Jan 10, 2022

Hyperthermia: A Potential Game-Changer in the Management of Cancers in Low-Middle-Income Group Countries

Niloy R. Datta, Bharati M. Jain, Zatin Mathi, Sneha Datta, Satyendra Johari, Ashok R. Singh, Pallavi Kalbande, Pournima Kale, Vitaladevuni Shivkumar, and Stephan Bodis, Cancers 2022, Volume 14, Issue 2, Article No. 315, online 9 January 2022; doi: 10.3390/cancers14020315

According to the Global Cancer Observatory, 59% of all cancers reported globally in 2020 were in the low-middle-income group countries (LMICs). Cancers of the breast, cervix, and head and neck, which constitute about a third of cancers in the LMICs, are largely in advanced stages and, thus, deemed inoperable. Chemoradiotherapy is usually advocated for treatment of these cases, but with limited success. Moderate hyperthermia at 40–44 °C, a multifaceted therapeutic modality, is a potent radiosensitizer and chemosensitizer that enforces immunomodulation akin to “in situ tumor vaccination”. Risk difference estimates from pairwise meta-analysis have shown that the local tumor control could be improved by 22.3% (p < 0.001), 22.1% (p < 0.001), and 25.5% (p < 0.001) in recurrent breast cancers, locally advanced cervix cancer (LACC), and locally advanced head and neck cancers, respectively, by adding hyperthermia to radiotherapy compared to radiotherapy alone. Furthermore, thermochemoradiotherapy in LACC have shown to reduce the local failure rates by 10.1% (p = 0.03) and decrease deaths by 5.6% (95% CI: 0.6–11.8%) compared to chemoradiotherapy alone. Hyperthermia could further be a cost-effective therapeutic modality, as the capital investment needed to set up a hyperthermia facility is relatively low. The safety and the benefits associated with the addition of hyperthermia to radiotherapy and/or chemotherapy for breast, cervix, and head and neck tumors has been well documented in various phase III randomized clinical trials and meta-analyses. As such, the inclusion of hyperthermia in the therapeutic armamentarium of clinical care, especially in the LMICs, may be a cost-effective and potentially game-changing addition to existing therapeutic options, especially for these tumor types.

The scientific and technical impact of the study can be summarized as:

  • Meta analyses of clinical studies of hyperthermia used in combination with radiotherapy and/or chemotherapy in locally advanced breast cancers, recurrent breast cancers, and locally advanced cervical cancers demonstrate improved outcomes compared to radio- and chemotherapy used alone
  • Clinical evidence indicates that integration of hyperthermia with radio- and/or chemotherapy is beneficial for the treatment of cancers in various sites, including superficial tumors, melanoma, choroidal melanoma, brain tumors, malignant germ cell tumors, soft tissue sarcomas, bone metastases, and cancers of the oesophagus, lung, pancreas, urinary bladder, prostate, rectum, anus, and others
  • Cost-benefit analyses and tumor-specific hyperthermia treatment considerations, presented in the context of approaches to the setup of hyperthermia treatment facilities in LMICs, suggest that hyperthermia could contribute minimally to the cost of primary treatment compared to that of standard chemotherapy and immunotherapy regimes
  • In addition to being more affordable, hyperthermia would be more tolerable and – by virtue of improving the therapeutic outcomes – can improve patients' quality-of-life