Anders Hugander

Results of regional hyperthermic perfusion for primary and recurrent melanomas of the extremities.

The technique for regional isolated perfusion has remained essentially the same since it was introduced in 1957, with the exception that heat was added in 1967 (Creech et al. 1958; Stehlin 1969). The anticancer drug most consistently used since 1957 is melphalan (Alkeran). The aim of isolation perfusion is to subject the tumor-bearing region to the influence of a high concentration of anticancer drugs in such a way that contamination of other parts of the body does not occur to any significant extent (Stehlin 1969). Malignant melanoma of the extremities seems especially suitable for this treatment, because local and regional metastases occur in up to 20% of patients (McBride et al. 1975). Reports of prolonged survival and local control of tumor growth have also encouraged many centers to perform this kind of treatment, not only for palliative (therapeutic) but also for curative (adjuvant) purposes (McBride et al. 1975; Stehlin et al. 1975; Martijn et al. 1982). In this report the experience with, and results of, hyperthermic melphalan perfusion for primary and recurrent melanoma in Lund since 1976 are presented.

Temperature distribution during radiant heat whole-body hyperthermia: experimental studies in the dog.

A radiant heat system for whole-body hyperthermia (WBH) has been safely and effectively used in mice, pigs and humans. This report details our adaptation of this methodology to dogs. Mongrel dogs were used to study different anaesthesia methods including spontaneous ventilation with or without intubation, as well as mechanical ventilation. Temperature distribution was studied during 42 degrees C WBH; intraabdominal, liver, bone marrow, brain, rectal, lung, oesophageal and skin temperatures were monitored. When a target temperature of 42 degrees C was achieved, temperature gradients between organs were minimal with the possible exception of bone marrow. Results obtained are consistent with the concept that the liver is a major source of metabolic heat production. The establishment of a dog model for WBH allows for physiological and pharmacological studies. The existence of spontaneous neoplasms should promote the use of this species for trials combining hyperthermia with other modalities.

Blockage of the hepatic-artery blood flow by biodegradable microspheres (Spherex®) combined with local hyperthermia in the treatment of experimental liver tumors in rats

SummaryThe effect of local hyperthermia and a simultaenous blockage of the hepatic-artery blood flow by degradable starch microspheres (Spherex®) was studied in a model of liver cancer in Wistar rats. Six days after each rat was inoculated with a cell suspension (NGW) in the central liver lobe, the rats were randomly allocated into four groups. The first group served as control, the second was treated with hyperthermia, the third by degradable starch microspheres (DSM) intraarterially, and the fourth with a combination of hyperthermia and DSM intraarterially. Tumor volumes were measured at laparotomy on days 0, 7, and 14. Temperature fluctuations in the tumor correlated well with those in the liver tissue, but were 2°–4° higher. The infusion of DSM did not change the pattern significantly. The tumor volumes were homogenous between the groups at the start of treatment. The tumor growth was significantly reduced compared with the control group at day 7 in group III (P<0.05) and group IV (P<0.01) but only in group IV at day 14 (P<0.05). No differences in survival were found. Local hyperthermia concurrent with a blockage of the nutritional tumor blood flow seems to offer a more prominent and lasting tumor-growth inhibition.

Local hyperthermia in treatment of experimental liver tumors.

An experimental model for local microwave hyperthermia treatment of liver tumors is presented. Fiftyfour Wistar rats were inoculated with a transplantable adenocarcinoma (NGW) in the central liver lobe. Ten to 16 days later 28 of the rats were exposed to local hyperthermia. A master thermistor placed in the liver parenchyma adjacent to the tumor controlled the hyperthermia, and the tumor‐bearing liver lobe was maintained at 42.0°C for 1 hour. At laparotomy 7 days after treatment, the tumor volume was measured. Four weeks after tumor inoculation, autopsy was performed. The tumor and the surrounding parenchyma was excised for histopathologic examination. A statistically significant reduction in tumor growth was found after exposure to local hyperthermia, the effect of hyperthermia being most pronounced in moderate‐sized tumors (300–500 mm3 or 0.5–0.75 g). In larger tumors (>900 mm3 or >1.1 g) extensive necrosis developed after hyperthermia treatment. This indicates good tumoricidial effect even in large tumors, although this is not obvious if reduction in tumor growth is used as the only parameter to evaluate the effect of hyperthermia.

Design and test of microwave interstitial applicators with improved longitudinal heating pattern.

A microwave applicator for interstitial hyperthermia was designed for use in conjunction with interstitial radiation therapy. Measurements were performed in phantom material and in the hind legs of anaesthetized pigs. In both studies two applicators were inserted in parallel at a distance of 2 cm and to a depth of 6 cm. The temperature distribution produced by two conventional applicators were compared with the temperature distribution produced by two applicators of the new design. Improvement of the heating pattern was found in both phantom and animal studies; the heating pattern produced by the new applicators was shifted towards the tip. This may be of clinical importance as heating can be achieved without applicator penetration through tumour tissue into normal tissue.

Experimental set-up for studies of microwave-induced hyperthermia in rats

A low-cost microprocessor-based temperature controller for hyperthermia experiments on rats is described. The system directs a microwave generator, used for heating, by feedback power regulating signals in accordance with the temperature in the animal. The microwave power is pulsed for short on-and-off periods and the temperature recordings are carried out during the off periods. More than 300 hyperthermia runs have been carried out on rats using this fully automated unit. The controller can direct the hyperthermia to the predetermined level with a deviation of +/- 0.1 degree C for systemic hyperthermia. For local hyperthermia in the liver, individual recorded mean temperatures were up to -0.5 degree C from the preset temperature.

Fractures caused by muscle traction following lumbar myelography with meglumine iothalamate (Conray 60) and meglumine iocarmate (Dimer-X)

SummaryOne case of extensive bilateral pelvis fractures as a result of muscle seizures following lumbar myelography with Conray 60 is described. The patient died from massive retroperitoneal hemorrhage and showed signs of so called pulmonary fat embolism secondary to the fractures. Also a case of fracture of the femoral neck following lumbar myelography with Dimer-X is reported.ZusammenfassungIn einem Fall wurden ausgedehnte Beckenfrakturen als Folge von Muskelkontraktionen nach lumbaler Myelographie mit Conray 60® beobachtet. Der Patient verstarb infolge einer massiven retroperitonealen Blutung und zeigte eine pulmonale Fettembolie. In einem anderen Fall trat eine Schenkelhalsfraktur nach einer lumbalen Dlyelographie mit Dimer-X® auf.