Treatment of primary, recurrent or inadequately resected high-risk soft-tissue sarcomas (STS) of adults

Wendtner, Clemens-M.; Abdel-Rahman, S.; Baumert, Jens; Falk, M.; Krych, M.; Santl, M.; Hiddemann, Wolfgang; Issels, Rolf D.

doi:10.1016/s0959-8049(01)00191-5

Cited by 51 publications

(7 citation statements)

References 25 publications

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“…This reflects the effectiveness of the combined treatment approach for local tumor control. 10,18,19 In particular, no patient in the EIA + RHT group showed early progression, whereas 10 patients (22.2%) in the chemotherapy-only group had early progression ( P < 0.001). As a consequence of reduced early progression, more patients continued to receive systemic therapy cycles 5 to 8 in the EIA + RHT arm.…”

Section: Discussionmentioning

confidence: 93%

Effectiveness of Regional Hyperthermia With Chemotherapy for High-Risk Retroperitoneal and Abdominal Soft-Tissue Sarcoma After Complete Surgical Resection

et al. 2014

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Objective To determine whether regional hyperthermia (RHT) in addition to chemotherapy improves local tumor control after macroscopically complete resection of abdominal or retroperitoneal high-risk sarcomas. Background Within the prospectively randomized EORTC 62961 phase- III trial, RHT and systemic chemotherapy significantly improved local progression-free survival (LPFS) and disease-free survival (DFS) in patients with abdominal and extremity sarcomas. That trial included macroscopically complete and R2 resections. Methods A subgroup analysis of the EORTC trial was performed and long-term survival determined. From 341 patients, 149 (median age 52 years, 18–69) were identified with macroscopic complete resection (R0, R1) of abdominal and retroperitoneal soft-tissue sarcomas (median diameter 10 cm, G2 48.3%, G3 51.7%). Seventy-six patients were treated with EIA (etoposide, ifosfamide, doxorubicin) + RHT (≥5 cycles: 69.7%) versus 73 patients receiving EIA alone (≥5 cycles: 52.1%, P = 0.027). LPFS and DFS as well as overall survival were determined. Results RHT and systemic chemotherapy significantly improved LPFS (56% vs 45% after 5 years, P = 0.044) and DFS (34% vs 27% after 5 years, P = 0.040). Overall survival was not significantly improved in the RHT group (57% vs 55% after 5 years, P = 0.82). Perioperative morbidity and mortality were not significantly different between groups. Conclusions In patients with macroscopically complete tumor resection, RHT in addition to chemotherapy resulted in significantly improved local tumor control and DFS without increasing surgical complications. Within a multimodal therapeutic concept for abdominal and retroperitoneal high-risk sarcomas, RHT is a treatment option beside radical surgery and should be further evaluated in future trials.

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Section: Discussionmentioning

confidence: 93%

Effectiveness of Regional Hyperthermia With Chemotherapy for High-Risk Retroperitoneal and Abdominal Soft-Tissue Sarcoma After Complete Surgical Resection

et al. 2014

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“…One RCT (yielding three publications), [13][14][15] five observational studies [56][57][58][59][60] , and seven single-arm trials [61][62][63][64][65][66][67] were identified. Additionally, one single-arm trial 68 included deep seated sarcomas, and one observational study mixed soft tissue tumours.…”

Section: High-risk Soft-tissue Sarcoma (Sts)mentioning

confidence: 99%

“…Five single-arm trials explored LRHT specifically added to standard peri-operative care. [63][64][65][66][67] In one, 13 patients received LRHT and radiation, with five participants receiving pre-operative chemotherapy and seven post-operative chemotherapy. 65 Limb REVIEW | Hyperthermia in Cancer Care salvation was possible for 12 of 13 patients; there was no local recurrence; the five-year survival was 40.4%, and DFS was 30.1%.…”

Section: High-risk Soft-tissue Sarcoma (Sts)mentioning

confidence: 99%

Hyperthermia in Cancer Care: A Literature Review

Conte

Psihogios

Seely

2021

CANDJ

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Introduction: Hyperthermia (HT) in cancer management refers to the external application of heat to raise intratumoural temperature to between 39°C and 45°C. Locoregional hyperthermia (LRHT) is the most used and studied type of HT in cancer care. A literature search was conducted to produce a monograph to help clinicians and patients make informed choices in considering the application of this therapy. Methods: A search was performed in Medline and Cochrane library for LRHT and cancer in May 2020. Eligible studies were English-language clinical studies reporting on efficacy, quality of life (QoL), safety, or feasibility. Additional cursory literature scoping was performed to identify missing papers and background information. Papers were independently screened by two reviewers. Following development of a full monograph, a condensed version suitable for publication was created and is presented here. Results: A total of 980 articles were identified and 166 met inclusion criteria. Most were single-arm or observational. However, among the 166, there were 7 systematic reviews (including 37 RCTs) and 18 additional RCTs identified. Several mechanisms of action have been proposed for HT in cancer care including physiological changes, direct cytotoxic effects, chemosensitization and radiosensitization, and immune modulation. Locoregional HT is used primarily as an adjunct to chemotherapy and radiotherapy due to its possible synergistic effects. Various studies demonstrated improved outcomes for patients treated with LRHT and chemo-and/or-radiotherapy. The best evidence for improved disease control and survival is seen for breast cancer (locally recurrent), cervical cancer, esophageal and gastric cancers, head and neck squamous cell carcinoma, and high-risk soft tissue sarcoma. Research related to quality of life (QoL) is limited and often focuses on pain. Hyperthermia with modern technology and treatment planning is generally well tolerated; the most common side effects are discomfort, mild pain, local erythema, skin burns, and, less commonly, subcutaneous burns. Trial heterogeneity and methodological concerns limit the strength of conclusions. Conclusions: Locoregional HT is a promising adjunct treatment to chemotherapy and radiotherapy for a variety of cancer types. To determine in what situations this therapy could be best applied, more high-quality well-controlled studies are needed.

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“…Hyperthermia could be applied preoperatively (347,348) and intraoperatively (349), and its whole-body application together with combined chemotherapies (Ifosfamide, Carboplatin, and Etoposide) is also published (350)(351)(352)(353). Extensive research and clinical investigation was done on the topic by Issels and his group (347,(354)(355)(356)(357)(358)(359)(360)(361). The research culminated in a large (n = 341) phase III randomized controlled trial (362) showing a 29.2% risk reduction (after 5.7 years median follow-up) in local progression or death when lesions were treated with locoregional hyperthermia combined with surgery and radiotherapy.…”

Section: Soft Tissuementioning

confidence: 99%

Quo Vadis Oncological Hyperthermia (2020)?

et al. 2020

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Heating as a medical intervention in cancer treatment is an ancient approach, but effective deep heating techniques are lacking in modern practice. The use of electromagnetic interactions has enabled the development of more reliable localregional hyperthermia (LRHT) techniques whole-body hyperthermia (WBH) techniques. Contrary to the relatively simple physical-physiological concepts behind hyperthermia, its development was not steady, and it has gone through periods of failures and renewals with mixed views on the benefits of heating seen in the medical community over the decades. In this review we study in detail the various techniques currently available and describe challenges and trends of oncological hyperthermia from a new perspective. Our aim is to describe what we believe to be a new and effective approach to oncologic hyperthermia, and a change in the paradigm of dosing. Physiological limits restrict the application of WBH which has moved toward the mild temperature range, targeting immune support. LRHT does not have a temperature limit in the tumor (which can be burned out in extreme conditions) but a trend has started toward milder temperatures with immune-oriented goals, developing toward immune modulation, and especially toward tumor-specific immune reactions by which LRHT seeks to target the malignancy systemically. The emerging research of bystander and abscopal effects, in both laboratory investigations and clinical applications, has been intensified. Our present review summarizes the methods and results, and discusses the trends of hyperthermia in oncology.

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Treatment of primary, recurrent or inadequately resected high-risk soft-tissue sarcomas (STS) of adults

Cited by 51 publications

References 25 publications

Effectiveness of Regional Hyperthermia With Chemotherapy for High-Risk Retroperitoneal and Abdominal Soft-Tissue Sarcoma After Complete Surgical Resection

Effectiveness of Regional Hyperthermia With Chemotherapy for High-Risk Retroperitoneal and Abdominal Soft-Tissue Sarcoma After Complete Surgical Resection

Hyperthermia in Cancer Care: A Literature Review

Quo Vadis Oncological Hyperthermia (2020)?

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