Pleural Mesothelioma Treatment
HITHOC is a way to give chemotherapy drugs directly to the chest cavity during surgery. Some doctors tell patients who are getting a pleurectomy and decortication (P/D) to have this done.
In this article, we will find out; HITOC pleural mesothelioma chemotherapy: Method, benefits and research
What is the HITHOC for pleural mesothelioma?
|HITOC pleural mesothelioma chemotherapy|
This kind of chemotherapy is called HITHOC. People with pleural mesothelioma can get it during a major surgery to remove a tumor.
After a patient has surgery and heals, they can also get the usual systemic chemotherapy.
The most common way to treat mesothelioma is through systemic chemotherapy. Most of the time, drugs used in systemic chemotherapy are given through an IV. The drugs get to every part of the body through the bloodstream. They kill cancer cells and slow the growth of tumors.
Used in aggressive multimodal cancer treatment
Locally kills cancer like radiation, but there's less chance of lung damage.
Some research shows that this is linked to longer survival times.
The procedure varies by surgeon and treatment center.
Most doctors think that HITHOC is an experiment. First, surgeons must use surgery to remove all visible cancer growths. Then, chemotherapy drugs are pumped into the chest cavity to soak all the organs that the tumours have touched. This kills any remaining cancer cells.
HITHOC is like hyperthermic intraperitoneal chemotherapy (HIPEC), which has been used to treat people with mesothelioma in their abdomens for a long time.
HITHOC hasn't been as successful as HIPEC so far. Most of the time, it's harder to treat pleural mesothelioma than peritoneal mesothelioma. But some doctors think that the HITHOC method can be made better.
2. HITHOC for pleural mesothelioma: who benefits most?
HITHOC is an option for patients who are strong enough to handle an aggressive treatment plan.
Some researchers say that HITHOC could be used instead of radiation therapy when radiation is too dangerous.
Multimodal treatment is the gold standard for extending survival with pleural mesothelioma. This is usually done with a mix of invasive surgery, local radiation, and chemotherapy that goes through the body.
In some cases, surgeons must take out one lung and all the diseased tissue around it. Then, if there are still cancer cells in the chest, the doctors use radiation to kill them.
Most of the time, though, surgeons leave both lungs in place.
During a pleurectomy and decortication, surgeons remove tumours from around the lung and scrape cancerous growths off the surface of the lung. This lowers the chance of problems during surgery and improves the patient's quality of life.
The problem is that using radiation therapy while the lung is still in place is dangerous. Radiation is very harmful to lung tissue.
When both lungs are present, HITHOC gives doctors a safe way to try to kill cancer cells in the chest.
A combination of lung-sparing surgery, HITHOC, and systemic chemotherapy may help patients whose cancer hasn't spread much.
3. HITHOC Pleural Mesothelioma Treatment Research
In 2013, Dr. David Sugarbaker led a study that looked at the results for hundreds of people with pleural mesothelioma who had received multimodal treatment between 2001 and 2009.
The researchers wanted to look at the differences between patients who got HITHOC and those who did not. In their analysis, they tried to find a balance between the two groups so that neither group had an advantage outside of their treatment plan.
Based on the experiences of 103 patients, the study found that patients who got HITHOC lived longer on average.
Time to live on average after surgery
HITHOC Group Surgical Survival Time: 35.3 months
Group of Comparison 22.8 months
In a study done in 2017, Italian researchers looked at the results for 49 people who got HITHOC between 2005 and 2014.
In these cases, surgeons tried to keep the lung and diaphragm working as much as possible. So, patients would not have trouble breathing all the time.
The researchers said that 79% of the patients were still alive one year after surgery and 45% were still alive two years after surgery.
4. Process of Hyperthermic Intrathoracic Chemotherapy (HITHOC)
Different mesothelioma treatment centres have different ways of doing the HITHOC procedure. This is a basic plan.
Prevent Kidney Damage
The patient starts getting extra fluids and medicine the day before surgery to protect their kidneys from the chemotherapy drugs. After surgery, the patient will continue to get extra fluids and medicine to protect them for a few days.
Surgeons take out the pleura, which is the tissue that covers the affected lung, and scrape away any cancer growth that can be seen. Before they close the chest, they place two drains that will connect to the HITHOC machine.
Warm up the chest
First, the HITHOC machine fills the patient's chest with saline solution, a type of medical salt water. The machine slowly heats the solution until it is hot enough to hurt cancer cells but not hot enough to hurt healthy cells.
Drugs for chemotherapy
The chemotherapy is added by the HITHOC machine. The most common drug is cisplatin, which can be mixed with other drugs like doxorubicin or epirubicin. Since the chemotherapy goes into the chest cavity instead of the bloodstream, doctors can give a much stronger dose. The drug can only get a few millimetres into tissue, so surgeons must first remove all of the visible tumours.
Finish the operation and get well
Surgeons take out the chemotherapy mixture and the drains and close all the cuts. The surgery takes several hours, but most people stay in the hospital for less than two weeks.
Give supplemental chemotherapy
HITHOC only kills cancer cells in the chest cavity, so the patient still needs normal systemic chemotherapy to kill any cancer cells that may have spread to other parts of their body. It is not clear if getting both HITHOC and radiation therapy is helpful or not.