Скачать презентацию HYPERTHERMIA 한국의학물리학회에 바란다 영남대학교 의과대학 방사선종양학교실 김명세 Скачать презентацию HYPERTHERMIA 한국의학물리학회에 바란다 영남대학교 의과대학 방사선종양학교실 김명세

3aaa01cd33418bd9b3444931ff708f09.ppt

  • Количество слайдов: 33

HYPERTHERMIA, 한국의학물리학회에 바란다. 영남대학교 의과대학 방사선종양학교실 김명세 HYPERTHERMIA, 한국의학물리학회에 바란다. 영남대학교 의과대학 방사선종양학교실 김명세

회원 여러분, 환영 합니다. 회원 여러분, 환영 합니다.

감사 드립니다. • 회장님, 회원 여러분! • 귀중한 시간. 감사 드립니다. • 회장님, 회원 여러분! • 귀중한 시간.

2000년 ICHO 세계온열종양학회 -의학물리학회 협조 -성공적인 학회 개최 가능. 2000년 ICHO 세계온열종양학회 -의학물리학회 협조 -성공적인 학회 개최 가능.

HYPERTHERMIA • Elevation of temperature to supraphysiologic level, between 40ºC-45ºC • 45ºC : Thermal HYPERTHERMIA • Elevation of temperature to supraphysiologic level, between 40ºC-45ºC • 45ºC : Thermal ablation

HYPERTHERMIA • BIOLOGIC RATIONALE 1. Direct cytotoxicity 2. Radiosensitizer 3. Chemosensitizer 4. Gene therapy HYPERTHERMIA • BIOLOGIC RATIONALE 1. Direct cytotoxicity 2. Radiosensitizer 3. Chemosensitizer 4. Gene therapy 5. Protein denature

HYPERTHERMIA • Direct cytotoxicity - 43. 5ºC : cell die exponentially 43. 5 (breakpoint) HYPERTHERMIA • Direct cytotoxicity - 43. 5ºC : cell die exponentially 43. 5 (breakpoint) - Rate of killing: increase with temperature (1ºC : doubles the rate of cell killing) (Gunderson & Tepper, clinical Radiation Oncology, 385 p, 2007)

HYPERTHERMIA 2. Radiosensitizer - Inhibits potentially lethal & sublethal damage repair. - DNA repair HYPERTHERMIA 2. Radiosensitizer - Inhibits potentially lethal & sublethal damage repair. - DNA repair process: heat sensitive. : No repair of chromosomal aberration by radiation.

HYPERTHERMIA 2. Radiosensitizer • Reoxigenation in periphery at 40ºC - 42ºC : Improve hypoxic, HYPERTHERMIA 2. Radiosensitizer • Reoxigenation in periphery at 40ºC - 42ºC : Improve hypoxic, radiosensitive • In tumor: vascular stasis - Arteriovenous shunting, thrombus formation. leucocyte plugging. - Vascular permeability - edema. stasis. - Anaerobic metabolism : Lactic acid , p. H : sensitive to HT,

HYPERTHERMIA 3. Chemosensitizer • Many chemotherapeutic agents: synergism with HT. • Mechanism 1) Increased HYPERTHERMIA 3. Chemosensitizer • Many chemotherapeutic agents: synergism with HT. • Mechanism 1) Increased cellular uptake 2) Increased oxygen radical production 3) Increased DNA damage & inhibition of repair

HYPERTHERMIA 3. Chemosensitizer • Chemotherapy agents: Loaded into liposomes (100 nm diameter) -HT augment HYPERTHERMIA 3. Chemosensitizer • Chemotherapy agents: Loaded into liposomes (100 nm diameter) -HT augment liposome drug delivery. -Liposome: do not extravasate at normothermia, but do at 40 -42ºC - even brain is sensitive

HYPERTHERMIA 3. Chemosensitizer • Most chemotherapy: sensitive, esp. 5 -FU: supraadditive with HT between HYPERTHERMIA 3. Chemosensitizer • Most chemotherapy: sensitive, esp. 5 -FU: supraadditive with HT between 39 -41ºC • 5 FU: continuous infusion-Lead to cell cycle block in S phase, relatively sensitive part to HT. • Reversal of drug resistance mechanisms • Topoisomerase II activity - activity of drug (>41. 8ºC )

HYPERTHERMIA 4. Gene therapy • Heat shock protein: potential role in regulating immune responses. HYPERTHERMIA 4. Gene therapy • Heat shock protein: potential role in regulating immune responses. • 42ºC, 30 min. : Several hundredfold induction of reporter protein expression under control of the HSP 70 promotor. • Improved tumor growth delay in B 16 melanoma model. • + RT: superior result

HYPERTHERMIA 4. Gene therapy *HT : effective in altering both adaptive & innate immunity. HYPERTHERMIA 4. Gene therapy *HT : effective in altering both adaptive & innate immunity. * 40ºC : could accelerate immune reactivity.

HYPERTHERMIA • Protein denaturation : ≥ 40ºC - Apoptosis & necrosis. HYPERTHERMIA • Protein denaturation : ≥ 40ºC - Apoptosis & necrosis.

HYPERTHERMIA In clinics • Hyperthermia alone : No long term tumor control - Widely HYPERTHERMIA In clinics • Hyperthermia alone : No long term tumor control - Widely practiced in alternative & complementary medicine • HT + RT - Clinical response rate: almost doubled in randomized &/or non randomized.

Rectal ca. Rectal ca.

HYPERTHERMIA In clinics • Trimodality with HT + RT + Chemo. TX. - Ongoing HYPERTHERMIA In clinics • Trimodality with HT + RT + Chemo. TX. - Ongoing randomized trial - Cervical cancer, colorectal cancer, esophageal cancer, brain tumor, Head & neck tumor, bladder tumor, pelvic tumor : Not finished, but favorable results.

HYPERTHERMIA In clinics • In triple treatment(HT+RT+CT) - Almost 100% local control. • No HYPERTHERMIA In clinics • In triple treatment(HT+RT+CT) - Almost 100% local control. • No complication, except mild burn. -- Accident due to carelessness.

HYPERTHERMIA WHY NOT POPULAR? In Clinics • Time consuming: about 1 hr. for 1 HYPERTHERMIA WHY NOT POPULAR? In Clinics • Time consuming: about 1 hr. for 1 Tx. • At least one doctor/ nurse/ technician should keep the patient. • In many clinical trials: good results, but no real time confidence.

HIFU(High Intensity Focused Ultrasound) HIFU(High Intensity Focused Ultrasound)

HYPERTHERMIA WHY NOT POPULAR? In Physics In International J Hyperthermia (2007. 2) 90%: Physics HYPERTHERMIA WHY NOT POPULAR? In Physics In International J Hyperthermia (2007. 2) 90%: Physics field.

HYPERTHERMIA WHY NOT POPULAR? In Physics • Homogenous temperature in target volume • Define HYPERTHERMIA WHY NOT POPULAR? In Physics • Homogenous temperature in target volume • Define temperature range precise and reproducible manner. • Non invasive dosimetry x • Should be visible, easy application

PROBLEMS? • Non invasive thermometry+ - still not use in most clinics • Cancer PROBLEMS? • Non invasive thermometry+ - still not use in most clinics • Cancer Tx. : Surgery + RT + Chemo. Tx. - Overall survival: ~40% - Very expensive • Complementary & Integrative Medicine (보완통합의학회)

보완통합의학? • 대체의학 : 질병 치료에 효능이 있다고 주장하지만, 정통 서양의학의 관점에서 볼때 그 보완통합의학? • 대체의학 : 질병 치료에 효능이 있다고 주장하지만, 정통 서양의학의 관점에서 볼때 그 효능 을 입증할만한 객관적이고 과학적인 근 거가 부족한 치료법. (대한보완통합의학회지 4(1) S-19, 2007) • 미국, 대체의학 비용: 40 -60% 의료보험비 지급 WHY NOT HYPERTHERMIA?

HYPERTHERMIA *Even with the limitations of current technology, the promise of HT is emerging HYPERTHERMIA *Even with the limitations of current technology, the promise of HT is emerging from the clinical trials. • As the technology improves, the benefits will only become more visible. (Gunderson & Tepper. Clinical Radiation Oncology. 385 p, 2007)

성공하는 사람들은 길에 눈이 쌓여도, 눈을 밟아가며 길을 나서지만, 실패하는 사람들은 눈이 녹기를 기다렸다가 성공하는 사람들은 길에 눈이 쌓여도, 눈을 밟아가며 길을 나서지만, 실패하는 사람들은 눈이 녹기를 기다렸다가 길을 떠난다

내겐 당신이 있습니다! 내 부족함을 채워주는 사람, 당신의 사랑이 쓰러진 나를 일으킵니다. 내게 용기, 내겐 당신이 있습니다! 내 부족함을 채워주는 사람, 당신의 사랑이 쓰러진 나를 일으킵니다. 내게 용기, 위로, 소망을 주는 당신, 내가 나를 버려도 나를 포기하지 않는 당신, 나를 사랑하는 이가 이 세상에 존재 한다는것, 그것이 내 삶의 가장 커다란 힘입니다. 저의 힘이 되어주신 여러분, 다시 한번 감사 드립니다!