Radiation Oncology/Melanoma/Hyperthermia

Hyperthermia and Cutaneous Melanoma

• Please see the Hyperthermia section for further information on hyperthermia

Randomized

• ESHO 3-85
  • Randomized multicenter. 70 patients with 134 recurrent melanoma lesions. Treated with RT alone (24/3 or 27/3) or RT + Hyperthermia (43C for 60 min). F/U 3-72 months
  • PMID 8676005 -- "Hyperthermia as an adjuvant to radiation therapy of recurrent or metastatic malignant melanoma. A multicentre randomized trial by the European Society for Hyperthermic Oncology." (Overgaard J, Int J Hyperthermia. 1996 Jan-Feb;12(1):3-20.)
  • PMID 7776772 "Randomised trial of hyperthermia as adjuvant to radiotherapy for recurrent or metastatic malignant melanoma. European Society for Hyperthermic Oncology" (Overgaard J, Lancet 1995 Mar 4;345(8949):540-3).
  • Only 14% received target HT due to difficulties with equipment
  • 2-year LC: RT alone 28% vs. RT+HT 46% (SS); RT 24/3 25% vs. 27/3 56% (SS)
  • Toxicity: not increased with HT

Retrospective

• Graz, 2003 (Austria) PMID 16296154 -- "Efficacy of superficial and deep regional hyperthermia combined with systemic chemotherapy and radiotherapy in metastatic melanoma." (Richtig E, J Dtsch Dermatol Ges. 2003 Aug;1(8):635-42.)
  • Retrospective. 15 patients; 12 patients superficial HT + CRT, 3 patients deep HT + CRT
  • Response: 5/15 CR, 6/15 PR, 2/15 SD. Best results in cutaneous or retroperitoneal mets
  • Conclusion: LC can be achieved in metastatic melanoma with HT

• Jefferson, 1993 (1980-1988) PMID 8416885 -- "Hyperthermia and radiation in advanced malignant melanoma." (Engin K, Int J Radiat Oncol Biol Phys. 1993 Jan;25(1):87-94.)
  • Retrospective. 28 patients with 33 lesions. RT mean 37 Gy (13-66 Gy) over 5-16 fractions. Hyperthermia given twice-weekly
  • Response: 12/33 CR, 17/33 PR. Superficial <3cm CR 50%, deep >3cm CR 9%
  • Toxicity: 42% nothing, 48% erythema, 14% blistering

• Indiana, 1990 (1970-1987) PMID 2128438 -- "An overview of the role of radiation therapy and hyperthermia in treatment of malignant melanoma." (Shidnia H, Adv Exp Med Biol 1990;267:531-45.)
  • Retrospective. 92 patients with 188 melanoma lesions. RT given 1-10 Gy/fx, HT after RT
  • Response: CR RT alone 34% vs. RT+HT 70%. If RT dose >4 Gy/fx, CR in RT alone 63% vs. RT+HT 77%

• Aarhus, 1987 (Denmark) PMID 3693983 -- "Hyperthermia as an adjuvant to radiotherapy in the treatment of malignant melanoma." (Overgaard J, Int J Hyperthermia. 1987 Nov-Dec;3(6):483-501.)
  • Retrospective. 115 cutaneous or LN mets. Treated RT (15/3 - 30/3) followed by heat (immediately 26 tumors, sequential 27 tumors).
  • Thermal enhancement tumor: 1.4 simultaneous HT, 1.2 sequential HT
  • Thermal enhancement normal tissue: 1.4 simultaneous (no improvement in therapeutic ratio), 1.0 sequential (improvement)

• 1986 PMID 3737980 -- "Combined treatment with radiation and hyperthermia in metastatic malignant melanoma." (Gonzalez Gonzalez D, Radiother Oncol. 1986 Jun;6(2):105-13.)
  • Retrospective. 24 patients, 38 lesions RT + HT, 8 lesions RT alone, 3 lesions HT alone. HT given with 30 min following RT to target 43C. RT given as 6-8 Gy once a week, or 4-5 Gy twice a week
  • Response: CR for RT+HT 50% (if 8 Gy/fx CR 83%), CR for RT alone 38%
  • Toxicity: enhancement of acute skin reaction, but not clinically significant

Review

• MC Virginia, 1996 PMID 8914205 -- "Role of radiotherapy and hyperthermia in the management of malignant melanoma." (Schmidt-Ullrich RK, Semin Surg Oncol. 1996 Nov-Dec;12(6):407-15.)