Using hyperthermia against cancer

Though hyperthermia – or overheating – combined with radiation, is used to help combat cancer in a number of European countries, this form of treatment is still in its infancy in Greece. The first mention of the relationship between heat and oncology appears in an aphorism of Hippocrates in 370 BC, as Vassilis Kouloulias, physicist, radiologist and oncologist, told Kathimerini in an interview. Hippocrates stated: «Diseases that cannot be treated with drugs are treated by the knife. And those which cannot be treated by the knife are treated by fire. Those which cannot be treated by fire are incurable.» The next mention of the connection was made in 1886 when a patient with a sarcoma on the face recovered completely after running a high fever for many days. In 1910, Muller was the first to mention the use of hyperthermia and radiation to treat cancer, and soon afterward the first clinical results were published. In 1996, an analysis was published of five studies concerning the connection between radiation and hyperthermia in patients whose breast cancer had affected the chest wall. It showed that radiation treatment had a success rate of 49 percent in local control of cancers, but when used in combination with hyperthermia the figure rose to 50 percent. «This analysis freed clinicians to use the method, which had been considered experimental until then,» explained Kouloulias. In clinical practice, parts of the body are heated to temperatures ranging from 42.5-45 degrees Celsius. Certain compact tumors that resist radiation treatment can be sensitized to radiation by the use of hyperthermia. The method involves focusing radiation with the help of special transmission wires that only heat the tumor. The treatment lasts about an hour and the patient feels a slight sensation of heat. Hyperthermia is mainly used to treat tumors on the surface or not far below it, such as melanoma or cancer of the lymph glands. Special equipment has been developed to deliver hyperthermia treatment to internal tumors (of the uterus, prostate and esophagus, pharynx and other organs). Unlike cauterization and surgical hyperthermia, which use temperatures in excess of 45 degrees Celsius and directly destroy cells, hypothermia works by preventing the cells from multiplying. The method is established in Europe, and every oncology and radiation clinic in the Netherlands, France, Belgium, Germany, Italy and the United States has a hypothermia department. In Greece, the leader in the field, and the source of much of the staff and funding for the development of hyperthermia equipment is the department of mechanical and computer engineering at the National Technical University (NTU). «This is a classic example of how worthwhile things can get done in Greece when there is cooperation,» NTU Professor Nikos Ouzounoglou told Kathimerini. «Having heard about the benefits of the method for cancer patients, we began to promote hyperthermia in cooperation with Professor Constantinos Papavassileiou of Athens University Medical School. We developed the equipment and initiated a treatment protocol at Areteion Hospital in 1986-87, with NTU funding. By 1995, the method had been used on 600 Greek patients, with significant results. The Greek experience of the method showed that a combination of radiation and hyperthermia improved the response of patients with tumors by 30-60 percent compared with simple radiation treatment, depending on the histology of the tumor. «We have developed many types of hyperthermia equipment, not all of which have been used clinically,» said Ouzounoglou. «It costs about 3,000 euros to make a hyperthermia machine for superficial tumors.» ‘We demand assistance’ The method has been in use at Hygeia, a privately owned hospital, since 1995. Hygeia rented equipment from NTU and paid the university to develop new equipment and maintain existing machines. Aretaion Hospital stopped using the method for lack of funds. NTU was no longer able to fund hyperthermia treatment due to the recent economic crisis and the shrinkage of funds available for research by educational institutions. «It would be very important for Greece and for Greek patients if the State, and above all the Health Ministry, which have been out of the picture all these years, took a brave decision to give financial assistance to NTU to develop the method further and to train staff in its use, with the ultimate aim of promoting it in public hospitals,» said Kouloulias. «We demand – and this is not a request, it is a demand – that the Greek State espouse the method and give its help unstintingly, for the good of Greek patients. All the more so considering that some patients travel to the Netherlands for treatment, including hyperthermia.»