Sinha Priyanshu M, Folefac Charlemagne A, Overgaard Jens, Horsman Michael R
Experimental Clinical Oncology-Department of Oncology, Aarhus University Hospital, 8200 Aarhus, Denmark.
Cancers (Basel). 2024 Nov 22;16(23):3916. doi: 10.3390/cancers16233916.
The conventional radiation treatment of cancer patients has typically involved a large number of daily treatments with relatively low doses of radiation. However, improved technology has now resulted in the increased use of fewer radiation fractions at a high dose per fraction. This latter approach is often referred to as hypofractionated irradiation. While conventional radiation typically kills tumor cells through the production of DNA damage, treatments with higher doses per fraction have been suggested to also kill cells via the induction of vascular damage. Such vascular effects will also increase the level of adverse microenvironmental conditions, such as hypoxia and acidity, that already exist in tumors. Cells existing in these adverse microenvironmental conditions are resistant to radiation but actually sensitive to hyperthermia (heating at 40-45 °C) treatment. This suggests that the combination of hypofractionated radiation and heat may be a viable treatment approach. While there are preliminary pre-clinical and even clinical studies investigating this option, there are actually no data on the optimal application for the greatest therapeutic benefit. In this critical review, we will present the rationale for combining hypofractionated radiation with hyperthermia and discuss what has been done and what should be done to establish this combination as an effective cancer therapy option.
癌症患者的传统放射治疗通常包括大量的每日治疗，每次辐射剂量相对较低。然而，技术的进步现已导致高剂量少分次放射治疗的使用增加。后一种方法通常被称为大分割照射。虽然传统放疗通常通过产生DNA损伤来杀死肿瘤细胞，但有人提出，高剂量分次治疗也可通过诱导血管损伤来杀死细胞。这种血管效应还会增加肿瘤中已存在的不良微环境条件的水平，如缺氧和酸性环境。存在于这些不良微环境条件下的细胞对辐射具有抗性，但实际上对热疗（40-45°C加热）敏感。这表明大分割放疗与热疗相结合可能是一种可行的治疗方法。虽然有初步的临床前甚至临床研究在探讨这种选择，但实际上尚无关于实现最大治疗益处的最佳应用的数据。在这篇批判性综述中，我们将阐述大分割放疗与热疗相结合的基本原理，并讨论为将这种联合治疗确立为一种有效的癌症治疗选择已经做了哪些工作以及应该做些什么。
