CLINICAL RESEARCH OF THREE-DIMENSIONAL CONFORMATION RADIOTERERAPY COMBINED WITH HYPERTHERMIAIN EXPECTING ITS RADIOSENS1TIZATION EFFECTS FOR LOCALLY ADVANCED AND POSTOPERATIVE RECURRENT TUMORS

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In radiation therapy (RT), it is generally difficult to obtain satisfactory treatment effects for the locally advanced and postoperative recurrent tumors. Then, a combination modality comprising of three-dimensional conformation radiotherapy (3D-CRT) and hyperthermia (HT) was applied to these tumors in their distinctive characteristics of dose distribution and radiosensitization effects.From January 2003 through December 2006, 25 patients (18 males and 7 females) were enrolled for this clinical study. They included carcinoma of the pancreas (8), gallbladder (2), bile duct (4), small bowel (2), sigmoid (2), and rectum (7) and distributed with an age between 43 and 80 years (59.4. in average). They were grouped by their present status as locally advanced (inoperable) cases (12), post-operative recurrent cases (12) and the other one (1). RT was mainly performed with a technique of 3D-CRT. The prescribed dose was 50-60 Gy with a conventional fractionation schedule. HT was applied once a we … More ek with a total of four or more sessions by means of RF-capacitive heating device (Thermotmn-RF8) with a therapeutic temperature of 41℃ or more and treatment time of 30 min. or more. Almost patients received concurrent chemotherapy (CT)comprising of GEM (800-1000mg) for pancreatic cancer and 5-FU/LV, UFT, TS-1 or FOLFOX for colorectal cancer. The treatment was able to be performed in full manner in 17/25 (68%), when it was evaluated under the condition that more than 70% of the treatment protocol had been done. As for completion ratio of the treatment, it was higher in the pancreas (7/8) and colorectal sites (7/9) than in other lesions. Local responses evaluated by the diagnostic imaging and clinical symptoms showed "excellent" in 7, "good" in 12 and "no-response" in 6, which meant 76% in response rate. Regarding treatment organs, it was higher in the pancreas (6/8) and the colorectal sites (8/9) than in the bile duct (4/6) or the small bowel (1/2). From a view point of condition of treatment performances, the number of cases showing "excellent", "good" and "no-response" was 6, 10, and 1, respectively, in the completely performed group and 1, 2 and 6, respectively, in the incompletely performed group, which was higher in the former group than in the latter one (94% vs 38%). 3D-CRT combined with HT showed an improvement of QOL (quality of life) including pain relief and decrease in amount of abnormal excretion. In toxicity, local pain and discomforts were occurred on the patients with obvious subcutaneous fat layer and a condition of colostomy constructed. Gastric ulcer was observed in 2 out of 8 patients with pancreatic cancer.In conclusions, 3D-CRT combined with HT and CT was evaluated as an effective treatment modality, especially applied to the patients with locally advanced pancreatic cancer and postoperative recurrent colorectal cancer. Less