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HITHOC with cytoreductive surgery improves survival in pleural mesothelioma without raising early postoperative riskHeat treatment shows survival benefit for pleural mesothelioma patients

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Key Takeaway
Consider adding HITHOC to cytoreductive surgery for pleural mesothelioma to improve overall survival without increasing early postoperative risk.

This meta-analysis of 6 studies involving 1060 patients evaluated the addition of hyperthermic intrathoracic chemotherapy (HITHOC) to cytoreductive surgery for pleural mesothelioma. The primary outcome was overall survival (OS), with secondary outcomes including 30-day and 90-day mortality, bronchopleural fistula/empyema, arrhythmia, and hospital length of stay.

The analysis demonstrated a significant survival benefit for HITHOC (HR 0.82, 95% CI 0.71-0.94). Median OS was 21.3 months (95% CI 19.2-24.9) in the HITHOC group versus 18.8 months (95% CI 17.5-20.9) in the non-HITHOC group. No statistically significant differences were observed for 30-day mortality (OR 0.53, 95% CI 0.16-1.05), 90-day mortality (OR 0.49, 95% CI 0.24-1.01), bronchopleural fistula/empyema (OR 0.55, 95% CI 0.07-4.12), arrhythmia (OR 1.17, 95% CI 0.45-3.06), or hospital length of stay (MD 0.38 days, 95% CI -4.61 to 5.37).

Limitations were not reported in the source. The meta-analysis included 6 studies with a total of 1060 patients, and the findings represent an association between HITHOC and improved survival, not causality from a primary trial. For practice, HITHOC appears to offer a survival advantage without increasing early postoperative risk in patients undergoing cytoreductive surgery for pleural mesothelioma.

How this fits prior evidence

This meta-analysis extends prior evidence on pleural mesothelioma treatment. Previous coverage highlighted 5-year OS benefit with nivolumab+ipilimumab (14% vs 6%) in unresectable disease, and a Phase II study of ivonescimab targeting 55% DCR in relapsed disease. The current findings add HITHOC as a surgical adjunct that improves OS (HR 0.82) without increasing early mortality, addressing a gap in optimizing cytoreductive surgery outcomes. It does not directly compare with systemic therapies but offers a complementary approach for resectable patients.

Living with pleural mesothelioma, a rare and aggressive cancer of the chest lining, presents a difficult road for many patients. When doctors perform cytoreductive surgery to remove the tumor, they are looking for ways to improve long-term outcomes. New data suggests that adding heat to the chemotherapy process during these surgeries could help.

A large review of 1,060 patients found that those who received hyperthermic intrathoracic chemotherapy (HITHOC) lived longer than those who did not. Specifically, the median survival for the HITHOC group was about 21 months, compared to roughly 19 months for the standard surgery group. This suggests a meaningful difference in how long patients can live after their procedure.

Importantly, this extra step of heating the chemotherapy did not seem to increase immediate risks. The study found no significant differences in early complications like heart rhythm issues or infections. While this analysis shows a clear link between heat treatment and longer survival, it is based on existing data rather than a single new trial. Talk with your doctor about how these findings might apply to specific treatment plans.

What this means for you:
Adding heat to chemotherapy during surgery for pleural mesothelioma is linked to longer survival without extra risks.

Common questions

What is HITHOC and how does it work?

HITHOC stands for hyperthermic intrathoracic chemotherapy. It involves heating the area of the chest during surgery while delivering chemotherapy. This method was found to be associated with a significant survival benefit for patients undergoing surgery for pleural mesothelioma.

Does this treatment make surgery more dangerous?

The study found no statistically significant difference in early risks like 30-day or 90-day mortality, heart rhythm issues (arrhythmia), or infections. This suggests that adding heat to the chemotherapy does not increase immediate postoperative risks for these patients.

How much longer did patients live with this treatment?

Patients who received HITHOC had a median survival of 21.3 months, while those who did not receive it had a median survival of 18.8 months. This indicates a measurable improvement in overall survival for the group receiving the heat treatment.

Study Details

Study typeMeta analysis
Sample sizen = 1,060
EvidenceLevel 1
Follow-up21.3 mo
PublishedJul 2026
View Original Abstract ↓
BACKGROUND: Pleural mesothelioma (PM) is a rare and aggressive malignancy with limited overall survival (OS) despite multimodal therapy. Cytoreductive surgery is the standard of care for selected patients. However, locoregional recurrence remains common. Hyperthermic intrathoracic chemotherapy (HITHOC) has been proposed as an adjunct to enhance local disease control. METHODS: A systematic review and meta-analysis were performed according to PRISMA guidelines and registered in PROSPERO (CRD420251132268). This study searched PubMed, Embase, and Cochrane Library up to 18 July 2025. Pooled hazard ratios (HRs), odds ratios (ORs), and mean differences (MDs) were calculated using random-effects models. Individual patient data (IPD) were reconstructed to generate Kaplan-Meier curves. RESULTS: Six studies comprising 1060 patients were included. Of these patients, 490 (46.2%) received HITHOC and 570 (53.8%) underwent surgery without HITHOC. Overall survival analysis showed a significant survival benefit for HITHOC (HR, 0.82; 95% confidence interval [CI] 0.71-0.94). The median OS was 21.3 months (95% CI, 19.2-24.9 months) in the HITHOC group versus 18.8 months (95% CI, 17.5-20.9 months) in the non-HITHOC group. No statistically significant differences were found for 30-day mortality (OR, 0.53; 95% CI, 0.16-1.05), 90-day mortality (OR, 0.49; 95% CI, 0.24-1.01), bronchopleural fistula/empyema (OR, 0.55; 95% CI, 0.07-4.12), arrhythmia (OR, 1.17; 95% CI, 0.45-3.06), or hospital length of stay (MD, 0.38 days; 95% CI, -4.61 to 5.37 days). CONCLUSION: For patients undergoing cytoreductive surgery for pleural mesothelioma, HITHOC is associated with a significant improvement in OS without increased early postoperative risk. These findings support the use of HITHOC in specialized centers with appropriate surgical expertise and patient selection.
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