The clinical benefit of hyperthermia in pancreatic cancer: a systematic review

Abstract

Objective: In pancreatic cancer, which is therapy resistant due to its hypoxic microenvironment, hyperthermia may enhance the effect of radio(chemo)therapy. The aim of this systematic review is to investigate the validity of the hypothesis that hyperthermia added to radiotherapy and/or chemotherapy improves treatment outcome for pancreatic cancer patients. Methods and materials: We searched MEDLINE and Embase, supplemented by handsearching, for clinical studies involving hyperthermia in pancreatic cancer patients. The quality of studies was evaluated using the Oxford Centre for Evidence-Based Medicine levels of evidence. Primary outcome was treatment efficacy; we calculated overall response rate and the weighted estimate of the population median overall survival (m p ) and compared these between hyperthermia and control cohorts. Results: Overall, 14 studies were included, with 395 patients with locally advanced and/or metastatic pancreatic cancer of whom 248 received hyperthermia. Patients were treated with regional (n ¼ 189), intraoperative (n ¼ 39) or whole-body hyperthermia (n ¼ 20), combined with chemotherapy, radiotherapy or both. Quality of the studies was low, with level of evidence 3 (five studies) and 4. The six studies including a control group showed a longer m p in the hyperthermia groups than in the control groups (11.7 vs. 5.6 months). Overall response rate, reported in three studies with a control group, was also better for the hyperthermia groups (43.9% vs. 35.3%). Conclusions: Hyperthermia, when added to chemotherapy and/or radiotherapy, may positively affect treatment outcome for patients with pancreatic cancer. However, the quality of the reviewed studies was limited and future randomised controlled trials are needed to establish efficacy. ARTICLE HISTORY

The Role of Hyperthermia in the Multidisciplinary Treatment of Malignant Tumors

“…82 There is abundant evidence that hyperthermia can enhance the efficacy of RT and chemotherapy in pancreatic cancer. [83][84][85] A recent study verified that anti-PD-1/PD-L1 immunotherapy combined with RT and hyperthermia can enhance the antitumor effect. 86 Nonetheless, there is no published clinical data available on pancreatic cancer based on the tripartite treatment of RT, hyperthermia, and immunotherapy, which is supported by only animal experiments and preclinical data.…”

Predictive value of SAR based quality indicators for head and neck hyperthermia treatment quality

“…SAR-based indicators have been correlated to temperature-based indicators being correlated to clinical outcome [4][5][6][10][11][12][13]. Those are the T50 and the T90, defined as the lower temperature covering respectively 50% or 90% of the HTV volume.…”

“…The therapeutic benefit of hyperthermia as adjuvant to radioand chemo-therapy has been proved in a number of clinical trials [1][2][3]. In the literature, treatment outcome has been prospectively and retrospectively correlated to different thermal dose parameters [4][5][6]. Following these thermal-and thermal-dose effect relations, a target conformal increase of the temperature should further enhance this clinical effectiveness [7].…”

A Combination of Radiotherapy, Hyperthermia, and Immunotherapy Inhibits Pancreatic Tumor Growth and Prolongs the Survival of Mice

“…Importantly, hyperthermia was well tolerated with minimal toxicity. Further support for hyperthermia in the clinical setting for treatment of PC comes from a recent meta-analysis that demonstrated an improved median overall survival with hyperthermia + radiotherapy compared to radiotherapy alone, 11.7 vs. 5.6 months respectively [31].…”

“…Tumors were collected at euthanasia at two different points (10 days and 45 days post-treatment). Tissues were then collected, and single cell suspensions were obtained for flow cytometry analysis [31]. Briefly, tumors were processed through a cell strainer and washed in PBS 2% FBS (Gemini) 1% PenStrep 1% NEAA (Gibco, Life Technologies, Gaithersburg, MD, USA).…”