Experience of Hyperthermia Treatment in Thailand results-THASTRO2016.pdf · Experience of...

Experience of Hyperthermia Treatment in Thailand

Pawinee Mahasittiwat, Walasuda Phoyen, Kamolrath Leedee, Napaporn Subjareun

11 March, 2016

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• A few number of equipment caused the limit experience in Thailand.

Thermotron RF-8: radiofrequency 8 MHz, a pair of electrodes

Background

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• At median F/U 7.1 yrs, data suggest comparable outcome (EFS, pelvic recurrence free survival, OS) for RT-CT and RT-HT in locally advanced cervical cancer (randomized RADCHOC trial)1.

• Thermoradiation therapy enhances the likelihood of CR rates in LRBCs over RT alone by 22% with minimal acute and late morbidities2.

1.Lutgens LC et al. RT combined with HT vs cisplatin for locally advanced cervical cancer: Results of the randomized RADCHOC trial. Raiother Oncol 2016 2.Datta NR et al. HT and RT in locoregional recurrent breast cancers: A systemic review and meta-analysis. Int J Radiat Oncol biol Phys 2015.

Background

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• Hyperthermia along with RT enhances the likelihood of CR in head and neck cancers by around 25% compared to RT alone with no sig additional acute and late morbidities1.

• Adding regional hyperthermia to standard neoadjuvant chemotherapy in patients with localized high-risk soft tissue sarcoma sig increased OS, DFS, and LPFS2

1.Datta NR, et al. HT and RT in the management of H&N cancers: A systematic review and meta-analysisl Int J Hyperthermia 2016 Feb;32(1):31-40 2.Issels RD et al. Long-term outcomes of the EORTC 62961/ESHO randomized phase III study. ECCO2015

Background

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• This retrospective study reported the results and complications in patients who received hyperthermia treatment in Siriraj Piyamaharajkarun Hospital.

Objectives

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• Hyperthermia treatment was combined with radiation therapy and/or chemotherapy in patients with locally advanced or metastases cancer.

• The response of treatment was evaluated at 3 months after completion of the main treatment (radiation and/or chemotherapy) according to RECIST criteria.

• The side effect of treatment also was recorded.

Material and methods

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Patients characteristic Total n= 38

Age (years) 36-81 Mean 60

Sex Male Female

17 (44.7%) 21 (55.3%)

No. of total treatment times/ course

1-11 Mean 3

Location of treated tumor Deep Superficial

34 (89.5%) 4 (10.5%)

Combined treatment Radiation Chemotherapy CMT+RT

26 (68.4%) 8 (21%)

4 (10.5%)

Region of treatment Neck Breast Axilla Chest Upper abdomen Pelvis Thigh

1 1 2 8

10 15

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Treatment watt 230-730 Mean 500

• From April to November 2015, 36 patients received 38 courses of hyperthermia treatment.

• Total 112 sessions of hyperthermia were performed.

Results

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Results No. %

CR 2 5.3%

PR 23 60.5%

SD 8 21%

PD 2 5.3%

Not applicable 3 (8%)

Complication All grade (%) High grade (%)

Feeling heat at skin 31 (81.6%) 5 (13.2%)

Pain at skin 10 (26.3%) 0 (0%)

Sweating at face 22 (57.9%) 2 (5.3%)

fatigue 22 (57.9%) 1 (2.6%)

Fat induration 7 (18.4%) N/A

Objective response rate = 65.8%

Results

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Disease No.

NSCLC 9

breast 5

Renal cell CA 5

cervix 3

bladder 2

rectum 2

prostate 2

sarcoma 1

stomach 1

GIST 1

HCC 1

pancreas 1

corpus 1

SCLC 1

esophagus 1

gallbladder 1

nasopharynx 1

Results by pain status* No.

CR 5

PR 8

Results by CT/MRI imaging

No.

PR 11

SD 2

BONE METASTASES = 13 pts

* Kwan-Hwa Chi Chi, M.D. Shin Kong Wu Ho-Su Memorial Hospital. Taiwan

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• Recurrent urothelial cell CA of bladder with hematuria and infection

• Palliative RT with HT wkly 48 Gy/24 fractions

• Post treatment no hematuria, do not need CBI, no infection

Before RT+ HT post RT+HT 1 month

Results (example case 1)

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• Advanced CA breast with the large Rt. axillary LN and pain (history of resist to chemotherapy regimens and quickly growth)

• Palliative RT 2.6 Gyx 15 F (equi dose BED= 40, TDF=44 Gy) with HT wkly

• Post treatmentdecreased size LN and no pain

Before RT+HT Post RT+HT 3 months


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• NSCLC with bone metastases and retained Foley’s catheter, could not walk

• Palliative RT 36 Gy/12 F (equi dose BED=38, TDF=44 Gy) + HT wkly

• Post treatment CR pain, no pain medicine, off Foley’s catheter, could walk

Before RT+HT Post RT + HT 2 months


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• From experience in SiPH, the interesting and promising result was demonstrated.

• Hyperthermia increased RT effect reduce tumor, no additional significant RT side effect

Discussion

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1.Anneke M. Westermann, et al. First results of Triple-Modality Treatment combining RT, CMT, and HT for the treatment of Pts with st IIB, III, and IVA cervical carcinoma. Cancer 2005; 104:763-70. 2.Kwan-Hwa Chi Chi, M.D Comparing the effectiveness of combined HT and EBRT vs EBRT alone in treating patients with painful bone metastases 3.Cihan Gani, et al. Long-term local control and survival after preoperative radiochemotherapy in combination with deep regional hyperthermia in locally advanced rectal cancer. Inter Jour of Hyperthermia 2016.

• More consideration in clinical;

– Cervical cancer 1: 68 pts received RT+CMT+HT, at F/U 538 days, OS=84%, CR 90%, comparable toxicity

– Bone metastases 2: on going, prelim result; HT +RT time to pain progression, response

– Rectal cancer 3: 103 pts reveived preop RT+CMT+HT or RT+CMT; 5yrs Kaplan-Meire estimate local control of 98% vs 87%, OS 88 vs 76%

Discussion

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• Hyperthermia in addition to standard radiation therapy and/or chemotherapy in locally advanced/ metastases cancer patients have shown the promising results without serious side effects.

Conclusions and clinical implications

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Experience of Hyperthermia Treatment in Thailand results-THASTRO2016.pdf · Experience of...

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