What Is Hyperthermia? An Introduction to Thermal Treatment for Cancer
Oncological hyperthermia uses heat to damage tumor cells, making them more sensitive to treatments such as radiotherapy and chemotherapy. It raises the tumor’s temperature, impairing cellular functions and improving the effectiveness of therapies.
Hyperthermia is a therapeutic technique used in oncology that exploits heat to selectively damage tumor cells. This treatment consists of raising the temperature of tumor tissue to a range between 42.5 and 43°C, with the goal of weakening malignant cells and making them more sensitive to other therapies such as radiotherapy and chemotherapy.
Hyperthermia can act in several ways:
- Directly on tumor cells, compromising their vital functions and inducing cell death.
- Altering the tumor microenvironment, reducing the supply of oxygen and nutrients that cancer cells need to proliferate.
- Enhancing the effects of other oncological treatments, increasing the effectiveness of chemotherapy and radiotherapy.
Hyperthermia Techniques: Methods and Clinical Applications for Oncological Treatment
Hyperthermia can be induced using ultrasound, microwaves, or radiofrequency, choosing the technology based on the treatment depth.
Hyperthermia can be induced in the body through various technologies, which differ in the type of energy used to generate heat. The main methods are:
Ultrasound: Uses mechanical waves with frequencies between 0.3 and 3 MHz. It can focus energy on narrow, deep areas, but reflection phenomena may limit its effectiveness.
Microwaves: Employ electromagnetic radiation with frequencies between 300 and 2450 MHz. They only penetrate a few centimeters into the body, making them more suitable for superficial treatments.
Radiofrequency: Uses electromagnetic radiation with frequencies below 300 MHz. It can reach depths greater than 10 cm, making it ideal for treating deep tumors.
Principle of Heat Penetration:
The effectiveness of hyperthermia depends on the energy’s ability to penetrate tissues. The higher the frequency, the lower the depth reached; the lower the frequency, the greater the penetration depth. For deep tumors, radiofrequency is preferred, while microwaves are used for superficial ones.
Which tumors can hyperthermia effectively treat?
Hyperthermia is an advanced oncological therapy that enhances the effectiveness of conventional treatments for various neoplasms, improving tumor response and the patient’s quality of life.
Hyperthermia is an advanced and effective oncological therapy, recognized as a therapeutic option for the treatment of numerous neoplasms, as highlighted by the guidelines of the Osaka Consensus Conference (2004).
Thanks to its ability to enhance the effectiveness of conventional therapies such as radiotherapy and chemotherapy, hyperthermia represents a valid therapeutic option, improving not only tumor response but also the patient’s quality of life.
Tumors for which hyperthermia is recommended:
Colorectal Tumor
Breast Cancer Recurrences
Cervical Cancer
Soft Tissue Sarcoma
Malignant Melanoma
Head and Neck
Bladder Tumors
Pancreatic Cancer
Anal Carcinoma
Hyperthermia has shown particularly promising results in the treatment of:
Peritoneal Carcinomatosis
Esophageal Tumor
Advanced Prostate Cancer
Glioblastoma Recurrences
Esophageal Tumors
Biological Mechanism of Hyperthermia: How Heat Affects Tumor and Healthy Cells
Hyperthermia heats the tumor up to 42.5°C, selectively damaging cancer cells and enhancing radiotherapy and chemotherapy.
Microwave or radiofrequency energy can be used to heat the tumor to about 42.5 °C. This treatment exploits the principle that heat damages tumor cells more than healthy cells. Cancer cells have an altered vascular system, which cannot effectively dissipate excess heat, while normal cells, thanks to a regular and well-developed vascular network, can dispose of the extra heat without significant damage.
Hyperthermia acts on tumor cells during the S phase of the cell cycle, when other traditional therapies, such as radiotherapy and chemotherapy, are less effective. Therefore, this treatment modality is often considered a complementary therapy to these options, enhancing their overall efficacy. Therefore, this treatment modality is often considered a complementary therapy to these options, enhancing their overall efficacy.
Terapie Combinate nel Trattamento Oncologico: Ipertermia, Radioterapia e Chemioterapia
Hyperthermia enhances radiotherapy and chemotherapy, improving therapeutic efficacy without increasing toxicity, and stimulates the immune system.
The main advantage of hyperthermia is its ability to enhance the effects of radiotherapy and chemotherapy while simultaneously reducing their side effects.
Clinical studies have demonstrated that integrating hyperthermia with these therapies significantly improves their effectiveness without increasing damage to healthy tissues. Radiotherapy is more effective when targeting well-oxygenated tumor cells, whereas it is less effective when acting on tumors with poor oxygenation. Hyperthermia, on the other hand, primarily affects tumor cells with low oxygenation, so combining the two therapies allows for targeting a greater number of neoplastic cells. Furthermore, hyperthermia prevents irradiated tumor cells from repairing the damage caused by radiation.
When the patient receives hyperthermia and radiotherapy simultaneously, tumor cells—which would normally be able to partially repair radiation-induced damage—are no longer able to do so and are destroyed more efficiently (apoptosis).
The main advantages of combining hyperthermia with conventional therapies are as follows:
- Increased therapeutic efficacy: Hyperthermia enhances the effectiveness of radiotherapy and chemotherapy without increasing toxicity.
- Low-dose radiation treatments: Combining hyperthermia with low doses of ionizing radiation has proven to be as effective as high doses, with the added benefit of reducing side effects.
In addition, hyperthermia is useful in treating tumor recurrences that occur after previous radiotherapy. It enables the reactivation of radiotherapy’s effectiveness even on tissues that have already been severely damaged by ionizing radiation.
Some tumors are successfully treated with the triple combination of hyperthermia, chemotherapy, and radiotherapy without increasing overall toxicity.
Numerous clinical studies have confirmed a significant increase in complete therapeutic response, with the clinical disappearance of the tumor, when hyperthermia is added to radio- or chemotherapy. On average, the response improves by about 35%, and this concerns tumors such as those of the breast, cervix, soft tissue sarcomas, bladder tumors, cerebral glioblastoma, and head and neck tumors.
Hyperthermia, in addition to being a potent radio- and chemo-sensitizer, increases the effectiveness of conventional treatments without raising toxicity. Moreover, it acts as an immunomodulator, stimulating the patient’s immune system, which is often weakened by traditional oncological treatments.
Most of these studies were conducted through randomized trials, in which patients were randomly divided into two groups: one group received hyperthermia in addition to conventional therapy, and the other received only the standard treatment (radiotherapy and/or chemotherapy).
Possible Side Effects and Treatment Safety
Hyperthermia improves the tolerance of oncological therapies with minimal side effects, reducing the risk of serious complications thanks to advanced technologies.
The introduction of hyperthermia into oncological treatment increases patients’ tolerance to therapies, while simultaneously improving tumor response and often also survival. The side effects of hyperthermia are minimal compared to those of traditional oncological therapies and do not add to them.
According to current data, the risk of complications is generally contained. Mild superficial burns, localized pain, or modest damage to the skin, muscles, and nerves in the treated area may occur. More serious complications, such as deep burns or fistulas, are rare and require longer healing times. Modern technologies have developed advanced equipment capable of minimizing undesired effects, which, in any case, are of short duration and limited extent.
Clinical Documentation
Andromedic's Work
- Estudio cuasi-experimental (caso-control) de factibilidad de la asociación del tratamiento con hipertermia profunda local a tratamientos estándar oncológicos y descripción de los patrones de respuestaDownload PDF
- Preliminary results of chemoradiation plus hyperthermia and high-dose-rate brachytherapy for locally advanced cervical carcinomaDownload PDF
- Feasibility of local deep hyperthermia treatment in conjunction with standard cancer treatments and patterns of responseDownload PDF
- Feasibility of a deep hyperthermia and radiotherapy programme for advanced tumors. First Spanish ExperienceDownload PDF
- Regional deep hyperthermia in combination with whole brain radiotherapy (wbrt) in poor prognosis patients with brain metastases.Download PDF
- Quasi-feasibility study (case-control) associating Local deep hypertermia treatment with standard cancer treatments and describing the pattern of response.Download PDF
Lavori Scientifici Ipertermia
- Regional hyperthermia combined with radiotherapy for uterine cervical cancers: a multi-institutional prospective randomized trial of the international atomic energy agencyDownload PDF
- A novel strategy of radiofrequency hyperthermia (neothermia) in combination with preoperative chemoradiotherapy for the treatment of advanced rectal cancer: a pilot studyDownload PDF
- Immune-related Effects of Local Hyperthermia in Patients with Primary Liver CancerDownload PDF
- Re-irradiation plus regional hyperthermia for recurrent non-small cell lung cancer: A potential modality for inducing long-term survival in selected patientsDownload PDF
- Radiotherapy with 8-mhz radiofrequency-capacitive regional hyperthermia for stage III non–small-cell lung cancer: the radiofrequency-output power correlates with the intraesophageal temperature and clinical outcomesDownload PDF
- Deep regional hyperthermia for the whole thoracic region using 8MHz radiofrequency-capacitive heating device: Relationship between the radiofrequency-output power and the intra-oesophageal temperature and predictive factors for a good heating in 59 patientsDownload PDF
- Hyperthermia Combined with Chemotherapy for Patients with Residual or Recurrent Oesophageal Cancer After Definitive ChemoradiotherapyDownload PDF
- Definitive radiotherapy plus regional hyperthermia with or without chemotherapy for superior sulcus tumors: A 20-year, single center experienceDownload PDF
- Feasibility study of postoperative intraperitoneal hyperthermochemotherapy by radiofrequency capacitive heating system for advanced gastric cancer with peritoneal seedingDownload PDF
- Quality assurance guidelines for superficial hyperthermia clinical trialsDownload PDF
- Quality assurance guidelines for superficial hyperthermia clinical trialsDownload PDF
- Effect of tumor properties on energy absorption, temperature mapping, and thermal dose in 13.56-MHz radiofrequency hyperthermiaDownload PDF
- Hyperthermia combined with Radiotherapy in locally advanced recurrent or metastatic diseaseDownload PDF
- The usefulness of mobile insulator sheets for the optimization of deep heating area for regional hyperthermia using a capacitively-coupled heating method: Phantom, simulation and clinical prospective studiesDownload PDF
- Locoregional hyperthermia of deep-seated tumours applied with capacitive and radiative systems: a simulation studyDownload PDF
- Bevacizumab-Based Chemotherapy Combined with Regional Deep Capacitive Hyperthermia in Metastatic Cancer Patients: A Pilot StudyDownload PDF
- A comparison of the heating characteristics of capacitive and radiative superficial hyperthermiaDownload PDF
- Quality assurance: Recommended guidelines for safe heating by capacitive-type heating technique to treat patients with metallic implantsDownload PDF
- Thermo-chemo-radiotherapy for advanced bile duct carcinomaDownload PDF
- Numerical model for RF capacitive regional deep hyperthermia in pelvic tumorsDownload PDF
- Die kapazitive Hyperthermie scheint das Schmerzansprechen bei der palliativen Bestrahlung von schmerzhaften Knochenmetastasen zu verbessernDownload PDF
- Preliminary results of chemoradiation plus hyperthermia and high-dose-rate brachytherapy for locally advanced cervical carcinomaDownload PDF
- Feasibility of local deep hyperthermia treatment in conjunction with standard cancer treatments and patterns of responseDownload PDF
- Quasi-feasibility study (case-control) associating Local deep hypertermia treatment with standard cancer treatments and describing the pattern of response.Download PDF
Linee Guida
- Quality assurance guidelines for superficial hyperthermia clinical trials: I. Clinical requirementsDownload PDF
- Guideline for the clinical application, documentation and analysis of clinical studies for regional deep hyperthermiaDownload PDF
- Guide to the use of hyperthermic equipment. 1. Capacitively-coupled heatingDownload PDF
- Quality assurance: Recommended guidelines for safe heating by capacitive-type heating technique to treat patients with metallic implantsDownload PDF
