Für die gegenwärtige Restrukturierung der europäischen Wohlfahrtsstaaten spielt das Paradigma der " Aktivierung" eine zentrale Rolle. Mit dem Ziel, die " Selbstverantwortung" von Wohlfahrtsempfängern zu stärken und deren Abhängigkeit von Sozialleistungen zu reduzieren, geht es dabei einerseits um die Umstrukturierung normativer Grundlagen, politischer Programme und rechtlicher wie administrativer Strukturen des Wohlfahrtsstaates, andererseits um die systematische Verknüpfung der Gewährung von staatlichen Leistungen mit Anforderungen an individuelles Verhalten zur Forcierung der Erwerbsintegration. Eine Vergleich von Aktierungsprogrammen in den Niederlanden, Dänemark, Schweden und Grossbritannien zeigt, dass, mit Ausnahme Grossbritanniens, oftmals verlässliche empirische Evaluierung fehlen. Jedoch gelang es mit der hier zusammengefassten systematischen Auswertung der vorliegenden Evaluationsstudien zu zeigen, dass zum einen die Zugänge zu den verschiedenen Programmelementen selektiv sind, zum anderen die Chancen auf den Abgang aus Leistungsbezug und den Übergang in Erwerbstätigkeit stark durch soziodemografische Merkmale der Programmteilnehmer beeinflusst werden.
Background. The purpose of this investigation was to evaluate feasibility, safety and efficacy of 3Dconformal radiotherapy (3D-RT) for inoperable non-small-cell lung cancer (NSCLC). Time to progression (TTP), including local recurrence and/or distant metastasis, local control rate (LCR), time to death (TTD) and side effects were evaluated. Patients and methods. From 1997 to 2002, a total of 84 patients with inoperable NSCLC were treated with 3D-RT according to a prospective protocol at our institution. Depending on performance status, lung function and dose-volume constraints, radiation doses of either 66-70 Gy or 50-60 Gy +/-platin-based chemotherapy were applied. Results. The treatment was well tolerated and the rate of side effects was low. Only one grade 4 pneumonitis was observed, the rate of grade 3 pneumonitis was 6% and 13% for grade 2. Two patients developed a grade 4 oesophagitis and no grade 3 oesophageal toxicity was observed. The analysis of dose-volume histograms (DVH) found a mean V 20 (lung volume that receives 20 Gy) for the ipsilateral lung (IL) of 42%, a mean V 20 for the contralateral lung (CL) of 14% and a mean lung dose IL of 25 Gy. The mean V 20 IL in patients developing a pneumonitis grade 2-4 was 53.3%. The mean follow-up was 24 month. There was no difference in TTP (median 15 months) in the different treatment groups. Patients receiving higher radiation doses (66-70 Gy) had a benefit in an overall survival (OS) when the additional chemotherapy was applied (28 month vs. 16 month). Local control rates of mean 22% after 2 years were low. Conclusions. The application of radiation doses up to 70 Gy is feasible and safe, also in combination with chemotherapy. Still, the local control and OS is poor. Thus, further trials to investigate the possibility of dose escalation in the lung without increasing lung toxicity significantly, also in more advanced tumour stages, are mandatory.
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