Intraperitoneal hyperthermic chemoperfusion (HIPEC or IPHC) is a type of hyperthermia therapy used in combination with surgery in the treatment of advanced abdominal cancers. In this procedure, warmed anti-cancer drugs are infused and circulated in the peritoneal cavity (abdomen) for a short period of time. The chemotherapeutic agents generally infused during IPHC are mitomycin-C and cisplatin.
Unlike systemic chemotherapy delivery, which circulates throughout the body via the bloodstream, HIPEC delivers chemotherapy directly to cancer cells in the abdomen. This allows for higher doses of chemotherapy treatment. Heating the solution may also improve the absorption of chemotherapy drugs by tumors and destroy microscopic cancer cells that remain in the abdomen after surgery.
Before patients receive HIPEC treatment, doctors perform cytoreductive surgery—a procedure to debulk, or reduce, the size of a cancerous tumor—within the abdomen. When as many tumors as possible have been removed, a heated, sterilized chemotherapy solution is delivered to the abdomen to penetrate and destroy remaining cancer cells. The solution is 41 to 42 degrees Celsius, about the temperature of a warm bath. It is circulated throughout the abdomen for approximately 90 minutes. The solution is then drained from the abdomen, and the incision is closed.
Uses of HIPEC
IPHC is generally used after surgical removal of as much cancer as possible (debulking), which may include the removal of all involved peritoneal areas. These procedures can be 8–10 hours long and carry a significant rate of complications. IPHC is used as a viable solution for certain advanced stage tumors in the abdomen that have spread many small tumors throughout the abdomen, when surgery is not likely to be possible or effective. It can also be applied, during surgery, directly on the area, for those whose abdominal cancer is advanced but is still considered surgically resectable, as an alternative to surgery and traditional chemotherapy alone.
The diseases most often treated with this method are cancer of the appendix, colorectal cancer, ovarian cancer, desmoplastic small round cell tumor, gastric cancer, mucinous adenocarcinoma (MAC) of appendix, mesothelioma, low-grade sarcoma.
Among patients with stage III epithelial ovarian cancer, the addition of HIPEC to interval cytoreductive surgery resulted in longer recurrence-free survival and overall survival than surgery alone and did not result in higher rates of side effects.
Various chemotherapies are used and there is no clear consensus on which drugs should be used. Mitomycin C and Oxaliplatin are the most commonly used agent for colorectal cancer, while Cisplatin is used in ovarian cancer.
30 mg in 3L for 60min + 10 mg for 40min
Given bidirectionally with 5-FU intravenously and oxalplatin in the peritoneum
460 mg/m2 for 30min at 42°-43 °C
The procedure is divided into three stages:
Exploration: Here the surgeon will open the abdomen evaluate the peritoneal cancer.
Debulking: In the debulking, or cytoreduction, phase of the procedure the surgeon will remove the visible tumor implants. However, even when the entire visible tumor is removed it is possible for microscopic cancer cells to still remain. The final stage of the procedure is meant to eliminate those cells.
Chemoperfusion: Here the abdominal cavity is rinsed with a heated chemotherapy solution. Unlike systemic chemotherapy that is delivered in the blood stream, throughout the whole body, the chemotherapy in the HIPEC procedure is largely isolated in the peritoneal cavity. Therefore, a much higher concentration of chemotherapy can be utilized, while the toxicity and side effects associated with systemic chemotherapy are minimized.
HIPEC is a treatment option for people who have advanced surface spread of cancer within the abdomen, but no cancer outside the abdomen.
-Allows for high doses of chemotherapy
-Enhances and concentrates chemotherapy within the abdomen
-Reduces the rest of the body’s exposure to the chemotherapy
-Improves chemotherapy absorption and susceptibility of cancer cells
-Reduces some chemotherapy side effects