Strahlentherapie und Onkologie : Organ der Deutschen Röntgengesellschaft ... [et al]
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The Health Care Structure Bill (Gesundheitsstrukturgesetz) and the Federal Health Care Tariff Regulation (Bundespflegesatzverordnung) pose new challenges for the chief physician in charge, which he has to face on account of hospital management control with department-specific internal budgeting of services, expenditure and remittance. In view of the impending establishment of care-related lump sums (Fallpauschalen) and special allowances for radiation therapy (Sonderentgelte) as well as the introduction of an appropriate internal budget plan, we resolved to draw up the service-cost ratio for 11 tumor entities, implementing calculation based on process evaluation, and to match this calculation to the actual proceeds from outpatient treatment covered either by general health insurance or private care insurance. ⋯ As to the reviewed tumor entities, modern standard radiotherapy cannot be administrated cost-effectively. A considerable degree of under-funding is especially evident with the inclusion of cost of investment and of the facilities. The cost-proceeds ratio is most unsatisfactory as regards GOA calculation, which is obsolete as far as service description and service payment is concerned. As it in no way measures up to the required standard of modern radiotherapy, reform is therefore urgently needed.
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In order to assess the influence of total-body irradiation technique on veno-occlusive disease (VOD) incidence, we retrospectively analyzed our leukemia patients treated with bone-marrow transplantation conditioned using total-body irradiation and high-dose chemotherapy. ⋯ In our series of 305 acute leukemia patients treated with allogenic or autologous bone-marrow transplantation, total-body irradiation technique (fractionation or instantaneous dose rate) did not seem to influence the incidence of VOD.
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During the course of AIDS, 25 to 44% of homosexual patients infected with the human immunodeficiency virus develop Kaposi's sarcoma. Main manifestation is the skin. Response rates of 80 to 100% can be achieved with total dosage up to 50 Gy. Nevertheless, remissions can also be attained with 20 Gy of fractionated radiotherapy. As clinical data on low dose conventional fractionated radiotherapy are insufficient we analysed the response rates of an overall dose of 20 Gy in conventional fractionation. ⋯ In patients with HIV associated Kaposi's sarcoma effective palliation can be achieved by means of radiotherapy with an overall dose of 20 Gy in conventional fractionation. Yet, the fraction of patients with complete responses is with 34 to 47% lower compared with doses above 20 Gy (66 to 100%). With reference to the reported data our results point to a dose-response relationship for Kaposi's sarcoma. Therefore higher total reference doses, e.g. 30 Gy with weekly 5 times 2 Gy or 24 Gy with 5 times 1.6 Gy for mucous lesions, respectively, are suggested as by this mean the complete response rate can be doubled.
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Comparative Study
Prognostic factors in high-grade malignant glioma. A multivariate analysis of 76 cases with postoperative radiotherapy.
Patients with malignant gliomas have a limited survival prognosis. We retrospectively analyzed data of malignant glioma patients with the aim of defining prognostic factors on which individualized treatment strategies might be built on. ⋯ Age of the patient is the most important factor for survival prognosis favouring younger age (< or = 45 years). The possible implications for radiation therapy are discussed.