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Hyperthermic intrathoracic chemotherapy (HITHOC) is a way of delivering chemotherapy drugs directly to the chest cavity during surgery. Some doctors recommend this procedure for patients who undergo a pleurectomy and decortication (P/D).
Written by Karen Selby, RN • Edited By Walter Pacheco • Medically Reviewed By Dr. Raja Michael Flores
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Selby, K. (2023, June 21). HITHOC Treatment for Pleural Mesothelioma. Asbestos.com. Retrieved December 6, 2023, from https://www.asbestos.com/treatment/chemotherapy/hithoc/
Selby, Karen. "HITHOC Treatment for Pleural Mesothelioma." Asbestos.com, 21 Jun 2023, https://www.asbestos.com/treatment/chemotherapy/hithoc/.
Selby, Karen. "HITHOC Treatment for Pleural Mesothelioma." Asbestos.com. Last modified June 21, 2023. https://www.asbestos.com/treatment/chemotherapy/hithoc/.
HITHOC is a special type of chemotherapy. Pleural mesothelioma patients can receive it during a major tumor-removing surgery.
After patients recover from surgery, they can receive the usual systemic chemotherapy as well.
Systemic chemotherapy is the most common treatment for mesothelioma. Systemic chemotherapy drugs are typically delivered through an IV. The drugs travel through the bloodstream to all parts of the body, killing cancer cells and slowing tumor growth.
HITHOC is considered experimental by most doctors. First, surgeons must remove all visible cancer growth through surgery. Chemotherapy drugs are then pumped into the chest cavity to soak all the organs touched by tumors, killing any cancer cells left behind.
HITHOC is similar to hyperthermic intraperitoneal chemotherapy (HIPEC). It’s an established treatment option for patients who have mesothelioma in their abdomen.
So far, HITHOC has not been as successful as HIPEC. In most cases, pleural mesothelioma is harder to treat than peritoneal mesothelioma. But some doctors are hopeful the HITHOC procedure can be improved.
HITHOC is an option for patients who are strong enough to endure an aggressive treatment plan.
Some researchers suggest using HITHOC as a substitute for radiation therapy in cases where radiation is too risky.
The gold standard for extending survival with pleural mesothelioma is multimodal treatment. This usually involves a combination of invasive surgery, local radiation and systemic chemotherapy.
In some cases, surgeons must remove one lung and all the diseased tissue around it. Doctors then use radiation to kill any cancer cells left behind in the chest.
However, more often surgeons leave patients with both lungs intact.
In a pleurectomy and decortication, surgeons remove tumors around the lung and scrape cancer growth off the lung’s surface. This reduces the risk of surgical complications and leads to a better quality of life for the patient.
The problem is that it is dangerous to use radiation therapy if the lung is still in place. Lung tissue is very sensitive to radiation.
HITHOC gives doctors a safe way to potentially kill cancer cells in the chest when both lungs are present.
Patients with very little cancer spread may benefit from a combination of treatments. Lung-sparing surgery, HITHOC and systemic chemotherapy are effective for pleural patients.
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In 2013, Dr. David Sugarbaker led a study that looked at the results for hundreds of patients who received multimodal treatment for pleural mesothelioma between 2001 and 2009.
The researchers wanted to compare patients who received HITHOC to patients who did not. In their analysis, they balanced both groups so neither group had any natural advantage outside of their treatment plan.
Based on the experience of 103 patients, the study reported a better median survival time for patients who received HITHOC.
Median Survival Time After Surgery
Surgery | Survival Time |
---|---|
HITHOC Group | 35.3 months |
Comparison Group | 22.8 months |
In a 2017 study, Italian researchers reported the results for 49 patients who received HITHOC between 2005 and 2014.
In these cases, surgeons tried to preserve lung and diaphragm function as much as possible. This way, patients would not have permanent breathing difficulty.
The researchers reported 79% of the patients were alive one year after surgery, and 45% were alive two years after surgery.
The HITHOC procedure varies depending on which mesothelioma treatment center performs it. This is a general outline.
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