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cancer

Turning up the heat to treat cancer
Turning up the heat to treat cancer The list of cancers treated using the hyperthermia approach is exhaustive but includes those involving multiple systems such as gastrointestinal, genitourinary, skin, gynecologic, sarcomas, and brain tumors.

Hyperthermia is an elevation in the temperature of the body and occurs when the body produces or absorbs more heat than it can release. Normally, this is not desirable as many health complications can arise, including disability or even death. It has been known for decades, however, that cancer cells are more vulnerable to other treatments when they are exposed to higher than normal body temperatures. Inducing hyperthermia in patients with certain types of cancer has shown promising results when used in conjunction with chemotherapy and radiation. Hyperthermia is induced clinically by using microwave, radioactive, or ultrasound frequencies to create heat and increase the body’s temperature.

Technique options
There are three different techniques used when hyperthermia is induced in the treatment of cancer: local hyperthermia, regional hyperthermia, and finally, whole body hyperthermia. Local hyperthermia means that the temperature is elevated in a very small area, primarily surrounding the tumor being treated. Local hyperthermia can by applied using three different methods. The first is externally in which the heat is applied just below the skin’s surface. The second is intraluminally, or endocavitary. This method involves using surgical techniques to open the body to apply the increased temperature to the areas of concern which is typically an area where a tumor lies or has been removed. This technique is useful in the case of esophageal or colorectal cancer. Finally, local hyperthermia can be applied interstitially. This is often used in patients with brain tumors where probes or needle-type devices are inserted with different forms of energy used to create heat.

Regional hyperthermia involves exposing a larger amount of tissue to the increased temperature and is subdivided into three different approaches. The first is called the deep tissue approach and is often used in the treatment of cervical or bladder cancer. The second is known as regional profusion and is typically used to treat the limbs of the body. Basically, the blood distributed to the limbs is heated in order to increase the effectiveness of chemotherapeutic drugs that are also infused into the limb’s blood circulation. It is classically used to treat melanoma. The third regional hyperthermia technique is known as continuous hyperthermia or peritoneal profusion. This technique inserts heated fluid containing chemotherapy into the peritoneal cavity, the space around the gut in the abdomen, and is similar to peritoneal dialysis where the abdominal organs are bathed in the warmed solution and then it is removed after a set time period. The third major form of hyperthermia therapy used to treat cancer is that of whole body hyperthermia. This is typically used when the cancer is wide-spread or metastatic and the entire body is raised to an elevated temperature, typically 106-108 degrees Fahrenheit. The body’s temperature can be raised by using hot water blankets or by placing the patient in a large incubator. As one can imagine, this form of hyperthermia can pose the most danger to a patient and must be very strictly monitored.

Clinical trial locations
Hyperthermia is a technique that is still evolving in the treatment of cancer and like any new treatment, will require much study through clinical trials. This technique has been far from standardized and anyone considering this approach should investigate participation in clinical trials. Clinical trials involving hyperthermia techniques are available at various medical institutions in the United States. The most active clinical trial programs using hyperthermia are located at Duke Cancer Center in Chapel Hill, NC; MD Anderson in Houston, TX; St. Luke’s/Roosevelt Hospital in NYC; Masonic Cancer Center at the University of Minnesota in Minneapolis, MN; and the University of Texas Health Science Center in Houston, TX. Currently, at Duke University Medical Center, cervical, breast, and sarcoma cancers are being treated with combinations of chemo-and radiation therapy while applying hyperthermia techniques in a supervised setting.
In general, whether a patient uses local, regional, or whole body hyperthermia, temperatures typically range between 106-113 degrees Fahrenheit. Just like radiation, certain parts of the body are more sensitive than others to higher temperatures. As one can imagine, complications such as burns, blisters, discomfort and pain can arise when exposing the body or parts of the body to increased heat. Damaged tissue can result in swelling, blood clots, bleeding, or even permanent damage. In addition to these local effects of hyperthermia, whole body hyperthermia can cause generalized nausea, vomiting, and diarrhea, symptoms that are often associated with other types of cancer therapy such as radiation and chemotherapy.

Which cancers have been treated using hyperthermia?
The list of cancers treated using the hyperthermia approach is exhaustive but includes those involving multiple systems such as gastrointestinal, genitourinary, skin, gynecologic, sarcomas, and brain tumors.

As stated earlier, hyperthermia has been used for years to weaken cancer cells and make other treatments more efficacious. It has been speculated that hyperthermia can do several things to cancer cells to increase their susceptibility to other forms of therapy such as chemotherapy and radiation therapy. Some of the more direct ways in which hyperthermia can kill cancer cells is by simple denaturization or the breaking down of proteins which can rapidly kill cancer cells. Less aggressive heat applications can possibly induce cell death by a method known as apoptosis. This literally means that the heat is programming a cancer cell to die. Until recently, little was known about how this occurred but there is some evidence that genetic changes in cancer cells such as altered growth pathways give cancer cells a survival advantage. These are known as DNA repair pathways and they can be affected by increasing the temperature of the cancer cells. A classic example is the BRCA repair pathway that can be deficient in some patients, giving them an advantage in responding to certain treatments. BRCA impaired cancers have the misfortune of having a defect in their ability to repair broken DNA. Many cancers, including breast, ovarian and prostate, can have defects in these pathways and therefore be destroyed by adding another insult to already repair-defective cancer cells by using chemotherapy or newer biologic therapies, such as agents as PARP-1 inhibitors. Unfortunately, most patients do not have this pathway defect but there is some evidence that heat can actually induce this defect, thereby reducing the ability of cancer cells to repair themselves.

Investigate all options
When a person is diagnosed with cancer, it is only normal to want to get as much information as possible on various treatments, both old and new. In fact, it is important that patients learn as much about their diagnosis and potential treatments as possible. This is also true in the treatment of cancer using hyperthermia techniques. Much information is available through the Internet and well meaning friends and relatives. But, as with any other evolving cancer treatment technique, it is critical to seek professional advice and by no means should any individual try to self- induce hyperthermia.

One should also be aware that there are clinics throughout the world that have offered to apply local, regional, and even whole body hyperthermia in order to facilitate cancer therapy. These are often times highly unregulated programs and do not involve actual clinical trials. They can be dangerous and should be avoided.

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"Turning up the heat to treat cancer"
   authored by:
ONCOLOGY
Dr. Fleming earned his MD degree from the University of Louisville, Kentucky, and completed his fellowship at the University of Kentucky which included an externship at the National Cancer Institute.He became a tenured professor in hematology/oncolog...



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