Torsten Landberg

Microwave-Induced Hyperthermia and Ionizing Radiation Preliminary Clinical Results

The combination of microwave-induced (2450 MHz) hyperthermia and ionizing radiation was used in 7 patients with superficial malignant tumours, which were considered refractory to other therapy. A newly developed heating system was used, allowing for a maintained temperature at the master probe of 42.5 degrees C +/- 0.5 degrees C during 45 min, but temperature measurements at multiple sites showed a marked variation. This preliminary series indicates that the combination of hyperthermia and ionizing radiation may be useful, the response rate (complete or partial) being 8 of 8 evaluable lesions. Even previously heavily irradiated sites responded. Technical improvements are highly needed to allow for controlled heating of any tissue volume.

Mantle Treatment of Hodgkin's Disease: Results and side effects

Eighty-seven patients were treated with the mantle technique for Hodgkins disease. Usually 40 Gy in 27 fractions in two series over 71 days were given. A local recurrence was diagnosed in 3 of 87 patients. An analysis of radiation reactions of the lung tissue, heart and pericardium, and spinal cord is reported. It is recommended to give mantle treatment for Hodgkins disease over a relatively long period of time such as in split-course in two series.

NEUTRON THERAPY - THE HISTORICAL BACKGROUND

Neutron therapy was first introduced by Stone et al. in 1938, i.e. more than 10 years earlier than electron beam therapy and only 6 years after the discovery of neutrons. In spite of the impressive accomplishment in generating an adequate therapy beam, time was also found for careful radiobiological studies of neutron beams. However, it was not considered that for a certain early reaction the late effects were much greater with neutrons than with x-rays. The severe late sequelae in proportion to the few good results motivated the closure of this therapy. Neutron therapy was again introduced in Hammersmith hospital at the end of the 1960s. The major reason seems to have been to overcome the oxygen effect. Encouraging results were reported. It was argued that the very favourable statistics on local tumour control were obtained at the expense of more frequent and more severe complications. A clinical trial in Edinburgh seemed to indicate this, but it was not proved in the end as the two trials differed regarding fractionation. Today about 16,000 patients have been treated with neutrons. The neutron beams now used differ significantly, both regarding dose distributions and microdosimetrical properties, from those utilized earlier. The advantage of neutrons is still, however, controversial. There are indications that neutron treatment may be favourable for some tumours. A careful cost-benefit study ought to be performed before the creation of a neutron therapy centre in Sweden as the group of patients suitable for neutrons is limited, and there may be new possibilities for improvement of photon and electron treatment with much smaller resources.

Radiation sensitivity of tissues irradiated during mantle treatment of Hodgkin's disease.

irradiation of supradiaphragmatic Hodgkin’s disease. It is hoped that this technique will produce better results than the involved-field technique. The value of such improvement may however possibly be reduced by an increased frequency and severity of late adverse effects of radiation, since the mantle field usually includes much more tissue than the involved-field treatment. LANDBERG et coll. ( 1971) in a preliminary report reviewed the literature and described some of the side effects of mantle treatment. The sequelae that have attracted most interest are those due to irradiation of the lung tissue, the heart and pericardium, the nervous system and the bone marrow and to some extent the mucous membranes, the thyroid and cdnnective tissue. This paper reports autopsy findings in different organs within the irradiated volume in two cases that had received mantle treatment with a split-course technique for Hodgkin’s disease. It also reviews the radiation sensitivity of some of these tissues.

Whole-body-casts for patient immobilization in mantle treatment, treatment of the inverted-Y and moving strip

A reliable patient fixation is mandatory in order to minimize the frequency and magnitude of beam geometry mistakes in radiotherapy.2 If large and irregular beams are used such as the upper mantle, the inverted-Y-beams and the moving strip, the treatment may be very prone to such mistakes, which may influence cure rate and side effects.’ Often it is necessary to treat the patient in both supine and prone positions, and such a shift of position further introduces the possibility of a change in both the outline of the patient and the position of internal organs. These two changes also may significantly influence the outcome of therapy. We have used large “whole-body”-casts for some years when treating large fields. The casts cover the patient from above the vertex of the skull down to the thighs. The immobilization and repositioning of the patient has been found to be very good with these large casts as judged from repeat treatment verification films. In case the patient is treated in both supine and prone positions, one cast is made for each position. Both casts are then produced with the patient in one position only. Thus the change of contour upon change of position is minimized. If the patient is treated only in one position with anterior-posterior beams, the low bulk density of the cast has not caused the 8 MV X-ray irradiation to give any detectable skin reaction. With the use of whole-body-casts in the treatment of the upper mantle in combination with individual dose planning with correction for tissue heterogeneity and checking the absorbed dose with extensive in viuo dose measurements only a 3% local recurrence has occurred in Hodgkin’s disease.3 The patient is first placed in prone position on a large sheet of paper, and the vertical outline is then drawn on the paper with a margin of 2 cm. The drawn outline is transferred to a 100 x 50 x 15 cm3 large styrofoam block. The block is cut vertically with a heated wire along the patient’s outline. The bottom of the cut block is sealed with a 2 cm thick Styrofoam slice and the two pieces are glued together. Pieces are cut

Hodgkin's Disease Irradiated with the Inverted-Y Technique

Thirty-four patients with Hodgkins disease were treated with the inverted-Y technique. Target absorbed dose was 40 Gy given in a split-course schedule to all but one patient. Only one recurrence occurred. Seventeen patients remained symptom-free after treatment and another 9 were rescued by further therapy. Eight patients died. All 7 patients in stages I and II are alive. In stage III A more patients with upper abdominal disease remained symptom-free after treatment than patients with lower abdominal disease. Of 7 patients in stage III B, 5 died. Actuarial survival at 10 years was significantly better for patients without systemic symptoms. Radiation side effects were mild. One serious complication occurred, acute gastrointestinal ulceration in the patient given the total dose in one series. No permanent symptom-producing side effects from liver, kidneys, spinal cord or bone marrow occurred.

En-bloc irradiation of tumours of the head and neck and their lymphatics. I. Technique and dosimetry.

A technique for en-bloc irradiation of tumours of the head and neck and their lymphatics, as well as its dosimetry and control measures, are reported.

En-bloc irradiation of tumours of the head and neck and their lymphatics. II. Early results and side effects.

The results and side effects of en-bloc irradiation of ear, nose and throat tumours and their lymphatics showed that the technique had been successful in nasopharyngeal carcinoma, but poor in carcinoma of the hypopharynx. Marked early and late radiation side effects were relatively common in high age and with certain tumour sites, whereas no correlation could be demonstrated with total absorbed dose, fractionation, cumulative radiation effect or major surgery.

En-Bloc Irradiation of Unresectable Bronchogenic Carcinomas and Their Regional Lymphatics

Patients with unresectable or inoperable bronchial carcinoma were treated with en-bloc irradiation of the tumour and the mediastinal lymph nodes to a total target absorbed dose of 40 Gy in 20 fractions. The first 52 patients were treated in one series and the last 45 patients in two series (split-course). Radiation adverse effects were only mild. The two regimens gave the same palliative results. The median survival was the same for the 2 groups (8 months). Most patients died in disseminated disease.

Effect of different radiation fractionation schedules on metastases from an oesophageal carcinoma

Subcutaneous metastases from an oesophageal carcinoma were irradiated using different schedules. The results have to be evaluated with greatest caution but indicate that with the same CRE value, few fractions caused less skin reactions than several, and the size of the shoulder of the cell survival curve was of the order of 0.7 Gy.