癌治療における併用療法としての低温度温熱処置の有用性について
従来, 臨床における温熱併用放射線療法は, 実験腫瘍に対する放射線照射と同時あるいは照射後の連続的加温処置のデータに基づき, 放射線照射の直後に加温する様式がとられてきた. 温熱治療を受ける患者の多くは, 通常治療法では難治性で進行した腫瘍を有していたり, すでに癌治療を受けた後の再発症例である事も多く, いわゆるPerformance statusの良くない場合も多い. 従って, 温熱処置による直接的殺腫瘍効果を期待して, 42℃以上の腫瘍内温度を確保しつつ1時間以上ある定まった体勢を保持させる事は至難の業であり, 加温による疼痛などの有害事象によって治療中断に陥る可能性も非常に高い. さら...
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Published in | Thermal Medicine Vol. 23; no. 3; pp. 103 - 112 |
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Main Authors | , , , , , |
Format | Journal Article |
Language | Japanese |
Published |
日本ハイパーサーミア学会
2007
|
Online Access | Get full text |
ISSN | 1882-2576 1882-3750 |
DOI | 10.3191/thermalmed.23.103 |
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Abstract | 従来, 臨床における温熱併用放射線療法は, 実験腫瘍に対する放射線照射と同時あるいは照射後の連続的加温処置のデータに基づき, 放射線照射の直後に加温する様式がとられてきた. 温熱治療を受ける患者の多くは, 通常治療法では難治性で進行した腫瘍を有していたり, すでに癌治療を受けた後の再発症例である事も多く, いわゆるPerformance statusの良くない場合も多い. 従って, 温熱処置による直接的殺腫瘍効果を期待して, 42℃以上の腫瘍内温度を確保しつつ1時間以上ある定まった体勢を保持させる事は至難の業であり, 加温による疼痛などの有害事象によって治療中断に陥る可能性も非常に高い. さらに, 現行の加温装置を用いて, 加温対象となる腫瘍をほぼ均一に, 直接的殺細胞効果を期待して42℃以上に加温することは非常に困難である. 他方, 温熱療法の併用が放射線照射による治療効率を高めた事を示した従来の多くの報告においては, 治療対象腫瘍の温度は40-41.5℃までしか加温されていない. 放射線治療による抗腫瘍効果の上昇を認めたにもかかわらず, 加温による直接的な殺腫瘍細胞効果の上昇, 放射線増感効果, 及び腫瘍血管障害効果は, 重要に思えない. 最近, 低温度温熱処置 (MTH) が誘導する血流増加作用やそれによる腫瘍酸素化作用などの生理的効果が, MTH後の放射線照射による放射線増感作用や, 薬剤の腫瘍分布上昇による化学療法増強効果をもたらす事が示唆されている. そこで, 40-41℃前後の低温度加温を加温目標に定めるならば, 患者の負担も軽減し, 体勢保持も確保され, 治療中断を避ける事も可能となる. 腫瘍内休止期細胞分画への効果に着目し, 化学療法や化学放射線療法に併用されたMTHの有用性も明らかにされている. 温熱併用放射線治療においては, 42-43℃以上の加温が保証されるならば, 温熱治療は放射線照射後に施行されるべきであるが, 42℃以上の加温が困難であるならば, 放射線照射と加温の順序を逆転させ, 腫瘍酸素化効果を誘導するMTH後に放射線照射を施行し, 放射線増感効果を臨床的に期待するのも有用であろうと考えられる. |
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AbstractList | 従来, 臨床における温熱併用放射線療法は, 実験腫瘍に対する放射線照射と同時あるいは照射後の連続的加温処置のデータに基づき, 放射線照射の直後に加温する様式がとられてきた. 温熱治療を受ける患者の多くは, 通常治療法では難治性で進行した腫瘍を有していたり, すでに癌治療を受けた後の再発症例である事も多く, いわゆるPerformance statusの良くない場合も多い. 従って, 温熱処置による直接的殺腫瘍効果を期待して, 42℃以上の腫瘍内温度を確保しつつ1時間以上ある定まった体勢を保持させる事は至難の業であり, 加温による疼痛などの有害事象によって治療中断に陥る可能性も非常に高い. さらに, 現行の加温装置を用いて, 加温対象となる腫瘍をほぼ均一に, 直接的殺細胞効果を期待して42℃以上に加温することは非常に困難である. 他方, 温熱療法の併用が放射線照射による治療効率を高めた事を示した従来の多くの報告においては, 治療対象腫瘍の温度は40-41.5℃までしか加温されていない. 放射線治療による抗腫瘍効果の上昇を認めたにもかかわらず, 加温による直接的な殺腫瘍細胞効果の上昇, 放射線増感効果, 及び腫瘍血管障害効果は, 重要に思えない. 最近, 低温度温熱処置 (MTH) が誘導する血流増加作用やそれによる腫瘍酸素化作用などの生理的効果が, MTH後の放射線照射による放射線増感作用や, 薬剤の腫瘍分布上昇による化学療法増強効果をもたらす事が示唆されている. そこで, 40-41℃前後の低温度加温を加温目標に定めるならば, 患者の負担も軽減し, 体勢保持も確保され, 治療中断を避ける事も可能となる. 腫瘍内休止期細胞分画への効果に着目し, 化学療法や化学放射線療法に併用されたMTHの有用性も明らかにされている. 温熱併用放射線治療においては, 42-43℃以上の加温が保証されるならば, 温熱治療は放射線照射後に施行されるべきであるが, 42℃以上の加温が困難であるならば, 放射線照射と加温の順序を逆転させ, 腫瘍酸素化効果を誘導するMTH後に放射線照射を施行し, 放射線増感効果を臨床的に期待するのも有用であろうと考えられる. |
Author | 増永, 慎一郎 西村, 恭昌 高橋, 正治 平岡, 真寛 小野, 公二 阿部, 光幸 |
Author_xml | – sequence: 1 fullname: 平岡, 真寛 organization: 京都大学大学院医学研究科放射線腫瘍学・画像応用治療学 – sequence: 1 fullname: 小野, 公二 organization: 京都大学原子炉実験所粒子線腫瘍学研究センター – sequence: 1 fullname: 高橋, 正治 organization: 京都大学名誉教授 – sequence: 1 fullname: 増永, 慎一郎 organization: 京都大学原子炉実験所粒子線腫瘍学研究センター – sequence: 1 fullname: 阿部, 光幸 organization: 京都大学名誉教授 – sequence: 1 fullname: 西村, 恭昌 organization: 近畿大学医学部放射線医学教室放射線腫瘍学部門 |
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Thermal Med, 23 : 41-47, 2007. 20) Masunaga S., Ono K., Suzuki M., Kinashi Y., Takagaki M., Hori H., Kasai S., Nagasawa H., Uto Y. : Usefulness of tirapazamine as a combined agent in chemoradiation and thermo-chemoradiation therapy at mild temperatures - reference to the effect on intratumor quiescent cells. Jpn J Cancer Res, 91 : 566-572, 2000. |
References_xml | – reference: 11) Song C.W., Park H., Griffin R.J. : Improvement of tumor oxygenation by mild hyperthermia. Radiat Res, 155 : 512-528, 2001. – reference: 22) Masunaga S., Ono K., Kirihata M., Takagaki M., Sakurai Y., Kinashi Y., Kobayashi T., Nagasawa H., Uto Y., Hori H. : Evaluation of the potential of p-boronophenylalaninol as a boron carrier in boron neutron capture therapy, referring to the effect on intratumor quiescent cells. Jpn J Cancer Res, 92 : 996-1007, 2001. – reference: 21) Masunaga S., Ono K., Nishimura Y., Kanamori S., Saga T., Suzuki M., Kinashi Y., Takagaki M., Kasai S., Nagasawa H., Uto Y., Hori H. : Combined effects of tirapazamine and mild hyperthermia on anti-angiogenic agent (TNP-470) treated tumors - reference to the effect on intratumor quiescent cells. Int J Radiat Oncol Biol Phys, 47 : 799-807, 2000. – reference: 27) Takahashi Y., Mai M. : Significance of prolonged NC as an endpoint of chemotherapy for solid tumors. Gan To Kagaku Ryoho, 27 : 683-688, 2000. (Japanese) – reference: 18) Urano M., Kuroda M., Nishimura Y. : For the clinical application of thermochemotherapy given at mild temperatures. Int J Hyperthermia, 15 : 79-107, 1999. – reference: 10) Oleson J.R. : Hyperthermia from the clinic to the laboratory : hypothesis (Eugene Robinson Special Lecture). Int J Hyperthermia, 11 : 315-322, 1995. – reference: 24) Terunuma H., Wada A., Deng X., Yasuma Y., Onishi T., Toki A., Abe H. : Mild hyperthermia modulates the relative frequency of lymphocyte cell subpopulations : an increase in a cytolitic NK cell subset and a decrease in a regulatory T cell subset. Thermal Med, 23 : 41-47, 2007. – reference: 1) Dewey W.C., Hopwood L.E., Sapareto S.A., Gerweck L.E. : Cellular responses to combinations of hyperhermia and radiation. Radiology, 123 : 463-474, 1977. – reference: 9) Dewhirst M.W., Griffin T.W., Smith A.R., Parker R.G., Hanks G.E., Brady L.W. : Intersociety Council on Radiation Oncology essay on the introduction of new medical treatments into practice. J Natl Cancer Inst, 85 : 951-957, 1993. – reference: 34) Laurie S.A., Bell J.C., Atkins H.L., Roach J., Bamat M.K., O'Neil J.D., Roberts M.S., Groene W.S., Lorence R.M. : A phase I clinical study of intravenous administration of PV701, an oncolytic virus, using two-step desensitization. Clin Cancer Res, 12 : 2555-2562, 2006. – reference: 26) Kondo M. : Doctor ! Please study "hyperthermia". Jpn J Hyperthermic Oncol, 19 : 234-235, 2003. (Japanese) – reference: 35) Winquist E., Knox J., Ayoub J.P., Wood L., Wainman N., Reid G.K., Pearce L., Shah A., Eisenhauer E. : Phase II trial of DNA methyltransferase I inhibition with the antisense oligonucleotide MG98 in patients with metastatic renal carcinoma : a National Cancer Institute of Canada Clinical Trials Group investigational new drug study. Invest New Drugs, 24 : 159-167, 2006. – reference: 23) Masunaga S., Ono K., Sakurai Y., Takagaki M., Kobayashi T., Suzuki M., Kinashi Y., Akaboshi M. : Response of quiescent and total tumor cells in solid tumors to neutrons with various cadmium ratios. Int J Radiat Oncol Biol Phys, 41 : 1163-1170, 1998. – reference: 4) Oleson J.R., Samulski T.V., Leopold K.A., Clegg S.T., Dewhirst M.W., Dodge R.K., George S.L. : Sensitivity of hyperthermia trial outcomes to temperature and time : Implications for thermal goals of treatment. 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Snippet | 従来, 臨床における温熱併用放射線療法は, 実験腫瘍に対する放射線照射と同時あるいは照射後の連続的加温処置のデータに基づき, 放射線照射の直後に加温する様式がとられてきた. 温熱治療を受ける患者の多くは, 通常治療法では難治性で進行した腫瘍を有していたり, すでに癌治療を受けた後の再発症例である事も多く,... |
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Title | 癌治療における併用療法としての低温度温熱処置の有用性について |
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