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Regional hyperthermia (42°) was applied to the canine liver by isolation‐perfusion in order to demonstrate that dog survival and maintenance of hepatic functional integrity were possible. Flow to the liver, 1 ml/min/g, was provided by gravity to the portal vein at 2/3 total flow, and by pump to the hepatic artery at 1/3 total flow. After 1 hour perfusion at 37°, 4/6 dogs survived and 5/8 survived perfusion at 42°. Hypoglycemia contributed to the two deaths at 37° and one at 42°. After two‐hour perfusion at 37°, 5/5 dogs survived, and 3/5 survived at 42°. After four‐hour perfusion at 37°, 1/1 dog survived, and 1/1 survived at 42°. Hyperlactemia occurred during all perfusions, but plateaued at a level of 8–10 mM. Plasma SGPT, SGOT, or 5‐nucleotidase levels during and after perfusion were mildly elevated, but returned to normal within 4–7 days. Perfusate chemistries (lactate, pyruvate, glucose, urea, total amino acids, ketone bodies, and enzymes) were used as indicators of hepatic functional integrity. Lactate in the perfusate showed no significant differences (P < 0.05) between 37 and 42°. Glucose increased in the perfusate during all perfusions. Urea synthesis occurred during all perfusions and was unchanged by a temperature of 42°. The total amino acid levels in the perfusate reflected endogenous proteolysis, which was unchanged at 42°. Ketone body production was increased during the two‐hour perfusions due to the addition of Intralipid to the perfusate. There were no significant differences in the perfusate enzyme levels at 37 and 42°. The data presented indicate that hepatic functional integrity can be maintained in the canine liver during isolation‐perfusion at 42°. Support of the dog during and after the temporary anhepatic state may be the crucial factor to survival. Thermotherapy by isolation‐perfusion of the liver could be useful for treating patients with cancer limited to the liver.
Regional hyperthermia (42°) was applied to the canine liver by isolation‐perfusion in order to demonstrate that dog survival and maintenance of hepatic functional integrity were possible. Flow to the liver, 1 ml/min/g, was provided by gravity to the portal vein at 2/3 total flow, and by pump to the hepatic artery at 1/3 total flow. After 1 hour perfusion at 37°, 4/6 dogs survived and 5/8 survived perfusion at 42°. Hypoglycemia contributed to the two deaths at 37° and one at 42°. After two‐hour perfusion at 37°, 5/5 dogs survived, and 3/5 survived at 42°. After four‐hour perfusion at 37°, 1/1 dog survived, and 1/1 survived at 42°. Hyperlactemia occurred during all perfusions, but plateaued at a level of 8–10 mM. Plasma SGPT, SGOT, or 5‐nucleotidase levels during and after perfusion were mildly elevated, but returned to normal within 4–7 days. Perfusate chemistries (lactate, pyruvate, glucose, urea, total amino acids, ketone bodies, and enzymes) were used as indicators of hepatic functional integrity. Lactate in the perfusate showed no significant differences (P < 0.05) between 37 and 42°. Glucose increased in the perfusate during all perfusions. Urea synthesis occurred during all perfusions and was unchanged by a temperature of 42°. The total amino acid levels in the perfusate reflected endogenous proteolysis, which was unchanged at 42°. Ketone body production was increased during the two‐hour perfusions due to the addition of Intralipid to the perfusate. There were no significant differences in the perfusate enzyme levels at 37 and 42°. The data presented indicate that hepatic functional integrity can be maintained in the canine liver during isolation‐perfusion at 42°. Support of the dog during and after the temporary anhepatic state may be the crucial factor to survival. Thermotherapy by isolation‐perfusion of the liver could be useful for treating patients with cancer limited to the liver.
A study was performed on regional hyperthermia for patients with locally advanced prostate carcinoma. The primary objective was to analyse the thermometry data with an emphasis on the possibility of replacing invasive thermometry by tumour-related intra-luminal thermometry. Fourteen patients were treated with a combination of conformal external beam radiotherapy (70 Gy) and hyperthermia. Hyperthermia was delivered using the Coaxial TEM system, one treatment per week, to a total of five treatments. Thermometry was performed in bladder, urethra, rectum and esophagus. Invasive thermometry in the prostate was carried out during one or two treatments for each patient by placing transperineally a central and a peripheral catheter. Heterogeneous temperature distributions were measured in the prostate. The mean average invasive temperature range was 1.1 degrees C. Due to the temperature heterogeneity and a limited number of thermometry sensors (mean 7, range 2-13), large variability between treatments and patients existed regarding achieved temperatures and dose. The mean invasive T90 was 40.2 +/- 0.6 degrees C and T50 was 40.8 +/- 0.6 degrees C. The mean Cum min T90>40.5 degrees C per treatment was 22 (range 0-50). Importantly, intra-luminal temperatures did not reliably predict invasively measured temperatures. Invasive thermometry, therefore, remains compulsory to calculate a thermal dose for an individual patient. Changes in temperature during treatment, measured by the urethral sensors, corresponded well with changes in temperature measured by the individual invasive sensors. Similar comparison of rectal temperature changes with intra-prostatic temperature changes was not as predictive. The similarity in temperature changes between the urethral and interstial sites, suggests that urethral temperatures are sufficient for treatment optimization. The SAR profile did not correspond with the temperature profile indicating heterogeneous perfusion. Although regional hyperthermia in combination with external beam radiotherapy for locally advanced prostate carcinoma is clinically feasible, the question on the importance of invasive thermometry remains.
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