There is a strong biological rationale for the use of hyperthermia as an
oncological treatment modality. Fifteen randomized trials have shown
significant improvement in clinical outcome when hyperthermia was added
to radiotherapy, chemotherapy or both. At temperatures ≥ 40 0C, heat can
cause direct celldeath, especially affecting cells that are relatively
resistant to chemotherapy and radiotherapy.
In this thesis, the status of hyperthermia in the treatment of locally
advanced cervix cancer in the Netherlands is presented and factors
predicting outcome are identified. Further, one possible way of
improving treatment quality, i.e. by using hyperthermia treatment
planning, is explored.
The addition of hyperthermia to in this clinical setting results in a
significant improvement in local control and a doubling of overall
survival, without adding to long-term treatment-related toxicity.
Patient-related predictive factors in this clinical setting are tumor
stage, tumor size and patient performance status, while the radiation
dose as well as thermal dose are predictive treatment-related factors.
We found a significant relationship between thermal dose and clinical
outcome for 420 patients, indicating that improvement in clinical
outcome can be achieved with increased thermal dose.
With the help of a hyperthermia treatment planning system, a computer
program that optimizes temperature distributions for specific patients,
possibly treatment quality can be improved and the thermal dose can be
increased. In this thesis, such a computer program is described and
adjusted for routine clinical use. Lastly, we conducted a randomized
trial to assess its current contribution to treatment quality and
thermal dose.http://repub.eur.nl/res/pub/20549/100902_Franckena%2C%20Martine.pdf
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