Narrative review of theoretical considerations regarding HITHOC between past and future

Our plain-English summary of Narrative review of theoretical considerations regarding HITHOC between past and future, by T.F. Molnar, A. Drozgyik (Annals of Translational Medicine, 2021).

The study

• Authors: T.F. Molnar, A. Drozgyik
• Journal: Annals of Translational Medicine
• Published: 2021;9(11):954
• Type of article: Review
• Cited by: 5 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Hyppocrates constructed the medicines-surgery-energy triangle which includes all therapeutical modalities. Hyperthermic intraoperative chemotherapy (HITHOC) is a synergy-based single stage multimodality treatment encompassing the locoregional manifestation of the systemic malignant process. Pleural space, thermal effect, lavage/irrigation and chemotherapy represent the basic science ports of the network hub: HITHOC. The malignant transformation and process of the pleural surface (and underlying lung) challenges space management and tissue control. Thermotherapy without local chemotherapy is insufficient, similar to the normothermic local irrigation aligned with anticancer agents. The local administration of combined heat-transfer fluid and chemotherapy with or without subsequent surgical removal offers reasonable outcome in extensive primary pleural neoplasms (malignant mesothelioma), advanced (> Stage IIIA) NSCLC, functionally inoperable lung cancer and pleural carcinosis from extrathoracic malignancies. Measured by symptom-free survival and the quality of life, HITHOC in its present form, offers a modest yet fully substantiated solution. HITHOC in combination with the local application of targeted therapy and/or immunotherapy administered in the pleural space are currently under investigation. Additional development including new acting substances, their solvents and the means regarding surgical delivery and anesthesiology techniques are sign posts up ahead. Level 2 evidence are required in order to stepping up the recommendation levels, rewriting protocols and guidelines, in which HITHOC earns its revered position in the decision making process it deserves.

2021 Annals of Translational Medicine. All rights reserved.

In plain English

This narrative review was not a study of patients or of asbestos exposure. The authors discussed the theory behind hyperthermic intraoperative chemotherapy (HITHOC), a treatment that delivers heated chemotherapy into the pleural space, the space between the membrane covering the lungs and the one lining the chest wall. They considered four elements: the pleural space, heat, washing (irrigation) of the space, and chemotherapy. The authors wrote that heated fluid without added drugs appeared to be a suboptimal approach. They wrote that earlier drugs given into the pleural space without heating failed to achieve a measurable antitumor effect. They named the main targets as extensive malignant mesothelioma, advanced (above Stage IIIA) non-small cell lung cancer, functionally inoperable lung cancer, and pleural spread from cancers elsewhere, such as breast and colon cancer. They listed possible future directions, including nanotechnology, hypo-oncotic solutions, and delivery by video-assisted keyhole surgery. The authors concluded that, measured by symptom-free survival and quality of life, the treatment offers a modest yet well established solution. They said existing prospective studies provide level III evidence and randomized 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 (commissioned article in a journal series on HITHOC); no new patient data
• Who was studied: No patients or participants. The authors discussed published literature and the anatomical, physical and (bio)chemical aspects of intrapleural HITHOC.
• Exposure: No asbestos or fiber exposure was studied. The subject was a cancer treatment, intrapleural hyperthermic intraoperative chemotherapy, considered through the pleural space, heat, irrigation and chemotherapy.
• Main results:
  • The authors stated that local heated fluid irrigation without an added drug appears to be a suboptimal solution.
  • In the authors' account of earlier work, cisplatin and later drugs (bleomycin, etoposide, taxanes) given into the pleural space without heating all failed to achieve a measurable antitumor effect there.
  • The authors named the main targets of intrapleural HITHOC: extensive malignant mesothelioma, advanced (above Stage IIIA) NSCLC, functionally inoperable lung cancer, and pleural carcinosis from extrathoracic cancers such as breast and colonic cancer.
  • As a future direction, the authors raised the question of whether hypo-oncotic solvents for the drugs would increase how well the treatment works.
• The authors' conclusion: The authors concluded that, measured by symptom-free survival and quality of life, intrapleural HITHOC in its present form offers a modest yet well established solution. They said prospective studies provide level III evidence and that randomized studies are needed.
• Limitations the authors state:
  • The authors limited the review to intrapleural HITHOC and excluded focused hyperthermia (tumor ablation).
  • The authors stated that they did not discuss recent evidence in full depth or detail the existing controversies.

Topics

Medical terms in this study, explained in our Lexicon: Chemotherapy, Malignant Transformation, Neoplasm, Mesothelioma, Lung Cancer, Quality of Life, Targeted Therapy, Immunotherapy.

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