Treatment outcomes of concurrent hyperthermia and chemoradiotherapy for pancreatic cancer: Insights into the significance of hyperthermia treatment

Abstract

Abstract.Patients with locally advanced unresectable pancreatic cancer (LAUPC) have a poor prognosis. In addition their quality of life impaired by cancer pain and biliary tract infections. Therefore, multimodality therapy and selection of optimal treatment methods are essential for achieving prolonged survival. The present study investigated the significance of using hyperthermia concurrently with multimodality therapy to improve treatment outcomes in patients with LAUPC. In total, 13 patients receiving concurrent hyperthermia and chemoradiotherapy (HCR) or chemoradiotherapy (CR) alone for LAUPC between 2002 and 2013 were analyzed retrospectively. Of the 13 patients, 5 received concurrent HCR and 8 received CR. The chemotherapy regimens were 5-fluorouracil (5-FU) in 5 patients and gemcitabine hydrochloride (GEM) in the other 8. Patients who gave consent for hyperthermia treatment received GEM plus CR. The median overall survival period for all patients was 12 months and the 1-year survival rate was 55%; the corresponding values were 12 months and 57% in the GEM CR group, and 15 months and 80% in the HCR group. Univariate analyses was perfomed to identify factors predicting recurrence after treatment. The potential prognostic factors analyzed were: Age, sex, performance status, location, tumor size, the tumor marker CA 19-9, total radiation dose, chemotherapy and hyperthermia. Univariate analysis for factors associated with outcomes revealed a significant difference favoring the HCR group [relative risk=15.97 (95% confidence interval: 12.87-19.83) P=0.021]. In conclusion, hyperthermia merits active recommendation to pancreatic cancer patients who have a positive attitude toward this treatment and whose performance status is satisfactory.

The clinical benefit of hyperthermia in pancreatic cancer: a systematic review

“…The included 14 studies combined 395 pancreatic cancer patients of whom 248 received HT (Table 1). Six out of 14 studies used a control population that enabled a comparison between treatments with and without hyperthermia [54,55,57,60,62,66]. In two studies, patients with a variety of carcinomas were included, but data were reported for the pancreatic patients separately [53,59].…”

“…For the patients who received HT within the studies, this HT was in combination with radiotherapy for 17 patients (7%, two studies) [53,55], with chemoradiotherapy for 82 patients (33%, four studies) [54,60,62,66], and with chemotherapy for 149 patients (60%) in the remaining eight studies. Three types of hyperthermia treatment were applied: locoregional, whole-body and intraoperative hyperthermia.…”

“…Overall survival rates were available for 12 studies (Table 5); two of these studies did not describe median OS for each cohort but did supply Kaplan-Meier curves [54,66]. For the six studies with a control group, the weighted estimate of the population median overall survival m p was 11.7 months for the cohorts receiving HT (median OS range 6-18.6 months), compared with 5.6 months for the control cohorts (4-11 months).…”

“…Locoregional hyperthermia was used in eight studies, with heating of tumour and surrounding tissue either radiative (using radiofrequency waves; 63 patients) [62,64] or capacitive (using electrodes; 126 patients) [53,58,60,63,65,66]. Treatment times varied from 40-60 min.…”

“…After the first and second selection (Figure 1), 14 studies were included [53][54][55][56][57][58][59][60][61][62][63][64][65][66]. Two patient cohorts were each described in two articles; for these we excluded the oldest [67,68] and included the latest [54,57].…”