Kapp D S, Lawrence R
Int J Radiat Oncol Biol Phys. 1984 Dec;10(12):2281-92. doi: 10.1016/0360-3016(84)90234-7.
Possible effects of fever during intracavitary radiation therapy on patient survival, local-regional control or metastatic spread of disease were analyzed in a group of 398 patients with previously untreated, invasive carcinoma of the uterine cervix, managed with a combination of external beam irradiation and intracavitary radium (ICR) applications at Yale-New Haven Medical Center and affiliated hospitals from January 1953 through December 1977. Cox step-wise proportional hazard models were used to test for the influence of elevated temperatures during ICR placements, controlling for the influence of other pretreatment patient parameters, including FIGO stage, age, blood count, prior supracervical hysterectomy and number of prior pregnancies. Increasing maximum temperatures noted during ICR placements were associated with: decreased patient survival (p = 0.014) and increased frequency with time of distant metastasis as the initial sites of treatment failure (p = 0.038). When patients were dichotomized on the basis of maximum temperature during ICR, distant metastasis as the initial site(s) of treatment failure was noted twice as frequently in patients with maximum temperatures greater than or equal to 101.0 degrees F (12.5%; 10/80 patients) than in those with maximum temperatures less than 101.0 degrees F during ICR placement (6.3%; 20/318 patients). No statistically significant differences were noted between the two groups in their distributions by stage, age, histology, year of diagnosis, or pretreatment hemoglobin, and the sites of distant metastasis and time course for clinical detection were similar in both groups. These results are in agreement with prior clinical studies in cancer of the uterine cervix which noted a poor prognosis in patients with cancer of cervix who developed fever during treatment. In addition, the finding of an association between an increased frequency of distant metastasis and temperature elevation during the ICR provides, for the first time, clinical data supporting the reports of an alteration or enhancement of distant metastasis following the application of whole body hyperthermia in murine, rabbit and canine tumors.
1953年1月至1977年12月期间，在耶鲁 - 纽黑文医学中心及其附属医院，对398例先前未经治疗的子宫颈浸润癌患者进行了分析，这些患者采用外照射和腔内镭疗（ICR）联合治疗。研究腔内放射治疗期间发热对患者生存、局部区域控制或疾病转移扩散的可能影响。使用Cox逐步比例风险模型来测试ICR放置期间体温升高的影响，并控制其他预处理患者参数的影响，包括国际妇产科联盟（FIGO）分期、年龄、血细胞计数、先前的次全子宫切除术和既往妊娠次数。ICR放置期间记录的最高温度升高与以下情况相关：患者生存率降低（p = 0.014），以及远处转移作为初始治疗失败部位的频率随时间增加（p = 0.038）。当根据ICR期间的最高温度将患者分为两组时，最高温度大于或等于101.0华氏度（12.5%；80例患者中的10例）的患者中，远处转移作为初始治疗失败部位的频率是ICR放置期间最高温度低于101.0华氏度的患者（6.3%；318例患者中的20例）的两倍。两组在分期、年龄、组织学、诊断年份或预处理血红蛋白分布方面无统计学显著差异，两组远处转移部位和临床检测时间进程相似。这些结果与先前关于子宫颈癌的临床研究一致，该研究指出治疗期间发热的子宫颈癌患者预后不良。此外，ICR期间远处转移频率增加与温度升高之间存在关联的发现首次提供了临床数据，支持了在小鼠、兔子和犬类肿瘤中应用全身热疗后远处转移改变或增强的报道。
