IntroductionLinear accelerator (Linac)-generated high-energy X-rays and electron beams that are generally used for radiotherapy are low-linear energy transfer (LET) forms of radiation, and have a relatively weak biological effect. High-energy X-rays and electron beams have minimal effects on tumors that contain many hypoxic cancer cells and/or large amounts of antioxidative enzymes. Examples of such tumors include malignant melanoma, various types of sarcomas, glioblastoma multiforme, and most relatively large tumors more than several centimeters in their long diameter. Thus, effective treatment of these tumors requires strategies to re-oxygenate hypoxic tumor cells and to inhibit antioxidative enzymes. Therapeutic response to a new enzyme-targeting radiosensitization treatment (KORTUC-SC) for patients with chemotherapy-resistant supraclavicular lymph node metastasis
AbstractWe have developed a new radiosensitizer containing hydrogen peroxide and sodium hyaluronate, part of a method we call "KORTUC II". This study aimed to evaluate the safety and effectiveness of KORTUC II specifically for patients with chemotherapy-resistant supraclavicular lymph node metastasis (KORTUC-SC). Twelve patients were enrolled after providing fully informed written consent. Most of the patients underwent PET-CT examinations prior to and 3-8 months after KORTUC-SC, and every 6 months thereafter if possible. The patients' age ranged from 58 to 77. The radiotherapy regimen was 4 Gy/ fraction, 3 fractions/ week, for 4 weeks, and the total dose was 48 Gy. The injection of 3 to 6 mL of the agent was started from the fifth radiotherapy fraction, and it was performed twice a week under ultrasonographic guidance. Therapeutic effects were evaluated by PET-CT examinations performed before and after KORTUC-SC treatment. The patients were well tolerated with minimal adverse effects. Of the 12 patients, 4, 5, 2 and 1 patient showed complete response, partial response, stable disease and progressive disease, respectively. The overall survival rate was 83% at 1 year and 75% at 2 years. The mean duration of follow-up at the end of February 2011 was 35.1 months. Based on the PET-CT studies, remarkable therapeutic effects of the KORTUC II treatment were clearly identified. The treatment outcomes were satisfactory. Welldesigned, prospective, randomized, clinical trials are needed to confirm the therapeutic efficacy of KORTUC-SC.