***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: There is no st and ard treatment for patients with pleural malignancies . The aim of this prospect i ve study was to investigate the toxicity and long-term results of a multimodality treatment consisting of surgery and intrathoracic chemohyperthermia ( ITCH ) for the treatment of patients with pleural malignancies . From January 1990 to August 2000 , 24 patients with mesothelioma ( n=17 ) , fibrosarcoma ( n=3 ) , pleural adenocarcinoma ( n=3 ) and thymoma ( n=1 ) were included . The mesothelioma stages were T1 or T2 in 10 cases , and T3 or T4 in seven cases . After cytoreductive surgery , ITCH was carried out for over 60 min , at inflow temperatures less than 45 ° C , either with mitomycin C ( n=7 ) or cisplatin ( n=5 ) or both ( n=12 ) . One patient died from major thoracic air leaks after major decortication and pleurectomy . Seven patients had complications , one pleural clotting necessitating reoperation . After a median follow-up of 89 months , the overall 1-year and 5-year survival rates were 74 and 27 % , respectively . For T1 and T2 mesothelioma patients , the median survival was 41.3 months , and for T3 and T4 tumours , it was 4.5 months ( P=0.001 ) . The fibrosarcoma patients are alive with no evidence of recurrence at 24 , 43 and 54 months . In the conclusion , the combination of surgery with ITCH with mitomycin and /or cisplatin  is relatively safe . This procedure may offer unexpected long-term survival in a selected group of patients ( T1 and T2 mesothelioma patients and fibrosarcoma patients ) Summary Background The effects of extra-pleural pneumonectomy ( EPP ) on survival and quality of life in patients with malignant pleural mesothelioma have , to our knowledge , not been assessed in a r and omised trial . We aim ed to assess the clinical outcomes of patients who were r and omly assigned to EPP or no EPP  in the context of trimodal therapy in the Mesothelioma and Radical Surgery ( MARS ) feasibility study . Methods MARS was a multicentre r and omised controlled trial in 12 UK hospitals . Patients aged 18 years or older who had pathologically confirmed mesothelioma and were deemed fit enough to undergo trimodal therapy were included . In a prer and omisation registration phase , all patients underwent induction platinum-based chemotherapy followed by clinical review . After further consent , patients were r and omly assigned ( 1:1 ) to EPP followed by postoperative hemithorax irradiation or to no EPP . R and omisation was done central ly with computer-generated permuted blocks stratified by surgical centre . The main endpoints were feasibility of r and omly assigning 50 patients in 1 year ( results detailed in another report ) , proportion r and omised who received treatment , proportion eligible ( registered ) who proceeded to r and omisation , perioperative mortality , and quality of life . Patients and investigators were not masked to treatment allocation . This is the principal report of the MARS study ; all patients have been recruited . Analyses were by intention to treat . This trial is registered , number IS RCT N95583524 . Findings Between Oct 1 , 2005 , and Nov 3 , 2008 , 112 patients were registered and 50 were subsequently r and omly assigned : 24 to EPP and 26 to no EPP . The main reasons for not proceeding to r and omisation were disease progression ( 33 patients ) , inoperability ( five patients ) , and patient choice ( 19 patients ) . EPP was completed satisfactorily in 16 of 24 patients assigned to EPP ; in five patients EPP was not started and in three patients it was ab and oned . Two patients in the EPP group died within 30 days and a further patient died without leaving hospital . One patient in the no EPP group died perioperatively after receiving EPP off trial in a non-MARS centre . The hazard ratio [ HR ] for overall survival between the EPP and no EPP groups was 1·90 ( 95 % CI 0·92–3·93 ; exact p=0·082 ) , and after adjustment for sex , histological subtype , stage , and age at r and omisation the HR was 2·75 ( 1·21–6·26 ; p=0·016 ) . Median survival was 14·4 months ( 5·3–18·7 ) for the EPP group and 19·5 months ( 13·4 to time not yet reached ) for the no EPP group . Of the 49 r and omly assigned patients who consented to quality of life assessment ( EPP n=23 ; no EPP n=26 ) , 12 patients in the EPP group and 19 in the no EPP group completed the quality of life question naires . Although median quality of life scores were lower in the EPP group than the no EPP group , no significant differences between groups were reported in the quality of life analyses . There were ten serious adverse events reported in the EPP group and two in the no EPP group . Interpretation In view of the high morbidity associated with EPP in this trial and in other non-r and omised studies a larger study is not feasible . These data , although limited , suggest that radical surgery in the form of EPP within trimodal therapy offers no benefit and possibly harms patients . Funding Cancer Research UK ( CRUK/04/003 ) , the June Hancock Mesothelioma Research Fund , and Guy 's and St Thomas ' NHS Foundation Trust Introduction : Malignant pleural mesothelioma is a fatal neoplasm related to asbestos exposure . We investigated the effects of pleurectomy/decortication ( P/D ) , hyperthermic pleural lavage with povidone-iodine and adjuvant chemotherapy in patients with malignant pleural mesothelioma . Patients and Methods : Observational prospect i ve study of patients referred for multimodality therapy and operated on at our institution between October 2004 and May 2010 . Thirty-six selected patients underwent P/D and hyperthermic pleural lavage , prophylactic radiotherapy , and adjuvant chemotherapy . All patients were review ed at 4 weeks and then 6 monthly in the outpatient clinic , with positron-emission tomography-computed tomography . Second-line treatments were administered when appropriate . Results : Thirty-day mortality was nil . Nine patients experienced postoperative complications : persistent air leak ( n = 5 , 13.9 % ) , chylothorax requiring surgical intervention ( n = 4 , 11 % ) , and adult respiratory distress syndrome ( n = 1 , 3.9 % ) . Fourteen of 36 patients were alive at last follow-up ( median follow-up : 33 months , range : 12–63 months ) . Ten patients were alive with no evidence of disease recurrence , four patients were alive with disease recurrence , and 22 patients had died of disease progression . Overall median survival ( Kaplan-Meier ) was 24 months ( 95 % confidence interval : 18.5–29.4 months ) . One-year survival was 91.7 % , and 2-year survival was 61 % . Patients undergoing complete macroscopical resection ( R0–R1 ) had a significantly better survival than those undergoing an incomplete macroscopical resection ( R2 ) ( median overall survival : 32 months versus 18.9 months , p = 0.012 ) . Conclusion : In our experience , P/D combined with hyperthermic pleural lavage with povidone-iodine and adjuvant chemotherapy is a well-tolerated multimodality treatment associated with low morbidity and mortality . This multimodality treatment compares favorably with classical trimodality regimens involving chemotherapy , extrapleural pneumonectomy , and adjuvant radiotherapy , in our experience . Study limitations include small sample size , nonr and omization , and patient selection bias PURPOSE This study investigated the feasibility of a novel approach to the treatment of malignant pleural mesothelioma by combining surgical resection with immediate postoperative intrapleural chemotherapy and subsequent systemic chemotherapy . PATIENTS AND METHODS Patients with biopsy-proven , resectable malignant pleural mesothelioma underwent pleurectomy/decortication immediately followed by intrapleural chemotherapy with cisplatin 100 mg/m2 and mitomycin 8 mg/m2 . Systemic chemotherapy was started 3 to 5 weeks postoperatively and included cisplatin 50 mg/m2 on days 1 , 8 , 15 , 22 , 36 , 43 , 50 , and 57 , and mitomycin 8 mg/m2 on days 1 and 36 . Patients were then monitored by serial chest and abdominal computed tomographic ( CT ) scans every 3 months until death or for a minimum of 18 months , whichever occurred first . RESULTS Of 36 patients entered onto the study , 28 had pleurectomy/decortication and intrapleural chemotherapy . There was one postoperative death , and two episodes of grade 4 renal toxicity after intrapleural chemotherapy . The 23 patients who also had systemic chemotherapy received a median of 80 % and 87 % of the planned total cisplatin and mitomycin doses , respectively . No grade 3 or 4 toxicities were observed . The overall survival rate of the 27 patients who were originally c and i date s for systemic chemotherapy was 68 % at 1 year and 40 % at 2 years , with a median survival duration of 17 months . Locoregional disease was the most common form of relapse ( 16 of 20 patients ) . CONCLUSION This short but aggressive combined modality regimen was generally well tolerated , but should not be used outside of a protocol setting because of the potential for serious toxicity . Overall survival was as good or better than with previously reported multimodality approaches , but other strategies are needed to improve local control OBJECTIVES A combination of cytoreductive surgery and hyperthermic intrathoracic chemotherapy perfusion ( HITHOC ) was performed for the treatment of primary and secondary pleural malignancies . We describe the perioperative management and our clinical experience . METHODS Between September 2008 and August 2011 , eight patients with pleural manifestation of thymoma ( Masaoka stage IVa ) and eight patients with malignant pleural mesothelioma ( MPM ) were prospect ively enrolled . Postoperative morbidity , recurrence and survival rates were analysed . RESULTS All the patients received multimodality therapy , including chemotherapy , radiation and surgical resection ( pleurectomy/decortication ) followed by the HITHOC procedure . Chemotherapy perfusion was performed with cisplatin ( 100 - 150 mg/m(2 ) ) at 42 ° C for 1 h. Severe chemotherapy-related complications were not observed . Reoperation was necessary in two patients . There was no 30-day mortality . The median stay on the intensive care unit was 1 day , and the median duration of hospitalization was 15 days . Pleural recurrence of thymoma was evident in one thymoma patient 6 months after HITHOC . At mean follow-up of 22 months , seven thymoma patients ( 7/8 ; 88 % ) are alive without recurrence . Tumour progression was present in six mesothelioma patients ( 6/8 ; 75 % ) . Four patients ( 50 % ) with MPM are alive , including two with no evidence of mesothelioma , and the median survival is 18 months . CONCLUSIONS Cytoreductive surgery in combination with HITHOC can be performed with acceptable morbidity and mortality rates in selected patients . Patients should be evaluated by an interdisciplinary team to determine their eligibility for this therapeutic alternative . Early clinical results may encourage the use of this surgical option to provide better local tumour control in a multimodality treatment setting Cytoreductive surgery and hyperthermic-intraoperative-intrapleural-chemotherapy ( HITHOC ) is a known approach for malignant pleural diseases ( MPD ) . This study was started to clarify the role of cytoreductive surgery and HITHOC in MPD . Criteria of inclusion were early-stage disease in malignant pleural mesothelioma ( MPM ) , young age , good condition and selected stage-M1a lung cancer . Six patients with MPM and two patients with lung cancer were enrolled . After surgical debulking , intrapleural cisplatin was administered for 60 min at 42.5 ° C . Wedge , rib resection and repaired diaphragm were added in three , one and one patient , respectively . Morbidity , toxicity and mortality was nil . Hospital stay was 8 days . Mean survival is 13.6 months . This experience confirms that cytoreductive surgery and HITHOC is a good option in the treatment of MPD . A r and omized controlled trial is necessary Abstract Background To evaluate the feasibility , safety and preliminary efficacy of B-ultrasound-guided continuous circulatory intrapleural hyperthermic perfusion ( IHP ) with distilled water ( DW ) at 48 ° C , for the treatment of malignant pleural effusion ( MPE ) . Methods Prospect i ve , r and omized interventional study in China ( from December 2008 to December 2011 ) in adults with MPE originating from disseminated pleural tumor . Exclusion criteria : thoracotomy or surgical resection , limited encapsulated pleural effusion or extensive pleural adhesions . Patients were r and omly divided into DW ( 12 patients ;  B-ultrasound-gu 
    Output:
    
The findings of the current study suggested that HITHOC is one of the safe and effective therapies in prolonging patients ’ median survival time and extending recurrence free interval