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Results of Hyperthermia Alone or with Radiation Therapy and/or Chemotherapy

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Hyperthermia in Cancer Treatment: A Primer

Part of the book series: Medical Intelligence Unit ((MIUN))

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Abstract

The interest in clinical hyperthermia (HT) was maximum in eighties and decreases during nineties of the last century but now, thank to possibility of heat deeply and to measure the temperature not invasively the interest is growing another time. On the other hand the biology of HT, clearly established during seventies, is now discussed with particular attention to the molecular pattern.

Heat alone can be used as a cytotoxic agent. Results from 14 studies about lesions treated with HT alone reported complete response (CR) rate of 13% and overall response (OR) rate of 51%; the response time was short.

HT alone can obtain results similar to some drugs employed as monochemotherapy. The result depends strictly from the possibility to obtain a good quality geometrical heat and to prescribe a sufficient number of heat session. The recommendation of the International Consensus meeting on HT held in 1989 was that results of heat alone should be used as a reference for such combinations.

We performed from 1983 to 1996 some studies concerning the association of HT and radiations (RT). The most important results were the 90% and 75% of OR and CR for chest wall recurrences (the majority of them pretreated with radiotherapy); the data obtained were similar to results of multicentric Italian data obtained in 212 lesions treated in 10 radiotherapy centres.

In the Overgaard, Myerson and van der Zee reviews about numerous studies the therapeutic enhancement ratio for patients treated with the association versus patients treated with radiotherapy alone is for the great majority of studies between 1.5 and 2.0

From 22 randomized studies we found in 15 a statistically significant advantage for patients treated with the association of HT and RT or radiochemotherapy versus patients treated with RT or chemotherapy alone. We would emphasise that the two American studies by RTOG (Radiation Therapy Oncology Group) are inconclusive because of sub-optimal technical way of HT.

The use of interstitial HT permits heat delivery to a well-defined volume which is frequently inaccessible to external local or deep HT. Interstitial HT uses placement into the treatment-planned volume of multiple microwave or radiofrequency antennas.

Intracavitary HT associated with radiation therapy and/or chemotherapy is under study from about 20 years, in particular for the carcinoma of the oesophagus. Several hundred patients have been treated in phase I-II studies in the far East: all reports showed good treatment tolerance and a lack of significant late complications but most of the reports are based on small number of patients and not provide sufficient information.

A strong biological rationale exists for the use of local HT and systemic chemotherapy in patients with superficial tumors. Superficial metastases are often associated with additional occult distant metastases that warrant systemic treatment. Preliminary results employing cisplatinum and bleomycin with local HT revealed high response rate even in tumors located in previously irradiated sites: the better results were obtained in the treatment of breast carcinoma, head and neck and malignant melanoma.

The most important prognostic factors affecting the response to HT are RT or heat dose: some of them may be more important than others in the clinical application, e.g., the temperature and total heating time, and, when HT is done in association with RT, radiation dose.

The great challenge for HT in the next future is to provide adequate heating to the full tumor volume, in particular for deep seated tumors. Radiation Therapy Oncology Group (RTOG) studies demonstrated that 42°C minimum temperature not were obtained for most tumors; now some devices will ultimately lead to better minimum temperature not only for superficial tumors but also for deep seated lesions. Another way to ameliorate HT in clinical setting will be the possibility to measure the temperature not invasively by means of magnetic resonance (MR) or ultrasound (US).

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Authors and Affiliations

  1. Radiotherapy Unit, Institute for Cancer Research and Treatment, Candiolo, Turin, Italy

    Pietro Gabriele

  2. Division of Molecular Angiogenesis, Institute for Cancer Research and Treatment (IRCC), Strada Provinciale 142, Candiolo, Turin, 10060, Italy

    Cristina Roca

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Gabriele, P., Roca, C. (2006). Results of Hyperthermia Alone or with Radiation Therapy and/or Chemotherapy. In: Hyperthermia in Cancer Treatment: A Primer. Medical Intelligence Unit. Springer, Boston, MA. https://doi.org/10.1007/978-0-387-33441-7_9

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