Radiation Oncology/Hyperthermia

Hyperthermia • Hyperthermia uses higher temperatures than diathermy, which is the deep heating of body tissue for relaxation or physical therapy • When combined with radiation therapy, it is called thermoradiotherapy Hyperthermic intraperitoneal chemotherapy • Intraperitoneal hyperthermic chemoperfusion (HIPEC or IPHC) is a type of hyperthermia therapy used in combination with surgery in the treatment of advanced abdominal cancers • In this procedure, warmed anti-cancer medications are infused and circulated in the peritoneal cavity (abdomen) for a short period of time • The chemotherapeutic agents generally infused during IPHC are mitomycin-C and cisplatin • Santiago González-Moreno, et al. World J Gastrointest Oncol. 2010 Feb 15; 2(2): 68–75. Hyperthermic intraperitoneal chemotherapy: Rationale and technique (21160924) Whole-body hyperthermia H Wehner et al. Whole-body hyperthermia with water-filtered infrared radiation: technical-physical aspects and clinical experiences. Int J Hyperthermia. 2001 Jan-Feb;17(1):19-30. (11212877) Eighty treatments of patients in an advanced stage of cancer (40 male, 40 female, April 1998-April 1999) were performed with a WBH device with water-filtered infrared radiation, IRATHERM 2000. The mean duration of the rising phase (37.5-41.5 degrees C) was 87 +/- 19 min. WBH with water-filtered infrared radiation in combination with induced hyperglycaemia and relative hyperoxaemia (procedure of systemic Cancer Multistep Therapy) is a safe and practicable procedure with good tolerability in the case of experienced application. Subpage: Level I evidence Breast cancer Melanoma Cervical cancer RT +/- Hyperthermia Duke (1994-2001) Randomized. 109 patients with superficial tumors (<= 3cm depth); breast 65%, H&N 13%, melanoma 10%. Tumors had to be "heatable" on initial HT. Arm 1) RT alone vs. Arm 2) RT + HT. Hyperthermia to >43C x1 hour, 2x/week. RT dose 30-60 Gy if previous RT, otherwise 60-70 Gy in 1.8-2.0 Gy/fx 2005 15860867 -- "Randomized trial of hyperthermia and radiation for superficial tumors." (Jones EL, J Clin Oncol. 2005 May 1;23(13):3079-85.) Outcome: CR RT 42% vs. RT+HT 66% (SS). Patients with prior RT had most benefit (68% vs. 23%, SS) Toxicity: Well tolerated, 1 Grade III thermal burn Conclusion: Significant local control benefit for HT International Collaborative Hyperthermia Group (1988-1991) -- combined results from 5 PIII trials Randomized. 5 trials merged due to slow accrual, closed early after benefit. 306 patients. Advanced primary or recurrent BCA; 50% active disease outside treatment area. Could have had prior RT. Trials: Dutch Hyperthermia Group (DHG), Medical Research Council (MRC BrI and BrR), European Society of Hyperthermic Oncology (ESHO), and Princes Margaret (PMH). Target hyperthermia 43C. RT given in various fractions. 1996 8690639 -- "Radiotherapy with or without hyperthermia in the treatment of superficial localized breast cancer: results from five randomized controlled trials. International Collaborative Hyperthermia Group." (Vernon CC, Int J Radiat Oncol Biol Phys. 1996 Jul 1;35(4):731-44.) Outcome: CR RT 41% vs. RT+HT 59% (SS); greatest effect in recurrent lesions in previous RT, where re-irradiation dose was low. 2-year OS ~40% (NS), 74% patients progressed outside HT area during follow-up Conclusion: Combined result demonstrated efficacy of hyperthermia as adjunct to RT for treatment of recurrence RTOG, 1991 1903023 -- "Randomized phase III study comparing irradiation and hyperthermia with irradiation alone in superficial measurable tumors. Final report by the Radiation Therapy Oncology Group." (Perez CA, Am J Clin Oncol 1991 Apr;14(2):133-41.) Randomized. 307 patients with superficial tumors. Treated with RT alone or RT + HT (following, to 42.5C for 45-60 min) Response: CR RT 30% vs. RT+HT 32%; improved LC in tumors <3cm Toxicity: comparable, but 30% thermal blisters in heated tumors Timing of Hyperthermia Jefferson, 1993 (1983-1990) 8515137 -- "Randomized trial of one versus two adjuvant hyperthermia treatments per week in patients with superficial tumours." (Engin K, Int J Hyperthermia. 1993 May-Jun;9(3):327-40.) Randomized. 41 patients with 44 superficial tumors. Treated with QW vs. BIW HT + RT (mean dose 45 Gy) 2-month CR: 59% QW HT vs. 55% BIW HT Predictive factors for CR: RT dose, tumor volume; Predictive factors for duration of response: minimum tumor temperature, tumor volume Toxicity: No difference. Conclusion: No difference in response or duration between once weekly and twice weekly hyperthermia Duration of Hyperthermia Temperature should be converted to 43 celsius-equivalent minutes Each 1C above 43C requires 1/2 time for equivalent thermal damage (e.g. 1 min @ 45C = 4 min @ 43C) Each 1C below 43C requires 4x increase in time for equivalent thermal damage (e.g. 1 min @ 42C = 0.25 min @ 43C) t2/t1 = 2^(Temp1-Temp2) Hyperthermic Intraperitoneal Chemotherapy (HIPEC) S J Valle et al. Hyperthermic Intraperitoneal Chemotherapy (HIPEC) Methodology, Drugs and Bidirectional Chemotherapy. Indian J Surg Oncol. 2016 Jun;7(2):152-9. (27065705) Wim Ceelen et al. Hyperthermic Intraperitoneal Chemotherapy: A Critical Review. Cancers (Basel). 2021 Jun 22;13(13):3114. (34206563)