Hyperthermia Therapies
Hyperthermia
Hyperthermia raises the temperature of a tumor region or of the whole body, under medical monitoring. Our physicians have used it for decades, with thousands of patients, alongside cancer treatment and in chronic infections such as Lyme disease.
Hyperthermia
Treatments in this group
- TherapyWhole-body hyperthermia
Whole-body hyperthermia raises the core body temperature to 38.5–42 °C / 101.3–107.6 °F under continuous medical monitoring, inside an inpatient program.
- TherapyLocal / regional hyperthermia
Local-regional hyperthermia directs energy to a selected area of the body.
- TherapyHFTT
High frequency thermotherapy (HFTT) heats a tumor from the inside with high-frequency electromagnetic energy delivered through applicators on the skin.
- Treatment program for international patientsWhole-body hyperthermia program
Whole-body hyperthermia raises the core body temperature under controlled medical conditions.
The three device-based forms, compared
Whole-body
- What it is
- Core temperature raised under water-filtered infrared light
- Used for
- Chronic Lyme disease, integrative oncology; a mild form in ME/CFS and Long COVID
- Session
- 4 to 6 hours, preparation to first rest
- Setting
- Inpatient ward, nurse and physician at the bed; sedation above 41 °C / 105.8 °F
- Recovery after a session
- Very tired that evening, aches possible the next day; in the Lyme program two recovery days follow
Local-regional
- What it is
- A tumor and its surroundings heated to 40–44 °C / 104.0–111.2 °F
- Used for
- Solid tumors, with radiotherapy or chemotherapy
- Session
- About 60 minutes
- Setting
- Treatment room, no anesthesia, nurse nearby
- Recovery after a session
- You go on with your day; skin may stay red for a few hours
HFTT
- What it is
- High-frequency energy between two applicators heats deep tumors
- Used for
- Liver, pancreas, abdomen and pelvis, with the oncologist's treatment
- Session
- 45 to 60 minutes
- Setting
- Applicators on the skin, no anesthesia
- Recovery after a session
- You carry on with your day; mild redness under an applicator fades
Your physician chooses the form from your diagnosis and findings.
What is hyperthermia?
Whole-body hyperthermia raises the core temperature to 38.5–42 °C / 101.3–107.6 °F and holds it for a set time. Our protocols come from decades of experience-based medicine on this ward. In oncology, randomized trials support local-regional heat with radiotherapy. In chronic Lyme disease we rely on laboratory data and our own experience since 1995, as controlled trials are still missing. A fifth method, fever therapy, lets the body produce its own fever of 39–40 °C / 102.2–104.0 °F.
What heat does to Borrelia in the laboratory
Round-body forms inside a host cell At body temperature, Borrelia can persist in host cells as rounded, dormant forms. 
Exit from the cell, spiral form As the temperature rises, the organisms leave the cell and take their spiral form. 
Loss of motility, shedding Under sustained heat stress the spirals lose motility and shed flagellar material. 
Immobile and fragmented After prolonged exposure the organisms are immobile and fragmented.
A whole-body session, start to finish
4 to 6 hours, with a nurse and a physician at the bed throughout.
Preparation
Vital signs, an IV line and a core-temperature probe; sedation for sessions above 41 °C / 105.8 °F.
Heating
Water-filtered infrared light raises your temperature step by step, like a building fever, while fluids run by infusion.
Monitoring at target
Held at your protocol's target; core temperature, heart rate, oxygen and blood pressure are watched continuously.
Cooling
Brought down step by step until your values settle.
Rest
The evening is for sleep. Sessions are never on consecutive days.
What it is used for
- ConditionIntegrative oncology
Alongside radiotherapy, chemotherapy or immunotherapy for solid tumors, never in their place.
- ConditionChronic Lyme disease
Two whole-body sessions at 41.6–41.8 °C / 106.9–107.2 °F with intravenous antibiotics.
- ConditionLong COVID
Mild whole-body sessions at 38.5–39.5 °C / 101.3–103.1 °F, paced to your energy.
- ConditionME/CFS
Mild sessions adapted to limited energy, as one part of a wider plan.
Evidence
The evidence is strongest for local-regional heat added to radiotherapy or chemotherapy in cervical cancer, recurrent breast cancer and soft-tissue sarcoma. For whole-body hyperthermia it is moderate in depression and limited in oncology and chronic Lyme disease.
Show the studies and the mechanism
Adding regional hyperthermia to radiotherapy in locally advanced cervical cancer was tested in a randomized Dutch multicenter trial (van der Zee et al., 2000) and reviewed by Cochrane (Lutgens et al., 2010). Five randomized trials in superficial, recurrent breast cancer were analyzed together by the International Collaborative Hyperthermia Group (Vernon et al., 1996). In high-risk soft-tissue sarcoma, regional hyperthermia with neoadjuvant chemotherapy was tested in a randomized phase 3 trial (Issels et al., 2010). European oncology guidelines include local-regional hyperthermia in these settings.
A randomized clinical trial of a single whole-body session in major depression was published in JAMA Psychiatry (Janssen et al., 2016). In oncology, whole-body hyperthermia with chemotherapy rests on smaller studies. In chronic Lyme disease the hospital's protocol is based on the laboratory finding that raised temperature and antibiotics act together against Borrelia burgdorferi (Reisinger et al., 1996) and on the hospital's clinical experience since 1995, which has not been tested in a controlled trial. Outside standard oncology treatment, your physician offers hyperthermia as a treatment attempt and decides it with you.
How heat works
Heat damages tumor cells once tissue passes about 42 °C / 107.6 °F, because tumor tissue with its chaotic blood supply cannot shed heat as well as healthy tissue. It blocks the repair of DNA damage caused by radiotherapy, and it widens blood vessels in the heated region, which carries more oxygen and chemotherapy into the tumor (Wust et al., 2002). At fever-range temperatures natural killer cells become more active and cells produce heat shock proteins that mark them for immune recognition (Dayanc et al., 2008). This is the rationale for mild whole-body hyperthermia and for fever therapy.
Risks and who should not have it
Whole-body hyperthermia is intensive. Every patient has an ECG and a lung-function test first, and it is not given in severe heart or vascular disease, pregnancy, acute thrombosis or active bleeding.
Show contraindications and side effects
Before the first whole-body session every patient has an ECG and a lung-function test, and where needed an echocardiogram or stress ECG. The physicians do not perform whole-body hyperthermia in patients with severe heart or vascular disease or a recent heart attack, uncontrolled seizure disorders, pregnancy, acute thrombosis, severe anemia, active bleeding or a clotting disorder, or brain metastases. During the session a nurse and a physician monitor core temperature, heart rate, oxygen level and blood pressure continuously.
The usual side effects are those of a strong fever: exhaustion that evening, thirst and a fast pulse. Lyme patients sometimes have a temporary Herxheimer reaction in the following days, which the team monitors and treats. Local-regional sessions mainly cause warmth and redness of the skin over the treated region.
Who looks after you
Julian Douwes M.D.
Chief Medical Officer
Program leadership and treatment protocol development
Martin Rößner M.D.
Chief Physician
Chief Physician; daily clinical care and patient consultations
Gabriele Zabel M.D.
Attending Physician
Physician on your inpatient care team
International Office
St. George Hospital
Your contact for inquiries, travel and follow-up questions
+49 8061 398-0info@clinicum-stgeorg.de
- Julia Wingert, International Office secretariat
+49 (0) 8061 398-284 julia.wingert@clinicum-stgeorg.de
- Julia Wingert, International Office secretariat
How hyperthermia fits an inpatient program
Heat is paired with the therapy it should strengthen: radiotherapy or chemotherapy in oncology, intravenous antibiotics in the Lyme program.
Show how the therapies are combined
In oncology, heat can be paired with radiotherapy, low-dose insulin-potentiated chemotherapy or immune infusions. In the Lyme program, the two whole-body sessions run with intravenous antibiotics, and the days between are for HELP apheresis, ozone therapy and immune support (see the Lyme treatment protocol). In ME/CFS and Long COVID, mild sessions are spaced so they cost less energy than they return.
Common questions about hyperthermia
What is hyperthermia in medicine?
Medical hyperthermia is the deliberate raising of tissue or core body temperature, by a device and under monitoring, as a treatment. Local-regional hyperthermia heats one region to 40–44 °C / 104.0–111.2 °F for about an hour. Whole-body hyperthermia raises the core temperature to 38.5–42 °C / 101.3–107.6 °F for a defined time. It is a different thing from malignant hyperthermia, a rare genetic reaction to certain anesthetics, and from heat stroke.
What conditions is hyperthermia used for at St. George Hospital?
In oncology, alongside radiotherapy, chemotherapy or immunotherapy for solid tumors. In chronic Lyme disease and its co-infections, as the core of the inpatient Lyme program. In ME/CFS and post-COVID syndrome in a mild form. Whether it belongs in your plan depends on your diagnosis, your findings and the screening before the first session.
Which types of hyperthermia do you offer?
Three device-based forms and one biological form. Whole-body hyperthermia heats the whole body under water-filtered infrared light. Local-regional hyperthermia and high-frequency thermotherapy heat one region of the body with radiofrequency energy. Fever therapy uses a bacterial preparation so that the body produces its own fever. Your physician chooses the form and the number of sessions from your diagnosis.
How long does a hyperthermia session take?
A whole-body session takes 4 to 6 hours including preparation, the heating phase, the time at the target temperature, the supervised cooling phase and the first rest. Local-regional sessions and HFTT take about 45 to 60 minutes and need no anesthesia.
Is hyperthermia safe?
Local-regional hyperthermia with radiotherapy has been tested in randomized trials and is part of oncology guidelines in Europe. Whole-body hyperthermia is an intensive procedure, which is why the hospital screens every patient with an ECG and lung function test, excludes patients with severe heart or vascular disease, uncontrolled seizures, pregnancy, acute thrombosis or active bleeding, and keeps a nurse and a physician in the room for the whole session.
Does hyperthermia hurt?
Local-regional treatment feels like deep, spreading warmth and is not painful for most patients. A whole-body session feels like a strong fever: heat, sweating, a fast pulse and thirst. Sessions above 41 °C / 105.8 °F are performed under sedation. The evening after a whole-body session you will be very tired.
Who supervises hyperthermia treatment?
Dr. Martin Rößner, Chief Physician for Internal Medicine and Oncology, supervises the hyperthermia protocols and decides the form, temperature and number of sessions for each patient. During a whole-body session a nurse and a physician stay at the bed and monitor core temperature, heart rate, oxygen level and blood pressure.
How much does hyperthermia cost?
Hyperthermia is billed as part of an inpatient program, not as a single session. After a physician has reviewed your findings, the International Office sends you a written, itemized cost overview: a package price plus individual add-ons. A deposit is paid before admission. The costs and insurance page explains the details.
References
- Comparison of radiotherapy alone with radiotherapy plus hyperthermia in locally advanced pelvic tumours: a prospective, randomised, multicentre trial. Lancet 2000. PMID 10791373
- Radiotherapy with or without hyperthermia in the treatment of superficial localized breast cancer: results from five randomized controlled trials. Int J Radiat Oncol Biol Phys 1996. PMID 8690639
- Neo-adjuvant chemotherapy alone or with regional hyperthermia for localised high-risk soft-tissue sarcoma: a randomised phase 3 multicentre study. Lancet Oncol 2010. PMID 20434400
- Combined use of hyperthermia and radiation therapy for treating locally advanced cervix carcinoma. Cochrane Database Syst Rev 2010. PMID 20238344
- Hyperthermia in combined treatment of cancer. Lancet Oncol 2002. PMID 12147435
- Antibiotics and increased temperature against Borrelia burgdorferi in vitro. Scand J Infect Dis 1996. PMID 8792482
- Whole-Body Hyperthermia for the Treatment of Major Depressive Disorder: A Randomized Clinical Trial. JAMA Psychiatry 2016. PMID 27172277
- Dissecting the role of hyperthermia in natural killer cell mediated anti-tumor responses. Int J Hyperthermia 2008. PMID 18214768
From the journal
Reading on Hyperthermia
- Hyperthermia · · 8 min read
Hyperthermia cancer treatment: Cost, what trials show and what to expect in Germany
Hyperthermia cancer treatment is a therapeutic approach that uses controlled heat to damage cancer cells and to make them more sensitive to conventional therapies such as chemotherapy and radiation. At St. George Hospital in Bad Aibling, Germany, we have…
- Hyperthermia · · 6 min read
Hyperthermia for Lyme disease: How heat therapy targets Borrelia
Borrelia burgdorferi, the spirochete behind Lyme disease, can change its form, hide within biofilms, evade the immune system, and persist in tissues with poor blood supply. Why heat is used against it, and how whole-body hyperthermia for Lyme works at St. George Hospital.
- Hyperthermia · · 7 min read
Hyperthermia therapy: A complete guide to medical hyperthermia treatment
Hyperthermia therapy is a medical treatment in which body tissue is exposed to controlled, elevated temperatures — typically 38.5–42.5 °C / 101.3–108.5 °F — to produce therapeutic effects. Unlike fever, which occurs as an uncontrolled response to illness, medical hyperthermia is a…
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