Combined interstitial hyperthermia and brachytherapy: Institute Gustave Roussy technique and preliminary results

In 1981, a protocol was developed at the Institute Gustave-Roussy, utilizing combined interstitial hyperthermia and brachytherapy, to treat recurrent tumors in previously irradiated areas. This protocol consisted of interstitial hyperthermia, 44 degrees C for 45 minutes, followed immediately by iridium 192 curietherapy, delivering 30 Gy in 2 or 3 days to the tumor volume. Fourteen implantations have been performed in 11 patients. Complete eradication of tumor has been achieved thus far in 10 cases. Two patients were not evaluable because of rapid death resulting from diffuse metastases, and two patients demonstrated a partial response (greater than 50% tumor reduction). Treatment has been generally well tolerated despite prior high dose irradiation. There has been only one serious complication-a large area of painful necrosis following retreatment of a recurrent floor of mouth carcinoma. Special "metallic-plastic" tubes were developed to improve tissue tolerance. We were able to document that a high and homogeneous temperature could be delivered throughout the tumor volume. The technical innovations, and the techniques of implantation and temperature documentation are described below.