title: Simultaneous radiotherapy and superficial hyperthermia for high-risk breast carcinoma: a randomised comparison of treatment sequelae in heated versus non-heated sectors of the chest wall hyperthermia.
abstract: OBJECTIVE
  In vitro data demonstrate that heat-induced radiosensitisation is maximised if hyperthermia and radiotherapy are given simultaneously, with the radiation fraction delivered midway through a hyperthermia session, rather than sequentially. The long-term normal tissue toxicity of full-dose simultaneous thermoradiotherapy is unknown.
  
  
  METHODS
  Patients with locally advanced breast cancer (T3, T4 or more than three involved nodes or local recurrence), no prior radiotherapy, received between four and eight sessions of simultaneous thermoradiotherapy. Hyperthermia always included the primary tumour site. In addition an electively heated sector (EHS) was included. The EHS was randomised to either medial or lateral to the tumour site, with the other side an irradiated but unheated control. As per our usual practice, patients received surgery and/or chemotherapy prior to radiotherapy. Radiation doses were 46-50 Gy followed by a boost of ≤16 Gy at 1.8-2 Gy per fraction. EHS and control sectors received the same dose.
  
  
  RESULTS
  A total of 57 evaluable cases with average follow-up of 79 months experienced two local and two nodal recurrences. There was no significant difference in ≥grade 2 toxicity for heated versus control sectors (LR χ(2 )= 0.78, p = 0.38) with no relationship between number of hyperthermia sessions and toxicity (LR χ(2 )= 2.90, p = 0.09).
  
  
  CONCLUSIONS
  Simultaneous full-dose thermoradiotherapy for breast cancer is feasible and well tolerated, with no significant difference in late toxicity between electively heated and unheated control sectors. All patients had hyperthermia to the primary tumour site with excellent local control.
authors.affiliation: Department of Radiation Oncology, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri, USA.
authors.forename: Sumeeta
authors.initials: S
authors.lastname: Varma
authors.forename: Robert
authors.initials: R
authors.lastname: Myerson
authors.forename: Eduardo
authors.initials: E
authors.lastname: Moros
authors.forename: Marie
authors.initials: M
authors.lastname: Taylor
authors.forename: William
authors.initials: W
authors.lastname: Straube
authors.forename: Imran
authors.initials: I
authors.lastname: Zoberi
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000532:radiotherapy / Q000628:therapy*; D003131:Combined Modality Therapy / Q000009:adverse effects; D005260:Female; D006801:Humans; D006979:Hyperthermia, Induced / Q000009:adverse effects; D008875:Middle Aged; D012867:Skin / Q000528:radiation effects*; D035441:Thoracic Wall