Missing guidelines

Demand to regulate oncologic hyperthermia

Unlike the USA, Italy, Germany or the Netherlands, Spain does not include hyperthermia in its national health catalogue. Worse, many non-medical centres are increasingly offering hyperthermia as an alternative treatment, a situation that infuriates Spanish oncologic radiotherapists.

Portrait of Jorge Contreras
Jorge Contreras

The Spanish Society of Radiotherapy and Oncology  (SEOR), representing over 1,000 of radio-therapists, is pushing for  guidelines to regulate the use of oncologic hyperthermia and include it  in cancer radiation therapy routine. ‘Having a regulatory framework is the only way we  can avoid proliferation of such centres. Oncologic hyperthermia must be  indicated, controlled and supervised by oncologic radiation therapists;  they are the only people who can prescribe and apply it. Hyperthermia  can be an asset when combined with other conventional treatments, such  as surgery, radiotherapy and chemotherapy,’ explained Jorge Contreras,  director of Magna Clinic Marbella and coordinator of the SEOR working  group on hyperthermia.

Hyperthermia is relatively easy to produce and  administer; basic equipment used in physiotherapy or cosmetics can  produce hyperthermia, which is why many non-medical centres can offer  hyperthermia as an alternative medicine. However, the only guarantee the treatment will  work is when oncologists control the whole process, Contreras said.  ‘When hyperthermia is applied without knowing the full treatment  combination, therapy may not be successful. Then there’s    a risk of  strengthening secondary effects induced by treatment instead of  improving it.’ The goal of hyperthermia is to boost treatment  effect and immune system response. It can also improve blood flow and  muscle relaxation, and alleviate symptoms.

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International studies are starting to show that  hyperthermia can improve treatment of breast cancer, soft tissue  sarcoma, colorectal and pancreas cancer, and brain and head and neck  tumours, such as larynx and oral cavity tumours. Researchers are also  working on validating hyperthermia in other applications – prostate  cancer, central nervous system tumours, e.g. multiform glioblastoma,  lung cancer. 

Contreras plans to use these results to foment  guidelines. But he insisted on the value of conducting such studies in  Spain as well. He deplores this fact: ‘The lack of nationwide-scale  studies in our country does not help.’ The technique was only introduced last year in  Spain, but only  a few hospitals so far offer hyperthermia and have the  right personnel. 

Other challenges of radiation cancer therapy, a  subspecialty recognised over 40 years ago in Spain, include better  equipment and personnel distribution countrywide, and wider access to  technologies, such as proton therapy. Only tertiary centres in Madrid,  Barcelona and Valencia have all the latest available technology.  Aditionally, projects to include proton therapy in the nation’s health  service catalogue are underway. 

Proton therapy enables tumour treatment more  locally and more radiation dose while reducing secondary effects. All  especially useful for  brain tumours, medullar cancer and tumours in  delicate areas.  However, most tumours are not that localised, Contreras  pointed out. ‘95% of tumours can be treated with currently available  technology.’


Profile:

Jorge Contreras is Radiation  Oncologist and Head of Training at Carlos Haya Hospital in Malaga. He  also sits on the tumour board and is president of the head and neck  tumour board. He is part of many scientific societies including the  Spanish Association of Radiation Oncology, the European Society for  therapeutic Radiology and Oncology (ESTRO), and the American Society for  therapeutic Radiology and Oncology (ASTRO). In addition, he coordinates  the group for the Development of Hyperthermy in Oncology of the Spanish  Society of Radiation Oncology.

04.08.2017

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