Radical Pleurectomy: What You Need to Know

What is HITHOC?

Radical Pleurectomy with or without adjacent organ resection with Hyperthermic Intra Thoracic Chemotherapy is usually done in adults with primary pleural malignancies like mesothelioma and secondary pleural tumours due to thymoma.

After the surgery is completed the patient is subjected to 90 mins of intraoperative chemotherapy at 42 degrees centigrade which helps us to kill all the microscopic cancer cells and has good locoregional control.

Any conditions that increase the levels of circulating oestrogen in the body, may increase the risk of developing breast cancer, such as genetically inherited conditions such as Klinefelter syndrome, liver cirrhosis, intake of hormonal medications that increase estrogen levels, etc.

• Prior radiation to the chest wall may increase the person’s risk of developing breast cancer in the future.
• A known family history of breast cancer affecting one or two close family relatives.
• Inheritance of known genetic mutations, related to breast cancer, such as BRCA 1, BRCA 2, etc.
• Just as in the case of women, risk of breast cancer increases with age in men as well!
• Swelling or some sort of injury to a male’s testicles or even surgery to remove the testicles, may increase the risk of developing breast cancer.
• Obesity

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Indications

HITHOC is never done in adolescence.

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Primary pleural tumours and secondary pleural tumours

Inward movement of nipple (retraction)

• Blood stained or blackish ooze from the nipple or nipple discharge
• Wound over the nipple-areola complex or breast, that is not healing.
• Enlarged lymph nodes in the underarm or neck

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Is it common in children? If so, why?

HITHOC is never done in adolescence.

The reason why we did this technology for this adolescent is because of the experience that we gained with adult patients. it was explained in detail to the patient and family members about the radicality of the procedure and its outcome, which can give us satisfactory locoregional control.

Inward movement of nipple (retraction)

• Blood stained or blackish ooze from the nipple or nipple discharge
• Wound over the nipple-areola complex or breast, that is not healing.
• Enlarged lymph nodes in the underarm or neck

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How common is it in India and what is the cause?

This procedure is not done in many centres in India, and even in adolescents, it is not reported elsewhere. this is the first case study of a HITHOC procedure in an adolescent group which proved to be effective in this particular patient, for this particular malignancy.

What are the challenges in HITHOC?

The challenge is that morbidity and mortality (ie death), are very high. but in our patient post-operative recovery was smooth and uneventful was then discharged within 2 weeks.

Outcome

Because no treatment was offered elsewhere, and no other treatment options have left this procedure proved in to be a curative procedure in this particular patient for a disease-free period of 1 year.

How was this procedure managed successfully?

He was monitored intensively in ICU, for a week where there is a high chance of morbidities like infection bleeding arrhythmia, electrolyte disturbances, renal dysfunction and pneumonia.

How was the patient post-surgery?

The patient is doing well, going to school without any difficulties for the past 1 year.