Tumor responses following multiple hyperthermia and X-ray treatments: role of thermotolerance at the cellular level.

We have investigated the effect of increasing numbers of hyperthermia fractions given at 7-day intervals, with or without fractionated radiotherapy, on tumor cure, tumor growth, and cell survival after in vivo or in vitro heat. The murine RIF tumor was treated by capacitive radiofrequency hyperthermia at 44.0 degrees C for 20 min for one to five treatments at weekly intervals (1-5 wk D1). Single treatments (1 wk D1) induced cure in 5% of tumors. Additional treatments (2-5 wk D1) induced similar rates of cure (0-16%, P greater than 0.05 for 1 wk versus 2, 3, 4 or 5 wk D1). 1 wk D1 resulted in marked growth delay compared to controls. Mean tumor diameter doubling times increased from 13.2 days to 27.5 days (P less than or equal to 0.01). 2-5 wk D1 induced little additional growth delay (doubling times, 27.8-32.3 days, P greater than 0.05 for 1 wk versus 2, 3, 4 or 5 wk D1). Fractionated radiotherapy of 3200 rads (400 rads given twice each week) significantly prolonged mean tumor doubling time to 26.2 days. The addition of one hyperthermia session to the fractionated radiotherapy (1 wk D1 + XRT) further increased doubling time to 34.2 days (P less than or equal to 0.01). Additional treatments (2-5 wk D1 + XRT) only modestly increased doubling times (36.0-39.5 days, P greater than 0.05 for 1 wk versus 2, 3, 4 or 5 wk D1). In vitro assay of cells dissociated from tumors 5, 10, or 15 days after 3 wk D1 showed increased survival to 44 degrees C compared to previously untreated controls, and this cellular thermoresistance proved to be transient and noninheritable (i.e., thermotolerance). These results indicate that tumors can develop a prolonged thermal resistance after multiple weekly treatments which significantly modifies the response to subsequent treatment and which is associated with cellular thermotolerance.