Accurate Three-Dimensional Thermal Dosimetry and Assessment of Physiologic Response Are Essential for Optimizing Thermoradiotherapy
Abstract
:Simple Summary
Abstract
1. Introduction
2. Hypoxia Is Caused by Imbalance between Oxygen Delivery and Oxygen Consumption Rate
- hypoxia,
- perfusion,
- metabolism and oxygen consumption rate and
- necrosis.
3. Challenges to Relating Temperatures Achieved during HT with Physiologic Response
3.1. Difference in Temperature Distributions between Rodent and Human Tumors
3.2. Thermometry in Human Tumors Is Mainly Acquired from Implanted Thermal Probes
4. Effects of Hyperthermia on Tumor Metabolism
4.1. Switch to Anaerobic Metabolism after Hyperthermia Treatment
4.2. Direct Cytotoxicity of HT
5. Effects of Hyperthermia on Tumor Perfusion and Hypoxia
5.1. Physiologic Effects during or Immediately after Heating
5.2. Physiologic Effects Occurring after Heating
5.3. Human Studies of Reoxygenation Post HT
5.4. Canine Studies of Reoxygenation Post HT
- Higher CEM43T10 was associated with an improvement in average pO2 (p = 0.0214) and reduction in HF (% points < 10 mmHg; p = 0.0451), 24 h after the first HT.
- There was a significant positive correlation between CEM43T90 and perfusion at 24 h post first hyperthermia fraction.
- Increases in average pO2 and perfusion at 24 h after the first HT were correlated with tumor volume reduction at the end of treatment.
- Higher Total CEM43T10 and Total CEM43T50 were associated with change in ADC at the end of treatment (p = 0.007 and p = 0.0007, respectively), but the trends were different for the 5Fx HT vs. 20Fx HT groups. Reduction in ADC is associated with lower diffusion coefficient of water, which can be interpreted as a relative decrease in water mobility. It has been reported that early onset of apoptosis or apoptosis mixed with necrosis is associated with increased ADC [113,114]. However, in situations where there is necrosis in the absence of apoptosis, chronic necrosis or fibrosis, ADC tends to decrease [115,116]. The increase in ADC associated with relatively high CEM43T10 and -T50 in the 20Fx HT group is consistent with the notion that higher cumulative thermal doses cause cell killing and increased edema. Extensive cell death could reduce oxygen consumption rate across a tumor, thereby contributing to improved oxygenation.
- Higher CEM43T10 and -T50 were significantly negatively correlated with greater tumor volume reduction at the end of therapy.
6. A Look Backward and Future Directions
7. Returning Back to Differences in Temperature Distributions between Rodent and Human Tumors
8. Conclusions
Supplementary Materials
Author Contributions
Funding
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Variable | Parameter Estimate | Hazard Ratio | Score p-Value | Wald p-Value |
---|---|---|---|---|
HF Post-Pre | −0.0643 | 0.94 | 0.0070 | 0.0340 |
Median pO2 Post-Pre | 0.0896 | 1.09 | 0.0230 | 0.0710 |
Pimo % area | −6.549 | 0.00 | 0.038 | 0.0510 |
PDE/ATP | 0.2246 | 1.25 | 0.0490 | 0.0640 |
Variable | N | CEM43T10 | CEM43T50 | CEM43T90 | |||
---|---|---|---|---|---|---|---|
Coefficient | p-Value | Coefficient | p-Value | Coefficient | p-Value | ||
Change ADC Pre-post * | 29 | −0.53 | 0.0030 | −0.56 | 0.0015 | 0.11 | 0.5665 |
iAUC change 24 h ^ | 17 | 0.07 | 0.7798 | 0.23 | 0.3599 | 0.5109 | 0.0311 |
Median pO2 change at 24 h ^ | 38 | 0.38 | 0.0214 | 0.27 | 0.1087 | −0.07 | 0.9829 |
Change HF 24 h ^ | 38 | −0.34 | 0.0451 | −0.27 | 0.1074 | −0.07 | 0.674 |
Volume change Pre-Post * | 38 | −0.42 | 0.0084 | −0.36 | 0.0258 | 0.2983 | 0.17 |
Variable | N | Coefficient | p-Value |
---|---|---|---|
iAUC median change 24 h | 17 | −0.47 | 0.0472 |
Median pO2 change 24 h | 38 | −0.040 | 0.0146 |
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Dewhirst, M.W.; Oleson, J.R.; Kirkpatrick, J.; Secomb, T.W. Accurate Three-Dimensional Thermal Dosimetry and Assessment of Physiologic Response Are Essential for Optimizing Thermoradiotherapy. Cancers 2022, 14, 1701. https://doi.org/10.3390/cancers14071701
Dewhirst MW, Oleson JR, Kirkpatrick J, Secomb TW. Accurate Three-Dimensional Thermal Dosimetry and Assessment of Physiologic Response Are Essential for Optimizing Thermoradiotherapy. Cancers. 2022; 14(7):1701. https://doi.org/10.3390/cancers14071701
Chicago/Turabian StyleDewhirst, Mark W., James R. Oleson, John Kirkpatrick, and Timothy W. Secomb. 2022. "Accurate Three-Dimensional Thermal Dosimetry and Assessment of Physiologic Response Are Essential for Optimizing Thermoradiotherapy" Cancers 14, no. 7: 1701. https://doi.org/10.3390/cancers14071701