Hyperthermia: The Optimal Treatment to Overcome Radiation Resistant Hypoxia

Elming, Pernille B.; Sørensen, Brita S.; Oei, Arlene L.; Franken, Nicolaas A.P.; Crezee, Johannes; Overgaard, Jens; Horsman, Michael R.

doi:10.3390/cancers11010060

Open AccessReview

Hyperthermia: The Optimal Treatment to Overcome Radiation Resistant Hypoxia

by

Pernille B. Elming

¹,

Brita S. Sørensen

¹

,

Arlene L. Oei

²,

Nicolaas A.P. Franken

²

,

Johannes Crezee

²

,

Jens Overgaard

¹

and

Michael R. Horsman

^1,*

¹

Department of Experimental Clinical Oncology, Aarhus University Hospital, DK-8000 Aarhus C, Denmark

²

Department of Radiation Oncology, Amsterdam University Medical Centers, University of Amsterdam, 1105AZ Amsterdam, The Netherlands

^*

Author to whom correspondence should be addressed.

Cancers 2019, 11(1), 60; https://doi.org/10.3390/cancers11010060

Submission received: 12 November 2018 / Revised: 14 December 2018 / Accepted: 29 December 2018 / Published: 9 January 2019

(This article belongs to the Special Issue New Developments in Radiotherapy)

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Abstract

Regions of low oxygenation (hypoxia) are a characteristic feature of solid tumors, and cells existing in these regions are a major factor influencing radiation resistance as well as playing a significant role in malignant progression. Consequently, numerous pre-clinical and clinical attempts have been made to try and overcome this hypoxia. These approaches involve improving oxygen availability, radio-sensitizing or killing the hypoxic cells, or utilizing high LET (linear energy transfer) radiation leading to a lower OER (oxygen enhancement ratio). Interestingly, hyperthermia (heat treatments of 39–45 °C) induces many of these effects. Specifically, it increases blood flow thereby improving tissue oxygenation, radio-sensitizes via DNA repair inhibition, and can kill cells either directly or indirectly by causing vascular damage. Combining hyperthermia with low LET radiation can even result in anti-tumor effects equivalent to those seen with high LET. The various mechanisms depend on the time and sequence between radiation and hyperthermia, the heating temperature, and the time of heating. We will discuss the role these factors play in influencing the interaction between hyperthermia and radiation, and summarize the randomized clinical trials showing a benefit of such a combination as well as suggest the potential future clinical application of this combination.

Keywords: hyperthermia; radiation therapy; hypoxia

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MDPI and ACS Style

Elming, P.B.; Sørensen, B.S.; Oei, A.L.; Franken, N.A.P.; Crezee, J.; Overgaard, J.; Horsman, M.R. Hyperthermia: The Optimal Treatment to Overcome Radiation Resistant Hypoxia. Cancers 2019, 11, 60. https://doi.org/10.3390/cancers11010060

AMA Style

Elming PB, Sørensen BS, Oei AL, Franken NAP, Crezee J, Overgaard J, Horsman MR. Hyperthermia: The Optimal Treatment to Overcome Radiation Resistant Hypoxia. Cancers. 2019; 11(1):60. https://doi.org/10.3390/cancers11010060

Chicago/Turabian Style

Elming, Pernille B., Brita S. Sørensen, Arlene L. Oei, Nicolaas A.P. Franken, Johannes Crezee, Jens Overgaard, and Michael R. Horsman. 2019. "Hyperthermia: The Optimal Treatment to Overcome Radiation Resistant Hypoxia" Cancers 11, no. 1: 60. https://doi.org/10.3390/cancers11010060

APA Style

Elming, P. B., Sørensen, B. S., Oei, A. L., Franken, N. A. P., Crezee, J., Overgaard, J., & Horsman, M. R. (2019). Hyperthermia: The Optimal Treatment to Overcome Radiation Resistant Hypoxia. Cancers, 11(1), 60. https://doi.org/10.3390/cancers11010060

Note that from the first issue of 2016, this journal uses article numbers instead of page numbers. See further details here.

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Hyperthermia: The Optimal Treatment to Overcome Radiation Resistant Hypoxia

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