Nagata Y, Hiraoka M, Nishimura Y, Masunaga S, Mitumori M, Okuno Y, Fujishiro M, Kanamori S, Horii N, Akuta K, Sasai K, Abe M, Fukuda Y
Department of Radiology, Kyoto University Hospital, Sakyo, Japan.
Int J Radiat Oncol Biol Phys. 1997 May 1;38(2):359-65. doi: 10.1016/s0360-3016(96)00625-6.
To evaluate thermometry and the clinical results of radiofrequency (RF) hyperthermia for advanced malignant liver tumors.
One hundred seventy-three patients with malignant liver tumors treated between 1983 and 1995 underwent hyperthermia. The 173 tumors consisted of 114 hepatocellular carcinomas (HCCs) and 59 non-HCCs (47 metastatic liver tumors and 12 cholangiocarcinomas). Eight-megahertz RF capacitive heating equipment was used for the hyperthermia. Two opposing 25-cm electrodes were generally used for heating the liver tumors. Our standard protocol was to administer hyperthermia 40-50 min twice a week for a total of eight sessions. The liver tumor temperature was measured by microthermocouples when possible. Transcatheter arterial embolization, radiotherapy, immunotherapy, and chemotherapy were combined with hyperthermia treatment in accordance with each patient's liver function.
One hundred forty (81%) of the 173 patients who underwent more than four sessions of hyperthermia were evaluated in this study. Thermometry was performed in 77 (55%) of these 140 patients. The maximum tumor temperature, average tumor temperature, and minimum tumor temperature in the HCC were (mean +/- standard error) 41.2 +/- 0.2 degrees C, 40.3 +/- 1.3 degrees C, and 40.1 +/- 0.2 degrees C, respectively. The same thermometry results for non-HCC were 42.3 +/- 0.2 degrees C, 41.2 +/- 0.2 degrees C, and 40.9 +/- 0.2 degrees C, respectively. The maximum and minimum temperatures (41.8 +/- 0.2 degrees C and 40.3 +/- 0.4 degrees C) in the patients with a complete or partial response (CR or PR) were higher than those in the patients with no response or progressive disease (NR or PD) (41.3 +/- 0.5 degrees C and 39.8 +/- 0.4 degrees C), but the difference was not significant. Of the 73 cases with HCC who were evaluated by computed tomography (CT), CR was achieved in 7 (10%), PR in 15 (21%), NR in 37 (51%), and PD in 14 (19%). Of the 45 cases involving liver metastases evaluated by CT, CR was achieved in 3 (7%), PR in 17 (38%), NR in 12 (27%), and PD in 13 (29%). The 1-year cumulative survival rate for HCC patients was 30.0%, and the 5-year survival rate was 17.5%. The 1-year survival of non-HCC patients was 32.5%, and the longest survival was 30 months. The sequelae of hyperthermia included focal fat necrosis in 20 patients (12%), gastric ulceration in 4 (2%), and liver necrosis in 1 (1%). The sequelae of thermometry were severe peritoneal pain in seven patients (11%), intraperitoneal hematoma in one (1%), and pneumothorax in one (1%).
Even though the thermometry results for liver tumors were not satisfactory, the treatment results are promising. Further clinical trials of RF capacitive hyperthermia for the treatment of advanced liver tumors should be encouraged.
评估针对晚期恶性肝肿瘤的射频（RF）热疗的温度测量及临床效果。
1983年至1995年间接受热疗的173例恶性肝肿瘤患者。这173个肿瘤包括114例肝细胞癌（HCC）和59例非HCC（47例肝转移瘤和12例胆管癌）。采用8兆赫兹的射频电容式加热设备进行热疗。通常使用两个相对的25厘米电极加热肝肿瘤。我们的标准方案是每周两次，每次热疗40 - 50分钟，共进行八次。尽可能通过微型热电偶测量肝肿瘤温度。根据每位患者的肝功能，将经动脉导管栓塞、放疗、免疫治疗和化疗与热疗相结合。
本研究评估了173例接受超过四次热疗的患者中的140例（81%）。这140例患者中有77例（55%）进行了温度测量。HCC患者的最高肿瘤温度、平均肿瘤温度和最低肿瘤温度分别为（均值±标准误差）41.2±0.2℃、40.3±1.3℃和40.1±0.2℃。非HCC患者的相同温度测量结果分别为42.3±0.2℃、41.2±0.2℃和40.9±0.2℃。完全缓解或部分缓解（CR或PR）患者的最高和最低温度（41.8±0.2℃和40.3±0.4℃）高于无缓解或疾病进展（NR或PD）患者（41.3±0.5℃和39.8±0.4℃），但差异不显著。在73例接受计算机断层扫描（CT）评估的HCC病例中，7例（10%）达到CR，15例（21%）达到PR，37例（51%）为NR，14例（19%）为PD。在45例接受CT评估的肝转移病例中，3例（7%）达到CR，17例（38%）达到PR，12例（27%）为NR，13例（29%）为PD。HCC患者的1年累积生存率为30.0%，5年生存率为17.5%。非HCC患者的1年生存率为32.5%，最长生存时间为30个月。热疗的后遗症包括20例患者（12%）出现局灶性脂肪坏死，4例（2%）出现胃溃疡，1例（1%）出现肝坏死。温度测量的后遗症包括7例患者（11%）出现严重的腹膜疼痛，1例（1%）出现腹腔内血肿，1例（1%）出现气胸。
尽管肝肿瘤的温度测量结果不尽人意，但治疗效果令人鼓舞。应鼓励进一步开展射频电容式热疗治疗晚期肝肿瘤的临床试验。
