The present challenge in the treatment of tumors is to reduce the number of patients that still die as a result of primary tumors. Today, the percentage of such deaths remains high at 30%, even when all the common therapeutic methods, namely surgery, radiotherapy, and chemotherapy, are applied. In order to reduce this percentage, new types of radiation sources with a higher linear energy transfer have been intro duced, such as neutrons and pions. Fractionation patterns have been modified and radiosensitizers have been applied to in crease biological efficiency. Studies of the combined application of chemotherapy and radiotherapy have been made to find the best therapeutic effect. In the early 1970s biological findings confirmed the effect of hyperthermia on tumor cells. The first clinical studies on hyper thermia treatment demonstrated that it resulted in better local tumor control. Further application of this treatment modality showed that hyperthermia should be used in addition to radio therapy and chemotherapy. Despite these encouraging results, hyperthermia has not been introduced into common clinical use, due primarily to technical problems. There are a number of methods of transferring heat into tumors; however, with regard to physical conditions, an op timum method has not yet been found. One of the reasons is that up to now we have had no reliable method of obtaining thermal mapping of all parts of the human body. Such measurements are required not only for dosimetric purposes but also for the regula tion of a hyperthermic system.

Physicians, biologists and physicists present their recent work in the field of hyperthermia with regard to both its application and its combination with radiation and chemotherapy. Current technical possibilities, clinical management and major aspects of its use for superficial and deep-seated tumors are pointed out. The main topics discussed are: changes of metabolism and microcirculation under heat conditions, the biological interaction of heat with X-rays and several chemotherapeutic agents, and the most recent clinical data from different institutions on the combined application in the treatment of cancer.

Oncothermia is the next generation medical innovation that delivers selective, controlled and deep energy for cancer treatment. The basic principles for oncothermia stem from oncological hyperthermia, the oldest approach to treating cancer. Nevertheless, hyperthermia has been wrought with significant controversy, mostly stemming from shortcomings of controlled energy delivery. Oncothermia has been able to overcome these insufficiencies and prove to be a controlled, safe and efficacious treatment option. This book is the first attempt to elucidate the theory and practice of oncothermia, based on rigorous mathematical and biophysical analysis, not centered on the temperature increase. It is supported by numerous in-vitro and in-vivo findings and twenty years of clinical experience. This book will help scientists, researchers and medical practitioners in understanding the scientific and conceptual underpinnings of oncothermia and will add another valuable tool in the fight against cancer. Professor Andras Szasz is the inventor of oncothermia and the Head of St Istvan University's Biotechnics Department in Hungary. He has published over 300 papers and lectured at various universities around the world. Dr. Oliver Szasz is the managing director of Oncotherm, the global manufacturer and distributor of medical devices for cancer treatment used in Europe & Asia since the late 1980s. Dr. Nora Szasz is currently a management consultant in healthcare for McKinsey & Co.

Contents Abdominal and Thoracic Magnetic Resonance Angiography: Challenges, Technical Approaches and First Clinical Applications. H.U. Kauczor, R. Hausmann, W. Semmler Magnetic Resonance Spectroscopy of Skeletal Muscle. F. Tr{ber, W.A. Kaiser, G. Layer, C. Kuhl, M. Reiser Hepatic Tumors: Relaxometry and Quantitative Tissue Characterization with Magnetic Resonance Imaging. A. Steudel, F. Tr{ber, M. Reiser Liver-Specific Particulate Contrast Agents: An Overview I. Ivancev, A. Lunderquist Contrast Medium Induced Nephropathy:Animal Experiments H.S. Thomsen et al. Rheological Properties of Blood after Diagnostic Cardiac Catheterisation with Iopromide. R. Bach et al. Color Coded Doppler Sonography of the Male Urethra During Voiding: New Observations of Flow in an Aqueous Medium and Their Physical Foundations. P. H}bsch, F. Hager, E. Benes Development of a Model of Arterial Stenosis Analysis Using Digital Subtraction Angiography: A Parametric Study of Image Quality. C. Renaudin, I. Magnin, A. Amiel Arterial Calcifications in Thoracoabdominal Computer Tomography: Frequency and Correlation with Risk Factors and Cardiovascular Diseases. J. Grich et al.

With contributions by numerous experts

Tumour therapy depends essentially on being able to destroy the clonogenic activity of tumour cells while keeping the damage to the normal tissue low. Clinical experience shows that tumour response varies greatly even if tumours with the same localisation, clinical, and histopathological staging are compared. Some tumours appear to be resistant to conventional radiotherapy (X-rays, y-rays or fast electrons) or chemotherapy. In these cases new therapy modalities are necessary. Combined therapy modalities seem to have advan tages for some resistant tumours; one possibility of such a treatment is to combine radiotherapy or chemotherapy with hyperthermia. This means that the local tumour, the tumour region or even the whole body of the patient has to be heated to temperatures between 40° to 45° C (in case of whole body hyperthermia to 42° C maximal) for a certain time (usually 30-60 min are adequate). Hyperthermia has a long tradition in medicine as a treatment modality for various diseases. Inscriptions of the old Egyptians and texts of the Greeks have pointed out its importance. Usually whole body hyperthermia has been used by the induction of fever. Local hyperthermia began around 1900 when Westermark treated unre sectable cervix carcinomas with hot water in a metallic coil. By the beginning of this century an increase of radiation effects was hy pothesised with hypothermia and later observed. However, only in the 1960s and 1970s were systematic investigations started which showed radiosensitisation and chemosensitisation by hyperthermia in cells and tissues including tumours.

"Internal" hyperthermia is a type of thermotherapy by which heat is sup plied to tumor tissue in situ. There are three different techniques for pro viding internal hyperthermia: (1) interstitial hyperthermia using implanted needle probes, (2) intracavitary hyperthermia using probes introduced into natural body cavities, and (3) perfusional hyperthermia by means of ex tracorporal blood heating. Compared with external hyperthermia, internal hyperthermia has been preferentially accepted by oncologists because it can be more easily combined with other forms of treatment, e. g., interstitial thermotherapy with brachytherapy, or perfusional hyperthermia with che motherapy. Various types of equipment for interstitial and intracavitary thermotherapy have been developed and used quite extensively in clinical trials, generally in combination with radiation therapy. There are four different methods for producing interstitial or intracavitary hyperthermia, each related to different types of heating. Most studies have been performed using radiofrequency electrodes (resistive heating) or coaxial microwave antennas (radiative heating). Recently, however, "hot source" techniques that rely on thermal conduction and blood flow convection for heat transport have found clinical application. These techniques include ferromagnetic implants activated by hot water or by electrical means. In the near future, new methods for in terstitial or intraluminal heating based upon advanced ultrasonic and laser technologies will be developed.