Ipertermia e Radioterapia nei tumori iatrogeni
Un trattamento in radioterapia può in una bassissima percentuale di pazienti indurre di per se un secondo tumore a distanza di tempo. In questo studio si prendono in considerazione pazienti che sono stati irradiati per un primo tumore in regione toracica e ne hanno sviluppato un secondo sarcomatoso nella medesima regione.
La maggior parte delle volte si tratta di un angiosarcoma, di per se neoplasia dotata di una elevata malignità biologica.
Nel presente lavoro pubblicato sulla rivista internazionale Cancer di Giugno 2011 (American Cancer Society) si prende in considerazione un nuovo trattamento combinato di radioterapia ed ipertermia sulla nuova neoplasia. Le risultanze dimostrano una elevata efficacia del trattamento combinato.
Department of Radiation Oncology and Hyperthermia, Academic Medical Center, Amsterdam, the Netherlands.
The objective of this study was to evaluate the role of reirradiation and hyperthermia in the treatment of radiation-associated sarcoma (RAS) in the thoracic region, which is an increasing, yet extremely rare condition with a poor prognosis.
Between 1979 and 2009, 16 patients with RAS in the thoracic region were treated in the Academic Medical Center and the Institute Verbeeten with reirradiation and hyperthermia. In 13 patients, this treatment was given for unresectable disease and 3 times after resection as adjuvant treatment. The median latency period between the original malignancy diagnosis and the RAS diagnosis was 86 months (range 19-212 months). Histology was angiosarcoma in 11 patients (69%). The literature on reirradiation with or without hyperthermia for RAS was reviewed.
The median survival was 15.5 months (range, 3-204 months). Four patients were not evaluable for response. The response rate for the remaining 12 patients was 75% (7 complete responses and 2 partial responses). Six patients remained free of local failure until death (5 months and 7 months) or last follow-up (8 months, 11 months, 39 months, and 68 months).
The current study indicates that combined reirradiation and hyperthermia for RAS in the thoracic region is feasible. The high response rate and the possibility of durable local control suggest that this treatment is promising. Cancer 2011;. © 2011 American Cancer Society.
Dr. Carlo Pastore