Integrating Loco-Regional Hyperthermia Into the Current Oncology Practice: SWOT and TOWS Analyses

Abstract

Moderate hyperthermia at temperatures between 40 and 44 • C is a multifaceted therapeutic modality. It is a potent radiosensitizer, interacts favorably with a host of chemotherapeutic agents, and, in combination with radiotherapy, enforces immunomodulation akin to "in situ tumor vaccination." By sensitizing hypoxic tumor cells and inhibiting repair of radiotherapy-induced DNA damage, the properties of hyperthermia delivered together with photons might provide a tumor-selective therapeutic advantage analogous to high linear energy transfer (LET) neutrons, but with less normal tissue toxicity. Furthermore, the high LET attributes of hyperthermia thermoradiobiologically are likely to enhance low LET protons; thus, proton thermoradiotherapy would mimic 12 C ion therapy. Hyperthermia with radiotherapy and/or chemotherapy substantially improves therapeutic outcomes without enhancing normal tissue morbidities, yielding level I evidence reported in several randomized clinical trials, systematic reviews, and meta-analyses for various tumor sites. Technological advancements in hyperthermia delivery, advancements in hyperthermia treatment planning, online invasive and non-invasive MR-guided thermometry, and adherence to quality assurance guidelines have ensured safe and effective delivery of hyperthermia to the target region. Novel biological modeling permits integration of hyperthermia and radiotherapy treatment plans. Further, hyperthermia along with immune checkpoint inhibitors and DNA damage repair inhibitors could further augment the therapeutic efficacy resulting in synthetic lethality. Additionally, hyperthermia induced by magnetic nanoparticles coupled to selective payloads, namely, tumor-specific radiotheranostics (for both tumor imaging and radionuclide therapy), chemotherapeutic drugs, immunotherapeutic agents, and gene silencing, could provide a comprehensive tumor-specific theranostic modality akin to "magic (nano)bullets." To get a realistic overview of the strength (S), weakness (W), opportunities (O), and threats (T) of hyperthermia, a SWOT analysis has been undertaken. Additionally, a TOWS analysis Datta et al.Hyperthermia: SWOT and TOWS Analyses categorizes future strategies to facilitate further integration of hyperthermia with the current treatment modalities. These could gainfully accomplish a safe, versatile, and cost-effective enhancement of the existing therapeutic armamentarium to improve outcomes in clinical oncology.

Hyperthermia Targeting the Tumor Microenvironment Facilitates Immune Checkpoint Inhibitors

“…Moreover, it also seems promising for PARPi, anti-angiogenesis treatments and other treatments to substitute radio/chemotherapy to combine with PD-1/PD-L1 mAb and hyperthermia for the treatment of tumors with low mutation, fewer neoantigens or disorganized tumor vessels. Thus, rational different combination therapies are promising for the eradication of tumors (131). For the second question, the authors believe that the patients should also be explored and selected for the combination, which point is also important for the first concern.…”

Vascular and extracellular matrix remodeling by physical approaches to improve drug delivery at the tumor site

“…Currently, accepted temperature to be reached by this technique is ranging from 39 to 43 °C [72]. Today this topic is well documented and, for thorough description, we invite the reader to go through the following reviews and references [8,[73][74][75]. Historically, the local increase of temperature in the tumour was assessed by physicians as being the best way to cure cancer.…”

The Economic Potential of Aceh Cattle Based on Its Farmers, Traders, and Consumers Perspective

“…The analysis also provides a real evaluation of the condition classified based on the strengths (S), weaknesses (W), opportunities (O), and threats (T) so that the S and O factors can be used to overcome the W and T factors. Also, future strategies can be identified and formulated based on the analysis results to improve current conditions that have been studied (Datta et al, 2020).…”