Different Indications for Hyperthermic Intrathoracic Chemotherapy Perfusion (HITHOC)

Introduction: Cytoreductive surgery and hyperthermic intrathoracic chemotherapy perfusion (HITHOC) represent a therapeutically option in advanced thoracic malignancies. HITHOC have been used in patients with malignant pleura mesothelioma and other rare oncological situations. There are only few studies even for pleura mesothelioma as the most common indication. Analyses for other indications are very limited. Aim of this study was to review outcome in patients undergoing HITHOC at the University Jena with a focus on the different indications.

Methods: A retrospective analysis of all patients received a cytoreductive surgery and HITHOC between 2014 and 2017 was performed. HITHOC was performed with the Kardialgut perfusion system for 45 to 60 minutes at 41.5 to 42.0°C in the end of the surgical procedure. Standard solution based on 0.9% NaCl containing cisplatin with a concentration of 125 to 150 mg/kg bodyweight.

Results: A total of 20 patients (male 14, female 6) were included with a medium age of 63 years. Indications for HITHOC were malignant pleura mesothelioma (25%), thymic carcinoma (15%), sarcoma (35%) and isolated pleural carcinomatosis (25%). Resection of the tumor and radical pleurectomy was performed in all cases. Additional operative procedures were extended pneumonectomy (n = 5), lobectomy (n = 1) and resection of the diaphragm (n = 1). Major complications occurred in 3 cases with ARDS, aspiration of perfusion solution and multi organ failure. 30-day mortality was 20%. Medium follow up was 21.7 months (range 1 - 35 month) with a survival of 60% until today. A major difference in outcome considering the underlying disease was not seen.

Conclusion: HITHOC provides a promising option in patients with advanced and rare thoracic malignancies with better survival rates as reported in literature. In addition to malignant pleura mesothelioma it also could be considered in the treatment of thymic carcinoma, sarcoma and isolated pleural carcinomatosis.

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