臺灣博碩士論文加值系統

隨著日新月異的科技發展，癌症治療的選項推陳出新，目標都希望病患以最少的手術時間及術後的併發症達到更長的腫瘤控制。熱消融是一種於人類醫學行之有年針對局部腫瘤治療的技術，此研究中使用的電磁導針熱療法為國立成功大學研發的系統，相對於傳統的外科手術，可有效縮短手術時間並經由短時間的高溫減少出血量，此外，由於沒有探針的限制，可擴大腫瘤治療的大小及範圍。
於2014年至2016年間的臨床試驗，共有21隻動物納入試驗，包含8例口腔腫瘤、7例體表軟組織肉瘤、3例肝臟腫瘤及3例貓注射型相關肉瘤。治療成效至試驗結束，共有8隻動物（38%）仍維持完全消退及及2隻動物（10%）維持部分消退，整體反應率為48%。全體動物的中位存活時間為279天，於18隻動物的中位腫瘤相關存活時間為296天，中位無病期時間為225天，臨床分期及腫瘤治療相對位置影響存活時間及無病期。治療相關較嚴重的副作用，主要仍見於體表及軟組織的傷害。於12隻動物血液學於二個月內與術前並無顯著差異，而免疫細胞分析由於隻數樣本數目不足，因此無法由此研究得到有效資訊。研究結果，可在犬肢端軟組織肉瘤見到較高完全消退率及較長的無病期，於少數口腔腫瘤病患可以有緩解症狀的效果。
未來期許可經由電磁導針熱療法造福更多的小動物，也希望有更大量的病例數研究支持特定的腫瘤治療應用，甚至用於有轉移的病患合併觀察免疫T細胞的變化，來提升治療的成效。

Thermal ablation is a local application that uses extreme temperature to induce cell injury. It is a new modality for cancer treatment and popped up with advanced technology since 1990s. Electromagnetic thermotherapy system that we used in this study is designed by National Cheng Kung University. This newly developed system pertain advantages of not only shortened surgical time and less bleeding during operation by rapid high temperature but also no limitation on the total numbers of inserted needles.
In this clinical trial between 2014 and 2016, total 21 patients were recruited and treated with tumor types including 8 oral tumors, 7 superficial soft tissue sarcomas, 3 hepatic tumors and 3 feline injection-site sarcomas. At the end of our trial, 8 (38%) patients were still in complete remission and 2 (10%) were in partial remission. Of the 21 patients, median overall survival time was 279 days and median progression free interval was 225 days. The median tumor specific survival time for the 18 patients was 296 days. In conclusions, patients with extremity STS had a better treatment efficacy and Progression free interval in the present study. Tumor-related adverse effects were mainly seen in superficial tumors with deep subcutaneous and soft tissue damage. During the follow up recheck time, no hematological changes were observed. A well-design study for specific tumor type or well-defined clinical staging underwent EMT treatment and synergic with T cell population analysis. may be required in order to apply in clinical setup.

口試委員會審定書 #
誌謝 ii
中文摘要 iii
ABSTRACT iv
CONTENTS v
LIST OF FIGURES viii
LIST OF TABLES ix
Chapter 1 Introduction 1
Chapter 2 Literature Review 2
2.1 Thermal ablation of tumors 2
2.1.1 Thermal ablation 2
2.1.2 Electromagnetic thermotherapy 3
2.1.3 The zones of hyperthermic ablation 4
2.2 Hyperthermia therapy induced anti-tumor immunity 4
2.2.1 Mechanisms of local hyperthermia and immune response 4
2.2.2 T cell population change thermal ablation 5
2.2.3 Regulatory T cells and antitumor immunity 6
2.3 Superficial Tumors 7
2.3.1 Soft tissue sarcoma (STS) 7
2.3.2 Feline injection site sarcoma (FISS) 8
2.4 Canine Oral Tumors 9
2.5 Visceral Tumors 9
2.5.1 Hepatic tumors 9
Chapter 3 Materials and Methods 11
3.1 Patient selection 11
3.2 Pre-treatment evaluation 11
3.3 Operative procedures 12
3.4 Follow up 13
3.5 Flow cytometric analysis 13
3.5.1 Blood sample preparation 13
3.5.2 Flow cytometry 13
3.6 Assessment of therapeutic effect 14
3.7 Adverse Effect 15
3.8 Statistical Analysis 15
Chapter 4 Results 17
4.1 Patient Population 17
4.2 Tumor Characteristic 17
4.2.1 Tumor types and locations 17
4.2.2 Pre-operative treatment and tumor staging 18
4.3 Treatment Efficacy 18
4.4 Adverse Effect 19
4.5 Hematological changes 20
4.6 Flow cytometric analysis of T cell population 21
Chapter 5 Discussion 22
5.1 Treatment efficacy 22
5.1.1 Overall treatment response 22
5.1.2 Soft tissue sarcomas (STS) – extremity location 23
5.1.3 Oral tumors 24
5.1.4 Hepatic tumors 26
5.1.5 Feline injection-site sarcoma 27
5.2 Treatment related adverse effect and management 28
5.2.1 General performance 28
5.2.2 Overall skin and soft tissue damage and management 29
5.3 T cell population and immune response 30
5.4 Limitations 31
5.5 Future aspects 32
Chapter 7 Conclusion 33
FIGURES 34
TABLES 49
REFERENCE 63

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