a Department of Radiation Oncology and Hyperthermia , Academic Medical Center, University of Amsterdam , Amsterdam , The Netherlands.
b Department of Surgery , Academic Medical Center, University of Amsterdam , Amsterdam , The Netherlands.
Int J Hyperthermia. 2018 Nov;34(7):969-979. doi: 10.1080/02656736.2017.1401126. Epub 2017 Nov 23.
In pancreatic cancer, which is therapy resistant due to its hypoxic microenvironment, hyperthermia may enhance the effect of radio(chemo)therapy. The aim of this systematic review is to investigate the validity of the hypothesis that hyperthermia added to radiotherapy and/or chemotherapy improves treatment outcome for pancreatic cancer patients.
We searched MEDLINE and Embase, supplemented by handsearching, for clinical studies involving hyperthermia in pancreatic cancer patients. The quality of studies was evaluated using the Oxford Centre for Evidence-Based Medicine levels of evidence. Primary outcome was treatment efficacy; we calculated overall response rate and the weighted estimate of the population median overall survival (m) and compared these between hyperthermia and control cohorts.
Overall, 14 studies were included, with 395 patients with locally advanced and/or metastatic pancreatic cancer of whom 248 received hyperthermia. Patients were treated with regional (n = 189), intraoperative (n = 39) or whole-body hyperthermia (n = 20), combined with chemotherapy, radiotherapy or both. Quality of the studies was low, with level of evidence 3 (five studies) and 4. The six studies including a control group showed a longer m in the hyperthermia groups than in the control groups (11.7 vs. 5.6 months). Overall response rate, reported in three studies with a control group, was also better for the hyperthermia groups (43.9% vs. 35.3%).
Hyperthermia, when added to chemotherapy and/or radiotherapy, may positively affect treatment outcome for patients with pancreatic cancer. However, the quality of the reviewed studies was limited and future randomised controlled trials are needed to establish efficacy.
在胰腺癌中，由于其缺氧的微环境，热疗可能会增强放射（化学）疗法的效果。本系统评价的目的是调查以下假设的有效性，即在放射治疗和/或化学疗法中加入热疗是否能改善胰腺癌患者的治疗效果。
我们在 MEDLINE 和 Embase 上进行了搜索，并通过手工搜索补充了相关内容，以寻找涉及胰腺癌患者热疗的临床研究。使用牛津循证医学中心证据水平评估研究质量。主要结局是治疗效果；我们计算了总缓解率和人群中位总生存期（m）的加权估计值，并比较了热疗组和对照组之间的这些值。
总共纳入了 14 项研究，共有 395 名局部晚期和/或转移性胰腺癌患者，其中 248 名接受了热疗。患者接受了区域热疗（n=189）、术中热疗（n=39）或全身热疗（n=20），联合化疗、放疗或两者联合治疗。研究质量较低，证据水平为 3 级（5 项研究）和 4 级。纳入对照组的 6 项研究显示，热疗组的 m 更长（11.7 个月 vs. 5.6 个月）。纳入对照组的 3 项研究报告的总缓解率也更高（43.9% vs. 35.3%）。
当热疗与化疗和/或放疗联合应用时，可能会对胰腺癌患者的治疗效果产生积极影响。然而，所审查研究的质量有限，需要进行未来的随机对照试验来确定其疗效。
