Experience of Hyperthermia Treatment in Thailand results-THASTRO2016.pdf · Experience of...
Transcript of Experience of Hyperthermia Treatment in Thailand results-THASTRO2016.pdf · Experience of...
Experience of Hyperthermia Treatment in Thailand
Pawinee Mahasittiwat, Walasuda Phoyen, Kamolrath Leedee, Napaporn Subjareun
11 March, 2016
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• A few number of equipment caused the limit experience in Thailand.
Thermotron RF-8: radiofrequency 8 MHz, a pair of electrodes
Background
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• At median F/U 7.1 yrs, data suggest comparable outcome (EFS, pelvic recurrence free survival, OS) for RT-CT and RT-HT in locally advanced cervical cancer (randomized RADCHOC trial)1.
• Thermoradiation therapy enhances the likelihood of CR rates in LRBCs over RT alone by 22% with minimal acute and late morbidities2.
1.Lutgens LC et al. RT combined with HT vs cisplatin for locally advanced cervical cancer: Results of the randomized RADCHOC trial. Raiother Oncol 2016 2.Datta NR et al. HT and RT in locoregional recurrent breast cancers: A systemic review and meta-analysis. Int J Radiat Oncol biol Phys 2015.
Background
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• Hyperthermia along with RT enhances the likelihood of CR in head and neck cancers by around 25% compared to RT alone with no sig additional acute and late morbidities1.
• Adding regional hyperthermia to standard neoadjuvant chemotherapy in patients with localized high-risk soft tissue sarcoma sig increased OS, DFS, and LPFS2
1.Datta NR, et al. HT and RT in the management of H&N cancers: A systematic review and meta-analysisl Int J Hyperthermia 2016 Feb;32(1):31-40 2.Issels RD et al. Long-term outcomes of the EORTC 62961/ESHO randomized phase III study. ECCO2015
Background
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• This retrospective study reported the results and complications in patients who received hyperthermia treatment in Siriraj Piyamaharajkarun Hospital.
Objectives
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• Hyperthermia treatment was combined with radiation therapy and/or chemotherapy in patients with locally advanced or metastases cancer.
• The response of treatment was evaluated at 3 months after completion of the main treatment (radiation and/or chemotherapy) according to RECIST criteria.
• The side effect of treatment also was recorded.
Material and methods
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Patients characteristic Total n= 38
Age (years) 36-81 Mean 60
Sex Male Female
17 (44.7%) 21 (55.3%)
No. of total treatment times/ course
1-11 Mean 3
Location of treated tumor Deep Superficial
34 (89.5%) 4 (10.5%)
Combined treatment Radiation Chemotherapy CMT+RT
26 (68.4%) 8 (21%)
4 (10.5%)
Region of treatment Neck Breast Axilla Chest Upper abdomen Pelvis Thigh
1 1 2 8
10 15
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Treatment watt 230-730 Mean 500
• From April to November 2015, 36 patients received 38 courses of hyperthermia treatment.
• Total 112 sessions of hyperthermia were performed.
Results
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Results No. %
CR 2 5.3%
PR 23 60.5%
SD 8 21%
PD 2 5.3%
Not applicable 3 (8%)
Complication All grade (%) High grade (%)
Feeling heat at skin 31 (81.6%) 5 (13.2%)
Pain at skin 10 (26.3%) 0 (0%)
Sweating at face 22 (57.9%) 2 (5.3%)
fatigue 22 (57.9%) 1 (2.6%)
Fat induration 7 (18.4%) N/A
Objective response rate = 65.8%
Results
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Disease No.
NSCLC 9
breast 5
Renal cell CA 5
cervix 3
bladder 2
rectum 2
prostate 2
sarcoma 1
stomach 1
GIST 1
HCC 1
pancreas 1
corpus 1
SCLC 1
esophagus 1
gallbladder 1
nasopharynx 1
Results by pain status* No.
CR 5
PR 8
Results by CT/MRI imaging
No.
PR 11
SD 2
BONE METASTASES = 13 pts
* Kwan-Hwa Chi Chi, M.D. Shin Kong Wu Ho-Su Memorial Hospital. Taiwan
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• Recurrent urothelial cell CA of bladder with hematuria and infection
• Palliative RT with HT wkly 48 Gy/24 fractions
• Post treatment no hematuria, do not need CBI, no infection
Before RT+ HT post RT+HT 1 month
Results (example case 1)
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• Recurrent urothelial cell CA of bladder with hematuria and infection
• Palliative RT with HT wkly 48 Gy/24 fractions
• Post treatment no hematuria, do not need CBI, no infection
Before RT+ HT post RT+HT 1 month
Results (example case 1)
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• Recurrent urothelial cell CA of bladder with hematuria and infection
• Palliative RT with HT wkly 48 Gy/24 fractions
• Post treatment no hematuria, do not need CBI, no infection
Before RT+ HT post RT+HT 1 month
Results (example case 1)
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• Advanced CA breast with the large Rt. axillary LN and pain (history of resist to chemotherapy regimens and quickly growth)
• Palliative RT 2.6 Gyx 15 F (equi dose BED= 40, TDF=44 Gy) with HT wkly
• Post treatmentdecreased size LN and no pain
Before RT+HT Post RT+HT 3 months
Results (example case 2)
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• NSCLC with bone metastases and retained Foley’s catheter, could not walk
• Palliative RT 36 Gy/12 F (equi dose BED=38, TDF=44 Gy) + HT wkly
• Post treatment CR pain, no pain medicine, off Foley’s catheter, could walk
Before RT+HT Post RT + HT 2 months
Results (example case 3)
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• NSCLC with bone metastases and retained Foley’s catheter, could not walk
• Palliative RT 36 Gy/12 F (equi dose BED=38, TDF=44 Gy) + HT wkly
• Post treatment CR pain, no pain medicine, off Foley’s catheter, could walk
Before RT+HT Post RT + HT 2 months
Results (example case 3)
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• NSCLC with bone metastases and retained Foley’s catheter, could not walk
• Palliative RT 36 Gy/12 F (equi dose BED=38, TDF=44 Gy) + HT wkly
• Post treatment CR pain, no pain medicine, off Foley’s catheter, could walk
Before RT+HT Post RT + HT 2 months
Results (example case 3)
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• From experience in SiPH, the interesting and promising result was demonstrated.
• Hyperthermia increased RT effect reduce tumor, no additional significant RT side effect
Discussion
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1.Anneke M. Westermann, et al. First results of Triple-Modality Treatment combining RT, CMT, and HT for the treatment of Pts with st IIB, III, and IVA cervical carcinoma. Cancer 2005; 104:763-70. 2.Kwan-Hwa Chi Chi, M.D Comparing the effectiveness of combined HT and EBRT vs EBRT alone in treating patients with painful bone metastases 3.Cihan Gani, et al. Long-term local control and survival after preoperative radiochemotherapy in combination with deep regional hyperthermia in locally advanced rectal cancer. Inter Jour of Hyperthermia 2016.
• More consideration in clinical;
– Cervical cancer 1: 68 pts received RT+CMT+HT, at F/U 538 days, OS=84%, CR 90%, comparable toxicity
– Bone metastases 2: on going, prelim result; HT +RT time to pain progression, response
– Rectal cancer 3: 103 pts reveived preop RT+CMT+HT or RT+CMT; 5yrs Kaplan-Meire estimate local control of 98% vs 87%, OS 88 vs 76%
Discussion
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• Hyperthermia in addition to standard radiation therapy and/or chemotherapy in locally advanced/ metastases cancer patients have shown the promising results without serious side effects.
Conclusions and clinical implications