Cytoreductive surgery and hyperthermic intrathoracic chemotherapy (HITHOC) in the treatment of primary and metastatic pleural malignancies - is extension of indications possible?

Abstract

Purpose: To present the experience of our center with cytoreductive surgery (CRS) and hyperthermic intrathoracic chemotherapy (HITHOC) in the treatment of various potentially resectable chemo-sensitive pleural malignancies, primary and metastatic, limited to the unilateral thoracic inlet, as well as to address potential extension of indications for this procedure. Methods: This retrospective study included patients treated with CRS+HITHOC at the Institute for Oncology and Radiology of Serbia from January 2018 to August 2021. Indications for CRS+HITHOC were: (1) potentially resectable chemo-sensitive primary or residual/recurrent thoracic malignancy, with no signs of disease outside the thoracic cavity, and (2) miscellaneous metastatic disease limited to the unilateral thoracic inlet. All HITHOC procedures were performed with 90 min cisplatin perfusion (100 mg/m2 in 1000 ml of 5%-glucose gradually heated to 42°C). Results: A total of 7 patients were included in this study, with a mean age of 41.43 ± 19.25 years (range: 16-62). R0 resections were achieved in all patients. All CRS+HITHOC procedures were uneventful, with no metabolic or hemodynamic disorders intraoperatively. Average follow-up was 25.71±9.83 months (range: 14-40). Overall survival rate was 100%. There were no local relapses in the thoracic cavity. Conclusions: This study showed that CRS+HITHOC procedure might be successfully used not only for current indications, but also for a limited metastatic disease of a primary outside the thoracic cavity. Larger, multicentric studies might provide more data on oncological outcomes and cost-effectiveness of this procedure. © 2021 Zerbinis Publications. All rights reserved.