A year ago, when Gayle Driscoll’s, breast cancer recurred on her skin, the 63-year-old retired teacher from Barnstable tried an experimental treatment that gave her radiation therapy some extra oomph . Every time she lay down for radiation treatment on her chest, her tumors were also heated with a special device that emitted radio frequency waves. After six weeks, the skin tumors were gone.
The heat therapy called hyperthermia was meant only as a local treatment — and the cancer ultimately spread to her bones — but it was “psychologically important” to her to see the tumors in her skin disappear, she said.
Hyperthermia, in which microwaves are used to raise the temperature of a tumor or the patient’s whole body to 104 to 106 degrees Fahrenheit, is a new twist on an old treatment idea that has gained new currency recently thanks to some successful studies.
Hypothermia significantly boosts the killing power of chemotherapy and radiation. It is generally used to help prevent local recurrences, but some doctors speculate that may improve overall survival as well. . At least eight studies in recent years have shown that adding hyperthermia to chemotherapy or radiation can improve local control of cancers of the esophagus, cervix, head and neck, brain, melanoma and breast cancers that have spread to the chest wall, said Dr. Mark Dewhirst, director of the hyperthermia program at Duke University Medical Center in Durham, N.C.
Scientists who have observed first hand the effects of hyperthermia are impressed. “I’m amazed at some of the tumors that just melt away with the combination of radiation and heat,” said Dr. David Wazer, radiation oncologist in chief at New England Medical Center.
At Long Beach Memorial Medical Center in California, Dr. Nisar Syed, director of radiation oncology, has treated more than 3,000 patients with hyperthermia plus radiation over the years. In many cases, “we saw rapid regression of the tumor,” he said, and in some cases, improved survival as well.”
In the future, hyperthermia could turn out to be among the most powerful anti-cancer weapons yet. Consider this idea, now being studied at
Duke: Researchers have created a tiny bubble, or liposome, with water on the inside and a ring of fat on the outside. Mixed in with the water is a chemotherapy drug, doxorubicin. The liposome is designed to be stable at body temperature but to burst when heated. By using hyperthermia to explode the liposomes, Dewhirst has shown in mice that doctors can deliver 30 times more chemotherapy than would otherwise be possible.
Scientists think hyperthermia probably fights cancer in several ways.
“When you combine heat and radiation, the cell-killing of cancer cells is better,” said Dr. Jay Harris , chairman of radiation oncology at both Dana-Farber and Brigham and Women’s Hospital.
Radiation works by damaging DNA. But there must be enough oxygen nearby for this damage to occur. Parts of tumors are tough to kill because they have a poor blood supply and thus, low oxygen levels. Raising the temperature of a tumor brings more blood, hence more oxygen, to the tumor.
With chemotherapy, drugs get in through small channels on the cell surface. “The heat opens these channels so that chemotherapy drugs can more easily enter in,” said Wazer of New England Medical Center.
Hyperthermia also seems to “jump-start the immune response,” at least in mice, said Elizabeth Repasky, an immunology professor at the Roswell Park Cancer Institute in Buffalo, N.Y., who is now looking at the effects in humans. Just as a fever with the flu may boost immune response, so may hyperthermia, a kind of artificial fever.
The idea of using heat to treat cancer started more than 100 years ago when an American surgeon, Dr. William B. Coley, noticed that some cancer patients who also had high fevers from bacterial infections had their tumors shrink. He began inducing fevers on purpose in cancer patients by infecting them with bacteria.
Several decades ago, a number of medical centers, including Dana-Farber and Johns Hopkins Medical Institute, began pursuing the idea — with disappointing results. Insurance payments for the procedures were low and a major study about 15 years ago showed no benefit to hyperthermia, though the study was highly flawed.
“So the technique was by and large abandoned,” said Wazer of NEMC.
The good news is that today, reimbursement rates are rising and the instruments that can deliver microwaves even to tumors deep into the body are more precise. In the last few years, new , better-designed studies “have rekindled interest” in the idea, said Harris. Moreover, the National Cancer Institute recently opted to grant $19 million to Duke to continue its hypothermia research.
Among the studies turning the tide for hyperthermia is one published last year by Dr. Ellen L. Jones, a Duke radiation oncologist. Writing in the Journal of Clinical Oncology, her team reported that, compared to patients getting radiation but not hyperthermia, those who got both had a significantly reduced the risk of recurrence of”superficial” tumors, chiefly breast cancers that had spread to the chest wall.
“I really trust the data coming out of this Duke group,” because the team was so meticulous, said Harris, who was not involved in the study.
In another study of 68 women with cervical cancer in the US, Norway and the Netherlands, also published last year, Jones and colleagues showed that a triple combination — hyperthermia, radiation and chemotherapy — was highly effective at lowering the risk of recurrence. A larger study comparing this triple treatment with standard treatment is now underway.
Dr. Joan M.C. Bull , director of thermal therapy research at the University of Texas Medical School at Houston is even pursuing whole-body hyperthermia for some kinds of cancers, including metastatic pancreatic cancer. Bull places patients, head and all, inside a radiant heat machine that brings body temperature to that of a high fever, about 104 F. It’s very safe, she said, though patients are monitored carefully. Some patients get “cranky” during the treatment, she said, as they might with a fever.
Working with rats, Bull has heated the body for about six hours, and found that chemotherapy can be given before, during and after heat treatment. Her early, still-unpublished, results “appear promising,” she said, particularly for cancers that have spread beyond a local area.
Clearly, more research is needed. But many regions now have at least one center. In Boston, it’s New England Medical Center; in Providence, a center is about to open at Rhode Island Hospital.
So if you or a loved one is getting treated for cancer, it’s worth asking a doctor if hyperthermia might help.