Introduction HITEC (hyperthermic intrathoracic chemotherapy) is a method of delivering chemotherapeutic agents directly to the chest cavity, often by way of video-assisted thoracoscopic surgery (VATS). This therapy has been reported in non-gynecologic malignancies including breast, mesothelioma, and pseudomyxoma peritonei. Its use in ovarian cancer has been reported in less than 10 cases to our knowledge. Here we present the Cleveland Clinic gynecologic oncology approach to HITEC therapy.

Description We demonstrate the use of HITEC for a 72yo female with recurrent high-grade papillary serous fallopian tube adenocarcinoma with persistent bilateral malignant pleural effusions and no other evidence of disease. In coordination with our cardiothoracic team, she underwent a left VATS and placement of chemotherapy tubing. She was premedicated with fosaprepitant, ondansetron, dexamethasone, potassium, magnesium, mannitol, and furosemide. Adriamycin (15 mg/m2) was then introduced into the ThermoChem system and infused intrathoracically and heated to 40–42 degrees Celsius for 45 min. This was followed by Cisplatin (100 mg/m2) in the same manner. Subsequently at her 6-month follow-up, imaging demonstrated resolution of her left sided pleural effusion. She then underwent HITEC of her right lung.

Conclusion/Implications Given the success of HIPEC (hyperthermic intraperitoneal chemotherapy) in certain randomized controlled trials for ovarian cancer treatment, HITEC is a promising therapy option for symptom control and disease management in select patients. Further exploration and research on its therapeutic benefit in gynecologic malignancies is warranted.