A new technological approach to radiant heat whole body hyperthermia

doi:10.1016/0304-3835(94)90252-6

Cancer Letters

Volume 79, Issue 2, 16 May 1994, Pages 137-145

https://doi.org/10.1016/0304-3835(94)90252-6 Get rights and content

Abstract

A new methodology for administering radiant heat whole body hyperthermia (WBH) in humans is described. The technology utilized circulates hot water in a cylinder constructed from copper tubing; the design incorporates a counter current distribution system to maintain thermal constancy. The tubing is coated with a temperature resistant high emissivity finish. Other features include a humidification system to eliminate evaporative heat losses. Data accured from initial evaluation of this apparatus with a canine model shows that there was no detectable WBH-related hematological, biochemical or physiological toxicity. The perceived advantages of this WBH-system are discussed.

References (20)

H.I. Robins et al.
Adjunctive therapy (whole body hyperthermia versus lonidamine) to total body irradiation for the treatment of favorable B cell neoplasms: a report of two pilot clinical trials and laboratory investigations
Int. J. Radiat. Oncol. Biol. Phys.
(1990)
H.I. Robins et al.
A pilot study of whole body hyperthermia and local irradiation for advanced non-small cell lung cancer confined to the thorax
Int. J. Radiat. Oncol. Biol. Phys.
(1988)
A. Hugander et al.
Temperature distribution during radiant heat whole body hyperthermia: experimental studies in the dog
Int. J. Hyperthermia
(1987)
A.J. Neville et al.
Effect of whole body hyperthermia and BCNU on the development of radiation myelitis in the rat
Int. J. Radiat. Biol.
(1984)
H.I. Robins
Whole body hyperthermia: the University of Wisconsin Clinical Cancer Center experience
H.I. Robins et al.
Phase I clinical trial of carboplatin and 41.8°C whole body hyperthermia in cancer patients
J. Clin. Oncol.
(1993)
H.I. Robins et al.
A non-toxic system for 41.8°C whole body hyperthermia: results of a phase I study using a radiant heat device
Cancer Res.
(1985)
H.I. Robins et al.
A preclinical trial of a radiant heat device for whole body hyperthermia using a porcine model
Cancer Res.
(1983)
H.I. Robins et al.
Beta-blockade during whole body hyperthermia: a toxicity study in the dog
Int. J. Hyperthermia
(1991)
H.I. Robins et al.
Rise in plasma beta-endorphin, ACTH and cortisol in cancer patients undergoing whole body hyperthermia
Horm. Metab. Res.
(1987)

There are more references available in the full text version of this article.

Cited by (44)

Sauna use as a lifestyle practice to extend healthspan
2021, Experimental Gerontology
Citation Excerpt :
Emerging evidence suggests that whole-body hyperthermia is beneficial in treating depression (Janssen et al., 2016). Whole-body hyperthermia employs radiation, convection, or conduction and is typically administered in the clinical setting using a variety of methods, such as the use of direct contact with a heated liquid (such as water or wax), hot blankets or suits, heating coils, or specialized lamps that emit infrared-A radiation in a confined area or chamber (Jia and Liu, 2010; Milligan, 1984; Robins et al., 1994). Exposure to high temperature stresses the body, eliciting a rapid, robust response that affects primarily the skin and cardiovascular systems (Fig. 1).
Sauna use, sometimes referred to as “sauna bathing,” is characterized by short-term passive exposure to high temperatures, typically ranging from 45 °C to 100 °C (113 °F to 212 °F), depending on modality. This exposure elicits mild hyperthermia, inducing a thermoregulatory response involving neuroendocrine, cardiovascular, and cytoprotective mechanisms that work in a synergistic fashion in an attempt to maintain homeostasis. Repeated sauna use acclimates the body to heat and optimizes the body's response to future exposures, likely due to the biological phenomenon known as hormesis. In recent decades, sauna bathing has emerged as a probable means to extend healthspan, based on compelling data from observational, interventional, and mechanistic studies. Of particular interest are the findings from large, prospective, population-based cohort studies of health outcomes among sauna users that identified strong dose-dependent links between sauna use and reduced morbidity and mortality. This review presents an overview of sauna practices; elucidates the body's physiological response to heat stress and the molecular mechanisms that drive the response; enumerates the myriad health benefits associated with sauna use; and describes sauna use concerns.
Evaluation on the capacity of selectively heating vessel-rich-skin to realize noninvasive whole body hyperthermia
2010, International Journal of Thermal Sciences
Citation Excerpt :
Through introducing blood circulation into a heat transfer device extracorporally, extra-corporal techniques (EWBH) was proved to be effective in attaining the target temperature but are associated with excess danger. In recent years, a radiative approach (RWBH) by microwave [6] and infrared [7–9] is proved to be safe in a number of phase I/II-trials and represents a promising modality that can be recommended for inducing WBH. However, irradiative approaches are inherently too cumbersome for precise temperature control and rapid induction.
The whole body hyperthermia (WBH) has been identified as a very promising way to treat malignant tumor. For the homogeneous temperature increase, the challenges remain for hyperthermia device designers to improve the apparatus either to reduce the invasiveness or to improve the heating performance. Among all the mechanisms of biological heat transfer, convection via blood flow serves as a rather efficient way to facilitate delivery of external heat into the human body. In this article, selectively heating vessel-rich-skin to noninvasively induce WBH is comprehensively evaluated. The thermally significant blood vessels are grouped into different body segments and their convective heat transfer intensity is investigated. The segments with large convective heat transfer intensity were proposed as potential places for allocating external heating applicator. Based on the compartment bio-heat transfer analysis, several existing strategies for WBH are justified and methods for optimizing each of the approaches are proposed in terms of efficiency and invasiveness. Specifically, muti-site extreme heating at hand and foot with 20 W each site will cause core temperature to increase 1 °C more during WBH, which as a result would save heating duration time to 0.6 h or 0.3 h, in radiative WBH and interventional WBH respectively. In addition, the irradiative extreme heating can be enhanced by surface cooling such that a 10 °C cold pad would double the administrated power and thus achieve 0.3 °C more temperature increase. The principle of focused heating on vessel-rich-skin region noninvasively is expected to implement both as an excellent auxiliary for existing WBH modalities as well as fundamental optimization rational for multisite noninvasive electromagnetic heating.
Comprehensive evaluation on the heating capacities of four typical whole body hyperthermia strategies via compartmental model
2008, International Journal of Heat and Mass Transfer
The whole body hyperthermia (WBH) is being regarded as a very promising way of efficiently treating patients with tumors already distributed throughout the human body. However, quite a few important issues still remain unclear, some of which are how much energy can be deposited into human body or how long will it take for a patient’s body core temperature to rise from its normal to the desired point. Aiming to provide a general background for tackling the complex heat transfer behavior throughout the whole human body during a WBH treatment, we propose in this paper to adopt a compartmental model for a comprehensive evaluation of several existing typical WBH methods. The heating performance of four heating strategies such as contact-heating-based WBH (CWBH), radiative- heating-based WBH (RWBH), extracorporeal circulative-heating-enabled WBH (EWBH) as well as interventional WBH (IWBH) were compared and evaluated. The characteristics of different WBH methods were assessed in detail from the engineering perspective. Further, the effect of the thermal regulation mechanism and brain cooling upon body temperature response during WBH was investigated. Specially, this research explained for the first time the reason why intravascular heating strategies could have a higher heating efficiency in raising body core temperature than that of the heating from outside. This study would help probe into the complex behavior of the temperature response of the human body subject to various WBH. The theoretical model and calculation method could serve as a valuable guidance for future tumor treatment planning.
Phase II study of carboplatin and whole body hyperthermia (WBH) in recurrent and metastatic cervical cancer
2004, Gynecologic Oncology
Hyperthermia enhances carboplatin cytotoxicity preclinically, and clinical studies have shown radiant heat Whole Body Hyperthermia (WBH) to be safe. In this study, the efficacy and toxicity of the combination of 41.8°C WBH and carboplatin in recurrent and/or metastatic cervical cancer were explored.
Recurrent and/or metastatic cervical cancer patients were treated with 41.8°C WBH and concurrent carboplatin, cycled every 28 days (max. 6 cycles).
Twenty-one of 25 participants were evaluable for response: one complete remission, six partial responses, stable disease in nine patients and progression in five, leading to a response rate of 33%. Three of four evaluable chemotherapy pre-treated patients progressed, while this was seen in only 2 of 17 chemotherapy-naive patients. The median survival is 7.8 months (range 1.3 to 43+) and no patients were lost to follow up. Grades 3/4 toxicities were common: leukopenia in 35%, thrombopenia in 61% and anemia in 22% of all treatments. Excessive, partly reversible renal toxicity was seen in two patients (grades 3 and 4).
The efficacy of WBH and carboplatin in recurrent and/or metastatic cervical cancer seems comparable to that of other palliative chemotherapy regimens in this disease. The considerable toxicity, though largely manageable, includes unexpected and severe unacceptable renal toxicity. This regimen seems less suitable for palliative care.
Ifosfamide, carboplatin and etoposide combined with 41.8°C whole body hyperthermia for malignant pleural mesothelioma
2003, Lung Cancer
We performed a phase II study combining 41.8 °C whole body hyperthermia with ICE chemotherapy, i.e. ifosfamide (5 g/m²), carboplatin (300 mg/m²) and etoposide (150 mg/m² on days 2 and 3), administered every 4 weeks, for patients with malignant pleural mesothelioma. Of 27 chemonäive, non-metastatic patients enrolled, 25 patients were evaluable for response. Overall response rate was 20% (five partial remissions; 95% CI 8.9–39.1%). Median survival time from the start of treatment for all patients was 76.6 weeks (95% CI 65.4–87.8 weeks). Progression free survival for all patients measured 29.6 weeks (95% CI 24.4–34.7 weeks). One year overall survival was 68% and 2 year overall survival was 20%. Major treatment toxicities included grade 3/4 neutropenia and thrombocytopenia in 74 and 33% of treatment cycles, respectively. One patient died due to sepsis. These promising results are consistent with continued clinical investigation; a phase III clinical trial with whole body hyperthermia as the independent variable has been initiated.
Whole-body hyperthermia (41.8°C) combined with bimonthly oxaliplatin, high-dose leucovorin and 5-fluorouracil 48-hour continuous infusion in pretreated metastatic colorectal cancer: A phase II study
2002, Annals of Oncology
Citation Excerpt :
Whole-body hyperthermia was administered by a humidified radiant heat device (RHS-7500; Enthermics Medical Systems, Inc., Menomonee Falls, WI, USA), exposing the patient to a low-density radiant heat while preventing evaporative heat loss. The radiant heat system for delivering WBH has been previously described in detail [32, 33] the only difference being that our system uses an array of thermocabeling instead of a technology using circulating hot water in a cylinder constructed from copper tubing. A hyperthermia treatment session was defined as raising the patient’s core temperature to 41.8°C.
Second- and third-line treatments remain a challenge in advanced colorectal cancer. Studies of bimonthly regimens of high-dose leucovorin (LV) and 5-fluorouracil (5-FU) by continuous infusion combined with oxaliplatin (L-OHP) have shown encouraging response rates in patients not responding to a bimonthly LV/5-FU regimen. Hyperthermic enhancement of L-OHP efficiency by increased DNA adduct formation has been demonstrated in vitro. This study was designed to address feasibility, toxicity and efficacy issues of whole-body hyperthermia (WBH) as an adjunct to L-OHP/LV/5-FU in pretreated patients after progression to first- and second-line treatments with LV/5-FU by continuous infusion and irinotecan.
Forty-four patients with advanced colorectal cancer, who had progressed during or within 3 months after completion of chemotherapy with LV/5-FU 24-h infusion (LV/5-FU_24h) (eight patients) or irinotecan combined with or after LV/5-FU_24h (36 patients), were treated with L-OHP 85 mg/m², 2-h intravenous (i.v.) infusion, followed by LV 200 mg/m², 1-h i.v. infusion, and 5-FU 3 g/m², 48-h continuous infusion. Every second cycle of the biweekly regimen was combined with WBH, thus allowing a comparison of toxicity with and without WBH in the same patient. Whole-body hyperthermia was administered by a humidified radiant heat device. The target temperature of 41.8°C was maintained for 60 min. L-OHP (2-h infusion) was started at a core body temperature of 39°C.
All patients could be evaluated for toxicity, and 41 patients were evaluable for response. A total of 273 L-OHP-containing regimens were administered, 130 with and 143 without WBH. Hyperthermic treatment combined with L-OHP/LV/5-FU showed no unexpected toxicities. WHO grade 3 toxicities were rare and evenly balanced between cycles given with or without WBH. One early death occurred due to sepsis and tumor lysis. The overall response rate was 20%, with two complete and six partial responses. Twenty-three patients (56%) had stable disease and nine patients (22%) progressive disease. With a median observation time of 70 weeks, the median time to progression was 21 weeks [95% confidence interval (CI) 17–25 weeks] and the median survival was 50 weeks (95% CI 39–61 weeks) from the start of therapy.
This trial suggests some advantage of combining L-OHP/LV/5-FU with WBH. Results compare favorably with the activity of similar regimens without WBH in less extensively pretreated patients. These data support further evaluation and warrant phase III studies.

View all citing articles on Scopus

^†: Current address: Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada N1G 2W1.

View full text

A new technological approach to radiant heat whole body hyperthermia

Abstract

Int. J. Radiat. Oncol. Biol. Phys.

Int. J. Radiat. Oncol. Biol. Phys.

Temperature distribution during radiant heat whole body hyperthermia: experimental studies in the dog

Int. J. Hyperthermia

Effect of whole body hyperthermia and BCNU on the development of radiation myelitis in the rat

Int. J. Radiat. Biol.

Whole body hyperthermia: the University of Wisconsin Clinical Cancer Center experience

Phase I clinical trial of carboplatin and 41.8°C whole body hyperthermia in cancer patients

J. Clin. Oncol.

A non-toxic system for 41.8°C whole body hyperthermia: results of a phase I study using a radiant heat device

Cancer Res.

A preclinical trial of a radiant heat device for whole body hyperthermia using a porcine model

Cancer Res.

Beta-blockade during whole body hyperthermia: a toxicity study in the dog

Int. J. Hyperthermia

Rise in plasma beta-endorphin, ACTH and cortisol in cancer patients undergoing whole body hyperthermia

Horm. Metab. Res.