A group of Mayo Clinic researchers recently completed an extensive review of the use of hyperthermic intrathoracic chemotherapy (HITHOC) to treat pleural mesothelioma, a rare cancer that develops in the lung lining.

When combined with tumor-removing surgery, HITHOC has been used to safely treat mesothelioma and other pleural diseases for over 30 years. However, it still hasn’t been widely implemented as a standard mesothelioma treatment.

In a close examination of HITHOC, the Mayo Clinic team found that the current research supports:

  • The survival benefits of HITHOC to patients with pleural disease
  • The need for HITHOC to become a standard treatment for pleural mesothelioma
  • The potential promise of offering HITHOC to more patients in the future

Learn more about HITHOC treatment for pleural mesothelioma and the study team’s recommendations below.


HITHOC is a specialized type of chemotherapy used by oncologists to treat certain cancers that affect the chest cavity (also called the pleural place).

It is similar to HIPEC, a heated chemotherapy treatment for peritoneal mesothelioma, which affects the abdominal lining. Cytoreduction with HIPEC is considered the gold standard for peritoneal patients, with nearly 70% surviving 5 years after their diagnosis thanks to the procedure.

In the 1990s, doctors began performing exploratory HITHOC techniques to improve survival for pleural mesothelioma patients, who have a lower average life expectancy than those with peritoneal mesothelioma.

HITHOC is a two-step process that involves:

  1. Removing tumors from the pleural space during mesothelioma surgery
  2. Bathing the surgery site with a warm saline solution infused with concentrated chemotherapy

Mesothelioma Hope can help you find a mesothelioma specialist who provides life-extending treatments like HITHOC. Get started by joining our Free Doctor Match program now.

Benefits of HITHOC for Mesothelioma Patients

According to Mayo Clinic researchers, doctors have observed improved overall survival and progression-free survival in patients who receive HITHOC after surgery (meaning their cancer does not grow or worsen for some time). Simply put, clinical trials show HITHOC can help extend the life of mesothelioma and lung cancer patients.

Several mesothelioma specialists have seen the benefits of HITHOC in clinical trials, including:

  • Lack of complications during surgery
  • Increased overall survival rate (percentage of patients alive at a certain time period after diagnosis)
  • Increased 5-year survival rate

For patients who qualify for HITHOC, preserving one or both lungs is usually the goal. HITHOC helps with this because doctors can use it to kill any cancer cells that were left behind during surgery.

In addition, HITHOC may provide a safer alternative to radiation therapy, as it can destroy cancer cells without damaging nearby organs.

Why Is HITHOC Not a Standard Mesothelioma Treatment?

Despite the benefits of HITHOC, it’s still not considered a standard treatment for pleural mesothelioma.

This is primarily for two reasons:

  1. There is no set pleural cancer index to determine a patient’s eligibility for HITHOC.
  2. There is no set method for the HITHOC procedure. For example, the late Dr. David M. Sugarbaker used mitomycin C and doxorubicin chemotherapy drugs for HITHOC, whereas other specialists use only cisplatin.

However, just as HIPEC became a standard procedure after it was introduced in the 1980s, Mayo Clinic researchers believe similar actions can be taken to expand HITHOC to more patients.

Proposal for Establishing HITHOC as a Standard Treatment for Mesothelioma

The researchers from the Mayo Clinic suggest specific actions to get HITHOC included as a standard approach, including:

  • Creating a similar index as HIPEC, that considers the unique behavior of cancer in the chest and lung lining
  • Developing a HITHOC task force responsible for assessing and implementing treatment standards and applications

With time and further research, doctors can establish a more standardized technique and use cases for HITHOC. In turn, this can help improve treatment practices, making it more effective for eligible mesothelioma patients.

Find Top Treatment Options for Your Mesothelioma Diagnosis

Treatment for mesothelioma is advancing every year, and with approaches like HITHOC, many patients may be able to achieve long-term survival.

Working with an experienced mesothelioma specialist is the best way to access treatments that can help you live longer and have a better quality of life.

Get help finding specialists in your area by signing up for our Free Doctor Match program.

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Laura WrightWritten by:

Lead Editor

Laura Wright is a journalist and content strategist with more than 15 years of professional experience. She attended college at the University of Florida, graduating magna cum laude with a bachelor’s degree in journalism in 2008. Her writing has been featured in The Gainesville Sun and other regional publications throughout Florida.

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  1. American Cancer Society. (2018). Surgery for Malignant Mesothelioma. Retrieved December 19, 2023, from https://www.cancer.org/cancer/types/malignant-mesothelioma/treating/surgery.html
  2. Aprile, V., Bacchin, D., Korasidis, S., et al. (2021). Hyperthermic Intrathoracic Chemotherapy (HITHOC) for thymoma: a narrative review on indications and results. Annals of Translational Medicine. Retrieved December 19, 2023, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8263885/
  3. Campany, M. E., Donato, B. B., Alwardt, C. M., et al. (2023). Hyperthermic intrapleural chemotherapy: an update. Journal of Thoracic Disease. Retrieved December 19, 2023, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10586986/
  4. University of Maryland, Marlene and Stewart Greenebaum Comprehensive Cancer Center. (n.d.). Cytoreductive Surgery and HIPEC – FAQs. Retrieved December 19, 2023, from https://www.umms.org/umgccc/cancer-services/cancer-types/gastrointestinal/diagnostic-treatment/peritoneal-surface-malignancies/cytoreductive-surgery-hipec

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