Preoperative Hyperthermochemoradiotherapy for Patients with Rectal Cancer

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Preoperative Hyperthermo-chemo-Radiotherapy (HCR therapy), consists of a combination of hyperthermia at 42 to 45^ﾟC for 40 minutes (2 times per week for two weeks), 5-fluorouracil (5-FU) or 1-hexylcarbamoyl-5-fluorouracil (HCFU), and a total of 30 Gy irradiation. The therapy was prescribed preoperatively most recently for 36 patients with rectal cancer. We used a radio-frequency system involving an endotract electrode with thermosensors for the hyperthermia. The effectiveness of preoperative HCR therapy was evaluated by irrigography, fiberscopy, and histopathologic findings in the resected specimens. Reduction in tumor size and amount was evident in most patients with all modes of assessment. Histologically, no or only a few viable cancer cells were seen in the resected specimens in twelve patients, a small number of viable cancer cells in thirteen, and a fair number of viable cancer cells in eleven patients ; there were no complications. This method of treatment is expected to play an important role in the interdisciplinary treatment for rectal cancer.The sensitivity to heat and radiation of 22 rectal cancer tissues obtained at biopsy was studied using the in vitro succinate dehydrogenase inhibition test. The succinate dehydrogenase activities of heat-treated cells were significantly lower than that of the radiation-treated cells (P<0.01). The succinate dehydrogenase activities of heat plus radiation treated cells were the lowest in tissues from cancer lesions. Although the number was small, there was a correlation between this test and clinical outcome in seven of nine cases.