Prien, Germany Travel is broadening, they say, and nowhere more so than in the comparison of innovative medical treatments. I am here in Germany to visit cancer clinics that use various unconventional methods. As I complete this two week tour of German and Swiss cancer clinics, I am struck by the degree to which certain treatments are viewed as fairly routine in this part of the world but are considered daringly "alternative" in other parts, particularly the US. The gap is glaring in the case of hyperthermia, i.e., the heating of tumors in order to take advantage of their sensitivity to the effects of higher temperatures.
Germany and the US each pioneered the use of hyperthermia in treating cancer. Germany had the Manfred von Ardenne Institute in East Germany, where scientists worked out the physics of delivering heat to tumors. But the US, too, was a leader. I remember an exciting article on the topic in 1976 in the Journal of the American Medical Association (JAMA), where the authors reported using sound waves to heat animal and human tumors by 5° to 9.5° C. They were able to "eradicate" animal cancers without destroying normal tissue. They reported: "Radiofrequency therapy produced tissue necrosis or substantial regression of cancer in 21 patients" (LeVeen 1976). When ultrasound waves were directed at a malignant lung, the tumor was superheated to 106° to 107° F, but the healthy tissue was cooled by normal blood circulation and protected from harm (New York Times, Jan. 7, 1997).
As a young science writer at Memorial Sloan-Kettering Cancer Center, I nervously phoned the lead author of that piece, Harry H. LeVeen, MD, chief of surgery at the Veterans Affairs Medical Center in Brooklyn. Dr. LeVeen assured me that hyperthermia would soon be accepted as a "fourth modality" in cancer therapy (after surgery, radiation and chemotherapy). And that was over 30 years ago! Almost half the population of the US wasn't even born when LeVeen made these predictions and, needless to say, hyperthermia is still not available for the vast majority of US patients.
In the US, hyperthermia is still struggling for recognition and acceptance. Some oncologists seem unaware of developments in continental Europe, Asia or other parts of the world. In Germany and its neighbors, however, hyperthermia is recognized as a useful adjuvant treatment for selected cancers.
If you put the search terms "thermotherapy" (a more precise term for hyperthermia) and "cancer" into the PubMed article database, you come up with about 8,500 articles. Of these, 158 refer to randomized clinical trials. You can sample these articles to see the potential power of adjuvant hyperthermia. For example, in Guangzhou, China (a city I enjoyed visiting last year), interventional radiologists added hyperthermia to other therapies in the treatment of primary liver cancer. The three-year survival with the standard treatment was 23 percent. But when hyperthermia was added it was 51 percent (Lu 2008). This is representative of numerous articles on the clinical effects of hyperthermia, which sometimes doubles the effectiveness of more conventional treatments.
The BSD Medical Corporation, based in Salt Lake City, makes heroic efforts to gain acceptance for hyperthermia in the US. In May they attained a Humanitarian Use Device (HUD) designation for the Company's BSD 2000 Hyperthermia System for use in conjunction with radiation therapy for the treatment of some cervical carcinoma patients. Following receipt of this designation, the Company has filed for a Humanitarian Device Exemption (HDE) from the Food and Drug Administration (FDA), which is currently under review. But try to get hyperthermia treatment in an American hospital and you will mostly experience frustration.
Last week I wrote about how America helped introduce the use of hyperthermia...and then failed to adopt its use in a widespread way. America innovates well, but frequently drops the ball when it comes to implementation. For example, on September 15, 2009, New York Times columnist Thomas L. Friedman wrote a perceptive column on how one American company had invented new machinery to manufacture solar energy panels. The company now has 14 factories around the world, including five in Germany and four in China. But none are in the USA, where the company is based. "Invented here, sold there," is America's slogan, says Friedman. Germany, in particular, generates almost half the renewable energy in the world and is making itself the "world-center for solar research, engineering, manufacturing and installation." This has added 50,000 new German jobs, making renewable energy its second largest industry after auto. (I saw solar panels on south-facing roofs everywhere I traveled in Germany.)
I would suggest that the same thing is happening with hyperthermia. Americans have figured out how to pair the BSD's hyperthermia equipment to GE Healthcare 1.5 Tesla magnetic resonance (MR) imaging system for precise hyperthermic targeting of tumors. A prototype was recently installed at Duke University School of Medicine in North Carolina. This can be electronically focused to target the three-dimensional shape, size, and location of the tumor and provide a dynamic form of control over the heat delivery. Good for Duke! Such systems will no doubt become the wave of the future. But let me make a prediction. Do not expect to see such devices coming to a typical American cancer center any time soon. If you want to have a reasonable chance of adding hyperthermia to your own treatment program you will still have to go to Germany, China or some other country that welcomes innovation. "Invented here, sold there" is America's rule in complementary medicine as well.
- Friedman, Thomas L. Have a nice day. New York Times, September 19, 2009.
- LeVeen HH, Wapnick S, Piccone V, Falk G, Ahmed Nafis. Tumor eradication by radiofrequency therapy. Responses in 21 patients. JAMA. 1976;235:2198-200.
- BSD Medical's Web site is BSD Medical
Hyperthermia Information: Dr. Ralph W. Moss 2/8/2010 - A Big Boost For Hyperthermia - Part I
Hyperthermia Information: Dr. Ralph W. Moss 2/14/2010 - A Big Boost For Hyperthermia - Part II
Hyperthermia Information: Dr. Ralph W. Moss 9/26/2010 - Hyperthermia Making Progress In Texas
Hyperthermia Information: Natural News 12/23/2010 - Heat Treatments Can Literally Destroy Cancer Overnight