Bischoff J, Lindner L H, Issels R D, Costa S
Universitätsfrauenklinik der Medizinischen Fakultät, Otto-von-Guericke-Universität, Magdeburg.
Zentralbl Gynakol. 2006 Oct;128(5):255-60. doi: 10.1055/s-2005-872560.
In the last decade progress in gynecological oncology has been achieved mainly by new cytotoxic drugs and advances in radiation technology. For example, the use of taxanes in the primary therapy of ovarian cancers and of combined radio-chemotherapy in cervical cancer has led to significant prolongations of survival. However, in case of relapse most gynaecological malignancies are associated with very poor prognosis. Efficacy of local and systemic therapy can be increased by combining radiotherapy and/or chemotherapy with locoregional hyperthermia (LRH). Increasing the temperature of the target tissue up to 41-43 degrees C leads to local hyperaemia and the tumor tissue becomes more responsive to cytotoxic interventions. In several prospective randomized studies the combination between LRH and radiotherapy was superior to radiotherapy alone in terms of local control (e. g. chest wall recurrence in breast cancer) and has led to longer overall survival in advanced cervical cancer. Platinum derivatives and other cytotoxic drugs have shown synergistic effects with LRH and the combination of both has elicited high response rates in recurrent cervical cancer. In phase-II-clinical trials the newly developed liposomal anthracyclines demonstrated synergistic effects with LRH in patients with refractory ovarian cancer. Our own experience has shown that adding LRH to radio- and/or chemotherapy is well tolerated by the patients. Despite of the fact, that the available data are still preliminary, the inclusion of LRH into multimodal cancer therapy concepts appears to be very promising. Well-designed comparative studies are still needed to evaluate the role of hyperthermia as an adjunct to conventional cancer therapy.
在过去十年中,妇科肿瘤学的进展主要得益于新型细胞毒性药物和放射技术的进步。例如,紫杉烷在卵巢癌的一线治疗中的应用以及同步放化疗在宫颈癌治疗中的应用,显著延长了患者的生存期。然而,大多数妇科恶性肿瘤复发时预后都很差。将放疗和/或化疗与局部区域热疗(LRH)相结合,可以提高局部和全身治疗的效果。将靶组织温度升高至41-43摄氏度会导致局部充血,肿瘤组织对细胞毒性干预的反应性增强。在几项前瞻性随机研究中,LRH与放疗联合应用在局部控制(如乳腺癌胸壁复发)方面优于单纯放疗,并延长了晚期宫颈癌患者的总生存期。铂类衍生物和其他细胞毒性药物已显示出与LRH具有协同作用,两者联合应用在复发性宫颈癌中产生了较高的缓解率。在II期临床试验中,新开发的脂质体蒽环类药物在难治性卵巢癌患者中显示出与LRH具有协同作用。我们自己的经验表明,患者对放疗和/或化疗联合LRH的耐受性良好。尽管现有数据仍属初步,但将LRH纳入多模式癌症治疗方案似乎非常有前景。仍需要精心设计的比较研究来评估热疗作为传统癌症治疗辅助手段的作用。
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