Anwendung der hyperthermen intrathorakalen Chemotherapie (HITHOC) in Deutschland

Zusammenfassung

Hintergrund Die hypertherme intrathorakale Chemotherapie (HITHOC) wird seit mehreren Jahren an einigen thoraxchirurgischen Kliniken zusätzlich zur chirurgischen Zytoreduktion im Rahmen eines multimodalen Therapieansatzes zur Behandlung maligner Pleuratumoren angewendet. Genaue Zahlen zur HITHOC in Deutschland liegen bislang nicht vor.

Material und Methode Deutschlandweite schriftliche Umfrage an den thoraxchirurgischen Kliniken bzw. Abteilungen zu Anzahl, Indikationen, technischer Durchführung, perioperativen Schutzmaßnahmen und Komplikationen der HITHOC.

Ergebnis Insgesamt wurden 116 Kliniken angeschrieben. Die Rücklaufquote des Fragebogens lag bei 43% (n = 50). In 33 Kliniken wurde bisher keine HITHOC durchgeführt. Gründe hierfür sind mangelnde Ressourcen oder Erfahrung mit der HITHOC (n = 17), gefolgt von einer fehlenden Überzeugung bez. der Wirkung des Verfahrens (n = 8) verbunden mit einer zu hohen Komplikationsrate (n = 3). In 17 Kliniken wurden seit 2008 insgesamt 343 HITHOC-Prozeduren durchgeführt. Eine eigene Perfusionsmaschine besitzen 8 Kliniken, während sich die restlichen Kliniken die Maschine ausleihen. Indikationen stellten in allen Kliniken das maligne Pleuramesotheliom (n = 17), häufig Thymome mit pleuraler Aussaat (n = 11) und seltener die sekundäre Pleurakarzinose (n = 7) dar. Die HITHOC erfolgte in 16 Kliniken am geschlossenen Thorax, in den meisten Fällen bei 42 °C (n = 12) und für 60 Minuten (n = 15). Es wird immer Cisplatin entweder als Mono- (n = 9) oder in Kombinationstherapie (n = 8) verwendet. Alle Kliniken gaben als Ziel der HITHOC die Verbesserung der lokalen Tumorkontrolle sowie eine Verlängerung des rezidivfreien bzw. Gesamtüberlebens an. Über Komplikationen wird nur in wenigen Fällen berichtet.

Schlussfolgerung Die HITHOC wird derzeit an mindestens 17 Kliniken in Deutschland weitgehend standardisiert mit entsprechenden perioperativen Maßnahmen und ohne schwerwiegende Komplikationen durchgeführt. Ziel ist die Verbesserung der lokalen Tumorkontrolle bei bösartigen Neubildungen der Pleura und einer damit verbundenen Verbesserung der Überlebenszeit bei guter Lebensqualität.

Abstract

Introduction For several years, hyperthermic intrathoracic chemotherapy (HITHOC) has been performed in a few departments for thoracic surgery in a multimodality treatment regime in addition to surgical cytoreduction. Specific data about HITHOC in Germany are still lacking.

Methods Survey in written form to all departments of thoracic surgery in Germany. The objective is the evaluation of HITHOC with respect to number, indications, technique, perioperative protection measure and complications.

Results A total of 116 departments of thoracic surgery were contacted, with a return rate of 43% (n = 50). HITHOC was not performed in 33 departments, due to lack of resources or experience (n = 17), missing efficacy of the procedure (n = 8) and fear of excessive complication rates (n = 3). Since 2008, a total of 343 HITHOC procedures have been performed in 17 departments. Eight departments have their own perfusion machine, whereas the remaining departments borrow the perfusion machine. Indications were malignant pleural mesothelioma in all departments (n = 17), thymoma with pleural spread (n = 11) and secondary pleural carcinosis (n = 7). The HITHOC was performed in nearly all departments after closing the chest (n = 16), with a temperature of 42 °C (n = 12) and for 60 minutes (n = 15). Cisplatin was always used, either alone (n = 9) or in combination (n = 8). In all the participating departments, the aims of the HITHOC were improvement in local tumor control and prolonged recurrence-free and overall survival. Relevant HITHOC-associated complications were low.

Conclusions HITHOC is performed in at least 17 departments of thoracic surgery in Germany, and is widely standardised with protective measures and a low rate of complications. The aims of the HITHOC are improvement in local tumor control in pleural malignancies combined with prolonged overall survival and better quality of life.

Schlüsselwörter

Thoraxchirurgie - hypertherme intrathorakale Chemotherapie - Pleuramesotheliom - Pleuratumor

Key words

thoracic surgery - hyperthermic intrathoracic chemotherapy - pleural mesothelioma - pleural tumor

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