Combined Intraoperative Thermoradiotherapy for Abdominal Malignancies: The Dartmouth Experience

  • T. A. Colacchio
  • T. P. Ryan
  • C. T. Coughlin
  • E. B. Douple
  • J. W. Strohbehn
Part of the Medical Radiology book series (MEDRAD)


Despite the advances in surgical resection and adjuvant treatment modalities, local recurrence continues to be a significant management problem with intra-abdominal malignancies, in particular for locally advanced colorectal and pancreatic malignancies. The preliminary results for the use of extended surgical resection, external beam radiotherapy, and intraoperative radiotherapy (Shipley etal. 1984; Roldan et al. 1988; Gunderson et al. 1987, 1988; Tuckson et al. 1988; Abe et al. 1987; Hoekstra et al. 1988; Sindelar et al. 1988; Gold-son 1981; Tepper et al. 1986) for the control of local disease recurrence in colorectal and pancreatic cancers demonstrate that lack of local control continues to be the major cause for failure of this combined modality approach. As a result, it is reasonable to investigate the use of hyperthermia in conjunction with these other modalities in the management of these tumors. Certainly for superficial tumors, clinical studies have shown improved results for combined hyperthermia with radiation therapy when compared with radiation therapy alone (Overgaard1985).


Adult Respiratory Distress Syndrome Pelvic Abscess Hyperthermia Treatment Thermal Dose Water Circulation System 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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  1. Abe M, Shibamoto V, Takahashi M, Hanabet, Tobet, Inamoto T (1987) Intraoperative radiotherapy in carcinoma of the stomach and pancreas. World J Surg 11: 459–464PubMedCrossRefGoogle Scholar
  2. Beard RH, Magin RL, Frizzell LA, Cain CA (1982) An annular focus ultrasonic lens for local hyperthermia treatment of small tumors. Ultrasound Med Biol 8: 177–184PubMedCrossRefGoogle Scholar
  3. Benkeser PJ, Frizzell LA, Goss SA, Cain CA (1989) Analysis of a multielement ultrasound hyperthermia applicator. IEEE Trans Ultrasonics, Ferroelectrics and Frequency Control 36: 319–325CrossRefGoogle Scholar
  4. Borrelli MJ, Bailey KI, Dunn F (1981) Early ultrasonic effects upon mammalian CNS structures (chemical synapses). J Acoust Soc Am 69: 1514–1516PubMedCrossRefGoogle Scholar
  5. Cain CA, Umemura S-I (1986) Concentric-ring and sector-vortex phased-array applicators for ultrasound hyperthermia. IEEE Trans Microwave Theory Tech 34: 542–551CrossRefGoogle Scholar
  6. Colacchio TA, Coughlin CT, Strohbehn JW, Stafford JH, Ryan TP, Douple EB, Crichlow RW (1989) Intraoperative radiation therapy and hyperthermia for unresectable intra-abdominal carcinomas. In: Sugahara T, Saito M (eds) Taylor & Francis, London, pp 561–562Google Scholar
  7. Colacchio TA, Coughlin C, Taylor J, Douple E, Ryan T, Crichlow RW (1990) Intraoperative radiation therapy and hyperthermia. Arch Surg 125: 370–375PubMedCrossRefGoogle Scholar
  8. Corry PM, Spanos WJ, Tilchen EJ, Barlogie B, Barkley HT, Armour EP (1982) Combined ultrasound and radiation therapy treatment of human superficial tumors. Radiology 145: 165–169PubMedGoogle Scholar
  9. Corry PM, Jabboury K, Armout EP (1987) Clinical experience with plane-wave ultrasound systems. In: Reeves RA, Paliwal BR (eds) Syllabus, a categorical course in radiation therapy hyperthermia. RSNA, New York, pp 151–158Google Scholar
  10. Coughlin CT, Douple EB, Strohbehn JW, Eaton WL, Trembly BS, Wong TZ (1983) Interstitial microwave-induced hyperthermia in combination with brachytherapy. Radiology 148: 285–288PubMedGoogle Scholar
  11. Coughlin CT, Wong TZ, Strohbehn JW, Colacchio TA, Sutton JE, Belch RZ, Douple EB (1985) Intraoperative interstitial microwave-induced hyperthermia and brachytherapy. Int J Radiat Oncol Biol Phys 11: 1673–1678PubMedCrossRefGoogle Scholar
  12. Coughlin CT, Strohbehn JW, Ryan TP, Roberts DW, Colacchio TA, Douple EB (1989) Interstitial hyperthermia for deep-seated malignancies. In: Sugahara T, Saito M (eds) Hyperthermic oncology 1988, vol 1. Taylor & Francis, London, pp 596–597Google Scholar
  13. Dickinson RJ (1984) An ultrasound system for local hyperthermia using scanned focused transducers. IEEE Trans Biomed Eng 31: 120–125PubMedCrossRefGoogle Scholar
  14. Fessenden P, Lee ER, Anderson TL, Strohbehn JW, Meyer JL, Samulski TV, Marmor JB (1984) Experience with a multi-transducer ultrasound system for localized hyperthermia of deep tissues. IEEE Trans Biomed Eng 32: 126–135CrossRefGoogle Scholar
  15. Frizzell LA (1988) Threshold dosages for damage to mammalian liver by high intensity focussed ultrasound. IEEE Trans Ultrasonics Ferroelectrics and Frequency Control 35: 578–581CrossRefGoogle Scholar
  16. Goldson AL (1981) Past, present and prospects of intraoperative radiotherapy. Semin Oncol 3: 59–64Google Scholar
  17. Gunderson LL, Cohen AC, Dosuretz DD et al. (1983) Residual, unresectable or recurrent colorectal cancer: external beam irradiation and intraoperative electron beam boost +/-resection. Int J Radiat Oncol Biol Phys 9: 1597–1606PubMedGoogle Scholar
  18. Gunderson LL, Martin JK, Kvols LK et al. (1987) Intraoperative and external beam irradiation =/-5-FU for locally advanced pancreatic cancer. Int J Radiat Oncol Biol Phys 13: 319–329PubMedCrossRefGoogle Scholar
  19. Gunderson LL, Martin JK, Beart RW et al. (1988) Intraoperative and external beam irradiation for locally advanced colorectal cancer. Ann Surg 207: 52–60PubMedCrossRefGoogle Scholar
  20. Hoekstra HJ, Restrepo C, Kinsella TJ et al. (1988) Histopathologic effects of intraoperative radiotherapy on pancreas and adjacent tissues: a postmortem analysis. J Surg Oncol 37: 104–108PubMedCrossRefGoogle Scholar
  21. Hynynen K, Roemer R, Anhalt D, Johnson C, Xu ZX, Swindell W, Cetas T (1987) A scanned, focused, multiple transducer ultrasonic system for localized hyperthermia treatments. Int J Hyperthermia 3: 21–35PubMedCrossRefGoogle Scholar
  22. Ibbini MS, Cain CA (1990) The concentric-ring array for ultrasound hyperthermia: combined mechanical and electrical scanning. Int J Hyperthermia 6: 401–419PubMedCrossRefGoogle Scholar
  23. Kato H, Hiraka M, Nakajima T, Ishida T (1985) Deep-heating characteristics of an RF capacitive heating device. Int J Hyperthermia 1: 15–28PubMedCrossRefGoogle Scholar
  24. Lele PP (1983) Physical aspects and clinical studies with ultrasound hyperthermia. In: Storm FC (ed) Hyperthermia in cancer therapy. Medical Hall, Boston, pp 333–367Google Scholar
  25. Marmor JB, Pounds D, Postic TP, Hahn G (1979) Treatment of superficial human neoplasms for local hyperthermia induced by ultrasound. Cancer 43: 188–197PubMedCrossRefGoogle Scholar
  26. Ocheltree KB, Benkeser PJ, Frizzell LA, Cain CA (1984) An ultrasonic-phased array applicator for hyperthermia. IEEE Trans Sonics Ultrasonics 31: 526–531Google Scholar
  27. Overgaard J (1985) Rationale and problems in the design of clinical studies. In: Overgaard J (ed) Hyperthermic oncology. Taylor & Francis, London, pp 325–338Google Scholar
  28. Pounds DW, Britt RH (1984) Single ultrasonic crystal techniques for generating uniform temperature distributions in homogeneously perfused tissues. IEEE Trans Sonics Ultrasonics 31: 482–490Google Scholar
  29. Rich TA, Cady B, McDermott et al. (1984) Ortho voltage intraoperative radiotherapy: a new look at an old idea. Int J Radiat Oncol Biol Phys 10: 1957–1965PubMedCrossRefGoogle Scholar
  30. Richmond RC, Stafford JH, Ryan TP, Mahtani HK, Memoli VA, Taylor JH, Coughlin CT (1991) Platinum levels and clinical responses of tumors treated by cisplatin with and without concurrent hyperthermia: A case study. Int J Hyperthermia 8: 142–156Google Scholar
  31. Roldan GE, Gunderson LL, Nagorney DM et al. (1988) External beam versus intraoperative and external beam irradiation for locally advanced pancreatic cancer. Cancer 61: 1110–1116PubMedCrossRefGoogle Scholar
  32. Ryan TP, Coughlin CT, Stafford JH, Lyons BE, Strohbehn JW, Douple EB (1986) Temperature analysis of ultrasound-induced hyperthermia in patients with superficial tumors (abstract). North American Hyperthermia Group Annual Meeting, Las Vegas, NVGoogle Scholar
  33. Ryan TP, Hartov A, Taylor J, Stafford J, Colacchio T (1990) A concentric ring ultrasound applicator for hyperthermia. Proc IEEE Eng Med Biol Soc 1: 270–271Google Scholar
  34. Ryan TP, Colacchio TA, Coughlin CT, Hartov A (1991a) Analysis of hyperthermia treatments: single vs. multiple-element applicators. Proceedings of the International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE PressGoogle Scholar
  35. Ryan TP, Hartov A, Colacchio TA, Coughlin CT, Stafford JH, Hoopes PJ (1991b) Analysis and testing of a concentric ring applicator for ultrasound hyperthermia with clinical results. Int Hyperthermia 7: 587–603CrossRefGoogle Scholar
  36. Ryan TP, Hoopes PJ, Taylor JH, Strohbehn JW, Roberts DW, Douple EB, Coughlin CT (1991c) Experimental brain hyperthermia: techniques for heat delivery and thermometry. Int J Radiat Oncol Biol Phys 20: 739–750PubMedCrossRefGoogle Scholar
  37. Ryan TP, Wikoff R, Hoopes PJ (1991d) An automated temperature mapping system for use in ultrasound or microwave hyperthermia. J Biomed Eng 13: 348–354PubMedCrossRefGoogle Scholar
  38. Ryan TP, Colacchio TA, Douple EB, Strohbehn JW, Coughlin CT (1992) Techniques for intraoperative hyperthermia with ultrasound: The Dartmouth experience with 19 patients. Int J Hyperthermia, vol 8. 4: 407–421PubMedCrossRefGoogle Scholar
  39. Samulski TV, Grant WJ, Oleson JR, Leopold KA, Dewhirst MW, Vallario P, Blivin J (1990) Clinical experience with a multi-element ultrasonic hyperthermia system: analysis of treatment temperatures. Int J Hyperthermia 6: 909–922PubMedCrossRefGoogle Scholar
  40. Sapozink MD, Cetas T, Corry PM, Egger MJ, Fessenden P (1988) Introduction to hyperthermia device evaluation. Int J Hyperthermia 4: 1–15PubMedCrossRefGoogle Scholar
  41. Shipley WU, Wood WC, Tepper JE et al. (1984) Intraoperative electron beam irradiation for patients with unresectable pancreatic carcinoma. Ann Surg 200: 289–296PubMedCrossRefGoogle Scholar
  42. Sindelar WF, Hoekstra HJ, Kinsella TJ et al. (1988) Surgical approaches and techniques in intraoperative radiotherapy for intra-abdominal, retroperitoneal, and pelvic neoplasms. Surgery 103: 247–256PubMedGoogle Scholar
  43. Tepper JE, Gunderson LL, Orlow E et al. (1984) Complications of intraoperative radiotherapy. Int J Radiat Oncol Biol Phys 10: 1831–1839PubMedCrossRefGoogle Scholar
  44. Tepper JE, Cohen AM, Wood WC et al. (1986) Intraoperative electron beam radiotherapy in the treatment of un-resectable rectal cancer. Arch Surg 121: 421–423PubMedCrossRefGoogle Scholar
  45. Trembly BS, Strohbehn JW, deSieyes DC, Douple EB (1982) Hyperthermia induced by an array of invasive microwave antennas. J Nat Cancer Inst Monogr 61: 497–499Google Scholar
  46. Tuckson W, Goldson AL, Ashayer E et al. (1988) Intraoperative RT for patients with carcinoma of the pancreas. Ann Surg 207: 648–654PubMedCrossRefGoogle Scholar
  47. Underwood HR, Burdette EC, Ocheltree KB, Magin RL (1987) A multi-element ultrasonic hyperthermia applicator with independent element control. Int J Hyperthermia 3: 257–267PubMedCrossRefGoogle Scholar
  48. Waterman FM (1990) Determination of the temperature artifact during ultrasound hyperthermia. Int J Hyperthermia 6:131–142PubMedCrossRefGoogle Scholar
  49. Waterman FM, Dewhirst MW, Fessenden P et al. (1991) RTOG quality assurance guidelines for clinical trials using hyperthermia administered by ultrasound. Int J Radiat Oncol Biol Phys 20: 1099–1107PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1993

Authors and Affiliations

  • T. A. Colacchio
    • 1
  • T. P. Ryan
    • 2
    • 3
  • C. T. Coughlin
    • 4
  • E. B. Douple
    • 4
  • J. W. Strohbehn
    • 3
  1. 1.Section of General Surgery, Department of SurgeryDartmouth-Hitchcock Medical CenterLebanonUSA
  2. 2.Section of Radiation OncologyDartmouth-Hitchcock Medical CenterLebanonUSA
  3. 3.Thayer School of EngineeringDartmouth CollegeHanoverUSA
  4. 4.Section of Radiation Oncology, Department of MedicineDartmouth- Hitchcock Medical CenterLebanonUSA

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