Overgaard J, Overgaard M
Danish Cancer Society, Department of Experimental Clinical Oncology, Aarhus.
Int J Hyperthermia. 1987 Nov-Dec;3(6):483-501. doi: 10.3109/02656738709140422.
One hundred and fifteen cutaneous or lymph node metastases from malignant melanoma were treated with three fractions of irradiation alone in 8 days (62 tumours) or followed by heat either immediately (simultaneous treatment, 26 tumours) or after an interval of 3-4 h (sequential therapy, 27 tumours). In addition, three tumours were treated unsuccessfully with heat alone. The total doses of radiation varied between 15 and 30 Gy, allowing a dose-response analysis. For irradiation alone the isoeffective dose to obtain 50 per cent complete response (TCD50) was 26.3 Gy. Addition of heat reduced the TCD50 significantly (p less than 0.05) with a thermal enhancement ratio (TER) of 1.43 for simultaneous treatment and 1.24 for sequential therapy. Also the persistent local control at 18 months was improved by hyperthermia (56 per cent versus 86 per cent, p less than 0.05). However, simultaneous treatment also enhanced the acute skin response to the same extent as the tumour (TER 1.42 for severe erythema). This schedule thus gave no therapeutic gain. In contrast, no normal tissue enhancement was found after sequential treatment (TER 1.02). Such a treatment schedule resulted in a significantly improved therapeutic ratio of 1.22. This effect was especially prominent in larger tumours (if sufficiently heated) and an analysis corrected for volume showed a TER of 1.51. A special analysis was performed in patients with multiple lesions. 15 pairs of tumours were given the same radiation dose, with or without hyperthermia. Out of these, 11 showed a better response, three showed the same response, and only in one pair was the best response in the tumour obtained by radiation alone.
115例恶性黑色素瘤皮肤或淋巴结转移瘤患者接受了治疗，其中8天内仅接受3次分割照射（62例肿瘤），或者随后立即进行热疗（同步治疗，26例肿瘤），或者间隔3 - 4小时后进行热疗（序贯治疗，27例肿瘤）。此外，3例肿瘤仅接受热疗，效果不佳。放射总剂量在15至30 Gy之间，以便进行剂量反应分析。仅照射时，获得50%完全缓解（TCD50）的等效剂量为26.3 Gy。添加热疗显著降低了TCD50（p小于0.05），同步治疗的热增强比（TER）为1.43，序贯治疗为1.24。热疗还改善了18个月时的局部持续控制情况（56%对86%，p小于0.05）。然而，同步治疗也在相同程度上增强了皮肤对放疗的急性反应（严重红斑的TER为1.42）。因此，该方案没有治疗增益。相比之下，序贯治疗后未发现正常组织增强（TER为1.02）。这样的治疗方案使治疗比显著提高至1.22。这种效果在较大肿瘤（如果充分加热）中尤为突出，体积校正分析显示TER为1.51。对有多发病变的患者进行了专项分析。15对肿瘤接受相同的放射剂量，一组有热疗，另一组没有。其中，11对显示热疗组反应更好，3对反应相同，只有1对中单独放疗的肿瘤反应最佳。
