Innovative HIPEC Therapy Provides Another Option for Cancer Patients

For a patient with cancer, standard treatments include surgery, radiation, chemotherapy or some combination of the three. Some cancers have historically been very resistant to these treatments. One such situation is when cancer involves the peritoneum, the lining of the abdominal cavity and its organs. This is caused by the spread of cancer cells from preexisting cancers such as colorectal, appendix, ovarian and stomach cancer. It also can  be caused by peritoneal mesothelioma.

The peritoneum is a naturally occurring membrane that forms a barrier between the bloodstream and the abdominal cavity. Many organs are located here, making it difficult to get chemotherapy drugs to the site of the tumor at a high enough concentration to be effective.

HIPEC for Peritoneal Cancer

Hyperthermic intraperitoneal chemoperfusion (or HIPEC) allows delivery of a high concentration of medication directly to the surfaces involved by cancer. This minimizes the toxicity that would be associated with using these doses delivered traditionally by intravenous drip (or IV).

Cytoreductive Surgery and HIPEC

When used in tandem with a technique called tumor debulking, HIPEC can be effective in treating patients with peritoneal cancer. The first part of the process, tumor debulking, also is known as cytoreductive surgery (CRS). This process removes all visible tumors from the abdomen. It often involves a simple removal of the lining of the abdominal cavity, but it may require removal of organs such as the gallbladder, spleen or part of the large or small intestine. The more complete the cytoreduction, the more effective the HIPEC phase is.

Once the cytoreductive phase of the surgery is completed, a heated solution of chemotherapy is circulated throughout the peritoneal cavity for 90 to 120 minutes. After this, the chemotherapy solution is removed and the abdomen is closed.

Cancers Best Treated by HIPEC

HIPEC is most effective in treating certain tumors of the gastrointestinal (GI) tract as well as primarily peritoneal-based tumors such as mesothelioma. Within the GI tract, the most widespread use is for treatment of tumors of the appendix.

These tumors occur along a spectrum. At one end, there are tumors that produce a thick mucus-like substance that distributes widely throughout the peritoneal cavity. This condition is called pseudomyxoma peritonei. On the other end of the spectrum is a more traditional type of appendix cancer.  While HIPEC can be used in this situation, it is far more effective in patients with pseudomyxoma peritonei. In a similar fashion to patients with appendix cancer, HIPEC can be used in selected patients with peritoneal involvement from colon cancer.

Good Candidates for HIPEC

Many factors determine if cytoreductive surgery and HIPEC are a good option. The surgeries tend to be long (up to 14 hours) and hospital stays may last more than two weeks. Good overall health and fitness is an important consideration. Organ function and nutritional parameters also are important, and both are closely assessed before making any decisions.

Two more important factors to consider are the type of tumor present and the amount of disease that exists. HIPEC is far more effective with certain cell types. The treatment is only truly effective if a complete cytoreduction can be performed. These two factors help determine whether someone is a good candidate or not. For example, we would be more willing to perform the procedure on a patient with a large amount of disease if their tumor type is favorable. If the tumor type is less favorable, we select patients with a low volume of the disease, where we have a strong belief that a complete cytoreduction is achievable.