DefinitionThis section has been translated automatically.
Increase of the body temperature to > 42 °C in the context of multimodal tumour therapy, also in combination with chemo- and radiation therapy in the sense of radio-chemo-thermo-therapy
General definitionThis section has been translated automatically.
In studies, the reduction of tumor mass correlates with the increase in temperature, hypoxia and the reduction of the pH value in the tissue. The following procedures are currently common:
- Local hyperthermia: The affected area is irradiated externally with ultrasound, radio waves or microwaves using an applicator. Local hyperthermia can be used for superficial lesions, i.e. tumours or metastases that lie just under the skin (e.g. cervical lymph node metastases).
- Regional hyperthermia: Large areas of the body, such as the pelvic area or the lower extremities, are heated by electromagnetic waves (radio waves or microwaves). The patient lies on a couch in a ring applicator. In this applicator, the antennas that emit the electromagnetic waves are arranged in a ring shape and generate a power distribution that can be controlled within limits by means of suitable phase and amplitude control. This control possibility allows overheating in normal tissue to be avoided and sufficiently high temperatures in the tumor to be achieved.
- Whole-body hyperthermia: Here the whole body is heated, whereby originally so-called contact methods (e.g. hot water, hot air or heated water blankets) were available. However, these methods are hardly used anymore due to intolerance. Nowadays, the body is heated from the outside using infrared rays of different wavelengths (so-called radiative methods). During treatment, the patient is located in a chamber that is largely thermally insulated.
- Interstitial hyperthermia: "antennas" or probes are inserted into the tumour, which allow heating directly inside the tumour. A treatment similar to this technique is seed application or "spiking". Seeds are capsules containing a radioactive substance (usually radioactive iodine) which are implanted directly into the tumour, where they destroy the tumour cells with their radiation. Since the radiation dose in the immediate vicinity of the seeds is very high, but decreases sharply with increasing distance, only the tumour is damaged. The use of fine magnetizable particles injected into the patient in a liquid also derives from this principle; such a magnetic liquid can be heated by a strong alternating magnetic field.
- Hyperthermic perfusion (see extremity perfusion, hyperthermic): A heated fluid (e.g. a cytostatic solution) is passed through the supplying veins of the part of the body affected by cancer. In order that only the diseased part is flushed, the body part must have its own blood supply (e.g. lower/upper extremity, liver). The flushing of body cavities, for example the abdominal cavity or the bladder, with heated fluids is also used. By warming the blood, whole-body hyperthermia can also be performed.
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EffectsThis section has been translated automatically.
Inactivation of the tumour cells, usually at a temperature > 42 °C for at least 30 minutes. In addition to the cytotoxic effect of the heat, there are immunological factors such as local cytokine release and further damage to the tumour cells.
IndicationThis section has been translated automatically.
Reduction of tumour mass in inoperable tumours. Thus, in pilot studies 52% of previously inoperable tumours could be surgically treated after all. Complete tumor regression rarely occurs with hyperthermia alone. Locally also for the reduction or rehabilitation of individual organ metastases, e.g. liver. Currently, surface hyperthermia is also used with good success for resistant verrucae vulgaris.
ImplementationThis section has been translated automatically.
- Whole body hyperthermia: By means of infrared, the body temperature is heated to 42 °C, under central attenuation or even under general anaesthesia.
- Local: The application head (infrared lamp) is positioned directly above the region to be heated and thus overheats a defined area.
Undesirable effectsThis section has been translated automatically.
Possibly leukopenia, thrombocytopenia, anemia, nausea, vomiting. In rare cases superficial burns and necrosis.
PreparationsThis section has been translated automatically.
e.g. Iratherm 2000
Note(s)This section has been translated automatically.
At present, hyperthermia does not yet represent a regular service of the statutory health insurance companies.
LiteratureThis section has been translated automatically.
- Issels R (1999) Hyperthermia combined with chemotherapy-biological rational, clinical application and treatment results. Oncology 22: 374-381
- Nickolaus B (1996) Hyperthermia: New concepts for an old procedure. German Medical Journal 93: A-1368, B-1068, C-968
- Richtig E et al (2003) Efficacy of superficial and deep regional hyperthermia combined with systemic chemotherapy and radiotherapy in metastatic melanoma. JDDG 1: 635-642
- Wehner H et al (2001) Whole body hyperthermia with water-filtered infrared radiation: Technical-physical aspects and clinical experiences. Int J Hyperthermia 17: 19-30
- Wiedemann GJ et al (1996) Ifosfamide and carboplatin combined with 41.8 °C whole body hyperthermia in patients with refractory sarcoma and malignant teratoma. Cancer Res 55: 5346-5350
- Wust P et al (2000) Feasibility and analysis of thermal parameters for the whole-body hyperthermia IRATHERM-2000 Int J Hyperthermia 16: 325-339
Prof. Dr. med. Peter Altmeyer