HIPEC Treatment of Patients with Peritoneal Cancer
Peritoneal metastasis (PM) originating from gastrointestinal and gynecological malignancies was very hard to treat and the prognosis for these patients was very poor. Fortunately, the treatment for patients with peritoneal cancer is evolving and improving. Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is an effective treatment option with curative intent. Hyperthermia enhances the cytotoxicity of chemotherapeutic drugs, thereby killing microscopic tumors and reducing the risk of tumor recurrence.
In cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC), visible cancerous tumors are first removed from the abdominal cavity surgically. The cavity is then bathed with hot chemotherapy (heated to 42 degrees Celsius) to kill any microscopic cancer cells that might still be present. Hyperthermia augments the cytotoxicity of chemotherapy, and intraperitoneal installation allows for delivery of much higher doses locally than are possible systemically, while minimizing toxicity. The specific type of chemotherapy used for HIPEC varies depending on the type of cancer being treated.
Based on the existed evidence current Indications for CRS and HIPEC are as follows:
- Pseudomyxona peritoneii (PMP)
- Appendix adenocarcinoma (PMCA)
- Peritoneal mesothelioma
- Colorectal cancer
- Ovarian cancer
- Gastric cancer
However, you have to take into account that CRS and HIPEC for disseminated intra-abdominal malignancies is a complex procedure with the potential for high morbidity and mortality. When CRS and HIPEC is performed at experienced high volume centers, it can be associated with long term survival with acceptable morbidity and mortality rates.
The decision to perform CRS and HIPEC should be made in a multidisciplinary setting with consideration of the risks and benefits, the timing in relation to systemic chemotherapy, and the patient and operative factors associated with increased morbidity and mortality. Morbidity and mortality vary by patient factors such as age, performance status, and nutrition status, and operative factors such as PCI, the organ systems affected by disease, tumor histology, and surgeon experience.
Therefore, if you were advised to get CRS and HIPEC treatment, you need discuss it with one of qualified HIPEC Centers. German Health Advisors can help you to prepare your case for the discussion in the Tumor Board in one of our partner Centers.