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Radiation Therapy in Cancer Oesophagus
Presentedz L994, KMIO Auditorium
Dr.V.Lokesh
Kidwai Memorial Institute of Oncology, Bangalore
lo kpreeth@hotmail. co{n
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Radiotherapy in Cancer Oesophagus 1993

  • 1. Radiation Therapy in Cancer Oesophagus Presentedz L994, KMIO Auditorium Dr.V.Lokesh Kidwai Memorial Institute of Oncology, Bangalore lo kpreeth@hotmail. co{n
  • 3. (q.ot-s)l-,tntrf st ,erru(r'o',1 il1i0 ' I(ou*'lry' l* /r,(',rs v, &t-ttntnfv lort toyrltrT ry{r'6 1"'-lu'r? ,. A) tJ! ,f tr"onpv ,t ? t-z+!A{ ('t U |'I'| uo|1uluznr{ lpltlut 4r*,L1."1 f,o y',o, ue+"nPrl{.t'J '/.99 ,7Ao ";Wttit4 y,,rf Pw ,"w) T , /,St ^.Ao uf qt '",*l 4".n rFr) vlot / ,Jt 3f votlvrtlpl O8 rDAQ Q"p* f" u'!p uf > truzll,
  • 4. pronpl Fo.Pt f rol"ooS 4c.c^Lr- uclic!t nati.fi C c.sc';rl r.'1rn.l pcrio ( na /..) , 4 "r c f-slvc,.c.h'c,a .l. 8.. 4. 5. comf,orloH.. J;le . --{tl,;l^/ - very 1"1'l'' . Aduant.^q.s .{ RT -
  • 5. JhdiccrFions {o, Rad;ation therc^ R T alonc Radical RT (cu,a.huc ;ohnQ good ga^cval oo"litioot. ,t. eanly or loco liae ,{ t t t'n o r.rrr ,/ l,lr9tt . S_ Jen* Ulyct 8/o - P?.r,a'.r(/ Lcsions elderly. I in[i'- . Patli ati Yc RT t. q. 5. l. 3. Larvqe frioary l-nrnavf > I c/'iYto Pll dt[- V^Phahc / llomqh3'qGw+tl r,.t^rhoai s -. if tiAe c-rpeclqe*)2 ls Erorc tf,t.^n {r* ,^r c c hg : i+ R It not .r p"l'd bo ;rr.Su$ in &rnaccqpk f.tc tncyhid ilJ. PI r^rhcrc radtcal o HcmPI a'[ c.^tre is inadui;aI le . 3.
  • 6. ---t l I I ctr..6:. )l I I I I I I I .s er-s I i i I i I ! I la al (c ) ,tn I "glF, innf lfr,. . r?. lCit 1n ti' ; lr, ,r!' l;lt'. , |,, J ,1 15ti n['' l, tq,1' :o.1 rlit irf ,J;rJ i o,1 )(d ifts d,rqn[' err'lra .'nJi ,tiv e 'slr., J; ",. cdia {rien 2n "-( a c.a,o e e€: ' ic hnilLi: Aerli ,ad f d '. ( Ai ! ov I T. r{ro Poo' ,A ,/, firl€r "I Jla 1 P ?-( o lrl ont,ra inclic PoLrcob in V-"l(.1 a.draoa ( fistula T: e slaF lisl"e.d lnucl,re -rnl Trarna0r - I l. 3. 3. 4. 5. 6. h,^ff uf enrt'lir'n : plcnna-l f Pr*;c..nJ;a'L Jrl..As. .7. .+,, RT
  • 7. Combdnal',^r"' CombineJ rnoclalilY Rationalc : Ca'0uo7hagus , ilcatly haic r:liscast '+ Lacol ' ) STok'aic anA c.L.n olhc'u1{ al diognoliatt poht"k R,; RT , ?"t cT t o .,o,t .-'*.,1 rJop. , c.T - co,rll imlrvove' by .:nodia:snsililalt''n' aflf c"t rnicrnsrrPlr' .n.hanfratic dir<t"sc' Syslr"';' Combioaftoo hcrrrr'f li. rt''' and Rr ( Pcc oP / poqlof) ood $ur.c1e! A. fovcsfigolioooI Th.ot t a. pewued - Ctr'Picol tvial 4vFolscsis : Adftihtoo of sutg.'y (ocrofh1l"l +.t t" r. loco'l tlist-" coatvol r. imV'ou. - XuatifT af, t;f' J. Potesil'lY lrrrFrtove '!tsrviva(
  • 8. Pre a9"rahive RT - O t. Rr J. .re.s e.lf on ncnf e,r fs Jterr:,a.ia;n1 r,{* "' Inrtiluhonal P.]:V Rcse,ryed r selccfcd ereup "l ptrcih a. ;,rx:,d :j.ner^l a,nJifron b. vcl,ahvely tj,.,e.r,.1 Airnt f ' non .vlesecl alrle tu-au-n,] Jf,dS, Jlr'ccfrrAl" sF.arilise rniero.rr*.fri< exl:o.nsian nl fC'k,"r"n*,n' clec vq6tJ?- tXc, possibtr- lrnr'.,r',r,", 1?-z.li,rV elr,lirr,.1 Sr,;tlet q' Conbral. llmph n*Jtt'l' 1-"'l'''fr'"i't i^ UG -ndic.,s*ion or . 5: Jeoual thc-. ' ?'c /P/,* oF Rr, trifl di-ioirh th' Jubo*aohot .vrisk a$ tor'n'el ionnr'l -fail'rvt ' Posh oberal'ive RT I indicnIionj nanned) rnarrgio 4 -f. va rnrdiaslroal if ,1'ou firrna*rt St,lrgor<.y . i i I I I I I J
  • 9. nob drlay suljicol Lreil-rnE c.rt lspctarfiro I od Phcnk ib batted mof. hcnil'ti $ron vc "tcou;lL . t^rho niqhF u, tJ-,PoO I I lI j no - io{tc^ etc.c allonrs aclcchoa tt'o?- RT : it han I I I I rl 'lI - r--l I
  • 10. ' /<. J,lro lri6,v't cb Ttcalnncnl o Qoccvs prc OP Diaqoatit ?otl o? if#5fi. 0fcvafio" Adlt' vaoF ftcro'1t71 rn rn Srn- | Sm- & -f rn -3 - cnclot 9???:c flcscehotf ' bJuab d'*rcthl" . R<r.t[tc 0 {t ;W;- :f- (N -w2 tnrrr (nf *) 5ln- I SrYr- L $crr- 3 No fu'*'nb A",;;;h';";t [,l;f.L oatc't) Aaa- casf " e 1 '*f I''.),, I *Sc..nc. cr"? io I aAuo.n',A (anc+ f ir'tr.'h^h't') I -'c^.-, t1'3€o;f 1/ - i--*^"llfnor?) Rala "* t.i-'1ll- r* J'r}*oio,* eY - o'/ rnrt'r - t L'S/' .9frl-1 - ft,F'/' loo / el 5fi g{.7f - A9-t'1. sm-L- e t{.7'/- - Srn-1 - 47'3 {' t a- 9e,/ g?-'l /, s 7./ eP
  • 11. R.r fannin aDccss-onf - to delctmioe 1: Tu.trotrt - tD groPv R7 . !!"tqg"l (e) Exhcvrnal. R T Tcch"il4cs diseane t 8il:-. a {.rFc.nsio o - Ta la eof c.tt; I in cart o.ccr.levc*to r :'. Ly Ncdat t. machiocl fohal,am:na Loto dos. qala ( sele thm; ttigtr close nq,[" ftni ?,t6 sclctltor. Jo.'ra l""Aiog (;: rnaorral 4+nl"nd;"2 ytc,noT. a.[+." ,. loa"lio6 lhEG)
  • 12. Erburn.^LRT - " I - I - I | . Detini I ion of {.otq.I vot^.'ne I . p'i anJ/ **,*ro..rt + apptapriabc n{Jr,o:Lt7'o"Jtl . loieotrel Str.b,nqcosa.t sfrrol (:;!,!'l$'t?,li;" '5*) | - bo,ele,'s i ate ).[*,ninrl 4 niffY!;:"::f,"i ' {o, pdl;{rvc i | - ,( e6o raa,.,gio (6uf ; i"[ l1), lrrrrno$i l$c .-tt*k ,JM rilli Suflhc (a'rhCa Ocfihogtls r b. Boeriu Sto .to ,to a'rd tocal, dcfc,rwri . dtttffi, alrovc lh? hcrrd etdotly ya RT? h'co hJ Spinal Strv ,lli r .'d. tv') , u/t a/t r/s n1 L/, fe, t (r. r'r9 thr rrA flo JhQ - rraioe rl (br ll llo G Locqli lcrfi'oa + ,a. paticol ula+ion X- Rtl| ' AP i ttidfK'b t"-.?rhl'i ,Ai "} Tang<| ralu'rc i I I I I I I I I I I I I __,.-{
  • 13. (dept1' s r,oi dlq) a,-*l .SpinaL Ard P.sih'eo a* b, inhomoScai*'1 cr.wections t. Vardalioo lo bodY Coa*orrrt f 3 lcvcls oa C T Scao at lli? dor*c'u:r S l.vclr to localiSt l*r.t tcv.4 rrid t cvcl trpPcv [.vcl ofl 5 /cild avra,"qc-enls ' 3 cootorrr5 aE uPPe,r middlc- , Lo,'zer. LcvcL o$ LotrXcE votur',e.eLn€ *ahen ;i- - T P D qF e".ch leve.l i: TeeonArl - Ita.s{er {hc ou} lioe. "|.Targel vol.rrne fhc 9 .D .D E a. chanj:A Poti oL oc*Dhaqua *."qi -t ir lccgllf . f,.'.::a t at'
  • 14. Ttealncab Ai-, l. To Lvea'E *h a to nioimige. fo m ioirnisc tumarrn va(urna haary,coc6trJf dote {o sp;.,o,l cord / ar"id s cl osc +D th c l..np ttcncl , br{F L(5C aTpvolri aLe b rrr^ c.t v c.o1ll* ^.. ls &. ue{,gcs Compcrttta'}ars bolut {cild c,o.ghiog t. d??r"Pyiale Ccrvo('"., J lr lr" l"s J. 1. 5. I I -J ,,/. , //
  • 15. C-ztvical/ WL Cticoi{ - Co' , faral^lcL oypoilaX taLcvot por{n(r exal,Ji^g apiaaL atd. . Eleehve $^rni 4 Supraclavicclcr,, ^*fupgct ^.d/aatincrl -pVnacle.r (*pq (ani no') ,Jrrn a. sfrlgte A P i Pot*qt. , Tl3f ^Pccf partcr "lollo-cl Ai Z Aol obh'1uo- thotacic inlet ' Ca (6-86/-.t-61*lt . t+o" Ar. rolahoa . $edge. fa'iv Po*alt lQrf. tdt,9 C^? 3 j.ild I- AP 2 - Rare obt;Vvc rqr6. 3o'ld Cla2carh^1 atw 4*f o ',.i','f*-r. tir-- cF4St' 45'N sctgr.t lfDtr CtlS' rrrrJ tra* 4*ttrf 2:#-rl ;{
  • 16. niddle /s,d Ca 39d At. rolaihoa lhuaTy Cobatt 6() Qr7*' LuaX &orz.celloo ,tAD' 60*' Av' 7A/= 33f t. F. 3 lcild I'echatquc- (glha|P- €o Lng arcahco SSD, SOu E," o6lllur 3|i&t49- 17tt3 lor.fg- llrtc A?: Ph | 1r3.. t'''F.qe l7rt- J6D f.r 6t lTrl- n?fqD zSnt-rryr no trol tirrcct'oo 5s9P loocFl I t t rt t9--zcioqg rt-t,9' lOtS{9 4... rzrb60. r*7 3. .T ,/
  • 17. Lawer Ys Ca Icsoyh^Jut - obtfqae Jitt"h'on L - shapeA po*al ( AP ' ? A :t., ',.' :o':.-'t'' '*/ 'F -"'( ^uj^, lofievior /,!^"*'+-Y*'il co,tiaa to ti*- botcl"t "t_:_ y. slg,rta;)C_ontiaa to Lotpcr oo';-., ,Jrnryssffi. Cootac 3'o*P o[ c'o{a. upto 4a - 45 6l + I Tertols <:: 2.o-2F4v. Lcf0 Prlcrtor a[tt1'^' A5 Hy ,r no lurq Ctrrcllctr loo.-."ssg Jgoo l4rq9- Aabioa f 8x lO" tf so 3ro 89 far |- 9P A0 69 tWCP6D
  • 18. Dose- Pruse'i*ioo Palliativa RT - Ootc: 2O ql rh 5,{, , s{l*L dt soql,rn ,of, fltn. {, tcvici 14 n* - if €lcneral G,l,:ls' ' 3d spli k Coct*te In Ao.ahve Al'tc',nPt' Radica.l R T T"l" RT. imyrovecl : cB) 6,, Confin uous @trnre lecho Toba( Dasc t 60- 65 ql rh Sto Grocck (zc,..ful*, eft*t r. Joih'al Goontc - |o-(947APt?} r,. ,Tll,,lr, 2o_2967 Spttt corrnsc tcchnfgt4e ( r- :j:) e. railialrffr" - 4e-+5e/ I {, Zucokrcs} l. Eupplorncob Cantr',Q. - e,O q/ - 2{6t af"U Snrrnr CoRD Dase Silo0t.D Unl r 7o +5 ql
  • 19. Tele- Rf + Intndrrrnirnl ll{er'n A?: PA + 3cr- 35 6/ (zeac47ft', {//'"at .t no,)oP 3{e;ld + &o - L{ 6y I t-, *t rrarb * I L BT + tZ E/ aF lc"*, , 1*- aidh"c { U:,*ltt bo'?!o ..ctrl ta {-tk' Clcro'rt t J'f-r'fi-- fte 6P- Rf Wf,e.lr |,t lE -.ztv - 5' ' - I : I i I I l l I j 'i i lrltlr I t I I Dosc t66/ fr Z&dccEt 6 1O* th { racet''r Carrr. - ercl,^dc (qr d'Jco f*ld fiO a'oaa'la'ntri' J tro. cE wl,l' *-valuahoo 'l- Sut"gzryl (crroprrog t a!" ;^/ it SurqcrTt h - nof 'feonrfilc ,'. Slclu'acd. & Rr = 2o-ztdr.ei 2.-Llrr* €Srdrrrtl {eeI I I
  • 20. uoPs m ed r2'ts {'t., t^t'r 46 - ie 0,, rh $-(ou J, > 6a*e srralt Paf'cr! la.67 6 {,oL' lr .rl*$ yrd ,.. AP r PA p'lalr 'tfft
  • 21. Brach y tfieryf/ ,' Br"rh1lhc1ry is r,r, .nclhod "f fiteal^rr* ln urhich aedcd aarlioq*ive haqrtcls' ^. .-.d ro clclivcv ta.'dio{ioo oF o. ntiort Jirfor,.. by lnterchlial , inh'.a,er,ivi+*/ a.{' sardacc apptr cafr*r. WirF this madc "t 94opy, ^ bigh dos. olO a,adtaho, ry se-- ,'{1dive'ic| Lo +,rr- taauurr hrit i urapiJ dorc {all "t$ in fibc. sqwound1 D0rrnal trssuc . Ca - Oesobbaqus {J fir,, fn0ra Lurnina.l,pra'chy+hcvap/ ,,/''- Source t Eclcc{voa LDlf fio ZrF nr rEttr . lf jcyosclt lr4 -HDR i I TcchoolgY ho" 'naAe' ILBT = Co,'rPlc.'".,| - 'J*nlbfa a o*y - attrac*Wc -J I .-*b4
  • 22. a, ,{.inrrr, nthlitfrr .r'tr;lt-e' l"nJi,trr,rliel.. e t'tt?.e'r f1ptr,, arl;til'7 m(i/r n' Nhyfc-,, 770 '2,6 4eeo oI t' Cacjirrm- | 37 fi,.l'r-s ?tl (.atsium - l!7 Scltfuno .LDR. p cllcls, 4 P,-tl..bft,'a Iri,l.iuro-l!l(tnr;f4".,t &o 7+ooo 4pf licalc,rs. Mqnqal.: Re.mobe t 2. 1.,.t'.' - Oulav, lc.ollf =- se'aT cf rtr.raln'' z 7 et.t - Ie.a.t, lcagl , €5r-o Ctan,rlt, z- Q a,.t rrrouth' holdct '- - '-tr lc;t' o raLlt ;,rrr2y P.s.t'c l*utct " , ;JlJ:'...i. ,','.1 : (.aetitrm'l!7 {"rrr a T46?$ - oulct, lcoq|ri 3 (q '- 1 t{tn.'tt }tt 1 f +"w1 lnnt, ttee'J^cal rnlrie l'v moq.lf, Abldcr sota.eo.' eactlum- l3t trtielium ' tct
  • 23. Jrrry) rvit -.:-l;'" " r,Aan.^ol {ff.'toaf'r crrarEv relf - ofra {d .. ccnkat iffp;'A;ia^^y Ptln ode.9 t"ac'^1 (i r I rl -T
  • 24. .J 4 gT alone is not ad.-1ur'-L. 6D d- nneWotr--{et 40' co--. 2 . C-octrbioah'c'r 2xt Rf + J t. FT r,i nnt.c-lt tn(lx' cr''rX , Z5a'o li?'1 Zha-o foo Pb' tn 5.t/flfv,o'l h 7a^* lYt 2y' 3y $ Wr,r.ferh'r.';tah. a[, tr+ar eI al (tsso2 ecuJ", r<-'.1-''i, -.'''l Frt kT + TLET 1tlrco Es /) gr/too Csr yS ,{sa I n.t.2 s1a.n)co.;s..l ki^-|. JL.E T sc/ 6o lJ/,r"" 7 /s1 a.{o rtr. ( {a.1 (-tsy.2 ( to'tr.2 Cnaaaq;nc Lccl"Fivcn.)/J
  • 25. f. Prn '/ Fbzes , c"'to'alo' t7t lts * Zrt QI 4o6v J'* ,i ,.1 I 5 t r-r'fva.( ,r r r^.. i t/. * 32/ '12+:f *Z- - zc/. I ' 57* - tcr/' I i J 7. {.*,ainf yd 1s'fsF,i Sla+<f- q2./. tgl'l i:tu-ie/' i I I 'r ! 6r,^'t''l€ I €e er . 2S4r 6*f I ir-st lS$7 * t' 2. H;shalca f, o'noa'*lt ll9t' *Z- - zc/. 57* - tqf 3. 2 Ert /7 ,rrrt +ILBT ^T.o: SL-%a" C24tzqe,1''h thF' Ro*k^jd ')zlt ieoYc*a'l'k ca E*AT + HDl'lLRr V'*" t1"5'CY '| ' €e S.OXot l^ el aL' t16( 4l 6*"{'s A 6 a HDRTBT cJ7 t ( a^^'t! Ct*. - n.e'lt'l.' t f;'*'c:? ,o3 fr BT tae*t Sc 2.rr kT t HDei HPRrnf +2rIe'f - 2s'l 1. lPj Pr l-1f 5, Petvovich 2 anaciala (fft r.-''- ut. (1t suottiv't' {€rF + lL}! 2/' € Ltt 2l at*a*' (s7r+l Rr Lc Yctuth JanlTQo-9:, fuorye'h"e ata6t''ti3' 7'{Pt' e* g, + IL!T Qrattl Lt--co;r 7-zs6r {^,*' fu67ot-x- - Eo /' - * *tb '. , --lt L,'s,'rloJ' a' llt = "91'/ p-LfQr. 6"otJ bcs -;;*-' lltc fu'";u''t' = 2'J "t' L.c{lt c* vl'" t : i'?-1., -., ; :'^ rr:#i' =' ir'i/ tJ *, fitfut*,-4lE' 4'(
  • 26. ca( C-a'ncc'' A La' 2*l'''"^(- Rt lllicrc selcckaa l+DR - inP"t^nl $haytai LiuTalfr k 2'7 Pk L t, . , t. Simuh,hao - eracl focah'oo "i' 'o,,,.^onl tcsioa t. oot* ael* .r l*f'm tr; T-t',^"'' G'{ar t7-Ulfi J wccLlT ia}cev-' p.rrrrF - 2 am.liovalroo ra d"glulift.o*'?fpt '"J ^ccr,,*p*f ;^cr ,.[t",., )r^r i, foct"'l &,rrlil{or, ,.ipyur..^kun s* N"1r.*'? ',l) T:l^ _ ca,-nz{ J.^r,,- b/ts tJ na,nnnt* albcan u^::,*'';i,f:;:;;;,, g ui.,,'l' !' a& n' b.r :;:: f";::L' "n ze'eeeft' a* ,/rH
  • 27. N e rc Then uh" A ,', o.r.L'rz. s Conlormoh"n a[ lhe.rc" Hi.gnet Joscs 4 cl"liveu) 4o +)''tv minin,l'$aX norrnal . possi|b ': of - Collimalror cletice ind..yrnAcnhy. t g-n*y owlal^ coctveahcan'l Pl'oh-' Fr Gt' turnon-t vc,l.u.^<. u'h;lc tiss,." "lot. - 7 2.c -.3t'seyua.L Po;t 'l.uu"a Conl ot..r,r'.,s ly rvtt^ r er zr" llfi ottouac! H'<- Tnhe^k .'. .zrast"lFs dn ve2l taile'.J Arn,.. tlol"i&t.{/'" onroual tl,c Lu,crpun volunc. f! j."r....r ' c-rc:,-.,..1 tr* ffir' 1,.:iuft1".w.
  • 28. etlhermlq Thc. eLiaieal apyl|cahca ,l h.ol- I ta Ccmbiniahoo r.'illf radia'l''.'r c''a{ c|h'*l.'tt c' dtuT't to oohante- lt'C- k'if l i'r7 cdb, SotttoT<- ,Hypt.rlHi,rrnia + Rf HYPultiuaic' + a1 +'c'1' Siclcxti c. arah'onale -. t .' R.acl;'o^ac^sttt 3ahon $ I,u,-arl. t. eliveeb hy pi+ncro."c. c1k'h rt.i9 Hvpo l6csis -' ,. Hypric ce.lls - Radiotcsdslrr-,1- ,*r!.|#?,n. J. Combiaahoo H + RT r.coqld eaha'oCe' A. biotc,qic 4/..{ "8 inueusiaq noftadirl + . Haha.. inviko , Slsd;at - 'll.-.,c,"I "a.lt4' +r. acldrHve 't st^Pvaaddifive, kittiol t;|lt{ ol- heat cnils;ocd c^itri a vatklT 'l C ?a1c"6 Vancdaniscd fu'n'PUe"al *umqult'I tnove ,o);o^r*oh..te Rl aa T<:'cnc:rttlanl3fn*F ofi tt'd nc-to,al {:issuc ' : I
  • 29. ,l il 'f I I I I I ,l Ylaclrincs : R.arli.,$. ltxeof | , rr'*'n1 Ctinr caf f. ohcn lt adva ol.o.',5a.1 aeclncd +h- rA Ca.-f. c rcpl16,Jctt,t h$e .l ltii J's'?*'r ,l kl , .7l€z)ee hrn A. 3. q. iaprcva, Joc*fi +.'C. I inprave - lual^'h7 a^nahvc motsis fika,oorPa"J €t."t rf* lnlctnnl fk| i i I H l ICF ?1 i rC@e () I j
  • 30. lebsuvo 5 hfmiqo c-I- aI JaPcto 35 Pt e A)'v laoVl,obb Ca-C-rc'rr' ,Wnroo, Rr t3.{tr,l}b 4$"c ,fe'r sc:-4o; 3 { .l'oJ I J - $|a,rnttro;o ?'{7 ' - Cispliho T$n-- LisP'enr, P'-'4 6 - S eC(*or-lovoqta) .t t.ll t *b &1 {, ++ll, 3oq7 ta t#,rt- 7. I (' I l{r il ( J. l JI.lt 0 l. tt w{,J I k##it:|f .ctrre^et> (otnPtek Jlcl,?cr-'L - ?arh'aJ. 'rD?6r/'c - L cttort l. - t1'r'/' (oarer,lll< d^Vat*" -a ., | ',t , Rcsccftrfti LV n*, - Z'el 0*'*'> , avo*a.r r,J*t;X:HL_:trLalr |7.,t ^n rcteled - {.SitY' l"ea(tc.;L- r5,t-lt, irn'(: - 4Y,.1",1lf'"-",, ' rl/ dcoPlrfih'oolt ' 'i' i I - lutt,,y.^;< (ct,d*tXtt| J tlypucalccatia Csxt'2 tulq;ey;rtt C+ f+rl - {r'r{r.,.f". { tt+) l;i^rnr, 7,c^,a'*lt (tru) - J,qtqr I tLvcr h l.tt'":' ' L:'t --'' -'-_- l -!_ I ;rale = 8a'/. LL'X/.(IPt't f,r.t* 0rp' (trt *3'n t|f*)! I +
  • 31. {,ara.mote on). a*seaal .a r.- * 33 locV,ral,k. U - ^bscrvo.hon. ?}.oio"t) Cashc, anrl. Co-watLevs e R, ?tt & 7 llel;um ion.r,/ u..f $''tr' -nc ia[>--ove^"n* 14 icrrft'iva.! /fr'"...{ t.^aFv"/ I Covcnr Pr*olo'.) obsuvahe: - aece.pta-bb n"<tr;J;y ra"k l.rca.l ta.ilwvt rak -56'/. nc ialptovcnz,cal Jo 'sunuivaf' { f De-ulvons ed ben 'hiqu aak "{ f't+.^t" {c-'-r"''heo (seco
  • 32. h tincerv e^ct {ra Hloh LsI it' is thc ro.I. a'{ rch;.1, fa-{rc^r d"y'ails if' on..J/' alon1 ;L l.^.L5. ilr. carr:", lF. f-rhrl., $,. Jt;rt,r, ;[t Ler ?-k"1." u,') ! (alc.h.o) -, d. Uldi'..- a*)i), 7o1on: , Ntcr^fr'ru Ylachiac otel z Cyc-lof taa . & oL Ca-Ccrof lrag"a 7 P*h'"'lo' 'o'lu'n[ - - - l- ., ,,1 '' rnir.J beamt Hif:Wc"*k'' lan ta'l" fi.;r..t r-1.,1' Cv"lokoo-r -= fuJco bt-- ' lrrrfl . f,.1.,.' '+i*!*x#
  • 33. hoton meJ,;cal sr.sco"'c.h (-e.nL'e-. ldvaalaqot Ir:y',icahans t t, Ca-OomPYJt'D - ' &o4ol ;qhu elcae J.liurr.4 (a u^r f i*ta''7 epil,elt*l mu.sclJar'il"t Qt-c-cs a.r-- (.v . Locc"t:gel , cl.'Po' l-or. 24vter) 6Gl'f,.7rct':54 *c. .{^r,7' .' ''.',2. lohea .t5,u3*/ is 'l*ro17hf 4z 'lt-'c' , tg P*lp,^ ;oi,; 3- ?!t -l*oJ l,ot s'^",1cY MvanceA Picna'rY | 5 Vrc Fr P'c r--ns + ?y t "lr!,i oiltve' P*h* t TD So'4 (.y (! - s'etvl ail ll 7b : Prcloa + X- RT Tu.,,it tr "l;soppr*"rJ conpl<(! rb c'll l{ 7b 3 of l{ - hq/ ulcor ia lu Ci'c'r'''l<na* il f'*2 g-{"ar la*u, 1d,*Iy hcql.d , Rz".".n:l'1k";5, no cviAencl- ol locn'l. (iclt t<t !'':, t' - t{" t"*1 t ("'-""-.'- hono f,)t 6h'n'uun ' | . . f-- il.,r F..,it^,". l' !.-t"l'*?-" "'1-'.','aa - G C"*, 8-'y"tl,ic:+r t'""- {'' r''r'rY i t - - -.n'&ua L.y"fiic:+t' /i"- rr*d r;..1s" ' ,' , .rt,&..n4. [r"J*if:'' n*.^--lf. - c1rv.t"', ^o "i]* ('1' . t.? lft-':l!i, *..,-t1t1cr*- i - I | .of'Jfi 5P"'ri)t")''+rn.-'--'h!t -r'wl,r J{.J l ct<4ac4}rt';- , sJ i. ^lJ I .,, , . . -ir -l*- . *a{".a |sJ,fl -u"';"') Hi.-:-1'''J ) "' '" -t(^' :. 6;;'i''" 14 - 0a'' ytJ' 1''-t A'' !'b'."' 1
  • 34. 4ff*lt.funrc.- r/ ahr'.f{ i * antoci,f a llph. t{o -2w eG,1 l*' b'!*'' inttalur,;AJ At''rtcn- |L'qf,Z {-, 3c n':n CT -2 Lv. blcb.tc;q + Rf -Sa-+oO/ n 3-5wl lcurottfld*'L &'1" 3 ua^ttuo! -3+t' E l*1r-tffiil ' 'ir. Ro^,It" l'{c,a, lntrc, oPetun Ca- }esc L/s acLtpttttttlt- '"te* *J altdo,*;nal CpcLac axls. ! Corr,a'rea nJnl u Q^.ph trodpt 1l77."llri Y,rr'r. tl modc of, t)t ft 'l Paao'tva'cl'"J (t-lgry u-c af fs' + ,utletciol lc tr prt , i ncl',vltt.n CaeJiac anauad Coatmc ;> h <7n' t-re' ,rvlcrtcntv'fe a'.(oriot' tyaptra'h'l 'l S Sup<flial I I I i I
  • 35. + Suurqe"y' Z;;grnl'1'hY) Rf bcant EtcetYons k. *au.chi e+o 9- 12 flev al C tae:'aL) il 7n: hdv 6-Oo*7 sbtra'E pve. al C.T+ .IoR, t ?rolocpl htcoeP r 't*+ Fafl $ql'*+gt Cr I v ,arolocpl E (ooe lmv t {frJ l.-'r( 2 +'Ll', ? bt'Jx? o.altiet_ .lg* Rr fa'ld. J twptray"h-7ttl/ Rcs&lh: Duoelenal tknars Vrr" t vc'unJtctaF- di -t- l ,lf'n*/ iru, , snfite- *r'doil" -2sct7
  • 36. t) TO tLI ' ,.f tlt' l-- - ' l'.'
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  • 39. ho t(r J N * $ $ s *$ . I h ,b -* l.F s N (t 'h c P )F r,CD .t ra F ...F -$ to t 9r F 's F :6 !r -rH $ +iT '*: E ;+] tr*3 )tL' h, s= ,-r ! b F". !i fi!"i -: t$ ir sE- 'il=._ F-__,_,___ s.T t EiF.F'o+c ef E rJ -r i' * F t f?+F5 -o t|r ?-9 -:,r sgrr L -.x- 5 -)g , G L l-- !I vr rv) eCr| $ie t9 3e tt' ^ {.; +T l'[ ;f Tt.i 'FJ - { l+ {= i-} i" .F iFI E o t .-!" 3 x rC- v rF,l ) ?lTt?-a F )d- ).- {tsl. lF iI-l- T Fl *sH $!R B$ E$ .; i't .c Ii'ci 5$ "+ latr. F ai N ,Jq (,| x & { 9e t x ta 1 ..$ oe *"0 l{iu"T ,{bc:. $ F$ .lq F G.' D At' o L r,. + h 3 !- !' i- g 5l $I.'f ta ;-$ t.
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  • 41. F -.ts tr o 5 ',F ^..f L ]T s) A 3;'F.SjrFg t ? 3!slltrtx g $ k I r [,U o.q i[ ] I tt ; ^ x .r ll ,i-l'xx lP .ry toq lrN t $ b$ too' x x x 33lll$. I lt. ) Q' h_r |r ) ) d' !- F ta, I o 73 '-l tr 6- e f{ ]F lc ' r $ s l[,i x ls i'e; P + tr F s 5' +. c.) t'?It rr ll lr iJ tto tr sq$ ?t.li.n {u. I E {x' ?? lrm'S rx ll i ' tt ,^ .F A1 .t I'll rr 4 tv -d xx (lt .1.l * t$ i t b i. r relIt ;" f 3 )., q i F
  • 42. {,lafcr1 r- cF al |.9E"7-3 2' " al -^. t ) r^r tr ;{ffir1n cr ql '7s 7r , - u/s- 2of , fr/r |L't{' s L/s f . fl, , To - o'l..rt- r.tl.) Tz-ll'{/", ag-$x | &^*-rytoo.4, nts/F tl rffi,A)rce^21^-F2 . f[CDO?tooatgl-t14, '.. t- a s0Rqeqz t-+ rrccF+ lw'o- I'- ToNoHo T, No Mo Ty N.o t'lr Tl NoM' To Nr Ho T Nq t|o (lg.3f.) c8.7'1.) (J.t l,) lg.1f.l (!,Jt) g. {{) T"- -T, -L .-rL J T3- T+- too tr 801 4rl ,€/ q,g'tr 33 /. r rf t p rN M (st ?rt) t?;'#"f € too /, _ 6{/. ze/ 5+/. f1 Nr Ho Tzt, N; Ml Cztcf) (s'L{) -, 30/. I ,l"ry-:tsj-k. Cl,l"bt*JV grr-o)-'7 ", Poyy c( el Au.ohne( J 3Y Sunvfva{ -F lC --- S*- l" e fv - ? Tz Nl tLl o (g. zl'), "lqtt. t^*d."- Sgr' q T5 N, F'lr (tx'tl) - eor 1e1 -57'S'/'
  • 43. ' 'ri-__ - a r/t tr! s.i(! F,- +n fJ' rt e 1>a_ tJ ra l ttr) €r- .i. Itr $u rd> a-t t J() -s
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  • 45. hn(t,r No4 Rr i'n' Dote | Tts t97{ I jf€ lgrt l)r't l91t ttrt tlrt t'r3 I 2. t7,/. 4 2' &t t6 2L lSso tt8 L I31L trlcroc,ib(f t.i SCf|* .-Ic^n kt ,r t7 It ,,rrl ,.Ot.I 9.1. 8'l t,," I tlct-ilt T.okaroa elcl frl*ep+t 3es t & (q-Jrt'.| 2t 6o-7oqf (y, >rrn 45^-,{.t/. Tr - 1-to-- 8'S/' TL >to* - t. 6./. T3 .. JllE:Io* 5. rrp-ea-hlcr. al ca 57,3 t9.t./. 8,4r 3.o r. lgld lel,oqac @9) pfnb Qt+>) Ualrlevs (tosS l)u+a |zs) vaailullc Qst) lSlrl Jtrn 1*1 3c' 8r, cadavlulrl 1too2 Ror.trcl CGtu) ,4 BGt, (ser(;lifrfi ttolq, vor, *4.t ,"{Wffi,;. De-ko Qct) s'o-lJq, lo4t z*k,,lq' rlt tu47 rftk ,frlt Yt# w) 2.9 3.5 2 &tl. ' $t' Gltz) 4'tl.'4rhtt) tl ,8 l€ 6 o o.E,/. F I to a/. 3/. ; il .i' ll, k+ t7'/ t7 /. tr, l2' peansoo Cz?s) t;*08, Hutte.y (es) s*-c{',r Selr, ciraa a Q ztS > 4{lzgq, Ncr^nrs) k++) Qr!{ftn*, rf ' .f:yrt'tt lto 766y qth, , '/j/rltl' 5e,:tL ilrrr val(f )
  • 46. iu)A{ $0' o* $' (5. f,c) E i,.D og -l ;[ l. ho _o u) - t" tbN trr t/r. qt (^' Pqg( 'iIl+P1J -., $a FT (( tc < It,t- .>r Fr( xD i:rfFKd-r,tr)R_i tr f tr 56 vl d' 3 (! -{ C { -t- -qa(.o Pd T,3'r^o h. F-:r^-'i { 1rrIr l- = .lt ri F t ( -b N * t RH' ; I 3 i 3 ti.'5{ilTt?+; Fs.D 3 6tl o{t )o o x F a F -} |tl -l -l- s s A il. F'-J o ) Jo in t o Tp 'o' & t __ o()DNfnqd R.a ooco eJVPP !eo t, rJl "tr q-t FD]! :F }'xl ut =91 --(N LoA
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  • 48. ' Resulls ) Pott CP ' RT : - Y- /amor,.h c[ af ( t lto -Eg) )73 $ta-qa T @, -tr Ea 6'9 - fi'eet frer) Naclr"l slalwt N- N+- ft: &' ?t C.urc,tv. rrrrr.kon -t Pasl(t? 31' 5l' .tunvivol '-i ili':;k# -'n',' 6+,,3r. 87 .8 {, 2,8 . 2'J/. 32. g/ 60'+ /. 2.9.6/ Rda,pse ralc=lr'.,',/ c@l ,/ ,/ a a &l.raHr-. vrsqkrnol/ {yrS "'i 's tl'SlJa:l furlof :.f Fc.l = {3.3 t (.sg:::,ft,i;'r" " ';' y/.- $"ll;ac"F Ttn i ere (Phanc !1) SutqtrY onlT _ P! No' ll9 rU.lcl7* $Oy. n s-J,-,- ncddan 18 mlti tf' 7+ 21, Jf 5lr. 13 r' Po{: ap R-T 4( -tt"'t'/:t f 02' t{,/. € f f, "atfr 6{ 3s,' f g ,/ .a.rr !F-
  • 49. ^r|s s_F tr r Ig l, (l J sl-(t $s s F di, f [* $ $s ,,{* I oo- (t, |.l , li Itf iY Lo n B f, { Tn o b n -l F$ ss f "lJ i^lr -'ltn Flq t: n'A i*? irF 5!rn" n 1 t lit;,, ?x ' $x I' €- J cqa -s uc9 N i." Nc t0 o? -t tc -F tt l+ F a Srtr el tt sB n I W $ rA C t t : * ., b':II 1g ?o*q f *q' {ftl v tf {. vJ i.w sR F I l/|o J F-l CI -ltr tsF' z $;$ .l '{ a.c : I t rA (^ i.! - ttr A tA) rra l0 'IG ' I .rro 4. ,! o
  • 50. $ 3[ 3 $k;'=atrrtt r F ll a' x l' -p- r t ] a :t ,)f !- s' to 5 .t ol Cr n.-" o n r-4 L'3 l I l{-l cs:F(i,"o vt tl ho (^ .J. ar -$ ar . r 0 F hrr A wCl t|ar+ :sX lle13 lrtl lr o rl 'rsl 1 rO ;!1}t g.i i'{!^ -ol, z i a F 5 s a t.F tB I 0. s{ ,a F F f t.tt r,| ooo ln^r
  • 51. i*t* - i l*. . *li & .E {,- J ** l l Fr t "556'lr., a' f; htof {pJ{ Its?'t fo - - '4r-.+at fl{s? +ryIs6't)Y 1o 14'',, 81 ,ar -3'l -!f*-l'9 *ryet*, I ' Urr.7r ltf - /.BT t- Z:X I *'7 .r-rALnvagt' t tl 7 'Aql .7t )l 5,5 ,5t? S't .s( j;g !n..tft tAU n9t ].r/r$' t?sq -bot /5oz +ac tz _9 IL s3 n Tf 4*^9ot ft{st),+ v}(glo l" uvul7l)T Lts t (c-)Sq*cr ' -/tr) qs > uol,Y7 ''86' ir.lrrro-r f QP I' o'nt/P4 t ?t9l .l> e-rr'x'/A,C-g '-t;rVe.,f o+ ouz/? sllns2?/ r'r t
  • 52. F+F tr( ./^ .l- F O-.Y sf $l.e! r t * U I b it hU Fg{ $G a.r.ttqroo tli r{ i f !s53fF t 't t / 'q- E q,r !3 ;:; t3T T ?; ? al=' t w n F -t ( tisF.n K -,!F D , f I=l J t' ir t,r(t F '-* FitnF y-r i*3 .J s -F h .' n J o tr e- D. * G .} ?uJ il ar- .o'i iigtFt5!- A f F F rF { -fu F lF r a X ''a lt n t T i- f i)'i sts3'F;" iA !r :t B l;l AhcAphK lttt'rq:a, ':*f -f .-l a+- if) q$ i i tt{+$ f I "e.^-E o f, i = .t. i..br t q? -t.- I t {l lr' Fq D ,ri dt .;i I r:nL:q ri 'rt) 1 r.S i liFt' vr o1 Frr -rt Kt-r:- bt { xt h'Fr 3o fr* ,.$Fli:i' I 1l
  • 53. fic,'*rJ" I 5a1-Gc Ql ( s-e" I iqao o1f,til l4Eo Earnle ('^^Jt"*"t*'tl / I 9b t4a,vcial tr3 Ahf"l );t { Rcbet vclste/ t'tty ,5c'Q1 i Q" (c f' ( t'l'e'!'''f &2 s Fu{oo r/ n+y,!, -2,1 {;:,, n .5 ( ve/n+rtDpp i1:ilff' ,, , *ff#|,-.. l qf ' k, exnc ?11 LokicA Py e* 1o 31 2C I z.g .9c 3+VL'tL 5t {'F g 8-I eoQTl ns (. zcohlr; Reg nlls - Ch c lnc r( Aclfc lLie'^ P / llcrl;.^ ('<a ^,-- i-'l*t (^fi t -- 'Lr 4 t+' lre, €.4 ^l e2- +f Cr a.< f'.) { 1... sdjc7' 5Fc '/, C3, EET. ! f .$ t { S+C/r'4^}or*'/'*') l}'-tt Q7 , $A [ *;h^/un ZL -|;96/ ,3 srd !{:_!,l,r,io (o47/e-7,, t7/ {fwn-1"' 'e-fu-'' sarl De?/ glcc,,'14" rvv.ltra,/u6l 43 y'. 1e tl'faf zy_ -^' tc r;, 2q 7'1"27 '5t-1.-t! t (g't' ':/ {'!' or n *r&/t" g t9'/' atr 2.V. So Q lt'w ?jJ"a+ go Q7 /swu * e -t.- Qc Q7 lI*'u' 9L il fi7 ( c,t c< st *1or qbvi c I i, jt7 .Ibhn tt rL /to ,q"r 3r. salof '/ . - 4r qil+'fx't' tffiin;y'nt -''Jt{t* 1'l ei lt, *lo nto Cf |G-ilq/ ,e 9 If