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[Transpupillary thermotherapy of choroidal neovascularisation (CNV) among other methods of treatment].

Choroidal neovascularization (CNV) secondary to age-related macular degeneration is a leading cause of vision loss in adults. Although most patients present with occult CNV, treatment has focused on the small percentage of eyes with well-delineated, classic CNV. Transpupillary thermotherapy is a recent advancement in the management of occult CNV. We demonstrated the effectiveness of transpupillary thermotherapy (TTT) for the treatment of occult choroidal neovascularization (CNV). In a retrospective, case selected trial 50 eyes with CNV secondary to age related macular degeneration (AMD) were studied. The eyes with CNV were treated with diode laser (810 nm) TTT. Laser beam sizes ranged between 0.8 and 3.0 mm and power settings between 700-800 mW. Treatment was given in one area for 1 minute. Transpupillary thermotherapy is a potential treatment for CNV. It is able to close choroidal neovascularization while maintaining visual function in patients with classic and especially occult disease.

Aged↗

Preliminary results of combined simultaneous transpupillary thermotherapy and ICG-based photodynamic therapy for choroidal melanoma.

BACKGROUND AND OBJECTIVE: To evaluate whether the combination of simultaneous hyperthermia by transpupillary thermotherapy and indocyanine green-based photodynamic therapy is an effective treatment for small and medium choroidal melanomas. PATIENTS AND METHODS: Twenty-five patients with small and medium choroidal melanomas were treated with combined simultaneous transpupillary thermotherapy and indocyanine green-based photodynamic therapy. RESULTS: The median age of the 25 patients was 64 years (range, 35 to 88 years). The pretreatment volume of the tumors ranged from 15.9 to 653.5 mm3 (mean, 118.7 +/- 146.6 mm3). After a mean of 2.4 treatments (range, 1 to 5 treatments), all of the tumors but one showed a significant volume reduction without clinical evidence of recurrences. The follow-up ranged from 6 to 59 months (mean, 12 +/- 14 months). Complications included retinal vascular occlusions, edema and superficial scarring of the macula, and rhegmatogenous retinal detachment. CONCLUSIONS: The effects of combined simultaneous transpupillary thermotherapy and indocyanine green-based photodynamic therapy appears to be effective in achieving local tumor control in selected small and medium choroidal melanomas.

Adult↗

[Local thermotherapy with rabdosia liquid as prophylactic measure for recurrence of superficial urinary bladder carcinoma: a non-randomized contemporary controlled study].

OBJECTIVE: To compare the actions of local thermotherapy with rabdosia liquid and repeated perfusion of mitomycin C for the postoperative prophylaxis of superficial urinary bladder carcinoma. METHODS: In the prospective non-randomized contemporary controlled study, 123 patients were divided into 2 groups. The patients in group A received local thermotherapy with rabdosia liquid starting from 1-2 months after operation, once tri-monthly for one year. Those in group B received intravesical perfusion of mitomycin C, starting from 2 weeks after operation, once weekly, six times in total, thereafter once monthly for one year. The recurrence rate, disease free interval, and adverse reaction after operation were observed. RESULTS: The follow-up lasted for 10-45 months with the average of 28.6 +/- 5.8 months. The recurrence rates in group A and B were 5.0% and 14.3%, respectively. Significant difference was shown when compared by Kaplan-Meier analysis of disease free interval and the recurrence rate between the two groups (P < 0.05). The occurrence rates of cystitis, hematuria, vesical contracture, urethral stricture were 28.3%, 5.0%, 1.7%, 1.7%, respectively in group A, 25.4%, 4.8%, 0%, 0%, respectively in group B, showing no significant difference between the two groups (P > 0.05). CONCLUSION: The effect of local thermotherapy with rabdosia liquid is reliable in preventing the recurrence of superficial urinary bladder transitional cell carcinoma.

Adult↗

1992 Student Writing Contest-1st Runner-up: A Comparison of Thermotherapy and Cryotherapy in Enhancing Supine, Extended-leg, Hip Flexion.

Eighteen healthy subjects (13 females and 5 males) were pretested and posttested under two treatment conditions in order to compare the effects of cryotherapy and thermotherapy on supine, extended-leg, hip flexion measurements. Cryotherapy treatments consisted of crushed ice bags secured to the posterior thigh for 20 minutes. On a separate day, thermotherapy treatment of moist heat pads were applied to the posterior thigh for 20 minutes. For pretest and posttest measurements, the subject's extended leg was taken to the end feel of passive hip flexion as maximum range of motion was assessed using a goniometer. Both cryotherapy and thermotherapy significantly improved immediate range of motion; however, there were no differences between the two treatment conditions. These results suggest that athletes wishing to obtain maximum range of motion immediately after treatment may select either ice or heat modalities. Individual conditions and preferences can be used to dictate treatment selection.

Journal Article↗

[Effect of thermotherapy on human esophageal carcinoma in culture and clinical cases].

Multidisciplinary treatment for advanced esophageal carcinoma, which is not resectable in many cases, has become an important subject to study. We have reported the effectiveness of thermotherapy in treatment of esophageal carcinoma by basic experiments using three cell strains of human esophageal carcinoma designated as SGF-3,4,5. Based on the results of the basic experiments, we have performed thermotherapy combined with radiotherapy, chemotherapy and immunotherapy on cases of advanced esophageal carcinoma since October 1985. As for the basic experiment, proliferation of SGF-3 was inhibited at more than 40 degrees C, SGF-4 at more than 41 degrees C and SGF-5 at more than 42 degrees C. We did not observe the recovery of the growth of SGF-3 after heating at 41 degrees C for 72 hours and 42 degrees C for more than 24 hours. And the growth of SGF-4 after heating at 42 degrees C for more than 48 hours did not recover either. No recovery of the growth of SGF-5 after heating at 42 degrees C for 72 hours was noted. Based on the data, combined therapy was performed in 12 patients with advanced esophageal carcinoma. The evaluation of the local response to the combined thermotherapy revealed CR in five cases, PR in five and NC in two.

Aged↗

Radiofrequency thermotherapy, local chemotherapy, and arterial occlusion in the treatment of nonresectable cancer.

Localized radiofrequency thermotherapy (RFTT) has been effective by itself in debulking cancers but has not accomplished total eradication by itself. Occlusion of the regional artery supplying the tumor drastically reduces the arterial pressure distal to occlusion and further impairs tumor blood flow leading to an accentuation of the temperature differentiation achieved by the normal tissue and tumor. Radiofrequency thermotherapy with vascular occlusion is combined with direct injection of an effective chemotherapeutic agent into the tumor. Radiofrequency thermotherapy is performed after injection of chemotherapy using bleomycin and mitomycin C for squamous cell cancers and Adriamycin and mitomycin C for adenocarcinoma. There are no adverse systemic responses to the small dose of chemotherapy used and the combination therapy is effective in destroying the tumor.

Antineoplastic Agents↗

[Transurethral thermotherapy by microwaves in patients with benign obstructive prostatic hypertrophy].

The effect of transurethral microwave thermotherapy (TUMT) with Prostatron in patients with benign prostatic hypertrophy was investigated. Two hundred and one patients were treated between January 1991 and June 1992 after informed consent was signed. The following examinations were carried out at screening: interview (including symptoms score evaluation), physical examination (including digital rectal examination), haematology and blood chemistry (including prostate specific antigen), ECG, chest Xray, kidney, bladder and prostate (transrectal) ultrasound sonography (USS) and uroflowmetry; pressure-flow study was performed in a selected group of patients. All enrolled patients had Madsen symptom score > or = 8; peak flow rate < or = 15 ml/s and post void residual urine < or = 200 ml. Patients with obstructive middle lobe of the prostate, any BPH complication or any suspicion of prostatic carcinoma were excluded from the study. Microwave thermotherapy with Prostatron was carried out according to software generation 2.0 (Prostasoft 2.0), the c10 (black) catheter was used in all patients. Follow-up visits were scheduled at 1 week, 1, 3, 6, 12, 18 months after microwave thermotherapy. Overall short- and long-term morbidity rates were 6.09 and 2.73 per cent, respectively. At 12 months, Madsen score was found to be reduced from 11.7 +/- 4.78 to 4.43 +/- 3.30; maximum flow rate (Qmax) was increased from 8.91 +/- 4.20 to 13.20 +/- 4.86; post void residual urine (PVRU) was reduced from 131 +/- 17.6 to 67.40 +/- 34.50.(ABSTRACT TRUNCATED AT 250 WORDS)

Follow-Up Studies↗

Experimental study of laparoscopic laser-induced thermotherapy for liver tumours.

BACKGROUND: Laser-induced thermotherapy is a minimally invasive method that can be applied percutaneously or during laparotomy for the treatment of malignant liver tumours. The aim of this experimental study was to investigate whether the laparoscopic approach is suitable for laser-induced thermotherapy. Laparoscopic ultrasonography was tested as an aid to intrahepatic positioning of the applicators as well as for online monitoring during application. METHODS: A neodymium yttrium-aluminium-garnet laser was used to induce thermal lesions in the healthy liver of ten German hybrid pigs. The length of application was 840 s. Forty applications were performed with normal hepatic blood flow and 40 with hepatic blood flow interrupted by means of a laparoscopic Pringle's manoeuvre. RESULTS: A total of 20 simultaneous multifibre applications with 80 single applications were performed. Thermal necrosis with a total volume of 50.3 cm3 was induced with high precision when hepatic blood flow was interrupted temporarily. When hepatic blood flow was normal, the total volume of thermal necrosis was only 14.6 cm3 (P < 0.01). Laparoscopic ultrasonography was used successfully as an aid for exact applicator positioning and for online monitoring. Method-related complications did not occur. CONCLUSION: The laparoscopic approach is an attractive means of application for laser-induced thermotherapy and it seems that clinical testing is justified.

Animals↗

[Transurethral thermotherapy of the prostate--a very promising treatment method for benign prostatic hyperplasia].

Transurethral resection of the prostate remains the most common method for the treatment of benign prostatic hyperplasia (BPH). Due to unsatisfactory results in about 18% of the patients new methods to treat BPH have been developed. We evaluated 45 patients 6 and 12 months after transurethral microwave thermotherapy using the Prostatron device with Prostasoft 2.5 software. There was a significant improvement of the urinary symptoms and of the quality of life index from 18 to 9.5 and from 3.2 to 1.6 points, respectively. Urinary flow rate improved from 8.8 to 12.1 ml/sec and residual urine was reduced from 101 to 52 ml. The treatment was well tolerated and side effects were minimal. High-energy transurethral microwave thermotherapy is an effective and safe minimal invasive alternative to treat BPH in selected patients. As no anesthesia is required transurethral microwave thermotherapy can also be offered to high risk and elderly patients.

Aged↗

Interstitial laser thermotherapy of adenocarcinoma transplanted into rat liver.

OBJECTIVE: To examine the effect of different temperatures and exposure times in interstitial laser thermotherapy. DESIGN: Controlled laboratory study. SETTING: University hospital, Sweden. MATERIAL: 48 male Wistar FU rats with dimethylhydrazine-induced adenocarcinoma transplanted into the liver. INTERVENTION: Treatment was given with an Nd:YAG laser and a feedback system for temperature regulation. Light was delivered into the centre of the tumour and the feedback thermistor probe was placed 3 mm from the tumour margin. Rats were treated at steady-state temperatures at the feedback thermistor of 43, 46, or 50 degrees C for 30 minutes, and at a steady-state temperature of 46 degrees C at the feedback thermistor also for 10 and 20 minutes. MAIN OUTCOME MEASUREMENT: Tumour control as assessed 6 days after treatment using light microscopical examination including immunohistochemical determination of bromodeoxyuridine (BrdU) incorporation into DNA as a measure of cell viability. RESULTS: Complete tumour necrosis was achieved in all rats treated for 30 minutes, in 6/8 rats treated for 10 minutes and in 6/8 rats treated for 20 minutes at 46 degrees C. During steady-state thermotherapy, temperatures at the tumour margin were about 11 degrees higher than at the feedback thermistor (range 54-61 degrees C). The surrounding liver tissue also became necrotic so that the total necrosis volume exceeded the pretreatment tumour volume. CONCLUSION: Interstitial laser thermotherapy at temperatures ranging from 54-61 degrees C at the tumour margin ensures total necrosis of a transplanted rat liver carcinoma provided that treatment is given for 30 minutes.

Adenocarcinoma↗

Interstitial laser-induced thermotherapy: influence of carbonization on lesion size.

BACKGROUND AND OBJECTIVE: The size of laser-induced coagulated lesions produced in porcine muscle in vitro using a cylindrical diffusing fiber tip and a conductive heat source, made by covering the diffuser with a hollow steel needle, were compared to investigate the influence of charring. MATERIALS AND METHODS: Light from a Nd:YAG laser was utilized for thermotherapy. A theoretical model for calculating tissue temperature was used to predict the experimental results and to simulate in vivo treatments. RESULTS: The metal-covered tip produced carbonization and tissue vaporization that was not found with the diffuser. After 20 min of irradiation at a laser power of 7 W, the coagulated volumes with and without carbonization were found to be 13.1 cm3 (range 12.4-14.1 cm3, n = 4) and 12.2 cm3 (range 11.5-13.4 cm3, n = 4), respectively. Mathematical simulations showed that in unperfused tissue, a diffusing laser heat source produces smaller lesions than does a conductive heat source at the same power, the difference in coagulated volume becoming smaller with increased treatment time and increased power. CONCLUSION: Using cylindrical diffusers, interstitial laser-induced thermotherapy without carbonization at the fiber tip can be as efficient as treatment with carbonization.

Animals↗

Biliary structures lead to tumour recurrences after laser-induced interstitial thermotherapy.

BACKGROUND AND OBJECTIVE: Thermal diffusion during laser-induced interstitial thermotherapy (LITT) has not yet been fully investigated in heterogeneous tissue architecture such as liver. LITT was performed on rabbit liver tumours to analyse the role of biliary structures in thermal diffusion. STUDY DESIGN/MATERIALS AND METHODS: Twenty-four VX2 tumours were grafted onto 12 rabbit livers. The animals were randomly separated into two groups when tumour size reached 8 mm. Thermotherapy was performed by delivering the 830-nm output of a diode laser to the centre of the tumour with a 300-,microm fibre. Irradiation conditions were 1.5 W over 900 sec. On day 7 or 14, the tumours were removed and stained with haematoxylin-eosin and picrosirius red F3BA (PR). Thermal damage was evaluated by PR and electron microscopic examinations. RESULTS: Among the treated tumours, recurrences were found both at the periphery (one on day 7, seven on day 14) and within the treated area (two on day 7, two on day 14). All recurrences were located in the vicinity of the biliary structures, which are frequently spared from thermal injury. CONCLUSION: Biliary ducts lead to a heat sink, thereby facilitating tumour recurrences.

Animals↗

Development of stereotactically guided laser interstitial thermotherapy of breast cancer: in situ measurement and analysis of the temperature field in ex vivo and in vivo adipose tissue.

BACKGROUND AND OBJECTIVE: The size (0.5-1.0 cm) of early nonpalpable breast tumors currently detected by mammography and confirmed by stereotactic core biopsy is of the order of the penetration depth of near infrared photons in breast tissue. In principle, stereotactically biopsied tumors, therefore, could be safely and efficiently treated with laser thermotherapy. The aim of the current study is to confirm the controlled heating produced by clinically relevant power levels delivered with an interstitial laser fiber optic probe adapted for use with stereotactic mammography and biopsy procedures. STUDY DESIGN/MATERIALS AND METHODS: Temperature increases and the resultant thermal field produced by the irradiation of ex vivo (porcine and human) and in vivo (porcine) tissue models appropriate to the treatment of human breast tissue by using cw Nd:YAG laser radiation delivered with a interstitial fiber optic probe with a quartz diffusing tip, were recorded with an array of fifteen 23-gauge needle thermocouple probes connected to a laboratory computer-based data acquisition system. RESULTS: By using a stepwise decreasing power cycle to avoid tissue charring, acceptably symmetric thermal fields of repeatable volumetric dimensions were obtained. Reproducible thermal gradients and predictable tissue necrosis without carbonization could be induced in a 3-cm-diameter region around the fiber probe during a single treatment lasting only 3 minutes. The time-dependences of the temperature rise of the thermocouples surrounding the LITT probe were quantitatively modeled with simple linear functions during the applied laser heating cycles. CONCLUSION: Analysis of our experimental results show that reproducible, symmetric and predictable volumetric temperature increases in time can be reliably produced by interstitial laser thermotherapy.

Adipose Tissue↗

Transurethral microwave thermotherapy in symptomatic benign prostatic hyperplasia: a possible association between androgen status and treatment result?

BACKGROUND: Nothing is yet known of possible endocrine effects of transurethral microwave thermotherapy (TUMT) or of possible influence of endocrine status on the result of thermotherapy. METHODS: Serum levels of testosterone (T), SHBG, estradiol, LH, and PSH were measured in 48 men with BPH before and 2-3 months after TUMT (Prostatron, Prostasoft 2.0; Technomed International, Lyon, France). Assessment of results was based on the patients' own estimations. RESULTS: The treatment did not alter hormone levels. Patients who reported response after 12 months (n = 21) had significantly lower outset levels of calculated free testosterone (fT) than in the nonresponders (n = 27). In the patients aged < 70 years (n = 13), both the fT and T values were lower than in the nonresponders (n = 15). There was no age difference between responders and nonresponders. CONCLUSIONS: TUMT did not influence hormone levels. These observations suggest that androgen status may influence the final result of treatment.

Aged↗

Can histopathology predict treatment outcome following high-energy transurethral microwave thermotherapy of the prostate? Results of a biopsy study.

BACKGROUND: Despite good results of high-energy transurethral microwave thermotherapy (TUMT) in the treatment of benign prostatic hyperplasia, it is still difficult to predict the response to treatment on an individual basis. Besides clinical baseline parameters, intrinsic histological parameters are suggested to play a role in the response variance after TUMT. In this study we analyzed histological parameters (vessel density and epithelium-stroma (E/S) ratio) in patients who were selected for high-energy TUMT and related these parameters to clinical outcome. METHODS: We treated 42 patients with high-energy TUMT, who prior to treatment agreed upon ultrasonographic investigation of the prostate in combination with biopsies of the peripheral and transitional zones of the prostate. For all separate biopsy locations, the histological stained prostate slides were morphometrically quantified with computer assistance and analyzed for E/S ratio and vessel density. Response to treatment was measured by using standardized response evaluation criteria and was correlated with histological outcome. RESULTS: The E/S ratio in the inner gland biopsies tended to be higher in the good response group compared to the very poor responders. Furthermore, a clear trend was seen towards a lower vessel density in good responders. Large prostates and prostates with a high E/S ratio responded well to the high-energy thermotherapy. CONCLUSIONS: Histopathological parameters of the prostate tend to be moderately predictive for clinical response in this research population. Poor responders appeared to have a somewhat higher vessel density in all prostate biopsy sides, and there was also a trend towards a lower E/S ratio in these patients.

Aged↗

Development of postoperative intrathoracic chemo-thermotherapy for lung cancer with objective of improving local cure.

From April 1985 through March 1988, 24 lung cancer patients with carcinomatous pleuritis were treated with a new combined treatment modality consisting of pulmonary resection and postoperative intrathoracic chemo-thermotherapy (PICT). They consisted of 15 male patients and nine female patients. A majority of the patients (79%%) had adenocarcinoma. The PICT was started 10 to 14 days after the operation. Immediately after a bolus intrathoracic injection of cisplatin (CDDP) 50-100 mg, thermotherapy was carried out using 13.56-MHz or 8.00-MHz radiofrequency waves for 60 minutes. The peripleural temperature was precisely monitored in 20 patients. The temperature was successfully maintained above 42 degrees C for 40 minutes in each of two or three treatment courses in 13 patients, with no complications. However, in the other seven patients the therapy resulted in incomplete treatment because of development of a side effect. Cytologic examination of the pleural effusion, which was performed after the completion of PICT, gave a negative result in 16 of 20 patients examined. The median follow-up period was 16 months. Local relapse was recognized in only three cases who received incomplete treatment or in whom no temperature measurement was performed. The overall survival of the treated patients (n = 24) was significantly prolonged in comparison with a historical control group treated by surgery only (n = 17) or exploratory thoracotomy (n = 11). Of those 17 patients treated by surgery only, ten patients (59%) died of local relapse. These results suggest that this new treatment modality consisting of pulmonary resection and PICT is useful for the treatment of lung cancer patients with carcinomatous pleuritis, especially in the light of improved local control.

Adenocarcinoma↗

A laser pumped Nd(3+)-doped YAG fiber-optic thermal tip for laser thermotherapy.

BACKGROUND AND OBJECTIVE: Photo-thermal converters have been successfully used in laser surgery; however, most of the currently used converters are likely to be damaged in the operations due to various problems, preventing them from being efficiently and repeatedly used in laser thermotherapy. Aiming to solve these problems, we report a new type of fiber-optic photo-thermal converter with higher stability. STUDY DESIGN/MATERIALS AND METHODS: A laser-pumped highly Nd(3+)-doped Y(3)Al(5)O(12) (YAG) crystal fiber tip had been fabricated for photo-thermal conversion by means of phonon relaxation. The 15at.% neodymium-doped near cylindrical YAG crystal fiber tip, with maximum diameter of 1.1 mm and length of 2.7 mm, was fabricated on a 1 mm-thick 42 mm-long pure YAG single crystal fiber by laser heated pedestal growth (LHPG) method. RESULTS AND CONCLUSION: Pumping by a Ti:Sapphire laser with central wavelength of 805 nm, the tip generated a temperature rise of 15 degrees C in egg white with pumping power of 710 mW, the tip temperature increased approximately linearly with the increased pumping power. The distribution of the temperature in two media had also been measured. Experimental results indicated that the tip was promising for laser thermotherapy applications.

Equipment Design↗

Temperature dependence of thermal damage to the sclera: exploring the heat tolerance of the sclera for transscleral thermotherapy.

Thermal damage to the human sclera in relation to temperature and duration of exposure was studied in order to determine the heat tolerance of the sclera with respect to transscleral thermotherapy of choroidal melanoma. Samples of human sclera were submerged in saline for 10 sec to 10 min at temperatures of 37-100 degrees C. The effects of heat on the shape, weight and size of the samples were studied. Thermal damage of scleral collagen was examined by polarized light microscopy (LM) and electron microscopy (EM). The sclera was embedded in epoxy resin and stained with toluidine blue for LM and with uranyl acetate and lead citrate for EM. Thermal damage of scleral collagen on polarized LM was graded on a five point scale. Scleral damage was visible on macroscopic examination and on LM and EM in sclera heated at 65 degrees C for 20 sec or longer, at 70 degrees C for 10 sec or longer, and at higher temperatures. A sigmoidal function was used to define the relation between temperature and changes in diameter, thickness, and weight of scleral samples. Using fitted functions, the threshold temperature for thermal damage was estimated to be 59-61 degrees C when samples were heated for 10 min, 62-63 degrees C when heated for 1 min, and 66-67 degrees C when heated for 10 sec; the threshold exposure time at 60 degrees C was estimated to be 7-12 min. These results indicate a temperature of 60 degrees C for 1 min is well tolerated by human donor sclera; information of in vivo studies is required to validate whether this setting can be used in transscleral thermotherapy (TSTT) for choroidal melanoma.

Adolescent↗