Abstract
Surgery-based multimodality therapies have been used to control the malignant effusion and its recurrence in malignant pleural mesothelioma (MPM). Hyperthermic intrathoracic chemotherapy (HITHOC) has been used in the treatment of malignant pleural mesothelioma, but the results were controversial. The aim of the current study was, therefore, to conduct a systematic review and meta-analysis on the effect of HITHOC on MPM therapy. After thorough searching of online databases, total 21 articles were included into qualitative systematic review and 5 of them were used to conduct qualitative meta-analysis. It was found that most of HITHOC was used in combination of surgical resection including extrapleural pneumonectomy or pleurectomy/decortication. Patients who received HITHOC had significantly longer median survival length compared to the patients without HITHOC (Hedges’s g = 0.384 ± 0.105, 95% CI: 0.178∼0.591, P < 0.001). In addition, HITHOC as palliative therapy was favored (Hedges’s g = 0.591 ± 0.201, 95% CI: 0.196∼0.967, P < 0.001) in terms of recurrence free interval. The findings of the current study suggested that HITHOC is one of the safe and effective therapies in prolonging patients’ median survival time and extending recurrence free interval.
Highlights
Malignant pleural mesothelioma (MPM) is a fatal malignancy
The findings of the current study suggested that Hyperthermic intrathoracic chemotherapy (HITHOC) is one of the safe and effective therapies in prolonging patients’ median survival time and extending recurrence free interval
Of the 21 articles for systematic review and meta-analysis, 5 articles were from USA [6, 16, 20, 21, 32]; 4 articles were from Netherlands [14, 15, 18]; 3 articles were from United Kingdom [22, 23, 33]; 2 from Japan [24, 25], 2 from Italy [30, 31], 2 from Germany [26, 27], one from Israel [28], Turkey [34], and France [29], respectively
Summary
Median survival following diagnosis is often less than 12 months with limited options of therapies including surgery, radiotherapy and chemotherapy [1, 2]. Extrapleural pneumonectomy (EPP) has been widely used to treat early stage MPM and has been known to prolong survival time in patients with favorable prognostic factors [3, 4]. Surgery-based multimodality therapies 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. Intrapleural injection of cytotoxic drugs with hyperthermic perfusion has been proved to enhance cytotoxic effect on tumor cells with limited systemic side effect. Potential mechanisms of hyperthermic intra-pleural or intraperitoneal chemotherapy are the tumor cells are directly exposed to higher concentration of chemotherapeutic agents, and up to 44°C for 1 hr hyperthermic exposure render the cancer cells become more sensitive to the chemotherapeutic drugs while the normal tissues are unharmed [8, 9]
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