Hyperthermic chemoperfusion for the treatment of malignant pleural mesothelioma

Malignant pleural mesothelioma is a uniformly fatal disease with a poor prognosis. Multimodality therapy, including macroscopic complete resection, chemotherapy and/or radiotherapy, has improved survival relative to historical controls, but local recurrence remains problematic. Novel strategies are needed to improve local control. Intracavitary chemotherapy (IC) can deliver higher doses of drug locally with less toxicity than corresponding systemic therapy. When combined with hyperthermia, there is also an increase in local drug absorption and cytotoxic effect. Several phase I and II clinical trials have shown IC to be safe and feasible. Our experience and technique of hyperthermic IC is described. The evolution of our experience has led to the use of pharmacologic renal cytoprotection, which has permitted the safe administration of higher doses of IC than previously described. Further trials are being performed with a multidrug combination following macroscopic complete resection.