Does HITHOC with surgery improve survival for pleural mesothelioma patients?
For pleural mesothelioma, surgery alone often leaves behind microscopic cancer cells that cause local recurrence. Hyperthermic intrathoracic chemotherapy (HITHOC) is a procedure where heated chemotherapy is circulated inside the chest during surgery to kill those remaining cells. The key question is whether adding HITHOC to surgery actually helps patients live longer. Based on the best available evidence, the answer is yes: HITHOC provides a modest but real survival benefit without increasing the risk of early death after surgery.
What the research says
A 2026 meta-analysis of six studies including 1,060 patients found that adding HITHOC to cytoreductive surgery improved overall survival by about 18% (hazard ratio 0.82) 17. Median survival was 21.3 months with HITHOC versus 18.8 months without it 17. Importantly, HITHOC did not increase 30-day or 90-day mortality rates, and the risk of complications like bronchopleural fistula was not significantly higher 17.
A separate large analysis using the National Cancer Database (3,232 patients) confirmed these findings: after matching patients with similar characteristics, HITHOC was linked to improved survival (median 20.5 vs. 16.8 months) and actually lower 30-day and 90-day mortality 8. However, HITHOC patients had longer hospital stays and more readmissions 8.
A 2021 narrative review also concluded that HITHOC following cytoreductive surgery provides good local control and better overall survival with a low complication rate 6. The authors noted that protocols vary widely and more structured studies are needed 6.
Other sources discuss different treatments for pleural mesothelioma, such as immunotherapy (nivolumab plus ipilimumab) 4, Tumor Treating Fields 2, pemetrexed side effects 3, and a new drug ivonescimab 5, but these do not directly address the question about HITHOC with surgery.
What to ask your doctor
- Is my tumor type and stage suitable for cytoreductive surgery with HITHOC?
- What is your center's experience with HITHOC, and how many procedures have they performed?
- How does the expected survival benefit (about 2-4 months median gain) compare with the risks of longer hospital stay and readmission?
- Would I be a candidate for other treatments like immunotherapy (nivolumab plus ipilimumab) instead of or after surgery?
- Are there any ongoing clinical trials for HITHOC or other therapies that I might consider?
This question is drawn from common patient questions about Oncology and answered using cited medical research. We do not provide individualized advice.