HYPERTHERMIC INTRAPERITONEAL CHEMOTHERAPY TREATMENT (HIPEC) IN DIGESTIVE SYSTEM CANCERS
In women, some ovarian, colon, rectum, gastric and appendix cancers may grow into peritoneum, and this situation is called Peritonitis Carcinomatosis. Peritonitis Carcinomatosis may be present when patients are first diagnosed or it may develop as a cancer relapse during the treatment. Cancers originating from peritoneum itself (pseudomyxoma peritonei) also causes Peritonitis Carcinomatosis.
Fluid accumulation containing cancer cells in the stomach due to cancer involvement in peritoneum is called malignacid. Stomach swells because of this fluid. Acid accumulation in the stomach causes shortness of breath and makes cancer cells spread to other body cavities. Intraabdominal cancer cell can spread to intestine surface and cause adherence and obstruction. Clinical table called ileus which is manifested by inability to dispose gas and stool, and vomiting develops. In that case, increasing undernutrition, weakness and weight loss is observed.
Patients are told that they no longer have treatment chance in the presence of Peritonitis Carcinomatosis (PC). If the patient has bowel obstruction, some mandatory surgical treatments must be performed in order to relieve the patient. In some patients, intravenous chemotherapy is administered with the hope of controlling or slowing the disease progress, however, generally this treatment is not successful.
Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy have become a hope for the treatment of these patients. Cytoreductive surgery is the removal of peritoneum with cancer involvement and all organs containing cancer cells. After the cytoreductive surgery is completed during the operation, chemotherapy drugs are administered within heated fluid directly into the abdomen. The purpose of heating the chemotherapy drug, selected as suitable for the disease, is the effect of heat in destroying the cancer cells. It is aimed to destroy any remaining microscopic cancer cells. This procedure is called Hyperthermic Intraperitoneal Chemotherapy (HIPEC).
Not every PC patient is suitable for this treatment. Above all, there is no benefit in applying hyperthermic intraperitoneal chemotherapy without removing peritoneum and other organs with cancer by cytoreductive surgery. If the patient has liver metastases and location and number of tumors are suitable for liver resection, then this treatment can be applied. However, HIPEC treatment has no benefit and use for widespread liver metastases, distant organ metastases like lung, bone and brain and extensive small bowel involvement.
Best results of this treatment method is obtained in patients with PC development due to ovarian cancer. Survival can be achieved in 5 years in 33-57% of these patients with cytoreduction, HIPEC and subsequent systemic chemotherapy. Survival is achieved in 27% of patients who receive treatment due to bowel cancer, however, this ratio is only 10% in gastric cancer patients. It should not be forgotten that survival is extended by surgery and hyperthermic intraperitoneal chemotherapy treatment in peritonitis carcinomatosis patients. It is not possible to completely remove cancer and provide a full cure.
Cytoreduction and HIPEC is a highly complex treatment with significant risk complications for patients. Therefore, suitable patient selection is crucial. Advanced age, additional diseases, disease type and expectation of life of the patient must be evaluated in detail and treatment decision must be made in light of such information. It is of crucial importance that this treatment is applied in experienced centers in order to achieve successful treatment of post surgery complications, close follow-up of patients and successful maintenance of the systemic treatment.