Roswell Park Comprehensive Cancer Center
Elm & Carlton St.
Buffalo, NY 14263

 

 

In the past, carcinomatosis was treated with systemic chemotherapy, with surgery for palliative purposes. More recently, cytoreduction, or surgical removal of all visible tumor nodules in the abdominal cavity, followed by hyperthermic intraperitoneal chemotherapy (HIPEC), has become an option. This procedure may be beneficial as part of the management of patients with cancers originating in the appendix such as pseudomyxoma peritoneii [also known as disseminated peritoneal adenomucinosis (DPAM), or peritoneal mucinous adenocarcinoma (PMCA)], gastrointestinal primary cancers such as colorectal cancer, and peritoneal mesothelioma. Both at RPCI and elsewhere, cytoreduction/HIPEC has had a meaningful impact on the survival rates of these patients. The increase in clinical interest and ongoing research has made patients and families more aware of this as a treatment option.

RPCI has a well-established cytoreduction/HIPEC program, with two surgeons providing consultation and surgical procedures. However, this procedure is not available at every center, given the required infrastructure, and expertise in surgical management and post-operative care. RPCI is the only center in Western New York offering cytoreduction/HIPEC. Also, not all patients are appropriate candidates for the procedure. We spend a great deal of time ensuring we have reviewed all of the patient’s information at a first visit and have a thorough discussion with the patient regarding risks and benefits.

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HIPEC at Roswell Park

CS/HIPEC for Advanced Abdominal Disease

Peritoneal carcinomatosis (PC) affects approximately 10% to 30% of patients with colorectal cancer and represents a challenging treatment issue for these patients. Response to modern oxaliplatin- and ironotecan-based systemic chemotherapy remains disappointing and median overall survival for colorectal PC is 12.7 months with a 5-year overall survival of ≤ 4% (Franko, et al. JCO 2011).

A complex procedure, CS/HIPEC can be done safely and offers many patients an effective therapeutic option.

HOW CS/HIPEC WORKS

After meticulous cytoreductive surgery to debulk the tumor(s), the peritoneal cavity is bathed with heated, high-dose chemotherapy. The procedure entails:

  • Removal of gross tumor through a combination of visceral resection and selective peritonectomies only for involved surfaces (no “peritoneal stripping”)
  • Chemotherapy dosing at 3 to 4 times the maximum tolerated dose for systemic therapy (taking advantage of the plasma/peritoneal barrier)
  • Mitotycin C is used most commonly
  • Hyperthermia—42˚C for 90 minutes—increases drug uptake by tumor cells and may be directly tumoricidal
  • At procedure’s end, all chemotherapy is removed Duration of hospital stay averages 10 to 14 days

BENEFITS OF CS/HIPEC

  1. Direct access to the tumor
  2. Minimizes tumor burden
  3. Maximizes chemotherapy dose (taking advantage of the plasma/peritoneal barrier)
  4. Achieves true fever range hyperthermia to increase response rates
  5. Does not preclude other therapies such as systemic chemotherapy

As a multidisciplinary comprehensive cancer center, we call upon highly-skilled professionals from all areas of cancer care, dedicated to treating the whole patient, not just their cancer. We work as a team along with the patient’s primary physician or community-based oncologist to provide optimal care delivered with compassion and respect.