Hyperthermia in Oncology – Principles and Therapeutic Outlook

Quality-assured local and regional hyperthermia procedures have been proven to enhance the clinical benefits of oncological standard treatments in several clinical settings, without a significant increase in late toxicity. This makes hyperthermia an attractive sensitizer for both radiotherapy and chemotherapy. During the past decade clinical evidence on the beneficial use of additive local and regional hyperthermia procedures as part of multimodality treatment approaches for several malignant diseases has increased significantly. Today, hyperthermia plays a role in the treatment of chest wall recurrences after breast cancer, locally advanced cervical cancer, locally advanced and recurrent rectal cancer, high risk soft tissue sarcoma, anal carcinoma and bladder cancer. It is no longer a question whether hyperthermia is an effective oncological treatment at all. Technical improvements in hyperthermia treatment quality assurance and delivery standards were summarized by a dedicated team of physicists, technicians and clinicians. This booklet is dedicated to the interested reader without any expertise in local and regional hyperthermia. It is designed to provide instant access with a focus on current and upcoming clinical research.

1.Principles of Hyperthermia13 1.1.Definition of Hyperthermia13 1.1.1.Different Temperature Regimes13 1.1.2.Heating Techniques14 1.1.3.References14 1.2.Physical Basics and Hyperthermia Applications14 1.2.1.Electromagnetic Irradiation14 1.2.2.Interaction of Non-Ionizing Electromagnetic Radiation with Matter16 1.2.3.Practical Realizations17 1.2.4.Planning and Optimization20 1.2.5.Harmful Effects of Non-Ionizing Radiation21 1.2.6.Further Heating Techniques21 1.2.7.Heat Transport22 1.2.8.References23 1.3.Biological Rationale of Hyperthermia23 1.3.1.Biological Rationale and Mode of Action of Hyperthermia23 1.3.2.Interaction of Hyperthermia and Chemotherapeutic Agents24 1.3.3.Interaction of Hyperthermia and Ionizing Radiotherapy24 1.3.4.Immune Modulation by Hyperthermia25 1.3.5.References26 2.Techniques, Clinical Use and Quality Assurance29 2.1.Hyperthermia Treatment Techniques29 2.1.1.Classical Techniques29 2.1.2.Recent Developments31 2.1.3.References33 2.2.Practical Recommendations35 2.2.1.Treatment Planning39 2.2.2.Treatment Monitoring41 2.2.3.Treatment Documentation42 2.2.4.Requirements and Characterization of Equipment42 2.2.5.Safety Aspects43 2.2.6.Hyperthermia Staff Requirements43 2.2.7.References43 2.3.Quality Assurance44 2.3.1.Heat Dosimetry44 2.3.2.The Hyperthermia QA Guidelines and Their Principles45 2.3.3.Thermometry and Verification47 2.3.5.Future Aspects48 2.3.6.References48 3.Clinical Results of Quality-Assured Hyperthermia51 3.1.Hyperthermia Alone51 3.2.Chemotherapy and Hyperthermia51 3.2.1.Peritoneal carcinomatosis of epithelial ovarian cancer (EOC)51 3.2.2.Non-muscle-invasive bladder cancer (NMIBC)52 3.2.3.High-risk soft tissue sarcomas (HR-STS) of adults53 3.2.4.Localized relapse or metastatic disease of soft-tissue sarcoma54 3.2.5.Pancreatic Cancer55 3.2.6.Breast Cancer56 3.2.7.Cervical Cancer56 3.2.8.Pedriatic Cancer56 3.2.9.References57 3.3.Radiotherapy and Hyperthermia59 3.3.1.Breast Cancer59 3.3.2.Rectal Cancer60 3.3.3.Cervical Carcinoma62 3.3.4.Further Results63 3.3.5.References63 3.4.Radiochemotherapy and Hyperthermia64 3.4.1.Breast Cancer64 3.4.2.Rectal Cancer64 3.4.3.Cervical Carcinoma65 3.4.4.Anal Cancer66 3.4.5.Bladder Cancer67 3.4.6.Esophageal Carcinoma68 3.4.7.Further Fields of Research69 3.4.8.References69 4.The Role of Hyperthermia in Pediatric Oncology71 4.1.Indications71 4.2.Locoregional Radiofrequency Hyperthermia in Children and Adolescents71 4.2.1.Application of Hyperthermia and Thermometry71 4.2.2.Analysis of Temperatures73 4.2.3.Hyper-PEI Treatment Schedule73 4.3.Limitations74 4.4.Results75 4.4.1.Experimental Studies75 4.4.2.Clinical Studies76 4.4.2.1.Radiofrequency Hyperthermia and Chemotherapy76 4.4.2.2.Radiofrequency Hyperthermia and Radiotherapy77 4.5.Technical Approach and Perspectives79 4.6.Surgical Techniques for Isolated Hyperthermic Perfusion with High-Dose Chemotherapy82 4.6.1.Isolated Hyperthermic Limb Perfusion82 4.6.2.Hyperthermic Intraperitoneal Chemoperfusion82 4.7.Clinical Aspects83 4.8.References84 5.Current and Future Clinical Trials87 5.1.Chemotherapy and Hyperthermia87 5.1.1.References90 5.2.Radiotherapy / Chemoradiation and Hyperthermia90 5.2.1.Anal Cancer90 5.2.2.Soft Tissue Sarcoma91 5.2.3.Rectal Cancer91 5.2.4.References92 6.Summary93 Index95