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Hyperthermia: A New Alternative Treatment for Cancer?

 

Ernestine Jideama

 

Introduction 

According to the American Cancer Society, in the year 2001, 1,268,000 people contracted cancer.  Since 1990 around 15,000,000 have been diagnosed with cancer.  One out of four Americans will die from cancer and cancer is the leading cause of death after heart disease with 553,400 American deaths from cancer in the year 2001: that’s about 1500 people per day (http://www.cancer.org/downloads/STT/F&F2001.pdf).

Cancer is caused by an uncontrollable spread of abnormal cells and can be triggered by various risk factors like an unhealthy lifestyle, exposure to radiation and chemicals, hormones, and genes.  Certain types of cancers can be prevented through the practice of a healthy lifestyle.  Avoiding the use of alcohol and smoking, exercising, eating nutritiously, and the use of sunscreen to prevent sunburn are all important steps for the prevention of some cancers.

The most accepted and common forms of treatment for cancer include radiation, chemotherapy, immunotherapy, surgery, or a combination of these.  Treatments such as chemotherapy and radiation are known for their painful side effects.  With movies like W;t and other media that candidly show the gruesome effects of treatments like chemotherapy, it is no wonder that people seek alternative therapy.  Because of this and other factors, new alternative treatments have been gaining recognition as viable treatments for cancer.  One of these rapidly rising treatments is a promising remedy called hyperthermia.     

 

 

Hyperthermia

 

 

What is it?

When you contract a virus or cold, a common symptom is fever.  The elevation of body temperature is a normal way in which the body fights invading organisms.  The creation of an elevated body temperature is used by the body to create a hostile environment for a pathogen to live.  Hyperthermia works in much the same fashion.  Hyperthermia “is a type of treatment in which body tissue is exposed to high temperatures to damage and kill cancer cells, or to make cancer cells more sensitive to the effects of radiation and certain anticancer drugs” (http://www.cancercenter.com/treatmentOptions/default.cfm/14/42). 

Serious hyperthermia research began in 1883 when Dr. William B.Coley read a paper by another American doctor named Busch.  Busch’s paper relayed the story of a patient who had an untreatable sarcoma of the face.  After the patient contracted the skin infection erysipelas which led to a fever ranging from 104o to 105.8oF, she spontaneously went into remission.  This paper sparked interest in Dr. Coley, and he consequently began 20 years of research (http://www.findarticles.com/cf_0/g2603/0004/2603000441/p1/article.jhtml?term=hyperthermia).

There are three types of hyperthermia treatments: local hyperthermia, regional hyperthermia, and whole-body heating; any of these treatments can be used according to the condition.  Local hyperthermia is most commonly used to treat tumors or small areas.  In order to internally heat the area, sterile probes like thin, heated wires, hollow tubes filled with warm water, implanted microwave antennae, and radiofrequency electrodes are used. 

 

 

 

Regional hyperthermia is used to heat an organ or a limb.  Perfusion is a method that is used for regional hyperthermia.  This method involves removing some of the patient’s blood, heating it, and then “perfusing” it into the organ or limb that needs to be heated.  In addition, a warm, anti-cancer solution is passed through the blood vessels, tissue, or organ of the affected area.  Another method is the use of magnets, ultrasound, and devices which use high energy.  These objects are placed over the area to be treated.  Whole–body heating is used for those with metastatic cancer (cancer that has spread throughout the body).  This method is achieved by using pyrogens to induce high fevers, warm-water blankets, hot wax, thermal chambers, full immersion baths, and steam baths (http://cis.nci.nih.gov/fact/7_3.htm)& http://www.bodytrends.com/arohyp.htm).

Obviously, it is more beneficial to begin treatment as soon as one is diagnosed with cancer. The degree of benefit is dependent on the “many factors, such as site and stage of cancer, age of patient, immune resistance, etc”. According to one site, hyperthermia treatments can be used by “anyone, at any age” and a typical course runs “five days a week, for five to eight weeks, with each treatment taking approximately one hour” (http://www.vci.org/frequent.htm).               

   

 

 

 

What is its purpose?

 The main purpose of this treatment as said before is to use therapeutic heat to kill or damage cancerous cells to consequently cure cancer.  Most websites claim that cancerous tumors in difficult to reach areas such as the brain, bone, throat, thyroid, lungs, breast, liver, pancreas, colon, ovaries, uterus, prostate and skin can be treated using hyperthermia.  The types of treatable tumors include adenocarcinoma, carcinoma, thymoma, squamous cell, mesothelioma, sarcoma, melanoma, lymphoma, and basal cell, according to one website (http://www.vci.org/hyperthe.htm).  This same website claims that hyperthermia can produce a better quality of life because it can significantly reduce pain. 

Another website argues that hyperthermia can stimulate the immune system by “increasing the production of antibodies and interferon”, can be used as a detoxification therapy “because it releases toxins stored in fat cells”, can also be used for the treatments of “bronchitis, pneumonia, sinusitis,… other conditions of the lungs and body cavities,… upper and lower respiratory tract infections, bladder problems,… urinary tract infections,…HIV, chronic fatigue syndrome, and other chronic and acute viral infections” (http://www.bodytrends.com/arohyp.htm). 

According to Dr. Fritz Schellander, a number of cancer patients can be treated using hyperthermia: patients that have inoperable tumors, that are in an advanced state with multiple metastases, those with a high risk of relapse, patients who refuse an operation, those who wish to reduce the risk of relapse, and patients who are currently undergoing chemotherapy or radiation (http://www.whale.to/cancer/hyperthermia.html).       

 

 

 

 

How does this treatment work?

Heat ranging from 103oF to 113oF is applied to the area that needs treatment.  Various websites argue that cancerous cells are more susceptible to the effects of heat than normal cells.  This high level of heat causes vital nutrients and oxygen to be cut off from the tumor because tumors “have an impaired ability to adapt their blood circulation to the effects of high temperatures”.  This situation is perpetuated by the fact that tumors are tightly packed groups of cells.  Also the excessive heat leads to “an accumulation of harmful metabolic by-products and excessive acidity in the tumor tissue”.  With the deprivation of nutrients and the addition of wastes and acidity, the tumor’s vascular system collapses and cancer cells are destroyed.  The membranes, cytoskeleton, and nucleus functions of the malignant cells are destroyed, consequently killing the abnormal cells.  Normal cells are not as vulnerable to heat because unlike abnormal cancerous cells, when heat is applied blood to normal cells, the blood vessels of the normal cells dilate, which dissipates the heat and cools down the cell’s environment (http://www.vci.org/healing.htm and http://www.whale.to/cancer/hyperthermia.html).     

    

 

 

 

What claims are made about hyperthermia’s effectiveness?

 According to many sources, hyperthermia is most effective when used in conjunction with other treatments like chemotherapy and radiation.  It is suggested that hyperthermia alone is an inadequate treatment for cancer.  A more concrete claim is made by the Valley Cancer Institute.  This treatment facility claims that in “a recent study comparing results from leading hyperthermia researchers showed that beneficial responses were obtained by only 33% of patients treated with radiation alone, compared to 67% when radiation therapy was combined with hyperthermia” (http://www.vci.org/healing.htm).  Another source relays the claim of the efficacy of hyperthermia in conjunction with radiation: in an animal experiment to cure a type of tumor, “radiation alone produced no cures, heat alone produced 22% cures, and combined modality produced 77% cures”.  Another claim is made by the same source about the effectiveness of hyperthermia alone.  This source declares that hyperthermia leads to shrinkage and “complete eradication” of 10-15% of tumors.  This claim is rendered useless because the source elaborates that the results do not last and usually the tumors redevelop.  One purpose of hyperthermia is to make tissue that is unresponsive to radiation more receptive to radiation.  After hyperthermia, the response rates are up to 93%, reports this same source (http://www.geocities.com/HotSprings/Villa/5443/alts/hytherm.html).          

     To support the claim that hyperthermia helps to treat chronic fatigue syndrome and HIV, one source reports a 70-75% rate for the cure of CFIDS and a “40% inactivation of HIV” when a temperature of 107.6oF is reached and a “100% inactivation” when a temperature of 132.8oF is reached.(www.bodytrends.com/arohyp.htm).       

 

 

 

 

Side Effects

Most side effects of hyperthermia are generally minor, according to most sources.  These include discomfort, local pain, and blisters, pain being the most pronounced side effect.

Side effects such as an increase in blood pressure and pulse are expected and are only temporary. 

One source noted that cardiac problems are possible in some patients.  In a very small number of cases however, first, second, or third degree burns have resulted.  One source noted that an overdose of pyrogens (fever-inducing chemicals) can lead to “serious, even fatal reactions in humans” and that the use of perfusion could cause “frequent persistent peripheral neuropathies, abnormal…blood coagulation, some damage to liver and kidneys, and brain hemorrhaging and seizures” (http://www.geocities.com/HotSprings/Villa/5443/alts/hytherm.html).    

 

 

 

 

What evidence is offered in support of these claims?

 The Valley Cancer Institute offers the most evidence to support their claims about the efficacy of hyperthermia.  On the website, the facility has numerous before/after photos of patients who have had and are now supposedly treated from neck metastasis, adenocarcinoma, aids induced lymphoma, brain tumors, breast cancer, and sinus sarcoma.  The website also boasts its appearance on the Discovery Health Channel and offers web surfers the opportunity to view the show, as well as its appearance in two magazines: Let’s Live and U.S. News and World Report.  In addition to these, the institute offers evidence of success through the write-up of their own observations seen in their patients and offers links to clinical trials (http://www.vci.org/links.htm).  In another source, the website offers short summaries of the results of a Medline search (http://www.geocities.com/HotSprings/Villa/5443/alts/hytherm.html).  Another site offers a link to some clinical trials, but offers no explanation of the findings of some of these clinical trials (http://cis.nci.nih.gov/fact/7_3.htm).

 

 

                              

 

 

  Who is presenting this information?

Many presenters are facilities and doctors who are trying to sell this treatment to potential patients. Other sources of information came from various cancer organizations and those researching this form of alternative therapy.  All in all, the presenters are either those who are trying to sell their products or those who are trying to raise awareness.  Obviously, those trying to sell their products are more likely to exaggerate the benefits and belittle the negative aspects of the treatment.   

 

A Review of Research on Hyperthermia

 

Evaluation of Presenter’s Claims 

     There is an abundance of published journals/research on hyperthermia that can be found through a Medline or CancerLit search.  Many of the claims made by various websites are founded and supported by various clinical trials and studies. 

     Hyperthermia aids in the destruction of cancer cells in much the same way as described above according to an article published in an issue of Controlled Clinical Trials.  Heat is “cytotoxic” (deadly) to tumor cells because of acidosis, hypoxia, restriction of blood flow within the tumor, and the inhibition of DNA synthesis and heat also restricts repair of cells after radiation.  Cells die from membrane-related damage and chromosome-related damage (Engin 1996).   The claim that hyperthermia increases the effect of radiotherapy seems to have the most support in journals and is well founded.  Many journals claim this basic theory that it is “ . . . unlikely that hyperthermia itself is capable of producing major tumor regression with sufficient predictability to make it a practical treatment modality, nor is it of practical value, at present, in therapy of most forms of cancer.  However under optimal conditions, hyperthermia can enhance the effectiveness of radiotherapy” (Kim, Dewhirst, and Young 1989).

     There is also evidence that suggests that hyperthermia reduces pain resulting from cancer.  There is not much evidence that supports the claims that hyperthermia can increase the strength of the immune system, treat respiratory problems, HIV,  and other problems.  The research I found primarily dealt with hyperthermia’s effects of various forms of cancer and none of the studies researched indicated hyperthermia’s benefit in any of these other areas. However, because I did not research every study, conclusions can not be drawn in regards to the truth of these other claims.  

 

Recognizable Benefits

 

    Because hyperthermia alone is not a viable treatment for cancer, it is used in conjunction with another form of treatment like chemotherapy, surgery, or radiation.  Most scientific journals and clinical trials observe that hyperthermia increases the effect of more conventionally accepted therapies. 

     In one clinical trial, the effects of hyperthermia on irradiation and chemotherapy were evaluated.  73% of the patients had recurrent adenocarcinomas of the breast, 20% had head and neck lesions, 7% had squamous cell carcinoma, and melanoma  in the extremities were in 7% of patients.  58% of the tumors were recurrent, 27% were untreated, and 15% were persistent lesions following initial treatment.  Radiation had been previously given to 54% of patients and 66% received chemotherapy.  In regards to the application of hyperthermia of the patients, only one session of hyperthermia was tolerated by less than half of the patients (45%), 17.5% tolerated 2 sessions, 10% tolerated 3 sessions, and 7.5% had 4 or more sessions.  One session consisted of an application of a heat of 45oC for 15 minutes.  When this was not tolerated due to pain, a temperature of 42.5oC was given for an hour.  As a result of the hyperthermia with chemo or irradiation 55% of the patients had complete tumor regression and 20% had partial tumor regression.  30% of the patients survived a minimum of one year after the study (Perez et al 1993). 

     In another study found in the European Journal of Cancer, “pain, tenesmi, discharges, and bleeding either disappeared or diminished in  more than 40% of the patients who had these systems” (Gonzalez, van Dijk, and Blank 1995).  Also in this same study, pain relief was obtained in more than 78% of the patients.  In this study done from 1985 to 1992, 72 patients with pelvic or colorectal cancer were given radiotherapy and hyperthermia.

     A third retrospective study evaluated limb reperfusion (repeated perfusion) given along with an anti-cancer drug, melphalan, and tumor necrosis factor to patients suffering from melanoma.  71% of the patients who were given TNF, melphalan, and reperfusion had a complete response and an additional amount of patients had a partial response, for an overall response rate of 94%.  (Bartlett, Ma, Alexander, Libutti, Fraker 1997). 

     A fourth study reviewed the use of regional hyperthermia and surgery alone and together to treat hepatic carcinoma, another type of cancer.  A session of hyperthermia consisted of a temperature of 60oC for 20 minutes.  Four groups were developed: Group A-lobectomy only, Group B-lobectomy plus hyperthermia, Group C-regional hepatectomy, Group D- regional hepatectomy and regional hyperthermia.  The survival rates of the four groups were compared.  The evaluation of the survival rates of Group A/B and Group C/D show the effectiveness of hyperthermia in conjunction with other treatments to improve overall survival rates.  The average survival time increases when hyperthermia is added to lobectomy (from 346.5 to 432.6 days) and when hyperthermia is added to a hepatectomy (from 525.4to 1142 days)(Ge and Huang 2000).

          These studies indicate that hyperthermia in conjunction with other treatments aids in the effectiveness of the conventional treatment.

 

 

Side Effects/Limitations of Hyperthermia

 

     Obviously, there will be various side effects caused by hyperthermia, despite the view that normal cells are more resistant to heat than cancerous cells. There are various side effects noticed in the above studies.  In one study, 47% of the patients who received hyperthermia experienced blistering and peeling of the skin.  All patients developed skin erythema and edema.  One patient in the study developed skin necrosis and another developed muscle and nerve toxicity which resulted in an amputation.  In summary, 85% of patients developed Grade 1-2 regional toxicity, while 15% had Grade 3-4 regional toxicity, and .5% required an amputation. (Bartlett et al 1997). 

     In another study evaluating the effects of heat on the nervous system, Hoopes writes that the most common systems of heat injury are the slowing of the EEG, confusion, disorientation, which primarily occurs in those who undergo whole-body hyperthermia.  Whole-body hyperthermia may also cause neurophysiological symptoms of spinal cord damage when a temperature of 40-42.5oC is reached for 2-6 hours. These symptoms are temporary, however.  Also, “convulsions or seizures are seen in those patients whose brain temperature exceeded 42-43oC for a period of an hour or more”(Hoopes 1991). 

     In a European Journal of Cancer study, it was observed that “in practically all the studies, pain and discomfort hampered hyperthermic treatment in a large proportion of patients, and resulted in interrupted or discontinued treatment or patient refusal” (Gonzalez et al 1995).  Other noted side effects included tachycardia and increased systolic and diabolic blood pressure, therefore those with sever cardiovascular problems should not be treated with deep-body hyperthermia.  Some extremely obese people experienced fat necrosis.  Acute toxicity included nausea and vomiting, diarrhea, and abdominal cramps.  A few cases of myonecrosis and peripheral neuropathy were noted.  A major limitation of hyperthermia is that temperatures in the therapeutic range (>42oC) are most of the time not reached. 

     Another study reiterated the role of pain in hyperthermia and noted also that erythema, ulceration, and herpes zoster in some patients in the study (Perez et al 1993).

     Many limitations of hyperthermia were noted in a study in Cancer Research.  Two of these limitations are the difficulty in heating large tumors and the low number of sites that can effectively be treated (Meyer 1984).  However, since this article was published in 1984, significant progress in technology has been achieved, but these limitations may still hold true to some degree.   

 

Conclusion

 

 

Cancer is a deadly disease affecting millions of people world-wide. Hyperthermia is a viable treatment (in conjunction with other treatments) that could prolong the life of a cancer patient and even help to treat cancer under optimal conditions.  According to the studies, one can conclude that hyperthermia is mostly beneficial in conjunction with other cancer treatments, namely, radiation, chemotherapy, and surgery if the patient can bear the pain experienced by high temperatures on the body.  The severity of side effects depends on each individual person, and universal conclusions cannot be made with regard to each individual person.  For more information regarding hyperthermia, contact your healthcare provider or you can research journals via of Medline, CancerLit, or Other Search Engines.   

 

 

References

Bartlett,David; Ma,Grace; Alexander,H.; Libutti,Steven; and Fraker,Douglas. (1997). Isolated Limb Reperfusion with Tumor Necrosis Factor and Melphalan in Patients with Extremity Melanoma after Failure of Isolated Limb Perfusion with Chemotherapeutics. Cancer, 80:2084-2090.  

Engin,Kayihan. (1996). Biological Rationale and Clinical Experience with Hyperthermia.  Controlled Clinical Trials, 17(4): 316-342.

Ge,Haiyan and Huang, Jiaoling. (2000). Regional Hyperthermia in the Treatment of Primary Hepatic Carcinoma. Journal of Surgical Oncology, 74:193-195.

Gonzalez, Gonzalez D,; van Dijk, J.D.P.; and Blank L. (1995). Radiotherapy and Hyperthermia.  European Journal of Cancer, 31A(7/8):1351-1355.

Hoopes,PJ.(1991). THE EFFECTS OF HEAT ON THE NERVOUS SYSTEM. Radiation Injury to the Nervous System,407-430.

Kim,JH.; DewhirstM.; and Young,CW;(1989). HYPERTHERMIA: CURRENT STATUS. PPO Updates,3(9): 1-9.

Meyer, John L. (1984). The Clinical Efficacy of Localized Hyperthermia.  Cancer Research, 44:4745-4751.

Perez,Carlos A.; Scott,Charles; Emami,Bahman; Hornback,Ned B.; Sneed,Penny K; Asbell,Susan O.; Janjan,Nora A.(1993).  Evaluation of 45oC Hyperthermia and Irradiation.  American Journal of Clinical Oncology, 16(6):477-481.

 

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