Centre for Radiation Oncology KSA-KSB, Cantonal Hospital Aarau, Aarau, Switzerland.
Doctoral Clinical Science Program, Medical Faculty, University of Zürich, Zürich, Switzerland.
Int J Hyperthermia. 2023;40(1):2275540. doi: 10.1080/02656736.2023.2275540. Epub 2023 Nov 6.
Radiotherapy (RT) in combination with deep regional hyperthermia (HT) after transurethral removal of bladder tumor (TURBT) can be offered to elderly and frail patients with muscle-invasive bladder cancer (MIBC). In total, 21 patients (mean age 84 years) with unifocal or multifocal MIBC received radiation to a dose of 48-50 Gy/16-20 fractions with weekly HT. The primary endpoint was the variation in temperature metrics, thermal dose expressed as cumulative equivalent minutes at 43 °C when the measured temperature is T (CEM43T) and net power applied in target volume per each HT session. Secondary endpoints were three-year overall survival (OS), disease-free survival (DFS), local progression-free survival (LPFS) and toxicity. The temperature metrics, CEM43T, mean and maximum net power applied did not differ significantly among the HT sessions of the 21 patients. With a median follow-up of 65 months, 52% (95% CI 32-72%) of patients had died 3 years after treatment. The three-year DFS and LPFS rates were 62% (95%CI 41-79%) and 81% (95%CI 60-92%), respectively. The three-year bladder preservation rate was 100%. Three out of four patients with local failure received a thermal dose CEM43T below a median of 2.4 min. The rates of acute and late grade-3 toxicities were 10% and 14%, respectively. The reproducibility of HT parameters between sessions was high. A moderately high CEM43T (> 2.4 min) for each HT session seems to be preferable for local control. RT combined with HT is a promising organ-preservation therapy for elderly and frail MIBC patients.
在经尿道膀胱肿瘤切除术（TURBT）后，联合深部区域性高热（HT）的放疗可用于肌层浸润性膀胱癌（MIBC）的老年和虚弱患者。共有 21 例（平均年龄 84 岁）单发或多发 MIBC 患者接受了 48-50Gy/16-20 次分割的放疗，并每周进行 HT。主要终点是温度指标的变化，以 43°C 时累积等效分钟数（CEM43T）和每次 HT 疗程中目标体积的净功率表示的热剂量，以及次要终点为 3 年总生存率（OS）、无病生存率（DFS）、局部无进展生存率（LPFS）和毒性。在 21 例患者的 HT 疗程中，温度指标、CEM43T、平均和最大净功率应用无显著差异。中位随访 65 个月后，52%（95%CI 32-72%）的患者在治疗后 3 年内死亡。3 年DFS 和 LPFS 率分别为 62%（95%CI 41-79%）和 81%（95%CI 60-92%）。3 年膀胱保留率为 100%。4 例局部失败患者中有 3 例接受的热剂量 CEM43T 低于中位数 2.4 分钟。急性和迟发性 3 级毒性的发生率分别为 10%和 14%。各 HT 疗程之间 HT 参数的重现性较高。每个 HT 疗程中 CEM43T 较高（>2.4 分钟）似乎更有利于局部控制。RT 联合 HT 是一种有前途的老年和虚弱 MIBC 患者的器官保存治疗方法。
