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Cytoreductive surgery and HITHOC, Future of Thoracic Surgery

Cytoreductive Surgery with Intraoperative Hyperthermic Intrathoracic Chemotherapy

Cytoreductive surgery with Intraoperative Hyperthermic Chemotherapy (HIPEC) has been used for over a decade now for abdominal cancers including metastatic colon cancer (peritoneal carcinomatosis) and malignant peritoneal mesothelioma.  During this lengthy procedure, surgeons remove as much gross disease as possible, and then infuse heated chemotherapy agents directly into the abdominal cavity to kill any residual cancer cells.  One of the benefits of this treatment is that by directly administering chemotherapy to the site of disease – the patient experiences less toxic side effects (versus intravenous or oral ingestion) and higher concentrations can be used, which are more effective at killing the malignant cells.  Research findings have been encouraging, and have shown significant improvement in median survival in comparison to standard treatment.

During my research in Bogotá, Colombia – I interviewed a general surgeon who was responsible for establishing a HIPEC treatment program in a local hospital there.  (There are less than 25 HIPEC treatment centers in the world.)  This spurred my interest in thoracic applications of this procedure (called the Sugarbaker procedure after the inventor, Dr. Paul Sugarbaker, an oncologist.)

In recent years, thoracic surgery has investigated and adopted some of this research for use and treatment of thoracic cancers, in a procedure known as HITHOC.  In thoracic surgery, intrathoracic (inside the chest) administration of heated chemotherapy in the operating room has been used primarily to treat malignant thymomas and malignant pleural mesothelioma.  Results of recent studies have been mixed – with the best results occurring in patients with thymomas.  In patients with mesothelioma, prognosis is dependent on stage.

Rutgers and Bree et. al at the Netherlands Cancer Institute published several additional studies on the subject,  looking at the effectiveness of different chemotherapeutic agents for HITHOC.  Given their extensive experience and knowledge on the subject, I have contacted the researchers at the Netherlands Cancer Institute to invite the authors to submit a guest post.  (I’d rather all of you hear from the experts!)

Additional References: (links when possible)

1. Dutch study using the Sugarbaker procedure for intrathoracic infusion for pleural thymomas and malignant pleural mesothelioma.  Bree et. al (2000) from Chest. Small study with only 14 patients but a nice discussion of the procedure with graphics. Multiple other studies from these authors, as mentioned above.

2. A nice blog that explains the Sugarbaker procedure.

3. Very small Japanese study from 2003 – five patients.  Notably, these patients had a different disease process – lung cancer with pleuritic carcinomatosis. 4 out of five patients demonstrated significant longevity after the procedure with no recurrence.

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About K Eckland

World of Thoracic Surgery is a blog about the work, research, and practices of thoracic surgeons around the world. It includes case studies, [sometimes] dry research, interviews with thoracic surgeons along with patient perspectives, and feedback.

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