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HPA Magazine 9
Generically, the term “hyperthermia” refers to an increase in temperature above the physiological level, with the goal of achieving a more efficient therapy, defined as an increase in temperature reaching between 39° and 45°. Oncology also turned to this physiological alteration as a form of destruction of tumour cells several years ago, through two methods: Loco-Regional Hyperthermia by Radiofrequency and Whole-body Infrared Hyperthermia. Dr Guy Vieira offers us some clarification on this additional weapon to combat cancer, available since October at the Hospital de Gambelas, and the second centre to be installed in Portugal.
How does Hyperthermia act physiologically on cancer?
Loco-Regional Hyperthermia by Radiofrequency and whole-body Infrared Hyperthermia are both treatment methods that on their own or together with chemotherapy and/or radiotherapy have the goal of destroying tumour cells; the sessions of both methods are performed as outpatient treatment, and therefore do not require hospitalisation.
Basically, hyperthermia stimulates the fever mechanism, which as we know is a physiological defence mechanism, which provokes the release of regulatory substances with the effect of protecting the diseased organism, increasing its immunity response.
As the tumour cells have an altered membrane, we can provoke their death (through apoptosis, which is programmed cell death) due to the induced overheating and through another method, interfere in the mitotic cycle of the cancer cell and place it in a phase that is more sensitive to other types of treatments (chemotherapy and/or radiotherapy).
This method is recent in portugal and only exists in the HPA, in Porto and very recently also in Lisbon but in some countries, it has been used for many years. why is this?
I believe that the reason is exclusively due to investment and to the sensitivity of adhering to other treatment methods. The equipment is expensive and despite it having been used for many years, it fell into disuse due to the side effects it provoked at the time. Fortunately, as in other fields of medicine, there has been technological development and today Hyperthermia is used in total safety. The proof is that in some countries, such as Germany, it remained active and is widely used nowadays.
I think that hyperthermia is a pillar in oncology treatment, in association with the classic methods, such as surgery, chemotherapy and radiotherapy, with the advantage of also being able to be applied with the new emerging cancer therapies, such as genetic therapy, reconstructive surgery with stem cells, together with stereotaxic radiosurgery (a technique used in radiotherapy with doses in single or multiple fractions), cancer vaccines or even the new drugs, such as immunotherapy.
What are the differences between the two types of Hyperthermia?
The objective of Loco-Regional Hyperthermia by Radiofrequency is to reach the optimum heat in the tumour, whether it is superficial or deep, without exceeding the tolerance limits of the normal surrounding tissues. Local hyperthermia is applied externally and not invasively, by means of two active electrodes that emit an electromagnetic energy aimed at the site of the treatment, leading to the destruction of the cancerous cells in a selective, focused way. This method, which take about 60 minutes per session, is indicated for tumours in the cervix, head and neck, lung, breast, pancreas, melanoma, bladder, rectum, prostate, oesophagus, soft tissue sarcomas and the central nervous system. The use of a pacemaker contraindicates this treatment because of interference of the electromagnetic field in the programming of the pacemaker.
Whole-body Infrared Hyperthermia produces irradiation throughout the body in sessions lasting approximately 180 minutes. The indications are similar to Loco-Regional Hyperthermia by Radiofrequency, with the contraindications regarding the presence of acute infections, heart failure, myocardial infarction, hyperthyroidism, pregnancy or epilepsy. This is also the type of treatment that can be used in the stimulation of our immune system (of defence).
Can Hyperthermia be used in any phase of the disease?
Yes, in any phase and together with any other treatments. Furthermore, studies show that this is one of the best auxiliary treatments for radiotherapy and chemotherapy because it increases the efficiency.
Recent clinical studies have also demonstrated evidence in relation to non-cancerous diseases, such as various types of chronic inflammatory process (bronchitis, asthma, prostatitis, ulcerated colitis, Crohn’s disease), fibromyalgia, degenerative diseases of the locomotor system and in select chronic and recurrent viral processes. There are also studies and centres which effectively use it in anti-aging treatments, together with other methods.
Is the efficiency of this treatment the same for the different types of cancer? and what about if the situation has already spread (metastasised)?
The previously described oncological situations are those where the results have shown more evidence, as generally speaking, they are patients who have “exhausted” the weapons of treatment or for which the efficiency is no longer the same. As for metastasis, yes, this treatment can and should be used, namely in situations of spreading to multiple organs (e.g.: liver, lung and bone) or in local reoccurrence in the breast (chest wall).
How does hyperthermia act in combination with chemotherapy and radiotherapy?
This relationship is explained through the increase of temperature attained in the affected organs, where it promotes a greater sensitivity in the respective tumour cells, therefore optimising the desired benefits of these treatments. In the specific case of chemotherapy, fostering the increase of the flux of the drugs in the part of the body where they are most needed. In regard to radiotherapy, favouring the tissues with more oxygen, where radiotherapy is more efficient and lessening some of the side effects produced by the accumulation of free radicals generated in the sessions.
Is Hypothermia contraindicated for any tumours? and what about the side effects?
As for side effects, they only exist for people with pacemakers, as mentioned, in the case of loco-regional Hyperthermia, in cases of cardiac interventions such as a coronary bypass or when there are metal prostheses near the area of the tumour or the area of irradiation.
Besides not being invasive, these therapy methods do not cause any risks to the patient, nor do they cause any significant additional side effects. After finishing a hypothermia session, the majority of the patients say the heat makes them feel good, although some show signs of tiredness. In isolated cases, the destruction of cancer cells can result in a slight fever. However, both of the effects are considered to be a good response to the treatment.
Hyperthermia of the Whole Body