Pleural mesothelioma, which develops in the lining of the lungs, is often treated with surgery when doctors believe they can remove most of the cancer.
For years, patients have had two surgical options: remove the entire lung or preserve the lung while removing the cancerous tissue surrounding it.
A new study published in The Annals of Thoracic Surgery looked at how patients fared when doctors combined these operations with HITHOC, a heated chemotherapy treatment delivered directly to the chest.
After reviewing more than 14 years of patient data, researchers found that lung-sparing surgery helped patients live longer and experience fewer complications than removing the lung. Patients who also received HITHOC saw even better results.
What Is HITHOC Treatment for Mesothelioma?
HITHOC stands for hyperthermic intrathoracic chemoperfusion. Doctors use this treatment after surgery to help destroy mesothelioma cells that may remain in the chest.
During the procedure, surgeons first remove as much of the cancer as possible. They then circulate a heated chemotherapy solution throughout the chest cavity. The heat helps the chemotherapy work more effectively against any remaining cancer cells.
Because the chemotherapy is delivered directly to the chest, doctors can target the area where the cancer developed while limiting exposure to the rest of the body. This approach may reduce some of the side effects often associated with traditional chemotherapy.
One of the benefits of HITHOC treatment is that patients don’t need a second procedure after surgery, as it’s performed during the same operation.
Get Your Free Mesothelioma Guide to learn about surgery, HITHOC, and more of the latest treatments for this cancer.
How Mesothelioma Cytoreduction and HITHOC Work Together
The first step in many mesothelioma surgeries is removing as much visible cancer as possible. This process is known as mesothelioma cytoreduction, or cytoreductive surgery.
While surgery can’t remove every cancer cell, taking out all visible tumors may help other treatments work more effectively. For example, following cytoreductive surgery for mesothelioma with HITHOC helps destroy microscopic cancer cells that may be left behind.
The main types of surgery used to treat pleural mesothelioma are:
- Pleurectomy and decortication (P/D), which removes the lining around the lungs and visible tumor tissue while leaving the affected lung in place.
- Extrapleural pneumonectomy (EPP), a more extensive procedure that removes the affected lung along with nearby tissue, including portions of the pleura (lung lining) and diaphragm.
Because the P/D procedure preserves the lung, many mesothelioma specialists prefer it when it’s appropriate for a patient’s diagnosis and overall health.
Key Findings From the HITHOC Surgery Study
Researchers reviewed the outcomes of 69 patients with pleural mesothelioma who underwent surgery and HITHOC between 2009 and 2023.
Among those patients:
- 55 underwent P/D with HITHOC
- 14 underwent EPP with HITHOC
- The median age was 67 years
- Nearly 74% of patients were male
When researchers compared the two surgeries, the results generally favored the lung-sparing P/D procedure.
P/D Appeared Safer Than EPP for Many Mesothelioma Patients
Researchers reported major complications in 12.7% of patients who underwent P/D, compared with 50% of patients who underwent EPP.
The study also found that two EPP patients experienced treatment-related kidney injury, while the P/D group had no clinically significant kidney injury.
These types of complications matter for the overall health and well-being of the patient. Recovery after mesothelioma surgery can be challenging, so lower complication rates may make it easier for patients to continue with additional treatment if needed.
Researchers Reported No 90-Day Mortality After P/D
Mesothelioma doctors often use 90-day mortality to evaluate whether surgery is safe because it extends beyond the hospital stay to include the critical recovery period afterward.
Among patients who underwent P/D with HITHOC, there were no deaths within 90 days of surgery. In the EPP group, two patients died during that same period, resulting in a 90-day mortality rate of 14.3%.
Patients Receiving Chemotherapy Lived Longer
Many patients who underwent P/D with HITHOC also received systemic (whole-body) chemotherapy as part of their treatment plan. Researchers found that patients who received chemotherapy after surgery lived longer than those who did not.
Median survival was 55 months for patients who received postoperative chemotherapy, compared with 18.2 months for those who didn’t.
This doesn’t mean chemotherapy will help every patient in the same way. Survival with mesothelioma can vary based on factors such as cancer stage, cell type, and overall health.
However, the findings highlight why many mesothelioma specialists use a combination of treatments rather than relying on one approach.
Could HITHOC Still Have a Role in Mesothelioma Treatment After MARS 2?
The MARS 2 trial raised questions about whether surgery should remain part of pleural mesothelioma treatment. Researchers found that patients who underwent surgery experienced more serious side effects and did not live longer than those who received standard treatment alone.
This new study looked at a more specific approach: lung-sparing P/D surgery combined with HITHOC. Patients who underwent that treatment had lower rates of serious complications than those treated with EPP, and no patients in the P/D group died within 90 days of surgery.
While the findings don’t mean surgery is right for everyone with pleural mesothelioma, they suggest that some may benefit when it’s performed at experienced treatment centers and combined with additional therapies such as HITHOC and chemotherapy.
Mesothelioma Hope Can Help You Explore Your Treatment Options
There’s a lot to take in and learn after a mesothelioma diagnosis. Understanding the nuances of treatments like surgery and chemotherapy can feel overwhelming — but Mesothelioma Hope is here for you.
We provide patients and families with trusted information and medical guidance to help them make informed decisions about their care.
Our Patient Advocates can help you:
- Find doctors who specialize in mesothelioma
- Explore surgery, chemotherapy, immunotherapy, and clinical trials
- Locate cancer centers that treat mesothelioma
- Understand whether you qualify for financial assistance
Call (866) 608-8933 or get our Free Mesothelioma Guide shipped directly to you and your family to learn more about what support resources are available.
