In-field lymph node recurrences remained the main risk after TCLI, and a deviation of >20% from the assigned radiation dose was the major risk factor for in-field recurrences. From these data, a total dose of 40-44 Gy in conventional fractionation for the treatment of macroscopic cb/cc lymphomas and 30 Gy for the treatment of subclinical disease is recommended. A randomized study comparing TCLI with EFI is now being organized by this group.
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.
From October 1987 to August 1991 a total of 141 closed-tip catheters were inserted into deep-seated or half-deep-seated tumours in 95 treatment areas. Most of the catheters (n = 79) were implanted in the pelvic region. In 139 punctures no clinical evidence of bleeding was seen. A transient blood loss was evident in only two patients. In addition, no nerve injury was observed. The problems with 141 implanted catheters were evaluated. Nineteen catheters (13%) were lost during the treatment series. In five displacement of the catheters was verified by repeat CT scans during the whole treatment. Eight catheters had to be removed due to infection. In two patients with advanced disease who were receiving a combination of chemotherapy and hyperthermia a strong inflammatory response was evident. Another patient developed an acute pancreatitis after catheter insertion. No metastasis in the invasive tracks has been seen in the follow-up period. In conclusion the insertion of closed-tip catheters by CT guidance is a sure and well-tolerated method. There were a few problems only with the implanted catheters throughout the whole treatment series.
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