Hyperthermia and radiation therapy for locally advanced or recurrent breast cancer

Abstract

Introduction This study aims to report the outcome and toxicity of combined hyperthermia (HT) and radiation therapy (RT) in treatment of locally advanced or loco-regionally recurrent breast cancer. Patients and Methods Patients treated with HT and RT from January 1991 to December 2007 were reviewed. RT doses for previously irradiated patients were >40 Gy and for RT naïve patients >60 Gy, at 1.8–2 Gy/day. HT was planned for 2 sessions/week, immediately after RT, for a minimum of 20 minutes and for >4 sessions. Superficial or interstitial applicators were used with temperature measured by superficial or interstitial thermisters based on target thickness. HT treatment was assessed by thermal equivalent dose (TED), >42.5°C and >43°C. Endpoints included treatment response, lack of local progression (local control), and survival. Results 127 patients received HT and RT to 167 sites. These included the intact breast (24.4%), chest wall/skin (67.7%), and breast/chest wall and nodes (7.9%). At a median follow-up of 13 months (mean 30±38), improved overall survival was significantly associated with increasing RT dose (p<0.0001), median TED 42.5°C≥200 minutes (p=0.003), and local control (p=0.0002). Local control at last follow-up was seen in 55.1% of patients. Complete response was significantly associated with median TED 42.5°C≥200 minutes (p=0.002) and median TED 43°C≥100 minutes (p=0.03). Conclusion HT and RT are effective for locally advanced or recurrent breast cancer in patients that have been historically difficult to treat by RT alone. Over 50% of patients achieved control of locoregional disease. Overall survival was improved with local control.

Temperature and thermal dose during radiotherapy and hyperthermia for recurrent breast cancer are related to clinical outcome and thermal toxicity: a systematic review

“…This systematic review shows that for patients with locoregional recurrent breast cancer treated with RT þ HT higher temperature and/or thermal dose during HT improves CR, LC and OS [4,15,[27][28][29][30][31][32][33][35][36][37]39,40,42], while increasing the incidence of thermal toxicity [33,36,[39][40][41]48,49]. It is intriguing to see that the CR of patients who received RT alone versus patients who received RT þ low dose HT were comparable; 38.1% [6] versus 36.2% (Figure 4), respectively.…”

“…Eight studies reported a significant univariate relationship between CR and thermal dose [28][29][30][31] or temperature [32,33,39,42] (Figure 3 and Table 1). Four studies [29,34,35,39] reported a trend (p < .1) between temperature and CR, while two studies did not find any relationship between CR and thermal dose parameters [43,44].…”

“…Multiple studies showed a significant relationship between the achieved thermal dose invasively (CEM42.5, CEM43, time > 42.5 C, time > 43 C) and CR (Figure 4). Patients who received a high thermal dose had on average 34% (range 27%-53%) more CR than patients who received a low thermal dose [4,15,[28][29][30][31][32][33][34].…”

“…The percentage temperature !40 C after adjusting for estrogen receptor status, initial T-stage, time interval between initial breast cancer to first failure, age at HT and concurrent RT [36]. [4,15,[28][29][30][31][32][33][34], local control (LC) at 12 months [15,[35][36][37][38] and à 6 months [33], overall survival (OS) at 18 months [15,31], and thermal toxicity [33,[39][40][41]. The values were calculated from subgroups of patients, which were grouped based on their variation in thermal dose parameters during hyperthermia treatment; thermal dose parameters above a certain cutoff value (high) versus thermal dose parameters below the cutoff value (low).…”

“…The time >42.5 C. Refaat et al [31] reported that when patients were treated with more than 200 min above 42.5 C, patients had better OS. This remained significant in multivariate analysis after adjusting for microscopic disease, RT dose and mastectomy.…”