Pilot Study of Whole-Body Hyperthermia Combined with Chemotherapy in Patients with Metastasised Pretreated Progressive Breast, Ovarian, and Colorectal Carcinomas

Systematic review about complementary medical hyperthermia in oncology

Hyperthermia is a generic term for different techniques using heat in cancer therapies. Temperatures of about 42° Celsius in combination with chemo- or radiotherapy may improve the effectiveness of those treatments. Clinical benefit is shown in “standard hyperthermia” with tumour temperatures assessed during treatment. This systematic review thoroughly assesses the state of evidence concerning the benefits and side effects of electro hyperthermia or whole-body hyperthermia (“alternative hyperthermia”) in oncology. From 26 April 2021 to 09 May 2021, a systematic search was conducted searching five electronic databases (Embase, Cochrane, PsycINFO, CINAHL and Medline) to find studies concerning the use, effectiveness and potential harm of alternative medical hyperthermia therapy on cancer patients. From all 47,388 search results, 53 publications concerning 53 studies with 2006 patients were included in this systematic review. The patients were diagnosed with different types of cancer. The hyperthermic methods included whole-body hyperthermia (WBH) with different methods and electro hyperthermia (EH). The majority of the included studies were single-arm studies, counting in total 32 studies. Six studies were randomized controlled trials (RCT). In addition, one systematic review (SR) was found. The most critical endpoints were tumour response, survival data, pain relief, myelosuppression and toxicities. Outcome was heterogeneous, and considering the methodological limitations, clinical evidence for the benefit of alternative hyperthermia in cancer patients is lacking. Neither for whole-body hyperthermia nor for electro hyperthermia there is any evidence with respect to improvement of survival or quality of life in cancer patients.

Whole-body hyperthermia in combination with systemic therapy in advanced solid malignancies

Whole-body hyperthermia (WBH) might be beneficial for patients with metastasized solid malignancies when combined with systemic therapy. This review identified and summarized the phase I/II studies (n = 13/14) conducted using this combination of therapies. Most of the phase II studies used radiant heating methods in a thermal dose of 41.8 °C (1 h). All studies used classic chemotherapy. Great inter-study heterogeneity was observed regarding treatment regimes, included patients and reported response rates (12-89%). Ovarian cancer, colorectal adenocarcinoma, lung cancer and sarcoma have been studied most. Most reported toxicity (grade 3/4) was myelosuppression. Treatment related mortality was present (4 patients) in three out 14 phase II studies (350 evaluable patients, over 966 cycles of WBH with chemotherapy). Absence of phase III trials makes the additive value of WBH highly speculative. As modern oncology offers many less invasive treatments options, it is unlikely WBH will ever find its way in routine clinical care.

Current devices for high-performance whole-body hyperthermia therapy

For late-stage cancer, whole-body hyperthermia (WBH) is highly regarded by physicians as a promising alternative to conventional therapies. Although WBH is still under scrutiny due to potential toxicity, its benefits are incomparable, as diversified devices and very promising treatment protocols in this area are advanced into Phase II and III clinical trials. Following the introduction of the WBH principle, this paper comprehensively reviews the state-of-art high-performance WBH devices based on the heat induction mechanisms - radiation, convection and conduction. Through analyzing each category's physical principle and heat-induction property, the advantages and disadvantages of the devices are evaluated. Technical strategies and critical scientific issues are summarized. For future developments, research directions worth pursuing are presented in this article.

Monitoring of whole-body hyperthermia with transesophageal echocardiography (TEE)

Hyperthermia induces tumor cell death by a spectrum of tumor tissue changes. As whole-body hyperthermia (WBH) can cause cardiovascular complications, especially when cardiotoxic cytostatic agents are administered, invasive cardiovascular monitoring during WBH is necessary. WBH requires a great deal of expenditure and bears the risk of severe toxicity. Furthermore cardiovascular stress, alterations of cardiac index and systemic vascular resistance are major problems during WBH. The purpose of this prospective study was to evaluate cardiovascular changes in patients undergoing WBH under general anesthesia using transesophageal echocardiography (TEE) with special focus on left ventricular function.

METHODS

Hemodynamic parameters were measured with standard monitoring and TEE at defined time points in 20 patients (ASA III) undergoing WBH: M37 (baseline, body temperature: 37 degrees C) after induction of anesthesia, M39 during warming up (39 degrees C), M41.8 at plateau level (41.8 degrees C), M38 during cooling period (38 degrees C).

RESULTS

Invasive monitoring and TEE measurements showed signs of hyperdynamic circulation with significant increase of the heart rate (73.6 +/- 13.7 min(-1) (M37), 104.6 +/- 13.0 min(-1) (M41.8)) and significant decrease of mean blood pressure (74.9 +/- 15.3 mmHg (M37), 65.3 +/- 11.2 mmHg (M41.8)). Cardiac index (CI) nearly doubled and stroke volume index (SVI) increased significantly from M37 to M41.8. Cardiac contractility, fractional area change (FAC) and ejection fraction (EF) increased. At M38 CI, SVI, FAC and EF showed a tendency to decrease compared to M41.8 but remained elevated compared to M37.

CONCLUSION

Patients undergoing WBH showed typical signs of hyperdynamic circulation without impairment of left ventricle which could be monitored excellently by TEE. We recommend using TEE especially in patients with an increased cardiac risk.