Whole Body Hyperthermia: Biological and Clinical Aspects

1. 1 Background neoplastic diseases which are currently refractory to conventional therapy. All aspects of both preclinical Anticancer effects of elevated (noncauterizing) tem and clinical WBH, ranging from molecular biology perature were first observed in ancient Egyptian times and physiology to WBH methodologies and clinical (Oleson and Dewhirst 1983). Hippocrates trials, will be comprehensively reviewed. It is our in (460-377 B. C. ) later incorporated fever therapy into a tention to provide the reader with a definitive resource homeopathic approach to disease (Le. , treating a dis of to evaluate the current status and future potential ease with a symptom of that disease). In the fourth WBH. In so doing, we will attempt to present the vari century, Refus of Ephesus advocated the use of fever ous perspectives and insights derived from the efforts induction to treat malignant diseases (Kluger 1980). of investigators throughout the world. We hope this In the nineteenth century tumor regressions accompa will encourage an expanded investigative commitment nying high fevers were reported both by Busch and to this exciting and innovative approach to cancer Bruns (Busch 1866; Bruns 1888). At the end of the therapy.

Texte du rabat

The preclinical rationale for whole body hyperthermia isscientifically sound. Realizing the potential of this newmodality to be a useful cancer therapy requires furtherbasic research and controlled clinical trials. Thistextprovides a foundation of knowledge to evaluate and initiatefuture studies. In this regard, the authors provide thefirst comprehensive review of the use of whole bodyhyperthermia to enhance the antineoplastic activityofionizing irradiation, chemotherapy and immunotherapy.Contents include a detailed summary and analysis offundamental principles as well asclinical and laboratoryexperience. For the clinical or laboratory researcher,useful descriptions of relevant animal models and conceptualaspects of in vitro systems are provided. The biophysics andmethodologies for inducing systemic hyperthermia are alsofully described. Non-oncological uses of whole bodyhyperthermia, as well as data relevant to betterunderstanding of the physiological responses to fever, arediscussed. It is anticipated that this substantial store ofknowledge should prove a key resource for understanding andutilizingthis emerging clinical treatment modality.

Contenu
1 Introduction.- 1.1 Background.- 1.2 Systemic versus Local and Regional Hyperthermia.- 1.3 Conceptual Approaches to the Therapeutic Use of WBH.- 1.4 Summary.- 2 Hyperthermia and the Immune System.- 2.1 Introduction.- 2.2 In Vitro Studies of Hyperthermia and Immune Effector Cells.- 2.3 In Vivo Studies: The Abscopal Response and Metastasis.- 2.4 Clinical Hyperthermia and the Abscopal Response.- 2.5 Clinical WBH and the Immune Response.- 2.6 Conclusions.- 3 WBH and Ionizing Irradiation.- 3.1 Background.- 3.2 Potential Advantages of WBH Compared to Local Hyperthermia.- 3.3 The Importance of Treatment Temperatures Used in Preclinical Studies.- 3.4 Possibly Controllable Clinical Treatment Variables.- 3.5 Clinical Investigations Combining WBH and Ionizing Irradiation.- 3.6 Summary.- 4 WBH and Chemotherapy.- 4.1 Introduction.- 4.2 Potential Mechanisms of Thermal Chemosensitization.- 4.3 Factors Which May Modify Thermal Chemosensitization.- 4.4 Therapeutic Index.- 4.5 Probable Thermal Sensitizing Agents.- 4.6 Future Directions for Preclinical Research.- 4.7 Clinical WBH Studies.- 5 Clinical and Biophysical Aspects of Systemic Hyperthermia.- 5.1 Thermal Regulation and WBH Methodologies.- 5.2 Monitoring Body Site Temperature During WBH.- 5.3 Cardiorespiratory Effects of WBH.- 5.4 Biochemical Effects of WBH.- 5.5 Hematological Changes.- 5.6 Neurological Sequelae.- 5.7 Endocrine Function and WBH.- 5.8 Gastrointestinal Toxicity.- 5.9 Miscellaneous Toxicities.- 6 WBH Animal Studies.- 6.1 Introduction.- 6.2 Large Animals.- 6.3 Murine Models.- 6.4 Special Considerations.- 7 Special Considerations for the Future.- 7.1 Nononcological Considerations.- 7.2 Implications of WBH Research for General Medical Practice.- 7.3 Systemic Hyperthermia: Summary Reflections Regarding Neoplastic Disease.- References.