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

SIMPLE SUMMARY: As per the Global Cancer Observatory, in 2020, 59% of all cancers globally have been reported from the low-middle-income group countries (LMICs). Cancers of the breast, cervix and head and neck constitute around one-third of the cancers in the LMICs. Most of them are in advanced stages and thus deemed inoperable. Chemoradiotherapy is usually advocated for treatment of these cases with limited success. Moderate hyperthermia at 40–44 °C is a multifaceted therapeutic modality. It is a potent radiosensitizer, chemosensitizer and enforces immunomodulation akin to “in situ tumour vaccination”. The safety and benefit of addition of hyperthermia to radiotherapy and/or chemotherapy in these sites have been well documented in various phase III randomized clinical trials and meta-analysis. Thus, including hyperthermia in the therapeutic armamentarium of clinical care, especially in the LMICs could be a potential game-changer and provide a cost-effective addendum to the existing therapeutic options, especially for these tumour sites. ABSTRACT: Loco-regional hyperthermia at 40–44 °C is a multifaceted therapeutic modality with the distinct triple advantage of being a potent radiosensitizer, a chemosensitizer and an immunomodulator. Risk difference estimates from pairwise meta-analysis have shown that the local tumour 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 over 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%) over chemoradiotherapy alone. As around one-third of the cancer cases in low-middle-income group countries belong to breast, cervix and head and neck regions, hyperthermia could be a potential game-changer and expected to augment the clinical outcomes of these patients in conjunction with radiotherapy and/or chemotherapy. Further, hyperthermia could also be a cost-effective therapeutic modality as the capital costs for setting up a hyperthermia facility is relatively low. Thus, the positive outcomes evident from various phase III randomized trials and meta-analysis with thermoradiotherapy or thermochemoradiotherapy justifies the integration of hyperthermia in the therapeutic armamentarium of clinical management of cancer, especially in low-middle-income group countries.