The conventional radiation treatment of cancer patients has typically involved a large number of daily treatments with relatively low doses of radiation. However, improved technology has now resulted in the increased use of fewer radiation fractions at a high dose per fraction. This latter approach is often referred to as hypofractionated irradiation. While conventional radiation typically kills tumor cells through the production of DNA damage, treatments with higher doses per fraction have been suggested to also kill cells via the induction of vascular damage. Such vascular effects will also increase the level of adverse microenvironmental conditions, such as hypoxia and acidity, that already exist in tumors. Cells existing in these adverse microenvironmental conditions are resistant to radiation but actually sensitive to hyperthermia (heating at 40–45 °C) treatment. This suggests that the combination of hypofractionated radiation and heat may be a viable treatment approach. While there are preliminary pre-clinical and even clinical studies investigating this option, there are actually no data on the optimal application for the greatest therapeutic benefit. In this critical review, we will present the rationale for combining hypofractionated radiation with hyperthermia and discuss what has been done and what should be done to establish this combination as an effective cancer therapy option.
传统癌症患者的放射治疗通常涉及每日多次、剂量相对较低的照射。然而，随着技术的进步，目前越来越多地采用单次高剂量、总次数较少的放射治疗方案。这种治疗方法常被称为大分割放射治疗。传统放射治疗主要通过造成DNA损伤来杀死肿瘤细胞，而单次高剂量的放射治疗则被认为还能通过诱导血管损伤来杀死细胞。这种血管效应会加剧肿瘤中已有的不利微环境条件，如缺氧和酸性。处于这些不利微环境条件下的细胞对放射治疗具有抵抗性，但实际上对热疗（40-45°C加热）敏感。这表明，大分割放射治疗与热疗的结合可能是一种可行的治疗方法。尽管已有初步的临床前甚至临床研究探讨这一方案，但目前尚无关于如何优化应用以获得最大治疗效果的数据。在这篇重要综述中，我们将阐述大分割放射治疗与热疗结合的理论依据，并讨论已开展的工作以及为确立这一组合作为有效癌症治疗选择所需进行的进一步研究。
The Rationale for Combining Hypofractionated Radiation and Hyperthermia
肿瘤(癌症)患者之家