{"id":11189,"date":"2025-10-02T14:50:09","date_gmt":"2025-10-02T14:50:09","guid":{"rendered":"https:\/\/andromedichyperthermia.com\/oncologic-hyperthermia-phase-3-trials\/"},"modified":"2025-10-04T08:28:06","modified_gmt":"2025-10-04T08:28:06","slug":"hupertermia-iii-faasi-uuringute","status":"publish","type":"post","link":"https:\/\/andromedichyperthermia.com\/et\/hupertermia-iii-faasi-uuringute\/","title":{"rendered":"H\u00fcpertermia terapeutiline integreerimine t\u00e4nap\u00e4eva onkoloogiasse: III faasi uuringute ja metaanal\u00fc\u00fcside kriitiline anal\u00fc\u00fcs (\u00fcldise elulemuse, haigusvaba elulemuse ja t\u00e4ieliku remissiooni tulemusn\u00e4itajad)"},"content":{"rendered":"<p><script type=\"application\/ld+json\">\n    {\n      \"@context\": \"https:\/\/schema.org\",\n      \"@type\": \"MedicalScholarlyArticle\",\n      \"headline\": \"H\u00fcpertermia terapeutiline integreerimine t\u00e4nap\u00e4eva onkoloogiasse: III faasi uuringute ja metaanal\u00fc\u00fcside kriitiline anal\u00fc\u00fcs (\u00fcldise elulemuse, haigusvaba elulemuse ja t\u00e4ieliku remissiooni tulemusn\u00e4itajad)\",\n      \"author\": {\n        \"@type\": \"Person\",\n        \"name\": \"Gologan Cristian, M.Sc.\",\n        \"jobTitle\": \"CEO\",\n        \"affiliation\": {\n          \"@type\": \"MedicalOrganization\",\n          \"name\": \"Andromedichyperthermia Center\"\n        }\n      },\n      \"keywords\": \"H\u00fcpertermia, onkoloogia, III faasi uuringud, elulemus, \u00fcldine elulemus, t\u00e4ielik ravivastus, t\u00e4ielik remissioon, sarkoom, emakakaelav\u00e4hk\"\n      \/* ... Schema FAQPage would be added separately for the FAQ section *\/\n    }\n<\/script><\/p>\n<div class=\"author-info\"><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Autoriteet ja asjatundlikkus (EEAT): <\/span><\/span><\/strong><br \/>\n<strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Autorid : <\/span><\/span><a href=\"https:\/\/andromedichyperthermia.com\/et\/doctor-veronica-iatan\/\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">dr Veronica Iatan, MD<\/span><\/span><\/a><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> , ja <\/span><\/span><a href=\"https:\/\/andromedichyperthermia.com\/et\/cristian-gologan\/\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Cristian Gologan, M.Sc.<\/span><\/span><\/a><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> , andromediaalne h\u00fcpertermia<\/span><\/span><\/strong><\/div>\n<h1><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">H\u00fcpertermia terapeutiline integreerimine t\u00e4nap\u00e4eva onkoloogiasse: III faasi uuringute ja metaanal\u00fc\u00fcside kriitiline anal\u00fc\u00fcs (\u00fcldise elulemuse, haigusvaba elulemuse ja t\u00e4ieliku remissiooni tulemusn\u00e4itajad)<\/span><\/span><\/h1>\n<h2><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">1. H\u00fcpertermia (HT) l\u00fchikokkuv\u00f5te ja p\u00f5hiprintsiibid<\/span><\/span><\/h2>\n<p><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Onkoloogiline h\u00fcpertermia (HT)<\/span><\/span><\/strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> , mis on defineeritud kui kontrollitud kuumuse rakendamine temperatuurivahemikus <\/span><\/span><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">39 \u00b0C kuni 45 \u00b0C<\/span><\/span><\/strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> , on adjuvantne ravimeetod, millel on <\/span><\/span><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">m\u00e4rkimisv\u00e4\u00e4rne kliiniline kasu, mida kinnitavad 1A taseme t\u00f5endid<\/span><\/span><\/strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> ( <\/span><\/span><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">III faasi randomiseeritud uuringud ja metaanal\u00fc\u00fcsid<\/span><\/span><\/strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> ), mitmete kaugelearenenud ja korduvate tahkete kasvajate ravis.<\/span><\/span><\/p>\n<div class=\"key-points\">\n<h3><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Peamised j\u00e4reldused &#8211; 1A taseme t\u00f5endid:<\/span><\/span><\/h3>\n<ul>\n<li><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Roll:<\/span><\/span><\/strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> HT ei h\u00e4vita kasvajat otseselt; see toimib v\u00f5imsa <\/span><\/span><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">bioloogilise sensibilisaatorina<\/span><\/span><\/strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> .<\/span><\/span><\/li>\n<li><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Kinnitatud eelised:<\/span><\/span><\/strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> 1A taseme andmete s\u00fcntees toob esile <\/span><\/span><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">\u00fcldise elulemuse (OS)<\/span><\/span><\/strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> ja <\/span><\/span><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">t\u00e4ieliku ravivastuse m\u00e4\u00e4ra (CR)<\/span><\/span><\/strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> j\u00e4rjepideva paranemise .<\/span><\/span><\/li>\n<li><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Peamised n\u00e4idustused:<\/span><\/span><\/strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> pehmete kudede sarkoomid, emakakaelav\u00e4hk, korduv rinnav\u00e4hk, pahaloomuline melanoom, p\u00f5iev\u00e4hk, p\u00e4rasoolev\u00e4hk ja pea- ja kaelapiirkonna (HNC) kasvajad.<\/span><\/span><\/li>\n<li><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Ohutus:<\/span><\/span><\/strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> See tugev terapeutiline kasu saavutatakse j\u00e4rjepidevalt <\/span><\/span><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">ilma s\u00fcsteemse toksilisuse v\u00f5i raskete k\u00f5rvaltoimete<\/span><\/span><\/strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> (3. v\u00f5i 4. aste) olulise suurenemiseta.<\/span><\/span><\/li>\n<li><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">J\u00e4reldus:<\/span><\/span><\/strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> HT on asendamatu adjuvant valitud kasvajate standardsetes multimodaalsetes raviskeemides.<\/span><\/span><\/li>\n<\/ul>\n<\/div>\n<h3><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">1.1. Onkoloogilise h\u00fcpertermia klassifikatsioon ja meetodid<\/span><\/span><\/h3>\n<h4><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">1.1.1. Loko-regionaalne h\u00fcpertermia (LR HT)<\/span><\/span><\/h4>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Seda kasutatakse vaagna-, rindkere- ja k\u00f5hupiirkonna kasvajate s\u00fcgavkuumutamiseks. Levinud meetodite hulka kuuluvad mahtuvuslikud raadiosageduslikud (RF) s\u00fcsteemid ja kiirguss\u00fcsteemid antennimassiivide sobitamisega. Need meetodid on loodud soojusenergia edastamiseks s\u00fcgavuti, sihtides terapeutilisi temperatuure kasvaja mahus, hoides samal ajal terveid kudesid taluvuspiirides. Eesm\u00e4rk on kogu kasvajamassi v\u00f5imalikult homogeense (isotermilise) kuumutamise saavutamine.<\/span><\/span><\/p>\n<h4><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">1.1.2. RF-moduleeritud h\u00fcpertermia (mHT)<\/span><\/span><\/h4>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Moduleeritud raadiosageduslik h\u00fcpertermia (mHT) on selgelt eristuv mitteinvasiivne meetod. Erinevalt traditsioonilisest isotermilisest kuumutamisest kasutab mHT mahtuvuslikku sidestust kandesagedusel 13,56 MHz, mida moduleerivad aja jooksul toimuvad fraktaalsed k\u00f5ikumised. T\u00f6\u00f6p\u00f5him\u00f5te tugineb energia\u00fclekandele, mis on suunatud rakumembraani tasemele. Suur dielektriline kadu tekib eelistatavalt v\u00e4hirakkude membraanides (nende muutunud elektriliste omaduste t\u00f5ttu), tekitades spetsiifilise temperatuurigradiendi, mis ergastab apoptootilisi radasid. See &#8220;seestpoolt v\u00e4ljapoole kuumutamise&#8221; mehhanism p\u00f5hjustab k\u00f5rgemaid kasvajasiseseid temperatuure ja v\u00e4hendab normaalse koe kahjustusi, eristades seda p\u00f5him\u00f5tteliselt tavalistest kiirgus- v\u00f5i mahtuvuslikest meetoditest.<\/span><\/span><\/p>\n<h4><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">1.1.3. Interstitsiaalne h\u00fcpertermia<\/span><\/span><\/h4>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">See meetod h\u00f5lmab soojuse invasiivset kohaletoimetamist, sageli antennide, varraste v\u00f5i seemnete kaudu, mis sisestatakse otse kasvajasse. Seda kasutatakse peamiselt ajukasvajate (glioomide) v\u00f5i korduvate pindmiste haiguste raviks.<\/span><\/span><\/p>\n<h3><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">1.2. Miks toimib terapeutiline aken 39\u201345 \u00b0C? (Bioloogilised mehhanismid)<\/span><\/span><\/h3>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">HT kliiniline efektiivsus III faasi tasemel on lahutamatult seotud selle keerukate bioloogiliste mehhanismide m\u00f5istmisega. Need mehhanismid \u00fcletavad lihtsa rakkude h\u00e4vimise, positsioneerides HT-d <\/span><span dir=\"auto\" style=\"vertical-align: inherit;\">standardsete ravimeetodite <\/span><\/span><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">multifunktsionaalse sensibiliseerijana .<\/span><\/span><\/strong><\/p>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Optimaalne temperatuur *39\u201345 \u00b0C* valitakse seet\u00f5ttu, et see maksimeerib kasvajaspetsiifilisi rakkude tasakaalustamatusi. Randomiseeritud uuringutes t\u00e4heldatud \u00fcldine edu tuleneb sellest sensibiliseerivast rollist, mis suurendab kiiritusravi (RT) ja keemiaravi (CHT) efektiivsust l\u00e4bi interaktsiooni kasvaja mikrokeskkonna ja rakulise aparaadiga.<\/span><\/span><\/p>\n<hr \/>\n<h2><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">2. Toimemehhanismid: kuidas h\u00fcpertermia v\u00f5imendab onkoloogilisi ravimeetodeid?<\/span><\/span><\/h2>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Kombineeritud ravi parem kliiniline efektiivsus tuleneb tugevast bioloogilisest s\u00fcnergiast, mis on suunatud kasvaja resistentsusele mitmel tasandil.<\/span><\/span><\/p>\n<h3><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">2.1. Radiosensibiliseerimine: kasvaja resistentsuse \u00fcletamine ja DNA parandamine<\/span><\/span><\/h3>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">H\u00fcpertermiat peetakse tugevaks radiosensibilisaatoriks, mis tegeleb kahe k\u00f5ige olulisema kiiritusravi eba\u00f5nnestumise allikaga:<\/span><\/span><\/p>\n<ol>\n<li><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">DNA parandamise p\u00e4rssimine:<\/span><\/span><\/strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> HT p\u00e4rsib kiirguse poolt kahjustatud DNA parandamise mehhanisme, tagades t\u00f5husama ja p\u00f6\u00f6rdumatu rakusurma.<\/span><\/span><\/li>\n<li><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Mikrokeskkonna hapnikuga varustamine:<\/span><\/span><\/strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> HT suurendab verevoolu ja parandab kasvaja hapnikuga varustamist, v\u00e4hendades h\u00fcpoksilist (kiirguskindlat) fraktsiooni.<\/span><\/span><\/li>\n<\/ol>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">See kasvaja mikrokeskkonna funktsionaalne modifikatsioon muudab varem resistentsed v\u00e4hirakud tavap\u00e4rase kiirituse suhtes palju tundlikumaks. See mikrotsirkulatsiooni muutus on m\u00e4\u00e4rav tegur, mis toetab *k\u00f5rgeid lokaalse-regionaalse kontrolli ja t\u00e4ieliku remissiooni m\u00e4\u00e4rasid, mida on t\u00e4heldatud h\u00fcpertermia re\u017eiimidega (CCRT+HT) keemiaravi ja kiiritusravi puhul selliste kasvajate puhul nagu lokaalselt levinud emakakaelav\u00e4hk (LACC) ja pea- ja kaelav\u00e4hk (HNC)*.<\/span><\/span><\/p>\n<h3><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">2.2. Kemosensibiliseerimine: narkokaubanduse ja rakkude omastamise parandamine<\/span><\/span><\/h3>\n<h4><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">2.2.1. S\u00fcnergia ja aditiivsus v\u00f5tmeisikutega<\/span><\/span><\/h4>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">HT-l on tugev s\u00fcnergistlik toime teatud oluliste onkoloogiliste keemiaravimite klassidega. Eelk\u00f5ige toimib HT s\u00fcnergiliselt plaatinap\u00f5histe ainete (tsisplatiin, karboplatiin) ja mitom\u00fctsiin C-ga. Neid aineid kasutatakse sageli III faasi peamiste n\u00e4idustuste korral, n\u00e4iteks emakakaelav\u00e4hi ja pea- ja kaelapiirkonna v\u00e4hi kasvajate korral, mis viitab sellele, et uuringutes t\u00e4heldatud kasu s\u00f5ltub t\u00e4iendavast bioloogilisest seosest, mitte ainult kuumusest. HT-l on ka aditiivne toime selliste ainetega nagu doksorubitsiin, ts\u00fcklofosfamiid ja gemtsitabiin.<\/span><\/span><\/p>\n<h4><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">2.2.2. Farmakokineetiline amplifikatsioon<\/span><\/span><\/h4>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">HT optimeerib ravimite kohaletoimetamist kasvaja tasandile, suurendades ravimite transporti kasvajatesse ja l\u00fcmfis\u00f5lmedesse (LN). See efekt on tingitud HT poolt esile kutsutud perfusiooni (verevoolu) suurenemisest ja rakumembraani l\u00e4bilaskvuse muutumisest. MHT puhul v\u00f5ib rakumembraani tasandil toimuv lokaliseeritud kuumenemise mehhanism, mida soodustab suur dielektriline kadu, v\u00f5imendada keemiaravi ainete rakusisest omastamist.<\/span><\/span><\/p>\n<h3><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">2.3. Immunomodulatsioon: &#8220;K\u00fclma&#8221; kasvaja muutmine &#8220;kuumaks&#8221; (immunogeenseks) kasvajaks<\/span><\/span><\/h3>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">\u00dcha enam tunnustatud toimemehhanism on HT v\u00f5ime moduleerida kasvajavastast immuunvastust, muutes immunoloogiliselt &#8220;k\u00fclmad&#8221; kasvajad efektiivselt &#8220;kuumadeks&#8221; (p\u00f5letikulisteks) kasvajateks.<\/span><\/span><\/p>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">HT toimib &#8220;in situ kasvajavaktsiinina&#8221;, indutseerides kuuma\u0161oki valkude (HSP) ja kasvaja antigeenide vabanemist. HSP-d, n\u00e4iteks HSP70, toimivad ohusignaalidena ja h\u00f5lbustavad antigeeni omastamist dendriitrakkude (DC) poolt. P\u00e4rast internaliseerimist migreeruvad DC-d l\u00fcmfis\u00f5lmedesse (LN), kus nad aktiveerivad ja initsieerivad ts\u00fctotoksilisi CD8+ T-rakke. See immunomoduleeriv protsess viib v\u00e4hirakkude l\u00fc\u00fcsi suurenemiseni looduslike tapjarakkude (NK) ja CD8+ T-rakkude poolt. Lisaks parandab HT rakuliste adhesioonimolekulide (CAM) ekspressiooni, h\u00f5lbustades l\u00fcmfots\u00fc\u00fctide transporti kasvaja piirkonda.<\/span><\/span><\/p>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Tabel 1 v\u00f5tab kokku h\u00fcpertermia mehhanistlikud koostoimed standardsete onkoloogiliste ravimeetoditega.<\/span><\/span><\/p>\n<p><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Tabel 1: H\u00fcpertermia ja standardsete onkoloogiliste ravimeetodite koostoime mehhanismid<\/span><\/span><\/strong><\/p>\n<table width=\"624\">\n<thead>\n<tr>\n<td width=\"104\"><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Sihtmehhanism<\/span><\/span><\/strong><\/td>\n<td width=\"104\"><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Bioloogiline efekt (39\u201345 \u00b0C)<\/span><\/span><\/strong><\/td>\n<td width=\"104\"><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Terapeutiline s\u00fcnergia<\/span><\/span><\/strong><\/td>\n<td width=\"104\"><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">S\u00fcnergistlikud ained<\/span><\/span><\/strong><\/td>\n<\/tr>\n<\/thead>\n<tbody>\n<tr>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">DNA parandamise p\u00e4rssimine<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">P\u00e4rsib DNA parandusmehhanisme;<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Sensibiliseerib rakke S-faasis <\/span><\/span><br \/>\n<span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Tugev radiosensibilisaator (komplementeerib RT-d)<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Kiiritusravi (RT)<\/span><\/span><\/td>\n<\/tr>\n<tr>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Kasvaja mikrokeskkond<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Suurendab verevoolu, parandab kasvaja hapnikuga varustatust, suurendab vaskularisatsiooni<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">V\u00f5imendab RT efektiivsust; Parandab narkokaubandust (kemosensibilisaator)<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">RT, tsisplatiin, mitom\u00fctsiin C<\/span><\/span><\/td>\n<\/tr>\n<tr>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Rakumembraan\/struktuur<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Suurenenud dielektriline kadu; <\/span><\/span><br \/>\n<span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">otsene apoptootiline signaalimine<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Parem ravimite imendumine;<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Tsisplatiin, karboplatiin, bleom\u00fctsiin<\/span><\/span><\/td>\n<\/tr>\n<tr>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Immuuns\u00fcsteem<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">HSP vabanemine, DC aktivatsioon, T-rakkude aktivatsioon, NK\/CD8+ T-rakkude l\u00fc\u00fcsi \u00fclesreguleerimine<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Kasvaja immunomodulaator; v\u00f5imendatud kasvajavastane immuunsus<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Immunoteraapia, kiiritusravi, s\u00fcdame isheemiat\u00f5bi<\/span><\/span><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>&nbsp;<\/p>\n<figure id=\"attachment_11120\" aria-describedby=\"caption-attachment-11120\" style=\"width: 747px\" class=\"wp-caption alignnone\"><img loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11120\" src=\"https:\/\/andromedichyperthermia.com\/wp-content\/uploads\/2025\/10\/mecanisme-biologice-hipertermie.jpg\" alt=\"Bioloogilised mehhanismid h\u00fcpertermia\" width=\"747\" height=\"412\" title=\"\" srcset=\"https:\/\/andromedichyperthermia.com\/wp-content\/uploads\/2025\/10\/mecanisme-biologice-hipertermie.jpg 747w, https:\/\/andromedichyperthermia.com\/wp-content\/uploads\/2025\/10\/mecanisme-biologice-hipertermie-300x165.jpg 300w\" sizes=\"auto, (max-width: 747px) 100vw, 747px\" \/><figcaption id=\"caption-attachment-11120\" class=\"wp-caption-text\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Bioloogilised mehhanismid h\u00fcpertermia<\/span><\/span><\/figcaption><\/figure>\n<h2><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">3. 1A taseme t\u00f5endite s\u00fcntees: metaanal\u00fc\u00fcside tulemused ja koondandmed<\/span><\/span><\/h2>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">HT p\u00f5hjalik hindamine p\u00f5hineb III faasi uuringute kollektiivsel anal\u00fc\u00fcsil. <\/span><\/span><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">1A taseme t\u00f5endite s\u00fcntees kinnitab HT \u00fcldist kliinilist kasu standardravile lisamisel mitme kasvajakategooria korral.<\/span><\/span><\/strong><\/p>\n<h3><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">3.1. Metaanal\u00fc\u00fctiliste j\u00e4relduste \u00fclevaade<\/span><\/span><\/h3>\n<p><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Hiljutine HT efektiivsuse anal\u00fc\u00fcs, mis h\u00f5lmas 12 III faasi uuringut, tuvastas kuus lokoregionaalse HT uuringut ja kuus uuringut, mis h\u00f5lmasid h\u00fcpertermilist intraperitoneaalset keemiaravi (HIPEC)[2]. Neist viies kuuest lokoregionaalsest HT uuringust t\u00e4heldati HT lisamisel standardsele keemiaravile ja\/v\u00f5i kiiritusravile \u00fcldise elulemuse (OS) ja\/v\u00f5i t\u00e4ieliku ravivastuse m\u00e4\u00e4ra (CR) paranemist[2]. See loob kindla teadusliku konsensuse, mis toetab HT kasutamist 1A taseme adjuvandina laia valiku lokoregionaalsete kasvajate puhul.<\/span><\/span><\/strong><\/p>\n<h3><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">3.2. Kvantifitseeritavad tulemused: \u00fcldine elulemus (OS), t\u00e4ielik ravivastus (CR) ja lokaalne kontroll<\/span><\/span><\/h3>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">HT kliinilist kasu saab kriitiliste onkoloogiliste tulemusn\u00e4itajate osas kvantifitseerida. Lokaalselt levinud emakakaelav\u00e4hi (LACC)* koondandmed n\u00e4itavad:<\/span><\/span><\/p>\n<ul>\n<li><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">T\u00e4ielik ravivastus (CR):<\/span><\/span><\/strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> CR m\u00e4\u00e4r suureneb oluliselt HT lisamisel (suhteline risk &#8211; *RR 0,56, 95% CI 0,39 kuni 0,79; **p &lt; 0,001*).<\/span><\/span><\/li>\n<li><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Lokaalse retsidiivi kontroll:<\/span><\/span><\/strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> HT v\u00e4hendab oluliselt lokaalse retsidiivi esinemissagedust (riskisuhe &#8211; *HR 0,48, 95% CI 0,37 kuni 0,63; **p &lt; 0,001*).<\/span><\/span><\/li>\n<li><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">\u00dcldine elulemus (OS):<\/span><\/span><\/strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> Multimodaalne ravi HT-ga annab parema \u00fcldise elulemuse (HR *0,67, 95% CI 0,45 kuni 0,99; **p = 0,05*).<\/span><\/span><\/li>\n<\/ul>\n<h2><\/h2>\n<h2><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">4. Spetsiifiliste III faasi uuringute anal\u00fc\u00fcs v\u00e4hi t\u00fc\u00fcbi j\u00e4rgi<\/span><\/span><\/h2>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">See detailne anal\u00fc\u00fcs uurib neid *kasvajapiirkondi, kus HT-d toetavad k\u00f5rgeima kaliibriga randomiseeritud kliinilised uuringud, keskendudes esmasele elluj\u00e4\u00e4misele ja ravivastuse tulemustele*.<\/span><\/span><\/p>\n<h3><\/h3>\n<h3><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">4.1. Pehmete kudede sarkoom (STS)<\/span><\/span><\/h3>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Pehmete kudede sarkoom on \u00fcks HT integreerimise v\u00f5rdlusn\u00e4idustusi, mida toetavad III faasi uuringud. Uuringud, mis v\u00f5rdlevad standardset neoadjuvantset keemiaravi neoadjuvantse keemiaravi pluss regionaalse h\u00fcpertermiaga (RHT), on n\u00e4idanud, et *HT lisamine suurendas elulemust ja parandas lokaalset progressioonivaba elulemust (LPFS).* <\/span><\/span><br \/>\n<span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Lokaliseeritud k\u00f5rge riskiga sarkoomi kontekstis on neoadjuvantraviks sobivate patsientide puhul RHT lisamine \u00f5igustatud paremate elulemuse tulemuste p\u00f5hjal. Lisaks n\u00e4itas nende uuringute translatsioonianal\u00fc\u00fcs olulist immunoloogilist mehhanismi. N\u00e4idati, et kombineeritud preoperatiivne ravi RHT-ga muudab p\u00f5him\u00f5tteliselt mittep\u00f5letikulise kasvaja p\u00f5letikuliseks kasvajaks. See kasvaja mikrokeskkonna \u00fcmberprogrammeerimine v\u00f5imaldab suurendada kasvajavastast immuunaktiivsust. See efekt n\u00e4itab, et pikaajaline elulemuse kasu ei tulene mitte ainult otsesest keemiaravi sensibiliseerimisest, vaid ka tugevast immunoloogilisest eelk\u00e4imisest, positsioneerides HT-d v\u00e4\u00e4rtusliku mikrokeskkonna modulatsiooni t\u00f6\u00f6riistana.<\/span><\/span><\/p>\n<p>&nbsp;<\/p>\n<h3><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">4.2. G\u00fcnekoloogiline v\u00e4hk: lokaalselt levinud emakakaelav\u00e4hk (LACC)<\/span><\/span><\/h3>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">T\u00f5endid HT kohta LACC-s, lisatuna samaaegsele keemiaravile (CCRT), on onkoloogias \u00fched veenvamad.<\/span><\/span><\/p>\n<h4><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">4.2.1. Uuringu konsensus (t\u00e4ielik remissioon ja lokaalne retsidiiv)<\/span><\/span><\/h4>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">S\u00fcstemaatiliselt kinnitavad randomiseeritud uuringute metaanal\u00fc\u00fcsid ja koondandmed trimodaalse ravi (CCRT + HT) eelist. <\/span><\/span><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Koondandmete anal\u00fc\u00fcs n\u00e4itas kombineeritud ravi puhul oluliselt k\u00f5rgemat t\u00e4ieliku ravivastuse m\u00e4\u00e4ra (CR) (RR 0,56; p &lt; 0,001) ja v\u00e4henenud lokaalset retsidiivide m\u00e4\u00e4ra (HR 0,48; p &lt; 0,001). See parem lokaalne ja regionaalne kontroll on muutnud trimodaalse ravi teostatavaks ja t\u00f5husaks l\u00e4henemisviisiks.<\/span><\/span><\/strong><\/p>\n<h4><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">4.2.2. \u00dcldise elulemuse (OS) kvantifitseerimine<\/span><\/span><\/h4>\n<p><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">\u00dcldine elulemus (OS) paranes oluliselt CCRT ja HT kombineerimisel, HR oli 0,67 (95% CI 0,45 kuni 0,99; p = 0,05).<\/span><\/span><\/strong><br \/>\n<span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> Kuigi ajaloolisi andmeid tuleb t\u00f5lgendada praeguste ravistandardite kontekstis, n\u00e4itas Itaalias l\u00e4bi viidud III faasi uuring, milles hinnati RT +- HT-d N3 lamerakuliste emakakaela l\u00fcmfis\u00f5lmede puhul sellest ajastust, silmatorkavat erinevust: *CR m\u00e4\u00e4r kombineeritud ravir\u00fchmas oli 82,3% versus 36,8% ainult kiiritusravi saanud onkoloogilistel patsientidel* [3,4]. Sama uuringu pikaajaline anal\u00fc\u00fcs n\u00e4itas *5-aastast \u00fcldist elulemust 55% versus 0% h\u00fcpertermia r\u00fchmas v\u00f5rreldes ainult kiiritusravi saanud r\u00fchmaga* [3,4]. Kuigi kontrollravi (RT monoteraapia) peetakse t\u00e4nap\u00e4evaste standardite (mis kasutavad CCRT-d) j\u00e4rgi halvemaks, on need ajaloolised tulemused endiselt \u00e4\u00e4rmiselt v\u00e4\u00e4rtuslikud, n\u00e4idates HT erakordset radiosensibiliseerivat v\u00f5imet, eriti suurte l\u00fcmfis\u00f5lmede haiguste korral, mis on tavaliselt v\u00e4ga h\u00fcpoksilised ja raviresistentsed.<\/span><\/span><\/p>\n<h4><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">4.2.3. Lisat\u00f5endid (OS)<\/span><\/span><\/h4>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">K\u00f5ige tugevama lisat\u00f5endi annab *emakakaelav\u00e4hk*, kus arvukates randomiseeritud uuringutes on uuritud lokoregionaalset h\u00fcpertermiat koos kiiritusravi (RT) v\u00f5i keemiaravi-kiiritusraviga (CTRT).<\/span><\/span><\/p>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Need tulemused (k\u00f5rgetasemelised t\u00f5endid emakakaelav\u00e4hi kohta) on saadud metaanal\u00fc\u00fcsidest, mis v\u00f5rdlevad standardravi (RT v\u00f5i CTRT) kombineeritud raviga (RT\/CTRT + h\u00fcpertermia):<\/span><\/span><\/p>\n<table width=\"624\">\n<thead>\n<tr>\n<td width=\"208\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Kliiniline n\u00e4itaja<\/span><\/span><\/td>\n<td width=\"208\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">RT + h\u00fcpertermia abil saavutatud tulemus<\/span><\/span><\/td>\n<td width=\"208\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Viide (l\u00e4bivaadatud tsitaadid)<\/span><\/span><\/td>\n<\/tr>\n<\/thead>\n<tbody>\n<tr>\n<td width=\"208\"><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">T\u00e4ielik ravivastus (CR)<\/span><\/span><\/strong><\/td>\n<td width=\"208\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">CR-i m\u00e4\u00e4ra j\u00e4rjepidev paranemine: <\/span><\/span><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">+22,1%<\/span><\/span><\/strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> v\u00f5rreldes lihtsa otsetee-rehabilitatsiooniga.<\/span><\/span><\/td>\n<td width=\"208\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Metaanal\u00fc\u00fcsid<\/span><\/span><\/td>\n<\/tr>\n<tr>\n<td width=\"208\"><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Kohalik-regionaalne kontroll (LRC)<\/span><\/span><\/strong><\/td>\n<td width=\"208\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">M\u00e4rkimisv\u00e4\u00e4rne paranemine: <\/span><\/span><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">+23,1%<\/span><\/span><\/strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> v\u00f5rreldes lihtsa RT-ga.<\/span><\/span><\/td>\n<td width=\"208\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Metaanal\u00fc\u00fcsid<\/span><\/span><\/td>\n<\/tr>\n<tr>\n<td width=\"208\"><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">\u00dcldine elulemus (OS)<\/span><\/span><\/strong><\/td>\n<td width=\"208\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">H\u00fcpertermia lisamisel t\u00e4heldati pikaajalise \u00fcldise elulemuse paranemist (HR 0,67; p = 0,03).<\/span><\/span><\/td>\n<td width=\"208\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Uuendatud metaanal\u00fc\u00fcs<\/span><\/span><\/td>\n<\/tr>\n<tr>\n<td width=\"208\"><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Haigusvaba elulemus (DFS)<\/span><\/span><\/strong><\/td>\n<td width=\"208\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">M\u00e4rkimisv\u00e4\u00e4rne paranemine 2- ja 3-aastases haigusvabas elulemuses kombineerituna CTRT-ga.<\/span><\/span><\/td>\n<td width=\"208\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">III faasi randomiseeritud uuringud<\/span><\/span><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>&nbsp;<\/p>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Siin on viidatud kolm metaanal\u00fc\u00fcsi ja III faasi uuring koos vastavate linkidega:<\/span><\/span><\/p>\n<h5><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">4.2.3.1. Metaanal\u00fc\u00fcs: CR, lokoregionaalne kontroll (LRC) ja \u00fcldine elulemus (OS) (Lutgens jt.)<\/span><\/span><\/h5>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Seda peetakse fundamentaalseks uuringuks (Cochrane&#8217;i \u00fclevaade), mis s\u00fcnteesis mitme randomiseeritud uuringu tulemusi ja kinnitas h\u00fcpertermia lisamise peamist kasu.<\/span><\/span><\/p>\n<table width=\"624\">\n<thead>\n<tr>\n<td width=\"312\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Kinnitatud n\u00e4itajad<\/span><\/span><\/td>\n<td width=\"312\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Peamine tulemus<\/span><\/span><\/td>\n<\/tr>\n<\/thead>\n<tbody>\n<tr>\n<td width=\"312\"><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">T\u00e4ielik ravivastus (CR)<\/span><\/span><\/strong><\/td>\n<td width=\"312\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">M\u00e4rkimisv\u00e4\u00e4rne paranemine (RR 0,56; p &lt; 0,001)<\/span><\/span><\/td>\n<\/tr>\n<tr>\n<td width=\"312\"><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Kohalik-regionaalne kontroll (LRC)<\/span><\/span><\/strong><\/td>\n<td width=\"312\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">M\u00e4rkimisv\u00e4\u00e4rne paranemine (HR 0,48; p &lt; 0,001)<\/span><\/span><\/td>\n<\/tr>\n<tr>\n<td width=\"312\"><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">\u00dcldine elulemus (OS)<\/span><\/span><\/strong><\/td>\n<td width=\"312\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">M\u00e4rkimisv\u00e4\u00e4rne paranemine 3 aasta m\u00f6\u00f6dudes (HR 0,67; p = 0,05)<\/span><\/span><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<ul>\n<li><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Pealkiri:<\/span><\/span><\/strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> H\u00fcpertermia ja kiiritusravi kombineeritud kasutamine lokaalselt levinud emakakaelav\u00e4hi ravis<\/span><\/span><\/li>\n<li><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Autorid:<\/span><\/span><\/strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> Lutgens L, van der Zee J, Pijls-Johannesma M, et al.<\/span><\/span><\/li>\n<li><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">PubMedi link (2010. aasta uuendus): <\/span><\/span><\/strong> <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/20091593\/\" target=\"_blank\" rel=\"noopener\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">https:\/\/pubmed.ncbi.nlm.nih.gov\/20091593\/<\/span><\/span><\/a><\/li>\n<\/ul>\n<h5><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">4.2.3.2. V\u00f5rgustiku metaanal\u00fc\u00fcs (NMA): parimad strateegiad (Datta jt 2019)<\/span><\/span><\/h5>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Selles uuringus kasutati t\u00e4iustatud meetodit (v\u00f5rgustiku metaanal\u00fc\u00fcs), et v\u00f5rrelda h\u00fcpertermiat 13 muu terapeutilise sekkumisega, reastades selle parimate valikute hulka.<\/span><\/span><\/p>\n<table width=\"624\">\n<thead>\n<tr>\n<td width=\"312\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Kinnitatud n\u00e4itajad<\/span><\/span><\/td>\n<td width=\"312\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Peamine tulemus<\/span><\/span><\/td>\n<\/tr>\n<\/thead>\n<tbody>\n<tr>\n<td width=\"312\"><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Ravi edetabel<\/span><\/span><\/strong><\/td>\n<td width=\"312\"><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">RT+HT<\/span><\/span><\/strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> ja <\/span><\/span><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">CTRT+HT<\/span><\/span><\/strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> olid kolme parima sekkumise hulgas, millel oli lokaalse resistentsi, \u00fcldise elulemuse ja toksilisuse osas k\u00f5ige suurem terviklik m\u00f5ju.<\/span><\/span><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<ul>\n<li><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Pealkiri:<\/span><\/span><\/strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> Erinevate raviv\u00f5imaluste efektiivsuse ja ohutuse hindamine lokaalselt levinud emakakaelav\u00e4hi korral: randomiseeritud kliiniliste uuringute s\u00fcstemaatiline \u00fclevaade ja v\u00f5rgustiku metaanal\u00fc\u00fcs<\/span><\/span><\/li>\n<li><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Autorid:<\/span><\/span><\/strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> Datta NR, Stutz E, Gomez S, Bodis S.<\/span><\/span><\/li>\n<li><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">PubMedi link: <\/span><\/span><\/strong> <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/30391522\/\" target=\"_blank\" rel=\"noopener\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">https:\/\/pubmed.ncbi.nlm.nih.gov\/30391522\/<\/span><\/span><\/a><\/li>\n<\/ul>\n<h5><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">4.2.3.3. III faasi uuring: haigusvaba elulemus (DFS) ja elukvaliteet mEHT-ga<\/span><\/span><\/h5>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">See on \u00fcks uuemaid III faasi uuringuid, mis kinnitab selliseid eeliseid nagu haigusvaba elulemus (DFS) ja elukvaliteedi paranemine, kui keemiaravi-kiiritusravile (CTRT) lisatakse kaasaegset h\u00fcpertermia tehnikat (mEHT).<\/span><\/span><\/p>\n<table width=\"624\">\n<thead>\n<tr>\n<td width=\"312\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Kinnitatud n\u00e4itajad<\/span><\/span><\/td>\n<td width=\"312\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Peamine tulemus<\/span><\/span><\/td>\n<\/tr>\n<\/thead>\n<tbody>\n<tr>\n<td width=\"312\"><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Haigusvaba elulemus (DFS)<\/span><\/span><\/strong><\/td>\n<td width=\"312\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">M\u00e4rkimisv\u00e4\u00e4rne paranemine 2- ja 3-aastases haigusvabas elulemuses mEHT lisamisega CTRT-le.<\/span><\/span><\/td>\n<\/tr>\n<tr>\n<td width=\"312\"><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Elukvaliteet (QoL)<\/span><\/span><\/strong><\/td>\n<td width=\"312\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">M\u00e4rkimisv\u00e4\u00e4rne elukvaliteedi paranemine ilma suurenenud toksilisuseta.<\/span><\/span><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<ul>\n<li><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Pealkiri:<\/span><\/span><\/strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> Moduleeritud elektroh\u00fcpertermia (mEHT) m\u00f5ju lokaalselt levinud emakakaelav\u00e4higa patsientide kahe- ja kolmeaastasele elulemusele<\/span><\/span><\/li>\n<li><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Autorid:<\/span><\/span><\/strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> Minnaar CA, Maposa I, Kotzen JA jt.<\/span><\/span><\/li>\n<li><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">MDPI link (t\u00e4istekst saadaval): <\/span><\/span><\/strong> <a href=\"https:\/\/www.mdpi.com\/2072-6694\/14\/3\/656\" target=\"_blank\" rel=\"noopener\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">https:\/\/www.mdpi.com\/2072-6694\/14\/3\/656<\/span><\/span><\/a><\/li>\n<\/ul>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Lokaalselt levinud emakakaelav\u00e4hi korral suurendab lokoregionaalse h\u00fcpertermia lisamine mitte ainult lokaalse kasvaja eradikatsiooni (CR) v\u00f5imalusi, vaid avaldab ka olulist positiivset m\u00f5ju pikaajalisele elulemusele (\u00fcldisele elulemusele ja haigusvabale elulemusele).<\/span><\/span><\/p>\n<h3><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">4.3. Pea- ja kaelapiirkonna v\u00e4hk (HNC)<\/span><\/span><\/h3>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Lokoregionaalne h\u00fcpertermia on 1A taseme ravi mitmesuguste pea- ja kaelakasvajate, sealhulgas korduvate ja kaugelearenenud haiguste korral, kus lokaalne kontroll m\u00f5jutab otseselt elukvaliteeti ja elluj\u00e4\u00e4mist.<\/span><\/span><\/p>\n<h4><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">4.3.1. III faasi randomiseeritud uuringu andmed<\/span><\/span><\/h4>\n<p><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Prospektiivsed, randomiseeritud III faasi uuringud on dokumenteerinud selgeid eeliseid keemiaravi ja kiiritusravi (KRT) kombineerimisel HT-ga v\u00f5rreldes ainult KRT-ga nasofar\u00fcngeaalse kartsinoomi (NPC) ravis.<\/span><\/span><\/strong><br \/>\n<span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> \u25cf <\/span><\/span><strong><a href=\"https:\/\/doi.org\/10.7314\/apjcp.2013.14.12.7395\" target=\"_blank\" rel=\"noopener\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Kang 2013<\/span><\/span><\/a><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> (NPC):<\/span><\/span><\/strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> See III faasi uuring teatas olulisest paranemisest. <\/span><\/span><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">5-aastane haigusvaba elulemus (DFS) suurenes 25,5%-lt 51,3%-le (p &lt; 0,005) ja 5-aastane \u00fcldine elulemus (OS) suurenes 50%-lt 68,4%-le (p &lt; 0,005). Ka t\u00e4ieliku remissiooni (CR) m\u00e4\u00e4r suurenes 62,8%-lt 81,6%-le<\/span><\/span><\/strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> . <\/span><\/span><br \/>\n<span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">\u25cf <\/span><\/span><strong><a href=\"https:\/\/journals.lww.com\/cancerjournal\/fulltext\/2010\/06040\/hyperthermia_with_radiation_in_the_treatment_of.16.aspx\" target=\"_blank\" rel=\"noopener\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Huilgol 2010<\/span><\/span><\/a><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> (suu\u00f5\u00f5nsus\/orofar\u00fcnks\/h\u00fcpofar\u00fcnks):<\/span><\/span><\/strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> T\u00e4ielikku ravivastust t\u00e4heldati <\/span><\/span><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">42,4%-l ainult kiiritusravi saanud r\u00fchmas, v\u00f5rreldes 78,6%-ga HT-ga ravitud r\u00fchmas<\/span><\/span><\/strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> . Erinevus oli statistiliselt oluline (&lt; 0,05). Kaplan-Meiri elulemuse anal\u00fc\u00fcs n\u00e4itas samuti olulist paranemist kiiritusravi ja HT kasuks. Annust piiravaid termilisi p\u00f5letusi ega liigset limaskesta v\u00f5i termilist toksilisust ei registreeritud.<\/span><\/span><\/p>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">M\u00e4rkimisv\u00e4\u00e4rne ja j\u00e4rjepidev haigusvaba elulemuse (DFS) ja \u00fcldise elulemuse (OS) paranemine pea- ja kaelapiirkonna v\u00e4hi korral, kus lokaalsete retsidiivide m\u00e4\u00e4r on sageli k\u00f5rge, r\u00f5hutab, et HT on efektiivne lokaalse kiiritusresistentsuse \u00fcletamisel, muutes selle oluliseks komponendiks kuratiivses ravis [5].<\/span><\/span><\/p>\n<h3><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">4.4. Seedetrakti v\u00e4hid: p\u00e4rasoole- ja p\u00e4rakuv\u00e4hk<\/span><\/span><\/h3>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">HT integreerimine neoadjuvantse keemiaradioteraapiaga (CRT) lokaalselt levinud p\u00e4rasoolev\u00e4hi korral on n\u00e4idanud olulist kasu lokoregionaalses kontrollis ja elluj\u00e4\u00e4mises.<\/span><\/span><\/p>\n<h4><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">4.4.1. III faasi tulemused p\u00e4rasoolev\u00e4hi ravis<\/span><\/span><\/h4>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Prospektiivses randomiseeritud uuringus * <\/span><\/span><a href=\"https:\/\/link.springer.com\/article\/10.1007\/s00066-018-1396-x\" target=\"_blank\" rel=\"noopener\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Ott 2019<\/span><\/span><\/a><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> * v\u00f5rreldi KRT-d KRT + HT-ga ning teatati HT r\u00fchmas olulistest 5-aastasest paranemisest: <\/span><\/span><br \/>\n<strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">\u25cf \u00dcldine elulemus (OS): 95,8% vs 74,5% (P = 0,045). <\/span><\/span><\/strong><br \/>\n<strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">\u25cf Haigusvaba elulemus (DFS): 89,1% vs 70,4% (P = 0,027). <\/span><\/span><\/strong><br \/>\n<strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">\u25cf Lokaalse retsidiivivaba elulemus (LRFS): 97,7% vs 78,7% (P = 0,006)<\/span><\/span><\/strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> .<\/span><\/span><\/p>\n<h4><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">4.4.2. Patoloogiline vastus ja kliinilised tagaj\u00e4rjed<\/span><\/span><\/h4>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">HT lisamine parandas ka patoloogilise t\u00e4ieliku ravivastuse (pCR) m\u00e4\u00e4ra, *metaanal\u00fc\u00fcs n\u00e4itab suurenemist 16%-lt (CRT) 22,5%-le (CRT+HT, p = 0,043).* <\/span><\/span><br \/>\n<strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">K\u00f5ige olulisem on see, et parem LRFS m\u00e4\u00e4r (97,7%) ja kolostoomiavaba elulemuse paranemine (87,7% vs 69,0%, P = 0,016) r\u00f5hutavad HT rolli mitte ainult kasvaja lokaalses steriliseerimises, vaid ka sulgurlihase s\u00e4ilitamise strateegiates.<\/span><\/span><\/strong><\/p>\n<p>&nbsp;<\/p>\n<h3><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">4.5. Pahaloomuline melanoom (loko-regionaalne haigus)<\/span><\/span><\/h3>\n<p><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">III faasi fundamentaalsed uuringud ( <\/span><\/span><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/7776772\/\" target=\"_blank\" rel=\"noopener\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Overgaard jt, 1995<\/span><\/span><\/a><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> ) on n\u00e4idanud, et kiiritusravi kombineerimine HT-ga parandab t\u00e4ielikku ravivastust ja \u00fcldist elulemust kaugelearenenud melanoomi korral.<\/span><\/span><\/strong><\/p>\n<p><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Peamised tulemused: kiiritusravi + h\u00fcpertermia vs. kiiritusravi<\/span><\/span><\/strong><\/p>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Euroopa mitmekeskuselises uuringus m\u00e4\u00e4rati 70 patsiendil juhuslikult 134 metastaatilist v\u00f5i korduvat melanoomi kahjustust, et saada kas ainult kiiritusravi v\u00f5i kiiritusravi, millele j\u00e4rgnes h\u00fcpertermia (43 \u00b0C 60 minutit).<\/span><\/span><\/p>\n<h5><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">1. Kohalik kasvaja kontroll (esmane tulemusn\u00e4itaja)<\/span><\/span><\/h5>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">K\u00f5ige olulisem tulemus oli pikaajalise lokaalse kasvajakontrolli oluline paranemine.<\/span><\/span><\/p>\n<table width=\"624\">\n<thead>\n<tr>\n<td width=\"156\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">L\u00f5pp-punkt<\/span><\/span><\/td>\n<td width=\"156\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Ainult kiiritusravi (RT)<\/span><\/span><\/td>\n<td width=\"156\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Kiiritusravi + h\u00fcpertermia (RT + HT)<\/span><\/span><\/td>\n<td width=\"156\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Peamine erinevus<\/span><\/span><\/td>\n<\/tr>\n<\/thead>\n<tbody>\n<tr>\n<td width=\"156\"><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Aktuariaalne kohalik kontroll 2 aasta m\u00f6\u00f6dudes<\/span><\/span><\/strong><\/td>\n<td width=\"156\"><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">28%<\/span><\/span><\/strong><\/td>\n<td width=\"156\"><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">46%<\/span><\/span><\/strong><\/td>\n<td width=\"156\"><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">M\u00e4rkimisv\u00e4\u00e4rne paranemine (p = 0,008)<\/span><\/span><\/strong><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<ul>\n<li><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">J\u00e4reldus:<\/span><\/span><\/strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> HT lisamine parandas lokaalset kasvajakontrolli 2 aastaga *18 protsendipunkti* v\u00f5rra.<\/span><\/span><\/li>\n<\/ul>\n<h5><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">2. Mitmem\u00f5\u00f5tmeline anal\u00fc\u00fcs (prognostilised tegurid)<\/span><\/span><\/h5>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Mitmem\u00f5\u00f5tmeline Coxi regressioonanal\u00fc\u00fcs kinnitas, et *h\u00fcpertermia* oli 2 aasta m\u00f6\u00f6dudes lokaalse kontrolli k\u00f5ige olulisem prognostiline tegur.<\/span><\/span><\/p>\n<table width=\"624\">\n<thead>\n<tr>\n<td width=\"208\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Prognostiline muutuja<\/span><\/span><\/td>\n<td width=\"208\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Risk (koefitsient)<\/span><\/span><\/td>\n<td width=\"208\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">P-v\u00e4\u00e4rtus<\/span><\/span><\/td>\n<\/tr>\n<\/thead>\n<tbody>\n<tr>\n<td width=\"208\"><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">H\u00fcpertermia<\/span><\/span><\/strong><\/td>\n<td width=\"208\"><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">1,73<\/span><\/span><\/strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> (kohaliku juhtimise jaoks)<\/span><\/span><\/td>\n<td width=\"208\"><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">p = 0,023<\/span><\/span><\/strong><\/td>\n<\/tr>\n<tr>\n<td width=\"208\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Kiirgusdoos<\/span><\/span><\/td>\n<td width=\"208\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">1.17<\/span><\/span><\/td>\n<td width=\"208\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">p = 0,05<\/span><\/span><\/td>\n<\/tr>\n<tr>\n<td width=\"208\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Kasvaja suurus<\/span><\/span><\/td>\n<td width=\"208\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">0,91<\/span><\/span><\/td>\n<td width=\"208\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">p = 0,05<\/span><\/span><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<ul>\n<li><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">J\u00e4reldus:<\/span><\/span><\/strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> See n\u00e4itab, et HT-st saadav kasu on s\u00f5ltumatu ja v\u00e4hemalt sama oluline kui kasutatud kiirgusdoos ja kasvaja suurus.<\/span><\/span><\/li>\n<\/ul>\n<h5><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">3. Elluj\u00e4\u00e4mine (lokaalne kontroll on raviv)<\/span><\/span><\/h5>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Uuringus t\u00e4heldati tugevat seost eduka lokaalse t\u00f5rje ja pikaajalise elluj\u00e4\u00e4mise vahel:<\/span><\/span><\/p>\n<ul>\n<li><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">5-aastane \u00fcldine elulemus:<\/span><\/span><\/strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> \u00fcldine m\u00e4\u00e4r oli 19%.<\/span><\/span><\/li>\n<li><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">T\u00e4ielikult kontrollitud haigusega patsientide 5-aastane elulemus:<\/span><\/span><\/strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> suurenes *38%-ni*.<\/span><\/span><\/li>\n<li><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">J\u00e4reldus:<\/span><\/span><\/strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> \u00dche v\u00f5i v\u00e4heste metastaatiliste kahjustuste edukal lokaalsel kontrollil oli *m\u00e4rkimisv\u00e4\u00e4rne ravipotentsiaal*, mis r\u00f5hutab HT-i pakutava suurenenud lokaalse efektiivsuse olulisust.<\/span><\/span><\/li>\n<\/ul>\n<h5><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">4. Toksilisus ja ohutus<\/span><\/span><\/h5>\n<ul>\n<li><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Kuumuse lisamine *ei suurendanud oluliselt \u00e4gedaid ega hilinenud kiiritusreaktsioone*.<\/span><\/span><\/li>\n<li><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Kuumt\u00f6\u00f6tlus oli \u00fcldiselt *h\u00e4sti talutav*.<\/span><\/span><\/li>\n<\/ul>\n<p><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">M\u00e4rkus:<\/span><\/span><\/strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> Uuringus mainiti raskusi termilise protokolli eesm\u00e4rgi (43 \u00b0C) saavutamisel, mis \u00f5nnestus vaid 14% t\u00f6\u00f6tlustest, mis viitab sellele, et optimeeritud kuumutusprotokollide korral v\u00f5iks tegelik kasu olla veelgi suurem.<\/span><\/span><\/p>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Arvestades, et melanoom on v\u00e4ga immunogeenne haigus ja oli \u00fcks esimesi immunoteraapia sihtm\u00e4rke, avab HT t\u00f5estatud v\u00f5ime esile kutsuda kasvajavastast immuunvastust ja parandada lokaalset kontrolli olulisi kliinilisi v\u00f5imalusi integreerimiseks uute immunoonkoloogiliste ainetega, v\u00f5imendades seel\u00e4bi kontrollpunktide blokaatorite efektiivsust [4].<\/span><\/span><\/p>\n<h3><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">4.6 Korduv rinnav\u00e4hk<\/span><\/span><\/h3>\n<h4><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">4.6.1. Metaanal\u00fc\u00fcs, mis kinnitab termoradioteraapia efektiivsust korduva rinnav\u00e4hi ravis<\/span><\/span><\/h4>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Metaanal\u00fc\u00fcs koondab III faasi kliiniliste uuringute andmeid, n\u00e4idates t\u00e4ielikku ravivastuse m\u00e4\u00e4ra (CR), mida mainiti kombineeritud ravi (kiiritusravi + h\u00fcpertermia) puhul *lokoregionaalse korduva rinnav\u00e4hi (LRBC)* korral.<\/span><\/span><\/p>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">See on uuring, mis toetab 1A taseme t\u00f5endusmaterjali j\u00e4reldusi, sh kombineeritud ravi *60\u201366% CR* m\u00e4\u00e4ra:<\/span><\/span><\/p>\n<p><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Uuring: <\/span><\/span><\/strong> <a href=\"https:\/\/www.sciencedirect.com\/science\/article\/abs\/pii\/S0360301615271994\" target=\"_blank\" rel=\"noopener\"><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">H\u00fcpertermia ja kiiritusravi lokoregionaalsete korduvate rinnav\u00e4hkide korral: s\u00fcstemaatiline \u00fclevaade ja metaanal\u00fc\u00fcs.<\/span><\/span><\/strong><\/a><\/p>\n<ul>\n<li><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Autorid:<\/span><\/span><\/strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> Datta NR, Puric E, Klingbiel D, Gomez S, Bodis S.<\/span><\/span><\/li>\n<li><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Avaldatud ajakirjas: <\/span><\/span><\/strong> <em><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">International Journal of Radiation Oncology Biology Physics<\/span><\/span><\/em><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> , 2016.<\/span><\/span><\/li>\n<li><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Kokkuv\u00f5te:<\/span><\/span><\/strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> Termokiiritusravi (RT + h\u00fcpertermia) suurendab t\u00e4ieliku ravivastuse m\u00e4\u00e4ra (CR) ligikaudu *22%* v\u00f5rreldes ainult kiiritusraviga; kahe ravir\u00fchma v\u00f5rdlusuuringutes saavutati RT + h\u00fcpertermia (HT) korral t\u00e4ieliku ravivastuse m\u00e4\u00e4r (CR) *60,2%*, v\u00f5rreldes ainult RT (kiiritusravi) 38,1%-ga, h\u00fcpertermiaga rekiiritusravi korral saavutades CR m\u00e4\u00e4ra *66,6%*.<\/span><\/span><\/li>\n<\/ul>\n<h4><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">4.6.2 Rinnav\u00e4hi kordumine rindkeres<\/span><\/span><\/h4>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">H\u00fcpertermia, tavaliselt kombinatsioonis kiiritusraviga, omab 1A taseme t\u00f5endeid rinnav\u00e4hi rindkere retsidiivi ravis. <\/span><\/span><br \/>\n<span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">See kombinatsioon on eriti v\u00e4\u00e4rtuslik rindkere seina retsidiivi kontekstis, kus raviv\u00f5imalused on sageli piiratud. Uuringud n\u00e4itavad k\u00f5rget t\u00e4ieliku ravivastuse m\u00e4\u00e4ra (CR), mis j\u00e4\u00e4b vahemikku 40% kuni 86%, ja lokaalse kontrolli m\u00e4\u00e4ra (LC), mis j\u00e4\u00e4b vahemikku 70% kuni 76%, kui kiiritusravi kombineeritakse HT-ga. Lisaks v\u00f5ib 5-aastane \u00fcldise elulemuse m\u00e4\u00e4r selle korduva haiguse korral ulatuda kuni 50%-ni. <\/span><\/span><br \/>\n<span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Kiirguse ja HT kombinatsioon pakub t\u00f5husat lokaalset strateegiat palliatiivseks ja pikaajaliseks kontrolliks, v\u00e4hendades sageli vajadust suurtes annustes p\u00e4\u00e4stva ravi v\u00f5i radikaalse kirurgia j\u00e4rele.<\/span><\/span><\/p>\n<h4><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">4.6.3. \u00dcldine trend lokoregionaalses ravis \u2013 muud onkoloogilised n\u00e4idustused 1. taseme t\u00f5endusmaterjaliga<\/span><\/span><\/h4>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">J\u00e4relduste laiendamine lokoregionaalsetele ravimeetoditele:<\/span><\/span><\/p>\n<ul>\n<li><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">T\u00f5endite konsolideerimine: <\/span><\/span><\/strong> <a href=\"https:\/\/www.sciencedirect.com\/science\/article\/abs\/pii\/S0360301615271994\" target=\"_blank\" rel=\"noopener\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Teine s\u00fcstemaatiline \u00fclevaade<\/span><\/span><\/a><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> ( <\/span><\/span><em><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">esimene oli Hildenbrandt jt<\/span><\/span><\/em><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> ) n\u00e4itab, et *5-s kuuest III faasi uuringust* (mis olid suunatud pindmistele ja lokoregionaalsetele kasvajatele \u2013 sh rinnav\u00e4hk, pea- ja kaelav\u00e4hk, melanoom) t\u00e4heldati *\u00fcldise elulemuse (OS)* ja\/v\u00f5i *t\u00e4ieliku ravivastuse (CR)* suurenemist, kui standardravile lisati h\u00fcpertermia.<\/span><\/span><\/li>\n<li><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Palliatiivsed rakendused:<\/span><\/span><\/strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> Uuringud mainivad, et h\u00fcpertermia koos kiiritusraviga viis valulike luumetastaaside korral *t\u00e4ieliku valuvastuse* olulise suurenemiseni, parandades oluliselt patsientide elukvaliteeti.<\/span><\/span><\/li>\n<\/ul>\n<h3><\/h3>\n<h3><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">4.7. Kusep\u00f5iev\u00e4hk: h\u00fcpertermiline intravesikaalne keemiaravi (HIVEC)<\/span><\/span><\/h3>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">H\u00fcpertermiline intravesikaalne keemiaravi (HIVEC) h\u00f5lmab mitom\u00fctsiin C (MMC) kuumutamist (tavaliselt temperatuurini 43 \u00b0C) p\u00f5ide instillatsiooni ajal mitte-lihas-invasiivse p\u00f5iev\u00e4hi (NMIBC) korral [6].<\/span><\/span><\/p>\n<h4><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">4.7.1. HIVEC-1 III faasi uuringu tulemused<\/span><\/span><\/h4>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">HIVEC-1 uuring, randomiseeritud 3. faasi uuring, eesm\u00e4rgiks oli v\u00f5rrelda retsidiivivaba elulemust (RFS) normotermilise MMC ja h\u00fcpertermilise MMC (43\u00b0C 30 v\u00f5i 60 minutit) korral keskmise riskiga NMIBC-ga (IR-NMIBC) patsientidel [6]. <\/span><\/span><br \/>\n<span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Esmane tulemusn\u00e4itaja (RFS): RFS 24 kuu m\u00f6\u00f6dudes ravikavatsuse (ITT) populatsioonis oli kontrollr\u00fchmas (normotermia) 77% v\u00f5rreldes 82%-ga (HT 30 min) ja 80%-ga (HT 60 min). Uuringus j\u00f5uti j\u00e4reldusele, et HT ei olnud 24 kuu m\u00f6\u00f6dudes RFS-i osas statistiliselt parem kui normotermiline MMC, p-v\u00e4\u00e4rtusega 0,6 [6]. <\/span><\/span><br \/>\n<span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Kliiniline t\u00e4hendus: IR-NMIBC paremuse puudumine viitab sellele, et keskmise riskiga populatsioon ei pruugi termilisest\/keemilisest s\u00fcnergiast piisavalt kasu saada v\u00f5i et uuringus kasutatud spetsiifilised termilised protokollid (nt fikseeritud kestus) olid optimaalsest v\u00e4iksemad.<\/span><\/span><\/p>\n<h4><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">4.7.2. N\u00fcansid ja progressioonivaba elulemus<\/span><\/span><\/h4>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Erinevalt IR-NMIBC RFS-i tulemusest r\u00f5hutavad teiste uuringute andmed kasu k\u00f5rge riskiga patsientidele, eriti neile, kellel BCG-ravi eba\u00f5nnestus. Anal\u00fc\u00fcs n\u00e4itas *ITT-anal\u00fc\u00fcsis HIVEC puhul oluliselt paremat progressioonivaba elulemust (PFS) v\u00f5rreldes BCG-ga (95,7% vs 71,8%; p = 0,043) [7]*. Teine uuring n\u00e4itas, et kuigi HIVEC-iga keemiaravi saavutas 1-aastase RFS-i m\u00e4\u00e4ra 60% ja p\u00f5ie s\u00e4ilitamise m\u00e4\u00e4ra 92,4%, j\u00e4\u00e4b ts\u00fcstektoomia v\u00e4ga k\u00f5rge riskiga patsientidel, kellel BCG eba\u00f5nnestub, ravi standardiks, kuigi HIVEC v\u00f5ib olla alternatiiviks neile, kes ei ole kirurgiliseks raviks sobivad [8]. See kinnitab, et HT efektiivsus p\u00f5iev\u00e4hi ravis s\u00f5ltub oluliselt patsientide kihistumisest.<\/span><\/span><\/p>\n<p>&nbsp;<\/p>\n<p><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Tabel 2 v\u00f5tab kokku h\u00fcpertermia integreerimise peamised III faasi kliinilised tulemused.<\/span><\/span><\/strong><\/p>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Tabel 2: III faasi peamised kliinilised tulemused h\u00fcpertermia korral onkoloogias (HT + standardravi vs. ainult standardravi)<\/span><\/span><\/p>\n<p>&nbsp;<\/p>\n<table width=\"624\">\n<thead>\n<tr>\n<td width=\"104\"><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">V\u00e4hi t\u00fc\u00fcp (HT-modaalsus)<\/span><\/span><\/strong><\/td>\n<td width=\"104\"><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Uuringu t\u00fc\u00fcp\/l\u00f5pp-punkt<\/span><\/span><\/strong><\/td>\n<td width=\"104\"><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">HT + standardne hooldus<\/span><\/span><\/strong><\/td>\n<td width=\"104\"><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Standardne monoteraapia<\/span><\/span><\/strong><\/td>\n<td width=\"104\"><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Statistiline olulisus\/l\u00f5pp-punkti tulemus<\/span><\/span><\/strong><\/td>\n<td width=\"104\"><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Viide<\/span><\/span><\/strong><\/td>\n<\/tr>\n<\/thead>\n<tbody>\n<tr>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Pehmete kudede sarkoom (LR HT + KT) 11,3 aastat<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">III faasi randomiseeritud (<\/span><\/span><\/p>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">5-aastane OS<\/span><\/span><\/p>\n<p>&nbsp;<\/p>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">10-aastane OS)<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">62,7%<\/span><\/span><\/p>\n<p>&nbsp;<\/p>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">52,6%<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">51,3%<\/span><\/span><\/p>\n<p>&nbsp;<\/p>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">42,7%<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">V\u00f5rreldes ainult neoadjuvantse keemiaraviga parandas regionaalse h\u00fcpertermia lisamine lokaalselt *haigusvaba elulemust (DFS)* (riskisuhe [HR] 0,65; 95% CI 0,49\u20130,86; P = 0,002).<\/span><\/span><\/p>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Keemiaravi ja h\u00fcpertermia r\u00fchma randomiseeritud patsientidel oli *\u00fcldine elulemus* pikenenud v\u00f5rreldes ainult neoadjuvantset keemiaravi saanud r\u00fchma randomiseeritud patsientidega (HR, 0,73; 95% CI, 0,54\u20130,98; P = 0,04), 5-aastane elulemus oli vastavalt 62,7% (95% CI, 55,2\u201370,1%) versus 51,3% (95% CI, 43,7\u201359,0%) ja 10-aastane elulemus oli vastavalt 52,6% (95% CI, 44,7\u201360,6%) versus 42,7% (95% CI, 35,0\u201350,4%).<\/span><\/span><\/td>\n<td width=\"104\"><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/29450452\/\" target=\"_blank\" rel=\"noopener\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">https:\/\/pubmed.ncbi.nlm.nih.gov\/29450452\/<\/span><\/span><\/a><\/td>\n<\/tr>\n<tr>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Emakakaelav\u00e4hk (LACC) (LR HT + RT) 12 aastat<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">III faasi randomiseeritud ( <\/span><\/span><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">12-aastane \u00fcldine elulemus<\/span><\/span><\/strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> )<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">37%<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">20%<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Oluliselt parem \u00fcldine elulemus (P &lt; 0,05)<\/span><\/span><\/td>\n<td width=\"104\"><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/17881144\/\" target=\"_blank\" rel=\"noopener\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">https:\/\/pubmed.ncbi.nlm.nih.gov\/17881144\/<\/span><\/span><\/a><\/td>\n<\/tr>\n<tr>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">P\u00e4rasoolev\u00e4hk (CRT + HT) 5 aastat<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">III faasi randomiseeritud<\/span><\/span><\/p>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">( <\/span><\/span><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">5-aastane OS<\/span><\/span><\/strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> ,<\/span><\/span><\/p>\n<p>&nbsp;<\/p>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">5-aastane haigusvaba elulemus<\/span><\/span><\/p>\n<p>&nbsp;<\/p>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">5-aastane lokaalne retsidiivivaba LRF<\/span><\/span><\/p>\n<p>&nbsp;<\/p>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">5-aastane kolostoomiavaba elulemus CFSR-i korral<\/span><\/span><\/p>\n<p>&nbsp;<\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">95,8%<\/span><\/span><\/p>\n<p>&nbsp;<\/p>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">89.1<\/span><\/span><\/p>\n<p>&nbsp;<\/p>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">97,7<\/span><\/span><\/p>\n<p>&nbsp;<\/p>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">87,7<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">74,5%<\/span><\/span><\/p>\n<p>&nbsp;<\/p>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">70,4%<\/span><\/span><\/p>\n<p>&nbsp;<\/p>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">78,7%<\/span><\/span><\/p>\n<p>&nbsp;<\/p>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">69,0%<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Paranenud \u00fcldine elulemus (P = 0,045)<\/span><\/span><\/p>\n<p>&nbsp;<\/p>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Paranenud haigusvaba elulemus ( <\/span><\/span><i><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">P<\/span><\/span><\/i><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> \u202f= 0,027),<\/span><\/span><\/p>\n<p>&nbsp;<\/p>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Paranenud LRF ( <\/span><\/span><i><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">P<\/span><\/span><\/i><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> \u202f= 0,006),<\/span><\/span><\/p>\n<p>&nbsp;<\/p>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Paranenud CFSR ( <\/span><\/span><i><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">P<\/span><\/span><\/i><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> \u202f= 0,016)<\/span><\/span><\/p>\n<p>&nbsp;<\/td>\n<td width=\"104\"><a href=\"https:\/\/link.springer.com\/article\/10.1007\/s00066-018-1396-x\" target=\"_blank\" rel=\"noopener\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">https:\/\/link.springer.com\/article\/10.1007\/s00066-018-1396-x<\/span><\/span><\/a><\/td>\n<\/tr>\n<tr>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Pea- ja kaelav\u00e4hi NPC (CRT + HT)<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">III faasi randomiseeritud (5-aastane haigusvaba haigus)<\/span><\/span><\/p>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">ja<\/span><\/span><\/p>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">5-aastane OS<\/span><\/span><\/p>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">ja<\/span><\/span><\/p>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">CR)<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">51,3%<\/span><\/span><\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">68,4%<\/span><\/span><\/p>\n<p>&nbsp;<\/p>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">81,6%<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">25,5%<\/span><\/span><\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">50%<\/span><\/span><\/p>\n<p>&nbsp;<\/p>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">62,8%<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">See III faasi uuring n\u00e4itas m\u00e4rkimisv\u00e4\u00e4rset paranemist.<\/span><\/span><\/td>\n<td width=\"104\"><strong><a href=\"https:\/\/doi.org\/10.7314\/apjcp.2013.14.12.7395\" target=\"_blank\" rel=\"noopener\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Kang 2013<\/span><\/span><\/a><\/strong><\/td>\n<\/tr>\n<tr>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Pea- ja kaelav\u00e4hk <\/span><\/span><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Suu\u00f5\u00f5nsus\/Suuneelu\/H\u00fcpofar\u00fcnks<\/span><\/span><\/strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> (RT + HT)<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">III faasi randomiseeritud (CR)<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">78,6%<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">42,4%<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Erinevus oli statistiliselt oluline (&lt; 0,05). Kaplan-Meiri elulemuse anal\u00fc\u00fcs n\u00e4itas samuti olulist paranemist kiiritusravi-HT kasuks. Annust piiravaid termilisi p\u00f5letusi ega liigset limaskesta v\u00f5i termilist toksilisust ei registreeritud.<\/span><\/span><\/td>\n<td width=\"104\"><strong><a href=\"https:\/\/journals.lww.com\/cancerjournal\/fulltext\/2010\/06040\/hyperthermia_with_radiation_in_the_treatment_of.16.aspx\" target=\"_blank\" rel=\"noopener\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Huilgol 2010<\/span><\/span><\/a><\/strong><\/td>\n<\/tr>\n<tr>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Pahaloomuline melanoom (RT + HT)<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">III faasi randomiseeritud (CR)<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">46%<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">28%<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">M\u00e4rkimisv\u00e4\u00e4rne paranemine kaheaastases aktuaarses lokaalses kontrollis (p = 0,008)<\/span><\/span><\/td>\n<td width=\"104\"><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/7776772\/\" target=\"_blank\" rel=\"noopener\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">https:\/\/pubmed.ncbi.nlm.nih.gov\/7776772\/<\/span><\/span><\/a><\/td>\n<\/tr>\n<tr>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Korduv rinnav\u00e4hk (RT + HT) \u2013 HT on NCCN-i suunistes<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">III faasi randomiseeritud (CR)<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">60,2%<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">38,1%<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">CR-i m\u00e4\u00e4r suurenes 57% v\u00f5rreldes<\/span><\/span><\/td>\n<td width=\"104\"><a href=\"https:\/\/www.sciencedirect.com\/science\/article\/abs\/pii\/S0360301615271994\" target=\"_blank\" rel=\"noopener\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">https:\/\/www.sciencedirect.com\/science\/article\/abs\/pii\/S0360301615271994<\/span><\/span><\/a><\/td>\n<\/tr>\n<tr>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">P\u00f5iev\u00e4hi IR NMI (HIVEC-1)<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">III faasi randomiseeritud (24-kuuline RFS)<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">80%-82%<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">77%<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Olulist erinevust ei t\u00e4heldatud (p = 0,6)<\/span><\/span><\/td>\n<td width=\"104\"><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/36435738\/\" target=\"_blank\" rel=\"noopener\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">https:\/\/pubmed.ncbi.nlm.nih.gov\/36435738\/<\/span><\/span><\/a><\/td>\n<\/tr>\n<tr>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Luumetastaasid (WBH + RT)<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">III faasi randomiseeritud (valu t\u00e4ielik kontroll)<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">47,4%<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">5,3%<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Paranenud t\u00e4ielik remissioon (P &lt; 0,05); ravivastuse saavutamise aeg l\u00fchenes 10 p\u00e4evani<\/span><\/span><\/td>\n<td width=\"104\"><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/38460451\/\" target=\"_blank\" rel=\"noopener\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">https:\/\/pubmed.ncbi.nlm.nih.gov\/38460451\/<\/span><\/span><\/a><\/td>\n<\/tr>\n<tr>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Luumetastaasid (RF HT + RT)<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">III faasi randomiseeritud (valu t\u00e4ielik kontroll)<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">37,9%<\/span><\/span><\/p>\n<p>&nbsp;<\/p>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">58,6%<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">7,1%<\/span><\/span><\/p>\n<p>&nbsp;<\/p>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">32,1%<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Paranenud t\u00e4ielik remissioon 3 kuu m\u00f6\u00f6dudes (P = 0,006);<\/span><\/span><\/p>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Kogunenud t\u00e4ielik remissioon 3 kuu jooksul p\u00e4rast ravi (P=0,045);<\/span><\/span><\/td>\n<td width=\"104\"><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/29066122\/\" target=\"_blank\" rel=\"noopener\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">https:\/\/pubmed.ncbi.nlm.nihs.gov\/29066122\/<\/span><\/span><\/a><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<div id=\"IDtable-wrap-foot\" class=\"NLM_table-wrap-foot\">\n<div id=\"TF4\">\n<p class=\"first last\"><span dir=\"auto\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">mEHT: moduleeritud elektroh\u00fcpertermia; KT: keemiaravi; RT: kiiritusravi; HT: h\u00fcpertermia; RITE: raadiosagedusega indutseeritud termokemoteraapia; HIPEC: h\u00fcpertermiline intraperitoneaalne keemiaravi; OS: \u00fcldine elulemus; DFS: haigusvaba elulemus; CR: t\u00e4ielik ravivastus; LC: lokaalne kontroll; PFS: progressioonivaba elulemus; ST: elulemusaeg<\/span><\/span><\/span><\/p>\n<\/div>\n<\/div>\n<h2><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">5. T\u00f5endid agressiivsete ja korduvate haiguste korral (\u00e4sja ilmnevad n\u00e4idustused)<\/span><\/span><\/strong><\/h2>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Selles osas anal\u00fc\u00fcsitakse keerulisi kasvajapaikmeid, mille kohta 1A taseme t\u00f5endeid on piiratud v\u00f5i alles v\u00e4ljat\u00f6\u00f6tamisel, kuid kus kvaliteetsed v\u00f5rdlevad uuringud n\u00e4itavad HT olulist rolli, eriti mHT kaudu.<\/span><\/span><\/p>\n<h3><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">5.1. Glioomid (multiformne glioblastoom \u2013 GBM ja astrots\u00fctoom \u2013 AST)<\/span><\/span><\/h3>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Glioomid, eriti multiformne glioblastoom (GBM), on tuntud oma \u00e4\u00e4rmise raviresistentsuse poolest. 1998. aastal l\u00e4bi viidud ajaloolises randomiseeritud uuringus, milles hinnati brahh\u00fcteraapia v\u00f5imendust koos h\u00fcpertermiaga GBM-i korral, dokumenteeriti kombineeritud ravi puhul elluj\u00e4\u00e4mise parem tulemus [9].<\/span><\/span><\/p>\n<h4><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">5.1.1. Andmed raadiosagedusmoduleeritud h\u00fcpertermia (mHT) kohta<\/span><\/span><\/h4>\n<p><a href=\"https:\/\/www.mdpi.com\/2072-6694\/15\/3\/880\" target=\"_blank\" rel=\"noopener\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Uuemad metaanal\u00fc\u00fcsid<\/span><\/span><\/a><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> n\u00e4itavad, et nii mEHT kui ka kasvajat ravivad v\u00e4ljad (TTF) v\u00f5ivad parandada glioblastoomi elulemust [10]. Kasu n\u00e4ib olevat suurim \u00e4sja diagnoositud patsientidel. N\u00e4iteks *mHT uuringutes oli \u00e4sja diagnoositud patsientide 1-aastane elulemus 73% versus 37% kontrollr\u00fchmas* (p = 0,0021) [10]. <\/span><\/span><br \/>\n<span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Korduva haiguse puhul *n\u00e4itas vaatluslik v\u00f5rdlev anal\u00fc\u00fcs, et mHT pikendas \u00fcldist elulemust (GBM mediaan 14 kuud vs 12 kuud, p = 0,026). Astrots\u00fctoomide (AST) puhul n\u00e4itas mHT olulist kasu, kusjuures keskmine\/mediaanne \u00fcldine elulemus oli parimas palliatiivses tugir\u00fchmas 72\/91,6 kuud versus 17\/34 kuud (p = 0,0006). Isegi korduva GBM-i korral oli mHT-ga ravitud patsientidel 5-aastane \u00fcldine elulemus 3,5% versus 1,2% parimas tugir\u00fchmas [*11].<\/span><\/span><\/p>\n<p><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">V\u00f5rdlevatest uuringutest saadud tugevad elulemuse signaalid isegi glioomide keerulises kliinilises kontekstis \u00f5igustavad HT lisamist kliinilistesse juhistesse 1A taseme n\u00e4idustusena.<\/span><\/span><\/strong><\/p>\n<h3><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">5.2. Pankreasev\u00e4hk (PK)<\/span><\/span><\/h3>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Pankreasev\u00e4hk on \u00e4\u00e4rmiselt surmav s\u00fcsteemne haigus, mille puhul HT liigitatakse praegu &#8220;tavaliseks palliatiivseks kliiniliseks t\u00f5endiks (II faasi uuringutest)&#8221;. Siiski on viimastel aastatel l\u00e4bi viidud ulatuslikud v\u00f5rdlevad uuringud andnud tugeva kliinilise signaali.<\/span><\/span><\/p>\n<h4><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">5.2.1. mEHT v\u00f5rdlev anal\u00fc\u00fcs metastaatilise PC korral<\/span><\/span><\/h4>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Suures <\/span><\/span><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/37398545\/\" target=\"_blank\" rel=\"noopener\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">retrospektiivses mitmekeskuselises vaatlusuuringus<\/span><\/span><\/a><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> (N = 217 III-IV staadiumi PC-ga patsienti) v\u00f5rreldi mEHT + CHT-d (peamiselt gemtsitabiinil p\u00f5hinevat) ainult CHT-ga. <\/span><\/span><br \/>\n<strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">\u25cf \u00dcldine elulemus (OS): OS paranes oluliselt mEHT r\u00fchmas (20 kuud vs 9 kuud CHT r\u00fchmas, P &lt; 0,001). <\/span><\/span><\/strong><br \/>\n<strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">\u25cf Progressioonivaba elulemus (PFS): PFS paranes samuti oluliselt (7 kuud vs 5 kuud, P &lt; 0,05). <\/span><\/span><\/strong><br \/>\n<strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">\u25cf Kasvaja ravivastus: mEHT-ga ravitud patsientidel registreeriti palju k\u00f5rgem osalise ravivastuse m\u00e4\u00e4r (PR) (45% vs 24%, P = 0,0018) ja oluliselt madalam progresseeruva haiguse (PD) m\u00e4\u00e4r (4% vs 31%, P &lt; 0,01).<\/span><\/span><\/strong><\/p>\n<h4><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">5.2.2. HT m\u00f5ju vanusele<\/span><\/span><\/h4>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Vanusep\u00f5hine elulemuse anal\u00fc\u00fcs n\u00e4itas ainulaadset kliinilist aspekti: moduleeritud raadiosagedusliku h\u00fcpertermia (mHT) poolt saavutatav \u00fcldise elulemuse kasu s\u00e4ilis olenemata sellest, kas patsiendid olid &lt;= 70-aastased v\u00f5i &gt; 70-aastased (m\u00f5lema r\u00fchma keskmine \u00fcldine elulemus oli 20 kuud). Seevastu eakatel patsientidel, kes said ainult CHT-d, oli \u00fcldine elulemus oluliselt madalam (8 kuud) kui noorematel patsientidel (12 kuud), mis n\u00e4itab CHT efektiivsuse v\u00e4henemist vanusega. *See viitab sellele, et mHT pakub tugevat efektiivsust ilma standardse CHT puhul t\u00e4heldatud vanusega seotud languseta, mis v\u00f5ib olla tingitud selle soodsast toksilisusprofiilist.* <\/span><\/span><br \/>\n<strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Suur kliiniline paranemine (keskmise \u00fcldise elulemuse kahekordistumine 9 kuult 20 kuule) on tekitanud suure n\u00f5udluse rahvusvaheliste randomiseeritud III faasi uuringute kiireloomulise korraldamise j\u00e4rele, millest m\u00f5ned on juba k\u00e4imas (nt NCT02862015, onkotermia mitmekeskuseline randomiseeritud kontroll metastaatilise k\u00f5hun\u00e4\u00e4rmev\u00e4hi korral).<\/span><\/span><\/strong><\/p>\n<p>&nbsp;<\/p>\n<h2><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">6. Ohutusprofiil ja elukvaliteet (QALY): HT k\u00f5rge terapeutiline indeks<\/span><\/span><\/h2>\n<h2><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">HT k\u00f5rge terapeutiline indeks<\/span><\/span><\/h2>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Laialdane kliiniline kasutuselev\u00f5tt s\u00f5ltub soodsa terapeutilise indeksi s\u00e4ilitamisest. *III faasi t\u00f5endid toetavad \u00fclekaalukalt fakti, et HT vastab sellele n\u00f5udele, suurendamata oluliselt rasket toksilisust.*<\/span><\/span><\/p>\n<h3><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">6.1. S\u00fcsteemse toksilisuse anal\u00fc\u00fcs (3.\u20134. aste)<\/span><\/span><\/h3>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Randomiseeritud uuringute s\u00fcstemaatiline anal\u00fc\u00fcs kinnitab, et HT *ei s\u00fcvenda s\u00fcsteemset toksilisust*, mis on p\u00f5hjustatud RT-st v\u00f5i CHT-st:<\/span><\/span><\/p>\n<ul>\n<li><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Emakakaelav\u00e4hk (LACC):<\/span><\/span><\/strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> \u00c4geda v\u00f5i hilise 3.\u20134. astme toksilisuse osas olulist erinevust ei t\u00e4heldatud (RR \u2248 1,0).<\/span><\/span><\/li>\n<li><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">P\u00e4rasoolev\u00e4hk:<\/span><\/span><\/strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> Toksilisuse profiil oli sarnane. Raskete 3.\u20134. astme naha- v\u00f5i seedetrakti reaktsioonide sagenemist ei t\u00e4heldatud.<\/span><\/span><\/li>\n<li><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Pankreasev\u00e4hk (mHT):<\/span><\/span><\/strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> Ei suurendanud keemiaraviga seostatavat hematoloogilist, maksa-, kopsu- ega metaboolset toksilisust.<\/span><\/span><\/li>\n<\/ul>\n<h3><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">6.2. H\u00fcpertermia meetoditele iseloomulikud k\u00f5rvaltoimed<\/span><\/span><\/h3>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">H\u00fcpertermiaga otseselt seotud k\u00f5rvaltoimed on valdavalt lokaalsed ja tavaliselt hallatavad: <\/span><\/span><br \/>\n<strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">\u25cf Lokaalne-regionaalne HT (LR HT):<\/span><\/span><\/strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> 3.\u20134. astme k\u00f5rvaltoimeid teatati 10\u201332%-l korduva rinnav\u00e4hi juhtudest, mis olid peamiselt seotud lokaalsete nahareaktsioonidega (kerged p\u00f5letused v\u00f5i ebamugavustunne). <\/span><\/span><br \/>\n<span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">\u25cf <\/span><\/span><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">RF-moduleeritud h\u00fcpertermia (mHT)<\/span><\/span><\/strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> : mHT-l on eriti soodne ohutusprofiil. K\u00f5hun\u00e4\u00e4rmev\u00e4hi uuringus teatati k\u00f5rvaltoimetest vaid 2,6%-l mHT seanssidest, sealhulgas 1. astme nahavalu v\u00f5i 1.\u20132. astme p\u00f5letused (1,1% juhtudest), mis taandusid kiiresti. <\/span><\/span><br \/>\n<span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">\u25cf <\/span><\/span><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">HIVEC-1 uuring (p\u00f5iev\u00e4hk):<\/span><\/span><\/strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> Kuigi t\u00f5sised k\u00f5rvaltoimed olid r\u00fchmade vahel sarnased (p = 0,5), oli k\u00f5rvaltoimete koguarv (peamiselt lokaalne ebamugavustunne ja spasmid) HT r\u00fchmas veidi suurem (35\u201348% vs 33% kontrollr\u00fchmas, p = 0,05), mis kinnitab lokaalseid, kuid ebaolulisi toimeid raske haigestumuse osas.<\/span><\/span><\/p>\n<h3><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">6.3. M\u00f5ju elukvaliteedile kohandatud aastate arvule (QALY)<\/span><\/span><\/h3>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Kombineerides eluea pikenemise elukvaliteediga, pakub QALY (kvaliteediga korrigeeritud eluaastate) kontseptsioon terapeutilise kasu majanduslikku ja inimlikku vaatenurka. HT dokumenteeritud kliinilised eelised \u2013 parem elulemus, k\u00f5rgemad t\u00e4ieliku remissiooni m\u00e4\u00e4rad ja parem lokaalne kontroll \u2013 viitavad pikaajalise kulude kokkuhoiu ja patsientide QALY paranemise suurele t\u00f5en\u00e4osusele, mis tugevdab kliinilise kasutuselev\u00f5tu argumenti. <\/span><\/span><br \/>\n<span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Tabel 3 v\u00f5rdleb HT integreerimise ohutusprofiili standardraviga.<\/span><\/span><\/p>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Tabel 3: Ohutuse ja toksilisuse v\u00f5rdlus (HT integratsioon vs standardravi)<\/span><\/span><\/p>\n<table width=\"624\">\n<thead>\n<tr>\n<td width=\"104\"><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">V\u00e4hi t\u00fc\u00fcp<\/span><\/span><\/strong><\/td>\n<td width=\"104\"><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Standardravi (kontrollr\u00fchm)<\/span><\/span><\/strong><\/td>\n<td width=\"104\"><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Sekkumine (HT + standardravi)<\/span><\/span><\/strong><\/td>\n<td width=\"104\"><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">3.-4. astme toksilisuse leiud<\/span><\/span><\/strong><\/td>\n<td width=\"104\"><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Kliiniline j\u00e4reldus<\/span><\/span><\/strong><\/td>\n<td width=\"104\"><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Viide<\/span><\/span><\/strong><\/td>\n<\/tr>\n<\/thead>\n<tbody>\n<tr>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Lokaalselt levinud emakakaelav\u00e4hk<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">CCRT \u00fcksi<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">CCRT + LR HT<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">\u00c4geda v\u00f5i hilise toksilisuse osas olulist erinevust ei t\u00e4heldatud (RR \\sim 1,0)<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Soodne terapeutiline indeks; s\u00fcsteemsed k\u00f5rvaltoimed ei s\u00fcvene.<\/span><\/span><\/td>\n<td width=\"104\"><a href=\"https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC9856725\/\" target=\"_blank\" rel=\"noopener\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC9856725\/<\/span><\/span><\/a><\/td>\n<\/tr>\n<tr>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">P\u00e4rasoole-\/p\u00e4rakuv\u00e4hk<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">CRT<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">CRT + LR HT<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">V\u00f5rreldav toksilisuse profiil; raskete seedetrakti v\u00f5i nahareaktsioonide sagenemist ei t\u00e4heldatud.<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">HT on ohutu koos vaagnapiirkonna CRT protokollidega.<\/span><\/span><\/td>\n<td width=\"104\"><a href=\"https:\/\/link.springer.com\/article\/10.1007\/s00066-018-1396-x\" target=\"_blank\" rel=\"noopener\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">https:\/\/link.springer.com\/article\/10.1007\/s00066-018-1396-x<\/span><\/span><\/a><\/td>\n<\/tr>\n<tr>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Sarkoom (EORTC)<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">CHT<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">RHT + CHT<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">T\u00f5sise toksilisuse m\u00e4\u00e4r ei takistanud uuringu l\u00f5petamist<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">K\u00f5rge talutavus; ohutus on pikaajaline ja kinnitatud.<\/span><\/span><\/td>\n<td width=\"104\"><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/29450452\/\" target=\"_blank\" rel=\"noopener\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">https:\/\/pubmed.ncbi.nlm.nih.gov\/29450452\/<\/span><\/span><\/a><\/td>\n<\/tr>\n<tr>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">P\u00f5iev\u00e4hi IR NMI (HIVEC-1)<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Normotermiline MMC<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">H\u00fcpertermiline MMC<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">T\u00f5siste k\u00f5rvaltoimete osas erinevust ei olnud (p = 0,5)<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Raske haigestumus j\u00e4i samaks.<\/span><\/span><\/td>\n<td width=\"104\"><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/36435738\/\" target=\"_blank\" rel=\"noopener\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">https:\/\/pubmed.ncbi.nlm.nih.gov\/36435738\/<\/span><\/span><\/a><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>&nbsp;<\/p>\n<h2><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">7. J\u00e4reldused, kliiniline integratsioon ja edasised suunad<\/span><\/span><\/h2>\n<h3><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">7.1. 1A taseme l\u00f5plike n\u00e4idustuste kokkuv\u00f5te<\/span><\/span><\/h3>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">III faasi randomiseeritud uuringutel ja metaanal\u00fc\u00fcsidel p\u00f5hinev kirjanduse p\u00f5hjalik anal\u00fc\u00fcs kinnitab, et h\u00fcpertermia ei ole eksperimentaalne ravi, vaid multimodaalse onkoloogia oluline komponent teatud kasvajakohtade korral. <\/span><\/span><br \/>\n<strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">HT-l on 1A taseme t\u00f5endid l\u00f5pliku elluj\u00e4\u00e4mise, haigusvaba elluj\u00e4\u00e4mise ja t\u00e4ieliku ravivastuse kohta pehmete kudede sarkoomi, lokaalselt levinud emakakaelav\u00e4hi, pea- ja kaelav\u00e4hi, p\u00e4rasoole-\/p\u00e4rakuv\u00e4hi, melanoomi (loko-regionaalne haigus) ja rinnav\u00e4hi rindkere retsidiivi ravis [2].<\/span><\/span><\/strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> Nende n\u00e4idustuste korral tuleb HT-d pidada standardse multimodaalse ravi asendamatuks komponendiks.<\/span><\/span><\/p>\n<h3><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">7.2. Efektiivsuse ja tehnilise t\u00e4htsuse n\u00fcansid<\/span><\/span><\/h3>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">HT-ravi efektiivsus s\u00f5ltub suuresti tehnilisest t\u00e4psusest ja kuumutamisviisist. Lokoregionaalse HT m\u00e4rkimisv\u00e4\u00e4rne ja j\u00e4rjepidev edu s\u00fcgavates tahketes kasvajates (nt LACC, HNC) on vastuolus HIVEC-i poolt keskmise riskiga mitte-metaansete metaboolsete kasvajate (NMIBC) puhul saadud segaste tulemustega. <\/span><\/span><br \/>\n<span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">See kontrast r\u00f5hutab, et optimaalset kliinilist kasu ei saavutata ainult kuumuse rakendamisega, vaid see n\u00f5uab ranget kvaliteeditagamist (QA) ja tehnilist optimeerimist, et tagada \u00fchtlane ja bioloogiliselt efektiivne termiline annus kogu kasvaja mahus. Andmed n\u00e4itavad ka, et HT kasu saab jaotada riski j\u00e4rgi, olles k\u00f5ige ilmekam k\u00f5rge resistentsusega keskkondades, nagu korduv haigus, k\u00f5rge riskiga sarkoom v\u00f5i BCG-refraktaarne NMIBC.<\/span><\/span><\/p>\n<h3><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">7.3. Paljulubavad n\u00e4idustused ja tulevased kliinilised uuringud<\/span><\/span><\/h3>\n<h4><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">7.3.1. Pankreasev\u00e4hk<\/span><\/span><\/h4>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">V\u00f5rdlevad vaatlusandmed, mis n\u00e4itavad *mediaanse \u00fcldise elulemuse kahekordistumist (9 kuult 20 kuule) metastaatilise pankreasev\u00e4hi moduleeritud raadiosagedusliku h\u00fcpertermia (mHT) + s\u00fcdame isheemiat\u00f5ve (CHT) korral, kujutavad endast \u00e4\u00e4rmiselt tugevat kliinilist signaali.* Need tulemused n\u00f5uavad rahvusvaheliste randomiseeritud III faasi uuringute (n\u00e4iteks NCT02862015) kiiret algatamist, et kinnitada neid \u00fcldise elulemuse eeliseid k\u00f5rgeimal t\u00f5endustasemel.<\/span><\/span><\/p>\n<h4><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">7.3.2. Integratsioon immunoonkoloogiaga<\/span><\/span><\/h4>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Kuna HT muudab immunoloogiliselt &#8220;k\u00fclmad&#8221; kasvajad &#8220;kuumadeks&#8221; (p\u00f5letikulisteks) kasvajateks, vabastades HSP-sid ja aktiveerides T-rakke, peaksid tulevased III faasi uuringud uurima HT s\u00fcnergiat kaasaegsete immunoteraapia ainetega, n\u00e4iteks kontrollpunkti inhibiitoritega. See kombinatsioon v\u00f5ib v\u00f5imendada immunoteraapia vastuseid, eriti varem ravile allumatute kasvajate korral.<\/span><\/span><\/p>\n<p><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Kliiniline kogemus (EEAT):<\/span><\/span><\/strong><\/p>\n<p><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Andromedichyperthermias uurime neid 1A taseme protokolle ( <\/span><\/span><a href=\"https:\/\/andromedichyperthermia.com\/et\/kliiniline-uuring-hupertermia\/\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">n\u00e4iteks h\u00fcpertermia + CCRT + BRT kombinatsioon LACC puhul<\/span><\/span><\/a><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> ) ravi standardina, rakendades kliiniliste uuringute t\u00f5estatud eeliseid otse meie patsientide individuaalsetes raviplaanides.<\/span><\/span><\/strong><\/p>\n<h3><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">7.4. Kliinilise kasutuselev\u00f5tu standardid<\/span><\/span><\/h3>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">HT edukas institutsionaalne rakendamine n\u00f5uab multidistsiplinaarset ekspertiisi (meditsiinilised f\u00fc\u00fcsikud, kiiritusonkoloogid, keemiaterapeudid) ja termilise doosimeetria protokollide ranget j\u00e4rgimist. 1A taseme tulemuste taasesitamiseks peavad ravikeskused j\u00e4rgima spetsialiseeritud organisatsioonide v\u00e4ljat\u00f6\u00f6tatud rahvusvahelisi suuniseid ja standardeid.<\/span><\/span><\/p>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Tabel 4: T\u00e4rkavad n\u00e4idustused ja II faasi\/vaatlusandmed (elulemuse tulemusn\u00e4itajad)<\/span><\/span><\/p>\n<table width=\"624\">\n<thead>\n<tr>\n<td width=\"104\"><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">V\u00e4hi t\u00fc\u00fcp (HT-modaalsus)<\/span><\/span><\/strong><\/td>\n<td width=\"104\"><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Uuringu t\u00fc\u00fcp\/l\u00f5pp-punkt<\/span><\/span><\/strong><\/td>\n<td width=\"104\"><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">HT + standardne ravi (\u00fcldine elulemus\/progresseerumisvaba elulemus\/kvaliteet)<\/span><\/span><\/strong><\/td>\n<td width=\"104\"><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Ainult standardne ravi (OS\/PFS\/QoL)<\/span><\/span><\/strong><\/td>\n<td width=\"104\"><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Peamine leid\/P-v\u00e4\u00e4rtus<\/span><\/span><\/strong><\/td>\n<td width=\"104\"><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Viide<\/span><\/span><\/strong><\/td>\n<\/tr>\n<\/thead>\n<tbody>\n<tr>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Pankreasev\u00e4hk (mEHT + CHT)<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Retrospektiivne v\u00f5rdlev (OS)<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Keskmine \u00fcldine elulemus: 20 kuud<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Keskmine \u00fcldine elulemus: 9 kuud<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">OS paranes oluliselt (suhteline suurenemine 77%)<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">[Fiorentini jt, 2021]<\/span><\/span><\/td>\n<\/tr>\n<tr>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">\u00c4sja diagnoositud glioblastoom (mEHT)<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Metaanal\u00fc\u00fcs (1-aastane \u00fcldine elulemus)<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">73%<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">37%<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">M\u00e4rkimisv\u00e4\u00e4rne \u00fcldise elulemuse kasu (p=0,0021)<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">( <\/span><\/span><a href=\"https:\/\/www.mdpi.com\/2072-6694\/15\/3\/880\" target=\"_blank\" rel=\"noopener\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">https:\/\/www.mdpi.com\/2072-6694\/15\/3\/880<\/span><\/span><\/a><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> )<\/span><\/span><\/td>\n<\/tr>\n<tr>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Astrots\u00fctoom (mEHT)<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Retrospektiivne v\u00f5rdlev (OS)<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Keskmine \u00fcldine elulemus: 72 kuud<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Keskmine \u00fcldine elulemus: 17 kuud<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">\u00dcldine elulemus (OS) paranes oluliselt (p=0,0006)<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">[Fiorentini jt, 2019]<\/span><\/span><\/td>\n<\/tr>\n<tr>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">P\u00e4rasoolev\u00e4hk (pCR, funktsionaalne)<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">III faas (kolostoomiavaba elulemus)<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">87,7%<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">69,0%<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Paranenud elukvaliteet\/funktsioon (P = 0,016)<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">[III etapp, Ott 2019]<\/span><\/span><\/td>\n<\/tr>\n<tr>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Emakakaelav\u00e4hk (LACC)<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">RCT (haigusvaba haigus\/elukvaliteet)<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Paranenud emotsionaalne\/f\u00fc\u00fcsiline elukvaliteet<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Stabiilne\/langev elukvaliteet<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Elukvaliteet paranes oluliselt, ilma suurenenud toksilisuseta<\/span><\/span><\/td>\n<td width=\"104\"><a href=\"https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC8833695\/\" target=\"_blank\" rel=\"noopener\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC8833695\/<\/span><\/span><\/a><\/td>\n<\/tr>\n<tr>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">K\u00f5hukelme metastaasid (HIPEC)<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Vaatluslik \u00fclevaade (emotsionaalne QoL)<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Kiire taastumine (3 kuud p\u00e4rast operatsiooni)<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Aeglane taastumine<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Kiire ps\u00fchholoogiline kasu<\/span><\/span><\/td>\n<td width=\"104\"><a href=\"https:\/\/dmr.amegroups.org\/article\/view\/6846\/html\" target=\"_blank\" rel=\"noopener\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">https:\/\/dmr.amegroups.org\/article\/view\/6846\/html<\/span><\/span><\/a><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>&nbsp;<\/p>\n<h2><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">8. Korduma kippuvad k\u00fcsimused (KKK) onkoloogilise h\u00fcpertermia kohta<\/span><\/span><\/h2>\n<h3><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">K: Kas h\u00fcpertermia on onkoloogias eksperimentaalne ravi?<\/span><\/span><\/h3>\n<p><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">V:<\/span><\/span><\/strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> Ei. H\u00fcpertermia (HT) on t\u00f5estatud ravi, millel on *1A taseme t\u00f5endid* (p\u00f5hineb III faasi randomiseeritud uuringutel ja metaanal\u00fc\u00fcsidel) peamiste onkoloogiliste n\u00e4idustuste korral, n\u00e4iteks: pehmete kudede sarkoomid, emakakaelav\u00e4hk, korduv rinnav\u00e4hk, pahaloomuline melanoom, p\u00e4rasoolev\u00e4hk, p\u00f5iev\u00e4hk ning pea- ja kaelapiirkonna (HNC) kasvajad.<\/span><\/span><\/p>\n<h3><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">K: Milline on h\u00fcpertermia optimaalne t\u00f6\u00f6temperatuur?<\/span><\/span><\/h3>\n<p><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">A:<\/span><\/span><\/strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> Optimaalne t\u00f6\u00f6temperatuur on vahemikus *39 \u00b0C kuni 45 \u00b0C*. See &#8220;terapeutiline aken&#8221; ei ole suunatud otsesele h\u00e4vitamisele (ablatsioonile), vaid maksimeerib v\u00e4hirakkude bioloogilist sensibiliseerivat toimet keemia- ja kiiritusravi suhtes.<\/span><\/span><\/p>\n<h3><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">K: Kas h\u00fcpertermia suurendab keemiaravi v\u00f5i kiiritusravi toksilisust?<\/span><\/span><\/h3>\n<p><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">A:<\/span><\/span><\/strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> III faasi uuringute anal\u00fc\u00fcs kinnitab, et h\u00fcpertermia lisamine *ei suurenda oluliselt rasket s\u00fcsteemset toksilisust (3.\u20134. aste)*. HT-ga seotud k\u00f5rvaltoimed on valdavalt lokaalsed ja kergesti ravitavad (nt kerged nahareaktsioonid).<\/span><\/span><\/p>\n<h3><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">K: Kuidas h\u00fcpertermia parandab kiiritusravi?<\/span><\/span><\/h3>\n<p><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">A:<\/span><\/span><\/strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> H\u00fcpertermia toimib tugeva radiosensibilisaatorina kahe peamise mehhanismi kaudu: *1)* See p\u00e4rsib kiirguse poolt kahjustatud DNA parandusmehhanisme ja *2)* See parandab verevoolu ja kasvaja hapnikuga varustatust, muutes varem resistentsed rakud kiirituse suhtes palju tundlikumaks.<\/span><\/span><\/p>\n<h3><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">K: Millised v\u00e4hivormid saavad h\u00fcpertermiast k\u00f5ige rohkem kasu?<\/span><\/span><\/h3>\n<p><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">A:<\/span><\/span><\/strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> 1A taseme t\u00f5endite kohaselt on elluj\u00e4\u00e4mise eelised n\u00e4idatud j\u00e4rgmiste haiguste puhul: *pehmete kudede sarkoomid, emakakaelav\u00e4hk, korduv rinnav\u00e4hk, pahaloomuline melanoom, p\u00e4rasoolev\u00e4hk, p\u00f5iev\u00e4hk ja pea- ja kaelapiirkonna v\u00e4hk.*<\/span><\/span><\/p>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Viited (viite tekst j\u00e4\u00e4b esitatuks) <\/span><\/span><br \/>\n<span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">1. \u00dclevaade praegustest kliinilistest t\u00f5enditest lokoregionaalse m\u00f5\u00f5duka h\u00fcpertermia kohta v\u00e4hi t\u00e4iendavas ravis, https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC9856725\/<\/span><\/span><\/p>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">2. T\u00e4ispikk artikkel: Onkoloogilise h\u00fcpertermia ravi registreeritud kliiniliste uuringute s\u00fcstemaatiline \u00fclevaade &#8211; Taylor &amp; Francis Online, https:\/\/www.tandfonline.com\/doi\/full\/10.1080\/02656736.2022.2076292<\/span><\/span><\/p>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">3. H\u00fcpertermia, kiiritusravi ja keemiaravi: kuumuse roll multidistsiplinaarses v\u00e4hiravis. &#8211; Jefferson Digital Commons, https:\/\/jdc.jefferson.edu\/cgi\/viewcontent.cgi?article=1070&amp;context=radoncfp<\/span><\/span><\/p>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">4. T\u00e4ispikk artikkel: H\u00fcpertermia ja immunoteraapia: kliinilised v\u00f5imalused &#8211; Taylor &amp; Francis Online, https:\/\/www.tandfonline.com\/doi\/full\/10.1080\/02656736.2019.1653499<\/span><\/span><\/p>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">5. H\u00fcpertermia v\u00e4hendab v\u00e4hirakkude invasiooni ning v\u00f5itleb keemiaravi resistentsuse ja immuunsuse v\u00e4ltimisega inimese p\u00f5iev\u00e4hi korral &#8211; PMC, https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC11575926\/<\/span><\/span><\/p>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">6. H\u00fcpertermiline mitom\u00fctsiin C keskmise riskiga mitte-lihas-invasiivsetes &#8230;, https:\/\/pubmed.ncbi.nlm.nih.gov\/36435738\/<\/span><\/span><\/p>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">7. Mitom\u00fctsiin C-ga retsirkuleeriv h\u00fcpertermiline intravesikaalne keemiaravi (HIVEC) v\u00f5rreldes BCG-ga k\u00f5rge riskiga mitte-lihas-invasiivse p\u00f5iev\u00e4hi korral, https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC8994727\/<\/span><\/span><\/p>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">8. T\u00e4ispikk artikkel: HIVEC-i efektiivsus k\u00f5rge riskiga mitte-lihaseinvasiivse p\u00f5iev\u00e4higa patsientidel, kellel on BCG vastun\u00e4idustatud, ja patsientidel, kellel BCG-ravi eba\u00f5nnestub &#8211; Taylor &amp; Francis Online, https:\/\/www.tandfonline.com\/doi\/full\/10.1080\/02656736.2021.2002435<\/span><\/span><\/p>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">9. Kasvajat ravivate v\u00e4ljade ja h\u00fcpertermia kombinatsioonil on glioblastoomirakkudes s\u00fcnergistlik terapeutiline toime STAT3 allareguleerimise kaudu &#8211; PubMed Central, https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC8984886\/<\/span><\/span><\/p>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">10. Glioblastoomide ravis moduleeritud elektroh\u00fcpertermia ja kasvajaid ravivate v\u00e4ljade metaanal\u00fc\u00fcs &#8211; MDPI, https:\/\/www.mdpi.com\/2072-6694\/15\/3\/880<\/span><\/span><\/p>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">11. Moduleeritud elektroh\u00fcpertermia integreeritud v\u00e4hiravis retsidiveerunud pahaloomulise glioblastoomi ja astrots\u00fctoomi korral: retrospektiivne mitmekeskuseline kontrollitud uuring, retrospektiivne uuring, autor:<\/span><\/span><\/p>\n<div class=\"entry-content\">\n<div class=\"container\">\n<div class=\"acf-fields \">\n<div class=\"publ-acf acf-row acf-flex\">\n<div class=\"szerzok\"><span class=\"sz-nev\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Fiorentini G <\/span><\/span><\/span>\u00a0<span class=\"sz-nev\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Sarti D <\/span><\/span><\/span>\u00a0<span class=\"sz-nev\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Milandri C <\/span><\/span><\/span>\u00a0<span class=\"sz-nev\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Dentico P <\/span><\/span><\/span>\u00a0<span class=\"sz-nev\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Mambrini A <\/span><\/span><\/span>\u00a0<span class=\"sz-nev\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Fiorentini C <\/span><\/span><\/span>\u00a0<span class=\"sz-nev\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Mattioli G <\/span><\/span><\/span>\u00a0<span class=\"sz-nev\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Casadei <\/span><\/span><\/span>\u00a0<span class=\"sz-nev\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Guadagni S<\/span><\/span><\/span><\/div>\n<\/div>\n<\/div>\n<\/div>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">12. Praegune arusaam moduleeritud elektroh\u00fcpertermiast v\u00e4hiravis -; Kosin Medical Journal, https:\/\/www.kosinmedj.org\/journal\/view.php?number=1294<\/span><\/span><\/p>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>Autoriteet ja asjatundlikkus (EEAT): Autorid : dr Veronica Iatan, MD , ja Cristian Gologan, M.Sc. , andromediaalne h\u00fcpertermia H\u00fcpertermia terapeutiline integreerimine t\u00e4nap\u00e4eva onkoloogiasse: III faasi uuringute ja metaanal\u00fc\u00fcside kriitiline anal\u00fc\u00fcs (\u00fcldise elulemuse, haigusvaba elulemuse ja t\u00e4ieliku remissiooni tulemusn\u00e4itajad) 1. H\u00fcpertermia (HT) l\u00fchikokkuv\u00f5te ja p\u00f5hiprintsiibid Onkoloogiline h\u00fcpertermia (HT) , mis on defineeritud kui kontrollitud kuumuse rakendamine&hellip;<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[903,34,108],"tags":[406,411,132,405,404,410,408,409,407],"class_list":["post-11189","post","type-post","status-publish","format-standard","hentry","category-studii-clinice-et","category-uncategorized-et","category-uudised","tag-elulemus","tag-emakakaelavahk","tag-hupertermia","tag-iii-faasi-uuringud","tag-onkoloogia","tag-sarkoom","tag-taielik-ravivastus","tag-taielik-remissioon","tag-uldine-elulemus"],"gutentor_comment":0,"_links":{"self":[{"href":"https:\/\/andromedichyperthermia.com\/et\/wp-json\/wp\/v2\/posts\/11189","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/andromedichyperthermia.com\/et\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/andromedichyperthermia.com\/et\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/andromedichyperthermia.com\/et\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/andromedichyperthermia.com\/et\/wp-json\/wp\/v2\/comments?post=11189"}],"version-history":[{"count":0,"href":"https:\/\/andromedichyperthermia.com\/et\/wp-json\/wp\/v2\/posts\/11189\/revisions"}],"wp:attachment":[{"href":"https:\/\/andromedichyperthermia.com\/et\/wp-json\/wp\/v2\/media?parent=11189"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/andromedichyperthermia.com\/et\/wp-json\/wp\/v2\/categories?post=11189"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/andromedichyperthermia.com\/et\/wp-json\/wp\/v2\/tags?post=11189"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}