Hyperthermic Intrathoracic Chemotherapy and Photodynamic Therapy: A Single-Institution Experience for Malignant Pleural Diseases.

INTRODUCTION: Hyperthermic intrathoracic chemotherapy (HITHOC) is an intraoperative treatment that involves the perfusion of heated chemotherapy agents within the thoracic cavity. Photodynamic therapy (PDT) utilizes systemically administered photosensitizing agents and targeted light exposure to eliminate residual cancer cells during the surgery. This study aimed to present our experience with local therapies in the management of pleural malignancies, describe the respective outcomes of each modality, and make a preliminary comparison. METHODS: We retrospectively and consecutively enrolled patients with advanced intrathoracic cancer (lung cancer, mesothelioma, and thymoma) with pleural involvement who underwent surgical resection followed by HITHOC or PDT at a single medical center between June 2005 and December 2022. Patients with extrathoracic metastases were excluded. The primary outcomes assessed were mortality rates and overall survival (OS), while the secondary outcomes included recurrence rates and progression-free survival (PFS). RESULTS: Seventy patients were included, with 15 undergoing HITHOC and 55 undergoing PDT. No significant differences were observed in terms of age, gender, or pathological stage between the two groups. Perioperative parameters, including operative time, estimated blood loss, postoperative length of stay, and intensive care unit stay duration, did not differ significantly between groups. Among patients with recurrence, 50% had localized disease within the chest cavity. HITHOC showed a 3-year OS of 70.5% and 2-year PFS of 46.8% (median follow-up 18.33 months), while PDT showed a 5-year OS of 53.4% and 5-year PFS of 25.5% (median follow-up 73.07 months). CONCLUSIONS: The clinical outcomes of our cohort are comparable to previous studies. Our preliminary data also suggest that HITHOC and PDT may have similar efficacy in treating pleural malignancies. However, the long-term outcomes associated with different neoadjuvant and adjuvant therapies remain unidentified.