Improvement of local control by regional hyperthermia combined with systemic chemotherapy (ifosfamide plus etoposide) in advanced sarcomas: updated report on 65 patients.

摘要: From July 1986 to 1990, 65 patients with deepseated, advanced sarcomas (43 soft-tissue sarcomas, 12 Ewing's 7 chondrosarcomas and 3 osteosarcomas) were entered in a protocol involving regional hyperthermia (RHT) combined systemic ifosfamide etoposide. RHT was produced by an electromagnetic deep heating device (BSD Medical Corporation, Salt Lake City, Utah). Of these patients, 62% (40 patients) had received ifosfamide-containing drug regimens before entering the study, 26% (17 pretreated surgery and/or radiation 12% (8 treated primarily. A total of 426 treatments (mean 6.6 RHT/patient) applied predominantly within pelvic region (82%) bearing relative large tumours volume 500 cm3). For chemotherapy, all (1.5 g/m2, days 1–5), etoposide (100 mg/m2, 1, 3, 5) 2-mercaptoethanesulphonic acid (mesna; 300 mg/m2×4, 1–5) only given on 1 5 repeated cycles every 4 weeks. Detailed thermal mapping invasive thermometry performed patients. In 61 evaluable for tumour control overall objective response rate including 9 complete responders (CR), partial (PR) 8 favourable histological (FHR) 34% (95% confidence limits, 23%–46%). Following CR, are alive remain disease-free survival 15.6 months). PR FHR, died from metastatic local disease after 4, 17, 39 months, patient other (acute myelocytic leukemia) 27 months. The stable at 29, 25, 11, 10, 8, 7, 6 Twenty-two revealed no change 18 showed progression (PD). Side-effects tolerable there indication enhanced bone marrow toxicity due addition chemotherapy. By analysis temperature parameters, time-averaged temperatures calculated 20% (T20), 50% (T50) or 90% (T90) measured sites differed significantly between (CR+PR+FHR) non-responders (PD), respectively (T20,P=0.001;T50,P= 0.0005;T90,P=0.0001). data further support strong potential plus sarcomas.