A narrative review of hyperthermic intrathoracic chemotherapy for advanced lung cancer

Our plain-English summary of A narrative review of hyperthermic intrathoracic chemotherapy for advanced lung cancer, by K. Song, R.M. Flores (Annals of Translational Medicine, 2021).

The study

• Authors: K. Song, R.M. Flores
• Journal: Annals of Translational Medicine
• Published: 2021;9(11):958
• Type of article: Review
• Cited by: 8 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

The traditional treatment of stage IV lung cancer is predominantly supportive or palliative. No current standardized guidelines promote the use of hyperthermic intrathoracic chemotherapy (HITHOC) in the treatment of advanced lung cancer with pleural involvement. Several small studies have examined the safety and utilization of HITHOC for this population, though the data is extremely limited. A review of the literature is presented in accordance with the Narrative Review checklist. The MEDLINE electronic database was searched for articles published in English from January 1999 - August 2020 using relevant keywords such as "hyperthermic intrathoracic chemotherapy", "hyperthermic intrapleural chemotherapy" and "HITHOC". This was supplemented by review and hand search of the reference lists. While data suggest a potential though controversial role for HITHOC for certain intrathoracic tumors such as malignant pleural mesothelioma and thymoma, there is insufficient evidence to confidently promote a role for hyperthermic intrathoracic chemotherapy in the treatment of advanced lung cancers. Existing studies are small, nonrandomized, and prone to bias. Hyperthermic intrathoracic chemotherapy is not a standardized treatment for advanced lung cancer, and is characterized by potentially serious side effects with little clinical benefit. Recent developments in targeted therapy and immunotherapy are unlikely to leave room for the development of large randomized controlled trials.

2021 Annals of Translational Medicine. All rights reserved.

In plain English

This was a narrative review by two authors from a New York department of thoracic surgery. It covered hyperthermic intrathoracic chemotherapy (HITHOC): heated, usually cisplatin-based chemotherapy fluid placed in the chest cavity, typically after tumor-removing surgery. The authors searched MEDLINE for English-language papers from January 1999 to August 2020, identifying 84 and reviewing 68. The article did not study asbestos exposure. A systematic review of 21 patients given debulking plus HITHOC for malignant effusion from non-small cell lung cancer reported a mean survival of 27 months. A randomized comparison with talc pleurodesis found no difference in overall survival. In one malignant pleural mesothelioma study, the complication rate was higher among 15 patients given extrapleural pneumonectomy plus radiation than among 20 given that operation or pleurectomy plus HITHOC plus radiation. The HITHOC group had two postoperative deaths and a significantly shorter time to local recurrence. A systematic review reported morbidity of about 30%. The authors concluded that HITHOC showed some weak benefit as an adjunct to cytoreduction for pleural spread of thymoma and malignant pleural mesothelioma, but no proven substantial benefit for advanced lung cancer.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Narrative review of published literature
• Who was studied: Published papers, not patients directly. The MEDLINE search covered January 1999 to August 2020 and found 84 English-language papers. Sixty-eight were reviewed, including papers on thymoma and malignant pleural mesothelioma. Papers focused mainly on cancers spreading from outside the chest were excluded.
• Exposure: No asbestos exposure was studied. The subject was a treatment, HITHOC. In the most common techniques this meant a cisplatin-based fluid at 42 to 45 degrees Celsius for 30 to 90 minutes, usually after pleurectomy and/or debulking surgery.
• Main results:
  • A reviewed systematic review covered 4 publications with 21 patients who had debulking plus HITHOC for malignant effusion from non-small cell lung cancer. It reported a mean survival of 27 months, with 62% alive at 1 year and 28.5% alive at 2 years.
  • A reviewed prospective randomized comparison of HITHOC with talc pleurodesis for malignant pleural effusion in non-small cell lung cancer reported no difference in overall survival. It reported comparable safety and efficacy.
  • A reviewed study of malignant pleural mesothelioma reported a higher complication rate among 15 patients treated with extrapleural pneumonectomy plus radiation. The comparison group was 20 patients treated with extrapleural pneumonectomy or pleurectomy plus HITHOC plus radiation, so the groups also differed in surgery. The HITHOC group included two postoperative deaths and had a significantly shorter time to local recurrence.
  • A reviewed systematic review of 27 articles found no perioperative or HITHOC-associated mortality in the included papers. Morbidity rates were about 30%.
  • In a reviewed study of 20 patients with mesothelioma or stage IVa thymoma, half showed significant circulatory and airway pressure changes that required vasopressors when HITHOC began. One patient developed asystole.
• The authors' conclusion: The authors concluded that HITHOC had shown some weak benefit as an adjunct to cytoreduction for pleural dissemination of thymoma and malignant pleural mesothelioma. They found its usefulness for advanced primary lung cancer poorly established and not generally recommended. They stated there is no proven substantial benefit for these patients.
• Limitations the authors state:
  • The authors stated that the available clinical data are scarce and heterogeneous, and that there are no large prospective randomized trials.
  • The authors stated that the existing studies are small, nonrandomized and prone to bias.

Topics

Medical terms in this study, explained in our Lexicon: Intrathoracic, Chemotherapy, Lung Cancer, Palliative Care, Pleural Mesothelioma, Targeted Therapy, Immunotherapy.

Related studies

• Present and future of cytoreductive surgery and hyperthermic intrathoracic chemotherapy for pleural metastases: a narrative review — A. Hajja, M. Atout, et al. (2026)
• Cytoreductive surgery and intraoperative hyperthermic intrathoracic chemotherapy in patients with malignant pleural mesothelioma or pleural metastases of thymoma — E. de Bree, S. van Ruth, et al. (2002)
• Cytoreductive surgery and hyperthermic intrathoracic chemotherapy perfusion for malignant pleural tumours: perioperative management and clinical experience — M. Ried, T. Potzger, et al. (2013)
• Local and systemic exposure of cisplatin during hyperthermic intrathoracic chemotherapy perfusion after pleurectomy and decortication for treatment of pleural malignancies — M. Ried, T. Potzger, et al. (2013)
• Effect of hyperthermic intrathoracic chemotherapy on the malignant pleural mesothelioma: a systematic review and meta-analysis — Z.Y. Zhao, S.S. Zhao, et al. (2017)
• Pharmacokinetics of doxorubicin and cisplatin used in intraoperative hyperthermic intrathoracic chemotherapy after cytoreductive surgery for malignant pleural mesothelioma and pleural thymoma — S. van Ruth, O. van Tellingen, et al. (2003)

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