The aim of this study was to investigate the role of mild hyperthermia (39-40 degrees C) in isolated cytostatic perfusion for patients with recurrent melanoma of the extremities. A total of 218 patients treated with mild hyperthermic perfusion was compared to 166 patients perfused under controlled normothermic conditions (37-38 degrees C). Only patients whose lesions had been excised before or at the moment of perfusion were eligible for this study. A variety of prognostic factors was controlled for in a Cox proportional hazards analysis. The application of mild hyperthermia did not influence limb recurrence-free interval nor survival (corrected P values 0.46 and 0.18, respectively). In this retrospective comparative study, no benefit for mild hyperthermia in regional isolated perfusion could be identified.

METHODSThe treatment of a patient with soft-tissue sarcoma was evaluated with FDG-PET. A limb-saving complete remission of a locally advanced liposarcoma of the left thigh was achieved with isolated regional perfusion of the limb with tumor necrosis factor alpha, interferon gamma and melphalan.RESULTSPET with 18F-FDG before perfusion showed high glucose consumption in the tumor. After perfusion, glucose metabolism in the tumor was absent. Subsequent excision confirmed complete necrosis of the tumor.CONCLUSIONFDG-PET may be useful in evaluating the results of isolateral regional limb perfusion for soft-tissue sarcomas.

We describe the results of clinical and (or) surgical staging used by the same surgeon to select a group of 41 patients with advanced rectal cancer for preoperative radiotherapy. Fifteen patients with resectable but advanced rectal cancer were subjected to a short course of radiotherapy (30 Gy in 10 days), immediately followed by resection. High dose preoperative radiotherapy (50–56 Gy in 5 weeks) was administered to 26 patients with borderline resectable or fixed cancer. Adequate resection of the tumour was possible in 21 of these 26 patients 4 weeks after the end of the radiotherapy. A total of 36 patients thus underwent resection after preoperative radiotherapy. No radiotherapy related acute or late morbidity was seen. On 31 December 1992 the results were investigated retrospectively. The median time since entering into the study was 87 months (range 27–141). During the follow-up, pelvic recurrence was detected in six patients; one patient had concomitant distant metastases. The local recurrence free survival at 5 years calculated by the Kaplan-Meier method was 72% (95% CI 58–85). Distant metastases without local recurrence developed in 11 patients. The calculated survival at 5 years was 45% (95% CI 30.5–59).

A malignant bone tumour may develop in the femur of a child. In the majority of cases it will be necessary to resect the bone involved, growth plate and adjacent tissues. A modular endoprosthetic system has been developed which can be extended non-invasively to bridge the defect resulting from such a resection. Elongation is achieved by using an external magnetic field. In vitro tests with a prototype showed that the lengthening element met all requirements. Six animal experiments showed that the lengthening element also functioned in vivo.

Purpose: The purpose of the study is to obtain dose guidelines for the delivery of intraoperative radiotherapy to the liver of patients with colorectal liver metastases. Following partial resection of the liver, a single high dose of 10, 20, 25, and 30 Gy intraoperative radiotherapy was applied to both the resection plane as well as a nonsurgically manipulated part of the liver of 25 beagles. The temporal sequence of histological and ultrastructural changes of these irradiated parts of the liver tissue was investigated.Methods and Materials: The feasibility of delivering single large dose of intraoperative electron beam radiotherapy to the normal and partially hepatectomized liver was experimentally investigated in a canine study.Results: There were no postoperative complications, no morbidity or mortality with a minimal follow-up of 1 year. Autopsy performed 3 months following irradiation showed only mild histopathological changes. One year following intraoperative radiotherapy more distinct histopathological changes consisting of capsular thickening, diffuse parenchymal fibrosis and subcapsular hepatocellular atrophy were found. The liver function remained intact.Conclusion: This study demonstrated that intraoperative radiotherapy to part of the liver in the canine model can be safely applied and doses up to 30 Gy are well tolerated.

Twenty patients with advanced primary or locally recurrent pelvic tumours treated by total pelvic exenteration are described. There wer no operative or postoperative deaths. The most frequent postoperative complications appeared to be related to previous irradiation. Four patients developed non-fatal intestinal complications within 30 days of operation that required further surgery. After a mean follow-up of 19 months the crude 2-year survival rate was 40 per cent. This procedure is judged to be useful in a selected group of patients.

During the last two decades increasingly complex surgical techniques have been developed to improve the resection rate in the surgical treatment of cancer. There is an enormous growth in the development of new chemotherapeutic agents, and in the insight in chemotherapy treatment regimens. Since growth factors became available, high dose intensive chemotherapy combined with autologous bone marrow transplant can be performed with a low morbidity and mortality rate. Within radiation oncology technical advances in methods of radiation therapy, including the use of computerized planning (3D) treatment and conformal treatment have decreased the radiation-induced morbidity. To increase the radiation effect, e.g. to improve local control, without increasing radiation toxicity, hyper fractionation, radiation-sensitizers, and radiation-protectors were clinically investigated. New radiation techniques and equipment like brachytherapy (BT) units and intraoperative radiotherapy (IORT) became available. All these new techniques are today also used in the treatment of cancer as a combined modality treatment, with the idea to improve the local control rate, the disease free-, and overall survival without increasing or inducing treatment morbidity, and more over to prevent multilating surgical procedures.

Posterolateral neck dissection, alone or combined with a modified radical neck dissection, may be an appropriate method of treating occult and clinically manifest nodal metastases of malignant epithelial tumours of the skin of the posterior scalp. The technique and results are described in 21 patients treated between February 1981 and November 1989. Transformation of nodal status from cN0 to pN+ was seen in five of 13 patients treated electively, who may benefit from such a procedure. During a mean follow-up of 47 months the disease was controlled locally in all patients. Three patients suffered regional recurrence of whom only one had a nodal recurrence within the region previously operated on. The results of this limited retrospective study confirm the value of posterolateral neck dissection in posterior scalp lesions.

Osteosarcoma may affect any bone but is mainly encountered in long bones like the femur and is rarely observed in flat bones [1]. According to Schajowicz

The majority of patients with soft tissue sarcoma (STS) or bone sarcomas (BS) of the upper limb can be treated today with limb saving procedures using combined modality therapies. However, for a small group of patients the interscapulothoracic (IST) amputation is the only final surgical treatment with either a curative or a palliative intent. Since 1972, 12 patients seven males and five females, median age 36 years (range 13-82) underwent an interscapulothoracic amputation; five for bone sarcomas, five for soft tissue sarcoma and two for locoregional metastases. There was no post-operative mortality or morbidity. During a median follow-up of 8 years (range 0.25-15), there was no local recurrence. The five-year survival rate for the soft tissue sarcomas was 80% and for the bone sarcomas 30%. The interscapulothoracic amputation is one of the major ablative surgical procedures which should be performed with curative intent, very rarely with a low palliative intent. The prognosis of an interscapulothoracic amputation for shoulder girdle malignancies is not different from extremity soft tissue sarcomas or bone sarcomas located more distally. The morbidity and local recurrence rate after interscapulothoracic amputation should be negligible.

19 consecutive patients underwent a posterolateral neck dissection (PLND) in continuity with a wide excision of the primary melanoma on the posterior scalp. After a mean follow-up of 74 months, 5 patients are alive with minimal morbidity. PLND can safely be performed, even bilaterally, as an elective or therapeutic procedure in posterior scalp melanoma.

Background. Hyperthermic isolated limb perfusion (HILP) has been shown to be effective for locoregional metastases or local recurrent disease. Locoregional recurrences after previous HILP is an unsolved problem.Methods. HILP with cisplatin, 20-30 mg/l perfused limb volume, was performed in seven patients with recurrent melanoma (five with Stage IIIA and two with Stage IIIAB) after previous HILP with melphalan with or without dactinomycin. A cisplatin perfusion without local excision was performed in four patients; this treatment resulted in two complete responses and one partial response. In three patients, a cisplatin perfusion was performed with local excision of the in-transit metastases.Results. During a median follow-up of 20 months (range, 10-25 months), in five (83%) patients the tumor recurred locally after a median period of 5 months (range, 3-11 months). No systemic toxicity was observed. Local toxicity consisted of postperfusion edema and neurotoxicity in all patients. The edema resolved within 2 weeks, which was in contrast to persistent neurotoxicity. A severe motor-sensory neuropathy was observed in three (43%) patients and mild sensory neuropathy in four (57%) patients.Conclusions. The severe neurotoxicity and the high local recurrence rate do not justify the use of HILP with cisplatin for recurrent melanoma after previous HILP with melphalan with or without dactinomycin.

Intraoperative electron beam radiotherapy (IORT) is clinically used as a potential adjunctive treatment to surgery of locally advanced pancreatic and gastric cancer. The tolerance of the pancreas to IORT was studied in 15 adult beagles, divided in 3 groups of 5 beagles in which 25, 30 or 35 Gy IORT was delivered through a 6-7 cm circular lucite cone with 6-8 MeV electrons to the pancreas and medial wall of the duodenum. The dogs were followed for endocrine and exocrine pancreatic insufficiency. Two dogs (13%) developed radiation-induced morbidity which consisted of a common bile duct stenosis and an enterocolic fistula, as was confirmed at autopsy after 8 and 18 months, respectively. After a follow-up of 1 year, none of the dogs had developed pancreatitis, diabetes or exocrine insufficiency. There was a significant reduction in serum insulin levels and glucose clearance rates without overt diabetes for 30 Gy and 35 Gy (p < 0.05). No significant changes were found for 25 Gy. This study suggests that 25 Gy IORT to the pancreas may be used clinically, and that higher IORT doses may induce endocrine pancreatic insufficiency in the long-term.

Groin dissection was performed in 151 consecutive patients from 1970 to 1984. Groin dissections were therapeutic in 138 cases (91%) and elective in 13 (9%). One hundred forty-three patients (95%) underwent an ilioinguinal node dissection, while eight (5%) were treated with an inguinal node dissection. In 88 patients, the groin dissection was combined with isolated regional perfusion. Primary wound closure was performed in 140 patients (93%). There was no 30-day postoperative mortality. Complications included temporary seroma (26 [17%] of 151 patients), wound infection (14 patients [9%]), wound necrosis (five patients [3%]), and edema (30 patients [20%]). Residual inguinal node metastases after groin dissection did not occur. Morbidity of groin dissection did not increase when the groin dissection was combined with isolated regional perfusion. Quantification of the degree of edema in 66 patients revealed functional limitation due to edema in three patients (4.5%). This technique of groin dissection gives good results with minimal functional morbidity of the affected leg.