Some like it hot: the potential role of hyperthermic intrathoracic chemotherapy in the multimodality treatment of pleural mesothelioma

Our plain-English summary of Some like it hot: the potential role of hyperthermic intrathoracic chemotherapy in the multimodality treatment of pleural mesothelioma, by K. Branch, P.S. Adusumilli, M.G. Zauderer (Translational Lung Cancer Research, 2023).

The study

• Authors: K. Branch, P.S. Adusumilli, M.G. Zauderer
• Journal: Translational Lung Cancer Research
• Published: 2023;12(2):187-189
• Type of article: Editorial, Comment
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

In plain English

This article is an editorial, not an original study. The authors commented on a retrospective study by Klotz and colleagues of 189 patients with epithelioid diffuse pleural mesothelioma treated at a single center from 2001 to 2018. Patients received chemotherapy, trimodal extrapleural pneumonectomy (EPP), or extended pleurectomy/decortication combined with hyperthermic intrathoracic chemotherapy and adjuvant chemotherapy (EPD/HITOC). According to the editorial, the EPD/HITOC group had a median overall survival of 38.1 months, compared with 24.0 months for EPP and 15.5 months for chemotherapy. Its 30-day mortality was 0%, versus 2.9% for EPP. The authors noted that 83% of the EPP group completed the full trimodal regimen. That was unexpected, since only 45–50% of patients generally complete it. They also noted that the criteria for choosing each surgery were not described, which raised possible selection bias, and that there was no control group. The authors concluded that the Klotz study did not provide the evidence needed to change current practice, and they called for a multi-center randomized controlled trial. The editorial does not discuss asbestos exposure.

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: Editorial commenting on a retrospective single-center study by Klotz et al. (Transl Lung Cancer Res 2022)
• Who was studied: The editorial itself studied no patients. The study it discusses (Klotz et al.) reviewed 189 patients with epithelioid diffuse pleural mesothelioma treated at a single center from 2001 to 2018. The location of the center is not stated in this text.
• Exposure: No asbestos exposure is discussed. The editorial concerns treatments: chemotherapy, trimodal extrapleural pneumonectomy (EPP), and extended pleurectomy/decortication with hyperthermic intrathoracic chemotherapy and adjuvant chemotherapy (EPD/HITOC).
• Main results:
  • In the Klotz et al. study, as reported by the editorial, median overall survival was 38.1 months in the EPD/HITOC group, 24.0 months in the EPP group and 15.5 months in the chemotherapy group.
  • In the Klotz et al. study, 30-day mortality was 0% in the EPD/HITOC group and 2.9% in the EPP group.
  • The editorial reports that perioperative morbidity was lower after EPD/HITOC than after EPP, giving the figures as 36.2% vs. 18.0%. The order of these figures, as printed, does not make clear which percentage belongs to which group.
  • After multivariate analysis, only the EPD/HITOC group was significantly associated with improved overall survival compared with chemotherapy.
  • 83% of the trimodal EPP group in the Klotz study completed both neoadjuvant chemotherapy and adjuvant radiation. The editorial authors called this unexpected, since successful completion of trimodal EPP is generally achieved by only 45–50% of patients.
• The authors' conclusion: The authors concluded that the Klotz et al. study did not provide the evidence needed to change current practice, and that a multi-center randomized controlled trial is needed to determine the benefits of HITOC.
• Limitations the authors state:
  • The editorial authors stated that the Klotz study did not describe the criteria used to choose trimodal EPP versus EPD/HITOC, so its outcomes may be affected by selection bias.
  • The editorial authors stated that the total number of patients with this cancer treated at the center during the period is unknown.
  • The editorial authors stated that the true benefit of HITOC cannot be discerned because there was no control group and the groups differed significantly in performance status and tumor stage.

Topics

Medical terms in this study, explained in our Lexicon: Intrathoracic, Chemotherapy, Pleural Mesothelioma.

Related studies

• Hyperthermic Intrathoracic Chemotherapy for Malignant Pleural Mesothelioma: The Forefront of Surgery-Based Multimodality Treatment — V. Aprile, A. Lenzini, et al. (2021)
• 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)
• 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)
• 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)
• Pressurized intrathoracic aerosol chemotherapy (PITAC) for malignant pleural mesothelioma-ex vivo evaluation of optimal treatment conditions and comparison with hyperthermic intrathoracic chemotherapy (HITOC) — K. Flöthmann, N. Zinne, et al. (2026)

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