International Journal of Hyperthermia最新文献

Background: Heat shock proteins have been implicated in the process of carcinogenesis. HSPA14, a member of the heat shock protein family, remains poorly understood in terms of its significance and pathomechanisms in breast cancer.

Methods: We analyzed the expression levels of HSPA14 and its prognostic significance in breast cancer using TCGA data. TCGA data was used to investigate the association between HSPA14 expression and clinicopathological features in breast cancer patients. GSEA analysis was conducted to identify the biological function of HSPA14. Spearman's correlation analysis was performed to examine the correlation between HSPA14 expression and immune cell infiltration, as well as immune checkpoint genes. Single cell transcriptomic data from GSE114727 was utilized to calculate the expression of HSPA14 in different cell subpopulations. The data on HSPA14 levels and drug sensitivity were extracted from the CellMiner dataset. The mRNA expression of HSPA14 was validated through cell experiments.

Results: HSPA14 expression is elevated in breast cancer, which is associated with poor overall survival. It can serve as a diagnostic biomarker for breast cancer patients. Pathway analysis revealed that HSPA14-associated differential genes are involved in cell cycle, apoptosis, cellular response to heat stress, and more. Additionally, HSPA14 expression is significantly correlated with the immune microenvironment. The expression of HSPA14 may also indicate drug sensitivity.

Conclusion: Our study elucidates the involvement of HSPA14 in tumorigenesis, particularly in modulating the immune response, shaping the immune microenvironment, and contributing to drug resistance, which are pivotal for the development of personalized breast cancer therapies.

Purpose: To evaluate the performance of a software algorithm developed to streamline microwave liver ablation parameter selection and to compare performance of this algorithm to that of experienced interventional radiologists.

Methods: Patients who underwent microwave ablation for treatment of liver tumors were retrospectively identified. An automated software platform was developed to select the top three 'best fit' combinations of microwave ablation power, time, and vendor for a given tumor to achieve a 5 mm minimal ablative margin (MAM). Generalized linear modeling was used to compare the performance of the software algorithm and experienced interventional radiologists with respect to selected ablation parameters and estimates of total ablative volume (TAV) and MAM. Statistical significance was set at p < 0.05.

Results: 35 patients were identified who underwent single-antenna microwave ablation for liver tumors. Mean estimated TAV was not significantly different between clinical practice (24.96 cm³, 95% CI: 21.18 - 28.75 cm³) and algorithm-derived parameters (23.89 cm³, 95% CI: 20.04 - 27.74 cm³; p > 0.05), indicating agreement in overall treatment approach. However, the algorithm consistently generated ablation parameter combinations with more favorable estimated MAM metrics and significantly lower variability (first algorithm: -5.33 mm, 95% CI -5.40 - -5.26 mm; second algorithm: -5.83 mm, 95% CI -6.01 - -5.65 mm; third algorithm: -6.06 mm, 95% CI -6.30 - -5.83 mm) compared to interventional radiologists (-1.02 mm, 95% CI -2.02 - -0.03 mm).

Conclusion: Streamlining microwave liver ablation parameter selection using an automated software algorithm reduces variability and improves estimated MAM coverage of liver tumors.

Background: Efficacy of current treatment options for cervical cancer require improvement. Previous in vitro studies have shown the enhancing effects of the addition of PARP1-inhibitors to chemoradiotherapy and thermoradiotherapy. The aim of our present study was to test efficacy of different combinations of treatment modalities radiotherapy, cisplatin, hyperthermia and PARP1-inhibitors using in vitro tumor models, ex vivo treated patient samples and in vivo tumor models.

Materials and Methods: In vitro clonogenic survival curves (0-6 Gy) show that PARP1-i (4-5 M Olaparib) enhances both chemoradiotherapy (0.3-0.5 µM cisplatin) and thermoradiotherapy (42 °C for 1 h) in SiHa, CaSki and HeLa cells. A cervical cancer mouse model and freshly obtained in-house developed patient-derived organoids were used to examine the effects of different treatment combinations. For the in vivo study, human cervical cancer (SiHa) cells were injected in the right hind leg of athymic nude mice. In vivo mouse experiments show that PARP1-i enhances thermoradiotherapy or chemoradiotherapy by reduction of tumor volumes. Five cycles of treatment were applied with the following doses per cycle: irradiation 3 Gy, hyperthermia 1 h at 42 °C, cisplatin at 2 mg/kg, and twice PARP1-i at 50 mg/kg.

Results: Quadruple treatment, combining radiotherapy, hyperthermia, cisplatin and PARP1-i, was very effective but also lead to severe side effects causing severe weight loss and death. In contrast, thermoradiotherapy or chemoradiotherapy with addition of PARP1-i, were effective without serious side effects.

Conclusion: The triple combinations are promising options for potentially more effective treatment of locally advanced cervical cancer without more toxicity.

Objective: We conducted the systematic review and meta-analysis to comprehensively compare ablation and surgery in terms of effectiveness, safety and multiple factors affecting life quality of patients with papillary thyroid cancer (PTC).

Methods: PubMed, Embase, Scopus, Web of Science and EBSCO were searched for relevant studies published between January 1980 and September 2023. Two reviewers independently extracted data according to the PRISMA recommendations and assessed the quality of each study with the Cochrane Risk of Bias Tool. Pooled analyses were performed using random or fixed-effects models, as appropriate.

Results: A total of 4829 patients with PTC from 19 eligible studies were included. Through the meta-analysis, similar tumor progression (OR: 1.07; 95% CI 0.78, 1.48; p = 0.66) and recurrence-free survival (OR: 0.86; 95% CI, 0.55, 1.34; p = 0.50) were found between the patients undergoing ablation and those undergoing surgery. More strikingly, the lower risk of major complications (OR: 0.31; 95% CI 0.24, 0.41; p < 0.001), the shorter hospital stay (MD = 3.67 d; 95% CI, -4.89, -2.44; p < 0.001), the abbreviated procedure time (MD: -66.33 min, 95% CI, -77.08, -55.59; p < 0.001), the less intraoperative blood loss (MD: -27.43 ml, 95% CI, -34.60, -20.27; p < 0.001) and the lower treatment cost (MD: -860.42 USD, 95% CI, -1008.03, -712.81; p < 0.001) were noticed in ablation techniques compared to surgical operation. Thermal ablation has shown multiple advantages by virtue of its percutaneous puncture compared with surgical resection.

Conclusion: As an effective, safe, minimally invasive and economical modality, thermal ablation might be a promising alternative to existing PTC management options.

Objectives: The study aimed to develop a non-enhanced MRI-based radiomics model for the preoperative prediction of the efficacy of adenomyosis after high-intensity focused ultrasound (HIFU) treatment.

Methods: The data of 130 patients with adenomyosis who underwent HIFU treatment were reviewed. Based on a non-perfused volume ratio (NPVR) of 50%, the patients were assigned to high ablation rate and low ablation rate groups. A radiomics model was constructed from the screened radiomics features and its output probability was calculated as the radiomics score (Radscore). The clinical-imaging model was constructed from the independent predictors of clinical-imaging characteristics. The combined model was constructed by integrating Radscore and clinical-imaging independent predictors. Receiver operating characteristic (ROC) curves, the Delong test, and decision curve analysis (DCA) were used to evaluate the models.

Results: The combined model had the best overall performance among the three models. The AUC (95% CI), specificity, sensitivity, accuracy, and precision of the combined model were 0.860 (0.786-0.935), 0.780, 0.756, 0.769, 0.738 in the training set, and 0.878 (0.774-0.983), 0.859, 0.667, 0.769, 0.800 in the test set, respectively. The Delong test showed that the performance of both the radiomics and combined models differed significantly from the clinical-imaging model. But the performance of the combined and the radiomics model was statistically equivalent. The DCA indicated that the combined model had better clinical net benefit.

Conclusion: The combined model based on non-enhanced MRI radiomics was effective in predicting the outcome of HIFU ablation of adenomyosis before surgery.

Background: Reliability of absolute specific absorption rate (SAR)/temperature levels predicted by treatment planning is strongly affected by tissue parameter uncertainties. Therefore, regular re-optimization to suppress hot spots can accidentally induce new hot spots elsewhere. Adaptive planning methods to avoid this problem re-optimize with respect to the current predicted 3D-distribution. This strategy is robust if reliability of predicted SAR/temperature changes (i.e., increases/decreases) after phase-amplitude adjustments is minimally affected by parameter uncertainties; this work evaluated this robustness.

Methods: We validated the basic concept in an inhomogeneous phantom, followed by a patient model. Uncertainties in electrical conductivity, permittivity and perfusion were mimicked by simulations using 100 random parameter samples from normal distributions. Reliability of predicted SAR/temperature increase/decrease after phase-amplitude adjustments was evaluated. Next, correlations between measured and simulated SAR and SAR changes were determined for phase settings evaluated at the treatment start for a treatment series. Finally, practical use in an adaptive workflow was illustrated.

Results: Local SAR/temperature increases/decreases after phase-amplitude adjustments can be predicted accurately. For the phantom, the measured 28.5% SAR decrease was predicted accurately(28.5 ± 0.7%). In the patient model, predicted SAR/temperature changes were typically accurate within a few percent. For the treatment series, correlations between measured and simulated (relative) SAR changes were much better(R²=0.70-0.82) than for absolute SAR levels(R²=0.29). Predictions of steering effects during treatment corresponded qualitatively with measurements/observations.

Conclusion: Predictions of SAR/temperature increases/decreases induced by phase-amplitude steering are hardly affected by tissue parameter uncertainties. On-line adaptive planning based on predicted changes is thus robust to effectively support clinical steering strategies.

Background: Post-Covid syndrome (PCS) has been an ongoing challenge since the COVID-19 pandemic. Relatively little is known about the effect of whole-body hyperthermia (WBH) in the treatment of PCS.

Methods: We retrospectively analyzed the data of patients with PCS who were treated as inpatients with a multimodal integrative therapy approach including WBH. The primary outcome comprised changes in Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) between T0 (at hospital admission) and T2 (four weeks after discharge), secondary outcomes were changes in Fatigue Impact Scale (FIS-D), Multidimensional Dyspnea Profile (MDP) and Covid-Associated Symptoms (CAS) between T0-T1 (at discharge) and T0-T2.

Results: FACIT-F yielded a significant increase (p < 0.001) between T0 (19.1 ± 8.4) and T2 (29.9 ± 13.0) (primary outcome), indicating an improved health status. While FIS-D and CAS scores improved significantly between T0 and T2, dyspnea parameters improved only between T0 and T1. 63% of respondents identified WBH as an effective treatment.

Conclusions: Study results provide preliminary evidence for potentially positive effects of WBH in the setting of this study, in which it is embedded in a multimodal therapy approach. The results should be substantiated by future RCTs to identify specific effects of individual therapy components.

Objective: Cardiovascular injury is a common complication of heat stroke (HS). However, the mechanism underlying vascular smooth muscle cells (VSMCs) following HS remains unclear.

Method: A rat and VSMCs model was established by simulating high-temperature exposure. Primary VSMC was extracted in vitro, and CCK8 screened the concentration of Nec-1 and detected cell proliferation activity. The expression of α-smooth muscle protein (α-SMA), osteopontin (OPN), receptor-interacting protein kinase 1 (RIPK1), receptor-interacting protein kinase 3 (RIPK3), Bcl-2 and Bax were detected by immunohistochemistry and Western blot.

Results: The results of in vivo experiments showed that with the prolongation of HS recovery time, α-SMA expression basically decreased and OPN expression increased. Meanwhile, the expression of RIPK1 and RIPK3 was increased, which promoted the occurrence of necroptosis. In vitro results showed that with the extension of HS recovery time, the proliferative viability of VSMCs decreased, the cell morphology changed, and the apoptotic cells increased. The fluorescence results indicate that the expression levels of RIPK1 and PIPK3 in the cells are elevated, accompanied by the typical characteristics of cell necroptosis. Nec-1 restored the decreased cell viability and the high expression of RIPK1 and RIPK3 induced by heat stroke, and improved the occurrence of cell necrotic apoptosis. Nec-1 also restored α-SMA expression, reduced OPN expression, and reversed phenotypic abnormalities of VSMC caused by heat stroke.

Conclusion: HS induces abnormal phenotypic transformation and necroptosis in VSMCs. Necrostatin-1 can improve necroptosis and maintain the contractile phenotype of VSMCs. This study can provide new insights into cardiovascular damage caused by high temperatures.

Objective: Pseudomyxoma peritoneum (PMP) of appendiceal origin poses significant treatment challenges with hyperthermic intraperitoneal chemotherapy (HIPEC) regimens offering viable outcomes. This study aimed to compare the efficacy and safety profiles of two HIPEC regimens: cisplatin + docetaxel (CD) and cisplatin + mitomycin C (CM).

Methods: PMP patients who underwent cytoreductive surgery (CRS) and HIPEC between January 2008 and December 2023 at our center were retrospectively analyzed. Patients were divided into CD and CM groups and matched for baseline characteristics using propensity score matching (PSM). Clinicopathological data, efficacy, and safety profiles were compared. Univariate and multivariate analyses identified independent prognostic factors, and subgroup analyses further compared the two regimens.

Results: After PSM, 104 patients met the inclusion criteria (52 in each group). The median overall survival (mOS) was significantly longer in the CD group (156.3 vs. 60.9 months, p = 0.018), with no significant differences in adverse event severity between groups. Multivariate analysis identified HIPEC regimen, completeness of cytoreduction (CC), and pathological type as independent prognostic factors. Subgroup analysis showed significant mOS benefit for the CD regimen in patients with peritoneal carcinomatosis index (PCI) ≥ 27, CC 2/3, high grade pathology, tumor markers ≥1 evaluated and BMI < 25 (all p < 0.005).

Conclusions: Following CRS, the CD regimen offers superior survival benefits compared to the CM regimen for PMP patients. These findings highlight the potential of personalized HIPEC strategies to optimize outcomes for PMP treatment.

Background: MR-guided focused ultrasound (MRgFUS) has been developed to treat essential tremor effectively and noninvasively. Currently, clinical examination is used to identify therapeutic efficacy during treatment, but MRgFUS surgery could benefit from real-time, rater-independent quantitative monitoring of tremor, such as accelerometry data.

Methods: Fourteen patients with medically refractory essential tremor underwent MRgFUS thalamotomy. Patients were instructed to hold postures during treatment. Tremor was monitored during each ultrasonic thermal sonication with MR-compatible accelerometers. Real-time feedback based on tremor amplitude in the 2-20 Hz band was calculated to evaluate the efficacy of each thermal ablation.

Results: On average 6 ± 2 ablative sonications only were required to induce improvement in tremor on the clinical rating scale for tremor (CRST) of 89 ± 11% at D + 7, 79 ± 12% at M + 1, 74 ± 19% at M + 3 and 72 ± 23% at M + 12. The overall predictive efficacy measured with accelerometry during the treatment was 70 ± 30%. The tremor amplitude reduction measured with accelerometry was correlated with CRST scores tremor reduction at multiple timepoints (ρ = 0.79 at D + 7, ρ = 0.75 at M + 1, ρ = 0.86 at M + 3, and ρ = 0.63 at M + 12) and accelerometric data gathered during treatment predicted CRST tremor improvement at M + 3 (0.88 area under ROC curve).

Conclusion: This exploratory study is a proof of concept suggesting that accelerometry measurements can provide real-time feedback on tremor reduction and can complement visual evaluation. In the future, the use of the outcome prediction introduced in this paper may shorten procedure time and limit adverse events by reducing the number of ablative administered sonications.