Long-term results of intrathoracic chemohyperthermia (ITCH) for the treatment of pleural malignancies

Our plain-English summary of Long-term results of intrathoracic chemohyperthermia (ITCH) for the treatment of pleural malignancies, by O. Monneuse, A.C. Beaujard, B. Guibert, et al (British Journal of Cancer, 2003).

The study

• Authors: O. Monneuse, A.C. Beaujard, B. Guibert, F.N. Gilly, P. Mulsant, P.Y. Carry, M. Benoit, O. Glehen
• Journal: British Journal of Cancer
• Published: 2003;88(12):1839-43
• Cited by: 29 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

There is no standard treatment for patients with pleural malignancies. The aim of this prospective study was to investigate the toxicity and long-term results of a multimodality treatment consisting of surgery and intrathoracic chemohyperthermia (ITCH) for the treatment of patients with pleural malignancies. From January 1990 to August 2000, 24 patients with mesothelioma (n=17), fibrosarcoma (n=3), pleural adenocarcinoma (n=3) and thymoma (n=1) were included. The mesothelioma stages were T1 or T2 in 10 cases, and T3 or T4 in seven cases. After cytoreductive surgery, ITCH was carried out for over 60 min, at inflow temperatures less than 45 degrees C, either with mitomycin C (n=7) or cisplatin (n=5) or both (n=12). One patient died from major thoracic air leaks after major decortication and pleurectomy. Seven patients had complications, one pleural clotting necessitating reoperation. After a median follow-up of 89 months, the overall 1-year and 5-year survival rates were 74 and 27%, respectively. For T1 and T2 mesothelioma patients, the median survival was 41.3 months, and for T3 and T4 tumours, it was 4.5 months (P=0.001). The fibrosarcoma patients are alive with no evidence of recurrence at 24, 43 and 54 months. In the conclusion, the combination of surgery with ITCH with mitomycin and/or cisplatin is relatively safe. This procedure may offer unexpected long-term survival in a selected group of patients (T1 and T2 mesothelioma patients and fibrosarcoma patients).

In plain English

This prospective study followed 24 patients with pleural cancers (cancers of the lining around the lungs) treated from January 1990 to August 2000. Seventeen had diffuse malignant mesothelioma; the others had metastatic carcinoma (3), fibrosarcoma (3) or thymoma (1). After surgery to remove tumour (not possible in one patient), patients received intrathoracic chemohyperthermia: the chest cavity was bathed for over 60 minutes in heated fluid containing mitomycin C, cisplatin or both. One patient died after surgery from major air leaks; six others had complications. Across all patients, 1-year survival was 74%, 5-year survival 27% and median survival 21 months. Among mesothelioma patients, median survival was 41.3 months with T1 or T2 tumours and 6 months with T3 or T4 tumours (the abstract gives 4.5 months for this group). The three fibrosarcoma patients were alive without evidence of recurrence at 24, 43 and 54 months, though one had needed a second operation for local recurrence. The authors concluded the treatment had acceptable morbidity and encouraging survival in selected patients, adding that strict selection may explain part of this and controlled 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: prospective study of a single treatment series (surgery plus intrathoracic chemohyperthermia), with no comparison group
• Who was studied: 24 patients with pleural malignancies treated January 1990 to August 2000 (17 males, 7 females, aged 27 to 73): 17 diffuse malignant mesothelioma (stage T1 in 5, T2 in 5, T3 in 6, T4 in 1), 3 metastatic carcinoma, 3 fibrosarcoma, 1 thymoma
• Exposure: Not asbestos. The study examined a treatment: surgery followed by heated intrapleural chemotherapy with mitomycin C (7 patients), cisplatin (5) or both (12) for over 60 minutes. Surgery was pleurectomy, decortication, or wedge or tumour resection in 23 patients; one patient had only an exploratory thoracotomy because the tumour was unresectable. The article does not discuss asbestos exposure.
• Main results:
  • One patient died in hospital after the operation, from major thoracic air leaks on the 15th postoperative day after extensive surgery for a T4 mesothelioma. Six other patients had surgical complications.
  • Blood levels of the drugs never reached the systemic toxic level, and there was no kidney or blood toxicity.
  • All 24 patients: 1-, 2-, 3- and 5-year actuarial survival rates were 74, 56, 51 and 27%, after a median follow-up of 89 months.
  • All 24 patients: overall median survival was 21 months.
  • Mesothelioma patients: 1-, 2-, 3- and 5-year actuarial survival rates were 69, 50, 42 and 8%, and overall median survival was 18 months.
  • Mesothelioma patients: according to the Results section, median survival was 41.3 months with T1 or T2 tumours and 6 months with T3 or T4 tumours (P = 0.001). The article's abstract gives 4.5 months for the T3 or T4 group.
  • Mesothelioma patients with T3 or T4 tumours: 1-year survival was 50%, and no patient was alive at 2 years.
  • In 11 patients the disease came back or progressed in the treated pleura.
  • The three fibrosarcoma patients were alive with no evidence of recurrence at 24, 43 and 54 months. One of them had needed a second procedure (pleurectomy and ITCH) for a local recurrence 41 months after the first.
  • No significant difference was found between patients treated with mitomycin C, cisplatin or both.
• The authors' conclusion: The authors concluded that surgery combined with ITCH using mitomycin C and/or cisplatin is associated with acceptable morbidity. They found encouraging survival in a selected group (mesothelioma patients with T1 and T2 tumours, and fibrosarcoma patients), but said controlled studies are needed to evaluate the benefit.
• Limitations the authors state:
  • Part of the survival results might be due to the strict selection of patients.
  • For the non-mesothelioma cancers, the variety of tumour types and small numbers prevent firm conclusions.
  • Symptoms and quality of life were not objectively measured before and after treatment.
  • The surgery used may not remove enough tumour for T3 or T4 disease.
  • There was no control group; the authors say controlled studies are necessary.

Topics

Medical terms in this study, explained in our Lexicon: Intrathoracic, Mesothelioma, Adenocarcinoma, Cytoreductive Surgery, Mitomycin C, Cisplatin, Median Overall Survival.

Related studies

• 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 intraoperative hyperthermic intrathoracic chemotherapy after pleurectomy decortication for treatment of malignant pleural mesothelioma: a comparative study — H.H. Elsayed, H.Y. Sharkawy, et al. (2024)
• Intrathoracic chemo-thermotherapy with radiofrequency waves after extrapleural pneumonectomy for malignant pleural mesothelioma — T. Tokunaga, M. Higashiyama, et al. (2011)
• Dose-Dependent Effect of Red Blood Cells Transfusion on Perioperative and Long-Term Outcomes in Peritoneal Surface Malignancies Treated with Cytoreduction and HIPEC — E. Nizri, S. Kusamura, et al. (2018)
• Multicystic mesothelioma: Operative and long-term outcomes with cytoreductive surgery and hyperthermic intra peritoneal chemotherapy — E. Nizri, D. Baratti, et al. (2018)
• What made hyperthermic intraperitoneal chemotherapy an effective curative treatment for peritoneal surface malignancy: A 25-year experience with 1,125 procedures — G. Passot, D. Vaudoyer, et al. (2016)

Browse more research in British Journal of Cancer, or return to medical research.