Engin K, Tupchong L, Moylan D J, Alexander G A, Waterman F M, Komarnicky L, Nerlinger R E, Leeper D B
Department of Radiation Oncology and Nuclear Medicine, Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA 19107.
Int J Hyperthermia. 1993 May-Jun;9(3):327-40. doi: 10.3109/02656739309005034.
One test for thermotolerance development in a clinical situation is to evaluate the effects of altering the hyperthermia fractionation interval on tumour response to thermoradiotherapy. Between 1983 and 1990 44 evaluable advanced superficial tumours of miscellaneous origin in 41 patients were randomized to receive either once-weekly or twice-weekly external microwave hyperthermia treatments combined with radiation therapy. The mean age of patients was 62 years, and 85% had failed previous therapy. All lesions were less than 8 x 8 x 4 cm (L x W x D) and were heated by external 915 MHz microwaves. The mean radiation dose was 44 +/- 3 Gy (mean +/- SE) in the once-weekly group and 46 +/- 3 Gy in the twice-weekly group (p = 0.64). The mean volume of the lesions heated once weekly was 17 +/- 6 versus 23 +/- 5 cm3 for those heated twice weekly (p = 0.45). Hyperthermia was administered once weekly for 4.6 +/- 0.2 sessions (range 3-7) or twice weekly for 8.1 +/- 0.3 sessions (range 4-10). Thermometry was performed using 3.4 +/- 0.2 catheters and 5.1 +/- 0.6 thermal sensors per tumour in the once-weekly group, and 2.7 +/- 0.2 catheters and 5.8 +/- 0.3 thermal sensors per tumour in the twice-weekly group. Of the 44 evaluable randomized lesions a complete response (CR) at 2 months post-treatment was observed in 59% (13/22) heated once weekly and 55% (12/22) in those heated twice weekly. The prognostic factors predictive of tumour complete response were found by logistic regression analysis to be radiation dose and tumour volume, while the prognostic factors predictive of duration of response (Cox proportional hazards analysis) were median minimum tumour temperature (Tmin), minimum tumour temperature during the first heat treatment (Tmin1) and tumour volume. The duration of local control in lesions with Tmin < or = 39.5 degrees C was 11.7 +/- 1.9 months while for lesions with Tmin > 39.5 degrees C it was 23.0 +/- 4.2 months (p = 0.01). The ED50 was calculated by logistic regression to be 40 Gy (95% CI = 22-54 Gy) for once- and twice-weekly heated lesions. There was not a significant difference in tumour response or duration of response between populations randomized to receive once- versus twice-weekly hyperthermia treatments. There was also no difference in skin reaction rates between once- and twice-weekly hyperthermia treatments, nor could a correlation be found between any thermal parameter and skin reactions.(ABSTRACT TRUNCATED AT 400 WORDS)
在临床情况下，一种用于评估热耐受发展的测试方法是，评估改变热疗分割间隔对肿瘤热放疗反应的影响。在1983年至1990年间，41例患者的44个可评估的不同来源的晚期浅表肿瘤被随机分组，分别接受每周一次或每周两次的体外微波热疗联合放射治疗。患者的平均年龄为62岁，85%的患者既往治疗失败。所有病灶均小于8×8×4厘米（长×宽×深），并通过体外915兆赫微波加热。每周一次治疗组的平均放射剂量为44±3戈瑞（平均±标准误），每周两次治疗组为46±3戈瑞（p = 0.64）。每周加热一次的病灶平均体积为17±6立方厘米，而每周加热两次的病灶为23±5立方厘米（p = 0.45）。热疗每周进行一次，共4.6±0.2次（范围3 - 7次）；或每周进行两次，共8.1±0.3次（范围4 - 10次）。每周一次治疗组每个肿瘤使用3.4±0.2根导管和5.1±0.6个热传感器进行温度测量，每周两次治疗组每个肿瘤使用2.7±0.2根导管和5.8±0.3个热传感器。在44个可评估的随机病灶中，治疗后2个月观察到完全缓解（CR）的情况为：每周加热一次的患者中有59%（13/22），每周加热两次的患者中有55%（12/22）。通过逻辑回归分析发现，预测肿瘤完全缓解的预后因素是放射剂量和肿瘤体积，而预测缓解持续时间（Cox比例风险分析）的预后因素是最低肿瘤温度中位数（Tmin）、首次热疗期间的最低肿瘤温度（Tmin1）和肿瘤体积。Tmin≤39.5摄氏度的病灶局部控制持续时间为11.7±1.9个月，而Tmin>39.5摄氏度的病灶为23.0±4.2个月（p = 0.01）。通过逻辑回归计算，每周加热一次和两次的病灶的ED50为40戈瑞（95%置信区间 = 22 - 54戈瑞）。随机接受每周一次与每周两次热疗的人群在肿瘤反应或反应持续时间上没有显著差异。每周一次和两次热疗的皮肤反应率也没有差异，并且在任何热参数与皮肤反应之间均未发现相关性。（摘要截短至400字）
