Engin K, Tupchong L, Waterman F M, Nerlinger R T, Hoh L L, McFarlane J D, Leeper D B
Department of Radiation Oncology and Nuclear Medicine, Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA 19107.
Int J Hyperthermia. 1993 Sep-Oct;9(5):645-54. doi: 10.3109/02656739309032053.
Advanced tumours in the head and neck 3-6 cm depth are too deep to be completely heated by external 915 MHz microwaves. A preliminary study was performed using interstitial plus external hyperthermia combined with external beam radiation therapy to heat tumours to depths > or = 3 cm. Nine advanced metastatic lesions of squamous cell carcinoma located in the head and neck were treated between 1987 and 1990 with the combined hyperthermia technique and radiation doses of 38-60 Gy (mean of 49 +/- 3 Gy). The mean tumour volume was 58 +/- 9 (SE) cm3 (range 24-94 cm3) with a mean tumour depth of 3.9 +/- 0.3 cm (range 3-5.5 cm). The deeper aspects of the tumour were heated by interstitial 915 MHz microwave antennas and the superficial aspects heated by external 915 MHz applicators. A single plane of polyurethane closed-end catheters, 16 Ga, were inserted under local anaesthesia approximately 1.5-2 cm apart in parallel arrays at the base of a lesion behind the sternomastoid muscle, or an equivalent site in a dissected neck, extending forward and angled deeply no more than 15 degrees. Hyperthermia was administered twice weekly immediately after radiation therapy in a mean of 5.3 +/- 0.7 external heat sessions (range 3-7) and a mean of 3.5 +/- 0.6 interstitial heat sessions (range of 1-6). Interstitial hyperthermia was usually administered in alternating sessions with external hyperthermia, but in some patients all of the sessions of one modality were administered followed by all of the sessions of the other modality. In no case were both interstitial and external heatings performed on the same day. Surface thermometers were used to monitor skin temperature during external hyperthermia sessions. Results showed that by 8 weeks after completion of treatment, six lesions exhibited a complete response (67%) and three a partial response (33%). One of the partial responses continued to regress and became a complete response (78% complete response). The recurrence rate in complete responders was 14% (1/7) with time to recurrence of 7.7 months. Six lesions were recurrence-free at last follow-up of 21.3 +/- 8.8 months. Skin reactions were absent in four fields (44%), erythema was noted in five (56%) and thermal blistering in one (11%). Ulceration occurred only in association with tumour breakdown when the skin was infiltrated by tumour (three patients, 33%).(ABSTRACT TRUNCATED AT 400 WORDS)
头颈部深度为3 - 6厘米的晚期肿瘤太深，无法被外部915兆赫微波完全加热。进行了一项初步研究，采用组织间加热加外部热疗并结合外照射放疗，将肿瘤加热至深度≥3厘米。1987年至1990年间，对9例位于头颈部的晚期转移性鳞状细胞癌病变采用联合热疗技术及38 - 60戈瑞（平均49±3戈瑞）的放射剂量进行治疗。平均肿瘤体积为58±9（标准误）立方厘米（范围24 - 94立方厘米），平均肿瘤深度为3.9±0.3厘米（范围3 - 5.5厘米）。肿瘤较深部位由组织间915兆赫微波天线加热，浅表部位由外部915兆赫的热疗仪加热。在局部麻醉下，将16号单平面聚氨酯封闭端导管以平行阵列形式插入，间距约1.5 - 2厘米，位于胸锁乳突肌后方病变底部或解剖颈部的等效部位，向前延伸且深度倾斜不超过15度。热疗在放疗后每周进行两次，平均进行5.3±0.7次外部热疗（范围3 - 7次）和3.5±0.6次组织间热疗（范围1 - 6次）。组织间热疗通常与外部热疗交替进行，但在一些患者中，一种方式的所有疗程先进行，然后再进行另一种方式的所有疗程。在任何情况下，组织间和外部热疗都不在同一天进行。在外部热疗过程中，使用表面温度计监测皮肤温度。结果显示，治疗完成8周后，6个病变出现完全缓解（67%），3个出现部分缓解（33%）。其中1个部分缓解持续消退，变为完全缓解（完全缓解率78%）。完全缓解者的复发率为14%（1/7），复发时间为7.7个月。在最后一次随访21.3±8.8个月时，6个病变无复发。4个区域（44%）无皮肤反应，5个区域（56%）出现红斑，1个区域（11%）出现热水疱。仅在肿瘤浸润皮肤导致肿瘤破溃时出现溃疡（3例患者，33%）。
