Hyperthermic intrathoracic chemotherapy in patients with malignant pleural mesothelioma after cytoreductive surgical procedures: a systematic review.

Surgery-based multimodality therapies for treatment of malignant pleural mesothelioma have been clinically explored in the past decades. In this regard, hyperthermic intrathoracic or intrapleural chemotherapy has been used as one of the multimodality therapies. The question addressed was In patients with malignant pleural mesothelioma who undergo macroscopic complete resection (MCR) does performing a Hyperthermic intrathoracic chemotherapy (HITOCH) lead to improvement in survival? The trial was registered in PROSPERO https://www.crd.york.ac.uk/prospero/ under registration number: CRD42024588823.Three hundred five papers were found using the reported search, 21 were relevant to our topic and only 7 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Six studies demonstrated a survival benefit for patients receiving HITOCH with a median survival ranging from 13-35 months in comparison to 11 -22.8 months for the non HITOCH group. Three out of the five studies compared extra-pleural pneumonectomy (EPP) to extended pleurectomy decortication (EPD) as the surgical preference for MCR. Only one study by Van Sandick et al. found a negative outcome with HITOCH in patients performing EPP (11 months vs 29 months). There was no reported mortality in relation to complications associated with HITOCH. The most common complication was atrial fibrillation followed by renal impairment. Despite the heterogeneity, small number of cases and lack of prospective randomised controlled trials, the body of evidence identified in this work demonstrates that HITHOC added to MCR in patients with pleural mesothelioma is safe and feasible. Possible improvement in recurrence free survival and overall survival warrant investigation in a randomised controlled trial.