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The primary treatment of lung cancer depends on tumor stage. In case of lung cancer in clinical stage I to IIb and T3N1 surgical treatment is recommended. The use of adjuvant chemotherapy is indicated in stage II and IIIa. In case of limited N2-disease trimodality therapy with chemo- or radiochemotherapy followed by surgery and eventual adjuvant radiotherapy leads to five year survival rate of about 20-40. Non resectable or extended mediastinal lymph node metastases are an indication for definite combined radiochemotherapy. Secondary resection may be evaluated in experienced centers. If the tumor has infiltrated the mediastinum or the upper sulcus (T3/4) or in case of solitary metastasis an individual trimodal treatment plan has to be elaborated. Also for small cell lung cancer surgery combined with chemotherapy can be applied in stage I and II, else and especially in stage III radiochemotherapy should be applied. Additional prophylactic cranial irradiation is used. The majority of lung cancer patients suffers from metastatic disease. The value of systemic chemotherapy is limited with significant, but small improvement in overall survival. Also treatment with the new molecularly targeted drugs does not result in a breakthrough in unselected patient cohorts. Recently, substantial progress could be achieved by personalized treatment approaches for patients harbouring special genetic alterations.

Radiotherapy in combination with simultaneous chemotherapy can improve survival of advanced esophageal adenocarcinoma. The extent of histopathological tumor regression achieved by the therapy is a relevant prognostic factor for this tumor entity. Response evaluation after radiochemotherapy of esophageal carcinoma will rely more and more on molecular factors and will allow individualization of the therapy. New combinations with taxanes and irinotecan as well as EGF receptor antagonists need to be evaluated in phase III trials. Postoperative chemoradiation and perioperative chemotherapy are evaluated in gastric adenocarcinomas and show a survival advantage. Surgery techniques used in theses trials are not recommended in current clinical guidelines.

Purpose: The aim of the subproject "Radiotherapy" within the competence network malignant lymphoma, funded by the Federal German Ministry of Education and Research (BMBF), was to build-up an electronic imaging transfer between five University departments of Radiation Oncology to improve communication between study centers and reference centers., Materials and Methods: We describe our experiences with these modern teleradiotherapeutic possibilities, its feasibility within mutticentric clinical trials., Results: Telemedical functions could successfully be integrated into the existing quality asssurance programs of radiotherapy. Since January 2001 more than 700 patients (trials HD10-HD15 of the German Hodgkin Study Group, GHSG) could be assessed after digital transfer via internet, on mobile data carriers or an ISDN-connection in the radiotherapy reference center Cologne. Transfer of digital imaging between participating study centers and the radiotherapy reference center allows immediate or a short-term evaluation of adequacy of treatment fields by expert radiation oncologists before the start of radiotherapy. This improves dialogue and consensus between radiotherapy reference centers and study centers and thus contributes towards high radiotherapy quality for lymphoma patients., Conclusion: The long-term aim is to network all those hospitals, institutions and private facilities taking part in the GHSG trials to achieve an integrated system of cooperation. This improves dialogue and consensus between the radiotherapy reference center and the study centers and thus contributes towards high radiotherapy quality for patients with Hodgkin's lymphoma.

Following surgical resection locally advanced oesophageal carcinomas exhibit a bad prognosis and therefore neoadjuvant therapeutic strategies were developed. Because success of therapy is associated with the extent of tumor regression in this context, the introduction of objective histopathological criteria seems to be very important. This study included 67 patients with oesophageal carcinomas (cT2-cT4 cNx cM0) that were treated with a cisplatin- and 5-fluorouracil-containing simultaneous radiochemotherapy. In 43 patients squamous cell, in 24 cases adenocarcinomas were diagnosed. After completion of therapy, a surgical resection and a histopathological examination of the tissue specimens were performed. The extent of tumor regression was histologically evaluated and therapy-induced alterations were graded semiquantitatively. Thereby, a significantly favorable prognosis was observed in the group of patients that showed a regression of carcinomas of 90% or more. Additionally, the extent of a resorptive-histiocytic reaction, giant cells and lymphocytic infiltrates correlated with the grade of regression. These results underline the importance of an exact examination and histomorphological evaluation of the response for the assessment of survival probability after neoadjuvant radiochemotherapy of oesophageal carcinomas.

Background: Between 1984 and 2002 more than 9500 pts. were enrolled in the multicentric randomized trials of the German Hodgkin Study Group (GHSG) and are evaluable for response, survival, recurrences, and toxicities. Actually the GHSG evaluates the efficacy of risk-adapted therapy composed of polychemotherapy (CT) and radiotherapy (RT). An extensive RT quality assurance program has been practiced during the study generations and will be continued., Patients and Methods: The 4th study generation (1998-2002) includes the following trials: In the HD10 trial (early stages) 4x ABVD are tested against 2x ABVD followed by 20 Gy Involved Field (IF)-RT vs. 30 Gy IF-RT (4 arms). In order to optimize CT-regimen and IF-RT dose for pts. with intermediate stage, the HD11 trial compares 4x ABVD with 4x BEACOPP baseline followed by 20 Gy IF-RT vs. 30 Gy IF-RT in a 4 arm design. Concerning advanced stages (HD12), the BEACOPP regimen is to be optimized and the necessity of additive RT is tested. The standard arm (8x BEACOPP escalated) is compared with the toxicity reduced arm (4x BEACOPP escalated + 4x BEACOPP baseline) followed by 30 Gy RT on initial bulky disease and/or residual tumor vs. no RT (4 arms)., Results: Interim results (without arm comparisons) with a median follow-up of 18 months for HD10 and HD11 and 20 months for HD12 are as follows: Freedom from Treatment Failure (FFTF) at 18 months is in the HD10 trial (390 pts.) 96.4%, in the HD11 trial (480 pts.) 91.5% and in the HD12 trial (550 pts.) 90.2%.The overall survival (OS) at 18 months is in HD10 98.2%, in HD11 98.5%, in HD12 93.5%. In HD10, HD11 and HD12 respectively, 1.8%, 1.9% and 2.5% of pts. died and 1.0%, 2.5% and 2.2% suffered early progression. CONCLUSION/FURTHER STRATEGY: In order to reduce the relapse rate and toxicity and to improve the quality of life, the new HD13 trial for early stages (Fig. 1a) compares 2x ABVD, 2x ABV, 2x AVD und 2x AV, each followed by 30 Gy IF-RT. For the intermediate stages, the FFTF rate should be improved by intensifying the standard regimen. Therefore the new trial HD14 (Fig. 1b) compares 4x ABVD with 2x BEACOPP escalated + 2x ABVD, each followed by 30 Gy IF-RT. In the new trial for advanced stages HD15 (Fig. 1c),the FFTF/OS rates are to be maintained and the quality of life to be improved. 8x BEACOPP escalated, 6x BEACOPP escalated and 8x BEACOPP baseline with shortened 14-day cycle are compared. The use of PET to decide on additive RT will also be investigated.

Introduction: Regarding the promising results of international trials we conducted the first German prospective multicentre phase II trial for organ preservation with primary simultaneous chemoradiation in advanced laryngeal and hypopharyngeal cancer., Patients and Methods: 28 of 30 recruited patients suffering from stage II and III (UICC) laryngeal and hypopharyngeal cancer were treated with primary simultaneous chemoradiation within an organ preservation program and monitored in follow-up of one year. Exclusion criteria included tumor infiltration of the laryngeal cartilage, bilateral neck nodes (N2c) and need for flap reconstruction in case of laryngectomy. The protocol included an accelerated concomitant boost chemoradiation (66 Gy) with Carboplatinum (70 mg/m2 1st and 5th week) and a restaging procedure one month after therapy. In case of residual disease, salvage laryngectomy and/or neck dissection were performed., Results: After follow-up of one year 20 of 28 patients (71%) were presented with stable complete remission and functionally preserved larynx. Of these 20 patients 3 developed pulmonary metastases, 1 secondary primary carcinoma of the lung and 3 neck metastases which needed neck dissections. The other patients showed in 4 cases relapsing tumor which was indicated for laryngectomy. One patient needed tracheotomy because of persisting edema and 2 patients died due to tumor progress. One patient died after complications due to salvage surgery., Conclusion: The organ preservation protocol was feasible with well tolerated early toxicity. Problems of screening for recurrent disease, salvage surgery and late toxicity should be noted and pronounced in patient information. Further studies should focus on the improvement of patient selection which could be realized by induction Chemotherapy (using new components like taxan) and/or use of prediction factors such as tumor volume and hemoglobin levels.

The pretherapeutic hemoglobin level (Hb) has been postulated to constitute a prognostic marker for outcome after primary chemoradiation of patients with advanced cancer of the head and neck. However, this hypothesis has not been tested systematically in large study samples. In the years 1992-1997, 125 patients with advanced head and neck cancer (stages III/IV UICC) were treated with primary chemoradiation in two different prospective multicentric trials, 62 patients in trial A (phase II, 1992-1995), and 63 in trial B (phase III, 1995-1997). Beside initial Hb, other pretherapeutic parameters with potential prognostic relevance were assessed and correlated with clinical outcome after 43-months follow-up: total tumor volume (TTV; calculated in initial CT scans), tumor oxygenation (polarographic measurements with Eppendorf histography), TNM, tumor localization, age, and performance status. The evaluation of the clinical end points (progression-free and overall survival and local tumor control) revealed that Hb and TTV were independent parameters with strong predictive character of outcome after primary chemoradiation in both trials (n = 125). Bivariate analysis showed < median (13.5 g/dl) a hazard ratio of 2.1 (P = 0.002) for Hb; and > median (98 ml) a Hazard ratio of 2.0 (P = 0.006) for TTV. Severe anemia (Hb < 10 g/dl) was an adverse factor in three patients. Hypoxia was associated with poorer initial therapeutical response but was not predictive of clinical outcome. Furthermore, tumor oxygenation showed no correlation with Hb. The other parameters examined failed to show prognostic significance. Our results indicate a high prognostic value of initial Hb for outcome after primary chemoradiation in advanced head and neck cancer and imply a therapeutic benefit of Hb substitution or erythropoietin administration. We propose to test this in randomized clinical trials.

Since 1994 the German Radiooncological Society has established a special commission for quality assurance in radiation oncology. The working agenda covers guidelines for dosimetry, infrastructure and organisation of a radiooncological department. The efforts are in close cooperation with the quality assurance programs of the EORTC. Corresponding guidelines are being published. They can be applied to create a quality assurance system in a radiooncological department. They are not considered definitive and are still receptive to benefit from further modifications.

Purpose: Follicle centre lymphoma grade I, II (REAL) or centroblastic-centrocytic lymphoma (Kiel classification) present a well defined clinical entity from a clinical point of view. These lymphomas are not curable by chemotherapy in early or advanced stages. They are treated by radiation therapy in early stages, but up to now the curative potency of radiotherapy has not been confirmed by prospective clinical trials., Patients and Methods: Between January 1986 and August 1993 117 adults with follicle centre lymphoma were recruited from 24 institutions to enter the multicentric prospective, not randomised clinical trial. Patients with histologically proven nodal follicle centre lymphoma of stages I, II and limited III were included. They were treated by a standardised radiotherapy regimen, in stage I by extended field and in stages II and III by total nodal irradiation. Dose per fraction was 1.8 to 2.0 Gy, in the abdominal bath 1.5 Gy up to a total dose of 26 Gy in adjuvant situation and 36 Gy to enlarged lymphoma., Results: All patients developed a complete remission at the end of radiotherapy. Median follow-up is 68 months. Overall survival of all patients in 86 +/- 3% at 5 and 8 years. Stage adjusted survival at 5 and 8 years was 89% for stage I, 86% for stage II and 81% for III. Patients in stages I and II < 60 years had survival rates of 94% at 5 and 8 years, patients > 60 years 63% (p < 0.0001). Recurrence free survival of all patients is 70% at 5 and 60 +/- 5% at 8 years. The number of recurrences is high with 29% at 5 and 41% at 8 years. All recurrences were seen within 7 years. The probability of localised nodal in-field recurrences is 11% and 22% at 5 and 8 years, respectively. Adverse prognostic factors were identified by multivariate analysis: age > 60 years, treatment breaks > or = 7 days and dose deviations > 20% from prescribed doses. Acute side effects of extended field irradiation were moderate., Conclusions: On the basis of these results radiotherapy is a potentially curative therapeutic approach in stages I, II and limited III of follicle centre lymphoma. The optimal technique is total lymphoid irradiation with doses of 30 Gy in the adjuvant situation and 40 to 44 Gy in enlarged lymphomas. The number of local recurrences leads to the assumption, that the extension of radiotherapy to the total lymphoid system might reduce their frequency.

Background: On a national and international level many scientific and health political efforts are undertaken to develop specific guidelines for various medical disciplines. They are thought to improve the transparency of the medical health system and guarantee an improvement and special care for the individual patients. Besides other medical disciplines radiation oncology also has to develop and establish such guidelines., Methods: After a specific definition of the different terms "standard", "guidelines" and "recommendation" a general description of the principle process involved in the development of guidelines is given. Furthermore, the current activities of the special working group "Quality Control in Radiation Oncology" of the German Radiation Oncology Society are elaborated., Results: A detailed set of guidelines is expected to be completed by the end of 1997.

Next to standard external beam radiation therapy, combined treatment schedules of percutaneous and endoluminal radiotherapy as well as simultaneous radiochemotherapy became important over the past ten years, especially for primarily inoperable, advanced carcinomas of the esophagus. Analyzing representative treatment protocols, the following conclusions are evident: the combination of external high-voltage therapy and endoluminal brachytherapy using high-dose afterloading techniques leads to intensified biologically effective tumor doses with increasing tumor control. The simultaneous application for radio- and chemotherapy with 5-fluorouracil, cisplatinum or mitomycin results in a longer median survival compared to irradiation alone, and it is comparable to results in historical controls with radical esophagectomy. Up to now, no reduction of distant metastases was seen after simultaneous radiochemotherapy regimen alone. There is some evidence, that intensified chemotherapy before or after radiochemotherapy might result in improved survival rates and decreased distant metastases.

We report on the case history of a 30-year-old man with chronic, therapy-resistant urticarial vasculitis for more than 1 year. On clinical examination a metastasizing malignant teratoma of the testes was diagnosed. For surgical management and oncological therapy the patient was referred to appropriate clinical units. After the treatment there urticarial vasculitis also disappeared without any specific therapy, but the persisting metastases in the lungs caused early reappearance of the urticarial vasculitis. Chemotherapy led to partial remission of metastases, and in fact also to an improvement in the urticarial alterations of the skin. Two months after the last cycle of chemotherapy metastases of the brain were discovered and at the same time the urticarial vasculitis was found to be present again in full-blown form.

Until now, radical irradiation has been the treatment of choice for patients with unresectable squamous cell carcinomas of the head and neck. In spite of improved radiation techniques, conventional radiotherapy remains mainly palliative for patients with advanced and unresectable disease stages. Our own results with accelerated radiotherapy (2 x 2.1 Gy/day, day 1-4 in week 1, 2, 5 and 6, total dose of 67.2 Gy) and simultaneous chemotherapy with carboplatin (50 mg/m2/treatment day) suggest that combined radiochemotherapy might improve the poor results achieved with conventional radiotherapy or sequential chemoradiotherapy in these patients. However, further studies are necessary to clarify whether modified radiotherapy or simultaneous chemotherapy or the combination of both are the reason for the improved treatment results. Furthermore, accelerated radiotherapy and simultaneous chemotherapy should also be investigated as an adjuvant postoperative treatment modality in primary resectable patients with advanced stage of disease to improve their poor prognosis.

In 33 patients of the multicenter German Hodgkin's Lymphoma Study Group the field borders of the paraaortic field were compared computer-assisted. It was seen that fields are chosen often too small or too large, though precise description of the fields is given in the protocol. In these patients the para-aortics were irradiated exclusively as extended field region. In addition to the above observation the clipping of the spleen pedicle provides the optimal help for correct positioning of this field. Overall a very low frequency of lymphatic clipping is observed, though clinical needs are obvious.

The left kidneys of Wistar rats were irradiated with a single dose of 20 Gy percutaneously and the local tissue partial oxygen saturation was measured with the multi wire surface electrode (Kessler and Lübbers). The rats were sacrificed at various intervals post irradiation and the pO2-measurements were compared with control values from the unirradiated contralateral kidneys in each animal. Beforehand "normal histograms" were obtained in unirradiated rats. 24 hours post irradiation hyperemia and local perfusion changes were observed, which nearly turned to normal in the course of four weeks. The histograms after 16 weeks proved persisting damage. After a short delay the nonirradiated right kidneys showed similar significant injuries. Further studies are required to clarify these alterations. The multi wire surface electrode render it possible to conceive early functional disturbances in organ microcirculation after high energy irradiation.

From August 1986 to May 1989, 15 patients suffering from Kaposi's sarcoma and serologically proven HIV infections were treated in the Department of Radiotherapy, University of Cologne, Medical Hospital. All patients were male and homosexual. Therapeutic objectives were palliation of pain and functional impairment as well as elimination of the cosmetically disturbing Kaposi's sarcoma. 68 localizations (facial skin, torso, extremities, sole of the foot, penis, oral mucosa and oropharynx) were irradiated. Depending on the individual therapy regimen, photons or high-energy electrons up to a total dose of 26 to 40 Gy, with single doses of 1.8 to 2.5 Gy were applied four to five times a week. In 66% of the cases, complete remission was achieved within the area of irradiation at the dermal or mucosal level, with at most a discrete residual pigmentation of the cluster remaining. Partial remission with at least 50% regression or a distinctive residual pigmentation was achieved in 31%. In 3% of the cases, a less than 50% regression of the Kaposi's lesions were achieved after radiotherapy. There were five local recurrences. Treatment with radiation is an effective local therapy in epidemic Kaposi's sarcoma and yields good functional and cosmetic results and also provides relief from pain.

In the German Hodgkin Study Group a radiotherapy assurance program is being carried out at the radiotherapeutic reference centre in Göttingen since April 1988: 74 patients were entered from 27 radiotherapeutic institutions. 18 of them participated in a quality assurance program and submitted the data of 29 patients: In 21 of the 29 patients the protocol was followed correctly. Physical aspects of quality control showed two major deviations from the protocol: one center used photon energies of more than 15 MVX without mould; another had a anterior-posterior loading of 3:1. The radiation oncology assessment detected six inadequate treatments: The safety margin was inappropriate in three of 26 mantle fields. Another center used a multiple field technique, and in two patients the paraaortic region was not irradiated.

Primary extramedullary plasmacytoma of the skin is a very rare disease; to our knowledge, only a few cases have been published in the world literature. In this paper, a patient who had a primary cutaneous plasmacytoma of the lower lip for 20 years is described. Serological, radiological and histological examinations excluded the possibility of an underlying multiple myeloma. The position of cutaneous plasmacytomas within the group of malignant plasma cell neoplasias is discussed and the relevant literature is reviewed.

The primary findings in 128 patients with malignancies of the nasal cavity and the paranasal sinuses were classified by 4 tumor classifications. The survival times and the rates of recurrences in relation to the stage of tumor were compared. Mostly cancers of advanced stages T3 and T4 with bad prognosis were treated: only 35% of the examined patients survived longer than 5 years. There was no obvious difference in the results of therapy in tumor cases T3 and T4 in relation to the different tumor classifications.

In the operative treatment of skin cancer large excisions are often necessary. The malignant melanoma must be excised primary with the 3--5 cm safety margin depending on the localisation. Therefore a primary wound closure is not possible, and the wound must be closed in a second step with skin grafts or regional flaps. Temporary grafting of the large excision-wound with a synthetic skin substitute (Epigard) is useful to observe recurrences and to bring the wound in a good condition for grafting. In the years 1979/1980 74 malignant melanomas and 157 basal cell carcinomas and squamous cell carcinomas were treated in this manner.

A stage dependent combined procedure of surgery and radiotherapy should be performed in penile carcinoma. Including all stages a local tumor control rate of 85% can be achieved if a radiation dosage of at least 55-60 Gy is applied. Surgery of recurrences is not impaired after radiotherapy. Prophylactic irradiation of regional lymph nodes should be performed in all tumors with more than T2 extension and in tumors located at the base of the Penis. Carcinoma of the urethra in general should be treated primarily by surgery, but in advanced tumors and in old patients a combined procedure of surgery and irradiation can be recommended. Prophylactic irradiation of the regional lymph nodes should be performed in tumors located in the proximal part of the urethra. In certain cases of infiltration of the bladder iliac lymph nodes should be irradiated as well. The results of 63 patients with penile carcinoma and 13 cases of carcinoma of the urethra are reported.

A historical survey precedes a discussion about the possibilities and limitations of free skin grafting. Although full thickness skin grafts are more resistant than split-thickness grafts, these are less demanding to the recipient site. In severe surgical defect wounds the wound bed should be conditioned using synthetic skin substitute Epigard prior to final wound closure. By using this temporary synthetic skin substitute the development of granulation tissue is being controlled. In an effort to optimize the adaptation of the graft on the wound surface, a technique of our own is being introduced. If the bordering granulation tissue at the wound edge is beveled by means of a high-speed milling cutter at an angle of 30 degrees, an equal-levelled adaptation is achieved.

CT examinations before and after radiotherapy were performed in 48 patients with choroidal melanomas who were submitted for a bulb-preserving irradiation with ruthenium-106. The authors wanted to investigate to which extent further, especially pretherapeutic informations are obtained by computed tomography, if performed in addition to well-known ophthalmologic examinations (ophthalmoscopy, fluorescence angiography, sonography). Furthermore the side reactions of therapy induced by the intervention or by the tumor should be visualized. The measurements of the tumor prominence were of special importance for the therapy planning, because they allowed to verify the response of radiotherapy by computed tomography. Our own patients had an average tumor regression of 1 to 2 mm within the first three months after the irradiation with ruthenium-106; after six months the prominence of the melanomas had decreased by 3 to 4 mm on an average. Interesting side effects, also for the ophthalmologist, were acute radiogenic retino-uveitises and parabulbar oedemas found in several patients who showed a marked regression within one or two weeks. Some late effects were scleral scars at the point of fixation of the ruthenium calotte.

A simple procedure for visualization of iatrogenic av-shunts in the upper extremity of patients on hemodialysis is presented. During compression proximal to the fistula (applying pressure of more than the patient's systolic value) 45 ml Metrizamide (80 mg iodine/ml) are injected into the venous limb of the shunt. A single xeroradiogram obtained 5-7 seconds later shows the arterial and venous vessels simultaneously. The examination requires less than 15 minutes to perform and is far less discomforting to the patient than arteriography. 42 patients were examined by this method without complications. Pathological findings - including stenoses, pseudoaneurysms and venous thromboses - were confirmed surgically.

The considerations of defect-closure in skin surgery are associated with the question--flap or graft? Different areas and conditions require individualized approaches to reconstruction. A great variety of ingenious flaps and the new method of skin-expander promote and favourise these techniques in surgical defect closure. Anyway the different grafts are still main-topics in skin surgery. Generally there exist three types of grafts. The split-thickness skin grafts, in its various modifications, are useful for functional closures of defects, while full-thickness skin grafts give better cosmetic results. The composite graft, containing epidermis, full dermis and cartilage, fits for reconstruction of contoured defects at the nose and ear. The nutrition of this special graft is limited by the contact-periphery between graft and defectborder. In contrast the survival of the other types of grafts depends on the undersurface, the degree of granulation tissue in the wound bed. The attention of many technical details, the skillness of the surgeon and some artistic considerations are the guarantors of successful grafting and of good cosmetic results.

Twenty-two own cases are presented in order to describe the clinical manifestations and therapy, especially the postoperative radiotherapy, in case of carcinomas of the upper urinary tract. The authors agree with literature to recommend a high voltage radiotherapy with 45 Gy to the regional lymph node groups and with 50 to 55 Gy to the former tumor region in case of all tumors with infiltrating growth, of demonstrated lymph node metastases and of subtotally removed primary tumors. Radiotherapy should become an essential part of the therapeutic conception for carcinomas of the renal pelvis and of the ureter because of the nearly complete absence of side effects and the small rate of local recurrences.

A report is given about the results of radiotherapy in 139 patients with vulvar carcinomas treated at the Radiologic University Hospital in Münster. This group of patients had undergone a very heterogenic preliminary treatment. Radiotherapy carried out mainly with 18 MeV electrons brought about a five-year survival rate of 58%. Due to the favorable action of the split course method, the incidence of side effects was very low regarding the total focal dose of 60 Gy (27% exudative reactions, 11% superficial ulcerations). Taking into account the unsurmountable difficulties caused by the high age of the patients and the numerous accompanying risk factors, the treatment results achieved during the last few years can probably only be gradually improved. After an operation performed as radically as possible, radiotherapy should aim at a low recurrence rate.

Computer tomography changes after retroperitoneal trauma are described on the basis of 19 patients seen by the authors. It appears that this method is superior to conventional techniques, both as a screening method and for carrying out follow-ups. The indications for angiography are thereby reduced.

The article reports on the findings obtained in 56 serial phlebographies of the upper extremity. Using 17 phlebographies without pathological findings as basis, the physiological phenomena of venous contrasting in the region of the shoulder and arm are examined. The remaining phlebograms with pathological findings are assessed according to different criteria, such as localisation and extent of venous vascular occlusion, visualisation of vascular clot and formation of collaterals resulting in collateral circulation.

Therapeutic results from 134 cases with malignant tumors of the nasal cavity and paranasal sinuses are reported. Retrospective classification based on clinical and roentgenological findings was possible in 121 cases. 49 patients underwent primary radiation treatment by 60Co-teletherapy, 46 were exposed to postoperative irradiation. The mean 2-year survival rate considering all stages and all kinds of malignant tumors amounts to 52%, the 5-year survival rate to ca. 32%. The 5-year survival rate obtained by means of curative tumor doses was 59%. Recurrences of the tumor appeared in 58 cases (43%), most of them in the course of a year. The therapeutic control of local tumor disease and the possibilities of an early detection of recurrences, improved with the help of new diagnostic methods, must therefore be regarded as the essential problems. No generally approved clinical classification of tumors of the nasal cavity and paranasal sinuses is available as yet, and the comparison of therapeutic results from different authors thus is difficult.

141 patients with endometrial cancer underwent radiation therapy at the department of radiology, University of Münster, between 1967 and 1979. The concept of the combined surgical and radiation therapy (intracavitary radium and percutaneous high voltage therapy) was adjusted to the stage (FIGO) and to the depth of penetration of invasive growth into the myometrium, this being ascertained by means of the excised tissues. Five-year survival for Stage-I patients amounted to 93.5%, for Stage II to 84.3% (ca. 80% were staged I or II). Radiation therapy of the aortic lymph nodes using monoaxial pendulum irradiation with 18-MV X-rays is discussed in detail, considering also the secondary radiation effects.

65 patients are presented who have been irradiated at the Radiologic University Hospital of M unster for recurrences of colorectal carcinomas primarily operated upon. In 54 cases the recurrence was located in the small pelvis, in 6 cases within the anastomotic region. The other patients showed cutaneous manifestations or an infestation of adjacent intestinal segments. Apart from the volume occupied by the tumor, the symptoms were above all marked pains. In 62% (40 patients), these pains could be controlled. 30% (19 patients) reported a considerable subjective improvement and 32% (21 patients) a marked diminution of pains. In 20% (13 patients) no modification was achieved, and 12 patients reported a deterioration of troubles. A prolonged survival time after irradiation of the recurrence was observed in those patients irradiated with a focal dose of more than 40 Gy.