HITHOC in Regensburg, Germany at the University Medical Center

Information about the Thoracic Surgery program at the University Medical Center in Regensburg, Germany – and their research into HITHOC.

After sending out several emails to multiple facilities with published research on HITHOC – Dr. Michael Ried of the University Medical Center in Regensburg, Germany responded with some interesting information about the thoracic surgery program at his facility, led by Dr. Hans Stefan Hofmann (who was cited in previous posts) and is the primary author of an article in German, called “Cytoreductive surgery and hyperthermic intrathoracic chemotherapy perfusion.”

Dr. Ried reports that surgical treatment of thymoma and malignant pleural mesothelioma are two of the procedures their department specializes in.  Since 2008, they have been performing HITHOC in these patients in combination with pleurectomy and decortication.

Dr. Reid reports that they will be publishing the results of a prospective study based on their experiences with HITHOC in the near future.

Contact information/ Program Summary details:

(note – site is entirely in German, no English version)

University Medical Center:  http://www.barmherzige-regensburg.de

Department of Thoracic Surgery:  http://www.barmherzige-regensburg.de/thoraxchirurgie.html

Chief of Thoracic Surgery: Dr. Hans Stefan Hofmann

General Contact information – department of thoracic surgery:  http://www.barmherzige-regensburg.de/1772.html?&L=0

Email: thoraxchirurgie@barmherzige-regensburg.de

I’ve included visible link information for your information.  Google translate will translate the website, as needed.

I have requested some additional program information, and will update this page, as soon as I receive it.

Additional Resources:

Dr. Hofmann is primary author on more than 40 journal articles on thoracic surgery topics (in English) – several dealing with lung cancer on a cellular level.  I have posted just a very small sample of citations here that I have selected among full text articles available on-line. (Names of articles may have been changed).

1. The wind of change in the therapy of lung cancer – in this free full-text article from 2006, Dr. Hofmann talks about the future of treatment for lung cancer.

2. The DNA of lung cancer – this article talks about specific DNA markers for aggressive lung cancers, and how these markers may be useful in targeting / treating disease.

3. Diagnosing lung cancer with DNA

4. While Dr. Hofmann is not the primary author on this article about treating a soldier wounded in Afghanistan with artificial lung therapies  – I thought it dovetailed nicely with our recent discussions on artificial lungs/ ecmo and ecmo-like therapies and future developments etc.

Intrathoracic Hyperthermic Chemotherapy (Hithoc) in advanced non-small lung cancer: the Nara Experience

As part of a continuing discussion of HITHOC (Hyperthermic IntraThoracic intraOperative Chemotherapy), today we are talking about the results of a small study conducted at the Nara Medical University, School of Medicine in Nara, Japan.

As part of a continuing discussion of HITHOC (Hyperthermic IntraThoracic intraOperative Chemotherapy), today we are talking about the results of a small study conducted at the Nara Medical University, School of Medicine in Nara, Japan.

While the study is small (just 19 patients in three groups), it’s important because the patients involved all had advanced lung cancer, with malignant pleural effusions or disseminated disease discovered at the time of surgery. This is important, as readers know, because lung cancers are often diagnosed late, (after patients develop malignant effusions), and that the prognosis for patients with malignant effusions is grim.

Population: 19 patients.

Notably, the treatment group C consisting of seven patients (which received no intrathoracic thermic treatment) who were treated during an earlier period (2001 – 2003). Group C had an average age of 64. Essentially a control group.

The remaining patients were treated during 2006 – 2008 and are divided into two groups;

Group A which received hyperthermic (hot) saline infusion with a 30 minute dwell time – consisted of seven patients.  This group was also older (average age 72).

Group B, consisting of five patients who received hyperthermic chemotherapy (cisplatin) infusion into the chest cavity with a 30 minute dwell time.

Note: Infusion in this post refers to instillation of fluid into the chest cavity, not an intravenous treatment.    All patients received post-operative adjuvant chemotherapy.

The grouping of A and B serves to distinguish whether the mechanism of treatment is related to the application of heat alone, or the application of heated chemotherapeutic agents.  Current theories about the effectiveness of HITHOC suggest that the heat of the chemotherapy allows the drugs to penetrate more deeply into the tissues compared to application of chemotherapy alone, but requires studies such as this to support this theory.

Interestingly, the pre-operative staging of these patients differed significantly from intra-operative findings with 8 patients diagnosed with early disease (stage I), five patients with stage II and only six patients as stage IIIA pre-operatively.  (Presence of a pleural effusion denotes stage IV).  Malignant effusions were not seen during pre-operative workup. (It is not uncommon to find more advanced cancer at the time of surgery.)

Surgery: All of the patients underwent a VATS procedure (video-assisted thoracoscopy).  The majority of patients of patients (16) underwent surgery to remove the primary lesion (cytoreductive surgery) with ten patients undergoing lobectomy and six patients undergoing wedge resection.

Intra-operative findings:  16 patients found to have malignant effusions, 10 patients with disseminated disease.

Results: No intra-operative/ post-operative deaths.

Group A (hot saline group): no deaths during follow-up period, with a median follow-up period of almost 20 months.  No recurrence of pleural effusions.

Group B (heated chemotherapy group): 4 deaths in follow-up period; median survival time was 41 months, one patient with recurrent pleural effusion 26 months after treatment.

Group C: (VATs alone): 5 deaths (during follow-up period) median survival 25 months, 4 patients with recurrent pleural effusions (average time to recurrent effusion: 3 months).

While this study is too small (with only five patients receiving intrathoracic chemotherapy) to generalize the results – it should prompt researchers into conducting more studies and trials into the use of hyperthermic intrathoracic chemotherapy in patients with late stage lung cancers.

The decreased incidence of pleural effusion in the treatment groups (A and B) is important also for quality of life issues.  However, these findings are also limited by the small study size.

I have written to Dr. Naito (corresponding author on this article) for further comment and information.


1. Kimura, M., Tojo, T., Naito, H., Nagata, Y., Kawai, N., & Taniquichi, S. (2010). Effects of a simple intraoperative intrathoracic hyperthermotherapy for lung cancer with malignant pleural effusion or dissemination. Interactive Cardiovascular & Thoracic Surgery 2010, April, 10 (4); 568 -71.  (linked to pdf).