Novità nelle cure
Ipertermia total body e tumori del colon retto: effetti sul sistema immunitario
L'ipertermia total body ad infrarosso (fever range) è da considerarsi valida opportunità coadiuvante in oncologia.
Il presente studio sperimentale è stato condotto per valutare l'attività della metodica nel ridurre lo stress sul sistema immunitario prodotti da intervento chirurgico (nel caso specifico priva di chirurgia per tumore del colonretto).
La conclusione è che l'attività del sistema immunitario può essere migliorata impiegando ipertermia total body prima dell'intervento chirurgico.
Ulteriori approfondimenti sono assolutamente auspicabili. Il lavoro clinico è stato pubblicato su rivista medica internazionale in lingua inglese.
Dr. Carlo Pastore
Br J Anaesth. 2012 Jul 31. [Epub ahead of print]
Effect of preoperative fever-range whole-body hyperthermia on immunological markers in patients undergoing colorectal cancer surgery.
Division of General Anaesthesia and Intensive Care, Department of Anaesthesiology, General Intensive Care and Pain Control.
Previous studies have demonstrated beneficial immunological effects of fever-range whole-body hyperthermia (FR-WBH) as an adjunct to non-surgical cancer therapy. We conducted a study of preoperative FR-WBH in patients undergoing colorectal cancer surgery to evaluate perioperative, hyperthermia-induced immunomodulation.
The trial was conducted as a subject-blinded, controlled, randomized study. Subjects in the FR-WBH group (n=9) were treated with FR-WBH before operation under propofol sedation; the target core temperature was 39 (0.5)°C with 1 h warming and 2 h plateau phase. Subjects in the control group (n=9) were treated with propofol sedation only. Blood samples were acquired before and after treatment, after operation, and 24, 48 h, and 5 days after the end of surgery. The following parameters were measured: lipopolysaccharide (LPS)-induced tumour necrosis factor (TNF)-α, procalcitonin (PCT), interleukin (IL)-6/10, heat shock proteins (HSPs) 60, 70, and 90, human leucocyte antigen-DR (HLA-DR), and LPS-binding protein (LBP).
HSPs were increased in the FR-WBH group after treatment [HSP60, 48 h postop: 143 (41)% vs 89 (42)%, P=0.04; HSP90, postop: 111 (33)% vs 64 (31)%, P=0.04; HSP70: P=0.40; FR-WBH vs control, P-values for area under the level/time curve]. TNF-α levels were elevated after surgery in the control group and remained near baseline in the FR-WBH group [24 h postop: 73 (68)% vs 151 (72)%, P=0.04]. PCT increased in both groups 24 h after surgery; in the control group, this increase was significantly higher (P=0.02). There were no significant differences for IL, HLA-DR, or LBP.
The immune system to react to surgical stress, as measured by a panel of laboratory indicators, might be improved by preoperative FR-WBH.