Medical Oncologist
CION Cancer Clinics
Heated chemotherapy in the chest (HITHOC): what it is and what it cannot promise | CION Cancer Clinics
HITHOC is a warmed chemotherapy solution washed around the inside of the chest at the end of an operation for mesothelioma, while you are still asleep. It is aimed at microscopic cancer left on the surfaces after the surgeon has removed what can be seen. The studies so far are small, and many centres treat it as an addition still being tested. This page explains how it is done, who it does not suit, and what to ask. CION Cancer Clinics’ surgical oncologists in Hyderabad can talk this through with you.
MI
Medically reviewed by Dr. Mohammed ImaduddinConsultant Surgical Oncologist · MBBS, MS (General Surgery), MCh (Surgical Oncology) · last reviewed September 2026, next review due September 2027
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On this page
- What is heated chemotherapy in the chest?
- How is it actually done?
- What the team weighs before suggesting it
- Chemotherapy in the chest and chemotherapy in the vein, compared
- Words you will see, in plain language
- What this page cannot tell you, and what to ask your centre
- Four things families ask us about HITHOC, and what is true
- Common questions about heated chemotherapy in the chest
The short answer
What is heated chemotherapy in the chest?
HITHOC is a warmed chemotherapy solution washed around the inside of the chest at the end of an operation for mesothelioma or, less often, other cancers that have spread to the lung lining. It is done while you are still asleep, straight after the surgeon has removed as much of the visible tumour as possible.
What the letters stand for
Hyperthermic intrathoracic chemotherapy: chemotherapy, given inside the chest, heated to a little above body temperature. It is the chest version of HIPEC, which does the same thing in the abdomen. The heat is thought to help the drug reach a little deeper into the lining and to work harder on the cells it touches.
Why it is still considered experimental in many places
The idea is sensible: after the surgeon has stripped the lining, microscopic cancer is almost always left behind, and a wash reaches those surfaces directly. But the studies so far are small, mostly from single centres, and there is no large trial showing clearly who benefits. Many chest surgeons regard it as an addition still being tested rather than a standard part of the operation. Any centre offering it should say so plainly.
Who it does not suit
It adds time under anaesthetic and a heavier recovery, so it is not offered to people who are frail, whose kidneys are weak, or where the surgeon could not remove most of the visible disease. Your team decides this; this page cannot.
In theatre
How is it actually done?
The operation comes first
The surgeon performs the planned operation, usually a pleurectomy and decortication, which means removing the chest lining and peeling the thickened lining off the lung. The wash is only worthwhile if most of the visible cancer has gone.
Tubes are placed
Before the chest is closed, inflow and outflow tubes are positioned inside it and connected to a pump with a heater. The chest is then closed or sealed around them.
The warm wash
A chemotherapy drug, most often cisplatin, is dissolved in warmed fluid and circulated around the chest for a set time while the anaesthetist watches your temperature, heart and kidneys.
Draining and closing
The fluid is drained out, the chest is rinsed, and ordinary chest drains are left in. You wake up in intensive care as you would after the operation alone, with a little more fluid to shift and closer watching of the kidneys.
Not sure whether this applies to you?
Ask an oncologistWeighing it up
What the team weighs before suggesting it
These are the things a surgical team considers. They are not a checklist you can score yourself against.
The type of disease
It has been studied mostly in mesothelioma of the epithelioid type, the commonest form. It is sometimes considered for thymic cancers and for other cancers that have spread over the lining, but experience there is thinner still.
How much can be removed
The wash reaches only the surface. It cannot deal with tumour lumps that were left behind. If the surgeon expects to leave visible disease, the wash is unlikely to be suggested.
Fitness and the kidneys
Cisplatin is hard on the kidneys and some of it is absorbed from the chest. Kidney tests, heart tests and breathing tests before surgery decide whether the extra strain is reasonable.
Usually rules it out
- Weak kidneys
- Poor general fitness
- Very reduced lung function
Where it sits in the whole plan
Chemotherapy and immunotherapy into the vein remain the main treatments for mesothelioma. The wash does not replace them. The team will explain how they fit around the operation.
Side by side
Chemotherapy in the chest and chemotherapy in the vein, compared
Heated wash in the chest (HITHOC)
Chemotherapy through a vein
Given once, during the operation, while you are asleep
Given in cycles over months, as a day-care patient
Reaches the surfaces of the chest directly
Reaches the whole body through the blood
Cannot treat cancer elsewhere in the body
Treats disease wherever it is, at lower concentration
Main risks are to the kidneys and a heavier recovery
Main risks are low blood counts, sickness and tiredness over the course
Evidence comes from small studies; not standard everywhere
Evidence comes from large trials; standard treatment
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On your report
Words you will see, in plain language
- Hyperthermic
- Heated above normal body temperature. The heat is part of the treatment, not a side effect.
- Intrathoracic
- Inside the chest. Intrapleural means the same thing, inside the lining around the lung.
- Cytoreduction
- Surgery that removes as much of the cancer as can be seen. The wash is only used after this.
- Macroscopic complete resection
- Nothing the surgeon could see was left behind. Microscopic cancer may still be present, which is what the wash is aimed at.
- Epithelioid
- The commonest type of mesothelioma under the microscope, and the type in which surgery and the wash have mostly been studied.
- Perfusion
- Circulating the warmed fluid round the chest with a pump.
Being straight with you
What this page cannot tell you, and what to ask your centre
It cannot tell you whether the wash will help you, or by how much. Nobody can yet say that with confidence, because the studies are small and the people in them were carefully chosen. It cannot tell you your prognosis, which depends on the type and stage of the disease and on how it responds to the main treatments.
What to ask if it is suggested
Ask how many of these the team has done and what happened. Ask whether it is being offered inside a study, and if not, why not. Ask what the extra risks are for you in particular, how it changes the recovery, and what the plan is without it. Ask what it adds to the cost, and whether your scheme or insurer will cover that part.
What to ask if it is not suggested
Ask whether it was considered and why it was set aside. Often the honest answer is that the evidence does not justify the added risk for your situation, and that is a reasonable answer. A centre that does not offer it is not withholding something proven.
Whether any centre, including CION, can offer this wash is a question for that centre. Ask directly, and ask what the alternative plan is.Commonly believed
Four things families ask us about HITHOC, and what is true
"The heat kills the cancer on its own."
Heat at these temperatures does not kill cancer by itself. It is used because it seems to help the drug penetrate and act. The chemotherapy does the work; the heat is a helper, and the surgery beforehand matters more than either.
"It means the whole chest is cleared of cancer."
It is aimed at microscopic disease on surfaces the surgeon has stripped. It does not reach tumour that was left behind, cancer within the lung, or cancer anywhere else in the body. That is why treatment into the vein is usually still needed.
"If a hospital offers it, it must be proven."
Availability is not proof. The technique is used in a small number of centres worldwide, mostly within studies. Ask to see what the centre bases its practice on, and be wary of anyone who promises a result.
"Chemotherapy in the chest is harmless because it stays local."
Some of the drug is absorbed into the blood, and the kidneys take the strain. Kidney injury is the effect the team watches for most closely, along with the extra fluid, the longer anaesthetic and a slower recovery.
Questions we are asked
Common questions about heated chemotherapy in the chest
Is HITHOC the same as HIPEC?
The idea is the same: a warmed chemotherapy wash applied directly to a lining after surgery. HIPEC is used in the abdomen, where it is better established for some cancers. HITHOC is the chest version, studied far less, and it should not borrow the abdominal evidence.
Does it replace normal chemotherapy?
No. Chemotherapy or immunotherapy into the vein stays the backbone of mesothelioma treatment, and is usually given before or after the operation whether or not a wash was used. The wash is an addition to the operation, not a substitute for the rest of the plan.
Will my mother be awake for it?
No. It happens at the end of the operation under the same general anaesthetic. She will not feel it or remember it. What she will notice is a slightly heavier recovery in intensive care, with more attention paid to her fluids and kidney tests in the first days.
What are the extra risks compared with the operation alone?
Mainly strain on the kidneys from the absorbed drug, a longer time under anaesthetic, and more fluid to clear afterwards. Some studies also describe more chest infections and longer stays. Your surgeon should put these in the context of your own fitness rather than as general figures.
Does it work for lung cancer that has spread to the lining?
It has been tried, but the experience is even smaller than in mesothelioma and it is not a standard treatment for that situation. Fluid from lung cancer on the lining is usually managed with talc or a catheter, alongside treatment into the vein.
Which drug is used?
Most centres use cisplatin, sometimes with a second drug such as doxorubicin. The amount and the length of the wash vary from centre to centre, because there is no agreed standard. That variation is itself a sign of how young the technique is.
Does CION offer HITHOC?
This page cannot answer that for any particular centre, and what is offered can change. Call the helpline, describe what has been found, and ask directly. Whatever the answer, ask for the complete plan, including what happens before and after the operation.
Is it covered by Aarogyasri or insurance?
Cover for the operation itself is usually available under Aarogyasri, CGHS, ECHS, EHS and most cashless insurers. Cover for the wash as an addition is less predictable, because it is not a standard package item. Ask the centre to itemise it and check with your scheme before you agree.
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Sources
- American Cancer Society — Chemotherapy for malignant mesothelioma
- American Cancer Society — Surgery for malignant mesothelioma
- National Cancer Institute — Malignant Mesothelioma Treatment (PDQ) - Patient Version
- Cancer Research UK — Mesothelioma
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
Pleurectomy and Decortication ExplainedThe operation the wash is added toWho Is a Candidate for Mesothelioma SurgeryWhat the team weighs before any big chest operationSurgery for Mesothelioma: What Is PossibleWhere surgery fits in the whole planChemotherapy guideThe treatment into the vein that remains the backboneDeciding on Cancer SurgeryHow to weigh an option with thin evidence
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