Update: This blog was updated February 22, 2021, with new survival rates from a study about HITHOC with mesothelioma surgery.
Hyperthermic intraperitoneal chemotherapy can add years to the life of a peritoneal mesothelioma patient.
So why isn’t hyperthermic intrathoracic chemotherapy used more for pleural mesothelioma?
Doctors in Europe wonder why this method of chemotherapy, shortened to the acronym HITHOC, isn’t a standard of care. They believe it should be included in the guidelines for treating malignant pleural mesothelioma.
Considering how effective it is for peritoneal mesothelioma (HIPEC), there’s merit to this. Mesothelioma Guide once analyzed how heated chemotherapy could be the end of the riskiest cancer surgeries, such as the lung-removing extrapleural pneumonectomy, due to high mortality rates.
What Is HITHOC?
HITHOC is an innovative chemotherapy method. During HITHOC, doctors deliver the chemotherapy drugs in “heated” liquid form directly into the thorax. It’s usually paired with surgery and performed following the main surgical operation, making it an “intraoperative” therapy.
Mesothelioma forms in the pleura, a membrane which narrowly separates the lung cavity from the chest wall. During surgery, doctors remove the pleural cavity and the two cell linings making up this membrane.
Resection of the pleura removes most mesothelioma tumors quickly. HITHOC is administered in this space and addresses remaining tumors around the thorax. The entire process lasts a few hours as doctors bathe the area in hot chemotherapy.
“HITHOC acts with a double action,” the European authors explained. “(The) chemotherapeutic drug has a local and direct effect on the tumor cells while hyperthermia enhances the impact of chemotherapy by increasing its penetration into the tissue.”
HIPEC is a similar therapy. It’s a liquid chemotherapy delivered into the abdomen for peritoneal mesothelioma. Doctors remove the peritoneum, the small membrane encompassing the abdomen, to address remaining mesothelioma cells not removed during surgery.
Reasons For and Against HITHOC
There are a few reasons why some doctors prefer HITHOC. First, the method avoids sending chemotherapy through the bloodstream.
Chemotherapy causes many side effects for patients. This is largely due to the drugs traveling through the bloodstream and attacking healthy blood cells and tissue before reaching the cancer site. HITHOC delivers the cancer-fighting drugs right into the target area.
A second reason for HITHOC is time. Rather than put patients through multiple rounds of traditional (intravenous) chemotherapy, doctors can use HITHOC once for a few hours and reassess.
HITHOC doesn’t cause many complications. Usually, the concerns are associated with the surgery: pleurectomy with decortication or extrapleural pneumonectomy. HITHOC can cause hyperthermia (body temperature above normal) but most studies don’t report any notable complications or morbidity due to the therapy.
There’s one last benefit of HITHOC: it’s promising mesothelioma survival rates.
Survival Rates for HITHOC With Pleural Mesothelioma Surgery
The European Respiratory Journal analyzed 13 cases of HITHOC with video-assisted pleurectomy with decortication (both lungs remain. The average survival time post-surgery was 31.6 months, and the two-year survival rate was above 50%. Five of the 13 patients survived for three years and are still alive, which is impressive compared to most mesothelioma studies.
In 2024, the Journal of Thoracic Disease published a study demonstrating HITHOC improved the survival, on average, for people receiving surgery. HITHOC led to an average survival of 20.5 months, whereas people receiving mesothelioma surgery without HITHOC had an average survival of 16.8 months. The study also showed HITHOC decreases the chance of patients dying within 30 days and 90 days of the surgery.
In 2013, the late Dr. David Sugarbaker conducted a HITHOC study with impressive results. The median survival for patients was 35 months.
Most mesothelioma patients live for a couple of years even after surgery. A median survival of nearly three years is hopeful.
Other studies reaffirm the benefit. In fact, one study surpassed Dr. Sugarbaker’s findings. The patients underwent pleurectomy with decortication. The median survival was an astounding 42 months (3.5 years).
Where Is HITHOC Offered to Patients?
HITHOC was created at least a couple decades ago, but it hasn’t been put into practice everywhere. It remains a specialty therapy, considered an “experimental” approach to treating mesothelioma.
Quite a few cancer centers offer HITHOC for pleural mesothelioma, but patients need to research the topic. A few of the cancer centers with HITHOC are:
- Baylor St. Luke’s in Houston
- AdventHealth in Orlando, Florida
- Brigham and Women’s Hospital in Boston
- University of Pittsburgh Medical Center
- Moffitt Cancer Center in Tampa
Our patient advocates can help with finding a cancer center offering HITHOC. Email our medical expert staff at information@mesotheliomaguide.com for immediate support.
Sources & Author
- Hyperthermic intrathoracic chemotherapy (HITHOC) should be included in the guidelines for malignant pleural mesothelioma. Annals of Translational Medicine. Retrieved from: https://atm.amegroups.com/article/view/60185/pdf. Accessed: 01/26/2021.
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Late Breaking Abstract – Comparison of VATS debulking surgery and HITHOC vs VATS talc pleurodesis alone in malignant pleural mesothelioma: a pilot study. European Respiratory Journal. Retrieved from: https://erj.ersjournals.com/content/56/suppl_64/4489. Accessed: 02/22/2021.
- Impact of hyperthermic intrathoracic chemotherapy (HITHOC) during resection of pleural mesothelioma on patient survival. Journal of Thoracic Disease. Retrieved from: https://pubmed.ncbi.nlm.nih.gov/38090290/. Accessed: 01/20/2024.
Sources & Author
