Intra-peritoneal perfusion chemotherapy for hyperthermia (HIPEC) is a new method in the treatment of tumors located in the peritoneal cavity. The treatment procedure usually combines cytoreductive surgery (surgery to reduce the tumor burden) with intraperitoneal perfusion hyperthermia chemotherapy (HIPEC). This method of treating ovarian cancer is discussed by prof. dr hab. med. Beata Śpiewankiewicz, Head of the Gynecological Oncology Clinic at the Oncology Center in Warsaw.
Intra-peritoneal Hyperthermia Perfusion Chemotherapy (HIPEC)is a complex procedure consisting of two, inseparable elements. The first is a surgical operation (usually very extensive) leading to the removal of all tumor foci (the diameter of the lesions left must not exceed 2.5-5 mm. The second element that is used immediately after the operation is an increase in the temperature in the peritoneal cavity to 42 degrees Celsius. C and perfusion of chemotherapeutic using a system of drains connected with a special pump (intraperitoneal chemotherapy in hyperthermia). The dose of the drug is determined as in systemic treatment, but due to hyperthermia, we obtain a higher concentration at the site of action. For cisplatin, this concentration is 30 times higher than with intravenous treatment, which makes this chemotherapy more effective.
intraperitoneal perfusion chemotherapy in hyperthermia: indications
- pseudomyxoma peritonei )
- colorectal cancer
- gastric cancer with peritoneal metastases
- ovarian cancer
- pancreatic cancer
- peritoneal mesothelioma ( mesothelioma peritonei )
- retroperitoneal sarcoma
- other cancers where the peritoneum is the only metastatic site
In gynecological oncology, it is not possible to state unequivocally when we can use this procedure, whether during primary surgery performed for ovarian cancer or after postponed surgery, i.e. after chemotherapy, or only in the treatment of recurrences. It is certainly used in advanced cases of ovarian cancer. HIPEC is definitely reserved for patients with intraperitoneal dissemination who have already used all other methods of treatment. The prerequisite for carrying out the procedure is insightfulnessqualification for this procedure, as well as having a trained medical team and highly specialized equipment. It is not a starting method for treating ovarian cancer and is not currently used in the first stage of the disease. There are studies, although there are few of them, which say about the use of intraperitoneal perfusion chemotherapy in hyperthermia during primary surgery.
HIPEC: contraindications
Contraindication to the use of hyperthermia is the age over 70 years of age. This is due to the systemic burden and the long healing process - 7 hours under general anesthesia. Other contraindications are metastases to retroperitoneal lymph nodes, metastases to the liver and lungs. Patients who previously received chemotherapy or radiotherapy must wait about 5-6 weeks after the last dose of chemotherapy or radiation.
Complications and side effects after chemotherapy in hyperthermia
Complications are mainly related to cytoreductive surgery, which is the major surgery that accompanies chemotherapy in hyperthermia. The patient may even die due to extensive surgical intervention. About 3 percent of deaths are reported worldwide. Complications are inflammation, temporary disorders of the respiratory system may appear, due to the long duration of the procedure, or disorders in the coagulation system that occur after surgery. As for hyperthermia perfusion chemotherapy alone, complications include persistent nausea and vomiting.
Chemotherapy in hyperthermia: qualification for the procedure
There is no one-person decision to qualify for treatment with this method. It is a procedure with the potential for serious complications, including death. In the clinic I run, the decision is made by a team of gynecologists, oncologists, oncologists, radiologists and anaesthesiologists. It is enough for a patient with an advanced form of ovarian cancer to visit our clinic. He can come without a referral, after making an appointment by phone, only with the current computed tomography and the existing documentation of the disease.
Chemotherapy in hyperthermia: prognosis after the procedure
Based on the observations of Polish patients, HIPEC is a promising method. We currently have 35 patients undergoing this procedure, 31 are alive without recurrence. After using HIPEC, 6 courses of systemic treatment are obligatory. The quality of life of patients after the procedure improves after 3 months. There are data in the literature that the length oflife of patients after this procedure. Their quality of life is also improving. The patients return to active professional work, they do not feel sick.
Chemotherapy in hyperthermia is not a medical experiment
Chemotherapy in hyperthermia is a novelty in Poland, but it is a recognized method of treatment, not a medical experiment. It is registered in the JGP system (the system of Uniform Patient Groups, a system in which all treatment processes and procedures are registered and described, both in clinical and cost terms). Italians have the longest history in the world - they are the creators of this method and have a 12-year follow-up with 60 patients who have used it. The barrier is the cost and the correct qualification for the procedure. Chemotherapy in hyperthermia in Poland is routinely carried out at the Oncology Center, but other centers are showing increasing interest.
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