Haim Bicher, M.D.Valley Cancer Institute
Los Angeles, CA USA
Two Cases of Stage III Cancer of the Tonsils with Immune Stimulation and
Thermoradiotherapy
Two patients with advanced squamous cell carcinoma of the tongue with extensive neck
metastasis and intractable pain were treated in the past 18 months with a combination
Immune Stimulation and Thermoradiotherapy. The rationale for IS is based upon the
observation that cancer is so often associated with a depressed or depleted immune system.
Consequently the use of immune activation substances is emphasized. Intravenous infusions
containing selenium, germanium, magnesium, vitamin C, B complex, folic acid, zinc, and
glutathione are given daily, 5 days per week for three weeks. Each infusion is followed by
an intramuscular injection of a poly peptide mixture derived from thymus and spleen. These
peptides are activators of T-cells and other cellular elements of the immune system. In
addition to the injectables, a number of special oral supplements are given both during
and after the initial infusions. These include vitamin A in emulsified form, vitamin E,
pancreatic enzymes, thymus extract, inositol hexaphosphate Coenzyme Q10, and Transfer
factor. These are continued on an out patient basis.
Thermoradiotherapy was administered as previously described with protracted
hyperfractionation to a total of 7000 cGy combined with daily hyperthermia treatments to
the area of primary tumor and both necks. Thermoradiotherapy was instituted at the end of
the induction phase of the IS treatment.
The results were gratifying, with complete responses accomplished in both cases, as
documented clinically, radiographically and with normal tumor markers. Pain palliation was
remarkable and early. There have been no recurrence or dissemination at this point.
David Spall, M.D.
OncoCare Cancer and Prostcare Clinic
Melbourne, AUSTRALIA
Clinical Experience with Hyperthermia: Hope or Hoax (Whole Body, Regional and Local
Hyperthermia)
This illustrated presentation is a review of clinical experience using both Whole Body
Hyperthermia utilizing the Heckel Tent (Heckel, Germany) and Regional L/HF (Microwave)
non-ionising energy at 434 MHz. In Whole Body Hyperthermia, heat is generated by reflected
energy from an array of infrared tubes. Core temperature is measured with either
oesophageal or rectal temperature measurement. Temperatures up to 42º C are obtainable,
however, because of the high risk of DIC. The preferred technique performed here utilizes
sustained core temperatures of 39º - 40º C. This is used concomitantly with modest dose
chemotherapy and occasionally with radiotherapy.
Regional Microwave or, more correctly, UHF Therapy (434 MHz) irradiates the areas of
concern (and often the whole body) by means of a BSD 2500 phased pentacular array into the
moving treatment field. In addition, we have an array of four broadly focused antennae
capable of delivering 3000 watts on a moving target. Each treatment is preceded by the
bolus injection of an analogue of L-Cysteine, precipitating excitation within the
glutathione cycle. UHF Therapy produces substantial heating of the skin but does not
produce an increase in intra-tumoural temperature. There is no thermal effect with our
apparatus and no claim has ever been made to that end; neither has it ever been used
adjunctively with x-ray therapy or chemotherapy.
Of particular interest is a demonstrated fall in tumour marker levels coincident with
the use of the high energy UHF non-ionising radiation. The data regarding many of these
cases have been documented and plotted on semi-logarithmic graph paper. These will be
presented.
Local Hyperthermia, induced by 300 MHz from two separate and collimated treatment
antennae, is used in the treatment of more superficial tumors of the head, neck, chest
wall, etc.
The Whole Body and Locally applied systems of treatment are also used adjunctively with
reduced doses of cytostatics following Culture and Sensitivity Testing (EVA). Some cases
are treated concomitantly immediately after radiotherapy.
Some encouraging results have been seen in the short term, with a number of stage four
patients long past their use by date. Long-term survival curves remain to be seen.
John Mon
Celsion Corporation
Columbia, MD USA
Focused Microwave Phased Array Thermotherapy for the Treatment of Primary Breast Tumors
Thermotherapy has often been used in multi-modality cancer treatment regimens to
enhance the effects of radiotherapy or chemotherapy. There also has been considerable
interest in using heat alone as a cancer treatment modalities as well as using focused
heat to activate drug and gene delivery. A special adaptive phased array (APA) focused
heating system has been designed to deliver localized thermotherapy at significantly high
thermodose levels to achieve tumor ablation and downsize tumors to enable breast
conservation. The system is capable of repeatedly and reliably administering focused
thermotherapy targeting only tumor without damaging normal tissues. Preliminary results
from Phase II studies employing the APA focused heat system to ablate small tumors (1
– 3 cm) and downsize larger tumors (4 – 10 cm) will be presented. These results
lead Celsion to initiate two pivotal studies to demonstrate the efficacy of using focused
heat to provide a minimally invasive treatment for breast cancer. The rationale and design
of the two pivotal studies will be presented. In addition, preclinical data leading to a
patient feasibility study using focused heat to activate temperature sensitive liposomes
to achieve rapid drug delivery and minimally invasive treatment of prostate cancer will be
presented.
Jerry Tennant, M.D.
SCENAR Therapy
Colleyville, TX USA
Cybernetic Biofeedback using the Self Controlled Energetic Neuro-Adaptive Regulator
(SCENAR) to Correct Chronic disease
"Cybernetic": the science of communication and control theory that is
concerned especially with the comparative study of automatic control systems (as the
nervous system and brain and mechanical-electrical communication systems)
Whenever an injury occurs, the area creates an electropositive Current of Injury. This
information is sent to the brain via the acupuncture meridians. The brain determines how
to heal the area and sends an instruction set via the analog perineural nervous system to
the area. It sets up local ionic capacitors to keep the area electropositive until healing
occurs. This is necessary because the things necessary to heal (RBC, WBC, fats and
proteins) are electronegative. The positive charge attracts the things necessary for
healing. Whenever the injured area becomes electronegative, healing stops and the area
becomes chronically diseased. The process can be reversed and healing re-activated using
cybernetic biofeedback using technology developed by the Russian space program. This
process will be discussed and clinical examples given.
Michael Reynolds
Zoetron Group
Penticton, British Columbia CANADA
Targeted Intracellular Hyperthermia in Cancer Therapy
The reason for the development of the subject protocol was to provide an efficacious
treatment for various forms of cancer and particularly for adenocarcinoma of the pancreas
entirely without recourse to any form of invasive treatment, thus precluding surgery,
radiation or chemotherapy.
This approach was founded on the precept that patients with diagnoses of late-stage
cancer inevitably also have a highly compromised immune system and that to further
compromise that immune system with invasive therapies is likely to be counterproductive
and should be avoided if any alternative is indeed available.
In a clinical environment, two hundred and eleven patients with confirmed diagnoses of
various forms and stages of cancer were treated using a directed, pulsed magnetic fields.
Further, twenty-five patients with adenocarcinoma of the pancreas were treated.
In all cases the outcomes were documented and statistics compiled demonstrating, inter
alia, a median survival time for cases of adenocarcinoma of the pancreas of more than
three times the established norm.
The methodology, documentation, collateral benefits, outcome statistics and side
effects and after effects will be presented together with an outline of the further
investigations now under way.
Jacoba van der Zee, M. D.
Daniel den Hoed Cancer Center
Rotterdam, The Netherlands
Clinical Practice of Hyperthermia in the Netherlands
In this presentation, a summary of the indications for application of hyperthermia (HT)
in our institute is given. Our experience demonstrates how a new treatment modality can
achieve acceptance within the oncology community.
We have applied HT clinically since 1978. We have experience with whole body HT,
regional perfusion HT, and local HT. Nowadays, only local HT is used, for both superficial
and deep seated tumours. For superficial HT the custom built 433 MHz multi-applicator
multi-amplifier system is used. Adequate heating is achieved to a depth of 4 cm. The
maximum area that can be treated in one session, using 6 Lucite Cone Applicators, is 20 x
30 cm2. For larger areas, two or more applications are given for one treatment.
For deep HT, the BSD-2000 system is used. During treatment, the power is increased upto
the patient’s tolerance limit, with adjustment of treatment settings when necessary.
Treatment duration is 60 minutes for superficial HT and 90 minutes for deep HT. When
combined with radiotherapy, HT is given once weekly, after radiotherapy.
For three indications, combined HT and radiotherapy has been accepted as standard
treatment, on the basis of effectiveness shown in randomized comparative studies [1,2,3].
For breast cancer recurring in previously irradiated areas, the schedule used is 8
fractions of 4 Gy applied twice weekly. The target area for HT is the whole volume at
risk, which is identical to the reirradiation field. In these patients, the combined
treatment results in 73% local control. With the same reirradiation alone, complete
response rates of 26-38% have been observed. For melanoma, the radiotherapy schedule used
depends mainly on location of the tumour and field size. In the ESHO study, the addition
of HT to radiotherapy resulted in improved complete response rate, from 35 to 62%, and
improved 2-years local control rate, from 28 to 46%. For cervix cancer, conventional
external radiotherapy plus brachytherapy is combined with HT since the Dutch Deep
Hyperthermia Trial showed considerably better 3 years local control (61% versus 41%) and
overall survival (51% versus 27%) rates with additional HT.
For two indications, HT is "standardly" added to radiotherapy after phase II
studies indicated better results with the combination (4,5). In these patient groups, a
phase III study seemed unfeasible due to the low number of patients available. For rectal
cancer recurring in previously irradiated areas, reirradiation is applied to a total dose
of 24 or 32 Gy, depending on previous radiation dose applied, given in fractions of 4 Gy
twice weekly. With the combined schedule a palliative effect is achieved in 72% of the
patients, of a longer duration than usually observed following radiation alone. In
mesothelioma with tumor growth into the chest wall causing pain, the addition of HT to 44
Gy, applied in thrice weekly 4 Gy fractions, resulted in considerably higher objective
(100% versus 54%) and palliative (94% versus 59%) response rates, and lower tumour
regrowth rate (8% versus 80%) or pain recurrence rate (25% versus 100%).
For cervix cancer in previously irradiated areas, simultaneously combined cisplatin and
HT became standard treatment after a phase I-II study had shown an objective response in
53% of the patients. Of 19 patients treated, salvage surgery became feasible after
combined treatment in one patient; one further patient is symptom free now for more than 4
years.
In the Netherlands, HT treatment can be applied in 4 institutes. Patients from
institutes in which HT equipment is not available receive radiotherapy in the original
institution and are referred to one of the HT centers for additional treatment. About half
of the patients treated in our unit are referred from other institutes.
[1] BrJCancer 79:483-490, 1999 [2] Lancet 345:483-490, 1995
[3] Lancet 355:1119-1125, 2000 [4] manuscript in preparation
[5] IntJROBP 43:511-516, 1999 [6] BrJCancer 80:1387-1391, 1999
Augustine Cheung, Ph.D.
Celsion Corporation
Columbia, MD USA
Thermodynamic Therapy for the Treatment of Cancer
Celsion Corporation, in conjunction with the Massachusetts Institute of Technology, has
developed an adaptive phased array (APA) microwave heating technology platform that allows
the delivery of localized focused heating of deep seated tumors and tissues at
significantly high thermo dose levels on a reliable and repeatable basis. The Company is
also interested in the development of a temperature sensitive liposome (TSL) capable of
delivering chemotherapeutics directly into targeted tumors through focused heating.
Celsion has developed a new cancer treatment approach referred to as thermodynamic therapy
(TDT). TDT combines the use of APA focused heat and TSL.
In TDT, toxic cancer chemotherapeutics are carried by TSL directly to a targeted tumor,
where the action of focused heat will trigger localized release of the drug in the tumor
at a much enhanced concentration level. In TDT, temperature elevation is kept below 42°C
so that the primary therapeutic action is solely chemotherapy.
Collaborative development efforts with scientists from Duke University led to the
successful formulation of a lysolipid based temperature-sensitive liposome (LTSL), which
encapsulated doxorubicin (LTSL-dox). Preclinical studies using animal tumor models
demonstrated the feasibility of heat triggered rapid drug release in tumors. An efficacy
demonstration of LTSL-dox in tumor control using human squamous cell carcinoma xenograft
line (FaDu) tumors heated to 41°C resulted in 11 out of 11 complete tumor regression (Cancer
Research 2000).
Using a GMP manufactured batch of the LTSL-dox, large animal toxicity studies have been
performed in rats and dogs. The results of the studies formed the basis of an IND
submission. A phase I dose escalation trial is to take place at the Roswell Park Cancer
Institute. The study objectives are to determine MTD, DLT, PK, safety and potential
therapeutic benefit of LTSL-dox in prostate cancer.
The concept of APA, LTSL, TDT, and the potential clinical applications will be
introduced. The clinical rationale and protocol for using TDT for treatment of prostate
cancer will be discussed.
William S. Maxfield, M. D.
Ocean Medical Center
Lauderdale-by-the-Sea, FL USA
The Value of Hyperbaric Oxygen Therapy in Cancer Care
Treatment of bone and soft tissue radionecrosis is an approved use of Hyperbaric oxygen
therapy (HBOT). Less well recognized is the value of HBOT in treating extravasation of
chemotherapy agents. The ability of HBOT to reduce edema and speed healing is documented.
HBOT has significantly decreased the morbidity of chemotherapy extravasations and should
also decrease morbidity of the hand and foot syndrome that is a complication of
Capecitabine chemotherapy.
The use of HBOT is routine treatment of carbon monoxide poisoning and decompression
illness. There is growing recognition of the value of HBOT for treatment of other
neurological conditions such as cerebral palsy, stroke, autism, Lyme disease,
ataxia-telangectasia, brain trauma and encephalopathies from meningitis and hypoxia.
Benefit from HBOT in
neurology is documented by clinical response and objective improvement demonstrated on
the SPECT brain scans obtained before and after HBOT. As in other neurological conditions
HBOT has cleared symptoms of the recently described chemo brain. Acute blood loss anemia
is a recognized indication for HBOT. Therefore, stimulation of hematopoietic tissue by
HBOT can be a significant factor in treating the anemia of cancer and could be synergistic
with erythroprotein anemia of cancer. HBOT has benefited the patient with chronic fatigue
syndrome and should help the cancer patient with fatigue.
As reported from Japan, in 1999 HBOT given immediately prior to radiation therapy for
brain tumors showed a 50% increase in survival for these patients. This technique works as
I used it 20 years ago for difficult cases such as synovial cell sarcoma. The concern that
increased oxygen might stimulate the growth of cancer is countered by the years of data
from HBOT use in osteoradionecrosis. The cancer recurrence rate for patients receiving
HBOT as part of the
reconstructive process is significantly less than for those who did not receive HBOT.
Also, there is experimental animal data showing that HBOT decreases the implantability of
cancer cells.
Based on the concepts outlined, there is a significant need to expand the use of HBOT
in the field of cancer care.
David Spall, M.D.
OncoCare Cancer and Prostcare Clinic
Melbourne, AUSTRALIA
Hyperthermia and Thermotherapy of the Prostate: Clinical Experience With Prostcare
The author introduced Prostate Thermotherapy to Australia in February 1996 for the
treatment of BPE (Benign Prostate Enlargement) using Trans Urethral Microwave
Thermotherapy (TUMT). In addition, Trans Rectal Microwave Thermotherapy (TRMT) has been
used, on an experimental basis, in the treatment of prostatic carcinoma and abacterial
prostatitis. TRMT for prostatic adenocarcinoma has only been used with patients who have
rejected recommended standard treatment modalities such as prostatectomy, radiotherapy and
bracytherapy. The preferred option would be to have TRMT immediately before radiotherapy.
Unfortunately, this is not available. Extra-capsular disease is treated adjunctively with
regional and whole body hyperthermia.
This paper presents a study of the techniques and clinical results with both TUMT and
TRMT from April 1996 to August 2002. From January 1996 to January 2000, prostate cancer
patients each received six TRMT treatments over a two-week period for sixty minutes each
session. In January 2000, each treatment session was increased to ninety minutes and 5 of
the 118 patients treated returned for re-treatment sessions at six to twelve month
intervals. There is a significantly improved clinical outcome directly related to
increased hyperthermia. Follow up of all patients is still being pursued; three of the
five patients cited above are in complete remission, four without adjunctive treatment.
One patient, with extra capsular disease and pelvic lymphadenopathy, is in complete
remission for more than one year.
Falling PSA levels are being witnessed in an increasing number of patients with
Prostatic Carcinoma who have declined emasculation either surgically or by hormone
blockade.
Retrospective review of patients who present with LUTS in varying degrees of BOO
associated with BPE will be reviewed. Intra prostatic temperatures as high as 55º C have
been obtained. Accurate intra prostatic temperature recordings are made possible by way of
radiometric temperature measurement using Planck’s Law.
Results described as excellent have been obtained in treating BPH with TUMT with
improved subjective symptoms in 90% of patients, and good results in 9% of patients with
BPE. Madsen Iversen Score is utilized as well as Qmax where possible.
The treatment system of choice is Prostcare by Odam Bruker (France).
Haim Bicher, M. D.
Valley Cancer Institute
Los Angeles, CA USA
Thermoradiotherapy in Breast Cancer: Treating with Curative Intent and Objective End
Point Parameters
Thermoradiotherapy is well established as an adjunct treatment of mammary
adenocarcinoma. Results in our series since 1984, encompassing 142 treated patients show a
90% response rate of which 72% are complete responses. However, when local treatment is
done in the face of disseminated disease, the response rate is markedly reduced. Response
rate increases with the number of hyperthermia treatments.
Since 1998 we instituted a Phase II study to early local breast cancer with protracted
radiation Hyperfractionation (PH) to the biological equivalent of 4500 Gy according to the
Ellis TDF formula and an increased number of Hyperthermia treatments (25 – 50 per
field_ with curative intent. These patients had refused surgery, chemotherapy or high dose
radiation therapy; therefore thermoradiotherapy was the only treatment given. Treatment
was directed to the primary tumor and areas of lymphatic drainage.
This presentation reports the results of the first 16 patients treated during the past
30 months. All treated tumors accomplished a complete response as determined 3 months
after last treatment. Only one has recurred. None disseminated thus far, but 2 showed
local extension in untreated areas (upper lung lobe in homolateral side) which required
treatment.
Side effects were minimal, only mild dermatitis and 6 first-degree hyperthermia burns.
Cosmetics results were most gratifying, the treated side showing mild retraction and
hardening in 50% of the cases.
Since we treat to effect, the need for objective evaluation is imperative. Therefore 3
parameters have been instituted: 1) Tumor markers, 2) PET scanning, 3) MRI with MR
spectroscopy to eliminate the size of the cholin peak in the positive areas. This
objective determination of response will be correlated with length of response,
dissemination and eventually survival. So far tested in 4 patients, objective response
determination seems to be remarkably accurate to assess local response.
These preliminary result show that thermoradiotherapy should be considered as a
treatment modality for early stage breast cancer.
Feng-tong Li, Hai-pan Wang
Tianjin Medical University
Tianjin, CHINA
Quality Assurance for Intracavitary Microwave Applicators
The performance of intracavitary microwave applicators for hyperthermia was determined
by many physical parameters. A set of different experiments was carried out to compare the
heating characteristics, namely the specific absorption rate (SAR) and temperature
distribution of intracavitary applicators with measurement quantitatively and display
qualitatively in muscle equivalent phantoms.
Changes in temperature at well-defined points were measured in Jian’s phantom
following a brief period of heating at high power levels by LUXTRON-3000 multichannel
fluoroptic thermometer. Changes in temperature at well-defined points were considered as
100% relative SAR. Then it was calculated and described the 10%, 50%, 90% - iso SAR.
Liquid crystal plate (LCT) thermography made contact with mapping temperature
distributions. The thermographies of intracavitary applicators could be taken when using
thermochrome LCPs together with a split phantom. A LCP reflected visible light at
different wave-lengths E, which depend on the temperature of the LCP. The LCPs have an
absolute temperature range of 6. Colour changes within the whole visible spectrum from red
to violet can be seen. After the equivalent phantom is flowed, there is a brief period of
heating at high power levels; immediately a photo is taken. Thermography and relative
temperature change distribution can be derived from this procedure.
When comparing quantitatively measured SAR-patterns and qualitatively observed
iso-thermal shapes on LCPs, conformity can be found for applicator type and position under
investigation. Conformity when comparing experimental and simulated ones is mainly due to
choosing well-defined points.
Roy C. Page, M.D.
Mid-South Surgical Oncology Center
Memphis, TN USA
Extreme Hyperthermia: Radio Frequency Ablations of Malignancies
Newer developments in minimally invasive techniques will allow accurate placement of an
ingenious device in tumors that can be heated to very high temperatures, thus destroying
the cancer. The presentation will demonstrate the progressive development of the device,
the technique for application and results of tumor destruction. This therapy can be used
in conjunction with other standard treatment to achieve superior results. Risks and
benefits will be presented
.
Michele de Simone, M.D.
Turin, ITALY
Cytoreduction and Hyperthermicantiblastic Peritoneal Perfusion (HAPP) in Treatment of
Peritoneal Multicystic Mesothelioma (MMP)
Peritoneal multicystic mesothelioma (MMP) is a rare neoplasia prevalently located in
the pelvis and abdomen with a mesothelial origin. Even if it has a low grade of clinical
malignity, recurrences of the disease after the only surgical procedure are rather
frequent (45%). In virtue of the poor response to systemic chemotherapeutics treatments,
we decided to treat the MMP with surgical cytoreduction and Hyperthermic Antiblastic
Peritoneal Perfusion (HAPP). HAPP is, in fact, particularly effective in the treatment of
peritoneal carcinosis of low-grade neoplasias.
Xiaofeng Zhang, M.D.
Shenqhen, P. R. CHINA
A New Device for Whole Body Hyperthermia
With the development of cancer whole body hyperthermia, lots of devices have been made.
But few of them can be applied in clinical use. That is partly because of the lack of
physical techniques, and partly because of the barrier of clinical skills. In this paper,
some technical difficulties on researching Whole Body Hyperthermia device have been
introduced. An experience of more than one year of clinical trials applying a new Whole
Body Hyperthermia System ET-SPACETM (Energy Technology, Inc., ETI) has been described in
detail.
Physical characteristics: The treatment chamber of ET-SPACETM is an enclosed capsule,
which looks like a spaceship. The head of the patient remains outside of the treatment
chamber, while the rest of the body is inside during the hyperthermia treatment.
ET-SPACETM applies specially designed infrared light source and red light with wavelengths
at 650-1400 nm. Eight temperature sensors have been used for measuring the body
temperature; they are put at inferior segments of the esophagus, rectum and Posterior
nasal meatuses, respectively; five sensors are respectively put at left and right chest,
left and right anterior superior iliac spine and the back. The thermal controlling point
is at inferior segments of the esophasgus, and the value of point temperatures display at
the controlling computer. Then the computer adjusts the lamp power according to the
tendency of the changing temperature.
Raymond U
Rex Healthcare Cancer Center
Raleigh, NC USA
Clinical Results Using 8 Mhz Radiofrequency Capacitive Hyperthermia and Radiotherapy
for Recurrent Breast Carcinoma
A clinical investigation has been conducted in recurrent and/or advanced breast
carcinoma to determine the safety and effectiveness of 8 Mhz radiofrequency capacitive
hyperthermia using the Thermotron rf-8.
Patients and methods: since 1988, a total of 46 patients have been enrolled in this
investigation. All patients had biopsy confirmed histological proof of recurrence and/or
were considered to have advanced breast carcinoma. The probability for local control with
radiation alone was estimated to be 5 and 25 %. All radiation therapy was delivered using
4. 6. 18. or 21 MeVlinear accelerator. The choice of beam type and energy was dependant on
tumor location, prior radiation dose, and the limiting adjacent normal tissues. Median
radiation dose of 50.4 Gy was delivered in 5-6 weeks using 1.8-2.0 Gy daily 5 times
weekly. The hyperthermia treatment objective was to deliver 42.0 – 44.0 degree C for
45050 minutes per session twice weekly with a median total of 10 sessions during the above
referenced radiation schedule.
Results: A total of 46 patients were eligible for treatment response analysis. A total
of 43 patients achieved compete tumor resolution.
Haim Bicher
Los Angeles, CA USA
Protracted Thermoradiotherapy Treating to Effect With Objective End Points
Hyperthermia has been proven to increase the response of malignant tumors to radiation
therapy in both experimental animal tumors and the clinical treatment of human cancer.
Based on our multi-year experience, first in re-treatment of previously radiated fields
that necessitated the use of low dose radiation fractions as adjunct to the heat
treatments, and then progressively applying the encouraging results obtained to areas
treated "de novo" and eventually to situations allowing a potentially curative
intent, treatment protocols have been devised and tested that yield positive preliminary
data showing superior tumor response rates and less side effects when compared with
historical controls at our institute.
The Hyperthermia part of the protocol extends the number of heat treatments to
correspond to the number of radiation-fractions, as each hyperthermia treatment proceeds
or follows each radiation treatment in close time proximity. The number of hyperthermia
treatments therefore varies from 25 – 50 per course for each treated field. Outcomes
confirm that more Hyperthermia fractions improve both tumor response and survival.
The radiation protocol consists of progressively decreasing daily doses of radiation
therapy combined with the daily Hyperthermia treatments. Typically the treatment is
started at a daily dose of 180cGy gradually reduced to 100cGy protracting a typical
radiation therapy treatment course from 5000cGy in five weeks to 5000cGy given in over
eight weeks; or 7000cGy in seven weeks to 7000cGy in 14 weeks. According to the ELLIS TDF
formula, this results in a 15% or 25% reduction of the effective radiation dose. The total
dose is of course adapted to the clinical situation. To this effect, the use of objective
end result parameters is introduced, including MR Spectroscopy, PET Scanning and Tumor
Marker levels. Increased radiation doses improve tumor response, but not survival, when
enough Hyperthermia is given. Increased Hyperthermia doses increase both response and
survival.
Conclusions: Protracted Hyperfractionation
- Decreases the radiation dose by 15% and 25%.
- Decreases the side effects of XRT (no diarrhea, fistula or pneumonitis in PH cases).
- Allows for more combined XRT-Hyperthermia treatments.
- Increases the effectiveness of the combined treatment in superficial and deep tumors.
- More Hyperthermia increases tumor response and survival.
- More Radiation improves tumor response but not survival when enough Hyperthermia is
given.
Question: What is the lowest radiation dose needed to potentiate Hyperthermia?
T.R. Shantha, M.D., Ph.D.
Integrated Medical Specialists, Integrated Chemotherapy Specialists
Stockbridge, GA USA
Intractable Gastro Intestinal and Colon Intramural and Peritoneal Cavity Candida
Infection Treated with Peritoneal (regional) Hyperthermia (warm Fluid Perfusion)
Candida albicans (yeast) is a normal inhabitant of the human gastrointestinal tract.
The organism is usually present in the urine, although Candida esophagitis or suppurative
thrombophlebitis may be the initial site of infection. They can cause massive systemic and
organ infection in patients compromised by malnutrition, prolonged central venous access
for hyper alimentation, chemotherapy therapy for cancer patients, prolonged administration
of broad-spectrum antibiotic, Corticosteroids and other immunosuppressive mediations.
The presence of Candida infection in the peritoneal cavity after surgery indicates a
leak from the gastrointestinal tract. Many antifungal agents are effective in treatment f
peritoneal infection. Once the infection invades the interstitial tissue of the
gastrointestinal track and becomes intramural infection, most of the antifungal treatments
may not be effective.
We describe a case of severe Candida infection of the peritoneal cavity and intramural
infection of the gastrointestinal tract including the colon, which resulted in three
emergency surgeries, and failed to respond to all conventional methods of treatment. Using
peritoneal hyperthermia (peritoneal perfusion of warm fluid), combined with an antifungal
agent – Fluconazole (Diflucan), successfully treated this case.
Case Report:
A 35-year-old female, weighing more than 400 pounds, had gastric stapling using silasic
(silicone banding procedure) band for obesity three years before. This surgical procedure
was revised to make it effective. Postoperatively, she developed yeast infection with
multiple discharging sinuses from the drainage site below the left hypochondrium at mid
axillary line. Subsequently, she developed a gastro-pleuro-bronchial fistula, which was
surgically corrected. She developed acute abdomen resulting in two exploratory
laparotomies and removal of the spleen and splenic flexure of the colon due to massive
yeast infection. Examination of the spleen revealed that the yeast had invaded the spleen
and gastrointestinal wall (intramural fungal infection).
She had suction tubes irrigating and suctioning with Fluconazole in 5% glucose from the
left hypochondriac area. The irrigating fluid contained Fluconazole. The patient continued
to deteriorate, looked toxic and was discharging greenish brown material through the
drainage tubing. Other surgical procedures such as reexploration and resection were ruled
out and thought that she would succumb to the infection. The patient was discussed in a
weekly meeting of infectious diseases and there were no other therapies forthcoming. The
prognosis was considered to be very poor. It was the consensus opinion of all the
consulting physicians that she would not recover.
J. Henriquez, M.D.
International BioCare Hospital
Tijuana, MEXICO
Whole Body Hyperthermia Combined with a Strong Nutritional Program is Beneficial for
the Treatment of AIDS
The objective of this study was to demonstrate the additive beneficial effects of
whole-body hyperthermia (WBH) associated with a strong nutritional program in patients
with AIDS. From October 1997 through September 2000, fifteen HIV positive patients (10
with AIDS, and 5 with
AIDS related complex, ARC) with documented disease progression after the use of
anti-virals, were treated with 2 sessions of WBH, raising the body's core temperature to
42.5° degrees C by means of extracorporeal perfusion, for a total of two hours, 4 days
apart combined with an already ongoing program that included total parenteral nutrition,
antioxidants and a special diet.
The procedure was well-tolerated by all patients; there were no deaths related to the
treatment and the laboratory tests showed dramatic improvement on viral loads and other
measurable parameters such as CD4-CD8 ratios, Hemoglobin, etc. These patients enjoyed much
better quality of life when compared to 15 control patients treated with antivirals and a
nutritional program alone.
