Hyperthermic intraperitoneal chemotherapy (HIPEC) has been shown to extend the life expectancy of patients with peritoneal cancer of colorectal origin. The same technique is now showing promise for cancers of the peritoneal cavity arising from gynecologic cancers.
Robert DeBernardo, MD, a member of Cleveland Clinic’s Department of Obstetrics and Gynecology who has been working with HIPEC for nearly three years, says the technique presents “a unique opportunity for women with gynecologic cancers.”
“We have found HIPEC to be effective for cancers of the ovary and fallopian tube, primary peritoneal cancer and, potentially, some advanced endometrial cancers,” he says. “Even with complete gross resection, microscopic disease is present and responds well to direct administration of chemotherapy in the abdomen. Heating these drugs during administration can augment their cytotoxicity.”
Changing the treatment paradigm
HIPEC is a welcome development in the treatment of a disease whose outcome has changed little in the past two decades. Surgical debulking followed by the introduction of intraperitoneal chemotherapy at normal temperature has been the most encouraging development, resulting in an improved survival of 1.5 years. Acceptance of the technique has been limited largely by its tolerability — an issue avoided by HIPEC, since patients are sedated for the procedure.
“HIPEC requires the patient be kept 90 minutes longer under anesthesia, but this allows us to expose the peritoneum to a very high concentrate of drug,” says Dr. DeBernardo.
Following the resection of visible disease, tubes are placed in the abdomen and the incision is closed. The drugs are heated and circulated under pressure, 45 minutes for the first drug and 45 minutes for the second drug. The tube is then removed, and the abdomen is irrigated and closed.
Altering the natural history of disease
Intraperitoneal chemotherapy extends life expectancy but does not necessarily cure gynecologic cancer. In some cases when the disease is eradicated in
the abdomen, the women live longer and the cancer recurs elsewhere, usually in the lung, lymph nodes or liver.
Dr. DeBernardo also is working with colleagues in thoracic surgery to begin utilizing hyperthermic intrathoracic chemotherapy (HITEC) in patients with metastatic ovarian cancer involving the lung. HITEC follows the same procedure: removing the tumor and instilling heated chemotherapy directly in the chest cavity at the time of surgery. The technique has shown promise in the few women treated to date.
“We have high hopes HIPEC, and possibly HITEC, can extend remission in a meaningful way,” he says.