Hyperthermic intrapleural chemotherapy: an update

Area of Science:

• Oncology
• Thoracic Surgery
• Surgical Oncology

Background:

• Hyperthermic intrathoracic chemotherapy (HITHOC) is an adjunct to cytoreductive surgery (CRS) for pleural malignancies like mesothelioma.
• HITHOC enhances cytotoxic agent penetration in the hyperthermic environment, crucial for challenging microscopic resections in pleural cancers.
• Current literature shows varied HITHOC techniques and outcomes, despite a favorable risk profile.

Purpose of the Study:

• To address the ambiguity in National Comprehensive Cancer Network (NCCN) guidelines regarding the benefit of HITHOC.
• To highlight the need for standardization in HITHOC utilization for pleural malignancies.
• To propose initiatives for wider application of HITHOC in managing pleural cancers.

Main Methods:

• Review of current literature on HITHOC in pleural malignancies.
• Analysis of NCCN guidelines and their limitations concerning intraoperative adjuvant therapies.
• Proposal for a task force and a pleural cancer index to standardize HITHOC.

Main Results:

• HITHOC's safety and efficacy are demonstrated, particularly for mesothelioma and other pleural metastases.
• A lack of definitive recommendations and standardization hinders HITHOC's broader use.
• The low prevalence of eligible patients contributes to the limited evidence base.

Conclusions:

• Standardization of HITHOC techniques is needed to improve outcomes for patients with pleural malignancies.
• A dedicated task force and a pleural cancer index could facilitate wider adoption and consistent application of HITHOC.
• Further investigation is warranted to solidify HITHOC's role in the surgical management of pleural cancers.