Cytoreductive surgery and intraoperative hyperthermic intrathoracic chemotherapy in patients with malignant pleural mesothelioma or pleural metastases of thymoma

Our plain-English summary of Cytoreductive surgery and intraoperative hyperthermic intrathoracic chemotherapy in patients with malignant pleural mesothelioma or pleural metastases of thymoma, by E. de Bree, S. van Ruth, P. Baas, et al (Chest, 2002).

The study

• Authors: E. de Bree, S. van Ruth, P. Baas, E.J. Rutgers, N. van Zandwijk, A.J. Witkamp, F.A. Zoetmulder
• Journal: Chest
• Published: 2002;121(2):480-7
• Cited by: 98 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Study Objectives: No established curative treatment is available for pleural thymoma metastases and malignant pleural mesothelioma (MPM). Recently, peritoneal malignancies have been treated by cytoreductive surgery and intraoperative hyperthermic intracavitary perfusion chemotherapy (HIPEC). We investigated the feasibility and safety of this multimodality treatment in the thoracic cavity.

Design: Patients with pleural thymoma metastases or early-stage MPM were enrolled in a feasibility study. Morbidity, recurrence, and survival rates were recorded.

Setting: The Netherlands Cancer Institute.

Patients: Three patients with pleural thymoma metastases and 11 patients with pleural mesothelioma were treated.

Interventions: Cytoreductive surgery and intraoperative hyperthermic intrathoracic perfusion chemotherapy (HITHOC) with cisplatin and adriamycin were performed. The mesothelioma patients received adjuvant radiotherapy on the thoracotomy wound and drainage tracts.

Measurements And Results: Morbidity and mortality rates were 47% and 0%, respectively. Reoperation was necessary in four cases. Severe chemotherapy-related complications were not observed. A solitary mediastinal and a contralateral pleural thymoma recurrence were successfully treated by radiotherapy and a contralateral HITHOC procedure. All thymoma patients were alive and free of disease after a mean follow-up period of 18 months. After a mean follow-up period of 7.4 months, nine mesothelioma patients are alive. Two mesothelioma patients died of contralateral pleural and peritoneal recurrent disease, while one patient is alive with locoregional recurrence.

Conclusions: Cytoreductive surgery and HITHOC with cisplatin and adriamycin is feasible in patients with pleural thymoma metastases and early-stage MPM, and is associated with acceptable morbidity rates. Early data on locoregional disease control are encouraging, and a phase II study will be conducted.

In plain English

This was a feasibility study at the Netherlands Cancer Institute. Surgeons removed tumor from the lining of the chest and then, during the same operation, circulated heated chemotherapy (cisplatin and adriamycin) through the chest cavity, a step the authors call HITHOC. Three patients with thymoma that had spread to the pleura and 11 patients with malignant pleural mesothelioma (MPM) were treated. Among the MPM patients, all but one were reported as occupationally exposed to asbestos. All 11 MPM patients were judged stage I before surgery, but 7 were found at operation to have stage II disease. Within 30 days of HITHOC the complication rate was 47% and four cases needed reoperation. There were no treatment-related deaths or severe chemotherapy-related complications. All thymoma patients were alive and free of disease after a mean follow-up of 18 months. After a mean follow-up of 7.4 months, nine MPM patients were alive. Two MPM patients had died of recurrent disease, and one was alive with recurrence. The authors concluded the treatment was feasible with acceptable morbidity, and they noted that follow-up was limited.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Feasibility study (single institution) of cytoreductive surgery followed by intraoperative hyperthermic intrathoracic perfusion chemotherapy (HITHOC)
• Who was studied: 3 patients with pleural thymoma metastases (treated June 1998 to August 2000) and 11 patients with malignant pleural mesothelioma, at the Netherlands Cancer Institute, Amsterdam
• Exposure: In its description of the MPM patients, the article reports that all but one were occupationally exposed to asbestos. No fiber types, jobs or doses are given. The treatment studied was surgery plus heated intrathoracic chemotherapy with cisplatin and adriamycin, with adjuvant radiotherapy to the wound and drain tracts for the mesothelioma patients.
• Main results:
  • For all treated patients, the complication rate in the 30 days after HITHOC was 47%, and there was no treatment-related mortality
  • Reoperation was needed in four cases
  • No severe chemotherapy-related complications were seen
  • 7 of the 11 MPM patients, all judged stage I before surgery, actually had stage II disease
  • All thymoma patients were alive and disease-free after a mean follow-up of 18 months
  • After a mean follow-up of 7.4 months, nine of the MPM patients were alive
  • Two MPM patients died of recurrent disease (contralateral pleural and peritoneal), and one MPM patient was alive with locoregional recurrence
  • For the whole series, locoregional, contralateral pleural and overall recurrence rates were 13%, 13% and 33%. Overall and disease-free survival rates were 85% and 78%.
• The authors' conclusion: The authors concluded that cytoreductive surgery and HITHOC with cisplatin and adriamycin is feasible in patients with pleural thymoma metastases and early-stage MPM, with acceptable morbidity rates
• Limitations the authors state:
  • The authors note the follow-up period was limited

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma.

Medical terms in this study, explained in our Lexicon: Cytoreductive Surgery, Intrathoracic, Chemotherapy, Pleural Mesothelioma, HIPEC, Cisplatin, Mesothelioma, Thoracotomy.

Related studies

• Pharmacokinetics of doxorubicin and cisplatin used in intraoperative hyperthermic intrathoracic chemotherapy after cytoreductive surgery for malignant pleural mesothelioma and pleural thymoma — S. van Ruth, O. van Tellingen, et al. (2003)
• Cytoreductive surgery and hyperthermic intrathoracic chemotherapy perfusion for malignant pleural tumours: perioperative management and clinical experience — M. Ried, T. Potzger, et al. (2013)
• Local and systemic exposure of cisplatin during hyperthermic intrathoracic chemotherapy perfusion after pleurectomy and decortication for treatment of pleural malignancies — M. Ried, T. Potzger, et al. (2013)
• Iterative cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for recurrent peritoneal metastases — T.C. Chua, L.E. Quinn, et al. (2013)
• Acute kidney injury after cytoreductive surgery and hyperthermic intraoperative cisplatin chemotherapy for malignant pleural mesothelioma — T. Hod, K.J. Freedberg, et al. (2021)
• A case of cardiac herniation after extrapleural pneumonectomy for malignant thymoma — S. Sonoda, Y. Kumagawa, et al. (2010)

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