Combined treatment of radioresistant malignant tumors with high frequency hyperthermia and gamma-rays therapy--recent results.

From the beginning of radiotherapy, efforts have been made to improve the therapeutic effects X-rays by heat. Recently, the combined therapy of heat and X-ray therapy has gained new interest because of failures of the megavoltage therapy of solid malignant tumors. Encouraged by our own animal experiments with a Walker-tumor of rats, since 1972 we have treated 52 patients with tumors of lower sensitivity. We used decimeter waves; wave length of 69 cm and a frequency of 433.92 MHz. After preheating for 3 to 5 min we added the gamma-rays of Caesium-137 or Cobalt-60 in usual rhythms. The total dose only in few cases exceeded 6000 to 6500 rads in six to seven weeks. We observed a relatively very good response for tumors of low sensitivity. The dose was between 20 and 30% lower which in the treatment of tumors of median sensitivity is acceptable. Local recurrences are rare and occurrence of distant metastases are within the characteristic development of certain malignant tumors. A prospective study has begun.

[Results of the radiation therapy of malignant epipharyngeal tumors in 1953-1977]. / Ergebnisse der Strahlentherapie bei malignen Epipharynxtumoren aus den Jahren 1953--1977.

134 patients having carcinomas of nasopharynx were treated with megavoltage radiotherapy. Treatment results in relation to histology, stage and tumor dose are reported. Patients with squamous cell carcinomas showed a shorter survival in comparison with tumors of higher sensibility. Patients with smaller tumors survived longer than others in advanced stages and patients who received more than 5000 rads had a better prognosis both in squamous cell carcinomas and tumors of higher sensibility. The value of a combined treatment of radiotherapy with hyperthermia and/or chemotherapy is discussed.

[Radiation therapy and treatment results in carcinoma of the esophagus (author's transl)]. / Strahlentherapie und Behandlungsergebnisse des Osophaguskarzinoms.

Results from radiotherapeutic treatment of 200 patients with malignant tumors of the esophagus are reported. The principal part is represented by squamous cell carcinomas with 88%, followed by adenocarcinomas with 4.5%, by more or less differentiated solid carcinomas with 4%, and small cell carcinomas with 1.5%. Sarcoma was found in three cases, one of them a myosarcoma, another a reticulosarcoma. An ectopic carcinoma of the gastric glands was present in one case. The staging was performed according to the TNM system. A focal dose of 6000 to 6500 rd within 6 or 8 weeks was tried for, using 60Co-gamma-rays. The one-year and five-year survival rates in stage T2N0M0 amounted to 80% and to 17%; no survival was obtained in stage T3N0M0. Out of the total of stage T2-3N0M0 cases 24% obtained one-year survival, and 2% five-year survival. In stages T3N2-3M0 and T3Nx-3M1 after one year 9% and 7% of the patients were alive. The mean survival time of stage T2N0M0 cases was 30.5 months; of T3N0M0, 7.3 months; of T3N1-3M0, 5.2 months; of T3Nx-3M1, 3.8 months. The one-year and five-year survival rates, being related to the irradiation dose administered, amounted to 28% and to 2% after a minimum dose of 5000 rd to the focus. With less than 5000 rd, none of the patients survived two years. The bad results of treatment demand new therapeutic pathways. Short-term pre-irradiation followed by surgical treatment is discussed as well as a combined radiation therapy with cobalt-60 and neutrons or a combined radio-chemotherapy using cytostatics.

[Effects and mechanism of a locally combined treatment with radiation and heat therapy (author's transl)]. / Leistung und Wirkungsmechanismus einer lokalen kombinierten Strahlentherapie- Wärmeanwendung

An animal experimental study on solid Walker-tumors was undertaken to determine the therapeutic effects utilizing hyperthermy in the form of combined decimeter wave megavolt treatment. Noted was the superior effect of combination therapy as compared to exclusive use of radiation therapy. Hyperthermy therapy alone does inhibit tumor growth but not involution. This inhibiting characteristic of hyperthermy probably changes cellular mitotic rhythm in the form of cellular synchronisation. The indications for combined hyperthermy megavolt treatment is hypoxic malignant tumors of low radiation sensitivity, especially in superficial and shallow tissue regions. The above treatment is tolerated well and no serious side effects have been observed.

[Radiological check-up examinations for the assessment of therapeutic response in malignant bone diseases]. / Radiologische Kontrolluntersuchungen zur Beurteilung des Therapieerfolges bei malignen Knochenerkrankungen

Results of the improved treatment in radiation therapy of malignant bone lesions demand regular check-up examinations in order to assess the therapeutic response. For this purpose roentgenographic verifications are recommended before the beginning of treatment and after finishing radiation therapy and furthermore two or three months later. Follow-up by radionuclide scanning is suggested. An initially possible increase of a bone lesion in the course of radiotherapeutic treatment does not justify to stop radiation therapy.