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FAQ-Frequently Asked Questions

- Who should consider a hyperthermia treatment?

- Is the local and regional hyperthermia tolerated well?

- Which rare side effects have occurred so far?

- What is the response rate to the hyperthermia treatment?

- When do I start to feel an improvement of my condition?

- Are the costs of hyperthermia taken over by the insurance?

- What is an applicator?

- What happens during a local hyperthermia?

- What happens during a deep regional hyperthermia?

- What happens during a whole body hyperthermia?

- Does the hyperthermia treatment cause pain?

- How long does the hyperthermia treatment take?

- Can I read during a hyperthermia treatment?

- Am I on my own in the treatment room?

- What if I can not bear the hyperthermia?

- How often is a hyperthermia carried out?

- Can I be healed by hyperthermia?

Who should consider a hyperthermia treatment?

The hyperthermia is not used as a single therapy. Normally it is combined either with chemotherapy or with radiotherapy (or with both).

The local or regional hyperthermia is useful for extended (advanced) tumors, which can not be treated sufficiently by an operation or by radiotherapy alone. Above all, local recurrences (re-growing tumors) belong to this category. Distant metastases (migration of the tumor into the whole body) can also be treated by applying whole-body hyperthermia (together with chemotherapy). Also in this context hyperthermia is only used, if the other (conventional) therapy methods have turned out to be insufficient.

A whole-body hyperthermia is applied especially, if the tumor has been treated with several chemotherapy sessions without any positive result and if the tumor has already relapsed several times or has not well responded. On the other hand, hyperthermia normally is not used, if there exists a standard therapy treatment for the tumor disease in question which shows good results. This must be examined in detail by an oncological department, respectively by an oncological center.

Is the local or regional hyperthermia tolerated well?

Generally speaking, the loco-regional hyperthermia is tolerated very well and can be carried out without special medicine or other preparing measures.

Typically there will be a local sensation of warmth or heat. Sometimes this sensation can increase to a feeling of discomfort or pain - if this is the case, the doctor must be immediately informed so that he can change the adjustments accordingly.

Only in exceptional cases there can occur discomforts which continue for a longer period (up to several weeks) or even a burn. During regional hyperthermia, fairly high power levels (several 100 Watts) are radiated into the body, thus causing heat stress. This stress corresponds roughly to a sauna visit and is tolerated without problems by patients with a stable circulation.

What you have to take into account, however, is that the hyperthermia takes 60-90 minutes. Some patients feel uneasy about being positioned in the applicator or on a stretcher over such a long period of time. Also the surrounding water cushions can cause a feeling of narrowness. It is important that the pains caused by the tumor are treated sufficiantly (i.e. the painkilling therapy must have been adjusted beforehand).

During a whole-body hyperthermia, the whole body is heated up to a temperature of 41-42 C. It is carried out under general anesthesia or with high doses of sedativa and it causes high strain to the whole body. It takes approximately one day to recover completely from the therapy. If there occur any side effects or complications, they are most probably due to the circulation. They are however very rare, if the patient has a healthy heart. Sometimes there may occur superficial burns.

Which rare side effects have occured so far?

If the sensitivity to temperature is restricted, there may happen undetected overheatings during local or regional hyperthermia. This can happen with tumors that have already been treated preliminarily, i.e. after extended operations and after radiation etc. In such cases, there may occur damages of the tissue, respectively necroses after hyperthermia. It is possible, however, to detect these risk groups by detailed pre-examinations and the actual rate of such incidents is under 1 % at the experienced centers.

In some rare cases, it may happen that the patient cannot stand being positioned in the ring-shaped applicator during one hour or more, due to claustrophobia (anxiety caused by narrow spaces). This problem can be checked beforehand by a so-called trial positioning. It may be useful to administer sedatives in this case. Sometimes (but rarely) it is not possible to apply hyperthermia in case of a claustrophobia.

As to the whole-body hyperthermia, the possible risks consist in the high strain to the circulation and the general anesthesia (respectively the high dosis of sedativa). In this context, temporary irritations of the heart (e.g. heart rythm disturbances) or of the brain (e.g. temporary disturbances of the consciousness) have been observed in a few rare cases. In principle also other organic systems can be affected (e.g. kidney, liver). But with the current treatment systems these side-effects occur very rarely (in the area of 1 %).

Extremly seldom the whole-body hyperthermia may take a lethal end (due mainly to the risk caused by the general anesthesia). According to our data this can happen in one amongst 1.000 treatments.

What is the response rate to the treatment with hyperthermia?

This depends of course on the individual syndrome and can not be answered generally. It must be considered that hyperthermia is applied exactly in those cases where the response rate to chemotherapy or radiotherapy alone is insufficient. There exist experience values for each individual treatment concept (or study concept), which you can obtain from your doctor in attendance.

For most treatment concepts, the response rate should be above 50 %. Sometimes, however, it must already be considered as a success if the state of health and the general condition can be stabilized by the therapy for a fairly long period of time (e.g. for several months).

When do I start to feel an improvement of my condition?

This also depends on the state of the disease in question. If the tumor causes trouble, especially pain, a relief may be felt already after a few treatments. Generally speaking, you should expect an improvement after several weeks.

Are the costs of hyperthermia reimbursed?

The centers joint in the IAH have set as their main goal the research and development of hyperthermia. At the moment, most health insurances (except private insurances) are not ready to reimburse hyperthermia as an out-patient therapy.

This is why hyperthermia normally is applied during an in-patient stay at the respective center and is possibly combined with further treatment appointments before and after the stay. For this in-patient stay, you need a reimbursement declaration signed by your health insurance (on the admission form of your family doctor).

It is recommended to indicate „performance of a combined tumor therapy“ as reason for the admission on the admission form, i.e. not to mention the term „hyperthermia“ at all, as it raises unnecessary discussions as we know by experience.

Some centers have a special agreement with the insurances about a special fee or a flat rate per case (this however is not so important for you as a patient). The active centers of the IAH will examine the indication for a heat therapy scrupulously and from the standpoint of the orthodox medicine. Therefore most probably the occurring costs will be covered by the cost object and you will not have to confront any further costs.

What is an applicator?

In the framework of hyperthermia, an applicator is a device which is used to induce the energy for the increase of temperature into the patient, respectively into the body area in question. As a rule, these are special antennas or arrays of antennas irradiating electromagnetic waves.

During the local (superficial) hyperthermia, the applicators are positioned on top of the tumor (normally they are coupled with an additional water cushion).
During the deep hyperthermia, the patient is positioned in a ring-shaped applicator and the body area which is to be treated is surrounded from all sides by a water bag (water bolus), which serves to radiate the energy into the body. The pressure of this water bag may be troublesome (see further above).
During the whole-body hyperthermia, the patient is introduced with his whole body into a cabin which is thermically closed as well as possible. This cabin is quipped by infra-red radiators. The head of the patient is outside of this cabin.

What happens during a local hyperthermia?

Local hyperthermia is used to treat superficial tumors. Under certain circumstances, it may be recommended to introduce under local anesthesia (with CT- and ultrasound monitoring) a catheter into the tumor for the temperature taking. This must be discussed with the doctor in attendance.

On the day of the heat therapy, you are comfortably positioned on a stretcher by the help of positioning aids and cushions. The applicator is positioned on the tumor and possibly fixed in this position by further measures. Additionally temperature probes are fixed on different points of the skin. Then the power is switched on and is increased step by step. Normally, there should be no irritations or pain (if there are, the power must be reduced). The desired temperatures are however not always doubtlessly reached during this procedure.

What happens during a regional deep hyperthermia?

As a rule, this therapy is used for a tumor in the pelvis area. Catheters are placed in the rectum, in the vagina and/or in the bladder in which temperature probes can be placed. Then the ring-shaped applicator is positioned over the area which is to be treated. This means that the whole cross-section of the body is surrounded by a ring of antennas. As a next step, the water bolus, surrounding the patient from all sides, is filled with water. The resulting water pressure can cause a certain claustrophobic feeling. When the water bolus is completely filled with water, the power is switched on (several 100 Watts). Slowly, during a period of 10-20 minutes, the tumor is heated up to the desired temperature (41-42 C). Now this temperature must be maintained during approx. 1 hour. In case there should be any discomforts during this time due to local overheatings, there are different measures to eliminate the discomfort (a.o. also the reduction of the power).

What happens during a whole-body hyperthermia?

The whole-body hyperthermia takes place under a high doses of sedativa or under general anesthesia. It is therefore more demanding than the loco-regional therapy procedures.

At the beginning the patient is positioned on the positioning table for the whole-body applicator and is prepared for the treatment. The necessary accesses to the veins (and possibly also to the arteries) are placed by the anesthesist. Then the anesthesia is induced. The further steps, including the positioning of further temperature probes in the lower intestines or in the bladder, are carried out with the patient being unaware.

During a whole-body hyperthermia, it takes 1-2 hours before the desired temperature of 41,5 - 42 C is reached in the whole organism. During another 60 minutes this temperature is maintained. Consequently, the treatment as a whole takes 2-3 hours plus a cooling down phase of approx. 30 minutes (until the temperatures in the body are again under 39 C).

Does the hyperthermia treatment cause pain?

There should be no pain during the local or regional hyperthermia.

In case a local overheating should have happened which causes discomfort or even pain, you must immediately inform the attending physician. He will then see to it that by different means this discomfort or pain is eliminated. Sometimes however, there are troubles caused by the tumor that existed already before the hyperthermia treatment. These troubles can often not be avoided. In that case additional pain killers are administered. The whole-body hyperthermia is carried out with high doses of sedative or under general anesthesia, therefore the patient will not feel any pain.

How long does the hyperthermia treatment take?

The therapeutic time as such is 45-60 minutes. In addition there is a heating-up phase of 10-30 minutes, i.e. the time until the tumor has reached the desired temperature. Therefore you must calculate 60-90 minutes on the whole for the local and regional hyperthermia. Whole-body hyperthermia takes 2-3 hours. After the power is switched off, the temperature in the treated area decreases fairly quickly.

Can I read during the hyperthermia?

It is possible to read a book or a magazin during the hyperthermia. Only few patients use this possibility though.

Am I on my own in the treatment room?

Normally there is either a nurse or a relative of yours in the treatment room at 1-2 m distance. Furthermore it is possible to call the physician or his assistent, who will be all the time nearby. In most centers the treatment cabins have windows facilitating the contact with the outside. That means that during the whole therapy there is a contact with either the members of the treatment team or even with a relative of yours.

What if I can not bear the hyperthermia?

The hyperthermia can immediately be stopped if the patient whishes so. If he wants to stop the treatment, the patient just informs the attending physician or the nurse. This happens very rarely, however.

How often is a hyperthermia carried out?

Typically a hyperthermia takes place 1-2 times a week. Radiations are normally carried out on a daily basis (i.e. 5 times a week). Some treatment schemes with chemotherapy are carried out once a week with hyperthermia. As a general rule, hyperthermia is not applied more often than twice a week.

Can I be healed by hyperthermia?

Hyperthermia is used especially for very advanced tumor diseases or tumor relapses (recurrences) or unresponsive (therapy-resistent) tumors. A healing of these tumor diseases is not very probable, as already conventional therapy methods have failed to cure or master the disease.

However, hyperthermia can contribute to stabilize the current state of illness for a fairly long period of time. We recommend that you discuss the profit and the chances of the treatment in detail with your attending physician.