3D neuroblastoma models expose divergent responses to magnetic hyperthermia and photothermal therapy

Purpose: Hyperthermia is emerging as an adjunct strategy in pediatric oncology, yet its translation is limited by poor understanding of how different modalities impact complex tumor microenvironments. Neuroblastoma (NB), the most common extracranial solid tumor in children, displays profound heterogeneity that hampers therapeutic predictability. Here, we performed the first systematic head-to-head comparison of photothermal therapy (PTT) and magnetic hyperthermia (MH) in tissue-engineered NB (TE-NB) models. Methods: TE-NB scaffolds incorporating five NB cell lines were loaded with magnetic nanoparticles (MNPs) and subjected to PTT (808-nm laser, 130 W/cm2, 10 min) or MH (285 kHz, 20 mT, 60 min). Constructs were analyzed at 24 h, 48 h, and 5 d post-treatment for DNA content, cell viability, proliferation (Ki67 immunohistochemistry), and apoptosis (caspase-3/7 staining). Results: MH produced consistent MNP-dependent heating with minimal background, while PTT was dominated by nonspecific medium absorption. Both modalities modulated proliferation within 24 h, but effects varied sharply by cell line and scaffold region, reflecting microenvironmental heterogeneity. By 48 h, PTT often triggered paradoxical increases in proliferation, whereas MH disrupted scaffold integrity, reduced DNA content, and suppressed Ki67 expression. Notably, neither modality induced sustained caspase-3/7 activation, indicating that cytotoxicity proceeds via non-apoptotic pathways. Conclusion: Our findings position MH as a superior modality for uniform heating and proliferation control in 3D NB models, but also highlight that hyperthermia should be considered a context-dependent modulator rather than a binary cytotoxic agent. By integrating patient-specific TE-NB platforms, precision hyperthermia could define individualized therapeutic windows, optimize combinations with pro-apoptotic or immunomodulatory agents, and accelerate translation of hyperthermia strategies for children with NB.