Engin K, Leeper D B, Tupchong L, Waterman F M
Department of Radiation Oncology, Jefferson Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania 19107-5097, USA.
Clin Cancer Res. 1995 Feb;1(2):139-45.
In recent years there have been numerous randomized and nonrandomized studies conducted to assess the efficacy of hyperthermia combined with either radiation therapy or chemotherapy, especially in the treatment of superficially seated malignant tumors. The major impact of hyperthermia is currently on locoregional control of tumor. Heat may be directly cytotoxic to tumor cells or inhibit repair of both sublethal and potentially lethal damage after radiation. These effects are augmented by the physiological conditions in tumors which lead to states of acidosis and hypoxia. Blood flow is often impaired in tumor relative to normal tissue, and hyperthermia may lead to a further decrease in blood flow and augment heat sensitivity. Three major areas of clinical investigation have borne the greatest fruit for hyperthermia as adjunctive therapy to radiation therapy. These include recurrent and primary breast lesions, melanoma, and head and neck neoplasms. The thermal enhancement ratio was increased in all cases and is estimated to be 1.4 for neck nodes, 1.5 for breast, and 2 for malignant melanoma. In general, the most important prognostic factors for complete response are radiation dose, tumor size, and minimal thermal parameters (minimum thermal dose, mean minimum temperature or temperature exceeded by 90% of thermal sensors). The number of heat fractions administered per week appears to have no bearing on the overall response, which may be indicative of the effects of thermotolerance. The total number of heat fractions delivered also appears to be irrelevant provided adequate heat is delivered in one or two sessions. The major prognostic factors for the duration of local control are tumor histology, concurrent radiation therapy dose, tumor depth, and mean minimum temperature.
近年来，已经进行了大量随机和非随机研究，以评估热疗联合放射治疗或化疗的疗效，特别是在治疗浅表性恶性肿瘤方面。目前，热疗的主要影响在于肿瘤的局部区域控制。热可能对肿瘤细胞具有直接细胞毒性，或抑制放疗后亚致死性损伤和潜在致死性损伤的修复。肿瘤中的生理状况会导致酸中毒和缺氧状态，从而增强这些效应。相对于正常组织，肿瘤中的血流通常受损，热疗可能导致血流进一步减少并增强热敏感性。作为放射治疗辅助疗法的热疗，在三个主要临床研究领域取得了最大成果。这些领域包括复发性和原发性乳腺病变、黑色素瘤以及头颈部肿瘤。在所有病例中，热增强比均有所提高，估计颈部淋巴结为1.4，乳腺为1.5，恶性黑色素瘤为2。一般来说，完全缓解的最重要预后因素是放射剂量、肿瘤大小和最小热参数（最小热剂量、平均最低温度或90%的热传感器所超过的温度）。每周给予的热疗次数似乎与总体反应无关，这可能表明了热耐受的影响。只要在一两个疗程中给予足够的热量，热疗的总次数似乎也无关紧要。局部控制持续时间的主要预后因素是肿瘤组织学、同步放射治疗剂量、肿瘤深度和平均最低温度。
