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Hyperthermia

Hyperthermia, a generally non-invasive gentle treatment, raises tumor temperature to approximately 108 degrees Fahrenheit, a temperature similar to high fever

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Hyperthermia Improves Response Rates When Used As A Combined Therapy

Per

cen

t %

Clinical Trial Results

¹Valdagni et al., 1993

²Overgaard et al., 1995

³Issels et al., 2010

⁴Colombo et al., 2010

⁵Van der Zee., 2000

⁶Vernon et al., 1996

⁷Hurwitz et al., 2011

⁸Kakehi et al., 1990

⁹Jones et al., 2005

¹ Vernon et al., 1996⁰

Long-Term Follow up- Randomized Trial comparing RT and RT & HT to Metastatic

Lymph Nodes in Stage IV Head & Neck Patients

Melanoma15X3 Gy, 6 hyperthermia

Coley’s Toxin

Mixture of dead bacteria

First attempts to utilize the immune system to counteract cancer.

Adjuvant to conventional surgery, chemotherapy and radiation

Effective in lymphomas

William Bradley Coley(1862-1936) surgeon and oncologist

Treatment Sites

Skin

Chest Wall

Lymph Nodes

Breast

Head and Neck

Axilla

Extremities

Bladder

Prostate

Pancreas

Vagina

Lower Pelvic Region

Rectum

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Hyperthermia Treatments

Stand Alone

Chemotherapy

Radiation Therapy

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Hyperthermia Compliments and Enhances Other Therapies

Hyperthermia is useful for pre-surgical down-staging

Heat with radiation reduces tumor volume

Hyperthermia sensitizes tumor cells to ionizing radiation

Same dose of radiation yields a better treatment response

A lower dose in patients previously irradiated yields same response

Hyperthermia is useful as a ‘trigger’ for targeting chemotherapy

Heat increases cell membrane permeability to enhance drug uptake

Hyperthermia stimulates immune response

Heat unmasks antigens on surfaces of cancer cells

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Hyperthermia Treatments

Direct Kill

Activating the Immune System

Heat Shock Proteins

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Heat Shock Proteins

Discovered in 1962

Conserved

Thermotolerance

Chaperone

Protection of cells

Heat upregulates expression of the HSP genes

Hyperthermia increase HSP 70 KD

Hyperthermia and Radiation Therapy

Improve Oxygenation of Tumors

Sub-lethal Radiation Damage

S Phase

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Tumor Vascular System

Defective

Leakey

Sympathetic nerve ending missing

Dilated and compressed regions

Irregular branching

Hammersen, 1985

Tumor Vascular System

Inefficient orientation

Relative sparse arterioles

Large flow variation

Large Diameter Shunts

Increased metabolic demand

Packing density

Dewhirst, 2008

Minchiton, 2006

Hypoxia Correlates with Negative Prognosis

Cervix Cancer

Pancreatic Cancer

Head and Neck

Prostate

Breast

Soft Tissue Sarcoma

Hocekel, 1993, 1996

Ide, 2007

Brizel, 1999

Movsas, 2002

Vaupel, 2001,

Lungren, 2007

Brizel, 1996

Hypoxia and Radiation Therapy

Hyperthermia Improves Chemotherapy Treatments

Improves Drug Delivery to the Tumors

Increases Permeability of the Cell Wall

Interfering of Sub-lethal Chemo Damage repair

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Hyperthermia Research Review

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Response of matched superficial lesions

Complete ResponseTumors Radiation Radiation

Author Treated Alone Plus Hyperthermia %

Kim, et al 99 46% 70%Arcangeli 123 39% 76%Overgaard (summary) 186 31% 74%Scott 62 39% 83%

Hyperthermia Treatment

External Superficial

Deep

Interstitial Intracavitary Whole Body

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Hyperthermia Process

Patient Selection

Insurance

Authorization

Records

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Hyperthermia Process (2)

Scheduling

Cyrus Rafie

Medical Oncologist

Radiation Oncologist

Same Day Scheduling

Labs

CT, PET CT, MRI

Biopsy

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Hyperthermia Process (3)

Review medical records

Review diagnostic images

Review with Radiologist

Review with Radiation or Medical Oncologist

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Hyperthermia Process (4)

Size of the tumor

Depth of tumor

Normal tissue

Blood flow

Nerves

Skin folds

Surgical suture lines

Pace maker

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Hyperthermia Devices

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Hyperthermia Treatment

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SONOTHERM® Hyperthermia… the Procedure

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1. The tumor is first located and examinedby mammography.

2. A biopsy is analyzed to determine the tissue make-up of the tumor.

3. An analysis of the tumor’s exterior shape and depth is made.

4. An energy pattern of ultrasound matching the tumor shape is programmed to the 16 transducer sections for optimal treatment.

SONOTHERM® Hyperthermia… the Process Within the Body

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1. Transducer emits ultrasound.

2. Ultrasound energy is absorbed by the tumor and converted to heat.

3. Heat penetrates tumor for therapeutic effect. Normal blood flow cools organs and other body

tissue.

Underdeveloped blood circulation makes tumors more vulnerable to heat.

Hyperthermia Equipment

Microwave

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Hyperthermia Devices

Regional Microwave

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Hyperthermia Devices

Capacitive

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Intracavitary Hyperthermia

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Whole body Hyperthermia

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Hyperthermia Codes

77600 External, 4 cm

77605 External, more than 5 cm

77610 Interstitial, 4 or less

77615 Interstitial, more than 4 77620 Intracavitary

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Adverse Effects

There are no known complications of hyperthermia.

Skin discomfort, irritation or local pain.

Blisters

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Hyperthermia Research Review

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The effect of adjunctive hyperthermia on the radiation response in human tumors

Frequency of Complete ResponseRadiation Radiation

Study No. of Patients / Tumors

Alone % Plus Hyperthermia %Arcangeli, et al 163 38 74

Overgaard 101 39 62Kim, et al 238 39 72Hiraoka, et al 33 25 71Kochegarov, et al

161 16 63Lindholm, et al 85 25 46Scott, et al 44 64 86Li, et al 124 29 54Val dagni, et al 78 36 73Vernon, et al

315 40 60

1,342 35% 66%

Beverly Hills Thermal Medicine

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