[Clinical results and prospects of hyperthermia in the treatment of patients with esophageal carcinoma]

Dept of Surgery II, Faculty of Medicine, Kyushu University.

Hyperthermia using a radiofrequency system with an endotract antenna, combined with irradiation and chemotherapy, was prescribed for patients with resectable (n = 62) and unresectable (n = 31) squamous cell carcinoma of the esophagus, admitted to the 2nd Department of Surgery, Kyushu University Hospital from 1978. The histopathological effectiveness, according to the Guidelines for Clinical and Pathologic Studies on Carcinoma of the Esophagus, and the long-term results were compared between two groups of patients treated with hyperthermo-chemo-radiotherapy (HCR therapy) and those treated with chemo-radiotherapy but not hyperthermia (CR therapy). In the resected cases, preoperative HCR therapy resulted in a significantly higher histopathological effectiveness rate (66%) compared with that in cases treated by CR therapy (49%) (p less than 0.05). The five-year survival rates of patients with resectable carcinoma given preoperative HCR therapy or CR therapy were 43.2% and 14.7%, respectively, and the two-year survival rates of those with unresectable carcinoma were 15.5% and 1.2%, respectively. Thus, HCR therapy produced not only a significantly higher histopathological effectiveness rate but also a significantly longer survival without severe side effects. This treatment would contribute to improvement of the prognosis of patients with carcinoma of the esophagus.

PMID: 2454610 [PubMed - indexed for MEDLINE]

1: Surg Gynecol Obstet. 1988 Oct;167(4):319-23. Links 

Long-term effects of hyperthermia combined with chemotherapy and irradiation for the treatment of patients with carcinoma of the esophagus.

Second Department of Surgery, Kyushu University, Fukuoka, Japan.

Hyperthermia combined with irradiation and chemotherapy was prescribed for patients with resectable or unresectable squamous cell carcinoma of the esophagus. The long term results were compared between two groups of patients; one group was treated with chemotherapy, radiotherapy and hyperthermia (HCR), and the other was treated with chemotherapy and radiotherapy, but not hyperthermia (CR). The five year survival rates of patients with resectable carcinoma, given preoperative HCR or CR, were 43.2 and 14.7 per cent, respectively; the difference was statistically significant (p less than 0.05). The two year survival rates of those with unresectable carcinoma and receiving HCR or CR were 15.5 and 1.2 per cent, respectively. In particular, for the patients classified as TNM Stages I and II, a significantly longer survival period was obtained with HCR. As severe side effects in patients given hyperthermia were nil, this treatment deserves serious consideration when treating patients with a malignant lesion of the esophagus.

PMID: 3420507 [PubMed - indexed for MEDLINE]

31 mei 2005: Bron: Int J Radiat Oncol Biol Phys. 1994 Jan 1;28(1):163-9.

Hyperthermie naast bestraling van inoperabele lymfklieren ontstaan vanuit mond- en keelkanker (plaveiselcarcinoom) geeft significant minder bijwerkingen en geeft ook significant betere 5-jaars overleving blijkt uit gerandomiseerde langjarige gerandomiseerde studie.

RESULTATEN: Het statistische significante verschil werd gemeten voor 'snelle' respons (p = 0.0164) en verbeterde 5-jaars lymfkliercontrole in de combinatie behandelgroep, (dus van bestraling en hyperthermie samen) (p = 0.015). Klinische verbetering werd gezien in tumorcontrole en resulteerde in een positief effect op de overleving en leidde tot een statistische significant betere 5 jaars overleving (p = 0.02). Ten aanzien van bijwerkingen of toxiciteit werden geen acute of later zich voordoende ernstige bijwerkingen gerapporteerd, twee patienten met botsterfte/botafname zou mogelijk gerelateerd kunnen zijn aan de behandeling. Een thermische analyse toonde geen significante relatie tot verschillende gebruikte temperaturen en de eindpunten van de studie.

Report of long-term follow-up in a randomized trial comparing radiation therapy and radiation therapy plus hyperthermia to metastatic lymph nodes in stage IV head and neck patients.

Valdagni R, Amichetti M.
Divisione di Radioterapia Oncologica, Clinica S. Pio X, Milano, Italy.

PURPOSE: The treatment of inoperable metastatic lymph nodes in patients with head and neck cancer represents a therapeutic challenge. Clinical results using conventional radiation therapy are disappointing; on the other hand, the evaluation of recent innovative radiotherapeutic methods is still pending. The end points of this analysis were focused on long-term local control, on its potential influence on survival, and on late toxicity of a previously reported randomized Phase III study comparing conventionally fractionated radical irradiation alone or combined with local hyperthermia in fixed and inoperable metastatic neck lymph nodes.

METHODS AND MATERIALS: The medical records of 41 patients (44 nodes) with advanced locoregional Stage IV squamous cell cancer of the head and neck and randomized to treatment in the period 1985-1986 with irradiation alone (22/23 evaluable nodes) or combined with external hyperthermia (18/21 evaluable nodes), were re-evaluated.

RESULTS: The statistically significant difference observed in "early" response (p = 0.0164) in favor of the combined treatment results in improved 5-year actuarial nodal control (p = 0.015). Clinical improvement noted in tumor control positively affects survival, leading to a statistically significant difference in survival at 5 years (p = 0.02). With respect to side effects, no clearly enhanced acute or late toxicity has been found; as severe late effects, two patients with bone necroses possibly related to the combined treatment have been observed. Thermal analysis failed to show a significant correlation between heating parameters and the end points of the study.

CONCLUSION: This report with 5-year follow-up confirms the efficacy and the absence of severe toxicity of the combination of radical radiation and hyperthermia in the treatment of metastatic lymph nodes in Stage IV squamous cell carcinoma of the head and neck.

Publication Types:
Clinical Trial
Randomized Controlled Trial

PMID: 8270437 [PubMed - indexed for MEDLINE]

1: Int J Hyperthermia. 2007 Nov;23(7):567-76. Links 

Winner of the "New Investigator Award" at the European Society of Hyperthermia Oncology Meeting 2007. The HYPERcollar: a novel applicator for hyperthermia in the head and neck.

Department of Radiation Oncology, Erasmus MC Daniel den Hoed Cancer Center, Section Hyperthermia, Rotterdam, The Netherlands. m.paulides@erasmusmc.nl

The purpose of this work was to define all features, and show the potential, of the novel HYPERcollar applicator system for hyperthermia treatments in the head and neck region. The HYPERcollar applicator consists of (1) an antenna ring, (2) a waterbolus system and (3) a positioning system. The specific absorption rate (SAR) profile of this applicator was investigated by performing infra-red measurements in a cylindrical phantom. Mandatory patient-specific treatment planning was performed as an object lesson to a patient with a laryngeal tumour and an artificial lymph node metastasis. Comfort tests with healthy volunteers have revealed that the applicator provides sufficient comfort to maintain in treatment position for an hour: the standard hyperthermia treatment duration in our centre. By phantom measurements, we established that a central focus in the neck can be obtained, with 50% iso-SAR lengths of 3.5 cm in transversal directions (x/y) and 9-11 cm in the axial direction (z). Using treatment planning by detailed electromagnetic simulations, we showed that the SAR pattern can be optimised to enable simultaneous encompassing of a primary laryngeal tumour and a lymph node metastasis at the 25% iso-SAR level. This study shows that the applicator enables a good control, and sufficient possibilities for optimisation, of the SAR pattern. In an ongoing clinical feasibility study, we will investigate the possibilities of heating various target regions in the neck with this apparatus.

PMID: 18038287 [PubMed - indexed for MEDLINE]