In April, Tobyn was diagnosed with stage 2 pleural epithelioid mesothelioma. After researching on the internet, she learned that surgery with hot chemotherapy could aide in preventing a recurrence of mesothelioma. Her number one goal was to be able to spend more time with her family.

Doctors are working hard to improve treatments for mesothelioma, focusing on controlling local disease. Mesothelioma has a high rate of recurrence. The use of hyperthermic intraoperative chemoperfusion (HIOC), commonly known as ‘hot chemo,’ is just one way doctors are hoping to decrease that rate.

What is HIOC?

Hyperthermic intraoperative chemoperfusion (HIOC) is the use of hot chemotherapy pumped directly into the thoracic cavity after surgery, washing the area. It is similar to HIPEC, which is used for peritoneal mesothelioma.

Some steps of the HIOC treatment process:

  • 1
    Doctors perform surgery (P/D or EPP) to remove tumors and other damaged tissue.
  • 2
    Hot chemo is circulated throughout the thoracic cavity for about 1 hour to kill off any remaining microscopic cancer cells.
  • 3
    Before and after treatment patients are given aggressive hydration and IV administration of sodium thiosulfate and amifostine to prevent kidney damage.

Cisplatin, one of the drugs used for IV chemotherapy, is the drug most commonly used for the procedure. Intracavity use allows for the drug to penetrate the cancer cells more effectively.

How Tobyn Found The Right HIOC Specialist

After deciding she wanted to pursue HIOC, Tobyn researched specialists who perform heated chemotherapy and came across the University of Pittsburgh Medical Center. It was only a short drive from her home in West Virginia and they specialized in both pleural and peritoneal mesothelioma with the use of heated chemotherapy.

Neil A. Christie, MD

Dr. Neil A. Christie

Thoracic surgeon, Dr. Neil Christie, seemed to be a good fit, not only because he had the first name of her favorite singer, Neil Young, but because he worked with a team of specialists that were knowledgeable, honest and caring.

He specializes in pleural mesothelioma and performing the pleurectomy with decortication (P/D) and extrapleural pneumonectomy (EPP) with heated intraoperative chemotherapy.

Tobyn was scheduled for a P/D and heated chemotherapy in May. The P/D procedure removes the lining of the lung and any affected tissues in the chest wall, diaphragm and pericardium.

“I wasn’t scared. I felt I had a great team. I was otherwise pretty healthy and really, didn’t have much choice but to do the surgery,” Tobyn told Mesothelioma Guide.

She had the support of her daughter, sister who is an oncology PACU nurse, and grandchildren.

HIOC Recovery and Side Effects

Studies have shown that HIOC after surgery is well tolerated by patients and it does not interfere with length of hospital stay or additional treatments, like intravenous chemotherapy and radiation. Patients with epithelioid cell type and localized lymph node involvement had the longest interval to recurrence post-surgery with HIOC.

Potential Side Effects of HIOC

  • Pulmonary edema
  • Renal toxicity
  • Atrial Fibrillation
  • Deep Venous Thrombosis
  • Anorexia and/or a change in appetite

Tobyn’s Recovery Experience

After 6 hours, Tobyn was out of surgery and in the ICU on oxygen with a breathing tube and lots of pain medication. The tube was removed by the next day and she was encouraged to move to a chair within 2 days.

“I then fully realized I had 3 tubes running from my lower chest area to 3 boxes that were draining my lung chest area. They were cumbersome and inhibited my movement somewhat, but weren’t painful.”

At no point did Tobyn experience pain. Overall she felt fatigued, brain fog, and a change in her taste buds, making it somewhat difficult to find foods she could tolerate. Tobyn was on a liquid diet until day 4, when she was able to tolerate a small amount of solid food.

She was soon downgraded to the medical floor where she continued to be for 8 more days. On the medical floor she performed breathing treatments 3 times per day, a common exercise in the  mesothelioma surgery recovery process.

Once home, Tobyn continued to struggle with those symptoms. By the third week, things started to gradually improve. She had less fatigue, decreased brain fog, and her appetite broadened allowing her to enjoy her comfort foods.

“I am now on week six and I feel pretty good.”

Tobyn Keeps a Positive Attitude

“Frankly, this wasn’t as bad as I thought it would be. I am not going to run in the Olympics, but I can walk about a quarter mile now, food is great, and I beat my computer at chess yesterday.”

“I got frustrated at first because I am not used to being dependent at all… but sometimes lessons in patience are good and my family and I are very close now.”

“There is no guarantee with meso… I feel the surgery gave me my best chance and the hot chemo has shown promising results. I will have to have some follow up chemo which will probably start soon. I do feel I have given myself more time and new stuff happens in research all the time.”

Image of Nurse Karen


To learn more about HIOC with surgery and how it could help delay recurrence, contact Karen at:

888-385-2024 x 102 or

    Sources & Author

Picture of Jenna Campagna, RN

About the Writer, Jenna Campagna, RN

Jenna Campagna is a registered nurse and patient advocate who is passionate about helping mesothelioma patients navigate their health care. She has over seven years of experience working with patients diagnosed with rare diseases including mesothelioma. Jenna is also a member of the Academy of Oncology Nurse & Patient Navigators and her goal is to connect patients to top mesothelioma specialists, treatment facilities, and clinical trials. Through her writing, she aims to simplify the complicated journey through mesothelioma by offering helpful tips and advice.