Effect of hyperthermic intrathoracic chemotherapy on the malignant pleural mesothelioma: a systematic review and meta-analysis

Our plain-English summary of Effect of hyperthermic intrathoracic chemotherapy on the malignant pleural mesothelioma: a systematic review and meta-analysis, by Z.Y. Zhao, S.S. Zhao, M. Ren, et al (Oncotarget, 2017).

The study

• Authors: Z.Y. Zhao, S.S. Zhao, M. Ren, Z.L. Liu, Z. Li, L. Yang
• Journal: Oncotarget
• Published: 2017;8(59):100640-100647
• Cited by: 35 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Surgery-based multimodality therapies have been used to control the malignant effusion and its recurrence in malignant pleural mesothelioma (MPM). Hyperthermic intrathoracic chemotherapy (HITHOC) has been used in the treatment of malignant pleural mesothelioma, but the results were controversial. The aim of the current study was, therefore, to conduct a systematic review and meta-analysis on the effect of HITHOC on MPM therapy. After thorough searching of online databases, total 21 articles were included into qualitative systematic review and 5 of them were used to conduct qualitative meta-analysis. It was found that most of HITHOC was used in combination of surgical resection including extrapleural pneumonectomy or pleurectomy/decortication. Patients who received HITHOC had significantly longer median survival length compared to the patients without HITHOC (Hedges's g = 0.384 ± 0.105, 95% CI: 0.178∼0.591, P < 0.001). In addition, HITHOC as palliative therapy was favored (Hedges's g = 0.591 ± 0.201, 95% CI: 0.196∼0.967, P < 0.001) in terms of recurrence free interval. The findings of the current study suggested that HITHOC is one of the safe and effective therapies in prolonging patients' median survival time and extending recurrence free interval.

In plain English

This systematic review and meta-analysis examined published studies of hyperthermic intrathoracic chemotherapy (HITHOC), heated chemotherapy circulated inside the chest, for malignant pleural mesothelioma. The authors searched PubMed, Embase and Web of Science for English and Chinese articles up to October 31, 2016. They reviewed 21 articles and pooled 5 that compared patients with and without HITHOC. Most HITHOC was given with surgery, and cisplatin was the drug used most often. Pooled median survival time was longer with HITHOC (Hedges's g 0.384, 95% CI 0.178 to 0.591, P less than 0.001). The recurrence-free interval also favored HITHOC (Hedges's g 0.591, 95% CI 0.196 to 0.967). One included study found longer survival after extrapleural pneumonectomy plus postoperative hemithoracic radiation than after extrapleural pneumonectomy plus HITHOC. Most articles reported no perioperative or HITHOC-associated deaths within 30 or 90 days. Reported complication rates ranged from 5.3% to 65%. The authors concluded that HITHOC is effective and safe. They noted that the five pooled studies were small and all combined HITHOC with other treatments. They also noted that these studies lacked properly controlled, randomized comparison groups, and that HITHOC techniques varied across the reviewed articles.

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: Systematic review and meta-analysis of published clinical studies
• Who was studied: Published studies of patients with malignant pleural mesothelioma treated with HITHOC. The authors searched PubMed, Embase and Web of Science for literature up to October 31, 2016, limited to English and Chinese. They included 21 articles in the systematic review and 5 in the meta-analysis. The studies came from the USA, Netherlands, United Kingdom, Japan, Italy, Germany, Israel, Turkey and France.
• Exposure: The treatment studied was hyperthermic intrathoracic (intrapleural) chemotherapy, mostly cisplatin, usually given with extrapleural pneumonectomy or pleurectomy/decortication. The article does not study asbestos exposure.
• Main results:
  • Across the 5 meta-analysis studies, the average of median survival time was longer in patients treated with HITHOC than in patients without HITHOC: Hedges's g = 0.384 (plus or minus 0.105), 95% CI 0.178 to 0.591, P less than 0.001.
  • The recurrence-free interval favored HITHOC: Hedges's g = 0.591 (plus or minus 0.201), 95% CI 0.196 to 0.967, P less than 0.001.
  • One included study (van Sandick et al, Netherlands) reported longer overall and disease-free survival in patients treated with extrapleural pneumonectomy plus postoperative hemithoracic radiation than in patients treated with extrapleural pneumonectomy plus intraoperative HITHOC.
  • Most of the 21 reviewed articles reported no perioperative or HITHOC-associated deaths within 30 or 90 days.
  • Reported rates of complications after surgery plus HITHOC ranged from 5.3% to 65% across the reviewed articles.
• The authors' conclusion: The authors concluded that HITHOC, as one of the surgery-based multimodality therapies for malignant pleural mesothelioma, is effective and safe.
• Limitations the authors state:
  • Only 5 studies were eligible for the meta-analysis, and each included few patients.
  • In all 5 meta-analysis studies, HITHOC was given in combination with other therapies.
  • HITHOC techniques differed across the 21 articles, including the drugs, their concentrations, the equipment, the perfusion volume and temperature, and the perfusion time.
  • The comparison (control) groups in the 5 meta-analysis studies were not properly controlled or randomized.
  • Because few studies were available, the effect of radiotherapy or systemic chemotherapy after surgery was not compared with that of HITHOC.

Topics

Medical terms in this study, explained in our Lexicon: Intrathoracic, Chemotherapy, Pleural Mesothelioma, Systematic Review, Meta-Analysis, Surgical Resection, Extrapleural Pneumonectomy (EPP), Pleurectomy/Decortication (P/D).

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• Risk factors for postoperative acute kidney injury after cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy: a meta-analysis and systematic review — D. Chen, Y. Ma, et al. (2025)
• 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)

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