Analysing preliminary results of percutaneous radiotherapy on 79 patients with localized prostatic carcinoma, the uncorrected five-year survival rate of all patients was 67.3%, that in stage O, A and B 89.5% and that of patients in stage C and D 64.5%. The tumour-free five-year survival rate of all patients was 50.2%. In three patients there was a recurrence (4%), in four others severe side-effects (5%). There were no fatal complications. Radiotherapy can be considered to be an alternative to operation even when the tumour is limited to the prostate.

A prospective, randomized clinical study on 91 patients with squamous cell carcinoma of the oesophagus was undertaken in order to investigate the radiosensitizing effect of misonidazole. After histologic verification and extensive diagnosis, the greater tumor region was at first irradiated during 2.5 weeks with ten fractions of 3 Gy each up to a target volume dose of 30 Gy. Prior to each fraction, patients received randomly misonidazole or a placebo in a dose of 1 g/m2 body surface. Then they were presented to the oncologic surgeon in order to decide whether a surgical resection should be performed or not. Following to this operation no further radiotherapy was performed. However, if a surgical intervention did not take place, radiotherapy was continued without administration of misonidazole or placebo up to a target volume dose of 60 to 70 Gy. There was no evidence of neurotoxic side effects or modifications of the blood count and some laboratory parameters caused by misonidazole. As to recurrence-free interval and survival time, no significant differences were found between the different therapy groups, so that a radiosensitizing effect of misonidazole was not demonstrated in this study. Regarding several positive phase II studies with misonidazole, some hopes had been placed in this study because at present the therapeutic situation in oesophagus carcinoma is extremely unsatisfactory. Even the combination of a most sophisticated operation technique prior or following to irradiation could not essentially improve the poor healing rates.

The malignant tumors of the gall bladder and the extrahepatic bile ducts belong to those having the most unfavorable prognosis. Similarly to the carcinomas of the pancreas, most of these tumors are in a very advanced stage when they are diagnosed. The survival times have not been improved by radical and ultraradical operation techniques, the operation mortality, however, has increased. In the meantime, the efficacy of radiotherapy has been proved for these tumors, too. So an additional application of radiotherapy seems indicated regarding the fact that most of these patients present postoperative locoregional recurrences. As for the carcinomas of the stomach and the pancreas, the best effect of radiotherapy can be expected in case of an intraoperative irradiation; furthermore direct percutaneous intraductal irradiation techniques have been developed for suitable cases. A possible efficacy of additional chemotherapy cannot be assessed yet; a locally adjuvant effect, as in patients with carcinoma of the pancreas, could be imagined. The authors present the surgical, radiotherapeutic, and chemotherapeutic results achieved hitherto in the treatment of the carcinomas of the extrahepatic bile ducts and the gall bladder and propose further possibilities for the future use of radiotherapy. After the failure of surgery alone an improvement of the bad prognosis of these carcinomas by cooperative therapy conceptions is a vital necessity, the more as the role of obstructive jaundice as fatal factor has been eliminated by the non-surgical percutaneous transhepatic drainage of bile ducts.

Apart from the classic combination of surgery and irradiation, four other treatment modalities are presently being evaluated in advanced head and neck tumours. These are: 1) antineoplastic chemotherapy 2) radiosensitizing agents 3) high LET radiotherapy 4)local hyperthermia Preoperative chemotherapy, followed by surgery and irradiation, has improved the local control as well as survival rates in phase II trials. Cis-platinum may yield some additional benefit due to its radiosensitizing properties. Radiosensitizing drugs such as nitro-imidazoles have so far failed to show any advantage in randomized trials, since neurotoxicity prevented maximum effective concentrations. The same is true for high LET radiotherapy with neutrons as compared to conventional irradiation. Local hyperthermia is considered as a palliation at the present time, when all other treatment modalities have been exhausted. In our centre, the preliminary results of radiotherapy and sensitization with cis-platinum in combination with surgery are encouraging. Some methods are discussed which permit the prediction of prognostic criteria for tumors under treatment. This may contribute to the optimization of individual treatment regimes in the future.

The different ways of metastases of carcinoma of the anus can hardly be removed by radical surgery and require other procedures than the lower carcinoma of the rectum. In comparing Miles operation in T3/T4 carcinomas of the anus with the combined therapy of local excision and radiotherapy results showed no great difference in T1/T2 tumors the Miles operation is not necessary. In T3/T4 carcinomas irradiation derives its worth from the few possible procedures ro radical surgery. In T1/T2 tumors irradiation can be an alternative (T1) or an additional treatment (T2) to the local excision.

Carcinoma of the anal region is rare compared with rectal cancer. It constitutes 2%-6% of all malignant tumours of the anorectal region. (Beersiek et al. to be published, Gam-stetter et al. 1977). The rareness of the disease causes therapeutic uncertainty and often gives rise to individualized therapy without proven guidelines. This was true for the therapeutic measured applied in the small number of patients presented here.

The role of radiotherapy and adjuvant chemotherapy in the primary treatment of osteogenic sarcomas and of Ewing's sarcoma is reviewed. In osteosarcoma radiotherapy can take the form of prophylactic total irradiation of the lung, but preoperative irradiation of the primary tumor has not proved successful. On the other hand, in Ewing's sarcoma primary and local irradiation is the therapy of choice, and is followed by adjuvant polychemotherapy over a long period.