Essential Questions to ask if you or a loved one has been diagnosed with Mesothelioma ***IMPORTANT***

Multimodal Treatment known as Hyperthermic Intraoperative Chemotherapy (HIOC)

Posted on: October 17, 2023 *Updated on: May 27, 2024

Hyperthermic intraoperative chemotherapy (HIOC), including hyperthermic intraperitoneal chemotherapy (HIPEC) and hyperthermic intrathoracic chemotherapy (HITHOC), is an evolving treatment strategy for mesothelioma. This approach aims to deliver high-dose chemotherapy directly to the affected area, minimizing systemic toxicity while maximizing localized treatment. Mesothelioma, a cancer typically linked to asbestos exposure, commonly affects the linings of the abdomen (peritoneal mesothelioma) or chest (pleural mesothelioma).

Multimodal Treatment

HIOC is commonly used as part of a multimodal treatment plan, which might also include surgical resection, radiation, and systemic chemotherapy. The goal of a multimodal approach is to attack the cancer from multiple angles, providing the best chance for survival or palliation.

HIPEC

In cases of peritoneal mesothelioma, HIPEC is usually paired with cytoreductive surgery. This involves the removal of visible tumor masses, followed by the infusion of heated chemotherapy agents directly into the abdominal cavity. The Wake Forest Baptist Cancer Center study suggests significant promise for this approach, with a median survival of 40 months and a one-year survival rate of 77%.

HITHOC

For pleural mesothelioma, HITHOC is typically paired with either pleurectomy/decortication (P/D) or extrapleural pneumonectomy (EPP). Both of these are extensive surgeries aimed at removing as much tumor mass as possible. The reported median survival rates ranging from 27 to 42 months across multiple studies are indeed encouraging.

Advantages and Limitations

Advantages

  1. Localized Treatment: One of the key advantages of HIOC is that it allows for high concentrations of chemotherapy drugs to be delivered directly to the tumor site.
  2. Reduced Systemic Toxicity: Because the chemotherapy is localized, there is less risk of systemic toxicity compared to traditional chemotherapy.
  3. Immediate Post-Surgical Treatment: HIOC can be performed immediately after surgical resection, targeting any microscopic tumor cells that may have been missed during surgery.

Limitations

  1. Technically Challenging: The procedure requires specialized expertise and equipment.
  2. Risk of Complications: As with any surgical procedure, there are risks of complications, including infection, bleeding, and damage to nearby organs.
  3. Not Suitable for All Patients: Due to the aggressive nature of the treatment, not all patients may be eligible.

Future Directions

Research is ongoing to better understand the optimal chemotherapy agents to use, the best way to administer these agents, and which patients are most likely to benefit from these therapies. Personalized medicine and genetic profiling might play a more significant role in determining who could benefit most from intraoperative therapies like HIOC in the future.

As always, it’s crucial for patients to discuss all treatment options, including the risks and benefits of HIOC, with their healthcare providers to determine the best course of action.