The aim of this study is to assess for the first time, the role of regional deep hyperthermia in combination with radiotherapy and systemic therapy in patients with poor prognosis of brain metastases (GPI ≤ 2.5).
Patients with confirmed cerebral metastases and classified as GPI score ≤ 2.5 were included in this prospective study. Pretreatment stratification was defined as patients with 0–1 GPI score (Group A) and patients with 1.5–2.5 GPI score (Group B). HT was applied twice a week, 60 min per session, during RT by regional capacitive device (HY-DEEP 600WM system) at 13.56 MHz radiofrequency.
Between June 2015 and June 2017, 15 patients and a total of 49 brain metastases were included in the protocol. All patients received all HT sessions as planned. RT and systemic therapy were also completed as prescribed. Tolerance to treatment was excellent and no toxicity was registered. Patients with HT effective treatment time longer than the median (W90time > 88%) showed better actuarial PFS at 6 and 12 months (100% and 66.7%, respectively) compared to those with less HT effective treatment time (50% and 0%, respectively) (p < 0.031). Median OS was 6 months (range 1–36 months). Stratification by GPI score showed a median OS of 3 months (CI 95% 2.49–3.51) in Group A and 8.0 months (CI 95% 5.15–10.41) in Group B (p = 0.035).
Regional hyperthermia is a feasible and safe technique to be used in combination with RT in brain metastases patients, improving PFS and survival in poor prognostic brain metastasis patients.
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Nayak L, Lee EQ, Wen PY. Epidemiology of brain metastases. Curr Oncol Rep. 2012;14(1):48–544. https://doi.org/10.1007/s11912-011-0203-y.
Nieder C, Mehta MP. Prognostic indices for brain metastases–usefulness and challenges. Radiat Oncol. 2009;4(4):10. https://doi.org/10.1186/1748-717X-4-10.
Sperduto PW, Chao ST, Sneed PK, et al. Diagnosis-specific prognostic factors, indexes, and treatment outcomes for patients with newly diagnosed brain metastases: a multi-institutional analysis of 4,259 patients. Int J Radiat Oncol Biol Phys. 2010;77(3):655–61. https://doi.org/10.1016/j.ijrobp.2009.08.025.
Crezee H, van Leeuwen CM, Oei AL, et al. Thermoradiotherapy planning: Integration in routine clinical practice. Int J Hyperth. 2015;32(1):41–9. https://doi.org/10.3109/02656736.2015.1110757.
Dewhirst MW, Vujaskovic Z, Jones E, et al. Re-setting the biologic rationale for thermal therapy. Int J Hyperth. 2005;21(8):779–90. https://doi.org/10.1080/02656730500271668.
Peeken JC, Vaupel P, Combs SE. Integrating hyperthermia into modern radiation oncology: what evidence is necessary? Front Oncol. 2017;7:132. https://doi.org/10.3389/fonc.2017.00132.
Vernon CC, Hand JW, Field SB, et al. Radiotherapy with or without hyperthermia in the treatment of superficial localized breast cancer: results from ve randomized controlled trials. International Collaborative Hyperthermia Group. Int J Radiat Oncol Biol Phys. 1996;35(4):731–44. https://doi.org/10.1016/0360-3016(96)00154-X.
van der Zee J, González González D, van Rhoon GC, et al. Comparison of radiotherapy alone with radiotherapy plus hyperthermia in locally advanced pelvic tumours: a prospective, randomised, multicentre trial. Dutch Deep Hyperthermia Group. Lancet. 2000;355(9210):1119–25. https://doi.org/10.1016/S0140-6736(00)02059-6.
Kang M, Liu WQ, Qin YT, et al. Long-term efficacy of microwave hyperthermia combined with chemoradiotherapy in treatment of nasopharyngeal carcinoma with cervical lymph node metastases. Asian Pac J Cancer Prev. 2013;14(12):7395–400. https://doi.org/10.7314/APJCP.2013.14.12.7395.
De Haas-Kock DFM, Buijsen J, Pijls-Johannesma M, et al. Concomitant hyperthermia and radiation therapy for treating locally advanced rectal cancer. Cochrane Database Syst Rev. 2009;3:CD006269. https://doi.org/10.1002/14651858.CD006269.
Datta NR, Puric E, Klingbiel D, et al. Hyperthermia and radiation therapy in locoregional recurrent breast cancers: a systematic review and meta-analysis. Int J Radiat Oncol Biol Phys. 2016;94(5):1073–87. https://doi.org/10.1016/j.ijrobp.2015.12.361.
Lutgens LCHW, Koper PCM, Jobsen JJ, et al. Radiation therapy combined with hyperthermia versus cisplatin for locally advanced cervical cancer: results of the randomized RADCHOC trial. Radiother Oncol. 2016;120(3):378–82. https://doi.org/10.1016/j.radonc.2016.02.010.
Byun YH, Gwak HS, Kwon JI, et al. Local recurrence of brain metastasis reduced by intra-operative hyperthermia treatment. Int J Hyperth. 2018;35(1):168–75. https://doi.org/10.1080/02656736.2018.148800.
Lloret M, García-Cabrera L, Hernandez A, et al. Feasibility of a deep hyperthermia and radiotherapy programme for advanced tumors: first Spanish experience. Clin Transl Oncol. 2019. https://doi.org/10.1007/s12094-019-02097-9.
Sahinbas H, Rosch M, Demiray M. Temperature measurements in a capacitive system of deep loco-regional hyperthermia. Electromagn Biol Med. 2017;36(3):248–58. https://doi.org/10.1080/15368378.2017.1307221.
Bruggmoser G, Bauchowitz S, Canters R, et al. Quality assurance for clinical studies in regional deep hyperthermia. Strahlenther Onkol. 2011;187(10):605–10. https://doi.org/10.1007/s00066-011-1145-x.
Conflict of interest
The authors declare no conflict of interest.
The study was approved by the Ethic Committee and registered under Eudract number 2018-001089-40.
Written inform consent for treatment was obtained from all patients.
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Lloret, M., García-Cabrera, L., Zajac, M. et al. Regional deep hyperthermia in combination with whole brain radiotherapy (WBRT) in poor prognosis patients with brain metastases. Clin Transl Oncol 23, 190–194 (2021). https://doi.org/10.1007/s12094-020-02404-9
- Brain metastases