Review: The Role of Hyperthermia in Treating Pancreatic Tumors

Abstract

There is only marginal improvement in outcome of treating pancreatic cancer in the last two decades. Time to open up and have a fresh look at complementary adjuvant treatment options. Hyperthermia may be one such option. Hyperthermic intraperitoneal chemotherapy (HIPEC) predominantly as a intrasurgical procedure has already proved its justification. Non-invasive loco regional hyperthermia as complement to either chemo or radiation has not yet reached a comparable status of evidence. However the potential to eventually grow into such evidence is already clearly observable. This review presents the various methodologies available for hyperthermia, covers the initial clinical data that has been published and gives an outlook to what can be expected in the next 2-3 years to come. Hyperthermia has the potential to significantly prolong life expectancies and this while maintaining a satisfying quality of life!

Synopsis of a clinical practice guideline for pancreatic ductal adenocarcinoma with peritoneal dissemination in Japan; Japan Peritoneal Malignancy Study Group

“…Compared with systemic chemotherapy, intraperitoneal chemotherapy appears to be advantageous for the treatment of peritoneal dissemination due to the high drug concentration achieved in the peritoneal cavity to directly contact tumor nodules. 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 Although hyperthermic intraperitoneal chemotherapy (HIPEC), 30 , 31 and pressurized intraperitoneal aerosol chemotherapy (PIPAC) 32 , 33 have also been implemented in patients with PDAC with peritoneal dissemination, the clinical efficacy of these options in patients with PDAC is still under investigation. Intraperitoneal chemotherapy with paclitaxel provided a better MST of 14‐16 months in a cohort of patients with occult peritoneal dissemination and of 28 months or longer in patients who underwent conversion surgery in phase II studies.…”

Modified-FOLFIRINOX combined with deep regional hyperthermia in pancreatic cancer: a retrospective study in Chinese patients

“…Thus hypoxia is decreased and PH value around tumor cells can be modulated. All these effects may facilitate a better inflow of the chemotherapy drugs into the region of tumor [79][80][81], in addition to increasing tumor sensitivity to chemotherapy [82].…”

Gemcitabine Combination Nano Therapies for Pancreatic Cancer

“…These liposomes when modified with polymer to lead to multi-functional nano formulation have a phase transition temperature of 42 °C which makes the formulation release its therapeutic moiety only when triggered with hyperthermia [64]. The normal body temperature of 37 °C does not allow the liposomes to avail the drug in a normal cellular environment but mild hypothermia at the tumor site triggers drug release at the specific site; therefore, this modulation provides significant drug availability at tumor sites [78]. Non-damaging mild hyperthermia assists as an external stimulus to surpass the cellular barrier and avail the drug at tumor-targeted sites [79].…”