Hyperthermia in the treatment of high-risk soft tissue sarcomas: a systematic review

Abstract

Background

The therapy of high-risk soft tissue sarcomas (STS) remains an interdisciplinary challenge. Regional hyperthermia (RHT) sparked interest as it has been shown to improve overall survival when added to perioperative chemotherapy (CTX). However, questions arise on how RHT should be optimally integrated into current multi-modal therapies.

Materials and Methods

We performed a systematic literature review according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies written in English and focused mainly on radiative RHT and superficial hyperthermia were evaluated and included. Studies including patients below the age of 18, with metastatic disease or review articles, were excluded.

Results

We identified 15 clinical reports from 1990 until July 2022. Three articles combined RHT + CTX, and twelve focused on combined RHT + radiotherapy (RT) or neoadjuvant chemoradiotherapy (CRT). Most treatments were based on invasive thermometry, and less on magnetic resonance imaging (MRI)-based, noninvasive thermometry for STS of the extremities. Perioperative chemotherapy was used for the combination of RHT and CTX, mostly Ifosfamide-based. The effectiveness of RT appeared to be increased by RHT, especially with two RHT sessions/week. The trimodal simultaneous approach of neoadjuvant RHT and CRT was also feasible. No significant toxicity of RHT was reported.

Conclusions

The gathered data strengthen the beneficial role of RHT in the multimodal setting. Further expert consensus and clinical trials are required to determine the optimal integration of RHT in treating STS.

Keywords:

• Hyperthermia
• sarcoma
• high-risk
• radiation
• chemotherapy

Authors’ contributions

Conceptualization and Supervision: Prof. Ghadjar P.

Investigation, data acquisition and analysis: All authors

Writing – original draft preparation: Veltsista D. P.

Writing – review and editing: All authors.

All authors have read and agreed to the published version of the manuscript.

Ethical approval

Due to the nature of this paper and its methodology, no institutional review board approval was required.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Notes

1 HR: estimate of the risk of dying. HR = 5.8 for MFS shows: if PME/PDE > 0.45, then the relative risk of dying would be 5.8-fold greater than if PME/PDE < 0.45. Similarly for OS, HR = 6.8 for OS shows: if PME/PDE > 0.45, then the relative risk of dying would be 6.8-fold greater than if PME/PDE < 0.45.

Additional information

Funding

This project was supported by the H2020 Marie Sklodowska–Curie program—HYPERBOOST (project number 955625). The trial is financialy supported by Thermosome GmbH.