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Thoracic Chemotherapy After Surgery Could Help Pleural Mesothelioma Patients Survive Longer

Published: January 22, 2021

Hyperthermic intrathoracic chemotherapy alongside aggressive therapy (HITHOC) could help extend pleural mesothelioma patient survival. Doctors perform this by circulating a heated high concentration chemotherapy solution in the chest cavity for one hour right after aggressive surgery is performed on a patient. They do this to kill microscopic tumor cells that doctors may have missed during surgery, potentially slowing down cancer recurrence. Results have not been proven in large clinical trials, so some doctors do not believe it is a viable option. For doctors to fully adopt the procedure, a large clinical trial with positive results is needed and maybe some doctors will start utilizing it.

A doctor is questioning why HITHOC is not recommended for pleural mesothelioma in certain publications. The National Comprehensive Cancer Network and the American Cancer Society of Clinical Oncology do not include it as a treatment for pleural mesothelioma. This doctor wants HITHOC to be a standard therapy and will be publishing a paper showing the successes that he has seen while using this treatment with pleurectomy and decortication surgery.

Specialists have tested the HITHOC procedure for the past decade and have seen mixed results. One doctor lead a study that found a 35.3 month survival for people undergoing the procedure versus a 22.8 month survival for patients just undergoing surgery. These patients did undergo an extrapleural pneumonectomy though, which is a very aggressive surgery that is not done much today. Recent studies of HITHOC focus on the safety and feasibility of the procedure when a complete surgical resection is utilized. There is a problem with surgery though because only a third of the patients diagnosed with pleural mesothelioma are able to undergo aggressive surgery.

The most recent study involving HITHOC compared it to surgery with talc pleurodesis. Thirteen of the patients who underwent HITHOC with surgery had a median 33-month survival compared to 19.6 months for the 14 patients not receiving HITHOC. The one-year survival rate was 69 percent for HITHOC patients while it was 57 percent for patients not receiving HITHOC. The two-year survival rate for HITHOC patients was 54 percent while it was 28.6 percent for those not receiving the treatment.

Doctors do not want to use the procedure because there have not been many clinical trials involving HITHOC. There have also been severe complications including renal failure. There is also no standardized therapy protocol for doctors using the technique. One doctor also believes it is too demanding technically and makes surgery last too long to be successful. He believes there is no point since pleural mesothelioma is a chemotherapy resistant cancer. Right now, multimodal therapy is considered the best treatment for pleural mesothelioma patients. It involves aggressive surgery, local radiation, and chemotherapy. When HITHOC is involved though, chemotherapy can be more concentrated and heated, making it better at killing cancer cells. If doctors study the procedure more, they could find a better standardized treatment for pleural mesothelioma sufferers.

Marcello Migliore et al., “Comparison of VATS debulking surgery and HITHOC vs VATS talc pleurodesis alone in malignant pleural mesothelioma: a pilot study” European Respiratory Journal (2020). [Link]
Marcello Migliore et al., “Hyperthermic intrathoracic chemotherapy (HITHOC) should be included in the guidelines for malignant pleural mesothelioma.” AME Groups (December 17, 2020). [Link]
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