Hyperthermic Intraperitoneal Chemotherapy (HIPEC), or what is more commonly known as heated chemotherapy, is a form of treatment for peritoneal cancers, like peritoneal mesothelioma, that is becoming more widely used. The chemotherapy solution is heated to a temperature that is higher than the average body temperature (hyperthermic), and then it is placed directly inside the peritoneal cavity (intraperitoneal), also known as the abdominal cavity.
How does the procedure work?
HIPEC is essentially the same no matter where it is performed. It is the second part of a two-part abdominal surgical procedure. During the first part, all visible tumors within the abdomen are removed, or what doctors call cytoreduction. The term “cytoreduction” means the number of cancer cells are decreased, but not completely eliminated. Cytoreduction is also sometimes referred to as debulking. The goal of cytoreduction is to shrink the size of the tumor so that chemotherapy will be more effective.
Once this has been completed, HIPEC is administered. During this part of the procedure, the heated chemotherapy solution is continuously circulated within the abdominal for approximately two hours. The temperature of the solution is monitored to be sure that remains constant throughout that time. The goal of HIPEC is to eliminate any cancer cells that were missed during surgery.
While the basic HIPEC procedure remains the same, some of the technical details differ according to the institution that performs it. These include the type and dose of chemotherapy used, how long the chemotherapy solution should be circulated within the abdominal cavity, what temperature the solution should be, and whether to administer HIPEC while the abdominal incision remains open or is closed.
What are the survival rates after this type of procedure?
In a study titled “Surgery for Peritoneal Mesothelioma”, published June 2011 in Current Treatment Options in Oncology, the authors said that the average overall survival in some patients selected for the combination of cytoreduction and HIPEC has been up to seven years. However, this procedure carries with it a 25 percent chance of developing other medical conditions as a result of having undergone it, and a seven percent chance of dying from it. However, they went on to add that in spite of these risks, “the best overall survival data have been associated with this surgical approach”.
Is this procedure right for everyone who has peritoneal mesothelioma?
The success of the procedure is very dependent upon choosing the right candidates for the surgery. Patients that have other medical conditions that make them a poor choice for surgery in general are definitely a poor choice for this type of surgery because of how complex and lengthy it is.
It is generally recommended that when a surgeon is considering a peritoneal mesothelioma patient for this procedure, they should use a CT scan and possibly perform a laparoscopy to determine if the tumor is operable. A laparoscopy is a minimally invasive surgical procedure during which a small cut is made in the abdomen and an instrument called a laparoscope is inserted so that the abdomen can be examined. The information gathered from this procedure together with what was learned from the CT scan will give the surgeon a better idea as to whether or not the surgery/ HIPEC combination will be successful in a particular patient.
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