HDR brachytherapy combined with interstitial hyperthermia in locally advanced cervical cancer patients initially treated with concomitant radiochemotherapy: a phase I study.

BACKGROUND AND PURPOSE: The aim of this study was to investigate whether hyperthermia (HT) combined with interstitial brachytherapy (ISBT) has any influence on acute and late side effects in patients with advanced cervical cancer. Local control (LC) and disease-free survival (DFS) were also analysed. MATERIALS AND METHODS: Following the completion of radiochemotherapy, patients with cervical cancer (FIGO stages I-III) were assigned to two treatment groups, either ISBT combined with interstitial hyperthermia (ISHT) or ISBT alone as a control group. Selection criterion for the ISBT combined with HT group was advanced cervical cancer with poor response to external beam radiotherapy. A total of 76 patients were included in the statistical analysis. Once a week, HT (at a temperature above 42.5°C) was administered for 45 min before and during high dose rate (HDR) brachytherapy (BT) in 43 patients. Four HT treatments were administered. RESULTS: The median follow-up time was 43 months (range 4-73 months). Significant differences were not observed for the distribution of early and late complications between the HT and no HT groups. Despite this, LC was similar in both groups. The 5-year DFS for the BT and BT + HT groups was 73.6% and 65.8%, respectively. The 5-year LC for the BT and BT + HT groups was 89% and 83%, respectively. For the majority of patients the maximum temperature level of 44-45°C was achieved during the ISHT. CONCLUSIONS: ISHT is well tolerated and does not affect treatment-related early or late complications.

[Intracavitary 500KHZ hyperthermia treatment of patients with endometrial and cervical cancer--preliminary clinical and pathological results]. / Wstepne wyniki zastosowania sródjamowej hipertermii 500 kHz u chorych na raka szyjki i trzonu macicy--ocena kliniczna i patologiczna.

Therapeutic effectiveness of elevated temperature is a well known issue. However raising the temperature inside the tumor sparing concurrently surrounding healthy tissue is not an easy task. Intracavitary, radiofrequency hyperthermia in uterine tumor cases allows to obtain elevated temperature in a simple, effective and safe way. Hyperthermic procedure was performed in 30 patients with cervical and endometrial cancer. In 10 cases it was a part of standard radiotherapy, in 20 hyperthermia proceeded radical surgery. A computer--controlled 300W amplifier and generator was used. Energy was transmitted via a modified Fletcher--type applicator. One or two 45-60 minute lasting sessions, with temperature reaching 46-49 degrees C were performed in each case. No severe side effects were seen. In a group where surgery was performed a characteristic temperature-induced changes were observed on tissue and cellular level. Higher number of performed procedures will be a base for randomized trials and, in the future enables us to incorporate hyperthermia into standard radiotherapy.

Robotic stereotactic body radiation therapy for liver-limited malignant tumors.

INTRODUCTION: Stereotactic body radiotherapy (SBRT) is rapidly gaining favor as a new treatment modality for malignant liver tumors. Most of the studies have recruited patients with disseminated disease originating from the liver. This study focuses on disease limited to the liver. AIM: To perform a retrospective analysis of all patients with liver tumors treated by robotic stereotactic body radiation therapy in a single center. MATERIAL AND METHODS: The study included 13 patients with 22 lesions. The inclusion criteria were: patients with 1-4 inoperable liver lesions and absence of any extrahepatic disease. All but 3 patients received 3 fractions delivered by the Cyberknife system of a total of 45 grey (Gy). The other 3 patients received 30 Gy. RESULTS: The median follow-up time was 10.8 months (range: 7-16). The median dose was 41.5 Gy (range: 30-45). One lesion regressed (8%). In 5 patients, the disease was locally stabilized (38%), and in 7 other patients progression occurred (54%). Twelve patients (92%) are still alive, and 1 patient (8%) died. In 1 patient a new cancer (leukemia) was diagnosed. CONCLUSIONS: The SBRT is well tolerated and effective for local control of most liver malignant tumors. It appears that SBRT is best suited for those patients in whom systemic recurrence can be controlled by chemotherapy. Further studies are mandatory to elucidate these effects on tumors of varying histology and to elaborate upon criteria used to select patients who can benefit most from this treatment.

HDR brachytherapy combined with interstitial hyperthermia in locally advanced cervical cancer patients initially treated with concomitant radiochemotherapy--a phase III study.

BACKGROUND AND PURPOSE: The aim of this randomised trial was to investigate whether hyperthermia (HT) combined with interstitial brachytherapy (ISBT) has any influence on local control (LC), disease-free survival (DFS), or acute and late side effects in patients with advanced cervical cancer. MATERIALS AND METHODS: After radiochemotherapy, consecutive patients with cervical cancer (FIGO stage II-III) were randomly assigned to two treatment groups, either ISBT alone or ISBT combined with interstitial hyperthermia (ISHT). A total of 205 patients were included in the statistical analysis. Once a week, HT, at a temperature above 42.5°C, was administered for 45min before and during the HDR BT. RESULTS: The median follow-up time was 45months (range 3-72months). An effect of hyperthermia was not detected for disease-free survival (DFS) (log-rank test: p=0.178) or for local control (LC) (p=0.991). According to Cox's analysis, HT did not significantly influence failure or interactions with potential prognostic factors for LC or DFS. Statistical differences were not observed for the distribution of early and late complications between the HT and non HT groups. CONCLUSIONS: ISHT is well-tolerated and does not affect treatment-related early or late complications. Improvements in DFS and LC were not observed following the addition of ISHT to ISBT.