What is Hyperthermia?
Hyperthermia is a therapeutic oncological treatment, which involves administering heat to a tumour tissue as selectively as possible, in order to increase its temperature to a value ranging between 42.5 and 43 °C.
Hyperthermia techniques
There are various ways of generating hyperthermia within the body, depending on the form of energy used. In particular, it is possible to distinguish between:
- Ultrasounds, mechanical waves with frequencies between 0.3 and 3 Mhz.
- Microwaves, electromagnetic radiation with frequencies between 300 and 2450 Mhz.
- Radiofrequency, electromagnetic radiation with frequencies below 300 Mhz.
Ultrasound makes it possible to focus energy on small volumes even at considerable depths, but it suffers heavily from the reflection phenomenon. From a clinical point of view, the use of non-ionising electromagnetic radiation is more functional.
Penetration is only a few centimetres in the case of microwaves, while depths exceeding ten centimetres are reached with radiofrequency techniques. The depth of penetration, in fact, increases as the frequency decreases. This is why radiofrequency is predominantly used in deep treatments.
Biological mechanism
The energy produced by microwaves or radiofrequency waves heats the tumour to a temperature of about 42.5 °C.
Heat affects cancer cells more than healthy cells. Most cancer cells have an altered vascular system that cannot dissipate excess heat; normal cells, on the other hand, are well supplied with a regular network of vessels and can easily dissipate the extra heat received.
Hyperthermia kills cancer cells during a cycle phase (phase S) where other cancer therapies are usually ineffective and is therefore considered a complementary treatment to radiotherapy and chemotherapy.
Combined therapies
The advantage of hyperthermia is that it can enhance the effects of radiotherapy and chemotherapy and reduce their side effects.
Clinical studies have shown that adding hyperthermia to these therapies increases their effectiveness, without causing more damage to normal tissue. Radiotherapy works when it targets well-oxygenated cancer cells, while it is less effective in the case of poorly oxygenated cells. On the contrary, more cancer cells will be killed by adding radiotherapy to hyperthermia. In addition, hyperthermia prevents the irradiated cancer cells from recovering from the radiation damage and repairing it.
If the patient receives both hyperthermia and radiotherapy at the same time, the cancer cells, which are normally able to partially repair the damage caused by irradiation, are no longer able to recover and die earlier (apoptosis).
Several clinical trials have also shown that low doses of ionising radiation combined with hyperthermia can be as effective against cancer as high doses alone. The combination of heat with radiation can thus provide effective treatments by reducing the side effects of high doses and improving patients’ quality of life.
Moreover, by combining hyperthermia with low doses of radiotherapy, it is possible to re-irradiate recurrences in tissue already highly damaged by ionising radiation developed after radiotherapy and that would not be further treatable.
Some cancers are successfully treated with the triple combination of hyperthermia, chemotherapy and radiotherapy, without an increase in overall toxicity.
Numerous clinical trials have shown an increased complete response with the clinical disappearance of cancer when hyperthermia is added to radiotherapy or chemotherapy. On average, the increase in response is around 35% and affects breast cancers, cervical cancers, soft tissue sarcomas, bladder cancers, glioblastoma and head and neck cancers.
Hyperthermia, being a powerful radiosensitizer and chemosensitizer, increases the efficacy of conventional treatments without adding toxicity. Moreover, it acts as an immune system modulator and is able to stimulate the natural defence system of the patient undergoing treatment, which is often weakened by cancer drugs and ionising radiation used in radiotherapy.
Most of these trials were conducted by randomly drawing patients. Some of them joined the experimental group, where hyperthermia was added to standard treatment, while others joined the control group where only conventional therapy – usually radiotherapy and/or chemotherapy – was administered. These clinical trials are referred to as randomised trials and their results cannot be manipulated by researchers as the patients were selected randomly.
Side effects
The addition of hyperthermia increases patients’ tolerance to treatment and simultaneously improves tumour response and often survival of these patients.
The side effects of hyperthermia are negligible compared to those caused by conventional cancer therapies and do not add up to them.
According to currently available data, the risks of complications are usually low and include transient superficial burns, pain in localised spots and moderate skin, muscle and nerve damage in the treated area. Rarely, more serious complications may occur such as deep burns or fistulas that take time to heal.
Modern technology has produced devices that are able to minimise undesirable effects, which, in any case, are not long-lasting and of little severity.
Cases in which hyperthermia should be administered
Based on the Osaka Consensus Conference (2004), hyperthermia should be administered in the following cases:
- Locally advanced or recurring colorectal cancer
- Recurrent breast cancer
- Cervical cancer
- Soft tissue sarcoma
- Recurrent skin cancer (malignant melanoma)
- Locally advanced head and neck cancers
- Locally advanced or recurrent bladder cancer
- Pancreatic cancer
- Locally advanced or recurrent anal carcinoma
Other cancers treatable with hyperthermia with good results include peritoneal carcinomatosis, advanced prostate cancer, recurrent glioblastoma, oesophageal cancers.
See full clinical documentation
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