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

Abstract

2019) Temperature and thermal dose during radiotherapy and hyperthermia for recurrent breast cancer are related to clinical outcome and thermal toxicity: a systematic reviewABSTRACT Objective: Hyperthermia therapy (HT), heating tumors to 40-45 C, is a known radiotherapy (RT) and chemotherapy sensitizer. The additional benefit of HT to RT for recurrent breast cancer has been proven in multiple randomized trials. However, published outcome after RT þ HT varies widely. We performed a systematic review to investigate whether there is a relationship between achieved HT dose and clinical outcome and thermal toxicity for patients with recurrent breast cancer treated with RT þ HT. Method: Four databases, EMBASE, PubMed, Cochrane library and clinicaltrials.gov, were searched with the terms breast, radiotherapy, hyperthermia therapy and their synonyms. Final search was performed on 3 April 2019. Twenty-two articles were included in the systematic review, reporting on 2330 patients with breast cancer treated with RT þ HT. Results: Thirty-two HT parameters were tested for a relationship with clinical outcome. In studies reporting a relationship, the relationship was significant for complete response in 10/15 studies, in 10/ 13 studies for duration of local control, in 2/2 studies for overall survival and in 7/11 studies for thermal toxicity. Patients who received high thermal dose had on average 34% (range 27%-53%) more complete responses than patients who received low thermal dose. Patients who achieved higher HT parameters had increased odds/probability on improved clinical outcome and on thermal toxicity. Conclusion: Temperature and thermal dose during HT had significant influence on complete response, duration of local control, overall survival and thermal toxicity of patients with recurrent breast cancer treated with RT þ HT. Higher temperature and thermal dose improved outcome, while higher maximum temperature increased incidence of thermal toxicity. ARTICLE HISTORY

Bevacizumab Plus FOLFOX-4 Combined With Deep Electro-Hyperthermia as First-line Therapy in Metastatic Colon Cancer: A Pilot Study

“…Among other physical treatments, hyperthermia (HT) proved to be an effective anti-tumor approach in combination with standard therapies. HT increases the temperature of tumor tissue up to 40-45°C and is applied as an enhancer of the effects both of radiotherapy and, to a lesser degree, of chemotherapy, in the treatment of different tumors, such as breast cancer, cervix carcinoma, head and neck cancer, glioblastoma, melanoma, peritoneal carcinomatosis, hepatocellular carcinoma, and soft tissue sarcoma, with significant improvements in clinical outcomes (48)(49)(50)(51)(52)(53)(54)(55)(56). Multiple direct and indirect mechanisms are responsible for the synergistic anti-cancer effect performed by HT.…”

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“…A particularly challenging situation is reirradiation due to STS relapse or radiation-induced STS. HT might be added to enhance tumor response to RT, whose dose is limited by previous RT [101][102][103]. In a retrospective analysis, the authors assessed the outcomes of 16 patients with radiation-induced STS in the thoracic region treated with HT+HFRT using two moderately hypofractionated regimens (3 Gy to 36 Gy, 12 fractions, three weeks, 6× HT; or 4 Gy to 32 Gy, eight fractions, two weeks, 4× HT) [6].…”

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