A Narrative Review of Regional Hyperthermia: Updates From 2010 to 2019

Abstract

The role of hyperthermia (HT) in cancer therapy and palliative care has been discussed for years in the literature. There are plenty of articles that show good feasibility of HT and its efficacy in terms of tumor response and survival improvements. Nevertheless, HT has never gained enough interest among oncologists to become a standard therapy in clinical practice. The main advantage of HT is the enhancement of chemotherapy (CHT), radiotherapy (RT), chemoradiotherapy (CRT), and immunotherapy benefits. This effect has been confirmed in several types of tumors: esophageal, gastrointestinal, pancreas, breast, cervix, head and neck, and bladder cancers, and soft tissue sarcoma. HT effects include oxygenation and perfusion changes, DNA repair inhibition and immune system activation as a consequence of new antigen exposure. The literature shows a wide variety of randomized, nonrandomized, and observational studies and both prospective and retrospective data to confirm the advantage of HT association to CHT and RT. There are still many ongoing trials on this subject. This article summarizes the available literature on HT in order to update the current knowledge on HT use in association with RT and/or CHT from 2010 up to 2019.

Recommendation of Regional Hyperthermia in the Treatment of Breast Cancer

“…They state that HT combined with RT or CT should be suggested to all patients "with advanced or recurrent [breast cancer] or at high risk of local recurrence." 1 We think that this statement is too general and "advanced breast cancer" as a recommended indication is too diffuse. We share the authors' view that "HT has never gained enough interest among oncologists to become a standard therapy in clinical practice."…”

“…Toxicity of combined HT/RT is especially important since most patients presenting with LRBC in pre-irradiated sites are treated with palliative intent. Toxicity data presented in Table 4 by Fiorentini et al 1 are neither complete (e.g., Linthorst et al 2 reported in detail HT-related thermal skin damage) nor correct (e.g., Oldenborg et al 3 reported ≥G3, not >G3 toxicity of 24%).…”

“…We have read with great interest the recent review and updates from Fiorentini et al 1 concerning the application of regional hyperthermia mainly in combination with radio- (RT) or chemotherapy (CT) in your esteemed journal. The authors describe the application of hyperthermia (HT) or “modulated electro-hyperthermia” (mEHT) in a large variety of tumor entities, highlighting the advantages of adding HT to standard treatments.…”

“…Concerning breast cancer, the authors list 9 studies: 5 of them address recurrent breast cancer, 2 deal with advanced or recurrent breast cancer, 1 with advanced breast cancer, and the remaining study with liver metastasis of breast cancer. They state that HT combined with RT or CT should be suggested to all patients “with advanced or recurrent [breast cancer] or at high risk of local recurrence.” 1 …”

Heat Flow Modeling for Controlled Focusing of Microwave Hyperthermia of Breast Cancer: a Computational Feasibility Study

“…Numerous clinical trials have proven that it is a promising approach to combine hyperthermia treatment (HT) with chemotherapy, enhancing certain anticancer drug's effects. The combination of hyperthermia and radiotherapy makes some cancer cells more sensitive to radiation while other normal cells are kept intact [2]- [4]. Tissue characteristics, tumor site, size, temperature control, duration of treatment, and flow of heat in the tumor tissue play a vital role in the effectiveness of HT [3].…”