Spicy hot.

Hyperthermia has long been touted as a radiosensitizer via interfering with DNA repair. Now we actually have a Taiwanese clinical trial which randomized patients with painful bone mets (mostly spine) to 30 Gy in 10 fractions +/- hyperthermia. Cool! Wait, no it's not...surface electrodes were used to raise internal temperatures surrounding the tumor to 40-43℃ for 40 minutes each day after radiation. Believe it or not, there was a clinical improvement in pain control, with over one-third of patients achieving complete pain response (CR) at 3 months with the addition of hyperthermia. Perhaps more interesting was the observation that over half of patients receiving hyperthermia achieved re-ossification at the tumor site, which the authors attribute to thermo-stimulation of osteoblast activity. There’s no proof, but re-ossification theoretically contributes to longer pain control and mechanical stability--two real problems in this population. But because haters gonna hate, the pain control in the radiation-alone arm was pretty bad (7% CR vs 18% in RTOG 97-14), and SBRT could arguably do better. So while this adds fodder to rad bio lunchroom convos, it’s unlikely to become the next hot trend anytime soon.