Abstract
Between January 1986 and June 1989, 45 lesions (30 head and neck, 11 pelvic and 4 other lesions) in 44 patients (24 males/20 females, 18 to 81 years) received interstitial Iridium-192 radiotherapy (IRT) and interstitial 915 MHz MW hyperthermia (IHT) supplemented by external beam radiotherapy (ERT). Minimum follow-up (FU) was 6 months (range: 6 to 39 months; mean: 16 months, SD ±9). Tumors were classified as advanced primary (AP, n=21), local recurrent (LR, n=18) and local metastatic (LM, n=6) lesions; LR and LM lesions were previously treated: surgery (n=30), chemotherapy (n=23) and prior external RT between 40 and 70 Gy (n=24). The mean dimension for 42 lesions was 4.5×4.0×3.0 ccm with (range: 12 to 135 ccm; mean: 54 ccm); 3 lesions had extensive tumor volumes >225 ccm.
IHT was applied immediately prior to and/or after low-dose IRT (20 to 30 Gy) for 60 min at temperatures between 41 °C and 44 °C. External RT was given for AP and LM lesions, but was variably applied for previously irradiated lesions to avoid a cumulative RT dose >110 Gy per site. Mean IRT dose was 27 Gy (range: 17 to 48 Gy,SD ±8) at a mean dose rate of 42 cGy/h (range: 25 to 70 cGy/h; SD ±12). 33 lesions received additional external RT of 30 to 56 Gy (mean: 47 Gy,SD ±9). Mean total RT dose (IRT+ERT dose) was 61 Gy (range: 31 to 82 Gy). Up to 42 thermistor/fiber-optic sensors were employed for invasive thermometry.
Initial response at 3 months FU was 31 (69%) CR, 10 (22%)o) PR and 4 (9%) NC. Long-Term response of 25 lesions at 12 months FU revealed 22 (88%) with local and 16 (64%) with local and regional tumor control (LC); 3 (10%) lesions developed in-field recurrences. Acute side-effects occured in 15 lesions (33%), and 12 (27%) experienced long-term sequelae with 3 (7%) requiring surgery. The following prognostic factors were identified: (1) lesion type (AP vs. LR/LM); (2) tumor volume (<80 ccm vs. >80 ccm); (3) total radiation dose (>50 Gy vs. <50 Gy); and (4) thermal parameters related to minimum temperature: minimum average temperature Tmin(av)>41 °C, homogeneity of tumor temperatures (TQ41 °C >75% vs. <75%). In summary the innovative treatment concept proved to be save and effective.
Zusammenfassung
Von Janur 1986 bis Juni 1989 wurden 45 Tumoren (30 Kopf-Hals-, 11 Becken- und 4 andere Malignome) bei 44 Patienten (24 Männer/20 Frauen, 18 bis 81 Jahre) mit interstitieller Iridium-192 Brachytherapie (IRT) und interstitieller 915 MHz Mikrowellen Hyperthermie (IHT) behandelt, zum Teil ergänzt durch externe Radiotherapie (ERT). Die minimale Nachbeobachtungszeit lag bei 6 Monaten (Bandbreite: 6 bis 39, im Mittel: 16 Monate). Die Tumoren wurden als primär fortgeschritten (AP, n=21), lokal rezidiviert (LR, n=18) oder lokal metastatisch (LM, n=6) eingestuft; viele LR und LM Tumoren waren vorbehandelt: Operation (n=30), Chemotherapie (n=23) oder Radiotherapie (n=24). 42 Tumoren hatten eine durchschnittliche Größe von 4,5×4,0×3,0 ccm (Bandbreite: 12 bis 135 ccm, im Mittel: 54 ccm); dagegen wiesen 3 Tumoren sehr große Volumina >225 ccm auf.
Die IHT wurde vor und/oder nach der Low-dose-IRT (20 bis 30 Gy) eingesetzt; angestrebt wurde für 60 Minuten eine Temperatur von 41 bis 44 °C. Eine externe RT wurde bei den nichtvorbestrahlten Tumoren mit 40 bis 50 Gy verabreicht, bei den vorbestrahlten Tumoren aber nur insoweit, als dabei die kumulative RT-Dosis von >110 Gy nicht überschritten wurde. Die IRT-Dosis betrug im Mittel 27 Gy (Bandbreite: 17 bis 48 Gy) und die Dosisrate 42 cGy/h (Bandbreite 25 bis 70 cGy/h). 33 Tumoren erhielten zusätzlich eine externe RT (Bandbreite: 30 bis 56 Gy, im Mittel: 47 Gy). Die gesamte RT-Dosis (IRT+ERT) lag bei 61 Gy (Bandbreite: 31 bis 82 Gy). Bis zu 42 Thermistor/faseroptische Sensoren wurden für die invasive Thermometrie eingesetzt.
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Seegenschmiedt, M.H., Sauer, R., Herbst, M. et al. Phase I/II interstitial thermo-radiotherapy for advanced and recurrent tumors. Acta Chir Austriaca 24, 211–213 (1992). https://doi.org/10.1007/BF02601746
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DOI: https://doi.org/10.1007/BF02601746
Key-words
- Advanced and recurrent tumors
- interstitial radiotherapy
- Iridium-142
- hyperthermia
- microwaves
- innovative cancer treatment methods