Status quo and directions in deep head and neck hyperthermia
- PDF / 2,887,978 Bytes
- 14 Pages / 595.276 x 790.866 pts Page_size
- 20 Downloads / 233 Views
REVIEW
Open Access
Status quo and directions in deep head and neck hyperthermia Margarethus M. Paulides* , Gerda M. Verduijn and Netteke Van Holthe
Abstract The benefit of hyperthermia as a potent modifier of radiotherapy has been well established and more recently also the combination with chemotherapy was shown beneficial. Also for head and neck cancer, the impact of hyperthermia has been clinically demonstrated by a number of clinical trials. Unfortunately, the technology applied in these studies provided only limited thermal dose control, and the devices used only allowed treatment of target regions close to the skin. Over the last decade, we developed the technology for deep and controlled hyperthermia that allows treatment of the entire head and neck region. Our strategy involves focused microwave heating combined with 3D patient-specific electromagnetic and thermal simulations for conformal, reproducible and adaptive hyperthermia application. Validation of our strategy has been performed by 3D thermal dose assessment based on invasively placed temperature sensors combined with the 3D patient specific simulations. In this paper, we review the phase III clinical evidence for hyperthermia in head and neck tumors, as well as the heating and dosimetry technology applied in these studies. Next, we describe the development, clinical implementation and validation of 3D guided deep hyperthermia with the HYPERcollar, and its second generation, i.e. the HYPERcollar3D. Lastly, we discuss early clinical results and provide an outlook for this technology. Keywords: Head and neck cancer, Radiofrequency, Hyperthermia, Electromagnetic modelling, Thermal therapy
Introduction In current clinical practice, tumors of the head and neck (H&N) region are treated with surgery, radiotherapy (RT), chemotherapy or combinations of these. Early cases are usually treated with either surgery or RT, where locally-advanced primary carcinoma of the H&N are treated with RT, often combined with chemotherapy [1]. Following the introduction of hyper-fractionation schedules of RT and technological improvements like intensity modulated RT (IMRT), higher tumor dose and reduction of some toxicity endpoints, such as xerostomia [2], can be achieved but the toxicity remains substantial [3, 4]. In 2000, Pignon et al. [5] published a three meta-analyses study, which showed that combining RT with simultaneous chemotherapy on average results in an 8 % absolute increase of the overall 2-years survival. More recently they observed a 4.5 % absolute benefit at 5-years in another meta-analysis involving 87 trials [6]. Still, improvement is warranted since locoregional recurrence rates are up to 30–60 % after complex
multimodality treatment [7]. In addition, more than 80 % of patients experience severe toxicity with current regimens, as well as enduring long-term effects from treatment, relapse, or metastasis [1]. For chemotherapy, the reported improved treatment outcomes were accompanied by enhanced systemic toxicity or exacerbate local tissue reactions, wh
Data Loading...
