The efficacy of hyperthermia in addition to RT or chemoradiotherapy has been validated in resectable and unresectable rectal cancer. Hyperthermia has a synergetic action with both radio- and chemotherapy. Tissutal temperature, to be effective as a cytotox-ic agent, must reach 40-45°C and last 30-60 min.

Hyperthermia can be administered over the whole body or restricted to neoplasm using an internal or external generator. In rectal cancer, endocavitary hyperthermia is usually utilised with an internal electrode that acts as a radiofrequency transducer. In the architectural structure of the neoplasm, with such chaotic vascular vessels, there are hypoperfused areas, poorly oxygenated, with low pH, that are less sensitive to radiation but highly exposed to a thermal increase [68].

Hyperthermia determines an increased blood supply with improved tissue oxygenation and oxygen represents the best sensitising agent to radiation. Hyperthermia seems to increase the cellular uptake and conversion in active metabolisis of some chemotherapeutic drugs such as 5-FU [69].

Authors showed a large quantity of necrotic tissue inside neoplasm and a better complete pathologic response in patients treated with neoadjuvant treatment that included hyperthermia [70-73] (Table 5).

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