1) Comment by Notter et al. on Kronenfeld et al. 2021, published in Cancers and proposal of international cooperation on treatment strategies for radiation-associated angiosarcoma of the breast
Almost simultaneously with the article „Notter M et al: Radiation-Associated Angiosarcoma of the Breast and Chest Wall Treated with Thermography-Controlled, Contactless wIRA-Hyperthermia and Hypofractionated Re-Irradiation, Cancers 2021, 13(15), 3911”,
In this paper, the importance of neoadjuvant systemic therapies is emphasised.
Complementing the very interesting data of Kronenfeld et al., Notter et al. emphasise in a comment the necessity of effective local therapy by means of combined hyperthermia and re-irradiation. This is especially true in the following cases:
• a complete surgical removal with wide resection margins could not be achieved
• the expected toxicity of systemic therapies does not seem acceptable due to age and comorbidities
• local recurrence.
Notter et al. propose an international collaboration to review existing and develop new therapeutic approaches for radiotherapy-induced angiosarcoma of the breast.
2) ICHO congress DIGITAL October 2021: Review I - Superficial hyperthermia with re-irradiation
Superficial hyperthermia combined with re-irradiation:
Akke Bakker (UMC Amsterdam) had shown in a systematic review a positive correlation of temperature and thermal dose with clinical outcome in inoperable local recurrences of breast cancer ("macroscopic disease"). In a new retrospective analysis of 112 patients treated postoperatively in Amsterdam ("microscopic disease"), local control after 3 years was 92% in the group with a higher thermal dose and 74% with a lower thermal dose. Akke Bakker suggested invasive temperature measurement as quality assurance even in routine use. Markus Notter showed from the 170 "macroscopic disease" patients published in Cancers in 2020, a subgroup of 39 patients with lesions deeper than 15mm, where the intratumoral temperatures achieved are usually below 40°C. Surprisingly, this subgroup did not show a worse response to therapy than the overall group.
One explanation could lie in the sequence and timing of the combined HT/re-RT. In all 170 patients, HT was performed before re-RT, and the time gap between HT and re-RT was just a few minutes. At this, oxygenation of hypoxic areas may play a greater role in radiosensitisation. This mechanism is already stimulated from about 39°C and too high temperatures (from about 43°C) can even be counterproductive. In almost all of the studies on which the review by Bakker et al. was based, the sequencing was reversed and the time interval between re-RT and HT was much longer. Here, the most important radiosensitising mechanism may be inhibition of DNA repair, which requires temperatures > 41°C.
Thomsen presented new measurements from the University Medical Center Freiburg on the increase in pO2 caused by wIRA irradiation in healthy volunteers: For example, at a depth of 13mm, the pO2 value increased from 46 to 81 mmHg and was still 72 mmHg 15 minutes after the end of wIRA irradiation.
The review of the ICHO regarding whole-body hyperthermia will follow in the next heckelnews shortly before Christmas.
3) Hyperthermia congress of the German Society for Hyperthermia (DGHT), March, 11-12, 2022 in Frankfurt/M
Programme and registration of the DGHT Congress 2022 are available at
At the DGHT General Assembly during the Medizinische Woche Baden-2021, it was decided that Posters can still be submitted. It would be very helpful if this tool is frequently used especially for smaller evaluations and case reports.
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