Kerner T, Deja M, Ahlers O, Löffel J, Hildebrandt B, Wust P, Gerlach H, Riess H
Department of Anesthesiology and Intensive Care Medicine, Charité Medical Center, Virchow Hospital, Humboldt University, D-13 353 Berlin, Germany.
Intensive Care Med. 1999 Sep;25(9):959-65. doi: 10.1007/s001340050989.
To establish the safety of systemic Cancer Multistep Therapy (sCMT) including whole body hyperthermia, by means of hemodynamic, laboratory and clinical investigations.
Prospective study.
University clinic.
12 patients with various cancers (with sCMT), a second group of 20 patients with colorectal carcinoma treated with chemotherapy (without sCMT).
25 treatments with sCMT for 60 min at 41.8 degrees C (including chemotherapy) were given in addition to induced hyperoxemia and hyperglycemia under general anesthesia.
Invasive monitoring of systemic and pulmonary hemodynamics as well as pulmonary gas exchange was used at 37 degrees C, 40 degrees C, 41.8 degrees C and 39 degrees C. In addition, laboratory parameters were measured before and within 4 days of therapy. At 41.8 degrees C, invasive monitoring showed characteristic signs of hyperdynamic circulation. In addition, right-to-left shunt, oxygen consumption, oxygen delivery and lactate levels were significantly different from pretreatment values. At the end of therapy, lactate levels and the extravascular lung water index increased, whereas all other parameters showed a clear tendency to return to initial values. Within the first day after sCMT, we measured a slight but significant reversible increase in serum creatinine compared to pretreatment values, but found no significant alterations of other chemical parameters. Between the sCMT group and controls, there was only a temporary significant difference in aspartate aminotransferase levels 2 days after therapy.
sCMT, including whole body hyperthermia, accompanied by suitable anesthesiological management and monitoring, does not lead to any serious or sustained organ dysfunction and can therefore be regarded as a safe therapy.
通过血流动力学、实验室及临床研究，确定包括全身热疗在内的系统性癌症多步骤疗法（sCMT）的安全性。
前瞻性研究。
大学诊所。
12例患有各种癌症的患者（接受sCMT治疗），另一组20例接受化疗的结直肠癌患者（未接受sCMT治疗）。
在全身麻醉下，除诱导性高氧血症和高血糖外，给予25次sCMT治疗，在41.8摄氏度下持续60分钟（包括化疗）。
在37摄氏度、40摄氏度、41.8摄氏度和39摄氏度时，对全身和肺血流动力学以及肺气体交换进行有创监测。此外，在治疗前及治疗后4天内测量实验室参数。在41.8摄氏度时，有创监测显示出高动力循环的特征性体征。此外，右向左分流、氧耗、氧输送和乳酸水平与治疗前值有显著差异。治疗结束时，乳酸水平和血管外肺水指数升高，而所有其他参数均显示出明显的恢复至初始值的趋势。在sCMT治疗后的第一天内，与治疗前值相比，我们测量到血清肌酐有轻微但显著的可逆性升高，但未发现其他化学参数有显著变化。在sCMT组和对照组之间，治疗后2天，天冬氨酸转氨酶水平仅存在暂时的显著差异。
sCMT，包括全身热疗，辅以适当的麻醉管理和监测，不会导致任何严重或持续性器官功能障碍，因此可被视为一种安全的治疗方法。
