A treatment option in the fields of
oncology and infectious diseases
by Jose A. Henriquez M.D.
Tijuana, Mexico

Hyperthermia, from the Greek words "hyper", meaning high, and "thermos", meaning temperature, can simply be defined as the elevation of the body temperature.

The physiological and biological mechanisms of hot-blooded mammals including humans demand that the body maintain a temperature that is normally above that of the external environment. However, it is important to note that the same functions can only successfully operate within very narrow temperature margins.

Our bodies have developed highly sophisticated heating and cooling systems to maintain a stable temperature within the narrow margins required regardless of environmental conditions. The process that attempts to maintain a steady internal thermic balance is called homeostasis.

There are only a few physiological conditions in which the thermic balance is changed: winter hibernation, egg-setting hens, and fever. Only a fever is a physiological thermic resource in humans.

Fever acts as a defence mechanism against a number of processes, mostly related to either infections or the presence of abnormal proteins in the bloodstream called pyrogenes.

One of the most immediate physiological effects of the fever is the acceleration of metabolic processes in general. Fever increases oxygen uptake and renders white blood cells more aggressive against bacteria, fungi or viruses. By making the cells more permeable, white blood cells are able to discharge into the bloodstream more aggressive substances against infectious organisms and increase their phagocytic (destructive) capability.

Fever within physiological limits can have many beneficial effects and will not produce any harm to normal cells that are able to cope with the higher metabolic demand. Human cells under specific metabolic conditions, such as cancer cells or infected cells, can be seriously challenged by thermic stress and may even be killed by it.

In summary, fever should be seen as an important physiological defense mechanism against disease.

BACKGROUND INFORMATION

Because of the empirical observation that the healing process is often preceded or accompanied by febrile episodes, the induction of thermic elevation has been attempted as a cure for thousand of years. In recent centuries there were reports of cures of cancer and cases of syphilis which improved spontaneously after severe fever episodes that were caused by other infections.

Hippocrates routinely buried patients in the desert sand to elevate their core body temperature in an attempt to cure disease. In the middle 1800's a German physician, Dr. William Bush, noted spontaneous remission of sarcomatous tumors in patients who sustained prolonged fever episodes. Dr. W. C. Coley at the turn of the century injected cancer patients with different toxins to create artificial fever with good results, and Dr. Julius Wagner-Jauregg, an Austrian physician, was awarded the Nobel Prize in medicine in 1927 for his successful work using malaria serum fever induction in patients plagued with severe complications of syphilis.

Hyperthermia represents a natural approach in combatting disease since it involves inducing an exaggerated version of the body's own fever state.

Medical research found that induced hyperthermia has damaging effects on cancerous cells and infectious agents, but the technical limitation in elevating body temperature in an accurate, consistent, and reproducible way was a major obstacle to accomplishing this goal in humans despite the exciting results obtained in experimental observations.

Many infectious agents are sensitive to heat - particularly, but not restricted to, human immunodeficiency virus (AIDS). hepatitis C virus and Lyme's disease - which die due to heat shock before the normal human biology is altered.

Summarizing, we observe that the artificial elevation of body temperature either through normal physiology (fever) or by induction (medical hyperthermia) is an important healing factor in the management and treatment of several infectious processes and in the treatment of cancer. Medical hyperthermia can be applied in cases where normal fever response is not present because of the inability of the host to react to the illness. Of key importance, medical hyperthermia is carried out under controlled circumstances, times and parameters, making it a safe and accurate therapeutic tool.

METHODS

It wasn't until the 1970s when Dr. Parks, a cardiothoracic surgeon, reported success in using an extracorporeal technique to conduct more than one thousand whole body hyperthermia sessions for the treatment of cancer. During the following two decades many additional studies have been conducted and documented.

The use of external sources of heat creates uneven heat distribution in the body and burns are not un common. The extracorporeal technique involves circulating blood through a closed circuit device. Extracorporeal circulating with the help of a pump will carry the blood through a heat exchange unit. Heat will be transferred to the blood and then recirculated into the body.

Utilizing the cardiovascular system for inducing hyperthermia from the "inside out" has the inherent advantage of creating extremely uniform heat distribution throughout the body.

During the procedure the patient under mild sedation, is continuously monitored. The information from thermometers in the body is fed back to the computer that controls the heat exchange unit. Because of this feedback mechanism the core body temperature can be consistently and reliably adjusted with an accuracy of one tenth of a degree.

In a routine treatment protocol temperature will be raised to a constant plateau that lasts 60 to 90 minutes at a temperature of 42 C. (108 F.).

Once the procedure is terminated the patient is transferred to his/her room, monitored and assisted through the following hours until the next day by specially trained nursing staff.

CRITERIA FOR ENTERING THE HYPERTHERMIA PROGRAM

The available medical information and experience have proven that medical Whole Body Hyperthermia (WBH) has two major classes of patients as potential beneficiaries: cancer patients and those with chronic progressive viral infections, mainly HIV and Hepatitis C.

CANCER : there are many "forms" of cancer in which hyperthermia can play a major role and lead to a successful result: Hyperthermia by itself can have lethal effects against certain expressions of cancer, and in an integrative protocol in which other nontoxic modalities are used this method is a major adjunctive therapy.

Cell death is a fundamental phenomenon of organisms occurring naturally as part of embryo development, in cell turnover in adults and as a result of injuries and pathological processes. There are two fundamental types of cell death - necrosis and apoptosis.

Necrosis involves damage to the cell by an external factor such as an injury, infectious agent or immune reaction and in fact is the cell death phenomenon that we have commonly recognized and understood.

Apoptosis or programmed cell death is characterized by a degradation of the cell with shrinkage and fragmentation triggered from within. Genetic material in each cell has information codes that allow the cell to evaluate its own functions.

Hyperthermia is one of the major apoptosis inducers. This is why remission of cancer has been empirically seen after febrile episodes and more recently under induced temperature elevation.

The damage and changes produced by hyperthermia can be enhanced with the use of substances that can further the metabolic problems of cancer cells. Vitamin C, glucose, low-dose chemotherapy and low-dose radiation therapy have been pointed to as important adjuvants for a more effective therapeutic outcome.

It has been proven that in patients with resistance to chemotherapy, whole body hyperthermia can reinstitute drug efficacy. It is widely recognized and scientifically proven that whole body hyperthermia renders cancer cells more sensitive to chemotherapy. This allows the use of milder forms of chemotherapy at lower doses and hence with fewer side effects and complications.

The same is true for radiation therapy: whole body hyperthermia can substantially increase the possible damage to the cancer cell with the use of radiation. And again it is possible to use fewer radiation sessions, with shorter times and lower doses in general, and still obtain good results with milder side effects.

INFECTIOUS DISEASE : the rationale for the use of whole body hyperthermia begins with nature itself: fever is the most immediate reaction to infection and at the same time one of the best known and earliest recognized defense mechanisms.

Under normal circumstances many infectious agents that were or still are important plagues of mankind can be damaged and destroyed at temperatures that are easily tolerated by normal human cells.

The presumed causative agents of human immune deficiency syndrome virus, hepatitis C virus and Lyme's disease are among the most notorious infections agents that due to their susceptibility to heat have become important targets of this method.

CLINICAL APPLICATION

Candidates for the whole-body hyperthermia are carefully evaluated not only in terms of the main diagnosis but also their general, nutritional and overall condition and specifically their lung and heart functions.

Careful clinical diagnosis and staging of the disease with all possible elements to establish the status of the illness will provide necessary information to allow both patient and physician to evaluate changes in the disease in an objective and systematic manner. This is vital in the planning of adjunctive and future therapies that will bring about a successful outcome.

Radiological studies, such as CT scans, MRI, and other X-ray images, are helpful elements with which to judge changes in the progression of a tumor. Laboratory findings - particularly tumor markers in blood - are also important factors in this assessment.

In the case of viral infections modern laboratories techniques can provide accurate information such as viral load quantification, antibody titer elevation and immunological reactions to the disease which provide important feedback to support or modify the treatment program.

Patients are placed in a hospital environment prior to the whole-body hyperthermia procedure. Medical evaluation is started at once.

Before the actual procedure begins the anesthesiologist places the patient under mild sedation. Two other physicians carry out the procedure with the assistance and help of two nurses. The entire process takes approximately 4 to 6 hours.

After the procedure, the patient is under constant observation with a physician and a private duty nurse during the rest of the day and night. Other than the effect of sedation patients should not expect any discomfort and normally sleep over the following hours.

Laboratories tests may show some changes following hyperthermia similar in nature to those observed after high fever. However, as in fever, these changes will return to normal in a few days and scientific studies prove they are inconsequential.

The day after the treatment most patients feel as they would feel after a normal febrile episode: tired, sleepy, and with mild aches and pain. All these symptoms are mild enough not to require any specific medication.

Thanks to careful surveillance and monitoring during the procedure patients rarely experience any discomfort. After a day, they normally resume the level of activity they had before the treatment.

It is highly recommended that any metabolic disturbances detected before hyperthermia be placed under control before this metabolism-challenging procedure is done.

Patients normally undergo integrative metabolic protocols before and after whole-body hyperthermia in order to enhance the positive aspects and results to be expected from such a comprehensive program.

FINAL CONSIDERATIONS

Hyperthermia has a long history of use in medicine in the treatment of a variety of diseases. Recently we have seen a resurgence of its importance as a potential treatment option in the management of chronic illness in the fields of oncology and infectious diseases.

Results from well formulated basic scientific studies and subsequent clinical studies have demonstrated that heat as a therapeutic option is a viable alternative. Heat therapy can be a tool which can be offered to many, but state-of-the-art technology, a professional staff well trained in these protocols and prudent patient screening must first be developed in order to implement a safe nontoxic procedure.

Chronic viral infections are the other group of diseases in which treatment options at present are not only limited but unfortunately are accompanied by short-term results. The prevalence of AIDS and hepatitis C in the current world population provides the challenge to seek affective alternatives to mange and arrest the progression of these potentially fatal conditions.

We cannot stress enough the importance of an accompanying protocol of detoxification and overall wellbeing as the foundation for more sophisticated forms of therapy.

The final determination of the value of this therapy in a particular case can only be decided by the interaction of doctor and patient together with the appropriate analysis of clinical and laboratory findings.