Hyperthermic Oncology from Bench to Bedside by Satoshi Kokura Toshikazu Yoshikawa & Takeo Ohnishi

Author:Satoshi Kokura, Toshikazu Yoshikawa & Takeo Ohnishi
Language: eng
Format: epub
Publisher: Springer Singapore, Singapore

19.3 Clinical Results of Chemoradiotherapy and Hyperthermia for Recurrent Esophageal Cancer

Loco-regional recurrence is a common problem in patients with esophageal cancer. Radiotherapy and/or chemotherapy are typically selected for postoperative loco-regional recurrence after surgery. Yahara et al. reported a retrospective case series involving treatment with radiotherapy with regional hyperthermia in 16 patients with recurrent esophageal cancer [9]. The objective tumor response rate was promising at 88 %. The median survival durations for CR and PR cases were 73 months and 7 months, respectively. Locoregional tumor control may be important for clinical outcomes in these tumors; therefore, further clinical investigation of the combined treatments of radiotherapy with regional hyperthermia is justified.

There are few treatment options for recurrent or persistent esophageal cancer after chemoradiotherapy, and no general therapeutic rules are available. Salvage esophagectomy following definitive chemoradiotherapy is one treatment option; however, this has shown high morbidity and mortality rates [10, 11]. Recently, there have been encouraging results for re-irradiation in many cases of recurrent tumors at various sites, such as head and neck cancer, lung cancer, and rectal cancer [12–14]. Because re-irradiation at relatively small doses may not provide local tumor control and adequate palliative effects, re-irradiation with hyperthermia may improve the clinical outcomes in patients with recurrent or residual tumor previously irradiated. Previous clinical results for re-irradiation with hyperthermia have been reported, in which higher local control rates and favorable palliative effects were demonstrated in patients with recurrent breast cancer and rectal cancer [15, 16]. Yamaguchi et al. reported on multimodal approaches, including re-irradiation, chemotherapy, and regional hyperthermia using an 8-MHz radiofrequency capacitive heating device for patients with recurrent or persistent esophageal cancer after radiotherapy [17]. The intra-esophageal temperatures were also measured in the study, and the maximum, minimum, and average temperatures were 42.2, 39.3, and 41.5 °C, respectively. For patients with early-stage recurrent or persistent esophageal cancer, these approaches appeared feasible, promising, and showed a high objective tumor response rate of 91 %, although advanced T stage at the time of re-irradiation was found to be significantly correlated with Grade 3 or higher toxicity in the esophagus.

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