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Interstitial microwave-induced hyperthermia and iridium brachytherapy for the treatment of obstructing biliary carcinomas.

In a phase I clinical study, 10 patients with obstructive biliary carcinomas were treated with single-antenna interstitial microwave hyperthermia and iridium-192 brachytherapy. For each patient a standard biliary drainage catheter was implanted percutaneously through the obstructed common bile duct. This catheter accommodated a single microwave antenna which operated at 915 MHz, and one or two fibreoptic thermometry probes for temperature measurement. Under fluoroscopic guidance the microwave antenna and temperature probes were positioned in the CT-determined tumour mass. The 60-min heat treatment achieved a central tumour temperature of 45-55 degrees C while keeping temperatures at the proximal and distal margins at 43 degrees C. Immediately following the hyperthermia treatment the microwave antenna and temperature probes were removed, and a single strand of iridium-192 double-strength seeds was inserted to irradiate the tumour length. A dose of 5500-7900 cGy calculated at 0.5 cm radially from the catheter was administered over 5-7 days. Upon removal of the iridium a second hyperthermia treatment was performed. A total of 18 hyperthermia treatments were administered to the 10 patients. In two cases the second hyperthermia treatment after brachytherapy was not possible due to a kink in the catheter, or bile precipitation in the catheter. All patients tolerated the procedure well, and there were no acute complications. To evaluate the volumetric heating potential of this hyperthermia method, specific absorption rate (SAR) values were measured at 182 planar points in muscle phantom. Insulated and non-insulated antenna performance was tested at 915 MHz in a biliary catheter filled with air, saline, or bile to mimic clinical treatments. The insulated antenna exhibited the best performance. Differences between antenna performance in saline and bile were also noted. In summary, this technique may have potential for tumours which obstruct biliary drainage and are accessible to percutaneous decompression using standard diagnostic radiological procedures.

Biliary Tract Neoplasms↗
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Experimental thermoradiotherapy of human tumour xenografts in nude mice: design of the hyperthermia system.

An experimental thermoradiotherapy study was started in 1986. For this study a hyperthermia system was developed for the heating of human tumours xenotransplanted into nude mice. Our treatment device was a four-channel computer-controlled hyperthermia system. Temperature was monitored by microwave radiometry at 3 GHz. Specifications of the radiometer were first evaluated under reference conditions, then thermal dosimetry was studied using non-invasive measurement of the brightness temperature TOR. Hyperthermia treatments were simulated in phantom material with radiometric monitor values TR of 40 and 41. In conjunction with the parameters of brightness temperature TOR, surface temperature TO and water bolus temperature TW thermal modelling was performed. Finally, we studied the influence of a perfused phantom to the microwave thermometry.

Animals↗
PubMedDate not supplied

Experimental thermoradiotherapy of human tumour xenografts in nude mice; design of the hyperthermia system.

An experimental thermoradiotherapy study was started in 1986. For this study a hyperthermia system was developed for heating human tumours xenotransplanted into nude mice. The treatment device was a four-channel computer-controlled hyperthermia system. Temperature was monitored by microwave radiometry at 3 GHz. Specifications of the radiometer were evaluated first under reference conditions. Subsequently, thermal dosimetry was studied using non-invasive measurement of brightness temperature, TOR. Hyperthermia treatments were simulated in phantom material with radiometric monitor values, TR, of 40 and 41. In conjunction with the parameters of TOR, surface temperature, T0, and water bolus temperature, TW, thermal modelling was performed. Influence of a perfused phantom also was studied on microwave thermometry.

Animals↗
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Effects of a second heating on rat liver blood flow.

Effects of a second heating on blood flow in the liver and cardiac output were studied in Fischer rats. Heating was done by an experimental capacitive heating device using 8 MHz radiofrequency. Thermometry was performed at seven points around the liver with thermocouples. Blood flow and cardiac output were measured with the radioactive microsphere method. The liver was preheated for 30 min at 41 or 43 degrees C, and then reheated 1-7 days later at 41 degrees C for 15 min. Hepatic arterial blood flow, portal venous blood flow and the cardiac output were measured immediately before and at the end of the reheating. Heating the liver at 41 degrees C for 15 min without preheating slightly increased the hepatic arterial blood flow, and reheating 1-7 days after the first heating caused a greater increase in the hepatic arterial blood flow. Increase in hepatic arterial blood flow caused by reheatings pointed to the development of thermotolerance or thermal adaptation in the hepatic artery. When the liver was heated at 41 degrees C for 15 min without preheating, the portal venous blood flow remained almost unchanged 1-7 days after the heating. On the other hand, a reheating at 41 degrees C for 15 min applied 1-7 days after the preheating reduced the portal venous blood flow. Reduction in portal venous blood flow was approximately parallel to reduction in cardiac output by reheating, pointing to the existence of a causal relationship. Reduction in portal venous blood flow by reheating may also be, in part, due to the decrease in the splanchnic blood flow resulting from a systemic adaptation to the heat stress.

Animals↗
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Randomized trial of one versus two adjuvant hyperthermia treatments per week in patients with superficial tumours.

One test for thermotolerance development in a clinical situation is to evaluate the effects of altering the hyperthermia fractionation interval on tumour response to thermoradiotherapy. Between 1983 and 1990 44 evaluable advanced superficial tumours of miscellaneous origin in 41 patients were randomized to receive either once-weekly or twice-weekly external microwave hyperthermia treatments combined with radiation therapy. The mean age of patients was 62 years, and 85% had failed previous therapy. All lesions were less than 8 x 8 x 4 cm (L x W x D) and were heated by external 915 MHz microwaves. The mean radiation dose was 44 +/- 3 Gy (mean +/- SE) in the once-weekly group and 46 +/- 3 Gy in the twice-weekly group (p = 0.64). The mean volume of the lesions heated once weekly was 17 +/- 6 versus 23 +/- 5 cm3 for those heated twice weekly (p = 0.45). Hyperthermia was administered once weekly for 4.6 +/- 0.2 sessions (range 3-7) or twice weekly for 8.1 +/- 0.3 sessions (range 4-10). Thermometry was performed using 3.4 +/- 0.2 catheters and 5.1 +/- 0.6 thermal sensors per tumour in the once-weekly group, and 2.7 +/- 0.2 catheters and 5.8 +/- 0.3 thermal sensors per tumour in the twice-weekly group. Of the 44 evaluable randomized lesions a complete response (CR) at 2 months post-treatment was observed in 59% (13/22) heated once weekly and 55% (12/22) in those heated twice weekly. The prognostic factors predictive of tumour complete response were found by logistic regression analysis to be radiation dose and tumour volume, while the prognostic factors predictive of duration of response (Cox proportional hazards analysis) were median minimum tumour temperature (Tmin), minimum tumour temperature during the first heat treatment (Tmin1) and tumour volume. The duration of local control in lesions with Tmin < or = 39.5 degrees C was 11.7 +/- 1.9 months while for lesions with Tmin > 39.5 degrees C it was 23.0 +/- 4.2 months (p = 0.01). The ED50 was calculated by logistic regression to be 40 Gy (95% CI = 22-54 Gy) for once- and twice-weekly heated lesions. There was not a significant difference in tumour response or duration of response between populations randomized to receive once- versus twice-weekly hyperthermia treatments. There was also no difference in skin reaction rates between once- and twice-weekly hyperthermia treatments, nor could a correlation be found between any thermal parameter and skin reactions.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMedDate not supplied

Automation of temperature control for large-array microwave surface applicators.

An adaptive temperature control system has been developed for the microstrip antenna array applicators used for large area superficial hyperthermia. A recursive algorithm which allows rapid power updating even for large antenna arrays and accounts for coupling between neighbouring antennas has been developed, based on a first-order difference equation model. Surface temperatures from the centre of each antenna element are the primary feedback information. Also used are temperatures from additional surface probes placed within the treatment field to protect locations vulnerable to excessive temperatures. In addition, temperatures at depth are observed by mappers and utilized to restrain power to reduce treatment-related complications. Experiments on a tissue-equivalent phantom capable of dynamic differential cooling have successfully verified this temperature control system. The results with the 25 (5 x 5) antenna array have demonstrated that during dynamic water cooling changes and other experimentally simulated disturbances, the controlled temperatures converge to desired temperature patterns with a precision close to the resolution of the thermometry system (0.1 degree C).

Algorithms↗
PubMedDate not supplied

Effect of hyperthermia on the central nervous system: a review.

Experimental data show that nervous tissue is sensitive to heat. Animal data indicate that the maximum tolerated heat dose after local hyperthermia of the central nervous system (CNS) lies in the range of 40-60 min at 42-42 x 5 degrees C or 10-30 min at 43 degrees C. No conclusions concerning the heat sensitivity of nervous tissue can be derived from clinical studies using localized hyperthermia. The choice whether or not to exceed the critical heat dose, as derived from laboratory studies, in clinical practice is very much dependent on the clinical situation such as the anatomical site and volume of the tissue involved, and prior therapy. Data on clinical application of whole body hyperthermia (WBH) show that nervous tissue can withstand a slightly higher heat dose than after localized heating, which might be the result of developing thermal resistance during treatment. Expression of thermotolerance was observed in the spinal cord of laboratory animals. After WBH in man at a maximum between 40 and 43 degrees C for 6 h-30 min CNS complications were reported, but other complications seemed to be more life-threatening. Most studies indicate that impairment of the CNS after WBH was not due to direct heat injury to the brain or spinal cord, but was secondary as a result of physiological changes. Heat, at least if applied shortly after X-rays, enhances the response of nervous tissue to radiation. Neurotoxicity of chemotherapeutic drugs does not seem to be a limiting complication in hyperthermia if combined with chemotherapy, but only few data are available. The limited clinical experience shows that safe hyperthermic treatment of CNS malignancies or tumours located close to the CNS seems feasible under appropriate technical conditions with adequate thermometry and taking the sensitivity of the surrounding normal nervous tissue into account.

Animals↗
PubMedDate not supplied

Effects of intraoperative hyperthermia on peripheral nerves: neurological and electrophysiological studies.

The tolerance of peripheral nerves to heat may limit the heat dose which can be applied to tumours. This may be particularly important in intraoperative hyperthermia (IOHT) for pelvic and retroperitoneal tumours. Furthermore the effects of hyperthermia alone must be known before its effects can be assessed in combination with irradiation. In this study injury to sciatic nerves was evaluated in 30 beagle dogs for 1 year following IOHT. IOHT was performed using a water circulating hyperthermia device with multichannel thermometry system. Neurological and electrophysiological examinations were done before, during and after IOHT treatment. Electrophysiological examinations showed a significant decrease in sciatic nerve conduction velocity and potential amplitude immediately after 60 min of heating for all temperatures. The greatest decrease in conduction velocity was observed for a temperature of 45 degrees C. Full recovery of nerve conduction velocity was observed 3 weeks following hyperthermia for all dogs except for those exposed to 45 degrees C. Neurological findings correlated with electrophysiological results. All five dogs which had nerve exposed to 45 degrees C for 60 min had severe neurological changes, with recovery taking place between 3 and 11 months after treatment. Based on these results it appears that temperatures to the peripheral nerve exceeding 44 degrees C for 1 h are likely to cause significant, but not necessarily permanent, nerve injury.

Action Potentials↗
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Influence of water bolus temperature on measured skin surface and intradermal temperatures.

Temperature measurements utilizing thermometry probes placed on the skin surface are often used clinically to assess temperatures for the purposes of power control and evaluating treatment efficacy. There is a question, however, as to what extent applicator temperature-controlled liquid coupling boluses can create temperature gradients which can cause significant differences between measurements taken by sensors placed on the skin surface and the actual temperature of the tissue beneath. To address this question, experiments were conducted with human subjects instrumented with surface and shallowly implanted temperature sensors. Microwave applicators with circulating bolus water set at 21 and 41 degrees C were used to induce a temperature gradient in depth in the superficial tissue by thermal conduction. No microwave energy was applied. The average measurement offset at 41 degrees C was 15% of the difference in temperature between the interstitially measured skin temperature and the coupling bolus temperature, towards the temperature of the coupling bolus. The corresponding offset with coupling boluses set near 21 degrees C was 32%. Different water bolus types and volumes were observed to induce different percentage offset errors.

Connective Tissue↗
PubMedDate not supplied

Thermoradiotherapy for superficial tumour deposits in the head and neck.

Tumour deposits in the head and neck region were treated with hyperthermia using 915 MHz external microwave applicators and radiation therapy between 1986 and 1990. The mean (+/- SE) radiation dose was 47 +/- 2 Gy (range 21-77 Gy). All but four patients had failed previous therapy. Mean tumour volume was 40 +/- 10 cm3 (range 0.3-276 cm3). Hyperthermia was administered biweekly in 80% of the patients in 6.0 +/- 0.4 sessions (range 1-10); thermometry involved 3.6 +/- 0.4 catheters (range 1-9) and 5.7 +/- 0.4 sensors (range 1-12) per tumour. Of the 50 lesions evaluable for response, 29 had a complete response (58%), and 20 had a partial response (40%). Lesions were stratified by depth. In tumours considered potentially heatable (i.e. depth < or = 3 cm and lateral dimensions at least 2 cm less than boundary of applicator), the complete response rate was 81% (26/32, 47 +/- 2 Gy, 15 +/- 3 cm3); whereas for patients with tumours deeper than 3 cm, the complete response rate was 17% (3/18, 48 +/- 3 Gy, 110 +/- 21 cm3), p = 0.0001. Among lesions < or = 3 cm depth that exhibited a complete response, six recurred (24%, 5.8 +/- 1.8 months) while 20 lesions were recurrence free at last follow-up of 11.9 +/- 1.2 months). The overall survival of patients with lesions < or = 3 cm depth was 11.5 +/- 1.3 months (range 2.4-32.3 months) while for patients with lesions > 3 cm depth survival was 6.7 +/- 0.9 months (range 2.1-18.6 months), p = 0.01. In superficial lesions with depth < or = 3 cm, multivariate logistic regression analysis indicated that the model best correlating with complete response included radiation dose (p = 0.08) and tumour volume (p = 0.08, model p = 0.004). Multivariate proportional hazard analysis indicated that the model best correlating with duration of local control included tumour depth (p = 0.03) and previous radiation therapy (p = 0.08, model p = 0.006). Twenty-two fields were treated without any skin reactions (39%), 23 evidenced erythema (40%) and eight thermal blistering (14%). Ulceration occurred in 11 treatment fields but in all but one of these cases the ulceration may have been due to tumour breakdown as there was direct invasion of the skin by tumour prior to the initiation of treatment. The maximal skin temperature was the best predictor of morbidity although the correlation was not statistically significant (p = 0.19).

Adenocarcinoma↗
PubMedDate not supplied

Application of new technology in clinical hyperthermia.

Two areas of technical progress related to hyperthermic oncology are presented: (1) numerical modelling of absorbed power and temperature distributions; and (2) non-invasive thermometry using magnetic resonance imaging. The results represent achievements made during the past 5 years at Duke University Medical Center's Departments of Radiation Oncology and Radiology. They represent examples of progress in the technology of hyperthermia that have potential for greatly improving the delivery, monitoring and assessment of clinical hyperthermia.

Body Temperature↗
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Site-specific phase I, II trials of hyperthermia at Kyoto University.

Site-specific phase I, II trials of locoregional hyperthermia undertaken at Kyoto University are briefly reviewed. Thermometry analysis demonstrated the usefulness of RF (radiofrequency) capacitive heating equipment in the treatment of various subsurface or deep-seated tumours including locally advanced breast cancers, soft tissue tumours, lung cancers involving the chest wall, liver tumours, unresectable or recurrent colorectal cancers, and invasive urinary bladder cancers. The difficulty in heating whole tumour volume or hypervascular tumours to therapeutic temperatures was also shown. Non-randomized trials for locally advanced breast cancers, unresectable or recurrent colorectal cancers and invasive urinary bladder cancers demonstrated a higher response rate in thermoradiotherapy than in radiotherapy alone. The complications associated with treatment were not generally serious except for chronic bowel damages in a trial for colorectal cancers. These promising phase I, II trials encourage the future phase III trials.

Breast Neoplasms↗
PubMedDate not supplied

Effects of intraoperative hyperthermia on canine sciatic nerve: histopathologic and morphometric studies.

Failure to achieve local control in the treatment of pelvic and retroperitoneal tumours results in a high rate of recurrences. The objective of intraoperative hyperthermia (IOHT) is to enhance the effect of intraoperative radiation therapy and to increase local tumour control. The tolerance of peripheral nerves to heat may limit the heat dose that can be applied to tumours. Histopathologic and histomorphometric changes of canine sciatic nerve after 60-min IOHT were studied in three groups of five dogs each for temperatures of 43, 44 and 45 degrees C. IOHT was performed using a water-circulating hyperthermia device with a multichannel thermometry system on surgically exposed sciatic nerve. Histopathologic and histomorphometric studies were done immediately, 3 weeks and 12 months after IOHT. Histologic changes observed immediately after treatment were minimal but at 3 weeks following 60-min 45 degrees C IOHT both axon and myelin loss and an increase in endoneurial fibrous tissue were observed. Twelve months after treatment a statistically significant decrease in axon, myelin and small vessel percentages as well as an increase in endoneurial and epineural connective tissue were observed for dog treated to 45 degrees C. Dog treated to 44 degrees C for 60 min had similar statistically significant but less severe changes. Twelve months after 43 degrees C IOHT for 60 min, nerve fibres appeared normal and endoneurial connective tissue was only increased mildly around small and medium-sized vessels. These results suggest that temperatures to the peripheral nerve > 44 degrees C for 60 min are likely to cause significant histopathologic changes that can be found 12 months after treatment. A hypothesis of the mechanism of heat injury to peripheral nerves was developed.

Animals↗
PubMedDate not supplied

Clinical system for simultaneous external superficial microwave hyperthermia and cobalt-60 radiation.

A system for simultaneous thermoradiotherapy was devised to investigate the possible benefits and/or complications of thermal radiosensitization in human superficial tumours. The system combines the well-known treatment modalities of external 915 MHz microwave hyperthermia and cobalt-60 teletherapy. Single waveguide applicators are utilized either attached to blocking trays, so that the gamma beam travels through a waveguide and into the patient (en face setup), or in a conventional way with the microwave propagation vector orthogonal to the gamma beam (orthogonal setup). With these setups a radiation fraction can be delivered in the middle of a 60-min, non-interrupted hyperthermia treatment. Temperatures and power level are remotely monitored and recorded outside the Cobalt room. Extensive measurements and testing showed that the operation of the hyperthermia system (generator, applicators, thermometry unit and temperature sensors) was not disrupted by irradiation and that the microwaves were confined to the treatment room and did not interfere with the operation of the Cobalt unit, of an adjacent linear accelerator or of an adjacent radiotherapy simulator. For the en face setup the dose distributions induced in solid water phantoms were uniform with the exception of a narrow (< 0.5 cm) region under the applicators' internal probes where 10-18% reduction exists. This dose defect is clinically smoothed using feathering techniques. The system has been successfully used without technical problems in 51 treatments in 15 patients (18 lesions) in a phase I/II clinical trial. An analysis of the thermal data showed that the temperature distributions achieved during simultaneous delivery have the same general characteristics of those achieved in conventional sequential hyperthermia with microwaves, and that the steady state distributions are maintained during the time of simultaneous irradiation. The tests performed in addition to the preliminary clinical experience clearly indicate that this type of combined therapy is technically feasible and safe. Here the system for simultaneous, external, superficial thermoradiotherapy and the implementation tests performed are described in detail. Preliminary clinical experience and results are also reported.

Cobalt Radioisotopes↗
PubMedDate not supplied

Thermoradiotherapy of superficial and subsurface tumours: analysis of thermal parameters and tumour response.

Between 1988 and 1993, 57 superficial and subsurface tumours of various tumour type were treated with a 430-MHz microwave heating device. Mean (range) tumour depth of the 57 tumours was 3.0 (0.5-6.5) cm. Fifty-four tumours were treated with thermoradiotherapy. Total radiation dose ranged from 20 to 70 Gy with a mean of 53 Gy. For the remaining three tumours, thermochemotherapy was performed. Hyperthermia was given once a week, and a total of 207 heat sessions was administered. Our goal of hyperthermia treatment was to elevate all monitored tumour points > 41 degrees C for > 30 min. The mean (range) number of intratumoral thermometry points was 3.7 (2-6). The goal of hyperthermia treatment was achieved in 49% of the sessions. At the time of maximum tumour regression, complete response was noted in 53% of the tumours treated with thermoradiotherapy. Univariate analysis demonstrated that parameters including tumour type (breast cancer versus others), tumour depth, minimum tumour temperature, average tumour temperature, minimum equivalent time at 43 degrees C, and number of heat sessions achieving the treatment goal significantly affected the tumour response of the combined treatment, while total radiation dose and number of heat sessions were not significant factors for tumour response. Multivariate logistic analysis revealed that only tumour depth (< 3 versus > or = 3 cm) was a significant prognostic factor for tumour response (p = 0.029). Tumour type (breast cancer versus others) and a number of heat sessions achieving the treatment goal (0-1 versus 2-5) were found to be of borderline significance in the multivariate analysis (p = 0.075 and 0.097 respectively). The number of heat sessions achieving a minimum tumour temperature of > 41 degrees C for > 30 min seems a practical thermal parameter that influences tumour response. The present study indicates the importance of quality and quantity of heat session on the treatment outcome of thermoradiotherapy.

Adolescent↗
PubMedDate not supplied

Temperature control and light penetration in a feedback interstitial laser thermotherapy system.

The aim of this study was to describe the performance of a closed loop interstitial laser thermotherapy system in processed liver and to demonstrate its suitability for treating a vascularized tumour in vivo. The thermotherapy system consisted of an Nd: YAG laser and a temperature feedback circuit including an automatic thermometry system and thermistor probes. Experiments in processed liver were performed with a sapphire probe and temperature control at a distance of 10 mm. In most experiments at 1-2 W, and in half of the experiments at 3 W, there was no carbonization, a moderate change in the light penetration and excellent control of the temperature. In experiments with output powers of 4-5 W there was carbonization with rapid deterioration of light penetration and impaired control of the temperature. Carbonization affected the distribution of temperatures, which were lower below, and higher above, the laser tip in experiments with carbonization as compared to experiments without carbonization. Treatment of an adenocarcinoma implanted into rat liver was performed at 2 W with a bare fibre and without blood inflow occlusion. The feedback thermistor probe was placed 3 mm outside the margin of the tumour (largest diameter 9.5 +/- 0.3 mm (mean +/- SEM)). Temperature control and light penetration characteristics were similar to those found in vitro. No tumour could be demonstrated at sacrifice 6 days later. It is concluded that a closed loop feedback system can produce stable and reproducible local hyperthermia, that it performs better when carbonization is avoided and light penetration is preserved and that it has a great potential for interstitial thermotherapy of malignant tumours.

Animals↗
PubMedDate not supplied

Ferromagnetic hyperthermia: functional and histopathologic effects on normal rabbit ocular tissue.

Ferromagnetic (FM) hyperthermia has previously been evaluated in a rabbit tumour model of ocular melanoma. To study the effect of focal heating in normal rabbit eyes, FM seeds were implanted into a 14-mm episcleral plaque an heated to operating temperatures of 48 or 58 degrees C. Thermal induction was performed by placing rabbits in a uniform, oscillating (11 kHz) magnetic field operating at 1200 W and as H-field strength of 265 A/m. Eyes were heated for 60 min with continuous scleral temperature monitoring. Hyperthermic effects were monitored by direct opthalmic examination, fundus photography, serial electroretinography and histopathology. Intraocular temperatures were mapped with direct fiberoptic thermometry. All treatment effects were confined to the area covered by the episcleral plaque. Direct ophthalmoscopic examination revealed early retinal whitening during heat induction followed by localized exudative retinal detachments, limited to the area of the retinal surface overlying the plaque, that resolved spontaneously. Serial electroretinography was virtually indistinguishable between the 48 and 54 degrees C temperature groups. We noted a minimal alteration in a- and b-wave amplitudes with no changes in implicit times. Histopathology at 3 weeks post-treatment documented chorioretinal scarring overlying the thermal plaque treatment zone. No evidence of heamorrhage infection, cataract or scleral thinning was noted. This study documents the apparent focal containment of thermal effects with FM heating utilizing operating temperatures ad high as 54 degrees C for 60 min, and discloses no evidence of diffuse ocular toxicity.

Animals↗
PubMed1990

The use of microwave-induced hyperthermia in conjunction with afterloading irradiation of vaginal carcinoma. A preliminary report.

Technically improved microwave antennas for clinical hyperthermia induction have made it possible to combine this treatment modality with external and intracavitary irradiation of vaginal and cervical carcinomas. A microwave applicator with a frequency of 915 MHz was used in tissue phantom measurements and inserted into perspex vaginal obturators for measurement of the specific absorption rate in different planes. A Lund Science Hyperthermia System 4010 with a 200 W generator and a separate thermometry system (ATS 100) was used in the patient treatments. Nine patients with vaginal squamous cell carcinomas have been treated with this applicator and obturator setup as an adjunct to intracavitary irradiation with high dose-rate afterloading technique. The treatments of two patients are described in this preliminary report.

Aged↗