Integrating Hyperthermia into Modern Radiation Oncology: What Evidence Is Necessary?
Integrating Hyperthermia into Modern Radiation Oncology: What Evidence Is Necessary?
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DOI：
10.3389/fonc.2017.00132
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发表时间：
2017
影响因子：
4.7
通讯作者：
Combs SE
中科院分区：
文献类型：
--
作者：
Peeken JC;Vaupel P;Combs SE
热疗是近几十年来人们讨论的热点问题之一。然而，它从未进入黄金时段。热增强辐射、化学治疗剂和免疫治疗的效果的基本生物学原理是显而易见的。临床前研究证实了这一效应。HT可能引发灌注和氧合的变化以及DNA修复机制的抑制。此外，有证据表明免疫刺激和诱导全身免疫反应。尽管有越来越多的可靠的临床研究，但只有少数中心将这种辅助治疗纳入其治疗方案。多年来，大量的前瞻性和随机临床数据显示，HT和放疗联合治疗对浅表性乳腺癌复发、宫颈癌或头颈部癌症等多种实体有明显的益处。关于研究较少的适应症，现有数据很有希望，目前正在招募更多的临床试验。我们接下来怎么办？存在临床前证据。在临床环境中，多个适应症受益于额外的HT。本文总结了目前的证据，并提出了未来研究的思路。
Hyperthermia (HT) is one of the hot topics that have been discussed over decades. However, it never made its way into primetime. The basic biological rationale of heat to enhance the effect of radiation, chemotherapeutic agents, and immunotherapy is evident. Preclinical work has confirmed this effect. HT may trigger changes in perfusion and oxygenation as well as inhibition of DNA repair mechanisms. Moreover, there is evidence for immune stimulation and the induction of systemic immune responses. Despite the increasing number of solid clinical studies, only few centers have included this adjuvant treatment into their repertoire. Over the years, abundant prospective and randomized clinical data have emerged demonstrating a clear benefit of combined HT and radiotherapy for multiple entities such as superficial breast cancer recurrences, cervix carcinoma, or cancers of the head and neck. Regarding less investigated indications, the existing data are promising and more clinical trials are currently recruiting patients. How do we proceed from here? Preclinical evidence is present. Multiple indications benefit from additional HT in the clinical setting. This article summarizes the present evidence and develops ideas for future research.