A closer look at Hyperthermia

Hyperthermia is used as an effective tool along with radiation or chemotherapy to treat cancer. Dr Nagraj G. Huilgol, Chief Radiation Oncologist, Nanavati Superspeciality Hospital & Centre for Hyperthermic Oncology and Medicine speaks to Neha Wagle about advances in Hyperthermia and the future of it. Excerpts:

Top Radiation Oncologists across the world gathered to impart and share knowledge and expertise at International Conference on Hyperthermia hosted by Nanavati Super Specialty Hospital (NSSH), Vile Parle from 15th February to 16th February. The 11th Biennial Conference Indian Association of Hyperthermia Oncology and Medicine is aimed at bringing in advanced treatment regimens and Hyperthermia awareness to India.

The two-day conference, which began on 15th February, witnessed extensive discussions on interesting themes such as integration of proton therapy and Hyperthermia, role of Hyperthermia in breast, head and neck and cervical cancer and economics of setting up Hyperthermia centre in India.

Dr Nagraj, could you let us know more about Hyperthermia?
The definition of Hyperthermia is heating temperature, the exact term for Hyper is ‘to raise’ and therme is ‘heat’. Hyperthermia is to raise the temperature of the tumor in the cancer; cancer becomes very susceptible for death. So when we add them with a very conventional treatment like radiation therapy, immunotherapy or Chemotherapy, the effects of this treatment go up. If one can effectively heat the tumor to 45C, there is also a chance that heat alone can also be lethal to cancer. Heat as a treatment for cancer is not new to India in the sense even before Ayurveda there is a mention of heat being used for the treatment of ‘Arboda’, it means cancer. But sadly we missed Renaissance of Hyperthermia in the 80’s. With the help of a Japanese professor, we bought a machine here for radio frequency reading. But very few of us are propagating the idea for Hyperthermia. There is reasonable number of brand maestros which says, “When you combine Hyperthermia with radiation therapy, Immunotherapy or Chemotherapy, the effects go up. There is a scientific method of doing it.” We have very sophisticated machines based on radio frequency; micro-wave and it can be integrated in MRI machines. So the whole idea is to add to whatever standard treatment we have. We have a large Head & Neck data and we have also published in international journals about the treatment of Hyperthermia with Chemotherapy, without Chemotherapy, with radiation so far.

At the core of it, what we understand is that heat as a modality of treatment is a primary force; it is the first to harness for treatment. When the present government talks about ancient heritage they should justify and talk about Hyperthermia than anything else. There is more scientific rationale for that. And as I said we have a radiation machine, it is imported from Japan, by a company called Thermatron. We have treated 3,000 patients till now since the year 2000. It is combined with Radiotherapy and Chemotherapy. The advantages of Hyperthermia are that it is not toxic until there is an occasional wound or a discomfort. If at all there is a discomfort, we don’t give it. It does not act to the side effects of radiation or Chemotherapy or Immunotherapy, it has its own side effect which is marginal. When we combine, it is very beneficial. We get 8-12 per cent increase in survival. And in Oncology anything around 8-12 per cent is a big number. This is more than a baby step.

What are the advances in Hyperthermia?
Addition of Hyperthermia enhances the effect of Radiation, Chemotherapy or combination of both by 8-12 per cent. In the clinical application of Hyperthermia, three methods can be distinguished: local, regional and whole-body Hyperthermia. Hyperthermia is under study in clinical trials and is not widely available. So further technological improvements will need to contribute to an easier and better controlled adequate application of Hyperthermia.

What are the challenges you faced in treating with Hyperthermia in Indian settings?
In India, this has not yet gone till the mainstream as most of the vendors will not venture into India as the people who did were not happy. Biggest challenge in Hyperthermia is it takes one hour at this propation. So here one can treat 10 patients maximum, and that is a big challenge. When a hospital invest money in a radio therapy machine, you have 40-60 patients which can 10 minutes for check-up and then turn it off, the incentives are more to the hospital to invest where they aren’t making any money. So Hyperthermia becomes a little difficult as it is not a primary treatment, it is an add-on treatment awareness of which is little limited. Anything which is different takes a little more time.

Can you talk about the future of Hyperthermia?
Hyperthermia has been here for a last 2 decades, it is popular in Japan, Germany, USA took a long time as the insurance did not recognise it for a while. Medical practices also driven by market forces so may be doctors find it easy to make money in some other way than spend an hour with the patient. Hyperthermia is a useful adjunct to Radiotherapy and Chemotherapy. Hyperthermia is an option to explore now instead of waiting for an exotic treatment to arrive to increase survival. A number of challenges must be overcome before Hyperthermia can be considered a standard treatment for cancer. Many clinical trials are
being conducted to evaluate the effectiveness of Hyperthermia. Some trials continue to research Hyperthermia in combination with other therapies for the treatment of different cancers. Other studies focus on improving Hyperthermia techniques.