Thermochemoradiotherapy improves oxygenation in locally advanced breast cancer
Thermochemoradiotherapy improves oxygenation in locally advanced breast cancer
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DOI：
10.1158/1078-0432.ccr-04-0133
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发表时间：
2004-07-01
影响因子：
11.5
通讯作者：
Vujaskovic, Z
中科院分区：
文献类型：
--
作者：
Jones, EL;Prosnitz, LR;Vujaskovic, Z
目的：本研究的目的是评估局部晚期乳腺癌（LABC）患者在乳房切除术后同时接受紫杉醇、热疗（HT）和放疗（RT）治疗的毒性、反应和氧合（pO(2)）的变化。实验设计：1995年10月至1999年2月，18例LABC患者入组。治疗包括紫杉醇（175 mg/m(2)），每3周给予3个周期。放射治疗包括乳房和局部淋巴结，剂量为50戈瑞，随后对未接受手术的患者增加到60-65戈瑞。在这种新辅助方案后，认为可切除的患者进行乳房切除术。HT每周两次。在第一次高温处理前和第一次高温处理后24 h测定氧合。结果：18例患者中有15例缓解，6例临床完全缓解，9例临床部分缓解，3例无反应。13例行乳房切除术，3例病理完全缓解。13例患者中有8例出现肿瘤缺氧（pO(2) = 4.7 +/- 1.2 mmHg）。5例肿瘤氧合良好（pO(2) = 27.6 +/- 7.8 mmHg）。治疗前氧合良好的肿瘤患者以及再氧合显著的肿瘤患者均有良好的临床反应。肿瘤再氧化似乎与温度有关，并与较低的热剂量有关。结论：这种新的治疗方案对LABC患者有很高的应答率。热疗可能提供一种策略，以改善肿瘤的再氧化和随之而来的治疗反应。然而，热疗对肿瘤再氧化的影响似乎取决于热剂量，需要进一步的研究。
Purpose: The purpose of this research was to evaluate toxicity, response, and changes in oxygenation (pO(2)) in patients with locally advanced breast cancer (LABC) treated with concurrent taxol, hyperthermia (HT), and radiation therapy (RT) followed by mastectomy.Experimental Design: Eighteen patients with LABC were enrolled from October 1995 through February 1999. Treatment consisted of taxol (175 mg/m(2)) given every 3 weeks for three cycles. Radiation therapy included the breast and regional nodes with a dose of 50 Gy, followed by a boost to 60-65 Gy for those not undergoing surgery. Mastectomy was performed for patients deemed resectable after this neoadjuvant program. HT was administered twice per week. Oxygenation was measured before the first HT treatment and 24 h after the first HT treatment.Results: Fifteen of 18 patients responded, 6 with a clinical complete response, 9 with a partial clinical response, and 3 nonresponders. Thirteen underwent mastectomy with 3 pathological complete responses. Tumor hypoxia was present in 8 of 13 patients (pO(2) = 4.7 +/- 1.2 mmHg). Five patients had well-oxygenated tumors (pO(2) = 27.6 +/- 7.8 mmHg). Patients with well-oxygenated tumors before treatment as well as those with significant reoxygenation had a favorable clinical response. Tumor reoxygenation appeared to be temperature dependent and associated with the lower thermal doses.Conclusions: This novel therapeutic program resulted in a high response rate in patients with LABC. Hyperthermia may offer a strategy for improving tumor reoxygenation with consequent treatment response. However, the effect of hyperthermia on tumor reoxygenation appears to depend on thermal dose and requires additional investigation.