Study objectives: No established curative
treatment is available for pleural thymoma metastases and malignant
pleural mesothelioma (MPM). Recently, peritoneal malignancies have been
treated by cytoreductive surgery and intraoperative hyperthermic
intracavitary perfusion chemotherapy (HIPEC). We investigated the
feasibility and safety of this multimodality treatment in the thoracic
Design: Patients with pleural thymoma
metastases or early-stage MPM were enrolled in a feasibility study.
Morbidity, recurrence, and survival rates were recorded.
Setting: The Netherlands Cancer Institute.
Patients: Three patients with pleural thymoma metastases
and 11 patients with pleural mesothelioma were treated.
Interventions: Cytoreductive surgery and intraoperative
hyperthermic intrathoracic perfusion chemotherapy (HITHOC) with
cisplatin and adriamycin were performed. The mesothelioma patients
received adjuvant radiotherapy on the thoracotomy wound and drainage
Measurements and results: Morbidity and
mortality rates were 47% and 0%, respectively. Reoperation was
necessary in four cases. Severe chemotherapy-related complications were
not observed. A solitary mediastinal and a contralateral pleural
thymoma recurrence were successfully treated by radiotherapy and a
contralateral HITHOC procedure. All thymoma patients were alive and
free of disease after a mean follow-up period of 18 months. After a
mean follow-up period of 7.4 months, nine mesothelioma patients are
alive. Two mesothelioma patients died of contralateral pleural and
peritoneal recurrent disease, while one patient is alive with
surgery and HITHOC with cisplatin and adriamycin is feasible in
patients with pleural thymoma metastases and early-stage MPM, and is
associated with acceptable morbidity rates. Early data on locoregional
disease control are encouraging, and a phase II study will be