HIPEC: A promising treatment for certain patients with Stage IV abdominal cancer

A technique that delivers high doses of heated chemotherapy directly to the abdominal cavity is a promising treatment for certain patients with Stage IV cancer. Hyperthermic intraperitoneal chemotherapy (HIPEC) kills cancer cells in the abdomen remaining after the surgical removal of tumors. Because it provides a targeted concentration of chemotherapy, outlooks can be promising for patients with advanced cancers and there are fewer side effects compared to traditional chemotherapy.

Many of my patients who come to my clinic are told they are going to live a few months. With these treatments, we can help patients with peritoneal metastases live significantly longer and even cure some of these stage IV cancers."

Kiran Turaga, MD, MPH, Chief of Surgical Oncology at Smilow Cancer Hospital and Assistant Medical Director for the Clinical Trials Office at Yale Cancer Center

What is HIPEC surgery?

There are two main components of HIPEC. The first is surgery to remove the peritoneum or lining of the abdomen, where cancer has spread. Towards the end of the surgery, chemotherapy heated to 108 degrees is pumped into the patient's abdominal cavity for about 90 minutes to kill any remaining microscopic cancer cells.

Afterwards, the chemotherapy is drained, and the incision is closed. Patients who undergo this treatment spend about five days in the hospital and then it takes another six weeks to recover. Abdominal cancer treatment HIPEC can be used to treat several types of metastatic or Stage IV cancers in the abdominal cavity including:

• Colorectal cancer
• Ovarian cancer
• Stomach cancer
• Appendix cancer
• Mesothelioma

For patients who are good candidates for HIPEC, they only undergo the surgery one time. However, it can be used in conjunction with other cancer treatments including immunotherapy.

"It's always a multidisciplinary team. We're working with oncologists, palliative care physicians, gastroenterologists, radiologists, dieticians, oncology nursing, and researchers. So, it's a whole team and everyone works together to take care of these patients," Dr. Turaga said.

Need for targeted chemotherapy

Currently Smilow Cancer Hospital is a premier hospital in Connecticut offering HIPEC and Dr. Turaga says this brings a much-needed surgery to the region. Many patients suffer from advanced abdominal cancers without good treatment options and unfortunately, incidents of colon cancer amongst younger patients are on the rise. The American Cancer Society estimates there are more than 106,000 new cases of colon cancer this year alone.

While the success rate depends on the type of cancer, outlooks are promising. For example, Dr. Turaga says many patients with appendix cancer can live another 20 years after undergoing treatment.