Franckena Martine, Fatehi Daryoush, de Bruijne Maarten, Canters Richard A M, van Norden Yvette, Mens Jan Willem, van Rhoon Gerard C, van der Zee Jacoba
Erasmus Medical Center Rotterdam, Department of Radiation Oncology, PO Box 5201, 3008 AE Rotterdam, The Netherlands.
Eur J Cancer. 2009 Jul;45(11):1969-78. doi: 10.1016/j.ejca.2009.03.009. Epub 2009 Apr 8.
Adding hyperthermia to standard radiotherapy (RT+HT) improves treatment outcome for patients with locally advanced cervical cancer (LACC). We investigated the effect of hyperthermia dose on treatment outcome for patients with LACC treated with RT+HT. We collected treatment and outcome data of 420 patients with LACC treated with hyperthermia at our institute from 1990 to 2005. Univariate and multivariate analyses were performed on response rate, local control, disease-specific survival and toxicity for these patients to search for a thermal dose response relationship. Besides commonly identified prognostic factors in LACC like tumour stage, performance status, radiotherapy dose and tumour size, thermal parameters involving both temperature and duration of heating emerged as significant predictors of the various end-points. The more commonly used CEM43T90 (cumulative equivalent minutes of T90 above 43 degrees C) was less influential than TRISE (based on the average T50 increase and the duration of heating, normalised to the scheduled duration of treatment). CEM43T90 and TRISE measured intraluminally correlate significantly and independently with tumour control and survival. These findings stimulate further technological development and improvement of deep hyperthermia, as they strongly suggest that it might be worthwhile to increase the thermal dose for LACC, either by treatment optimisation or by prolonging the treatment time. These results also confirm the beneficial effects from hyperthermia as demonstrated in our earlier randomised trial, and justify applying radiotherapy and hyperthermia as treatment of choice for patients with advanced cervical cancer.
在标准放疗基础上加用热疗（放疗+热疗）可改善局部晚期宫颈癌（LACC）患者的治疗效果。我们研究了热疗剂量对接受放疗+热疗的LACC患者治疗效果的影响。我们收集了1990年至2005年在我院接受热疗的420例LACC患者的治疗及预后数据。对这些患者的缓解率、局部控制率、疾病特异性生存率和毒性进行单因素和多因素分析，以寻找热剂量反应关系。除了LACC中常见的预后因素，如肿瘤分期、体能状态、放疗剂量和肿瘤大小外，涉及温度和加热持续时间的热参数也成为各种终点的重要预测因素。常用的CEM43T90（43℃以上T90的累积等效分钟数）的影响小于TRISE（基于平均T50升高和加热持续时间，根据预定治疗持续时间进行标准化）。腔内测量的CEM43T90和TRISE与肿瘤控制和生存显著且独立相关。这些发现刺激了深部热疗技术的进一步发展和改进，因为它们强烈表明，通过治疗优化或延长治疗时间来增加LACC的热剂量可能是值得的。这些结果也证实了我们早期随机试验中热疗的有益效果，并证明放疗和热疗是晚期宫颈癌患者的首选治疗方法。
