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Szasz A. Pulsing Addition to Modulated Electro-Hyperthermia. Bioengineering (Basel) 2024; 11:725. [PMID: 39061807 PMCID: PMC11273694 DOI: 10.3390/bioengineering11070725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Revised: 06/25/2024] [Accepted: 07/03/2024] [Indexed: 07/28/2024] Open
Abstract
Numerous preclinical results have been verified, and clinical results have validated the advantages of modulated electro-hyperthermia (mEHT). This method uses the nonthermal effects of the electric field in addition to thermal energy absorption. Modulation helps with precisely targeting and immunogenically destroying malignant cells, which could have a vaccination-like abscopal effect. A new additional modulation (high-power pulsing) further develops the abilities of the mEHT. My objective is to present the advantages of pulsed treatment and how it fits into the mEHT therapy. Pulsed treatment increases the efficacy of destroying the selected tumor cells; it is active deeper in the body, at least tripling the penetration of the energy delivery. Due to the constant pulse amplitude, the dosing of the absorbed energy is more controllable. The induced blood flow for reoxygenation and drug delivery is high enough but not as high as increasing the risk of the dissemination of malignant cells. The short pulses have reduced surface absorption, making the treatment safer, and the increased power in the pulses allows the reduction of the treatment time needed to provide the necessary dose.
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Affiliation(s)
- Andras Szasz
- Department of Biotechnics, Hungarian University of Agriculture and Life Sciences, 2100 Gödöllő, Hungary
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Faghihi Moghaddam F, Bakhshandeh M, Mofid B, Sahinbas H, Faeghi F, Mirzaei H, Rakhsha A, Yousefi Kashi AS, Sadeghi R, Mahdavi A. Clinical effectiveness of combined whole body hyperthermia and external beam radiation therapy (EBRT) versus EBRT alone in patients with painful bony metastases: A phase III clinical trial study. J Therm Biol 2024; 120:103804. [PMID: 38460451 DOI: 10.1016/j.jtherbio.2024.103804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 11/13/2023] [Accepted: 01/23/2024] [Indexed: 03/11/2024]
Abstract
PURPOSE To evaluate the response rate, pain relief duration, and time it took for pain to decline or resolve after radiation therapy (RT) with or without fever-range Whole Body Hyperthermia (WBH) in bony metastatic patients with mainly primary tumor of prostate and breast cancer leading to bone pain. MATERIALS & METHODS Bony metastatic patients with pain score ≥4 on the Brief Pain Inventory (BPI) underwent RT of 30 Gy in 10 fractions in combination with WBH with nursing care under medical supervision versus RT-alone. WBH application time was 3-4 h in three fractions with at least 48-h intervals. All patients were stratified primary site, breast or prostate cancer vs others, BPI score, and exclusion criteria. The primary endpoint was complete response (CR) (BPI equal to zero with no increase of analgesics) within two months of follow-up. RESULTS Based on this study, the RT-alone group showed the worst pain. The study was terminated after the enrollment of a total of 61 patients, 5 years after the first enrollment (April 2016 to February 2021). Finally, the CR rate in RT + WBH revealed the most significant difference with RT-alone, 47.4% versus 5.3% respectively within 2 months post-treatment (P-value <0.05). The time of complete pain relief was 10 days for RT + WBH, while the endpoint was not reached during the RT-alone arm. Pain progression or stable disease was observed in half of the patients in RT-alone group within 4 weeks after treatment. However, this score was near zero in RT + WBHT patients in two months post-treatment. CONCLUSIONS WBH plus RT showed significant increases in pain relief and shorter response time in comparison with RT-alone for patients with bone metastatic lesions.
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Affiliation(s)
- Fahimeh Faghihi Moghaddam
- Biomedical Engineering and Medical Physics Department, Faculty of Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohsen Bakhshandeh
- Department of Radiation Technology, Faculty of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Bahram Mofid
- Department of Radiation Oncology, Shohada-e Tajrish Educational Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hüseyin Sahinbas
- Institute for Hyperthermia Research, Partner of the Marien Hospital Herne, Hospital of the RuhrUniversity, Bochum, Germany
| | - Fariborz Faeghi
- Department of Radiation Technology, Faculty of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamidreza Mirzaei
- Department of Radiation Oncology, Shohada-e Tajrish Educational Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Afshin Rakhsha
- Department of Radiation Oncology, Shohada-e Tajrish Educational Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amir Shahram Yousefi Kashi
- Department of Radiation Oncology, Shohada-e Tajrish Educational Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Reza Sadeghi
- Department of Radiation Oncology, Shohada-e Tajrish Educational Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Arash Mahdavi
- Department of Radiology, Modarres Educational Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Chia BSH, Ho SZ, Tan HQ, Chua MLK, Tuan JKL. A Review of the Current Clinical Evidence for Loco-Regional Moderate Hyperthermia in the Adjunct Management of Cancers. Cancers (Basel) 2023; 15:cancers15020346. [PMID: 36672300 PMCID: PMC9856725 DOI: 10.3390/cancers15020346] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 12/23/2022] [Accepted: 12/27/2022] [Indexed: 01/06/2023] Open
Abstract
Regional hyperthermia therapy (RHT) is a treatment that applies moderate heat to tumours in an attempt to potentiate the effects of oncological treatments and improve responses. Although it has been used for many years, the mechanisms of action are not fully understood. Heterogenous practices, poor quality assurance, conflicting clinical evidence and lack of familiarity have hindered its use. Despite this, several centres recognise its potential and have adopted it in their standard treatment protocols. In recent times, significant technical improvements have been made and there is an increasing pool of evidence that could revolutionise its use. Our narrative review aims to summarise the recently published prospective trial evidence and present the clinical effects of RHT when added to standard cancer treatments. In total, 31 studies with higher-quality evidence across various subsites are discussed herein. Although not all of these studies are level 1 evidence, benefits of moderate RHT in improving local tumour control, survival outcomes and quality of life scores were observed across the different cancer subsites with minimal increase in toxicities. This paper may serve as a reference when considering this technique for specific indications.
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Affiliation(s)
- Brendan Seng Hup Chia
- Division of Radiation Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore 169610, Singapore
- Correspondence:
| | - Shaun Zhirui Ho
- Department of Radiation Oncology, 585 North Bridge Rd, Level 10 Raffles Specialist Centre, Singapore 188770, Singapore
| | - Hong Qi Tan
- Division of Radiation Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore 169610, Singapore
| | - Melvin Lee Kiang Chua
- Division of Radiation Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore 169610, Singapore
| | - Jeffrey Kit Loong Tuan
- Division of Radiation Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore 169610, Singapore
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Arrojo E, Fiorentini G, Ghadjar P, Minnaar C, Szasz AM, Szasz A. Commentary on "Systematic review about complementary medical hyperthermia in oncology" by Liebl et al. Clin Exp Med 2022; 22:667-672. [PMID: 36239869 PMCID: PMC9588469 DOI: 10.1007/s10238-022-00902-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 07/30/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Elisabeth Arrojo
- University Hospital Marques de Valdecilla, Santender, Cantabria, Spain
- Medical Institute of Advanced Oncology (INMOA), Madrid, Spain
| | - Giammaria Fiorentini
- Former Director Medical Oncology Unit and Hyperthermia Service, Onco-Hematology Department, Azienda Ospedaliera Marche Nord, Pesaro, Italy
| | - Pirus Ghadjar
- Department of Radiation Oncology, Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
| | - Carrie Minnaar
- Department of Radiation Sciences, University of the Witwatersrand, Johannesburg, South Africa.
- Wits Donald Gordon Academic Hospital, Johannesburg, South Africa.
| | - A Marcell Szasz
- Division of Oncology, Department of Internal Medicine and Oncology, Semmelweis University, Budapest, Hungary
| | - Andras Szasz
- Biotechnics Department, Hungarian University of Agriculture and Life Sciences, Godollo, Hungary
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Hübner J, Dörfler J, Liebl C, Käsmann L. Answer to Commentary on "Systematic review about complementary medical hyperthermia in oncology" by Liebl et al. Clin Exp Med 2022; 22:673-678. [PMID: 36239870 PMCID: PMC9588464 DOI: 10.1007/s10238-022-00901-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 09/10/2022] [Indexed: 11/27/2022]
Affiliation(s)
- J Hübner
- Klinik für Innere Medizin II; Universitätsklinikum Jena, Jena, Germany.
| | - J Dörfler
- Klinik für Innere Medizin II; Universitätsklinikum Jena, Jena, Germany
| | - C Liebl
- Klinik für Innere Medizin II; Universitätsklinikum Jena, Jena, Germany
| | - L Käsmann
- LMU Klinikum Munich, Munich, Germany
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Heterogeneous Heat Absorption Is Complementary to Radiotherapy. Cancers (Basel) 2022; 14:cancers14040901. [PMID: 35205649 PMCID: PMC8870118 DOI: 10.3390/cancers14040901] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/20/2022] [Accepted: 01/30/2022] [Indexed: 12/10/2022] Open
Abstract
Simple Summary This review shows the advantages of heterogeneous heating of selected malignant cells in harmonic synergy with radiotherapy. The main clinical achievement of this complementary therapy is its extreme safety and minimal adverse effects. Combining the two methods opens a bright perspective, transforming the local radiotherapy to the antitumoral impact on the whole body, destroying the distant metastases by “teaching” the immune system about the overall danger of malignancy. Abstract (1) Background: Hyperthermia in oncology conventionally seeks the homogeneous heating of the tumor mass. The expected isothermal condition is the basis of the dose calculation in clinical practice. My objective is to study and apply a heterogenic temperature pattern during the heating process and show how it supports radiotherapy. (2) Methods: The targeted tissue’s natural electric and thermal heterogeneity is used for the selective heating of the cancer cells. The amplitude-modulated radiofrequency current focuses the energy absorption on the membrane rafts of the malignant cells. The energy partly “nonthermally” excites and partly heats the absorbing protein complexes. (3) Results: The excitation of the transmembrane proteins induces an extrinsic caspase-dependent apoptotic pathway, while the heat stress promotes the intrinsic caspase-dependent and independent apoptotic signals generated by mitochondria. The molecular changes synergize the method with radiotherapy and promote the abscopal effect. The mild average temperature (39–41 °C) intensifies the blood flow for promoting oxygenation in combination with radiotherapy. The preclinical experiences verify, and the clinical studies validate the method. (4) Conclusions: The heterogenic, molecular targeting has similarities with DNA strand-breaking in radiotherapy. The controlled energy absorption allows using a similar energy dose to radiotherapy (J/kg). The two therapies are synergistically combined.
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Clinical Evidence for Thermometric Parameters to Guide Hyperthermia Treatment. Cancers (Basel) 2022; 14:cancers14030625. [PMID: 35158893 PMCID: PMC8833668 DOI: 10.3390/cancers14030625] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/14/2022] [Accepted: 01/19/2022] [Indexed: 01/01/2023] Open
Abstract
Hyperthermia (HT) is a cancer treatment modality which targets malignant tissues by heating to 40-43 °C. In addition to its direct antitumor effects, HT potently sensitizes the tumor to radiotherapy (RT) and chemotherapy (CT), thereby enabling complete eradication of some tumor entities as shown in randomized clinical trials. Despite the proven efficacy of HT in combination with classic cancer treatments, there are limited international standards for the delivery of HT in the clinical setting. Consequently, there is a large variability in reported data on thermometric parameters, including the temperature obtained from multiple reference points, heating duration, thermal dose, time interval, and sequence between HT and other treatment modalities. Evidence from some clinical trials indicates that thermal dose, which correlates with heating time and temperature achieved, could be used as a predictive marker for treatment efficacy in future studies. Similarly, other thermometric parameters when chosen optimally are associated with increased antitumor efficacy. This review summarizes the existing clinical evidence for the prognostic and predictive role of the most important thermometric parameters to guide the combined treatment of RT and CT with HT. In conclusion, we call for the standardization of thermometric parameters and stress the importance for their validation in future prospective clinical studies.
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Nagata T, Kanamori M, Sekine S, Arai M, Moriyama M, Fujii T. Clinical study of modulated electro-hyperthermia for advanced metastatic breast cancer. Mol Clin Oncol 2021; 14:103. [PMID: 33796292 PMCID: PMC8010507 DOI: 10.3892/mco.2021.2265] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 03/05/2021] [Indexed: 11/06/2022] Open
Abstract
Modulated electro-hyperthermia (mEHT) is a new treatment modality developed to overcome the problems associated with traditional hyperthermia; mEHT uses a precise impedance-matched system and modulated radiofrequency current flow to malignant tumors. It selects the malignant cells based on their biophysical differences, due to their high metabolic rate, individual (autonomic) behavior and membrane status. The aim of the present study was to report the outcomes of mEHT in the treatment of advanced breast cancer. mEHT was examined in 10 patients with advanced metastatic breast cancer and recurrent disease, who were considered incurable by standard therapy protocols. Of the 10 patients, partial response was achieved in 3, disease stability in 3, and progressive disease in 4; however, their quality of life was improved based on their subjective reports. No adverse effects were observed in any of the 10 patients. The present study demonstrated the feasibility of mEHT as a possible therapy for advanced breast cancer cases when standard therapies fail. Moreover, mEHT had no side effects and may be combined with various treatments for long-term therapy.
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Affiliation(s)
- Takuya Nagata
- Department of Surgery, Toho University Ohashi Medical Center, Tokyo 153-8515, Japan
| | - Masahiko Kanamori
- Department of Human Science, University of Toyama, Toyama 930-0194, Japan
| | - Shinichi Sekine
- Department of Surgery, Kamiichi General Hospital, Toyama 930-0391, Japan
| | - Mie Arai
- Department of Surgery, Toyama Nishi General Hospital, Toyama 939-2716, Japan
| | - Makoto Moriyama
- Department of Surgery, Tomei Atsugi Hospital, Kanagawa 243-8571, Japan
| | - Tsutomu Fujii
- Department of Science and Surgery, University of Toyama, Toyama 930-0194, Japan
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Synergic effects of nanoparticles-mediated hyperthermia in radiotherapy/chemotherapy of cancer. Life Sci 2021; 269:119020. [PMID: 33450258 DOI: 10.1016/j.lfs.2021.119020] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 12/05/2020] [Accepted: 01/02/2021] [Indexed: 12/15/2022]
Abstract
The conventional cancer treatment modalities such as radiotherapy and chemotherapy suffer from several limitations; hence, their efficiency needs to be improved with other complementary modalities. Hyperthermia, as an adjuvant therapeutic modality for cancer, can result in a synergistic effect on radiotherapy (radiosensitizer) and chemotherapy (chemosensitizer). Conventional hyperthermia methods affect both tumoral and healthy tissues and have low specificity. In addition, a temperature gradient generates in the tissues situated along the path of the heat source, which is a more serious for deep-seated tumors. Nanoparticles (NPs)-induced hyperthermia can resolve these drawbacks through localization around/within tumoral tissue and generating local hyperthermia. Although there are several review articles dealing with NPs-induced hyperthermia, lack of a paper discussing the combination of NPs-induced hyperthermia with the conventional chemotherapy or radiotherapy is tangible. Accordingly, the main focus of the current paper is to summarize the principles of NPs-induced hyperthermia and more importantly its synergic effects on the conventional chemotherapy or radiotherapy. The heat-producing nanostructures such as gold NPs, iron oxide NPs, and carbon NPs, as well as the non-heat-producing nanostructures, such as lipid-based, polymeric, and silica-based NPs, as the carrier for heat-producing NPs, are discussed and their pros and cons highlighted.
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Lee SY, Fiorentini G, Szasz AM, Szigeti G, Szasz A, Minnaar CA. Quo Vadis Oncological Hyperthermia (2020)? Front Oncol 2020; 10:1690. [PMID: 33014841 PMCID: PMC7499808 DOI: 10.3389/fonc.2020.01690] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 07/29/2020] [Indexed: 12/19/2022] Open
Abstract
Heating as a medical intervention in cancer treatment is an ancient approach, but effective deep heating techniques are lacking in modern practice. The use of electromagnetic interactions has enabled the development of more reliable local-regional hyperthermia (LRHT) techniques whole-body hyperthermia (WBH) techniques. Contrary to the relatively simple physical-physiological concepts behind hyperthermia, its development was not steady, and it has gone through periods of failures and renewals with mixed views on the benefits of heating seen in the medical community over the decades. In this review we study in detail the various techniques currently available and describe challenges and trends of oncological hyperthermia from a new perspective. Our aim is to describe what we believe to be a new and effective approach to oncologic hyperthermia, and a change in the paradigm of dosing. Physiological limits restrict the application of WBH which has moved toward the mild temperature range, targeting immune support. LRHT does not have a temperature limit in the tumor (which can be burned out in extreme conditions) but a trend has started toward milder temperatures with immune-oriented goals, developing toward immune modulation, and especially toward tumor-specific immune reactions by which LRHT seeks to target the malignancy systemically. The emerging research of bystander and abscopal effects, in both laboratory investigations and clinical applications, has been intensified. Our present review summarizes the methods and results, and discusses the trends of hyperthermia in oncology.
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Affiliation(s)
- Sun-Young Lee
- Department of Radiation Oncology, Chonbuk National University Hospital, Jeonbuk, South Korea
| | | | - Attila Marcell Szasz
- Division of Oncology, Department of Internal Medicine and Oncology, Semmelweis University, Budapest, Hungary
| | - Gyula Szigeti
- Innovation Center, Semmelweis University, Budapest, Hungary
| | - Andras Szasz
- Biotechnics Department, St. Istvan University, Godollo, Hungary
| | - Carrie Anne Minnaar
- Department of Radiation Oncology, Wits Donald Gordon Medical Center, Johannesburg, South Africa
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Datta NR, Kok HP, Crezee H, Gaipl US, Bodis S. Integrating Loco-Regional Hyperthermia Into the Current Oncology Practice: SWOT and TOWS Analyses. Front Oncol 2020; 10:819. [PMID: 32596144 PMCID: PMC7303270 DOI: 10.3389/fonc.2020.00819] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 04/27/2020] [Indexed: 12/14/2022] Open
Abstract
Moderate hyperthermia at temperatures between 40 and 44°C is a multifaceted therapeutic modality. It is a potent radiosensitizer, interacts favorably with a host of chemotherapeutic agents, and, in combination with radiotherapy, enforces immunomodulation akin to “in situ tumor vaccination.” By sensitizing hypoxic tumor cells and inhibiting repair of radiotherapy-induced DNA damage, the properties of hyperthermia delivered together with photons might provide a tumor-selective therapeutic advantage analogous to high linear energy transfer (LET) neutrons, but with less normal tissue toxicity. Furthermore, the high LET attributes of hyperthermia thermoradiobiologically are likely to enhance low LET protons; thus, proton thermoradiotherapy would mimic 12C ion therapy. Hyperthermia with radiotherapy and/or chemotherapy substantially improves therapeutic outcomes without enhancing normal tissue morbidities, yielding level I evidence reported in several randomized clinical trials, systematic reviews, and meta-analyses for various tumor sites. Technological advancements in hyperthermia delivery, advancements in hyperthermia treatment planning, online invasive and non-invasive MR-guided thermometry, and adherence to quality assurance guidelines have ensured safe and effective delivery of hyperthermia to the target region. Novel biological modeling permits integration of hyperthermia and radiotherapy treatment plans. Further, hyperthermia along with immune checkpoint inhibitors and DNA damage repair inhibitors could further augment the therapeutic efficacy resulting in synthetic lethality. Additionally, hyperthermia induced by magnetic nanoparticles coupled to selective payloads, namely, tumor-specific radiotheranostics (for both tumor imaging and radionuclide therapy), chemotherapeutic drugs, immunotherapeutic agents, and gene silencing, could provide a comprehensive tumor-specific theranostic modality akin to “magic (nano)bullets.” To get a realistic overview of the strength (S), weakness (W), opportunities (O), and threats (T) of hyperthermia, a SWOT analysis has been undertaken. Additionally, a TOWS analysis categorizes future strategies to facilitate further integration of hyperthermia with the current treatment modalities. These could gainfully accomplish a safe, versatile, and cost-effective enhancement of the existing therapeutic armamentarium to improve outcomes in clinical oncology.
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Affiliation(s)
- Niloy R Datta
- Centre for Radiation Oncology KSA-KSB, Kantonsspital Aarau, Aarau, Switzerland
| | - H Petra Kok
- Department of Radiation Oncology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Hans Crezee
- Department of Radiation Oncology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Udo S Gaipl
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Stephan Bodis
- Centre for Radiation Oncology KSA-KSB, Kantonsspital Aarau, Aarau, Switzerland
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Qiao G, Wang X, Zhou X, Morse MA, Wu J, Wang S, Song Y, Jiang N, Zhao Y, Zhou L, Zhao J, Di Y, Zhu L, Hobeika A, Ren J, Lyerly HK. Immune correlates of clinical benefit in a phase I study of hyperthermia with adoptive T cell immunotherapy in patients with solid tumors. Int J Hyperthermia 2020; 36:74-82. [PMID: 31795830 DOI: 10.1080/02656736.2019.1647350] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Purpose: To characterize the T cell receptor (TCR) repertoire, serum cytokine levels, peripheral blood T lymphocyte populations, safety, and clinical efficacy of hyperthermia (HT) combined with autologous adoptive cell therapy (ACT) and either salvage chemotherapy (CT) or anti-PD-1 antibody in patients with previously treated advanced solid tumors.Materials and methods: Thirty-three (33) patients with ovarian, pancreatic, gastric, colorectal, cervical, or endometrial cancer were recruited into the following therapeutic groups: HT + ACT (n = 10), HT + ACT + anti-PD-1 inhibitor (pembrolizumab) (n = 11) and HT + ACT + CT (n = 12). Peripheral blood was collected to analyze TCR repertoire, measurements of cytokines levels and lymphocyte sub-populations before and after treatment.Results: The objective response rate (ORR) was 30% (10/33), including three complete responses (CR) (9.1%) and seven partial responses (PR) (21.2%) and a disease control rate (DCR = CR + PR + SD) of 66.7% (22 of 33). The most common adverse reactions, blistering, subcutaneous fat induration, local heat-related pain, vomiting and sinus tachycardia, were observed in association with HT. IL-2, IL-4, TNF-α, and IFN-γ levels in peripheral blood were significantly increased among the clinical responders (p < 0.05) while IL-6 and IL-10 were elevated among those with progressive disease (p < 0.05). Peripheral blood CD8+/CD28+ T cells increased (p = 0.002), while the CD4+/CD25+/CD127+Treg cells decreased after therapy (p = 0.012). TCR diversity was substantially increased among the clinical responders.Conclusions: Combining HT with ACT plus either CT or anti-PD-1 antibody was safe, generated clinical responses in previously treated advanced cancers, and promoted TCR repertoire diversity and favorable changes in serum IL-2, IL-4, TNF-α, and IFN-γ levels in clinical responders.
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Affiliation(s)
- Guoliang Qiao
- Department of Medical Oncology, Beijing Key Laboratory for Therapeutic Cancer Vaccines, Capital Medical University Cancer Center, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Xiaoli Wang
- Department of Medical Oncology, Beijing Key Laboratory for Therapeutic Cancer Vaccines, Capital Medical University Cancer Center, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Xinna Zhou
- Department of Medical Oncology, Beijing Key Laboratory for Therapeutic Cancer Vaccines, Capital Medical University Cancer Center, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Michael A Morse
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Jiangping Wu
- Department of Medical Oncology, Beijing Key Laboratory for Therapeutic Cancer Vaccines, Capital Medical University Cancer Center, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Shuo Wang
- Department of Medical Oncology, Beijing Key Laboratory for Therapeutic Cancer Vaccines, Capital Medical University Cancer Center, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Yuguang Song
- Department of Medical Oncology, Beijing Key Laboratory for Therapeutic Cancer Vaccines, Capital Medical University Cancer Center, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Ni Jiang
- Department of Medical Oncology, Beijing Key Laboratory for Therapeutic Cancer Vaccines, Capital Medical University Cancer Center, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Yanjie Zhao
- Department of Medical Oncology, Beijing Key Laboratory for Therapeutic Cancer Vaccines, Capital Medical University Cancer Center, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Lei Zhou
- Department of Medical Oncology, Beijing Key Laboratory for Therapeutic Cancer Vaccines, Capital Medical University Cancer Center, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Jing Zhao
- Department of Medical Oncology, Beijing Key Laboratory for Therapeutic Cancer Vaccines, Capital Medical University Cancer Center, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Yan Di
- Department of Medical Oncology, Beijing Key Laboratory for Therapeutic Cancer Vaccines, Capital Medical University Cancer Center, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Lihong Zhu
- Department of Gynecological Oncology, Beijing Gynecology Hospital, Capital Medical University, Beijing, China
| | - Amy Hobeika
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Jun Ren
- Department of Medical Oncology, Beijing Key Laboratory for Therapeutic Cancer Vaccines, Capital Medical University Cancer Center, Beijing Shijitan Hospital, Capital Medical University, Beijing, China.,Department of Surgery, Duke University Medical Center, Durham, NC, USA
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Ou J, Zhu X, Chen P, Du Y, Lu Y, Peng X, Bao S, Wang J, Zhang X, Zhang T, Pang CLK. A randomized phase II trial of best supportive care with or without hyperthermia and vitamin C for heavily pretreated, advanced, refractory non-small-cell lung cancer. J Adv Res 2020; 24:175-182. [PMID: 32368355 PMCID: PMC7190757 DOI: 10.1016/j.jare.2020.03.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 02/29/2020] [Accepted: 03/14/2020] [Indexed: 12/13/2022] Open
Abstract
Our previous study indicated that intravenous vitamin C (IVC) treatment concurrent with modulated electrohyperthermia (mEHT) was safe and improved the quality of life (QoL) of non-small-cell lung cancer (NSCLC) patients. The aim of this trial was to further verify the efficacy of the above combination therapy in previously treated patients with refractory advanced (stage IIIb or IV) NSCLC. A total of 97 patients were randomized to receive IVC and mEHT plus best supportive care (BSC) (n = 49 in the active arm, receiving 1 g/kg * d IVC concurrently with mEHT, three times a week for 25 treatments in total) or BSC alone (n = 48 in the control arm). After a median follow-up of 24 months, progression-free survival (PFS) and overall survival (OS) were significantly prolonged by combination therapy compared to BSC alone (PFS: 3 months vs 1.85 months, P < 0.05; OS: 9.4 months vs 5.6 months, P < 0.05). QoL was significantly increased in the active arm despite the advanced stage of disease. The 3-month disease control rate after treatment was 42.9% in the active arm and 16.7% in the control arm (P < 0.05). Overall, IVC and mEHT may have the ability to improve the prognosis of patients with advanced NSCLC.
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Key Words
- AUC, area under the curve
- BSC, best supportive care
- CA15-3, carbohydrate antigen 15-3
- CEA, carcinoembryonic antigen
- CI, confidence interval
- CR, complete response
- CRP, C-reactive protein
- CT, computed tomography
- CYFRA21-1, cytokeratin-19 fragments
- DCR, disease control rate
- ECOG, Eastern Cooperative Oncology Group
- EGFR, epidermal growth factor receptor
- G6PD, glucose 6-phosphate dehydrogenase
- HT, hyperthermia
- IL-6, interleukin- 6
- IVC, intravenous vitamin C
- Modulated electrohyperthermia
- NSCLC, non-small-cell lung cancer
- Non-small-cell lung cancer
- OS, overall survival
- Overall survival
- PD, progressive disease
- PFS, progression-free survival
- PR, partial response
- QLQ-C30, Quality of Life Questionnaire
- QoL, quality of life
- Quality of life
- RECIST, Response Evaluation Criteria in Solid Tumors
- Remission rate
- SCC, squamous cell carcinoma antigen
- SD, stable disease
- TKIs, tyrosine kinase inhibitors
- TNF-α, Tumor Necrosis Factor-α
- Vitamin C
- mEHT, modulated electrohyperthermia
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Affiliation(s)
- Junwen Ou
- Cancer Center, Clifford Hospital, Jinan University, Guangzhou, PR China
| | - Xinyu Zhu
- Cancer Center, Clifford Hospital, Jinan University, Guangzhou, PR China
| | - Pengfei Chen
- Cancer Center, Clifford Hospital, Jinan University, Guangzhou, PR China
| | - Yanping Du
- Cancer Center, Clifford Hospital, Jinan University, Guangzhou, PR China
| | - Yimin Lu
- Hyperthermia Center, Clifford Hospital, Jinan University, PR China
| | - Xiufan Peng
- Cancer Center, Clifford Hospital, Jinan University, Guangzhou, PR China
| | - Shuang Bao
- Cancer Center, Clifford Hospital, Jinan University, Guangzhou, PR China
| | - Junhua Wang
- Hyperthermia Center, Clifford Hospital, Jinan University, PR China
| | - Xinting Zhang
- Cancer Center, Clifford Hospital, Jinan University, Guangzhou, PR China
| | - Tao Zhang
- Cancer Center, Clifford Hospital, Jinan University, Guangzhou, PR China
| | - Clifford L K Pang
- Cancer Center, Clifford Hospital, Jinan University, Guangzhou, PR China
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Jun HJ, Park SJ, Kang HJ, Lee GY, Lee N, Park JH, Yoo HS. The Survival Benefit of Combination Therapy With Mild Temperature Hyperthermia and an Herbal Prescription of Gun-Chil-Jung in 54 Cancer Patients Treated With Chemotherapy or Radiation Therapy: A Retrospective Study. Integr Cancer Ther 2020; 19:1534735420926583. [PMID: 32449629 PMCID: PMC7249570 DOI: 10.1177/1534735420926583] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 03/25/2020] [Accepted: 04/23/2020] [Indexed: 12/18/2022] Open
Abstract
Background: The combination of herbal medicine with conventional treatment increases the survival rate of cancer patients, but the effect is not great. Hyperthermia may have a synergistic effect with herbal medicine alongside conventional medicine. Objective: To monitor the efficacy of hyperthermia together with Gun-Chil-Jung (GCJ) capsule for event-free survival (EFS) and overall survival (OS) for the treatment of various cancers. Methods: We collected data retrospectively on 54 cancer patients of all stages. They were divided into 4 groups according to each hyperthermia or GCJ treatment period. Hyperthermia with 0.46 MHz radiofrequency wave was applied a power of 50 to 100 W for 70 minutes. GCJ capsules were administered orally 3 times a day. Results: The median follow-up was 13.4 months, and 25 (55.6%) patients showed disease-related events. Hyperthermia with GCJ treatment was administered in combination group (n = 36, 66.7%) and traditional Korean medicine-only group (n = 17, 31.5%). The median EFS was 190 days, and the median OS was 390 days. The group of hyperthermia 7 times or fewer and GCJ more than 28 days showed longer EFS and OS. The analysis of superiority between hyperthermia and GCJ showed no significant difference (EFS, P = .55; OS, P = .364). Conclusions: The combination of hyperthermia 1 to 2 times a week with GCJ treatment may improve survival of cancer patients treated or being treated with conventional cancer therapies.
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Affiliation(s)
- Hyeong Joon Jun
- Seoul Korean Medicine Hospital of
Daejeon University, Seoul, Republic of Korea
| | - So-Jung Park
- Dunsan Korean Medicine Hospital of
Daejeon University, Daejeon, Republic of Korea
| | - Hwi-Joong Kang
- Seoul Korean Medicine Hospital of
Daejeon University, Seoul, Republic of Korea
| | - Ga-Young Lee
- Cheonan Korean Medicine Hospital of
Daejeon University, Cheonan, Republic of Korea
| | - Namhun Lee
- Cheonan Korean Medicine Hospital of
Daejeon University, Cheonan, Republic of Korea
| | - Ji Hye Park
- Seoul Korean Medicine Hospital of
Daejeon University, Seoul, Republic of Korea
| | - Hwa-Seung Yoo
- Seoul Korean Medicine Hospital of
Daejeon University, Seoul, Republic of Korea
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15
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Guillemin PC, Gui L, Lorton O, Zilli T, Crowe LA, Desgranges S, Montet X, Terraz S, Miralbell R, Salomir R, Boudabbous S. Mild hyperthermia by MR-guided focused ultrasound in an ex vivo model of osteolytic bone tumour: optimization of the spatio-temporal control of the delivered temperature. J Transl Med 2019; 17:350. [PMID: 31651311 PMCID: PMC6814062 DOI: 10.1186/s12967-019-2094-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 10/11/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Magnetic resonance guided focused ultrasound was suggested for the induction of deep localized hyperthermia adjuvant to radiation- or chemotherapy. In this study we are aiming to validate an experimental model for the induction of uniform temperature elevation in osteolytic bone tumours, using the natural acoustic window provided by the cortical breakthrough. MATERIALS AND METHODS Experiments were conducted on ex vivo lamb shank by mimicking osteolytic bone tumours. The cortical breakthrough was exploited to induce hyperthermia inside the medullar cavity by delivering acoustic energy from a phased array HIFU transducer. MR thermometry data was acquired intra-operatory using the proton resonance frequency shift (PRFS) method. Active temperature control was achieved via a closed-loop predictive controller set at 6 °C above the baseline. Several beam geometries with respect to the cortical breakthrough were investigated. Numerical simulations were used to further explain the observed phenomena. Thermal safety of bone heating was assessed by cross-correlating MR thermometry data with the measurements from a fluoroptic temperature sensor inserted in the cortical bone. RESULTS Numerical simulations and MR thermometry confirmed the feasibility of spatio-temporal uniform hyperthermia (± 0.5 °C) inside the medullar cavity using a fixed focal point sonication. This result was obtained by the combination of several factors: an optimal positioning of the focal spot in the plane of the cortical breakthrough, the direct absorption of the HIFU beam at the focal spot, the "acoustic oven effect" yielded by the beam interaction with the bone, and a predictive temperature controller. The fluoroptical sensor data revealed no heating risks for the bone and adjacent tissues and were in good agreement with the PRFS thermometry from measurable voxels adjacent to the periosteum. CONCLUSION To our knowledge, this is the first study demonstrating the feasibility of MR-guided focused ultrasound hyperthermia inside the medullar cavity of bones affected by osteolytic tumours. Our results are considered a promising step for combining adjuvant mild hyperthermia to external beam radiation therapy for sustained pain relief in patients with symptomatic bone metastases.
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Affiliation(s)
- Pauline C Guillemin
- Image Guided Interventions Laboratory (GR-949), Faculty of Medicine, University of Geneva, Geneva, Switzerland.
| | - Laura Gui
- Image Guided Interventions Laboratory (GR-949), Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Orane Lorton
- Image Guided Interventions Laboratory (GR-949), Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Thomas Zilli
- Radiation Oncology Division, University Hospitals of Geneva, Geneva, Switzerland
| | - Lindsey A Crowe
- Radiology Division, University Hospitals of Geneva, Geneva, Switzerland
| | - Stéphane Desgranges
- Equipe Chimie Bioorganique et Systèmes Amphiphiles, Institut des Biomolécules Max Mousseron, UMR 5247, Avignon Université, 84911, Avignon, France
| | - Xavier Montet
- Image Guided Interventions Laboratory (GR-949), Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Radiology Division, University Hospitals of Geneva, Geneva, Switzerland
| | - Sylvain Terraz
- Image Guided Interventions Laboratory (GR-949), Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Radiology Division, University Hospitals of Geneva, Geneva, Switzerland
| | - Raymond Miralbell
- Radiation Oncology Division, University Hospitals of Geneva, Geneva, Switzerland
| | - Rares Salomir
- Image Guided Interventions Laboratory (GR-949), Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Radiology Division, University Hospitals of Geneva, Geneva, Switzerland
| | - Sana Boudabbous
- Image Guided Interventions Laboratory (GR-949), Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Radiology Division, University Hospitals of Geneva, Geneva, Switzerland
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16
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Mattsson MO, Simkó M. Emerging medical applications based on non-ionizing electromagnetic fields from 0 Hz to 10 THz. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2019; 12:347-368. [PMID: 31565000 PMCID: PMC6746309 DOI: 10.2147/mder.s214152] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 08/23/2019] [Indexed: 12/13/2022] Open
Abstract
The potential for using non-ionizing electromagnetic fields (EMF; at frequencies from 0 Hz up to the THz range) for medical purposes has been of interest since many decades. A number of established and familiar methods are in use all over the world. This review, however, provides an overview of applications that already play some clinical role or are in earlier stages of development. The covered methods include modalities used for bone healing, cancer treatment, neurological conditions, and diathermy. In addition, certain other potential clinical areas are touched upon. Most of the reviewed technologies deal with therapy, whereas just a few diagnostic approaches are mentioned. None of the discussed methods are having such a strong impact in their field of use that they would be expected to replace conventional methods. Partly this is due to a knowledge base that lacks mechanistic explanations for EMF effects at low-intensity levels, which often are used in the applications. Thus, the possible optimal use of EMF approaches is restricted. Other reasons for the limited impact include a scarcity of well-performed randomized clinical trials that convincingly show the efficacy of the methods and that standardized user protocols are mostly lacking. Presently, it seems that some EMF-based methods can have a niche role in treatment and diagnostics of certain conditions, mostly as a complement to or in combination with other, more established, methods. Further development and a stronger impact of these technologies need a better understanding of the interaction mechanisms between EMF and biological systems at lower intensity levels. The importance of the different physical parameters of the EMF exposure needs also further investigations.
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Affiliation(s)
- Mats-Olof Mattsson
- SciProof International AB, Östersund, Sweden
- Strömstad Akademi, Institute for Advanced Studies, Strömstad, Sweden
| | - Myrtill Simkó
- SciProof International AB, Östersund, Sweden
- Strömstad Akademi, Institute for Advanced Studies, Strömstad, Sweden
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17
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Ariyafar T, Mahdavi SR, Geraily G, Fadavi P, Farhood B, Najafi M, Ashouri A, Khalafi L, Shirazi A. Evaluating the effectiveness of combined radiotherapy and hyperthermia for the treatment response of patients with painful bony metastases: A phase 2 clinical trial. J Therm Biol 2019; 84:129-135. [PMID: 31466745 DOI: 10.1016/j.jtherbio.2019.06.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Revised: 03/27/2019] [Accepted: 06/01/2019] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Since the survival time of patients with bony metastases has noticeably improved in recent years, these patients are at high risk of complications associated with this metastasis. Hence, the appropriate choice of treatment modality or combination of therapeutic approaches can lead to increasing bone pain relief, improving quality of life, etc. This study is aimed to evaluate the effectiveness of combined radiotherapy and hyperthermia for the treatment response of patients with painful bony metastases. PATIENTS AND METHODS In a single-arm clinical trial, 23 eligible patients (14 female and 9 male) with the mean age of 67 years old and suffering from bony metastases were enrolled in the study. Two hours after radiotherapy, the patients underwent hyperthermia for 1 h in the supine position. All the patients completed the brief pain inventory (BPI) assessment tool and quality of life questionnaire (QLQ-C30) from the European Organization for Research and Treatment of Cancer (EORTC) at the baseline, end of the treatment and 1, 2 and 3 months thereafter. The response to the treatment was assessed as the zero score (complete response) or two or more than two-point drop of the worst pain within the preceding 24 h (partial response) during the 3-month posttreatment. RESULTS All the pain intensity and interference scores, except the pain interference with the enjoyment of life score, significantly decreased. A total of 18 out of 23 patients (78%) achieved complete or partial response. The number of patients using pain relief medications decreased from 74% (n=17) at the baseline to 48% (n=11) 3 months later. Moreover, except for nausea and vomiting, appetite loss, diarrhea and financial impact problems, the patients' quality of life improved significantly in all the functional scales and symptoms within 3 months. CONCLUSION This study showed that using hyperthermia in combination with radiotherapy significantly ameliorated bone pain among the patients suffering from cancer with painful bony metastases.
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Affiliation(s)
- Tayebeh Ariyafar
- Department of Medical Physics and Biomedical Engineering, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Rabie Mahdavi
- Department of Medical Physics, School of Medicine, Iran University of Medical Science, Tehran, Iran
| | - Ghazale Geraily
- Department of Medical Physics and Biomedical Engineering, Tehran University of Medical Sciences, Tehran, Iran
| | - Pedram Fadavi
- Radiation Oncology Department, Iran University of Medical Sciences, Tehran, Iran
| | - Bagher Farhood
- Department of Medical Physics and Radiology, Faculty of Paramedical Sciences, Kashan University of Medical Sciences, Kashan, Iran
| | - Masoud Najafi
- Department of Radiology and Nuclear Medicine, School of Paramedical Sciences, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Asieh Ashouri
- Cardiovascular Diseases Research Center, Department of Cardiology, Heshmat Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Leila Khalafi
- Department of Medical Physics, School of Medicine, Iran University of Medical Science, Tehran, Iran
| | - Alireza Shirazi
- Department of Medical Physics and Biomedical Engineering, Tehran University of Medical Sciences, Tehran, Iran.
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18
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Elming PB, Sørensen BS, Oei AL, Franken NAP, Crezee J, Overgaard J, Horsman MR. Hyperthermia: The Optimal Treatment to Overcome Radiation Resistant Hypoxia. Cancers (Basel) 2019; 11:E60. [PMID: 30634444 PMCID: PMC6356970 DOI: 10.3390/cancers11010060] [Citation(s) in RCA: 124] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 12/14/2018] [Accepted: 12/29/2018] [Indexed: 12/23/2022] Open
Abstract
Regions of low oxygenation (hypoxia) are a characteristic feature of solid tumors, and cells existing in these regions are a major factor influencing radiation resistance as well as playing a significant role in malignant progression. Consequently, numerous pre-clinical and clinical attempts have been made to try and overcome this hypoxia. These approaches involve improving oxygen availability, radio-sensitizing or killing the hypoxic cells, or utilizing high LET (linear energy transfer) radiation leading to a lower OER (oxygen enhancement ratio). Interestingly, hyperthermia (heat treatments of 39⁻45 °C) induces many of these effects. Specifically, it increases blood flow thereby improving tissue oxygenation, radio-sensitizes via DNA repair inhibition, and can kill cells either directly or indirectly by causing vascular damage. Combining hyperthermia with low LET radiation can even result in anti-tumor effects equivalent to those seen with high LET. The various mechanisms depend on the time and sequence between radiation and hyperthermia, the heating temperature, and the time of heating. We will discuss the role these factors play in influencing the interaction between hyperthermia and radiation, and summarize the randomized clinical trials showing a benefit of such a combination as well as suggest the potential future clinical application of this combination.
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Affiliation(s)
- Pernille B Elming
- Department of Experimental Clinical Oncology, Aarhus University Hospital, DK-8000 Aarhus C, Denmark.
| | - Brita S Sørensen
- Department of Experimental Clinical Oncology, Aarhus University Hospital, DK-8000 Aarhus C, Denmark.
| | - Arlene L Oei
- Department of Radiation Oncology, Academic University Medical Centers, University of Amsterdam, 1105AZ Amsterdam, The Netherlands.
| | - Nicolaas A P Franken
- Department of Radiation Oncology, Academic University Medical Centers, University of Amsterdam, 1105AZ Amsterdam, The Netherlands.
| | - Johannes Crezee
- Department of Radiation Oncology, Academic University Medical Centers, University of Amsterdam, 1105AZ Amsterdam, The Netherlands.
| | - Jens Overgaard
- Department of Experimental Clinical Oncology, Aarhus University Hospital, DK-8000 Aarhus C, Denmark.
| | - Michael R Horsman
- Department of Experimental Clinical Oncology, Aarhus University Hospital, DK-8000 Aarhus C, Denmark.
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19
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Lee S, Son B, Park G, Kim H, Kang H, Jeon J, Youn H, Youn B. Immunogenic Effect of Hyperthermia on Enhancing Radiotherapeutic Efficacy. Int J Mol Sci 2018; 19:E2795. [PMID: 30227629 PMCID: PMC6164993 DOI: 10.3390/ijms19092795] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 09/11/2018] [Accepted: 09/13/2018] [Indexed: 12/15/2022] Open
Abstract
Hyperthermia is a cancer treatment where tumor tissue is heated to around 40 °C. Hyperthermia shows both cancer cell cytotoxicity and immune response stimulation via immune cell activation. Immunogenic responses encompass the innate and adaptive immune systems, involving the activation of macrophages, natural killer cells, dendritic cells, and T cells. Moreover, hyperthermia is commonly used in combination with different treatment modalities, such as radiotherapy and chemotherapy, for better clinical outcomes. In this review, we will focus on hyperthermia-induced immunogenic effects and molecular events to improve radiotherapy efficacy. The beneficial potential of integrating radiotherapy with hyperthermia is also discussed.
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Affiliation(s)
- Sungmin Lee
- Department of Integrated Biological Science, Pusan National University, Busan 46241, Korea.
| | - Beomseok Son
- Department of Integrated Biological Science, Pusan National University, Busan 46241, Korea.
| | - Gaeul Park
- Department of Integrated Biological Science, Pusan National University, Busan 46241, Korea.
| | - Hyunwoo Kim
- Department of Integrated Biological Science, Pusan National University, Busan 46241, Korea.
| | - Hyunkoo Kang
- Department of Integrated Biological Science, Pusan National University, Busan 46241, Korea.
| | - Jaewan Jeon
- Department of Integrated Biological Science, Pusan National University, Busan 46241, Korea.
| | - HyeSook Youn
- Department of Integrative Bioscience and Biotechnology, Sejong University, Seoul 05006, Korea.
| | - BuHyun Youn
- Department of Integrated Biological Science, Pusan National University, Busan 46241, Korea.
- Department of Biological Sciences, Pusan National University, Busan 46241, Korea.
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20
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Chi MS, Yang KL, Chang YC, Ko HL, Lin YH, Huang SC, Huang YY, Liao KW, Kondo M, Chi KH. Comparing the Effectiveness of Combined External Beam Radiation and Hyperthermia Versus External Beam Radiation Alone in Treating Patients With Painful Bony Metastases: A Phase 3 Prospective, Randomized, Controlled Trial. Int J Radiat Oncol Biol Phys 2018; 100:78-87. [DOI: 10.1016/j.ijrobp.2017.09.030] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 09/11/2017] [Accepted: 09/13/2017] [Indexed: 01/04/2023]
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21
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Abstract
The term hyperthermia broadly refers to either an abnormally high fever or the treatment of a disease by the induction of fever. Its effect depends on the temperature and exposure time. The increasing number of applications and clinical trials at universities, clinics, and hospitals prove the feasibility and applicability of clinical therapeutic hyperthermia. This chapter aims to outline and discuss the means by which electromagnetic energy and other techniques can provide elevation of temperature within the human body. Because of the individual characteristic of each type of treatment, different modalities of heating systems have evolved. The chapter concludes with a discussion of challenges and opportunities for further improvement in technology and routine clinical application.
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Affiliation(s)
- Riadh W Y Habash
- School of Electrical Engineering and Computer Science, and McLaughlin Centre for Population Health Risk Assessment, University of Ottawa, Ottawa, ON, Canada.
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22
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Peeken JC, Vaupel P, Combs SE. Integrating Hyperthermia into Modern Radiation Oncology: What Evidence Is Necessary? Front Oncol 2017; 7:132. [PMID: 28713771 PMCID: PMC5492395 DOI: 10.3389/fonc.2017.00132] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 06/06/2017] [Indexed: 12/13/2022] Open
Abstract
Hyperthermia (HT) is one of the hot topics that have been discussed over decades. However, it never made its way into primetime. The basic biological rationale of heat to enhance the effect of radiation, chemotherapeutic agents, and immunotherapy is evident. Preclinical work has confirmed this effect. HT may trigger changes in perfusion and oxygenation as well as inhibition of DNA repair mechanisms. Moreover, there is evidence for immune stimulation and the induction of systemic immune responses. Despite the increasing number of solid clinical studies, only few centers have included this adjuvant treatment into their repertoire. Over the years, abundant prospective and randomized clinical data have emerged demonstrating a clear benefit of combined HT and radiotherapy for multiple entities such as superficial breast cancer recurrences, cervix carcinoma, or cancers of the head and neck. Regarding less investigated indications, the existing data are promising and more clinical trials are currently recruiting patients. How do we proceed from here? Preclinical evidence is present. Multiple indications benefit from additional HT in the clinical setting. This article summarizes the present evidence and develops ideas for future research.
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Affiliation(s)
- Jan C Peeken
- Department of Radiation Oncology, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - Peter Vaupel
- Department of Radiation Oncology, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - Stephanie E Combs
- Department of Radiation Oncology, Klinikum rechts der Isar, Technische Universität München, München, Germany.,Department of Radiation Sciences (DRS), Institute of Innovative Radiotherapy (iRT), Helmholtz Zentrum München, Neuherberg, Germany
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23
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Schlesinger D, Lee M, Ter Haar G, Sela B, Eames M, Snell J, Kassell N, Sheehan J, Larner JM, Aubry JF. Equivalence of cell survival data for radiation dose and thermal dose in ablative treatments: analysis applied to essential tremor thalamotomy by focused ultrasound and gamma knife. Int J Hyperthermia 2017; 33:401-410. [PMID: 28044461 PMCID: PMC6203314 DOI: 10.1080/02656736.2016.1278281] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Thermal dose and absorbed radiation dose have historically been difficult to compare because different biological mechanisms are at work. Thermal dose denatures proteins and the radiation dose causes DNA damage in order to achieve ablation. The purpose of this paper is to use the proportion of cell survival as a potential common unit by which to measure the biological effect of each procedure. Survival curves for both thermal and radiation doses have been extracted from previously published data for three different cell types. Fits of these curves were used to convert both thermal and radiation dose into the same quantified biological effect: fraction of surviving cells. They have also been used to generate and compare survival profiles from the only indication for which clinical data are available for both focused ultrasound (FUS) thermal ablation and radiation ablation: essential tremor thalamotomy. All cell types could be fitted with coefficients of determination greater than 0.992. As an illustration, survival profiles of clinical thalamotomies performed by radiosurgery and FUS are plotted on a same graph for the same metric: fraction of surviving cells. FUS and Gamma Knife have the potential to be used in combination to deliver a more effective treatment (for example, FUS may be used to debulk the main tumour mass, and radiation to treat the surrounding tumour bed). In this case, a model which compares thermal and radiation treatments is valuable in order to adjust the dose between the two.
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Affiliation(s)
- D Schlesinger
- a Department of Radiation Oncology , University of Virginia , Charlottesville , VA , USA
- c Department of Neurosurgery , University of Virginia , Charlottesville , VA , USA
| | - M Lee
- b Focused Ultrasound Foundation , Charlottesville , VA , USA
| | - G Ter Haar
- d Division of Radiotherapy and Imaging , The Institute of Cancer Research:Royal Marsden Hospital , London , UK
| | - B Sela
- b Focused Ultrasound Foundation , Charlottesville , VA , USA
| | - M Eames
- b Focused Ultrasound Foundation , Charlottesville , VA , USA
| | - J Snell
- b Focused Ultrasound Foundation , Charlottesville , VA , USA
- c Department of Neurosurgery , University of Virginia , Charlottesville , VA , USA
| | - N Kassell
- b Focused Ultrasound Foundation , Charlottesville , VA , USA
- c Department of Neurosurgery , University of Virginia , Charlottesville , VA , USA
| | - J Sheehan
- a Department of Radiation Oncology , University of Virginia , Charlottesville , VA , USA
- c Department of Neurosurgery , University of Virginia , Charlottesville , VA , USA
| | - J M Larner
- a Department of Radiation Oncology , University of Virginia , Charlottesville , VA , USA
| | - J-F Aubry
- a Department of Radiation Oncology , University of Virginia , Charlottesville , VA , USA
- e ESPCI Paris, PSL Research University, CNRS, INSERM, Institut Langevin , Paris , France
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24
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Shoji H, Motegi M, Takakusagi Y, Asao T, Kuwano H, Takahashi T, Ogoshi K. Chemoradiotherapy and concurrent radiofrequency thermal therapy to treat primary rectal cancer and prediction of treatment responses. Oncol Rep 2016; 37:695-704. [PMID: 27959450 PMCID: PMC5355662 DOI: 10.3892/or.2016.5300] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 08/10/2016] [Indexed: 12/18/2022] Open
Abstract
The present study aimed to evaluate a previously reported predictive formula of output-limiting symptoms induced by radiofrequency (RF) to determine the efficacy of this neoadjuvant chemoradiation (NACR) and concurrent RF thermal therapy. The present study included 81 consecutive patients with confirmed diagnoses of rectal adenocarcinoma that was localized in the mid-low rectum (up to 12 cm from the anal verge) who received NACR [intensity-modulated radiotherapy (IMRT), 50 Gy/25 fractions, capecitabine 1,700 mg/m2/day for 5 days/week)] with concurrent thermal therapy (Thermotron-RF8, once a week for 5 weeks with 50 min irradiation). Patients with progressive disease (PD) did not receive RF outputs higher than the predicted value. Some patients who were predicted to receive more output in fact received more than the predicted output. In patients who were predicted to receive moderately higher outputs, 37.5% of the patients experienced pathological complete responses, which was the highest rate, while in those who did not receive more than the predicted output, 66.7% of the patients experienced PD, which was the highest rate in the present study. We speculate that RF thermal therapy may offset the chemoradiation effects in some patients. Adding thermal therapy as a multimodality therapy to NACR potentially affects patients with lower predicted outputs and actual observed outputs slightly higher than the predictive value. Our predictive equation for initial energy output, in which output‑limiting symptoms can be used to predict treatment efficacy, consequently, can be used to decide whether to continue this treatment modality.
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Affiliation(s)
- Hisanori Shoji
- Division of Surgery, Hidaka Hospital, Gunma 370-0001, Japan
| | | | | | - Takayuki Asao
- Initiative for Advanced Research, Gunma University, Gunma 371-8511, Japan
| | - Hiroyuki Kuwano
- Department of General Surgical Science, Graduate School of Medicine, Gunma University, Gunma 371-8511, Japan
| | - Takeo Takahashi
- Department of Radiation Oncology, Saitama Medical Center, Saitama Medical University, Saitama 350-8550, Japan
| | - Kyoji Ogoshi
- Division of Cancer Diagnosis and Cancer Treatment, Hidaka Hospital, Gunma 370-0001, Japan
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Lara NC, Haider AA, Ho JC, Wilson LJ, Barron AR, Curley SA, Corr SJ. Water-structuring molecules and nanomaterials enhance radiofrequency heating in biologically relevant solutions. Chem Commun (Camb) 2016; 52:12630-12633. [PMID: 27722511 PMCID: PMC5079531 DOI: 10.1039/c6cc06573b] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
For potential applications in nano-mediated radiofrequency cancer hyperthermia, the nanomaterial under investigation must increase the heating of any aqueous solution in which it is suspended when exposed to radiofrequency electric fields. This should also be true for a broad range of solution conductivities, especially those that artificially mimic the ionic environment of biological systems. Herein we demonstrate enhanced heating of biologically relevant aqueous solutions using kosmotropes and a hexamalonoserinolamide fullerene.
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Affiliation(s)
- Nadia C Lara
- Department of Chemistry and Smalley-Curl Institute, Rice University, Houston, TX 77005, USA
| | - Asad A Haider
- Department of Chemistry and Smalley-Curl Institute, Rice University, Houston, TX 77005, USA
| | - Jason C Ho
- Department of Surgery, Baylor College of Medicine, Houston, TX 77030, USA.
| | - Lon J Wilson
- Department of Chemistry and Smalley-Curl Institute, Rice University, Houston, TX 77005, USA
| | - Andrew R Barron
- Department of Chemistry and Smalley-Curl Institute, Rice University, Houston, TX 77005, USA and Department of Materials Science and Nanoengineering, Rice University, Houston, TX 77005, USA and Energy Safety Research Institute (ESRI), Swansea University Bay Campus, Swansea, SA1 8EN, UK and Centre for NanoHealth (CNH), Swansea University, Singleton Park, Swansea, SA2 8PP, UK
| | - Steven A Curley
- Department of Surgery, Baylor College of Medicine, Houston, TX 77030, USA. and Department of Materials Science and Nanoengineering, Rice University, Houston, TX 77005, USA
| | - Stuart J Corr
- Department of Chemistry and Smalley-Curl Institute, Rice University, Houston, TX 77005, USA and Department of Surgery, Baylor College of Medicine, Houston, TX 77030, USA. and Department of Biomedical Engineering, University of Houston, Houston, TX 77204, USA
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Qin Y, Sun Y, Liu Y, Luo Y, Zhu J. Pilot study of radiofrequency hyperthermia in combination with gefitinib in gefitinib-effective patients with advanced NSCLC. Thorac Cancer 2016; 7:422-7. [PMID: 27385984 PMCID: PMC4930961 DOI: 10.1111/1759-7714.12346] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 02/06/2016] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Non-small-cell lung cancer (NSCLC) is the leading cause of death from cancer in China. Gefitinib is effective for patients with positive epidermal growth factor receptor gene mutation; however, acquired drug resistance counteracts the duration response. Hyperthermia is widely clinically applied in the treatment of solid tumors. This pilot study was designed to evaluate the feasibility of the combination of gefitinib and hyperthermia. METHODS Patients newly diagnosed with advanced NSCLC were screened. Eleven patients who responded to first-line gefitinib treatment were enrolled in the study. Along with 250 mg gefitinib daily, local radiofrequency hyperthermia was administered twice a week until tumor progression was observed. The serum, heat shock protein (HSP)70, was also frequently detected during the course. RESULTS The most common toxicity included skin rash (81.8%) and abnormal liver function (45.5%) when treated with gefitinib, and fatty scleroma (36.4%) was observed when combined with hyperthermia. Grade 3 side effects (skin rash) occurred in only one patient. Median progression-free survival was 22 months (95% confidence interval [CI]: 12.95-31.05 months) and median overall survival was 26 months (95% CI: 22.81-29.19 months). Serum HSP70 concentration increased and maintained a significantly high level compared with the baseline before hyperthermia administration. CONCLUSIONS The novel therapy of gefitinib combined with radiofrequency hyperthermia is safe and effective for advanced NSCLC patients. Whether an improvement in therapeutic efficacy is associated with the elevation of serum HSP70 concentration requires further study.
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Affiliation(s)
- Yijia Qin
- West China School of Medicine Sichuan University Chengdu China
| | - Yu Sun
- Department of Radiation Oncology West China Hospital, Sichuan University Chengdu China
| | - Yongmei Liu
- Department of Thoracic Oncology West China Hospital, Sichuan University Chengdu China
| | - Yiqiao Luo
- West China School of Medicine Sichuan University Chengdu China
| | - Jiang Zhu
- Department of Thoracic Oncology West China Hospital, Sichuan University Chengdu China
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Mallory M, Gogineni E, Jones GC, Greer L, Simone CB. Therapeutic hyperthermia: The old, the new, and the upcoming. Crit Rev Oncol Hematol 2015; 97:56-64. [PMID: 26315383 DOI: 10.1016/j.critrevonc.2015.08.003] [Citation(s) in RCA: 120] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Revised: 07/09/2015] [Accepted: 08/04/2015] [Indexed: 01/12/2023] Open
Abstract
Hyperthermia has long been used for cancer treatment, either alone or in combination with chemotherapy, radiation therapy, or both. Its efficacy and versatility continue to be well demonstrated in randomized trials across a number of primary cancers, but barriers to its widespread adoption persist including effective delivery and verification systems. This article describes hyperthermia, details its biological mechanisms of action and immunological effects, and summarizes select preclinical data and key clinical trials combining hyperthermia with standard cancer treatments. Current challenges and emerging technologies that have the potential to make this translational therapy more accessible to a greater number of patients are also described.
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Affiliation(s)
- Matthew Mallory
- Virginia Commonwealth University, Internal Medicine, Richmond, VA 23298, USA.
| | - Emile Gogineni
- New York Institute of Technology College of Osteopathic Medicine, Old Westbury, NY 11568, USA.
| | - Guy C Jones
- Radiation Oncology Branch, National Cancer Institute, National Institutes of Health, 9000 Rockville Pike, MD, 20892, USA.
| | - Lester Greer
- Department of Radiation Oncology, Fort Belvoir Community Hospital, 9300 DeWitt Loop Fort Belvoir, 22060, VA, USA.
| | - Charles B Simone
- Department of Radiation Oncology, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia PA 19104, USA.
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Datta NR, Ordóñez SG, Gaipl US, Paulides MM, Crezee H, Gellermann J, Marder D, Puric E, Bodis S. Local hyperthermia combined with radiotherapy and-/or chemotherapy: recent advances and promises for the future. Cancer Treat Rev 2015; 41:742-53. [PMID: 26051911 DOI: 10.1016/j.ctrv.2015.05.009] [Citation(s) in RCA: 290] [Impact Index Per Article: 32.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2015] [Revised: 05/16/2015] [Accepted: 05/20/2015] [Indexed: 02/08/2023]
Abstract
Hyperthermia, one of the oldest forms of cancer treatment involves selective heating of tumor tissues to temperatures ranging between 39 and 45°C. Recent developments based on the thermoradiobiological rationale of hyperthermia indicate it to be a potent radio- and chemosensitizer. This has been further corroborated through positive clinical outcomes in various tumor sites using thermoradiotherapy or thermoradiochemotherapy approaches. Moreover, being devoid of any additional significant toxicity, hyperthermia has been safely used with low or moderate doses of reirradiation for retreatment of previously treated and recurrent tumors, resulting in significant tumor regression. Recent in vitro and in vivo studies also indicate a unique immunomodulating prospect of hyperthermia, especially when combined with radiotherapy. In addition, the technological advances over the last decade both in hardware and software have led to potent and even safer loco-regional hyperthermia treatment delivery, thermal treatment planning, thermal dose monitoring through noninvasive thermometry and online adaptive temperature modulation. The review summarizes the outcomes from various clinical studies (both randomized and nonrandomized) where hyperthermia is used as a thermal sensitizer of radiotherapy and-/or chemotherapy in various solid tumors and presents an overview of the progresses in loco-regional hyperthermia. These recent developments, supported by positive clinical outcomes should merit hyperthermia to be incorporated in the therapeutic armamentarium as a safe and an effective addendum to the existing oncological treatment modalities.
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Affiliation(s)
- N R Datta
- Centre of Radiation Oncology, KSA-KSB, Kantonsspital Aarau, Aarau, Switzerland.
| | - S Gómez Ordóñez
- Centre of Radiation Oncology, KSA-KSB, Kantonsspital Aarau, Aarau, Switzerland.
| | - U S Gaipl
- Department of Radiation Oncology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany.
| | - M M Paulides
- Department of Radiation Oncology, Hyperthermia Unit, Erasmus MC Cancer Institute, Rotterdam, The Netherlands.
| | - H Crezee
- Department of Radiation Oncology, Academic Medical Centre, University of Amsterdam, The Netherlands.
| | - J Gellermann
- Praxis/Zentrum für Strahlentherapie und Radioonkologie, Janusz-Korczak-Str. 12, 12627 Berlin, Germany.
| | - D Marder
- Centre of Radiation Oncology, KSA-KSB, Kantonsspital Aarau, Aarau, Switzerland.
| | - E Puric
- Centre of Radiation Oncology, KSA-KSB, Kantonsspital Aarau, Aarau, Switzerland.
| | - S Bodis
- Centre of Radiation Oncology, KSA-KSB, Kantonsspital Aarau, Aarau, Switzerland; Department of Radiation Oncology, University Hospital Zurich, Switzerland.
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29
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Kim YP, Choi Y, Kim S, Park YS, Oh IJ, Kim KS, Kim YC. Conventional cancer treatment alone or with regional hyperthermia for pain relief in lung cancer: A case-control study. Complement Ther Med 2015; 23:381-7. [PMID: 26051573 DOI: 10.1016/j.ctim.2015.04.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Revised: 10/23/2014] [Accepted: 04/01/2015] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To investigate the effect of combining conventional treatment with regional hyperthermia on cancer pain in lung cancer patients. DESIGN Case-control study. SETTING One Korean university hospital and three complementary cancer clinics. MAIN OUTCOMES AND MEASURES Main outcome was effective analgesic score (EAS, PI[1+(M/10)], 1: anti-inflammatory drug consumption at a regular dosage, M: weekly dose (mg) of oral morphine equivalent and PI: pain intensity) at four time points (baseline (days -30 to 0), time 1 (days 1-60), time 2 (days 61-120), and time 3 (days 121-180)). Propensity score matching between the hyperthermia and control groups was performed using a 1:5 ratio. A linear mixed effects model was employed to measure EAS changes over time in the two groups. RESULTS At baseline, there were 83 subjects in the control group and 32 subjects in the hyperthermia group. At time 3, there were 49 subjects in the control group and 16 subjects in the hyperthermia group. Analyses showed rate of change of EAS, treatment×time was significant (p=0.038). This significant difference was mainly observed for time 1 (mean difference: 101.76 points, 95% confidence interval: 10.20-193.32 points, p=0.030). CONCLUSIONS Our results indicate an increase in cancer pain in lung cancer patients administered regional hyperthermia, particularly during the early stage of hyperthermia treatment.
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Affiliation(s)
- Yeon-Pyo Kim
- Department of Family Medicine, Chonnam National University Hwasun Hospital, Republic of Korea; Life After Cancer Treatment (LACT) Clinic, Chonnam National University Hwasun Hospital, Republic of Korea.
| | - Yuri Choi
- Department of Family Medicine, Chonnam National University Hwasun Hospital, Republic of Korea; Life After Cancer Treatment (LACT) Clinic, Chonnam National University Hwasun Hospital, Republic of Korea
| | - Sun Kim
- Department of Family Medicine, Chonnam National University Hwasun Hospital, Republic of Korea; Life After Cancer Treatment (LACT) Clinic, Chonnam National University Hwasun Hospital, Republic of Korea
| | - Yoon-Sung Park
- Information Statistics Team, The Environmental Health Center for Allergic Rhinitis, INHA University Hospital, Republic of Korea
| | - In-Jae Oh
- Department of Pulmonary Medicine, Chonnam National University Hwasun Hospital, Republic of Korea
| | - Kyu-Sik Kim
- Department of Pulmonary Medicine, Chonnam National University Hwasun Hospital, Republic of Korea
| | - Young-Chul Kim
- Department of Pulmonary Medicine, Chonnam National University Hwasun Hospital, Republic of Korea
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Hurwitz M, Stauffer P. Hyperthermia, radiation and chemotherapy: the role of heat in multidisciplinary cancer care. Semin Oncol 2014; 41:714-29. [PMID: 25499632 DOI: 10.1053/j.seminoncol.2014.09.014] [Citation(s) in RCA: 86] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The compelling biologic basis for combining hyperthermia with modern cancer therapies including radiation and chemotherapy was first appreciated nearly half a century ago. Hyperthermia complements radiation as conditions contributing to radio-resistance generally enhance sensitivity to heat and sensitizing effects occur through increased perfusion/tumor oxygenation and alteration of cellular death pathways. Chemosensitization with hyperthermia is dependent on the particular mechanism of effect for each agent with synergistic effects noted for several commonly used agents. Clinically, randomized trials have demonstrated benefit including survival with the addition of hyperthermia to radiation or chemotherapy in treatment of a wide range of malignancies. Improvements in treatment delivery techniques, streamlined logistics, and greater understanding of the relationship of thermal dosimetry to treatment outcomes continue to facilitate wider clinical implementation. Evolving applications include thermal enhancement of immunotherapy, targeted drug delivery and application of principals of thermal biology towards integration of thermal ablation into multimodality oncologic care.
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Affiliation(s)
- Mark Hurwitz
- Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, PA.
| | - Paul Stauffer
- Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, PA
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Szasz A. Current status of oncothermia therapy for lung cancer. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2014; 47:77-93. [PMID: 24782955 PMCID: PMC4000888 DOI: 10.5090/kjtcs.2014.47.2.77] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 03/24/2014] [Accepted: 03/28/2014] [Indexed: 11/22/2022]
Abstract
Lung cancer is one of the most common malignant tumors, and it has the highest death rate. Oncothermia is a feasible and successful treatment for lung cancer. Results show a remarkable survival benefit for patients, with a good quality of life. The treatment has no, or in some cases mild, side-effects and could decrease the adverse effects of the complementary treatment. Applying oncothermia together with other treatment methods could increase the effects and result in better performance. A comparison of studies demonstrates a good correspondence in the data, which strengthens the reliability of the studies, and clearly shows the feasibility of the application of oncothermia to treating all kinds of pulmonary malignancies including non-small-cell and small-cell primary tumors, and all of the metastatic diseases of the pulmonary system.
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Affiliation(s)
- Andras Szasz
- Department of Biotechnics, St. Istvan University, Godollo, Hungary
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32
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Shoji H, Motegi M, Osawa K, Okonogi N, Okazaki A, Andou Y, Asao T, Kuwano H, Takahashi T, Ogoshi K. Does standardization of radiofrequency hyperthermia benefit patients with malignancies? ACTA ACUST UNITED AC 2014. [DOI: 10.4993/acrt.22.28] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Rubovszky G, Nagy T, Gődény M, Szász A, Láng I. Successful Treatment of Solitary Bone Metastasis of Non-Small Cell Lung Cancer with Bevacizumab and Hyperthermia. Pathol Oncol Res 2012; 19:119-22. [DOI: 10.1007/s12253-012-9551-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2011] [Accepted: 05/31/2012] [Indexed: 01/04/2023]
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