The increase in heat causes an increase in the blood flow to the tumour. This increased blood flow results in an increase in the concentration of the chemotherapy in the tumour. There is also more oxygen brought to the tumour by the blood. This is important because radiotherapy causes more damage when there is oxygen in the tumour.[3,4]

The main action of radiation therapy and chemotherapy is on the DNA of the tumour cells. However the cells will try to repair the damage done by radiation and chemotherapy. This repair process is very difficult under heated conditions and therefore, on top of increasing the cell killing effect of the treatments, hyperthermia also inhibits and slows down the tumour cells’ ability to repair the damage done by the treatments.[5,6]

Heating the region also stimulates an immune response at the site of the tumour which can support and promote the body’s ability to fight against the cancer.[7,8]

Your oncologist may recommend that you add Hyperthermia treatments to your chemotherapy or radiotherapy, if you have a cancer that is known to be responsive to Hyperthermia. Hyperthermia may be added to your treatment if you have a recurrence in a location that has already been treated with radiation or if you have already had chemotherapy. Hyperthermia is often used to sensitise tumours that are known to be resistant to radiation or chemotherapy. In some rare instances Hyperthermia may be used by itself, in between chemotherapy or radiotherapy. Studies have been conducted on tumours of the gastrointestinal tract, urinary tract, liver, lung, head and neck, brain, cervix, prostate, melanomas, and sarcomas. While there are some tumour types for which the use of Hyperthermia is still considered experimental, there are many tumour types with a large amount of research. The most researched tumours are cervical cancer, head and neck cancers, recurrent breast cancers, and sarcomas.[9–13] Speak to your oncologist if you think you may have a tumour that could benefit from the addition of Hyperthermia to your treatment regime.

The main action of radiation therapy and chemotherapy is on the DNA of the tumour cells. However the cells will try to repair the damage done by radiation and chemotherapy. This repair process is very difficult under heated conditions and therefore, on top of increasing the cell killing effect of the treatments, hyperthermia also inhibits and slows down the tumour cells’ ability to repair the damage done by the treatments.[5,6]

Heating the region also stimulates an immune response at the site of the tumour which can support and promote the body’s ability to fight against the cancer.[7,8]

Various types of Hyperthermia have been developed to heat tumours at different sites within the body. The methods used to heat tumours include antenna-array focused electromagnetic energy, radiofrequency inductive or capacitive heating, ultrasound, or infra-red heating.

Whole body Hyperthermia aims to raise the temperature of the entire body. There are several institutions in Europe and America which are applying whole body Hyperthermia for people in whom the cancer has spread to various parts of the body. Studies are already available and more studies are being conducted on the use of whole body Hyperthermia combined with chemotherapy. The results are positive.[14–16] Increasing the whole body temperature increases the heart rate, breathing rate and perspiration. The functioning of the kidneys is also altered during whole body Hyperthermia. This makes whole body Hyperthermia challenging to administer and in order to ensure a safe treatment, the patient must be carefully monitored to make sure that their body is not under too much stress.

Regional Hyperthermia

Regional Hyperthermia involves the heating of the general region in which the tumour is found (for example the abdomen, chest area or a limb) . Regional heating does not have the same challenges as whole body heating and the heating is most commonly achieved by isolated perfusion of organs or limbs, or by irrigation of body cavities. Deep heating techniques using radiofrequency and microwave energy have also been developed. Challenges with these techniques include burns and damage to healthy tissue.

Local Hyperthermia

Local Hyperthermia involves heating up only the tumour using external or internal energy sources. Different types of energy can be used, such as radiofrequency, microwaves or ultrasound. For superficial tumours, infrared light can also be used to heat the tumour.

Intraluminal, Intravesical or Endocavitary Hyperthermia

Some tumours are accessible through body cavities. In these cases the probes can be inserted the body cavity (eg oral cavity, rectum, vagina, urethra), instead of surgically inserted (as is the case in interstitial heating). Body cavities, such as the mouth, rectum, and urethra, provide access to tumours of the digestive tract, urinary tract and prostate (in men). In women, the vagina can provide access to some tumours of the female reproductive system.

At our practice, we use a technique known as modulated Electro-Hyperthermia. Modulated Electro-Hyperthermia is a form of local Hyperthermia that is able to selectively heat up tumours using low frequency radio waves. The technique is suitable for tumours regardless of their depth or location in the body.

The device is manufactured by a company called Oncotherm GmBH. The technique involves lying on a bed that has an electrode built into the base.

A second electrode, housed in an adjustable applicator is then placed over the treatment area. The two electrodes use capacitive coupling to generate an electromagnetic field using radiofrequency energy. The frequency used is very low. At 13.56MHz the frequency is even lower than the lowest frequency used for radio stations, and it is therefore very safe.

The device has a self-selecting technology which is based on the difference in the biophysical properties of malignant tissue and healthy tissue. The malignant (cancer) tissue responds differently to the electromagnetic field and one of the consequences of this is that the cancer tissue begins to heat up.

The technique that we use is very safe. There is a very small (1%) chance of developing a small blister in the area if the treatment is too hot, and there is a chance that, if there is a lot of fatty tissue in the treatment area. The fatty tissue may suffer a low grade “burn” resulting in a round, painful lump in the fatty tissue, which disappears over six to eight weeks.  However, this is not common and only happens in roughly ten out of a hundred patients.[10] If the brain is being treated, you have a risk of developing headaches and nausea after the treatment that may persist for a few hours, and there is a small risk of having a seizure during a treatment to the brain. Although brain tumours independently increase your risks of having a seizure.[18]

Before the treatment you will be asked to remove anything metal or anything that may interfere with the electromagnetic field. This includes jewellery, zips, buckles, cell phones, wallets etc. You may also be asked to empty your bladder. During the treatment you will lie on the Hyperthermia bed, with the treatment area covered with medical paper toweling, and the electrode will be placed onto your body. The electrode will begin to feel warm during the treatment, however it should never feel uncomfortably hot. The process should be pain free and relaxing. Most people fall asleep during the treatment. The duration of a Hyperthermia treatment can vary from 30 minutes to 1½ hours, depending on the site of the tumour. After the treatment you may feel slightly light headed and thirsty. You will be advised to drink plenty of fluids and rest afterwards.

Your first port of call is your Oncologist. Your Oncologist will be able to tell you if you are eligible for treatment. If you are eligible for treatment or would like more information, please contact us via our contact page.

Hyperthermia combined with chemotherapy or radiotherapy has been investigated for the treatment of a variety of tumours. Below is a list of some cancer types that have shown positive responses to Hyperthermia. For more information on which cancer types can be treated with Hyperthermia, please ask your Oncologist or send us a query by email.

*Cervical cancer stages IIB and higher (supported by research)

*Recurrent local disease or residual disease in cervical cancer patients after treatment with radiotherapy (supported by research)

*A local recurrence (in the chest wall) in breast cancer patients previously treated with radiotherapy (supported by research)

*A local recurrence in a previously irradiated region (supported by research)

*Head and neck cancers (supported by research)

*Bone metastases (supported by research)

*Soft tissue sarcomas (supported by research)

*Brain tumours (positive results in early studies)

*Pancreas (positive results in early studies)

*Liver metastases from colorectal cancer (supported by research)

*Rectal cancer (supported by research)

This list is not exhaustive. Please note that the above is a typical indication and patient specific factors may affect the applicability of the list above. For confirmation please consult with your Oncologist.

https://www.cancer.gov/about-cancer/treatment/types/surgery/hyperthermia-fact-sheet

References:

1. Mohamed F, Marchettini P, Stuart OA, et al. Thermal Enhancement of New Chemotherapeutic Agents at Moderate Hyperthermia. Annals of Surgical Oncology. 2003;10(4):463-468.
2. Dewhirst MW, Vujaskovic Z, Jones E, et al. Re-setting the biologic rationale for thermal therapy. International Journal of Hyperthermia. 2005;21(8):779-790.
3. Song CW, Park HJ, Lee CK, et al. Implications of increased tumor blood flow and oxygenation caused by mild temperature hyperthermia in tumor treatment. International Journal of Hyperthermia. 2005;21(8):761-767.
4. Griffin RJ, Dings RPM, Jamshidi-Parsian A, et al. Mild temperature hyperthermia and radiation therapy: role of tumor vascular thermotolerance and relevant physiological factors. International Journal of Hyperthermia. 2010;26(3):256-263.
5. Pandita TK, Pandita S, Bhaumik SR. Molecular Parameters of Hyperthermia for Radiosensitization. Critical Reviews in Eukaryote Gene Expression. 2009;19(3):235-251.
6. Oei AL, Vriend LEM, Crezee J, et al. Effects of hyperthermia on DNA repair pathways: One treatment to inhibit them all. Radiation Oncology. 2015;10(1):1-13.
7. Werthmöller N, Frey B, Rückert M, et al. Combination of ionising radiation with hyperthermia increases the immunogenic potential of B16-F10 melanoma cells in vitro and in vivo. International Journal of Hyperthermia. 2016;32(1):23-30.
8. Akutsu Y, Tamura Y, Murakami K, et al. Can modulated electro-hyperthermia ( mEHT ) elicit immune reaction ? – From basic and clinical research. 2014;11(November):2014.
9. Datta NR, Ordóñez SG, Gaipl US, et al. Local hyperthermia combined with radiotherapy and- / or chemotherapy : Recent advances and promises for the future. Cancer Treatment Reviews. 2015;41(9):742-753.
10. Minnaar CA, Kotzen JA, Akinwale O, et al. The effect of modulated electro-hyperthermia on local disease control in HIV-positive and -negative cervical cancer women in South Africa : Early results from a phase III randomised controlled trial. PLoS ONE. 2019;14(6):e0217894.
11. Datta NR, Rogers S, Klingbiel D, et al. Hyperthermia and radiotherapy with or without chemotherapy in locally advanced cervical cancer: a systematic review with conventional and network meta-analyses. International Journal of Hyperthermia. 2016;32(7):809-821.
12. Datta NR, Stutz E, Liu M, et al. Concurrent chemoradiotherapy vs. radiotherapy alone in locally advanced cervix cancer: A systematic review and meta-analysis. Gynecologic Oncology. 2017;145(2):374-385.
13. Oldenborg S, Griesdoorn V, Van Os R, et al. Reirradiation and hyperthermia for irresectable locoregional recurrent breast cancer in previously irradiated area: Size matters. Radiotherapy and Oncology. 2015;117(2):223-228.
14. Douwes FR, Hospital SG, Str R, et al. Local and whole body hyperthermia in chemoresistant ovarian cancer. 2013;70(June):83043.
15. Bull JMC, Scott GL, Strebel FR, et al. Fever-range whole-body thermal therapy combined with cisplatin, gemcitabine, and daily interferon-α: A description of a phase I-II protocol. International Journal of Hyperthermia. 2008;24(8):649-662.
16. van der Horst A, Versteijne E, Besselink M, et al. The clinical benefit of hyperthermia in pancreatic cancer: a systematic review. International Journal of Hyperthermia. 2018;34(7):969-979.
17. P.K. S. Survival Benefit of Hyperthermia in a Prospective Boost + Hyperthermia for Glioblastoma Multiforme. Elsevier Science. 1998;40(2):287-295.
18. Fiorentini G, Sarti D, Milandri C, et al. Retrospective observational Clinical Study on Relapsed Malignant Gliomas Treated with Electro-hyperthermia Presented at 35 th ICHS , Guangzhou , 2017. 2018;22(February):32-45.