Two or six hyperthermia treatments as an adjunct to radiation therapy yield similar tumor responses: results of a randomized trial

Daniel S. Kapp, Ivy A Petersen, Richard S. Cox, George M. Hahn, Peter Fessenden, Stavros D. Prionas, Eric R. Lee, John L. Meyer, Thaddeus V. Samulski, Malcolm A. Bagshaw

Research output: Contribution to journalArticle

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Abstract

From March 1984 to February 1988, 70 patients with 179 separate treatment fields containing superficially located (<3 cm from surface) recurrent or metastatic malignancies were stratified based on tumor size, histology, and prior radiation therapy and enrolled in prospective randomized trials comparing two versus six hyperthermia treatments as an adjunct to standardized courses of radiation therapy. A total of 165 fields completed the combined hyperthermia-radiation therapy protocols and were evaluable for response. No statistically significant differences were observed between the two treatment arms with respect to tumor location; histology; initial tumor volume; patient age and pretreatment performance status; extent of prior radiation therapy, chemotherapy, hormonal therapy, or immunotherapy; or concurrent radiation therapy. The means for all fields of the averaged minimum, maximum, and average measured intratumoral temperatures were 40.2°C, 44.8°C, 42.5°C, respectively, and did not differ significantly between the fields randomized to two or six hyperthermia treatments. The treatment was well tolerated with an acceptable level of complications. At 3 weeks after completion of therapy, complete disappearance of all measurable tumor was noted in 52% of the fields, ≥50% tumor reduction was noted in 7% of the fields, <50% tumor reduction was noted in 21% of the fields, and continuing regression (monotonic regression to <50% of initial volume) was noted in 20% of the fields. No significant differences were noted in tumor responses at 3 weeks for fields randomized to two versus six hyperthermia treatments (p = 0.89). Cox regression analyses were performed to identify pretreatment or treatment parameters that correlated with duration of local control. Tumor histology, concurrent radiation dose, and tumor volume all correlated with duration of local control. The mean of the minimum intratumoral temperatures (<41°C vs. ≥41°C) was of borderline prognostic significance in the univariate analysis, and added to the power of the best three covariate model. Neither the actual number of hyperthermia treatments administered nor the hyperthermia protocol group (two versus six treatments) correlated with duration of local control. The development of thermotolerance is postulated to be, at least in part, responsible for limiting the effectiveness of multiple closely spaced hyperthermia treatments.

Original languageEnglish (US)
Pages (from-to)1481-1495
Number of pages15
JournalInternational Journal of Radiation Oncology, Biology, Physics
Volume19
Issue number6
DOIs
StatePublished - 1990
Externally publishedYes

Fingerprint

hyperthermia
radiation therapy
Fever
Radiotherapy
tumors
Neoplasms
histology
Therapeutics
regression analysis
Histology
pretreatment
therapy
Tumor Burden
chemotherapy
Temperature
Immunotherapy
dosage
Regression Analysis
temperature
Radiation

Keywords

  • Complications
  • Hyperthermia
  • Local control
  • Number of treatments
  • Prognostic parameters
  • Superficial lesions
  • Thermotolerance

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Radiation

Cite this

Two or six hyperthermia treatments as an adjunct to radiation therapy yield similar tumor responses : results of a randomized trial. / Kapp, Daniel S.; Petersen, Ivy A; Cox, Richard S.; Hahn, George M.; Fessenden, Peter; Prionas, Stavros D.; Lee, Eric R.; Meyer, John L.; Samulski, Thaddeus V.; Bagshaw, Malcolm A.

In: International Journal of Radiation Oncology, Biology, Physics, Vol. 19, No. 6, 1990, p. 1481-1495.

Research output: Contribution to journalArticle

Kapp, Daniel S. ; Petersen, Ivy A ; Cox, Richard S. ; Hahn, George M. ; Fessenden, Peter ; Prionas, Stavros D. ; Lee, Eric R. ; Meyer, John L. ; Samulski, Thaddeus V. ; Bagshaw, Malcolm A. / Two or six hyperthermia treatments as an adjunct to radiation therapy yield similar tumor responses : results of a randomized trial. In: International Journal of Radiation Oncology, Biology, Physics. 1990 ; Vol. 19, No. 6. pp. 1481-1495.
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N2 - From March 1984 to February 1988, 70 patients with 179 separate treatment fields containing superficially located (<3 cm from surface) recurrent or metastatic malignancies were stratified based on tumor size, histology, and prior radiation therapy and enrolled in prospective randomized trials comparing two versus six hyperthermia treatments as an adjunct to standardized courses of radiation therapy. A total of 165 fields completed the combined hyperthermia-radiation therapy protocols and were evaluable for response. No statistically significant differences were observed between the two treatment arms with respect to tumor location; histology; initial tumor volume; patient age and pretreatment performance status; extent of prior radiation therapy, chemotherapy, hormonal therapy, or immunotherapy; or concurrent radiation therapy. The means for all fields of the averaged minimum, maximum, and average measured intratumoral temperatures were 40.2°C, 44.8°C, 42.5°C, respectively, and did not differ significantly between the fields randomized to two or six hyperthermia treatments. The treatment was well tolerated with an acceptable level of complications. At 3 weeks after completion of therapy, complete disappearance of all measurable tumor was noted in 52% of the fields, ≥50% tumor reduction was noted in 7% of the fields, <50% tumor reduction was noted in 21% of the fields, and continuing regression (monotonic regression to <50% of initial volume) was noted in 20% of the fields. No significant differences were noted in tumor responses at 3 weeks for fields randomized to two versus six hyperthermia treatments (p = 0.89). Cox regression analyses were performed to identify pretreatment or treatment parameters that correlated with duration of local control. Tumor histology, concurrent radiation dose, and tumor volume all correlated with duration of local control. The mean of the minimum intratumoral temperatures (<41°C vs. ≥41°C) was of borderline prognostic significance in the univariate analysis, and added to the power of the best three covariate model. Neither the actual number of hyperthermia treatments administered nor the hyperthermia protocol group (two versus six treatments) correlated with duration of local control. The development of thermotolerance is postulated to be, at least in part, responsible for limiting the effectiveness of multiple closely spaced hyperthermia treatments.

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