Autophagy inhibition mediated via an injectable and NO-releasing hydrogelfor amplifying the antitumor efficacy of mild magnetic hyperthermia

While mild hyperthermia holds great potential in the treatment of solid tumors, the thermal stress-triggered selfrepairingautophagy significantly compromises its efficacy. To circumvent this obstacle, an injectable hydrogel(NO-Gel) composed of thermosensitive poly(ethylene glycol)-polypeptide copolymers modified with abundantNO donors on their side chains is developed. Meanwhile, ferrimagnetic Zn0.5Fe2.5O4 magnetic nanoparticles(MNPs) with high magnetic-heat conversion efficiency are synthesized and loaded into NO-Gel to obtainMNPs@NO-Gel. The MNPs@NO-Gel system exhibits a sol-gel transition upon heating, and has the ability toperform multiple magnetic hyperthermia therapy (MHT) after only one administration due to the even distributionand strong immobilization of MNPs in NO-Gel. NO can be continuously liberated from NO-Gel and thisprocess is markedly accelerated by MHT. Additionally, MNPs@NO-Gel maintains its integrity in vivo for over onemonth and the released MNPs are metabolized by the spleen. After a single administration of MNPs@NO-Gel atthe tumor site, three mild MHT treatments with similar effects are fulfilled, and the sufficient supply of NOeffectively inhibits MHT-induced autophagic flux via blocking the formation of autophagosomes and synchronouslydestroying lysosomes, thereby substantially boosting the efficacy of mild MHT. As a consequence, CT-26colon tumors are completely eliminated without causing severe side-effects.

Recurrent malignant hyperthermia after scoliosis correction surgery

Malignant hyperthermia(MH)is a genetic disorder of skeletal muscle cells that affects muscle cytoplasmic calcium homeostasis,with high mortality and low morbidity.Generally,it presents with non-specific signs of a hypermetabolic response,including high fever,tachycardia,and elevated end-tidal carbon dioxide(ETCO_(2)).The successful treatment lies in the timely recognition and early use of dantrolene.[1]As an inhibitor of Ca2+release through ryanodine receptor(RYR)channels,the skeletal muscle relaxant dantrolene has proven to be both a valuable experimental probe of intracellular Ca2+signaling and a lifesaving treatment for MH.[2]Dominant mutations in the skeletal muscle RYR1 gene are well-recognized causes of both malignant hyperthermia susceptibility(MHS)and central core disease(CCD).

Structural, Magnetic and Heating Efficiency of Ball Milled γ-Fe2O3/Gd2O3 Nanocomposite for Magnetic Hyperthermia

The preparation of γ-Fe2O3/Gd2O3 nanocomposite for possible use in magnetic hyperthermia application was done by ball milling technique. The nanocomposite was characterized by X-ray diffraction (XRD) and vibrating sample magnetometer (VSM). The heating efficiency and the effect of milling time (5 h and 30 h) on the structural and magnetic properties of the nanocomposite were reported. XRD analysis confirms the formation of the nanocomposite, while magnetization measurements show that the milled sample present hysteresis with low coercivity and remanence. The specific absorption rate (SAR) under an alternating magnetic field is investigated as a function of the milling time. A mean heating efficiency of 68 W/g and 28.7 W/g are obtained for 5 h and 30 h milling times respectively at 332 kHz and 170 Oe. The results showed that the obtained nanocomposite for 5 h milling time is a promising candidate for magnetic hyperthermia due to his properties which show an interesting magnetic behavior and high specific absorption rate.

Hyperthermia on skin immune system and its application in the treatment of HPV-infected skin diseases

In this paper, the effects of hyperthermia on cells and immune system are introduced briefly. The mechanism of action of hyperthermia on human papilloma virus （HPV）-infected skin diseases was elaborated as an example in this paper. Many studies have proved that hyperthermia affects a number of cellular and molecu- lar constitutes in the skin immune system, involving both innate and adaptive immune responses; the efficacy of hyperthermia in treating some infectious and cancerous conditions has been validated and applied in clinics, while molecular mechanisms of hyperthermia affecting the immunereaction is still unclear.

Real-Time MRI-Controlled Ultrasound Hyperthermia System for Superficial Tumor Treatment

Ultrasound hyperthermia is one of the most important methods in tumor treatment and characterized by non-invasiveness. Magnetic resonance imaging(MRI)-based temperature mapping techniques are safe compared with invasive methods and have been applied to detect temperature changes for a variety of applications. Among these techniques, the proton resonance frequency(PRF) method is relatively advanced. With a temperature measuring experiment, the effectiveness of PRF method has been proved, because the outcome temperature curve and the real temperature curve fit well. After that, an experiment has been conducted on tumors inside rabbit legs and the result indicates that this system is able to performance hyperthermia at targets based on PRF method in temperature mapping.

Pencil Beam Grid Antenna Array for Hyperthermia Breast Cancer Treatment System

In this paper, efficient, high gain and pencil beam grid antenna array is proposed for hyperthermia breast cancer therapy system. The proposed antenna bandwidth extends from 4.8 GHz to 4.9 GHz at resonant frequency of 4.86 GHz. This frequency band has been reported for the breast cancer hyperthermia therapy. The grid long and short sides are responsible for the undesired cross-polarized radiation and desired copolarized radiation, respectively. The unsuitability of the conventional grid antenna array is ensured by investigating its radiation properties. The proposed grid antenna array short side width is varied and its long side width is kept wide as possible to enhance the radiation properties and to reduce the losses. Also, a reflector has been used for gain enhancement purpose. The proposed grid antenna array achieves side lobe level and 3 dB beam width of —27.9 dB and 25.9° for the E-plane and —27.9 dB and 26.3° for the H-plane, respectively. The breast phantom is irradiated by both proposed and conventional grid antenna arrays for 10 minutes. The proposed grid antenna array achieves 8°C temperature increase within the breast phantom area compared to 2°C temperature increase for conventional one. The proposed grid antenna array is highly efficient, high gain and light weight, and it has a very suitable radiation property for hyperthermia breast cancer therapy.

Estimation of overall heat transfer coefficient of cooling system in RF capacitive hyperthermia

The study presented in this article involves the estimation of the overall heat transfer coefficient of cooling system in RF capacitive hyperthermia treatment using inverse problem based on the conjugate gradient method to provide improved distribution of temperature. The temperature data computed numerically from the direct problem using the finite difference time domain method are used to simulate the temperature measurements. The effects of the errors and sensor positions upon the precision of the estimated results are also considered. The results show that a reasonable estimation of the unknown can be obtained. Finally, measurements in a tissue-equivalent phantom are employed to appraise the reliability of the presented method. The comparison of computed data with measurements shows a good agreement between numerical and experimental results.

Effect of hyperthermia perfusion chemotherapy combined with systemic chemotherapy on the expression and secretion of malignant molecules in advanced bladder cancer

Objective: To study the effect of hyperthermia perfusion chemotherapy combined with systemic chemotherapy on the expression and secretion of malignant molecules in advanced bladder cancer. Methods: Patients who were diagnosed with advanced bladder cancer in Gongan County People's Hospital between March 2015 and December 2017 were chosen and randomly divided into two groups, experimental group accepted hyperthermia perfusion chemotherapy combined with systemic chemotherapy, and control group accepted routine infusion chemotherapy combined with systemic chemotherapy. The expression levels of proliferation and invasion genes in the lesions as well as the secretion of cytokines in the urine were measured before chemotherapy and 3 months after chemotherapy. Results: Livin, Bcl-2, TRAP1 and MMP9 mRNA expression in lesions as well as VEGF, TGF-β1, MCP-1 and CEACAM1 secretion in urine of both groups after chemotherapy were lower than those before chemotherapy whereas Bad, LRIG3, Beclin1, KLF4, CHD13 and E-cadherin mRNA expression in lesions as well as IFN-γ and IL-2 secretion in urine were higher than those before chemotherapy, and Livin, Bcl-2, TRAP1 and MMP9 mRNA expression in lesions as well as VEGF, TGF-β1, MCP-1 and CEACAM1 secretion in urine of experimental group were significantly lower than those of control group whereas Bad, LRIG3, Beclin1, KLF4, CHD13 and E-cadherin mRNA expression in lesions as well as IFN-γ and IL-2 secretion in urine were significantly higher than those of control group. Conclusion: Hyperthermia perfusion chemotherapy combined with systemic chemotherapy can be more effective than routine infusion chemotherapy combined with systemic chemotherapy to regulate the expression and secretion of malignant molecules in advanced bladder cancer.

Eff ect of post-rewarming fever after targeted temperature management in cardiac arrest patients: a systematic review and meta-analysis

BACKGROUND:Targeted temperature management(TTM),as a therapeutic temperature control strategy for cardiac arrest(CA),is recommended by guidelines.However,the relationship between postrewarming fever(PRF)and the prognosis of CA patients is unclear.Therefore,we aim to summarize the studies regarding the infl uence of PRF on patients with CA.METHODS:EMBASE,PubMed,and Cochrane Central databases were searched from inception to March 13,2022.Randomized clinical trials(RCTs)and cohort studies on PRF in CA patients were included.According to the heterogeneity,the meta-analysis was performed using a random eff ects model or fi xed eff ects model to calculate the pooled odds ratios(ORs)and corresponding 95%confi dence intervals(CIs).The outcome data were unfavorable neurological outcome and mortality.RESULTS:The meta-analysis included 11 observational studies involving 3,246 patients.The results of the meta-analysis show that PRF(body temperature>38.0℃)has no eff ect on the neurological outcome of CA patients(OR 0.71,95%CI 0.43–1.17,I282%)and has a signifi cant relationship with lower mortality(OR 0.63;95%CI 0.49–0.80,I239%).However,PRF with a stricter defi nition(body temperature>38.5℃)was associated with worse neurological outcome(OR 1.44,95%CI 1.08–1.92,I245%)and higher mortality(OR 1.71,95%CI 1.25–2.35,I247%).CONCLUSION:This study suggests that PRF>38.0℃ may not affect the neurological outcome and have a lower mortality in CA patients who completed TTM.However,PRF>38.5℃ is a potential prognostic factor for worse outcomes in CA patients.

Extraction method of nanoparticles concentration distribution from magnetic particle image and its application in thermal damage of magnetic hyperthermia

Magnetic particle imaging(MPI)technology can generate a real-time magnetic nanoparticle(MNP)distribution image for biological tissues,and its use can overcome the limitations imposed in magnetic hyperthermia treatments by the unpredictable MNP distribution after the intratumoral injection of nanofluid.However,the MNP concentration distribution is generally difficult to be extracted from MPI images.This study proposes an approach to extract the corresponding concentration value of each pixel from an MPI image by a least squares method(LSM),which is then translated as MNP concentration distribution by an interpolation function.The resulting MPI-based concentration distribution is used to evaluate the treatment effect and the results are compared with the ones of two baseline cases under the same dose:uniform distribution and MPI-based distribution considering diffusion.Additionally,the treatment effect for all these cases is affected by the blood perfusion rate,which is also investigated deeply in this study.The results demonstrate that the proposed method can be used to effectively reconstruct the concentration distribution from MPI images,and that the weighted LSM considering a quartic polynomial for interpolation provides the best results with respect to other cases considered.Furthermore,the results show that the uniformity of MNP distribution has a positive correlation with both therapeutic temperature distribution and thermal damage degree for the same dose and a critical power dissipation value in the MNPs.The MNPs uniformity inside biological tissue can be improved by the diffusion behavior after the nanofluid injection,which can ultimately reflect as an improvement of treatment effect.In addition,the blood perfusion rate considering local temperature can have a positive effect on the treatment compared to the case which considers a constant value during magnetic hyperthermia.

Magnetite Nanoparticles Coated with Synthetic Polymer for Hyperthermia Application: Review

Hyperthermia treatment using appropriate magnetic materials in an alternating magnetic field to generate heat has been proposed as a low-invasive cancer treatment method. Magnetite iron oxide nanoparticles (Fe3O4) are expected to be an appropriate type of magnetic material for this purpose due to its biocompatibility. Several polymers are used to Fe3O4 MNPs to avoid or decrease agglomeration, and in most cases increase dispersion stability. In this review, we will give briefly how these coated magnetite nanoparticles (PMNPs) are synthesized in the first part. The main characterization techniques usually used to study the properties of these MNPs are prseneted in the second part. Finally, most recent results on the heating ability of polymeric coated magnetite nanoparticles (PMNPs) are given in the last part of this review.

Hyperthermia combined with chemotherapy vs chemotherapy in patients with advanced pancreatic cancer:A multicenter retrospective observational comparative study

BACKGROUND Several studies report the useful therapeutic results of regional hyperthermia in association with chemotherapy(CHT) and radiotherapy for the treatment of pancreatic cancer. Modulated electrohyperthermia(mEHT) is a new hyperthermia technique that induces immunogenic death or apoptosis of pancreatic cancer cells in laboratory experiments and increases tumor response rate and survival in pancreatic cancer patients, offering beneficial therapeutic effects against this severe type of cancer.AIM To assess survival, tumor response and toxicity of mEHT alone or combined with CHT compared with CHT for the treatment of locally advanced or metastatic pancreatic cancer.METHODS This was a retrospective data collection on patients affected by locally advanced or metastatic pancreatic cancer(stage Ⅲ and IV) performed in 9 Italian centers, members of International Clinical Hyperthermia Society-Italian Network. This study included 217 patients, 128(59%) of them were treated with CHT(no-mEHT) and 89(41%) patients received mEHT alone or in association with CHT. mEHT treatments were performed applying a power of 60-150 watts for 40-90 min, simultaneously or within 72 h of administration of CHT.RESULTS Median patients’ age was 67 years(range 31-92 years). mEHT group had a median overall survival greater than non-mEHT group(20 mo, range 1.6-24, vs 9 mo, range 0.4-56.25, P < 0.001). mEHT group showed a higher number of partial responses(45% vs 24%, P = 0.0018) and a lower number of progressions(4% vs 31%, P < 0.001) than the no-mEHT group, at the three months follow-up. Adverse events were observed as mild skin burns in 2.6% of mEHT sessions.CONCLUSION mEHT seems safe and has beneficial effects on survival and tumor response of stage Ⅲ-IV pancreatic tumor treatment. Further randomized studies are warranted to confirm or not these results.

Malignant hyperthermia as a rare complication of local lidocaine injection:A case report

BACKGROUND Malignant hyperthermia(MH)is a hypermetabolic disorder of skeletal muscles triggered by exposure to volatile anesthetics and depolarizing muscular relaxants.It manifests with clinical presentations such as tachycardia,muscle rigidity,hyperpyrexia,and rhabdomyolysis in genetically predisposed individuals with ryanodine receptor or calcium voltage-gated channel subunit alpha1 S mutations.Local anesthetics,such as lidocaine,are generally considered safe;however,complications can arise,albeit rarely.Lidocaine administration has been reported to induce hypermetabolic reactions resembling MH in susceptible individuals.The exact mechanism by which lidocaine might trigger MH is not fully understood.Although some mechanisms are postulated,further research is needed for a better understanding of this.CASE SUMMARY We present the case of MH in a 43-year-old male patient with an unknown genetic predisposition following a lidocaine injection during a dental procedure.This case serves as a reminder that while the occurrence of lidocaine-induced MH is rare,lidocaine can still trigger this life-threatening condition.Therefore,caution should be exercised when administering lidocaine to individuals who may be susceptible to MH.It is important to note that prompt intervention played a crucial role in managing the patient’s symptoms.Upon recognizing the early signs of MH,aggressive measures were initiated,including vigorous intravenous normal saline administration and lorazepam.Due to the effectiveness of these interventions,the administration of dantrolene sodium,a specific antidote for MH,was deferred.CONCLUSION This case highlighted the significance of vigilant monitoring and swift action in mitigating the detrimental effects of lidocaine-induced MH.Caution should be exercised when administering lidocaine to individuals who may be predisposed to MH.It is very important to be aware and vigilant of the signs and symptoms of MH as early recognition and treatment intervention are important to prevent serious complications to decrease mortality.

Calculation of Electromagnetic Field and SAR Dis- tributions of Two Antenna Structures for Bone Tu- mors Microwave Hyperthermia

Objective: To investigate the electromagnetic field and specific absorptionrate (SAR) distribution of different structure applicators with different depths for treating bonetumors using microwave hyperthermia. Methods: The finite element method (FEM) was used to calculate,electromagnetic field and SAR distribution. Two different structure applicators were simulated. Theone is simple coaxial antenna, which has been successfully used in clinic treating bone tumors inTangdu hospital of the Forth Military Medical University several years. It was formed by a coaxialcable peeled off the out copper at end. The other applicator was coaxial- slot antenna, which waswidely used in microwave hyperthermia. The applicator inserted into the cylindrical bone withdifferent depths, and worked at the frequency of 2 450 MHz. Results: The electric field and SARgenerated by the simple coaxial applicator were mainly concentrated out the tissues, and were notuniform in the tissues, while the coaxial- slot applicator well transmits the electric field and SARinto the tissues, and can easily treat different position by adjusting the slat position.Conclusion: The results calculated by EFM, were well accordant with the experimental and clinicalresulls, and will be important for improving the clinical effects of microwave hyperthermia.

围手术期恶性高热护理培训方案的制订与应用

目的探讨构建的围手术期恶性高热护理培训方案在麻醉科护士培训中的应用效果。方法2023年10—11月对河南省郑州大学第一附属医院的72名麻醉科护士分为两组开展培训。试验组(36名)采用构建的围手术期恶性高热护理培训方案进行培训,培训大纲围绕七大模块展开;对照组(36名)采用常规的多媒体理论授课和视频演示的方法进行培训。比较两组学员的围手术期恶性高热护理能力评分、理论考核成绩,以及对培训效果的评价情况。结果试验组的围手术期恶性高热护理能力评分、理论考核成绩、培训和满意度效果评价均高于对照组,差异有统计学意义(P<0.05)。结论本研究所构建的围手术期恶性高热护理培训方案有助于提高麻醉科护士恶性高热护理能力,改善培训效果和培训质量。

Elevated brain temperature under severe heat exposure impairs cortical motor activity and executive function

Background:Excessive heat exposure can lead to hyperthermia in humans,which impairs physical performance and disrupts cognitive function.While heat is a known physiological stressor,it is unclear how severe heat stress affects brain physiology and function.Methods:Eleven healthy participants were subjected to heat stress from prolonged exercise or warm water immersion until their rectal temperatures(T_(re))attained 39.5℃,inducing exertional or passive hyperthermia,respectively.In a separate trial,blended ice was ingested before and during exercise as a cooling strategy.Data were compared to a control condition with seated rest(normothermic).Brain temperature(T_(br)),cerebral perfusion,and task-based brain activity were assessed using magnetic resonance imaging techniques.Results:T_(br)in motor cortex was found to be tightly regulated at rest(37.3℃±0.4℃(mean±SD))despite fluctuations in T_(re).With the development of hyperthermia,T_(br)increases and dovetails with the rising T_(re).Bilateral motor cortical activity was suppressed during high-intensity plantarflexion tasks,implying a reduced central motor drive in hyperthermic participants(T_(re)=38.5℃±0.1℃).Global gray matter perfusion and regional perfusion in sensorimotor cortex were reduced with passive hyperthermia.Executive function was poorer under a passive hyperthermic state,and this could relate to compromised visual processing as indicated by the reduced activation of left lateral-occipital cortex.Conversely,ingestion of blended ice before and during exercise alleviated the rise in both T_(re)and T_(bc)and mitigated heat-related neural perturbations.Conclusion:Severe heat exposure elevates T_(br),disrupts motor cortical activity and executive function,and this can lead to impairment of physical and cognitive performance.

In situ engineered magnesium alloy implant for preventing postsurgical tumor recurrence

Invasive tumors are difficult to be completely resected in clinical surgery due to the lack of clear resection margins,which greatly increases the risk of postoperative recurrence.However,chemotherapy and radiotherapy as the traditional means of postoperative adjuvant therapy,are limited in postoperative applications,such as multi-drug resistance and low sensitivity,etc.Therefore,an engineered magnesium alloy rod is designed as a postoperative implant to completely remove postoperative residual tumor tissue and inhibit tumor recurrence by gas and mild magnetic hyperthermia therapy(MMHT).As a reactive metal,magnesium alloy responds to the acidic tumor microenvironment by continuously generating hydrogen.The in-situ generation of hydrogen not only protects the surrounding normal tissue,but also enables the magnesium alloy to achieve MMHT under lowintensity alternating magnetic field(AMF).Furthermore,the numerous reactive oxygen species(ROS)produced by heat stress will combine with nitric oxide(NO)generated in situ,to produce more toxic reactive nitrogen species(RNS)storm.In summary,engineered magnesium alloy can completely remove residual tumor tissue and inhibit tumor recurrence by MMHT and RNS storm under low-intensity AMF,and the biodegradability of magnesium alloy makes great potential for clinical application.

智能姜黄素纳米颗粒联合热疗对肝癌Huh 7细胞的抑制作用

目的制备并表征智能姜黄素(curcumin,Cur)-四氧化三铁(Fe_(3)O_(4))纳米颗粒(Cur-Fe_(3)O_(4)NPs),探讨体外协同热疗后对Huh 7细胞的抑制作用。方法采用溶剂热法合成Fe_(3)O_(4)纳米团簇,再化学结合携带Cur,合成Cur-Fe_(3)O_(4)NPs。用傅里叶红外光谱(FT-IR)和透射电子显微镜(TEM)等表征验证。用紫外分光光度法测定NPs的载药率。使用透析法进行药物释放实验,比较射频(radiofrequency,RF)热疗组与无热疗组的Cur释放率。根据不同处理方式将Huh 7细胞分为单纯热疗组、游离Cur组、Cur-Fe_(3)O_(4)NPs组、Cur+RF组和Cur-Fe_(3)O_(4)NPs+RF组,通过CCK-8法评估不同处理组的细胞毒性。结果FT-IR观察到在570 cm^(-1)处是Fe-O键,在963.75 cm^(-1)处Cur连接成功。透射电镜观察Fe_(3)O_(4)纳米团簇和Cur-Fe_(3)O_(4)NPs的粒径分别为(50.7±10.2)nm和(94.0±12.2)nm。Cur-Fe_(3)O_(4)NPs载药率为69.91%。无热疗组Cur-Fe_(3)O_(4)NPs释放Cur约68%,热疗组NPs释放Cur明显增多到85%。细胞毒性实验表明,单纯热疗组和游离Cur组Huh 7细胞存活率均在90%左右;与单纯热疗组和游离Cur组相比,Cur-Fe_(3)O_(4)NPs组细胞活力降低(P<0.05);与其他三组比较,Cur-Fe_(3)O_(4)NPs+RF组Huh 7细胞的存活率明显下降(P<0.0001)。结论Cur-Fe_(3)O_(4)NPs可有效释放Cur,协同热疗后对肝癌Huh 7细胞有明显抑制作用。

Intraperitoneal perfusion of cytokine-induced killer cells with local hyperthermia for advanced hepatocellular carcinoma

AIM:To study the effect and tolerance of intraperitoneal perfusion of cytokine-induced killer(CIK) cells in combination with local radio frequency(RF) hyperthermia in patients with advanced primary hepatocellular carcinoma(HCC).METHODS:Patients with advanced primary HCC were included in this study.CIK cells were perfused intraperitoneal twice a week,using 3.2 × 10 9 to 3.6 × 10 9 cells each session.Local RF hyperthermia was performed 2 h after intraperitoneal perfusion.Following an interval of one month,the next course of treatment was administered.Patients received treatment until disease progression.Tumor size,immune indices(CD3 +,CD4 +,CD3 + CD8 +,CD3 + CD56 +),alpha-fetoprotein(AFP) level,abdominal circumference and adverse events were recorded.Time to progression and overall survival(OS) were calculated.RESULTS:From June 2010 to July 2011,31 patients diagnosed with advanced primary HCC received intraperitoneal perfusion of CIK cells in combination with local RF hyperthermia in our study.Patients received an average of 4.2 ± 0.6 treatment courses(range,1-8 courses).Patients were followed up for 8.3 ± 0.7 mo(range,2-12 mo).Following combination treatment,CD4 +,CD3 + CD8 + and CD3 + CD56 + cells increased from 35.78% ± 3.51%,24.61% ± 4.19% and 5.94% ± 0.87% to 45.83% ± 2.48%(P = 0.016),39.67% ± 3.38%(P = 0.008) and 10.72% ± 0.67%(P = 0.001),respectively.AFP decreased from 167.67 ± 22.44 to 99.89 ± 22.05 ng/mL(P = 0.001) and abdominal circumference decreased from 97.50 ± 3.45 cm to 87.17 ± 4.40 cm(P = 0.002).The disease control rate was 67.7%.The most common adverse events were low fever and slight abdominal erubescence,which resolved without treatment.The median time to progression was 6.1 mo.The 3-,6-and 9-mo and 1-year survival rates were 93.5%,77.4%,41.9% and 17.4%,respectively.The median OS was 8.5 mo.CONCLUSION:Intraperitoneal perfusion of CIK cells in combination with local RF hyperthermia is safe,can efficiently improve immunological status,and may prolong survival in HCC patients.

Role of radiotherapy in the management of hepatocellular carcinoma:A systematic review

Many patients with hepatocellular carcinoma(HCC) present with advanced disease,not amenable to curative therapies such as surgery,transplantation or radiofrequency ablation. Treatment options for this group of patients include transarterial chemoembolization(TACE) and radiation therapy. Especially TACE,delivering a highly concentrated dose of chemotherapy to tumor cells while minimizing systemic toxicity of chemotherapy,has given favorable results on local control and survival. Radiotherapy,as a therapeutic modality of internal radiation therapy with radioisotopes,has also achieved efficacious tumor control in advanced disease. On the contrary,the role of external beam radiotherapy for HCC has been limited in the past,due to the low tolerance of surrounding normal liver parenchyma. However,technological innovations in the field of radiotherapy treatment planning and delivery,have provided the means of delivering radical doses to the tumor,while sparing normal tissues. Advanced and highly conformal radiotherapy approaches such as stereotactic body radiotherapy and proton therapy,evaluated for efficacy and safety for HCC,report encouraging results. In this review,we present the role of radiotherapy in hepatocellular carcinoma patients not suitable for radical treatment.