Two years ago, doctors told Lisa Ridgeway she had triple negative breast cancer, a very aggressive disease with no cure.
“There are not a lot of drugs that work, or work for a long period of time,” Ridgeway told Ivanhoe.
The mom of two was facing a typical life expectancy of just three years.
“That’s a mom’s horror story, knowing that you aren’t going to be here,” she said.
Lisa had surgery, radiation, and chemo, but her cancer came back two more times. Now she’s trying something new.
Doctors at the Cleveland Clinic are offering patients hyperthermia treatment.
“Hyperthermia is heat therapy. It’s actually been around since the time of the Egyptians,” Jennifer Yu, MD, Radiation Oncologist at Cleveland Clinic, told Ivanhoe.
A hot bag is placed on top of the skin. A microwave unit heats the bag and the tissue under it to about 110 degrees. The heat increases blood flow and makes tumors more sensitive to radiation.
“And it improves cell kill,” Dr. Yu said.
In one study, 66 percent of cancer patients who had hyperthermia and radiation had their tumors shrink completely compared to just 42 percent who had only radiation.
Lisa hopes the treatment will give her more time.
“My choice is I want to live,” she said.
Dr. Yu says there are about 10 centers around the country using hyperthermia for breast cancer. Typically, treatments last one hour and are performed one to two times a week. Hyperthermia is also used in other cancers such as melanomas, gynecologic cancers, and head and neck cancers.
BACKGROUND: Breast cancer refers to when cancer forms somewhere in breast tissue, commonly beginning in the lining of the milk ducts. Breast cancer can also originate in the milk glands, called lobules, and is considered to be invasive when the cancer spreads to surrounding healthy tissue from where it first began. With more than 200,000 new cases diagnosed in 2013 alone, breast cancer is one of the most common cancers in women. Men can also have breast cancer, but it is highly unusual and only 2,240 men were diagnosed with the disease in 2013. (Source: http://www.cancer.gov/cancertopics/types/breast)
RISK FACTORS: Certain lifestyle choices and hereditary factors can raise women’s risk of developing breast cancer. In particular, women with the BRCA1 and BRCA2 genes have a significantly higher likelihood of breast and ovarian cancer. Women now have the choice of being tested for these genes so that they can take preventative measures. Starting your period before age 12 or menopause after age 55 can also raise women’s risk and the likelihood of breast cancer is naturally higher as women age. While these risk factors are out of people’s control, women can control other factors such as weight, alcohol consumption, and use of birth control. (Source: http://www.nlm.nih.gov/medlineplus/breastcancer.html)
NEW TECHNOLOGY: Doctors now have a new option to help treat breast cancer called hyperthermia. Essentially a heat therapy, hyperthermia is used in conjunction with chemotherapy to help kill cancer cells. A bag is placed over the tumor, and microwaves heat it up to about 110 degrees. The heat improves blood flow in and around the tumor, allowing the radiation to target cancer stem cells which help the tumor grow. Generally patients receive one to two one hour long hyperthermia treatments a week, along with their radiation treatments. (Dr. Jennifer Yu, http://www.cancer.gov/cancertopics/factsheet/Therapy/hyperthermia)
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Jennifer Yu, M.D., Radiation Oncologist at Cleveland Clinic, talks about a new hyperthermia technique that could revolutionize the way doctors treat cancer.
It seems now we are hearing of new very individualized, personalized ways to treat breast cancer, that the case?
Dr. Yu: That is the case. Here at the Cleveland Clinic, we have a particular modality called hyperthermia which is heat therapy which can be used in conjunction with radiation in particular, for a subset of patients that have recurrent breast cancer. These are patients who have had prior radiation but now have the recurrent disease that has come back locally within their breast or within their chest wall and now need additional radiation therapy.
Does it replace chemotherapy?
Dr. Yu: It does not replace chemotherapy, but it’s used in conjunction with radiation, so that we can improve the efficacy of radiation. Chemotherapy is often used subsequently or used prior to radiation and hyperthermia. The purpose of the chemotherapy really is to combat the disease that has spread to other parts of the body. The radiation and hyperthermia is focused on a particular area so that we can palliate symptoms such as fungating breast tumors that are bleeding or foul smelling with discharge. Having a recurrent type of breast cancer especially one that you can see has a lot of psychological toll on patients; developing ways to treat these effectively is important.
What is hyperthermia?
Dr. Yu: Hyperthermia is heat therapy. It’s actually been around since the time of the ancient Egyptians and has been used a modality to either treat diseases by itself or used in conjunction with other types of therapies. Mostly hyperthermia has been used with radiation to improve the efficacy of the radiation.
So, how does it work?
Dr. Yu: Hyperthermia treats tissues to 109 to 110° Fahrenheit and it improves cancer cell death.
So it helps kill cancer?
Dr. Yu: That’s correct.
In a way microwaves it?
Dr. Yu: Not quite. We do use microwaves to heat the tumor. Hyperthermia also improves blood flow and boosts the immune system to fight the cancer. It can also help to target a different population of cancer cells such as the cancer stem cells that are responsible for repopulating the tumor. These cells are highly resistant to traditional radiation, so using the hyperthermia plus the radiation helps us to kill off these cells in addition to the rest of the tumor, the bulk of the cancer cells.
How does this work? How do you do it physically?
Dr. Yu: Physically, we use microwave technology to heat up the breast or other tissues that we are treating.
And so is it a laser? I’m trying to visualize it here.
Dr. Yu: It’s a noninvasive technology to heat up the skin and deeper tissues.
So could I go home and buy a heat pack and just lay it on my breast to help kill things?
Dr. Yu: No, it’s important to have quality controls to make sure that you’re heating the tissues properly and not overheating tissues. It has minimal effect on its own and should be used with radiation.
What happens if you overheat it?
Dr. Yu: If you overheat, some patients can develop blisters. They can develop ulcerations of their skin.
Is it every day for a week? Is it once a month? Is it when you are getting radiation?
Dr. Yu: We use it in conjunction with radiation. Typically patients will receive one to two hyperthermia treatments per week with the radiation.
And so how long does it stay on you?
Dr. Yu: We treat for an hour.
Have you seen promising results from it?
Dr. Yu: There are several phase III clinical trials. These are randomized trials that have shown the benefits of hyperthermia plus radiation compared to radiation alone.
And can you elaborate on any of those types of studies?
Dr. Yu: Those studies have consistently shown that with the combination of hyperthermia plus radiation we are able to achieve better control of the tumors.
I’d have to think for most patients like this is actually a no brainer. It’s not like there is a big risk to it going into it?
Dr. Yu: I think the biggest question is deciding whether or not to re-irradiate. So for a patient who has had prior radiation, is the timing right to repeat the radiation? Because repeat radiation does have its own side effects. When we do decide that repeat radiation is the best treatment modality for this particular patient at this time then we’ll add the hyperthermia on top.
And can this hyperthermia be used for several different cancers?
Dr. Yu: It can. It has been used for melanoma, it has been used for some recurrent head and neck cancers, and for gynecologic cancers as well. There are additional studies going on looking at it in terms of GI cancers, pancreatic cancers, rectal cancers, and anal cancers, for example.
So what does this look like?
Dr. Yu: Patients come in and they lie on a gurney, then a heating pad, a hot water bag essentially, is placed on top of the area that we want to treat. We also apply a microwave system or a microwave unit on top of that water bag, so that we can heat the tissues a bit deeper. There are a few centers in the country that have the capability to do hyperthermia. We are one of the few centers in the entire country that can do this and the only center in Ohio.
Do you know how many a few are?
Dr. Yu: Maybe 10? I’m not sure. I’m not sure how many active ones there are but there are less than 10 active academic places in the country that participate in the Society for Thermal Medicine meetings.