Hyperthermic Intrathoracic Chemotherapy (HITHOC) for Pleural Malignancies—Experience from Indian Centers

Patel, Mahesh D.; Damodaran, Dileep; Rangole, Ashvin; Shaikh, Sakina; Shah, Kairav; Bagwade, Rajendra; Bhatt, Aditi

doi:10.1007/s13193-018-0859-y

Cited by 9 publications

(7 citation statements)

References 24 publications

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“…When practical, it appears that most surgeons have opted for a more minimalistic approach, removing only isolated pleural implants 2,20 . Nonetheless, there are several advocates for both total pleurectomy, EPP, and HITEC in this setting 3,21 . Interestingly, when the extent of resection was evaluated as a potential independent variable associated with either PFS or OS, it was not shown to be related to either outcome in our investigation.…”

Section: Discussionmentioning

confidence: 66%

“…As a result, divergent practices exist, ranging from nonoperative management to maximal resection, even including extrapleural pneumonectomy (EPP) in select cases. Furthermore, some even have advocated for hyperthermic intrathoracic chemotherapy (HITEC) in conjunction with radical resections to fully eradicate disease 3,4 . In vitro models have demonstrated rapid cell death of thymic cell lines via cellular fixation, following washes with povidone‐iodine, suggesting a potential less‐toxic agent to the host, which could be used to control micrometastatic disease following surgical resection 5 …”

Section: Introductionmentioning

confidence: 99%

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Importance of resection for locoregional disease control in Masaoka stage IVA thymic neoplasms

Corsini

Mitchell

Hofstetter

et al. 2020

Journal of Surgical Oncology

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Background and Objectives It is unclear if a specific strategy for simultaneous treatment of primary thymic neoplasms and pleural metastases confers benefit for Masaoka stage IVA disease. We reviewed our experience with thymic neoplasms with concurrent pleural metastases to identify factors influencing outcomes. Methods Records of patients who presented with stage IVA thymic neoplasms from 2000 to 2018 were assessed. Multivariate Cox proportional hazards analyses were completed to determine predictors of progression‐free and overall survival. Results Forty‐eight patients were identified, including 34 (71%) who underwent surgery. Median overall and progression‐free survival were 123 and 21 months, respectively. The extent of resection varied, and was most commonly thymectomy plus partial pleurectomy (22, 65%). Median progression‐free survival for patients who underwent surgical resection versus those who had not was 24 versus 12 months (P = .018). Following surgical resection, mediastinal recurrence was uncommon (2, 6%, vs 7, 50% nonoperatively). Five‐year survival rates in these groups were suggestive of possible benefit to surgery (87% vs 68%). Conclusions Thymic neoplasms with pleural dissemination represents a treatment challenge. As part of a multidisciplinary approach, surgery appears to be associated with more favorable long‐term results, although selection bias may account for some of the survival differences observed.

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Section: Discussionmentioning

confidence: 66%

Section: Introductionmentioning

confidence: 99%

Importance of resection for locoregional disease control in Masaoka stage IVA thymic neoplasms

Corsini

Mitchell

Hofstetter

et al. 2020

Journal of Surgical Oncology

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“…Conventional chemotherapy may effectively control or stabilize locally advanced and metastatic SFTP (57). Hyperthermic intrathoracic chemotherapy has been used in primary and secondary pleural malignancies such as SFTP to improve local control, prolong survival, and improve quality of life (58). Also, safe, efficient, and fewer side effects of local microwave-thermal ablation has been used for the treatment of postoperative recurrence of SFTP (59).…”

Section: Discussionmentioning

confidence: 99%

Rapidly growing solitary fibrous tumors of the pleura: a case report and review of the literature

Zuo¹,

Zhou²,

Sun³

et al. 2020

Ann Transl Med

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A solitary fibrous tumor (SFT) is a rare spindle cell tumor-derived from mesenchymal cells. It may be linked to the fusion of the NAB2-STAT6 gene caused by 12q chromosome rearrangement. It can occur in the connective tissue of any part of the body; however, it is most common in the pleura. Solitary fibrous tumors of the pleura (SFTP) are a persistent painless mass with slow growth. With the increase of the tumor, there will be corresponding compression symptoms. Pleural effusion is rare, and the cytology of pleural effusion is mostly negative. Occasionally, SFTP can induce paraneoplastic syndrome, distant metastasis, and malignant transformation. Lung function may have mild to moderate restrictive ventilation dysfunction. CT is a crucial method for the clinical diagnosis of SFTP. The histopathological features of SFTP are the coexistence of sparse and dense areas. CD34, CD99, Bcl-2, and vimentin are the most valuable immunohistochemical markers.The positive expression rate of STAT6 in benign SFT was even 100%. Adhesion or unclear boundary with surrounding tissues, pleural effusion or calcification, tumors with a maximum diameter greater than 10 cm, invasive growth, uneven density, metastasis or recurrence, paraneoplastic syndrome, moderate to severe cell heterogeneity, high Ki67 proliferation index, and low STAT6 expression suggest SFTP may be a malignant tumor. Gene analysis on next generation sequencing may help reveal the mutation characteristics of SFTP. Complete tumor resection is the gold standard of SFTP. Resectability is the most important prognostic factor. Age, size, mitosis, and necrosis are considered risk stratification factors for prognosis. Fortunately, 80% of SFTP are benign and have anexcellentprognosis but need long-term follow-up.We report a case of rapidly growing tumor with pleural effusion within 9 months, who was surgically treated and is currently under follow-up. And the literature is reviewed.

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“…In thoracic surgery field, HITHOC is performed since the 90s, mostly in case of malignant pleural mesothelioma (MPM) and pleural spread of thymoma (stage IVa de novo thymoma, DNT, or pleural recurrences, TPR), even if its use for unilateral pleural carcinomatosis due to lung cancer or other primitive tumors as well as for rare pleural disease as the solitary fibrous tumor are also described by some authors (16)(17)(18).…”

Section: Indications Of Hithocmentioning

confidence: 99%

Hypertermic Intrathoracic Chemotherapy (HITHOC) for thymoma: a narrative review on indications and results

Aprile¹,

Bacchin²,

Korasidis³

et al. 2021

Ann Transl Med

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Objective: With this narrative review, we retraced the history of hypertermic intrathoracic chemotherapy (HITHOC) since the beginning, analyzing literature on operative technique, feasibility and efficacy of this treatment. Moreover, we report the fifteen-year experience of our center in this relatively new technique, for what concerns both early postoperative results and long-term oncological outcomes.Background: Thymomas are frequently misdiagnosed and recognized in advanced stage, often with pleural dissemination, especially when not associated to Myasthenia Gravis that allows an early diagnosis during the initial assessment. Moreover, the natural history of locally advanced thymoma is characterized by a high rate of pleural or pericardial relapses. Surgery has always been considered a milestone in thymoma's treatment, even in case of serous dissemination or relapses, although his role as exclusive therapy does not guarantee an acceptable local disease control. In case of disseminated disease, different multidisciplinary protocols have been experimented, from chemotherapy to radiation therapy, alone or associated to surgery, in order to increase overall and disease-free survival, but the breakthrough happened in the early 90s with the introduction of HITHOC following surgery. Combination of surgery and HITHOC resulted in less toxic than systemic chemotherapy and providing a good local disease control in patients with stage IVa thymomas or thymoma's pleural recurrences.Methods: We searched PubMed for relevant literature, up to January 2020, on hypertermic intrapleural chemotherapy for thymomas (TPR or DNT), selecting only those reporting information about HITHOC protocol used, postoperative course and oncological outcomes.Conclusions: HITHOC is a safe and feasible procedure, with a very low complication rate and negligible systemic effects of chemotherapeutic agents, effective in controlling both TPR and DNT, in particular as regards local disease-free survival.

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Hyperthermic Intrathoracic Chemotherapy (HITHOC) for Pleural Malignancies—Experience from Indian Centers

Cited by 9 publications

References 24 publications

Importance of resection for locoregional disease control in Masaoka stage IVA thymic neoplasms

Importance of resection for locoregional disease control in Masaoka stage IVA thymic neoplasms

Rapidly growing solitary fibrous tumors of the pleura: a case report and review of the literature

Hypertermic Intrathoracic Chemotherapy (HITHOC) for thymoma: a narrative review on indications and results

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