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.
How HIPEC Can Be Used to Effectively Treat Mesothelioma
Hyperthermic 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 abdominal cavity with anti-cancer drugs that have been heated. This novel method of treating cancer not only controls cancer but also results in fewer adverse effects compared to conventional chemotherapy.
How Is HIPEC Done?
HIPEC is done in 2 parts. The first part involves looking inside the abdomen with a camera and removing or ablating all visible cancer (cytoreductive surgery). The procedure is performed in the operating room under general anesthesia. The visible tumor may be removed using cryoablation (freezing), ultrasonic ablation or thermal ablation.
Following surgery, the second part of the procedure is performed. The surgeon inserts 2 tubes into the abdominal cavity. One tube delivers heated chemotherapeutic drug(s) to the abdominal cavity and the other drains fluid out of the abdominal cavity. The chemotherapeutic drug(s) are heated in a nearby device and instilled into the abdominal cavity. The chemotherapeutic drugs are heated and the temperature of the abdomen may reach anywhere from 104-107 degrees Fahrenheit. The anticancer drug is heated to make the chemotherapy agents more effective at killing cancer and improve blood flow in the abdomen. While the heated anticancer drug is being infused, the patient is placed on a special cooling blanket which ensures that the body temperature does not get too high during treatment.
To ensure that the medication reaches all areas of the abdominal cavity and kills the residual cancer cells, the patient is gently rocked back and forth on the table for 90-120 minutes. This rocking maneuver may help reduce recurrence of the cancer.
Once the treatment is completed, the abdominal cavity is washed with a sterile solution, the tubes are removed, the incisions are closed and the patient is taken to the recovery room. The entire HIPEC procedure may take anywhere from 6-8 hours.
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.
- 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. HIPEC is more focused treatment and directed towards the site of the cancer. Because the treatment is focused, high doses of chemotherapeutic drugs can be used.
- The heating kills cancer cells more effectively.
- HIPEC is ideal for treating cancers that are not visible to the naked eye.
Does HIPEC Work?
Current evidence shows that some cancers treated with HIPEC have improved survival rates compared to standard chemotherapy treatment.
HIPEC is associated with some adverse effects. Because the cancer medication causes intense inflammation of the bowels, one must be prepared to receive nutrition through an IV for 7-14 days after the procedure.
The other side effects are mainly related to the surgical procedure and depend on the location of tumors, extent of resection and/or type of ablation procedure used.
Who Is a Candidate for HIPEC?
HIPEC treatment is an option for individuals who have advanced cancer within the abdominal cavity. The disease must be limited to the abdomen and not spread to other organs. Some patients with extensive cancer will require systemic chemotherapy to shrink the tumor before they become eligible for HIPEC.
How Long Does One Stay in the Hospital?
The average length of stay for patients who have undergone HIPEC varies from 8-12 days.
Where Is HIPEC Treatment Done?
HIPEC requires a team of professionals who have specialized in treatment of cancers. The treatment is only available at certain cancer centers. The team consists of a cancer surgeon, dietitian, oncologists, social workers and physical therapists. Because of the need for extensive resources, this treatment is not available in all cancer centers.
What Work up Is Required for HIPEC?
Prior to HIPEC, your ability to withstand the procedure will be assessed. You will work closely with therapists and dietitians to build your endurance and nutritional status. After discharge you will be encouraged to resume physical therapy. An oncology nurse will be in regular contact with you to ensure that there are no problems that need immediate attention.
What Types of Cancers Are Treated with HIPEC?
In general cancers that are frequently treated with HIPEC include:
- Appendiceal cancer
- Colon cancer
- Stomach cancer
- Primary peritoneal cancer
- Pseudomyxoma peritonei