Combined wIRA-Hyperthermia and Hypofractionated Re-Irradiation in the Treatment of Locally Recurrent Breast Cancer: Evaluation of Therapeutic Outcome Based on a Novel Size Classification

Abstract

Effective tumor control in patients suffering from unresectable locally recurrent breast cancer (LRBC) in pre-irradiated areas can be achieved by re-irradiation combined with superficial hyperthermia. Using this combined modality, total re-irradiation dose and toxicity can be significantly reduced compared to conventionally fractionated treatment schedules with total doses of 60–66 Gy. Applying contact-free, thermography-controlled water-filtered infrared-A superficial hyperthermia, immediately followed by hypofractionated re-irradiation, consisting of 4 Gy once per week up to a total dose of 20 Gy, resulted in high overall response rates even in large-sized tumors. Comparability of clinical data between different combined Hyperthermia (HT)/Radiotherapy (RT) treatment schedules is impeded by the highly individual characteristics of this disease. Tumor size, ranging from microscopic disease and small lesions to large-sized cancer en cuirasse, is described as one of the most important prognostic factors. However, in clinical studies and analyses of LRBC, tumor size has so far been reported in a very heterogeneous way. Therefore, we suggest a novel, simple and feasible size classification (rClasses 0–IV). Applying this classification for the evaluation of 201 patients with pre-irradiated LRBC allowed for a stratification into distinct prognostic groups.

Reirradiation for Locoregional Recurrent Breast Cancer

“…Previous studies have reported a variety of techniques for reirradiation to the breast or chest wall including limited radiation fields, electrons, twice-daily radiation, superficial chest wall brachytherapy, concurrent systemic therapy, and hyperthermia. 7 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 Whether improvements in radiation treatment delivery, such as optimized 3-dimensional conformal RT, intensity modulated RT, deep inspiratory breath hold, and particle therapy, increase the therapeutic ratio of reirradiation is not well established. Herein, we report toxicities and outcomes for a cohort of patients with breast cancer treated at a single institution with a second course of repeat breast/chest wall/nodal RT.…”

wIRA-heating of piglet skin and subcutis in vivo: proof of accordance with ESHO criteria for superficial hyperthermia

“…Moreover, pigs are unable to dissipate heat by sweating. Therefore, more human data assessed in superficial tissues under in vivo conditions are needed to verify transferability of results determined in this study for piglets although comparable data in humans have already been reported [2][3][4][5][6][7][8][9][10][11][12][13][14][15]. For clinical application, additional consideration of significant influencing factors is recommended in order to enable adequate tissue heating of patients, e.g.…”

“…Upon wIRA-heating of superficial recurrences of breast cancers, Notter et al [14] reported mean tissue temperatures between 42 C at the skin surface and about 40 C at a depth of 20 mm after reaching thermal steady state. These data agree with heating states assessed in piglets and which are comparable with tissue temperatures previously reported for various therapeutic applications of wIRA [2][3][4][5][6][7][8][9][10][11][12][13]15].…”

“…Water-filtered infrared-A radiation (wIRA) is considered by the European Society for Hyperthermic Oncology (ESHO) as an 'external non-contacting IR heating system' for superficial hyperthermia in oncology [1] with reference to a number of published data [2][3][4][5][6][7][8][9][10][11][12]. Notter et al [13][14][15] reported the successful use of wIRA-HT, immediately followed by hypofractionated re-irradiation for the treatment of locally recurrent breast cancer. Physical and photobiological basics of wIRA in thermal therapy were provided by Piazena et al [16] and Vaupel et al [17] with reference to the ESHO quality assurance guidelines for superficial hyperthermia in oncology (see [1]).…”

Serial locally applied water-filtered infrared a radiation in axial spondyloarthritis – a randomized controlled trial

“…wIRAR has both, temperature-dependent and non-dependent effects, which are without relevant thermal energy transfer and/or relevant temperature changes [16]. It is therefore not only used in acute and chronic wound healing as it promotes perfusion, alleviates pain and has antiinfectious effects [17], but is also used in oncology [18], dermatology [16] and rheumatology [12]. Until now, wIRAR has only been use in rheumatology and especially in treating axSpA as a whole-body treatment.…”