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Hyperthermic Pleural Perfusion Treatment

Late-stage or advanced cancers can sometimes spread along the chest cavity's inner lining (pleura), also called the pleural cavity.

This type of cancer spread is called pleural metastases.

Doctors treat some pleural metastases with hyperthermic pleural perfusion. UPMC Hillman Cancer Center is one of only a handful of cancer centers in the U.S. where surgeons use this technique.

What is Hyperthermic Pleural Perfusion?

Hyperthermic pleural perfusion is an advanced surgical technique by which very high doses of heated chemotherapy are given directly into the pleural cavity to treat advanced cancers that have spread along the chest cavity's inner lining.

Doctors generally use it combined with and immediately after a specialized surgical procedure called cytoreductive surgery (CRS):

  • CRS aims to surgically remove all visible cancer nodules.
  • Hyperthermic pleural perfusion aims to treat small cancer nodules or invisible (microscopic) cancer cells that may be left behind after CRS.

In traditional chemo, doctors give people drugs through an IV or by mouth. These drugs kill the cancer cells but may also cause many side effects.

Hyperthermic pleural perfusion delivers medicine directly to the site of cancer (pleural cavity). This heated chemotherapy solution kills cancer cells while causing minimal side effects outside the chest cavity.

If you have pleural metastases, hyperthermic pleural perfusion treatment may be right for you.

Sometimes it's used along with other therapies, such as IV chemotherapy and radiation.

Hyperthermic pleural perfusion isn't for everyone. If you're too sick or have a different type of cancer, another treatment may work better. Your cancer team will present you with options based on your unique situation.

As with any complex procedure, there are benefits and risks to hyperthermic pleural perfusion treatment.

  • Doctors can apply high doses of chemo directly to tumors in the chest cavity while limiting side effects in the rest of the body.
  • Heating cancer cells to above-normal temperatures make them easier to destroy with chemo and radiation.
  • It may be the best option for people with certain aggressive lung cancers, like pleural mesothelioma.
  • Hyperthermic pleural perfusion requires specialized equipment and a highly trained treatment team like UPMC Hillman Cancer Center's expert surgeons.
  • Hyperthermic pleural perfusion carries risks that are similar to other major surgeries.

Cancers We Treat with Hyperthermic Pleural Infusion

Doctors use hyperthermic pleural perfusion to treat two types of cancers in the chest cavity:

  • Pleural metastases
  • Pleural mesothelioma

Pleural metastases have spread from elsewhere in the body to the chest wall's inner lining (pleural cavity), such as the:

  • Lungs
  • Breasts
  • Ovaries
  • Pancreas
  • Colon

Pleural mesothelioma is a rare cancer that forms directly from the inner lining of the chest wall. It's extremely aggressive and hard to treat effectively. The main risk factor is exposure to asbestos.

What Can I Expect During Hyperthermic Pleural Perfusion?

Hyperthermic pleural perfusion is a lengthy, complex procedure. Here's what to expect before, during, and after treatment.

As with any surgery, you can't eat or drink anything after a certain time the night before. Your doctor will give you instructions about whether to take your other medications.

A surgeon generally combines hyperthermic pleural perfusion with CRS.

First, your doctor performs CRS to remove all visible cancer nodules (or as much of the tumor as possible). Hyperthermic pleural perfusion immediately follows to treat any leftover small or invisible tumor nodules. The surgery itself can last a long time, depending on how many tumors are present.

You will sleep through the treatment under general anesthesia.

During hyperthermic pleural perfusion, the surgeon inserts small tubes and temperature probes into the abdomen:

  • One tube delivers the heated chemotherapy solution into your abdomen.
  • The other tube circulates the fluid back to a heating element to maintain a temperature between 105 and 107.6 F (40.6 C to 42 C) in the abdomen.

The surgeon will rock you back and forth for about one hour to ensure the chemotherapeutic drug washes over all the cancer cells. This process aims to kill any remaining cancer within the pleural cavity.

At the end of CRS-hyperthermic pleural perfusion, the surgeon turns off the pump and allows your body to return to a normal temperature. The surgeon will flush your abdomen with a saline solution to clear out the medicine and remove the tubes and temperature probes.

Once your treatment is complete, doctors will send you to the recovery room. Your recovery time will depend on a few factors, including how sick you are. However, you can expect to spend a week or two in the hospital after the treatment.

Once you go home, the cancer team will follow up with you as you heal from the surgery. The team will give you specific details on making follow-up visits. Expect to feel more tired than usual for a few months as your body regains strength.

Contact Us About Regional Perfusion Cancer Treatment

Surgeons see Koch Center patients at UPMC Hillman Cancer Center in Shadyside.

To learn more about regional perfusion therapy, contact the David C. Koch Regional Perfusion Cancer Therapy Center. Alternatively, you can call UPMC Hillman Cancer Center at 412-692-2852.