HEATED INTRAPERITONEAL CHEMOTHERAPY FOR ABDOMINAL TUMORS

Tumors that have spread to the lining surfaces of the peritoneal (abdominal) cavity from primary colorectal cancer, gastric cancer, and appendiceal cancer, or mesothelioma — known as peritoneal carcinomatosis — are generally very difficult to treat.

The behavior of these peritoneal surface malignancies is the same: the tumor spreads along the peritoneal lining of the abdomen, secretes mucus and/or leads to ascites (abnormal accumulation of fluid in spaces between tissues and organs), and ultimately causes bowel obstruction, difficulty breathing, and death.

Dr. Colette R.J. Pameijer uses an innovative combination of surgery and chemotherapy, called HIPEC — which stands for heated intraperitoneal chemotherapy — to destroy these deadly abdominal tumors. This aggressive treatment is helping to significantly improve, and may even extend, the lives of patients who are in desperate need.

The HIPEC procedure is designed to attempt to kill any remaining cancer cells after the bulk of the abdominal tumor is removed.

Dr. Pameijer emphasizes the survival benefits: "Patients with carcinomatosis from colorectal cancer may survive 2 years with this treatment, compared with maybe 6 months with systemic chemotherapy, depending on their response. Patients with appendiceal carcinoma or mesothelioma have a 5-year survival rate of as high as 60% with HIPEC."

HIPEC involves the use of conventional chemotherapy drugs heated to a high temperature that helps to kill cancer cells. Not only that, by bathing the abdomen with heated chemotherapy immediately following surgery, a higher dose of medication can be used than would normally be tolerated by a patient if given intravenously — the traditional way chemotherapy is administered.

Giving the chemotherapy in the abdomen at the time of surgery allows for greater concentrations of the drug where it is specifically needed. Adding heat at the particular temperature used in the HIPEC procedure has a three-fold advantage:

l The heat kills cancer cells while not affecting normal cells.
l The heat makes the killing effect of the chemotherapy more powerful.
l The heat softens the tumor nodules so the penetration of the chemotherapy into the tumor is enhanced.

The procedure also improves drug absorption and effect with minimal exposure to the rest of the body. In this way, many of the normal side effects of chemotherapy may be avoided.

THE PROCEDURE
The surgery involves debulking all of the tumor. It usually includes removing affected parts of the peritoneum, the omentum, and possibly bowel. When this surgery is complete, cannulas (flexible tubes) are placed in the abdomen, and the abdomen is temporarily closed.

A roller pump, as in cardiac bypass, is used to circulate fluid through the peritoneal cavity. The fluid passes through a heat exchanger, which warms it to approximately 107 degrees Fahrenheit (41-42 degrees Celsius). This procedure, in turn, warms the peritoneal cavity. When the peritoneum reaches 102.2 degrees Fahrenheit (39 degrees Celsius), the chemotherapy drug mitomycin C is added to the circulating fluid.

The circulation of heated chemotherapy then continues for a total of 2 hours.

At this point, the peritoneum is flushed with Ringer’s lactate solution, and the abdomen re-opened. The cannulas are removed, and any bleeding is controlled. The abdomen is then formally closed. Patients are transferred to the intensive care unit postoperatively, where they usually stay for 1-2 days. The average hospital stay is 9 days.

For consultations/appointments with Dr. Pameijer, please call 631-638-1000.