Oncological hyperthermia: The correct dosing in clinical applications

Lee,Sun-Young; Szigeti,Gyula   Peter; Szasz,Attila  Marcell

doi:10.3892/ijo.2018.4645

Oncological hyperthermia: The correct dosing in clinical applications

Authors:
- Sun-Young Lee
- Gyula Peter Szigeti
- Attila Marcell Szasz
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Affiliations: Department of Radiation Oncology, Chonbuk National University Hospital-Chonbuk National University Medical School, Jeonju, Jeonbuk 561-712, Republic of Korea, Institute of Human Physiology and Clinical Experimental Research, Semmelweis University, 1083 Budapest, Hungary, Cancer Center, Semmelweis University, 1083 Budapest, Hungary
Published online on: November 23, 2018 https://doi.org/10.3892/ijo.2018.4645
Pages: 627-643
Copyright : © Lee et al. This is an open access article distributed under the terms of Creative Commons Attribution License [CC BY 4.0].

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Abstract

The problem with the application of conventional hyperthermia in oncology is firmly connected to the dose definition, which conventionally uses the concept of the homogeneous (isothermal) temperature of the target. Its imprecise control and complex evaluation is the primary barrier to the extensive clinical applications. The aim of this study was to show the basis of the problems of the misleading dose concept. A clear clarification of the proper dose concept must begin with the description of the limitations of the present doses in conventional hyperthermia applications. The surmounting of the limits the dose of oncologic hyperthermia has to be based on the applicability of the Eyring transition state theory on thermal effects. In order to avoid the countereffects of thermal homeostasis, the use of precise heating on the nanoscale with highly efficient energy delivery is recommended. The nano‑scale heating allows for an energy‑based dose to control the process. The main aspects of the method are the following: i) It is not isothermal (no homogeneous heating); ii) malignant cells are heated selectively; and iii) it employs high heating efficacy, with less energy loss. The applied rigorous thermodynamical considerations show the proper terminology and dose concept of hyperthermia, which is based on the energy‑absorption (such as in the case of ionizing radiation) instead of the temperature‑based ideas. On the whole, according to the present study, the appropriate dose in oncological hyperthermia must use an energy‑based concept, as it is well‑known in all the ionizing radiation therapies. We propose the use of Gy (J/kg) in cases of non‑ionizing radiation (hyperthermia) as well.

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