A pioneer in the field of hyperthermic
oncology with a renowned clinical background in this field, Dr. James Bicher is
also internationally recognized for his numerous contributions in basic
microcirculation and drug research.
Dr. James I. Bicher entered medical school at age 16. He
studied under and conducted research with Nobel Prize Laureate Dr. B.A. Houssay. At
Jerusalem's Hadassah Medical School, he focused on the effects of blood circulation on
cancerous tumors. Upon graduation, he continued his research in Israel and Europe, then
came to the United States in 1968. He received his radiation therapy training at Roswell
Park Memorial Institute, a major cancer research center, in Buffalo, New York, where he
later became associate director of that department .
Dr. James I. Bicher is founder and past president of the American
Society of Clinical Hyperthermic Oncology (ASCHO) and current president of the
International Clinical Hyperthermia Society (ICHO). He is the author of eight published
books, and over 200 scientific papers. Recently he edited Consensus on Hyperthermia for
the 1990's, a compilation of medical papers from physicians and oncologist worldwide.
Dr. Bicher holds seven patents, including components used in hyperthermia.
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James Bicher, MD, latest publications
Cerebral Blood Flow Regulation
Authors: Nodar P. Mitagvaria
( Inst. of Physiology, Tbilisi, Georgia) Haim (James) I. Bicher
(Valley Cancer Institute, Los Angeles, CA)
Book Description:
Studies of the mechanisms relating blood supply to the brain
appeared to be, in some sense, at a deadlock. Despite
extensive application of different methodical approaches, no
qualitative progress has been observed in these studies at
the present time. This is perhaps due to the traditional,
but not understandable, separation of neurophysiological and
"circulatory" studies. It may seem very paradoxical, but the
study of cerebral blood circulation proceeds almost in
complete isolation from the knowledge about brain functions
and does not take into account the specificity of the
working brain as a part of the whole body. This book
comprehensively addresses the issues of blood flow
regulation.
It is well known that the brain belongs to the group of
organs having a high level of oxygen consumption. Oxygen
consumption by the brain is an average 4.6 ml per 100 g of
tissue per minute. In humans, the level of oxygen
consumption by the whole brain attains 46 ml/min. This makes
up approximately 20% of the total oxygen volume consumed by
the organism. Consequently, the cerebral tissue is
characterized by highly energetic processes. There is
evidence indicating that even in functionally resting
conditions, 18% of the entire energy expenditure of the body
is utilized by the brain Calculations made by Rushmer
indicate that the intensity of energy consumption by the
human brain appears to be on average 20 Watt.
Table of Contents:
INTRODUCTION
SECTION 1. Regulation of local cerebral blood flow
during systemic arterial pressure changes.
Chapter I. Some theoretical prerequisites
1.1. Historical background
1.2. Possible reasons for controversial interpretations of
the results in the study of autoregulation.
Chapter II. Main theories of autoregulation of
cerebral blood flow
2.1. Miogenic theory
2.2. Metabolic theory
2.3. Neurogenic theory
Chapter III. Analysis of dynamic characteristics of
local cerebral blood flow autoregulation
3.1. Analysis of the dynamic characteristics of local CBF
autoregulation in case of short-lasting systemic arterial
pressure changes - Results of modelling
3.2. Dynamic characteristics of autoregulation of cerebral
blood supply in response to prolonged variations in systemic
arterial pressure
Chapter IV. Structural organisation in the brain
blood supply autoregulation.
SECTION 2. Regulation of local cerebral blood flow
during oxygen insufficiency
Chapter V. Some theoretical prerequisites
5.1. Historical background
5.2. The homeostatic range of cerebral blood flow and its
role in heterogenity of CBF-responses during hypoxia
Chapter VI. Dynamic characteristics of regulation of
local blood flow in the cerebral cortex under conditions of
hypoxia, anoxia and asphyxia
SECTION 3. Regulation of local blood flow in the
brain during changes in its functional-metabolic activity
Chapter VII. General problems of the brain functional
activity and local blood flow coupling
7.1. Blood supply to the cortex of "nonworking" brain
7.2. The local blood flow coupling with cortical electrical
activity
7.3. Blood flow in the cortex during sensory stimulation
7.4. Blood flow in the cortex during motor activity
7.5. Blood flow in the cortex during mental activity
7.6. Blood flow in the cortex during emotional actions
Chapter VIII. Dynamic characteristics of local blood
flow regulation in different brain structures during
performance of behavioral acts
8.1. Choice of the experimental conditions
8.2. Redistribution of local blood flow in different
cortical areas during maze task solution.
8.3. Possible mechanisms of the cortical blood flow
responses during functional loads
8.4. Dynamics of local blood flow in the rats cerebral
cortex following injection of anticholinergic drugs.
Chapter IX. Dynamics of local blood flow and oxygen
tension in the brain in different phases of the sleep-waking
cycle
9.1. Historical background
9.2. Local blood flow and PO2 changes in the dorsal
hippocampus and sensorimotor cortex during sleep-wakefulness
cycle
SECTION 4. Cerebral blood flow, oxygen supply, and
morphological changes induced by local hyperthermia
Chapter X. Dynamics of local cerebral blood flow
during microwave radiation
10.1. Experimental and clinical study of microwave radiation
10.2. Dynamic characteristics of the regulation of local
cerebral blood flow during local microwave radiation of the
brain.
Chapter XI. Physiological and morphological changes
in cerebral tissue, caused by hyperthermia-induced
thrombosis of the cerebral vessels.
11.1. The physiological effects of hyperthermia treatment
11.2 The role of local blood flow intensity, blood
rheological properties and free radicals in development of
local hyperthermia-induced morphological changes in cerebral
tissue
Thermoradiotherapy with curative
intent - Breast, head, neck and prostate tumors
James Haim I. Bicher,
Nazar Al-Bussam
Summary
Purpose: To
evaluate the effectiveness of hyperfractionated thermoradiotherapy (HTRT)
in patients suffering from early stage cancers of the breast, head and
neck and prostate that refuse conventional radiation surgery or
chemotherapy. Response rates and survival were determined using
objective end points (MRI, MRS, PET scan and tumor markers).
Material and Methods:
Fractionation used involved daily hyperthermia treatments in conjunction
with each radiation fraction. Radiation daily doses are progressively
decreased from 180 to 100 cGy resulting in protracted treatment time
that decreases the isoeffect biological equivalent dose by 15 % to 25 %.
This decrease is compensated by the increased number of hyperthermia
fractions which potentiates each radiation dose. Treatment is continued
until an objective complete response is attained, or failure determined.
40 breast patients, 17 head and neck and 15 prostate patients were
treated with a follow up of two to five years. All patients were early
stage (III-a or less).
Results:
Complete response rates were 82 % for breast patients, 88 % for head and
neck and 93 % for prostate patients. Projected 5 year survival rates
were 80 % for breast patients, 88 % for head and neck, 87 % for prostate
patients. Side effects were less than with curative radiation therapy
alone. No Grade IV toxicity (Common Toxicity Criteria) was observed.
Conclusion:
Protracted hyperfractionation of daily thermoradiotherapy decreases the
side effects of radiation therapy, allows treating to effect using
objective end point parameters, accomplishes a high percentage of
complete responses and a high 5-year survival rate in the 80-90 % range
in early superficial tumors. It can be considered as potentially
curative in Stage I-II breast, head and neck and prostate cancer when
used and researched as such.
Keywords
Cancer - head and neck - breast - prostate
- hyperthermia - radiation - survival
Forschung
DZO 2006; 38: 116-122
DOI: 10.1055/s-2006-952049
Karl F. Haug Verlag in MVS Medizinverlage Stuttgart GmbH & Co. KG
Scientific Paper presented by Dr. James Bicher in the XXVII
International Clinical Hyperthermia Society, Florence, Italy, October 2005.
THERMORADIOTHERAPY WITH CURATIVE INTENT - BREAST, HEAD AND NECK AND
PROSTATE TUMORS
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, 17 head and neck and 15 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
1 Decreases the radiation dose by 15 to 25%;
2 Decreases the side effects of radiation therapy;
3 Allows treating to effect using objective end point parameters (tumor markers, PET
scans, MRI, etc.);
4 Accomplishes a high percentage of complete responses in superficial tumors;
5 Accomplishes a high 5-year survival rate in the 80-90% range in early superficial
tumors;
6 Is potentially curative in early stage breast, head and neck and prostate cancers.
Keywords: Cancer, head and neck, breast, prostate, hyperthermia, radiation,
survival.
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