Bakker Akke, Kolff M Willemijn, Holman Rebecca, van Leeuwen Caspar M, Korshuize-van Straten Linda, de Kroon-Oldenhof Rianne, Rasch Coen R N, van Tienhoven Geertjan, Crezee Hans
Department of Radiation Oncology, Academic Medical Center (AMC), Amsterdam, The Netherlands.
Department of Radiation Oncology, Academic Medical Center (AMC), Amsterdam, The Netherlands.
Int J Radiat Oncol Biol Phys. 2017 Jun 1;98(2):392-399. doi: 10.1016/j.ijrobp.2017.02.009. Epub 2017 Feb 16.
To investigate the relationship of thermal skin damage (TSD) to time-temperature isoeffect levels for patients with breast cancer recurrence treated with reirradiation plus hyperthermia (reRT + HT), and to investigate whether the treatment history of previous treatments (scar tissue) is a risk factor for TSD.
In this observational study, temperature characteristics of hyperthermia sessions were analyzed in 262 patients with recurrent breast cancer treated in the AMC between 2010 and 2014 with reirradiation and weekly hyperthermia for 1 hour. Skin temperature was measured using a median of 42 (range, 29-82) measurement points per hyperthermia session.
Sixty-eight patients (26%) developed 79 sites of TSD, after the first (n=26), second (n=17), third (n=27), and fourth (n=9) hyperthermia session. Seventy percent of TSD occurred on or near scar tissue. Scar tissue reached higher temperatures than other skin tissue (0.4°C, P<.001). A total of 102 measurement points corresponded to actual TSD sites in 35 of 79 sessions in which TSD developed. Thermal skin damage sites had much higher maximum temperatures than non-TSD sites (2.8°C, P<.001). Generalized linear mixed models showed that the probability of TSD is related to temperature and thermal dose values (P<.001) and that scar tissue is more at risk (odds ratio 0.4, P<.001). Limiting the maximum temperature of a measurement point to 43.7°C would mean that the probability of observing TSD was at most 5%.
Thermal skin damage during reRT + HT for recurrent breast cancer was related to higher local temperatures and time-temperature isoeffect levels. Scar tissue reached higher temperatures than other skin tissue, and TSD occurred at lower temperatures and thermal dose values in scar tissue compared with other skin tissue. Indeed, TSD developed often on and around scar tissue from previous surgical procedures.
探讨接受再程放疗加高温治疗（再程放疗 + 高温治疗，reRT + HT）的乳腺癌复发患者的皮肤热损伤（TSD）与时间 - 温度等效水平之间的关系，并研究既往治疗史（瘢痕组织）是否为TSD的危险因素。
在这项观察性研究中，分析了2010年至2014年期间在AMC接受再程放疗和每周1小时高温治疗的262例复发性乳腺癌患者高温治疗期间的温度特征。每次高温治疗使用中位数为42个（范围为29 - 82个）测量点测量皮肤温度。
68例患者（26%）在第一次（n = 26）、第二次（n = 17）、第三次（n = 27）和第四次（n = 9）高温治疗后出现了79处TSD。70%的TSD发生在瘢痕组织上或其附近。瘢痕组织达到的温度高于其他皮肤组织（0.4°C，P <.001）。在发生TSD的79次治疗中的35次治疗中，共有102个测量点对应实际的TSD部位。皮肤热损伤部位的最高温度远高于非TSD部位（2.8°C，P <.001）。广义线性混合模型显示，TSD的发生概率与温度和热剂量值相关（P <.001），且瘢痕组织风险更高（比值比0.4，P <.001）。将测量点的最高温度限制在43.7°C意味着观察到TSD的概率最多为5%。
复发性乳腺癌再程放疗 + 高温治疗期间的皮肤热损伤与局部温度升高和时间 - 温度等效水平有关。瘢痕组织达到的温度高于其他皮肤组织，与其他皮肤组织相比，瘢痕组织中TSD在较低温度和热剂量值时发生。实际上，TSD常发生在既往手术瘢痕组织上及其周围。
