Moran C J, Marchosky J A, Wippold F J, DeFord J A, Fearnot N E
Mallinckrodt Institute of Radiology, Washington University Medical Center, St. Louis, MO 63110, USA.
J Neurooncol. 1995 Oct;26(1):53-63. doi: 10.1007/BF01054769.
Intracranial metastases commonly complicate oncologic care affecting 140,000 patients per year in the United States. Treatment of these tumors is difficult and often unsuccessful. Hyperthermia is a treatment alternative that has shown promise in treating cancer in other areas. Therefore it was employed in an attempt to provide increased tumor control in CNS metastases.
This Phase I and Phase II clinical trial of interstitial hyperthermia with recurrent or progressive intracranial metastatic disease was undertaken to evaluate complications, delivery of heat and patient outcome.
Feared complications of clinically significant bleeding, increased mass, or infection from the interstitial implant and treatment did not occur. The seizures which occurred in 4 patients were controlled with additional anticonvulsants. Three venous thromboembolic events were treated medically and with percutaneously placed inferior vena cava filters. The KPS of the majority of patients declined slightly with treatment but rebounded to near baseline within several months. CT scans demonstrated decrease or stabilization of tumor volumes in 7 of the 13 patients. In 4 of these patients, regression or stabilization persisted until death from nonCNS disease.
Interstitial hyperthermia therapy for intracranial metastases is technically feasible and may provide increased tumor control. In this small series, it did not cause unreasonable complications. This therapy has some positive effect, but requires study of more patients before its role is definitively known. Combining hyperthermia with brachytherapy and/or chemotherapy is being evaluated.
颅内转移瘤常使肿瘤治疗变得复杂，在美国每年有140000名患者受其影响。这些肿瘤的治疗困难且常常不成功。热疗是一种在其他领域治疗癌症已显示出前景的治疗选择。因此，它被用于尝试提高中枢神经系统转移瘤的肿瘤控制率。
开展了这项针对复发性或进展性颅内转移性疾病的间质热疗的I期和II期临床试验，以评估并发症、热传递及患者预后。
未出现人们所担心的具有临床意义的出血、肿块增大或间质植入及治疗引起的感染等并发症。4例患者发生的癫痫发作通过加用抗惊厥药物得到控制。3例静脉血栓栓塞事件采用药物治疗并经皮置入下腔静脉滤器。大多数患者的KPS评分在治疗后略有下降，但在数月内反弹至接近基线水平。CT扫描显示13例患者中有7例肿瘤体积减小或稳定。其中4例患者，肿瘤消退或稳定一直持续到因非中枢神经系统疾病死亡。
间质热疗治疗颅内转移瘤在技术上是可行的，且可能提高肿瘤控制率。在这个小样本系列研究中，它未引起不合理的并发症。这种治疗有一些积极作用，但在其作用被明确了解之前还需要对更多患者进行研究。目前正在评估热疗与近距离放疗和/或化疗联合应用的效果。
