Long-Term Outcome in a Phase II Study of Regional Hyperthermia Added to Preoperative Radiochemotherapy in Locally Advanced and Recurrent Rectal Adenocarcinomas.

Baard-Christian Schem,Olav Dahl,Martin Anton Ott,Frank Pfeffer,Olav Mella,Johan N Wiig,Sabine Leh,Nils Sletteskog,Mette Pernille Myklebust,Torbjørn Frøystein

doi:10.3390/cancers14030705

Abstract

Simple SummaryRegional hyperthermia added to standard preoperative chemoradiotherapy for locally advanced and recurrent rectal cancer gives a high complete response rate and an improved long-term recurrence free survival.Hyperthermia was added to standard preoperative chemoradiation for rectal adenocarcinomas in a phase II study. Patients with T3-4 N0-2 M0 rectal cancer or local recurrences were included. Radiation dose was 54 Gy combined with capecitabine 825 mg/m2 × 2 daily and once weekly oxaliplatin 55 mg/m2. Regional hyperthermia aimed at 41.5–42.5 °C for 60 min combined with oxaliplatin infusion. Radical surgery with total or extended TME technique, was scheduled at 6–8 weeks after radiation. From April 2003 to April 2008, a total of 49 eligible patients were recruited. Median number of hyperthermia sessions were 5.4. A total of 47 out of 49 patients (96%) had the scheduled surgery, which was clinically radical in 44 patients. Complete tumour regression occurred in 29.8% of the patients who also exhibited statistically significantly better RFS and CSS. Rate of local recurrence alone at 10 years was 9.1%, distant metastases alone occurred in 25.6%, including local recurrences 40.4%. RFS for all patients was 54.8% after 5 years and CSS was 73.5%. Patients with T50 temperatures in tumours above median 39.9 °C had better RFS, 66.7% vs. 31.3%, p = 0.047, indicating a role of hyperthermia. Toxicity was acceptable.

Highlights

Patients presenting locally advanced rectal cancer (LARC) or primarily non-resectable rectal cancer have a dire prognosis [1]
It was of interest to explore whether a preoperative combination of radiation, chemotherapy and hyperthermia could improve the results of surgery for rectal cancer
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Summary

Introduction

Patients presenting locally advanced rectal cancer (LARC) or primarily non-resectable rectal cancer have a dire prognosis [1]. Preoperative radiation for advanced rectal cancer [4,5,6] and palliative radiotherapy for metastasized or irresectable rectal cancer [7,8,9] is well established. The clinical benefit of superficial hyperthermia for malignant melanomas and deep pelvic hyperthermia as an adjuvant to radiotherapy for cervical cancer has been documented [10,11,12,13]. It was of interest to explore whether a preoperative combination of radiation, chemotherapy and hyperthermia could improve the results of surgery for rectal cancer. At the time the study was initiated, few clinical studies had treated primary rectal cancer by radiation combined with deep hyperthermia [13,15,16,17]

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Conclusion