[heckel NEWS LETTER] 2020년 9월호

관리자 2020.09.08 조회 351
1) wIRA-heating of piglet skin and subcutis in vivo: proof of accordance with ESHO criteria for superficial hyperthermia
Thermography-controlled superficial hyperthermia using water-filtered infrared A (wIRA) is a new method to efficiently treat irresectable locally recurrent superficial tumors in combination with radiotherapy, especially in pre-irradiated areas. Recently, the evaluation of 201 patients with locally recurrent breast cancer has been published in cancers.

The quality assurance guidelines of the European Society for Hyperthermic Oncology (ESHO) specify the II. Technical requirements for heating devices using phantoms. 
In a recently published piglet study, superficial heating using wIRA has been examined under in vivo conditions. Heating rates and specific absorption rates were in full accordance with the ESHO standards.

The publication of Piazena H, Müller W and Vaupel P is open access available at https://pubmed.ncbi.nlm.nih.gov/32689831/

2) Comprehensive Review on Heating Technology for Malignant Tumors
This review presents an excellent overview of numerous clinical hyperthermia and ablation techniques used for local, locoregional, and whole body therapy. The authors emphasize the need for "many dedicated devices designed to meet specific heating requirements for specific tumor sites".

For superficial hyperthermia up to a depth of 1.5-2cm hydrosun®-TWH1500 is described as a unique device for "contact free heating of large tumors", "avoiding both overheating of the skin and tissue dehydration" by using water-filtered infrared A, and enabling "real-time infrared thermography measurement and control of superficial temperatures".

For deeper target areas microwave antenna and capacitive techniques are appropriate.
For whole-body hyperthermia Iratherm1000 and heckel-HT3000 are assessed as the both commercially available devices, using "water-filtered infrared A and are capable of providing a safe, well controlled and fairly homogeneous temperature elevation".

The publication of Kok HP, Cressman ENK, Ceelen W, Brace CL, Ivkov R, Grüll H, ter Haar G, Wust P, Crezee J is open access available at https://www.tandfonline.com/doi/full/10.1080/02656736.2020.1779357

3) Integrating Loco-Regional Hyperthermia Into the Current Oncology Practice: SWOT and TOWS Analyses
In most protocols of studies and routine use, hyperthermia is combined with other therapeutic modalities, acting as a potent radiosensitizer, chemosensitizer and immunomodulator. The publication provides a most helpful overview on the underlying mechanisms.

Using the SWOT matrix, the Strengths (S), Weakness (W), Opportunities (O), and Threats (T) of hyperthermia are analysed, followed by a TOWS analysis identifying "these relevant strategies to expedite the integration of hyperthermia in clinical oncology practice:

(a) Well-designed multicentric phase III trials in tumor sites, especially in those clinical situations where standard therapeutic interventions yield unsatisfactory outcomes (e.g., locally advanced pancreatic cancers) and also in situations where organ preservation approach with HT could add immense value to the quality of life (e.g., soft tissue sarcomas of the extremities and anal cancers).

(b) Improved quality assurance measures in HT treatments: this includes use of reliable and reproducible operator-independent treatment control procedures based on online planning and online temperature feedback to achieve the desired tumor temperatures.

(c) Increasing awareness among the oncologists and patients about the potential therapeutic advantages with HT.

(d) Increasing health insurance and reimbursements highlighting the cost–benefit and cost-effectiveness of integrating HT with existing treatment modalities."

The publication of Datta NR, Kok HP, Crezee H, Gaipl US, Bodis S is open access available at https://www.frontiersin.org/articles/10.3389/fonc.2020.00819/full

4) Rapid pain reduction by the use of local wIRA therapy (hydrosun®-750 irradiator) in the treatment of axial spondyloarthritis - a Randomized Clinical Trial
Patients with active disease undergoing a 7-day multimodal rheumatologic complex treatment under non-steroidal anti-inflammatory drug (NSAID) therapy were randomised. The interventional group (IG) received additional serial local wIRA treatment of the back (2 treatments for 30 min per day for 6 days). 36 patients of the IG and 35 patients of the control group (CG) completed the trial.
Multimodal rheumatologic complex treatment including wIRA application (IG) or not (CG) resulted both in a significant reduction in disease activity and functional indexes.

However, TNF-α levels were significantly decreased only in the wIRA-IG with a significant difference to the CG. Due to a rapid reduction in pain, 26 (76%) patients in the wIRA-IC reduced or even stopped their NSAID drug therapy after trial completion, compared to only 1 patient of the CG. A reason for these desirable effects of wIRA therapy could be the described change in TNF-α levels.

The publication of Klemm P, Eichelmann M, Aykara I, Hudowenz O, Dischereit G, Lange U is open access available at https://www.tandfonline.com/doi/full/10.1080/02656736.2020.1804079

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