{"id":11193,"date":"2025-10-02T14:50:09","date_gmt":"2025-10-02T14:50:09","guid":{"rendered":"https:\/\/andromedichyperthermia.com\/oncologic-hyperthermia-phase-3-trials\/"},"modified":"2025-10-03T09:21:57","modified_gmt":"2025-10-03T09:21:57","slug":"hipertermijas-iii-fazes-petijumu","status":"publish","type":"post","link":"https:\/\/andromedichyperthermia.com\/lv\/hipertermijas-iii-fazes-petijumu\/","title":{"rendered":"Hipertermijas terapeitisk\u0101 integr\u0101cija m\u016bsdienu onkolo\u0123ij\u0101: III f\u0101zes p\u0113t\u012bjumu un metaanal\u012b\u017eu kritiska anal\u012bze (OS, DFS, CR galapunkti)"},"content":{"rendered":"<p><script type=\"application\/ld+json\">\n    {\n      \"@context\": \"https:\/\/schema.org\",\n      \"@type\": \"MedicalScholarlyArticle\",\n      \"headline\": \"Hipertermijas terapeitisk\u0101 integr\u0101cija m\u016bsdienu onkolo\u0123ij\u0101: III f\u0101zes p\u0113t\u012bjumu un metaanal\u012b\u017eu kritiska anal\u012bze (OS, DFS, CR galapunkti)\",\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, onkolo\u0123ija, III f\u0101zes p\u0113t\u012bjumi, izdz\u012bvo\u0161ana, kop\u0113j\u0101 remisija (OS), piln\u012bga atbildes reakcija, piln\u012bga remisija (CR), sarkoma, dzemdes kakla v\u0113zis, 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;\">Autorit\u0101te un ekspert\u012bze (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\/lv\/doctor-veronica-iatan\/\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Veronika Iatana, MD<\/span><\/span><\/a><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> , un <\/span><\/span><a href=\"https:\/\/andromedichyperthermia.com\/lv\/cristian-gologan\/\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Kristi\u0101ns Gologans<\/span><\/span><\/a><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> , ma\u0123istra gr\u0101ds androm\u0113diskaj\u0101 hipertermij\u0101<\/span><\/span><\/strong><\/div>\n<h1><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Hipertermijas terapeitisk\u0101 integr\u0101cija m\u016bsdienu onkolo\u0123ij\u0101: III f\u0101zes p\u0113t\u012bjumu un metaanal\u012b\u017eu kritiska anal\u012bze (OS, DFS, CR galapunkti)<\/span><\/span><\/h1>\n<h2><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">1. Hipertermijas (HT) kopsavilkums un pamatprincipi<\/span><\/span><\/h2>\n<p><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Onkolo\u0123isk\u0101 hipertermija (HT)<\/span><\/span><\/strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> , kas defin\u0113ta k\u0101 kontrol\u0113ta siltuma pielieto\u0161ana temperat\u016br\u0101 no <\/span><\/span><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">39\u00b0C l\u012bdz 45\u00b0C<\/span><\/span><\/strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> , ir adjuvanta terapeitisk\u0101 metode, kas ir <\/span><\/span><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">pier\u0101d\u012bjusi iev\u0113rojamu kl\u012bnisko ieguvumu, ko apstiprina 1A l\u012bme\u0146a pier\u0101d\u012bjumi<\/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 f\u0101zes randomiz\u0113ti p\u0113t\u012bjumi un metaanal\u012bzes<\/span><\/span><\/strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> ), da\u017e\u0101du progres\u0113jo\u0161u un recidiv\u0113jo\u0161u cieto audz\u0113ju \u0101rst\u0113\u0161an\u0101.<\/span><\/span><\/p>\n<div class=\"key-points\">\n<h3><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Galvenie secin\u0101jumi \u2014 1.A l\u012bme\u0146a pier\u0101d\u012bjumi:<\/span><\/span><\/h3>\n<ul>\n<li><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Loma:<\/span><\/span><\/strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> HT tie\u0161i neizn\u012bcina audz\u0113ju; t\u0101 darbojas k\u0101 sp\u0113c\u012bgs <\/span><\/span><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">biolo\u0123isks sensibilizators<\/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;\">Apstiprin\u0101ti ieguvumi:<\/span><\/span><\/strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> 1.A l\u012bme\u0146a datu sint\u0113ze izce\u013c past\u0101v\u012bgu <\/span><\/span><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">kop\u0113j\u0101s dz\u012bvildzes (OS)<\/span><\/span><\/strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> un <\/span><\/span><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">piln\u012bgas atbildes reakcijas r\u0101d\u012bt\u0101ja (CR)<\/span><\/span><\/strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> uzlabo\u0161anos .<\/span><\/span><\/li>\n<li><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Galven\u0101s indik\u0101cijas:<\/span><\/span><\/strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> m\u012bksto audu sarkomas, dzemdes kakla v\u0113zis, recidiv\u0113jo\u0161s kr\u016bts v\u0113zis, \u013caundab\u012bga melanoma, ur\u012bnp\u016b\u0161\u013ca v\u0113zis, taisn\u0101s zarnas v\u0113zis un galvas un kakla (HNC) audz\u0113ji.<\/span><\/span><\/li>\n<li><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Dro\u0161\u012bba:<\/span><\/span><\/strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> \u0160is sp\u0113c\u012bgais terapeitiskais ieguvums tiek past\u0101v\u012bgi sasniegts <\/span><\/span><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">bez b\u016btiskas sist\u0113misk\u0101s toksicit\u0101tes palielin\u0101\u0161an\u0101s vai smag\u0101m blakuspar\u0101d\u012bb\u0101m<\/span><\/span><\/strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> (3. vai 4. pak\u0101pe).<\/span><\/span><\/li>\n<li><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Secin\u0101jums:<\/span><\/span><\/strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> HT ir neaizst\u0101jams adjuvants standarta multimod\u0101l\u0101s terapijas sh\u0113m\u0101s atsevi\u0161\u0137iem audz\u0113jiem.<\/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. Onkolo\u0123isk\u0101s hipertermijas klasifik\u0101cija un veidi<\/span><\/span><\/h3>\n<h4><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">1.1.1. Lokore\u0123ion\u0101l\u0101 hipertermija (LR HT)<\/span><\/span><\/h4>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">To izmanto iegur\u0146a, kr\u016b\u0161u kurvja un v\u0113dera dobuma audz\u0113ju dzi\u013cai sild\u012b\u0161anai. Izplat\u012bt\u0101k\u0101s metodes ietver kapacitat\u012bv\u0101s radiofrekvences (RF) sist\u0113mas un starojuma sist\u0113mas ar antenu mas\u012bvu saska\u0146o\u0161anu. \u0160\u012bs metodes ir paredz\u0113tas, lai pieg\u0101d\u0101tu siltumener\u0123iju dzi\u013cum\u0101, m\u0113r\u0137\u0113jot uz terapeitisko temperat\u016bru audz\u0113ja tilpum\u0101, vienlaikus saglab\u0101jot veselos audus tolerances robe\u017e\u0101s. M\u0113r\u0137is ir p\u0113c iesp\u0113jas viendab\u012bg\u0101ka (izotermiska) visas audz\u0113ja masas sild\u012b\u0161ana.<\/span><\/span><\/p>\n<h4><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">1.1.2. RF modul\u0113ta hipertermija (mHT)<\/span><\/span><\/h4>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Modul\u0113t\u0101 RF hipertermija (mHT) ir at\u0161\u0137ir\u012bga neinvaz\u012bva pieeja. At\u0161\u0137ir\u012bb\u0101 no tradicion\u0101l\u0101s izotermisk\u0101s sild\u012b\u0161anas, mHT izmanto kapacitat\u012bvo savienojumu ar nes\u0113jfrekvenci 13,56 MHz, ko modul\u0113 frakt\u0101\u013cu sv\u0101rst\u012bbas laika gait\u0101. Darb\u012bbas princips balst\u0101s uz ener\u0123ijas p\u0101rnesi, kas v\u0113rsta uz \u0161\u016bnu membr\u0101nas l\u012bmeni. Augsti dielektriskie zudumi galvenok\u0101rt rodas v\u0113\u017ea \u0161\u016bnu membr\u0101n\u0101s (to main\u012bto elektrisko \u012bpa\u0161\u012bbu d\u0113\u013c), radot specifisku temperat\u016bras gradientu, kas ierosina apoptozes ce\u013cus. \u0160is &#8220;sild\u012b\u0161anas no iek\u0161puses uz \u0101ru&#8221; meh\u0101nisms rada augst\u0101ku intratumor\u0101lo temperat\u016bru un samazina norm\u0101lu audu boj\u0101jumus, b\u016btiski at\u0161\u0137irot to no standarta radi\u0101cijas vai kapacitat\u012bvaj\u0101m metod\u0113m.<\/span><\/span><\/p>\n<h4><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">1.1.3. Interstici\u0101la hipertermija<\/span><\/span><\/h4>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">\u0160\u012b metode ietver invaz\u012bvu siltuma pieg\u0101di, bie\u017ei vien caur anten\u0101m, stie\u0146iem vai s\u0113kl\u0101m, kas tiek ievietotas tie\u0161i audz\u0113j\u0101. To galvenok\u0101rt izmanto smadze\u0146u audz\u0113ju (gliomu) vai recidiv\u0113jo\u0161u virspus\u0113ju slim\u012bbu \u0101rst\u0113\u0161anai.<\/span><\/span><\/p>\n<h3><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">1.2. K\u0101p\u0113c darbojas terapeitiskais logs 39\u201345\u00a0\u00b0C? (Biolo\u0123iskie meh\u0101nismi)<\/span><\/span><\/h3>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">HT kl\u012bnisk\u0101 efektivit\u0101te, kas pier\u0101d\u012bta III f\u0101zes l\u012bmen\u012b, ir neatdal\u0101ma no t\u0101s sare\u017e\u0123\u012bto biolo\u0123isko meh\u0101nismu izpratnes. \u0160ie meh\u0101nismi p\u0101rsniedz vienk\u0101r\u0161u \u0161\u016bnu destrukt\u012bvo reakciju, pozicion\u0113jot HT k\u0101 <\/span><\/span><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">daudzfunkcion\u0101lu<\/span><\/span><\/strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> standarta \u0101rst\u0113\u0161anas meto\u017eu sensibilizatoru.<\/span><\/span><\/p>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Optim\u0101l\u0101 temperat\u016bra *39\u201345\u00a0\u00b0C* ir izv\u0113l\u0113ta, jo t\u0101 maksim\u0101li palielina audz\u0113jam rakstur\u012bgo \u0161\u016bnu nel\u012bdzsvarot\u012bbu. Randomiz\u0113tos p\u0113t\u012bjumos nov\u0113rotie kop\u0113jie pan\u0101kumi ir saist\u012bti ar \u0161o sensibiliz\u0113jo\u0161o lomu, kas uzlabo staru terapijas (RT) un \u0137\u012bmijterapijas (CHT) efektivit\u0101ti, mijiedarbojoties ar audz\u0113ja mikrovidi un \u0161\u016bnu aprind\u0101m.<\/span><\/span><\/p>\n<hr \/>\n<h2><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">2. Darb\u012bbas meh\u0101nismi: K\u0101 hipertermija pastiprina onkolo\u0123isk\u0101s \u0101rst\u0113\u0161anas rezult\u0101tus?<\/span><\/span><\/h2>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Kombin\u0113t\u0101s terapijas augst\u0101k\u0101 kl\u012bnisk\u0101 efektivit\u0101te ir sp\u0113c\u012bgas biolo\u0123isk\u0101s siner\u0123ijas rezult\u0101ts, kas vair\u0101kos l\u012bme\u0146os v\u0113rsta uz audz\u0113ja rezistenci.<\/span><\/span><\/p>\n<h3><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">2.1. Radiosensitiz\u0101cija: audz\u0113ja rezistences p\u0101rvar\u0113\u0161ana un DNS atjauno\u0161ana<\/span><\/span><\/h3>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Hipertermija tiek atz\u012bta par sp\u0113c\u012bgu radiosensibilizatoru, kas nov\u0113r\u0161 divus no b\u016btisk\u0101kajiem staru terapijas neveiksmes avotiem:<\/span><\/span><\/p>\n<ol>\n<li><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">DNS atjauno\u0161anas inhib\u012bcija:<\/span><\/span><\/strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> HT inhib\u0113 starojuma boj\u0101tos DNS atjauno\u0161anas meh\u0101nismus, nodro\u0161inot efekt\u012bv\u0101ku un neatgriezenisku \u0161\u016bnu n\u0101vi.<\/span><\/span><\/li>\n<li><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Mikrovides sk\u0101bek\u013ca pieg\u0101de:<\/span><\/span><\/strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> HT palielina asins pl\u016bsmu un uzlabo audz\u0113ja sk\u0101bek\u013ca pieg\u0101di, samazinot hipoksisko (pret starojumu iztur\u012bgo) frakciju.<\/span><\/span><\/li>\n<\/ol>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">\u0160\u012b audz\u0113ja mikrovides funkcion\u0101l\u0101 modifik\u0101cija padara iepriek\u0161 rezistentas v\u0113\u017ea \u0161\u016bnas daudz jut\u012bg\u0101kas pret parasto apstaro\u0161anu. \u0160\u012bs mikrocirkul\u0101cijas izmai\u0146as ir noteico\u0161ais faktors, kas pamato *augsto lokore\u0123ion\u0101l\u0101s kontroles un piln\u012bgas remisijas (CR) l\u012bmeni, kas dokument\u0113ts \u0137\u012bmijterapijas un staru terapijas laik\u0101 ar hipertermijas re\u017e\u012bmiem (CCRT+HT) t\u0101du audz\u0113ju k\u0101 lok\u0101li progres\u0113jo\u0161a dzemdes kakla v\u0113\u017ea (LACC) un galvas un kakla v\u0113\u017ea (HNC) gad\u012bjum\u0101*.<\/span><\/span><\/p>\n<h3><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">2.2. \u0136\u012bmisk\u0101 sensitiz\u0101cija: narkotiku tirdzniec\u012bbas un \u0161\u016bnu uz\u0146em\u0161anas uzlabo\u0161ana<\/span><\/span><\/h3>\n<h4><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">2.2.1. Siner\u0123ija un papildin\u0101m\u012bba ar galvenajiem a\u0123entiem<\/span><\/span><\/h4>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">HT uzr\u0101da sp\u0113c\u012bgu siner\u0123isku iedarb\u012bbu ar noteikt\u0101m b\u016btisku onkolo\u0123isko \u0137\u012bmijterapijas l\u012bdzek\u013cu klas\u0113m. Jo \u012bpa\u0161i HT darbojas siner\u0123iski ar plat\u012bnu saturo\u0161iem l\u012bdzek\u013ciem (cisplat\u012bnu, karboplat\u012bnu) un mitomic\u012bnu C. \u0160os l\u012bdzek\u013cus bie\u017ei lieto galvenaj\u0101s III f\u0101zes indik\u0101cij\u0101s, piem\u0113ram, dzemdes kakla v\u0113\u017ea un galvas un kakla v\u0113\u017ea (HNC) audz\u0113ju \u0101rst\u0113\u0161an\u0101, kas liecina, ka nov\u0113rotais ieguvums p\u0113t\u012bjumos ir atkar\u012bgs no komplement\u0101ras biolo\u0123iskas saist\u012bbas, ne tikai no karstuma. HT ir ar\u012b papildino\u0161a iedarb\u012bba ar t\u0101diem l\u012bdzek\u013ciem k\u0101 doksorubic\u012bns, ciklofosfam\u012bds un gemcitab\u012bns.<\/span><\/span><\/p>\n<h4><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">2.2.2. Farmakokin\u0113tisk\u0101 amplifik\u0101cija<\/span><\/span><\/h4>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">HT optimiz\u0113 z\u0101\u013cu pieg\u0101di audz\u0113ja l\u012bmen\u012b, palielinot z\u0101\u013cu transport\u0113\u0161anu uz audz\u0113jiem un limfmezgliem (LN). \u0160is efekts tiek attiecin\u0101ts uz HT izrais\u012bto perf\u016bzijas (asins pl\u016bsmas) palielin\u0101\u0161anos un \u0161\u016bnu membr\u0101nas caurlaid\u012bbas izmai\u0146\u0101m. mHT gad\u012bjum\u0101 lokaliz\u0113t\u0101s sild\u012b\u0161anas meh\u0101nisms \u0161\u016bnu membr\u0101nas l\u012bmen\u012b, ko veicina augsti dielektriskie zudumi, var pastiprin\u0101t \u0137\u012bmijterapeitisko l\u012bdzek\u013cu intracelul\u0101ro uz\u0146em\u0161anu.<\/span><\/span><\/p>\n<h3><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">2.3. Imunomodul\u0101cija: &#8220;Aukst\u0101&#8221; audz\u0113ja p\u0101rveido\u0161ana par &#8220;karstu&#8221; (imunog\u0113nu) audz\u0113ju<\/span><\/span><\/h3>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Arvien vair\u0101k atz\u012bts darb\u012bbas meh\u0101nisms ir HT sp\u0113ja modul\u0113t pretv\u0113\u017ea im\u016bnreakciju, efekt\u012bvi p\u0101rveidojot imunolo\u0123iski &#8220;aukstus&#8221; audz\u0113jus par &#8220;karstiem&#8221; (iekaisu\u0161iem) audz\u0113jiem.<\/span><\/span><\/p>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">HT darbojas k\u0101 &#8220;in situ audz\u0113ja vakc\u012bna&#8221;, induc\u0113jot karstuma \u0161oka olbaltumvielu (HSP) un audz\u0113ja antig\u0113nu izdal\u012b\u0161anos. HSP, piem\u0113ram, HSP70, darbojas k\u0101 briesmu sign\u0101li un veicina antig\u0113nu uz\u0146em\u0161anu dendritiskaj\u0101s \u0161\u016bn\u0101s (DC). P\u0113c internaliz\u0113\u0161anas DC migr\u0113 uz limfmezgliem (LN), kur t\u0101s aktiviz\u0113 un ierosina citotoksisk\u0101s CD8+ T \u0161\u016bnas. \u0160is im\u016bnmodul\u0113jo\u0161ais process izraisa v\u0113\u017ea \u0161\u016bnu l\u012bzes palielin\u0101\u0161anos dabisko killer\u0161\u016bnu (NK) un CD8+ T \u0161\u016bnu ietekm\u0113. Turkl\u0101t HT uzlabo \u0161\u016bnu adh\u0113zijas molekulu (CAM) ekspresiju, veicinot limfoc\u012btu transport\u0113\u0161anu uz audz\u0113ja vietu.<\/span><\/span><\/p>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">1. tabul\u0101 ir apkopota hipertermijas meh\u0101nisk\u0101 mijiedarb\u012bba ar standarta onkolo\u0123iskaj\u0101m \u0101rst\u0113\u0161anas metod\u0113m.<\/span><\/span><\/p>\n<p><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">1.\u00a0tabula: Hipertermijas mijiedarb\u012bbas meh\u0101nismi ar standarta onkolo\u0123iskaj\u0101m terapij\u0101m<\/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;\">M\u0113r\u0137a meh\u0101nisms<\/span><\/span><\/strong><\/td>\n<td width=\"104\"><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Biolo\u0123isk\u0101 iedarb\u012bba (39 \u00b0C &#8211; 45 \u00b0C)<\/span><\/span><\/strong><\/td>\n<td width=\"104\"><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Terapeitisk\u0101 siner\u0123ija<\/span><\/span><\/strong><\/td>\n<td width=\"104\"><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Siner\u0123iski a\u0123enti<\/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;\">DNS atjauno\u0161anas inhib\u012bcija<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Kav\u0113 DNS atjauno\u0161anas meh\u0101nismus;<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Sensibiliz\u0113 \u0161\u016bnas S f\u0101z\u0113. <\/span><\/span><br \/>\n<span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Sp\u0113c\u012bgs radiosensibilizators (komplementa 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;\">Audz\u0113ja mikrovide<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Palielina asins pl\u016bsmu, uzlabo audz\u0113ja apg\u0101di ar sk\u0101bekli, palielina asinsvadu cirkul\u0101ciju<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Pastiprina revers\u0101s terapijas (RT) efektivit\u0101ti; Uzlabo narkotiku tirdzniec\u012bbu (\u0137\u012bmiski sensibilizators)<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">RT, cisplat\u012bns, mitomic\u012bns 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;\">\u0160\u016bnas membr\u0101na\/strukt\u016bra<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Palielin\u0101ti dielektriskie zudumi; <\/span><\/span><br \/>\n<span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Tie\u0161a apoptotisk\u0101 signaliz\u0101cija<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Uzlabota z\u0101\u013cu absorbcija;<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Cisplat\u012bns, karboplat\u012bns, bleomic\u012bns<\/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;\">Im\u016bnsist\u0113ma<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">HSP atbr\u012bvo\u0161ana, DC aktiv\u0101cija, T \u0161\u016bnu aktiviz\u0113\u0161ana, l\u012bzes pastiprin\u0101\u0161ana ar NK\/CD8+ T \u0161\u016bn\u0101m<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Audz\u0113ja im\u016bnmodulators; Pastiprin\u0101ta pretv\u0113\u017ea imunit\u0101te<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Imunoterapija, staru terapija, \u0161\u016bnu \u0137\u012bmijterapija<\/span><\/span><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>&nbsp;<\/p>\n<figure id=\"attachment_11120\" aria-describedby=\"caption-attachment-11120\" style=\"width: 747px\" class=\"wp-caption alignnone\"><img loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11120\" src=\"https:\/\/andromedichyperthermia.com\/wp-content\/uploads\/2025\/10\/mecanisme-biologice-hipertermie.jpg\" alt=\"Biolo\u0123iskie meh\u0101nismi hipertermijas\" 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;\">Biolo\u0123iskie meh\u0101nismi hipertermija<\/span><\/span><\/figcaption><\/figure>\n<h2><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">3. 1.A l\u012bme\u0146a pier\u0101d\u012bjumu sint\u0113ze: metaanal\u012b\u017eu rezult\u0101ti un apkopotie dati<\/span><\/span><\/h2>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">HT p\u0101rliecino\u0161ais nov\u0113rt\u0113jums ir balst\u012bts uz III f\u0101zes p\u0113t\u012bjumu kolekt\u012bvo anal\u012bzi. <\/span><\/span><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">1A l\u012bme\u0146a pier\u0101d\u012bjumu sint\u0113ze apstiprina visp\u0101r\u0113ju kl\u012bnisku ieguvumu no HT pievieno\u0161anas standarta terapijai vair\u0101k\u0101s audz\u0113ju kategorij\u0101s.<\/span><\/span><\/strong><\/p>\n<h3><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">3.1. Metaanal\u012btisko secin\u0101jumu p\u0101rskats<\/span><\/span><\/h3>\n<p><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Nesen\u0101 HT efektivit\u0101tes anal\u012bz\u0113, kur\u0101 bija iek\u013cauti 12 III f\u0101zes p\u0113t\u012bjumi, tika identific\u0113ti se\u0161i lokore\u0123ion\u0101l\u0101s HT p\u0113t\u012bjumi un se\u0161i p\u0113t\u012bjumi, tostarp hipertermisk\u0101s intraperitone\u0101l\u0101s \u0137\u012bmijterapijas (HIPEC) p\u0113t\u012bjumi [2]. No tiem pieci no se\u0161iem lokore\u0123ion\u0101lajiem HT p\u0113t\u012bjumiem uzr\u0101d\u012bja palielin\u0101tu kop\u0113jo izdz\u012bvo\u0161anu (OS) un\/vai uzlabotu piln\u012bgas atbildes reakcijas r\u0101d\u012bt\u0101ju (CR), pievienojot HT standarta \u0137\u012bmijterapijai un\/vai staru terapijai [2]. Tas nostiprina stabilu zin\u0101tnisku vienpr\u0101t\u012bbu, kas atbalsta HT lieto\u0161anu k\u0101 1A l\u012bme\u0146a adjuvantu pla\u0161am lokore\u0123ion\u0101lo audz\u0113ju vietu kl\u0101stam.<\/span><\/span><\/strong><\/p>\n<h3><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">3.2. Kvantitat\u012bvi nosak\u0101mi ieguvumi: kop\u0113j\u0101 dz\u012bvildze (OS), piln\u012bga atbildes reakcija (CR) un lok\u0101la kontrole<\/span><\/span><\/h3>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">HT kl\u012bniskie ieguvumi ir kvantific\u0113jami kritiskos onkolo\u0123iskos m\u0113r\u0137a krit\u0113rijos. Apkopotie dati par *lok\u0101li progres\u0113jo\u0161u dzemdes kakla v\u0113zi (LACC)* liecina:<\/span><\/span><\/p>\n<ul>\n<li><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Piln\u012bga atbildes reakcija (CR):<\/span><\/span><\/strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> CR r\u0101d\u012bt\u0101js iev\u0113rojami palielin\u0101s, pievienojot HT (relat\u012bvais risks &#8211; *RR 0,56, 95% TI 0,39 l\u012bdz 0,79; **p &lt; 0,001*).<\/span><\/span><\/li>\n<li><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Lok\u0101las recid\u012bva kontrole:<\/span><\/span><\/strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> HT b\u016btiski samazina lok\u0101las recid\u012bva bie\u017eumu (riska attiec\u012bba &#8211; *HR 0,48, 95\u00a0% TI 0,37 l\u012bdz 0,63; **p &lt; 0,001*).<\/span><\/span><\/li>\n<li><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Kop\u0113j\u0101 dz\u012bvildze (OS):<\/span><\/span><\/strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> multimod\u0101la \u0101rst\u0113\u0161ana ar HT nodro\u0161ina lab\u0101ku OS (HR *0,67, 95\u00a0% TI 0,45 l\u012bdz 0,99; **p = 0,05*).<\/span><\/span><\/li>\n<\/ul>\n<h2><\/h2>\n<h2><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">4. Specifisku III f\u0101zes p\u0113t\u012bjumu anal\u012bze p\u0113c v\u0113\u017ea veida<\/span><\/span><\/h2>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">\u0160aj\u0101 detaliz\u0113taj\u0101 anal\u012bz\u0113 tiek p\u0113t\u012btas t\u0101s *audz\u0113ja vietas, kur HT ir apstiprin\u0101ta augst\u0101k\u0101s raud\u012bbas randomiz\u0113tos kl\u012bniskajos p\u0113t\u012bjumos, koncentr\u0113joties uz prim\u0101ro izdz\u012bvo\u0161anas un atbildes reakcijas rezult\u0101tiem*.<\/span><\/span><\/p>\n<h3><\/h3>\n<h3><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">4.1. M\u012bksto audu sarkoma (MTS)<\/span><\/span><\/h3>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">M\u012bksto audu sarkoma ir viena no HT integr\u0101cijas etalonindik\u0101cij\u0101m, ko apstiprina III f\u0101zes p\u0113t\u012bjumi. P\u0113t\u012bjumi, kuros sal\u012bdzin\u0101ta standarta neoadjuvanta \u0137\u012bmijterapija ar neoadjuvantu \u0137\u012bmijterapiju plus re\u0123ion\u0101lu hipertermiju (RHT), ir pier\u0101d\u012bju\u0161i, ka *HT pievieno\u0161ana palielin\u0101ja dz\u012bvildzi un uzlaboja lok\u0101lo dz\u012bvildzi bez slim\u012bbas progres\u0113\u0161anas (LPFS).* <\/span><\/span><br \/>\n<span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Lokaliz\u0113tas augsta riska sarkomas kontekst\u0101 pacientiem, kuri ir ties\u012bgi sa\u0146emt neoadjuvantu \u0101rst\u0113\u0161anu, RHT iek\u013cau\u0161ana ir pamatota, pamatojoties uz uzlabotiem izdz\u012bvo\u0161anas rezult\u0101tiem. Turkl\u0101t \u0161o p\u0113t\u012bjumu transl\u0101cijas anal\u012bze atkl\u0101ja svar\u012bgu imunolo\u0123isku meh\u0101nismu. Tika pier\u0101d\u012bts, ka kombin\u0113ta pirmsoper\u0101cijas terapija ar RHT p\u0101rveido audz\u0113ju, kas b\u016bt\u012bb\u0101 nebija iekaisis, par iekaisu\u0161u audz\u0113ju. \u0160\u012b audz\u0113ja mikrovides p\u0101rprogramm\u0113\u0161ana \u013cauj palielin\u0101t pretv\u0113\u017ea im\u016bno aktivit\u0101ti. \u0160is efekts nor\u0101da, ka ilgtermi\u0146a izdz\u012bvo\u0161anas ieguvums ir saist\u012bts ne tikai ar tie\u0161u \u0137\u012bmijterapijas sensibiliz\u0101ciju, bet ar\u012b ar sp\u0113c\u012bgu imunolo\u0123isku priming, pozicion\u0113jot HT k\u0101 v\u0113rt\u012bgu mikrovides modul\u0101cijas r\u012bku.<\/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. Ginekolo\u0123iskais v\u0113zis: lok\u0101li progres\u0113jo\u0161s dzemdes kakla v\u0113zis (LACC)<\/span><\/span><\/h3>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Pier\u0101d\u012bjumi par HT par labu LACC gad\u012bjum\u0101, pievienojot to vienlaic\u012bgai \u0137\u012bmijterapijai un staru terapijai (CCRT), ir vieni no p\u0101rliecino\u0161\u0101kajiem onkolo\u0123ij\u0101.<\/span><\/span><\/p>\n<h4><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">4.2.1. Izp\u0113tes vienpr\u0101t\u012bba (piln\u012bga remisija un lok\u0101la recid\u012bva)<\/span><\/span><\/h4>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Sistem\u0101tiski metaanal\u012bzes un apkopoti dati no randomiz\u0113tiem p\u0113t\u012bjumiem apstiprina trimod\u0101l\u0101s terapijas (CCRT + HT) priek\u0161roc\u012bbas. <\/span><\/span><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Apkopoto datu anal\u012bze uzr\u0101d\u012bja iev\u0113rojami augst\u0101ku piln\u012bgas atbildes reakcijas r\u0101d\u012bt\u0101ju (CR) (RR 0,56; p &lt; 0,001) un samazin\u0101tu lok\u0101l\u0101s recid\u012bva bie\u017eumu (HR 0,48; p &lt; 0,001), lietojot kombin\u0113to terapiju. \u0160\u012b p\u0101r\u0101k\u0101 lokore\u0123ion\u0101l\u0101 kontrole ir padar\u012bjusi trimod\u0101lu \u0101rst\u0113\u0161anu par iesp\u0113jamu un efekt\u012bvu pieeju.<\/span><\/span><\/strong><\/p>\n<h4><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">4.2.2. Kop\u0113j\u0101s dz\u012bvildzes (OS) kvantitat\u012bva noteik\u0161ana<\/span><\/span><\/h4>\n<p><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Kop\u0113j\u0101 dz\u012bvildze (OS) tika iev\u0113rojami uzlabota, kombin\u0113jot CCRT ar HT, ar HR 0,67 (95% TI 0,45 l\u012bdz 0,99; p = 0,05).<\/span><\/span><\/strong><br \/>\n<span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> Lai gan v\u0113sturiskie dati j\u0101interpret\u0113 pa\u0161reiz\u0113jo terapeitisko standartu kontekst\u0101, III f\u0101zes p\u0113t\u012bjum\u0101 no It\u0101lijas, kur\u0101 tika nov\u0113rt\u0113ta RT +- HT N3 plakanajiem kakla limfmezgliem no t\u0101 laika, tika nov\u0113rota p\u0101rsteidzo\u0161a at\u0161\u0137ir\u012bba: *CR r\u0101d\u012bt\u0101js kombin\u0113t\u0101s terapijas grup\u0101 bija 82,3% sal\u012bdzin\u0101jum\u0101 ar 36,8% onkolo\u0123iskajiem pacientiem, kuri tika \u0101rst\u0113ti tikai ar staru terapiju* [3,4]. T\u0101 pa\u0161a p\u0113t\u012bjuma ilgtermi\u0146a anal\u012bz\u0113 tika zi\u0146ots par *5 gadu kop\u0113jo dz\u012bvildzi 55% sal\u012bdzin\u0101jum\u0101 ar 0% hipertermijas grup\u0101, sal\u012bdzinot ar tikai staru terapijas grupu* [3,4]. Lai gan kontroles re\u017e\u012bms (RT monoterapija) p\u0113c m\u016bsdienu standartiem (kas izmanto CCRT) tiek uzskat\u012bts par zem\u0101ku, \u0161ie v\u0113sturiskie rezult\u0101ti joproj\u0101m ir \u0101rk\u0101rt\u012bgi v\u0113rt\u012bgi, demonstr\u0113jot HT \u0101rk\u0101rt\u0113jo radiosensibiliz\u0113jo\u0161o sp\u0113ju, \u012bpa\u0161i liela apjoma limfmezglu slim\u012bbas gad\u012bjum\u0101, kas parasti ir \u013coti hipoksiska un rezistenta pret terapiju.<\/span><\/span><\/p>\n<h4><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">4.2.3. Papildu pier\u0101d\u012bjumi (OS)<\/span><\/span><\/h4>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Visliel\u0101ko papildu pier\u0101d\u012bjumu l\u012bmeni sniedz *dzemdes kakla v\u0113zis*, kur daudzos randomiz\u0113tos p\u0113t\u012bjumos ir p\u0113t\u012bta lokore\u0123ion\u0101l\u0101 hipertermija kombin\u0101cij\u0101 ar staru terapiju (RT) vai \u0137\u012bmijterapiju un staru terapiju (CTRT).<\/span><\/span><\/p>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">\u0160ie rezult\u0101ti (augsta l\u012bme\u0146a pier\u0101d\u012bjumi par dzemdes kakla v\u0113zi) ir ieg\u016bti no metaanal\u012bz\u0113m, kur\u0101s sal\u012bdzin\u0101ta standarta terapija (RT vai CTRT) ar kombin\u0113to \u0101rst\u0113\u0161anu (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;\">Kl\u012bniskais indikators<\/span><\/span><\/td>\n<td width=\"208\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Rezult\u0101ts sasniegts ar staru terapiju (RT) + hipertermiju<\/span><\/span><\/td>\n<td width=\"208\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Atsauce (recenz\u0113tas atsauces)<\/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;\">Piln\u012bga atbilde (CR)<\/span><\/span><\/strong><\/td>\n<td width=\"208\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Past\u0101v\u012bgs CR r\u0101d\u012bt\u0101ja uzlabojums: <\/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;\"> sal\u012bdzin\u0101jum\u0101 ar vienk\u0101r\u0161u RT.<\/span><\/span><\/td>\n<td width=\"208\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Metaanal\u012bzes<\/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;\">Viet\u0113j\u0101 re\u0123ion\u0101l\u0101 kontrole (LRC)<\/span><\/span><\/strong><\/td>\n<td width=\"208\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Iev\u0113rojams uzlabojums: <\/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;\"> sal\u012bdzin\u0101jum\u0101 ar vienk\u0101r\u0161o RT.<\/span><\/span><\/td>\n<td width=\"208\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Metaanal\u012bzes<\/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;\">Kop\u0113j\u0101 dz\u012bvildze (OS)<\/span><\/span><\/strong><\/td>\n<td width=\"208\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Pievienojot hipertermiju, tika nov\u0113rota ilgtermi\u0146a kop\u0113j\u0101s dz\u012bvildzes uzlabo\u0161an\u0101s (HR 0,67; p = 0,03).<\/span><\/span><\/td>\n<td width=\"208\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Atjaunin\u0101ta metaanal\u012bze<\/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;\">Dz\u012bvildze bez slim\u012bbas paz\u012bm\u0113m (DFS)<\/span><\/span><\/strong><\/td>\n<td width=\"208\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Iev\u0113rojams 2 un 3 gadu DFS uzlabojums, lietojot kombin\u0101cij\u0101 ar CTRT.<\/span><\/span><\/td>\n<td width=\"208\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">III f\u0101zes randomiz\u0113ti p\u0113t\u012bjumi<\/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;\">\u0160eit ir nor\u0101d\u012btas tr\u012bs metaanal\u012bzes un III f\u0101zes p\u0113t\u012bjums, k\u0101 ar\u012b atbilsto\u0161\u0101s saites:<\/span><\/span><\/p>\n<h5><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">4.2.3.1. Metaanal\u012bze: CR, lokore\u0123ion\u0101l\u0101 kontrole (LRC) un kop\u0113j\u0101 dz\u012bvildze (OS) (Lutgens et al.)<\/span><\/span><\/h5>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">\u0160is tiek uzskat\u012bts par fundament\u0101lu p\u0113t\u012bjumu (Kokr\u0101na apskats), kur\u0101 tika sintez\u0113ti vair\u0101ku randomiz\u0113tu p\u0113t\u012bjumu rezult\u0101ti, apstiprinot hipertermijas pievieno\u0161anas galveno ieguvumu.<\/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;\">Apstiprin\u0101tie indikatori<\/span><\/span><\/td>\n<td width=\"312\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Galvenais rezult\u0101ts<\/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;\">Piln\u012bga atbilde (CR)<\/span><\/span><\/strong><\/td>\n<td width=\"312\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">B\u016btisks uzlabojums (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;\">Viet\u0113j\u0101 re\u0123ion\u0101l\u0101 kontrole (LRC)<\/span><\/span><\/strong><\/td>\n<td width=\"312\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">B\u016btisks uzlabojums (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;\">Kop\u0113j\u0101 dz\u012bvildze (OS)<\/span><\/span><\/strong><\/td>\n<td width=\"312\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">B\u016btisks uzlabojums p\u0113c 3 gadiem (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;\">Nosaukums:<\/span><\/span><\/strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> Hipertermijas un staru terapijas kombin\u0113ta lieto\u0161ana lok\u0101li progres\u0113jo\u0161as dzemdes kakla karcinomas \u0101rst\u0113\u0161an\u0101<\/span><\/span><\/li>\n<li><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Autori:<\/span><\/span><\/strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> Lutgens L, van der Zee J, Pijls-Johannesma M, et al.<\/span><\/span><\/li>\n<li><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">PubMed saite (2010.\u00a0gada atjaunin\u0101jums): <\/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. T\u012bkla metaanal\u012bze (NMA): lab\u0101k\u0101s strat\u0113\u0123ijas (Datta et al. 2019)<\/span><\/span><\/h5>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">\u0160aj\u0101 p\u0113t\u012bjum\u0101 tika izmantota uzlabota metode (t\u012bkla metaanal\u012bze), lai sal\u012bdzin\u0101tu hipertermiju ar 13 cit\u0101m terapeitisk\u0101m intervenc\u0113m, ierindojot to starp lab\u0101kaj\u0101m iesp\u0113j\u0101m.<\/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;\">Apstiprin\u0101tie indikatori<\/span><\/span><\/td>\n<td width=\"312\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Galvenais rezult\u0101ts<\/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;\">\u0100rst\u0113\u0161anas rangs<\/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;\"> un <\/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;\"> bija starp trim lab\u0101kaj\u0101m intervenc\u0113m ar visliel\u0101ko visaptvero\u0161o ietekmi uz LRC, OS un toksicit\u0101ti.<\/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;\">Nosaukums:<\/span><\/span><\/strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> Da\u017e\u0101du terapeitisko iesp\u0113ju efektivit\u0101tes un dro\u0161\u012bbas nov\u0113rt\u0113jums lok\u0101li progres\u0113jo\u0161a dzemdes kakla v\u0113\u017ea gad\u012bjum\u0101: randomiz\u0113tu kl\u012bnisko p\u0113t\u012bjumu sistem\u0101tisks p\u0101rskats un t\u012bkla metaanal\u012bze<\/span><\/span><\/li>\n<li><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Autori:<\/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;\">PubMed saite: <\/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 f\u0101zes p\u0113t\u012bjums: dz\u012bvildze bez slim\u012bbas paz\u012bm\u0113m (DFS) un dz\u012bves kvalit\u0101te ar mEHT<\/span><\/span><\/h5>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">\u0160is ir viens no jaun\u0101kajiem III f\u0101zes p\u0113t\u012bjumiem, kas apstiprina t\u0101dus ieguvumus k\u0101 dz\u012bvildze bez slim\u012bbas progres\u0113\u0161anas (DFS) un uzlabota dz\u012bves kvalit\u0101te (QoL), pievienojot modernu hipertermijas tehniku \u200b\u200b(mEHT) \u0137\u012bmijterapijai un staru terapijai (CTRT).<\/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;\">Apstiprin\u0101tie indikatori<\/span><\/span><\/td>\n<td width=\"312\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Galvenais rezult\u0101ts<\/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;\">Dz\u012bvildze bez slim\u012bbas paz\u012bm\u0113m (DFS)<\/span><\/span><\/strong><\/td>\n<td width=\"312\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Pievienojot CTRT terapijai mEHT, iev\u0113rojami uzlaboj\u0101s 2 un 3 gadu dz\u012bvildze bez slim\u012bbas progres\u0113\u0161anas (DFS).<\/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;\">Dz\u012bves kvalit\u0101te (QoL)<\/span><\/span><\/strong><\/td>\n<td width=\"312\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Iev\u0113rojams dz\u012bves kvalit\u0101tes uzlabojums bez paaugstin\u0101tas toksicit\u0101tes.<\/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;\">Nosaukums:<\/span><\/span><\/strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> Modul\u0113tas elektrohipertermijas (mEHT) ietekme uz lok\u0101li progres\u0113jo\u0161a dzemdes kakla v\u0113\u017ea pacientu divu un tr\u012bs gadu izdz\u012bvo\u0161anu<\/span><\/span><\/li>\n<li><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Autori:<\/span><\/span><\/strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> Minnaar CA, Maposa I, Kotzen JA, et al.<\/span><\/span><\/li>\n<li><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">MDPI saite (pilns teksts pieejams): <\/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;\">Lok\u0101li progres\u0113jo\u0161a dzemdes kakla v\u0113\u017ea gad\u012bjum\u0101 lokore\u0123ion\u0101l\u0101s hipertermijas pievieno\u0161ana ne tikai palielina lok\u0101la audz\u0113ja izn\u012bcin\u0101\u0161anas (CR) iesp\u0113jas, bet ar\u012b b\u016btiski pozit\u012bvi ietekm\u0113 ilgtermi\u0146a izdz\u012bvo\u0161anu (OS un DFS).<\/span><\/span><\/p>\n<h3><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">4.3. Galvas un kakla v\u0113zis (HNC)<\/span><\/span><\/h3>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Lokore\u0123ion\u0101l\u0101 hipertermija ir 1A l\u012bme\u0146a \u0101rst\u0113\u0161anas metode da\u017e\u0101diem galvas un kakla audz\u0113jiem, tostarp recidiv\u0113jo\u0161iem un progres\u0113jo\u0161iem audz\u0113jiem, kur lok\u0101lai kontrolei ir tie\u0161a ietekme uz dz\u012bves kvalit\u0101ti un izdz\u012bvo\u0161anu.<\/span><\/span><\/p>\n<h4><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">4.3.1. III f\u0101zes randomiz\u0113tu p\u0113t\u012bjumu dati<\/span><\/span><\/h4>\n<p><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Prospekt\u012bvos, randomiz\u0113tos III f\u0101zes p\u0113t\u012bjumos ir dokument\u0113ti skaidri ieguvumi, kombin\u0113jot \u0137\u012bmijterapiju (CRT) ar HT, sal\u012bdzinot ar CRT vienu pa\u0161u nazofaring\u0101las karcinomas (NPC) gad\u012bjum\u0101.<\/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;\"> \u0160aj\u0101 III f\u0101zes p\u0113t\u012bjum\u0101 zi\u0146ots par iev\u0113rojamu uzlabojumu. <\/span><\/span><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">5 gadu dz\u012bvildze bez slim\u012bbas (DFS) palielin\u0101j\u0101s no 25,5% l\u012bdz 51,3% (p &lt; 0,005), un 5 gadu kop\u0113j\u0101 dz\u012bvildze (OS) palielin\u0101j\u0101s no 50% l\u012bdz 68,4% (p &lt; 0,005). Ar\u012b piln\u012bgas remisijas (CR) r\u0101d\u012bt\u0101js palielin\u0101j\u0101s no 62,8% l\u012bdz 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;\"> (Mutes dobums\/Orofarinkss\/Hipofarinkss):<\/span><\/span><\/strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> Piln\u012bga atbildes reakcija tika nov\u0113rota <\/span><\/span><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">42,4% pacientu, kas sa\u0146\u0113ma tikai staru terapiju, sal\u012bdzinot ar 78,6% HT grup\u0101<\/span><\/span><\/strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> . At\u0161\u0137ir\u012bba bija statistiski noz\u012bm\u012bga (&lt; 0,05). Kaplana-Meira izdz\u012bvo\u0161anas anal\u012bze ar\u012b uzr\u0101d\u012bja iev\u0113rojamu uzlabojumu par labu staru terapijai-HT. Netika re\u0123istr\u0113ti devu ierobe\u017eojo\u0161i termiski apdegumi vai p\u0101rm\u0113r\u012bga g\u013cot\u0101das vai termiska toksicit\u0101te.<\/span><\/span><\/p>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Iev\u0113rojamais un past\u0101v\u012bgais DFS un OS pieaugums HNC gad\u012bjum\u0101, kur lok\u0101las recid\u012bva bie\u017eums bie\u017ei vien ir augsts, uzsver, ka HT ir efekt\u012bva lok\u0101las staru terapijas rezistences p\u0101rvar\u0113\u0161an\u0101, padarot to par b\u016btisku iz\u0101rst\u0113jo\u0161as \u0101rst\u0113\u0161anas sast\u0101vda\u013cu [5].<\/span><\/span><\/p>\n<h3><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">4.4. Ku\u0146\u0123a-zarnu trakta v\u0113zis: taisn\u0101s zarnas un an\u0101l\u0101s atveres v\u0113zis<\/span><\/span><\/h3>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">HT integr\u0101cija ar neoadjuvantu \u0137\u012bmijterapiju (CRT) lok\u0101li progres\u0113jo\u0161a taisn\u0101s zarnas v\u0113\u017ea gad\u012bjum\u0101 ir pier\u0101d\u012bjusi b\u016btiskus ieguvumus lokore\u0123ion\u0101l\u0101 kontrol\u0113 un izdz\u012bvo\u0161an\u0101.<\/span><\/span><\/p>\n<h4><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">4.4.1. III f\u0101zes rezult\u0101ti taisn\u0101s zarnas v\u0113\u017ea \u0101rst\u0113\u0161an\u0101<\/span><\/span><\/h4>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Prospekt\u012bvaj\u0101 randomiz\u0113taj\u0101 p\u0113t\u012bjum\u0101 * <\/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;\"> * tika sal\u012bdzin\u0101ta sirds resinkroniz\u0101cijas terapija (KRT) ar KRT + HT, un tika zi\u0146ots par iev\u0113rojamiem 5 gadu uzlabojumiem HT grup\u0101: <\/span><\/span><br \/>\n<strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">\u25cf Kop\u0113j\u0101 dz\u012bvildze (OS): 95,8% pret 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 Dz\u012bvildz\u012bba bez slim\u012bbas paz\u012bm\u0113m (DFS): 89,1% pret 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 Dz\u012bvildz\u012bba bez lok\u0101las recid\u012bva (LRFS): 97,7% pret 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. Patolo\u0123isk\u0101 reakcija un kl\u012bnisk\u0101s sekas<\/span><\/span><\/h4>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Pievienojot HT, uzlaboj\u0101s ar\u012b patolo\u0123iski piln\u012bgas atbildes reakcijas (pCR) r\u0101d\u012bt\u0101js, *metaanal\u012bze uzr\u0101da pieaugumu no 16\u00a0% (CRT) l\u012bdz 22,5\u00a0% (CRT+HT, p\u00a0=\u00a00,043).* <\/span><\/span><br \/>\n<strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Vissvar\u012bg\u0101kais ir tas, ka augst\u0101kais LRFS r\u0101d\u012bt\u0101js (97,7\u00a0%) un kolostomijas br\u012bvas dz\u012bvildzes r\u0101d\u012bt\u0101ju uzlabo\u0161an\u0101s (87,7\u00a0% pret 69,0\u00a0%, P\u00a0=\u00a00,016) izce\u013c HT lomu ne tikai lok\u0101l\u0101 audz\u0113ja steriliz\u0101cij\u0101, bet ar\u012b sfinktera saglab\u0101\u0161anas strat\u0113\u0123ij\u0101s.<\/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. \u013baundab\u012bga melanoma (lokore\u0123ion\u0101la slim\u012bba)<\/span><\/span><\/h3>\n<p><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Fundament\u0101lie III f\u0101zes p\u0113t\u012bjumi ( <\/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 et al., 1995<\/span><\/span><\/a><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> ) ir pier\u0101d\u012bju\u0161i, ka staru terapijas apvienojums ar HT uzlabo piln\u012bgas atbildes reakcijas r\u0101d\u012bt\u0101ju un kop\u0113jo izdz\u012bvo\u0161anas laiku progres\u0113jo\u0161as melanomas gad\u012bjum\u0101.<\/span><\/span><\/strong><\/p>\n<p><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Galvenie rezult\u0101ti: staru terapija + hipertermija sal\u012bdzin\u0101jum\u0101 ar staru terapiju<\/span><\/span><\/strong><\/p>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Eiropas daudzcentru p\u0113t\u012bjum\u0101 70 pacientiem nejau\u0161i tika iedal\u012bti 134 metast\u0101tiski vai recidiv\u0113jo\u0161i melanomas boj\u0101jumi, lai sa\u0146emtu vai nu tikai staru terapiju, vai staru terapiju, kam seko hipertermija (43\u00b0C 60 min\u016btes).<\/span><\/span><\/p>\n<h5><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">1. Viet\u0113ja audz\u0113ja kontrole (prim\u0101rais m\u0113r\u0137a krit\u0113rijs)<\/span><\/span><\/h5>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Vissvar\u012bg\u0101kais rezult\u0101ts bija iev\u0113rojams ilgtermi\u0146a lok\u0101l\u0101s audz\u0113ja kontroles uzlabojums.<\/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;\">Galapunkts<\/span><\/span><\/td>\n<td width=\"156\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Tikai staru terapija (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;\">Galven\u0101 at\u0161\u0137ir\u012bba<\/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;\">Aktu\u0101ra viet\u0113j\u0101 kontrole 2 gadu laik\u0101<\/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;\">B\u016btisks uzlabojums (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;\">Secin\u0101jums:<\/span><\/span><\/strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> HT pievieno\u0161ana uzlaboja lok\u0101lo audz\u0113ja kontroli par *18 procentpunktiem* p\u0113c 2 gadiem.<\/span><\/span><\/li>\n<\/ul>\n<h5><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">2. Daudzfaktoru anal\u012bze (prognostiskie faktori)<\/span><\/span><\/h5>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Daudzfaktoru Koksa regresijas anal\u012bze apstiprin\u0101ja, ka *hipertermija* bija vissvar\u012bg\u0101kais prognostiskais faktors lok\u0101lai kontrolei p\u0113c 2 gadiem.<\/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;\">Prognozes main\u012bgais<\/span><\/span><\/td>\n<td width=\"208\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Risks (izred\u017eu attiec\u012bba)<\/span><\/span><\/td>\n<td width=\"208\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">P v\u0113rt\u012bba<\/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;\"> (lok\u0101lajai vad\u012bbai)<\/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;\">Radi\u0101cijas deva<\/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;\">Audz\u0113ja izm\u0113rs<\/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;\">Secin\u0101jums:<\/span><\/span><\/strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> Tas par\u0101da, ka HT sniegtais ieguvums ir neatkar\u012bgs un vismaz tikpat svar\u012bgs k\u0101 izmantot\u0101 starojuma deva un audz\u0113ja lielums.<\/span><\/span><\/li>\n<\/ul>\n<h5><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">3. Izdz\u012bvo\u0161ana (lok\u0101l\u0101 kontrole ir \u0101rstnieciska)<\/span><\/span><\/h5>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">P\u0113t\u012bjum\u0101 tika nov\u0113rota sp\u0113c\u012bga saikne starp veiksm\u012bgu lok\u0101lu kontroli un ilgtermi\u0146a izdz\u012bvo\u0161anu:<\/span><\/span><\/p>\n<ul>\n<li><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">5 gadu kop\u0113j\u0101 dz\u012bvildze:<\/span><\/span><\/strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> kop\u0113jais r\u0101d\u012bt\u0101js bija 19%.<\/span><\/span><\/li>\n<li><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">5 gadu dz\u012bvildze pacientiem ar piln\u012bb\u0101 kontrol\u0113tu slim\u012bbu:<\/span><\/span><\/strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> palielin\u0101j\u0101s l\u012bdz *38%*.<\/span><\/span><\/li>\n<li><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Secin\u0101jums:<\/span><\/span><\/strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> Veiksm\u012bgai vienas vai da\u017eu metast\u0101tisku boj\u0101jumu lok\u0101lai kontrolei bija *iev\u0113rojams \u0101rstniecisks potenci\u0101ls*, kas uzsver HT nodro\u0161in\u0101t\u0101s lok\u0101l\u0101s efektivit\u0101tes paaugstin\u0101\u0161anas noz\u012bmi.<\/span><\/span><\/li>\n<\/ul>\n<h5><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">4. Toksicit\u0101te un dro\u0161\u012bba<\/span><\/span><\/h5>\n<ul>\n<li><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Karstuma pievieno\u0161ana *b\u016btiski nepalielin\u0101ja ak\u016btas vai v\u0113l\u012bnas starojuma reakcijas*.<\/span><\/span><\/li>\n<li><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Sild\u012b\u0161anas proced\u016bra kopum\u0101 bija *labi panesama*.<\/span><\/span><\/li>\n<\/ul>\n<p><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Piez\u012bme.<\/span><\/span><\/strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> P\u0113t\u012bjum\u0101 tika min\u0113tas gr\u016bt\u012bbas sasniegt termisk\u0101 protokola m\u0113r\u0137i (43\u00a0\u00b0C), un tas izdev\u0101s tikai 14\u00a0% apstr\u0101des gad\u012bjumu, kas liecina, ka faktiskais ieguvums var\u0113tu b\u016bt v\u0113l liel\u0101ks, optimiz\u0113jot sild\u012b\u0161anas protokolus.<\/span><\/span><\/p>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">\u0145emot v\u0113r\u0101, ka melanoma ir \u013coti imunog\u0113na slim\u012bba un bija viens no pirmajiem imunoterapijas m\u0113r\u0137iem, HT pier\u0101d\u012bt\u0101 sp\u0113ja izrais\u012bt pretv\u0113\u017ea im\u016bnreakciju un uzlabot lok\u0101lo kontroli paver iev\u0113rojamas kl\u012bniskas iesp\u0113jas integr\u0101cijai ar jauniem imunoonkolo\u0123iskiem l\u012bdzek\u013ciem, t\u0101d\u0113j\u0101di pastiprinot kontrolpunktu blokatoru efektivit\u0101ti [4].<\/span><\/span><\/p>\n<h3><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">4.6 Recidiv\u0113jis kr\u016bts v\u0113zis<\/span><\/span><\/h3>\n<h4><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">4.6.1. Metaanal\u012bze, kas apstiprina termoradioterapijas efektivit\u0101ti atk\u0101rtota kr\u016bts v\u0113\u017ea gad\u012bjum\u0101<\/span><\/span><\/h4>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Metaanal\u012bz\u0113 ir apkopoti dati no III f\u0101zes kl\u012bniskajiem p\u0113t\u012bjumiem, kas par\u0101da piln\u012bgas atbildes reakcijas r\u0101d\u012bt\u0101ju (CR), kas min\u0113ts kombin\u0113t\u0101s terapijas (staru terapija + hipertermija) gad\u012bjum\u0101 *lokore\u0123ion\u0101la recidiv\u0113jo\u0161a kr\u016bts v\u0113\u017ea (LRBC)* gad\u012bjum\u0101.<\/span><\/span><\/p>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">\u0160is ir p\u0113t\u012bjums, kas apstiprina 1A l\u012bme\u0146a pier\u0101d\u012bjumu secin\u0101jumus, tostarp *60\u201366\u00a0% piln\u012bgas remisijas* r\u0101d\u012bt\u0101jus kombin\u0113tas \u0101rst\u0113\u0161anas gad\u012bjum\u0101:<\/span><\/span><\/p>\n<p><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">P\u0113t\u012bjums: <\/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 un staru terapija lokore\u0123ion\u0101lu recidiv\u0113jo\u0161u kr\u016bts v\u0113\u017ea gad\u012bjum\u0101: sistem\u0101tisks p\u0101rskats un metaanal\u012bze.<\/span><\/span><\/strong><\/a><\/p>\n<ul>\n<li><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Autori:<\/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;\">Public\u0113ts: <\/span><\/span><\/strong> <em><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Starptautiskais radi\u0101cijas onkolo\u0123ijas biolo\u0123ijas un fizikas \u017eurn\u0101ls<\/span><\/span><\/em><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> , 2016.<\/span><\/span><\/li>\n<li><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Secin\u0101jums:<\/span><\/span><\/strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> Termoradioterapija (RT + hipertermija) palielina piln\u012bgas atbildes reakcijas (CR) r\u0101d\u012bt\u0101ju par aptuveni *22%*, sal\u012bdzinot ar tikai staru terapiju; p\u0113t\u012bjumos, kuros sal\u012bdzin\u0101ja abas \u0101rst\u0113\u0161anas grupas, ar RT + hipertermiju (HT) tika sasniegts piln\u012bgas atbildes reakcijas (CR) r\u0101d\u012bt\u0101js *60,2%*, sal\u012bdzinot ar 38,1%, lietojot tikai RT (staru terapiju), sasniedzot CR r\u0101d\u012bt\u0101ju *66,6%* atk\u0101rtotas apstaro\u0161anas ar hipertermiju gad\u012bjum\u0101.<\/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\u016bts v\u0113\u017ea recid\u012bvs kr\u016b\u0161u kurv\u012b<\/span><\/span><\/h4>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Hipertermijai, parasti kombin\u0101cij\u0101 ar staru terapiju (ST), ir 1A l\u012bme\u0146a pier\u0101d\u012bjumi kr\u016bts v\u0113\u017ea recid\u012bva \u0101rst\u0113\u0161an\u0101. <\/span><\/span><br \/>\n<span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">\u0160\u012b kombin\u0101cija ir \u012bpa\u0161i v\u0113rt\u012bga kr\u016b\u0161kurvja sienas recid\u012bva kontekst\u0101, kur \u0101rst\u0113\u0161anas iesp\u0113jas bie\u017ei vien ir ierobe\u017eotas. P\u0113t\u012bjumi uzr\u0101da augstu piln\u012bgas atbildes reakcijas (CR) r\u0101d\u012bt\u0101ju, kas sv\u0101rst\u0101s no 40% l\u012bdz 86%, un lok\u0101las kontroles (LC) r\u0101d\u012bt\u0101jus no 70% l\u012bdz 76%, ja staru terapija tiek kombin\u0113ta ar HT. Turkl\u0101t 5 gadu kop\u0113j\u0101s dz\u012bvildzes r\u0101d\u012bt\u0101ji \u0161\u012bs atk\u0101rtot\u0101s slim\u012bbas gad\u012bjum\u0101 var sasniegt pat 50%. <\/span><\/span><br \/>\n<span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">ST+HT kombin\u0101cija nodro\u0161ina efekt\u012bvu lok\u0101lu paliat\u012bv\u0101s apr\u016bpes un ilgtermi\u0146a kontroles strat\u0113\u0123iju, bie\u017ei vien samazinot nepiecie\u0161am\u012bbu p\u0113c lielas devas gl\u0101b\u0161anas terapijas vai radik\u0101las oper\u0101cijas.<\/span><\/span><\/p>\n<h4><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">4.6.3. Lokore\u0123ion\u0101l\u0101s terapijas visp\u0101r\u0113j\u0101s tendences \u2014 citas onkolo\u0123iskas indik\u0101cijas ar 1.\u00a0l\u012bme\u0146a pier\u0101d\u012bjumiem<\/span><\/span><\/h4>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Secin\u0101jumu attiecin\u0101\u0161ana uz lok\u0101li re\u0123ion\u0101laj\u0101m terapij\u0101m:<\/span><\/span><\/p>\n<ul>\n<li><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Pier\u0101d\u012bjumu konsolid\u0101cija: <\/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;\">Otrais sistem\u0101tisks p\u0101rskats<\/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;\">pirmais bija Hildenbrandt et al<\/span><\/span><\/em><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> .) liecina, ka *5 no 6 III f\u0101zes p\u0113t\u012bjumiem* (kuru m\u0113r\u0137is bija virspus\u0113ji un lokore\u0123ion\u0101li audz\u0113ji, tostarp kr\u016bts v\u0113zis, galvas un kakla v\u0113zis, melanoma) uzr\u0101d\u012bja *kop\u0113j\u0101s dz\u012bvildzes (OS)* un\/vai *piln\u012bgas atbildes reakcijas (CR)* palielin\u0101\u0161anos, kad standarta terapijai tika pievienota hipertermija.<\/span><\/span><\/li>\n<li><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Paliat\u012bv\u0101 terapija:<\/span><\/span><\/strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> P\u0113t\u012bjumos min\u0113ts, ka hipertermija kombin\u0101cij\u0101 ar staru terapiju (RT) iev\u0113rojami palielin\u0101ja *piln\u012bgu atbildes reakciju uz s\u0101p\u0113m* s\u0101p\u012bgu kaulu metast\u0101\u017eu gad\u012bjumos, t\u0101d\u0113j\u0101di iev\u0113rojami uzlabojot pacientu dz\u012bves kvalit\u0101ti (QoL).<\/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. Ur\u012bnp\u016b\u0161\u013ca v\u0113zis: hipertermiska intravezik\u0101la \u0137\u012bmijterapija (HIVEC)<\/span><\/span><\/h3>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Hipertermisk\u0101 intravezik\u0101l\u0101 \u0137\u012bmijterapija (HIVEC) ietver mitomic\u012bna C (MMC) uzsild\u012b\u0161anu (parasti l\u012bdz 43\u00b0C) ur\u012bnp\u016b\u0161\u013ca instil\u0101cijas laik\u0101 neinvaz\u012bva ur\u012bnp\u016b\u0161\u013ca v\u0113\u017ea (NMIBC) gad\u012bjum\u0101 [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 f\u0101zes p\u0113t\u012bjuma rezult\u0101ti<\/span><\/span><\/h4>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">HIVEC-1 p\u0113t\u012bjums, randomiz\u0113ts 3. f\u0101zes p\u0113t\u012bjums, bija v\u0113rsts uz to, lai sal\u012bdzin\u0101tu izdz\u012bvo\u0161anu bez recid\u012bva (RFS) ar normotermisku MMC un hipertermisku MMC (43\u00b0C 30 vai 60 min\u016btes) pacientiem ar vid\u0113ja riska NMIBC (IR-NMIBC) [6]. <\/span><\/span><br \/>\n<span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Prim\u0101rais m\u0113r\u0137a krit\u0113rijs (RFS): RFS p\u0113c 24 m\u0113ne\u0161iem \u0101rst\u0113\u0161anas pl\u0101notaj\u0101 (ITT) popul\u0101cij\u0101 bija 77% kontroles grup\u0101 (normotermija), sal\u012bdzinot ar 82% (HT 30 min) un 80% (HT 60 min). P\u0113t\u012bjum\u0101 tika secin\u0101ts, ka HT nebija statistiski p\u0101r\u0101ka par normotermisku MMC attiec\u012bb\u0101 uz RFS p\u0113c 24 m\u0113ne\u0161iem, ar p v\u0113rt\u012bbu 0,6 [6]. <\/span><\/span><br \/>\n<span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Kl\u012bnisk\u0101 noz\u012bme: P\u0101r\u0101kuma tr\u016bkums IR-NMIBC liecina, ka vid\u0113ja riska popul\u0101cija, iesp\u0113jams, neg\u016bst pietiekamu labumu no termisk\u0101s\/\u0137\u012bmisk\u0101s siner\u0123ijas vai ka p\u0113t\u012bjum\u0101 izmantotie specifiskie termiskie protokoli (piem\u0113ram, fiks\u0113ts ilgums) nebija optim\u0101li.<\/span><\/span><\/p>\n<h4><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">4.7.2. Nianses un dz\u012bvildze bez slim\u012bbas progres\u0113\u0161anas<\/span><\/span><\/h4>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">At\u0161\u0137ir\u012bb\u0101 no IR-NMIBC RFS rezult\u0101ta, citu p\u0113t\u012bjumu dati izce\u013c ieguvumu augsta riska pacientiem, \u012bpa\u0161i tiem, kuriem BCG terapija nebija veiksm\u012bga. Anal\u012bze ITT anal\u012bz\u0113 uzr\u0101d\u012bja *iev\u0113rojami lab\u0101ku dz\u012bvildzi bez slim\u012bbas progres\u0113\u0161anas (PFS) HIVEC grup\u0101 sal\u012bdzin\u0101jum\u0101 ar BCG (95,7% pret 71,8%; p = 0,043) [7]*. Cits p\u0113t\u012bjums par\u0101d\u012bja, ka, lai gan \u0137\u012bmijtermija ar HIVEC sasniedza 60% 1 gada RFS r\u0101d\u012bt\u0101ju un 92,4% ur\u012bnp\u016b\u0161\u013ca saglab\u0101\u0161anas r\u0101d\u012bt\u0101ju, \u013coti augsta riska pacientiem, kuriem BCG terapija neizdodas, cistektomija joproj\u0101m ir apr\u016bpes standarts, lai gan HIVEC var b\u016bt alternat\u012bva tiem, kuriem oper\u0101cija nav piem\u0113rota [8]. Tas apstiprina, ka HT efektivit\u0101te ur\u012bnp\u016b\u0161\u013ca v\u0113\u017ea gad\u012bjum\u0101 ir b\u016btiski atkar\u012bga no pacientu stratifik\u0101cijas.<\/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. tabul\u0101 ir apkopoti galvenie III f\u0101zes kl\u012bniskie rezult\u0101ti hipertermijas integr\u0101cijas jom\u0101.<\/span><\/span><\/strong><\/p>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">2.\u00a0tabula: Galvenie III\u00a0f\u0101zes kl\u012bniskie rezult\u0101ti hipertermijas \u0101rst\u0113\u0161an\u0101 onkolo\u0123ij\u0101 (HT\u00a0+\u00a0standarta apr\u016bpe sal\u012bdzin\u0101jum\u0101 ar standarta apr\u016bpi vien)<\/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\u0113\u017ea veids (HT modalit\u0101te)<\/span><\/span><\/strong><\/td>\n<td width=\"104\"><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">P\u0113t\u012bjuma veids\/m\u0113r\u0137a krit\u0113rijs<\/span><\/span><\/strong><\/td>\n<td width=\"104\"><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">HT + standarta apr\u016bpe<\/span><\/span><\/strong><\/td>\n<td width=\"104\"><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Standarta apr\u016bpes monoterapija<\/span><\/span><\/strong><\/td>\n<td width=\"104\"><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Statistisk\u0101 noz\u012bm\u012bba\/rezult\u0101ts<\/span><\/span><\/strong><\/td>\n<td width=\"104\"><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Atsauce<\/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;\">M\u012bksto audu sarkoma (LR HT + CT) 11,3 gadi<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">III f\u0101zes randomiz\u0113ts (<\/span><\/span><\/p>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">5 gadu 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 gadu OS)<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">62,7%<\/span><\/span><\/p>\n<p>&nbsp;<\/p>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">52,6%<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">51,3%<\/span><\/span><\/p>\n<p>&nbsp;<\/p>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">42,7%<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Sal\u012bdzinot ar tikai neoadjuvantu \u0137\u012bmijterapiju, re\u0123ion\u0101l\u0101s hipertermijas pievieno\u0161ana lok\u0101li uzlaboja *slim\u012bbas br\u012bvo dz\u012bvildzi (DFS)* (riska attiec\u012bba [HR], 0,65; 95\u00a0% TI, 0,49\u20130,86; P\u00a0=\u00a00,002).<\/span><\/span><\/p>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Pacientiem, kuri tika nejau\u0161in\u0101ti iedal\u012bti \u0137\u012bmijterapijas un hipertermijas grup\u0101, bija ilg\u0101ki *kop\u0113jie dz\u012bvildzes (OS) r\u0101d\u012bt\u0101ji*, sal\u012bdzinot ar tiem, kuri tika nejau\u0161in\u0101ti iedal\u012bti tikai neoadjuvantas \u0137\u012bmijterapijas grup\u0101 (HR, 0,73; 95% TI, 0,54\u20130,98; P = 0,04), ar 5 gadu dz\u012bvildzi 62,7% (95% TI, 55,2\u201370,1%) pret 51,3% (95% TI, 43,7%\u201359,0%) un 10 gadu dz\u012bvildzi attiec\u012bgi 52,6% (95% TI, 44,7%\u201360,6%) pret 42,7% (95% TI, 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;\">Dzemdes kakla v\u0113zis (LACC) (LR HT + RT) 12 gadi<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">III f\u0101zes randomiz\u0113ts ( <\/span><\/span><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">12 gadu OS<\/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;\">Iev\u0113rojami lab\u0101ka kop\u0113j\u0101 dz\u012bvildze (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;\">Taisn\u0101s zarnas v\u0113zis (KRT + HT) 5 gadi<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">III f\u0101zes randomiz\u0113ts<\/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 gadu oper\u0113t\u0101jsist\u0113ma<\/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 gadu 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 gadu lok\u0101la recid\u012bva nesaturo\u0161a LRF<\/span><\/span><\/p>\n<p>&nbsp;<\/p>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">5 gadu dz\u012bvildze bez kolostomijas (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;\">Uzlabota kop\u0113j\u0101 dz\u012bvildze (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;\">Uzlabota dz\u012bvildze bez slim\u012bbas progres\u0113\u0161anas (DFS) ( <\/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;\">Uzlabots 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;\">Uzlabots 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;\">Galvas un kakla v\u0113\u017ea 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 f\u0101zes randomiz\u0113ta (5 gadu DFS)<\/span><\/span><\/p>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">un<\/span><\/span><\/p>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">5 gadu OS<\/span><\/span><\/p>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">un<\/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;\">\u0160aj\u0101 III f\u0101zes p\u0113t\u012bjum\u0101 tika zi\u0146ots par iev\u0113rojamu uzlabojumu.<\/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;\">Kangs 2013<\/span><\/span><\/a><\/strong><\/td>\n<\/tr>\n<tr>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Galvas un <\/span><\/span><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">kakla v\u0113zis Mutes dobums\/Orofarinkss\/Hipofarinkss<\/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 f\u0101zes randomiz\u0113ts (CR)<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">78,6%<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">42,4%<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">At\u0161\u0137ir\u012bba bija statistiski noz\u012bm\u012bga (&lt; 0,05). Kaplana-Meira izdz\u012bvo\u0161anas anal\u012bze ar\u012b uzr\u0101d\u012bja iev\u0113rojamu uzlabojumu par labu staru terapijai-HT. Netika re\u0123istr\u0113ti devu ierobe\u017eojo\u0161i termiski apdegumi vai p\u0101rm\u0113r\u012bga g\u013cot\u0101das vai termiska toksicit\u0101te.<\/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;\">\u013baundab\u012bga 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 f\u0101zes randomiz\u0113ts (CR)<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">46%<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">28%<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">B\u016btisks uzlabojums 2 gadu aktu\u0101ra lok\u0101laj\u0101 kontrol\u0113 (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;\">Recidiv\u0113jo\u0161a kr\u016bts v\u0113\u017ea (RT + HT) \u0101rst\u0113\u0161ana \u2014 HT iek\u013cauta NCCN vadl\u012bnij\u0101s<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">III f\u0101zes randomiz\u0113ts (CR)<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">60,2%<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">38,1%<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">CR r\u0101d\u012bt\u0101js palielin\u0101j\u0101s par 57% relat\u012bvi<\/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;\">Ur\u012bnp\u016b\u0161\u013ca v\u0113\u017ea 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 f\u0101zes randomiz\u0113ts (24 m\u0113ne\u0161u RFS)<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">80%-82%<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">77%<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Nav b\u016btiskas at\u0161\u0137ir\u012bbas (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;\">Kaulu metast\u0101zes (WBH + RT)<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">III f\u0101zes randomiz\u0113ts (s\u0101pju piln\u012bga nov\u0113rt\u0113\u0161ana)<\/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;\">Uzlabota piln\u012bga remisija (P &lt; 0,05); laiks l\u012bdz atbildes reakcijai samazin\u0101ts l\u012bdz 10 dien\u0101m<\/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;\">Kaulu metast\u0101zes (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 f\u0101zes randomiz\u0113ts (s\u0101pju piln\u012bga nov\u0113rt\u0113\u0161ana)<\/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;\">Uzlabota piln\u012bga remisija (CR) p\u0113c 3 m\u0113ne\u0161iem (P = 0,006);<\/span><\/span><\/p>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Uzkr\u0101t\u0101 piln\u012bga remisija (CR) 3 m\u0113ne\u0161u laik\u0101 p\u0113c \u0101rst\u0113\u0161anas (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: modul\u0113ta elektrohipertermija; KT: \u0137\u012bmijterapija; RT: staru terapija; HT: hipertermija; RITE: radiofrekvences induc\u0113ta termo\u0137\u012bmijterapija; HIPEC: hipertermiska intraperitone\u0101la \u0137\u012bmijterapija; OS: kop\u0113j\u0101 dz\u012bvildze; DFS: dz\u012bvildze bez slim\u012bbas paz\u012bm\u0113m; CR: piln\u012bga atbildes reakcija; LC: lok\u0101la kontrole; PFS: dz\u012bvildze bez slim\u012bbas progres\u0113\u0161anas; ST: izdz\u012bvo\u0161anas laiks<\/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. Pier\u0101d\u012bjumi agres\u012bvu un atk\u0101rtotu slim\u012bbu gad\u012bjum\u0101 (jaunas indik\u0101cijas)<\/span><\/span><\/strong><\/h2>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">\u0160aj\u0101 sada\u013c\u0101 tiek analiz\u0113tas sare\u017e\u0123\u012btas audz\u0113ju vietas, kur 1A l\u012bme\u0146a pier\u0101d\u012bjumi ir ierobe\u017eoti vai tiek izstr\u0101d\u0101ti, bet kur augstas kvalit\u0101tes sal\u012bdzino\u0161ie p\u0113t\u012bjumi liecina par b\u016btisku HT lomu, \u012bpa\u0161i izmantojot mHT.<\/span><\/span><\/p>\n<h3><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">5.1. Gliomas (Glioblastoma Multiforme &#8211; GBM un Astrocitoma &#8211; AST)<\/span><\/span><\/h3>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Gliomas, \u012bpa\u0161i Glioblastoma Multiforme (GBM), ir paz\u012bstamas ar savu \u0101rk\u0101rt\u0113jo rezistenci pret \u0101rst\u0113\u0161anu. V\u0113sturisk\u0101 randomiz\u0113t\u0101 1998.\u00a0gada p\u0113t\u012bjum\u0101, kur\u0101 tika v\u0113rt\u0113ta brahiterapijas pastiprin\u0101juma un hipertermijas kombin\u0101cija GBM gad\u012bjum\u0101, tika dokument\u0113ts izdz\u012bvo\u0161anas ieguvums par labu kombin\u0113tajai grupai [9].<\/span><\/span><\/p>\n<h4><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">5.1.1. Dati par RF modul\u0113tu hipertermiju (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;\">Jaun\u0101k\u0101s metaanal\u012bzes<\/span><\/span><\/a><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> liecina, ka gan mEHT, gan audz\u0113ja \u0101rst\u0113\u0161anas lauki (TTF) var uzlabot izdz\u012bvo\u0161anu glioblastomas gad\u012bjum\u0101 [10]. \u0160\u0137iet, ka ieguvums ir visliel\u0101kais nesen diagnostic\u0113tiem pacientiem. Piem\u0113ram, *1 gada izdz\u012bvo\u0161ana mHT p\u0113t\u012bjumos nesen diagnostic\u0113tiem pacientiem bija 73% sal\u012bdzin\u0101jum\u0101 ar 37% kontroles grup\u0101* (p = 0,0021) [10]. <\/span><\/span><br \/>\n<span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Recidiv\u0113jo\u0161as slim\u012bbas gad\u012bjum\u0101 *nov\u0113rojumu sal\u012bdzino\u0161\u0101 anal\u012bze zi\u0146oja, ka mHT pagarin\u0101ja kop\u0113jo dz\u012bvildzi (OS) (GBM medi\u0101na 14 m\u0113ne\u0161i sal\u012bdzin\u0101jum\u0101 ar 12 m\u0113ne\u0161iem, p = 0,026). Astrocitomu (AST) gad\u012bjum\u0101 mHT uzr\u0101d\u012bja iev\u0113rojamu ieguvumu, vid\u0113jai\/medi\u0101nai OS bija 72\/91,6 m\u0113ne\u0161i sal\u012bdzin\u0101jum\u0101 ar 17\/34 m\u0113ne\u0161iem lab\u0101kaj\u0101 paliat\u012bv\u0101 atbalsta grup\u0101 (p = 0,0006). Pat atk\u0101rtotas GBM gad\u012bjum\u0101 pacientiem, kas \u0101rst\u0113ti ar mHT, 5 gadu OS bija 3,5% sal\u012bdzin\u0101jum\u0101 ar 1,2% lab\u0101kaj\u0101 atbalsta grup\u0101 [*11].<\/span><\/span><\/p>\n<p><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Sp\u0113c\u012bgie izdz\u012bvo\u0161anas sign\u0101li no sal\u012bdzino\u0161iem p\u0113t\u012bjumiem, pat sare\u017e\u0123\u012bt\u0101 gliomu kl\u012bniskaj\u0101 kontekst\u0101, attaisno HT iek\u013cau\u0161anu kl\u012bniskaj\u0101s vadl\u012bnij\u0101s k\u0101 1A l\u012bme\u0146a indik\u0101ciju.<\/span><\/span><\/strong><\/p>\n<h3><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">5.2. Aizku\u0146\u0123a dziedzera v\u0113zis (PK)<\/span><\/span><\/h3>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Aizku\u0146\u0123a dziedzera v\u0113zis ir \u0101rk\u0101rt\u012bgi let\u0101la sist\u0113miska slim\u012bba, kur HT pa\u0161laik tiek klasific\u0113ta k\u0101 &#8220;Bie\u017ei sastopami paliat\u012bvi kl\u012bniskie pier\u0101d\u012bjumi (no II f\u0101zes p\u0113t\u012bjumiem)&#8221;. Tom\u0113r p\u0113d\u0113jos gados veikti lieli sal\u012bdzino\u0161i p\u0113t\u012bjumi ir rad\u012bju\u0161i sp\u0113c\u012bgu kl\u012bnisko sign\u0101lu.<\/span><\/span><\/p>\n<h4><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">5.2.1. mEHT sal\u012bdzino\u0161\u0101 anal\u012bze metast\u0101tiskas PC gad\u012bjum\u0101<\/span><\/span><\/h4>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Liel\u0101 <\/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;\">retrospekt\u012bv\u0101 nov\u0113ro\u0161anas daudzcentru p\u0113t\u012bjum\u0101<\/span><\/span><\/a><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> (N=217 pacienti ar III\u2013IV stadijas PC) tika sal\u012bdzin\u0101ta mEHT + CHT (galvenok\u0101rt uz gemcitab\u012bna b\u0101zes) ar CHT vienu pa\u0161u. <\/span><\/span><br \/>\n<strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">\u25cf Kop\u0113j\u0101 dz\u012bvildze (OS): OS bija iev\u0113rojami uzlabojusies mEHT grup\u0101 (20 m\u0113ne\u0161i, sal\u012bdzinot ar 9 m\u0113ne\u0161iem CHT grup\u0101, 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 Dz\u012bvildze bez slim\u012bbas progres\u0113\u0161anas (PFS): Ar\u012b PFS bija iev\u0113rojami uzlabojusies (7 m\u0113ne\u0161i, sal\u012bdzinot ar 5 m\u0113ne\u0161iem, 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 Audz\u0113ja atbildes reakcija: Pacientiem, kuri tika \u0101rst\u0113ti ar mEHT, bija daudz augst\u0101ks da\u013c\u0113jas atbildes reakcijas r\u0101d\u012bt\u0101js (PR) (45% pret 24%, P = 0,0018) un iev\u0113rojami zem\u0101ks progres\u0113jo\u0161as slim\u012bbas (PD) r\u0101d\u012bt\u0101js (4% pret 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 ietekme atkar\u012bb\u0101 no vecuma<\/span><\/span><\/h4>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Izdz\u012bvo\u0161anas anal\u012bze p\u0113c vecuma atkl\u0101ja unik\u0101lu kl\u012bnisku aspektu: modul\u0113tas RF hipertermijas (mHT) sniegtais kop\u0113j\u0101s dz\u012bvildzes (OS) ieguvums saglab\u0101j\u0101s neatkar\u012bgi no t\u0101, vai pacienti bija &lt;= 70 gadus veci vai &gt; 70 gadus veci (ab\u0101m grup\u0101m vid\u0113jais OS bija 20 m\u0113ne\u0161i). Turpret\u012b gados vec\u0101kiem pacientiem, kuri sa\u0146\u0113ma tikai CHT, bija iev\u0113rojami zem\u0101ks OS (8 m\u0113ne\u0161i) nek\u0101 jaun\u0101kiem pacientiem (12 m\u0113ne\u0161i), kas nor\u0101da uz CHT efektivit\u0101tes samazin\u0101\u0161anos l\u012bdz ar vecumu. *Tas liecina, ka mHT pied\u0101v\u0101 stabilu efektivit\u0101ti bez ar vecumu saist\u012btas samazin\u0101\u0161an\u0101s, kas nov\u0113rota ar standarta CHT, iesp\u0113jams, pateicoties t\u0101 labv\u0113l\u012bgajam toksicit\u0101tes profilam.* <\/span><\/span><br \/>\n<strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">B\u016btiskais kl\u012bniskais uzlabojums (vid\u0113j\u0101 OS divk\u0101r\u0161o\u0161an\u0101s no 9 l\u012bdz 20 m\u0113ne\u0161iem) ir rad\u012bjis lielu piepras\u012bjumu p\u0113c steidzamas starptautisku randomiz\u0113tu III f\u0101zes p\u0113t\u012bjumu organiz\u0113\u0161anas, no kuriem da\u017ei jau ir uzs\u0101kti (piem\u0113ram, NCT02862015, Daudzcentru RCT par onkotermiju metast\u0101tiska aizku\u0146\u0123a dziedzera v\u0113\u017ea gad\u012bjum\u0101).<\/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. Dro\u0161\u012bbas profils un dz\u012bves kvalit\u0101te (QALY): HT augstais terapeitiskais indekss<\/span><\/span><\/h2>\n<h2><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">HT augstais terapeitiskais indekss<\/span><\/span><\/h2>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Pla\u0161a kl\u012bnisk\u0101 ievie\u0161ana ir atkar\u012bga no labv\u0113l\u012bga terapeitisk\u0101 indeksa saglab\u0101\u0161anas. *III f\u0101zes pier\u0101d\u012bjumi p\u0101rliecino\u0161i apstiprina faktu, ka HT atbilst \u0161ai pras\u012bbai, b\u016btiski nepalielinot smagu toksicit\u0101ti.*<\/span><\/span><\/p>\n<h3><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">6.1. Sist\u0113misk\u0101s toksicit\u0101tes anal\u012bze (3.\u20134. pak\u0101pe)<\/span><\/span><\/h3>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Randomiz\u0113tu p\u0113t\u012bjumu sistem\u0101tiska anal\u012bze apstiprina, ka HT *nepastiprina sist\u0113misko toksicit\u0101ti*, ko izraisa RT vai CHT:<\/span><\/span><\/p>\n<ul>\n<li><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Dzemdes kakla v\u0113zis (LACC):<\/span><\/span><\/strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> Ak\u016btas vai v\u0113l\u012bnas 3.\u20134. pak\u0101pes toksicit\u0101tes gad\u012bjum\u0101 b\u016btiska at\u0161\u0137ir\u012bba netika nov\u0113rota (RR \u2248 1,0).<\/span><\/span><\/li>\n<li><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Taisn\u0101s zarnas v\u0113zis:<\/span><\/span><\/strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> toksicit\u0101tes profils bija l\u012bdz\u012bgs. Netika konstat\u0113ta smagu 3.\u20134. pak\u0101pes \u0101das vai ku\u0146\u0123a-zarnu trakta reakciju palielin\u0101\u0161an\u0101s.<\/span><\/span><\/li>\n<li><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Aizku\u0146\u0123a dziedzera v\u0113zis (mHT):<\/span><\/span><\/strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> nepalielin\u0101ja \u0137\u012bmijterapijas izrais\u012bto hematolo\u0123isko, aknu, plau\u0161u vai vielmai\u0146as toksicit\u0101ti.<\/span><\/span><\/li>\n<\/ul>\n<h3><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">6.2. Nev\u0113lam\u0101s blakuspar\u0101d\u012bbas, kas rakstur\u012bgas hipertermijas metod\u0113m<\/span><\/span><\/h3>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Ar hipertermiju tie\u0161i saist\u012btas blakuspar\u0101d\u012bbas p\u0101rsvar\u0101 ir lokaliz\u0113tas un parasti ir kontrol\u0113jamas: <\/span><\/span><br \/>\n<strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">\u25cf Lok\u0101li re\u0123ion\u0101l\u0101 HT (LR HT):<\/span><\/span><\/strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> 3.\u20134. pak\u0101pes blakuspar\u0101d\u012bbas tika zi\u0146otas 10\u201332\u00a0% atk\u0101rtota kr\u016bts v\u0113\u017ea gad\u012bjumu, galvenok\u0101rt saist\u012bb\u0101 ar lok\u0101l\u0101m \u0101das reakcij\u0101m (viegliem apdegumiem vai 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 modul\u0113ta hipertermija (mHT)<\/span><\/span><\/strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> : mHT ir \u012bpa\u0161i labv\u0113l\u012bgs dro\u0161\u012bbas profils. Aizku\u0146\u0123a dziedzera v\u0113\u017ea p\u0113t\u012bjum\u0101 blakuspar\u0101d\u012bbas tika zi\u0146otas tikai 2,6\u00a0% mHT seansu, tostarp 1. pak\u0101pes \u0101das s\u0101pes vai 1.\u20132. pak\u0101pes apdegumi (1,1\u00a0% gad\u012bjumu), kas \u0101tri izzuda. <\/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 p\u0113t\u012bjums (ur\u012bnp\u016b\u0161\u013ca v\u0113zis):<\/span><\/span><\/strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> Lai gan nopietnas blakuspar\u0101d\u012bbas ab\u0101s grup\u0101s bija l\u012bdz\u012bgas (p\u00a0=\u00a00,5), kop\u0113jais blakuspar\u0101d\u012bbu (galvenok\u0101rt lok\u0101ls diskomforts un spazmas) skaits bija nedaudz liel\u0101ks HT grup\u0101 (35\u201348\u00a0% sal\u012bdzin\u0101jum\u0101 ar 33\u00a0% kontroles grupu, p\u00a0=\u00a00,05), apstiprinot lokaliz\u0113tu, bet nenoz\u012bm\u012bgu ietekmi uz smagu saslimst\u012bbu.<\/span><\/span><\/p>\n<h3><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">6.3. Ietekme uz dz\u012bves kvalit\u0101tes kori\u0123\u0113tiem gadiem (QALY)<\/span><\/span><\/h3>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Apvienojot dz\u012bves ilguma palielin\u0101\u0161anos ar dz\u012bves kvalit\u0101ti, QALY (kvalit\u0101tes kori\u0123\u0113to dz\u012bves gadu) koncepcija pied\u0101v\u0101 ekonomisku un cilv\u0113cisku perspekt\u012bvu par terapeitisko ieguvumu. Dokument\u0113tie HT kl\u012bniskie ieguvumi \u2014 uzlabota dz\u012bvildze, augst\u0101ki piln\u012bgas remisijas r\u0101d\u012bt\u0101ji un lab\u0101ka lok\u0101la kontrole \u2014 liecina par lielu ilgtermi\u0146a izmaksu ietaup\u012bjuma un pacientu QALY uzlabo\u0161an\u0101s varb\u016bt\u012bbu, pastiprinot argumentus par labu kl\u012bniskai ievie\u0161anai. <\/span><\/span><br \/>\n<span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">3.\u00a0tabul\u0101 ir sal\u012bdzin\u0101ts HT integr\u0101cijas dro\u0161\u012bbas profils ar standarta \u0101rst\u0113\u0161anu.<\/span><\/span><\/p>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">3.\u00a0tabula: Dro\u0161\u012bbas un toksicit\u0101tes sal\u012bdzin\u0101jums (HT integr\u0101cija sal\u012bdzin\u0101jum\u0101 ar standarta apr\u016bpi)<\/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\u0113\u017ea veids<\/span><\/span><\/strong><\/td>\n<td width=\"104\"><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Standarta \u0101rst\u0113\u0161ana (kontrole)<\/span><\/span><\/strong><\/td>\n<td width=\"104\"><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Intervence (HT + standarta \u0101rst\u0113\u0161ana)<\/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. pak\u0101pes toksicit\u0101tes atradumi<\/span><\/span><\/strong><\/td>\n<td width=\"104\"><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Kl\u012bniskais secin\u0101jums<\/span><\/span><\/strong><\/td>\n<td width=\"104\"><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Atsauce<\/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;\">Lok\u0101li progres\u0113jo\u0161s dzemdes kakla v\u0113zis<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">CCRT vien<\/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;\">Nav b\u016btiskas at\u0161\u0137ir\u012bbas ak\u016bt\u0101 vai v\u0113l\u012bn\u0101 toksicit\u0101t\u0113 (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;\">Labv\u0113l\u012bgs terapeitiskais indekss; sist\u0113misk\u0101s blakuspar\u0101d\u012bbas netiek pastiprin\u0101tas.<\/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;\">Taisn\u0101s zarnas\/an\u0101l\u0101s atveres v\u0113zis<\/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;\">Sal\u012bdzin\u0101ms toksicit\u0101tes profils; Nav smagu ku\u0146\u0123a-zarnu trakta vai \u0101das reakciju pieauguma<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">HT ir dro\u0161a kombin\u0101cij\u0101 ar iegur\u0146a sirds resinkroniz\u0101cijas protokoliem.<\/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;\">Smaga toksicit\u0101tes pak\u0101pe netrauc\u0113ja p\u0113t\u012bjuma pabeig\u0161anai<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Augsta panesam\u012bba; dro\u0161\u012bba ir apstiprin\u0101ta ilgtermi\u0146\u0101.<\/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;\">Ur\u012bnp\u016b\u0161\u013ca v\u0113\u017ea 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;\">Normotermiska MMC<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Hipertermiska MMC<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Nav at\u0161\u0137ir\u012bbas nopietnu blakuspar\u0101d\u012bbu zi\u0146\u0101 (p = 0,5)<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Smaga saslimst\u012bba palika nemain\u012bga.<\/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. Secin\u0101jumi, kl\u012bnisk\u0101 integr\u0101cija un turpm\u0101kie virzieni<\/span><\/span><\/h2>\n<h3><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">7.1. 1.A l\u012bme\u0146a gal\u012bgo indik\u0101ciju kopsavilkums<\/span><\/span><\/h3>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">R\u016bp\u012bga literat\u016bras anal\u012bze, kuras pamat\u0101 ir III f\u0101zes randomiz\u0113ti p\u0113t\u012bjumi un metaanal\u012bzes, apstiprina, ka hipertermija nav eksperiment\u0101la terapija, bet gan b\u016btiska multimod\u0101las onkolo\u0123ijas sast\u0101vda\u013ca noteiktu audz\u0113ju lokaliz\u0101ciju gad\u012bjum\u0101. <\/span><\/span><br \/>\n<strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Hipertermijai (HT) ir 1A l\u012bme\u0146a pier\u0101d\u012bjumi par gal\u012bgu izdz\u012bvo\u0161anu, izdz\u012bvo\u0161anu bez slim\u012bbas paz\u012bm\u0113m un piln\u012bgas atbildes reakcijas ieguvumiem m\u012bksto audu sarkomas, lok\u0101li progres\u0113jo\u0161a dzemdes kakla v\u0113\u017ea, galvas un kakla v\u0113\u017ea, taisn\u0101s zarnas\/an\u0101l\u0101s atveres v\u0113\u017ea, melanomas (lokore\u0123ion\u0101la slim\u012bba) un kr\u016bts v\u0113\u017ea recid\u012bva \u0101rst\u0113\u0161an\u0101 [2].<\/span><\/span><\/strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> \u0160o indik\u0101ciju gad\u012bjum\u0101 HT j\u0101uzskata par neaizst\u0101jamu standarta multimod\u0101las terapijas sast\u0101vda\u013cu.<\/span><\/span><\/p>\n<h3><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">7.2. Efektivit\u0101tes un tehnisk\u0101s noz\u012bmes nianses<\/span><\/span><\/h3>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">HT \u0101rst\u0113\u0161anas efektivit\u0101te ir dzi\u013ci atkar\u012bga no tehnisk\u0101s precizit\u0101tes un sild\u012b\u0161anas metodes. Iev\u0113rojamie un past\u0101v\u012bgie lokore\u0123ion\u0101l\u0101s HT pan\u0101kumi dzi\u013co cieto audz\u0113ju (piem\u0113ram, LACC, HNC) \u0101rst\u0113\u0161an\u0101 kontrast\u0113 ar jauktajiem rezult\u0101tiem, ko HIVEC ieguvusi vid\u0113ja riska neiromuskul\u0101r\u0101 multiplas v\u0113\u017ea (NMIBC) gad\u012bjum\u0101. <\/span><\/span><br \/>\n<span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">\u0160\u012b at\u0161\u0137ir\u012bba uzsver, ka optim\u0101ls kl\u012bniskais ieguvums netiek sasniegts tikai ar siltuma pielieto\u0161anu, bet ir nepiecie\u0161ama stingra kvalit\u0101tes nodro\u0161in\u0101\u0161ana (QA) un tehnisk\u0101 optimiz\u0101cija, lai nodro\u0161in\u0101tu vienm\u0113r\u012bgu un biolo\u0123iski efekt\u012bvu termisko devu vis\u0101 audz\u0113ja tilpum\u0101. Dati ar\u012b liecina, ka HT ieguvumu var iedal\u012bt p\u0113c riska, un tas ir visizteikt\u0101kais augstas rezistences vid\u0113s, piem\u0113ram, atk\u0101rtotas slim\u012bbas, augsta riska sarkomas vai BCG refrakt\u0101ra NMIBC gad\u012bjum\u0101.<\/span><\/span><\/p>\n<h3><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">7.3. Daudzsolo\u0161as indik\u0101cijas un turpm\u0101kie kl\u012bniskie p\u0113t\u012bjumi<\/span><\/span><\/h3>\n<h4><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">7.3.1. Aizku\u0146\u0123a dziedzera v\u0113zis<\/span><\/span><\/h4>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Sal\u012bdzino\u0161ie nov\u0113rojumu dati, kas liecina par *vid\u0113j\u0101s kop\u0113j\u0101s dz\u012bvildzes divk\u0101r\u0161o\u0161anos (no 9 l\u012bdz 20 m\u0113ne\u0161iem) modul\u0113tas RF hipertermijas (mHT) + CHT gad\u012bjum\u0101 metast\u0101tiska aizku\u0146\u0123a dziedzera v\u0113\u017ea gad\u012bjum\u0101, ir \u0101rk\u0101rt\u012bgi sp\u0113c\u012bgs kl\u012bniskais sign\u0101ls.* \u0160ie rezult\u0101ti rada nepiecie\u0161am\u012bbu steidzami uzs\u0101kt starptautiskus randomiz\u0113tus III f\u0101zes p\u0113t\u012bjumus (piem\u0113ram, NCT02862015), lai apstiprin\u0101tu \u0161os kop\u0113j\u0101s dz\u012bvildzes ieguvumus ar visaugst\u0101ko pier\u0101d\u012bjumu l\u012bmeni.<\/span><\/span><\/p>\n<h4><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">7.3.2. Integr\u0101cija ar imunolo\u0123isko onkolo\u0123iju<\/span><\/span><\/h4>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">T\u0101 k\u0101 HT imunolo\u0123iski &#8220;aukstos&#8221; audz\u0113jus p\u0101rveido par &#8220;karstiem&#8221; (iekaisu\u0161iem) audz\u0113jiem, atbr\u012bvojot HSP un aktiviz\u0113jot T \u0161\u016bnas, turpm\u0101kajos III f\u0101zes p\u0113t\u012bjumos vajadz\u0113tu izp\u0113t\u012bt HT siner\u0123iju ar moderniem imunoterapijas l\u012bdzek\u013ciem, piem\u0113ram, kontrolpunktu inhibitoriem. \u0160\u012b kombin\u0101cija var\u0113tu pastiprin\u0101t imunoterapijas atbildes reakcijas, \u012bpa\u0161i iepriek\u0161 refrakt\u0101ru audz\u0113ju gad\u012bjum\u0101.<\/span><\/span><\/p>\n<p><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Kl\u012bnisk\u0101 pieredze (EEAT):<\/span><\/span><\/strong><\/p>\n<p><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Andromedichyperthermia kl\u012bnik\u0101 m\u0113s p\u0113t\u0101m \u0161os 1A l\u012bme\u0146a protokolus ( <\/span><\/span><a href=\"https:\/\/andromedichyperthermia.com\/lv\/kliniskais-petijums-par-hipertermiju\/\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">piem\u0113ram, hipertermijas + CCRT + BRT kombin\u0101ciju LACC \u0101rst\u0113\u0161anai<\/span><\/span><\/a><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\"> ) k\u0101 apr\u016bpes standartu, tie\u0161i p\u0101rv\u0113r\u0161ot kl\u012bnisko p\u0113t\u012bjumu pier\u0101d\u012btos ieguvumus m\u016bsu pacientu individu\u0101lajos \u0101rst\u0113\u0161anas pl\u0101nos.<\/span><\/span><\/strong><\/p>\n<h3><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">7.4. Kl\u012bnisk\u0101s ievie\u0161anas standarti<\/span><\/span><\/h3>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Veiksm\u012bgai augstas temperat\u016bras terapijas (HT) ievie\u0161anai iest\u0101d\u0113 ir nepiecie\u0161ama daudznozaru pieredze (medic\u012bnas fizi\u0137i, staru onkologi, \u0137\u012bmijterapeiti) un stingra termisk\u0101s dozimetrijas protokolu iev\u0113ro\u0161ana. Lai reproduc\u0113tu 1A l\u012bme\u0146a rezult\u0101tus, \u0101rstniec\u012bbas centriem ir j\u0101iev\u0113ro starptautisk\u0101s vadl\u012bnijas un standarti, ko izstr\u0101d\u0101ju\u0161as specializ\u0113tas organiz\u0101cijas.<\/span><\/span><\/p>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">4.\u00a0tabula: Jaun\u0101s indik\u0101cijas un II\u00a0f\u0101zes\/nov\u0113rojumu dati (izdz\u012bvo\u0161anas krit\u0113riji)<\/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\u0113\u017ea veids (HT modalit\u0101te)<\/span><\/span><\/strong><\/td>\n<td width=\"104\"><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">P\u0113t\u012bjuma veids\/m\u0113r\u0137a krit\u0113rijs<\/span><\/span><\/strong><\/td>\n<td width=\"104\"><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">HT + standarta apr\u016bpe (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;\">Standarta apr\u016bpe vien (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;\">Galvenais atkl\u0101jums\/P v\u0113rt\u012bba<\/span><\/span><\/strong><\/td>\n<td width=\"104\"><strong><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Atsauce<\/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;\">Aizku\u0146\u0123a dziedzera v\u0113zis (mEHT + CHT)<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Retrospekt\u012bv\u0101 sal\u012bdzino\u0161\u0101 (OS)<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Vid\u0113j\u0101 kop\u0113j\u0101 dz\u012bvildze: 20 m\u0113ne\u0161i<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Vid\u0113j\u0101 kop\u0113j\u0101 dz\u012bvildze: 9 m\u0113ne\u0161i<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">OS iev\u0113rojami uzlaboj\u0101s (relat\u012bvais pieaugums par 77\u00a0%)<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">[Fiorentini et al., 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;\">Jaundiagnostic\u0113ta glioblastoma (mEHT)<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Metaanal\u012bze (1 gada 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;\">B\u016btisks kop\u0113j\u0101s dz\u012bvildzes (OS) ieguvums (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;\">Retrospekt\u012bv\u0101 sal\u012bdzino\u0161\u0101 (OS)<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Vid\u0113j\u0101 kop\u0113j\u0101 dz\u012bvildze: 72 m\u0113ne\u0161i<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Vid\u0113j\u0101 kop\u0113j\u0101 dz\u012bvildze: 17 m\u0113ne\u0161i<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">OS iev\u0113rojami uzlaboj\u0101s (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 et al., 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;\">Taisn\u0101s zarnas v\u0113zis (pCR, funkcion\u0101ls)<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">III f\u0101ze (dz\u012bvildze bez kolostomijas)<\/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;\">Uzlabota dz\u012bves kvalit\u0101te\/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 f\u0101ze, 2019.\u00a0g. s\u0101kums]<\/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;\">Dzemdes kakla v\u0113zis (LACC)<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">RCT (dz\u012bves bez slim\u012bbas progres\u0113\u0161anas\/dz\u012bves kvalit\u0101te)<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Uzlabota emocion\u0101l\u0101\/fizisk\u0101 dz\u012bves kvalit\u0101te<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Stabila\/samazino\u0161a dz\u012bves kvalit\u0101te<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Dz\u012bves kvalit\u0101te iev\u0113rojami uzlaboj\u0101s, bez paaugstin\u0101tas toksicit\u0101tes<\/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;\">Peritone\u0101l\u0101s metast\u0101zes (HIPEC)<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Nov\u0113rojumu p\u0101rskats (emocion\u0101l\u0101 dz\u012bves kvalit\u0101te)<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">\u0100tra atvese\u013co\u0161an\u0101s (3 m\u0113ne\u0161i p\u0113c oper\u0101cijas)<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">L\u0113na atvese\u013co\u0161an\u0101s<\/span><\/span><\/td>\n<td width=\"104\"><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">\u0100trs psiholo\u0123isks ieguvums<\/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. Bie\u017ei uzdotie jaut\u0101jumi (BUJ) par onkolo\u0123isko hipertermiju<\/span><\/span><\/h2>\n<h3><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">J: Vai hipertermija ir eksperiment\u0101la \u0101rst\u0113\u0161anas metode onkolo\u0123ij\u0101?<\/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;\"> N\u0113. Hipertermija (HT) ir p\u0101rbaud\u012bta \u0101rst\u0113\u0161anas metode ar *1A l\u012bme\u0146a pier\u0101d\u012bjumiem* (pamatojoties uz III f\u0101zes randomiz\u0113tiem p\u0113t\u012bjumiem un metaanal\u012bz\u0113m) galveno onkolo\u0123isko indik\u0101ciju gad\u012bjum\u0101, piem\u0113ram: m\u012bksto audu sarkomas, dzemdes kakla v\u0113zis, atk\u0101rtots kr\u016bts v\u0113zis, \u013caundab\u012bga melanoma, taisn\u0101s zarnas v\u0113zis, ur\u012bnp\u016b\u0161\u013ca v\u0113zis un galvas un kakla (HNC) audz\u0113ji.<\/span><\/span><\/p>\n<h3><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">J: K\u0101da ir optim\u0101l\u0101 darba temperat\u016bra hipertermijai?<\/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;\"> Optim\u0101l\u0101 darba temperat\u016bra ir no *39\u00b0C l\u012bdz 45\u00b0C*. \u0160is &#8220;terapeitiskais logs&#8221; nav v\u0113rsts uz tie\u0161u izn\u012bcin\u0101\u0161anu (abl\u0101ciju), bet gan uz v\u0113\u017ea \u0161\u016bnu biolo\u0123isko sensibiliz\u0113jo\u0161o iedarb\u012bbu uz \u0137\u012bmijterapiju un staru terapiju.<\/span><\/span><\/p>\n<h3><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">J: Vai hipertermija palielina \u0137\u012bmijterapijas vai staru terapijas toksicit\u0101ti?<\/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 f\u0101zes p\u0113t\u012bjumu anal\u012bze apstiprina, ka hipertermijas pievieno\u0161ana *b\u016btiski nepalielina smagu sist\u0113misku toksicit\u0101ti (3.\u20134. pak\u0101pe)*. Ar HT saist\u012bt\u0101s blakuspar\u0101d\u012bbas p\u0101rsvar\u0101 ir lokaliz\u0113tas un viegli p\u0101rvald\u0101mas (piem\u0113ram, vieglas \u0101das reakcijas).<\/span><\/span><\/p>\n<h3><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">J: K\u0101 hipertermija uzlabo staru terapiju?<\/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 darbojas k\u0101 sp\u0113c\u012bgs radiosensibilizators, izmantojot divus galvenos meh\u0101nismus: *1)* T\u0101 kav\u0113 starojuma boj\u0101tos DNS atjauno\u0161anas meh\u0101nismus un *2)* T\u0101 uzlabo asinsriti un audz\u0113ja apg\u0101di ar sk\u0101bekli, padarot iepriek\u0161 rezistentas \u0161\u016bnas daudz jut\u012bg\u0101kas pret apstaro\u0161anu.<\/span><\/span><\/p>\n<h3><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">J: K\u0101di v\u0113\u017ea veidi visvair\u0101k g\u016bst labumu no hipertermijas?<\/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;\"> Saska\u0146\u0101 ar 1A l\u012bme\u0146a pier\u0101d\u012bjumiem ir pier\u0101d\u012bta izdz\u012bvo\u0161anas priek\u0161roc\u012bba \u0161\u0101dos gad\u012bjumos: *m\u012bksto audu sarkomas, dzemdes kakla v\u0113zis, atk\u0101rtots kr\u016bts v\u0113zis, \u013caundab\u012bga melanoma, taisn\u0101s zarnas v\u0113zis, ur\u012bnp\u016b\u0161\u013ca v\u0113zis un galvas un kakla v\u0113zis.*<\/span><\/span><\/p>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">Atsauces (Atsauces teksts paliek t\u0101ds pats k\u0101 nor\u0101d\u012bts) <\/span><\/span><br \/>\n<span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">1. Pa\u0161reiz\u0113jo kl\u012bnisko pier\u0101d\u012bjumu p\u0101rskats par lok\u0101li re\u0123ion\u0101lu m\u0113renu hipertermiju v\u0113\u017ea papildterapij\u0101, 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. Pilns raksts: Re\u0123istr\u0113to kl\u012bnisko p\u0113t\u012bjumu par onkolo\u0123isk\u0101s hipertermijas \u0101rst\u0113\u0161anu sistem\u0101tisks p\u0101rskats \u2014 Taylor &amp; Francis Online, https:\/\/www.tandfonline.com\/doi\/full\/10.1080\/02656736.2022.2076292<\/span><\/span><\/p>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">3. Hipertermija, staru terapija un \u0137\u012bmijterapija: siltuma loma daudznozaru v\u0113\u017ea apr\u016bp\u0113. &#8211; Jefferson Digital Commons, https:\/\/jdc.jefferson.edu\/cgi\/viewcontent.cgi?article=1070&amp;context=radoncfp<\/span><\/span><\/p>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">4. Pilns raksts: Hipertermija un imunoterapija: kl\u012bnisk\u0101s iesp\u0113jas \u2014 Taylor &amp; Francis Online, https:\/\/www.tandfonline.com\/doi\/full\/10.1080\/02656736.2019.1653499<\/span><\/span><\/p>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">5. Hipertermija samazina v\u0113\u017ea \u0161\u016bnu inv\u0101ziju un apkaro \u0137\u012bmijrezistenci un im\u016bnsist\u0113mas apie\u0161anu cilv\u0113ka ur\u012bnp\u016b\u0161\u013ca v\u0113\u017ea gad\u012bjum\u0101 \u2014 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. Hipertermisks mitomic\u012bns C vid\u0113ja riska neinvaz\u012bv\u0101s musku\u013cu \u0101rst\u0113\u0161anas metod\u0113s &#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. Recirkul\u0113jo\u0161a hipertermiska intravezik\u0101la \u0137\u012bmijterapija ar mitomic\u012bnu C (HIVEC) sal\u012bdzin\u0101jum\u0101 ar BCG augsta riska neinvaz\u012bva ur\u012bnp\u016b\u0161\u013ca v\u0113\u017ea gad\u012bjum\u0101, 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. Pilns raksts: HIVEC efektivit\u0101te pacientiem ar augsta riska neinvaz\u012bvu ur\u012bnp\u016b\u0161\u013ca v\u0113zi, kuriem BCG ir kontrindic\u0113ta, un pacientiem, kuriem BCG terapija neizdodas \u2014 Taylor &amp; Francis Online, https:\/\/www.tandfonline.com\/doi\/full\/10.1080\/02656736.2021.2002435<\/span><\/span><\/p>\n<p><span dir=\"auto\" style=\"vertical-align: inherit;\"><span dir=\"auto\" style=\"vertical-align: inherit;\">9. Audz\u0113ju \u0101rst\u0113jo\u0161o lauku un hipertermijas kombin\u0101cijai ir siner\u0123iska terapeitiska iedarb\u012bba glioblastomas \u0161\u016bn\u0101s, samazinot STAT3 l\u012bmeni \u2014 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. Modul\u0113tas elektrohipertermijas un audz\u0113ju \u0101rst\u0113\u0161anas lauku metaanal\u012bze glioblastomu \u0101rst\u0113\u0161an\u0101 &#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. Modul\u0113ta elektrohipertermija integr\u0113t\u0101 v\u0113\u017ea \u0101rst\u0113\u0161an\u0101 recidiv\u0113jo\u0161as \u013caundab\u012bgas glioblastomas un astrocitomas gad\u012bjum\u0101: retrospekt\u012bvs daudzcentru kontrol\u0113ts p\u0113t\u012bjums, retrospekt\u012bvs p\u0113t\u012bjums, autors:<\/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. Pa\u0161reiz\u0113j\u0101 izpratne par modul\u0113tu elektrohipertermiju v\u0113\u017ea \u0101rst\u0113\u0161an\u0101 -; Kosin Medical Journal, https:\/\/www.kosinmedj.org\/journal\/view.php?number=1294<\/span><\/span><\/p>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>Autorit\u0101te un ekspert\u012bze (EEAT): Dr. Veronika Iatana, MD , un Kristi\u0101ns Gologans , ma\u0123istra gr\u0101ds androm\u0113diskaj\u0101 hipertermij\u0101 Hipertermijas terapeitisk\u0101 integr\u0101cija m\u016bsdienu onkolo\u0123ij\u0101: III f\u0101zes p\u0113t\u012bjumu un metaanal\u012b\u017eu kritiska anal\u012bze (OS, DFS, CR galapunkti) 1. Hipertermijas (HT) kopsavilkums un pamatprincipi Onkolo\u0123isk\u0101 hipertermija (HT) , kas defin\u0113ta k\u0101 kontrol\u0113ta siltuma pielieto\u0161ana temperat\u016br\u0101 no 39\u00b0C l\u012bdz 45\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":[172,951,37],"tags":[380,384,381,375,376,377,382,378,379,383],"class_list":["post-11193","post","type-post","status-publish","format-standard","hentry","category-news-lv","category-studii-clinice-lv","category-uncategorized-lv","tag-dzemdes-kakla-vezis","tag-e-e-a-t-lv","tag-hipertermija-lv","tag-iii-fazes-petijumi","tag-izdzivosana","tag-kopeja-remisija-os","tag-onkologija-lv","tag-pilniga-atbildes-reakcija","tag-pilniga-remisija-cr","tag-sarkoma-lv"],"gutentor_comment":0,"_links":{"self":[{"href":"https:\/\/andromedichyperthermia.com\/lv\/wp-json\/wp\/v2\/posts\/11193","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/andromedichyperthermia.com\/lv\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/andromedichyperthermia.com\/lv\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/andromedichyperthermia.com\/lv\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/andromedichyperthermia.com\/lv\/wp-json\/wp\/v2\/comments?post=11193"}],"version-history":[{"count":0,"href":"https:\/\/andromedichyperthermia.com\/lv\/wp-json\/wp\/v2\/posts\/11193\/revisions"}],"wp:attachment":[{"href":"https:\/\/andromedichyperthermia.com\/lv\/wp-json\/wp\/v2\/media?parent=11193"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/andromedichyperthermia.com\/lv\/wp-json\/wp\/v2\/categories?post=11193"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/andromedichyperthermia.com\/lv\/wp-json\/wp\/v2\/tags?post=11193"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}