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HITHOC Treatment for Pleural Mesothelioma

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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).

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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.

  • Used in aggressive multimodal cancer treatment
  • Kills cancer locally like radiation, but with less risk of lung damage
  • Associated with improved survival times in some research studies
  • Procedure varies depending on the surgeon and treatment center

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), 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 perfected.

Who Can Benefit from HITHOC?

HITHOC is an option for patients who are strong enough to endure an aggressive treatment plan.

Some researchers suggest HITHOC is best used 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 kill cancer cells in the chest when both lungs are present.

Patients with very little cancer spread may benefit most from a combination of lung-sparing surgery, HITHOC and systemic chemotherapy.

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Research on HITHOC Treatment

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 percent of the patients were alive one year after surgery, and 45 percent were alive two years after surgery.

Hyperthermic Intrathoracic Chemotherapy (HITHOC) Process

The HITHOC procedure varies depending on which mesothelioma treatment center performs it. This is a general outline.

  1. Prevent Kidney Damage

    The day before surgery, the patient starts receiving extra fluids and medication to protect their kidneys from the chemotherapy drugs. The patient will continue to receive extra fluids and protective medication for a few days after surgery.

  2. Remove Tumors

    Surgeons remove the pleura (tissue lining around the affected lung) and scrape away all visible cancer growth. Before they close the chest, they place two drains to connect to the HITHOC machine.

  3. Heat the Chest Cavity

    The HITHOC machine first fills the patient’s chest with a type of medical salt water called saline solution. The machine slowly heats the solution until it is hot enough to weaken cancer cells, but not hot enough to damage healthy cells.

  4. Add Chemotherapy Drugs

    The HITHOC machine adds the chemotherapy. Cisplatin is the drug most commonly used, and it may be combined with another drug such as doxorubicin or epirubicin.

    Because the chemotherapy enters the chest cavity rather than the bloodstream, doctors can use a much more powerful dose. The drug can only penetrate a few millimeters into tissue, which is why surgeons must thoroughly remove visible tumors first.

  5. Finish the Surgery and Recovery

    Surgeons remove the chemotherapy mixture and the drains and close all incisions. The surgery takes several hours, but most patients spend less than two weeks in the hospital.

  6. Provide Adjuvant Chemotherapy

    HITHOC only targets cancer cells in the chest cavity, so the patient still needs treatment with normal systemic chemotherapy to target cancer cells that may have spread to the rest of their body. It is not clear if there is any benefit to receiving both HITHOC and radiation therapy.

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Registered Nurse and Patient Advocate

Karen Selby joined in 2009. She is a registered nurse with a background in oncology and thoracic surgery and was the regional director of a tissue bank before becoming a Patient Advocate at The Mesothelioma Center. Karen has assisted surgeons with thoracic surgeries such as lung resections, lung transplants, pneumonectomies, pleurectomies and wedge resections. She is also a member of the Academy of Oncology Nurse & Patient Navigators.

Walter Pacheco, Managing Editor at
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4 Cited Article Sources

The sources on all content featured in The Mesothelioma Center at include medical and scientific studies, peer-reviewed studies and other research documents from reputable organizations.

  1. Ambrogi, M. C., et al. (2017). Diaphragm and lung–preserving surgery with hyperthermic chemotherapy for malignant pleural mesothelioma: A 10-year experience.
    Retrieved from:
  2. Zhao, Z. Y., et al. (2017). Effect of hyperthermic intrathoracic chemotherapy on the malignant pleural mesothelioma: a systematic review and meta-analysis.
    Retrieved from:
  3. Sugarbaker, D. J., et al. (2013). Hyperthermic intraoperative pleural cisplatin chemotherapy extends interval to recurrence and survival among low-risk patients with malignant pleural mesothelioma undergoing surgical macroscopic complete resection.
    Retrieved from:
  4. Ried, M., et al. (2012). Cytoreductive surgery and hyperthermic intrathoracic chemotherapy perfusion for malignant pleural tumours: perioperative management and clinical experience. Retrieved from:

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Last Modified April 12, 2020

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