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your publication in IJ. Hyperthermia Sep 2008

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  • your publication in IJ. Hyperthermia Sep 2008

    Dear Prof. Wust,
    Thank you so much for providing us possibility to address questions to you. Please excuse me for writing these questions in English.
    1. In your above publication, you touch upon the issue of quality of life and limiting risk and burden for patients in palliative condition. Is chemotherapy combind with hyperthermia a treatment option for an elderly patinet with wide-spread (P3) peritoneal dissemination of appendix cancer having a concomitant serious disease such as chronic pulmonary thromboembolism? If yes, which chemotherapy (FOLFOX, capecitabine, etc.) is the best choice? Or do you rather recommend a palliative care than an active therapy?

    2. Is there any known adverse effect of hyperthermia on pulmonary thromboembolism? Would it increase the risk of blood coagulation?

    3. Would it be possible to reduce 5-FU dose in FOLFOX regimen when combined with hyperthermia and can you still expect therapeutic effect? If yes, which dose and schedule do you suggest? I'm asking this question because 5-FU has an adverse interaction with warfarin which the patient is receiving.

    4. In your publication patients received various chemotherapy such as monotherpay of Oxaliplatin and FOLFOX. Did you observe any difference in efficacy when combined with hyperthermia?

    5. In Figure 1 of the above publication, you show that about 20% patients with abdominal dissemination derived from colon cancer died between 3-6 months, and a subgroup of patients achieved a long term survival. Was there no effect of the therapy in the former 20% patients? Or these patients would have died even earlier if no treatment was given?
    What were the determining factor among these patient subsets? You describe that it was not related to the temperature applied. Was it related to type of chemotherapy or presence/absence of liver metastasis?

    6. Can your regimen be tried safely at other hospitals that is equipped with a similar system such as Thermotron-RF8? Or does it require very specific technique and experience?

    7. What is the reason why regional hyperthermia is less often employed in combination with chemotherapy, whereas the combination with radiotherapy (w/o chemotherapy) is more reported?

    Thanking you in advance for taking time to answer these questions.

    very best regards
    Nozomi


  • Re: your publication in IJ. Hyperthermia Sep


    Quality of life is normally not compromised by RHT (regional hyperthermia), but the treatment can be stressful and needs motivation. RHT plus chemotherapy can be an option for peritoneal carcinosis, but is in each case a palliative treatment.
    A fresh thrombosis is a contraindication for RHT . FOLFOX might be possible with RHT, but the best synergism is known for oxaliplatin. The data are not sufficient to evaluate different schemes of chemotherapy, but we feel that platinum-containing schemes are favourable for hyperthermia.
    We cannot evaluate the effectiveness of RHT in conjunction with chemotherapy because we would need a prospective trial (which cannot be performed in the moment). But I guess that in some cases the RHT has no additional benefit to chemotherapy.
    A real advantage is only in a subgroup and needs in particular an appropriate technique. We believe that Thermotron is not suitable to heat the abdomen.
    Because medical oncologists are typically not so interested in hyperthermia (too technical), the combination chemo plus heat is less often investigated than RT plus heat.

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