Kapp D S, Cox R S
Department of Radiation Oncology, Stanford University Medical Center, CA 94305, USA.
Int J Radiat Oncol Biol Phys. 1995 Nov 1;33(4):887-99. doi: 10.1016/0360-3016(95)00212-4.
In previously reported studies using radiation therapy (XRT) and hyperthermia (HT) for treatment of superficial metastases from adenocarcinoma of the breast, we have identified several pretreatment and treatment parameters that correlated with rate of initial complete response (ICR) recorded at 3 weeks and duration of local control (DLC). These parameters include minimal intratumoral temperature, Tmin, and the temperature exceeded by 90% of the measured intratumoral temperatures, T90. Recently, others have shown that thermal dose defined as the cumulative time of isoeffective treatments with T90 = 43 degrees C (CUM EQ MIN T90 43) was predictive of complete response in superficial tumors. We have assessed the prognostic value of several formulations of this parameter for both ICR and DLC in a relatively uniform patient population treated with XRT-HT.
The corresponding EQ MIN T90 43 were calculated for 332 HT treatments in 111 HT fields in 83 patients who started treatment between October 1982 and May 1992. Each field contained only one measurable superficially located nodular tumor recurrence or metastasis from adenocarcinoma of the breast that was treated with XRT-HT, had mapped or multiple point temperatures recorded, and had at least one posttreatment follow-up evaluation. The thermal doses from all treatments delivered to a field were added to obtain the total thermal dose, SUM EQ MIN T90 43. Logistic and life-table multivariate analyses were performed to determine which pretreatment parameters (including initial T-stage, prior XRT, and tumor volume at the time of HT) and treatment parameters (including XRT dose, Tmin, T90, thermal dose, and hormonal therapy) best correlated with ICR and DLC.
Of the treatment parameters tested, SUM EQ MIN T90 43 had the strongest correlation with both ICR (p = 0.0002) and DLC (p = 0.0014). Also, SUM EQ MIN T90 43 contributed to the best multivariate models predictive of ICR and DLC.
For this relatively uniform patient population, we have confirmed that SUM EQ MIN T90 43 is the treatment parameter most strongly correlated with not only response following XRT-HT, but also duration of local control. This formulation of thermal dose should permit prescriptions to be written for HT treatments. Prospective trials designed to confirm this thermal dose relationship are to be encouraged.
在先前报道的使用放射治疗（XRT）和热疗（HT）治疗乳腺癌浅表转移的研究中，我们确定了几个与3周时记录的初始完全缓解率（ICR）和局部控制持续时间（DLC）相关的治疗前和治疗参数。这些参数包括瘤内最低温度Tmin以及90%的测量瘤内温度所超过的温度T90。最近，其他人表明，定义为T90 = 43摄氏度的等效有效治疗累积时间的热剂量（CUM EQ MIN T90 43）可预测浅表肿瘤的完全缓解。我们在接受XRT-HT治疗的相对同质患者群体中评估了该参数的几种形式对ICR和DLC的预后价值。
计算了1982年10月至1992年5月开始治疗的83例患者111个HT野中332次HT治疗的相应EQ MIN T90 43。每个野仅包含一个可测量的浅表性结节状肿瘤复发或乳腺癌转移灶，接受XRT-HT治疗，记录了映射或多点温度，并且至少有一次治疗后随访评估。将所有给予一个野的治疗的热剂量相加，得到总热剂量SUM EQ MIN T90 43。进行逻辑回归和寿命表多变量分析，以确定哪些治疗前参数（包括初始T分期、先前的XRT和HT时的肿瘤体积）和治疗参数（包括XRT剂量、Tmin、T90、热剂量和激素治疗）与ICR和DLC最相关。
在所测试的治疗参数中，SUM EQ MIN T90 43与ICR（p = 0.0002）和DLC（p = 0.0014）的相关性最强。此外，SUM EQ MIN T90 43有助于建立预测ICR和DLC的最佳多变量模型。
对于这个相对同质的患者群体，我们已经证实SUM EQ MIN T90 43是不仅与XRT-HT后的反应，而且与局部控制持续时间最密切相关的治疗参数。这种热剂量形式应允许为HT治疗开具处方。鼓励开展旨在证实这种热剂量关系的前瞻性试验。
