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Chemotherapy During Mesothelioma Surgery: Is it Dangerous?

chemotherapy during mesothelioma surgeryA new study finds that chemotherapy during mesothelioma surgery does not raise the risk for complications. That could be good news for pleural mesothelioma patients who want to keep cancer at bay as long as possible.

A group of Indian doctors compared the cases of thoracic cancer patients who had surgery with or without intraoperative chemotherapy.

Only one of the “surgery + chemotherapy” patients developed a serious complication. Patients in this group also lived longer than those who did not receive intraoperative chemotherapy.

When Do Doctors Use Chemotherapy During Mesothelioma Surgery?

The two primary types of mesothelioma surgery are extrapleural pneumonectomy (EPP) or lung-sparing pleurectomy/decortication (P/D).

Patients often have chemotherapy prior to surgery to shrink their mesothelioma tumor. Many have chemotherapy afterward to keep tumors from coming back.

When it is used in the chest cavity, intraoperative chemotherapy during mesothelioma surgery is called HITHOC (heated intrathoracic chemotherapy). HITHOC involves rinsing the chest cavity with a heated mixture of chemotherapy drugs while the patient is still on the operating table.

Mesothelioma cells that are left behind during surgery can form new tumors. Even the most radical surgery cannot remove all of these cells. Some cancer centers offer HITHOC as a way to prevent new mesothelioma tumors from forming.

Complications After Mesothelioma Surgery

The new study focused on the cases of seven surgery patients who had HITHOC and four who did not.

“At a median follow-up of 9 months, five patients of the HITHOC group were alive, four without recurrence, and one with recurrence,” reports lead author Mahesh Patel of Zydus Hospital in Ahmedabad.

Only one patient who had chemotherapy during mesothelioma surgery experienced a serious (Grade 3 – 4) complication. None of them died. In contrast, one of the patients in the non-HITHOC group died of surgery complications.

Writing in the Indian Journal of Surgical Oncology, the authors conclude, “HITHOC can be performed without increasing the morbidity [complication rate] of P/D or EPP.”

Chemotherapy During Mesothelioma Surgery Becoming More Common

For people with malignant pleural mesothelioma, surgery offers the best odds of survival. But the risks and side effects can be severe.

A 2017 Italian study suggested that chemotherapy during mesothelioma surgery could allow surgeons to perform a less radical operation. This could minimize side effects and may even extend mesothelioma survival.

As evidence grows about the potential advantages of chemotherapy during mesothelioma surgery, more centers have started to offer it. Not surprisingly, patients treated in the most experienced centers tend to have the best outcomes.


Patel, MD, et al, “Hyperthermic Intrathoracic Chemotherapy (HITHOC) for Pleural Malignancies-Experience from Indian Centers”, February 2019, Indian Journal of Surgical Oncology, https://link.springer.com/article/10.1007%2Fs13193-018-0859-y

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