The effect of hyperthermia on cell survival in a mouse tumour without bloodflow

Hyperthermia can alter tumor physiology and improve chemo- and radio-therapy efficacy

Hyperthermia has demonstrated clinical success in improving the efficacy of both chemo- and radio-therapy in solid tumors. Pre-clinical and clinical research studies have demonstrated that targeted hyperthermia can increase tumor blood flow and increase the perfused fraction of the tumor in a temperature and time dependent manner. Changes in tumor blood circulation can produce significant physiological changes including enhanced vascular permeability, increased oxygenation, decreased interstitial fluid pressure, and reestablishment of normal physiological pH conditions. These alterations in tumor physiology can positively impact both small molecule and nanomedicine chemotherapy accumulation and distribution within the tumor, as well as the fraction of the tumor susceptible to radiation therapy. Hyperthermia can trigger drug release from thermosensitive formulations and further improve the accumulation, distribution, and efficacy of chemotherapy.

A differential low pH effect on tumour cells grown in vivo and in vitro when treated with hyperthermia

The effectiveness of low extracellular pH in sensitizing cells to heat was studied using SCK mammary carcinoma cells of A/J mice. Solid tumours of 400-600 mg or cells grown in vitro for less than 13 weeks were dispersed to single cells and the in vivo- or in vitro-derived cells were suspended in a medium of pH 7.2 or 5.5-6.6 and then heated at 41-44 degrees C in vitro using a water bath. The dispersion procedure did not alter the heat sensitivity of these cells, but acidic medium of pH below 6.6 caused an increase in heat sensitivity. This effect of low pH decreased with increasing temperature of heating for both cell types. However, the effect was much smaller on in vivo-derived cells than that on in vitro-derived cells for any heating temperature tested. This reduction of the pH effect was also observed for cells derived from larger tumours as well as tumours at an early stage of growth in which the internal milieu was not acidic. This indicates that cellular adaptation to low intratumour pH was not the cause of the reduced pH effect; instead, factors other than low pH must cause the reduced pH effect seen in tumour-derived cells.

Effect of hyperthermia on the lactic acid and beta-hydroxybutyric acid content in tumour

The effects of hyperthermia on the content of lactic acid and beta-hydroxybutyric acid in the SCK mammary carcinoma and the leg muscle of A/J mice were studied. The contents of lactic acid in the SCK tumour before heating was 9.32 mumol/g, and the content of beta-hydroxybutyric acid was only 0.013 mumol/g. The lactic acid content in the tumour increased to 17.5 mumol/g at 0 h after heating at 41.5 degrees C for 30 min and then decreased to the control level 3 h later. When heated at 43.5 degrees C for 30 min, the lactic acid content in the tumour increased to 24 mumol/g at the end of heating and remained elevated for 24 h. The content of beta-hydroxybutyric acid increased continuously reaching 0.45 mumol/g at 5 h after heating at 43.5 degrees C for 30 min, and then declined thereafter. The contents of lactic acid and beta-hydroxybutyric acid in the muscle also increased after heating, but these increases were far less than those observed in the tumours. The absolute amount of lactic acid in the heated tumours was far greater than that of beta-hydroxybutyric acid, and thus appeared to play the major role for the increased acidity in the heated tumours.

Hyperthermia for cancer: a practical perspective

A causal relationship between hyperpyrexia and tumor regression was first suggested in 1866, when Busch reported the cure of a histologically diagnosed sarcoma in a middle-aged woman, following a bout of erysipelas. Over the years, interest in the effect of heat on cancer has remained alive, but this interest has increased dramatically in recent years. The literature on this subject is broadly reviewed and the clinical results discussed. It is apparent from clinical studies thus far that it is a relatively simple undertaking to treat superficial neoplasms with hyperthermia. However, the major challenges in clinical thermotherapy pertain to patients with deeply situated tumors. The lack of safe and reliable methods of monitoring temperature in deep tissues is a major impediment to a thorough understanding of thermal dosimetry in clinical hyperthermia, and routine thermal dosimetry in clinical hyperthermia will have to await the development of reliable noninvasive thermometry. As responses have been reported with modest levels of hyperthermia, the need for thermometry is somewhat lessened, given that invasive monitoring is imperfect and somewhat risky when used in deeply seated tumours. The eventual place of thermotherapy in the treatment of malignant tumours in man is as yet unclear and must be rigourously and thoroughly assessed in well-designed, prospective, randomized patient trials.

Response to heat treatment (42.5 degrees C) in vivo and in vitro of five human melanoma xenografts

The response to heat (42.5 degrees C) of five human melanoma xenografts was studied. Tumours grown subcutaneously in the hind leg of athymic mice were heated in a water-bath and specific growth delay was used as a measure of response. In other experiments, cells from the same xenografts were heated in vitro and the colony-forming ability was assayed in soft agar. The slopes of the in-vivo dose-response curves (specific growth delay versus heating time) varied within a factor of about three among the five melanomas. The Do values of the in-vitro heat survival curves ranged from 44 +/- 3 to 123 +/- 15 min. The response to heat in vivo was not positively correlated with the tumour volume-doubling time, the growth fraction, the cell loss factor or the intrinsic heat sensitivity of the tumour cells, i.e., the Do values of the in vitro heat survival curves. If the results obtained in the present work are representative for clinical practice, they indicate that the response to heat may vary considerably among tumours in different patients. This variability can probably not be predicted from measurements of cytokinetic parameters of the tumours. The lack of correlation between the response to heat in vivo and in vitro demonstrates that extrapolations of results from studies in vitro to tumours are highly speculative and, when attempted, should be executed only with extreme caution.

Blood flow and intravascular volume of mammary adenocarcinoma 13726A and normal tissues of rat during and following hyperthermia

The effects of hyperthermia on blood flow and intravascular volume were studied in mammary adenocarcinoma 13762A growing subcutaneously in the leg of Fischer F344 rats. The blood flow was determined using microspheres labelled with 125I, and the blood volume was determined using red blood cells labelled with 51Cr. At the end of heating with water bath at 43.5 degrees C for 1 hour, there was a marked elevation of 51Cr in tumor. The 125I content in tumor also was mildly elevated. Histologically there was a greater number of patent blood vessels per unit area, and they were dilated and hyperemic. In addition, widespread and diffuse hemorrhage could be seen. It appeared, therefore, that the increased 51Cr and 125I label in the tumors immediately after heating was, at least in part, a result of leakage of the labels to extravascular space in addition to possible vasodilation and increased blood flow. At 1 and 5 hours after heating, tumor blood flow was considerably reduced, and at 16 hours both tumor blood flow and blood volume were considerably reduced. Histological examination demonstrated that the tumor blood vessels remained dilated and hyperemic after heating. The effect of heat on blood flow and blood volume in the skin and muscle adjacent to the tumors was also investigated. Blood flow and blood volume in the surrounding normal tissues were significantly elevated at the end of heating. Blood flow was relatively unchanged at 1, 5, and 16 hours after heating, but blood volume was reduced to about one half. These findings indicate that hyperthermia may induce greater damage to vasculature of tumors than normal tissues, and that vascular damage in tumors may take some time to express itself following moderate hyperthermia.