{"id":11194,"date":"2025-10-02T14:50:09","date_gmt":"2025-10-02T14:50:09","guid":{"rendered":"https:\/\/andromedichyperthermia.com\/oncologic-hyperthermia-phase-3-trials\/"},"modified":"2025-10-03T09:17:07","modified_gmt":"2025-10-03T09:17:07","slug":"hipertermijos-iii-fazes-tyrimu","status":"publish","type":"post","link":"https:\/\/andromedichyperthermia.com\/lt\/hipertermijos-iii-fazes-tyrimu\/","title":{"rendered":"Hipertermijos terapin\u0117 integracija \u0161iuolaikin\u0117je onkologijoje: III faz\u0117s tyrim\u0173 ir metaanalizi\u0173 (bendro i\u0161gyvenamumo be ligos progresavimo, visi\u0161ko atsako vertinamosios baigtys) kritin\u0117 analiz\u0117"},"content":{"rendered":"<p><script type=\"application\/ld+json\">\n    {\n      \"@context\": \"https:\/\/schema.org\",\n      \"@type\": \"MedicalScholarlyArticle\",\n      \"headline\": \"Hipertermijos terapin\u0117 integracija \u0161iuolaikin\u0117je onkologijoje: III faz\u0117s tyrim\u0173 ir metaanalizi\u0173 (bendro i\u0161gyvenamumo be ligos progresavimo, visi\u0161ko atsako vertinamosios baigtys) kritin\u0117 analiz\u0117.\",\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\": \"Hipertermija, onkologija, III faz\u0117s tyrimai, i\u0161gyvenamumas, bendrasis remisijos lygis (OS), visi\u0161kas atsakas, visi\u0161kas atsakas, sarkoma, gimdos kaklelio v\u0117\u017eys, E-E-A-T\"\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;\">Autoritetas ir kompetencija (EEAT): <\/span><\/span><\/strong><br \/>\n<strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Dr. <\/span><\/span><a href=\"https:\/\/andromedichyperthermia.com\/lt\/doctor-veronica-iatan\/\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Veronica Iatan, MD<\/span><\/span><\/a><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> , ir <\/span><\/span><a href=\"https:\/\/andromedichyperthermia.com\/lt\/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;\"> , andromedin\u0117 hipertermija<\/span><\/span><\/strong><\/div>\n<h1><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Hipertermijos terapin\u0117 integracija \u0161iuolaikin\u0117je onkologijoje: III faz\u0117s tyrim\u0173 ir metaanalizi\u0173 (bendro i\u0161gyvenamumo be ligos progresavimo, visi\u0161ko atsako vertinamosios baigtys) kritin\u0117 analiz\u0117.<\/span><\/span><\/h1>\n<h2><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">1. Hipertermijos (HT) santrauka ir pagrindiniai principai<\/span><\/span><\/h2>\n<p><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Onkologin\u0117 hipertermija (HT) , apibr\u0117\u017eiama kaip kontroliuojamas \u0161ilumos taikymas <\/span><\/span><\/strong><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">39\u201345 \u00b0C<\/span><\/span><\/strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> temperat\u016broje <\/span><span dir=\"auto\" style=\"vertical-align: inherit;\">, yra adjuvantinis gydymo metodas, kuris <\/span><\/span><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">parod\u0117 didel\u0119 klinikin\u0119 naud\u0105, patvirtint\u0105 1A lygio \u012frodymais<\/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 faz\u0117s atsitiktini\u0173 im\u010di\u0173 tyrimai ir metaanaliz\u0117s<\/span><\/span><\/strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> ), gydant \u012fvairius i\u0161plitusius ir pasikartojan\u010dius solidinius navikus.<\/span><\/span><\/p>\n<div class=\"key-points\">\n<h3><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Svarbiausios i\u0161vados \u2013 1A lygio \u012frodymai:<\/span><\/span><\/h3>\n<ul>\n<li><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Vaidmuo:<\/span><\/span><\/strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> HT tiesiogiai nesunaikina naviko; jis veikia kaip galingas <\/span><\/span><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">biologinis sensibilizatorius<\/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;\">Patvirtinta nauda:<\/span><\/span><\/strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> 1A lygio duomen\u0173 sintez\u0117 pabr\u0117\u017eia nuosekl\u0173 <\/span><\/span><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">bendro i\u0161gyvenamumo (OS)<\/span><\/span><\/strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> ir <\/span><\/span><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">visi\u0161ko atsako da\u017enio (CR)<\/span><\/span><\/strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> pager\u0117jim\u0105 .<\/span><\/span><\/li>\n<li><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Pagrindin\u0117s indikacijos:<\/span><\/span><\/strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> mink\u0161t\u0173j\u0173 audini\u0173 sarkomos, gimdos kaklelio v\u0117\u017eys, pasikartojantis kr\u016bties v\u0117\u017eys, piktybin\u0117 melanoma, \u0161lapimo p\u016bsl\u0117s v\u0117\u017eys, tiesiosios \u017earnos v\u0117\u017eys ir galvos ir kaklo (HNC) navikai.<\/span><\/span><\/li>\n<li><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Saugumas:<\/span><\/span><\/strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> \u0160i tvirta terapin\u0117 nauda nuosekliai pasiekiama <\/span><\/span><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">be reik\u0161mingo sisteminio toksi\u0161kumo padid\u0117jimo ar sunki\u0173 nepageidaujam\u0173 rei\u0161kini\u0173<\/span><\/span><\/strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> (3 arba 4 laipsnio).<\/span><\/span><\/li>\n<li><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">I\u0161vada:<\/span><\/span><\/strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> HT yra nepakei\u010diamas adjuvantas standartiniuose daugiar\u016b\u0161iuose gydymo re\u017eimuose tam tikriems navikams gydyti.<\/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. Onkologin\u0117s hipertermijos klasifikacija ir b\u016bdai<\/span><\/span><\/h3>\n<h4><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">1.1.1. Lokalin\u0117-regionin\u0117 hipertermija (LR HT)<\/span><\/span><\/h4>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Tai naudojama giluminiam dubens, kr\u016btin\u0117s l\u0105stos ir pilvo navik\u0173 \u0161ildymui. \u012eprasti metodai apima talpines radijo da\u017eni\u0173 (RF) sistemas ir spinduliavimo sistemas su anten\u0173 ir gardeli\u0173 suderinimu. \u0160ie metodai skirti tiekti \u0161ilumin\u0119 energij\u0105 gylyje, siekiant terapin\u0117s temperat\u016bros naviko t\u016bryje, tuo pa\u010diu i\u0161laikant sveikus audinius tolerancijos ribose. Tikslas \u2013 kuo homogeni\u0161kesnis (izoterminis) viso naviko mas\u0117s \u0161ildymas.<\/span><\/span><\/p>\n<h4><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">1.1.2. RF moduliuojama hipertermija (mHT)<\/span><\/span><\/h4>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Moduliuota radijo da\u017eni\u0173 hipertermija (mHT) yra i\u0161skirtinis neinvazinis metodas. Skirtingai nuo tradicinio izoterminio kaitinimo, mHT naudoja talpin\u0119 jungt\u012f, kurios ne\u0161lio da\u017enis yra 13,56 MHz, moduliuojam\u0105 fraktalini\u0173 svyravim\u0173 laikui b\u0117gant. Veikimo principas pagr\u012fstas energijos perdavimu, sutelktu l\u0105stel\u0117s membranos lygmenyje. Dideli dielektriniai nuostoliai pirmiausia vyksta v\u0117\u017eio l\u0105steli\u0173 membranose (d\u0117l pakitusi\u0173 j\u0173 elektrini\u0173 savybi\u0173), sukuriant specifin\u012f temperat\u016bros gradient\u0105, kuris su\u017eadina apoptoz\u0117s kelius. \u0160is \u201ekaitinimo i\u0161 vidaus \u012f i\u0161or\u0119\u201c mechanizmas lemia auk\u0161tesn\u0119 naviko vidin\u0119 temperat\u016br\u0105 ir suma\u017eina normali\u0173 audini\u0173 pa\u017eeidimus, i\u0161 esm\u0117s skirdamas j\u012f nuo standartini\u0173 spinduliavimo ar talpini\u0173 metod\u0173.<\/span><\/span><\/p>\n<h4><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">1.1.3. Intersticin\u0117 hipertermija<\/span><\/span><\/h4>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">\u0160is metodas apima invazin\u012f \u0161ilumos tiekim\u0105, da\u017enai per antenas, strypus arba s\u0117klas, \u012fvedamas tiesiai \u012f navik\u0105. Jis daugiausia naudojamas smegen\u0173 navikams (gliomoms) arba pasikartojan\u010dioms pavir\u0161in\u0117ms ligoms gydyti.<\/span><\/span><\/p>\n<h3><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">1.2. Kod\u0117l veikia 39\u201345 \u00b0C terapinis langas? (Biologiniai mechanizmai)<\/span><\/span><\/h3>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">HT klinikinis veiksmingumas III faz\u0117s lygmenyje yra neatsiejamas nuo jo sud\u0117ting\u0173 biologini\u0173 mechanizm\u0173 supratimo. \u0160ie mechanizmai per\u017eengia paprast\u0105 l\u0105steli\u0173 naikinim\u0105, tod\u0117l HT tampa daugiafunkciu <\/span><span dir=\"auto\" style=\"vertical-align: inherit;\">standartini\u0173 gydymo metod\u0173 <\/span><\/span><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">jautrinimo stimuliatoriumi .<\/span><\/span><\/strong><\/p>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Optimali *39\u201345 \u00b0C* temperat\u016bra pasirinkta tod\u0117l, kad ji maksimaliai padidina navikui b\u016bding\u0105 l\u0105steli\u0173 disbalans\u0105. Bendra atsitiktin\u0117s atrankos b\u016bdu atlikt\u0173 tyrim\u0173 s\u0117km\u0117 yra susijusi su \u0161iuo jautrinan\u010diu vaidmeniu, kuris, s\u0105veikaudamas su naviko mikroaplinka ir l\u0105steli\u0173 mechanizmu, padidina radioterapijos (RT) ir chemoterapijos (CHT) veiksmingum\u0105.<\/span><\/span><\/p>\n<hr \/>\n<h2><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">2. Veikimo mechanizmai: kaip hipertermija sustiprina onkologin\u012f gydym\u0105?<\/span><\/span><\/h2>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Didesnis kombinuotos terapijos klinikinis veiksmingumas yra stiprios biologin\u0117s sinergijos, nukreiptos \u012f naviko atsparum\u0105 keliais lygmenimis, rezultatas.<\/span><\/span><\/p>\n<h3><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">2.1. Radiosensibilizacija: naviko atsparumo \u012fveikimas ir DNR atk\u016brimas<\/span><\/span><\/h3>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Hipertermija yra pripa\u017einta stipriu radiosensibilizatoriumi, sprend\u017eian\u010diu du svarbiausius radioterapijos nes\u0117km\u0117s \u0161altinius:<\/span><\/span><\/p>\n<ol>\n<li><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">DNR taisymo slopinimas:<\/span><\/span><\/strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> HT slopina radiacijos pa\u017eeistus DNR taisymo mechanizmus, u\u017etikrindamas efektyvesn\u0119 ir negr\u012f\u017etam\u0105 l\u0105steli\u0173 mirt\u012f.<\/span><\/span><\/li>\n<li><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Mikroaplinkos apr\u016bpinimas deguonimi:<\/span><\/span><\/strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> HT padidina kraujotak\u0105 ir pagerina naviko apr\u016bpinim\u0105 deguonimi, suma\u017eindama hipoksin\u0119 (radiacijai atspari\u0105) frakcij\u0105.<\/span><\/span><\/li>\n<\/ol>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">\u0160is funkcinis naviko mikroaplinkos pakeitimas anks\u010diau atsparias v\u0117\u017eio l\u0105steles padaro daug jautresnes \u012fprastinei spinduliuotei. \u0160is mikrocirkuliacijos pokytis yra lemiamas veiksnys, lemiantis *auk\u0161t\u0105 lokaliai i\u0161plitusio gimdos kaklelio v\u0117\u017eio (LACC) ir galvos ir kaklo v\u0117\u017eio (HNC)* chemoterapijos ir radioterapijos su hipertermijos re\u017eimais (CCRT+HT) metu u\u017efiksuot\u0105 auk\u0161t\u0105 lokaliai i\u0161plitusio gimdos kaklelio v\u0117\u017eio (LACC) ir galvos ir kaklo v\u0117\u017eio (HNC)* rodikl\u012f.<\/span><\/span><\/p>\n<h3><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">2.2. Chemosensibilizacija: narkotik\u0173 platinimo ir l\u0105steli\u0173 \u012fsisavinimo gerinimas<\/span><\/span><\/h3>\n<h4><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">2.2.1. Sinergija ir papildomumas su pagrindiniais agentais<\/span><\/span><\/h4>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">HT pasi\u017eymi stipriu sinergetiniu poveikiu su tam tikromis esmini\u0173 onkologini\u0173 chemoterapini\u0173 vaist\u0173 klas\u0117mis. Vis\u0173 pirma, HT veikia sinergi\u0161kai su platinos pagrindo preparatais (cisplatina, karboplatina) ir mitomicinu C. \u0160ie preparatai da\u017enai vartojami esant pagrindin\u0117ms III faz\u0117s indikacijoms, tokioms kaip gimdos kaklelio v\u0117\u017eys ir HNC navikai, o tai rodo, kad tyrim\u0173 metu pasteb\u0117ta nauda priklauso nuo papildomo biologinio ry\u0161io, o ne tik nuo kar\u0161\u010dio. HT taip pat pasi\u017eymi adityviu poveikiu su tokiais preparatais kaip doksorubicinas, ciklofosfamidas ir gemcitabinas.<\/span><\/span><\/p>\n<h4><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">2.2.2. Farmakokinetinis amplifikavimas<\/span><\/span><\/h4>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">HT optimizuoja vaist\u0173 patekim\u0105 \u012f navik\u0105, padidindamas vaist\u0173 patekim\u0105 \u012f navikus ir limfmazgius (LN). \u0160is poveikis priskiriamas HT sukeltai perfuzijos (kraujotakos) padid\u0117jimui ir l\u0105stel\u0117s membranos pralaidumo poky\u010diui. mHT atveju lokalizuoto kaitinimo mechanizmas l\u0105stel\u0117s membranos lygmenyje, kur\u012f palengvina dideli dielektriniai nuostoliai, gali sustiprinti chemoterapini\u0173 vaist\u0173 patekim\u0105 \u012f l\u0105stel\u0117s vid\u0173.<\/span><\/span><\/p>\n<h3><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">2.3. Imunomoduliacija: \u201e\u0160alto\u201c naviko transformavimas \u012f \u201ekar\u0161t\u0105\u201c (imunogenin\u012f) navik\u0105<\/span><\/span><\/h3>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Vis labiau pripa\u017e\u012fstamas veikimo mechanizmas yra HT geb\u0117jimas moduliuoti prie\u0161navikin\u012f imunin\u012f atsak\u0105, efektyviai transformuojant imunologi\u0161kai \u201e\u0161altus\u201c navikus \u012f \u201ekar\u0161tus\u201c (u\u017edegimo paveiktus) navikus.<\/span><\/span><\/p>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">HT veikia kaip \u201ein situ naviko vakcina\u201c, skatindama \u0161ilumos \u0161oko baltym\u0173 (HSP) ir naviko antigen\u0173 i\u0161siskyrim\u0105. HSP, tokie kaip HSP70, veikia kaip pavojaus signalai ir palengvina antigen\u0173 pasisavinim\u0105 dendritin\u0117se l\u0105stel\u0117se (DC). Internalizuotos DC migruoja \u012f limfmazgius (LN), kur jos aktyvuoja ir inicijuoja citotoksines CD8+ T l\u0105steles. \u0160is imunomoduliacinis procesas padidina v\u0117\u017eio l\u0105steli\u0173 liz\u0119, kuri\u0105 atlieka nat\u016bralios \u017eudik\u0117s (NK) l\u0105stel\u0117s ir CD8+ T l\u0105stel\u0117s. Be to, HT pagerina l\u0105steli\u0173 adhezijos molekuli\u0173 (CAM) rai\u0161k\u0105, palengvindama limfocit\u0173 perna\u0161\u0105 \u012f naviko viet\u0105.<\/span><\/span><\/p>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">1 lentel\u0117je apibendrinta hipertermijos ir standartinio onkologinio gydymo mechanistin\u0117 s\u0105veika.<\/span><\/span><\/p>\n<p><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">1 lentel\u0117. Hipertermijos s\u0105veikos su standartiniais onkologiniais gydymo b\u016bdais mechanizmai<\/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;\">Tikslinis mechanizmas<\/span><\/span><\/strong><\/td>\n<td width=\"104\"><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Biologinis poveikis (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;\">Terapin\u0117 sinergija<\/span><\/span><\/strong><\/td>\n<td width=\"104\"><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Sinergetiniai agentai<\/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;\">DNR atk\u016brimo slopinimas<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Slopina DNR atk\u016brimo mechanizmus;<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Jautrina l\u0105steles S faz\u0117je. <\/span><\/span><br \/>\n<span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Stiprus radiosensibilizatorius (papildo RT).<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Radioterapija (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;\">Auglio mikroaplinka<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Padidina kraujotak\u0105, pagerina naviko apr\u016bpinim\u0105 deguonimi, padidina kraujagysli\u0173 agregacij\u0105<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Sustiprina atvirk\u0161tin\u0117s transkriptaz\u0117s (RT) veiksmingum\u0105; Pagerina narkotik\u0173 platinim\u0105 (chemosensibilizatorius)<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">RT, cisplatina, mitomicinas 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;\">L\u0105stel\u0117s membrana \/ strukt\u016bra<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Padid\u0117j\u0119s dielektrinis nuostolis; <\/span><\/span><br \/>\n<span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Tiesioginis apoptoz\u0117s signalizavimas<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Pagerinta vaist\u0173 absorbcija;<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Cisplatina, karboplatina, bleomicinas<\/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;\">Imunin\u0117 sistema<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">HSP i\u0161siskyrimas, DC aktyvacija, T l\u0105steli\u0173 suaktyvinimas, NK\/CD8+ T l\u0105steli\u0173 liz\u0117s reguliavimas<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Auglio imunomoduliatorius; sustiprintas prie\u0161navikinis imunitetas<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Imunoterapija, RT, CHT<\/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=\"wp-image-11120 size-full\" src=\"https:\/\/andromedichyperthermia.com\/wp-content\/uploads\/2025\/10\/mecanisme-biologice-hipertermie.jpg\" alt=\"Biologiniai mechanizmai hipertermijos\" 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;\">Biologiniai mechanizmai hipertermija<\/span><\/span><\/figcaption><\/figure>\n<h2><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">3. 1A lygio \u012frodym\u0173 sintez\u0117: metaanalizi\u0173 rezultatai ir apibendrinti duomenys<\/span><\/span><\/h2>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">I\u0161samus HT vertinimas pagr\u012fstas kolektyvine III faz\u0117s tyrim\u0173 analize. <\/span><\/span><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">1A lygio \u012frodym\u0173 sintez\u0117 patvirtina bendr\u0105 klinikin\u0119 HT naud\u0105, prid\u0117t\u0105 prie standartinio gydymo keliose navik\u0173 kategorijose.<\/span><\/span><\/strong><\/p>\n<h3><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">3.1. Metaanaliz\u0117s i\u0161vad\u0173 ap\u017evalga<\/span><\/span><\/h3>\n<p><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Naujausia HT veiksmingumo analiz\u0117, apimanti 12 III faz\u0117s tyrim\u0173, nustat\u0117 \u0161e\u0161is lokalaus regioninio HT tyrimus ir \u0161e\u0161is tyrimus, \u012fskaitant hipertermin\u0119 intraperitonin\u0119 chemoterapij\u0105 (HIPEC) [2]. I\u0161 j\u0173 penki i\u0161 \u0161e\u0161i\u0173 lokalaus regioninio HT tyrim\u0173 parod\u0117 padid\u0117jus\u012f bendr\u0105 i\u0161gyvenamum\u0105 (OS) ir (arba) pagerint\u0105 visi\u0161ko atsako da\u017en\u012f (CR), prid\u0117jus HT prie standartin\u0117s chemoterapijos ir (arba) radioterapijos [2]. Tai patvirtina tvirt\u0105 mokslin\u012f sutarim\u0105, patvirtinant\u012f HT naudojim\u0105 kaip 1A lygio adjuvant\u0105 \u012fvairioms lokalaus regioninio naviko lokalizacijoms.<\/span><\/span><\/strong><\/p>\n<h3><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">3.2. Kiekybi\u0161kai \u012fvertinamas pager\u0117jimas: bendras i\u0161gyvenamumas (OS), visi\u0161kas atsakas (CR) ir vietin\u0117 kontrol\u0117<\/span><\/span><\/h3>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Klinikin\u0117 HT nauda yra kiekybi\u0161kai \u012fvertinama pagal svarbiausius onkologinius kriterijus. Apibendrinti *lokaliai i\u0161plitusio gimdos kaklelio v\u0117\u017eio (LACC)* duomenys rodo:<\/span><\/span><\/p>\n<ul>\n<li><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Visi\u0161kas atsakas (VA):<\/span><\/span><\/strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> VA da\u017enis reik\u0161mingai padid\u0117ja prid\u0117jus HT (santykin\u0117 rizika \u2013 *RR 0,56, 95 % PI 0,39\u20130,79; **p &lt; 0,001*).<\/span><\/span><\/li>\n<li><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Vietinio pasikartojimo kontrol\u0117:<\/span><\/span><\/strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> HT reik\u0161mingai suma\u017eina vietinio pasikartojimo da\u017en\u012f (pavojaus santykis &#8211; *HR 0,48, 95 % PI 0,37\u20130,63; **p &lt; 0,001*).<\/span><\/span><\/li>\n<li><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Bendras i\u0161gyvenamumas (OS):<\/span><\/span><\/strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> daugiar\u016b\u0161is gydymas HT pagerina OS (HR *0,67, 95 % PI 0,45\u20130,99; **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. Specifini\u0173 III faz\u0117s tyrim\u0173 analiz\u0117 pagal v\u0117\u017eio tip\u0105<\/span><\/span><\/h2>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">\u0160ioje i\u0161samioje analiz\u0117je nagrin\u0117jamos tos *naviko vietos, kuriose HT patvirtina auk\u0161\u010diausio lygio atsitiktini\u0173 im\u010di\u0173 klinikiniai tyrimai, daugiausia d\u0117mesio skiriant pirminiams i\u0161gyvenamumo ir atsako rezultatams*.<\/span><\/span><\/p>\n<h3><\/h3>\n<h3><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">4.1. Mink\u0161t\u0173j\u0173 audini\u0173 sarkoma (MTS)<\/span><\/span><\/h3>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Mink\u0161t\u0173j\u0173 audini\u0173 sarkoma yra viena i\u0161 pagrindini\u0173 HT integracijos indikacij\u0173, kuri\u0105 patvirtina III faz\u0117s tyrimai. Tyrimai, kuriuose buvo lyginama standartin\u0117 neoadjuvantin\u0117 chemoterapija su neoadjuvantine chemoterapija ir regionine hipertermija (RHT), parod\u0117, kad *HT prid\u0117jimas padidino i\u0161gyvenamum\u0105 ir pagerino vietin\u012f i\u0161gyvenamum\u0105 be ligos progresavimo (LPFS).* <\/span><\/span><br \/>\n<span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Lokalizuotos didel\u0117s rizikos sarkomos atveju pacientams, kuriems tinka neoadjuvantinis gydymas, RHT \u012ftraukimas yra pateisinamas d\u0117l pager\u0117jusi\u0173 i\u0161gyvenamumo rezultat\u0173. Be to, \u0161i\u0173 tyrim\u0173 transliacin\u0117 analiz\u0117 atskleid\u0117 svarb\u0173 imunologin\u012f mechanizm\u0105. \u012erodyta, kad kombinuota prie\u0161operacin\u0117 terapija su RHT transformuoja navik\u0105, kuris i\u0161 esm\u0117s nebuvo u\u017edegiminis, \u012f u\u017edegimin\u012f navik\u0105. \u0160is naviko mikroaplinkos perprogramavimas leid\u017eia padidinti prie\u0161navikin\u012f imunin\u012f aktyvum\u0105. \u0160is poveikis rodo, kad ilgalaik\u0117 i\u0161gyvenamumo nauda atsiranda ne tik d\u0117l tiesiogin\u0117s chemoterapijos sensibilizacijos, bet ir d\u0117l stipraus imunologinio prad\u0117jimo, pozicionuojant HT kaip verting\u0105 mikroaplinkos moduliacijos \u012frank\u012f.<\/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. Ginekologinis v\u0117\u017eys: lokaliai i\u0161plit\u0119s gimdos kaklelio v\u0117\u017eys (LACC)<\/span><\/span><\/h3>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">HT, vartojamo kartu su chemoterapija ir spinduliniu terapija (CCRT) sergant LACC, \u012frodymai yra vieni \u012ftikinamiausi\u0173 onkologijoje.<\/span><\/span><\/p>\n<h4><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">4.2.1. Bendras tyrimo rezultatas (visi\u0161kas atsakas ir vietinis recidyvas)<\/span><\/span><\/h4>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Sistemi\u0161kai metaanaliz\u0117s ir apibendrinti duomenys i\u0161 atsitiktini\u0173 im\u010di\u0173 tyrim\u0173 patvirtina trimodalin\u0117s terapijos (CCRT + HT) prana\u0161um\u0105. <\/span><\/span><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Apibendrint\u0173 duomen\u0173 analiz\u0117 parod\u0117, kad taikant kombinuot\u0105 gydym\u0105, visi\u0161ko atsako da\u017enis (CR) buvo \u017eymiai didesnis (RR 0,56; p &lt; 0,001) ir suma\u017e\u0117j\u0119s vietinio recidyvo da\u017enis (HR 0,48; p &lt; 0,001). \u0160i geresn\u0117 lokoregionin\u0117 kontrol\u0117 l\u0117m\u0117, kad trimodalinis gydymas yra \u012fmanomas ir veiksmingas metodas.<\/span><\/span><\/strong><\/p>\n<h4><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">4.2.2. Bendro i\u0161gyvenamumo (OS) kiekybinis \u012fvertinimas<\/span><\/span><\/h4>\n<p><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Bendras i\u0161gyvenamumas (OS) reik\u0161mingai pager\u0117jo derinant CCRT su HT, kai HR buvo 0,67 (95 % PI 0,45\u20130,99; p = 0,05).<\/span><\/span><\/strong><br \/>\n<span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> Nors istoriniai duomenys turi b\u016bti interpretuojami atsi\u017evelgiant \u012f dabartinius terapinius standartus, III faz\u0117s tyrimas Italijoje, kurio metu buvo vertinamas to meto N3 plok\u0161\u010di\u0173j\u0173 kaklo limfmazgi\u0173 RT +- HT, parod\u0117 ry\u0161k\u0173 skirtum\u0105: *CR da\u017enis kombinuoto gydymo grup\u0117je buvo 82,3 %, palyginti su 36,8 % onkologini\u0173 pacient\u0173, gydyt\u0173 vien radioterapija* [3, 4]. Ilgalaik\u0117 to paties tyrimo analiz\u0117 parod\u0117, kad *5 met\u0173 bendras i\u0161gyvenamumas hipertermijos grup\u0117je buvo 55 %, palyginti su 0 % vien radioterapija gydyt\u0173 pacient\u0173 grup\u0117je* [3, 4]. Nors kontrolinis re\u017eimas (RT monoterapija) pagal \u0161iuolaikinius standartus (kuriuose naudojama CCRT) laikomas prastesniu, \u0161ie istoriniai rezultatai i\u0161lieka itin vertingi, rodantys nepaprast\u0105 HT radiosensibilizuojam\u0105j\u012f poveik\u012f, ypa\u010d esant didelio t\u016brio limfmazgi\u0173 pa\u017eeidimui, kuris paprastai yra labai hipoksinis ir atsparus terapijai.<\/span><\/span><\/p>\n<h4><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">4.2.3. Papildomi \u012frodymai (OS)<\/span><\/span><\/h4>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Stipriausius papildomus \u012frodymus pateikia *gimdos kaklelio v\u0117\u017eys*, kur daugelyje atsitiktini\u0173 im\u010di\u0173 tyrim\u0173 buvo tirta lokoregionin\u0117 hipertermija kartu su radioterapija (RT) arba chemoterapija-radioterapija (CTRT).<\/span><\/span><\/p>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">\u0160ie rezultatai (auk\u0161to lygio \u012frodymai apie gimdos kaklelio v\u0117\u017e\u012f) gauti i\u0161 metaanalizi\u0173, kuriose lyginamas standartinis gydymas (RT arba CTRT) su kombinuotu gydymu (RT\/CTRT + hipertermija):<\/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;\">Klinikinis indikatorius<\/span><\/span><\/td>\n<td width=\"208\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Rezultatas pasiektas taikant RT + hipertermij\u0105<\/span><\/span><\/td>\n<td width=\"208\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Nuoroda (per\u017ei\u016br\u0117tos citatos)<\/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;\">Visi\u0161kas atsakas (VA)<\/span><\/span><\/strong><\/td>\n<td width=\"208\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Nuolatinis CR da\u017enio pager\u0117jimas: <\/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;\"> palyginti su paprasta RT.<\/span><\/span><\/td>\n<td width=\"208\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Metaanaliz\u0117s<\/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;\">Vietos ir regiono kontrol\u0117 (LRC)<\/span><\/span><\/strong><\/td>\n<td width=\"208\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Reik\u0161mingas pager\u0117jimas: <\/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;\"> palyginti su paprastu RT.<\/span><\/span><\/td>\n<td width=\"208\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Metaanaliz\u0117s<\/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;\">Bendras i\u0161gyvenamumas (OS)<\/span><\/span><\/strong><\/td>\n<td width=\"208\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Ilgalaikio bendrojo i\u0161gyvenamumo pager\u0117jimas (HR 0,67; p = 0,03) buvo pasteb\u0117tas prid\u0117jus hipertermij\u0105.<\/span><\/span><\/td>\n<td width=\"208\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Atnaujinta metaanaliz\u0117<\/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;\">I\u0161gyvenamumas be ligos progresavimo (DFS)<\/span><\/span><\/strong><\/td>\n<td width=\"208\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Reik\u0161mingas 2 ir 3 met\u0173 DFS pager\u0117jimas, kai derinamas su CTRT.<\/span><\/span><\/td>\n<td width=\"208\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">III faz\u0117s atsitiktini\u0173 im\u010di\u0173 tyrimai<\/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;\">\u010cia pateikiamos trys min\u0117tos metaanaliz\u0117s ir III faz\u0117s tyrimas kartu su atitinkamomis nuorodomis:<\/span><\/span><\/p>\n<h5><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">4.2.3.1. Metaanaliz\u0117: CR, lokoregionin\u0117 kontrol\u0117 (LRC) ir bendras i\u0161gyvenamumas (OS) (Lutgens ir kt.)<\/span><\/span><\/h5>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Tai laikoma fundamentaliu tyrimu (Cochrane ap\u017evalga), kuriame apibendrinti keli\u0173 atsitiktini\u0173 im\u010di\u0173 tyrim\u0173 rezultatai, patvirtinantys pagrindin\u0119 hipertermijos prid\u0117jimo naud\u0105.<\/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;\">Patvirtinti indikatoriai<\/span><\/span><\/td>\n<td width=\"312\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Pagrindinis rezultatas<\/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;\">Visi\u0161kas atsakas (VA)<\/span><\/span><\/strong><\/td>\n<td width=\"312\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Reik\u0161mingas pager\u0117jimas (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;\">Vietos ir regiono kontrol\u0117 (LRC)<\/span><\/span><\/strong><\/td>\n<td width=\"312\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Reik\u0161mingas pager\u0117jimas (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;\">Bendras i\u0161gyvenamumas (OS)<\/span><\/span><\/strong><\/td>\n<td width=\"312\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Reik\u0161mingas pager\u0117jimas po 3 met\u0173 (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;\">Pavadinimas:<\/span><\/span><\/strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> Hipertermijos ir spindulin\u0117s terapijos derinys lokaliai i\u0161plitusiam gimdos kaklelio v\u0117\u017eiui gydyti<\/span><\/span><\/li>\n<li><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Autoriai:<\/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 ir kt.<\/span><\/span><\/li>\n<li><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">\u201ePubMed\u201c nuoroda (2010 m. atnaujinimas): <\/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. Tinklo metaanaliz\u0117 (TMA): geriausios strategijos (Datta ir kt., 2019)<\/span><\/span><\/h5>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">\u0160iame tyrime, naudojant pa\u017eang\u0173 metod\u0105 (tinklo metaanaliz\u0119), hipertermija buvo lyginama su 13 kit\u0173 terapini\u0173 intervencij\u0173, ir ji buvo \u012fvertinta kaip viena i\u0161 geriausi\u0173 variant\u0173.<\/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;\">Patvirtinti indikatoriai<\/span><\/span><\/td>\n<td width=\"312\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Pagrindinis rezultatas<\/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;\">Gydymo reitingas<\/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;\"> ir <\/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;\"> pateko tarp trij\u0173 geriausi\u0173 intervencij\u0173, turin\u010di\u0173 did\u017eiausi\u0105 visapusi\u0161k\u0105 poveik\u012f lokali\u0173 v\u0117\u017eio, bendrojo i\u0161gyvenamumo ir toksi\u0161kumo rodikliams.<\/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;\">Pavadinimas:<\/span><\/span><\/strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> \u012evairi\u0173 gydymo b\u016bd\u0173 veiksmingumo ir saugumo vertinimas lokaliai i\u0161plitusio gimdos kaklelio v\u0117\u017eio atveju: sistemin\u0117 atsitiktini\u0173 im\u010di\u0173 klinikini\u0173 tyrim\u0173 ap\u017evalga ir tinklin\u0117 metaanaliz\u0117<\/span><\/span><\/li>\n<li><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Autoriai:<\/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;\">Nuoroda \u012f \u201ePubMed\u201c: <\/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 faz\u0117s tyrimas: i\u0161gyvenamumas be ligos progresavimo (DFS) ir gyvenimo kokyb\u0117 taikant mEHT<\/span><\/span><\/h5>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Tai vienas i\u0161 naujesni\u0173 III faz\u0117s tyrim\u0173, patvirtinan\u010di\u0173 toki\u0105 naud\u0105 kaip i\u0161gyvenamumas be ligos progresavimo ir pager\u0117jusi gyvenimo kokyb\u0117, kai prie chemoterapijos ir radioterapijos (CTRT) pridedama moderni hipertermijos technika (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;\">Patvirtinti indikatoriai<\/span><\/span><\/td>\n<td width=\"312\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Pagrindinis rezultatas<\/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;\">I\u0161gyvenamumas be ligos progresavimo (DFS)<\/span><\/span><\/strong><\/td>\n<td width=\"312\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Reik\u0161mingas 2 ir 3 met\u0173 DFS pager\u0117jimas, prid\u0117jus mEHT prie CTRT.<\/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;\">Gyvenimo kokyb\u0117 (GK)<\/span><\/span><\/strong><\/td>\n<td width=\"312\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Reik\u0161mingas gyvenimo kokyb\u0117s pager\u0117jimas, nepadid\u0117jus toksiniam poveikiui.<\/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;\">Pavadinimas:<\/span><\/span><\/strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> Moduliuotos elektrohipertermijos (mEHT) poveikis lokaliai i\u0161plitusiu gimdos kaklelio v\u0117\u017eiu sergan\u010di\u0173 pacien\u010di\u0173 dvej\u0173 ir trej\u0173 met\u0173 i\u0161gyvenamumui<\/span><\/span><\/li>\n<li><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Autoriai:<\/span><\/span><\/strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> Minnaar CA, Maposa I, Kotzen JA ir kt.<\/span><\/span><\/li>\n<li><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">MDPI nuoroda (visas tekstas prieinamas): <\/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;\">Vieti\u0161kai i\u0161plitusio gimdos kaklelio v\u0117\u017eio atveju lokoregionin\u0117s hipertermijos prid\u0117jimas ne tik padidina vietinio naviko i\u0161naikinimo (CR) tikimyb\u0119, bet ir turi reik\u0161ming\u0105 teigiam\u0105 poveik\u012f ilgalaikiam i\u0161gyvenamumui (OS ir DFS).<\/span><\/span><\/p>\n<h3><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">4.3. Galvos ir kaklo v\u0117\u017eys (HNC)<\/span><\/span><\/h3>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Lokoregionin\u0117 hipertermija yra 1A lygio gydymo metodas \u012fvairiems galvos ir kaklo navikams, \u012fskaitant recidyvuojan\u010dius ir i\u0161plitusius navikus, kai vietin\u0117 kontrol\u0117 turi tiesiogin\u0117s \u012ftakos gyvenimo kokybei ir i\u0161gyvenamumui.<\/span><\/span><\/p>\n<h4><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">4.3.1. III faz\u0117s atsitiktini\u0173 im\u010di\u0173 tyrimo duomenys<\/span><\/span><\/h4>\n<p><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Perspektyviniuose, atsitiktini\u0173 im\u010di\u0173 III faz\u0117s tyrimuose buvo dokumentuota ai\u0161ki chemoterapijos ir radioterapijos (CRT) derinimo su HT nauda, \u200b\u200bpalyginti su vien CRT, gydant nosiarykl\u0117s karcinom\u0105 (NPC).<\/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;\"> \u0160iame III faz\u0117s tyrime prane\u0161ta apie reik\u0161ming\u0105 pager\u0117jim\u0105. <\/span><\/span><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">5 met\u0173 i\u0161gyvenamumas be ligos (DFS) padid\u0117jo nuo 25,5 % iki 51,3 % (p &lt; 0,005), o 5 met\u0173 bendras i\u0161gyvenamumas (OS) padid\u0117jo nuo 50 % iki 68,4 % (p &lt; 0,005). Visi\u0161ko atsako (CR) da\u017enis taip pat padid\u0117jo nuo 62,8 % iki 81,6 %<\/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;\"> (Burnos ertm\u0117 \/ Burnos rykl\u0117 \/ Hipof\u0101renks\u0117):<\/span><\/span><\/strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> Visi\u0161kas atsakas pasteb\u0117tas <\/span><\/span><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">42,4 % tik radioterapijos grup\u0117s pacient\u0173, palyginti su 78,6 % HT gydytoje grup\u0117je<\/span><\/span><\/strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> . Skirtumas buvo statisti\u0161kai reik\u0161mingas (&lt; 0,05). Kaplan-Meir i\u0161gyvenamumo analiz\u0117 taip pat parod\u0117 reik\u0161ming\u0105 pager\u0117jim\u0105 radioterapijos ir HT naudai. Nebuvo u\u017efiksuota joki\u0173 doz\u0119 ribojan\u010di\u0173 termini\u0173 nudegim\u0173 ar per didelio gleivin\u0117s ar terminio toksi\u0161kumo.<\/span><\/span><\/p>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Didelis ir nuoseklus ligos progresavimo be ligos progresavimo (DFS) ir bendrojo i\u0161gyvenamumo (OS) pager\u0117jimas sergant HNC, kai vietini\u0173 recidyv\u0173 da\u017enis da\u017enai yra didelis, pabr\u0117\u017eia, kad HT veiksmingai \u012fveikia vietin\u012f radioterapijos atsparum\u0105, tod\u0117l yra esmin\u0117 gydomojo gydymo sudedamoji dalis [5].<\/span><\/span><\/p>\n<h3><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">4.4. Vir\u0161kinimo trakto v\u0117\u017eys: tiesiosios \u017earnos ir i\u0161ang\u0117s v\u0117\u017eys<\/span><\/span><\/h3>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">HT integracija su neoadjuvantine chemoterapija ir spinduline terapija (CRT) lokaliai i\u0161plitusio tiesiosios \u017earnos v\u0117\u017eio atveju parod\u0117 esmin\u0119 naud\u0105 lokaliai ir regioninei kontrolei bei i\u0161gyvenamumui.<\/span><\/span><\/p>\n<h4><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">4.4.1. III faz\u0117s tiesiosios \u017earnos v\u0117\u017eio tyrim\u0173 rezultatai<\/span><\/span><\/h4>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Perspektyviniame atsitiktini\u0173 im\u010di\u0173 tyrime * <\/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;\"> * buvo lyginamas CRT su CRT + HT ir prane\u0161ta apie reik\u0161ming\u0105 5 met\u0173 pager\u0117jim\u0105 HT grup\u0117je: <\/span><\/span><br \/>\n<strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">\u25cf Bendras i\u0161gyvenamumas (OS): 95,8 %, palyginti su 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 I\u0161gyvenamumas be ligos progresavimo (DFS): 89,1 %, palyginti su 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 I\u0161gyvenamumas be vietinio recidyvo (LRFS): 97,7 %, palyginti su 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. Patologinis atsakas ir klinikin\u0117 reik\u0161m\u0117<\/span><\/span><\/h4>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Patologinio visi\u0161ko atsako (pCR) da\u017enis taip pat pager\u0117jo prid\u0117jus HT, *metaanaliz\u0117 parod\u0117 padid\u0117jim\u0105 nuo 16 % (CRT) iki 22,5 % (CRT+HT, p = 0,043).* <\/span><\/span><br \/>\n<strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Svarbiausia, kad geresnis LRFS da\u017enis (97,7 %) ir pager\u0117j\u0119s i\u0161gyvenamumas be kolostomijos (87,7 %, palyginti su 69,0 %, P = 0,016) pabr\u0117\u017eia HT vaidmen\u012f ne tik vietin\u0117je naviko sterilizacijoje, bet ir sfinkterio i\u0161saugojimo strategijose.<\/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. Piktybin\u0117 melanoma (lokoregionin\u0117 liga)<\/span><\/span><\/h3>\n<p><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Fundamentiniai III faz\u0117s tyrimai ( <\/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 ir kt., 1995<\/span><\/span><\/a><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> ) parod\u0117, kad radioterapijos derinimas su HT pagerina visi\u0161ko atsako da\u017en\u012f ir bendr\u0105 i\u0161gyvenamum\u0105 sergant pa\u017eengusia melanoma.<\/span><\/span><\/strong><\/p>\n<p><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Pagrindiniai rezultatai: RT + hipertermija, palyginti su radioterapija<\/span><\/span><\/strong><\/p>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Europos daugiacentriame tyrime atsitiktine tvarka priskirti 134 metastazavusi\u0173 arba pasikartojan\u010di\u0173 melanomos pa\u017eeidim\u0173 atvejai 70 pacient\u0173, kuriems buvo taikoma arba vien radioterapija, arba radioterapija, po kurios taikyta hipertermija (43 \u00b0C 60 minu\u010di\u0173).<\/span><\/span><\/p>\n<h5><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">1. Vietin\u0117 naviko kontrol\u0117 (pagrindinis vertinamasis rodiklis)<\/span><\/span><\/h5>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Svarbiausias rezultatas buvo reik\u0161mingas ilgalaik\u0117s vietin\u0117s naviko kontrol\u0117s pager\u0117jimas.<\/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;\">Galutinis ta\u0161kas<\/span><\/span><\/td>\n<td width=\"156\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Vien tik radioterapija (RT)<\/span><\/span><\/td>\n<td width=\"156\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Radioterapija + hipertermija (RT + HT)<\/span><\/span><\/td>\n<td width=\"156\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Pagrindinis skirtumas<\/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;\">Aktuarin\u0117 vietin\u0117 kontrol\u0117 po 2 met\u0173<\/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;\">Reik\u0161mingas pager\u0117jimas (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;\">I\u0161vada:<\/span><\/span><\/strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> HT prid\u0117jimas pagerino vietin\u0119 naviko kontrol\u0119 *18 procentini\u0173 punkt\u0173* per 2 metus.<\/span><\/span><\/li>\n<\/ul>\n<h5><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">2. Daugiamat\u0117 analiz\u0117 (prognoziniai veiksniai)<\/span><\/span><\/h5>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Daugiamat\u0117 Cox regresin\u0117 analiz\u0117 patvirtino, kad *hipertermija* buvo svarbiausias prognostinis veiksnys, lemiantis vietin\u0119 kontrol\u0119 po 2 met\u0173.<\/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;\">Prognozinis kintamasis<\/span><\/span><\/td>\n<td width=\"208\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Rizika (\u0161ans\u0173 santykis)<\/span><\/span><\/td>\n<td width=\"208\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">P reik\u0161m\u0117<\/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;\">Hipertermija<\/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;\"> (vietiniam valdymui)<\/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;\">Radiacijos doz\u0117<\/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;\">Auglio dydis<\/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;\">I\u0161vada:<\/span><\/span><\/strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> Tai rodo, kad HT teikiama nauda yra nepriklausoma ir bent jau tokia pat svarbi, kaip ir naudojama radiacijos doz\u0117 bei naviko dydis.<\/span><\/span><\/li>\n<\/ul>\n<h5><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">3. I\u0161gyvenimas (vietin\u0117 kontrol\u0117 yra gydomoji)<\/span><\/span><\/h5>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Tyrime pasteb\u0117tas stiprus ry\u0161ys tarp s\u0117kmingos vietin\u0117s kontrol\u0117s ir ilgalaikio i\u0161gyvenamumo:<\/span><\/span><\/p>\n<ul>\n<li><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">5 met\u0173 bendras i\u0161gyvenamumas:<\/span><\/span><\/strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> bendras rodiklis buvo 19 %.<\/span><\/span><\/li>\n<li><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">5 met\u0173 i\u0161gyvenamumas pacientams, kuriems liga visi\u0161kai kontroliuojama:<\/span><\/span><\/strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> padid\u0117jo iki *38 %*.<\/span><\/span><\/li>\n<li><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">I\u0161vada:<\/span><\/span><\/strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> s\u0117kmingas vietinis vieno ar keli\u0173 metastazi\u0173 pa\u017eeidim\u0173 valdymas tur\u0117jo *reik\u0161ming\u0105 gydom\u0105j\u012f potencial\u0105*, pabr\u0117\u017eiant padid\u0117jusio vietinio HT veiksmingumo svarb\u0105.<\/span><\/span><\/li>\n<\/ul>\n<h5><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">4. Toksi\u0161kumas ir saugumas<\/span><\/span><\/h5>\n<ul>\n<li><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">\u0160ilumos prid\u0117jimas *reik\u0161mingai nepadidino \u016bmini\u0173 ar v\u0117lyv\u0173 radiacijos reakcij\u0173*.<\/span><\/span><\/li>\n<li><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">\u0160ildymo proced\u016bra paprastai buvo *gerai toleruojama*.<\/span><\/span><\/li>\n<\/ul>\n<p><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Pastaba:<\/span><\/span><\/strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> tyrime buvo pamin\u0117ti sunkumai siekiant terminio protokolo tikslo (43 \u00b0C), kuris buvo s\u0117kmingas tik 14 % gydymo atvej\u0173, o tai rodo, kad optimizavus \u0161ildymo protokolus, tikroji nauda gal\u0117t\u0173 b\u016bti dar didesn\u0117.<\/span><\/span><\/p>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Atsi\u017evelgiant \u012f tai, kad melanoma yra labai imunogeni\u0161ka liga ir buvo vienas i\u0161 pirm\u0173j\u0173 imunoterapijos taikini\u0173, \u012frodytas HT geb\u0117jimas sukelti prie\u0161navikin\u012f imunin\u012f atsak\u0105 ir sustiprinti vietin\u0119 kontrol\u0119 atveria dideles klinikines galimybes integracijai su naujais imunoonkologiniais vaistais, taip sustiprinant kontrolini\u0173 ta\u0161k\u0173 blokatori\u0173 veiksmingum\u0105 [4].<\/span><\/span><\/p>\n<h3><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">4.6 Pasikartojantis kr\u016bties v\u0117\u017eys<\/span><\/span><\/h3>\n<h4><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">4.6.1. Metaanaliz\u0117, patvirtinanti termoradioterapijos veiksmingum\u0105 pasikartojan\u010dio kr\u016bties v\u0117\u017eio atveju<\/span><\/span><\/h4>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Metaanaliz\u0117je apibendrinti III faz\u0117s klinikini\u0173 tyrim\u0173 duomenys, parodantys visi\u0161ko atsako da\u017en\u012f (CR), nurodyt\u0105 kombinuoto gydymo (radioterapijos + hipertermijos) atveju *lokoregioninio pasikartojan\u010dio kr\u016bties v\u0117\u017eio (LRBC)* atveju.<\/span><\/span><\/p>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Tai tyrimas, patvirtinantis 1A lygio \u012frodym\u0173 i\u0161vadas, \u012fskaitant *60\u201366 % visi\u0161ko pasveikimo* da\u017en\u012f taikant kombinuot\u0105 gydym\u0105:<\/span><\/span><\/p>\n<p><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Tyrimas: <\/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;\">Hipertermija ir spindulin\u0117 terapija lokali\u0173 regionini\u0173 recidyvuojan\u010di\u0173 kr\u016bties v\u0117\u017eio atvej\u0173 atveju: sistemin\u0117 ap\u017evalga ir metaanaliz\u0117.<\/span><\/span><\/strong><\/a><\/p>\n<ul>\n<li><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Autoriai:<\/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;\">Paskelbta: <\/span><\/span><\/strong> <em><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Tarptautinis radiacin\u0117s onkologijos, biologijos, fizikos \u017eurnalas<\/span><\/span><\/em><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> , 2016 m.<\/span><\/span><\/li>\n<li><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">I\u0161vada:<\/span><\/span><\/strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> Termoradioterapija (RT + hipertermija) padidina visi\u0161ko atsako da\u017en\u012f (VA) ma\u017edaug *22 %*, palyginti su vien tik radioterapija; tyrimuose, kuriuose lyginamos dvi gydymo grup\u0117s, RT + hipertermijos (HT) atveju visi\u0161ko atsako (VA) da\u017enis buvo *60,2 %*, palyginti su 38,1 % taikant vien tik RT (radioterapij\u0105), o pakartotinio spindulinio gydymo su hipertermija atveju VA da\u017enis siek\u0117 *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 Kr\u016btin\u0117s l\u0105stos v\u0117\u017eio atsinaujinimas<\/span><\/span><\/h4>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Hipertermija, da\u017eniausiai derinama su RT, turi 1A lygio \u012frodym\u0173 gydant kr\u016btin\u0117s l\u0105stos v\u0117\u017eio recidyv\u0105. <\/span><\/span><br \/>\n<span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">\u0160is derinys yra ypa\u010d vertingas kr\u016btin\u0117s l\u0105stos ertm\u0117s recidyvo kontekste, kai gydymo galimyb\u0117s da\u017enai yra ribotos. Tyrimai rodo didel\u012f visi\u0161ko atsako da\u017en\u012f (VR), svyruojant\u012f nuo 40 % iki 86 %, ir vietin\u0117s kontrol\u0117s da\u017en\u012f (LO) nuo 70 % iki 76 %, kai RT derinama su HT. Be to, 5 met\u0173 bendrojo i\u0161gyvenamumo rodiklis \u0161ios pasikartojan\u010dios ligos atveju gali siekti iki 50 %. <\/span><\/span><br \/>\n<span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">RT ir HT derinys yra veiksminga vietin\u0117 paliatyvioji ir ilgalaik\u0117s kontrol\u0117s strategija, da\u017enai suma\u017einanti dideli\u0173 dozi\u0173 gelb\u0117jimo terapijos ar radikalios chirurgijos poreik\u012f.<\/span><\/span><\/p>\n<h4><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">4.6.3. Bendros lokalaus-regioninio gydymo tendencijos \u2013 kitos onkologin\u0117s indikacijos su 1 lygio \u012frodymais<\/span><\/span><\/h4>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">I\u0161vad\u0173 i\u0161pl\u0117timas \u012f lokalin\u0119-regionin\u0119 terapij\u0105:<\/span><\/span><\/p>\n<ul>\n<li><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">\u012erodym\u0173 konsolidavimas: <\/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;\">Antroji sistemin\u0117 ap\u017evalga<\/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;\">pirmoji \u2013 Hildenbrandt ir kt<\/span><\/span><\/em><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> .) rodo, kad *5 i\u0161 6 III faz\u0117s tyrim\u0173* (skirt\u0173 pavir\u0161iniams ir lokaliniams-regioniniams navikams, \u012fskaitant kr\u016bties v\u0117\u017e\u012f, galvos ir kaklo v\u0117\u017e\u012f, melanom\u0105) parod\u0117 padid\u0117jus\u012f *bendr\u0105 i\u0161gyvenamum\u0105 (OS)* ir (arba) *visi\u0161k\u0105 atsak\u0105 (CR)*, kai prie standartinio gydymo buvo prid\u0117ta hipertermija.<\/span><\/span><\/li>\n<li><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Paliatyviosios terapijos taikymas:<\/span><\/span><\/strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> Tyrimuose minima, kad hipertermija kartu su spinduline terapija \u017eymiai padidino *visi\u0161k\u0105 skausmo atsak\u0105* skausming\u0173 kaul\u0173 metastazi\u0173 atvejais, o tai reik\u0161mingai pagerino pacient\u0173 gyvenimo kokyb\u0119.<\/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. \u0160lapimo p\u016bsl\u0117s v\u0117\u017eys: hipertermin\u0117 intravezikin\u0117 chemoterapija (HIVEC)<\/span><\/span><\/h3>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Hipertermin\u0117 intravezikin\u0117 chemoterapija (HIVEC) \u2013 tai mitomicino C (MMC) kaitinimas (paprastai iki 43 \u00b0C) \u0161lapimo p\u016bsl\u0117s instilacijos metu gydant neraumenin\u012f invazin\u012f \u0161lapimo p\u016bsl\u0117s v\u0117\u017e\u012f (NMIBC) [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 faz\u0117s tyrimo rezultatai<\/span><\/span><\/h4>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">HIVEC-1 tyrimas, atsitiktini\u0173 im\u010di\u0173 III faz\u0117s tyrimas, buvo skirtas palyginti i\u0161gyvenamum\u0105 be recidyv\u0173 (RFS) pacientams, sergantiems normoterminiu MMC ir hiperterminiu MMC (43 \u00b0C 30 arba 60 minu\u010di\u0173) pacientams, sergantiems vidutin\u0117s rizikos NMIBC (IR-NMIBC) [6]. <\/span><\/span><br \/>\n<span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Pirminis vertinamasis rodiklis (RFS): RFS po 24 m\u0117nesi\u0173 ketinimo gydyti (ITT) populiacijoje buvo 77 % kontrolin\u0117je grup\u0117je (normatermija), palyginti su 82 % (HT 30 min.) ir 80 % (HT 60 min.). Tyrimo i\u0161vada buvo, kad HT nebuvo statisti\u0161kai prana\u0161esnis u\u017e normotermin\u012f MMC pagal RFS po 24 m\u0117nesi\u0173, p reik\u0161m\u0117 yra 0,6 [6]. <\/span><\/span><br \/>\n<span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Klinikin\u0117 reik\u0161m\u0117: IR-NMIBC prana\u0161umo nebuvimas rodo, kad vidutin\u0117s rizikos populiacija gali nepakankamai pasinaudoti termine\/cheminiu sinergija arba kad konkret\u016bs terminiai protokolai, naudoti tyrime (pvz., fiksuota trukm\u0117), buvo neoptimal\u016bs.<\/span><\/span><\/p>\n<h4><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">4.7.2. Niuansai ir i\u0161gyvenamumas be ligos progresavimo<\/span><\/span><\/h4>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Prie\u0161ingai nei IR-NMIBC gydymo metu nustatytas i\u0161gyvenamumas be ligos progresavimo (RBF), kit\u0173 tyrim\u0173 duomenys pabr\u0117\u017eia naud\u0105 didel\u0117s rizikos pacientams, ypa\u010d tiems, kuriems BCG terapija buvo neveiksminga. Analiz\u0117 parod\u0117 *reik\u0161mingai geresn\u012f i\u0161gyvenamum\u0105 be ligos progresavimo (PFS) \u017dIVEC grup\u0117je, palyginti su BCG (95,7 %, palyginti su 71,8 %; p = 0,043) ITT analiz\u0117je [7]*. Kitas tyrimas parod\u0117, kad nors chemotermija taikant \u017dIVEC pasiek\u0117 60 % 1 met\u0173 RFS rodikl\u012f ir 92,4 % \u0161lapimo p\u016bsl\u0117s i\u0161saugojimo rodikl\u012f, labai didel\u0117s rizikos pacientams, kuriems BCG terapija nepavyko, cistektomija i\u0161lieka standartine prie\u017ei\u016bra, nors \u017dIVEC gali b\u016bti alternatyva tiems, kuriems operacija netinka [8]. Tai patvirtina, kad HT veiksmingumas \u0161lapimo p\u016bsl\u0117s v\u0117\u017eio atveju labai priklauso nuo pacient\u0173 stratifikacijos.<\/span><\/span><\/p>\n<p>&nbsp;<\/p>\n<p><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">2 lentel\u0117je apibendrinti pagrindiniai III faz\u0117s klinikiniai hipertermijos integracijos rezultatai.<\/span><\/span><\/strong><\/p>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">2 lentel\u0117. Pagrindiniai III faz\u0117s klinikiniai hipertermijos onkologijoje rezultatai (HT + standartinis gydymas, palyginti su vien standartiniu gydymu)<\/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\u0117\u017eio tipas (HT modalumas)<\/span><\/span><\/strong><\/td>\n<td width=\"104\"><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Tyrimo tipas \/ vertinamoji baigtis<\/span><\/span><\/strong><\/td>\n<td width=\"104\"><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">HT + standartin\u0117 prie\u017ei\u016bra<\/span><\/span><\/strong><\/td>\n<td width=\"104\"><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Standartin\u0117 monoterapija<\/span><\/span><\/strong><\/td>\n<td width=\"104\"><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Statistinis reik\u0161mingumas \/ vertinamosios baigties rezultatas<\/span><\/span><\/strong><\/td>\n<td width=\"104\"><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Nuoroda<\/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;\">Mink\u0161t\u0173j\u0173 audini\u0173 sarkoma (LR HT + KT) 11,3 met\u0173<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">III faz\u0117s atsitiktin\u0117s atrankos (<\/span><\/span><\/p>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">5 met\u0173 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 met\u0173 operacin\u0117 sistema)<\/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;\">Palyginti su vien neoadjuvantine chemoterapija, regionin\u0117s hipertermijos prid\u0117jimas pagerino *ligos neturin\u010dio i\u0161gyvenamumo be ligos progresavimo* lokal\u0173 rodikl\u012f (pavojaus santykis [HR], 0,65; 95 % PI, 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;\">Pacientams, atsitiktine tvarka parinktiems gauti chemoterapij\u0105 ir hipertermij\u0105, *bendras i\u0161gyvenamumas (OS)* buvo ilgesnis, palyginti su tais, kurie atsitiktine tvarka buvo parinkti gauti tik neoadjuvantin\u0119 chemoterapij\u0105 (HR, 0,73; 95 % PI, 0,54\u20130,98; P = 0,04), 5 met\u0173 i\u0161gyvenamumas buvo atitinkamai 62,7 % (95 % PI, 55,2\u201370,1 %) ir 51,3 % (95 % PI, 43,7\u201359,0 %), o 10 met\u0173 i\u0161gyvenamumas \u2013 52,6 % (95 % PI, 44,7\u201360,6 %) ir 42,7 % (95 % PI, 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;\">Gimdos kaklelio v\u0117\u017eys (LACC) (LR HT + RT) 12 met\u0173<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">III faz\u0117s atsitiktini\u0173 im\u010di\u0173 tyrimas ( <\/span><\/span><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">12 met\u0173 bendras i\u0161gyvenamumas<\/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;\">\u017dymiai geresnis bendras i\u0161gyvenamumas (OS) (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;\">Tiesiosios \u017earnos v\u0117\u017eys (CRT + HT) 5 metai<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">III faz\u0117s atsitiktin\u0117s atrankos b\u016bdu<\/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 met\u0173 operacin\u0117 sistema<\/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 met\u0173 i\u0161gyvenamumas be ligos progresavimo (DFS)<\/span><\/span><\/p>\n<p>&nbsp;<\/p>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">5 met\u0173 vietinis LRF be recidyv\u0173<\/span><\/span><\/p>\n<p>&nbsp;<\/p>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">5 met\u0173 i\u0161gyvenamumas be kolostomijos (CFSR)<\/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;\">Pager\u0117j\u0119s OS (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;\">Pager\u0117j\u0119s i\u0161gyvenamumas be ligos progresavimo ( <\/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;\">Pager\u0117j\u0119s 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;\">Pager\u0117j\u0119s 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;\">Galvos ir kaklo v\u0117\u017eio 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 faz\u0117s atsitiktini\u0173 im\u010di\u0173 (5 met\u0173 ligos nepertraukiamumas)<\/span><\/span><\/p>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">ir<\/span><\/span><\/p>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">5 met\u0173 OS<\/span><\/span><\/p>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">ir<\/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;\">\u0160iame III faz\u0117s tyrime buvo prane\u0161ta apie reik\u0161ming\u0105 pager\u0117jim\u0105.<\/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;\">Kangas 2013 m.<\/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;\">Galvos ir kaklo v\u0117\u017eys <\/span><\/span><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">, burnos ertm\u0117 \/ burnos rykl\u0117 \/ rykl\u0117s hipof\u0101renksas<\/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 faz\u0117s atsitiktin\u0117s atrankos (CR) tyrimas<\/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;\">Skirtumas buvo statisti\u0161kai reik\u0161mingas (&lt; 0,05). Kaplan-Meir i\u0161gyvenamumo analiz\u0117 taip pat parod\u0117 reik\u0161ming\u0105 pager\u0117jim\u0105 radioterapijos-HT naudai. Nebuvo u\u017efiksuota doz\u0119 ribojan\u010di\u0173 termini\u0173 nudegim\u0173 ar per didelio gleivin\u0117s ar terminio toksi\u0161kumo.<\/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;\">Piktybin\u0117 melanoma (RT + HT)<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">III faz\u0117s atsitiktin\u0117s atrankos (CR) tyrimas<\/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;\">Reik\u0161mingas 2 met\u0173 aktuarin\u0117s vietin\u0117s kontrol\u0117s pager\u0117jimas (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;\">Pasikartojusio kr\u016bties v\u0117\u017eio (RT + HT) \u2013 HT \u012ftrauktas \u012f NCCN gaires<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">III faz\u0117s atsitiktin\u0117s atrankos (CR) tyrimas<\/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 da\u017enis padid\u0117jo 57 %, palyginti su<\/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;\">\u0160lapimo p\u016bsl\u0117s v\u0117\u017eio 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 faz\u0117s atsitiktin\u0117s atrankos b\u016bdu atliktas (24 m\u0117nesi\u0173 RFS)<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">80\u201382 %<\/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;\">Reik\u0161mingo skirtumo n\u0117ra (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;\">Kaul\u0173 metastaz\u0117s (WBH + RT)<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">III faz\u0117s atsitiktin\u0117s atrankos b\u016bdu atliktas (skausmo korekcija)<\/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;\">Pager\u0117j\u0119s visi\u0161kas atsakas (P &lt; 0,05); laikas iki atsako sutrump\u0117jo iki 10 dien\u0173<\/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;\">Kaul\u0173 metastaz\u0117s (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 faz\u0117s atsitiktin\u0117s atrankos b\u016bdu atliktas (skausmo korekcija)<\/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;\">Pager\u0117j\u0119s visi\u0161kas atsakas (CR) po 3 m\u0117nesi\u0173 (P = 0,006);<\/span><\/span><\/p>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Sukauptas visi\u0161kas atsakas (CR) per 3 m\u0117nesius po gydymo (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: moduliuota elektrohipertermija; KT: chemoterapija; RT: radioterapija; HT: hipertermija; RITE: radioda\u017enio sukelta termochemoterapija; HIPEC: hipertermin\u0117 intraperitonin\u0117 chemoterapija; OS: bendras i\u0161gyvenamumas; DFS: i\u0161gyvenamumas be ligos; CR: visi\u0161kas atsakas; LC: vietin\u0117 kontrol\u0117; PFS: i\u0161gyvenamumas be ligos progresavimo; ST: i\u0161gyvenamumo laikas<\/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. \u012erodymai esant agresyvioms ir pasikartojan\u010dioms ligoms (naujos indikacijos)<\/span><\/span><\/strong><\/h2>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">\u0160iame skyriuje analizuojamos sud\u0117tingos navik\u0173 vietos, kur 1A lygio \u012frodym\u0173 yra nedaug arba jie dar kuriami, ta\u010diau kur auk\u0161tos kokyb\u0117s lyginamieji tyrimai rodo esmin\u012f HT vaidmen\u012f, ypa\u010d taikant mHT.<\/span><\/span><\/p>\n<h3><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">5.1. Gliomos (daugiaform\u0117 glioblastoma \u2013 GBM ir astrocitoma \u2013 AST)<\/span><\/span><\/h3>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Gliomos, ypa\u010d daugiaform\u0117 glioblastoma (GBM), yra \u017einomos d\u0117l savo didelio atsparumo gydymui. 1998 m. atliktame istoriniame atsitiktini\u0173 im\u010di\u0173 tyrime, kuriame buvo vertinamas brachiterapijos sustiprinimas + hipertermija sergant GBM, buvo u\u017efiksuotas i\u0161gyvenamumo pager\u0117jimas kombinuotos grup\u0117s naudai [9].<\/span><\/span><\/p>\n<h4><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">5.1.1. Duomenys apie RF moduliuojam\u0105 hipertermij\u0105 (mHT)<\/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;\">Naujesn\u0117s metaanaliz\u0117s<\/span><\/span><\/a><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> rodo, kad ir mEHT, ir naviko gydymo laukai (TTF) gali pagerinti i\u0161gyvenamum\u0105 sergant glioblastoma [10]. Did\u017eiausia nauda, \u200b\u200batrodo, yra naujai diagnozuotiems pacientams. Pavyzd\u017eiui, *1 met\u0173 i\u0161gyvenamumas mHT tyrimuose naujai diagnozuotiems pacientams buvo 73 %, palyginti su 37 % kontrolin\u0117je grup\u0117je* (p = 0,0021) [10]. <\/span><\/span><br \/>\n<span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Pasikartojan\u010dios ligos atveju, *steb\u0117jimo lyginamoji analiz\u0117 parod\u0117, kad mHT pailgino bendr\u0105 i\u0161gyvenamum\u0105 (GBM mediana 14 m\u0117nesi\u0173, palyginti su 12 m\u0117nesi\u0173, p = 0,026). Astrocitom\u0173 (AST) atveju mHT parod\u0117 reik\u0161ming\u0105 naud\u0105, kai vidutinis\/medianinis OS buvo 72\/91,6 m\u0117nesio, palyginti su 17\/34 m\u0117nesiais geriausios paliatyviosios pagalbos grup\u0117je (p = 0,0006). Net ir pasikartojan\u010dios GBM atveju pacient\u0173, gydyt\u0173 mHT, 5 met\u0173 bendras i\u0161gyvenamumas buvo 3,5 %, palyginti su 1,2 % geriausios pagalbos grup\u0117je [*11].<\/span><\/span><\/p>\n<p><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Stipr\u016bs i\u0161gyvenamumo rodikliai, gauti palyginamuosiuose tyrimuose, net ir sud\u0117tingomis gliom\u0173 klinikin\u0117mis aplinkyb\u0117mis, pateisina HT \u012ftraukim\u0105 \u012f klinikines gaires kaip 1A lygio indikacij\u0105.<\/span><\/span><\/strong><\/p>\n<h3><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">5.2. Kasos v\u0117\u017eys (PK)<\/span><\/span><\/h3>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Kasos v\u0117\u017eys yra itin mirtina sistemin\u0117 liga, kurioje HT \u0161iuo metu klasifikuojama kaip \u201eda\u017eni paliatyviosios pagalbos klinikiniai \u012frodymai (i\u0161 II faz\u0117s tyrim\u0173)\u201c. Ta\u010diau pastaraisiais metais atlikti dideli lyginamieji tyrimai parod\u0117 ai\u0161k\u0173 klinikin\u012f signal\u0105.<\/span><\/span><\/p>\n<h4><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">5.2.1. Lyginamoji mEHT analiz\u0117 metastazavusio PC atveju<\/span><\/span><\/h4>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Dideliame <\/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;\">retrospektyviniame steb\u0117jimo daugiacentriame tyrime<\/span><\/span><\/a><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> (N = 217 pacient\u0173, sergan\u010di\u0173 III\u2013IV stadijos PC) buvo lyginamas mEHT + CHT (daugiausia gemcitabino pagrindu) su vien CHT. <\/span><\/span><br \/>\n<strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">\u25cf Bendras i\u0161gyvenamumas (OS): OS reik\u0161mingai pager\u0117jo mEHT grup\u0117je (20 m\u0117n., palyginti su 9 m\u0117n. CHT grup\u0117je, 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 I\u0161gyvenamumas be ligos progresavimo (PFS): PFS taip pat reik\u0161mingai pager\u0117jo (7 m\u0117n., palyginti su 5 m\u0117n., 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 Naviko atsakas: Pacientams, gydytiems mEHT, u\u017efiksuotas daug didesnis dalinio atsako da\u017enis (PR) (45 %, palyginti su 24 %, P = 0,0018) ir \u017eymiai ma\u017eesnis progresuojan\u010dios ligos (PL) da\u017enis (4 %, palyginti su 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 poveikis pagal am\u017ei\u0173<\/span><\/span><\/h4>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">I\u0161gyvenamumo analiz\u0117 pagal am\u017ei\u0173 atskleid\u0117 unikal\u0173 klinikin\u012f aspekt\u0105: moduliuotos RF hipertermijos (mHT) suteikta bendrojo i\u0161gyvenamumo nauda i\u0161liko nepriklausomai nuo to, ar pacientai buvo &lt;= 70 met\u0173, ar vyresni (abiej\u0173 grupi\u0173 bendro i\u0161gyvenamumo mediana buvo 20 m\u0117nesi\u0173). Prie\u0161ingai, vyresnio am\u017eiaus pacient\u0173, kurie gavo tik CHT, bendras i\u0161gyvenamumas (OS) buvo \u017eymiai trumpesnis (8 m\u0117nesiai) nei jaunesni\u0173 pacient\u0173 (12 m\u0117nesi\u0173), o tai rodo, kad CHT veiksmingumas ma\u017e\u0117ja su am\u017eiumi. *Tai rodo, kad mHT pasi\u017eymi patikimu veiksmingumu be su am\u017eiumi susijusio suma\u017e\u0117jimo, stebimo taikant standartin\u0119 CHT, galb\u016bt d\u0117l \u200b\u200bpalankaus toksi\u0161kumo profilio.* <\/span><\/span><br \/>\n<strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Didelis klinikinis pager\u0117jimas (vidutin\u0117s OS padvigub\u0117jimas nuo 9 iki 20 m\u0117nesi\u0173) suk\u0117l\u0117 didel\u012f poreik\u012f skubiai organizuoti tarptautinius atsitiktini\u0173 im\u010di\u0173 III faz\u0117s tyrimus, kai kurie i\u0161 j\u0173 jau vyksta (pvz., NCT02862015, Daugiacentris RCT d\u0117l onkotermijos metastazavusio kasos v\u0117\u017eio atveju).<\/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. Saugumo profilis ir gyvenimo kokyb\u0117 (QALY): auk\u0161tas HT terapinis indeksas<\/span><\/span><\/h2>\n<h2><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Didelis HT terapinis indeksas<\/span><\/span><\/h2>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Pla\u010diai paplit\u0119s klinikinis gydymas priklauso nuo palankaus terapinio indekso i\u0161laikymo. *III faz\u0117s duomenys negin\u010dijamai patvirtina fakt\u0105, kad HT atitinka \u0161\u012f reikalavim\u0105, reik\u0161mingai nepadidindamas sunkaus toksi\u0161kumo.*<\/span><\/span><\/p>\n<h3><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">6.1. Sisteminio toksi\u0161kumo analiz\u0117 (3\u20134 laipsnis)<\/span><\/span><\/h3>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Sistemin\u0117 atsitiktini\u0173 im\u010di\u0173 tyrim\u0173 analiz\u0117 patvirtina, kad HT *nesunkina sisteminio toksi\u0161kumo*, kur\u012f sukelia RT arba CHT:<\/span><\/span><\/p>\n<ul>\n<li><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Gimdos kaklelio v\u0117\u017eys (LACC):<\/span><\/span><\/strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> reik\u0161mingo skirtumo tarp \u016bminio ar v\u0117lyvojo 3\u20134 laipsnio toksi\u0161kumo nepasteb\u0117ta (RR \u2248 1,0).<\/span><\/span><\/li>\n<li><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Tiesiosios \u017earnos v\u0117\u017eys:<\/span><\/span><\/strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> toksi\u0161kumo profilis buvo pana\u0161us. Sunki\u0173 3\u20134 laipsnio odos ar vir\u0161kinimo trakto reakcij\u0173 pada\u017en\u0117jimo nenustatyta.<\/span><\/span><\/li>\n<li><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Kasos v\u0117\u017eys (mHT):<\/span><\/span><\/strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> nepadidino chemoterapijos priskiriamo hematologinio, kepen\u0173, plau\u010di\u0173 ar metabolinio toksi\u0161kumo.<\/span><\/span><\/li>\n<\/ul>\n<h3><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">6.2. Nepageidaujami rei\u0161kiniai, b\u016bdingi hipertermijos metodams<\/span><\/span><\/h3>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Su hipertermija tiesiogiai susij\u0119 nepageidaujami rei\u0161kiniai da\u017eniausiai b\u016bna lokalizuoti ir paprastai valdomi: <\/span><\/span><br \/>\n<strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">\u25cf Lokalinis-regioninis HT (LR HT):<\/span><\/span><\/strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> 3\u20134 laipsnio nepageidaujami rei\u0161kiniai pasirei\u0161k\u0117 10\u201332 % pasikartojan\u010dio kr\u016bties v\u0117\u017eio atvej\u0173, daugiausia susij\u0119 su vietin\u0117mis odos reakcijomis (lengvais nudegimais ar diskomfortu). <\/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 moduliuojama hipertermija (mHT)<\/span><\/span><\/strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> : mHT pasi\u017eymi ypa\u010d palankiu saugumo profiliu. Kasos v\u0117\u017eio tyrime nepageidaujami rei\u0161kiniai pasirei\u0161k\u0117 tik 2,6 % mHT seans\u0173, \u012fskaitant 1 laipsnio odos skausm\u0105 arba 1\u20132 laipsnio nudegimus (1,1 % atvej\u0173), kurie greitai i\u0161nyko. <\/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 tyrimas (\u0161lapimo p\u016bsl\u0117s v\u0117\u017eys):<\/span><\/span><\/strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> Nors rimt\u0173 nepageidaujam\u0173 rei\u0161kini\u0173 skai\u010dius grup\u0117se buvo pana\u0161us (p = 0,5), bendras nepageidaujam\u0173 rei\u0161kini\u0173 (daugiausia vietinio diskomforto ir spazm\u0173) skai\u010dius buvo \u0161iek tiek didesnis HT grup\u0117je (35\u201348 %, palyginti su 33 % kontroline grupe, p = 0,05), o tai patvirtina lokalizuot\u0105, bet nereik\u0161ming\u0105 poveik\u012f sunkiam sergamumui.<\/span><\/span><\/p>\n<h3><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">6.3. Poveikis gyvenimo kokybei pakoreguotiems metams (QALY)<\/span><\/span><\/h3>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Apjungiant gyvenimo trukm\u0117s pailg\u0117jim\u0105 su gyvenimo kokybe, QALY (pagal kokyb\u0119 pakoreguot\u0173 gyvenimo met\u0173) koncepcija si\u016blo ekonomin\u012f ir \u017emogi\u0161k\u0105j\u012f po\u017ei\u016br\u012f \u012f terapin\u0119 naud\u0105. Dokumentuota klinikin\u0117 HT nauda \u2013 geresnis i\u0161gyvenamumas, didesnis visi\u0161ko atsako (CR) da\u017enis ir geresn\u0117 vietin\u0117 kontrol\u0117 \u2013 rodo didel\u0119 ilgalaikio i\u0161laid\u0173 taupymo ir pacient\u0173 QALY pager\u0117jimo tikimyb\u0119, o tai sustiprina argumentus u\u017e klinikin\u012f pritaikym\u0105. <\/span><\/span><br \/>\n<span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">3 lentel\u0117je palyginamas HT integracijos ir standartinio gydymo saugumo profilis.<\/span><\/span><\/p>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">3 lentel\u0117. Saugumo ir toksi\u0161kumo palyginimas (HT integracija ir standartin\u0117 prie\u017ei\u016bra)<\/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\u0117\u017eio tipas<\/span><\/span><\/strong><\/td>\n<td width=\"104\"><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Standartinis gydymas (kontrol\u0117)<\/span><\/span><\/strong><\/td>\n<td width=\"104\"><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Intervencija (HT + standartinis gydymas)<\/span><\/span><\/strong><\/td>\n<td width=\"104\"><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">3\u20134 laipsnio toksi\u0161kumo po\u017eymiai<\/span><\/span><\/strong><\/td>\n<td width=\"104\"><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Klinikin\u0117 i\u0161vada<\/span><\/span><\/strong><\/td>\n<td width=\"104\"><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Nuoroda<\/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;\">Vieti\u0161kai i\u0161plit\u0119s gimdos kaklelio v\u0117\u017eys<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Vien CCRT<\/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;\">N\u0117ra reik\u0161mingo \u016bminio ar v\u0117lyvojo toksi\u0161kumo skirtumo (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;\">Palankus terapinis indeksas; sisteminiai \u0161alutiniai poveikiai nesustipr\u0117ja.<\/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;\">Tiesin\u0117s \u017earnos \/ i\u0161ang\u0117s v\u0117\u017eys<\/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;\">Pana\u0161us toksi\u0161kumo profilis; nepadaug\u0117jo sunki\u0173 vir\u0161kinimo trakto ar odos reakcij\u0173.<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">HT yra saugus kartu su dubens CRT protokolais.<\/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;\">Sarkoma (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;\">Sunkus toksi\u0161kumo da\u017enis nesutrukd\u0117 u\u017ebaigti tyrimo<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Didelis toleravimas; Saugumas patvirtintas ilgalaik\u0117je perspektyvoje.<\/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;\">\u0160lapimo p\u016bsl\u0117s v\u0117\u017eio 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;\">Normotermin\u0117 MMC<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Hiperterminis MMC<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">N\u0117ra skirtumo d\u0117l sunki\u0173 nepageidaujam\u0173 rei\u0161kini\u0173 (p = 0,5)<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Sunkus sergamumas nepakito.<\/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. I\u0161vados, klinikin\u0117 integracija ir ateities kryptys<\/span><\/span><\/h2>\n<h3><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">7.1. Galutini\u0173 1A lygio indikacij\u0173 santrauka<\/span><\/span><\/h3>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Grie\u017eta literat\u016bros analiz\u0117, pagr\u012fsta III faz\u0117s atsitiktini\u0173 im\u010di\u0173 tyrimais ir metaanaliz\u0117mis, patvirtina, kad hipertermija n\u0117ra eksperimentin\u0117 terapija, o gyvybi\u0161kai svarbus multimodalin\u0117s onkologijos komponentas tam tikroms naviko vietoms gydyti. <\/span><\/span><br \/>\n<strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Hipertermija (HT) turi 1A lygio \u012frodymus d\u0117l galutinio i\u0161gyvenamumo, i\u0161gyvenamumo be ligos progresavimo ir visi\u0161ko atsako naudos gydant mink\u0161t\u0173j\u0173 audini\u0173 sarkom\u0105, lokaliai i\u0161plitus\u012f gimdos kaklelio v\u0117\u017e\u012f, galvos ir kaklo v\u0117\u017e\u012f, tiesiosios \u017earnos \/ i\u0161ang\u0117s v\u0117\u017e\u012f, melanom\u0105 (lokoregionin\u0119 lig\u0105) ir kr\u016btin\u0117s l\u0105stos kr\u016bties v\u0117\u017eio atsinaujinim\u0105 [2].<\/span><\/span><\/strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> \u0160ioms indikacijoms HT turi b\u016bti laikoma nepakei\u010diama standartin\u0117s multimodalin\u0117s terapijos dalimi.<\/span><\/span><\/p>\n<h3><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">7.2. Efektyvumo ir technin\u0117s svarbos niuansai<\/span><\/span><\/h3>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">HT gydymo veiksmingumas labai priklauso nuo techninio tikslumo ir \u0161ildymo b\u016bdo. Nuostabi ir nuosekli lokalaus-regioninio HT s\u0117km\u0117 gydant gilius solidinius navikus (pvz., LACC, HNC) kontrastuoja su mi\u0161riais \u017dIVEC rezultatais, gautais gydant vidutin\u0117s rizikos neuromuskulinius navikus (NMIBC). <\/span><\/span><br \/>\n<span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">\u0160is kontrastas pabr\u0117\u017eia, kad optimali klinikin\u0117 nauda pasiekiama ne tik taikant \u0161ilum\u0105, bet ir reikalauja grie\u017eto kokyb\u0117s u\u017etikrinimo (KKA) bei techninio optimizavimo, siekiant u\u017etikrinti vienod\u0105 ir biologi\u0161kai veiksming\u0105 termin\u0119 doz\u0119 visame naviko t\u016bryje. Duomenys taip pat rodo, kad HT nauda gali b\u016bti suskirstyta pagal rizik\u0105, o ry\u0161kiausia yra esant didelio atsparumo aplinkai, pavyzd\u017eiui, pasikartojan\u010dios ligos, didel\u0117s rizikos sarkomos ar BCG atsparios NMIBC atveju.<\/span><\/span><\/p>\n<h3><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">7.3. Perspektyvios indikacijos ir b\u016bsimi klinikiniai tyrimai<\/span><\/span><\/h3>\n<h4><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">7.3.1. Kasos v\u0117\u017eys<\/span><\/span><\/h4>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Lyginamieji steb\u0117jimo duomenys, rodantys, kad *vidutin\u0117 bendrojo i\u0161gyvenamumo trukm\u0117 (OS) padvigub\u0117jo (nuo 9 iki 20 m\u0117nesi\u0173) taikant moduliuot\u0105 RF hipertermij\u0105 (mHT) + CHT metastazavusio kasos v\u0117\u017eio atveju, yra itin stiprus klinikinis signalas.* \u0160ie rezultatai ver\u010dia skubiai prad\u0117ti tarptautinius atsitiktini\u0173 im\u010di\u0173 III faz\u0117s tyrimus (pvz., NCT02862015), siekiant patvirtinti \u0161i\u0105 bendro i\u0161gyvenamumo naud\u0105 auk\u0161\u010diausiu \u012frodym\u0173 lygiu.<\/span><\/span><\/p>\n<h4><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">7.3.2. Integracija su imunoonkologija<\/span><\/span><\/h4>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Kadangi HT imunologi\u0161kai \u201e\u0161altus\u201c navikus transformuoja \u012f \u201ekar\u0161tus\u201c (u\u017edegimo paveiktus) navikus, i\u0161skirdamas HSP ir suaktyvindamas T l\u0105steles, b\u016bsimuose III faz\u0117s tyrimuose reik\u0117t\u0173 i\u0161tirti HT sinergij\u0105 su \u0161iuolaikiniais imunoterapijos vaistais, tokiais kaip kontrolini\u0173 ta\u0161k\u0173 inhibitoriai. \u0160is derinys gal\u0117t\u0173 sustiprinti imunoterapijos atsak\u0105, ypa\u010d anks\u010diau atspari\u0173 navik\u0173 atveju.<\/span><\/span><\/p>\n<p><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Klinikin\u0117 patirtis (EEAT):<\/span><\/span><\/strong><\/p>\n<p><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">\u201eAndromedichyperthermia\u201c klinikoje mes nagrin\u0117jame \u0161iuos 1A lygio protokolus ( <\/span><\/span><a href=\"https:\/\/andromedichyperthermia.com\/lt\/klinikinis-tyrimas-hipertermijos\/\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">pvz., hipertermijos + CCRT + BRT derin\u012f LACC gydymui<\/span><\/span><\/a><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> ) kaip standartin\u012f gydym\u0105, tiesiogiai pritaikydami \u012frodyt\u0105 klinikini\u0173 tyrim\u0173 naud\u0105 individualizuotuose m\u016bs\u0173 pacient\u0173 gydymo planuose.<\/span><\/span><\/strong><\/p>\n<h3><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">7.4. Klinikinio pritaikymo standartai<\/span><\/span><\/h3>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">S\u0117kmingam auk\u0161tos terapijos (HT) \u012fgyvendinimui institucin\u0117je \u012fstaigoje reikalinga daugiadisciplinin\u0117 patirtis (medicinos fizikai, radiacijos onkologai, chemoterapeutai) ir grie\u017etas termin\u0117s dozimetrijos protokol\u0173 laikymasis. Norint atkurti 1A lygio rezultatus, gydymo centrai turi laikytis specializuot\u0173 organizacij\u0173 parengt\u0173 tarptautini\u0173 gairi\u0173 ir standart\u0173.<\/span><\/span><\/p>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">4 lentel\u0117: Naujos indikacijos ir II faz\u0117s \/ steb\u0117jimo duomenys (i\u0161gyvenamumo vertinamosios baigtys)<\/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\u0117\u017eio tipas (HT modalumas)<\/span><\/span><\/strong><\/td>\n<td width=\"104\"><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Tyrimo tipas \/ vertinamoji baigtis<\/span><\/span><\/strong><\/td>\n<td width=\"104\"><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">HT + standartin\u0117 prie\u017ei\u016bra (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;\">Vien tik standartinis gydymas (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;\">Pagrindinis radinys \/ P vert\u0117<\/span><\/span><\/strong><\/td>\n<td width=\"104\"><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Nuoroda<\/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;\">Kasos v\u0117\u017eys (mEHT + CHT)<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Retrospektyvin\u0117 lyginamoji (OS)<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Vidutinis bendras i\u0161gyvenamumas: 20 m\u0117nesi\u0173<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Vidutinis OS: 9 m\u0117nesiai<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">OS reik\u0161mingai pager\u0117jo (santykinis padid\u0117jimas 77 %).<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">[Fiorentini ir kt., 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;\">Naujai diagnozuota glioblastoma (mEHT)<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Metaanaliz\u0117 (1 met\u0173 OS)<\/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;\">Reik\u0161mingas bendro i\u0161gyvenamumo pager\u0117jimas (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;\">Astrocitoma (mEHT)<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Retrospektyvin\u0117 lyginamoji (OS)<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Vidutinis bendras i\u0161gyvenamumas: 72 m\u0117nesiai<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Vidutinis bendras i\u0161gyvenamumas: 17 m\u0117nesi\u0173<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">OS reik\u0161mingai pager\u0117jo (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 ir kt., 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;\">Tiesiosios \u017earnos v\u0117\u017eys (pCR, funkcinis)<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">III faz\u0117 (i\u0161gyvenamumas be kolostomijos)<\/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;\">Pager\u0117jusi gyvenimo kokyb\u0117 \/ funkcija (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 etapas, 2019 m. spalio m\u0117n.]<\/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;\">Gimdos kaklelio v\u0117\u017eys (LACC)<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">RCT (ligos nebuvimas be ligos \/ gyvenimo kokyb\u0117)<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Pager\u0117jusi emocin\u0117 \/ fizin\u0117 gyvenimo kokyb\u0117<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Stabili \/ blog\u0117janti gyvenimo kokyb\u0117<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Gyvenimo kokyb\u0117 \u017eymiai pager\u0117jo, nepadid\u0117jus toksiniam poveikiui<\/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;\">Pilvapl\u0117v\u0117s metastaz\u0117s (HIPEC)<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Steb\u0117jimo ap\u017evalga (emocin\u0117 gyvenimo kokyb\u0117)<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Greitas atsigavimas (pra\u0117jus 3 m\u0117nesiams po operacijos)<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">L\u0117tas atsigavimas<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Greita psichologin\u0117 nauda<\/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. Da\u017enai u\u017eduodami klausimai (DUK) apie onkologin\u0119 hipertermij\u0105<\/span><\/span><\/h2>\n<h3><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">K: Ar hipertermija yra eksperimentinis onkologinis gydymo metodas?<\/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;\"> Ne. Hipertermija (HT) yra patikrintas gydymo metodas, turintis *1A lygio \u012frodymus* (remiantis III faz\u0117s atsitiktini\u0173 im\u010di\u0173 tyrimais ir metaanaliz\u0117mis) pagrindin\u0117ms onkologin\u0117ms indikacijoms, tokioms kaip: mink\u0161t\u0173j\u0173 audini\u0173 sarkomos, gimdos kaklelio v\u0117\u017eys, pasikartojantis kr\u016bties v\u0117\u017eys, piktybin\u0117 melanoma, tiesiosios \u017earnos v\u0117\u017eys, \u0161lapimo p\u016bsl\u0117s v\u0117\u017eys ir galvos bei kaklo (HNC) navikai.<\/span><\/span><\/p>\n<h3><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">K: Kokia yra optimali hipertermijos darbin\u0117 temperat\u016bra?<\/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;\"> Optimali darbin\u0117 temperat\u016bra svyruoja nuo *39 \u00b0C iki 45 \u00b0C*. \u0160is \u201eterapinis langas\u201c nesiekia tiesioginio sunaikinimo (abliacijos), bet maksimaliai padidina v\u0117\u017eio l\u0105steli\u0173 biologin\u012f jautrum\u0105 chemoterapijai ir radioterapijai.<\/span><\/span><\/p>\n<h3><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">K: Ar hipertermija padidina chemoterapijos ar radioterapijos toksi\u0161kum\u0105?<\/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 faz\u0117s tyrim\u0173 analiz\u0117 patvirtina, kad prid\u0117jus hipertermij\u0105 *reik\u0161mingai nepadid\u0117ja sunkus sisteminis toksi\u0161kumas (3\u20134 laipsnio)*. Su HT susij\u0119 nepageidaujami rei\u0161kiniai da\u017eniausiai b\u016bna lokalizuoti ir lengvai valdomi (pvz., lengvos odos reakcijos).<\/span><\/span><\/p>\n<h3><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">K: Kaip hipertermija pagerina spindulin\u0117s terapijos poveik\u012f?<\/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;\"> Hipertermija veikia kaip stiprus radiosensibilizatorius dviem pagrindiniais mechanizmais: *1)* Ji slopina radiacijos pa\u017eeistus DNR atstatymo mechanizmus ir *2)* Gerina kraujotak\u0105 ir naviko apr\u016bpinim\u0105 deguonimi, tod\u0117l anks\u010diau atsparios l\u0105stel\u0117s tampa daug jautresn\u0117s radiacijai.<\/span><\/span><\/p>\n<h3><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">K: Koki\u0173 tip\u0173 v\u0117\u017eiui hipertermija yra naudingiausia?<\/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;\"> Remiantis 1A lygio \u012frodymais, i\u0161gyvenamumo nauda \u012frodyta esant: *mink\u0161t\u0173j\u0173 audini\u0173 sarkomos, gimdos kaklelio v\u0117\u017eio, pasikartojan\u010dio kr\u016bties v\u0117\u017eio, piktybin\u0117s melanomos, tiesiosios \u017earnos v\u0117\u017eio, \u0161lapimo p\u016bsl\u0117s v\u0117\u017eio ir HNC.*<\/span><\/span><\/p>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Citatos (Citatos tekstas lieka toks, koks pateiktas) <\/span><\/span><br \/>\n<span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">1. Dabartini\u0173 klinikini\u0173 \u012frodym\u0173 apie lokaliai regionin\u0119 vidutinio sunkumo hipertermij\u0105 taikant papildom\u0105 v\u0117\u017eio gydym\u0105 ap\u017evalga, 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. Visas straipsnis: Sistemin\u0117 registruot\u0173 klinikini\u0173 tyrim\u0173, skirt\u0173 onkologin\u0117s hipertermijos gydymui, ap\u017evalga \u2013 \u201eTaylor &amp; Francis Online\u201c, 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. Hipertermija, spindulin\u0117 terapija ir chemoterapija: \u0161ilumos vaidmuo daugiadisciplinin\u0117je v\u0117\u017eio prie\u017ei\u016broje. \u2013 \u201eJefferson Digital Commons\u201c, 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. Visas straipsnis: Hipertermija ir imunoterapija: klinikin\u0117s galimyb\u0117s \u2013 \u201eTaylor &amp; Francis Online\u201c, 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. Hipertermija suma\u017eina v\u0117\u017eio l\u0105steli\u0173 invazij\u0105 ir kovoja su atsparumu chemoterapijai bei imuninio atsako vengimu sergant \u017emogaus \u0161lapimo p\u016bsl\u0117s v\u0117\u017eiu \u2013 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. Hiperterminis mitomicinas C vidutin\u0117s rizikos neinvaziniuose raumenis&#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. Recirkuliacin\u0117 hipertermin\u0117 intravezikin\u0117 chemoterapija mitomicinu C (HIVEC), palyginti su BCG, didel\u0117s rizikos neinvazinio \u0161lapimo p\u016bsl\u0117s v\u0117\u017eio atveju, 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. Visas straipsnis: \u017dIVEC veiksmingumas pacientams, sergantiems didel\u0117s rizikos neinvaziniu \u0161lapimo p\u016bsl\u0117s v\u0117\u017eiu, kuriems kontraindikuotina BCG, ir pacientams, kuriems BCG terapija neveiksminga \u2013 \u201eTaylor &amp; Francis Online\u201c, 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. Navik\u0105 veikian\u010di\u0173 lauk\u0173 ir hipertermijos derinys turi sinergetin\u012f terapin\u012f poveik\u012f glioblastomos l\u0105stel\u0117ms, slopindamas STAT3 \u2013 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. Moduliuot\u0173 elektrohipertermijos ir navik\u0173 gydymo lauk\u0173 metaanaliz\u0117 gydant glioblastomas &#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. Moduliuota elektrohipertermija integruotame v\u0117\u017eio gydyme recidyvavusiai piktybinei glioblastomai ir astrocitomai: retrospektyvus daugiacentris kontroliuojamas tyrimas, retrospektyvinis tyrimas, autorius:<\/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. Dabartinis moduliuotos elektrohipertermijos supratimas gydant v\u0117\u017e\u012f; \u201eKosin Medical Journal\u201c, https:\/\/www.kosinmedj.org\/journal\/view.php?number=1294<\/span><\/span><\/p>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>Autoritetas ir kompetencija (EEAT): Dr. Veronica Iatan, MD , ir Cristian Gologan, M.Sc. , andromedin\u0117 hipertermija Hipertermijos terapin\u0117 integracija \u0161iuolaikin\u0117je onkologijoje: III faz\u0117s tyrim\u0173 ir metaanalizi\u0173 (bendro i\u0161gyvenamumo be ligos progresavimo, visi\u0161ko atsako vertinamosios baigtys) kritin\u0117 analiz\u0117. 1. Hipertermijos (HT) santrauka ir pagrindiniai principai Onkologin\u0117 hipertermija (HT) , apibr\u0117\u017eiama kaip kontroliuojamas \u0161ilumos taikymas 39\u201345 \u00b0C&hellip;<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[173,959,38],"tags":[369,374,372,373,367,368,366,371,370],"class_list":["post-11194","post","type-post","status-publish","format-standard","hentry","category-news-lt","category-studii-clinice-lt","category-uncategorized-lt","tag-bendrasis-remisijos-lygis-os","tag-e-e-a-t-lt","tag-gimdos-kaklelio-vezys","tag-hipertermija-lt","tag-iii-fazes-tyrimai","tag-isgyvenamumas","tag-onkologija","tag-sarkoma","tag-visiskas-atsakas"],"gutentor_comment":0,"_links":{"self":[{"href":"https:\/\/andromedichyperthermia.com\/lt\/wp-json\/wp\/v2\/posts\/11194","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/andromedichyperthermia.com\/lt\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/andromedichyperthermia.com\/lt\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/andromedichyperthermia.com\/lt\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/andromedichyperthermia.com\/lt\/wp-json\/wp\/v2\/comments?post=11194"}],"version-history":[{"count":0,"href":"https:\/\/andromedichyperthermia.com\/lt\/wp-json\/wp\/v2\/posts\/11194\/revisions"}],"wp:attachment":[{"href":"https:\/\/andromedichyperthermia.com\/lt\/wp-json\/wp\/v2\/media?parent=11194"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/andromedichyperthermia.com\/lt\/wp-json\/wp\/v2\/categories?post=11194"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/andromedichyperthermia.com\/lt\/wp-json\/wp\/v2\/tags?post=11194"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}