Hyperthermia in Cancer Care

The use of high temperature heat in a therapeutic setting or simply "hyper-thermia" is an emerging treatment tool in the field of cancer (i.e. a field known as thermal medicine). It has been shown that cancer cells (i.e. both leukemia & solid tumors) are more sensitive to hyperthermia than normal tissue cells. This has given researchers greater hope of using medically supervised high temperature heating as an effective treatment for cancer.

Several research centers & hospitals throughout Europe, Asia, and the United States are actively studying the application of hyperthermia on weakening and even killing cancer cells within the body. In addition, this same research is also showing how hyperthermia can be combined together with radiation, chemotherapy, and immunotherapy medicines so that their positive effects can be enhanced in the killing of cancer cells. In basic terms you are "boosting" the benefits of chemotherapy, radiotherapy, and immunotherapy with heat! For patients whose cancers have become more resistant to chemotherapy, hyperthermia is also showing promise in making those situations work better as well.

There are 3 general ways on how hyperthermia is used in the field of cancer

1. Ablation - where tumors are literally "burned" or "fried" using specific, medically guided techniques
2. Localized - where specific tumor sites, usually closer to the skin, are heated (41-45 C) using microwave or ultrasound at a confined spot only
3. Whole Body (WBH) - where the entire body is heated to a point that makes tumor cells vulnerable (>39 C) and the body is stimulated to fight disease (i.e. like a fever). This is the type of hyperthermia used by Dr. Lemmo

Dr. Lemmo uses the heckel - HT 2000 medical unit for providing whole body hyperthermia (WBH) treatments in cancer care. This exact unit is also being researched at the University of Texas Medical School at Houston as a means to enhance chemotherapy treatments and, consequently, improve results. The HT 2000 was originally developed by a Dr. Martin Heckel, MD in Europe as a way to more efficiently supply thermal energy to the body and deeper tissues using infrared (IR) radiation. Yes, the same infrared that is being used in a lot of the popular sauna's on the market today. The infrared heating has a high proportion of short wavelengths (infrared A) close to the range of normal visible light, which is why you see bright light when the unit is on. The medical device creates a complete reflection scattering of the primary radiation, which produces a uniform, skin-compatible surface irradiation. A high amount of this radiation penetrates the skin (i.e. epidermis) to a depth where the blood can absorb the heat and spread it throughout the tissue and organs. Subsequently, the body center or core is heated. It is for some of these reasons why whole body hyperthermia is considered more advantageous for widespread (i.e. metastatic) cancers than the other types of hyperthermia treatments available.

To help the body maintain heat, a specially designed tent is used made of a flexible, thermally insulating material. The tent is placed over the treatment table or bed and the patient comfortably lies inside during the IR radiation phase. There is lots of room for patients to move around, read a book, etc. during this temporary period. Windows in the roof of the tent permit eye contact and easy conversation. For those that may be a little more claustrophobic, a "head-out" method is also available.

Once the desired temperature is reached using IR radiation, the tent wall is folded down and wrapped on to the patient (with your head out of course). This insulating thermal blanket then becomes the method on how the therapeutic heat is maintained over a prolonged period of time (i.e. the heat-retention phase). It is common for the body temperature to increase another 0.3-1 C during this period.

How hyperthermia works in cancer

There are several reasons as to how whole body hyperthermia (WBH) may work in fighting cancer:

• increases cancer fighting immune system chemicals in the body (i.e. NK, TNF-alpha, G-CSF, GM-CSF)
• increases the immune system cells in cancer cell killing (i.e. macrophage, lymphocyte, cytotoxic T cells, dendritic cells)
• allows the immune system to more easily "see" tumor cells (increased antigen recognition)
• increases lymphocyte recruitment and trafficking into the tumor area
• increases heat-shock proteins
• increases blood flow/oxygen to the more low oxygen tumors (i.e. hypoxic tumors)
• makes tumor cell walls more "leaky" or weaker allowing cancer-killing medicines to enter the cell more easily

Medically supervised treatment

Because heating the body to higher than normal temperatures (i.e. >39 C) can be a stress on the heart & body, patients are closely monitored using heart EKG, oxygen saturation, blood pressure, respiration rate monitor, and of course temperature probes. Before and after blood tests will be required as well. In addition, because it is normal for patients to lose several litres of fluid during heating, an intravenous drip is also important during this process. Customized injectible ingredients/medicines will be added to each individual cancer case. Throughout the hyperthermia treatment, oxygen will also be given by face mask or nasal canula.

It is important to mention that this kind of treatment is not for every patient (i.e. it is not a beach sun vacation). It is why several treatment centers use some form of sedation during each treatment (i.e. an Ativan or sleeping pill may be needed for some patients). It is also possible that underlying body weaknesses may manifest during or following treatment. As a consequence, Dr. Lemmo will evaluate the benefits & risks for each case during the initial consultation with you.

How long is a normal treatment session

As a general rule, the desired target temperature (39-41.8 C) is maintained for approximately 1 hour (60 minutes). When including the pre-heating phase and post-cooling down phase, a treatment can take approximately 3-4 hours in total.

How often are treatments given

WBH is normally performed in a series of at least 3 but usually 6-12 sessions. The session intervals depend both on the patient's reaction and also if the patient is receiving active chemotherapy, radiation, or other cancer fighting agents. In several published papers, WBH is commonly given during or very close to each conventional cancer treatment. Thus, for example, if a patient is on her/his 4th treatment cycle of chemotherapy, then the patient could have at least a similar number (i.e. 4) of WBH treatments as well. It is OK, however, for patients to receive 1-2 treatments of WBH per week or 6 sessions over a two to three-week period if clinically indicated.