From the Guidelines
Hyperthermia therapy, specifically regional hyperthermia, is a recommended treatment approach for sarcoma, particularly for patients with locally advanced or recurrent disease, as it has been shown to improve local control and disease-free survival when used in addition to systemic chemotherapy 1.
Overview of Hyperthermia Therapy
Hyperthermia therapy involves raising the temperature of tumor tissue to damage cancer cells, typically used as an adjunct to standard therapies like chemotherapy and radiation.
- Hyperthermia works by heating tumor tissues to 40-43°C (104-109.4°F), which damages proteins and structures within cancer cells while potentially sparing normal tissues.
- For sarcomas, regional hyperthermia is most common, delivered via external devices that emit energy (microwave, radiofrequency, or ultrasound) to heat the target area.
Treatment Sessions and Side Effects
- Treatment sessions typically last 30-90 minutes and are usually administered 1-3 times weekly during a course of radiation or chemotherapy.
- Side effects are generally mild and may include pain, discomfort, or burns at the treatment site.
Efficacy of Hyperthermia Therapy
Hyperthermia appears to enhance the effectiveness of other treatments by increasing blood flow to tumors, improving drug delivery, inhibiting DNA repair in cancer cells, and triggering immune responses against the tumor.
- A large, randomized phase III study found that regional hyperthermia in addition to systemic chemotherapy was associated with a local control and disease-free survival advantage when compared with chemotherapy alone 1.
Clinical Recommendations
Regional hyperthermia is recommended as an option for patients with high-risk sarcomas, particularly those with locally advanced or recurrent disease, in addition to systemic chemotherapy 1.
- Isolated limb perfusion may also be an option in this patient population, although it has no impact on systemic control.
- Adjuvant chemotherapy is not standard treatment in adult-type soft tissue sarcomas, but can be proposed as an option to high-risk individual patients for shared decision-making.
From the Research
Relationship Between Hyperthermia and Sarcoma
- Hyperthermia has been shown to be a promising approach in the treatment of various types of cancer, including sarcoma 2.
- The use of hyperthermia in combination with chemotherapy or radiotherapy has been found to result in improved clinical outcomes, including increased response rates and overall survival, in patients with high-risk soft tissue sarcoma 3, 4.
- Regional hyperthermia, in particular, has been found to be effective in enhancing the effects of chemotherapy in the treatment of high-risk soft tissue sarcoma, with improved local progression-free survival and disease-free survival rates 3.
- The combination of hyperthermia with chemotherapy has also been found to be effective in inducing a systemic antitumor effect, with regression of metastatic disease, in patients with rhabdomyosarcoma 5.
- The mechanisms underlying the effectiveness of hyperthermia in the treatment of sarcoma are thought to include the induction of heat shock proteins, the enhancement of anti-cancer immune responses, and the targeting of tumor vasculature 2, 5.
Clinical Evidence
- A randomized phase 3 trial found that the addition of regional hyperthermia to chemotherapy resulted in improved local progression-free survival and disease-free survival rates in patients with high-risk soft tissue sarcoma 3.
- A pilot study found that the combination of regional hyperthermia with systemic chemotherapy resulted in a clinical response rate of 27% and a pathologic response rate of 31% in patients with high-risk sarcoma 6.
- A case report found that regional hyperthermia combined with low-dose chemotherapy resulted in a complete metabolic response of the local tumor and regression of metastases in a patient with alveolar rhabdomyosarcoma 5.
Hyperthermia Techniques
- Hyperthermia can be applied using various techniques, including local hyperthermia, regional hyperthermia, and whole body hyperthermia 2.
- Regional hyperthermia can be applied using electromagnetic deep-regional-heating devices or other methods 3, 6.
- The choice of hyperthermia technique depends on the location and size of the tumor, as well as the patient's overall health status 2.