Cytoreductive surgery and hyperthermic intrathoracic chemotherapy perfusion for malignant pleural tumours: perioperative management and clinical experience

Eur J Cardiothorac Surg. 2013 Apr;43(4):801-7. doi: 10.1093/ejcts/ezs418. Epub 2012 Aug 10.


Objectives: A combination of cytoreductive surgery and hyperthermic intrathoracic chemotherapy perfusion (HITHOC) was performed for the treatment of primary and secondary pleural malignancies. We describe the perioperative management and our clinical experience.

Methods: Between September 2008 and August 2011, eight patients with pleural manifestation of thymoma (Masaoka stage IVa) and eight patients with malignant pleural mesothelioma (MPM) were prospectively enrolled. Postoperative morbidity, recurrence and survival rates were analysed.

Results: All the patients received multimodality therapy, including chemotherapy, radiation and surgical resection (pleurectomy/decortication) followed by the HITHOC procedure. Chemotherapy perfusion was performed with cisplatin (100-150 mg/m(2)) at 42°C for 1 h. Severe chemotherapy-related complications were not observed. Reoperation was necessary in two patients. There was no 30-day mortality. The median stay on the intensive care unit was 1 day, and the median duration of hospitalization was 15 days. Pleural recurrence of thymoma was evident in one thymoma patient 6 months after HITHOC. At mean follow-up of 22 months, seven thymoma patients (7/8; 88%) are alive without recurrence. Tumour progression was present in six mesothelioma patients (6/8; 75%). Four patients (50%) with MPM are alive, including two with no evidence of mesothelioma, and the median survival is 18 months.

Conclusions: Cytoreductive surgery in combination with HITHOC can be performed with acceptable morbidity and mortality rates in selected patients. Patients should be evaluated by an interdisciplinary team to determine their eligibility for this therapeutic alternative. Early clinical results may encourage the use of this surgical option to provide better local tumour control in a multimodality treatment setting.

Publication types

  • Clinical Trial

MeSH terms

  • Aged
  • Antineoplastic Agents / administration & dosage
  • Cisplatin / administration & dosage
  • Combined Modality Therapy / methods*
  • Feasibility Studies
  • Humans
  • Hyperthermia, Induced / methods*
  • Male
  • Mesothelioma / drug therapy
  • Mesothelioma / surgery
  • Mesothelioma / therapy*
  • Middle Aged
  • Pleural Neoplasms / drug therapy
  • Pleural Neoplasms / surgery
  • Pleural Neoplasms / therapy*
  • Postoperative Complications
  • Prospective Studies
  • Thoracic Surgical Procedures / methods
  • Thymoma / drug therapy
  • Thymoma / surgery
  • Thymoma / therapy*
  • Tomography, X-Ray Computed
  • Treatment Outcome


  • Antineoplastic Agents
  • Cisplatin