Hehr T, Wust P, Bamberg M, Budach W
Klinik für Radioonkologie, Eberhard-Karls Universität Tübingen, Germany.
Onkologie. 2003 Jun;26(3):295-302. doi: 10.1159/000071628.
The disappointing results for inoperable, locally advanced or recurrent solid tumours of the uterine cervix, rectum, chest wall, liver and deep seated, high-risk sarcomas after conventional radiotherapy alone necessitate the search for improved treatments. A benefit from simultaneous radiochemotherapy with regard to local tumour control and survival has been shown for a rising number of tumour entities. Radiofrequency hyperthermia is established in only a few centres, and represents another option to intensify the effect of radio- and chemotherapy. Altogether 11 randomised phase III trials with more than 1,000 patients proved the combination of hyperthermia (40-42 degrees C for at least 1 h) and radiation therapy in reference to local tumour control. Two of these trials could demonstrate a survival benefit; e.g. in locally advanced cervical cancer, stage FIGO IIB-IVa, the 3-year survival was improved from 27 to 51% with the addition of hyperthermia. Frequently trial design (main endpoint local tumour control), a low number of patients or a short follow- up period are the reasons why most trials of thermoradiotherapy failed to demonstrate a survival benefit. Disadvantageous effects of hyperthermia like an increased rate of distant metastases as a result of hyperthermia-induced elevated perfusion can be largely ruled out. While at the moment the equivalence of thermoradiotherapy and radiochemotherapy is still under evaluation, future studies have to investigate the question whether hyperthermia can add benefits when used in combination with simultaneous radiochemotherapy. An ongoing investigation of hyperthermia in multimodal treatment strategies for locally advanced solid tumours is warranted. These trials will help to improve temperature monitoring and temperature distribution and define particular groups of patients who will profit from the addition of hyperthermia. The 'Interdisziplinäre Arbeitsgruppe Hyperthermie', a working group of the German Cancer Society, introduces clinical protocols, treatment devices, and provides information for patients at www.hyperthermie.org.
对于子宫颈、直肠、胸壁、肝脏等无法手术切除、局部晚期或复发的实体瘤以及深部、高危肉瘤，单纯常规放疗的效果令人失望，因此有必要寻找更好的治疗方法。越来越多的肿瘤实体已显示同步放化疗在局部肿瘤控制和生存方面具有益处。射频热疗仅在少数中心开展，是增强放疗和化疗效果的另一种选择。共有11项随机III期试验，涉及1000多名患者，证实了热疗（40-42摄氏度至少1小时）与放疗联合对局部肿瘤控制的效果。其中两项试验显示出对生存有益；例如，在局部晚期宫颈癌（国际妇产科联盟IIB-IVa期）中，加用热疗后3年生存率从27%提高到了51%。大多数热放疗试验未能显示出生存益处，原因通常是试验设计（主要终点为局部肿瘤控制）、患者数量少或随访期短。热疗导致远处转移率增加等不良影响，如因热疗引起的灌注升高所致，在很大程度上可以排除。目前热放疗与放化疗的等效性仍在评估中，未来的研究必须探讨热疗与同步放化疗联合使用时是否能带来额外益处。有必要对局部晚期实体瘤的多模式治疗策略中的热疗进行持续研究。这些试验将有助于改进温度监测和温度分布，并确定能从加用热疗中获益的特定患者群体。德国癌症协会的一个工作组“Interdisziplinäre Arbeitsgruppe Hyperthermie”在www.hyperthermie.org上介绍临床方案、治疗设备并为患者提供信息。
