Present and future of cytoreductive surgery and hyperthermic intrathoracic chemotherapy for pleural metastases - a narrative review

Sep 22, 2026

This narrative review examines how cytoreductive surgery combined with hyperthermic intrathoracic chemotherapy (HITHOC) may reshape management of secondary pleural cancers. It addresses clinical challenges posed by pleural malignancies, summarizes evidence on HITHOC effectiveness and integration with other therapies, and highlights obstacles limiting wider real-world adoption. Key findings indicate improved overall and progression-free survival with reduced complications and mortality, while future work requires standardized protocols and larger multinational datasets.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages15

Reading Time38 min

AccessFree to download

Background

Pleural malignancies and current treatment approaches

Methods

Evidence search and study selection

Results

Clinical outcomes and emerging therapeutic directions

Conclusion

Future research priorities

EUROPEAN RESPIRATORY REVIEW REVIEW A. HAJJA ET AL. Present and future of cytoreductive surgery and hyperthermic intrathoracic chemotherapy for pleural metastases: a narrative review Amro Hajja1, Miral Atout1, Rasoul Turko1, Haadi Syed1, Paula Duarte D’Ambrosio2,8, Ricardo Mingarini Terra2,8, Amal Abdulhaq3, Marco Nardini4,8, Marcello Carlo Ambrogi5,6,8, Marco Lucchi5,6,8, Hassan Robaidi1,3, Waleed Saleh1,3, Khaled AlKattan1,3 and Marcello Migliore 1,3,7,8 1College of Medicine, Alfaisal University, Riyadh, Saudi Arabia. 2 Instituto do Coração, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil. 3Thoracic Surgery and Lung Transplant, Lung Health Centre, Organ Transplant Center of Excellence (OTCoE), King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia. 4 Department of Thoracic Surgery, St. James’s University Hospital, Leeds, UK. 5 Department for Surgical, Medical, Molecular Pathology and Critical Care, University of Pisa, Pisa, Italy. 6 Division of Thoracic Surgery, University Hospital of Pisa, Pisa, Italy. 7 Department of General Surgery and Medical Specialties, University of Catania, Catania, Italy. 8Working group on HITHOC of Assembly 8 of the European Respiratory Society. Corresponding author: Marcello Migliore ([mmiglior@hotmail.com](mmiglior@hotmail.com)) Shareable abstract (@ERSpublications) Can cytoreductive surgery and hyperthermic intrathoracic chemotherapy reshape treatment for secondary pleural cancers? This review explores the potential of this therapy and what is needed to bring it into real-world clinical practice. [https://bit.ly/4rMh2CG](https://bit.ly/4rMh2CG) Cite this article as: Hajja A, Atout M, Turko R, et al. Present and future of cytoreductive surgery and hyperthermic intrathoracic chemotherapy for pleural metastases: a narrative review. Eur Respir Rev 2026; 35: 250213 [DOI: 10 . 1183/16000617 .0213-2025] . Copyright ©The authors 2026 This version is distributed under the terms of the Creative Commons Attribution NonCommercial Licence 4 .0. For commercial reproduction rights and permissions contact [permissions@ersnet.org](permissions@ersnet.org) Received: 11 Sept 2025 Accepted: 1 Dec 2025 Abstract Background Pleural malignancies pose a significant clinical challenge due to their poor prognosis and limited treatment options. Hyperthermic intrathoracic chemotherapy (HITHOC) is an emerging modality that has shown promise in treating primary pleural cancers when used with cytoreductive surgery (CRS), but its efficacy in treating pleural malignancies other than mesothelioma remains underexplored. This review aims to evaluate recent advancements in HITHOC use for nonmesothelioma pleural cancers and provide insights into its potential clinical applications. Methods A comprehensive Boolean search was conducted using PubMed/Medline and Google Scholar to identify relevant studies on the use of HITHOC for nonmesothelioma pleural cancers. Studies exclusively focused on pleural mesothelioma were excluded. Findings were summarised to address key questions regarding HITHOC’s effectiveness, integration with other therapies and obstacles to its broader use. Results HITHOC, when combined with CRS, could prolong overall and progression-free survival and reduce complication and mortality rates in patients with advanced pleural cancers. Advances in chemoimmunotherapy, the evolution of minimally invasive techniques and the emergence of precision surgery hold significant promise in the treatment of pleural malignancies. Conclusion Given the challenges associated with HITHOC, including protocol variability and technical complexity, future research using larger, multinational datasets is essential to support its broader application and to identify patient-specific characteristics that enhance its efficacy in treating pleural cancers. Introduction Pleural malignancies represent a significant clinical challenge due to th

FAQs

What clinical problem does the review focus on?

Pleural malignancies are presented as a significant challenge due to aggressive behavior, poor prognosis, and limited treatment options.

How is HITHOC used in relation to cytoreductive surgery (CRS)?

The review describes HITHOC following CRS, where visible tumor deposits are removed first and hyperthermic chemotherapy is then used to improve local control and outcomes.

What benefits are reported when HITHOC is combined with CRS?

Combined treatment may prolong overall and progression-free survival and can reduce complication and mortality rates in advanced pleural cancer patients.

Sep 22, 2026

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