Hyperthermic Intrathoracic Chemotherapy (HITHOC) for Mesothelioma

Hyperthermic Intrathoracic Chemotherapy (HITHOC) | Treatment

Hyperthermic Intrathoracic Chemotherapy, or HITHOC, is an innovative approach to treating pleural mesothelioma, a cancer impacting the lining of the lungs. This technique involves the application of heated chemotherapy directly into the pleural cavity, typically following surgeries aimed at tumor removal.

The Process of HITHOC

Unlike systemic chemotherapy that distributes drugs throughout the body, HITHOC targets the specific area affected by cancer – the pleural cavity. By heating the chemotherapy drugs, the treatment becomes more effective, penetrating deeper into the tumor cells. This localized, heated application is critical in potentially improving the survival rates of patients with malignant pleural mesothelioma.

HITHOC vs. HIPEC

While HITHOC is specifically for pleural mesothelioma, a similar technique known as Hyperthermic Intraperitoneal Chemotherapy (HIPEC) is used for peritoneal mesothelioma, affecting the abdominal lining. Both methods share the principle of heated chemotherapy but differ in their application areas.

How HITHOC Helps

Post-surgery, HITHOC is employed to address any residual mesothelioma cells. Surgeries like Pleurectomy/Decortication (P/D) or Extrapleural Pneumonectomy (EPP) remove the majority of the tumor, but not necessarily all cancerous cells. HITHOC aims to eradicate these remaining cells, thus complementing the surgical effort.

Benefits of Localized Chemotherapy

HITHOC’s localized nature allows for a higher concentration of drugs at the target site, reducing potential damage to healthy cells elsewhere. The heating element of HITHOC (around 107°F) selectively targets cancer cells, which are more heat-sensitive than normal cells, thereby enhancing treatment efficacy.

The HITHOC Procedure

The procedure begins with hydration to protect the kidneys, followed by the main surgery to remove as much cancer tissue as possible. Then, chemotherapy drugs are circulated in the pleural cavity using tubes, with the process lasting 1-2 hours. Finally, a saline rinse cleanses the cavity of residual chemotherapy.

Survival and Quality of Life

Studies indicate that HITHOC, when combined with surgery, can extend the survival of pleural mesothelioma patients, sometimes significantly. It also tends to improve or maintain patients’ quality of life. According to the National Library of Medicine, data from the National Cancer Database was examined to identify patients who underwent surgery to remove peritoneal metastases (PM) between 2006 and 2017. The final group we looked at included 3,232 patients. Out of these, 365 patients had a procedure called HITHOC. After comparing patients with similar characteristics, we found that those who had HITHOC tended to stay in the hospital longer (about 12 days compared to 7 days for those who didn’t have it) and were more likely to come back to the hospital within 30 days after leaving (about 10% compared to 5%). However, they were less likely to die within 30 days (3.2% compared to 6%) and within 90 days (7.5% compared to 10.9%). Looking at the overall survival, patients who had HITHOC tended to live longer than those who didn’t (about 20.5 months compared to 16.8 months). When we used a statistical method to adjust for other factors that could affect survival, we still found that HITHOC was linked with better overall survival, both in the entire group and when we looked only at patients who were matched to be similar.

Other Benefits

In addition to potentially prolonged survival, HITHOC offers quicker recovery, allowing patients to proceed to subsequent treatments. Its targeted approach means fewer side effects than systemic chemotherapy and a higher effectiveness due to the higher drug concentration and heat application.

Side Effects

While HITHOC is promising, it’s important to acknowledge potential side effects, such as abnormal heart rhythms or kidney complications. Precautionary measures like adequate hydration can mitigate some risks.

HITHOC represents a significant advancement in the treatment of pleural mesothelioma. Patients considering this option should consult their healthcare team for a comprehensive understanding of the benefits and risks. As research progresses, HITHOC continues to show potential as a key component in the fight against this challenging disease.