A recent study shows any type of surgery combined with hyperthermic intrathoracic chemotherapy (HITHOC) results in improved disease-free intervals and overall survival rates for pleural mesothelioma patients – specifically when HITHOC is administered at a higher dose.

Using chemotherapy during surgery – which is what HITHOC does – is an experimental treatment for mesothelioma and most cancers. However, the method typically helps peritoneal mesothelioma patients survive for 3-5 years, so pleural mesothelioma doctors are giving more consideration to the idea, including ways to improve the science by testing dosage amounts.

Hyperthermic Intrathoracic Chemotherapy Explained

Hyperthermic intrathoracic chemotherapy (HITHOC) is a heated liquid form of chemotherapy delivered directly to the chest cavity. It’s a type of heated intraoperative chemotherapy (HIOC). The other type is heated intraperitoneal chemotherapy (HIPEC), designated for peritoneal mesothelioma surgery patients. HITHOC treatment is paired with a type of thoracic surgery – administering the chemotherapy right after the operation but before the patient’s incision is closed. 

Cytoreduction is a medical term for removing all visible tumors from an area. Cytoreductive surgery is the general term for mesothelioma surgery.

The most common cytoreductive surgery for pleural mesothelioma is a pleurectomy with decortication (P/D). This procedure is often paired with hyperthermic intrathoracic chemotherapy as an “intraoperative therapy” – the combination of treatments and the application of chemotherapy directly to the tumor site during the surgery process.  

Pleural mesothelioma forms in the pleura – a narrow membrane separating the lung cavity from the chest wall. During a pleurectomy with decortication, mesothelioma surgeons resect the pleural cavity and the two cell linings that make up the membrane. 

Resecting the pleura removes most of the mesothelioma tumors. Once the operation is complete, hyperthermic intrathoracic chemotherapy (HITHOC) aims to kill any remaining tumors not accessible during P/D. The process of HITHOC can be completed within a few hours as mesothelioma specialists bathe the lung cavity in heated chemotherapy.


Survival Benefits

HITHOC has already proved to be successful in increasing patient survival. Most patients who receive HITHOC with pleural mesothelioma surgery survive for multiple years after the treatment. One study of early-stage patients led to a median survival of 42 months for P/D with HITHOC.

However, this study tested the theory of increasing the dosage of HITHOC and in doing so could further increase survival rates.

The study consisted of 15 studies – consisting of 598 participating patients. The patients were separated among three groups: one group received the typical treatment of HITHOC and surgery; another group did not receive HITHOC or surgery at all; and the last group underwent surgery along with a higher dose of HITHOC.

Of all three test groups, the group that underwent surgery and received a higher dose of HITHOC presented optimal results. These patients’ survival were significantly higher than those receiving the typical treatment. Higher dosage patients’ survival were between 18 and 31 months versus 6-18 months for patients with a lower dosage. Patients that did not receive HITHOC treatment showed survival of 5-36 months.

Although the typical treatment plan of surgery and HITHOC does present promising results for pleural mesothelioma patients, this study proves that patients who received a higher dose of HITHOC saw the best results for life expectancy.


    Sources & Author


    Cytoreductive surgery with hyperthermic intrathoracic chemotherapy for malignant pleural mesothelioma: a systematic review.  National Library of Public Medicine. Retrieved from: https://pubmed.ncbi.nlm.nih.gov/35410957/. Accessed: 04/19/2022.


    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.


Camryn Keeble image

About the Writer, Camryn Keeble

Camryn Keeble is the senior content writer and editor for Mesothelioma Guide. She creates mesothelioma-related content for the Mesothelioma Guide website. Camryn's goal is to decipher advanced information regarding mesothelioma into informative, simplified content to educate those affected by mesothelioma. She also works diligently to raise awareness of mesothelioma and its effects on patients and their loved ones.

    Sources & Author

Picture of Camryn Keeble

About the Writer, Camryn Keeble

Camryn Keeble is the senior content writer and editor for Mesothelioma Guide. She creates informative content to educate mesothelioma patients and their loved ones on news, treatments and more. She also works diligently to raise awareness of the dangers of asbestos exposure and the effects of mesothelioma.