Hyperthermic Intrathoracic Chemotherapy (HITOC) after Cytoreductive Surgery for Pleural Malignancies—A Retrospective, Multicentre Study

Abstract

In the context of quality assurance, the objectives were to describe the surgical treatment and postoperative morbidity (particularly renal insufficiency). A retrospective, multicentre study of patients who underwent cytoreductive surgery (CRS) with cisplatin-based HITOC was performed. The study was funded by the Deutsche Forschungsgemeinschaft (DFG, German Research Foundation (GZ: RI 2905/3-1)). Patients (n = 350) with malignant pleural mesothelioma (n = 261; 75%) and thymic tumours with pleural spread (n = 58; 17%) or pleural metastases (n = 31; 9%) were analyzed. CRS was accomplished by pleurectomy/decortication (P/D: n = 77; 22%), extended P/D (eP/D: n = 263; 75%) or extrapleural pneumonectomy (EPP: n = 10; 3%). Patients received cisplatin alone (n = 212; 61%) or cisplatin plus doxorubicin (n = 138; 39%). Low-dose cisplatin (≤125 mg/m2 BSA) was given in 67% of patients (n = 234), and high-dose cisplatin (>125 mg/m2 BSA) was given in 33% of patients (n = 116). Postoperative renal insufficiency appeared in 12% of the patients (n = 41), and 1.4% (n = 5) required temporary dialysis. Surgical revision was necessary in 51 patients (15%). In-hospital mortality was 3.7% (n = 13). Patients receiving high-dose cisplatin were 2.7 times more likely to suffer from renal insufficiency than patients receiving low-dose cisplatin (p = 0.006). The risk for postoperative renal failure is dependent on the intrathoracic cisplatin dosage but was within an acceptable range.

Multimodal therapy of epithelioid pleural mesothelioma: improved survival by changing the surgical treatment approach

“…The final cisplatin concentration was 40 mg/L. The flow was set to 1,000 mL/min (15)(16)(17). By using the technique in a standardized scheme, HITOC can be implemented in other facilities as well.…”

Surgical cytoreduction and hyperthermic intrathoracic chemotherapy for thymic tumours with pleural spread is effective on survival: results from the multicentre German hyperthermic intrathoracic chemotherapy study

“…We retrospectively analysed a subgroup of patients with TET and pleural spread (stage IVa), which were collected in the ‘German HITOC study’, a multicentre, retrospective study funded by the Deutsche Forschungsgemeinschaft—DFG, German Research Foundation (GZ: RI 2905/3–1) [ 13 , 15 ]. The trial is registered in the German Registry of Clinical Studies (DRKS-ID: DRKS00015012).…”

“…The study protocol of the entire study specified the inclusion and exclusion criteria for the German HITOC study [ 13 , 15 ]. In this analysis, a subgroup of patients with TET stage IVa due to pleural metastases, who underwent CRS and cisplatin-based HITOC within 1 surgery were included.…”

“…For years, additional intracavitary therapy approaches have been investigated to improve local tumour control, with hyperthermic intrathoracic chemotherapy (HITOC) being increasingly performed [ 9–12 ]. In addition to MPM, TET with pleural involvement are suitable for a combined surgical approach including HITOC [ 13 , 14 ]. However, reliable data are lacking for this particular therapy, as only feasibility studies and small retrospective studies have been published so far.…”

A glimpse into the role of debulking surgery and hyperthermic intrathoracic chemotherapy (HITHOC) in the management of malignant pleural mesothelioma

“…It seems clear that renal toxicity and mortality developed in patients who underwent EPP, and not in those who underwent P/D (13)(14)(15). A retrospective, multicenter study of 700 patients who underwent cytoreductive surgery plus cisplatin based HITHOC reported significant postoperative morbidity related to HITHOC, particularly renal insufficiency (26,27) since it appeared in 41 patients (12%) and the risk for postoperative renal failure was dependent on the intrathoracic cisplatin dosage.…”