Cho C H, Wust P, Hildebrandt B, Issels R D, Sehouli J, Kerner T, Deja M, Budach V, Gellermann J
Charité - Universitätsmedizin Berlin, Clinic for Radiotherapy, Berlin, Germany.
Int J Hyperthermia. 2008 Aug;24(5):399-408. doi: 10.1080/02656730801929915.
Peritoneal carcinomatosis is a stage of gynecological and gastrointestinal malignancies with poor prognosis. Options for enhancing the effect of standard chemotherapy, such as aggressive surgery and intraperitoneal chemotherapy, have limitations. In this phase I/II study, we evaluated regional hyperthermia of the pelvis and abdomen using the annular-phased-array technique as an adjunct to chemotherapy.
Forty-five patients with peritoneal carcinomatosis (with or without liver metastases) in colorectal cancer (CRC) (n = 16), ovarian cancer (OC) (n = 17), or gastric/pancreatic/biliary cancer (n = 12) underwent standard chemotherapy and regional hyperthermia. Most CRC patients received second-line chemotherapy. All OC patients were platinum resistant. Regional hyperthermia was applied using a SIGMA-60 applicator (OC), a SIGMA-Eye/MR applicator (CRC), or various ring applicators (gastric/pancreatic/biliary cancer).
Abdominal regional hyperthermia was well tolerated, with acceptable acute discomfort and no long-term morbidity. The SIGMA-Eye/MR applicator achieved higher systemic temperatures (associated with higher systemic stress) and more effective heating of the upper abdomen; the SIGMA-60 applicator achieved higher temperatures (and power densities) in the pelvis. Three-year overall survival was encouraging for patients with CRC (22%) and OC (29%) but not gastric/pancreatic/biliary cancer. For the SIGMA-60 applicator (patients with OC), higher measured temperatures at the vaginal stump correlated with better outcome. CONCLUSIONS. The SIGMA-60 and SIGMA-Eye/MR applicators are feasible for abdominal heating and have low toxicity. The SIGMA-60 applicator is specifically suitable for malignancies with high pelvic burden; the SIGMA-Eye/MR applicator better heats the upper abdomen, including the liver. Further randomized investigations are warranted.
腹膜癌病是妇科和胃肠道恶性肿瘤的一个阶段，预后较差。增强标准化化疗效果的方法，如积极手术和腹腔内化疗，都存在局限性。在这项I/II期研究中，我们评估了使用环形相控阵技术对盆腔和腹部进行区域热疗作为化疗辅助手段的效果。
45例患有腹膜癌病（伴或不伴肝转移）的结直肠癌（CRC）患者（n = 16）、卵巢癌（OC）患者（n = 17）或胃/胰腺/胆管癌患者（n = 12）接受了标准化化疗和区域热疗。大多数CRC患者接受二线化疗。所有OC患者均对铂类耐药。使用SIGMA - 60施源器（用于OC）、SIGMA - Eye/MR施源器（用于CRC）或各种环形施源器（用于胃/胰腺/胆管癌）进行区域热疗。
腹部区域热疗耐受性良好，急性不适可接受，且无长期并发症。SIGMA - Eye/MR施源器可使全身温度更高（与更高的全身应激相关），对上腹部的加热更有效；SIGMA - 60施源器可使盆腔温度更高（及功率密度更高）。CRC患者（22%）和OC患者（29%）的三年总生存率令人鼓舞，但胃/胰腺/胆管癌患者并非如此。对于SIGMA - 60施源器（OC患者），阴道残端测得的温度越高，预后越好。结论：SIGMA - 60和SIGMA - Eye/MR施源器用于腹部加热可行且毒性低。SIGMA - 60施源器特别适用于盆腔负荷高的恶性肿瘤；SIGMA - Eye/MR施源器对上腹部（包括肝脏）的加热效果更好。有必要进行进一步的随机研究。
