Prien, Germany — Travel is broadening, they say, and nowhere more so than in the comparison of innovative medical treatments. I am here in Germany to visit cancer clinics that use various unconventional methods. As I complete this two-week tour of German and Swiss cancer clinics, I am struck by the degree to which certain treatments are viewed as fairly routine in this part of the world but are considered daringly "alternative" in other parts, particularly the US. The gap is glaring in the case of hyperthermia, i.e., the heating of tumors in order to take advantage of their sensitivity to the effects of higher temperatures.

Germany and the US each pioneered the use of hyperthermia in treating cancer. Germany had the Manfred von Ardenne Institute in East Germany, where scientists worked out the physics of delivering heat to tumors. But the US, too, was a leader. I remember an exciting article on the topic in 1976 in the Journal of the American Medical Association (JAMA), where the authors reported using sound waves to heat animal and human tumors by 5º to 9.5º C. They were able to "eradicate" animal cancers without destroying normal tissue. They reported: "Radiofrequency therapy produced tissue necrosis or substantial regression of cancer in 21 patients" (LeVeen 1976). When ultrasound waves were directed at a malignant lung, the tumor was superheated to 106 to 107º F, but the healthy tissue was cooled by normal blood circulation and protected from harm (New York Times, Jan. 7, 1997).

As a young science writer at Memorial Sloan-Kettering Cancer Center, I nervously phoned the lead author of that piece, Harry H. LeVeen, MD, chief of surgery at the Veterans Affairs Medical Center in Brooklyn. Dr. LeVeen assured me that hyperthermia would soon be accepted as a "fourth modality" in cancer therapy (after surgery, radiation and chemotherapy). And that was over 30 years ago! Almost half the population of the US wasn't even born when LeVeen made these predictions and, needless to say, hyperthermia is still not available for the vast majority of US patients.

In the US, hyperthermia is still struggling for recognition and acceptance. Some oncologists seem unaware of developments in continental Europe, Asia or other parts of the world. In Germany and its neighbors, however, hyperthermia is recognized as a useful adjuvant treatment for selected cancers.

If you put the search terms "thermotherapy" (a more precise term for hyperthermia) and "cancer" into the PubMed article database, you come up with about 8,500 articles. Of these, 158 refer to randomized clinical trials. You can sample these articles to see the potential power of adjuvant hyperthermia. For example, in Guangzhou, China (a city I enjoyed visiting last year), interventional radiologists added hyperthermia to other therapies in the treatment of primary liver cancer. The three-year survival with the standard treatment was 23 percent. But when hyperthermia was added it was 51 percent (Lu 2008). This is representative of numerous articles on the clinical effects of hyperthermia, which sometimes doubles the effectiveness of more conventional treatments.

The BSD Medical Corporation, based in Salt Lake City, makes heroic efforts to gain acceptance for hyperthermia in the US. In May they attained a Humanitarian Use Device (HUD) designation for the Company's BSD-2000 Hyperthermia System for use in conjunction with radiation therapy for the treatment of some cervical carcinoma patients. Following receipt of this designation, the Company has filed for a Humanitarian Device Exemption (HDE) from the Food and Drug Administration (FDA), which is currently under review. But try to get hyperthermia treatment in an American hospital and you will mostly experience frustration.

TO BE CONCLUDED, WITH REFERENCES, NEXT WEEK

--Ralph W. Moss, Ph.D.

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