Anwendung der hyperthermen intrathorakalen Chemotherapie (HITHOC) in Deutschland

Ried, Michael; Hofmann, Hans‐Stefan; Dienemann, Hendrik; Eichhorn, Martin

doi:10.1055/a-0573-2419

Cited by 10 publications

(5 citation statements)

References 26 publications

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“…EPP itself can lead to severe medical and surgical complications and requires multidisciplinary expertise for both prevention and management [14]. In a meta-analysis of 21 studies for pleural mesothelioma, the authors found that while surgery may cause complications like bronchopleural fistula, diaphragm rupture, or laryngeal nerve dysfunction, HITHOC itself did not cause such adverse effects [15]. A review of HITHOC performed at German thoracic surgery centers also found a low rate of major complications [16].…”

Section: Discussionmentioning

confidence: 99%

“…Looking at each of the diseases individually, the median survival in pleural mesothelioma is dismal. With multimodality treatment comprising of surgery with intrathoracic and systemic chemotherapy with or without radiotherapy, the median survival is still only 15-18 months and the median DFS under 12 months [15]. The therapy itself is intense, and many patients may not be able to withstand this aggressive treatment.…”

Section: Discussionmentioning

confidence: 99%

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Hyperthermic Intrathoracic Chemotherapy (HITHOC) for Pleural Malignancies—Experience from Indian Centers

Patel

Damodaran

Rangole

et al. 2018

Indian J Surg Oncol

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Hyperthermic intrathoracic chemotherapy (HITHOC) has been used in addition to radical surgery for primary and secondary pleural malignancies to improve local control, prolong survival, and improve the quality of life. This study was performed to study the indications, methodology, perioperative outcomes, and survival in patients undergoing HITHOC at Indian centers. A retrospective analysis of prospectively collected demographic and clinical data, perioperative and survival data of patients undergoing surgery with or without HITHOC was performed. From January 2011 to May 2018, seven patients underwent pleurectomy/decortication (P/D) or extrapleural pneumonectomy (EPP) with HITHOC and four had P/D or EPP alone at three Indian centers. P/D was performed in two and EPP in nine patients. The primary tumor was pleural mesothelioma in eight, metastases from thymoma in one, germ cell tumor in one, and solitary fibrous tumor of the pleura in one. HITHOC was performed using cisplatin. Grade 3-4 complications were seen in one patient in the HITHOC group and none in the non-HITHOC group, and one patient in the non-HITHOC group died of complications. At a median follow-up of 9 months, five patients of the HITHOC group were alive, four without recurrence, and one with recurrence. One patient in the non-HITHOC group was alive and disease-free at 24 months, and two died of progression at 18 and 36 months. HITHOC can be performed without increasing the morbidity of P/D or EPP. Most of these patients require multimodality treatment and are best managed by multidisciplinary teams.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Hyperthermic Intrathoracic Chemotherapy (HITHOC) for Pleural Malignancies—Experience from Indian Centers

Patel

Damodaran

Rangole

et al. 2018

Indian J Surg Oncol

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“…Hyperthermic intrathoracic chemotherapy (HITOC) is an innovative, additive treatment for selected patients with primary or secondary malignant pleural tumors. In Germany, about 350 of these procedures have been performed in 10 years by 17 specialized clinics, and the number is increasing (Ried et al 2018). Over a period of 60 min, the thoracic cavity is perfused with a heated solution to improve local tumor control after surgical cytoreduction .…”

Section: Introductionmentioning

confidence: 99%

“…These results urge caution, but dermal contact can be prevented by taking the appropriate safety measures (Landeck et al 2015). To prevent the exposure of the operating room (OR) personnel, specific safety regulations must be applied (safety instruction, gloves compatible with cytostatic drugs, protective surgical gowns, safety glasses, dedicated containers for disposal of cytostatic agents) (Ried et al 2018).…”

Section: Introductionmentioning

confidence: 99%

Exposure to cisplatin in the operating room during hyperthermic intrathoracic chemotherapy

Markowiak¹,

Ried²,

Larisch³

et al. 2021

Int Arch Occup Environ Health

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Purpose Hyperthermic intrathoracic chemotherapy (HITOC) is an additive, intraoperative treatment for selected malignant pleural tumors. To improve local tumor control, the thoracic cavity is perfused with a cisplatin-containing solution after surgical cytoreduction. Since cisplatin is probably carcinogenic to humans, potential contamination of surfaces and pathways of exposure should be systematically investigated to enable risk assessments for medical staff and thus derive specific recommendations for occupational safety. Methods Wipe sampling was performed at pre-selected locations during and after ten HITOC procedures, including on the surgeon's gloves, for the quantitation of surface contaminations with cisplatin. After extraction of the samples with hydrochloric acid, platinum was determined as a marker for cisplatin by voltammetry. Results High median concentrations of cytostatic drugs were detected on the surgeons’ (1.73 pg Cis-Pt/cm2, IQR: 9.36 pg Cis-Pt/cm2) and perfusionists’ (0.69 pg Cis-Pt/cm2, IQR: 1.73 pg Cis-Pt/cm2) gloves. The display of the perfusion device showed partially elevated levels of cisplatin up to 4.92 pg Cis-Pt/cm2 and thus could represent an origin of cross-contamination. In contrast, cisplatin levels on the floor surfaces in the area of the surgeon and the perfusion device or in the endobronchial tube were relatively low. Conclusion With a correct use of personal protective equipment and careful handling, intraoperative HITOC appears to be safe to perform with a low risk of occupational exposure to cisplatin.

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“…= erweiterte Pleurektomie/Dekortikation, EPP = extrapleurale Pneumonektomie, P/D = Pleurektomie/Dekortikation, SD = Standardabweichung, VATS = videoassistierte Thorakoskopie rapie (HITOC) durchgeführt, dies wurde von insgesamt 9 Kliniken dokumentiert (▶ Tab. 2)[7].Sekundäre PleurakarzinoseBei 317 (61,4 %) Patienten des Registers wurde eine thoraxchirurgische Behandlung aufgrund einer sekundären Pleurakarzinose durchgeführt. Insbesondere Bronchial-(33,5 %; n = 107) oder Mammakarzinome (27,9 %; n = 89) wurden häufig als Primarius genannt, sodass allein diese beiden Entitäten 2 2 ⁄3 3 der Primärtumoren ausmachten.…”

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Fünf Jahre PLEURATUMOR-Register der Deutschen Gesellschaft für Thoraxchirurgie

2020

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Zusammenfassung Hintergrund Seit dem 01.01.2015 dokumentiert das deutschlandweite „PLEURATUMOR-Register der DGT“ die wichtigsten Parameter von thoraxchirurgisch behandelten Patienten mit primären und sekundären malignen Pleuraerkrankungen. Sowohl Erst- als auch Rezidiverkrankungen sollen in dieser Onlinedatenbank erfasst werden. Ein besonderer Schwerpunkt des Registers liegt auf der Dokumentation von Patienten mit einer Pleurakarzinose, einem malignen Pleuramesotheliom und Tumoren des Thymus mit pleuraler Aussaat. Material und Methoden Im März 2020 erfolgte eine strukturierte Auswertung aller bis einschließlich Dezember 2019 dokumentierten Patienten in der Datenbank. Ergebnisse Zu diesem Zeitpunkt nahmen 33 Abteilungen/Kliniken am PLEURATUMOR-Register teil. Es wurden bisher 670 Patienten erfasst. Von diesen Datensätzen waren 522 Fälle vollständig und bei 516 dieser Patienten wurde eine Operation durchgeführt. Im Jahr 2017 wurden bisher die meisten Patienten vollständig dokumentiert (n = 135; 26,2%), im Jahr 2019 waren es 72 (14%). Mit 317 gelisteten Patienten (61,4%) war die Pleurakarzinose die am häufigsten erfasste pleurale Tumorerkrankung, gefolgt vom malignen Pleuramesotheliom (n = 175; 33,9%) sowie dem pleural metastasierten Thymom/Thymuskarzinom (n = 11; 2,1%). Der Großteil der Patienten (n = 499; 96,7%) wurde aufgrund einer Erstmanifestation behandelt. Der am häufigsten dokumentierte Eingriff war die VATS-Talkumpleurodese (n = 204; 39,5%). Bei 69 Patienten (13,4%) führte man im Anschluss an eine zytoreduktive Operation eine hypertherme intrathorakale Chemotherapie durch. Postoperative Komplikationen traten bei 107 Patienten (20,7%) auf, in 35 Fällen (6,8%) war eine operative Revision erforderlich. Die 30-Tage-Letalität betrug insgesamt 8,3% (n = 43). Schlussfolgerung Durch die konsequente Dateneingabe der teilnehmenden Kliniken konnte bereits eine repräsentative Datenmenge an pleuralen Tumorerkrankungen erfasst werden. Zukünftig erhoffen wir uns eine konsequente und möglichst vollständige Fortführung der Dateneingabe sowie die Initiierung von registerbasierten Studien.

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Anwendung der hyperthermen intrathorakalen Chemotherapie (HITHOC) in Deutschland

Cited by 10 publications

References 26 publications

Hyperthermic Intrathoracic Chemotherapy (HITHOC) for Pleural Malignancies—Experience from Indian Centers

Hyperthermic Intrathoracic Chemotherapy (HITHOC) for Pleural Malignancies—Experience from Indian Centers

Exposure to cisplatin in the operating room during hyperthermic intrathoracic chemotherapy

Fünf Jahre PLEURATUMOR-Register der Deutschen Gesellschaft für Thoraxchirurgie

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