Department of Radiation Oncology, Chonbuk National University Hospital-Chonbuk National University Medical School, Jeonju, Jeonbuk 561-712, Republic of Korea.
Institute of Human Physiology and Clinical Experimental Research, Semmelweis University, 1083 Budapest, Hungary.
Int J Oncol. 2019 Feb;54(2):627-643. doi: 10.3892/ijo.2018.4645. Epub 2018 Nov 23.
The problem with the application of conventional hyperthermia in oncology is firmly connected to the dose definition, which conventionally uses the concept of the homogeneous (isothermal) temperature of the target. Its imprecise control and complex evaluation is the primary barrier to the extensive clinical applications. The aim of this study was to show the basis of the problems of the misleading dose concept. A clear clarification of the proper dose concept must begin with the description of the limitations of the present doses in conventional hyperthermia applications. The surmounting of the limits the dose of oncologic hyperthermia has to be based on the applicability of the Eyring transition state theory on thermal effects. In order to avoid the countereffects of thermal homeostasis, the use of precise heating on the nanoscale with highly efficient energy delivery is recommended. The nano‑scale heating allows for an energy‑based dose to control the process. The main aspects of the method are the following: i) It is not isothermal (no homogeneous heating); ii) malignant cells are heated selectively; and iii) it employs high heating efficacy, with less energy loss. The applied rigorous thermodynamical considerations show the proper terminology and dose concept of hyperthermia, which is based on the energy‑absorption (such as in the case of ionizing radiation) instead of the temperature‑based ideas. On the whole, according to the present study, the appropriate dose in oncological hyperthermia must use an energy‑based concept, as it is well‑known in all the ionizing radiation therapies. We propose the use of Gy (J/kg) in cases of non‑ionizing radiation (hyperthermia) as well.
传统热疗在肿瘤学中的应用存在一个问题，这与剂量定义密切相关，传统上使用目标的均匀（等温）温度的概念。其控制不精确和评估复杂是广泛临床应用的主要障碍。本研究的目的是展示误导性剂量概念问题的基础。正确剂量概念的明确澄清必须从描述常规热疗应用中现有剂量的局限性开始。克服剂量限制，肿瘤热疗的剂量必须基于热效应的 Eyring 过渡态理论的适用性。为了避免热平衡的反作用，建议在纳米尺度上使用精确加热和高效能量传递。纳米尺度加热允许基于能量的剂量来控制该过程。该方法的主要方面如下：i）它不是等温的（没有均匀加热）；ii）恶性细胞被选择性加热；iii）它采用高热效，能量损失较小。所应用的严格热力学考虑表明了热疗的正确术语和剂量概念，这是基于能量吸收（如在电离辐射的情况下）而不是基于温度的概念。总的来说，根据本研究，肿瘤热疗中的适当剂量必须使用基于能量的概念，就像所有电离辐射疗法一样。我们建议在非电离辐射（热疗）的情况下也使用 Gy（J/kg）。
