Hyperthermic intrathoracic chemotherapy
Hyperthermic intrathoracic chemotherapy (HITOC) is part of a surgical strategy employed in the treatment of various pleural malignancies. The pleura in this situation could be considered to include the surface linings of the chest wall, lungs, mediastinum, and diaphragm. HITOC is the chest counterpart of HIPEC. Traditionally used in the treatment of malignant mesothelioma, a primary malignancy of the pleura, this modality has recently been evaluated in the treatment of secondary pleural malignancies (e.g. thymic tumors, secondary pleural carcinosis). Metastases to the pleural surface from any primary tumor represents Stage IV disease which carries in general an  extremely poor prognosis. In addition; in highly selected situations the pleura can be involved by local spread or “seeding” from thoracic tumors such as lung, esophageal, and thymic cancers. Secondary pleural malignancies include metastasis from distant primary tumors including breast, colon, ovarian, uterine and renal cell carcinoma among others; as well as certain sarcomas and pseudomyxoma peritonei. Treatment options for such advanced diseases are limited to systemic chemotherapy, radiation, and supportive care measures. These may include management for shortness of breath due to recurrent, symptomatic malignant pleural effusions. However, the surgical removal of large pleural deposits with infusion of hyperthermic  chemotherapy may offer significant survival and symptomatic benefit for patients in this disease category. The rationale for this approach is the simultaneous utilization of three different antineoplastic strategies: surgical resection, chemotherapy, and hyperthermia. The goal of surgical cytoreduction is to remove all gross disease including tumors that are in resectable areas of the lung or other structures and any large pleural nodules. After complete resection of visible disease, the chest cavity is perfused with hyperthermic chemotherapy with the goal of treating microscopic or minimally visible disease. The chemotherapy bathes the inside of the chest in concentrations that are very effective  against the cancer cells but without the level of toxicity that could occur if the chemotherapy was given through the blood stream. The increased heat of the chemotherapy perfusion can itself injure the cancer cells and makes the chemotherapy more effective. Diseases treated. There are other intra-abdominal malignancies that may cross the diaphragm and cause disease in the chest that could be potentially helped by HITOC. Some examples would include: