Adding Hyperthermia to Chemotherapy Increased Survival in Sarcoma

Preoperative tumor-shrinking (neoadjuvant) chemotherapy combined with regional hyperthermia prolonged survival in soft tissue sarcoma patients, according to a study in JAMA Oncology published in February 2018.

What Is Sarcoma?

Sarcomas develop in the body’s soft tissues, such as muscle, fat, tendons and blood vessels, and are rare cancers, accounting for less than 1% of all cancers. Soft tissue sarcomas have many subtypes, few effective drugs and treatment outcomes that are often less encouraging than desired. The intensive search for new, effective treatments has therefore continued for a long time. For sarcomas without metastasis to other organs and confined to their original area (localized), preoperative or postoperative radiotherapy combined with surgery is considered standard treatment. International guidelines recommend chemotherapy before or after surgery as an option for patients considered high-risk because of large tumor size, high grade or location.

• What is hyperthermia - heat treatment? Does it have a role in cancer treatment?

Aiming to heat the target tumor to 40 – 43 degrees, hyperthermia, also called thermotherapy , has been shown in numerous previous scientific studies to enhance chemotherapy and radiotherapy in some cancers and stimulate immunity, acting somewhat like immunotherapy.

To evaluate hyperthermia in soft tissue sarcoma, this open-label phase 3 clinical trial enrolled 341 high-risk patients with early-stage disease whose locally advanced tumors could not be operated on immediately.

Patients were divided into 2 groups: one received 4 cycles of standard neoadjuvant chemotherapy (doxorubicin, ifosfamide and etoposide), while the other received chemotherapy plus regional hyperthermia.

According to the Study Results:

• Patients were followed for a median of 11.3 years.
• Cancer recurred in 67% (220 patients), and 57% died (188 patients).
• Regional disease control with treatment (local progression-free survival) was 35% better with hyperthermia plus chemotherapy than chemotherapy alone.
• Most importantly, hyperthermia plus chemotherapy significantly prolonged overall survival in 27% of patients.
• With hyperthermia plus chemotherapy, 5-year survival was 63%, compared with 51% for chemotherapy alone; 10-year survival was 53% versus 43%.

The study was stopped because chemotherapy alone did not demonstrate a significant contribution to survival.

In conclusion, adding regional hyperthermia appears to be an effective option for soft tissue sarcoma patients requiring neoadjuvant treatment.