중등도 온열요법이 종양세포에 대한 세포독성, 종양혈관에 미치는 영향 및 면역학적 영향 등 다양한 항종양 활성을 가지고 있음에도 불구하고, 중등도 온열요법은 그 자체만으로는 항암효과가 뚜렷하지 않아, 방사선치료나 항암제 치료와 병용하여 암치료에 사용되고 있으면서, 심각한 부작용이 없이 어느 정도의 긍정적인 효과를 보이고 있다. 모든 연구에서 긍정적인 결과를 보이지 못한 것은 열충격 반응 그 자체가 온열요법의 항암효과를 방해하기 때문이다. 그러므로 온열요법의 효과를 증가시키기 위해서는 온열요법의 항암효과에 대한 부정적인 영향을 제거해야 한다. 암세포뿐만 아니라 혈관, 면역 세포 및 결체조직 등을 포함하고 있는 종양조직의 열 스트레스에 대한 반응은 매우 복잡하지만, 임상적으로 사용되고 있는 약물 중 열 스트레스 반응을 조절할 수 있는 약물들이 암환자의 온열요법 치료 효과를 개선시킬 수 있는 지에 대한 연구가 필요하다. 이 종설에서는 현재 임상에서 사용하고 있는 온열요법 장치로서 최신의 기술이며, 중등도 온도가 정상 조직에 대한 부작용 없이 기존 치료법의 효과를 증가시킬 수 있기 때문에, 비침습적 체외용 고주파 중등도 온열요법을 중심으로 다룬다.
중등도 온열요법이 종양세포에 대한 세포독성, 종양혈관에 미치는 영향 및 면역학적 영향 등 다양한 항종양 활성을 가지고 있음에도 불구하고, 중등도 온열요법은 그 자체만으로는 항암효과가 뚜렷하지 않아, 방사선치료나 항암제 치료와 병용하여 암치료에 사용되고 있으면서, 심각한 부작용이 없이 어느 정도의 긍정적인 효과를 보이고 있다. 모든 연구에서 긍정적인 결과를 보이지 못한 것은 열충격 반응 그 자체가 온열요법의 항암효과를 방해하기 때문이다. 그러므로 온열요법의 효과를 증가시키기 위해서는 온열요법의 항암효과에 대한 부정적인 영향을 제거해야 한다. 암세포뿐만 아니라 혈관, 면역 세포 및 결체조직 등을 포함하고 있는 종양조직의 열 스트레스에 대한 반응은 매우 복잡하지만, 임상적으로 사용되고 있는 약물 중 열 스트레스 반응을 조절할 수 있는 약물들이 암환자의 온열요법 치료 효과를 개선시킬 수 있는 지에 대한 연구가 필요하다. 이 종설에서는 현재 임상에서 사용하고 있는 온열요법 장치로서 최신의 기술이며, 중등도 온도가 정상 조직에 대한 부작용 없이 기존 치료법의 효과를 증가시킬 수 있기 때문에, 비침습적 체외용 고주파 중등도 온열요법을 중심으로 다룬다.
Despite that moderate hyperthermia can exert various antitumor activities such as direct cytotoxic effects on tumor cells, effects on tumor vasculatures and immunological effects, hyperthermia has been usually combined with radiotherapy or chemotherapy due to its limited efficacy in cancer treatment...
Despite that moderate hyperthermia can exert various antitumor activities such as direct cytotoxic effects on tumor cells, effects on tumor vasculatures and immunological effects, hyperthermia has been usually combined with radiotherapy or chemotherapy due to its limited efficacy in cancer treatment, showing some positive clinical benefits with generally well-tolerated side effects. Since heat shock responses itself can interfere with the anti-tumor effects of hyperthermia, not all of these studies might have demonstrated positive clinical outcomes in cancer patients. Therefore, the negative anti-tumor effect of hyperthermia should be reduced to enhance the effectiveness of hyperthermia. Although the responses to heat stress of tumor tissues containing vessels, immune cells, connective tissues as well as cancer cells, are very complicated, it is needed to study in the near future if some clinically available drugs, which can modulate heat stress responses, can improve the efficacy of hyperthermia in patients with cancer. In this review, the effect of clinical hyperthermia centered on non-invasive external hyperthermia using radiofrequency at moderate temperature will be discussed, since it is the state-of-the-art technology in the current clinical practice of hyperthermia, and a moderate operational temperature is used to increase the therapeutic effectiveness of conventional therapy without additional toxicity to normal tissues.
Despite that moderate hyperthermia can exert various antitumor activities such as direct cytotoxic effects on tumor cells, effects on tumor vasculatures and immunological effects, hyperthermia has been usually combined with radiotherapy or chemotherapy due to its limited efficacy in cancer treatment, showing some positive clinical benefits with generally well-tolerated side effects. Since heat shock responses itself can interfere with the anti-tumor effects of hyperthermia, not all of these studies might have demonstrated positive clinical outcomes in cancer patients. Therefore, the negative anti-tumor effect of hyperthermia should be reduced to enhance the effectiveness of hyperthermia. Although the responses to heat stress of tumor tissues containing vessels, immune cells, connective tissues as well as cancer cells, are very complicated, it is needed to study in the near future if some clinically available drugs, which can modulate heat stress responses, can improve the efficacy of hyperthermia in patients with cancer. In this review, the effect of clinical hyperthermia centered on non-invasive external hyperthermia using radiofrequency at moderate temperature will be discussed, since it is the state-of-the-art technology in the current clinical practice of hyperthermia, and a moderate operational temperature is used to increase the therapeutic effectiveness of conventional therapy without additional toxicity to normal tissues.
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성능/효과
an irreversible cytotoxicity [17, 27, 52]. In this study, temperature of 43℃ seemed to be a critical breakpoint to induce significant cell death, since the induction of cell death at lower temperatures below 42~43℃ is remarkably lower than that at higher temperature above 43℃. This re- sult is related with the reference temperature of 43oC for calculation of thermal dose, CEM 43oC T90, the number of cumulative equivalent minutes at 43oC exceeded by 90% of monitored points within the tumor.
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