Future of Hyperthermia

[Radonc90]

---

Members don't see this ad.

What is the future of hyperthermia?

Someone told me that very few Rad Onc Depts have hyperthermia and the clinical data do not convinve Hosp administrators to buy it.

I know a few depts have hyperthermia but it seems like dinosaurs...

Any opinions?

 

[stephew]

What is the future of hyperthermia?

Someone told me that very few Rad Onc Depts have hyperthermia and the clinical data do not convinve Hosp administrators to buy it.

I know a few depts have hyperthermia but it seems like dinosaurs...

Any opinions?

i dont think its very sexy right now.

 

[3dtp]

i dont think its very sexy right now.

A few years back the folks a Duke did quite a bit of work on this. They spent quite a few years on hyperthermia. I'm not certain if they ever published their results but the consensus there was that it didn't work and they've moved on to other things.

 

[alphacentauri]

Actually, Duke still has an active hyperthermia program. Check out their department website - there's a lot of info. UCSF also has a small hyperthermia program. From the attendings I've spoken to about it, hyperthermia has actually been shown to be a useful adjuct to chemo and radiation in certain tumor types; however, it's not particularly profitable, so most centers won't support it.

 

[3dtp]

Actually, Duke still has an active hyperthermia program. Check out their department website - there's a lot of info. UCSF also has a small hyperthermia program. From the attendings I've spoken to about it, hyperthermia has actually been shown to be a useful adjuct to chemo and radiation in certain tumor types; however, it's not particularly profitable, so most centers won't support it.

That's interesting. I didn't know that. I guess I should do my homework before I shoot my mouth off!

The guys I knew there have moved on and I based my comment on personal communications with them from a few years ago. There hasn't been much published on it recently. I think there was an article sometime last summer from a group in India that looked at hyperthermia/RT for bulky IIB cervical cancer. They came to the conclusion that it didn't work, I think. I'll try and find the article.

Also there was an RTOG study in the early '90s or so that Emami did while he was still at Mallinckrodt and I think they came to the conclusion it didn't work either. I think there was an old RTOG study in the mid to early '80s that didn't demonstrate any advantage on anything larger than a cm or so.

As for cost, I think it's still reimbursible, and the cost of the equipment isn't (or at least wasn't) extravagant, so I'm not sure I buy the cost aspect.
I guess I've just seen or at least remember more non-positive studies than ones that showed a benefit.

So, has Duke had any luck with their more recent work?

 

[alphacentauri]

I'm definitely no expert on the subject at all; it's just something I find interesting. I was out at Duke very recently and the topic did come up a bit, but no one got into specifics about Duke's recent outcomes. Maybe someone more familiar with Duke's program can comment? I found a few semi-recent (2002) references on the NCI website:

http://www.cancer.gov/cancertopics/factsheet/Therapy/hyperthermia

I'll also take a look and see if I can find some more specific data. As far as the reimbursement issue, the impression I had from the attending I spoke with was that the procedure was not well-reimbursed/not reimbursed at all by insurance companies - I agree, seems odd. But again, this was just coming from one attending.

 

[Adawaal]

Yeah, not a lot of places seem to be actively treating with hyperthermia these days. In addition to Duke, I know a few years ago Northwestern was still doing a few cases here and there.

There's at least one current study in the OB-GYN (read, NOT Rad Onc) world where they're using intraoperative hyperthermic chemotherapy for advanced ovarian disease. Apparently it's several hours of sloshing this crap around in the pelvis.

One guy at NCI whose name escapes me has an active lab that has shown pretty convincingly that certain drugs can activate the same hsp pathways as hyperthermia. In addition to the COX-2 inhibitors, they've identified at least a couple of other drugs as well.

 

[trublu]

I was out at Duke very recently and the topic did come up a bit, but no one got into specifics about Duke's recent outcomes. Maybe someone more familiar with Duke's program can comment?

recent outcomes:

J Clin Oncol. 2005 May 1;23(13):3079-85.
Cancer. 2005 Aug 15;104(4):763-70.

and general info:

http://dukemednews.org/news/article.php?id=9450

 

[3dtp]

recent outcomes:

J Clin Oncol. 2005 May 1;23(13):3079-85.
Cancer. 2005 Aug 15;104(4):763-70.

and general info:

http://dukemednews.org/news/article.php?id=9450

Hmmm, $19M, 19 years, takes us back to 1987 10 of 12 patients had CR to Chemo/Rads/heat.

Those numbers are not convincing, statistically strong and are pretty underwhelming, if that's the best they can do. And those are from Duke's propaganda site. Sheesh! I'll pull the articles this week and have a look see.

Rotman, Eifel, Rose, the SWOG, GOG and RTOG have done a lot of work since then with a lot more patients. Result: Chemo/Rads for bulky Ib-IIIa with intercavitary brachy boost seem to have done the best, using platinum based chemo, and 84 Gy to Point A.

So, they've spent $19M of our money, with little to show except the thermometry is complicated (which we knew), the thermal energy transfer is difficult (which we knew), and it takes ultrasophisticated imaging to even have a reasonable chance.

I'd jump on the bandwagon in a minute if I thought there was a snowball's chance in hyperthermia that this works. I remain skeptical.

 

[3dtp]

recent outcomes:

J Clin Oncol. 2005 May 1;23(13):3079-85.
Cancer. 2005 Aug 15;104(4):763-70.

and general info:

http://dukemednews.org/news/article.php?id=9450

The first article restricted use to superficial lesions, and contained a mix of both previously treated and new patients, RT doses were different, and varied as were the sites and types of cancers. While they did say that hyperthermia gave better response, the mean dose was slightly higher 50 v. 55 Gy, so, I 'm not sure what, if anything can really be discerned from this paper.

The second is somewhat better, in that it focuses on a specific site, but the thermal doses were different, the European centers had significantly better results than the American. The follow up times were quite short and I suspect that the results may level out when enough follow up time has passed. It'll be interested to see how the Phase III RCT pans out, but you're right, it does look like their techniques were pretty uncomfortable and invasive. Maybe they could mix Duke's MRI thermometry with what they're trying to do to get a better idea of heat localization and intensity.

 

[bob1988]

I was just doing some Friday night reading on hyperthermia and obviously it's still a bit controversial. Folks in Japan and Europe use it and have published good results with it. Not so much in this country. I know that Duke is big on it. And Maryland is doing it now. Northwestern does it now and then. UCSF and Stanford do it in the Bay Area.

What is the current thought about hyperthermia? Still fringe or does it have potential to make inroads?