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HITHOC Treatment for Pleural Mesothelioma

Hyperthermic intrathoracic chemotherapy (HITHOC) can be combined with surgery to treat cancer of the lung lining (pleural mesothelioma). During HITHOC, heated chemotherapy drugs are applied directly to the chest cavity to remove cancer cells left behind after surgery. Learn more about the procedure and let Mesothelioma Hope connect you with top doctors.

Fact-Checked and Updated by: Jenna Tozzi, RN

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What Is HITHOC for Mesothelioma?

HITHOC involves bathing the chest cavity with a highly concentrated dose of chemotherapy after tumor-removing surgery. Heating the chemotherapy allows it to penetrate deeper and kill more tumor cells.

It’s most commonly performed after pleurectomy with decortication, or P/D, a type of surgery used to remove tumors from the lung lining (pleura) in patients with pleural mesothelioma. HITHOC may also be performed after an extrapleural pneumonectomy (EPP), which is another surgery for mesothelioma that removes the entire cancerous lung.

Further, doctors may recommend HITHOC when radiation therapy is too risky and could damage the patient’s lung tissue.

Key Facts on HITHOC Treatment for Pleural Mesothelioma

  • Process: Surgery site is bathed in a warm chemotherapy infusion to kill remaining cancer cells
  • Chemotherapy drug used: Cisplatin (may also be combined with doxorubicin or epirubicin)
  • Benefits: More targeted than systemic (whole-body) chemotherapy but with fewer side effects; can help control the spread of cancer
  • Eligibility: Patients who qualify for mesothelioma surgery
  • Possible side effects: Cardiac arrhythmia (irregular heartbeat), kidney complications, pneumonia
  • Impact on prognosis: Longer survival — up to 35 months in some patients

Interested in HITHOC treatment? The first step is finding a specialist who’s familiar with pleural mesothelioma — use our Free Doctor Match service to get started.

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How Does Hyperthermic Intrathoracic Chemotherapy Treat Mesothelioma?

HITHOC works by delivering a high dose of chemotherapy directly to where a patient’s cancer is located in order to destroy mesothelioma cells. While EPP surgery and P/D surgery are effective procedures for removing cancerous tissue, they may leave mesothelioma cells behind.

HITHOC helps destroy the cancer cells that were too small to be removed with surgery, giving patients a better chance of improving their life expectancy.

“HITHOC represents an innovative strategy for addressing the challenges of treating mesothelioma. By administering heated chemotherapy directly within the thoracic cavity, we aim to improve the efficacy of treatment and provide better outcomes for patients.”

- Quote from Dr. David Sugarbaker, pleural mesothelioma specialist

HITHOC is similar to hyperthermic intraperitoneal chemotherapy (HIPEC) after cytoreductive surgery, which is the gold standard treatment for patients with peritoneal mesothelioma, another type of asbestos-related cancer that develops in the abdominal lining.

HITHOC treatment for pleural mesothelioma is considered experimental, but some researchers are pushing for it to become a standard treatment based on benefits to patients in clinical studies.

Benefits of HITHOC for Mesothelioma

  • Enhanced chemotherapy delivery: HITHOC is directly administered within the chest cavity during surgery. This allows higher concentrations of chemotherapy to reach cancerous tissues, which helps make treatment more effective.
  • Extended survival: In a study of 103 patients, HITHOC extended survival up to 35 months. The average life expectancy for pleural mesothelioma is 18 months.
  • Lower risk of complications: Medical literature shows that HITHOC has very low complication rates.
  • Minimized side effects: The targeted nature of HITHOC may result in fewer side effects compared to traditional chemotherapy. This is because the heated chemotherapy is focused on the area where it is needed most instead of entering the bloodstream to the rest of the body.
  • Quick recovery: Research suggests that most patients recover quickly from the procedure, which means they can proceed to standard chemotherapy or receive other additional treatments if needed.

Who’s Eligible for Hyperthermic Intrathoracic Chemotherapy?

Mesothelioma patients may be a good candidate for HITHOC if:

  • Their cancer is in an early stage and hasn’t spread very far.
  • They are healthy enough to have surgery.
  • They can’t undergo radiation therapy and need a substitute treatment.

A mesothelioma doctor can determine if you or a loved one is a candidate for HITHOC and other treatments. Sign up for our Free Doctor Match service to get help scheduling an appointment with a local specialist.

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We'll help you connect with a local mesothelioma specialist for personalized treatment.

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What to Expect During HITHOC Treatment for Mesothelioma

The HITHOC procedure can vary depending on the hospital and the doctor who conducts it.

However, HITHOC treatment follows this general process:

  1. Pre-surgery medication and fluids: The medical team administers fluids and medications to protect the kidneys from any adverse effects of chemotherapy.
  2. Tumor-removing surgery: The doctor performs EPP or P/D surgery (depending on the patient’s case) to remove as much tumor tissue as possible.
  3. HITHOC preparation: A machine fills the chest cavity with saline solution, where it’s slowly heated to between 110 and 113 degrees Fahrenheit. This temperature range is hot enough to allow the chemotherapy to attack cancer cells but not so hot that it harms healthy cells.
  4. Heated chemotherapy application: Chemotherapy is pumped into the patient’s chest cavity to kill cancer cells that aren’t visible to the naked eye. This process usually takes 1-2 hours.
  5. Saline rinse: The patient’s surgery team may rinse the pleural cavity with a saline solution to wash away the remaining chemotherapy drugs.
  6. Recovery: Most HITHOC patients stay in the hospital for 2 weeks after surgery, with a team of nurses and doctors monitoring their recovery and managing any side effects.
  7. Continued chemotherapy (if needed): The patient may need traditional chemotherapy sessions to kill cancer cells in other areas of the body and prevent tumors from returning.

HITHOC Side Effects and Complications

HITHOC is a specialized and effective procedure for treating pleural mesothelioma, like any medical procedure. it may be associated with certain side effects and complications.

Some potential complications of surgery with HITHOC include:

  • Acute respiratory distress syndrome/respiratory failure
  • Atrial fibrillation, or AFib (a quivering or irregular heartbeat)
  • Damage to the nerves of the larynx (voice box)
  • Deep vein thrombosis (blood clots)
  • Diaphragm rupture
  • Empyema (a collection of pus in the pleural cavity)
  • Kidney failure

Patients who have had lung-removing surgery are more vulnerable to complications. However, mesothelioma doctors take extra precautions to prevent these side effects, such as administering fluids and medications before surgery.

Have questions about HITHOC or other mesothelioma treatments? Call (866) 608-8933 to speak to one of our registered nurses for free.

HITHOC Recovery and Follow-Up Care

The recovery time after surgery with HITHOC can vary for each patient, depending on their overall health, the invasiveness of the surgery, and their individual response to treatment.

Generally, patients who undergo HITHOC treatment for pleural mesothelioma may stay in the hospital for about 2 weeks following the procedure.

After undergoing HITHOC, you will receive follow-up care from your medical team. The specifics of your follow-up plan will depend on your health, how you respond to HITHOC, and your mesothelioma treatment plan.

You can generally expect the following after receiving HITHOC:

  • Regular appointments to check your progress: After undergoing HITHOC, your medical team will follow up with you every three months to assess side effects and complications, if any.
  • Imaging tests to monitor your cancer: You will also have regular imaging scans, blood tests, and clinical examinations to evaluate how your mesothelioma responds to HITHOC.
  • Lifestyle changes to help you recover more quickly: Your medical team will provide strategies for boosting your overall health and immune system after HITHOC, such as incorporating a mesothelioma diet.

Clinical Research on HITHOC Mesothelioma Treatment

Research and clinical trials exploring how HITHOC fits into mesothelioma treatment have shown encouraging results.

In 2013, Dr. David Sugarbaker, a pioneer in malignant pleural mesothelioma treatment, studied the outcomes of hundreds of pleural mesothelioma patients from 2001 to 2009.

This study compared patients who received HITHOC to those who did not. It revealed that patients receiving HITHOC had better median survival (35.3 months) than those who did not (22.8 months).

Further, a study published by the Journal of Thoracic Disease in 2023 noted that pleural mesothelioma patients lived roughly 4 months longer if they received HITHOC after surgery.

Find Doctors for HITHOC Treatment with Our Help

At Mesothelioma Hope, your hope for a brighter future is our priority. If you’re considering HITHOC or other treatments, our dedicated nurses and Patient Advocates are here to support you every step of the way.

We can help you find experienced doctors and specialists who are well-versed in HITHOC treatment for pleural mesothelioma.

Contact us today at (866) 608-8933 or sign up for our Free Doctor Match service to take the next positive step in your mesothelioma treatment plan.

HITHOC Treatment for Pleural Mesothelioma FAQs

What is intrathoracic chemotherapy for mesothelioma?

Intrathoracic chemotherapy for mesothelioma involves delivering chemotherapy drugs directly into the chest cavity after tumor-removing surgery to target cancer cells that are too small to be seen.

This localized approach helps enhance the effectiveness of surgery while minimizing side effects associated with standard chemotherapy.

What are the indications for HITHOC?

Hyperthermic intrathoracic chemotherapy (HITHOC) is a specialized treatment approach used in the management of certain cancers, particularly malignant pleural mesothelioma.

The indications for HITHOC include:

  • Malignant pleural mesothelioma: HITHOC is commonly considered for patients with malignant pleural mesothelioma, a cancer that affects the lining of the lungs (pleura) and is caused by asbestos exposure.
  • Limited tumor spread: HITHOC is typically considered when the spread of the mesothelioma is confined to the chest cavity and not distant organs. This is because HITHOC is normally performed after cytoreductive surgery to remove visible tumors within the chest.
  • Optimal candidate selection: Patients selected for HITHOC are carefully evaluated based on factors such as their overall health, stage of mesothelioma, and response to prior treatments. The goal is to identify individuals who are likely to benefit from the procedure.
  • Multimodal treatment plan: HITHOC is often included as part of a multimodal treatment plan, which may include surgery, chemotherapy, immunotherapy, and sometimes radiation therapy. The combination of these treatments aims to maximize the chances of controlling or eliminating the cancer.

Has HITHOC helped any pleural mesothelioma patients?

Yes. Several clinical studies have shown that HITHOC can extend survival in pleural mesothelioma patients.

For example, a 2023 review of the National Cancer Database revealed that patients who underwent HITHOC after surgery had a median life expectancy of 20.5 months, compared to 16.8 months for patients treated with surgery alone.

Jenna TozziWritten by:

Director of Patient Advocacy

Jenna Tozzi, RN, is the Director of Patient Advocacy at Mesothelioma Hope. With more than 15 years of experience as an adult and pediatric oncology nurse navigator, Jenna provides exceptional guidance and support to mesothelioma patients and their loved ones. Jenna has been featured in Oncology Nursing News and is a member of the Academy of Oncology Nurse & Patient Navigators & the American Nurses Association.

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  1. Ambrogi, M. C., et al. (2018). Diaphragm and lung-preserving surgery with hyperthermic chemotherapy for malignant pleural mesothelioma: A 10-year experience. The Journal of thoracic and cardiovascular surgery, 155(4), 1857–1866.e2. Retrieved January 11, 2024, from
  2. Aprile, V., et al. (2021). Hyperthermic Intrathoracic Chemotherapy (HITHOC) for thymoma: a narrative review on indications and results. Annals of translational medicine, 9(11), 957. Retrieved January 11, 2024, from
  3. Aprile, V., et al. (2021). Hyperthermic Intrathoracic Chemotherapy for Malignant Pleural Mesothelioma: The Forefront of Surgery-Based Multimodality Treatment. Journal of clinical medicine, 10(17), 3801. Retrieved January 11, 2024, from
  4. Elliott, I. A., et al. (2023). Impact of hyperthermic intrathoracic chemotherapy (HITHOC) during resection of pleural mesothelioma on patient survival. Journal of thoracic disease, 15(11), 6140–6150. Retrieved January 11, 2024, from
  5. Järvinen, T., Paajanen, J., Ilonen, I., & Räsänen, J. (2021). Hyperthermic Intrathoracic Chemoperfusion for Malignant Pleural Mesothelioma: Systematic Review and Meta-Analysis. Cancers, 13(14), 3637. Retrieved January 11, 2024, from
  6. Migliore, M., Ried, M., Molins, L., Lucchi, M., Ambrogi, M., Molnar, T. F., & Hofmann, H. S. (2021). Hyperthermic intrathoracic chemotherapy (HITHOC) should be included in the guidelines for malignant pleural mesothelioma. Annals of translational medicine, 9(11), 960. Retrieved January 11, 2024, from
  7. Patel, M. D., Damodaran, D., Rangole, A., Shaikh, S., Shah, K., Bagwade, R., & Bhatt, A. (2019). Hyperthermic Intrathoracic Chemotherapy (HITHOC) for Pleural Malignancies-Experience from Indian Centers. Indian journal of surgical oncology, 10(Suppl 1), 91–98. Retrieved January 11, 2024, from
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