局部热疗在头颈癌综合治疗中的应用

The Application of local hyperthermia in the combined treatment of head and neck carcinomas

本文综述了当今热疗联合放、化疗在头颈癌治疗中的应用情况。温热(40～44℃)能显著增加放疗和(或)化疗的疗效,并在多方面具有合理性。加热技术的改进确保了有效的加热深度和精确的加热温度。温热的抗肿瘤机理是诱导肿瘤细胞凋亡,多项临床试验取得了令人鼓舞的结果。局部热疗的主要不良反应是皮肤的急性烫伤水泡、溃疡或不适(疼痛)。当联合放、化疗时,全身的不良反应主要是可接受的中度血液毒性和轻度胃肠道毒性。组织氧和度、p53、Hsp表达等参数可以预测热疗的效果。影响热疗疗效的因素包括热耐受情况、热增敏剂的应用、均匀加热以及有效的治疗温度等。随着肿瘤综合序列治疗概念的建立,热疗在头颈癌辅助治疗中将起到越来越重要的作用。

The purpose of this article is to review the current clinical application of local hyperthermia(HT)combined with conventional therapeutic modalities:radiotherapy(RT)or/and chemotherapy(CT)in the treatment of head and neck cancer.Many studies have demonstrated that hyperthermia(40～44℃)has a potential effect on RT and CT,which has theoretical rationality.Technical improvements have facilitated the application of HT by ensuring effective heating depth and precise thermometry.The anti-tumor mechanism of HT is to induce the tumor cells apoptosis.Several clinical phase I/II trails performed in the advanced,recurrent,unresectable head and neck cancer resulted in promising local control.The main side-effects of HT are acute cutaneous thermal blisters or ulcerations and discomfort(pain).The systemic toxici-ty is acceptable when combined with RT or/and CT,including moderate haematologic toxicity and mild gastrointestinal toxicity,no serious side effects were observed compared with that of RT or CT used alone.Tissue oxygenation,expression of p53and heat shock protein(Hsp)may predict the treatment outcome.The factors affecting hyperthermia are heat toler-ance,the application of drugs enhancing thermo-sensitivity,equably temperature control and effective treatment tempera-ture etc.With the establishment of sequential combined treatment concept,HT will play more and more important role in the adjuvant treatment of head and neck cancer.