0206_MICROWAVE HYPERTHERMIA AS AN ADJUNCT TO RADIATION THERAPY.pdf

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Int. J. Radiation Oncology Biol. Phys., Vol. i2, pp. 1667-1671 0360-3016/86 $3.00 + .00Prin ted in the U .S.A . A ll rights reserved . C o pyrigh t 1986 P ergam on Journals L td .

Original Contribution

MICROWAVE HYPERTHERMIA AS AN ADJUNCT TO RADIATION THERAPY:SUMMARY EXPERIENCE OF 56 MULTIFRACTION TREATMENT CASES

H A I M I. BICHER M .D . , R A L P H S . WOLFSTEIN, M . D ., * B . S . L E W ~ N S K Y , M . D ., ~H. S. FRE, M.D. AND A. G. FINGERHUT, M.D.]Valley Cancer Inst i tute, 14427 Chase St . , Sui te 203, Panorama C ity, CA 91402

Results in 256 cases of malignant disease treated by multifraction combination hyperthermia-radiation therapyunder the supervision of one physician are presented. The overall response rate was 94 including a 62 completeresponse. Comp lications specifically ascribed to hyperthermia w ere minor, and most side effects of combined treat-ment were radiation dose related. Tum or response was somew hat better for chest wall recurrence (72 CR) andfor adenocarcinoma in general (64 CR), but no significant dependence on tumor site or type was found. Mostpatients were treated with low dose external radiation with hyperthermia given by air cooled microwave applicatorsor intracavitary antennae operating at 915 or 300 M Hz, and some by interstitial microwave antennae plus 192 Ir.Results appeared to be independent of the microwave source em ployed. Response did depend on radiation dose:complete response rate with 4000 rad was 65 , and with 2000 rad was 42 .Hyperthermia, Radiotherapy, Cancer treatment.

INTRODUCTIONH yper therm ia i s pas t the s tage o f exper imen ta l labora to rytechn ique and in some aspec t s i s wel l in to Phase I I c l i n ica lt r ia l s . M e c ha n i sms o f a c t i o n , t ha t i s , d i r e c t c e l l k il l w i thor without radiation,7 microcirculation changes,3 a n d p Hshift,3 are be ing es tab l ished . Even wi th evo lv ing equ ipm en ta nd c ha ng i ng p r o to c o l s , i ts va l u e a s a n a d ju nc t in c a nc e rt r e a tm e n t i s a c c e p ta b le i n t he r a p i d l y i nc r e a s i ng nu m b e rof clinical studies1249-2123-25 published since 1977. Resultsp r e se n te d he r e sho w tha t t he s a me p e r c e n ta ge o f tu mo rresponse and favorable therapeutic indices have beenma in ta ined a t our Hyp er thermia Cl in i cs as comp ared wi thprevious ly publ i shed c l in ica l exper iences .

In previous publications47 we reported an effectivef ra c t io na t i o n r e g i me n u s i ng 42 -45 C l o c a l hy p e r the rm i ac o m b i ne d wi th l o w do se ( 1 6 0 0 r a ds ) i rr a d i a t io n , y i e l d i ngan overa l l comple te response ra te o f 65% in 121 t rea tmen tf ie ld s evaluable a t 2 m on ths po s t t rea tm en t . These resu l t si nc l u de a n e n l a r ge d se r i e s u s i ng i n t r a c a v i t a r y a nd i n t e r -s t i ti a l a i r cooled mic row ave an tennae , a s w e l l a s exte rna lappl i ca tor s .

METHODS AND MATER I ALSAir cooled microwave applicators and intracavitarya n t e n n a e o p e r a ti n g a t 9 1 5 a n d 3 0 0 M H z * w e r e u s e d i n

hy p e r the r mi a t r e a tme n t o f tu m o r s i n s e ve r a l b o dy s i t e s .They were design ed and tested for physical character ist ics,heat distribution in phantoms, and treatment fields inpat ients . Al l pa t ients accep ted fo r t rea tment s igned con-sent fo rm s af te r l earning the p o tent ia l r i sks and be nef i tsof the c l i n ica l i nves t iga t i on . H om ogene i ty o f t emp era tu resa nd m i n i mu m l e a ka ge l e ve l s we re de t e r mi ne d a nd f o u ndsatisfactory. Routinely, treatment temperatures of 42-45C were obtained at tumor depths while the surfacewa s k e p t b e l o w 4 0 C u s i ng a i r c o o l i ng o f sk in ( wi th e x -t e rna l t r ea tment) or o f an tenna jacke t (wi th in t r acav i ta ryt r ea tment) . Us ing 300 M H z inc reased the e ffec t ive pen-e t r a ti o n f r o m 3 to 5 c m.A sys tem fo r i n te rs t it i a l rad io therapy w i th hyper thermiah a s a l s o be e n d e v i s e d u s i n g m i c r o w a v e i n d u c e d h e a t d e -l i ve r e d th r o u gh a s e r i e s o f i n t e r s ti t ia l m i c r o -a n te nna e i n -t r o du c e d i n to the p l a s t i c c a r r ie r s t ha t a re a no r m a l c o m -p o ne n t o f the S y e d -N e b l i t t de v i c e a nd o the r i mp l a n t a p -plicators.5 According to the volume of implantationr e q u ir e d , th e s y s t e m c a n o p e r a te a t 9 1 5 o r 3 0 0 M H z , th el o we r f r eq u e nc y b e i ng u se d whe n g r e a tbr p e ne t r a t io n o fm icrowaves i s des i r ed e i the r because of a la rge r implan tvolum e or b igge r in te r -an tenna spac ing . A sp ec ia l fea tureof th i s sys tem i s a i r cool ing o f the an tenna jacke ts whichavoids hot spot formation around them, and is progres-s ive ly imp or tan t a s the in te r -an tenna spac ing inc reases .

* Dept. of Hyperthermic Oncology, Daniel Freeman Me-m o r i a l Ho sp i t a l , I n g l ewo o d , C A 9 0 3 0 1 .] W e s te r n Tumo r M e d ic a l G rou p , Inc ., V an Nu y s , C A 9 1411 .R e p r i n t re q u e s ts t o : H a i m I . B i c h e r , M . D .

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A c c e p t e d f o r p u b l ic a t io n 2 4 M a r c h 1 9 8 6 .* S u p p l i e d b y H B C I M e d i c a l G r o u p , 1 4 4 2 7 C h a s e S t . , P a n -o r a m a C i t y , C A .


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H yp er the r mi a /r ad io t he r apy sum mar y exper i ence H . I . B IC H E R et al. 1669Use of intracavitary antenna has been less successful.

Several patients have been unable to tolerate insertion ofthe antenna for a full course, and proctitis or esophagitiswas severe in four of the 20 patients completing treatment.Seven (35%) showed total response, while 3 (15%) showedno response.

Overall results in the current series of patients treatedat Western Tumor Medical Group and Daniel FreemanMemorial Hospital analyzed by cell type, are shown inTable 4. Little variation in response has been noted. Bestresults have been obtained in adenocarcinoma of breastincluding chest wall, lymph node and breast recurrence,and advanced primary disease. This is also the largest sin-gle group of patients in the series including 53 separatefields. All fields showed at least partial response, withcomplete response in 72% (Table 5). Since skin reactionwas no greater than expected for the same dose of radiationalone, except for occasional thermal burns, we began giv-ing hyperthermia along with full dose radiation for pre-viously unirradiated recurrent breast carcinoma. Tumorregrowth was arrested for about 3 months in partial re-sponses. Total responses persisted on average 5 to 6months, in many cases up to the life of the patient.

Toxicity is summarized in Table 2. Proctitis secondaryto the use of a rectal intracavitary antenna in combinedtherapy was, in general, more than anticipated from ra-diation therapy alone and persisted somewhat longer, oc-casionally up to 6 weeks following completion of treat-ment. Otherwise, except for focal burns occurring in lessthan 10% of patients at some point during the treatmentcourse, side effects were those anticipated from a similardose of radiation therapy alone. The few cases of ulcer-ation and fistulae that developed appeared most likelybecause of rapid tumor regression. Although listed ascomplications, pleural effusion can be expected in patientswith extensive lymphangitic disease of the chest wallwithout treatment. Overall, more than half the treatedpatients showed no side effects whatsoever.

Table 4 . Resu l t s by his tology--Current ser iesHisto logy No. of f ie lds Response

M a l ig n a n t m e l a n o m a 6S q u a m o u s c e l l C a 4

A d e n o c a r c i n o m a 78

Other (sarcoma , basal ce l l ,l y m p h o m a , t hy m o m a )Tot a l

101 35

2 CR (33 )4 PR (67 )20 CR (48.8%)1 5 P R ( 3 6 . 6 % )6 NR (14.6%)

50 CR (64.1 )26 PR (33.3 )2 NR (2.6 )8 C R (8 0 % )2 PR (20 )8478

C R (5 9 . 3 % )P R (3 4 . 8 % )NR (5.9 )

Table 5 . Resul t s : Breas t and chest wal l - -Cu rren t ser iesResponse

T r e a t m e n t Fields C o m p l e t e P a r t i a l5-6000 rad25-30/12-15 10 8 (80% ) 2 (2 0% )4000 rad

20/10 31 2 3 ( 7 4 % ) 8 (26% )2000 radi0/10 12 7 (57 % ) 5 (43% )Total 53 38 (7 2 % ) 1 5 (2 8% )

D I S C U S S I O NNo te tha t a l l of the pa t i en ts inc luded in th i s r epo r t weret r e a te d u nd e r t he su p e r v i s i o n o f o ne p h y s i c i a n u s i ng thesame equipm ent in a l l pa t i en ts . In the cur ren t se r ie s eachhy p e r the r mi a s e s s i o n f o l l o we d a r a d i a ti o n f r a c ti o n . H e a twa s d e l i ve r e d f o r 1 h r a t t he the r a p e u t i c r a nge o f 42 Cminimum and 45C maximum tumor temperature.An alys i s of r e sul ts a s to the e ffec t of va r ia t ions f rom th i si de a l t r e a tm e n t i n t he c l i n i c a l s e tt i ng , ha ve no t b e e n u n -de r t a ke n . W e ha ve o b se r ve d , ho we ve r , t ha t a r e a s o f i n -c o m p l e t e tu mo r r e sp o nse o r e a r l y r e c u r r e nc e a p p e a r t ob e a t t he p e r i p he r y o r i n a n a r e a o the r wi se i na c c e s s i bl eto microwave heating. Therefore we conclude that theimp or tance o f ma inta in ing a l l a reas o f tum or a t the the r -a p e u t i c r a nge i s p a r a mo u n t , a nd th i s ha s b e e n e l e ga n t l ydem on st ra t ed b y D ew hir s t et al.8 Other conclusions con-c e r n i ng the o p t i ma l nu m b e r o f hy p e r the r mi a s e s s i o ns o rdu r a t i o n o f e a c h se s s i o n ; t he r a d i a t i o n f r a c ti o n r e q u i r e d

fo r op t imum hyper thermia e f fec t ; o r whether hyper ther -m i a sho u l d b e g i ve n b e f o r e r a the r t ha n a f te r a r a d i a t i o nf r ac t ion , r em ains for the fu ture . Resul t s of th i s s tudy andothers, including our own, show remarkable similarityb o th a s t o s a f e ty a nd e f f e c t ive ne s s o f c o mb i ne d h y p e r -the rmia - rad ia t ion the rapy, i r r e spec t ive of the pa ram e te r sof hype r the rmic t r ea tments .In previous publications,47 we described a low radia-t i o n -hy p e r the r mi a c o m b i na t io n ( a l so r e c o r de d a s R TO Gprotocol 78-06A). Briefly, treatment consisted of fourf rac ti ons o fhyper therm ia a lone fo l l owed af te r 1 w eek res tby four addi t iona l frac t ions o f hyper therm ia th i s t ime im -me dia te ly fo l lowing 400 rad r ad ia t ion f r ac t ions . A l l t r ea t-m e nts we r e s e p a r a t e d by 7 2 -9 6 ho u r s fo l l o wi ng a M o n-day/Thursday or Tuesday/Friday pattern. Each hyper-thermia treatment was for 11/2 hr at the prescribedtemperature (45C alone or 42C with radiation). Onehundred twen ty-one f ields (tumo rs) were t reated accordingt o t h i s p r o to c o l a nd e va l u a b l e f o r a t l e a s t 2 mo n ths p o s tt r ea tment . The f ina l r e sul t s showed no m ajor toxic ity anda rate of 65 complete responses and 30 partial re-sponses (Table 6) . In our o ve ra l l expe r ience , t rea t ing 256fields in 182 patients, tumor response was complete in158 (61 .7%), and p a r t ia l in 84 (32 .4%).

YAm et al . 1 2 r e p o r t e d a n o ve r a l l tu m o r c o n t r o l r a te o f


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1670 I . J . R ad ia t ion O nco logy B io log y P hys ic s S e p t e m b e r 1 9 8 6 , V o l u m e 1 2 , N u m b e r 9T a b l e 6 . S u m m a r y o f r esu lt s - - P r ev i o u s se r ie s

121 f ie lds t reatedC om ple t e re s pons ePar t ia l respon seNo responseRecurrenceC o m p l i c a t i o n s

(82 pat ient s)7 9 (6 5 . 3 % )3 6 (2 9 . 7 % )6 (5.0%)L o c a lM a r g i n a lSk in bu r nsTongu e andp h a r y n xburnsGrand malseizure

532 ( c omp le t e ly he a le d)2 ( c omp le t e ly he a le d)1 (neck t rea tment-epi lept ic h is tory)

78% in 50 patients with a variety of cutaneous lesionsgiven a wide r ang e of r ad ia t ion d ose and f r ac tion s ize andhyp e r the rmia (43 .5 C us ing wate r ba th imm ers ion of RF(27.12 MHz) induction) ranging from two 30 minute tof ive 60 minute t r ea tmen ts (fo l lowing rad ia t ion) , wi th goo dresults independent of both radiation sensitivity (Mela-no m a , M y c o s i s F u ngo i de s ) a nd t r e a tm e n t p a r a me te r s .Hornback et al.9 1 a l so e mp l o y e d a wi de r a nge o f r a -d i a ti o n a n d h y p e r th e r m i a ( 4 33 . 9 2 M H z m i c r o w a v e ) d o s ein the t rea tmen t of 72 pa t i en ts wi th advanced ca nce r , r e -por t ing be t te r con t ro l wi th hype r the rm ia g iven a f te r r a the rt ha n b e f o r e a r a d i o the r a p y f r a c ti o n ( c o m p l e t e r e mi s s i o nof symptom s respec t ive ly 92% and 53%).R epor t s on In te rs t it i a l Therm orad io therapy have sho wnexcellent tumor response without increased morbidity.M a n n i n g et al., 13,14 Vora et al .25 and Oleson et al. 16 gavea single 30 minute hyperthermia treatment prior to ra-d i a ti o n , w h e r e a s P u t h a w a l a a n d S y e d 17 g a v e t w o h y p e r -t h e r m i a t re a t m e n t s f o r 1 h o u r i m m e d i a te l y p r e c e d i n g a n df o l lo wi ng 1 9 2 I r i d i u m t r e a tme n t . O l e so n et al. repor ted81% complete and partial response rate in 52 patientsg i ve n 3 0 0 0 r a d i n t e r s t it i a l r a d i a ti o n f o l l o wi ng hy p e r the r -m i a , the m o s t f a vo r a b l e t e c hn i q u e i n t he i r o ve r a l l e x p e -r i ence us ing va r ious hype r the rmia t r ea tment me thods r e -su l ti ng i n 5 6 % r e sp o nse r a t e i n 1 6 2 p a t i e n ts .16W e have found tha t bo th the deg ree o f tumor reg ress ionand the l eng th o f response depend o n rad ia t ion dose . (Ta7ble 3) W e have a l so conc lud ed tha t hype r the rm ia is sa fe ,and ad ds no thin g to the e f fec t o f radia t ion therapy a lon eo n n o r m a l t is su e . The r e f o r e , we ha ve b e ga n to g i ve f u l ldose radiation therapy plus hype~hermia for previouslyu n t r e a te d r e c u r r en c e a n d f o r p r i m a r y t u m o r s w i t h a p o o rp r o gn o s i s f o r lo c a l c o n t r o l b y r a d i a t io n the r a p y a l o n e o ro ther m odal i t ies . Ear ly resu l t s i n the few cases g iven 5000to 7400 rad p lus hyper thermia have been p rom is ing (Table3) , but these require long term follow-up to assess respon seduration.Two g r o u p s ha ve r e p o r t e d l o ng t e r m f o l l o w-u p da ta i npat ients g iven fu l l course radio therapy p lus hyper thermia

for superficial lesions, most with radiation only internalc o n t r o l , b o th w i th s i mi l a r e x c e l l e n t r e su l t s :Arcangel i et al. ~ used th ree d i ffe ren t t rea tmen t reg im enswith s l ight ly be t te r respon se bu t mo re s ide e f fec ts in thetwo g r o u p s g i ve n h i gh r a d i a t io n f r a c t i o ns twi c e we e k l y .In an internal control group, 26 patients with multipleneck node m e tas tases were g iven th ree fr ac t ions pe r dayto ta l l ing 500 rads to a to ta l do se o f 6000 rads . Of tumorsgiven hyperthermia (twice weekly for 45 minutes at4 3 . 5 C u s i n g 5 0 0 M H z m i c r o w a v e s , a f te r t h e s e c o n d r a -d ia t ion f r ac tion , for a to ta l of 7 se ss ions) , 73% com ple te lyreg ressed . Com ple te response ra te o f l es ions tha t rece ivedM D F r a d i a ti o n a l o ne wa s 42 % . Bo th sp e e d a nd du r a t i o nof tumor control were increased by heat, with three ofseven patients surviving at 18 months showing recur-rence--all in areas treated by radiation alone. Toxicitywas no grea te r in a reas r ece iv ing com bined t r ea tm ent .In 3 1 p a i r e d l e s io ns g i ve n 6 0 0 0 r a ds i n 6 we e k s , S c o t tet aL2~ r epor ted 39% to ta l r e sponse to r ad ia t ion a lone a t6 m o n ths , b u t l e s io ns a l so r e c e i v i ng hy p e r the r mi a ( twi c eweekly for 45 minutes at 42-43C by 915 MHz micro-waves , imm ed ia te ly fo l l owing rad ia t ion) showed 87% to ta lresponse at 6 months. All lesions receiving combinedtreatment remained controlled in 19 patients alive at 1year com pared to 53% of l e s ions t rea ted by r ad io the rapya l o ne . S i x p a t i e n t s e va l u a b le a t 2 y e a r s sho w e d o n e r e -c u r r e nc e , in a n a r e a g i ve n r a d i o the r a p y a l o ne . The y a l soconcluded that adding local hyperthermia to definitiveradiotherapy resulted in more rapid and more completetumor response and better long term control. WhereasA r c a nge l i c o nc l u de d tha t o p t i ma l t r e a tme n t sho u l d r e su l tb y a dd i ng 5 -7 s e s s i o ns o f hy p e r the r mi a t o a f u l l c o nve n -t i ona l r ad io the rapy cour se , Scot t gave 12 se ss ions .Based on our preliminary experience and with theserepor t s1 2 ~ conf i rming safe ty and ef f icacy , we are enc our-aged to continue full dose standard fraction size radio-t he r a p y c o m b i ne d wi th hy p e r the r m i a fo r a c c e s s i b le a d -va nc e d p r i ma r y a nd p r e v i o u s l y u n i r ra d i a t e d r e c u r re n t o rme tas ta t ic ma l ignan t d i sease .H yper therm ia has a tt a ined wel l-deserved accep tance inthe t r ea tment of r ecur ren t and m e tas ta t ic supe r f i c ia l ma-lignant disease as a result of the many reported clinicalstudies, including our own. We may also cautiously an-ticipate significant improvement in long term control ofadvanced head and neck superficial primary disease.H o we ve r , f o r hy p e r the r mi a t o b e c o m e f i rml y e s t a bl i she das a four th m oda l i ty in the pan theo n of cance r t rea tmen t ,the ability to safely heat deep tumors, including thoses u c h a s a d e n o c a r c i n o m a o f p a n c r e a s th a t r e s p o n d s o d i s -m a l l y t o c u r r e n t t he r a p y , is r e q u i r e d . S e ve r a l g r o u p s a r es t u d y in g h y p e r t h e rm i a t re a t m e n t o f d e e p s e a t ed t u m o r susing various techniques, so far with limited suc-c e s s . 6 1 5 1 8 1 9 23

REFERENCES1. Arcangeli, G., Cividalli, A., Nervi, C., Creton, G.: Tumorcontrol and therapeutic gain with different schedules ofco m b i n ed r a d i o t h e r a p y a n d l o ca l ex t e r n a l h y p er t h e r m i a i n

human cancer , lnt. J. Radiat. Oncol. Bio . Phys. 9:1125-1134, 1983.2. Arcangeli, G., Barni, E., Cividalli, A., Mauro, F., Morelli,


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H yper t he r mi a /r ad i o t he rapy sum mar y exper i ence H . I . B IC H E R et aL 1671D . , N er v i , C . , S p a n o , M . , T a b o cch i n i , A . : Ef fec t i v en ess o fmic r ow ave hy pe r t he r mia c om bine d wi t h ion iz ing r ad ia tion :Clin ica l resul ts on neck node metas tases . Int . J . Radiat . On-col. Biol. Phys. 6: 143-148, 1980.3. Bicher, H., Hetzel, F.: Effects of hyperthermia on normaland tumor microenvironment. Radiology 137: 523-530,19 8 0 .4. Bicher, H., Hetzel, F., Sandhu, T.: Results of a phase I/IIclinical trial of fractionated hyperthermia in combinationwi t h l o w d o se i o n i z i n g r a d i a ti o n . Hyperthermia, H. Bicher,and D. Bruley (Eds.). New York, Plenum Press. 1982, pp.87-89.5. Bicher, H., Moore, D., Wolfstein, R.: A method for inter-s t it i a l t he r mor ad io t he r apy . Proc. of 4 Int Syrup. Hyp erther-mic Onco l . (Aarhus, Denmark) 1: 595-598, 1984.6. Bicher, H., Moore, D., Wolfstein, R.: Air-cooled 300 MHzapp l i c a t o r s u se d in a p a r a l le l oppo s e d phas e d s y s t e m ( PO-PAS) . Int. J. Radiat. Oncol. Biol. Phys. 1 1 : S 1 : 2 1 7 , 1 9 8 5(abst.).

7. Bicher, H., Sandhu, T., Hetzel, F.: Hyperthermia and ra-diat ion in combinat ion: A c l in ical f rac t ionat ion regime. Int.J. Radiat . Onco l. Bio l . Phys. 6: 867-870, 1980.8. De w hi r s t, M . , S im D . , Sapa r e t o , S . : Imp or t anc e of min imu m

t u m o r t em p er a t u r e i n d e t e r m i n i n g ea r l y a n d l o n g t e r m r e -sp o n ses o f sp o n t a n eo u s ca n i n e a n d f e l in e t u m o r s t o h ea tand radiation. Cancer Res. 44: 43-50 , 1984 .

9. Hornback, N., Shupe, R., Homayon, S., Joe B., Sayoc, E.,M a r sh a l l , C . : P r e l i m i n a r y c l i n i ca l r e su l t s o f co m b i n ed 4 3 3M H z mic r owave t he r apy and r ad ia tion t he r apy on pa t i e n tswi t h a d v a n ced ca n cer . Cancer 40: 2854-2863 , 1977 .10. Hornback, N., Shupe, R., Shidnia, H., Joe, B., Sayoc, E.,G e or ge , R . , M ar s ha l l, C . : R ad ia tion and mic r owav e t he r apyin the treatment of advanced cancer. Radiology 130: 459-

464, 1979.1 1 . Jo h n so n , R . , S a n d h u , T . , H e t z e l , F . , K o wa l , H . , B i ch er , H . ,Son g , S . : A p i lo t s tudy to invest iga te the therape ut ic ra t ioof hyper thermia 41 .5-42 .0C and rad ia t ion . Int. J. Radiat.Oncol. Bio l . Phys. 5: 947-954, 1979.12 . Kim, J., Hahn, G., Benjamin, F.: Treatment of superficialcancers by combinat ion hyperthermia and rad ia t ion the rapy.Clin Bull 9: 13-16, 1979.13. M a n n i n g , M . , C e t a s , T . , M i l le r , R ., O l eso n , J ., C o n n er , W . ,Gerne r , E. : Cl in ica l hyper the rmia: Resul t s of a phase I c l in -i ca l tr i a l em p l o y i n g h y p er t h e r m i a a l o n e o r i n co m b i n a t io nwith external beam or interstitial radiotherapy. Cancer 49:205-216, 1982.

14. Manning, M., Cetas, T., Gerner, E.: Interstitial thermora-d i o t h e r a p y . NatT. Cancer Inst. Monog. 61: 3 57-3 60 , 19 8 2 .15. Oleson, J., Manning, M., Heusinkveld, R.: Hyperthermiaby m agne t i c indu c t ion . I I . C l in i c a l e xpe r i e nc e wi t h c onc e n -tric electrodes. Int J Radiat Oncol Biol Phys 9: 549-556, 1983.16. Oleson, J., Manning, M., Sim, D., Heusinkveld, R., Aris-tizabal, S., Cetas, T., Hevezi, J., Connor, W.: A review oft h e U n i v er s it y o f Ar i z o n a h u m a n c l i n i ca l h y p er t h e r m i a ex -perience. Front. Radiat . Ther. Onc. 18: 136-143, 1984.1 7 . P u t h a w a l a , A . , S y ed , A . , S h e i k h , K . : T h er m o en d o cu r i e t h -erapy in the t reatmen t of pers is tent and/or recur rent tumo rs( A bs t .) In t e r na tiona l C l in i c a l H y pe r t he r mia So c ie t y , A me r -ican Clinical Hyperthermia Meeting, Palm Springs, CA,D e c e m b e r 1 9 8 4 .18. Sapozink, M., Gibbs, F., Gates, K., Stewart, J.: Regionalh y p er t h e r m i a i n t h e t r ea tm e n t o f c l i n i cal l y a d v a n ced d eepseated mal ignan cy: Resu l ts of a s tudy em ploy ing an an nu laa r r a y a p p l i ca t o r . In t . J . Radiat . Oncol. Bio l . Phys. 10: 775-786, 1984.1 9 . S a p o z i n k, M . , G i bb s , F ., T h o m so n , J . , E l t ri n g h a m , J . , S tew-a r t , J . : A c o m p a r i so n o f d eep r eg i o n a l h y p er t h e r m i a fr o man annu la r a r r ay and a c onc e n t r i c c o i l i n t he s ame p a t i en t s .Int J Radiat Oncol Biol Phys 1 1 : 1 7 9 - 1 9 0 , 1 9 8 5 .20 . Sc o t t , R . , Johns o n , R . , Kowal , H . , Kr i s hnams e t t y , R ., S t o r y ,K . , C l a y , L . : H y p er t h e r m i a in co m b i n a t io n wi t h r a d i o t h e r -apy; a review of five years experience in the treatment ofsuperf ic ia l tumors . Int. J. Rad iat. Oncol. Biol. Phys. 9:1327-1333, 1983.2 1 . Scott, R., Johnson, R., Story, K., Clay, L.: Local hyper-thermia in combination with definitive radiotherapy: in-creased tumor clearance, reduced recurrence rate in ex-tended fo l low-up . Int . J . Radiat . Oncol . B iol . Phys . 1 0 : 2 1 1 9 -2123, 1984.2 2 . Siegel, S.: Non Parametric Statistics. NY, McGraw Hill,19 56 .2 3. Storm, K., Silberman, A., Ramming, K, Kaiser, L., Harri-so n , W . , E l li o t , R ., H a sk e ll , C . , S a r n a , G . , M o r t o n , D . : C l i n -i ca l t h e r m o ch em o t h er a p y : A co n t r o l led t r ia l in a d v a n cedcancer patients. Cancer 5 3 : 8 6 3 - 8 6 8 , 1 9 8 4 .

24. U, R., Noell, K., Woodward, K., Worde, B., Fishburn, R.,M i l le r , L . : M i c r o wa v e i n d u ced l o ca l h y p er t h e r m i a in co m -bination with radiotherapy of human malignant tumors.Cancer 45: 638-646, 1980.25. Vora, N., Forell, B., Joseph, C., Lipsett, J., Archambeau,J . : In ters t i t i a l implan t wi th in ters t i t i a l hyper thermia . n c e r50: 2518-2523, 1982.


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