Masters, Andrew; (1994) Interstitial laser hyperthermia for solid organ tumours. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

This thesis describes the potential use of interstitial laser hyperthermia (ILH) to treat certain solid organ tumours. In addition, the influence of tissue optical characteristics on laser tissue interaction is investigated and a novel technique for assessing the extent of laser mediated necrosis is described. The first 3 chapters give a brief description of lasers in medicine, a review of hyperthermia and discuss the principles and current status of ILH respectively. Chapter 4 identifies areas of research for this thesis with an explanation of the rationale and potential clinical benefits. Chapter 5 discusses the problems of detecting and treating hepatic metastases. The management of solid organ tumours remains on the whole unsatisfactory. A simple, non-invasive technique is required which can arrest or retard tumour growth. In principle, ILH may fulfil such a role. Chapters 6, 7 and 8 describe the results of clinical feasibility studies treating patients with hepatic, pancreatic and breast cancer using ILH with percutaneous fibre placement under ultrasound guidance. A total of 22 patients were successfully and safely treated. All showed radiological and or histological evidence of at least partial tumour necrosis. Fundamental to the safe application of ILH in oncology is an understanding of the elements determining the outcome of laser tissue interaction. Tissue optical characteristics is one such factor and chapter 9 studies a subcutaneous tumour comparing reproducibility and the extent of necrosis with normal liver using comparable laser parameters. In liver, the extent of necrosis was significantly larger emphasizing the importance of light scattering in enhancing the biological effect. Success of ILH depends on matching the extent of laser mediated necrosis to the tissue volume under treatment. Current techniques assessing the extent of laser mediated necrosis in solid organs are relatively crude. Chapter 10 studies a novel approach using laser doppler flowmetery to enhance precision of predicting the extent of necrosis. Results were sufficiently encouraging to merit further work. Chapter 11 concludes with a brief discussion of future areas of research and development.

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