Interstitial laser thermotherapy (ILT) of breast cancer.

AIM: To find out if ILT can be used as radical treatment of breast cancer. METHOD: Twenty-four patients, aged 39-84 (mean 61), with invasive breast cancer were treated with ILT. All underwent mammography, ultrasound and core biopsy before treatment. The tumour was an invasive ductal carcinoma in 15 patients, a lobular carcinoma in eight and lobular-ductal cancer in one. Average tumour diameter was 14 mm on ultrasound (5-35). Patients were treated in the outpatient clinics under local anaesthesia. Probes were placed under ultrasound guidance, in 19 patients, and ILT was performed with a diode laser at a steady-state temperature of 48 degrees C for 30 min using temperature feedback control. Standard surgical excision was performed 12 (4-23) days after ILT and was preceded by Doppler ultrasound. RESULTS: Treatment-induced necrosis of invasive cancer was 33% (range 0-100) and was complete in three patients. At follow-up before surgery, the extent of laser damage could not be judged with ultrasound, although abolished tumour blood flow was demonstrated after treatment resulting in large necroses. Efficacy of treatment varied negatively with tumour size. The inefficacy of ILT was mainly due to the underestimation of tumour size by mammography and ultrasound and the shortcomings of these methods to demonstrate tumour borders, tumour irregularity and carcinoma in situ (CIS). ILT was well tolerated. Five patients had breast tenderness, and three patients had pain, during the first day after treatment. Small skin necroses were observed in two patients. CONCLUSION: Small breast cancers can be treated radically with ILT. The method may become useful in the treatment of breast cancer but needs further refinement, even for small well-defined breast cancers, if it is going to be employed for radical treatment.

Computed tomographic angiography of the liver via the coeliac axis.

Sixty computed tomographic angiographic (CTA) examinations of the liver were performed with contrast injection into the coeliac axis. Data from both an arterial and a portal venous phase were recorded. In 41 patients it was possible to compare the results of CTA with palpation of the liver during laparotomy. The results from CTA and laparotomy were the same in 35 patients (85%). In one patient CTA disclosed verified liver lesions not diagnosed at laparotomy. There were 2 false negative and 3 false positive CTA examinations. In the remaining 19 patients, a clinical follow-up period of at least 6 months was used to evaluate the results of CTA. In the 7 patients in whom CTA showed benign lesions or a normal liver parenchyma, the clinical follow-up revealed no evidence of tumour growth in the liver.

Preoperative computed tomography for evaluation of tumour growth in patients with gastric cancer.

In 31 patients with proven gastric malignancy, computed tomography (CT) was done before surgical exploration. Tumour growth was assessed with each method independently, but following the same protocol. The results of the CT examination were compared with the surgical findings and the diagnostic accuracy of CT was evaluated. Liver metastases could be demonstrated with specificity 10/10 and sensitivity 20/21. The predictive value of the positive test (Pv+) was 10/11, and the predictive value of the negative test (Pv-) was 20/20. Tumour growth to the pancreas was shown by CT with specificity 4/5 and sensitivity 26/26, with Pv+ = 4/4 and Pv- = 26/27. Enlarged lymph nodes around the coeliac axis could be shown with specificity 6/6, Pv+ = 18/18 and Pv- = 6/13. The accuracy of CT was also evaluated regarding tumour growth to oesophagus, colon and greater and lesser omenta. Tumour resectability was predicted by the radiologist with the help of CT. The specificity was 26/26 and sensitivity 4/5, Pv+ = 26/27 and Pv- = 4/4. In this study, therefore, CT had high diagnostic accuracy in regard to extent of intraabdominal growth and resectability. In selected patients it may thus be possible, when resection is not feasible, to avoid exploratory laparotomy.

[Dilatation of esophageal strictures using a balloon catheter]. / Dilatation der Oesophagusstrikturen mit einem Ballonkatheter.

The technique of balloon catheter dilatation of benign esophageal strictures is presented. A general anesthetic is unnecessary which is an advantage in older patients. Moreover, the encouraging results and the absence of complications support the opinion that balloon catheter dilatation is an excellent alternative in the treatment of esophageal strictures.