Peritoneal surface malignancies describe a subset of cancers that spread inside the abdomen. They are diseases that in the past have had few medical or surgical options. Cytoreductive surgery involves removing all visible tumors and HIPEC involves circulating chemotherapy heated up 107 degrees Fahrenheit to directly target cancer cells.
“We make a midline incision in the abdomen and remove every tumor growth visible to the naked eye,” says Jula Veerapong, MD, surgical oncologist at Saint Louis University Hospital and a SLUCare physician. “We then temporarily close the incision and insert inflow and outflow tubes for heated chemotherapy which targets microscopic disease. “
As the chemotherapy is applied, Dr. Veerapong and his colleagues physically massage or agitate the patient’s abdomen for up to 90 minutes as the chemotherapy is circulating from the perfusion machine.
“Current thinking is that heat enhances the tumor killing activity of the chemotherapy itself,” says Dr. Veerapong.
The theoretical benefits of HIPEC include increased tissue penetration for enhanced tumor destruction, treatment of microscopic disease and floaters, and more favorable pharmacokinetics. Moreover, advantages include optimal treatment timing (chemotherapy can be delivered at the time of surgery as opposed to waiting for wound healing), direct cytotoxic effects of administering chemotherapy to cancer cells, the ability to safely deliver higher concentrations of chemotherapy compared to intravenous delivery, and the ability to break down scar tissue (from prior surgery) to ensure that all peritoneal surfaces are treated.
“There is retrospective data to support the use of HIPEC in certain diseases like pseudomyxoma peritonei, appendiceal cancer, and mesothelioma. There are also randomized control trials in the use of HIPEC in colorectal cancer,” says Dr. Veerapong.
“The data for HIPEC in ovarian cancer patients is evolving. The best outcomes are in those patients who have had their tumors completely removed,” he says. “There are ongoing randomized trials. This represents the start of treatment for patients with carcinomatosis.”
Dr. Veerapong says the treatment is appropriate for selected patients. “It depends on the tumor type and how advanced the disease is,” he says.
Cancer that has spread to the lining surfaces of the peritoneal (abdominal) cavity from appendiceal cancer, primary colorectal cancer, mesothelioma, ovarian cancer, primary peritoneal cancer, certain sarcomas, and pseudomyxoma peritonei – often grouped under the moniker of peritoneal carcinomatosis – are examples of such types that are treated at Saint Louis University Hospital.
Historically, treatment for some of these conditions has not been good, with low cure rates and adverse side effects from traditional chemotherapy. With HIPEC, Dr .Veerapong feels it is an alternative for patients who otherwise may not have many options.
For more information, call 314-577-6131.
About Saint Louis University Hospital
Saint Louis University Hospital is a 356-licensed bed quaternary/tertiary referral center located in the heart of the city of St. Louis. Approximately 75 percent of patients are drawn from a 150-mile radius. Through affiliation as the teaching hospital for Saint Louis University, the hospital provides patients and their families with an environment of medical innovation. Working in this endeavor are the hospital’s medical staff partners, SLUCare, the physicians of Saint Louis University. The hospital admits more than 17,000 patients annually, performs more than 200 organ transplants a year and is a Level I Trauma Center that treats more than 2,000 major trauma cases a year. For more information, please visit www.sluhospital.com.
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