Primary advanced and local recurrent head and neck tumors: effective management with interstitial thermal radiation therapy

THE CHEMISTRY AND BIOLOGY OF GOLD NANOPARTICLE-MEDIATED PHOTOTHERMAL THERAPY: PROMISES AND CHALLENGES

Under laser radiation, cells labeled with gold nanoparticles (AuNPs) are believed to suffer thermal damage due to the transfer of the absorbed light from the AuNPs to the cells. This process, which involves complex mechanisms such as the rapid electron–phonon decay in the AuNPs , followed by phonon–phonon relaxation, culminates in the localized heating of both the AuNPs and the cells, setting the rational for the use of these nanostructures, under laser light, in cancer photothermal therapy (PTT). Here, we discuss the chemical and biological aspects of this promising new therapeutic approach, including the advantages over conventional cancer therapies and the challenges that scientists still need to overcome to progress toward translation research.

Effectiveness of RF capacitive hyperthermia combined with radiotherapy for stages III and IV oro-hypopharyngeal cancers: a non-randomized comparison between thermoradiotherapy and radiotherapy

Seventy-two patients with Stages III and IV (TNM, UICC, 1987) squamous-cell carcinoma of the oropharynx and hypopharynx (oro-hypopharyngeal cancer) were treated with external irradiation, or irradiation plus 13.56 MHz radiofrequency (RF) capacitive hyperthermia from 1989 to 1995. This study compared initial response, histological effect and 5-year survival rate of thermoradiotherapy (TRT) group with those of radiotherapy alone (RT) group. In the TRT group, 15 patients were treated definitively, and 18 patients preoperatively. In the RT group, 15 patients were treated definitively, and 24 patients preoperatively. With definitive irradiation, the complete response rate of the primary lesions was 73% in the TRT group and 27% in the RT group (p = 0.009) and the complete response rate of the metastatic lymph nodes was 80% in the TRT group and 27% in the RT group (p = 0.005). With preoperative irradiation, the pathological CR (No residual cancerous cells) rate of the primary lesions was 56% in the TRT group and 8% in the RT group (p = 0.01), and the pathological CR rate of the lymph nodes was 72% in the TRT group and 21% in the RT group (p = 0.001). The 5-year survival rates with definitive irradiation were 47.6% in the TRT group and 18.7% in the RT group (p = 0.025). Thus TRT was more effective than RT for advanced oro-hypopharyngeal cancer.

Outpatient interstitial thermoradiotherapy

BACKGROUND

Hyperthermia enhances the cytocidal effect of ionizing radiation. Several pilot studies demonstrated that the combination of interstitial hyperthermia and interstitial radiotherapy (interstitial thermoradiotherapy) is safe and effective. However, these studies mainly utilized low dose rate brachytherapy, and therefore, required hospitalization. With the availability of median or high dose rate brachytherapy devices, we piloted a study to evaluate the feasibility, toxicity and efficacy of interstitial thermoradiotherapy performed in an outpatient setting.

METHODS

Between 1989 and 1993, 27 patients with a diagnosis of carcinoma of the head and neck region (n = 23), carcinoma of the breast (n = 3), or malignant melanoma (n = 1) received 1 or 2 sessions of interstitial thermoradiotherapy. Median patient age was 66 years (range: 37-83 years). Treatment consisted of 60 minutes of 915 MHz microwave interstitial hyperthermia, followed by iridium-192 seed implants, either by Micro-Selectron HDR (10-12 Gray [Gy] in 8.5-21 minutes) or high activity (5-8 mCi per seed) seeds (10-15 Gy in 2-4 hours). In addition to interstitial temperature measurements, a real-time thermal camera was used to monitor the surface temperature spatial distribution. power supply and/or position of interstitial microwave applicators was adjusted when appropriate. All but one patient also received external beam irradiation prior to implants.

RESULTS

Patients tolerated treatments well although 16 (59%) of them required analgesics during hyperthermia sessions. Skin blisters or ulcerations occurred in only 6 (22%), and all but 2 healed. Complete response occurred in 24 patients (89%), partial in 3 (11%). With a median follow up of 16 months (range: 3-43 months), the 2-year actuarial local control rate was 74%.

CONCLUSIONS

The results of this study indicate that outpatient interstitial thermoradiotherapy is convenient, safe, and efficacious for treating human neoplasms.

Detection with the polymerase chain reaction of human papillomavirus DNA in condylomata acuminata treated with CO2 laser and microwave

BACKGROUND

The recurrence rates of condyloma acuminata are high. The reasons for the relatively high relapse rates with different treatments are unknown.

METHODS

Twelve specimens of condylomata acuminata of the vulva were excised from 12 patients and divided into three parts. One part was untreated, the second and the third parts were treated with CO2 laser and microwave, respectively. DNA was then extracted from tissue by proteolytic digestion and amplified by the polymerase chain reaction. Dot blots were performed with the use of radiolabeled consensus and human papilloma virus (HPV) type-specific probes.

RESULTS

HPV DNA was amplified in 100% of untreated specimens (6-HPV 6; 6-HPV 11), and in 83.3% and 50% of specimens treated with CO2 laser and microwave, respectively. There was a significant difference in detection between untreated and microwave-treated specimens (chi 2 = 4.18, P < 0.05).

CONCLUSION

Microwave damages HPV DNA more effectively than CO2 laser.

Multivariate analysis of prognostic parameters using interstitial thermoradiotherapy (IHT-IRT): tumor and treatment variables predict outcome

PURPOSE

From January 1986 to October 1991, 90 patients with localized tumors were treated in a Phase I/II trial using low-dose 192Ir brachytherapy (IRT) plus interstitial 915 MHz microwave (MW) hyperthermia (IHT) and external beam radiotherapy (ERT). Tumors were classified as locally advanced primary (class 1: 27), recurrent (class 2: 40), metastatic (class 3: 10) and persistent (class 4: 13) lesions. The treatment sites included tumors of the head and neck (62), pelvis (26), and others (2). The mean cuboidal tumor volume was 63 cm3 (range: 8-288 cm3). Most recurrent and metastatic lesions (48) had received prior treatment including ERT.

METHODS AND MATERIALS

The treatment protocol prescribed two heating sessions (each 60 min) at 41-44 degrees C before and after IRT. One hundred sixty-one IHT sessions were evaluated. Invasive thermal data were recorded at an average of 18 sites throughout the implant volume. Several thermal variables were analyzed (e.g., averaged parameters: Tmaxav, Tmean, Tminav; index parameters: T10, T50, T90). The study was evaluated with a minimum follow up (FU) of one year. Median follow-up was 19 months.

RESULTS

At 3 months FU, a complete response (CR) was observed in 59 of 90 (66%) patients. At 12 months FU, local control (LC) was achieved in 54 of 84 (64%) evaluable patients. Ten patients developed a local and 14 a regional recurrence (REC) after achieving a CR and/or LC. At last FU, a total of 31 (34%) patients were still alive and 28 (31%) patients had relapse-free survival. For all 90 patients, the median overall survival was 20 months and the median relapse-free survival was 17 months. Overall and relapse-free survival was significantly longer for primary and persistent lesions as compared to recurrent and metastatic lesions (p = 0.002; p < 0.001). Totally 22 (24%) patients experienced acute or subacute side-effects (Grade 1: 12 patients; Grade 2: eight patients; Grade 3: two patients).

CONCLUSION

Univariate logistic regression analysis revealed significant dependencies of CR, LC and REC upon tumor parameters as well as radiation and thermal parameters. The overall and relapse free survival was associated with tumor and radiation parameters. The multivariate analysis revealed two independent predictors of CR: tumor volume and minimum tumor temperature variables. We conclude, that IHT-IRT is a safe and effective treatment. The results provide important implications for planning HT-RT studies and for defining quality assurance (QA) criteria and thermal performance standards in HT studies.

Thermoradiotherapy with combined interstitial and external hyperthermia in advanced tumours in the head and neck with depth > or = 3 cm

Advanced tumours in the head and neck 3-6 cm depth are too deep to be completely heated by external 915 MHz microwaves. A preliminary study was performed using interstitial plus external hyperthermia combined with external beam radiation therapy to heat tumours to depths > or = 3 cm. Nine advanced metastatic lesions of squamous cell carcinoma located in the head and neck were treated between 1987 and 1990 with the combined hyperthermia technique and radiation doses of 38-60 Gy (mean of 49 +/- 3 Gy). The mean tumour volume was 58 +/- 9 (SE) cm3 (range 24-94 cm3) with a mean tumour depth of 3.9 +/- 0.3 cm (range 3-5.5 cm). The deeper aspects of the tumour were heated by interstitial 915 MHz microwave antennas and the superficial aspects heated by external 915 MHz applicators. A single plane of polyurethane closed-end catheters, 16 Ga, were inserted under local anaesthesia approximately 1.5-2 cm apart in parallel arrays at the base of a lesion behind the sternomastoid muscle, or an equivalent site in a dissected neck, extending forward and angled deeply no more than 15 degrees. Hyperthermia was administered twice weekly immediately after radiation therapy in a mean of 5.3 +/- 0.7 external heat sessions (range 3-7) and a mean of 3.5 +/- 0.6 interstitial heat sessions (range of 1-6). Interstitial hyperthermia was usually administered in alternating sessions with external hyperthermia, but in some patients all of the sessions of one modality were administered followed by all of the sessions of the other modality. In no case were both interstitial and external heatings performed on the same day. Surface thermometers were used to monitor skin temperature during external hyperthermia sessions. Results showed that by 8 weeks after completion of treatment, six lesions exhibited a complete response (67%) and three a partial response (33%). One of the partial responses continued to regress and became a complete response (78% complete response). The recurrence rate in complete responders was 14% (1/7) with time to recurrence of 7.7 months. Six lesions were recurrence-free at last follow-up of 21.3 +/- 8.8 months. Skin reactions were absent in four fields (44%), erythema was noted in five (56%) and thermal blistering in one (11%). Ulceration occurred only in association with tumour breakdown when the skin was infiltrated by tumour (three patients, 33%).(ABSTRACT TRUNCATED AT 400 WORDS)