Wilfried Budach Thomas Hehr

5540 Purpose: Inoperable loco-regional recurrences of head and neck cancer in a previously irradiated volume (RH&N) represent a therapeutic dilemma. Chemotherapy alone has no curative potential, whereas re-irradiation and concurrent chemoradiation can salvage a small fraction of patients. Mucosal toxicity of concurrent chemoradiation requires substantial dose reduction of chemotherapy. Alternating chemoradiation enables one to give full-dose chemotherapy and radiotherapy. The latter maybe especially advantages for recurrent, potentially radiation resistant tumors. The feasibility and efficacy of an full-dose docetaxel containing alternating chemoradiation schedule was tested in two sequential trials. Patients and Methods: Thirty-nine patients (Karnofsky Performance score ≥ 70%) with histologically proven recurrent squamous cell cancer that occurred ≥ 6 months in a previously irradiated area (≥ 60 Gy) were considered unresectable and unsuitable for brachytherapy. Alternating chemoradiation consisted of three cycles of docetaxel 50 mg/m² d1 and cisplatin 15 mg/m² d2–5, q d22, and involved field radiotherapy 2.0 Gy QD d8–12, d15–19, d29–33, and d36–40 (patients 1 - 27 received 40.0 Gy total dose, patients 28 - 39 received 49.6 Gy total dose with concomittant boost). Dose reduction of docetaxel to 50 mg/m² was necessary, because of hematological toxicity in the first 12 patients with docetaxel 60 mg/m². Results: Alternating chemo-re-irradiation was applied as planned in 19 of 37 patients, with re-irradiation completed per protocol in 80%. Overall, patients received 80 % of the intended dose of docetaxel and 75% of cisplatin. Mucositis CTC °III occurred in 17%, leukopenia CTC ≥°III in 32%, and four early deaths were observed. Median follow up 18 months, median time to local progression and overall survival 10 months, respectively, 2-year survival rate 20%. Conclusions: Alternating chemo-re-irradiation in RH&N resulted in 80% overall response with acceptable toxicity. A significant minority of patients had durable tumor control with a chance of long-term survival.

4036 Background: The US-Intergroup study 0116 has demonstrated a significant survival benefit for pts receiving adjuvant Rtx/CTx following complete resection of gastric cancer. The current study evaluates the feasibility, toxicity and efficacy of a novel adjuvant combined modality treatment strategy containing a 3–4-drug chemotherapy regimen (CTx) plus 5-FU-based RTx/CTx. Patients and methods: Between 12/2000 and 10/2003 96 pts were included. Treatment consisted of 2 cycles of FA 500 mg/m² (2h) / 5-FU 2000 mg/m² (24h) once weekly for 6 consecutive weeks, P 175 mg/m² (3h) weeks 1 and 4 and DDP 50 mg/m² (1h) weeks 2 and 5 or 2 cycles of FA 500 mg/m² (2h) / 5-FU 2000 mg/m² (24h) once weekly for 6 consecutive weeks with DDP 50 mg/m² (1h) weeks 1,3,5. The applied regimen was individually chosen by each center. Radiation therapy with 45 Gy plus concomitantly applied 5-FU 225mg/m²/24h was scheduled in between the 2 cycles. Pts with completely resected adenocarcinoma of the stomach including a systematic D1 or D2 lymph node dissection (LND) were eligible. Results: Treatment: FA/5-FU/P/DDP 44 pts; FA/5-FU/DDP 52 pts. Pts characteristics: median age: 52 years [25–69]; extended/total/subtotal gastrectomy 38%/49%/13%; D1/D2 LND 31%/69%, stage distribution: UICC stage II 36%, IIIA 25%, IIIB 18%, IV(M0) 21%. Toxicity CTC III/IV: granulocytopenia 42%, neutropenic infection 4%; anorexia 13%; diarrhea 8%, nausea/vomiting 10%; early death 1 pt due to pneumocystis carinii pneumonia; study discontinuation 19 pts (11x toxicity, 6x personal reasons, 2x tumor progression). Median follow-up for all pts is 12 months [3–22]. 18% of pts have relapsed and 82% of pts are alive without tumor recurrence. Projected 2-year progression-free survival is 61% [95% CI: 42%–80%]. Conclusions: These novel RTx/CTx regimens appear feasible and safe with acceptable toxicity indicating that DDp can be safely added to 5-FU/FA and that even a 3-drug regimen is a feasible treatment option for adjuvant radiochemotherapy in gastric cancer patients. No significant financial relationships to disclose.

This paper reports on a woman with a rapidly growing recurrent cystosarcoma phyllodes malignum after two major attempts of surgery. In this situation, neoadjuvant hyperfractionated radiotherapy, superficial hyperthermia and ifosfamide were administered. Toxicity was mild. Resection of the tumour bed revealed a pathologically complete response with an actual disease free follow-up of 48 months.

Phase constancy and accuracy are significant for regional hyperthermia with phased array radiofrequency hyperthermia systems. They are both necessary for a precise target steering in therapy. For the BSD 2000 system (BSD Medical Corp. Salt Lake City, Utah, USA), the phase values of all channels are checked with a self-developed automatic on-line phase measurement system. On different days the phases are measured under identical conditions, where the output paths are cut off with 50 ohm dummy loads to suppress the influence of the radiation conditions of the antennae on the measurement values. The results show how the phase values of the four channels change in the first 30 min and from day to day. During this time interval after the start the phases drop down by up to 15 degrees. For the time later changes are very slight and the differences from day to day are negligible. The phase shift that occurs in the first 30 min is as high as a change of the target point by 1 cm. Earlier switching on of the amplifiers prevents this shift occurring during the treatment. The measurement system provides a good tool for determination of phase accuracy and is easy to realize.

Local tumour control after irradiation alone for advanced, inoperable carcinomas of the bladder and rectum or inoperable recurrent cervical carcinoma is usually disappointing. Both preclinical and clinical studies reported improvements by adding hyperthermia to radiotherapy. Reports for phase II/III trials do not indicate any enhanced side effects. However, two cases of acute suppurating appendicitis were observed in a series of patients treated with deep regional hyperthermia. Eighty patients with advanced, inoperable, or recurrent rectal or recurrent cervical tumours were treated with deep regional hyperthermia (313 sessions) in addition to radiotherapy between September 1995 and October 1998. The treatment for two of these patients (2.5%) had to be discontinued after the fourth/second hyperthermia treatments at 19.8/10.8 Gy total dose, respectively, for symptoms of pain in the right pelvis and elevated rectal temperature. Both patients underwent laparotomy and were found to have suppurative appendicitis. In addition to the retrocoecal location in both patients, evidence of preexisting chronic appendicitis, and appendiceal faecalith were observed in each patient. The development of acute appendicitis in 2.5% of patients during a course of deep regional thermoradiotherapy for pelvic tumour is much higher than the expected incidence of appendicitis in the general population (< 1/1000) (Korner et al. 1997). An enhanced risk of suppurative appendicitis in patients undergoing pelvic thermoradiotherapy cannot be excluded, especially in retrocoecal located appendices with obstructed appendix lumen from preexisting chronic appendicitis or faecalith.