Abstract
The use of hyperthermia as a treatment in oncology is a common topic for debate. Some researchers expect a breakthrough in oncological treatments with hyperthermia, whereas others have disregarded the method. Serious questions concerning hyperthermia have arisen. Should homogeneous (isothermal) or heterogeneous (selective) heating being used? When we use selective heating (heterogeneity), should the entire tumour be targeted or should the malignant cells be individually selected? Does the mechanism involve thermal cell death or thermally-assisted cell death? Is the goal necrosis or apoptosis? Is hyperthermia safe as a monotherapy or does it have to be combined with conventional treatments? When the selection is local, how do we act on disseminated cells that represent a high risk of life threatening metastases? When local heating is the focus, how should it be carried out with measured and controlled? Our objective is to show how precise, selective heat transfer is necessary to remove malignant cells and, consequently, how hyperthermia as part of the immune-oncology can change the game in this promising field of oncological therapies.
Highlights
Hyperthermia in oncology has a long and controversial history
Further study of uterine cervix carcinoma showed the benefit of survival [48], but the distant metastases were more than three times higher when hyperthermia was combined with radiotherapy compared to the earlier data [49]
The original idea of hyperthermia was to kill the cells by necrotic way; and so, necrosis was studied to determine the dosing of hyperthermia [56] [57]
Summary
Hyperthermia in oncology has a long and controversial history. The technical challenges together with our incomplete understanding of the bio-electromagnetic mechanisms have made it difficult to accept hyperthermia as a standard treat-. Due to the incomplete understanding of the underlying mechanisms of hyperthermia in oncotherapy, the controversies block the expansion of clinical applications [6]. The new therapies compete with hyperthermia rather than work alongside it. Gold standard treatments, such as chemotherapy, have become more targeted, utilizing more sophisticated antibody, nano-delivery [7], and liposomal [8] [9] delivery methods. These treatments are personalized and the local control of the tumour is secondary to survival and quality of life. We have to face the challenges and the limits of hyperthermia applications anticipating the advice of Albert Einstein: “once we accept our limits, we go beyond them” [17]
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