic chemotherapy and intraventricular mafosfamide, he died 21 months after diagnosis due to tumor although remission could be achieved. Only one child is still in remission 86 months after diagnosis.

Because late vessel failure has been speculated as a possible limitation of vascular brachytherapy, we conducted a prospective clinical evaluation at 6, 12, 24, and 36 months of follow-up after irradiation with strontium-90/yttrium-90 for in-stent restenosis, regardless of the patient's symptomatic status. We report complete 3-year follow-up data for 106 consecutive patients. The cumulative rate of death at 6, 12, 24, and 36 months was 0.9%, 0.9%, 0.9%, and 1.9% respectively. The corresponding rates for acute ST-elevation myocardial infarction were 2.8%, 4.7%, 4.7%, and 4.7%, respectively. The cumulative rate of late thrombotic occlusion at 6, 12, 24, and 36 months was 3.8%, 4.7%, 4.7%, and 4.7%, respectively. The corresponding rates of target lesion revascularization and target vessel revascularization were 8.5% and 12.3% (p = 0.046),14.2% (p = 0.157) and 18.0% (p = 0.046),12.3% and 18.9% (p = 0.008), and 21.7% (p = 0.083) and 29.2% (p = 0.005), respectively. The cumulative rate of all major adverse cardiovascular events at 6, 12, 24, and 36 months was 16.1%, 24.5% (p = 0.003), 27.4% (p = 0.083), and 35.8% (p = 0.003), respectively. In conclusion, these results indicate a delayed and, even in the third year after the index procedure, continued restenotic process after 0 irradiation of in-stent restenotic lesions. (c) 2005 Elsevier Inc. All rights reserved.

Die Radiochemotherapie des nicht-kleinzelligen Bronchialkarzinoms (NSCLC) wird derzeit optimiert. Ziel unserer Phase I Studie ist es, die optimale Dosis Docetaxel (DCT) als Konsolidierungstherapie nach SRCHT mit Cisplatin und DCT zu bestimmen.

Einleitung: Die PET (F-18 FDG) erfasst im Gegensatz zu CT und MRT metabolische/funktionelle Vorgänge und liefert bei BC ergänzende Informationen zu Therapieplanung und Verlauf.

The aim of this study was to investigate the time course of angiographic restenosis rate and late loss after successful percutaneous coronary intervention and vascular brachytherapy with beta-irradiation using strontium-90/yttrium-90 in 98 patients who were prospectively enrolled into a quantitative angiographic and clinical follow-up protocol at 6, 12, and 24 months after the index procedure, regardless of their symptom status. Actuarial restenosis rates measured 11.2 +/- 5% at 6 months of follow-up, 24.5 +/- 5% at 12 months, and 28.5 +/- 6% at 24 months, respectively. Late loss of the stent segment during the first 6 months measured 0.38 +/- 0.40 mm (6 to 12 months: 0.25 +/- 0.38 mm; 12 to 24 months: 0.16 +/- 0.32 mm), of the injured segment 0.27 +/- 0.21 mm (6 to 12 months: 0.21 +/- 0.26 mm; 12 to 24 months: 0.13 +/- 0.24 mm), of the irradiated segment 0.18 +/- 0.29 mm (6 to 12 months: 0.19 +/- 0.31 mm; 12 to 24 months: 0.11 +/- 0.27 mm), and of the analysis segment 0.18 +/- 0.36 mm (6 to 12 months: 0.17 +/- 0.29 mm; 12 to 24 months: 0.11 +/- 0.20 mm). Restenosis after angioplasty and beta-irradiation of in-stent restenotic lesions is not complete within 6 months but is sustained with a gradual decrease over 24 months.

Drug Prescribing for Patients with Chronic Kidney Disease in General Practice: a Cross-Sectional Study

BACKGROUND:Vascular brachytherapy (VBT) has been proven to reduce restenosis rate and unwanted cardiac events in several randomized trials. Long-term data on populations at high risk for re-interventions are few. The aim of this study was to assess the acute and one-year outcome of beta-radiation in coronary in-stent restenoses with a high likelihood of recurrence.METHODS:In 79 patients, VBT using 90Yttrium/Strontium or 32Phosphorus, was performed. Clinical and angiographic follow-up was carried out after 6 months and 1 year.RESULTS:44.4 % of patients had three-vessel coronary artery disease and a high prevalence of cardiovascular risk factors and comorbidity. Mean lesion length was 36.8+/-18.9 mm. VBT was successful in all patients. Fractionation of VBT was necessary in 2,5 %. Acute gain of luminal diameter was 2.15+/-0.89 mm. During the hospital stay one acute myocardial infarction (AMI) not associated with VBT occurred. After 6 months loss of luminal diameter measured 0.39+/-0.47 mm, equaling a restenosis rate (RR) of 16.8 % (1 year: 0.60+/-0.56 mm, RR 33.5 %). 18.9 % of patients required revascularization of the target lesion (1 year: 29.5 %). After 6 months, all patients survived, three had an AMI after discontinuation of clopidogrel, one of them was asymptomatic (1 year: 1 cardiac death, 2 symptomatic AMI).CONCLUSION:Beta-VBT in patients at a high risk for recurrence after angioplasty is feasible and safe. Though the clinical and angiographic results at 1 year showed some impairment as opposed to the 6-months-follow-up, they nevertheless are largely superior to those patients from historic controls not treated with VBT.

Background: Vascular brachytherapy (VBT) has been proven to reduce restenosis rate and unwanted cardiac events in several randomized trials. Long-term data on populations at high risk for re-interventions are few. The aim of this study was to assess the acute and one-year outcome of beta-radiation in coronary in-stent restenoses with a high likelihood of recurrence.Methods: In 79 patients, VBT using (90)Yttrium/Strontium or (32)Phosphorus, was performed. Clinical and angiographic follow-up was carried out after 6 months and 1 year.Results: 44.4% of patients had three-vessel coronary artery disease and a high prevalence of cardiovascular risk factors and comorbidity. Mean lesion length was 36.8 +/- 18.9mm. VBT was successful in all patients. Fractionation of VBT was necessary in 2,5%. Acute gain of luminal diameter was 2.15 +/- 0.89 mm. During the hospital stay one acute myocardial infarction (AMI) not associated with VBT occurred. After 6 months loss of luminal diameter measured 0.39 +/- 0.47 mm, equaling a restenosis rate (RR) of 16.8% (1 year: 0.60 +/- 0.56 mm, RR 33.5%). 18.9% of patients required revascularization of the target lesion (I year: 29.5%). After 6 months, all patients survived, three had an AMI after discontinuation of clopidogrel, one of them was asymptomatic (1 year: 1 cardiac death, 2 symptomatic AMI).Conclusion: Beta-VBT in patients at a high risk for recurrence after angioplasty is feasible and safe. Though the clinical and angiographic results at 1 year showed some impairment as opposed to the 6-months-follow-up, they nevertheless are largely superior to those patients from historic controls not treated with VBT.