Seegenschmiedt M H, Brady L W, Sauer R
Department of Radiation Oncology, University of Erlangen-Nürnberg, West Germany.
Am J Clin Oncol. 1990 Aug;13(4):352-63.
Interstitial hyperthermia (IHT) combined with brachycurietherapy (thermoradiotherapy) has gained increasing popularity among radiation oncologists due to its potential as an effective radio- and chemosensitizer. IHT offers considerable advantages over percutaneous methods: confined treatment volume, better sparing of normal tissue, accessibility of deeper tumors, more homogeneous therapeutic temperature distribution, and better control and evaluation of thermal parameters using extensive "thermal mapping" procedures. This article addresses technical principles and clinical applications of IHT methods, radiofrequency (RF), microwave (MW), and hot source (HS) hyperthermia. Clinical phase I/II studies have used IHT palliatively for primary advanced, persistent, or local recurrent tumors, which have responded poorly to conventional treatment. The preliminary clinical data on greater than 500 patients treated with interstitial thermoradiotherapy are extremely promising despite the broad variation among the different treatment approaches. The observed complete response (CR) rate in various clinical trials ranges between 11 and 74%. The differences between the various techniques are minor, with a CR of 57% for interstitial RF hyperthermia (169 of 299 patients) and 60% for interstitial MW hyperthermia (130 of 215 patients). Despite extensive pretreatment, the total observed compliation rate of 22% for RF hyperthermia (67 of 299) and 21% for MW hyperthermia (45 of 215) is acceptable. The prognostic treatment factors identified are tumor volume, applied radiation dose, sufficiently high minimum tumor temperatures, and good thermal parameters, i.e., good quality of the hyperthermia treatment sessions. Technical innovations may facilitate and improve clinical applications and should allow broad clinical implementations of IHT, e.g., intraoperative hyperthermia, and even intracavitary hyperthermia. From these experiences it would appear that IHT is an effective and safe treatment modality, especially when combined with radiotherapy for tumor palliation. Prospective randomized multicentric studies have already been initiated to investigate its role in palliative and adjuvant tumor therapy.
间质热疗（IHT）联合近距离放疗（热放疗）因其作为一种有效的放疗和化疗增敏剂的潜力，在放射肿瘤学家中越来越受欢迎。与经皮方法相比，IHT具有相当多的优势：治疗体积受限、对正常组织的更好保护、深部肿瘤的可及性、更均匀的治疗温度分布，以及使用广泛的“热图”程序对热参数进行更好的控制和评估。本文探讨了IHT方法、射频（RF）、微波（MW）和热热源（HS）热疗的技术原理和临床应用。临床I/II期研究已将IHT用于原发性晚期、持续性或局部复发性肿瘤的姑息治疗，这些肿瘤对传统治疗反应不佳。尽管不同治疗方法之间存在广泛差异，但关于500多名接受间质热放疗患者的初步临床数据非常有前景。在各种临床试验中观察到的完全缓解（CR）率在11%至74%之间。各种技术之间的差异较小，间质RF热疗的CR率为57%（299例患者中的169例），间质MW热疗的CR率为60%（215例患者中的130例）。尽管进行了广泛的预处理，但RF热疗的总观察到的并发症发生率为22%（299例中的67例），MW热疗的并发症发生率为21%（215例中的45例）是可以接受的。确定的预后治疗因素包括肿瘤体积、应用的放射剂量、足够高的最低肿瘤温度以及良好的热参数，即热疗疗程的良好质量。技术创新可能会促进和改善临床应用，并应允许IHT在临床上广泛应用，例如术中热疗，甚至腔内热疗。从这些经验来看，IHT似乎是一种有效且安全的治疗方式，尤其是与放疗联合用于肿瘤姑息治疗时。前瞻性随机多中心研究已经启动，以研究其在姑息性和辅助性肿瘤治疗中的作用。
