Estimated number of children with cancer eligible for hyperthermia based on population- and treatment-related criteria

Abstract

Patients with recurrent, progressed or otherwise, therapy resistant malignancies, whose diseases are not amenable to standard therapies, may benefit from hyperthermia (HT). Based on the number of 1600 newly diagnosed malignancies, in patients < 15 years of age, per annum of which 70% are successfully treated on the standard treatment protocols of the German Society of Pediatric Oncology and Hematology (GPOH) and allowing for various drop-outs for reasons such as lack of established protocols, insufficient state of health and others, this means that as many as 100 children per annum can be expected to be enrolled into phase I/II trials in Germany. In view of the promising results in adults, phase I/II HT studies have also been performed in children and adolescents with recurrent or advanced malignancies including Ewing's tumours, aggressive fibromatosis, and germ cell tumours. Recent results in paediatric studies indicate the feasibility of both regional deep HT and whole body HT, and the best case analysis reveals promising response rates (CR + PR) as well as some long-term remissions. Technical modifications, due to the smaller body diameters, led to mean intratumoural temperatures in paediatric patients similar to those reported for adults in whom an improved outcome was demonstrated. The results in children and adolescents even suggest that introduction of HT into standard treatment protocols may be promising to improve tumour response and event-free survival in patients with poor risk malignancies of childhood.

Current status of radiant whole-body hyperthermia at temperatures >41.5°C and practical guidelines for the treatment of adults. The German ‘Interdisciplinary Working Group on Hyperthermia’

“…Extra-corporal techniques have proved to be effective in attaining the targeted temperature, but similarly show a high degree of toxicity. An exception has to be made in paediatric oncology, where extra-corporal WBH is associated with a more favourable toxicity profile in children younger than 3 years of age, due to the small body size and better fluid and electrolyte control [4]. Radiative WBH proved to be safe and effective in a number of phase I/II-trials and, thus, represents the only modality that can be recommended for the induction of WBH at temperatures >41.5 C today [3,5,6].…”

Role of heat treatment in childhood cancers: Distinct resistance profiles of solid tumor cell lines towards combined thermochemotherapy

“…In this context, there is a growing experience with the application of locoregional hyperthermia at temperatures between 42°C and 44°C in combination with chemotherapy in order to improve the cytotoxic effects in the tumor area. The clinical value of locoregional hyperthermia combined with chemotherapy and/or radiotherapy has been demonstrated in recent phase II/III trials showing improved local control and long‐term survival rates in children and adults with advanced tumors 7–12.…”

Hyperthermie

“…Aufgrund der geringen Fallzahl von Kindern und Jugendlichen mit malignen Tumoren und der frühzeitigen Entwicklung von Fernmetastasen kommen derzeit ca. 20 Patienten/Jahr für die lokoregionale Hyperthermie in Betracht (Wessalowski 1999).…”