Wust P, Gellermann J, Harder C, Tilly W, Rau B, Dinges S, Schlag P, Budach V, Felix R
Clinic for Radiation Medicine, Charité Medical School, Campus Virchow-Klinikum, Berlin, Germany.
Int J Radiat Oncol Biol Phys. 1998 Jul 15;41(5):1129-37. doi: 10.1016/s0360-3016(98)00165-5.
Invasive thermometry for regional hyperthermia is time-consuming, uncomfortable, and risky for the patient. We tried to estimate the benefit/cost ratio of invasive thermometry in regional hyperthermia using the radiofrequency system BSD-2000.
We evaluated 182 patients with locally advanced pelvic tumors that underwent regional hyperthermia. In every patient a tumor-related temperature measurement point was obtained either by invasive or minimally invasive catheter measurement tracks. In the earlier period for every patient an intratumoral measurement point was decided as obligatory and intratumoral catheters were implanted intraoperatively, CT guided, or under fluoroscopy. In the later period, invasive thermometry often was avoided, if a measurement point in or near the tumor was reached by an endoluminally inserted catheter (rectal, vaginal, cervical, urethral, or vesical). For every patient side effects and complications referred to thermometry were evaluated and compared with the potential benefit of the invasively achieved temperature data. The suitability of endolumimally registered temperatures is analyzed to estimate local feasibility (specific absorption rate achieved) and local effectiveness (thermal parameters correlated with response).
In 74 of 182 patients invasive thermometry was performed, at most CT-guided for soft tissue sarcomas and rectal recurrences. In 14 of 74 (19%) side effects such as local inflammation, pain, or abscess formation occurred that enforced removal of the catheter. However, local problems were strongly correlated with the dwell time of the catheter and nearly never occurred for dwell times less than 5 days. Fortunately, no fatal complications (e.g., bleeding or perforation) occurred during or after implantation which could be attributed to the invasive thermometry procedure. Endoluminal tumor-related temperature rises per time unit (to estimate power density) were correlated with intratumoral rises at the same patients (where both measurements were available). For a subgroup of patients pooled in two Phase II studies with rectal (n = 37) and cervical (n = 18) carcinomas thermal parameters derived from endoluminal measurements were correlated with response or local control, resp.
If a tumor-related endoluminal temperature measurement point is available, additional invasive thermometry gives no further information to improve the power deposition pattern. For primary rectal and cervical cancer, and probably as well for prostate, bladder and anal cancer, endoluminal measurements are suitable to estimate local feasibility and effectiveness. Therefore, invasive thermometry is dispensable in the majority of patients. In some selected cases, temperature measurement in the tumor center is required to estimate the maximum temperature. In those cases, dwell time of catheters should be minimized--and it should be considered to perform invasive thermometry at the beginning (one or two heat treatments).
用于区域热疗的侵入性体温测量对患者来说耗时、不适且有风险。我们试图使用射频系统BSD - 2000评估区域热疗中侵入性体温测量的效益/成本比。
我们评估了182例接受区域热疗的局部晚期盆腔肿瘤患者。在每例患者中，通过侵入性或微创导管测量路径获得与肿瘤相关的温度测量点。在早期，每例患者的瘤内测量点被确定为必需的，并且在术中、CT引导下或透视下植入瘤内导管。在后期，如果通过腔内插入导管（直肠、阴道、宫颈、尿道或膀胱）到达肿瘤内或肿瘤附近的测量点，则通常避免进行侵入性体温测量。对每例患者与体温测量相关的副作用和并发症进行评估，并与侵入性获得的温度数据的潜在益处进行比较。分析腔内记录温度的适用性，以估计局部可行性（实现的比吸收率）和局部有效性（与反应相关的热参数）。
182例患者中有74例进行了侵入性体温测量，对于软组织肉瘤和直肠复发最多采用CT引导。74例中有14例（19%）出现局部炎症、疼痛或脓肿形成等副作用，导致导管拔除。然而，局部问题与导管留置时间密切相关，留置时间少于5天时几乎从不发生。幸运的是，植入期间或之后未发生可归因于侵入性体温测量程序的致命并发症（如出血或穿孔）。同一患者腔内肿瘤相关温度每单位时间的升高（用于估计功率密度）与瘤内升高相关（两种测量均可行时）。对于两项II期研究中汇总的一组直肠癌（n = 37）和宫颈癌（n = 18）患者，腔内测量得出的热参数分别与反应或局部控制相关。
如果有与肿瘤相关的腔内温度测量点，额外的侵入性体温测量不会提供进一步信息来改善功率沉积模式。对于原发性直肠癌和宫颈癌，可能还有前列腺癌、膀胱癌和肛门癌，腔内测量适用于估计局部可行性和有效性。因此，在大多数患者中侵入性体温测量是不必要的。在一些特定情况下，需要测量肿瘤中心温度以估计最高温度。在这些情况下，应尽量缩短导管留置时间，并且应考虑在开始时（一或两次热疗）进行侵入性体温测量。
