Today various methods are used in cancer treatment, and recently developed therapies produce promising results. However, despite therapies like surgery, chemotherapy, radiotherapy, immunotherapy, etc., the disease may not be confined to the site of origin and spread to other intraabdominal organs and the membrane called peritoneum that lines the abdominal wall. Drugs administered through the intravenous route do not adequately reach peritoneal areas affected by cancer and the therapy proves insufficient. At this point when the classic cancer therapy fails to produce the desired response, cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) (CRS + HIPEC), a method is considered that will increase both the patient's life expectancy and comfort. In this treatment method which must be decided with a multidisciplinary approach (oncologist, surgeon, radiologist, etc.), all cancer cells are removed by combining surgery and hypothermic chemotherapy applied to the abdominal cavity. The treatment aims to ensure long-term survival and even cure in some patients.
How is it performed?
All involved intraabdominal organs (ovaries, colon, stomach, spleen, etc.) and peritoneum that lines the abdominal wall are removed and complete or near-complete resection of tumors is performed to leave no visible (macroscopic) tumor tissue (cytoreductive surgery). After that, through 4 drains connected to the chemotherapy pump, chemotherapy drugs at a temperature of 42-43⁰C are delivered to every site of the abdomen. This procedures lasts for 60 to 90 minutes, at the end of which approximately 3 liters of chemotherapy fluid is withdrawn back, and the procedure terminated.
Why are drugs administered by warming?
Administration of warmed chemotherapy drugs facilitates drug penetration into tumor tissue and increases its effectiveness. In addition, high temperature has an anti-tumor effect and contributes to the uniform distribution of the drug overall intra-abdominal surfaces.
In which types of cancer is it used?
It is most frequently applied in peritoneal cancer stemming from peritoneal cells or mesothelioma, and ovarian cancer, appendix, colon, and rectal cancer.
How effective is it?
This treatment increases long-term survival subject to correct patient selection, and even ensures cure in some patients. Peritoneal cancer, appendix cancer, ovarian cancer in women and colorectal cancers are the groups of disease in which the most significant effect is seen in long-term survival. 5-year survival can reach > 90% in peritoneal mesothelioma.
In which cases is it counter-indicated?
This treatment is not applied when cancer has spread to tissues and organs other than the abdomen (lung, bone, brain, etc.) HIPEC may be applied in the liver when there are 3 or less metastatic foci that can be removed. However, the procedure will not be performed in case of diffuse liver involvement. Moreover, HIPEC will not be performed in case of small bowel involvement which will not leave enough bowel to survive if surgery is performed.