热疗加放射治疗的热参数与肿瘤反应的相关性研究

Relationships between thermal parameters and tumor response in the combination of using hyperthermia with radiotherapy

目的通过热疗加放射治疗的热参数与肿瘤反应的相关性研究，寻找１个更有效的评价热疗疗效的热参数或热剂量。方法对５４例晚期恶性肿瘤进行放射治疗加超声热疗。热疗每周加热２次，每次６０分钟，在放射治疗后３０分钟内进行，共６～１０次，每次都行肿瘤内测温，测温点平均５个，每１０秒记录１个温度数据。最终进行肿瘤反应与肿瘤内最高温度（Ｔｍａｘ），最低温度（Ｔｍｉｎ），平均温度（Ｔａｖ），Ｔ９０，Ｔ５０，Ｔ１０，％Ｔ以及肿瘤中央区测温点温度大于４２℃，４２．５℃的持续时间（ＣｕｍｍｉｎＴｃｅｎｔｅｒ＞４２℃，４２．５℃）等热参数的多元回归分析。结果在可评价的４５例中，总有效率为８０．０％。多元回归分析显示ＣｕｍｍｉｎＴｃｅｎｔｅｒ＞４２．５℃与肿瘤反应差异有显著意义（Ｐ＜０．０１），ＣｕｍｍｉｎＴｃｅｎｔｅｒ＞４２℃，４１℃和Ｔ９０等的反应差异无显著意义。结论放射治疗加超声热疗可进一步提高巨块肿瘤的局部控制率。ＣｕｍｍｉｎＴｃｅｎｔｅｒ＞４２．５℃是一个评价热疗疗效的重要热参数。

Objective To search for more effective thermal parameters related to tumor response in advanced malignancies treated with combined hyperthermia and radiation therapy. Methods Fiftyfour patients with advanced malignancies who received two hyperthermia treatments per week with ultrasound hyperthermia during conventional fractionation irradiation. Hyperthermia was given for 60 minutes within 30 minutes following irradiation with 610 sessions of hyperthermia. Multipoint thermometry was used during every hyperthermia with temperature data obtained every 10 seconds. An average of 5 interstitial sites were monitored in each treatment per tumor. Multivariate logistic regression analysis was used to correlate the tumor response to Tmax,Tmin, Tav, T90, T50, T10, %T, and the cumulative minutes when the temperature reached 42.5 in the tumor center (Cum min Tcenter>42.5). Results Fortyfive patients were valuable. The complete and overall response rates were 33.3% and 80.0%, respectively. Multivariate logistic regression analysis showed that a descriptor of Cum min Tcenter>42.5 was significantly associated with complete tumor response. Conclusions Hyperthermia is a useful supplement to irradiation by increasing the local control of advanced malignancies, and that Cum min Tcenter>42.5, combining time/temperature descriptor,may well be an important thermal parameter or the best predicting model.