THERMORADIOTHERAPY IN BREAST CANCER – THE

TREATMENT OF LOCALIZED INFLAMMATORY

RECURRENCE

Bicher, H., M. D.; Wolfstein, R., M. D.;

Keen, T., M. N.; Carter, S., Ph. D.

Valley Cancer Institute, Los Angeles, CA, U.S.A

Thermoradiotherapy is well established as a primary or adjunct treatment of mammary adenocarcinoma. Results in our series since 1984, encompassing 151 treated patients show a 90% response rate of which 71% 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.

Localized inflammatory breast cancer, usually extending from the affected breast or mastectomy site to the chest wall is a rapidly lymphatic spreading form for cancer, usually resistant to radiation or chemotherapy, and prone to rapid dissemination.

This presentation reports on a phase 1 clinical trial involving 79 fields in 19 patients. Each field received 2000-4000cGy of external beam bolused radiation combined with 25 or more hyperthermia treatments given within one hour of the radiation.

Response rate was gratifying. 91% of the fields responded to the combined treatment, with complete disappearance of the inflammatory process in 81% of the treated areas. There was only one recurrence in the areas of complete response while areas that responded partially showed regrowth within 3 months of treatment. Side effects were minimal, in the form of 6 first degree superficial burns. There was no correlation between the response rate and the radiation dose.

 ESHO, Verona Italy, May 30^th – June 2^nd , 2001.

A METHOD OF CURATIVE THERMORADIOTHERAPY
IN SUPERFICIAL TUMORS, BREAST, HEAD AND NECK AND PROSTATE

JAMES I. BICHER, M.D., NAZAR Al-BUSSAM, M.D. and RALPH S. WOLFSTEIN, M.D.

Valley Cancer Institute, Los Angeles, California U.S.A.

Objectives: Hyperthermia increases the response of malignant tumors to radiation therapy in experimental animals and clinical treatment. In our 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 "de novo" and eventually with 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. Based on these results and an increasing world literature we undertook to treat with curative intent superficial heatable tumors of the breast, prostate and head neck regions in patients that had refused conventional cancer therapy.

Methods: The hyperthermia part of the protocol extends the number of heat treatments to correspond to the number of radiation-fractions. The number of hyperthermia treatments therefore varies from 25-50 per course for each treated field. The radiation protocol consists of progressively decreasing daily doses of radiation therapy. Typically the treatment is started at a daily dose of 180 cGy gradually reduced to 100 cGy protracting a typical radiation therapy treatment course from 5000 cGy in five weeks to 5000 cGy given in over eight weeks; or 7000 cGy in seven weeks to 7000 cGy 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 adapted to the clinical situation. To this effect, the use of objective end result parameters is introduced, including MRI, MR Spectroscopy, PET Scanning and Tumor Marker levels. Treatment is continued until these parameters revert to normal. Forty breast patients, 27 head and neck and 18 prostate patients were treated with a follow up period of two to five years. All patients were early stage (less than III).

Results: Breast patients showed an 82% complete response rate, head and neck patients 88% complete response rate and prostate patients 93% complete response rate. Projected 5 year survival rates were 80% for breast patients, 88% for head and neck, and 87% for prostate patients.

Conclusion: Protracted hyperfractionation of daily thermoradiotherapy