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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 | Medically Reviewed By Dr. Raja Michael Flores | Edited By Walter Pacheco | Last Update: October 14, 2024
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 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.
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.
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.
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.
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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.
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
Surgery | Survival Time |
---|---|
HITHOC Group | 35.3 months |
Comparison Group | 22.8 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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Selby, K. (2024, October 14). HITHOC Treatment for Pleural Mesothelioma. Asbestos.com. Retrieved December 19, 2024, from https://www.asbestos.com/treatment/chemotherapy/hithoc/
Selby, Karen. "HITHOC Treatment for Pleural Mesothelioma." Asbestos.com, 14 Oct 2024, https://www.asbestos.com/treatment/chemotherapy/hithoc/.
Selby, Karen. "HITHOC Treatment for Pleural Mesothelioma." Asbestos.com. Last modified October 14, 2024. https://www.asbestos.com/treatment/chemotherapy/hithoc/.
A medical doctor who specializes in mesothelioma or cancer treatment reviewed the content on this page to ensure it meets current medical standards and accuracy.
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Dr. Raja Flores is chairman of the Department of Thoracic Surgery at Mount Sinai Hospital and a professor of surgery at the Icahn School of Medicine in New York City. He is a world leader in the treatment of pleural mesothelioma.
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