Wust P, Hildebrandt B, Sreenivasa G, Rau B, Gellermann J, Riess H, Felix R, Schlag P M
Department of Radiation Oncology, Charité Medical School, Campus Virchow Klinikum, Berlin, Germany.
Lancet Oncol. 2002 Aug;3(8):487-97. doi: 10.1016/s1470-2045(02)00818-5.
Hyperthermia, the procedure of raising the temperature of tumour-loaded tissue to 40-43 degrees C, is applied as an adjunctive therapy with various established cancer treatments such as radiotherapy and chemotherapy. The potential to control power distributions in vivo has been significantly improved lately by the development of planning systems and other modelling tools. This increased understanding has led to the design of multiantenna applicators (including their transforming networks) and implementation of systems for monitoring of E-fields (eg, electro-optical sensors) and temperature (particularly, on-line magnetic resonance tomography). Several phase III trials comparing radiotherapy alone or with hyperthermia have shown a beneficial effect of hyperthermia (with existing standard equipment) in terms of local control (eg, recurrent breast cancer and malignant melanoma) and survival (eg, head and neck lymph-node metastases, glioblastoma, cervical carcinoma). Therefore, further development of existing technology and elucidation of molecular mechanisms are justified. In recent molecular and biological investigations there have been novel applications such as gene therapy or immunotherapy (vaccination) with temperature acting as an enhancer, to trigger or to switch mechanisms on and off. However, for every particular temperature-dependent interaction exploited for clinical purposes, sophisticated control of temperature, spatially as well as temporally, in deep body regions will further improve the potential.
热疗是将负载肿瘤的组织温度升高至40 - 43摄氏度的一种治疗方法,作为一种辅助疗法与各种既定的癌症治疗方法(如放疗和化疗)联合使用。近年来,通过治疗计划系统和其他建模工具的发展,在体内控制功率分布的能力有了显著提高。这种深入的理解促使了多天线施源器(包括其转换网络)的设计以及电场(如电光传感器)和温度监测系统(特别是在线磁共振断层扫描)的实现。几项比较单纯放疗或放疗联合热疗的III期试验表明,热疗(使用现有标准设备)在局部控制(如复发性乳腺癌和恶性黑色素瘤)和生存率(如头颈部淋巴结转移、胶质母细胞瘤、宫颈癌)方面具有有益效果。因此,现有技术的进一步发展以及分子机制的阐明是合理的。在最近的分子和生物学研究中,出现了一些新的应用,如基因治疗或免疫治疗(疫苗接种),温度作为增强剂来触发或开启及关闭相关机制。然而,对于临床上利用的每一种特定的温度依赖性相互作用,在深部身体区域对温度进行精确的时空控制将进一步提升其潜力。
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