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10 – 12 °C HILOTHERAPY® for the prevention of polyneuropathy (CIPN) and hand-foot syndrome (HFS)
HILOTHERAPY® Chemo Care A prophylactic treatment, precise to a single degree.
HILOTHERAPY® is a form of thermo-physiotherapy which applies a constant temperature in a targeted way to a localised treatment area. At 10–12°C, HILOTHERAPY® can greatly reduce the risk of chemotherapy-induced polyneuropathy (CIPN) or hand-foot syndrome occurring, or even eliminate the risk all together.
The risk: Polyneuropathy (CIPN) and hand-foot syndrome (HFS)
Chemotherapy is often associated with complications that are known as chemotherapy-induced polyneuropathy (CIPN) or hand-foot syndrome (HFS). These complications occur due to the chemotherapy drug working its way into the blood capillaries (the very smallest vessels) of the hand and feet, and causing damage to these areas.
Polyneuropathie (CIPN) / hand-foot syndrome (HFS)
Chemotherapy is the most-feared of the treatments available to cancer patients. There is a great deal of fear due to the typical side effects: nausea, vomiting, possible infections, hair loss and, last but not least, the development of painful nerve damage in the hands and feet (polyneuropathy - CIPN). Whilst patients recover quickly from many side effects once chemotherapy has been completed; in the case of CIPN (chemotherapy-induced polyneuropathy) patients are often faced with a long-term complication that continues over several years, significantly impacting their quality of life.
CIPN particularly occurs in patients treated with taxane-containing drugs and platinum analogues. Other drugs, such as vinca alkaloids (incl. vincristine, or more rarely, vinblastine and vinorelbine), 5-fluoropyrimidines (5-FU, capecitabine), cyclophosphamide, cytarabine, doxorubicin, sorafenib and sunitinib may lead to these complications to a greater or lesser degree.
A medical problem
- Up to 20% of patients develop severe HFS and polyneuropathy
- Patients are often forced to postpone therapy, or take a reduced dose (from just 2nd degree complications); some patients are even forced to stop treatment entirely.
Complaints that can even persist years after therapy;
- it is not uncommon for symptoms to be irreversible.
Symptoms of polyneuropathy /
Polyneuropathy manifests itself as hypersensitivity to stimuli, pain, burning and/or tingling in the hands and feet, loss of sensitivity (numbness), in some cases with associated problems relating to coordination of movement and balance. Those affected are barely able to distinguish between hot and cold, or this ability may even be lost completely. The primary effects include paraesthesia (abnormal sensation in skin) and pains.
A special form of the disease, hand-foot syndrome, occurs when there is an associated inflammatory skin reaction in the hands and feet. Complaints are varied: painful areas of red skin, burning sensations (sometimes with skin abrasions), excess sensitivity to pain and at later stages, even numbness.
Where acute symptoms present during chemotherapy, the treatment intervals must often be extended, the dose reduced, and, in the most severe cases, the treatment discontinued entirely.
Grade 1: Tingling, painless swelling or erythema of the hands and/or feet, or complaints that do not impact on the patient's everyday activities.
Grade 2: Painful erythema and swelling of the hands and/or feet, and/or complaints that impact on the patient's everyday activities.
Grade 3: A moist peeling of the skin, ulceration, blistering and severe pain in the hands and/or feet, and/or severe symptoms which make it impossible for the patient to work or carry out the activities of daily life.
The mechanism by which polyneuropathy occurs relies on two processes:
- direct damage to sensory neurons (nerve cells) due to the chemotherapy drug, partly due to oxidative stress, which is triggered by the drug.
- Inflammatory processes in the nervous system. Where exactly the damage occurs to the sensory neurons depends primarily on the specific chemotherapy drug administered.
In addition to the classical chemotherapy drugs, even new targeted approaches (e.g. with antibody conjugates) similarly lead to CIPN (Younes, Clin Oncol, 2012), a fact which is indicative of the continuing and even increasing relevance of CIPN as a side effect of oncological therapies.
According to current understanding, the cause behind these symptoms is blood supply through enlarged capillaries to the nerve cells of the sensory nerve system. There is a different protein composition of the capillary cell wall, which becomes more permeable to certain chemotherapy drugs. This leads to the drugs causing significant damage to nerve cells.
The exact mechanism through which hand-foot syndrome develops is not fully understood. It is assumed that a proportion of the chemotherapy drugs are released onto the skin surface via the sweat glands where it contacts with oxygen to form “free radicals”. These free radicals damage tissue cells of the skin, with damage being particularly severe where the skin has a more callous quality and the substances are absorbed like a sponge: on the palm of the hand and the sole of the foot.
How does HILOTHERAPY® help to prevent CIPN and HFS?
In order to prevent the chemotherapy drug from entering the capillaries of the extremities, both blood circulation and metabolism of these areas must be slowed. This can be achieved by reducing the temperature of the tissues. A temperature reduction of 10°C brings about a reduction in metabolic rate of 50%. Using HILOTHERAPY®, the local tissue temperature in the region of the hands and feet can be kept at a cool and constant level, set to a specific value. Reducing metabolism and blood circulation to a constant level limits how much of the chemotherapy drug enters into the extremities.
Using the device
HILOTHERAPY® functions using a combination of the HILOTHERM ChemoCare device, specially-designed cuffs for each application to the body, and a closed-loop circulation system through which a cooling medium flows. High-sensitivity sensors monitor to ensure a stable temperature for the duration of the treatment, even over a period of many hours. Using HILOTHERAPY®, a specific value can be set and carefully maintained for the local temperature applied to cool tissues in the region of the hands and feet. This reduction of metabolism and blood circulation to a constant level acts primarily to limit the influx of chemotherapy drugs. HILOTHERAPY® is used to continuously cool hands and feet for 30 minutes prior to starting chemotherapy, for the duration of the treatment, and for min. 60 minutes following the end of treatment.
Dipl.-Med. René Schubert
Dipl.-Med. René Schubert
A specialist practice for gynaecological Oncology, Specialist in Gynaecology
and Obstetrics/Sp Gynaecological Oncology
“Maintaining a pre-treatment time of 30 minutes before starting chemotherapy has proven effective. Patients have reported the uniform cold application of the treatment to be far more comfortable than cooling with ice gloves. With prior application of cold, significantly fewer side effects were reported (a mild sensory disorder in 10% of cases) when compared with ice gloves (40% reporting sensory disorders). With no cooling whatsoever, the rate at which polyneuropathy side effects occur is approx. 80%. HILOTHERAPY®, when used preventively, is currently the only treatment approach providing the best-possible chances of avoiding peripheral chemotherapy-induced polyneuropathy.”
The ChemoCare device has been developed for use in in-patients in hospitals and clinics and is applied before, during and after a chemotherapy treatment session. Hospitals/clinics can buy a device outright, with finance, or on a lease. Simply get in touch with one of our team.
We would be delighted to contact your doctor in order to make it possible for you to use the device. Please get in touch with one of our team.
HILOTHERAPY® is used immediately prior to, during, and following a chemotherapy treatment session at the respective clinic/hospital.
Unfortunately, the German statutory health insurers do not cover costs for this treatment. We would also be delighted to give you further information regarding costs for the treatment.