Hyperthermia can alter tumor physiology and improve chemo- and radio-therapy efficacy
Abstract
Hyperthermia has demonstrated clinical success in improving the efficacy of both chemo- and radio-therapy in solid tumors. Pre-clinical and clinical research studies have demonstrated that targeted hyperthermia can increase tumor blood flow and increase the perfused fraction of the tumor in a temperature and time dependent manner. Changes in tumor blood circulation can produce significant physiological changes including enhanced vascular permeability, increased oxygenation, decreased interstitial fluid pressure, and reestablishment of normal physiological pH conditions. These alterations in tumor physiology can positively impact both small molecule and nanomedicine chemotherapy accumulation and distribution within the tumor, as well as the fraction of the tumor susceptible to radiation therapy. Hyperthermia can trigger drug release from thermosensitive formulations and further improve the accumulation, distribution, and efficacy of chemotherapy.
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In solid tumors, hyperthermia increases tumor blood flow and the tumor perfusion fraction in a temperature- and time-dependent manner.
“In solid tumors, hyperthermia increases tumor blood flow and increases the tumor perfusion fraction in a temperature‐ and time‐dependent manner.”
From Hypoxia signaling in cancer: Implications for therapeutic interventions (2023) · cites this paper as [241]
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Nanomedicine Strategies in Conquering and Utilizing the Cancer Hypoxia Environment
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Anti-Tumor Strategies of Photothermal Therapy Combined with Other Therapies Using Nanoplatforms
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“Increase of radiosensitivity PTT-induced hyperthermia can improve the sensitivity of tumor cells to radiation by inhibiting DNA repair mechanisms and increasing oxidative stress.”
InfluentialAn optimal portfolio of photothermal combined immunotherapy
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“Based on experimental preclinical and clinical data, it is often concluded that heatinduced increases in TBF are the principal (or even exclusive) drivers of concurrent (“secondary”) changes in the oxygenation status [26] and are principally involved in most of the heat-induced sensitizing mechanisms described above.”
BackgroundPyroelectric Janus nanomotors to promote cell internalization and synergistic tumor therapy
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Image-guided drug delivery in nanosystem-based cancer therapies
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Magnetic Particle Imaging: From Tracer Design to Biomedical Applications in Vasculature Abnormality
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Multifunctional stimuli-responsive hybrid nanogels for cancer therapy: Current status and challenges
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Synergies between therapeutic ultrasound, gene therapy and immunotherapy in cancer treatment
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“In addition, targeted HT can increase tumor perfusion and blood flow in a temperature- and time-dependent way [5].”
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“The sensitization occurs mostly via increased blood perfusion, increased oxygenation, inhibition of chemotherapy-induced DNA damage repair, and boosting local/systemic immune response according to previous researches [26, 27].”
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Gold-Nanoparticle Hybrid Nanostructures for Multimodal Cancer Therapy
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Electromagnetic Field‐Programmed Magnetic Vortex Nanodelivery System for Efficacious Cancer Therapy
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Injectable hydrogels for the delivery of nanomaterials for cancer combinatorial photothermal therapy
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Cutting-Edge Therapies for Lung Cancer
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“This process aims to eliminate cancer cells or inhibit their growth without causing harm to normal tissues [147].”
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“At the same time, thermal ablation is similar to surgical treatment, mostly disposable treatment; mild hyperthermia, due to the low energy input, usually requires repeated, longer heating time (> 30 min) to achieve any effect (15).”
BackgroundIn vivo fiber-optic fluorescent sensor for real-time pH monitoring of tumor microenvironment
Li, Z., Lan, N., Cheng, Z., Jin, F., Song, E., Xu, Z., Zhang, Y., Feng, Y., Cai, X., Ran, Y., et al. (2024) · Chemical Engineering Journal · doi:10.1016/j.cej.2024.152495 · Cited by 34 · see citing works
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Engineered bacteria breach tumor physical barriers to enhance radio-immunotherapy
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Triggered release from thermosensitive liposomes improves tumor targeting of vinorelbine
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Self-citationExternal Basic Hyperthermia Devices for Preclinical Studies in Small Animals
Priester, M. I., Curto, S., van Rhoon, G. C., & ten Hagen, T. L. M. (2021) · Cancers · doi:10.3390/cancers13184628 · Cited by 28 · see citing works
“Application of mild hyperthermia (40–43 ◦C) is able to induce sublethal effects to the target region, which can induce beneficial mechanisms on both a tissue- and cellular level [1,2].”
BackgroundZhang, A., & Gao, L. (2023) · International Journal of Nanomedicine · doi:10.2147/ijn.s436268 · Cited by 29 · see citing works
“19,20 It serves as a comprehensive cancer treatment approach, supplementing surgery, radiotherapy, chemotherapy, targeted therapy, and immunotherapy.”
BackgroundImproving Tumor Targeting and Penetration for Nanoparticle‐Mediated Cancer Therapy
Luo, Z., Chen, C., & Li, S. (2025) · Small Methods · doi:10.1002/smtd.202401860 · Cited by 27 · see citing works
Synergetic Thermal Therapy for Cancer: State-of-the-Art and the Future
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“(2) Heating enhances vascular permeability, increases oxygenation, decreases interstitial fluid pressure, reestablishes normal physiological pH conditions, thus increases extravasation of the nano-drugs from the bloodstream and cellular uptake of the chemotherapeutic agents, and, finally, enhances the killing effect […”
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“In clinical practice, local hyperthermia raises the intra-tumor temperature to 39–45 � C or higher by external energy, including ultrasound (US), radiofrequency, and microwaves [5].”
BackgroundDomingo-Diez, J., Souiade, L., Marta, S., Manzaneda‐González, V., Guerrero‐Martínez, A., Breton, L. M., Isidoro, M. R., Ramírez‐Castillejo, C., Serrano Olmedo, J. J., & Ramos, M. (2023) · Congreso Anual de la Sociedad Española de Ingeniería Biomédica (CASEIB) · doi:10.31428/10317/13474 · Cited by 25 · see citing works
Advances in screening hyperthermic nanomedicines in 3D tumor models
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Mechanistic Insights on Hyperthermic Intraperitoneal Chemotherapy in Ovarian Cancer
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“Hyperthermic treatment involves the administration of controlled heat above the physiologically normal range, ideally targeting the malignant tissue [43,44].”
BackgroundPhotothermal Therapy: A New Approach to Eradicate Cancer
Dash, S. R., & Kundu, C. N. (2021) · Current Nanoscience · doi:10.2174/1573413717666210301112058 · Cited by 23 · see citing works
Influence of lung cancer model characteristics on tumor targeting behavior of nanodrugs
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Nanostructure-reinforced multifunctional hydrogels for synergistic cancer therapy
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Modulating tumor mechanics with nanomedicine for cancer therapy
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Unravelling the Triad of Lung Cancer, Drug Resistance, and Metabolic Pathways
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“The goal of this procedure is to eradicate cancer cells or stop their proliferation without endangering healthy tissues [107,108].”
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Systematic review of the registered clinical trials for oncological hyperthermia treatment
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“increases the tumor blood flow, permeability, pO2, pH and tumor nutritional status [5].”
BackgroundReaching new lights: a review on photo-controlled nanomedicines and their in vivo evaluation
Remmers, R. C. P. A., & Neumann, K. (2023) · Biomaterials Science · doi:10.1039/d2bm01621d · Cited by 20 · see citing works
Hyperthermia and radiotherapy: physiological basis for a synergistic effect
Righini, M. F., Durham, A., & Tsoutsou, P. P. (2024) · Frontiers in Oncology · doi:10.3389/fonc.2024.1428065 · Cited by 19 · see citing works
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Self-citationProgress and potential of nanobubbles for ultrasound-mediated drug delivery
Chen, L. E., Nittayacharn, P., & Exner, A. A. (2025) · Expert Opinion on Drug Delivery · doi:10.1080/17425247.2025.2505044 · Cited by 16 · see citing works
“On a broader tissue level, mild hyperthermia increases vessel dilation, permeability, and blood flow, which can increase drug penetration into solid tumors [101].”
Thermoelectric and pyroelectric cancer therapy
Kim, H., Kim, C., Hur, S., Song, G., Song, H., Kang, H., & Yoon, J. (2025) · Coordination Chemistry Reviews · doi:10.1016/j.ccr.2025.217132 · Cited by 16 · see citing works
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Biodegradable photothermal thermosensitive hydrogels treat osteosarcoma by reprogramming macrophages
Luo, G., Xu, Z., Zhong, H., Shao, H., Liao, H., Liu, N., Jiang, X., Zhang, Y., & Ji, X. (2023) · Biomaterials Science · doi:10.1039/d2bm01900k · Cited by 16 · see citing works
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“…- nificantly increased when combined with one hour of HT exposure, it is important to note that the enhancement in cytotoxicity that can be caused by HT is influenced by a number of factors including the time and temperature of exposure as well as the cytotoxic threshold of the treated cells [25].”
Self-citationPromoting Nanoparticle Delivery Efficiency to Tumors by Locally Increasing Blood Flow There
Fan, F., Xie, B., & Yang, L. (2021) · ACS Applied Bio Materials · doi:10.1021/acsabm.1c00871 · Cited by 13 · see citing works
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“Selective heating could lead to localized vasodilatation, increased perfusion, and the temporary alteration of vascular integrity [8].”
BackgroundMurali, N., Rainu, S. K., Sharma, A., Siddhanta, S., Singh, N., & Betal, S. (2024) · ACS Omega · doi:10.1021/acsomega.4c03825 · Cited by 11 · see citing works
“32 Mahlert et al. 33 investigated photodynamic therapy for treating gastrointestinal tumors.”
Heating Induced Nanoparticle Migration and Enhanced Delivery in Tumor Treatment Using Nanotechnology
Gu, Q., & Zhu, L. K. (2024) · Bioengineering · doi:10.3390/bioengineering11090900 · Cited by 11 · see citing works
Scouting the efficacy of targeted gold nanoparticles in the landscape of cancer therapy
Fatima, M., Gupta, G., Arora, S., Alsayari, A., Wahab, S., & Kesharwani, P. (2024) · European Polymer Journal · doi:10.1016/j.eurpolymj.2024.112924 · Cited by 11 · see citing works
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Multifunctional fiber-optic theranostic probe for closed-loop tumor photothermal therapy
Li, Z., Li, Z., Cheng, Z., Borri, C., Giannetti, A. E., Lan, N., Long, J., Chen, W., Cai, X., Yang, J., et al. (2026) · Light Science & Applications · doi:10.1038/s41377-026-02219-3 · Cited by 10 · see citing works
“Furthermore, PTT can reshape the tumor-suppressive microenvironment through different mechanisms including enhanced blood perfusion, reduced tumor interstitial pressure, and induced immunogenic cell death (ICD) 39 – 41 .”
Poly(2-oxazoline)-Based Thermoresponsive Stomatocytes
Terracciano, R., Liu, Y., Varanaraja, Z., Godzina, M., Yilmaz, G., van Hest, J. C. M., & Becer, C. R. (2024) · Biomacromolecules · doi:10.1021/acs.biomac.4c00726 · Cited by 10 · see citing works
Development of Cationic Lipid LAH4-L1 siRNA Complexes for Focused Ultrasound Enhanced Tumor Uptake
Abuhelal, S., Centelles, M. N., Wright, M., Mason, A. J., & Thanou, M. (2023) · Molecular Pharmaceutics · doi:10.1021/acs.molpharmaceut.2c00909 · Cited by 10 · see citing works
“35,36 Tumor vascular permeability presents one of the important challenges which needs to be overcome to improve drug delivery.”
AQ4N nanocomposites for hypoxia-associated tumor combination therapy
Inam, A., Zhang, S., Zhang, S., & Wu, D. (2024) · Biomaterials Science · doi:10.1039/d4bm00883a · Cited by 9 · see citing works
Kulkarni-Dwivedi, N., Patel, P. R., Shravage, B. V., Umrani, R. D., Paknikar, K. M., & Jadhav, S. H. (2022) · Nanomedicine · doi:10.2217/nnm-2022-0171 · Cited by 9 · see citing works
Progress of Mesoporous Silica Coated Gold Nanorods for Biological Imaging and Cancer Therapy
Ma, J., Li, Y., Ying, Y., Wu, B., Liu, Y., Zhou, J., & Hu, L. (2023) · ChemMedChem · doi:10.1002/cmdc.202300374 · Cited by 9 · see citing works
Exploring the rationale for thermotherapy in COVID-19
Mancilla-Galindo, J., & Galindo-Sevilla, N. (2021) · International Journal of Hyperthermia · doi:10.1080/02656736.2021.1883127 · Cited by 9 · see citing works
Innovative therapeutic strategies to overcome radioresistance in breast cancer
Arnold, C. R., Mangesius, J., Portnaia, I., Ganswindt, U., & Wolff, H. A. (2024) · Frontiers in Oncology · doi:10.3389/fonc.2024.1379986 · Cited by 8 · see citing works
Wu, L., Xin, Y., Guo, Z., Gao, W., Zhu, Y., Wang, Y., Ran, R., & Yang, X. (2021) · Chemical Research in Chinese Universities · doi:10.1007/s40242-021-1068-8 · Cited by 8 · see citing works
Zhang, H., Xu, J., Gao, B., Wang, H., Huang, J., Zhou, J., Yang, R., Yan, F., & Peng, Y. (2021) · Frontiers in Pharmacology · doi:10.3389/fphar.2021.750847 · Cited by 8 · see citing works
“Hyperthermia combined with nanoparticles loaded with chemotherapeutic agents holds great promise for the treatment of cancer (Dunne et al., 2020).”
BackgroundPreparation and In Vitro Evaluation of Thermosensitive Liposomes Targeting Ovarian Cancer
Pu, X., Wang, X., Wang, F., Li, S., & Yin, G. (2022) · Current Drug Delivery · doi:10.2174/1567201819666220321110812 · Cited by 7 · see citing works
A temperature-responsive drug release system based on MoS2 nanosheets and 1-tetradecanol
Salimi, M., Shokrgozar, M. A., Hamid Delavari, H., Mehravi, B., & Vossoughi, M. (2023) · Colloids and Surfaces A Physicochemical and Engineering Aspects · doi:10.1016/j.colsurfa.2023.132061 · Cited by 7 · see citing works
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Fabrication of a dual stimuli-responsive magnetic nanohydrogel for delivery of anticancer drugs
Massoumi, B., Mossavi, R., Motamedi, S., Derakhshankhah, H., Vandghanooni, S., & Jaymand, M. (2021) · Drug Development and Industrial Pharmacy · doi:10.1080/03639045.2021.1988099 · Cited by 7 · see citing works
Ott, O. J., Gaipl, U. S., Lamrani, A., & Fietkau, R. (2022) · Seminars in Radiation Oncology · doi:10.1016/j.semradonc.2022.10.011 · Cited by 7 · see citing works
The integration of hyperthermia and drug delivery
Dunne, M., Evans, J. C., Dewhirst, M. W., & Allen, C. J. (2020) · Advanced Drug Delivery Reviews · doi:10.1016/j.addr.2020.11.011 · Cited by 7 · see citing works
Self-citationMicelle-like Nanoparticles for Drug Delivery and Magnetically Enhanced Tumor Chemotherapy
Xie, L., Zuo, X., Wang, B., Li, D., Chang, W., Ji, S., & Ding, D. (2024) · ACS Biomaterials Science & Engineering · doi:10.1021/acsbiomaterials.4c01897 · Cited by 6 · see citing works
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Pathobiology and clinical significance of malignant pleural effusions
Woods, A. T., Murray, A. A., Vincent, B. G., Akulian, J., & Pecot, C. (2026) · EMBO Molecular Medicine · doi:10.1038/s44321-025-00363-8 · Cited by 6 · see citing works
“…tight and adherens junctions, enhancing membrane and paracellular permeability, increasing vascular permeability, and lowering interstitial fl uid pressure — together enabling deeper penetration into densely packed pleural tumor layers (van Stein et al, 2021; Dunne et al, 2020; Li et al, 2013).”
Omar, H. W., Alkurdi, Y. A., Fathima, A., & Alsharaeh, E. H. (2024) · Nanomaterials · doi:10.3390/nano14191547 · Cited by 6 · see citing works
“A synergistic combination of anticancer therapies, such as hyperthermia therapy for ablation of cancer cells and targeted drug delivery, could possibly mitigate the adverse effects of conventional treatment while simultaneously improving the effectiveness of localized cancer treatment [4–7].”
BackgroundMelt-derived copper-doped ferrimagnetic glass-ceramic for tumor treatment
Miola, M., Bruno, M., Gerbaldo, R., Laviano, F., & Verné, E. (2021) · Ceramics International · doi:10.1016/j.ceramint.2021.08.056 · Cited by 6 · see citing works
Hyperthermia inhibits growth of nasopharyngeal carcinoma through degradation of c-Myc
Li, X., Duan, S., Zheng, Y., Yang, Y., Wang, L., Li, X., Zhang, Q. H., Thorne, R. F., Li, W., & Yang, D. (2022) · International Journal of Hyperthermia · doi:10.1080/02656736.2022.2038282 · Cited by 6 · see citing works
- Authors
- Dunne, M., Regenold, M., & Allen, C.
- Affiliations
- University of Toronto (CA)
- Corresponding author
- Dunne, Michael
- Venue
- Advanced Drug Delivery Reviews
- Publisher
- Elsevier BV
- Published
- 2020
- Volume
- 163-164
- Pages
- 98-124
- ISSN
- 0169-409X (ISSN-L)
- OpenAlex
- W3042726211
- Cited by
- 150
- References
- 423
- Citations by year
- 2026: 22 · 2025: 25 · 2024: 31 · 2023: 29 · 2022: 19 · 2021: 22 · 2020: 2
- FWCI
- 1.51
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Advanced Drug Delivery Reviews (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Canadian Institutes of Health Research
- Topics
- Physical Sciences › Engineering › Biomedical Engineering › Ultrasound and Hyperthermia Applications
- Physical Sciences › Engineering › Biomedical Engineering › Nanoplatforms for cancer theranostics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Cancer Research › Cancer, Hypoxia, and Metabolism
- Keywords
- hyperthermia, tumor physiology, tumor perfusion, vascular permeability, tumor oxygenation, interstitial fluid pressure, tumor pH, nanomedicine, thermosensitive drug release, radiosensitization, combination therapy
- MeSH terms
- Hyperthermia, Antineoplastic Agents, Capillary Permeability, Combined Modality Therapy, Humans, Hydrogen-Ion Concentration, Hyperthermia, Induced, Neoplasms, Oxygen, Radiotherapy, Time Factors, Drug Delivery Systems, Tumor Microenvironment, Drug Liberation
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