Regional hyperthermia combined with chemo could improve survival in sarcoma patients

29 Apr 2010

Treating high-risk sarcoma with hyperthermia, by applying regional heat, alongside chemotherapy could improve the chances of survival, concludes an article published  online first in The Lancet Oncology.

There are just over 10,000 new cases of soft-tissue sarcomas in the USA every year, and half of these people will eventually die of the disease. Yet the best way to treat this cancer is unclear. Hyperthermia in addition to chemotherapy has already shown promise in early trials. The theory is that the heat boosts the activity of the drugs by helping to kill the cancer cells directly.

Rolf Issels at the Klinikum der Universität, and the Helmholtz Zentrum, München, Germany, and colleagues undertook a phase-3 study of 341 patients to investigate whether this combination treatment could improve survival in patients with high-risk sarcomas. All patients were assigned to pre-operative and post-operative chemotherapy with etoposide, ifosfamide, and doxorubicin. 169 of these (selected at random) were given additional treatment with regional hyperthermia concentrated on the sarcoma. The team’s aim was to measure local progression-free and disease-free survival - ie, how many people survived without local tumour progression or any evidence of disease.

Patients who were given hyperthermia in addition to chemotherapy were 42% more likely to survive with local control, and 30% more likely to survive free of disease than those given chemotherapy alone.

Hyperthermia had "moderate" toxicity, say the team. Patients who were given regional hyperthermia were more likely to develop leucopenia (reduced white-blood cells), probably because of the heating field covering part of the bone marrow, especially in patients with large abdominal or pelvic tumours, say the researchers.

"Whether a similar benefit will be seen in lower risk patients, and whether the safety profile will be the same, and hence the trade off between benefit and harm worthwhile, remains to be established," they add. Based on these results, their current routine clinical practice consists of pre-operative and post-operative first-line chemotherapy combined with regional hyperthermia – in addition to preoperative radiotherapy – where possible.

The authors say: "This randomised trial provides the first evidence that regional hyperthermia added to preoperative and postoperative chemotherapy is clinically more effective than chemotherapy alone in a specific population of patients with high-risk STS. This therapeutic strategy offers a new treatment option, and can be integrated in the multimodal treatment approach for these patients."

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Source: The Lancet Oncology