| Rank |
Pathway / Axis |
Cancer / Tumor Context |
Normal Tissue Context |
TSF |
Primary Effect |
Notes / Interpretation |
| 1 |
Proteotoxic stress / protein denaturation |
Misfolded protein burden ↑; proteostasis overload ↑ |
Heat stress response (tolerance higher if well-perfused) |
P, R |
Core physical stressor |
Direct heat disrupts protein folding and complex stability; tumors can be more vulnerable due to baseline stress and poor perfusion. |
| 2 |
Heat Shock Response (HSF1 → HSPs) |
HSP70/HSP90 ↑; stress tolerance ↑ (can be protective) |
HSP induction ↑ (protective) |
R, G |
Adaptive survival program |
HSP induction is a major adaptation; can blunt repeated heat exposures and is a key reason scheduling matters. |
| 3 |
DNA damage repair inhibition / radiosensitization |
HR repair ↓; DNA repair capacity ↓ (reported) |
↔ (tissue-dependent) |
R |
Sensitization to radiation |
Hyperthermia can impair DNA repair processes (notably homologous recombination), increasing radiation effectiveness when timed appropriately. |
| 4 |
Tumor perfusion / oxygenation changes |
Perfusion ↑ (often) → oxygenation ↑; hypoxia ↓ (context) |
Perfusion ↑ |
P, R |
Microenvironment modulation |
Improved perfusion can increase oxygenation (helping radiotherapy) and improve delivery of some drugs; effects depend on local vascular state. |
| 5 |
Cell membrane / cytoskeleton disruption |
Membrane permeability ↑; cytoskeletal stress ↑ |
↔ / injury possible at higher exposures |
P, R |
Physical cell stress |
Heat can increase permeability and alter membrane trafficking; contributes to drug uptake in some settings. |
| 6 |
Intrinsic apoptosis / necrosis (dose-dependent) |
Apoptosis ↑ or necrosis ↑ at higher thermal dose |
Collateral injury risk if overdosed |
R, G |
Direct cytotoxicity (thermal dose dependent) |
At moderate hyperthermia, sensitization dominates; at higher thermal dose, direct cell killing becomes more prominent. |
| 7 |
Immune activation / DAMP release (ICD-like signals) |
DAMPs ↑; antigen presentation ↑ (reported) |
— |
G |
Immune support |
Heat stress and tumor cell damage can release DAMPs and promote immune visibility; strength varies by regimen and tumor type. |
| 8 |
Vascular effects (edema, vessel damage) at higher dose |
Vascular injury ↑ at higher thermal dose |
Normal tissue injury risk ↑ |
R, G |
Toxicity / local control effects |
At higher temperatures or prolonged exposure, vascular damage contributes to tumor control but increases normal tissue risk. |
| 9 |
Chemo-sensitization (drug delivery + stress synergy) |
Drug uptake ↑; cytotoxic synergy ↑ (reported) |
Systemic toxicity may ↑ depending on regimen |
R, G |
Combination leverage |
Heat can potentiate some agents (e.g., platinum drugs) and improve delivery; regimen-specific. |
| 10 |
Thermal dose / parameter dependence (time×temp) |
Outcome depends on temperature, duration, targeting, and timing vs RT/chemo |
Safety depends on precision and monitoring |
— |
Translation constraint |
Hyperthermia is highly dose-dependent; “too little” yields little sensitization, “too much” increases burns/necrosis risk. |