Energy deprivation of cancer cells increases sensitivity to killing by hyperthermia. Recent cell culture studies suggest that certain naphthoquinones, especially menadione (vitamin K3), have anti-tumour activity by interfering with the energy metabolism of cells, resulting in the inhibition of aerobic glycolysis. We therefore studied the cytotoxic effects of menadione in HeLa cells in combination with hyperthermia. The cell culture data show that the cytotoxicity is markedly increased in cells deprived of glucose in the medium at 37 degrees C after exposure to menadione. When cells were exposed to menadione (20-40 microM) and hyperthermia (41-42 degrees C), there was a dramatic potentiation of heat-induced cytotoxicity in cells deprived of glucose in the medium. These data suggest that glucose-deficient cancer cells could be selectively killed by the combined treatment of menadione and mild hyperthermia, both of which can be readily achievable in humans.