Hyperthermic intrathoracic chemotherapy (HITHOC) should be included in the guidelines for malignant pleural mesothelioma

Our plain-English summary of Hyperthermic intrathoracic chemotherapy (HITHOC) should be included in the guidelines for malignant pleural mesothelioma, by M. Migliore, M. Ried, L. Molins, et al (Annals of Translational Medicine, 2021).

The study

• Authors: M. Migliore, M. Ried, L. Molins, M. Lucchi, M. Ambrogi, T.F. Molnar, H.S. Hofmann
• Journal: Annals of Translational Medicine
• Published: 2021;9(11):960
• Type of article: Editorial
• Cited by: 18 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

In plain English

This article was an editorial commentary, commissioned for a journal series on hyperthermic intrathoracic chemotherapy (HITHOC), and did not undergo external peer review. It reported no new study, but the authors said they had updated the count of patients operated on in Catania for their table, which listed that series with 19 patients. HITHOC, as the authors described it, is concentrated chemotherapy, usually cisplatin, in warmed saline that is circulated in the chest for 60 minutes right after surgery for malignant pleural mesothelioma. The authors noted that the latest European task force guidelines did not discuss or cite HITHOC, and that other societies' guidelines did not report on it either. The ASCO guidelines did list at least 3 HITHOC papers in their references. The authors' table listed seven series of surgery plus HITHOC, with 8 to 104 patients. Six were earlier published studies and one was the updated Catania series. The authors acknowledged that HITHOC has no standardized protocol and is still viewed with some suspicion. They concluded that writers of future guidelines should be encouraged to discuss and/or include HITHOC as a possible adjuvant treatment after debulking surgery.

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: Editorial commentary (opinion piece, commissioned, not externally peer reviewed), with an evidence table that includes an updated patient count for the authors' own Catania series
• Who was studied: No new study population. The commentary concerns treatment guidelines for malignant pleural mesothelioma (MPM). Its table includes the authors' Catania series, listed with 19 patients, whose count was updated in this manuscript.
• Exposure: No asbestos exposure was studied. The subject is a treatment: HITHOC, a concentrated dose of chemotherapy (usually cisplatin) in 3 to 4 liters of warmed saline, circulated in the chest for 60 minutes after pleurectomy/decortication or extrapleural pneumonectomy.
• Main results:
  • The authors observed that the latest ERS/EACTS/ESTS guidelines on MPM did not discuss or cite HITHOC as an addition to surgery.
  • The authors noted that the ASCO 2018 guidelines cite at least 3 papers on HITHOC for MPM in their reference list.
  • The authors compiled a table of seven series of surgery combined with HITHOC for MPM, ranging from 8 to 104 patients. Six are earlier published studies. The seventh is the authors' Catania series (VATS pleurectomy decortication, 19 patients, median survival 27 months), whose patient count was updated in this manuscript.
  • The authors characterized earlier studies as showing good quality of life and median survival of up to 35 months without increased morbidity or mortality. This summarizes other studies.
• The authors' conclusion: The authors concluded that writers of future MPM guidelines should be encouraged to discuss and/or include HITHOC as a type of adjuvant treatment to be considered after debulking surgery.
• Limitations the authors state:
  • The authors stated that there is no standardized protocol for HITHOC.
  • The authors acknowledged that the procedure is still viewed with some suspicion because of differences in methods and because of significant toxicities such as acute kidney injury, which they said have rarely been reported.

Topics

Medical terms in this study, explained in our Lexicon: Intrathoracic, Chemotherapy, Pleural Mesothelioma.

Related studies

• The Role of Hyperthermic Intrathoracic Chemotherapy (HITHOC) in Thoracic Tumors — F. Danuzzo, M.C. Sibilia, et al. (2024)
• Impact of hyperthermic intrathoracic chemotherapy (HITHOC) during resection of pleural mesothelioma on patient survival — I.A. Elliott, H. He, et al. (2023)
• 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)
• Hyperthermic Intrathoracic Chemotherapy (HITOC) after Cytoreductive Surgery for Pleural Malignancies-A Retrospective, Multicentre Study — M. Ried, J. Kovács, et al. (2021)
• Adequate nephroprotection reduces renal complications after hyperthermic intrathoracic chemotherapy — T. Markowiak, N. Kerner, et al. (2019)

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