[en] Purpose: The limited information in the literature suggests that intracranial germinoma with syncytiotrophoblastic giant cells (STGC) producing human chorionic gonadotropin (HCG) is associated with a higher recurrence rate compared with pure germinoma producing no HCG. To determine whether the poorer prognosis for germinoma with STGC is an inevitable finding, we retrospectively analyzed data for our patients. Methods and Materials: Data were analyzed for 44 patients who had pretreatment examination of HCG titers in the serum and/or cerebrospinal fluid 9CSF) and underwent radiotherapy between 1978 and 1993. The diagnosis of germinoma was made histologically in 19 patients and clinically in 25 according to the established criteria. The treatment volume was the primary tumor site in 9 patients, the cerebrospinal axis in 29, and other in 6. The median follow-up period was 90 months. Results: Twenty (45%) of the 44 patients had elevated HCG titer. The abnormal HCG levels ranged from 4.9 to 189 mIU/ml (median: 18 mIU/ml) in serum and 8.2 to 660 mIU/ml (median: 26 mIU/ml) in CSF. No difference was found between the two groups in any patient or treatment characteristics including tumor size and incidence of CSF dissemination. The mean radiation dose to the primary tumor site was 46.4 Gy for pure germinoma and 47.5 Gy for germinoma with STGC. The 10-year survival and relapse-free survival rates were both 100% for the patients with germinoma with STGC and both 89% for those with pure germinoma. Among these patients, only two with pure germinoma developed recurrence. Conclusions: Our data suggest that the prognosis of intracranial germinoma with STGC treated with adequate radiation therapy does not differ from that of pure germinoma. Our current policy of delivering 40-45 Gy for tumors < 4 cm in diameter seems to be a reasonable treatment for germinoma with STGC

[en] Purpose/Objective: Intracranial germinomas are classified into pure germinoma and germinoma with syncytiotrophoblastic giant cells (STGC). The latter is characterized by slight to moderate elevation of human chorionic gonadotropin (HCG) levels (< 2,000 mIU/ml) in the serum or cerebrospinal fluid (CSF). There are very few data on the prognosis of germinoma with STGC, but limited data suggest a higher recurrence rate of this subtype. On this basis, some advocate more intensive treatment for germinoma with STGC. To determine whether the poorer prognosis for this subtype is a universal finding, a retrospective analysis was performed. Materials and Methods: Forty-four germinoma patients who had pretreatment examination of HCG titers and underwent radiation therapy between 1978 and 1993 were analyzed. Both serum and CSF HCG levels were examined in 19 patients, while only serum or CSF levels were examined in 20 and 5 patients, respectively. There were 37 males and 7 females aged from 8 to 32 years (median age: 16 years). The tumor site was the pineal region in 19, sellar/suprasellar region in 13, both pineal and suprasellar region in 6, and basal ganglia in 6. Nineteen patients were diagnosed histologically and 25 patients were clinically diagnosed according to the established criteria for intracranial germinoma. The treatment volume was the primary tumor site in 9 patients, the cerebrospinal axis in 29, the whole brain in 4, and the primary site plus spinal axis in 2. The radiation dose to the primary tumor site ranged between 19 and 60 Gy (mean: 47 Gy). Results: Twenty (45%) of the 44 patients had a high HCG titer. The abnormal HCG levels ranged from 4.9 to 189 mIU/ml (median: 18) in the serum and 8.2 to 660 mIU/ml (median: 36) in the CSF. In the 19 patients who had both serum and CSF examinations, the serum and CSF findings were concordant. No difference was found in the patient and treatment characteristics between the two groups. The mean radiation dose to the primary tumor site was 46.4 Gy for germinomas with normal HCG levels and 47.5 Gy for those with high levels. The median follow-up period was 74 months for patients with normal HCG levels and 85 months for those with high HCG levels. The Kaplan-Meier 10-year survival and relapse-free survival rates for all 44 patients were both 94%. These rates were 89% and 88%, respectively, for patients with normal HCG levels, while they were both 100% for those with high HCG levels. The differences were not significant. In this series, only 2 patients with normal HCG titers developed recurrence. Five patients with HCG levels > 100 mIU/ml are alive without recurrence at 78-122 months after radiotherapy. Conclusion: Our data suggest that the prognosis of intracranial germinoma with STGC (demonstrating high HCG levels) treated adequately by radiation therapy does not differ from that of pure germinoma. There appears to be no need to distinguish the two subtypes when developing a treatment plan. However, because of the paucity of such data, more information would be useful to better understand the nature of germinoma with STGC

[en] A fluorinated 2-nitroimidazole radiosensitizer KU-2285 was given orally to 14 patients. The daily dose ranged from 0.5 to 2.0 g and the total dose given ranged from 0.8 to 28 g/m². Possible toxicities observed were vomiting in two patients, muscle cramping in one and multiple joint pain in one. All these complications were mild and transient and no other toxicity was observed. The peak serum concentration of KU-2285 was 25-30 μg/ml at the dose of 1 g/m². The cumulative toxicity of KU-2285 appears to be relatively low and further clinical trials seem to be warranted

[en] Intraoperative radiation therapy (IORT) was used in an attempt to improve curability in surgery for gastric cancer. High-energy electron beams were used to deliver single doses of 28 to 35 Gy to the tumor bed and to major nodal sites where a gross malignancy remained or a microscopic malignancy was highly suspected to remain after gastrectomy. The 5-year actuarial survival rates in 101 evaluable patients who underwent intraoperative radiation therapy were as follows : Stage I, 87.2 % ; Stage II, 83.5 % ; Stage III, 62.3 % ; and Stage IV, 14.7 %. Intraoperative radiation therapy produced no improvement in survival over surgery alone in Stage I, though it prolonged survival in Stage II, III, and IV. Survival rate in each of these improved stages was about the same as that of the previous stage with surgery alone. Complications and indications are also discussed. (author)

[en] From recent clinical and experimental data, it has become clear that the total dose in multi-fraction irradiations depends more critically on a size of dose per fraction for late than for early injury to normal tissues. In the light of problems and limitations in applying the NSD and TDF formulae, new TDF tables were proposed in this article for the prediction of late injury to normal tissues in different fraction-schedules. The preparation of new TDF tables were made by retouching values of the exponents of N and T in the Ellis' NSD formula, where new exponents were derived from clinical data previously reported by various investigators. The use of new TDF tables proposed here is absolutely limited to the prediction of late effect in a definite organ, since newly employed exponents of N and T are specific to each normal organ. (author)

[en] Current trends of intraoperative radiation therapy (IORT) as well as its physical and radiobiological rationale were described in this article by reviewing a considerable amount of clinical data reported in worldwide publications in the last 10 years. IORT has been applied mostly in combination with fractionated external beam radiation therapy (EBRT) for the treatment of a variety of cancers, of which pancreatic cancer was the most frequent disease in absolute terms. There existed, however, a diversity of appraisals as to treatment outcome using IORT when compared to fractionated EBRT alone: probabilities of local control and survival and incidences of morbidity as well varied to a considerable extent among reports. The disagreement among the reports seemed to produce some doubts as to whether patients were eligible suitably for receiving IORT and whether IORT was performed at respective institutions with appropriate techniques of not only radiotherapy but also surgery and post-treatment care. It was thought at the time that the treatment quality of IORT should be re-evaluated after clarifying these moot points. (author). 76 refs

[en] An analysis of the effectiveness of radiotherapy was performed in 165 patients with non-small cell carcinoma of the lung who received more than 4500 cGy as a definitive treatment between April 1980 and March 1983 and survived longer than 2 months after the start of radiotherapy. Of patients with inoperable malignancy, 38.8% for stage II survived 3 years and 27.7% for stage III, while 4.1% of patients with stage IV disease were 2 year s urvivors. Median survivals of patients for each stage were 24.7, 18.7 and 5.9 months, respectively. As for further analysis of stage III, better results for year-survival rates and median survivals were observed in Tsub(1-2) N₂ M₀ than in T₃ Nsub(0-1) M₀. Based on these results, the role of radiotherapy for non-small cell lung cancer was discussed. (author)

[en] Although conventional fractionation schedules with daily fraction of 180 - 200 cGy and 5 treatment days per week have been satisfactory in the treatment of some tumors, there is reason to believe that the results of radiation therapy could be improved in some cases by appropriate alterations in treatment schedules. Since the last decade, multiple daily fractionation schemes have been adopted in the treatment of cancer of the head and neck, the brain and other sites. Radiation biology provides the promising rationale on the use of multiple fractions per day (MFD) that increasing the number of dose fractions with a concomitant decrease in size of dose per fraction leads to a preferential sparing of late responding tissues and to a potential sensitization of tumors. In this article, results of radiation therapy with MFD were reviewed based on the radiobiological implications. (author)

[en] Technique, indication and clinical results of intraoperative radiotherapy in neoplasms of the stomach, colorectum, pancreas, biliary tract, prostate, mediastinum, brain and bone, and soft-tissue sarcoma are reported. The cancerocidal dose in intraperative radiotherapy for each cancer was estimated from the histological examination in the irradiated field. (author)

[en] Intra-operative radiotherapy (IOR) was performed for the treatment of 101 patients with gastric cancer. Doses of 28 to 35 Gy with electron beams were delivered during the surgical procedure to tumour beds, high risk lymphnodes and/or remaining cancer nests after gastrectomy. Five-year survival rates were 87.2% for patients with Stage I disease, 83.5% for Stage II, 62.3% for Stage III and 14.7% for Stage IV. Compared with the data on 110 patients treated by surgery alone, IOR has yielded better results in patients with locally advanced disease. Based on these results, indications of IOR for gastric cancer were discussed. (author)