Hyperthermia for breast cancer – pro

Hyperthermia has a place in standard therapeutic armamentarium for breast cancer. National Comprehensive Cancer Network (NCCN) has for the first time included it in its 2007 Breast Cancer Guidelines for recurrent cancer of the chest wall (breast cancer) and other localized cancer recurrences. This announcement significantly supports the progressive emergence of hyperthermia therapy as a mainline therapy in the treatment of cancer. Hyperthermia therapy (heat) devices and radiation therapy devices are the only medical devices listed in the NCCN Clinical Practice Guidelines in Oncology for Breast Cancer. One of the landmark studies supporting this addition to the NCCN Guidelines was published in the May 1, 2005 edition of the Journal of Clinical Oncology, the official journal of the American Society of Clinical Oncology (ASCO). The study followed 109 patients with superficial tumors, the majority of whom were experiencing post-mastectomy breast cancer recurrence. Patients were randomized to receive either radiation alone or radiation accompanied by hyperthermia therapy twice a week throughout the course of their treatment. Of those patients who had previously received radiation therapy, 68 percent of those who received a second course of radiation combined with hyperthermia therapy experienced total tumor disappearance, while 24 percent of those patients who received radiation alone experienced total tumor disappearance.

Hyperthermia was first described in a radiation text in 1935, in a paper that was titled, “Preliminary study of the effect of artificial fever upon hopeless tumor cases.” I think “hopeless tumor cases” is the key here. There were a number of well-designed trials in the 1970s and 1980s looking at the use of heat or hyperthermia and radiation, but by the late 1980s, most hyperthermia trials were abandoned because of technical issues. 1989 was the last year of a report from a phase III trial of any size through the Radiation Therapy Oncology Group (RTOG), and it was a negative trial. Heat added nothing to radiation in a palliative setting. But in the last decade, there have been six randomized trials, including the one from Duke, looking again at this issue. These six trials together included a total of less than 400 women with breast cancer and less than 160 women with re-irradiation of a chest wall lesion. None of the trials showed any survival advantage.

This was possible because surface cancers are accessible to heat. Internal mets are much harder to treat. The Germans at St. Geirge are exploring nanotechnology heating, and others are using microwaves but this is cearly a very experimental approach at thsi time, as is combination of hyperthermia and chemotherapy for breast cancer.

Sakurai H, Mitsuhashi N, Tamaki Y, et al. Interaction between low dose-rate irradiation, mild hyperthermia and low-dose caffeine in a human lung cancer cell line. Int J Radiat Biol. 1999 Jun;75(6):739-45.

nccn.org, breast cancer

L. Kronberger, P. Wagner, M. Puchinger, H. Stranzl, P. Kohek: Radiofrequency-Hyperthermia in Combination with Chemo and Radiotherapy in Palliative Treatment of Breast Cancer: A Case Report. The Internet Journal of Surgery. 2004. Volume 5 Number 2.

Vernon C C and Hand J W (2002) Hyperthermia in the treatment of cancer in Treatment Of Cancer (4th Edition) Eds. Price P and Sikora K. London, Arnold, 81 –102.Wust P et al (2002)

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