Heated Intrathoracic Chemotherapy Could Extend Mesothelioma Survival

Research & Clinical Trials
Reading Time: 4 mins
Publication Date: 05/03/2022
Fact Checked
Our fact-checking process begins with a thorough review of all sources to ensure they are high quality. Then we cross-check the facts with original medical or scientific reports published by those sources, or we validate the facts with reputable news organizations, medical and scientific experts and other health experts. Each page includes all sources for full transparency.
Reviewed

Asbestos.com is the nation’s most trusted mesothelioma resource

The Mesothelioma Center at Asbestos.com has provided patients and their loved ones the most updated and reliable information on mesothelioma and asbestos exposure since 2006.

Our team of Patient Advocates includes a medical doctor, a registered nurse, health services administrators, veterans, VA-accredited Claims Agents, an oncology patient navigator and hospice care expert. Their combined expertise means we help any mesothelioma patient or loved one through every step of their cancer journey.

More than 30 contributors, including mesothelioma doctors, survivors, health care professionals and other experts, have peer-reviewed our website and written unique research-driven articles to ensure you get the highest-quality medical and health information.

About The Mesothelioma Center at Asbestos.com

  • Assisting mesothelioma patients and their loved ones since 2006.
  • Helps more than 50% of mesothelioma patients diagnosed annually in the U.S.
  • A+ rating from the Better Business Bureau.
  • 5-star reviewed mesothelioma and support organization.
Learn More About Us

Testimonials

"My family has only the highest compliment for the assistance and support that we received from The Mesothelioma Center. This is a staff of compassionate and knowledgeable individuals who respect what your family is experiencing and who go the extra mile to make an unfortunate diagnosis less stressful. Information and assistance were provided by The Mesothelioma Center at no cost to our family."
Lashawn
Mesothelioma patient’s daughter
  • Google Review Rating
  • BBB Review Rating

How to Cite Asbestos.com’s Article

APA

Povtak, T. (2022, May 3). Heated Intrathoracic Chemotherapy Could Extend Mesothelioma Survival. Asbestos.com. Retrieved February 4, 2023, from https://www.asbestos.com/news/2022/05/03/heated-intrathoracic-chemotherapy-pleural-mesothelioma/

MLA

Povtak, Tim. "Heated Intrathoracic Chemotherapy Could Extend Mesothelioma Survival." Asbestos.com, 3 May 2022, https://www.asbestos.com/news/2022/05/03/heated-intrathoracic-chemotherapy-pleural-mesothelioma/.

Chicago

Povtak, Tim. "Heated Intrathoracic Chemotherapy Could Extend Mesothelioma Survival." Asbestos.com. Last modified May 3, 2022. https://www.asbestos.com/news/2022/05/03/heated-intrathoracic-chemotherapy-pleural-mesothelioma/.

Patients with pleural mesothelioma undergoing aggressive surgery should consider combining it with controversial hyperthermic intrathoracic chemotherapy to extend survival, according to a recent study.

Although the procedure, also known as HITHOC, has yet to be proven effective in a randomized clinical trial – and still is being debated by mesothelioma specialists – the report has elevated its status as a potentially useful adjuvant.

“We concluded that the heated chemotherapy, delivered in a specialty center, has shown benefit,” researcher Alan G. Dawson told The Mesothelioma Center at Asbestos.com. “It should have a place in the multimodality approach to treatment.”

Dawson studies malignant pleural mesothelioma with the Thoracic Oncology Research Group at the University of Leicester, United Kingdom.

Annals of Surgical Oncology published this latest retrospective review in April, drawing from 598 patients in 15 different studies covering eight countries.

Pleural Mesothelioma Survival Times Rise Significantly

The results showed significant improvement for those undergoing the combination treatment as compared to those receiving the surgery and traditional systemic chemotherapy.

“I was actually quite surprised at the findings,” Dawson said. “Going in, there was a lot of skepticism. Most thought there would be no difference in survival, or not much in the way of difference. The numbers, though, show that there is.”

Overall survival of those receiving the novel combination ranged from 11 to 75 months, compared with a 5- to 36-month range for those having surgery without HITHOC. The disease-free interval ranged from 7.2 to 57 months for the combination group, compared with 12.1 to 21 months for those bypassing HITHOC.

HITHOC involves circulating a heated, high-concentration chemotherapy solution throughout the chest cavity for 60-90 minutes immediately following aggressive surgery.

The belief is that the heated chemotherapy will kill any tumor cells that evaded the surgeon, which will slow the potential cancer recurrence.

Therapy Proven with Peritoneal Mesothelioma

While HIPEC, a similar procedure used effectively for peritoneal mesothelioma in the abdominal cavity, has proven to be a huge treatment benefit, HITHOC is used in a much smaller percentage of patients alongside surgery.

Specialty centers throughout the United Kingdom all have opted against using it, although this latest report could change things. Some thoracic surgeons in the U.S. have been using it, but others have opted against it.

Very few published guidelines for treatment of pleural mesothelioma include HITHOC. The National Comprehensive Cancer Network guideline does not. The latest American Society of Clinical Oncology guideline recently addressed it, but with considerable caution.

The recommendation is that “intracavity therapies may be delivered safely in experienced centers of excellence, but that their role in improving outcome is indeterminate.”

HITHOC Comes with Risks

Dosage levels made a considerable difference in the effectiveness of the HITHOC, according to the report. The higher dosage levels led to almost double the median overall survival times. Direct application in the thoracic cavity allows for a much higher local concentration, in contrast to typical systemic therapy.

As the report illustrates, though, the HITHOC procedure is not without risks. Morbidity rates can rise with the combination treatment.

According to the report, 12 of the 15 studies included data on morbidity. Atrial fibrillation was the most common morbidity at 20.4%. Renal complications were reported in 16.8% of the patients.

Selection of Mesothelioma Patients Is Key

The report also emphasizes the importance of proper selection of patients in receiving the aggressive surgery and HITHOC combination.

The heated chemotherapy regimen adds another 90 minutes to an aggressive surgery that already can take anywhere from four to 8 hours, a reason some surgeons opt against using it.

Traditionally, multimodal therapy consisting of surgery, radiation and systemic chemotherapy has been used to obtain extended survival, but recent years have included these smaller studies with HITHOC.

Two-year survival rates in this report ranged from 25% to 67%, while three-year survival rates ranged from 17% to 42%.

“It’s never been proven in a randomized trial, but evidence suggests there are benefits,” Dawson said. “If you are well enough to be considered for aggressive surgery, I would say you should consider the heated chemotherapy that can kill the tumor cells left behind.”

blue medical health symbol
Connect with a Mesothelioma Doctor
Find a Top Specialist Near You