Step-down Heating Research Articles

Application of HIPEC simulations for optimizing treatment delivery strategies

Introduction Hyperthermic IntraPEritoneal Chemotherapy (HIPEC) aims to treat microscopic disease left after CytoReductive Surgery (CRS). Thermal enhancement depends on the temperatures achieved. Since the location of microscopic disease is unknown, a homogeneous treatment is required to completely eradicate the disease while limiting side effects. To ensure homogeneous delivery, treatment planning software has been developed. This study compares simulation results with clinical data and evaluates the impact of nine treatment strategies on thermal and drug distributions. Methods For comparison with clinical data, three treatment strategies were simulated with different flow rates (1600-1800mL/min) and inflow temperatures (41.6–43.6 °C). Six additional treatment strategies were simulated, varying the number of inflow catheters, flow direction, and using step-up and step-down heating strategies. Thermal homogeneity and the risk of thermal injury were evaluated. Results Simulated temperature distributions, core body temperatures, and systemic chemotherapeutic concentrations compared well with literature values. Treatment strategy was found to have a strong influence on the distributions. Additional inflow catheters could improve thermal distributions, provided flow rates are kept sufficiently high (>500 mL/min) for each catheter. High flow rates (1800 mL/min) combined with high inflow temperatures (43.6 °C) could lead to thermal damage, with CEM 43 10 values of up to 27 min. Step-up and step-down heating strategies allow for high temperatures with reduced risk of thermal damage. Conclusion The planning software provides valuable insight into the effects of different treatment strategies on peritoneal distributions. These strategies are designed to provide homogeneous treatment delivery while limiting thermal injury to normal tissue, thereby optimizing the effectiveness of HIPEC.

Mammalian cell sensitivity to hyperthermia in various cell lines: a new universal and predictive description

Introduction The Cumulative Equivalent Minute at 43 °C (CEM43) thermal dose model has been empirically derived more than 30 years ago and still serves as a benchmark for hyperthermia protocols despite the advent of regulatory network models. However, CEM43 suffers from several limitations regarding its inability to predict the effect of complex time varying profiles (thermotolerance, step-down heating), to predict synergistic effects with drug treatments or to explain the specificity of a cell line in thermal resistance. Objective Define a new generic predictive tool for thermal injury based on regulatory network models. Identify the biological parameters that account for the thermal resistance. Materials Comparative study of cell survival upon hyperthermia collected from literature (17 sets in 11 publications that cover 14 different cell lines from 8 different tissues). Results A dynamical model describes accurately cell survival according to the amplitude and duration of exposure but also molecular chaperone expression level. In the case of square shape hyperthermia, approximated analytical expression of the cell survival is derived from the dynamical model and compared to CEM43 description. The molecular chaperone expression level defines the thermal resistance of a given cell line and can be estimated from a single experimental result through an easy-to-use graphical tool. Conclusion The tools offered here can be useful for designing treatments combining hyperthermia and chemotherapy targeting molecular chaperones, but also for designing personalized hyperthermic treatment by prior biochemical screening of molecular chaperones. These tools could advantageously replace the description of CEM43.

532 The seco-taxane idn5390 is able to target class III beta-tubulin and to overcome paclitaxel resistance

The effect of step-down heating (SDH) on the radiosensitization induced by simultaneous hyperthermia and radiation was investigated in a C3H mammary carcinoma inoculated into the feet of CDF1 mice and the skin of normal CDF1 feet. SDH consisted of a sensitizing treatment (ST) of 44.5 °C/10 min followed by a test treatment (TT) of 41.5 °C for 30, 60 or 120 min. Simultaneous administration of radiation and hyperthermia was achieved by delivering radiation in the middle of the TT. The endpoint selected was the radiation dose needed to achieve either tumor control or moist desquamation in 50% of the animals. The results were evaluated by the thermal enhancement ratio (TER), defined as dose of radiation needed to achieve endpoint in relation to dose of combined radiation and hyperthermia needed to achieve the endpoint. SDH of tumors increased the TER significantly compared with step-up heating (SUH). The ratios between TCD50 values for corresponding SDH and SUH increased with TT heating time and at 120 min a 2.5-fold increase in the radiosensitizing effect was achieved. It has previously been shown that SDH alone causes thermosensitization in tumors by decreasing the activation energy. However, the effect was too small to explain the increased radiosensitization observed with SDH. In the normal tissue studies SDH combined with radiation treatment gave a lower TER compared to the SDH tumor results, suggesting a possible therapeutic gain.

DC heating-induced step instability on Si(001) vicinal surfaces

Direct-current (DC) heating-induced step instabilities such as step bunching and step wandering on Si(001) vicinal surfaces (0–17° off-angle) were studied at 1000–1200°C. It was found that step bunching occurs in the areas where a step-up heating current is supplied. Step wandering occurs on the vicinal surface inclined towards the [100] direction with a large miscut where a step-down heating current is supplied. The distances between neighboring step bands formed on the surfaces after step bunching do not depend on the off-angle of the initial surfaces. However, the distances on the surfaces inclined towards the [100] direction are larger than those on the surfaces inclined towards the [110] direction. They also depend on the substrate temperature regardless of the off-direction of the vicinal surfaces. These observations indicate that electromigration effects on the (001) vicinal surfaces are asymmetric in the mobility of silicon adatoms.

The treatment of malignancy by hyperthermia

The use of hyperthermia for the selective destruction of tumours may be applied by a whole body, surgical perfusion or interstitial techniques. The main determinant of selectivity is tumour blood flow. The effects of hyperthermia may be augmented by step-down heating, manipulating pH changes and sensitisation by chemotherapy or specific pharmacological agents.

Step-down heating enhances the cytotoxicity of human tumour necrosis factor on murine and human tumour cell lines in vitro.

The response of tumour necrosis factor (TNF)-sensitive murine L929 cells to TNF was enhanced approximately 1000-fold after step-down heating (SDH) for 30 min at a sensitizing temperature (ST) of 43 degrees C and a subsequent 24 h incubation at a test temperature (TT) of 40.5 degrees C, compared to continuous treatment at 37 degrees C. The TNF-resistant phenotype of murine EMT-6 mammary adenocarcinoma cells could be overcome by 24 h heating at a TT of 40.5 degrees C, and their sensitivity to TNF could be further increased by preheating at the ST for up to 60 min. The response of TNF-sensitive HCT-15 human colon adenocarcinoma cells was somewhat similar to that of L929 cells except that there was u approximately 2.5 log increase in TNF-sensitivity due solely to heating at 40.5 degrees C. The response of TNF-resistant DLD-1 human colon adenocarcinoma cells was similar to that of EMT-6 cells. In contrast, three normal cell lines demonstrated greater resistance to any TNF/SDH treatment examined. Our results suggest that SDH may overcome the resistance or enhance the response of tumour cells to TNF while minimizing cytotoxic effects on normal cells.

Stepdown hyperthermia in human melanoma cells

Human melanoma cells have been used to evaluate whether stepdown heating (SDH) could increase the effectiveness of long-duration mild hyperthermia (LDMH). The effects of these treatments were also evaluated on cell survival and DNA polymerase inactivation. Short treatments (30 min) at 43 degrees C did not result in much SDH effect for subsequent protracted heating at 40 degrees C. The effect on DNA polymerases was also very small. However, heating at 44 degrees C for 30 min had a large SDH heating effect on subsequent heating at 40 degrees C and 41 degrees C. The SDH effect occurred mainly in the first 5-10 h of subsequent LDMH and, at longer heating times, the rate of cell killing was reduced. The 44 degrees C SDH effect was also observed on DNA polymerase inactivation. Comparing the degree of cell killing and polymerase inactivation showed a good correlation for the various SDH protocols.

A unified model for cell-killing by heat: Interpretation of continuous, step-down, step-up and split heating

We have already proposed a model for the lethal effects of heat on cells. In the model, a three-step process for cellular inactivation was hypothesized: 1) heating produces sublethal damage; 2) the damage is repaired in a certain time period; 3) the cell is inactivated when it undergoes cumulative sublethal damage to the extent that it cannot be repaired. Using the previous model, we investigated the modifications of the survival curve in 1) continuous heating, 2) step-down heating, 3) step-up heating, and 4) recovery from the thermal injury by split heating. These four phenomena were explained well with the mathematical model.

Sensitization to cisplatin action by step‐down heating in cddp‐sensitive and ‐resistant cells

Hyperthermia treatment (> or = 43 degrees C) has been shown to be able to (partially) reverse acquired cDDP resistance. However, such heat treatment is difficult to achieve in the clinic. Short pre-treatment at a high temperature (> 42 degrees C), immediately before a treatment at a lower temperature (< 42 degrees C) can enhance the heat toxicity of the lower temperatures. This "step-down heating schedule" was explored for its possible drug-sensitizing potential in in vitro-cultured cDDP-sensitive and -resistant murine and human tumour cells. A 10-min pre-treatment at 44 degrees C enhanced the cytotoxicity of 41 degrees C hyperthermia alone. It also enhanced sensitivity to cDDP when given at 37 degrees C. However, it did not increase the 41 degrees C-induced cDDP sensitization. Thus, no correlation was found between heat kill and cDDP sensitization for step-down heating schedules. The observed effects of step-down heating were comparable in sensitive and in resistant cells, so the step-down heating schedule, unlike the 43 degrees C treatment, did not lead to a decrease of the cDDP-resistance factor. Yet the total cytotoxicity caused by this treatment protocol was 10-fold more than for cDDP with 41 degrees C alone, due to the extra hyperthermic cell killing and the cDDP-sensitizing effect of the pre-treatment. This treatment could have a substantial impact on cDDP efficacy in the clinic even when cDDP resistance has developed.

Effects of step-down and step-up heating on the development of thermotolerance in a C3H mammary carcinoma in vivo.

The effects of step-down (SDH) and step-up heating (SUH) on the development of thermotolerance were investigated in a C3H mammary carcinoma in vivo. The endpoint was tumour growth time, i.e. the time for a tumour to reach a volume five times that of the first treatment day. SDH consisted of 44.5 degrees C/5 min followed immediately by 41.0 degrees C/120 min. SUH consisted of the same heat treatments but in reverse sequence. Thermotolerance was detected by subsequent heating at 43.5 degrees C at variable intervals following the primary SDH or SUH. The degree of thermotolerance was quantified by the thermotolerance ratio (TTR) calculated as a ratio between the slope of the dose-response curve for tumours heated at 43.5 degrees C and tumours preheated with either SDH or SUH followed by 43.5 degrees C. Both SDH and SUH induced thermotolerance. However, the maximal degree of thermotolerance and the time interval to reach maximum thermotolerance were different. For SUH maximal thermotolerance was observed at 8 h with a TTR of 3.6. For SUH, thermotolerance peaked at 24-28 h with a TTR of 7.3. In both cases thermotolerance had decayed with a 120 h interval. The SDH priming induced about 2.5 times more heat damage than SUH. The results are therefore in agreement with previous data obtained in the same tumour model by single heating showing that both the degree and the time to reach maximal thermotolerance increases with pretreatment heat damage. In addition, the results indicate that thermotolerance and thermosensitization are independent phenomena.

The thermosensitivity of human gingival squamous carcinoma ca9-22 cells with oncogeneerbB-1/EGFR

The heat sensitivity of Human gingival squamous carcinoma Ca9-22 cells with oncogeneerbB-1/EGFR and Chinese hamster V79 cells of normal thermosensitivity as control was investigated. Colony formitig ability of the treated cells was assayedin vitro. Heat-treatment period-survival and the concerned curves were drawn. The slopes of exponentially regressing parts of the survival curves were estimated in the T0 values of cellular thermosensitivity and subjected to Arrhenius analysis. The 42–44°C time-survival curves of Ca9-22 Cells showed biphasic slopes which indicated the presence of thermotolerance induction during continuous heating even at 44°C while for the V79 cells the biphasic slopes due to thermotolerance induction were shown in temperatures at and before 42°C. In comparison of T0 values with V79 cells, those of Ca9-22 cells were longer (less thermosensitive) by about 2.1 fold at 43°C and 1.2 fold at 44°C Both V79 and Ca9-22 cells were sensitized by 44–42°C step-down heating (SDH). 42°C heat treatment period-survival curves of 44°C ( 5 minute) preheated V79 cells; while Ca9-22 cells under the same treatment condition for not only 5 minutes but 20 minutes showed biphasic slope, which indicated the presence of thermotolerance. The thermosensitization ratio (TSR) of Ca9-22 cells were smaller than V79 cells. Arrhenius curves a breaking points at 44°C and 43°C for Ca9-22 and V79 cells, respectively. The activation energies of V79 cells were 145kcal/molc and 400 kcal/mole above and below 43°C (P < 0.05), respectively, while those of Ca9-22 cells were 200 kcal/mole and 250 kcal/mole above and below 44°C (P <0.05), respectively. These data suggested that oncogeneerbB-1 /EGFRcontained in Ca9-22 cells may contribute to reduce thermosensitivity and variety in term of G1 phase as shown in fractionated Hydroxyurea treatment.

Step-down heating of human melanoma xenografts: effects of the tumour microenvironment

Thermosensitisation by step-down heating (SDH) has previously been demonstrated in experimental rodent tumours. The purpose of the study reported here was to investigate whether the SDH effect in tumours in part may be attributed to heat-induced alterations in the capillary network and/or the microenvironment. Two human melanoma xenograft lines differing substantially in vascular parameters were selected for the study. A thermostatically regulated water bath was used for heat treatment. The conditioning treatment (44.5 degrees C or 45.5 degrees C for 15 min) was given in vivo, whereas the test treatment (42.0 degrees C for 45, 90, 135 or 180 min) was given either in vitro or in vivo. Treatment response was measured in vitro using a cell clonogenicity assay. Fraction of occluded vessels following heat treatment was assessed by examination of histological sections from tumours whose vascular network was filled with a contrast agent. Tumour bioenergetic status and tumour pH were measured by 31P magnetic resonance spectroscopy. The conditioning heat treatments caused significant vessel occlusion, decreased tumour bioenergetic status and decreased tumour pH in both tumour lines. The SDH effect measured when the test treatment was given in vivo was significantly increased relative to that measured when the test treatment was given in vitro. The magnitude of the increase showed a close relationship to fraction of occluded vessels, tumour bioenergetic status and tumour pH measured 90 min after treatment with 44.5 degrees C or 45.5 degrees C for 15 min. The increased SDH effect in vivo was probably attributable to tumour cells that were heat sensitive owing to the induction of low nutritional status and pH during the conditioning treatment. Consequently, the SDH effect in some tumours may in part be due to heat-induced alterations in the microenvironment. This suggests that SDH may be exploited clinically to achieve increased cell inactivation in tumours relative to the surrounding normal tissues.

A Generalized Concept for Cell Killing by Heat: Effect of Acutely Induced Thermotolerance and Decay of Thermosensitization

Acute thermotolerance was induced in Chinese hamster ovary cells by heating at 43 degrees C for 45 min followed by incubation at 37 degrees C for up to 85 h. The degree of thermotolerance induced was quantified by a second heat exposure at 43 degrees C. To study the interaction of thermotolerance and thermosensitization, thermotolerant cells (43 degrees C/45 min-->37 degrees C/10 h) were subjected to step-down heating consisting of a priming heat treatment at 43 degrees C for 45 to 300 min followed immediately by a graded test treatment at 40 degrees C. Decay of thermosensitization was assayed by separating the priming treatment at 43 degrees C for 45 or 60 min and the test treatment at 40 degrees C by incubation at 37 degrees C for up to 24 h. The experimental data were analyzed by using a mathematical model published previously (H. Jung, Radiat. Res. 106, 56-72, 1986). According to this model, cell killing by heat is a two-step process. In a first step, heating produces nonlethal lesions at a rate p which, in a second step, are converted into lethal events at a rate c. Both rates were shown to depend on temperature. Data analysis, which was performed under the assumption that the rate constant c(T) is not altered by acute thermotolerance, showed that the rate constant p(43 degrees C) decreased exponentially (half-time 1.08 +/- 0.15 h) with increasing thermotolerance development, i.e., with increasing duration of the incubation interval at 37 degrees C. The rate p(43 degrees C) approached a minimum value by 14 +/- 3 h, where it was lower by a factor of 30 compared to normally sensitive cells. For incubation times at 37 degrees C exceeding 14 h, p(43 degrees C) increased exponentially with a doubling time of 13.9 +/- 0.9 h and approached the control level by 85 h. Decay of thermosensitization was quantified by calculating the number of nonlethal lesions from the data recorded for the sequences 43 degrees C-->37 degrees C-->43 degrees C and 43 degrees C-->37 degrees C-->40 degrees C. With increasing incubation interval at 37 degrees C, the number of nonlethal lesions induced per cell by a priming heat shock at 43 degrees C for 45 min remained constant for about 1.5 h and then decreased exponentially with a half-time of 2.0 +/- 0.5 h. Thus the two processes that occur simultaneously after a heat shock at 43 degrees C for 45 min, i.e., development of acute thermotolerance and decay of thermosensitization, proceed with different kinetics as could be separated by applying the model.

Time-temperature relationships for step-down heating in normal and thermotolerant cells.

Normal and thermotolerant H35 cells were submitted to step-down heating (SDH). SDH can significantly reduce the induction and expression of thermotolerance. For SDH a sensitizing treatment (ST) at 44.6 degrees C was followed by a test treatment (TT) at a lower hyperthermic temperature. The comparison between the thermotolerant and non-thermotolerant condition was based on isosurvival ST doses. For both conditions dose-effect relationships were obtained by plotting the ST-surviving fraction against the D0 of a TT. The TT was at either 41 or 42.5 degrees C, representing respectively, a permissive or a non-permissive condition for chronic induction of thermotolerance (CIT). The complex dose-effect relationships are partly exponential. In non-thermotolerant cells tested at 42.5 degrees C the dose-effect relationship between ST and TT is relatively weak. At 41 degrees C, however, the expression of CIT is strongly inhibited after a ST that kills < 20% of the cells. At higher ST doses the response is comparable with that at 42.5 degrees C. In thermotolerant cells a high degree of thermosensitization is also observed for relatively low ST doses, but in contrast with non-thermotolerant cells a stronger dose-effect relationship remains at the higher ST doses. Ultimately this results in a comparatively higher degree of thermosensitization that can be achieved in non-thermotolerant cells. For example, at an isosurviving fraction of 0.15 the reduction of D0 is non-thermotolerant cells at 42.5 degrees C is less than five times, whereas in thermotolerant cells, the D0 reduction is between 40 and 50 times. A similar reduction is found in non-thermotolerant cells tested at 41 degrees C. Subsequently, an isosurvival ST dose of about 40% was used in combination with a TT that was varied between 39 and 44 degrees C. D0's were plotted in an Arrhenius diagram to obtain a time-temperature relationship for the effect of SDH on thermotolerant and non-thermotolerant cells. The four plots are all biphasic with a downward inflection. Thermotolerance causes an upward shift of the inflection point of 2 degrees C relative to single-heated cells, whereas SDH causes a downward shift of 1 degree C in single-heated cells and of 2 degrees C in thermotolerant cells. For most of the temperature range, i.e. 39-43.5 degrees C, SDH decreases the activation energies.

Mild step-down heating causes increased levels of HSP68 and of HSP84 mRNA and enhances thermotolerance.

Mammalian cells exhibit increased sensitivity to hyperthermic temperatures of 38-42 degrees C after an acute high-temperature heat shock; this phenomenon is known as thermo-sensitization or the step-down heating effect. In order to determine whether the increase of heat shock mRNA after heat stress can be thermosensitized, we studied the induction of the mRNA of HSP68 and of HSP84 after application of step-down heating (SDH) in Reuber H35 rat hepatoma cells. SDH consisted of a pretreatment of 30 min at 41.5, 42.5 or 43.5 degrees C, followed by a continuous incubation at a lower hyperthermic temperature (40 or 41 degrees C). After mild pretreatment (30 min at 41.5 degrees C) the mRNA level of HSP68 was increased by subsequent incubation at 40 degrees C, although incubation at 40 degrees C alone had no effect. This increase was even more pronounced at 41 degrees C. An increase in the level of HSP84 mRNA was also observed after mild pretreatment (41.5 degrees C/30 min) followed by 41 degrees C post-incubation. Interestingly, an enhanced occurrence of thermotolerance was also observed upon application of mild step-down heating (42 degrees C/30 min-40 degrees C-43.5 degrees C/60 min). In contrast, cell cultures treated for 30 min at 43.5 degrees C (a temperature which induces an increase in HSP mRNA levels) showed an inhibited or delayed synthesis of HSP mRNA when post-treated at 40 or 41 degrees C. Under these conditions the development of thermotolerance did not take place either. With respect to the effect of step-down heating on HSP mRNA levels as well as on thermotolerance development, our data imply that a distinction should be made between 'mild' and 'severe' pretreatment temperature of the step-down heating protocol.

A mathematical model for cell killing by heat applied to a C3H mammary carcinoma in vivo.

Jung (1986) has proposed a mathematical model for cell killing by hyperthermia which assumes that heat killing involves two steps: the production (p) of non-lethal lesions at random and a subsequent conversion (c) into lethal lesions. The p & c model has been shown to predict the survival of CHO cells heated in vitro even when complicated biological phenomena such as thermotolerance and step-down heating (SDH) are involved (Jung 1986, 1991). In the present study the objective was to test the p & c model's ability to describe the effect of single heating and SDH in an experimental tumour in vivo. The endpoint was tumour growth delay (GD). The doubling times (DT) for untreated and heated tumours were similar, and the surviving fraction (SF) could therefore be estimated using: SF = -in(2).GD/DT. SF was fitted to the model by non-linear regression. The p & c model adequately described the GD obtained by SDH (39-44.5 degrees C) and single heating above 42.5 degrees C. Multiple linear regression showed that the residuals for single heating and SDH were independent of both heating time and temperature. However, the residuals for single heating (41-44.5 degrees C) were significantly correlated to heating time when analysed separately. The GD obtained by the use of extended single heating times at or below 42.5 degrees C was therefore overestimated by the model. Development of chronic thermotolerance during heating may account for the observed divergence. The Arrhenius plots for both p and c were log-linear with activation energies of 678 and 311 kJ/mol, respectively. Jung (1986) has previously reported similar p and c activation energies above 42.5 degrees C for CHO cells in vitro.

Thermosensitization, heat shock protein synthesis and development of thermotolerance in M-14 human tumor cells subjected to step-down heating.

M-14 human tumor cells have been subjected to two regimens of step-down heating (SDH) consisting of a conditioning treatment at 42 degrees C for 1 h or at 44.5 degrees C for 20 min, immediately followed by heating at 40 degrees C. Both conditioning treatments thermosensitize the cells towards the subsequent heating at 40 degrees C; the thermosensitization ratio is 6.4 for cells conditioned at 42 degrees C for 1 h and 32.3 for cells conditioned at 44.5 degrees C for 20 min. The overall protein synthetic activity is reduced to 32.7% or 18.4% of control values following 1 h at 42 degrees C and 20 min at 44.5 degrees C, respectively; this inhibition is followed by a full recovery of the synthetic activity during the subsequent exposure at 40 degrees C. SDH-treated cells synthetize four heat shock proteins, with approximate molecular weights of 28, 64, 70 and 90 kDa. The pattern of HSPs induction observed in SDH-treated cells is similar to that found in cells subjected to single hyperthermic exposures. Cells subjected to the SDH sequence 42 degrees C/1 h-->40 degrees C/4 h develop thermotolerance, as indicated by a reduced sensitivity to further hyperthermic challenges.

Winner of the Lund Science Award 1992 Thermosensitization induced by step-down heating: A review on heat-induced sensitization to hyperthermia alone or hyperthermia combined with radiation

A few minute's exposure to a high temperature (sensitizing treatment, ST) may substantially increase the cytotoxic and the radiosensitizing effect of a subsequent heating at a lower temperature (test treatment, TT). This phenomenon, which is known as step-down heating (SDH) or thermosensitization, has been observed both in cultured cells in vitro and in tumours and normal tissues in vivo. The effect of SDH increases with a lowering of TT temperature, but it is rapidly lost at temperatures very close to 37 degrees C. SDH-induced thermosensitization decays within a few hours, when an interval is inserted between ST and TT. In vitro results suggest an exponential decay of the SDH effect with half times ranging from 1.5- to 3.1 h. The effect of SDH increases with increasing ST time or temperature. For single heating, the Arrhenius plot is biphasic with activation energies of 500-800 and 1200-1700 kJ/mol above and below a break point temperature in the region 42.5-43.0 degrees C, respectively. For SDH, the Arrhenius plot gradually becomes monophasic with increasing severity of ST and it approaches asymptotically to an activation energy of about 400 kJ/mol. The reduction of the activation energy depends on cell survival after the priming ST and not on the specific ST heating time or temperature. SDH strongly enhances hyperthermic radiosensitization with a 5-6-fold reduction of the radiation dose required to achieve tumour control. The thermosensitizing and the radiosensitizing effects of SDH have several features in common. Both effects become more prominent when the TT temperature is decreased and when the ST heating time or temperature increases. In addition, the decay kinetics for both effects are comparable. For heat alone, the effect of SDH in tumour and normal tissue seems to be quantitatively similar. However, the therapeutic ratio may be increased by combining SDH with radiation. Biologically, the critical subcellular targets involved in the SDH effect have not been revealed. However, the ability of SDH to inhibit the clearance of heat-induced aggregation of proteins in the nucleus is interesting. Blockage of the nuclear function by proteins is a central theory in the present molecular biological models for both cell kill by heat and heat radiosensitization. Clinically, SDH may be an advantage since even a short exposure to high temperature increases the effect of an otherwise inadequate heat treatment. The disadvantages are that SDH complicates thermal dose calculations, and may cause unacceptable damage to normal tissue.

Effect of thermotolerance and step-down heating on thermal radiosensitization in CHO cells.

Chinese hamster ovary cells were exposed to single or fractionated heat treatments followed by irradiation on ice with graded doses of X-rays. The dose-response curves obtained were fitted by the linear-quadratic equation -ln(S/S0) = alpha D + beta D2 and analysed in terms of TER10%, alpha and beta. Thermal enhancement ratio, TER10%, was reduced when heat sensitivity was lowered either by chronic (pretreatment 40 degrees C, 16 h) or acute (43 degrees C, 45 min-37 degrees C, 10 h) thermotolerance, but was enhanced after step-down heating (43-40 degrees C or 45-40 degrees C). It could be shown that thermal radiosensitization, as expressed by TER10%, is modified by thermotolerance or step-down heating only to the extent to which cellular survival is modified by the corresponding pretreatments. However, the relative change of alpha and beta was found to be different for thermotolerance and step-down heating. For thermotolerant cells the values for alpha and beta were reduced by about the same factor, whereas step-down heating caused an increase in both parameters, which was greater for alpha than for beta. Data analysis showed that the modification of thermal radiosensitization by thermotolerance can be interpreted as if the cells were heated at the given temperature for a shorter time, whereas after step-down heating the cells responded as if they were exposed to a higher temperature prior to irradiation.

Intrinsic thermal response, thermotolerance development and stepdown heating in murine bone marrow progenitor cells.

Thermal response, thermotolerance development and stepdown heating (SDH) in the murine bone marrow granulocyte-macrophage (CFU-GM) progenitors were determined in vitro. Marrow was removed from femora and tibia, heated in McCoy's 5A medium plus 15% FBS and cultured in soft agar in the presence of three different sources of colony stimulating factor. D0's (+/- SE) for survival curves of CFU-GM heated in vitro were 147 +/- 13, 71 +/- 9, 37 +/- 2, 19 +/- 0.7, 11 +/- 1, and 4.3 +/- 0.3 min, for temperatures of 41.8, 42, 42.3, 42.5, 43 and 44 degrees C, respectively. Arrhenius analysis showed inactivation enthalpies of 812 +/- 9 KJoules/mole (193 +/- 2 Kcal/mole) above, and 2142 +/- 157 KJoules/mole (509 +/- 37 Kcal/mole) below, an inflection at 42.5 degrees C. Thermotolerance development was evident during prolonged hyperthermia exposure at temperatures below 42.5 degrees C (chronic hyperthermia) as a change in the slope of the survival curves after approximately 110 min of heating. Thermotolerance development at 37 degrees C after exposure to temperatures of 43 degrees C or greater (acute hyperthermia) was assessed by fractionated heat treatments consisting of an initial heat treatment (15 min at 44 degrees C) followed by incubation at 37 degrees C and challenge with 15 min or 25 min at 44 degrees C. Maximum thermotolerance occurred after 210 and 330 min at 37 degrees C, respectively. The half-time for maximum thermotolerance development was 36 min. Depending on the amount of heat damage and the maximum amount of thermotolerance development, the decay of thermotolerance was complete after approximately 48-72 h at 37 degrees C. An exposure of 10 min at 44 degrees C before incubation at 40 or 41 degrees C (stepdown heating) reduced the slope of the 40 or 41 degrees C survival curves by inhibiting thermotolerance development that would have otherwise occurred. D0's were 100 +/- 19 and 45 +/- 5 min for 40 and 41 degrees C incubation preceded by 10 min at 44 degrees C, respectively. These studies indicate that whole-body or regional hyperthermia protocols designed either to treat solid tumours or to purge leukemic stem cells from marrow ex vivo should avoid inadvertent temperature elevations to large volumes of marrow. Although, marrow progenitors are capable of thermotolerance development during exposure to temperatures up to 42.3 degrees C, results suggest that conditions of stepdown heating may prevent thermotolerance development.