Hyperthermia as an adjuvant to radiotherapy in the treatment of malignant melanoma.

One hundred and fifteen cutaneous or lymph node metastases from malignant melanoma were treated with three fractions of irradiation alone in 8 days (62 tumours) or followed by heat either immediately (simultaneous treatment, 26 tumours) or after an interval of 3-4 h (sequential therapy, 27 tumours). In addition, three tumours were treated unsuccessfully with heat alone. The total doses of radiation varied between 15 and 30 Gy, allowing a dose-response analysis. For irradiation alone the isoeffective dose to obtain 50 per cent complete response (TCD50) was 26.3 Gy. Addition of heat reduced the TCD50 significantly (p less than 0.05) with a thermal enhancement ratio (TER) of 1.43 for simultaneous treatment and 1.24 for sequential therapy. Also the persistent local control at 18 months was improved by hyperthermia (56 per cent versus 86 per cent, p less than 0.05). However, simultaneous treatment also enhanced the acute skin response to the same extent as the tumour (TER 1.42 for severe erythema). This schedule thus gave no therapeutic gain. In contrast, no normal tissue enhancement was found after sequential treatment (TER 1.02). Such a treatment schedule resulted in a significantly improved therapeutic ratio of 1.22. This effect was especially prominent in larger tumours (if sufficiently heated) and an analysis corrected for volume showed a TER of 1.51. A special analysis was performed in patients with multiple lesions. 15 pairs of tumours were given the same radiation dose, with or without hyperthermia. Out of these, 11 showed a better response, three showed the same response, and only in one pair was the best response in the tumour obtained by radiation alone.