I have been performing localized deep hyperthermia, a new and promising cancer treatment, with a device made by the company Oncotherm in my practice since October 2005.
The goal of localized deep hyperthermia is to overheat tumour cells using high-frequency waves, which causes hypoaemia (oxygen shortage), an acidic cell milieu and nutrient depletion of the tumour. This is thought to disrupt cell metabolism and cause cell death. The effects of simultaneously administered chemotherapy and/or radiation therapy are facilitated by localozed deep hyperthermia, and in some
cases formerly ineffective chemotherapy and/or radiation therapy can yield positive results. Tumour cells present with "heat shock proteins" on their cell surface after application of heat, thus becoming more distinguishable from healthy tissue as "heat shock proteins" are only displayed by tumour cells and can be identified by the immune system as such. Due to positive clinical experiences, the method is now employed my various hospitals and clinics in Germany and abroad. Localized deep hyperthermia has been recognized as the fourth pillar of oncological therapy alongside surgery, radiation therapy and chemotherapy by the Society for Biological Cancertherapy, Heidelberg.
Hyperthermia (with temperatures between 40-44 °C) is not used as a stand-alone treatment. Normally it is combined with either chemotherapy or radiation therapy, or both. Local or regional hyperthermia can be beneficial for large (advanced) tumours, for which neither surgery nor radiation therapy suffice as treatments. Especially locally relasping (regrowing) tumours fall into this category.
Distal metastases (which are distributed throughout the body) may also be treated with whole-body hyperthermia (alongside chemotherapy). Again, hyperthermia is only used if all other (conventinal) treatments have failed to produce adequate results. In the case of whole-body hyperthermia this is particularly applicable if several chemotherapy attempts have already failed and if the disease has re-occured.
In hyperthermia one differentiates between following procedures and applications:
Local hyperthermia is applied in the case of spatially restricted tumours on the body surface (i.e. skin cancer). Local heat applicators are put directly onto the superficial tumour.
Regional hyperthermia is applied in the case of vast, deeper located tumours of the abdomen or pelvic area, which are nontheless still spatially restricted. Energy is transmitted via ring applicators, surrounding the treatment area with radiofrequency waves connected to the body by a water bolus. Normally a temperature of 42-43 °C will be maintained in given body areas for an hour.
Partial body hyperthermia constitutes further development of the regional hyperthermia treatment, and is performed under the control of magnetic resonance tomography. Application and power are chosen so that the entire abdominal cavity will be heated.
Whole body hyperthermia is used in cancers which have already spread across large parts of the body, i.e. in the case of several metastates. Heating takes place through infra-red radiation onto the body's surface (known as radiative systems).
Thermoablation is employed in the case of a limited number of small tumour assemblies, maximally 3 -4 cm in size. Energy is transferred by laser or radiofrequency waves.
A solution containing superparamagnetic nanoparticles is infiltrated into the target tissue (> 5cm) which is then heated by applying a magnetic field to the defined region.
Here, antennas are put directly into the tumour or close to the tumour via bodily cavities. This enables very small-scale warming, which is usually combined with so-called afterloading therapy (interstitial radiation therapy).
Hyperthermia is typically used for difficult cases of disease, such as:
* Locally advanced tumours that are poorly or not operable at all.
* Tumours which would only be operable if taking inacceptable side effects into account
* Tumours which reoccured after repeated conventional treatments.
* Cancers which include specific additional risk factors.
Hyperthermia can be employed in the following cases:
* Pancreatic cancer
* Connective tissue tumours
* Bladder cancer
* Bronchial carcinoma
* Breat cancer
* Colorectal cancer
* Ovarian cancer
* Cervical cancer
* Skin cancer
* Brain tumours
* Testicular cancer
* Hodgkin's and non-Hodgkin's lymphoma
* Head and neck tumours
* Liver metastates
* Lung cancer
* Lymph node cancer
* Prostate cancer
* Esophageal cancer
Hyperthermia can also be beneficial for other cancers not featured in this list, for example in the case of inoperable, superficial tumours which do not respond well to other kinds of treatment.
Hyperthermia should be taken into consideration if the usual therapeutic approaches (surgery, chemotherapy, radiation) are unlikely to succeed or have already proven to be insufficient (relapse). The use of (local) hyperthermia also depends on the accesibility of the tumour with the available technical options (applicators).
The locoregional hyperthermia is generally very well tolerated and can be performed without special drugs or other preparations. Typically occurs at a local heating or hot sensation. Sometimes, this feeling of warmth as a discomfort to be increased to a feeling of pain - this must be reported immediately to the doctor and leads to a change of attitude. Only in exceptional cases it can cause prolonged symptoms (up to weeks) or even get a burn.
In regional hyperthermia are major benefits (several 100 W) in the body irradiated, so that there is a heat stress. This is about a sauna session and is tolerated by patients kreislaufgesunden easily.
It should be noted, however, that hyperthermia lasts 60-90 minutes. From some patients, the storage in the applicator or is felt even on a couch over such a long period of time than unpleasant. The surrounding water cushion can also lead to a feeling of tightness. Important that pain arising from the tumor treated well enough (it must get it a proper adjustment of analgesic therapy is to be done).
Some excerpts study to demonstrate the effectiveness of combined thermal therapy:
2003 in Hungary (Dani et al.) Carried out the control arm in metastatic lung, breast and pancreatic cancer, each with over 100 patients) and in Hyperthermiearm. The results of hyperthermia in the combined group had a 30% better tumor control and longer survival times.
A recently published study (Bull et al. ICHO 2004) from USA also shows the superior effect of combined thermal chemotherapy, some with Kompletremissionen.
For similar results, other studies found in various tumor entities in the combined therapy. Due to a 1998 study completed it can be seen that the efficiency increase was detected with chemotherapy in combination of hyperthermia treatment.
Study: R. Issels, GFS Research Center for Environment and Health, Institute of Molecular Immunology and Medical Center Grosshadern, Medical Clinic III: "Hyperthermia Combined with Chemotherapy-Biological Rationale, Clinical Application and Treatment Results" Oncology 1999; 22:374-381
Continue to report Issels et al. As van de Zee et al. were more than convincing results in the treatment of tumors refractory to surgery, chemotherapy and radiotherapy. In 38 patients who were treated with the combination of regional hyperthermia plus ifosfamide / etoposide, he achieved a remission rate of 37%. In a neoadjuvant approach with the combination of regional hyperthermia plus EIA (etoposide, ifosfamide, adriamycin) in 59 patients, the remission rate of 47%. The 5-year survival rate was 46%.
Van de Zee J, Gonzalez DG, van Rhoon GC, van Dijk JDP, van Putten WLJ, Hart AAM. Comparison of Radiotherapy with Radiotherapy Alone in Locally Advanced Pelvic Hyperthermia plus Tumours: a prospective, randomized, multicentre trial. The Lancet 2000, 355:1119-1125.
Could prove in this phase III trial is also a clear superiority of combined therapy with hyperthermia, the combination of this therapy in Holland in certain tumors and sites are used as standard therapy.
Kakehi et al. treated 33 patients with gastric carcinoma and 22 patients with pancreatic carcinoma with regional hyperthermia of 40.5 to 43 ° C in combination with chemotherapy. The remission rates were 39 and 36%, and in two thirds of the patients was also an improvement in tumor-related symptoms can be achieved.
Sugiyama et al. compared in a retrospective approach, the intra-arterial chemotherapy alone (HAI: 8 patients) with the combination of regional hyperthermia (HAI + HT: 9 patients) in patients with irresectable liver metastases. The response rates of 44% vs. 25% and the 2-year survival rates of 35% vs. 12% were higher in the combined therapy of HAI and regional HT as the sole HAI arm.
Douwes et al showed in a pilot study, the results of a study of 19 brain tumor hyperthermia patients (glioblastoma). Then showed 15% (3 patients) complete cure, and about 65% (patient 13) a Partialremission (PR) or stable disease (SD).
Hager et al. 35 patients were retrospectively found in patients with brain tumors, clear signs of an extension of survival and quality of life by the combination of chemotherapy and local hyperthermia.