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The objective of this study was to determine whether neoadjuvant chemotherapy in combination with hyperthermia (HT) would improve oxygenation in locally advanced breast tumours. The study describes a new optimized ultrasound guided technique of pO 2 measurement using Eppendorf polarographic oxygen probes in 18 stage IIB-III breast cancer patients. Prior to treatment, tumour hypoxia (median pO 2 < 10 mmHg) was present in 11/18 patients (average median pO 2 = 3.2 mmHg). Seven patients had well oxygenated tumours (median pO 2 of 48.3 mmHg). Eight patients with hypoxic tumours prior to treatment had a significant improvement ( p = 0.0008) in tumour pO 2 after treatment (pO 2 increased to 19.2 mmHg). In three patients, tumours remained hypoxic (average median pO 2 = 4.5 mmHg). The advantages of the ultrasound guided pO 2 probe are in the accuracy of the Eppendorf electrode placement in tumour tissue, the ability to monitor electrode movement through the tumour tissue during the measurement and the ability to avoid electrode placement near or in large blood vessels by using colour Doppler imaging. The results of this preliminary study suggest that the combination of neoadjuvant chemotherapy and hyperthermia improves oxygenation in locally advanced breast tumours that are initially hypoxic. [ABSTRACT FROM AUTHOR]

We prospectively evaluated whether delivering a thermal dose of ≥10 cumulative equivalent minutes at 43°C to >90% of the tumour sites monitored (CEM43° T[sub 90]) would produce a pathologic complete response (pCR) in ≥ 75% of high-grade soft tissue sarcomas treated pre-operatively with thermoradiotherapy. The impact of thermal dose on local failure (LF), distant metastasis (DM), and toxicity was also assessed. Thirty-five patients ≥ 18 years old with grade 2 or 3 soft tissue sarcomas accessible for invasive thermometry were enrolled on the protocol. All patients received megavoltage external beam radiotherapy (RT) in daily fractions of 1.8-2.0Gy, five times a week, to a median total dose of 50Gy and an initial hyperthermia treatment (HT) of 1h duration utilizing the BSD 2000 with Sigma 60 or MAPA applicators at frequencies of 60-140MHz. Further HT was given for patients with CEM43° T[sub 90] > 0.5 after initial HT ('heatable' patients), twice a week to a maximum of 10 HT or CEM43° T[sub 90] > 100. Of the 35 patients entered, 30 had heatable tumours, one of which was inevaluable for pCR or LF as the patient died of DM prior to surgery, leaving 29 evaluable patients. Of these 29 patients, 15 (52%) had a pCR (95% CI: 37-73%), significantly less than the projected rate of ≥75% (p = 0.02). Of the 25 heatable tumours that achieved CEM43° T[sub 90] ≥10, 14 (56% ) had a pCR (95% CI: 39-78%) significantly less than the projected rate (p = 0.06). Three of the 29 patients (10% ) with heatable tumours had a LF, versus 1/5 unheatable tumours (p = 0.48). Fourteen of the 30 patients (47%) with heatable tumours developed DM, versus 2/5 unheatable tumours (p = 1.00). Ten of the 30 patients (33%) with heatable tumours developed treatment-induced toxicity. Thus, no correlation of thermal dose with histologic response was observed. Prospective control of CEM43° T[sub 90] failed to achieve the projected pCR rate following pre-operative thermoradiotherapy for high-grade soft tissue sarcomas, despite excellent local control. Possible explanations for this outcome are discussed. [ABSTRACT FROM AUTHOR]

Discusses a study on the contribution of thermochemoradiotherapy to the improvement of oxygenation in locally advanced breast cancer. Evaluation of the toxicity and efficacy of the treatment that consisted of concurrent taxane, radiotherapy and hyperthermia; Impact of the therapy on tumor hypoxia; Criticisms of the benefits of the actual treatment regimen.