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Hyperthermia Helps Reduce Tumors in Cancer Patients

Breaking News - May 2005 - Week 1

(May 4, 2005)

Healthcare in  the News

-- Researchers now have strong evidence that turning up the heat on a cancerous tumor just before radiation therapy appears to destroy the tumor much more often than radiation alone does, according to a report in the Journal of Clinical Oncology.

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The combined treatment method seems to effectively address breast, chest wall, head, neck, and skin cancer in newly diagnosed patients and in those coping with recurring illness.

The heating process - a noninvasive procedure known as hyperthermia - relies on microwaves to dramatically elevate tumor temperature to approximately 112 degrees Fahrenheit.

A One-Two Punch

Researchers say that such a thermal assault renders cancerous blood vessel walls more porous, while simultaneously provoking a helpful rise in cellular oxygen levels. In this weakened state, the tumor becomes much more vulnerable to subsequent radiation treatment.

"We're trying to sensitize the tumor cells to the tumor cell-killing potential of other therapies," says study author Dr. Ellen Jones, a Duke University radiation oncologist. "We use it to make these other treatments more effective."

Hyperthermia is not, in itself, a new technology. But 20-year-old studies exploring the potential of a combined hyperthermia-radiation cancer treatment did not reveal much promise at the time.

The new study, however, suggests that control of the heating process has been sufficiently improved to ensure that microwave-increased temperature levels can be properly maintained, delivered, and localized within the tumor region.

From 1994 through 2001, Dr. Jones and her team followed 108 men and women diagnosed with breast, chest wall, head, neck, or skin cancer. The patients were described as having "incurable disease" that gave them a less than 50 percent chance of responding to conventional treatment.

Although the study included patients being treated for both initial and recurring cancer, the largest grouping was comprised of women in whom cancer had recurred in the chest wall following a mastectomy for breast cancer.

The researchers tested the combined treatment effect solely on "superficial tumors" - tumors that extended no more than approximately one inch below the skin.

After all the patients underwent an initial hyperthermia treatment, half continued to receive the heat treatment alongside radiation therapy while the rest received only radiation.

The hyperthermia group was treated twice a week for a total of no more than 10 sessions. Each treatment lasted one to two hours, with at least 48 hours between sessions.

Radiation therapies were individualized for each patient, with those patients who had already undergone radiation before the study receiving significantly lower doses than those who had never undergone such treatment.

The researchers found that full tumor shrinkage was achieved in 66 percent of the patients on the combined therapies, and only 42 percent of patients receiving just radiation therapy.

Even more dramatic were the findings concerning those patients with recurring cancer who had already previously undergone radiation. Among these men and women, 68 percent of the patients on combined treatment experienced full tumor shrinkage, compared with 24 percent of the radiation-alone patients.

Among patients who had never received radiation, 65 percent of the combined treatment patients had full tumor eradication, compared with 51 percent of the radiation patients.

The Duke team has concluded that hyperthermia appears to be a safe and effective boost to radiation treatment efforts to stem the spread of local tumors - while noting that side effects, such as skin burns, appeared to be minimal.

They stress, however, that nothing yet suggests combination therapy will actually improve survival rates overall.

New Approach Brings Added Hope

But for cancer patients waging a tug of war with a spreading disease, hyperthermia does offer hope for a markedly better quality of life. Elimination and/or reduction of tumors via combined therapy can significantly reduce pain and discomfort, the researchers note.

And they further observed that while the combined treatment option can benefit all cancer survivors, patients suffering the most pain - those engaged in long-term struggles with recurring cancers - have the most to gain.

Recurrent cases, they note, usually involve particularly aggressive cancers that have proven resistant to radiation, chemotherapy, and/or surgery. Combining hyperthermia with lower-dose radiation may open treatment doors that are otherwise closed.

Dr. Jones says she and her colleagues were actively working to expand on the hyperthermia option by adding chemotherapy to the mix.

"Hyperthermia works," says Dr. Steven Stroup, a radiation oncologist at the Sarah Cannon Cancer Clinic at the Centennial Medical Center in Nashville, Tenn.

"This is absolutely where the field of radiation oncology is going, to improve the effects with regard to tumor control," agrees Dr. David Parda, chairman of the department of radiation oncology at Allegheny General Hospital in Pittsburgh.

But he also cautions that more research is needed to establish the limits of hyperthermia's usefulness.

"The study researchers didn't treat tumors greater than 3 centimeters - a little more than an inch - in size," he explains. "So, I really think that it's important for people to be aware that its applicability, so far, is limited to very small tumors.

"And a lot of recurrent cancers are larger than that," he says. "So, widespread applicability would have to be proven with further studies."

Always consult your physician for more information.



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Hyperthermia Defined

According to the National Institutes of Health (NIH), hyperthermia (also called thermal therapy or thermotherapy) is a type of cancer treatment in which body tissue is exposed to high temperatures (up to 113°F).

Research has shown that high temperatures can damage and kill cancer cells, usually with minimal injury to normal tissues. By killing cancer cells and damaging proteins and structures within cells, hyperthermia may shrink tumors.

Hyperthermia is under study in clinical trials (research studies with people) and is not widely available, the NIH states.

Hyperthermia is almost always used with other forms of cancer therapy, such as radiation therapy and chemotherapy. Hyperthermia may make some cancer cells more sensitive to radiation or harm other cancer cells that radiation cannot damage.

When hyperthermia and radiation therapy are combined, they are often given within an hour of each other. Hyperthermia can also enhance the effects of certain anticancer drugs.

Numerous clinical trials have studied hyperthermia in combination with radiation therapy and/or chemotherapy, the NIH states.

These studies have focused on the treatment of many types of cancer, including sarcoma, melanoma, and cancers of the head and neck, brain, lung, esophagus, breast, bladder, rectum, liver, appendix, cervix, and peritoneal lining (mesothelioma).

Many of these studies, but not all, have shown a significant reduction in tumor size when hyperthermia is combined with other treatments.

However, not all of these studies have shown increased survival in patients receiving the combined treatments, according to the NIH.

Several methods of hyperthermia are currently under study, including local, regional, and whole-body hyperthermia.

In local hyperthermia, heat is applied to a small area, such as a tumor, using various techniques that deliver energy to heat the tumor.

Different types of energy may be used to apply heat, including microwave, radiofrequency, and ultrasound. Depending on the tumor location, there are several approaches to local hyperthermia:

  • External approaches are used to treat tumors that are in or just below the skin. External applicators are positioned around or near the appropriate region, and energy is focused on the tumor to raise its temperature.
  • Intraluminal or endocavitary methods may be used to treat tumors within or near body cavities, such as the esophagus or rectum. Probes are placed inside the cavity and inserted into the tumor to deliver energy and heat the area directly.
  • Interstitial techniques are used to treat tumors deep within the body, such as brain tumors. This technique allows the tumor to be heated to higher temperatures than external techniques. Radiofrequency ablation (RFA) is a type of interstitial hyperthermia that uses radio waves to heat and kill cancer cells.

In regional hyperthermia, various approaches may be used to heat large areas of tissue, such as a body cavity, organ, or limb.

  • Deep tissue approaches may be used to treat cancers within the body, such as cervical or bladder cancer.

    External applicators are positioned around the body cavity or organ to be treated, and microwave or radiofrequency energy is focused on the area to raise its temperature.
  • Regional perfusion techniques can be used to treat cancers in the arms and legs, such as melanoma, or cancer in some organs, such as the liver or lung.

    In this procedure, some of the patient’s blood is removed, heated, and then pumped (perfused) back into the limb or organ. Anticancer drugs are commonly given during this treatment.
  • Continuous hyperthermic peritoneal perfusion (CHPP) is a technique used to treat cancers within the peritoneal cavity (the space within the abdomen that contains the intestines, stomach, and liver), including primary peritoneal mesothelioma and stomach cancer.

Whole-body hyperthermia is used to treat metastatic cancer that has spread throughout the body.

Always consult your physician for a diagnosis.

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