Hyperthermia (HT) which can be directly cytotoxic to cancer cells, impairs the synthesis of cellular proteins : if not properly chaperoned by heat shock proteins (HSP), this can lead to irreversible and toxic protein aggregates. Clinically, it is preferred to use HT in combination with radiation therapy and chemotherapy. Although the combination of thermoradiotherapy has been widely studied, much attention has recently been focused on the search for compounds which can sensitize tumor cells to HT damage, but at the same time lead to minimal damage to normal cells. Synergy between HT and drugs may be caused by the occurrence of multiple events such as HT damage to ATP-binding cassette transporters, intracellular drug detoxification pathways, and the reparability of drug-induced DNA adducts. This may be why cells with acquired drug resistance (often multi-factorial) can be made responsive to drugs again by the combination of a drug exposure in conjunction with HT. In this review, the mechanism of HT-induced apoptosis and compounds which can sensitize cancer cells to HT-induced apoptosis are discussed.

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The mechanism involved in the potentiation of cell killing and antitumor activity which result from combined treatments with hyperthermia and chemotherapeutic drugs is believed to be an increase in DNA damage caused by an increase in drug uptake. These events can be brought about by the disruption of membrane permeability by hyperthermia. It has recently been suggested that the contribution of reactive oxygen species (ROS) to the cytotoxic activity of anti-cancer drugs may be important in combined treatments utilizing hyperthermia and chemotherapeutic drugs. The present review examines the possibility that ROS, generated from chemotherapeutic drugs or by interactions between chemotherapeutic drugs and biomaterials or hyperthermia, may make a major contribution to the potentiation of cell killing and antitumor activity in thermochemotherapy.

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This report discusses a patient with malignant fibrous histiocytoma (MFH) who was successfully treated with thermo-radiotherapy. The patient was treated with 48 Gy of radiotherapy and 4 sessions of hyperthermia. He displayed a tumor on his shoulder which reached a maximum size of 13 cm. The tumor size gradually decreased after the end of the treatments, and 5 months later the tumor had completely disappeared. There has been no recurrence for 18 months.

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Traditionally, the treatment of choice for uterine fibroids has been watchful waiting or surgery. Recently, thermal ablation of uterine fibroids has been shown to be an effective alternative treatment. One of these ablation techniques, high intensity focused ultrasound (HIFU) which allows radiation-free treatment, has been used for the treatment of uterine fibroids. The aim of this study was to observe the efficacy and safety of HIFU used for the treatment of uterine fibroids. Fifty-two patients with uterine fibroids were treated with HIFU with ultrasound guidance. Clinical outcomes, ultrasound results, improvement of symptoms, and complications were reviewed. Follow up evaluations were obtained, when possible, at 3, 6, 12, 24, 36 months after HIFU therapy (mean, 20 months). Symptoms were improved in all patients. Seventy-nine percent (41/52) of the treated patients showed either obvious or partial improvements in their symptoms. After HIFU treatment, blood flow in the uterine fibroids was reduced or was even completely blocked judging from imaging examinations. All uterine fibroids decreased in volume at a few months to three years after treatment. No severe complications were observed after HIFU ablation. The only complication was skin burn, which was usually resolved with conservative treatment. Two women underwent hysterectomies during the follow-up period. This study demonstrates that ultrasound-guided HIFU can be a valuable therapy for women with uterine fibroids.

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