Re-irradiation plus regional hyperthermia for recurrent non-small cell lung cancer: a potential modality for inducing long-term survival in selected patients.

PURPOSE: The purpose of this study was to assess the toxicity and efficacy of re-irradiation plus regional hyperthermia for recurrent NSCLC and to identify the predictors of long-term survival. METHODS AND MATERIALS: A total of 33 patients with recurrent NSCLC treated with re-irradiation plus regional hyperthermia were retrospectively analyzed. The median total dose of initial radiotherapy and re-irradiation were 70 Gy and 50 Gy, respectively. A median of 5 hyperthermia treatments using an 8-MHz radiofrequency-capacitive device were applied during re-irradiation in all patients. RESULTS: Toxicity of Grade 3 was seen in 3 (9%) patients, and no Grade 4 or 5 toxicity was observed. The median overall survival, local control, and disease progression-free survival times after re-irradiation were 18.1, 12.1, and 6.7 months, respectively. Eight patients achieved a long-term survival (more than 3 years after re-irradiation), and 4 of them underwent a third round of irradiation for re-recurrent tumors. Univariate analyses showed that a smaller tumor size (<4 cm) and the absence of distant metastases were significant predictors for a better overall survival. The absence of distant metastases was also found to be a significant predictor for better disease progression-free survival in the univariate analyses. In the subset analyses of 23 patients treated with hyperthermia using electrodes of 30 cm in diameter, the use of a higher radiofrequency-output power tended to be associated with a better prognosis in terms of the local control rate. CONCLUSIONS: Re-irradiation plus regional hyperthermia for recurrent NSCLC appears feasible, with acceptable toxicity, and may be a promising treatment that can result in the long-term survival of patients without distant metastasis and larger recurrent tumors.

Multimodal approaches including three-dimensional conformal re-irradiation for recurrent or persistent esophageal cancer: preliminary results.

The purpose of this study was to assess the toxicity and efficacy of multimodal approaches, including three-dimensional conformal re-irradiation, for patients with recurrent or persistent esophageal cancer after radiotherapy. Thirty-one patients with esophageal cancer treated with three-dimensional conformal re-irradiation were retrospectively analyzed. Of the 31 patients, 27 patients received concurrent chemotherapy, and 14 patients underwent regional hyperthermia during the re-irradiation. We divided the patients into two groups on the basis of their clinical condition: the curative group (n = 11) or the palliative group (n = 20). Severe toxicities were detected in one patient with Grade 3 esophageal perforation in the curative group, and 5 patients had a Grade 3 or higher toxicity of the esophagus in the palliative group. Advanced T stage at the time of re-irradiation was found to be significantly correlated with Grade 3 or higher toxicity in the esophagus. For the curative group, 10 (91%) of 11 patients had an objective response. For the palliative group, symptom relief was recognized in 8 (57%) of 14 patients with obvious swallowing difficulty. In conclusion, in the curative group with early-stage recurrent or persistent esophageal cancer, the multimodal approaches, including three-dimensional conformal re-irradiation, may be feasible, showing acceptable toxicity and a potential value of promising results, although further evaluations especially for the toxicities of the organs at risk are required. In the palliative group, the benefit of our therapy may be restrictive because severe esophageal toxicities were not uncommon in the patients with advanced T stage at the time of re-irradiation.

Deep regional hyperthermia for the whole thoracic region using 8 MHz radiofrequency-capacitive heating device: relationship between the radiofrequency-output power and the intra-oesophageal temperature and predictive factors for a good heating in 59 patients.

PURPOSE: To assess the relationship between the radiofrequency (RF) output power and the intra-oesophageal temperature for hyperthermia of the whole thoracic region, and also to evaluate the patients' characteristics associated with adequate heating. MATERIALS AND METHODS: Fifty-nine patients with thoracic cancer treated with radiotherapy plus hyperthermia were retrospectively analysed. The 8-MHz RF capacitive heating device was applied, both the upper and lower electrodes were 300 mm in diameter, placed on opposite sides of the whole thoracic region. All the patients also underwent intra-oesophageal temperature measurements. RESULTS: All thermal parameters, T(min), T(max), T(ave), and %T ≥ 41°C, of the intra-oesophageal temperature highly correlated with the median RF output power (p < 0.0001), and the relations were independent in the multivariable analyses including clinical characteristics (p < 0.01). The performance status showed a statistically significant association on T(max), T(ave) and %T ≥ 41°C (p < 0.05). The patient age and subcutaneous fat at some levels were inversely correlated with the thermal parameters (p < 0.05). CONCLUSION: The RF output power was significantly correlated with the intra-oesophageal temperature; it could be used as a promising parameter to assess the efficacy of hyperthermia for the whole thoracic region. Higher intra-oesophageal temperature may be achieved in patients with good performance status, younger age and thinner subcutaneous fat.

Definitive radiotherapy plus regional hyperthermia with or without chemotherapy for superior sulcus tumors: a 20-year, single center experience.

PURPOSE: To assess the efficacy and toxicity of definitive radiotherapy (RT) plus regional hyperthermia (HT) in treating superior sulcus tumors (SSTs), and to identify predictors of positive outcomes. METHODS AND MATERIALS: Twenty-four patients with SSTs treated with definitive RT plus regional HT were retrospectively analyzed. The median total dose of RT was 70 Gy. All patients were treated with an 8-MHz RF-capacitive heating device. Twelve of 24 (50%) patients also underwent chemotherapy. Those with either subcutaneous fat measuring 2.5 cm or greater, or any other serious complications did not undergo this therapy. RESULTS: Overall survival, local control, and distant metastasis-free survival rates at 3 years were 47%, 55%, and 71%, respectively. Chemotherapy and younger age (<65 years) were significant predictors of the overall survival rate. Clinical stage (IIB) was a statistically significant prognostic indicator for local control survival rate. Toxicities were mild, with Grade 3 dermatitis seen in one patient. CONCLUSIONS: Definitive RT plus regional HT with chemotherapy may be a promising treatment for SSTs. The results justify further evaluation with detailed treatment protocols in a large number of patients.