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

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 chemo-immunotherapy, 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.