Interstitial thermoradiotherapy: A technical and clinical study of 29 implantations performed at the Institut Gustave-Roussy

Abstract

In 1981, a protocol was developed at the Institut Gustave-Roussy, combining interstitial hyperthermia and brachytherapy. Twenty-nine implantations were performed in 23 patients. All the lesions except three were located in previously irradiated areas. The protocol consisted of interstitial hyperthermia, 44 degrees C for 45 min, immediately followed by iridium-192 brachytherapy, delivering a dose of 30 Gy in the first 17 implantations, and a dose of 40 Gy in the next 12 (the dose was increased because of two local relapses in the first 17 cases). Special 'metal-plastic' tubes have been designed to heat the tumour specifically and to spare the surrounding healthy tissues. Among the 25 implantations for which a complete thermal mapping was available, a minimum temperature of 44 degrees C was reached in 16 cases, 43 degrees C in 5 cases and 42 degrees C in 4. The temperature inhomogeneity within the treated volume was less than 1 degrees C in 16 cases, and up to 4 degrees C in only one instance. Short-term clinical results (at two months) are available for 23 implantations: a 100 per cent response rate and a 83 per cent complete regression rate was observed. Follow-up is still short for most patients and long-term local control cannot be evaluated. Treatment has been generally well tolerated despite prior irradiation. Thus, technically satisfactory hyperthermia could be obtained in most cases, short-term clinical results are encouraging, and the technique merits further study.

Swallow recovery in an oral cancer patient following surgery, radiotherapy, and hyperthermia

“…8 Complications following radiotherapy for treatment of primary and recurrent tongue base and oropharyngeal tumors, including external beam radiotherapy, hyperthermia, and/or interstitial implantation, have been well-documented in the literature, including soft tissue necrosis. [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28] However, few studies have documented the effects on swallow functioning of radiotherapy as primary treatment for tongue base and oropharyngeal tumors.lg This study examined the effects of combined treatment with interstitial hyperthermia and radiotherapy in a previously external beam irradiated and surgically treated oral cancer patient. The patient described had initially demonstrated excellent swallow recovery using maneuvers following surgery and external beam irradiation.…”

The accuracy of temperature measurement from within an interstitial microwave antenna

“…Clinical results indicate that local tumour control may be achieved in more than 50 percent of previously treated patients, with a low incidence of treatment complications (Vora et al 1982, Aristizabal and Oleson 1984, Cosset et al 1984, Emami et al 1984, Cosset et al 1985, Emami and Perez 1985, Emami ef al. 1987, Lam et al 1988.…”

“…Furthermore, they increase the number of locations with documented temperature, without increasing the number of implanted catheters. Temperature measurement from within LCF electrodes has been reported to correlate fairly well with external tissue temperature (Cosset et al 1985). Temperature measurement from within interstitial MW antennas, however, is a relatively new technique.…”