Intra-abdominal hyperthermic chemoperfusion, aka hyperthermic intraperitoneal chemotherapy, or shortly HIPEC or hot chemotherapy.
Some cancers and their advanced stages may not be treated by traditional intravenous chemotherapy. Regardless of the chemotherapy, the disease is progressing and the patient’s condition is deteriorating more rapidly than anticipated. These are the cases where HIPEC is applied. Cytoreductive surgery and hot chemotherapy are among the most advanced methods towards the terminal stage cancer treatment.
Many intra-abdominal cancer diseases may also affect the serous membrane forming the lining of the abdominal cavity, called the ‘peritoneum’. Generally, this is an indication that the cancer has progressed to its end stage. Most often, hot chemotherapy (HIPEC) is used for ovarian cancer treatment in female patients. Furthermore, it is also applied for colorectal, stomach, appendix, peritoneal and pancreatic cancers.
Intravenous chemotherapy is an inappropriate treatment method in peritoneal cancers, because drugs cannot efficiently reach the peritoneum. However, HIPEC alone is not sufficient. Hot chemotherapy is part of the treatment, and the treatment itself is characterized by three stages. The underlying principle is that the peritoneum is regarded as an organ. The first stage of the procedure includes removal of all affected parts of the peritoneum and the affected organs through cytoreductive surgery. If not performed, the application of HIPEC becomes pointless and vice versa. In the second stage, following removal of all tumorous tissues and while the patient is still under anaesthesia, HIPEC is performed. This is a procedure of treating the abdominal cavity with hyperthermic chemotherapy medication. It aims to destroy the microscopic metastases remnants. The third stage of the treatment, which follows cytoreductive surgery and HIPEC, is the inclusion of systemic chemotherapy. The ‘cytoreductive surgery + HIPEC + systemic chemotherapy trio’ today is the only manner of treatment ensuring chances of survival for terminal patients.
The surgical procedure which includes cytoreductive surgery and hot chemotherapy is a tough one and it lasts between 6 and 10 hours and requires an experienced surgical team and expertise in the area of pelvic, liver and gynaecological surgery, medical oncologists to regulate the chemotherpaty schedules, radiologists for the preoperative diagnostic imaging, pathologists to inspect the diagnosis, nuclear medicine specialists for the PET scan assessment, nutritionists to appoint the appropriate diet, anaesthesiologists for the patient’s follow up and qualified intensive care staff.