温熱療法による疼痛の軽減効果について検討した.激痛を来したPancoast型肺癌, 直腸癌の再発例に放射線療法との併用を行い良好な徐痛効果を得た.温熱療法は放射線の耐容量を照射された症例にも頻回に使用でき, 除痛には温熱単独にても効果が認められた.進行癌や再発癌の疼痛緩和に温熱療法は有用であると考えられた.

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The results obtained in cases inoperable advanced cancer of the thoracic esophagus were reviewed with consideration of improvement in QOL.
42 patients were divided into 4 groups; 15 received hyperthermia (HT group), 8 radiochemotherapy alone (RC group), 8 bypass operation and 11 endoscopic endoprosthesis. On evaluation of local response, the response rate was 80% in the HT group and 50% in RC group with a significant differences. Five of 6 cases which could not receive oral intake before treatment showed two steps or more improvement in the HT group. Oral intake was considered impossible in only one patient. In the RC group, there was only one case which achieved 2 step improvement. Oral intake was impossible in four of 8 patients in this group. “Effective oral intake period” and “effective oral intake ratio” were calculated in terms of the length of time during which patients had effective oral digestion. An effective oral ratio of more than 90% was achieved in 5 cases in the HT group, but in only one in the RC group. Five of these six cases showed complete response to combined therapy. Therefore, it was suggested that downsizing of the tumor may lead to improvement of oral intake. The average period of staying at home were 167.3 days in the HT, 45.6 days in the RC, 0.88 days in BO, and 57.1 days in EP group. Three patients in HT and only one in RC group were allowed to remain at home for more than 90% of their survival period. The majority of patients, however, had an at home index below 30%.
Radiochemotherapy combined with hyperthermia for nonresectable esophageal cancer may increase improvement of QOL in cases showing good response. Cases that showed no change or progressive disease could neither achieve improved oral intake nor liberation from hospitalization and had a poor QOL. Therefore, early management of malignant stricture after radiochemotherapy combined with hyperthermia, for example endoscopic prosthesis, is recommended in cases which show no change or progressive disease.

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The influence of irradiation and/or hyperthermia on the wound healing in the rats was studied. In this study, an exteriorized segment of the small intestine or the skin of the right foot was exposed to single doses of irradiation (15Gy), local hyperthermia (44°C, 30 minutes), or irradiation plus hyperthermia. After the treatment, intestinal anastomosis or skin suture was performed. The wound healing was assessed by the bursting pressure of the anastomosis, by the tensile strength of suture of the skin, by the hydroxyproline concentration of the tissue around the anastomosis or the skin suture. The wound healing was significantly deteriorated in the group of irradiation. On the other hand, there was no difference in wound healing between the group of hyperthermia and the control group. In the group of combined irradiation and hyperthermia, depressed wound healing was observed. However in this group further deterioration of wound healing was not observed comparing to the irradiation group. It was concluded that under the conditions of this experimental model, hyperthermia did not cause any significant deterioration of wound healing of the intestinal anastomosis and the skin suture.

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Ultrasonically induced heating methods are discussed. The heating characteristics are dependent on the construction of an ultrasound applicator, in the same way as in the electromagnetic heating methods. In this paper, a single-plane heating method is investigated theoretically with ring-function and experimentally with agar-graphite mixture phantoms. The results show that in order to obtain uniform heating distributions, it is effective to use a single plane applicator with a hole on the center and to scan the heating ultrasonic frequency.

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現在, 超音波加温とマイクロ波加温の欠点を補うために, 超音波とマイクロ波の同時照射の研究が行われているので, 本研究では電磁波加温と超音波加温の両者に使用可能なサーミスタの開発を行った.温度検出部にSiCセラミックサーミスタを用いリード線にSiC繊維を使用した電磁波の干渉を受けないオールセラミックサーミスタにさまざまな材料でシールドを行い, 超音波照射時とマイクロ波照射時のノイズを評価した.その結果, ステンレスでシールドしたオールセラミックサーミスタは超音波照射実験とマイクロ波照射実験の両者でノイズが認められなかった.これは, オールセラミックサーミスタのコーティング用のテフロンとステンレスの界面で超音波の反射があり, またステンレスによる超音波の吸収があるためにサーミスタの温度検出部が超音波のエネルギーを直接吸収しないためであると考えられる。本研究で開発したサーミスタは, 超音波加温とマイクロ波加温の両用サーミスタとして極めて有望であると考えられる。

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本報では, 臨床応用のための基礎的研究として多点温度計測に基づき, 限られた領域の加温中の実時間温度分布推定を線形補完法により試みた.電波レンズアプリケータ付き430MHzマイクロ波加温装置を用いて, 筋肉等価寒天ファントムを加温中に, ファントム内に挿入した熱電対アレイによる実測値を基にファントム内の温度分布を推定した.さらに, 面状ヒータを用いて血流ファントムの加温実験を行い, 同様な方法でファントム内の温度分布を求めて実測値と比較した.その結果, いずれの場合とも推定温度と実測温度の間には比較的良い一致が認められた.本方法は, ハイパーサーミアの臨床における限られた領域の温度分布推定法, 或いは他の温度分布推定法のための誤差補正法として極めて有望であると考えられる.

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ヒト結腸の腺癌由来のHT-29細胞の多細胞のスフェロイドを構築し, MMCと温熱の併用効果を細胞生残率曲線を基に検討した.その結果, 多細胞スフェロイドで見られるMMC抵抗性コンポーネントは, 温熱により大きく増感され, 固形腫瘍に対するMMCと温熱の併用の有効性が示唆された.

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再発癌および切除不能癌47例に対し温熱化学療法を施行した.温熱療法は13.5MHzRF波誘電加温装置を使用し, 併用化学療法にはCDDP 10mgおよびMMC4mgを温熱療法と同時に点滴静注した.4回以上の有効加温を施行し得た29例に関し温熱化学療法の効果を臨床的に検討した.腫瘍縮小効果判定が可能であった20例においてCR1例, PR5例で奏功率は30%であった.腫瘍マーカーが治療前値の50%以下に低下した症例は12/25例 (48.0%) であった.Performance statusの改善を13/29例 (44.3%) に, 臨床症状の改善を17/29例 (58.6%) に認めた.温熱化学療法はPerformance status の grade2までが適応と思われた.以上より温熱化学療法は腫瘍縮小効果に加え, 腫瘍マーカー値や臨床症状の改善から考慮すると有用な治療法と思われた.

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