22 maart 2012: als u hier klikt kunt u een overzicht inzien van een rapport van The Centers for Medicare & Medicaid Services (CMS)
 vergelijkbaar met bij ons CVZ over gebruik van hyperthermie bij borstkanker. Het instituut dat adviezen geeft over vergoedingen van behandelingen.  Onderaan dit artikel heb ik een referentie lijst behorend bij dit artikel geplaatst over hyperthermie bij borstkanker.  Laatste update is van september 2011

2 juli 2009: Bron: Journal of Clinical Oncology, 2009 ASCO Annual Meeting Proceedings (Post-Meeting Edition).
Vol 27, No 15S (May 20 Supplement), 2009: 631
© 2009 American Society of Clinical Oncology

Hyperthermie aanvullend op bestraling bij zowel lokaal uitgezaaide borstkanker als bij een recidief van borstkanker geeft beduidend betere controle over borstkanker en zorgt voor langere tijd tot progressie van de ziekte en verhoging van mediane overleving. Dit blijkt uit een perspresentatie op ASCO 2009  van een retropostpectieve studie gedaan bij 130 patienten in de periode 1991 tot 2007. De lokale controle werd nog beter als de bestralingsintensiteit en de duur van de hyperthermnie was opgevoerd. Opvallend ook dat de kankerpatienten die microscopisch kleine uitzaaiingen hadden (11% van de deelneemsters) allemaal profiteerden van deze aanpak en nog niemand daarvan heeft binnen de studietijd een recidief gehad. En opmerkelijk ook omdat de hyperthermie apparatuur de laatste jaren sterk verbeterd is en mert de oude apparatuur deze resultaten al werden bereikt. Het lijkt dus heel zinnig als u bestraling (of chemo) krijgt voor uw borstkanker om daar aanvullend hyperthermie bij te doen. Volgende maand komen we met een ervaringsverhaal van een vrouw die direct na de diagnose van niet hormoongevoelige borstkanker met uitzaaiing in de lymfklier hyperthermie is gaan doen aanvullend op de chemo en daar goede resultaten mee verkreeg want ze is nu al 5 jaar klinisch kankervrij en ze hoefde zelfs na de chemo plus hyperthermie geen geplande bestraling meer omdat de hyperthermie samen met de chemo ervoor had gezorgd dat de tumoren zeer veel geslonken waren. Hier het abstract van de studie.

Hyperthermia and radiation therapy for locally advanced or recurrent breast cancer

K. D. Kiel, T. Refaat, N. Navanandan and V. Sathiaseelan

Memorial Health University Medical Center, Savannah, GA; University of Alexandria, Alexandria, Egypt; Northwestern Memorial Hospital, Chicago, IL

631

Background: Hyperthermia is a known radiation sensitizer. Thisretrospective series evaluates a single institutional experiencewith hyperthermia and radiotherapy (RT) for locally advanced/recurrentbreast cancer, many referred for palliation. 

Methods: Recordsof 130 pts with locally advanced/recurrent breast cancers treatedwith hyperthermia and RT from 1991–2007 were reviewed.40% had distant metastases. 168 different sites were irradiatedto 16–76.4 Gy (median 50 Gy) with conventional fractionsand treated with 1–11 hyperthermia sessions twice/wk (median6). 58 pts required >1 hyperthermia field to cover tumor.Intratumoral temperature goal was >42.5°C for >45min. Thermal equivalent dose (TED) was calculated for each treatment(min above 42.5 and 43°C).

Results: Median and mean FU of alive patients was 20 and 32 mos, respectively. 27 pts were treated for locally advanced and 103 for recurrent cancer onthe chest wall, nearby skin, or nodes. Treated sites were: intactbreast (21%), chest wall/skin (66%), nodes (12%). Disease volumewas microscopic in 11%, less than 3 cm in 11%, and greater thanin 78%. Various concurrent chemotherapy regimens were givenin 56%. 40% of treated sites had prior RT (median 50 Gy). CRwas seen in 52% and CR/PR in 79% in pts with measurable tumor.5 mastectomies were done, with no residual cancer in 1. Localcontrol (LC) at last FU was obtained in 58% of treated sites.Type (primary vs recurrent), location (breast/chest wall/node),extent of disease (3 cm), or prior RT were not associated withLC. Improved LC was seen with increased RT dose, 36%, 52%, and70% for 16–39.6 Gy, 40–50 Gy, and 50+ Gy, respectively.LC also improved with more minutes of hyperthermia - medianof 238 min and 147 min TED 42.5°C & 43°C, respectivelyin pts with LC, and median of 180 min and 105 min TED 42.5°Cand 43°C, respectively in pts without LC. All pts with microscopicdisease are controlled. 16 pts (12%) are NED (mean 32 mos).

Conclusions: Hyperthermia and RT improves local control and can palliate locally advanced or recurrent breast cancer, evenin previously irradiated pts - a quality of life issue. Although the followup of this poor prognosis group is short, local controlappears to be maintained to death for many pts. Pts with microscopicresidual cancer after resection may benefit from the combination.

No significant financial relationships to disclose.

 

This policy is based on the following evidence-based guidelines:
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practice guidelines in oncology-v.1.2008. National Comprehensive Cancer
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http://www.nccn.org/professionals/physician_gls/PDF/breast.pdf
2.  National Comprehensive Cancer Network (NCCN). Breast cancer. NCCN Clinical
Practice Guidelines in Oncology. V.1.2009.  
3.  Hayes Search & Summary. Light Induced Enhanced Selective Hyperthermia
(LIESH) for the Treatment of Breast Cancer. February 28, 2008. Available at:
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53&searchStore=%24search_type%3Dall%24icd%3D%24keywords%3Dhyperth
ermia%2Cbreast%2Ccancer%24status%3Dall%24page%3D1%24from_date%3
D%24to_date%3D%24report_type_options%3D%24technology_type_options%
3D%24organ_system_options%3D%24specialty_options%3D%24order%3Dasea
rchRelevance
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References – Update July 2011
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for recurrent breast cancer - a second curative approach.  BMC Cancer. 2011
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References – Update September 2010
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Adjuvant Therapy. J Clin Oncol 27:15s, 2009.
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persistent locoregional recurrent breast cancer: A retrospective study. Int J
Hyperthermia. 01-JAN-2010; 26(2): 136-44. 
References – Update September 2009
1.  (CMS) Centers for Medicare & Medicaid. NCD for Hyperthermia for Treatment of
Cancer (110.1). Available at:
http://www.cms.hhs.gov/mcd/viewncd.asp?ncd_id=110.1&ncd_version=1&bask
et=ncd%3A110%2E1%3A1%3AHyperthermia+for+Treatment+of+Cancer
 
References – Update September 2008
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