• 7/17/2006
  • Long Beach, CA
  • Phillip Zonkel
  • Long Beach PressTelegram.com

Sabrina Mansfield is receiving her final hyperthermia treatment a therapy designed to kill her aggressive and recurrent cancer.
She has seven catheters in her neck and head. Each one beams microwave energy to heat a precise location of her cancer-riddled tissue.

When this heating is combined with radiation or chemotherapy, it increases the success rate of these therapies for eradicating cancer cells, according to recent research.

“We needed to be extremely aggressive with Sabrina’s treatment,” says Dr. Behrooz Hakimian, Mansfield’s radiation oncologist at Cedars-Sinai Medical Center, who recommended the combination therapy. “She probably had one chance of treatment at this point. I wanted her to have the best treatment.”

Mansfield received her treatment from Dr. Nisar Syed, director of radiation oncology at Long Beach Memorial Medical Center, who is considered a leader in the field of hyperthermia. Syed has been administering the procedure for more than 22 years and has treated more than 3,000 patients. Of Syed’s patients, he says approximately 25 percent had recurrent cancer after treatment.

“Dr. Syed has the most experience in Southern California, if not on the West Coast, in using hyperthermia,” Hakimian says. “He’s magical with his hands.”

Hyperthermia works on selected cancers: head and neck, tongue, throat, cervix, prostate, melanoma, sarcoma and breast cancer on the chest wall. They can be locally advanced tumors that have not metastasized or recurrent cancers that have been treated with surgery, chemotherapy and/or radiation. Sixty-five percent of Syed’s patients had head and neck cancers, ones similar to Mansfield’s.

In 1992, one of Syed’s former patients had a large recurrent tumor on her right neck (similar to Mansfield’s) and tonsils removed. She received several hyperthermia-radiation treatments and has been cancer free for 14 years.

Syed is optimistic about Mansfield’s prognosis.

“Sabrina will respond very well,” he says. “She has hope.”

Before receiving hyperthermia, Mansfield says, the past 12 months were a long nightmare.

In June 2005, the 29-year-old Sherman Oaks resident had two malignant tumors removed (one from her tongue and one from her right neck) and then underwent two months of chemotherapy and a full dose of IMRT radiation.

The treatments were grueling. The chemotherapy made her nauseous. The radiation gave her severe mouth infections and an excruciating sore throat that prevented her from talking or eating for a month, causing severe malnutrition. The radiation also made her so weak she could barely stand.

It took Mansfield eight weeks to recover from the toxic side effects.

Then, in March, Mansfield found a large, ominous mass under her right jaw, the same location as her previous tumor.

“It felt like a tennis ball was pushing its way out,” she says.

The growth was removed and tested malignant Mansfield’s cancer had returned.

“I was pretty upset. I had to go through all that treatment and it wasn’t effective,” she says. “That was one of the most miserable experiences in my life.”

That was when she was sent to Dr. Syed for hyperthermia treatment, which has less painful side effects.

The procedure involves slowly raising the temperature of tumors and surrounding tissue to anywhere from 105 to 108 degrees Fahrenheit for 30 to 60 minutes. Patients often feel warm (comparable to a high fever), but the most significant side effect is a small (1 inch or less in area) burn on the skin.

The heat is administered in different ways, including beaming microwaves onto tumors near the skin’s surface or inserting catheters that emit microwaves into the tumor itself or the affected organ.

Hyperthermia, which can be given before or after the radiation, boosts the killing power of radiation and chemotherapy by up to 10 times. When the tumor reaches the desired temperature, it’s blasted with chemotherapy or radiation.

Hyperthermia increases blood and oxygen circulation within the tumor, making a smaller dose of radiation or chemotherapy more effective. That lower dosage is important to patients with recurrent cancer; their body can tolerate only so many rounds of radiation before it damages or even destroys healthy tissue or bone surrounding the cancer.

Radiation therapy works best on cells with high amounts of oxygen, while hyperthermia is most effective against oxygen-starved cells. This one-two punch is designed to kill all the cancer cells.

The heat triggers a series of physiological events that are critical to the tumor’s demise. The blood vessels leak more than normal blood vessels, and heat opens them wider, enabling chemotherapy and radiation to penetrate more effectively and kill the cells.

Heat also increases a tumor’s level of oxygen, a critical element to the proper functioning of radiation and chemotherapy inside a cell.

Finally, heat amplifies the level of DNA damage that chemotherapy and radiation inflict upon the cancer cells. It prevents enzymes from repairing the damaged cancer cells.

Hyperthermia is not a new treatment. Writings from the ancient Egyptians maybe the world’s first oncologists claim they used an instrument called a “fire drill” to treat breast cancer. Hippocrates, the father of medicine, is credited with the saying, “What is not cured by the knife may be cured by fire.”

More than 100 years ago, American surgeon Dr. William B. Coley noticed some cancer patients, who also had high fevers from bacterial infections, had their tumors shrink. He began actively inducing fevers to cancer patients by infecting them with bacteria with similar results. But the treatment was controversial due to ethical concerns and toxic side effects.

Doctors have long thought that heat could boost the fighting power of some cancer therapies, but how much to heat the tumor and for how long and which cancers are susceptible has stymied the field and flawed past research.

Other practical barriers have slowed hyperthermia’s widespread use: such as when the tumor is hard to access, or the target is hard to hit and physicians cannot easily measure a tumor’s temperature.

But those obstacles have been challenged in recent years thanks to at least eight studies that have yielded promising results of combining hyperthermia with radiation or chemotherapy.

“There’s a lot of potential in hyperthermia for controlling tumors and for prolonging quality of life and survival,” says Rosemary Wong, radiation biologist and program director of radiation research at the National Cancer Institute. “Now we are getting the science to prove it.”

The May 2005 issue of the Journal of Oncology published a groundbreaking study by Duke University that used precise dosing, rigorous quality controls and full tumor exposure to ensure that the effects of hyperthermia are accurate and quantifiable.

In a sample of 109 female patients with cancers in the breast, chest wall, head and neck and melanoma who had previously undergone radiation, 23 percent had no evidence of active cancer with a second dose, compared to 68 percent who received heat and radiation.

“This is very significant,” says Dr. Ellen Jones, associate professor of radiation oncology and clinical director of the hyperthermia program at Duke University. “I’m very enthused, but we need to proceed in the framework of research protocol to be seen as credible.”

Hakimian is enthused by Mansfield’s treatment. “Her cancer is under control,” he says.

Mansfield says she hasn’t had any side effects from the hyperthermia and is optimistic about the future.

“My biggest fear was dying at such a young age. I had quite an aggressive beast,” Mansfield says. “I’m very pleased I went ahead with the hyperthermia and radiation. I’m very positive about my outcome.”

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