Clinical results of thermoradiotherapy of locally advanced and recurrent breast cancers--comparison of results with radiotherapy alone

From August 1979 through January 1988, 23 breast cancer patients with 25 tumors supposed to be refractory to conventional treatment were treated by thermoradiotherapy. Of the 25 tumors, 10 were locally advanced primary tumors [Group 1], 4 locally advanced recurrent tumors after operation more than 5 cm in maximum diameter [Group 2], and 11 locally recurrent tumors after radiotherapy [Group 3]. The present study was not a formal randomised-trial, but a historical-controlled study. The results were compared with tumors which were treated by radiation therapy alone between July 1962 and August 1979. The historical control groups comprised 11 tumors for Group 1, 17 for Group 2 and 19 for Group 3. Employing 4 types of heating devices (8, 13.56 MHz capacitive RF, 430, 2450 MHz microwave), hyperthermia was administered once or twice a week after irradiation, for 30-60 minutes per session, up to a total sessions of 2-9. Radiotherapy was delivered in fractions of 180 to 200 cGy per day, 5 days per week, up to 28-74.4 Gy in total, or in fraction of 400 cGy, two times per week, up to 28-60 Gy. Tumor temperatures were measured by inserting thermocouples into the tumors. The tumors that did not recur during follow-up of more than 3 months were regarded as locally controlled tumors, and the local control rate was calculated. The local control rate in Group 2 and the local response rate (CR + PRa) in Group 1 were higher than those of the historically controlled tumors. In Group 3, hyperthermia combined with lower total doses of irradiation showed a high local response rate similar to that by radiation therapy alone. Thus local hyperthermia in combination with radiation therapy seems to be more effective than radiotherapy alone for locally advanced and recurrent breast cancers.     

Radiation and hyperthermia in the treatment of superficial and semi-deep tumors: heat profile, heat doses, tumor remission

Between August, 1986 and October, 1987, 364 hyperthermia treatments combined with radiotherapy were performed in mostly locally advanced and recurrent tumors. Half of the patients could only be exposed to relatively small radiation doses of 20 to 36 Gy. The therapy results of 24 patients with 26 treated tumor sites showed complete remission in 22% and partial remission in 42% of the sites. The dependence of tumor remission on the dose of radiation and heat and the inhomogeneity of the temperature distribution are discussed.     

Neuroblastoma of the olfactory nerve. Radiotherapy experiences in 6 patients

Six patients with neuroblastomas of the olfactory nerve (esthesioneuroblastoma) are presented who were irradiated between 1983 and 1986 at the Medical Radiologic Institute of Tübingen. Clinical manifestations, diagnostics, histology, therapy, and courses are compared and discussed with regard to a survey of literature. An attempt is made to find out the value of radiotherapy in the treatment of this rare disease. In stage A (tumor restricted to the nasal cavity, 1 patient), a local tumor control of up to now 28 months could be achieved by a treatment combination of surgery and radiotherapy. A treatment consisting of surgery or radiotherapy alone should even in this stage only be performed in connection with a close follow-up because of the increased local recurrence risk. Tumors of stage B (manifestation in the nasal cavity and the paranasal sinuses) did not occur in this group of patients. Five patients suffered from tumors of stage C (tumor extent beyond the paranasal sinuses). A good palliative effect was obtained temporarily by radiotherapy alone in three out of these patients showing large inoperable tumors and rapidly progressing clinical symptoms. A complete remission now lasting 16 months was achieved only in one patient by radical surgery with unilateral evisceration of orbit and homogeneous postirradiation. In case of stage C tumors it is recommended to perform, if possible, a radical tumor excision with evisceration of orbit in case of unilateral manifestation in the orbit and a postirradiation applying a radical, large volume technique. In order to reduce the risk of radiogenic cerebral necroses, it should be attempted to avoid dose maxima as they can occur when applying a combined ventro-dorsal and lateral irradiation technique.     

Results from 215 patients with laryngeal carcinoma treated with sole radiotherapy or with a combination of radiotherapy and operation (author's transl)]

Results of radiotherapy alone or in combination with surgery in 215 patients with laryngeal cancer are reported (treatment time between 1963 and 1976). In patients with glottic cancer, the cure rate is about 80% and surgical treatment for persistent/recurrent cancer was necessary only in a few cases. Analysis of tumor dose, tumor control rate and complication rate shows that in cases with glottic cancer a tumor dose between 1900 and 2000 ret is necessary and tolerable. In patients with supraglottic laryngeal cancer, the cure rate is about 55%. Early stages (T1N0M0) were mostly treated by radiotherapy alone, moderately advanced stages (T1N1,T2N0+1) mostly received radiotherapy as a primary treatment and were operated in case of irradiation failure. Advanced stages were primarily treated by a combined therapy, and by radiotherapy alone if they were inoperable. In early cases, who are to be treated by radiotherapy alone, the tumor dose should be about 1900 ret. In moderate cases, treatment by primary irradiation alone is possible, if the patient can be followed up regularly; surgery is indicated, if the patient cannot unequivocally be classified as symptomless. In some of these cases, there is no tumor demonstrable histologically in the excised larynx. In using this treatment policy, there is a better functional treatment result than in using primary combined treatment in moderately advanced cases with supraglottic laryngeal cancer.     

Radiochemotherapy in Combination with Regional Hyperthermia in Preirradiated Patients with Recurrent Rectal Cancer

BACKGROUND AND PURPOSE: Encouraging results of phase II studies combining chemotherapy with radiotherapy have been published. In this study, the results of a multimodal salvage therapy including radiochemotherapy (RCT) and regional hyperthermia (RHT) in preirradiated patients with recurrent rectal cancer are reported. PATIENTS AND METHODS: All patients enrolled had received previous pelvic irradiation (median dose 50.4 Gy). The median time interval between prior radiotherapy and the onset of local recurrence was 34 months. The combined treatment consisted of reirradiation with a median dose of 39.6 Gy (30.0-45.0 Gy), delivered in fractions of 1.8 Gy/day. 5-fluorouracil was given as continuous infusion 350 mg/m(2)/day five times weekly, and RHT (BSD-2000 system) was applied twice a week within 1 h after radiotherapy. The primary endpoint was local progression-free survival (LPFS); secondary endpoints were overall survival, symptom control, and toxicity. RESULTS: 24 patients (median age 59 years) with a previously irradiated locally recurrent adenocarcinoma of the rectum were enrolled. The median LPFS was 15 months (95% confidence interval 12-18 months] with a median follow-up of 27 months (16-37 months). The overall 1-year and 3-year survival rates were 87% and 30%, respectively. Pain was the main symptom in 17 patients. Release of pain was achieved in 12/17 patients (70%). No grade 3 or 4 hematologic or skin toxicity occurred. Grade 3 gastrointestinal acute toxicity was observed in 12.5% of the patients. Paratumoral thermometry revealed a homogeneous distribution of temperatures. CONCLUSION: RCT combined with RHT is an efficient salvage therapy showing high efficacy with acceptable toxicity and can be recommended as treatment option for this unfavorable group of preirradiated patients with local recurrence of rectal cancer.     

Breast conservation surgery and interstitial brachytherapy in the management of locally recurrent carcinoma of the breast: the Allegheny General Hospital experience

PURPOSE: To evaluate lumpectomy followed by interstitial brachytherapy as an acceptable salvage therapy for women who have developed localized recurrence of breast cancer after conservation surgery and postoperative external radiotherapy. METHODS AND MATERIALS: Between 1/1998 and 10/2006, 21 patients with T0 or T1 in-breast recurrence of carcinoma were offered interstitial low-dose rate brachytherapy after tumor re-excision as an alternative to salvage mastectomy. All patients had failed lumpectomy followed by standard postoperative external beam radiotherapy (range, 5000-6040cGy) as treatment for the initial breast carcinoma. Seven recurred as ductal carcinoma in situ, 2 as infiltrating lobular carcinoma, and 12 as recurrent invasive carcinoma. The recurrent tumors were excised with final margins of resection free of residual disease per National Surgical Adjuvant Breast and Bowel Project definition. Tumor bed implantation was then carried out with an interstitial technique using (192)Ir with the target volume consisting of the tumor bed plus a minimum 1.0-cm clinical margin. The required minimum dose delivered to the target volume was 4500-5000cGy (range, 4500-5530). RESULTS: Twenty of 21 patients were free of local disease with a median observation time of 40 months (range, 3-69). The single patient who developed a second local recurrence was treated successfully with simple mastectomy. Two patients succumbed to systemic disease at 17 and 24 months after salvage implant therapy. One patient developed a contralateral breast cancer. Cosmetic results defined by the National Surgical Adjuvant Breast and Bowel Project cosmesis scale were acceptable. One patient developed a localized seroma requiring multiple needle aspirations before complete resolution. Two patients developed localized skin breakdown in the tumor bed. One healed after 6 months of conservative treatment. The other healed 9 months later with Grade II cosmesis. This patient also developed a concurrent postoperative wound infection. CONCLUSIONS: Repeat lumpectomy followed by brachytherapy is feasible and may be an acceptable alternative to salvage mastectomy in patients who locally fail conservation breast therapy; however, longer followup and greater patient numbers may be needed to better define the role of salvage brachytherapy.     

Treatment results of radiotherapy for squamous cell carcinoma of the cheek mucosa]

The results of radiotherapeutic treatment in 71 patients with squamous cell carcinoma of the cheek mucosa were reviewed. The actuarial 5-year local control rate was 100% for T1 (8 patients), 62% for T2 (43), 65% for T3 (17) and 0% for T4 (3). The patients were divided into four groups according to treatment modality; group 1 was treated by radiotherapy alone (R), group 2 by radiotherapy combined with chemotherapy of BLM or PEP (R + C), group 3 by external radiotherapy followed by surgery (R + S) and group 4 by a combination of radiotherapy, chemotherapy and surgery (R + C + S). The 5-year local control rate was 44% for R (11 patients), 61% for R + C (39), 63% for R + S (6) and 80% for R + C + S (15). Nine of 14 cases or 64% of the surgical specimens in the R + C + S group showed no tumor cells microscopically, a rate comparable with the 5-year local control rate of the R + C group. Including the results of secondary treatment by surgery for recurrent cases, the ultimate local control rate was 83% in both the R and R + C groups. The local control rate was 88% for carcinoma located in the anterior half of the cheek and 53% for that in the posterior cheek. The results suggested that tumors extending to the bucco-alveolar sulci would be more difficult to control by radiotherapy alone, with or without chemotherapy.     

Analysis of patients treated with radiotherapy in the year 1990.

We analyzed the patients treated with radiotherapy in Gunma University Hospital in 1990, to determine the characteristics of the practice of radiotherapy. During this period, 540 patients with various diseases received radiation therapy. Five hundred thirty-one (98.3%) of them had malignant tumors, and the remaining nine had benign diseases. Of the patients with malignant tumors, primary tumor of the head and neck (21.7%), and lung and mediastinum (13.0%) were most common. Four of nine patients with benign diseases had pterygium. Three hundred thirty-two patients (63%) had previously untreated malignant tumors. Curative radiotherapy was performed in 296 patients (56%), and palliative radiotherapy in 235 (44%). Of CRG patients, 43% were treated with radiation alone and 40% with surgery followed by radiotherapy. The proportion who received curative radiotherapy was the highest in patients with cervical cancer (80%). Twenty-four of 34 patients treated with intracavitary irradiation had cervical cancer. Interstitial irradiation was performed in nine patients. Four patients with pterygium were treated postoperatively with surface irradiation using an Sr-90 contact device. Radioactive iodine was administered to ten patients: eight thyroid cancer patients and two hyperthyroid patients.     

The combined radiation and hormonal therapy of prostatic carcinoma: a conceptual analysis]

The concept of a combination of radiotherapy and hormonal therapy for the treatment of locally advanced carcinoma of the prostate was evaluated in view of an improved success rate compared to radiotherapy alone. At present, however, radiotherapy still remains the central mode of therapy in the treatment of the local tumor. The time sequence in a combination with hormonal therapy is of importance. Antecedent hormonal treatment can reduce tumor size, thus improving local conditions for percutaneous--and especially interstitial--radiotherapy; it is indicated in patients with voiding problems. An improvement in survival rates has so far not been achieved, however, local tumor remission rates are better. With concomitant hormonal therapy, compared to radiotherapy alone, tumor progression rates are lower. It remains to be seen, whether these results can be improved by using newer pharmacological ways of androgen blockade. The application of androgen withdrawal as a secondary measure with local tumor persistence or progression after radiotherapy remains a palliative treatment of limited efficacy. Due to the heterogeneity of the available study reports and the concurrent lack of controlled, randomized trials, a conclusive evaluation of the concept of combined radio- and hormonal therapy of prostatic cancer is as yet not possible.     

Radiotherapy in the treatment of carcinoma of the major salivary glands

The authors conducted a retrospective study on 99 patients with malignant tumors of the major salivary glands, who had been treated by radiotherapy between 1976 and 1986: 86 cases of parotid tumors and 13 cases of submandibular gland tumors. Only 28 tumors (28%) were T1-T2, N0-N1. Local control, 3-5 and 8-year survival rates, and complications were considered. Radiation therapy alone was performed on 19 patients (19%), while combined surgical and radiation therapy was performed on 80 patients (80%). The results of radiation therapy alone and combined with surgery are discussed. Loco-regional disease control was obtained in 9 out of 19 patients (47%) by irradiation alone, and by combined irradiation and surgery in 60 out of 80 cases (75%). Distant metastases developed in 23 out of 99 patients (23%). Loco-regional metastases were the most frequent cause of death (20 out of 55 cases: 36%). Severe complications were extremely rare. The results demonstrate not only the advantages of combined treatment but also the value of radiotherapy alone in the treatment of tumors of the major salivary glands.     

Locally recurrent breast cancer: pulse dose rate brachytherapy for repeat irradiation following lumpectomy-- a second chance to preserve the breast

PURPOSE: To perform and assess the effectiveness of local excision of recurrent tumor followed by postoperative pulse dose rate (PDR) brachytherapy. MATERIALS AND METHODS: From 1994 to 2000, 17 patients who had small recurrent breast carcinomas after initially undergoing breast-conserving therapy (BCT), which included postoperative radiation therapy, were treated with local tumor excision and PDR brachytherapy. Recurrences occurred at a median time of 50 months (range, 11-208 months) after primary treatment. Eight patients underwent a combination of PDR brachytherapy (total dose range, 12.5-28.0 Gy) and external-beam radiation therapy (EBT) (total dose range, 12-30 Gy). Nine patients underwent radiation therapy with 40.2-50.0-Gy PDR brachytherapy only. The prescribed radiation dose was 0.5-1.0 Gy per pulse. Patients were examined for local tumor control and treatment-related side effects. RESULTS: Twelve of 17 patients had no local tumor at a median follow-up time of 59 months (range, 20-84 months); two of these patients showed signs of having distant disease. One patient died after a cerebral stroke without evidence of tumor. Four women treated with combined EBT and brachytherapy had secondary local tumor recurrences 4, 8, 8, and 11 months after therapy and had to undergo mastectomy. Despite having undergone radiation therapy previously, patients had side effects limited to moderate (grade 1-2) fibrosis. CONCLUSION: Local tumor excision combined with PDR brachytherapy for small local-regional tumor recurrences after primary BCT is feasible and well tolerated and might obviate mastectomy. Preliminary experiences are encouraging. Further studies are required for appropriate patient selection.     

Endoluminal irradiation of tracheobronchial tumors using a high dose rate iridium-192 afterloading device

We report about 50 patients with inoperable bronchus tumors treated since March 1986 in a prospective non randomized study with high dose rate iridium-192 afterloading (AL) irradiation in 140 applications. 26 patients were treated combined with external irradiation. 32 were treated before with laser therapy, one with chemotherapy (small cell carcinoma). The actuarial survival rate (Kaplan-Meier) was 26% after 36 weeks for all patients; 38% for combined endoluminal and external irradiation and 9% for patients treated with AL alone. Death was caused by the local tumor in 85%. In 41% lethal bleeding was seen.     

Neutron radiotherapy in adenoidcystic carcinoma: preliminary experience at the Münster neutron facility

In adenoidcystic carcinoma macroscopic residual disease after surgery, inoperable and recurrent tumors are characterized by relapse rates up to 70% if treated according to conventional treatment strategies including photon radiotherapy. By neutron therapy a tumor control rate of 70% has been reported. At the d,T-generator (14 MeV) in Münster nine patients with adenoidcystic carcinoma of the salivary glands in locally advanced stage have been treated since 1/86. A combined modality schedule (30 Gy photon/5 to 10 Gy neutrons) used in the beginning has been replaced by a definitive neutron therapy (15 Gy) with single fractions of 1.0 to 1.3 Gy in five to six weeks. Treatment planning included CT/MRI as well as computer assisted dose calculations based on a specific software for neutron therapy. The volume reduction by neutron radiotherapy was 82% for advanced disease. Continuous remission was achieved in seven of nine patients in a short follow-up period of medium 15 months (from six to 28 months). The two recurrences occurred at the field edge. Based on this preliminary experience and on a survey of the literature the main issues for neutron therapy in salivary glands tumors in particular adenoidcystic carcinomas are discussed: histology, stage, tumor size, location, surgery, treatment planning and delivery, dose, and side effects. A long term evaluation of neutron therapy within a controlled clinical multicenter trial is proposed.     

Results of Three Dimensional Conformal Radiotherapy and Hormonal Therapy for Local Recurrence after Radical Prostatectomy

Background and Purpose: Analysis of treatment results of combined three–dimensional conformal radiotherapy (3DCRT) and hormonal therapy in patients with locally recurrent prostate cancer after radical prostatectomy.Patients and Methods: Between 1992 and 1998, 24 patients presented with a rising prostate–specific antigen (PSA) between 4 and 152 months following radical prostatectomy and a local recurrence demonstrated by imaging. Recurrence was biopsy–proven in 13 cases. All patients were treated with 3DCRT to a total dose of 60–70 Gy. 21 patients (88%) received adjuvant hormone therapy up to a maximum of 6 months.Results: All patients showed a response in PSA values after therapy. Median follow–up is 43 months. Overall survival is 80% and 67% at 3 and 5 years, respectively. Biochemical control rates are 53% and 38% at 3 and 5 years, respectively. 14 patients developed a second PSA relapse. Acute and late toxicities, classified with the RTOG score, were moderate.Conclusion: Radiotherapy and short–term adjuvant hormone therapy represent an effective and well–tolerated treatment for locally recurrent prostate cancer after radical prostatectomy resulting in good local control. Long–term prognosis in terms of biochemical control and disease–specific survival remains poor.     

三维适形放射治疗局部晚期非小细胞肺癌长期生存分析

目的 评估三维适形放疗局部晚期非小细胞肺癌的长期疗效、放疗毒副反应及影响患者的预后因素。方法 2000年11月至2004年5月在河北医科大学第四医院接受根治性三维适形放疗并经病理或细胞学证实的Ⅲa/Ⅲb期非小细胞肺癌患者106例。46例接受单纯放射治疗;另60例接受化疗,其中同期化疗41例,序贯化疗19例。对相关临床指标进行单因素、多因素分析,并用预后指数模型综合评价放疗疗效。结果 全组患者治疗后,1、3、5年生存率分别为50.0%、22.2%、15.5%;1、3、5年局部控制率分别为80.2%、53.8%、32.7%;中位生存期12个月。其中单纯放疗、序贯放化疗及同期放化疗的中位生存期分别为10、12及13个月;Ⅲ_a与Ⅲ_b期患者中位生存时间分别为13、10.2个月。单因素分析结果显示,性别、治疗前卡氏评分、病理类型、锁骨上淋巴结、吸烟状况、治疗前血红蛋白值、N分期、瘤体最大直径、肿瘤体积、GTV大小及近期疗效为患者预后影响因素;多因素分析结果显示,吸烟状况、GTV大小及治疗前血红蛋白值为预后独立影响因素。全组≥2级放射性食管炎18例,占17.0%;≥2级放射性肺炎39例,占36.8%;≥3级血液学毒性反应11例,占10.4%。结论 三维适形放射治疗局部晚期非小细胞肺癌显示了较好的疗效,吸烟状况、GTV大小及治疗前血红蛋白值为非小细胞肺癌患者预后的主要影响因素。预后指数模型能够显著提高多指标联合的预测价值。     

TACE联合局部热疗治疗肝癌并肝动脉门静脉瘘的短期疗效观察

目的观察肝动脉化学性栓塞（TACE）联合经皮局部热疗治疗肝癌合并肝动脉门静脉瘘（HAPS）的近期治疗效果。资料与方法对25例肝癌合并HAPS患者,先行肝动脉明胶海绵颗粒或弹簧圈堵塞瘘口及供血动脉,必要时加用碘油栓塞,3d后再行经皮穿刺微波凝固治疗（PMCT）或射频消融（PRFA）治疗,术后2个月行CT或MR增强、DSA检查,观察瘘口闭塞、肿瘤坏死及临床症状好转等情况。结果25例27个病灶DSA造影发现43处HAPS,其中中央型21处,周围型22处,经明胶海绵颗粒及弹簧圈栓塞后瘘口及供血动脉完全闭塞。18个病灶进行了PM—CT治疗,9个病灶进行了PRFA治疗。2个月DSA复查,17处HAPS再通（中央型12处,周围型5处）。CT或MR增强扫描示6个病灶完全坏死,19个病灶坏死面积〉50％;8个病灶缩小50％以上,10个病灶缩小25％～50％。所有病例无严重并发症发生,术后腹胀、腹泻及腹水等门脉高压相关症状明显减轻或消失。结论TACE联合经皮局部热疗可以有效地治疗肝癌合并HAPS。     

Reirradiation of Locally Recurrent Nasopharyngeal Carcinoma

PURPOSE: To study the efficacy of reirradiation as salvage treatment in patients with locally recurrent nasopharyngeal carcinoma. PATIENTS AND METHODS: Between 1993 and 2000, 20 consecutive patients (twelve males and eight females) with nasopharyngeal cancer, previously irradiated in different Hungarian institutions, were reirradiated for biopsy-proven locally recurrent tumor. Histologically, 85% of the patients had WHO type III, 5% type II, and 10% type I disease. Stages I-IV (AJCC 1997 staging system) were assigned to five (25%), seven (35%), five (25%), and three (15%) patients, respectively; none of them had distant metastases, and only eight (40%) displayed regional dissemination. The median time period between termination of primary treatment and local recurrence was 30 (range, 10-204) months.Brachytherapy was the method most frequently used: in ten cases alone (especially for rT1 tumors), and in eight cases in combination with external beam therapy. Two patients with locally advanced disease underwent external beam therapy only. The median dose in the event of brachytherapy alone was 20 Gy (4 x 5 Gy or 5 x 4 Gy, range, 16-36 Gy), and the dose range for exclusive external irradiation was 30-40 Gy. In cases of combined irradiation, a median 20-Gy brachytherapy (range, 16-40 Gy) was associated with 30-40 Gy of external irradiation. Radiotherapy was supplemented by neck dissection (six patients), nasopharyngectomy (one patient), or chemotherapy (eleven patients). RESULTS: 16 patients were reirradiated once, three twice, and one patient three times, with a median equivalent dose for tumor effect of 36 Gy (mean, 44 Gy; range, 19-117 Gy; the estimated alpha/beta-ratio was 10 Gy). The median equivalent dose of reirradiation for late effect on normal tissue (with an estimated 70% delivery of the tumor dose) amounted to 30 Gy (mean, 37 Gy; range, 13-101 Gy, estimated alpha/beta-ratio 3 Gy). After a median follow-up of 37 (range, 12-72) months, the overall survival was 60% (12/20). Seven of the twelve surviving patients are currently tumor-free. After primary irradiation, xerostomy occurred in all patients as an unavoidable side effect of treatment. Following reirradiation, a severe (grade 3 or higher) late toxicity (CTC criteria, version 2) has been observed in two tumor-free patients (10%) so far (necrosis of soft palate and paresis of glossopharyngeal nerve). CONCLUSION: Retreatment of nasopharyngeal carcinoma with radiotherapy (preferably a combined modality), can result in longterm local control and survival in a substantial proportion of patients, at the price of an acceptable morbidity.     

Methods and clinical results of interstitial thermoradiotherapy

Besides percutaneous hyperthermia techniques, some new interstitial procedures have been developed and included into the arsenal of radiotherapists. As compared to percutaneous techniques, considerable benefits are offered by interstitial methods: a more homogeneous distribution of therapeutical temperatures, a better sparing of normal tissue, the possibility to treat deep tumors, and better therapy control and evaluation by extensive "thermal mapping" within the target volume. This study presents the technical principles and the clinical possibilities of the interstitial hyperthermia methods developed hitherto: resistive radiofrequency hyperthermia, radiative microwave hyperthermia, inductive ferromagnetic seed hyperthermia, and conductive hot-water perfusion hyperthermia. Until now, interstitial thermo-radiotherapy was only performed during some phase I/II studies. It was applied for palliative reasons in persisting and recurrent tumors accessible for implantation and situated in superficial to semi-deep locations with no or insufficient response to differently combined treatment modalities (surgery, radiotherapy, or chemotherapy). The preliminary clinical results obtained in almost 300 patients are quite promising: complete remission rates up to 70% have been achieved. Interstitial hyperthermia represents an effective and safe therapy modality, especially when combined with radiotherapy in palliative tumor therapy. At present, several prospective randomized multicentric studies are conducted to investigate its value as adjuvant therapy modality.     

Treatment of Cerebral Metastases from Breast Cancer with Stereotactic Radiosurgery

BACKGROUND AND PURPOSE: The role of stereotactic radiosurgery (SRS) alone or in combination with whole brain radiotherapy (WBRT) in the treatment of cerebral metastases from breast carcinoma is discussed controversially. To elucidate the role of SRS in this context, a retrospective study evaluating the benefit of SRS and prognostic factors for survival was performed. PATIENTS AND METHODS: From 1986 to 2003, 62 patients with cerebral metastases from breast cancer were treated for 103 lesions. Ten patients received SRS alone (group 1), 13 patients were treated with WBRT and SRS as a focal boost (group 2), and 39 patients received WBRT and salvage SRS (group 3) for recurrent metastases at a later time point. RESULTS: Survival was increased in patients receiving SRS only compared to WBRT and SRS as a focal boost. Patients < 40 years of age had a favorable outcome (p > 0.04). However, no other prognostic factors could be identified. Overall tolerance of radiation was acceptable. Median local control intervals were 9 months for all patients, 6.5 months in group 1, 4 months in group 2, and 9 months in group 3, respectively. There were no significant intergroup differences. CONCLUSION: SRS alone is an effective treatment for patients with one to three brain metastases from breast cancer. A randomized trial should be performed to evaluate whether WBRT is a necessary component in the primary treatment of these patients. Salvage SRS is an effective therapy option after WBRT.     

Neutron therapy (dT, 14 MeV) for recurrence of rectal cancer: interim analysis from Münster.

For rectal recurrent cancer and macroscopic residual disease after surgery neutron radiotherapy has been suggested to be superior to photon radiotherapy. At the d,T generator in Münster (14 MeV) 20 patients have been treated with a combined photon-/neutron-radiotherapy: two patients with residual disease after surgery: among the 18 patients with rectal recurrence 15 for pain relief; all for tumor control. Tumor resection had been carried out in five recurrent tumors. Six patients presented with distant metastases. 30 to 40 Gy photons for tumor region and potential microscopic spread with 2 Gy per fraction and 5 to 10 Gy neutrons for macroscopic tumor volume with 0.7 to 1.6 Gy per fraction were applied using multiple fields (three to five). The mean follow-up period is nine months. Pain relief was achieved in eleven of 15 patients (73%), the onset of pain was fast, the probability for a pain-free period is 46% for nine months and for survival 56% for twelve months. Side-effects were slight to moderate beside a severe subcutaneous fibrosis in two patients. The superiority of neutrons to photons in rectal recurrent cancer remains questionable and is to be proven in a prospective trial comparing different schedules for frequency, onset and duration of pain relief, tumor control, survival and side-effects.