Surgery for esophageal cancer is a very difficult operation, even today with modern medical techniques. One of the most important aspects of such surgery is the difficulty of reconstructing the esophagus. In such a surgical procedure, the stomach and intestines are used to provide material to repair any esophageal damage, thus requiring a large and extensive operation which is difficult with elderly patients. Although an improvement in prognosis for the quality of life can be expected if the cancer is resectable, there are a many cases which are diagnosed too late for effective surgery. To help these patients, a peristalsis stent with a hyperthermia function was developed for use with terminal esophageal cancer patients when surgery is not an option. The peristalsis stent with a hyperthermia function has three characteristics : 1) It is completely noninvasive ; 2) hyperthermia can be delivered to the carcinoma tissue ; and 3) it incorporates a peristalsis function. This stent is expected to provide an alternative tool for the treatment of terminal esophageal cancer.

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The ultimate goal of cancer treatment is to achieve a complete eradication of the cancer. However, patients with terminal cancer are also treated to obtain an improvement in their quality of life (QOL).
In this report, we describe the dramatic response of an end-stage pancreatic cancer patient with cachexia to a combination of hyperthermia (HT) and chemotherapy (CH). The patient was treated with a combination of intermittent 5-FU/cisplatin (CDDP) therapy and HT. Three months later, the local recurrent cancer had disappeared, the liver metastases were reduced by 80%, the lung metastatic lesion was markedly reduced, tumor markers had returned to normal, and the cachexia had been almost reversed. Performance status (PS) improved from 4 to 1, QOL improved, and the patient survived until his 258th hospital day.
In this patient, the combination of CH and HT was useful not only for improvement of cachexia, but also for tumor reduction. A possible mechanism leading to this effect is discussed.

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Hyperthermia is considered to be a treatment capable of a direct cytocidal effect, following 3 primary modalities for cancer treatment : surgery, radiotherapy, and chemotherapy. Usually, success in raising a tumor's temperature to 43°C or above produces a strong anticancer effect both in vitro and in vivo, and a change of the inactivation energy of cells occurs at temperatures above 43°C. Although the cytocidal effect of mild hyperthermia (below 43°C) is negligible, such a treatment often appears to enhance the sensitivity of tumors to anticancer drugs, cytokines, and low-dose-rate irradiation. It has also been reported that mild hyperthermia, even when applied locally, increases immunological competence and enhances cytocidal effects via immunological responses. Heat shock proteins (HSPs), are molecular chaperones believed to be involved in thermoresistance events during hyperthermia, and also involved in the enhancement of immunological competence. Although immunotherapy and hyperthermia have fallen short of expectations, these two approaches, when combined appropriately, may provide synergistic treatments more effective than expected of either alone. The mechanism of hyperthermia action is also being studied at the genetic level, and the possibility of molecule-targeted treatments coupled with hyperthermia aimed at specific target genes is being studied. In this report, the present state of these approaches is described.

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The aim of the work described here was to develop a magnetic resonance (MR) technique for guiding a Focused Ultrasound Surgery (FUS) focal point to a specific target in the liver, which is mobile and deforms with respiration. In the present approach, vessels were used as landmarks for liver tissue tracking. The translational distances and amount of expansion and contraction of the tissue were analyzed by locating the center of gravity of veins by filtering the sagittal, cine MR images of the liver during free breathing. Target locations at which the FUS foci were to be located were identified using information provided by the positions of the veins at each time point. In healthy volunteer experiments (N=2), the lower limit of the spatial matrix dimension for delineating the contour of the veins was 128×128. The average displacement of the liver was 19.6±3.6 mm in the superior-inferior (SI) direction and 3.1±1.4 mm in the anterior-posterior (AP) direction. The deformation was 3.7±1.1 mm in the SI direction and 3.0±1.2 mm in the AP direction. The gaps between the actual and the estimated target points were 0.7±0.5 mm SI, 0.6±0.4 mm AP, and 1.0±0.5 mm linearly with the vessel combinations used in this work. Temperature elevations simulated by using a bio-heat transfer equation revealed that the temperature elevation loss around the center of the focus in the liver under target tracking was about 20% of that occurring with breath holding. These results suggest that the proposed technique is sufficiently accurate for targeting the FUS focus on a specific tissue location and for tracking the slice slab for thermometry to observe regional heating.

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