Hyperthermic Intrathoracic Chemotherapy for Malignant Pleural Mesothelioma: The Forefront of Surgery-Based Multimodality Treatment

Our plain-English summary of Hyperthermic Intrathoracic Chemotherapy for Malignant Pleural Mesothelioma: The Forefront of Surgery-Based Multimodality Treatment, by V. Aprile, A. Lenzini, F. Lococo, et al (Journal of Clinical Medicine, 2021).

The study

• Authors: V. Aprile, A. Lenzini, F. Lococo, D. Bacchin, S. Korasidis, M.G. Mastromarino, G. Guglielmi, G. Palmiero, M.C. Ambrogi, M. Lucchi
• Journal: Journal of Clinical Medicine
• Published: 2021;10(17)
• Type of article: Review
• Cited by: 23 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Introduction: Malignant Pleural Mesothelioma (MPM) is characterized by an aggressive behavior and an inevitably fatal prognosis, whose treatment is still far from being standardized. The role of surgery is questionable since a radical resection is unattainable in most cases. Hyperthermic IntraTHOracic Chemotherapy (HITHOC) combines the advantages of antitumoral effects together with those of high temperature on the exposed tissues with the aim to improve surgical radicality.

Material And Methods: this is a narrative review on the role of HITHOC in the management of MPM patients. To provide data on the beginnings and the historical evolution of this technique, we searched the available literature by selecting the more exhaustive papers on this topic.

Results: from 1994 to date different authors experimented HITHOC following a cytoreductive surgery in MPM, obtaining in most cases a good local control and a better overall survival associated to very low complication rate.

Conclusions: HITHOC may be considered as a safe, feasible and effective procedure although there is a high heterogeneity between different protocols adopted worldwide. More structured studies are needed to reach a unanimous consensus on this technique.

In plain English

This article was a narrative review, not a new study, of hyperthermic intrathoracic chemotherapy (HITHOC) for malignant pleural mesothelioma. In HITHOC, chemotherapy is circulated through the chest cavity after surgery to remove tumor; most regimens used cisplatin. The authors searched PubMed for English-language literature up to January 2021. They selected studies that reported the HITHOC protocol, the course after surgery, and cancer outcomes. Their tables summarized nine studies published from 1994 to 2019, each with 7 to 104 treated patients. In a 2013 study by Sugarbaker and colleagues, 72 patients given heated cisplatin had a median overall survival of 35.3 months, compared with 22.8 months in a comparison group of 31 patients who did not receive it. In a 2018 study by Ambrogi and colleagues, which included several of this review's authors, 49 patients had a median overall survival of 22 months. The authors concluded that HITHOC may be considered safe, feasible and effective. They noted that protocols vary widely, that most of the evidence is retrospective, and that more structured studies are needed.

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 studies on HITHOC in malignant pleural mesothelioma
• Who was studied: Published studies found in PubMed up to January 2021, English language only. The tables summarize nine studies (1994 to 2019) with 7 to 104 patients each.
• Exposure: HITHOC after cytoreductive surgery (extrapleural pneumonectomy or pleurectomy/decortication), mostly with cisplatin, alone or combined with mitomycin, doxorubicin, epirubicin, gemcitabine or amifostine. Asbestos is mentioned only as the main risk factor for the disease.
• Main results:
  • In the reviewed Sugarbaker 2013 study, the 72 patients given hyperthermic cisplatin had a longer disease-free interval (27.1 vs. 12.8 months) and longer overall survival (35.3 vs. 22.8 months) than the 31-patient comparison group.
  • In the reviewed Ambrogi 2018 study of 49 patients, median overall survival was 22 months. It was 35 months in early stage and 17 months in advanced stage patients.
  • In the reviewed Klotz study of 71 patients, median overall survival was 16.1 months. By tumor type it was 9.2 months for sarcomatoid, 10.9 months for biphasic and 17.9 months for epithelioid.
  • In the reviewed Hod et al. study of 512 patients given cisplatin-based HITHOC, about half developed mild acute kidney injury, and 3.2% required renal replacement therapy.
• The authors' conclusion: The authors concluded that HITHOC may be considered a safe, feasible and effective local treatment, but that more structured studies are needed to reach consensus.
• Limitations the authors state:
  • HITHOC techniques are very heterogeneous across studies (surgery, drugs, doses, perfusion machine, temperature, duration).
  • Most of the literature consists of retrospective analyses.
  • Large randomized studies are difficult because the tumor is rare and has high mortality.

Topics

Medical terms in this study, explained in our Lexicon: Intrathoracic, Chemotherapy, Pleural Mesothelioma, Prognosis, Cytoreductive Surgery, Overall Survival.

Related studies

• Some like it hot: the potential role of hyperthermic intrathoracic chemotherapy in the multimodality treatment of pleural mesothelioma — K. Branch, P.S. Adusumilli, et al. (2023)
• Comparison of video-assisted pleurectomy/decortication surgery plus hyperthermic intrathoracic chemotherapy with VATS talc pleurodesis for the treatment of malignant pleural mesothelioma: A pilot study — M. Migliore, M. Fiore, et al. (2023)
• Multimodal Treatment of Pleural Mesothelioma with Cytoreductive Surgery and Hyperthermic Intrathoracic Chemotherapy: Impact of Additive Chemotherapy — L.V. Klotz, J. Zimmermann, et al. (2024)
• Present and future of cytoreductive surgery and hyperthermic intrathoracic chemotherapy for pleural metastases: a narrative review — A. Hajja, M. Atout, et al. (2026)
• Diaphragm and lung-preserving surgery with hyperthermic chemotherapy for malignant pleural mesothelioma: A 10-year experience — M.C. Ambrogi, P. Bertoglio, et al. (2018)
• 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)

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