Heat helps boosts antitumor effect of chemotherapy
To test the therapeutic strategy of regional hyperthermia during chemotherapy, Rolf Issel, MD, of the University Hospital in Munich, Germany, and colleagues conducted a study involving 341 patients who had adult-type soft tissue sarcoma with no evidence of distant metastases.
Participants were randomized to neoadjuvant chemotherapy of etoposide, ifosfamide, and doxorubicin alone or combined with regional hyperthermia. Using radiofrequency to reach a target tumor temperature of 42°C, researchers applied regional hyperthermia for 60 minutes on days 1 and 4 of each chemotherapy cycle during induction and postinduction therapy.
Results of the study found that regional hyperthermia during induction was associated with a 42% reduction in risk of local progression or death compared with chemotherapy alone. All patient subgroups experienced benefit from hyperthermia treatment, but the effect was significant in those with nonextremity tumors. Overall survival didn't improve with regional hyperthermia in the entire group, but did in a prespecified per-protocol analysis of the 78.9% of patients who completed chemotherapy.
The team also reported a 30% improvement in disease-free survival with the use of regional heating during chemotherapy and that the treatment response rate was also better at 28.8% in the regional hyperthermia group compared with 12.7% in the chemotherapy alone group.
“This therapeutic strategy offers a new treatment option and can be integrated in the multimodal treatment approach for these patients,” said Dr. Issel. While Dr. Issel's team concluded that regional hyperthermia could be safely combined with the chemotherapy regimen tested, they warned about “generalizing the results to lower-risk soft tissue sarcoma patients, who might have a different safety profile and thus a different balance of potential benefit and harm.”