BACKGROUND: Hyperthermia is a type of cancer treatment in which body tissue is exposed to high temperatures to damage and kill cancer cells. It was introduced into clinical oncology practice several decades ago. Positive clinical results, mostly obtained in single institutions, resulted in clinical implementation albeit in a limited number of cancer centres worldwide. Because large scale randomised clinical trials (RCTs) are lacking, firm conclusions cannot be drawn regarding its definitive role as an adjunct to radiotherapy in the treatment of locally advanced cervical carcinoma (LACC). OBJECTIVES: To assess whether adding hyperthermia to standard radiotherapy for LACC has an impact on (1) local tumour control, (2) survival and (3) treatment related morbidity. SEARCH STRATEGY: The electronic databases of the Cochrane Central Register of Controlled Trials (CENTRAL), (Issue 1, 2009) and Cochrane Gynaecological Cancer Groups Specialised Register, MEDLINE, EMBASE, online databases for trial registration, handsearching of journals and conference abstracts, reviews, reference lists, and contacts with experts were used to identify potentially eligible trials, published and unpublished until January 2009. SELECTION CRITERIA: RCTs comparing radiotherapy alone (RT) versus combined hyperthermia and radiotherapy (RHT) in patients with LACC. DATA COLLECTION AND ANALYSIS: Between 1987 and 2009 the results of six RCTs were published, these were used for the current analysis. MAIN RESULTS: 74% of patients had FIGO stage IIIB LACC. Treatment outcome was significantly better for patients receiving the combined treatment (Figures 1 to 3). The pooled data analysis yielded a significantly higher complete response rate (relative risk (RR) 0.56; 95% confidence interval (CI) 0.39 to 0.79; p < 0.001), a significantly reduced local recurrence rate at 3 years (hazard ratio (HR) 0.48; 95% CI 0.37 to 0.63; p < 0.001) and a significanly better overall survival (OS) at three years following the combined treatment with RHT(HR 0.67; 95% CI 0.45 to 0.99; p = 0.05). No significant difference was observed in treatment related acute (RR 0.99; 95% CI 0.30 to 3.31; p = 0.99) or late grade 3 to 4 toxicity (RR 1.01; CI 95% 0.44 to 2.30; p = 0.96) between both treatments. AUTHORS' CONCLUSIONS: The limited number of patients available for analysis, methodological flaws and a significant over-representation of patients with FIGO stage IIIB prohibit drawing definite conclusions regarding the impact of adding hyperthermia to standard radiotherapy. However, available data do suggest that the addition of hyperthermia improves local tumour control and overall survival in patients with locally advanced cervical carcinoma without affecting treatment related grade 3 to 4 acute or late toxicity.
BACKGROUND:Hyperthermia is a type of cancer treatment in which body tissue is exposed to high temperatures to damage and kill cancer cells. It was introduced into clinical oncology practice several decades ago. Positive clinical results, mostly obtained in single institutions, resulted in clinical implementation albeit in a limited number of cancer centres worldwide. Because large scale randomised clinical trials (RCTs) are lacking, firm conclusions cannot be drawn regarding its definitive role as an adjunct to radiotherapy in the treatment of locally advanced cervical carcinoma (LACC). OBJECTIVES: To assess whether adding hyperthermia to standard radiotherapy for LACC has an impact on (1) local tumour control, (2) survival and (3) treatment related morbidity. SEARCH STRATEGY: The electronic databases of the Cochrane Central Register of Controlled Trials (CENTRAL), (Issue 1, 2009) and Cochrane Gynaecological Cancer Groups Specialised Register, MEDLINE, EMBASE, online databases for trial registration, handsearching of journals and conference abstracts, reviews, reference lists, and contacts with experts were used to identify potentially eligible trials, published and unpublished until January 2009. SELECTION CRITERIA: RCTs comparing radiotherapy alone (RT) versus combined hyperthermia and radiotherapy (RHT) in patients with LACC. DATA COLLECTION AND ANALYSIS: Between 1987 and 2009 the results of six RCTs were published, these were used for the current analysis. MAIN RESULTS: 74% of patients had FIGO stage IIIB LACC. Treatment outcome was significantly better for patients receiving the combined treatment (Figures 1 to 3). The pooled data analysis yielded a significantly higher complete response rate (relative risk (RR) 0.56; 95% confidence interval (CI) 0.39 to 0.79; p < 0.001), a significantly reduced local recurrence rate at 3 years (hazard ratio (HR) 0.48; 95% CI 0.37 to 0.63; p < 0.001) and a significanly better overall survival (OS) at three years following the combined treatment with RHT(HR 0.67; 95% CI 0.45 to 0.99; p = 0.05). No significant difference was observed in treatment related acute (RR 0.99; 95% CI 0.30 to 3.31; p = 0.99) or late grade 3 to 4 toxicity (RR 1.01; CI 95% 0.44 to 2.30; p = 0.96) between both treatments. AUTHORS' CONCLUSIONS: The limited number of patients available for analysis, methodological flaws and a significant over-representation of patients with FIGO stage IIIB prohibit drawing definite conclusions regarding the impact of adding hyperthermia to standard radiotherapy. However, available data do suggest that the addition of hyperthermia improves local tumour control and overall survival in patients with locally advanced cervical carcinoma without affecting treatment related grade 3 to 4 acute or late toxicity.
Authors: G Bruggmoser; S Bauchowitz; R Canters; H Crezee; M Ehmann; J Gellermann; U Lamprecht; N Lomax; M B Messmer; O Ott; S Abdel-Rahman; M Schmidt; R Sauer; A Thomsen; R Wessalowski; G van Rhoon Journal: Strahlenther Onkol Date: 2012-09 Impact factor: 3.621
Authors: Matthias W Beckmann; Frederik A Stübs; Martin C Koch; Peter Mallmann; Christian Dannecker; Anna Dietl; Anna Sevnina; Franziska Mergel; Laura Lotz; Carolin C Hack; Anne Ehret; Daniel Gantert; Franca Martignoni; Jan-Philipp Cieslik; Jan Menke; Olaf Ortmann; Carmen Stromberger; Karin Oechsle; Beate Hornemann; Friederike Mumm; Christoph Grimm; Alina Sturdza; Edward Wight; Kristina Loessl; Michael Golatta; Volker Hagen; Timm Dauelsberg; Ingo Diel; Karsten Münstedt; Eberhard Merz; Dirk Vordermark; Katja Lindel; Christian Wittekind; Volkmar Küppers; Ralph Lellé; Klaus Neis; Henrik Griesser; Birgit Pöschel; Manfred Steiner; Ulrich Freitag; Tobias Gilster; Alexander Schmittel; Michael Friedrich; Heidemarie Haase; Marion Gebhardt; Ludwig Kiesel; Michael Reinhardt; Michael Kreißl; Marianne Kloke; Lars-Christian Horn; Regina Wiedemann; Simone Marnitz; Anne Letsch; Isabella Zraik; Bernhard Mangold; Jochen Möckel; Céline Alt; Pauline Wimberger; Peter Hillemanns; Kerstin Paradies; Alexander Mustea; Dominik Denschlag; Ulla Henscher; Reina Tholen; Simone Wesselmann; Tanja Fehm Journal: Geburtshilfe Frauenheilkd Date: 2022-02-11 Impact factor: 2.915
Authors: Caspar M van Leeuwen; Arlene L Oei; Kenneth W T K Chin; Johannes Crezee; Arjan Bel; Anneke M Westermann; Marrije R Buist; Nicolaas A P Franken; Lukas J A Stalpers; H Petra Kok Journal: Radiat Oncol Date: 2017-04-27 Impact factor: 3.481
Authors: Maarten G Thomeer; Vincent Vandecaveye; Loes Braun; Frenchey Mayer; Martine Franckena-Schouten; Peter de Boer; Jaap Stoker; Erik Van Limbergen; Marrije Buist; Ignace Vergote; Myriam Hunink; Helena van Doorn Journal: Eur Radiol Date: 2018-06-25 Impact factor: 5.315
Authors: Iva VilasBoas-Ribeiro; Sven A N Nouwens; Sergio Curto; Bram de Jager; Martine Franckena; Gerard C van Rhoon; W P M H Heemels; Margarethus M Paulides Journal: Med Phys Date: 2022-06-26 Impact factor: 4.506
Authors: Marloes IJff; Johannes Crezee; Arlene L Oei; Lukas J A Stalpers; Henrike Westerveld Journal: Int J Gynecol Cancer Date: 2022-01-19 Impact factor: 3.437