Sagowski Christoph, Jaehne Michael, Kehrl Wolfgang, Hegewisch-Becker Susanna, Wenzel Sören, Panse Jens, Nierhaus Axel
Klinik und Poliklinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany.
Eur Arch Otorhinolaryngol. 2002 Jan;259(1):27-31. doi: 10.1007/pl00007524.
Previous studies have reported synergistic effects of combined hyperthermia and chemotherapy and/or irradiation. The discussed underlying mechanism for this effect is an synergistic cytotoxic and radiosensitizing effect of hyperthermia. In addition, tumor blood-flow and, consequently, tumor oxygenation are increased during hyperthermia. Tumor response to irradiation and chemotherapy of well-oxygenated and vascularized tumors, in general, is superior to that of hypoxic tumors. Therefore, tumor oxygenation is recognized as an important predictive factor in the therapy of malignant tumors. Technically, the head-neck area remains outside the hyperthermia chamber during whole-body hyperthermia (WBH) as currently applied in a number of cancer treatment regimens. The aim of this therapeutic approach was to evaluate whether the blood flow during WBH also increased in the head-neck region and, if so, whether tumor oxygenation increase accordingly.
A 60-year-old male Caucasian patient, with the original diagnosis of pT3 pN2b M0 squamous cell carcinoma of the oral cavity, who had undergone primary surgery and irradiation (total dose 60 Gy), developed three local recurrences with consecutive surgical resection, presenting now with another recurrent local tumor (histologically confirmed) without surgical or radiotherapeutical options due to lymphangiosis carcinomatosa. WBH was applied under full anaesthesia, using a humidified radiant heat device (Enthermics Medical Systems RHS-7500) in combination with synchronous application of chemotherapy (ifosfamide and carboplatin). Four cycles of this combined treatment (one cycle per month) were given. Tumor oxygenation and temperature were continuously monitored by Licox catheters by means of one point measurement during each treatment (3.5 h).
With a latency of 10 min, the increase of intratumoral temperature in the oral cavity was comparable to reference values in the esophagous. Maximum intratumoral temperature (oral cavity) was 41.8 degrees C (F). The average increase of tumor oxygenation was more than 100% in each individual cycle. Clinically, a partial tumor response was observed.
During combined WBH and polychemotherapy, oxygenation is also significantly improved in a tumor in the head and neck area despite the fact that head and neck area remains outside the hyperthermia chamber during WBH. Intratumoral temperatures achieved are comparable to esophageal and rectal temperatures obtained during WBH.
先前的研究报道了热疗与化疗和/或放疗联合应用的协同效应。对此效应所讨论的潜在机制是热疗具有协同细胞毒性和放射增敏作用。此外，热疗期间肿瘤血流量增加，进而肿瘤氧合增加。一般来说，氧合良好且血管化的肿瘤对放疗和化疗的反应优于缺氧肿瘤。因此，肿瘤氧合被认为是恶性肿瘤治疗中的一个重要预测因素。从技术上讲，在目前许多癌症治疗方案中应用的全身热疗（WBH）期间，头颈部区域处于热疗舱外。这种治疗方法的目的是评估WBH期间头颈部区域的血流量是否也会增加，如果增加，肿瘤氧合是否相应增加。
一名60岁的男性白种人患者，最初诊断为口腔pT3 pN2b M0鳞状细胞癌，曾接受过原发手术和放疗（总剂量60 Gy），出现三次局部复发并连续进行了手术切除，现又出现另一处复发性局部肿瘤（经组织学证实），由于淋巴管癌病而没有手术或放疗选择。在全身麻醉下进行WBH，使用加湿辐射热装置（Enthermics Medical Systems RHS - 7500）并同步应用化疗（异环磷酰胺和顺铂）。给予四个周期的这种联合治疗（每月一个周期）。在每次治疗（3.5小时）期间，通过Licox导管通过单点测量连续监测肿瘤氧合和温度。
延迟10分钟后，口腔内肿瘤温度的升高与食管中的参考值相当。肿瘤内最高温度（口腔）为41.8华氏度。在每个单独周期中，肿瘤氧合的平均增加超过100%。临床上观察到部分肿瘤反应。
在WBH与多药化疗联合应用期间，尽管在WBH期间头颈部区域处于热疗舱外，但头颈部区域肿瘤的氧合也显著改善。所达到的肿瘤内温度与WBH期间获得的食管和直肠温度相当。
