Straight Talk about Mesothelioma, a blog series created by Michael T. Milano, M.D., Ph.D., a radiation oncology specialist, as a resource for mesothelioma patients and their loved ones.
In order to appreciate the benefits of cytroreductive surgery and HIPEC, it is important to understand some of the basic concepts of HIPEC.
What Exactly Is Hyperthermic Intraperitoneal Chemotherapy (HIPEC)?
Hyperthermic (Heated) intraperitoneal chemotherapy (HIPEC) is a relatively new method of treating certain cancers. This treatment is often referred to as “heated chemotherapy.” The treatment entails filling the patient’s abdominal cavity with anti-cancer drugs that have been heated-up. This unique method of treating cancer not only kills cancer cells, but also results in fewer adverse effects compared to intravenous (IV) chemotherapy.
How Is HIPEC Done?
HIPEC is done in 2 parts, one right after the other. The first part involves looking inside the abdomen with a camera inserted through small abdominal incisions. All of the visible cancer is then removed through the help and guidance of this camera; this part of the procedure is known as “cytoreductive surgery.” The typical HIPEC procedure is performed in the operating room under general anesthesia. The visible tumors may be surgically removed or ablated by freezing” (cryoablation), sound waves (ultrasonic ablation), or insertion of a heat probe (thermal ablation).
Following the surgical procedure, the second part of the procedure is performed in which heated chemotherapeutic drug(s) are inserted into the abdominal cavity. The surgeon inserts 2 tubes into the patient’s abdominal cavity: one tube delivers the heated chemotherapeutic drug(s), while the other drains fluid out of the abdominal cavity. This part allows for treatment of cancer cells that remain after resection and ablation, and are not visible to the naked eye.
Sounds Strange… What Does the Heat Do?
Before their delivery into the patient’s abdominal cavity, the chemotherapeutic drug(s) are heated in a nearby device. As the heated chemotherapeutic drugs are introduced to the body, the temperature of the abdomen may reach anywhere from 104-107 degrees Fahrenheit. While the heated anti-cancer drug(s) enter into the abdominal cavity and become infused, the patient is placed on a special cooling blanket which helps to make sure that the body temperature does not get too high during the treatment.
The rationale for heating the chemotherapy is to make it more effective at killing cancer cells. Additionally, the heat also improves blood flow within the abdomen, which improves the delivery of chemotherapy to the cancer cells in the abdomen.
While the heated chemotherapy drugs are being introduced to the patient, he or she is gently rocked back-and-forth on the table for 90-to-120 minutes. This “rocking maneuver” helps spread the medication evenly inside of the patient’s abdominal cavity, and may help reduce chances for cancer recurrence.
Once the treatment is completed, the abdominal cavity is washed with a sterile solution, the tubes are removed, incisions are closed up, and the patient is taken to the recovery room. The entire HIPEC procedure may take anywhere from 6-8 hours.
What Are the Benefits of HIPEC?
HIPEC has several advantages when compared to the standard chemotherapy:
- HIPEC is usually administered as a single treatment. On the other hand, standard chemotherapy requires several sessions given over many weeks or months. Standard chemotherapy, given over a long period, could also add to a patient’s expenses, and repeated visits to the doctor’s might require the individual to take more time off from work.
- With HIPEC treatment, the drugs are delivered directly into the abdominal cavity which minimizes risks of toxicity, as the drug does not enter the whole body’s circulation system. More importantly, any side effects that occur are of a much shorter duration because the abdomen is rinsed and all leftover drugs are removed at the end of treatment. With standard oral or intravenous chemotherapy, the medication spreads to all body parts and causes a variety of adverse effects.
- HIPEC is a much more “focused” treatment and is directed towards a patient’s specific kind of cancer. Because the treatment is so focused, much higher doses of chemotherapeutic drugs can be used. This way of administering chemotherapy is much more likely to kill any remaining or lingering cancer cells when compared to standard systemic therapy.
- The heating-up of the anti-cancer drugs can kill cancer cells more effectively than conventional chemotherapy.
- Even though HIPEC is a relatively new type of treatment, recent reports show that in patients who have been diagnosed with mesothelioma early in the cancer’s development, it can cure nearly 25% of patients. This is a significant statistical improvement when HIPEC is compared against systemic chemotherapy, where cure is very rarely achieved.
- Several studies have now reported that in selected cancer patients, HIPEC treatment can improve a person’s overall life expectancy. Studies further report that a combination of cytoreductive surgery and HIPEC may be more effective and beneficial than chemotherapy or surgery alone.
- The quality of life after cytoreductive surgery and HIPEC is also very much improved. There are minimal long-term side effects like those seen with systemic chemotherapy. Following recovery these individuals are able to resume daily living activities and have faster recovery from the surgery.
- The advantage of such a surgery is that it can remove all obvious cancer before it can cause complications like fluid buildup and/or bowel obstruction.
Cytoreductive surgery with HIPEC is usually performed in patients with early cancer and those who are deemed “fit” to undergo the procedure. When the surgery is done in patients with early-stage cancer it can be even prove curative. In patients with advanced cancer, however, the surgery can help relieve the symptoms that a cancer patient is experiencing, but it often does not affect survival.
