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EDITORIAL
Year : 2019  |  Volume : 10  |  Issue : 4  |  Page : 155

Hyperthermic oncology, it is time of resurrection


Advanced Centre for Radiation Oncology, Dr. Balabhai Nanavati Hospital, Mumbai, India

Date of Submission01-Feb-2020
Date of Acceptance01-Feb-2020
Date of Web Publication14-Feb-2020

Correspondence Address:
Dr. Nagraj Gururaj Huilgol
Advanced Centre for Radiation Oncology, Dr. Balabhai Nanavati Hospital, Mumbai
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jrcr.jrcr_5_20

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How to cite this article:
Huilgol NG. Hyperthermic oncology, it is time of resurrection. J Radiat Cancer Res 2019;10:155

How to cite this URL:
Huilgol NG. Hyperthermic oncology, it is time of resurrection. J Radiat Cancer Res [serial online] 2019 [cited 2020 Jun 1];10:155. Available from: http://www.journalrcr.org/text.asp?2019/10/4/155/278410



Heat as a therapeutic agent at large and as a treatment for cancer dates back to the earliest medical treatise in India.

The first effort to use hyperthermia in the modern context India dates back to the nineties when Thermatron was installed in Cancer Institute (WIA), Adyar, Chennai. Dr. BB Singh's group in BARC performed some seminal laboratory search in the area of hyperthermia around that time. In 2000, a modified Thermatron was established in Nanavati Hospital, Mumbai. Earlier clinical trials by Dr. NR Datta were performed on a leased machine. This was not followed by any further trials for the lack of an access to technology.

Heat in conjunction with radiation therapy and chemotherapy has shown promising results. The effects of hyperthermia are a consequence of inducing changes in cell membrane permeability, influencing intracellular organelles, inducing DNA breaks, and inhibiting repair. Hyperthermia also has a profound effect on tumor vasculature. The capacity of heat to induce DNA double-strand break has been described mired in controversy. However, recent research suggests a possibility of DNA breaks following hyperthermia. Heat as a potent immunogenic India agent has gained credence in the recent past. By regulating anti tumour immunity. Annihilation of heat stock proteins and developing effective thermal sensitizers will give newer possibilities to hyperthermia. Hyperthermia combined with immunotherapy is an exciting area for exploration. Innovation in technology of heating has plateaued. Both microwave and radiofrequency (RF) heating are the commonly used heating systems. Oncotherm, a RF-based system, is based on thermal and nonthermal effects of RF currents. Online thermometry is now feasible. Heat-sensitive liposome as a drug corner was proposed by Prof. Milton Yatwin. It begs further exfoliation for clinical use. Magnetic resonance imaging online thermometry with microwave hyperthermia is marketed by Pyrexar. It helps optimize energy input by selected steering. Sonography has a potential to be developed for noninvasive thermometry. Computerized treatment planning system is a step in the right direction. There is also a need for optimizing distribution of energy such that tumor sizes are targeted. Human anatomy with extremes in contours always poses a challenge. Hyper collar designed by Dutch group, led by Dr. Gerard Van Rhoon, is one such effort. Treatment duration of 40–60 min can be harrowing for patients. It also reduces the throughput on the machine which adversely affects the economic feasibility of expensive machines. High intensity focused ultrasound hyperthermia (HIFU) is another ability thermal modality which is yet to gain popularity. The ongoing randomized trials of Hyperthermic intraperitoneal chemotherapy (HIPEC) should help decide the utility of the procedure.

There is enough evidence for the effectiveness of hyperthermia in the treatment of cancer. Biologically basis for modality is on sound evidence from the laboratories. Technology needs further innovation. It is only then the next generation will walk in to the new dawn of hyperthermic oncology. This brief editorial lists an amazing progress in technology and biology of hyperthermic oncology. An affordable technology with or without the thermometry can shift the balance toward popularity this modality. Head-and-neck cancers, scrounge in the developing countries, can benefit immensely. The efforts to combine hyperthermia with protons may enhance the effects of protons.

It is time to reflect, regroup, and strategize for optimizing technology.






 

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