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29 maart 2016: Bron: Radiat Oncol. 2016; 11: 21. Published online 2016 Feb 11. doi:10.1186/s13014-016-0588-8

In de Daniel den Hoed - Erasmus Medisch Centrum wordt al vele jaren hyperthermie toegepast bij o.a. baarmoederhalskanker, borstkanker, melanomen maar ook bij tumoren in het hoofd - halsgebied. Meestal zijn dit tumoren gekarakteriseerd als strottehoofdkanker, neuskanker, slokdarmkanker of kanker in tong en mond. Maar ook wel tumoren vanuit een melanoom dus. 
Enkele jaren geleden zijn ze in Rotterdam begonnen om een soort van halsband (HYPERcollar) te maken die de dieper liggende tumoren in mond en hals verwarmt (hyperthermie) tijdens bv. bestralen of toediening van chemo:
hyperthermie nekbrace uit Rotterdam 2
In 2013 werd er gepubliceerd over de manier waarop de makers van de HYPERcollar erin waren gelsaagd een constante temperatuur te bewerkstelligen bij de dieper gelegen tumoren: Clinical integration of software tool VEDO for adaptive and quantitative application of phased array hyperthermia in the head and neck.
Nu is er dan een eerste publicatie: status quo and directions in deep head and neck hyperthermia over de resultaten met deze vorm van hyperthermie waarbij de HYPERcollar verbeterd is met een 3D. Een publicatie die grotendeels gaat over hoe ze de temperatuur zo hoog mogelijk kunnen krijgen en houden, maar toch ook een klein stukje over de eerste resultaten met de eerste groep patienten:

In 2014, we analyzed the treatments of the subgroup of patients with tumors that are considered to be in the traditional H&N regions (27 patients and in total 119 treatments of one hour). The target was the CTV of RT and the median CTV size was 63.5 ml. Delivery of power occasionally beyond 1 kW and estimated SAR levels (according to [36]) of on average 72.6 W/kg did not lead to achieving 43 °C. In the 16 patients where interstitial thermometry could be applied, we measured target temperatures up to 38.1–42.3 °C. Hence SAR levels up to four-fold of the SAR delivered in the pelvic region (~16 W/kg) still in cases produced unsatisfactory temperatures, which is a strong indication of the tremendous thermoregulatory response in the H&N region as compared to other regions. Excluding the three patients that were treated in a post-operative setting, a response rate of 53 % was obtained [54]. This response is very promising considering the learning curve and the fact that this was a very unfavorable patient group, i.e. 33 % locally advanced and 67 % re-irradiation. Importantly, no severe complications or enhanced thermal or mucosal toxicities were observed.

hyperthermie nekbrace uit Rotterdam

Een aantal jaren geleden heb ik een voorlichtingsfilm gemaakt over verschillende vormen van hyperthermie, weaaronder het hyperthermie systeem met antennes in de Daniel den Hoed en interviews met o.a. dr. Coby van der Zee. De grondlegster van de hyperthermie in Rotterdam. Coby heeft de film ook goedgekeurd en was enthousiast, maar de directie van het Erasmus Medisch Centrum heeft de publicatie van de film alsnog verboden omdat de andere vormen van hyperthermie, o.a. gefilmd bij dr. Robert Gorter er beter uitkwamen in de film. Helaas heb ik dus nooit die film mogen publiceren.
Inmiddels heeft het Erasmus Medisch Centrum gebroken met BSD, die het monopolie hadden op de hyperthermie apparatuur in Nederland (ook in Waalwijk / Tilburg en AMC Amsterdam). Ik moet zeggen dat ik niet begrijp waarom ze in Nederland stug doorgaan met deze ingewikkelde hyperthermie systemen terwijl de electro hyperthermie apparatuur al jarenlang bewijst goede resultaten te geven, ook op dieper liggende tumoren. Apparatuur die te koop is voor zeg €  200.000,--. En een vorm van hyperthermie die weinig tot niet belastend is voor de patiënten en zelfs ook kan worden toegepast voor hersentumoren.
Zomaar enkele studies eruit gehaald, zie verder ook gerelateerede artikelen: een studie waarbij electro hyperthermie werd gegeven naast chemo: Unresectable Primary and Recurrent Head and Neck Tumors: Effect of Hyperthermia and Carboplatin—Preliminary Experience
bij patienten echt in het laatste stadium van hun ziekte en waarvan van de 8 patienten er zelfs nog 1 klinisch kankervrij werd.
En deze studie waarin electro hyperthermie werd gegeven naast bestraling met een verdubbeling van de effectiviteit: (82.3% (14/17) for the combined treatment arm versus 36.8% (7/19)) for the control arm
in vergelijking met alleen bestraling. En dit is een studie al uit 1988!!!!: 

Valdagni R, Amichetti M, Pani G. Radical radiation alone versus radical radiation plus microwave hyperthermia for N3 (TNM-UICC) neck nodes: a prospective randomized clinical trial. Int J Radiat Oncol Biol Phys 1988; 15:13-24

met deze conclusie: This report with 5-year follow-up confirms the efficacy and the absence of severe toxicity of the combination of radical radiation and hyperthermia in the treatment of metastatic lymph nodes in Stage IV squamous cell carcinoma of the head and neck
Maar goed ik ben geen arts, noch onderzoeker. Ik vind het wel jammer en echt verspilling van kennis, tijd en geld dat dit zo gaat.
Het volledige studierapport: status quo and directions in deep head and neck hyperthermia is gratis in te zien.
Hier het abstract van de studie met de HYPERcollar:

The HYPERcollar redesign improves water bolus shape, stability and skin contact. The renewed positioning strategy allows for positioning of the patient within the required precision of ±5 mm. By clinically introducing the new design, we aim at improving not only treatment quality and reproducibility, but also patient comfort and operator handling, which are all important for a better hyperthermia treatment quality

Radiat Oncol. 2016; 11: 21.
Published online 2016 Feb 11. doi:  10.1186/s13014-016-0588-8
PMCID: PMC4751675

Status quo and directions in deep head and neck hyperthermia

Abstract

The benefit of hyperthermia as a potent modifier of radiotherapy has been well established and more recently also the combination with chemotherapy was shown beneficial. Also for head and neck cancer, the impact of hyperthermia has been clinically demonstrated by a number of clinical trials. Unfortunately, the technology applied in these studies provided only limited thermal dose control, and the devices used only allowed treatment of target regions close to the skin. Over the last decade, we developed the technology for deep and controlled hyperthermia that allows treatment of the entire head and neck region. Our strategy involves focused microwave heating combined with 3D patient-specific electromagnetic and thermal simulations for conformal, reproducible and adaptive hyperthermia application. Validation of our strategy has been performed by 3D thermal dose assessment based on invasively placed temperature sensors combined with the 3D patient specific simulations. In this paper, we review the phase III clinical evidence for hyperthermia in head and neck tumors, as well as the heating and dosimetry technology applied in these studies. Next, we describe the development, clinical implementation and validation of 3D guided deep hyperthermia with the HYPERcollar, and its second generation, i.e. the HYPERcollar3D. Lastly, we discuss early clinical results and provide an outlook for this technology.

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Plaats een reactie ...

1 Reactie op "Mond- en keelkanker: Hyperthermie met halsband geeft hoopvolle eerste resultaten bij tumoren in hals en mond bij voorbehandelde kankerpatienten met een recidief"

  • Maarten :
    Beste columnist van Kanker-Actueel,

    Dank voor de bespreking van onze nieuwe technologie. Het is goed te weten dat u werkt aan het breder beschikbaar maken en bespreken van de wetenschappelijke kennis.

    Inderdaad is al lange tijd bekend dat hyperthermie de effecten van radiotherapie en chemotherapie versterkt, zonder blijvende bijwerkingen meetbaar te versterken. Ook voor het hoofd en hals gebied zijn hiervoor meerdere studies uitgevoerd die de positieve effecten van hyperthermie laten zien.

    In het artikel wat u aanhaalt geven wij een overzicht van deze studies, en de gebruikte technologie. De toegepaste apparatuur in de studies is inderdaad veel eenvoudiger dan de apparatuur die wij hebben ontwikkeld (HYPERcollar3D). Maar met een goede reden. Die studies richten zich maar op een deel van het probleem. Met bestaande apparatuur kan maximaal 4 cm van de huid worden verwarmd. Onze technologie kan zowel oppervlakkige tumoren als veel diepere tumoren effectief verwarmen. Zelf dicht bij de hersenen kunnen we de warmte toch nog goed richten. Daarnaast kan de warmte met de HYPERcollar3D worden aangepast aan de patiënt. Met deze aanpak kan zowel de tumor, als omringende uitzaaiingen in de lymfklieren worden behandeld in het hele hoofd-hals gebied. Dit maakt de inzet van hyperthermie potentieel dus veel effectiever. Onze eerste resultaten geven al een eerste indicatie van de winst: voor een groep patiënten met veel slechtere prognose (eerder bestraald) zien we een gelijke tot betere behandeluitkomst.

    Hopelijk maakt dit onze aanpak duidelijk. In de komende tijd gaan we werken aan het breder beschikbaar maken van deze technologie. Hiermee hopen we een grote steen bij te dragen aan effectieve en kosteneffectieve gezondheidszorg.

    Met vriendelijke groet,
    Maarten

    PS Overigens heeft Erasmus MC niet gebroken met BSD. Dit is apparatuur die bewezen effectief is en waarmee een bewezen effectieve en kosteneffectieve behandeling kan worden uitgevoerd. Alternatieven voor goede en gecontroleerde hyperthermie behandeling in het bekken gebied zijn nog niet beschikbaar.

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