When one today rereads the papers by Ling and collegues published in 1981 and the book edited by Frommhold and Hübener in 1984, one realizes that almost all the criticisms articulated 10 years ago are applicable to today’s status of computed tomography (CT) for treatment planning in radiation oncology. Since 1975 several hundred papers have been published by radiooncologists and radiophysicists, presenting a variety of excellent ideas to improve hard- and software for the special needs of the radiotherapist. However, only limited effort has been made by leading companies to realize these suggestions. Credit must be given to the committed work of small and often poorly equipped groups at universities and in small companies, making possible at least in the software sector some important scientific progress in treatment planning using CT or magnetic resonance imaging (MRI). The most important reason for this disappointing situation is the fact that there is only a small market for radiation therapy hardware but a huge market for diagnostic radiology equipment. Large companies tend to invest only in public relations to boost their products. There is certainly some truth in the criticism that there is no therapeutic counterpart to increasingly sophisticated and expensive diagnostic tools.

After change of management at the Radiotherapy Department of the University of Hamburg also a change in treatment policy resulted. Of 72 patients treated since then 63 had soft-tissue sarcomas (at 83 localisations) and 13 adenoid-cystic carcinomas, only ten were treated for other indications. Neutrons only were applied in contrast to many boost applications in the past. The total doses administered were between 13.6 and 16 Gy and the doses per fraction between 0.8 and 1.2 Gy depending on tumor mass and localisation. To compare the treatment modalities all earlier treated patients with soft tissue sarcomas were reexamined and the results critically compared to earlier reported ones. There were considerable differences in the side effects found now and reported earlier. Moderate or severe fibrosis was found in 13% of the cases who received less than 13.4 Gy and in 54% of the cases who received a higher total dose. In the new series up to now only in 15 cases local recurrences and in eleven cases distant metastases occurred. Nothing can be yet said on the late effects.

From 1979 through 1983, 78 patients underwent short-term preirradiation before primary operation for rectal carcinoma at the Medical Radiation Institute of Tübingen. A hyperfractionated total dose of 16 Gy was applied within a maximum time of 36 hours in four fractions of 4 Gy each. Surgery was performed at the last irradiation day. The medium observation time of the total group of patients was five years and three months, at least 40 months. The local recurrence rate of all patients followed up is 9% (7/78), for stage Dukes A it is 6% (2/32), for stage Dukes B 0%(0/25), for stage Dukes C 27% (3/11), and for stage Dukes D 20% (2/10). In the group of 68 patients showing no metastases at the moment of surgery, the rate of formation of remote metastases amounts to 21%, in stage Dukes A to 13% (4/32), in stage Dukes B to 24% (6/25), and in stage Dukes C to 36% (4/11). The relapse-free survival during the follow-up period is 66% (45/68), for stage Dukes A 69% (22/32), for stage Dukes B 68% (17/25), and for stage Dukes C 55% (6/11). There were no acute or late radiogenic complications. Compared to publications about cases treated only by surgery, the present preirradiated patient's group shows a considerable lower local recurrence rate and an increased relapse-free survival rate. These improved treatment results are probably due to preoperative irradiation. The incidence of perioperative complications was not increased by preoperative irradiation.

The results of percutaneous irradiation of 111 patients with prostatic carcinomas during the years from 1974 through 1984 are retrospectively analyzed. A 8 MV X-radiation was applied in form of a moving field therapy charging the prostatic bed with a dose of 67.5 Gy in the 90% isodose enclosing the tumor; the regional lymph nodes were exposed to a total dose of 40 to 50 Gy. CT irradiation planning was used since 1976. All patients showing metastases received endocrine treatment or a cytostatic therapy. The corrected probability of a 10 year survival is 88% for a collective of carcinomas mainly limited to the capsula. Local recurrences were found in 2.7% and local recurrences accompanied by formation of metastases in 5.4% of cases. 12% of the patients showed chronic radiogenic side effects. The influence exerted on the survival curves by tumor stage, histological grade as well as other prognostic factors is discussed.

Between 1969 and 1984, a group of 54 patients with plastic induration of the penis was treated at the Medical Radiation Institute of the University of Tübingen. During the first years conventional X-ray irradiation was applied, and since 1974 patients were submitted to 3 or 5 MeV electron irradiation of a linear accelerator, until a total focal dose of 20 Gy was accumulated. 78% of these patients were between 50 and 60 years old. Sixteen patients suffered from a simultaneous Dupuytren contracture, one patient had a fibrosis of mamma virilis. The treatment results reached from satisfactory until very good in 69% of all cases. Complete regression or a considerable improvement was obtained for indurations in 59%, for deviations in 69%, and for erection algesia in 79%. Radiogenic damages can be excluded in case of a gonad exposition of 0.2 Gy. There were no permanent cutaneous lesions after a total focal dose of 20 Gy. The prognostic importance of an early treatment is underlined; late stages presenting ossifications can be treated only by surgery. For routine diagnosis of site, extent, and possible mineralization of the regions involved, soft ray phallography performed with the technique of mammography can be used.

Despite the great progress made by tumor therapy in recent years, it has not yet been possible to obtain a decisive improvement in the five-year survival of about 20% and the five-year recurrence-free survival of about 30% of patients suffering from advanced T3 oropharynx carcinomas. A new way to improve the poor prognosis of these patients is only offered by the possibilities of modern radiotherapy with ultrahard X-radiation as well as by the progress of microsurgery. Up to now, the recurrence-free survival of our patient's group suffering from primarily inoperable T3 oropharynx carcinomas has reached 60% (increase of about 40%). This was achieved by preoperative high-dose irradiation and subsequent implantation of myocutaneous skin flaps with the vascular bundle supplying the flap with blood. As is shown by the communications of literature and our own experience, about 80% of all recurrences will appear within the first 24 months after the end of therapy. In our preoperatively high-dose irradiated group, the observation period is meanwhile 48 months, and the recurrence-free survival is still by 40% higher than that of the control groups. Although a new formation of local recurrences cannot be excluded for the further observation time and despite the small number of patients, the rate of recurrence-free patients suffering from tumors of stage T3N+ signifies a most promising therapeutic approach.

Two patient groups submitted to different treatment schemes--with and without postoperative radiotherapy--were investigated in a retrospective study in order to find out the frequency of recurrences after conservative surgery in mammary carcinoma of the stages T1 and T2. Postoperative radiotherapy following to conservative surgery was found to be the most efficient method to prevent recurrences in patients presenting negative as well as positive axillary lymph node findings. During a follow-up period of 26 months, there was only one recurrence in 50 patients treated by conservative surgery and subsequent radiotherapy, whereas the recurrence rate of patients not irradiated after surgery was 23%.

The authors present the technique of CT reconstruction of the shape of the uterus in topograms of the pelvic region. The treatment scheme of combined endocavitary and percutaneous radiotherapy of uterine cervix carcinomas can be improved by means of the described method. The reliability of this method is compared to that of radiotherapy planning based on measuring radiography. Modifications of the position of the uterus obtained by endocavitary inserts proved to be relevant if the endocavitary regions exposed to high doses are left out from percutaneous therapy.

Dynamic CT in combination with intravenous bolus injection of contrast material provides a study of the pharmacokinetics in great vessels as well as in tissues. If the enhancement in the region of interest is plotted against time, the time-enhancement diagrams obtained reflect the contrast material passage mathematically. In abdominal tumours a great variety of patterns in time-enhancement diagrams is available. Some characteristic patterns could be related to the theoretical aspects of contrast medium distribution in vessels and tissues, i.e. the rapid arterial enhancement corresponding to aortic perfusion, a portal enhancement in liver and portal vein and a rather slow "extravascular" enhancement due to diffusion into the extravascular space. The very short period just behind the capillary passage of contrast material seems to be the most interesting one concerning identification of benign and malignant tumours. In 48 abdominal tumours time-enhancement diagrams were taken and correlated to the histological findings; preliminary findings are discussed concerning to a possible differential diagnosis between benign and malignant tissue.