Hyperthermic Intrathoracic Chemotherapy in Thoracic Surgical Oncology: Future Challenges of an Exciting Procedure

A glimpse into the role of debulking surgery and hyperthermic intrathoracic chemotherapy (HITHOC) in the management of malignant pleural mesothelioma

“…Guidelines for the use of HITHOC for MPM do not exist and its absence could create confusion for patients, oncologists and surgeons (8,(13)(14)(15)(16). Nevertheless, in 2020 an expert recommendation paper has been published in Germany (17).…”

“…Although a recent paper from the United States (25) reported a high incidence of renal toxicity as acute kidney injury. It seems clear that renal toxicity and mortality developed in patients who underwent EPP, and not in those who underwent P/D (13)(14)(15). A retrospective, multicenter study of 700 patients who underwent cytoreductive surgery plus cisplatin based HITHOC reported significant postoperative morbidity related to HITHOC, particularly renal insufficiency (26,27) since it appeared in 41 patients (12%) and the risk for postoperative renal failure was dependent on the intrathoracic cisplatin dosage.…”

“…Several systematic reviews and meta-analyses have concluded that EPP was associated with more postoperative mortality and morbidity in comparison with P/D. It was also concluded that EPD decreased mortality and morbidity by 2.5 folds and that it improved survival (15,22,(34)(35)(36)(37). MPM symptomatically; however, several studies observed that its surgical complications risks weigh more than the possible benefits and that VATS pleurodesis is a more effective and less invasive method (3) (Figure 3).…”

“…However, any residual microscopic disease can lead to MPM progression. To try and overcome this, HITHOC is administered (Video 1) and is associated with a higher disease-free interval and overall survival especially when administered at a high dose (15). Our preferred surgical approach is a VATS via a mini-thoracotomy of 8-12 cm instead of large thoracotomies with/without rib resection (38).…”

ERS International Congress 2021: highlights from the Thoracic Surgery and Lung Transplantation Assembly

“…Finally, Till Markowiak (Regensburg, Germany) presented the current concepts regarding hyperthermic intrathoracic chemotherapy (HITOC) [ 35 , 36 ]. To begin with, HITOC plays a crucial role as an additive procedure to cytoreductive surgery for the treatment of MPM.…”