Conference Papers in Science

Conference Paper

Critical Analysis of Electromagnetic Hyperthermia Randomized Trials: Dubious Effect and Multiple Biases

Table 17

The contradictions of the classical theory of hyperthermia and data of randomized clinical trials.


	Hyperthermia theory	Premise	Hypothesis	In fact

1	HT is the most effective in hypoxic areas	Large tumors are mainly hypoxic	Effect of HT should be much stronger in large tumors	Effect of HT is much weaker in large tumors [5, 7, 11]
2		Large tumors are easier to heat	Effect of HT should be much stronger in large tumors	Effect of HT is much weaker in large tumors [5, 7, 11]
3	Higher temperature means stronger effect	In van der Zee et al. trial [21], average temperature in cervix was <40°C and near 1°C lower than in rectum and bladder [37]	Effect of HT in cervix cancer should be worse than in rectum and bladder cancer	Effect of HT in cervix cancer was much stronger than in rectum and bladder cancer [21]
4	Higher temperature means stronger effect	In Vasanthan et al. trial [15], the average temperature in cervix was >41°C	Effect of HT in Vasanthan et al. [15] trial should be stronger then in van der Zee et al. [21]	Effect of HT in Vasanthan et al. trial was much worse [15, 21]
5		In Vasanthan et al. trial [15], the average temperature in Chennai group was 41.8°C and in Pusan group only 38.1°C	Effect in Chennai group should be much stronger (see Figure 13)	2-year local control was the same [15]
6	HT promotes cell cycle synchronization, thus enhancing the effect of RT	If exists, the synchronization should progress with more sessions	The more the HT sessions are, the stronger the effect should be	Effect of multiple HT sessions is not stronger [8, 9]
7	Hyperthermia damages tumors or enhances the RT damage of malignant tissues	If exists, the damage should accumulate		Effect of multiple HT sessions is not stronger [8, 9]
8	Moderate HT (<42°C) leads to enhancement of tumor blood flow and oxygenation	Overwhelming majority of trials use HT after RT	Use of HT after RT is not effective because of insufficient temperature and could compensate RT damaging by improving tumor metabolism in view of better blood flow and oxygenation	Thermoradiotherapy trials are mainly unsuccessful [5, 7–9, 15, 20, 22], but some of them show remarkable success [11, 24]
9	Extreme HT (≥42°C) leads to hypoxia, acidosis, and energy deprivation	Average maximum temperature in tumor never exceeds 42°C
10	Thermal dose (CEM43°C ) is a main factor of HT success	Thermal dose is a temperature multiplied to duration of exposure	Higher temperature should provide stronger effect	Higher temperature does not mean stronger effect (rows 2–5)
11	Thermal dose (CEM43°C ) is a main factor of HT success		Longer exposure to heat should provide stronger effect	Effect of multiple HT sessions is not stronger [8, 9]