Fever range whole body hyperthermia for re-irradiation of head and neck squamous cell carcinomas: Final results of a prospective study

Zschaeck, Sebastian; Weingärtner, Julian; Ghadjar, Pirus; Wust, Peter; Mehrhof, Felix; Kalinauskaitė, Goda; Ehrhardt, Vincent Henrique; Hartmann, Vivian; Tinhofer, Ingeborg; Heiland, Max; Coordes, Annekatrin; Kofla, Grzegorz; Budach, Volker; Stromberger, Carmen; Beck, Marcus

doi:10.1016/j.oraloncology.2021.105240

Cited by 7 publications

(3 citation statements)

References 32 publications

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“…This potency is well-studied in breast cancer, showing again higher complete response rates when hyperthermia is added to radiotherapy [ 20 ]. There are few studies reporting on the addition of hyperthermia to radiotherapy in recurrent or SP HNC [ 11 , 21 ]. Recently, we have published the clinical outcome using our previous head and neck applicator, the Hypercollar, in 27 HNC patients, including 18 recurrent or SP HNC patients [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

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Feasibility, SAR Distribution, and Clinical Outcome upon Reirradiation and Deep Hyperthermia Using the Hypercollar3D in Head and Neck Cancer Patients

Kroesen

Holthe

Sümser

et al. 2021

Cancers

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(1) Background: Head and neck cancer (HNC) patients with recurrent or second primary (SP) tumors in previously irradiated areas represent a clinical challenge. Definitive or postoperative reirradiation with or without sensitizing therapy, like chemotherapy, should be considered. As an alternative to chemotherapy, hyperthermia has shown to be a potent sensitizer of radiotherapy in clinical studies in the primary treatment of HNC. At our institution, we developed the Hypercollar3D, as the successor to the Hypercollar, to enable improved application of hyperthermia for deeply located HNC. In this study, we report on the feasibility and clinical outcome of patients treated with the Hypercollar3D as an adjuvant to reirradiation in recurrent or SP HNC patients; (2) Methods: We retrospectively analyzed all patients with a recurrent or SP HNC treated with reirradiation combined with hyperthermia using the Hypercollar3D between 2014 and 2018. Data on patients, tumors, and treatments were collected. Follow-up data on disease specific outcomes as well as acute and late toxicity were collected. Data were analyzed using Kaplan Meier analyses; (3) Results: Twenty-two patients with recurrent or SP HNC were included. The average mean estimated applied cfSAR to the tumor volume for the last 17 patients was 80.5 W/kg. Therefore, the novel Hypercollar3D deposits 55% more energy at the target than our previous Hypercollar applicator. In patients treated with definitive thermoradiotherapy a complete response rate of 81.8% (9/11) was observed at 12 weeks following radiotherapy. Two-year local control (LC) and overall survival (OS) were 36.4% (95% CI 17.4–55.7%) and 54.6% (95% CI 32.1–72.4%), respectively. Patients with an interval longer than 24 months from their previous radiotherapy course had an LC of 66.7% (95% CI 37.5–84.6%), whereas patients with a time interval shorter than 24 months had an LC of 14.3% (95% CI 0.7–46.5%) at 18 months (p = 0.01). Cumulative grade 3 or higher toxicity was 39.2% (95% CI 16.0–61.9%); (4) Conclusions: Reirradiation combined with deep hyperthermia in HNC patients using the novel Hypercollar3D is feasible and deposits an average cfSAR of 80.5 W/kg in the tumor volume. The treatment results in high complete response rates at 12 weeks post-treatment. Local control and local toxicity rates were comparable to those reported for recurrent or SP HNC. To further optimize the hyperthermia treatment in the future, temperature feedback is warranted to apply heat at the maximum tolerable dose without toxicity. These data support further research in hyperthermia as an adjuvant to radiotherapy, both in the recurrent as well as in the primary treatment of HNC patients.

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Section: Discussionmentioning

confidence: 99%

“…In primary HNC, elevation of target temperatures to 40–44 °C results in around 20 percent increase in LC [ 9 ]. In recurrent HNC, however, the effect of adjuvant hyperthermia to radiotherapy has not been explored thoroughly [ 2 , 10 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

Feasibility, SAR Distribution, and Clinical Outcome upon Reirradiation and Deep Hyperthermia Using the Hypercollar3D in Head and Neck Cancer Patients

Kroesen

Holthe

Sümser

et al. 2021

Cancers

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“…Clinical studies have shown that hyperthermia increases the effectiveness of radiotherapy and chemotherapy for various anatomical sites, without inducing significant side effects [1][2][3][4]. This adjuvant effect of hyperthermia on radiotherapy was shown also for cancers of the head and neck (H&N) [5][6][7][8][9]. In 2007, we developed the HYPERcollar [10] in order to extend the application of hyperthermia from superficial regions to deeper target regions.…”

Section: Introductionmentioning

confidence: 99%

Experimental Validation of the MRcollar: An MR Compatible Applicator for Deep Heating in the Head and Neck Region

Sümser

Drizdal

Bellizzi

et al. 2021

Cancers

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Clinical effectiveness of hyperthermia treatments, in which tumor tissue is artificially heated to 40–44 °C for 60–90 min, can be hampered by a lack of accurate temperature monitoring. The need for noninvasive temperature monitoring in the head and neck region (H&N) and the potential of MR thermometry prompt us to design an MR compatible hyperthermia applicator: the MRcollar. In this work, we validate the design, numerical model, and MR performance of the MRcollar. The MRcollar antennas have low reflection coefficients (<−15 dB) and the intended low interaction between the individual antenna modules (<−32 dB). A 10 °C increase in 3 min was reached in a muscle-equivalent phantom, such that the specifications from the European Society for Hyperthermic Oncology were easily reached. The MRcollar had a minimal effect on MR image quality and a five-fold improvement in SNR was achieved using the integrated coils of the MRcollar, compared to the body coil. The feasibility of using the MRcollar in an MR environment was shown by a synchronous heating experiment. The match between the predicted SAR and measured SAR using MR thermometry satisfied the gamma criteria [distance-to-agreement = 5 mm, dose-difference = 7%]. All experiments combined show that the MRcollar delivers on the needs for MR—hyperthermia in the H&N and is ready for in vivo investigation.

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Whole-Body Hyperthermia in Oncology: Renaissance in the Immunotherapy Era?

Zschaeck

Beck

2022

Water-Filtered Infrared a (wIRA) Irradiation

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A short introduction to the use of whole-body hyperthermia (WBH) in oncology is provided. The main focus is on fever-range whole-body hyperthermia (FRWBH), since various preclinical studies have shown promising results using this approach. However, FRWBH has not been comprehensively investigated in clinical oncology trials. Having provided an overview on the methods to induce WBH, we will summarize preclinical and clinical data on the mode of action of FRWBH. The latter treatment positively affects the tumor micromilieu, especially by decreasing tumor hypoxia. It has the potential to enhance tumor-directed immune reactions and has proven anti-depressive and potential analgesic effects in patients without cancer. These pleiotropic effects align with good tolerability and high acceptability by patients. Given the available evidence, we argue that FRWBH should be investigated as an adjunct to modern cancer treatments in controlled clinical trials.

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Fever range whole body hyperthermia for re-irradiation of head and neck squamous cell carcinomas: Final results of a prospective study

Cited by 7 publications

References 32 publications

Feasibility, SAR Distribution, and Clinical Outcome upon Reirradiation and Deep Hyperthermia Using the Hypercollar3D in Head and Neck Cancer Patients

Feasibility, SAR Distribution, and Clinical Outcome upon Reirradiation and Deep Hyperthermia Using the Hypercollar3D in Head and Neck Cancer Patients

Experimental Validation of the MRcollar: An MR Compatible Applicator for Deep Heating in the Head and Neck Region

Whole-Body Hyperthermia in Oncology: Renaissance in the Immunotherapy Era?

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