**4.14. Role of hyperthermia in treatment of cervical cancer patients**

160 Hyperthermia

15, and 16 months after ablation (48) .

treatment options include RFA or embolization.

**4.13. RFA of malignant biliary obstruction** 

surgical resection, had a significantly higher rate of recurrence (90.9%) than did patients who underwent resection alone (57.1%). However, this difference probably reflects a selection bias, since RFA was never used for patients whose tumors were resectable. Patients who were treated with RFA either alone or as a combined modality with resection also had a shorter disease-free interval (7.4 months) than patients who underwent resection alone (18.6 months). Avritscher et al reported three advanced GIST patients whose focal liver progression was successfully treated with RFA. The patients remained progression-free at 8,

In an ASCO poster presentation, Dileo et al reported treating 9 patients with percutaneous CT-guided RFA for single or limited site(s) of progressing disease (8 liver lesions and 1 soft tissue lesion). Thee were no complications from the RFA procedure. With median follow-up of 4.2 months (range 1-11 months), all patients had their lesions completely ablated. Five patients developed systemic progression, while 4 patients remain stable on continued treatment with imatinib (median follow-up 5.8 m). The authors concluded "In this small cohort, percutaneous RFA appears to be a safe and effective treatment for localized sites of progression. This procedure helps to manage limited IM-resistant GIST. Continuation of imatinib to control systemic sites of imatinib-sensitive GIST despite emergence of limited

Evaluating the evidence about RFA for GIST. RFA appears to be a viable palliative option for patients with advanced GIST who develop focal progression of liver or peritoneal disease during imatinib therapy and who are not otherwise candidates for surgical resection. Alternatively, RFA offers a potentially curative option for patients who exhibit a partial response to imatinib and have focal residual disease that is not amenable to surgical resection .The guidelines (NCCN, 2010) also recommend the use of RFA for the treatment of gastrointestinal stromal tumors with limited progression. Progression is defined as a new lesion or increase in tumor size. The NCCN guidelines state that, for limited progressive disease that is potentially easily resectable, surgical resection should be considered. Other

In an open-label, pilot study, Steel et al in 2011 examined the safety of endobiliary bipolar RFA in patients with malignant biliary obstruction and reported the 90-day biliary patency of this novel procedure. Main outcome measures were immediate and 30-day complications as well as 90-day stent patency. A total of 22 patients (16 pancreatic, 6 cholangiocarcinoma) were includedin this study. Deployment of an RFA catheter was successful in 21 patients. Self-expandable metal stents (SEMSs) placement was achieved in all cases of successful RFA catheter deployment. One patient failed to demonstrate successful biliary decompression after SEMS placement and died within 90 days. All other patients maintained stent patency at 30 days. One patient had asymptomatic biochemical pancreatitis, 2 patients required percutaneous gallbladder drainage, and 1 patient developed rigors. At 90-day follow-up, 1 additional patient had died with a patent stent, and 3 patients had occluded biliary stents.

clonal resistance can be justified on the basis of this exploratory work." (49)

Today, the technique is a standard treatment for patients with advanced cervical cancer, or patients with less advanced cervical cancer that cannot clinically tolerate chemotherapy. It is recommended and used as an alternative to the international gold standard of combined radiation therapy and cisplatin-based chemotherapy (51). The Dutch Deep Hyperthermia Trial, conducted between 1990 and 1996 and published in the Lancet in 2000, was a prospective, randomized trial that compared the outcomes of 358 patients with advanced bladder, cervical, and rectal tumors. Half of the patients received only radiation therapy and the other half received both radiation therapy and hyperthermia. Three-year outcomes revealed that hyperthermia improved both pelvic control and overall survival rates, but seemed to be most effective for patients with advanced cervical cancer (52). At 36 months, of an original cohort of 114 patients with advanced cervical cancer, the 58 patients receiving both treatments showed a complete response rate of 83%, compared with 57% for the 56 patients who only received radiation therapy. The survival rate was 51% for the combined treatment group, compared with 27% for the radiation therapy-only group. Furthermore, hyperthermia treatments did not enhance radiation toxicity and were reported to be cost-effective

However, long-term outcomes (**12-year follow-up)** was addressed by a follow-up study published in 2008 that tracked outcomes for both groups 12 years following treatment. The patients who received the combined treatment continued to have significantly better outcomes. The outcomes for the combined therapy group remained consistent. At the end of the study period, 37% of this group was still alive, compared with 20% who received radiation only. Of the combined therapy group, 56% retained pelvic tumor control, compared with 37% for the radiation therapy group. Pelvic recurrence developed in 25% of the combined therapy group and 31% of the radiation therapy group. Approximately onethird of both cohorts developed distant metastasis. Both groups experienced the same number of grades 3-5 radiation-induced toxicities (53).
