Improve Rectal Cancer Treatment with Hyperthermia
Colorectal cancer is the third most common cancer in world according to the World Cancer Research Fund International. With nearly 1.4 million new cases diagnosed in 2012. New evidence shows that, in many cases, diet and exercise can prevent the disease.
Clinical results like the one below reveal that Radiation treatments are more effective when combined with Hyperthermia. Hyperthermia warms the tumor to temperatures in the "fever range" which makes the cancer cells more sensitive to treatment. Normal healthy cells recover while cancer cells die.
7a. Rectal Cancer
A Cochrane review was performed to quantify the potential beneficial effect of hyperthermia in addition to radio(chemo) therapy in locally advanced rectal cancer. Six randomized trials were included.
A significant higher complete response rate was observed in the combined treatment arms (RR 2.67, p=0.01). Overall survival after 2 years was significantly higher in the combined treatment arm (OR 0.49, p= 0.001), although this difference disappeared at longer follow-up times.
De Haas-Kock et al. Concomitant hyperthermia and radiation therapy for treating locally advanced rectal cancer. Cochrane Database of Systematic Reviews 2009, issue 3.
7b. Rectal cancer palliative treatment
One randomized trial compared conventional radiotherapy with or without hyperthermia in patients with rectal cancer. In another study the palliative effect of reirradiation plus hyperthermia was evaluated.
In the randomized trial the palliative effect of radiotherapy combined with hyperthermia was larger than that of radiotherapy alone. With hyperthermia, complete palliation was achieved in 45% of the patients for a median duration of 17 months, vs 25% for a median duration of 7 months without hyperthermia.
Reirradiation with 8 fractions of 4 Gy, applied twice weekly, combined with hyperthermia, resulted in a good or complete palliation in 72% of the patients, for a median duration of 6 months.
The Dutch Deep Hyperthermia Trial has recruited patient at AMC Amsterdam and Erasmus Rotterdam; Amsterdam has used its home build device similar to the BSD 1000 and Rotterdam the BSD 2000 device.
Juffermanns has been using a third party device to be identified in the publication.
Hyperthermia and Radiotherapy:
When hyperthermia is combined with radiotherapy, general treatment guidelines of the ESHO European Society of Hyperthermic Oncology recommend:
- Target volume for hyperthermia: When the radiotherapy total dose is considered to be sufficient for a high probability of local control for microscopic disease, the target volume for hyperthermia is the gross tumor volume. When the radiotherapy total dose is lower, the target volume for hyperthermia is the clinical target volume.
- Sequence of treatment modalities: Hyperthermia is given after the radiotherapy fraction, once or twice weekly with a time interval between two hyperthermia treatments of minimum 72 hours. The time interval between radiotherapy and hyperthermia may vary from 30 minutes to five hours.
- Duration of hyperthermia treatment: Superficial hyperthermia total 60 minutes, deep hyperthermia total 90 minutes (including 30 minutes heating-up time)
Reirradiation and hyperthermia is considered standard of care by the Health Insurance Council of the Netherlands.
- Van der Zee and González González. Authors reply. The Lancet 2000;356:772.
- Juffermans et al. Reirradiation and hyperthermia in rectal carcinoma: a retrospective study on palliative effect. Cancer. 2003 Oct 15;98(8):1759-66.