The addition of deep hyperthermia to gemcitabine-based chemoradiation may achieve enhanced survival in unresectable locally advanced adenocarcinoma of the pancreas.

INTRODUCTION: Driven by the current unsatisfactory outcomes for patients with locally advanced pancreatic cancer (LAPC), a biologically intensified clinical protocol was developed to explore the feasibility and efficacy of FOLFORINOX chemotherapy followed by deep hyperthermia concomitant with chemoradiation and subsequent FOLFORINOX chemotherapy in patients with LAPC. METHODS: Nine patients with LAPC were treated according to the HEATPAC Phase II trial protocol which consists of 4 cycles of FOLFORINOX chemotherapy followed by gemcitabine-based chemoradiation to 56 Gy combined with weekly deep hyperthermia and then a further 8 cycles of FOLFORINOX chemotherapy. RESULTS: One grade three related toxicity was reported and two tumours became resectable. The median overall survival was 24 months and 1 year overall survival was 100%. CONCLUSIONS: Intensification of chemoradiation with deep hyperthermia was feasible in nine consecutive patients with LAPC.

Local hyperthermia combined with radiotherapy and-/or chemotherapy: recent advances and promises for the future.

Hyperthermia, one of the oldest forms of cancer treatment involves selective heating of tumor tissues to temperatures ranging between 39 and 45°C. Recent developments based on the thermoradiobiological rationale of hyperthermia indicate it to be a potent radio- and chemosensitizer. This has been further corroborated through positive clinical outcomes in various tumor sites using thermoradiotherapy or thermoradiochemotherapy approaches. Moreover, being devoid of any additional significant toxicity, hyperthermia has been safely used with low or moderate doses of reirradiation for retreatment of previously treated and recurrent tumors, resulting in significant tumor regression. Recent in vitro and in vivo studies also indicate a unique immunomodulating prospect of hyperthermia, especially when combined with radiotherapy. In addition, the technological advances over the last decade both in hardware and software have led to potent and even safer loco-regional hyperthermia treatment delivery, thermal treatment planning, thermal dose monitoring through noninvasive thermometry and online adaptive temperature modulation. The review summarizes the outcomes from various clinical studies (both randomized and nonrandomized) where hyperthermia is used as a thermal sensitizer of radiotherapy and-/or chemotherapy in various solid tumors and presents an overview of the progresses in loco-regional hyperthermia. These recent developments, supported by positive clinical outcomes should merit hyperthermia to be incorporated in the therapeutic armamentarium as a safe and an effective addendum to the existing oncological treatment modalities.

[Chronic lymphocytic leukemia and loss of strength in the right arm--not a typical combination]. / Chronische lymphatische Leukämie und Kraftverlust im rechten Arm--eine nicht typische Kombination.

We report a case of metastatic renal cancer as a second malignancy in a patient with chronic lymphocytic leukemia (CLL). Six years after the primary CLL diagnosis, the clinical presentation of this patient was not typical for CLL, requiring further diagnostic steps. Due to the long-lasting course of CLL second cancers can occur in these patients. In addition some forms of tumors, such as Kaposi sarkoma, malignant melanoma, laryngeal carcinoma, lung cancer and Hodgkin Lymphoma are found more frequently in this patient population. Men with CLL have an increased risk for brain tumors, women for gastric and bladder cancers.

[Correlation of risk factors with the efficacy of applied therapies by breast conserving procedure in breast cancer]. / Korrelation von Risikofakoren mit angewandten Therapien bei brusterhaltend behandelten Mammakarzinomen.

1007 cases of female breast cancer patients treated with breast conserving surgery and subsequently irradiation with a median dose of 66 (50-80) Gy including boost with tangential high voltage photon beams. 34.6% (348/1007) received no further therapies, 53.4% (538/1007) Tamoxifen, 26% (262/1007) an adjuvant chemotherapy +/- Tamoxifen. All tumors were classified on the basis of the pathologic-anatomical spreading: 70.7% (712/1007) pT1a-c, 27.4% (276/1007) pT2. 1.9% (19/1007) pT3-4 due to the refusal of mastectomy or an error in the preoperative diagnosis. 32.5% (327/1007) showed proven axillary metastases, of which 26.3% (86/327) > or = 4 LN+. Median age 56 (23-92) years. The local relapse rate after a median follow-up of 70 (12-264) months amounted to 5.9% (59/1007). Distant metastases were registered in 11.5% (116/1007). A total of 8.8% (89/1007) died as consequence of breast cancer, 3.2% (32/1007) of other causes. In 82.6% (816/988) of the pT1/pT2 tumors the resection area had been described. In 29.8% (156/524) in the resected parts there were found rests of tumors. The LRFS falls from 94% to 82% and by remained R1 (26/524) to 47%. Correlation likewise the DMFS, which sanks from 81% to 68% respectively to 63%. We expect a second wave of metastases like the situation by local relapses. Often the R1-resection was connected with other histological high risk factors as multifocality/-centricity, necrosis or vascular invasion. If one divides the patient case sample into a first group with special risk factors (< or = 40 years of age, > or = 4 positive axillary lymph nodes, vascular invasion), and a second which exhibited none of these components, the first group had a 23-26% lower disease free survival rate. Amazing is the fact that, subsequent to a lumpectomy and irradiation, the use or non use of Tamoxifen and/or cytostatics was without proven statistical significance. The evaluation was conceived and implemented more than 20 years ago, and documentation was continuously collected ever since. We're aware of the lack of randomization, but there are less the randomized studies than rather its transformations respectively the daily routine who will decide about life and death. However, evaluations of this data by medical oncologists would, on the one hand, make it possible to better assess the importance of the available data and our results, and, on the other hand, clarify the clinical value of partially and/or completely applied medical treatments.

[Breast carcinoma: value of adjuvant therapy after mastectomy? Overview of personal results over > or = 20 years]. / Mammakarzinom: Was brachten adjuvante Therapien nach Ablatio? Uberblick über unsere Ergebnisse über > or = 20 Jahre.

Analysis of 626 consecutive locoregional postoperative irradiated patients after mastectomy. 49.5% (310/626) were without further therapies, 32.8% (205/626) received TAM and 17.7% (111/626) an adjuvant chemotherapy +/- TAM. All tumours were classified on the basis of the pathologic-anatomical spreading. Median age 59 (25-91) years, follow-up 180 (60-265) months. Local relapses 7.1%, distant metastases 40.4%, death as consequence of breast cancer 35.6%, in 20.3% death of other causes. Cause specific survival (CSS) by negative axilla in 76%, by 1 to 3 LN+ metastases in 55% and by > or = LN+ in 30%. On the basis of the final results, lymphnode status, vascular invasion and initial tumor size have been the most important risk factors of prognostic relevance. Their rate of local relapses have been twice to six times as high, the distant metastasis 1.5 to 2 times more frequent. Immense differences too in comparing the CSS after 20 years: high risk collective 26 to 47%, low risk 65 to 72%. No statistical difference has shown in the low risk collective between the therapy groups. As referred back to the initial axillary status, 39.6% (248/626) have been without positive LN at the time of mastectomy. 76.2% (189/248) have remaind without distant metastases (DM), in 78.4% (149/190) without adjuvant therapy after locoregional irradiation. In 60.4% (378/626) the axilla was attacked. 48.7% (184/378) remained without distant metastases. 19.6% (36/184) with chemotherapy, 49.4% (91/184) with TAM and 31% (57/184) without supplemented systemic therapies. With 1 to 3 LN+ 58.4% (108/185) neither clinical nor radiological dissemination proven. It may be due to the efficiency of chemotherapy and TAM that only in 38.2% (13/34) respectively in 34.3% (23/67) distant metastases have been proven. In contrary after > or = 4 LN+ the chemotherapy-group has had 76.2% (48/63) and by combination with vascular invasion 85.2% (23/27) distant metastases. An opposite effect cannot be excluded. A positive axilla may but doesn't have to be a harbinger of tumor generalisation, since on third has remained without distant metastases despite of the lack of adjuvant therapies after locoregional irradiation. Is it possible a consequence of the irradiation too? No side effects of importance: Absence of plexopathies, no cardiotoxicity, 0.8% rib-necrosis after high dose irradiation as a consequence of R1-resections. There are no reasons for a renunciation of postmastectomy irradiation because of its secondary effects.