Written by Karen Selby, RN | Medically Reviewed By Dr. Raja Michael Flores | Edited By Walter Pacheco | Last Update: October 14, 2024

What Is HITHOC?

Heated Intrathoracic Chemotherapy (HITHOC) is a specialized treatment that uses heated chemotherapy to target cancer cells in the chest cavity. It is typically performed after surgery to remove visible tumors. Doctors deliver chemotherapy directly to the affected area while the chest is still open.

The chemotherapy solution is heated and circulated through the chest cavity for 60 to 90 minutes to improve its effectiveness. Like hyperthermic intraperitoneal chemotherapy (HIPEC) for abdominal cancers, the heat helps the drugs penetrate cancer cells more deeply. This method increases the chances of killing the remaining microscopic cancer cells.

HITHOC aims to reduce the risk of cancer recurrence and improve long-term outcomes. By combining surgery with heated chemotherapy, HITHOC offers a more targeted and aggressive treatment approach, minimizing damage to healthy tissues and maximizing the impact on cancerous cells.

After patients recover from surgery, they can also receive the usual systemic chemotherapy, which is the most common treatment for mesothelioma. Patients who undergo HITHOC often experience fewer systemic side effects compared to traditional chemotherapy because the treatment remains localized in the chest cavity.

HITHOC vs. HIPEC

HITHOC and HIPEC are both heated chemotherapy treatments, but they target different areas. HITHOC treats cancers in the chest cavity, like pleural mesothelioma. HIPEC is used for cancers in the abdomen, such as peritoneal mesothelioma. Both involve surgery to remove tumors, followed by heated chemotherapy to kill the remaining cancer cells.

Doctors may use specific chemotherapy drugs in each treatment, but effective options for both include cisplatin, doxorubicin and mitomycin C. Both treatments help deliver intense chemotherapy to a particular area, reducing side effects that occur with traditional chemotherapy.

Hyperthermic Intrathoracic Chemotherapy (HITHOC) Process

The HITHOC procedure varies depending on which mesothelioma treatment center performs it. While the specifics of the process can vary between treatment centers, the general approach remains consistent.

  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.

After HITHOC, most patients stay in the hospital for around two weeks to ensure proper recovery and manage side effects. The localized approach allows for higher doses of chemotherapy directly to the chest, reducing common side effects like nausea and fatigue.

This combination of surgery and heated chemotherapy offers a more aggressive treatment option with potentially better outcomes for patients with pleural mesothelioma and other chest cancers.

Benefits of HITHOC for Mesothelioma

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 improves the patient’s quality of life. The problem is that it is dangerous to use radiation therapy if the lung is still in place. Lung tissue is susceptible 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.

Side Effects of HITHOC

HITHOC has some side effects, but they are usually manageable. Common side effects include tiredness, chest pain and inflammation in the chest. Some patients may feel nauseous or lose their appetite because of the chemotherapy. Since the treatment targets the chest directly, serious side effects like hair loss are less likely compared to regular chemotherapy.

Even though HITHOC is focused on the chest cavity, there are risks. Some patients may develop an infection or have fluid buildup in the lungs. There is also a chance of damage to nearby tissues during surgery. It’s important to talk to your doctor about these risks so they can help you manage any side effects during recovery.

Research on HITHOC Treatment

In 2013, Dr. David Sugarbaker led a study examining the results of hundreds of patients receiving multimodal pleural mesothelioma treatment 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 their treatment plan. The study, based on the experience of 103 patients, reported a better median survival time for patients who received HITHOC.

Median Survival Time After Surgery

SurgerySurvival Time
HITHOC Group35.3 months
Comparison Group22.8 months

In a 2017 study, Italian researchers reported the results of 49 patients who received HITHOC between 2005 and 2014. In these cases, surgeons tried to preserve lung and diaphragm function as much as possible. The researchers reported 79% of the patients were alive one year after surgery, and 45% were alive two years after surgery.

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