Outubro de 2002
Destin, Florida, USA.
by Haim Bicher, M.D.
Valley Cancer Institute

Two Cases of Stage III Cancer of the Tonsils with Immune Stimulation and Thermoradiotherapy
Two patients with advanced squamous cell carcinoma of the tongue with extensive neck metastasis and intractable pain were treated in the past 18 months with a combination Immune Stimulation and Thermoradiotherapy. The rationale for IS is based upon the observation that cancer is so often associated with a depressed or depleted immune system. Consequently the use of immune activation substances is emphasized. Intravenous infusions containing selenium, germanium, magnesium, vitamin C, B complex, folic acid, zinc, and glutathione are given daily, 5 days per week for three weeks. Each infusion is followed by an intramuscular injection of a poly peptide mixture derived from thymus and spleen. These peptides are activators of T-cells and other cellular elements of the immune system. In addition to the injectables, a number of special oral supplements are given both during and after the initial infusions. These include vitamin A in emulsified form, vitamin E, pancreatic enzymes, thymus extract, inositol hexaphosphate Coenzyme Q10, and Transfer factor. These are continued on an out patient basis.

Thermoradiotherapy was administered as previously described with protracted hyperfractionation to a total of 7000 cGy combined with daily hyperthermia treatments to the area of primary tumor and both necks. Thermoradiotherapy was instituted at the end of the induction phase of the IS treatment.

The results were gratifying, with complete responses accomplished in both cases, as documented clinically, radiographically and with normal tumor markers. Pain palliation was remarkable and early. There have been no recurrence or dissemination at this point.

David Spall, M.D.
OncoCare Cancer and Prostcare Clinic
Melbourne, AUSTRALIA

Clinical Experience with Hyperthermia: Hope or Hoax (Whole Body, Regional and Local Hyperthermia)
This illustrated presentation is a review of clinical experience using both Whole Body Hyperthermia utilizing the Heckel Tent (Heckel, Germany) and Regional L/HF (Microwave) non-ionising energy at 434 MHz. In Whole Body Hyperthermia, heat is generated by reflected energy from an array of infrared tubes. Core temperature is measured with either oesophageal or rectal temperature measurement. Temperatures up to 42º C are obtainable, however, because of the high risk of DIC. The preferred technique performed here utilizes sustained core temperatures of 39º - 40º C. This is used concomitantly with modest dose chemotherapy and occasionally with radiotherapy.

Regional Microwave or, more correctly, UHF Therapy (434 MHz) irradiates the areas of concern (and often the whole body) by means of a BSD 2500 phased pentacular array into the moving treatment field. In addition, we have an array of four broadly focused antennae capable of delivering 3000 watts on a moving target. Each treatment is preceded by the bolus injection of an analogue of L-Cysteine, precipitating excitation within the glutathione cycle. UHF Therapy produces substantial heating of the skin but does not produce an increase in intra-tumoural temperature. There is no thermal effect with our apparatus and no claim has ever been made to that end; neither has it ever been used adjunctively with x-ray therapy or chemotherapy.

Of particular interest is a demonstrated fall in tumour marker levels coincident with the use of the high energy UHF non-ionising radiation. The data regarding many of these cases have been documented and plotted on semi-logarithmic graph paper. These will be presented.

Local Hyperthermia, induced by 300 MHz from two separate and collimated treatment antennae, is used in the treatment of more superficial tumors of the head, neck, chest wall, etc.

The Whole Body and Locally applied systems of treatment are also used adjunctively with reduced doses of cytostatics following Culture and Sensitivity Testing (EVA). Some cases are treated concomitantly immediately after radiotherapy.

Some encouraging results have been seen in the short term, with a number of stage four patients long past their use by date. Long-term survival curves remain to be seen.

John Mon
Celsion Corporation
Columbia, MD USA

Focused Microwave Phased Array Thermotherapy for the Treatment of Primary Breast Tumors
Thermotherapy has often been used in multi-modality cancer treatment regimens to enhance the effects of radiotherapy or chemotherapy. There also has been considerable interest in using heat alone as a cancer treatment modalities as well as using focused heat to activate drug and gene delivery. A special adaptive phased array (APA) focused heating system has been designed to deliver localized thermotherapy at significantly high thermodose levels to achieve tumor ablation and downsize tumors to enable breast conservation. The system is capable of repeatedly and reliably administering focused thermotherapy targeting only tumor without damaging normal tissues. Preliminary results from Phase II studies employing the APA focused heat system to ablate small tumors (1 – 3 cm) and downsize larger tumors (4 – 10 cm) will be presented. These results lead Celsion to initiate two pivotal studies to demonstrate the efficacy of using focused heat to provide a minimally invasive treatment for breast cancer. The rationale and design of the two pivotal studies will be presented. In addition, preclinical data leading to a patient feasibility study using focused heat to activate temperature sensitive liposomes to achieve rapid drug delivery and minimally invasive treatment of prostate cancer will be presented.

Jerry Tennant, M.D.
SCENAR Therapy
Colleyville, TX USA

Cybernetic Biofeedback using the Self Controlled Energetic Neuro-Adaptive Regulator (SCENAR) to Correct Chronic disease
"Cybernetic": the science of communication and control theory that is concerned especially with the comparative study of automatic control systems (as the nervous system and brain and mechanical-electrical communication systems)

Whenever an injury occurs, the area creates an electropositive Current of Injury. This information is sent to the brain via the acupuncture meridians. The brain determines how to heal the area and sends an instruction set via the analog perineural nervous system to the area. It sets up local ionic capacitors to keep the area electropositive until healing occurs. This is necessary because the things necessary to heal (RBC, WBC, fats and proteins) are electronegative. The positive charge attracts the things necessary for healing. Whenever the injured area becomes electronegative, healing stops and the area becomes chronically diseased. The process can be reversed and healing re-activated using cybernetic biofeedback using technology developed by the Russian space program. This process will be discussed and clinical examples given.

Michael Reynolds
Zoetron Group
Penticton, British Columbia CANADA

Targeted Intracellular Hyperthermia in Cancer Therapy
The reason for the development of the subject protocol was to provide an efficacious treatment for various forms of cancer and particularly for adenocarcinoma of the pancreas entirely without recourse to any form of invasive treatment, thus precluding surgery, radiation or chemotherapy.

This approach was founded on the precept that patients with diagnoses of late-stage cancer inevitably also have a highly compromised immune system and that to further compromise that immune system with invasive therapies is likely to be counterproductive and should be avoided if any alternative is indeed available.

In a clinical environment, two hundred and eleven patients with confirmed diagnoses of various forms and stages of cancer were treated using a directed, pulsed magnetic fields.

Further, twenty-five patients with adenocarcinoma of the pancreas were treated.

In all cases the outcomes were documented and statistics compiled demonstrating, inter alia, a median survival time for cases of adenocarcinoma of the pancreas of more than three times the established norm.

The methodology, documentation, collateral benefits, outcome statistics and side effects and after effects will be presented together with an outline of the further investigations now under way.

Jacoba van der Zee, M. D.
Daniel den Hoed Cancer Center
Rotterdam, The Netherlands

Clinical Practice of Hyperthermia in the Netherlands
In this presentation, a summary of the indications for application of hyperthermia (HT) in our institute is given. Our experience demonstrates how a new treatment modality can achieve acceptance within the oncology community.

We have applied HT clinically since 1978. We have experience with whole body HT, regional perfusion HT, and local HT. Nowadays, only local HT is used, for both superficial and deep seated tumours. For superficial HT the custom built 433 MHz multi-applicator multi-amplifier system is used. Adequate heating is achieved to a depth of 4 cm. The maximum area that can be treated in one session, using 6 Lucite Cone Applicators, is 20 x 30 cm 2. For larger areas, two or more applications are given for one treatment. For deep HT, the BSD-2000 system is used. During treatment, the power is increased upto the patient’s tolerance limit, with adjustment of treatment settings when necessary. Treatment duration is 60 minutes for superficial HT and 90 minutes for deep HT. When combined with radiotherapy, HT is given once weekly, after radiotherapy.

For three indications, combined HT and radiotherapy has been accepted as standard treatment, on the basis of effectiveness shown in randomized comparative studies [1,2,3]. For breast cancer recurring in previously irradiated areas, the schedule used is 8 fractions of 4 Gy applied twice weekly. The target area for HT is the whole volume at risk, which is identical to the reirradiation field. In these patients, the combined treatment results in 73% local control. With the same reirradiation alone, complete response rates of 26-38% have been observed. For melanoma, the radiotherapy schedule used depends mainly on location of the tumour and field size. In the ESHO study, the addition of HT to radiotherapy resulted in improved complete response rate, from 35 to 62%, and improved 2-years local control rate, from 28 to 46%. For cervix cancer, conventional external radiotherapy plus brachytherapy is combined with HT since the Dutch Deep Hyperthermia Trial showed considerably better 3 years local control (61% versus 41%) and overall survival (51% versus 27%) rates with additional HT.

For two indications, HT is "standardly" added to radiotherapy after phase II studies indicated better results with the combination (4,5). In these patient groups, a phase III study seemed unfeasible due to the low number of patients available. For rectal cancer recurring in previously irradiated areas, reirradiation is applied to a total dose of 24 or 32 Gy, depending on previous radiation dose applied, given in fractions of 4 Gy twice weekly. With the combined schedule a palliative effect is achieved in 72% of the patients, of a longer duration than usually observed following radiation alone. In mesothelioma with tumor growth into the chest wall causing pain, the addition of HT to 44 Gy, applied in thrice weekly 4 Gy fractions, resulted in considerably higher objective (100% versus 54%) and palliative (94% versus 59%) response rates, and lower tumour regrowth rate (8% versus 80%) or pain recurrence rate (25% versus 100%).

For cervix cancer in previously irradiated areas, simultaneously combined cisplatin and HT became standard treatment after a phase I-II study had shown an objective response in 53% of the patients. Of 19 patients treated, salvage surgery became feasible after combined treatment in one patient; one further patient is symptom free now for more than 4 years.

In the Netherlands, HT treatment can be applied in 4 institutes. Patients from institutes in which HT equipment is not available receive radiotherapy in the original institution and are referred to one of the HT centers for additional treatment. About half of the patients treated in our unit are referred from other institutes.

[1] BrJCancer 79:483-490, 1999 [2] Lancet 345:483-490, 1995

[3] Lancet 355:1119-1125, 2000 [4] manuscript in preparation

[5] IntJROBP 43:511-516, 1999 [6] BrJCancer 80:1387-1391, 1999

Augustine Cheung, Ph.D.
Celsion Corporation
Columbia, MD USA

Thermodynamic Therapy for the Treatment of Cancer
Celsion Corporation, in conjunction with the Massachusetts Institute of Technology, has developed an adaptive phased array (APA) microwave heating technology platform that allows the delivery of localized focused heating of deep seated tumors and tissues at significantly high thermo dose levels on a reliable and repeatable basis. The Company is also interested in the development of a temperature sensitive liposome (TSL) capable of delivering chemotherapeutics directly into targeted tumors through focused heating. Celsion has developed a new cancer treatment approach referred to as thermodynamic therapy (TDT). TDT combines the use of APA focused heat and TSL.

In TDT, toxic cancer chemotherapeutics are carried by TSL directly to a targeted tumor, where the action of focused heat will trigger localized release of the drug in the tumor at a much enhanced concentration level. In TDT, temperature elevation is kept below 42°C so that the primary therapeutic action is solely chemotherapy.

Collaborative development efforts with scientists from Duke University led to the successful formulation of a lysolipid based temperature-sensitive liposome (LTSL), which encapsulated doxorubicin (LTSL-dox). Preclinical studies using animal tumor models demonstrated the feasibility of heat triggered rapid drug release in tumors. An efficacy demonstration of LTSL-dox in tumor control using human squamous cell carcinoma xenograft line (FaDu) tumors heated to 41°C resulted in 11 out of 11 complete tumor regression ( Cancer Research 2000).

Using a GMP manufactured batch of the LTSL-dox, large animal toxicity studies have been performed in rats and dogs. The results of the studies formed the basis of an IND submission. A phase I dose escalation trial is to take place at the Roswell Park Cancer Institute. The study objectives are to determine MTD, DLT, PK, safety and potential therapeutic benefit of LTSL-dox in prostate cancer.

The concept of APA, LTSL, TDT, and the potential clinical applications will be introduced. The clinical rationale and protocol for using TDT for treatment of prostate cancer will be discussed.

William S. Maxfield, M. D.
Ocean Medical Center
Lauderdale-by-the-Sea, FL USA

The Value of Hyperbaric Oxygen Therapy in Cancer Care
Treatment of bone and soft tissue radionecrosis is an approved use of Hyperbaric oxygen therapy (HBOT). Less well recognized is the value of HBOT in treating extravasation of chemotherapy agents. The ability of HBOT to reduce edema and speed healing is documented. HBOT has significantly decreased the morbidity of chemotherapy extravasations and should also decrease morbidity of the hand and foot syndrome that is a complication of Capecitabine chemotherapy.

The use of HBOT is routine treatment of carbon monoxide poisoning and decompression illness. There is growing recognition of the value of HBOT for treatment of other neurological conditions such as cerebral palsy, stroke, autism, Lyme disease, ataxia-telangectasia, brain trauma and encephalopathies from meningitis and hypoxia. Benefit from HBOT in

neurology is documented by clinical response and objective improvement demonstrated on the SPECT brain scans obtained before and after HBOT. As in other neurological conditions HBOT has cleared symptoms of the recently described chemo brain. Acute blood loss anemia is a recognized indication for HBOT. Therefore, stimulation of hematopoietic tissue by HBOT can be a significant factor in treating the anemia of cancer and could be synergistic with erythroprotein anemia of cancer. HBOT has benefited the patient with chronic fatigue syndrome and should help the cancer patient with fatigue.

As reported from Japan, in 1999 HBOT given immediately prior to radiation therapy for brain tumors showed a 50% increase in survival for these patients. This technique works as I used it 20 years ago for difficult cases such as synovial cell sarcoma. The concern that increased oxygen might stimulate the growth of cancer is countered by the years of data from HBOT use in osteoradionecrosis. The cancer recurrence rate for patients receiving HBOT as part of the

reconstructive process is significantly less than for those who did not receive HBOT. Also, there is experimental animal data showing that HBOT decreases the implantability of cancer cells.

Based on the concepts outlined, there is a significant need to expand the use of HBOT in the field of cancer care.

David Spall, M.D.
OncoCare Cancer and Prostcare Clinic
Melbourne, AUSTRALIA

Hyperthermia and Thermotherapy of the Prostate: Clinical Experience With Prostcare
The author introduced Prostate Thermotherapy to Australia in February 1996 for the treatment of BPE (Benign Prostate Enlargement) using Trans Urethral Microwave Thermotherapy (TUMT). In addition, Trans Rectal Microwave Thermotherapy (TRMT) has been used, on an experimental basis, in the treatment of prostatic carcinoma and abacterial prostatitis. TRMT for prostatic adenocarcinoma has only been used with patients who have rejected recommended standard treatment modalities such as prostatectomy, radiotherapy and bracytherapy. The preferred option would be to have TRMT immediately before radiotherapy. Unfortunately, this is not available. Extra-capsular disease is treated adjunctively with regional and whole body hyperthermia.

This paper presents a study of the techniques and clinical results with both TUMT and TRMT from April 1996 to August 2002. From January 1996 to January 2000, prostate cancer patients each received six TRMT treatments over a two-week period for sixty minutes each session. In January 2000, each treatment session was increased to ninety minutes and 5 of the 118 patients treated returned for re-treatment sessions at six to twelve month intervals. There is a significantly improved clinical outcome directly related to increased hyperthermia. Follow up of all patients is still being pursued; three of the five patients cited above are in complete remission, four without adjunctive treatment. One patient, with extra capsular disease and pelvic lymphadenopathy, is in complete remission for more than one year.

Falling PSA levels are being witnessed in an increasing number of patients with Prostatic Carcinoma who have declined emasculation either surgically or by hormone blockade.

Retrospective review of patients who present with LUTS in varying degrees of BOO associated with BPE will be reviewed. Intra prostatic temperatures as high as 55º C have been obtained. Accurate intra prostatic temperature recordings are made possible by way of radiometric temperature measurement using Planck’s Law.

Results described as excellent have been obtained in treating BPH with TUMT with improved subjective symptoms in 90% of patients, and good results in 9% of patients with BPE. Madsen Iversen Score is utilized as well as Qmax where possible.

The treatment system of choice is Prostcare by Odam Bruker (France).

Haim Bicher, M. D.
Valley Cancer Institute
Los Angeles, CA USA

Thermoradiotherapy in Breast Cancer: Treating with Curative Intent and Objective End Point Parameters
Thermoradiotherapy is well established as an adjunct treatment of mammary adenocarcinoma. Results in our series since 1984, encompassing 142 treated patients show a 90% response rate of which 72% 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.

Since 1998 we instituted a Phase II study to early local breast cancer with protracted radiation Hyperfractionation (PH) to the biological equivalent of 4500 Gy according to the Ellis TDF formula and an increased number of Hyperthermia treatments (25 – 50 per field_ with curative intent. These patients had refused surgery, chemotherapy or high dose radiation therapy; therefore thermoradiotherapy was the only treatment given. Treatment was directed to the primary tumor and areas of lymphatic drainage.

This presentation reports the results of the first 16 patients treated during the past 30 months. All treated tumors accomplished a complete response as determined 3 months after last treatment. Only one has recurred. None disseminated thus far, but 2 showed local extension in untreated areas (upper lung lobe in homolateral side) which required treatment.

Side effects were minimal, only mild dermatitis and 6 first-degree hyperthermia burns. Cosmetics results were most gratifying, the treated side showing mild retraction and hardening in 50% of the cases.

Since we treat to effect, the need for objective evaluation is imperative. Therefore 3 parameters have been instituted: 1) Tumor markers, 2) PET scanning, 3) MRI with MR spectroscopy to eliminate the size of the cholin peak in the positive areas. This objective determination of response will be correlated with length of response, dissemination and eventually survival. So far tested in 4 patients, objective response determination seems to be remarkably accurate to assess local response.

These preliminary result show that thermoradiotherapy should be considered as a treatment modality for early stage breast cancer.

Feng-tong Li, Hai-pan Wang
Tianjin Medical University
Tianjin, CHINA

Quality Assurance for Intracavitary Microwave Applicators
The performance of intracavitary microwave applicators for hyperthermia was determined by many physical parameters. A set of different experiments was carried out to compare the heating characteristics, namely the specific absorption rate (SAR) and temperature distribution of intracavitary applicators with measurement quantitatively and display qualitatively in muscle equivalent phantoms.

Changes in temperature at well-defined points were measured in Jian’s phantom following a brief period of heating at high power levels by LUXTRON-3000 multichannel fluoroptic thermometer. Changes in temperature at well-defined points were considered as 100% relative SAR. Then it was calculated and described the 10%, 50%, 90% - iso SAR.

Liquid crystal plate (LCT) thermography made contact with mapping temperature distributions. The thermographies of intracavitary applicators could be taken when using thermochrome LCPs together with a split phantom. A LCP reflected visible light at different wave-lengths E, which depend on the temperature of the LCP. The LCPs have an absolute temperature range of 6. Colour changes within the whole visible spectrum from red to violet can be seen. After the equivalent phantom is flowed, there is a brief period of heating at high power levels; immediately a photo is taken. Thermography and relative temperature change distribution can be derived from this procedure.

When comparing quantitatively measured SAR-patterns and qualitatively observed iso-thermal shapes on LCPs, conformity can be found for applicator type and position under investigation. Conformity when comparing experimental and simulated ones is mainly due to choosing well-defined points.

Roy C. Page, M.D.
Mid-South Surgical Oncology Center
Memphis, TN USA

Extreme Hyperthermia: Radio Frequency Ablations of Malignancies
Newer developments in minimally invasive techniques will allow accurate placement of an ingenious device in tumors that can be heated to very high temperatures, thus destroying the cancer. The presentation will demonstrate the progressive development of the device, the technique for application and results of tumor destruction. This therapy can be used in conjunction with other standard treatment to achieve superior results. Risks and benefits will be presented.

Michele de Simone, M.D.
Turin, ITALY

Cytoreduction and Hyperthermicantiblastic Peritoneal Perfusion (HAPP) in Treatment of Peritoneal Multicystic Mesothelioma (MMP)
Peritoneal multicystic mesothelioma (MMP) is a rare neoplasia prevalently located in the pelvis and abdomen with a mesothelial origin. Even if it has a low grade of clinical malignity, recurrences of the disease after the only surgical procedure are rather frequent (45%). In virtue of the poor response to systemic chemotherapeutics treatments, we decided to treat the MMP with surgical cytoreduction and Hyperthermic Antiblastic Peritoneal Perfusion (HAPP). HAPP is, in fact, particularly effective in the treatment of peritoneal carcinosis of low-grade neoplasias.

Xiaofeng Zhang, M.D.
Shenqhen, P. R. CHINA

A New Device for Whole Body Hyperthermia
With the development of cancer whole body hyperthermia, lots of devices have been made. But few of them can be applied in clinical use. That is partly because of the lack of physical techniques, and partly because of the barrier of clinical skills. In this paper, some technical difficulties on researching Whole Body Hyperthermia device have been introduced. An experience of more than one year of clinical trials applying a new Whole Body Hyperthermia System ET-SPACETM (Energy Technology, Inc., ETI) has been described in detail.

Physical characteristics: The treatment chamber of ET-SPACETM is an enclosed capsule, which looks like a spaceship. The head of the patient remains outside of the treatment chamber, while the rest of the body is inside during the hyperthermia treatment. ET-SPACETM applies specially designed infrared light source and red light with wavelengths at 650-1400 nm. Eight temperature sensors have been used for measuring the body temperature; they are put at inferior segments of the esophagus, rectum and Posterior nasal meatuses, respectively; five sensors are respectively put at left and right chest, left and right anterior superior iliac spine and the back. The thermal controlling point is at inferior segments of the esophasgus, and the value of point temperatures display at the controlling computer. Then the computer adjusts the lamp power according to the tendency of the changing temperature.

Raymond U
Rex Healthcare Cancer Center
Raleigh, NC USA

Clinical Results Using 8 Mhz Radiofrequency Capacitive Hyperthermia and Radiotherapy for Recurrent Breast Carcinoma
A clinical investigation has been conducted in recurrent and/or advanced breast carcinoma to determine the safety and effectiveness of 8 Mhz radiofrequency capacitive hyperthermia using the Thermotron rf-8.

Patients and methods: since 1988, a total of 46 patients have been enrolled in this investigation. All patients had biopsy confirmed histological proof of recurrence and/or were considered to have advanced breast carcinoma. The probability for local control with radiation alone was estimated to be 5 and 25 %. All radiation therapy was delivered using 4. 6. 18. or 21 MeVlinear accelerator. The choice of beam type and energy was dependant on tumor location, prior radiation dose, and the limiting adjacent normal tissues. Median radiation dose of 50.4 Gy was delivered in 5-6 weeks using 1.8-2.0 Gy daily 5 times weekly. The hyperthermia treatment objective was to deliver 42.0 – 44.0 degree C for 45050 minutes per session twice weekly with a median total of 10 sessions during the above referenced radiation schedule.

Results: A total of 46 patients were eligible for treatment response analysis. A total of 43 patients achieved compete tumor resolution.

Haim Bicher
Los Angeles, CA USA

Protracted Thermoradiotherapy Treating to Effect With Objective End Points
Hyperthermia has been proven to increase the response of malignant tumors to radiation therapy in both experimental animal tumors and the clinical treatment of human cancer. Based on our multi-year 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 applying the encouraging results obtained to areas treated "de novo" and eventually to situations allowing a potentially 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.

The Hyperthermia part of the protocol extends the number of heat treatments to correspond to the number of radiation-fractions, as each hyperthermia treatment proceeds or follows each radiation treatment in close time proximity. The number of hyperthermia treatments therefore varies from 25 – 50 per course for each treated field. Outcomes confirm that more Hyperthermia fractions improve both tumor response and survival.

The radiation protocol consists of progressively decreasing daily doses of radiation therapy combined with the daily Hyperthermia treatments. Typically the treatment is started at a daily dose of 180cGy gradually reduced to 100cGy protracting a typical radiation therapy treatment course from 5000cGy in five weeks to 5000cGy given in over eight weeks; or 7000cGy in seven weeks to 7000cGy 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 of course adapted to the clinical situation. To this effect, the use of objective end result parameters is introduced, including MR Spectroscopy, PET Scanning and Tumor Marker levels. Increased radiation doses improve tumor response, but not survival, when enough Hyperthermia is given. Increased Hyperthermia doses increase both response and survival.

Conclusions: Protracted Hyperfractionation

• Decreases the radiation dose by 15% and 25%.
• Decreases the side effects of XRT (no diarrhea, fistula or pneumonitis in PH cases).
• Allows for more combined XRT-Hyperthermia treatments.
• Increases the effectiveness of the combined treatment in superficial and deep tumors.
• More Hyperthermia increases tumor response and survival.
• More Radiation improves tumor response but not survival when enough Hyperthermia is given.

Question: What is the lowest radiation dose needed to potentiate Hyperthermia?

T.R. Shantha, M.D., Ph.D.
Integrated Medical Specialists, Integrated Chemotherapy Specialists
Stockbridge, GA USA

Intractable Gastro Intestinal and Colon Intramural and Peritoneal Cavity Candida Infection Treated with Peritoneal (regional) Hyperthermia (warm Fluid Perfusion)
Candida albicans (yeast) is a normal inhabitant of the human gastrointestinal tract. The organism is usually present in the urine, although Candida esophagitis or suppurative thrombophlebitis may be the initial site of infection. They can cause massive systemic and organ infection in patients compromised by malnutrition, prolonged central venous access for hyper alimentation, chemotherapy therapy for cancer patients, prolonged administration of broad-spectrum antibiotic, Corticosteroids and other immunosuppressive mediations.

The presence of Candida infection in the peritoneal cavity after surgery indicates a leak from the gastrointestinal tract. Many antifungal agents are effective in treatment f peritoneal infection. Once the infection invades the interstitial tissue of the gastrointestinal track and becomes intramural infection, most of the antifungal treatments may not be effective.

We describe a case of severe Candida infection of the peritoneal cavity and intramural infection of the gastrointestinal tract including the colon, which resulted in three emergency surgeries, and failed to respond to all conventional methods of treatment. Using peritoneal hyperthermia (peritoneal perfusion of warm fluid), combined with an antifungal agent – Fluconazole (Diflucan), successfully treated this case.

Case Report:

A 35-year-old female, weighing more than 400 pounds, had gastric stapling using silasic (silicone banding procedure) band for obesity three years before. This surgical procedure was revised to make it effective. Postoperatively, she developed yeast infection with multiple discharging sinuses from the drainage site below the left hypochondrium at mid axillary line. Subsequently, she developed a gastro-pleuro-bronchial fistula, which was surgically corrected. She developed acute abdomen resulting in two exploratory laparotomies and removal of the spleen and splenic flexure of the colon due to massive yeast infection. Examination of the spleen revealed that the yeast had invaded the spleen and gastrointestinal wall (intramural fungal infection).

She had suction tubes irrigating and suctioning with Fluconazole in 5% glucose from the left hypochondriac area. The irrigating fluid contained Fluconazole. The patient continued to deteriorate, looked toxic and was discharging greenish brown material through the drainage tubing. Other surgical procedures such as reexploration and resection were ruled out and thought that she would succumb to the infection. The patient was discussed in a weekly meeting of infectious diseases and there were no other therapies forthcoming. The prognosis was considered to be very poor. It was the consensus opinion of all the consulting physicians that she would not recover.

J. Henriquez, M.D.
International BioCare Hospital
Tijuana, MEXICO

Whole Body Hyperthermia Combined with a Strong Nutritional Program is Beneficial for the Treatment of AIDS
The objective of this study was to demonstrate the additive beneficial effects of whole-body hyperthermia (WBH) associated with a strong nutritional program in patients with AIDS. From October 1997 through September 2000, fifteen HIV positive patients (10 with AIDS, and 5 with

AIDS related complex, ARC) with documented disease progression after the use of anti-virals, were treated with 2 sessions of WBH, raising the body's core temperature to 42.5° degrees C by means of extracorporeal perfusion, for a total of two hours, 4 days apart combined with an already ongoing program that included total parenteral nutrition, antioxidants and a special diet.