·       Peritoneal cancers are increasing worldwide

·       HIPEC an alternative method to deliver of chemotherapy to patients with peritoneal cancers directly into the abdomen

·       HIPEC in combination with surgery and intravenous chemotherapy offers higher chance of cure for patients with peritoneal cancers

By : Shaima Hassan

Peritoneum is the inner thin lining in the abdomen that protects and covers the intestines, uterus, rectum, and bladder.

Peritoneal cancers usually mean two things.

-     those which arise in the peritoneum itself like mesothelioma and primary peritoneal cancers 

-      those originating in other organs like ovary, colon etc and later spread to the peritoneum

Dr. Anil Kamath, Senior Consultant and Surgical Oncologist at Apollo Hospital, disclosed that the number of patients diagnosed with peritoneal cancers is increasing

“Previously, knowledge about peritoneal cancer was very limited but, through the years and thanks to advancements in the field of medicine, we have come to understand the disease better. Today globally more than half a million patients are affected by either primary or secondary peritoneal cancers,” Dr. Kamath said.

With the surge in the number of cases, Dr. Kamath said many specialists worldwide are now using the Hyperthermic Intraperitoneal Chemotherapy (HIPEC) method as part of the treatment process for patients diagnosed with the disease and other relevant health conditions.

HIPEC is an alternative method of administering chemotherapy to the patient. It is used when we need large dosage of medicine is needed to reach the peritoneum. HIPEC is often used in combination with intravenous chemotherapy

HIPEC  is now a well-accepted treatment modality for pseudomyxoma peritonei, a type of cancer in which mucous producing cells deposit in the abdomen causing it to bloat with jelly like material. This condition usually develops because of tumors in the appendix.

HIPEC is also used in mesothelioma, a cancer that starts in the peritoneum related to asbestos exposure; ovarian cancer with peritoneal metastases and high risk of recurrence; recurrent ovarian cancer with limited peritoneal metastases; and stomach cancer with limited peritoneal and omental deposits.

HIPEC is usually combined with debulking surgery, a procedure in which a large percentage of a tumor is surgically removed. Normally, chemotherapy is given intravenously. But in HIPEC, after the surgery, catheters are placed in the abdomen. This way, the chemotherapy is administered in the abdomen directly.

The combination is done for better treatment outcomes.  For instance, a surgery with HIPEC done in patients diagnosed with stage 3c ovarian cancer has been found to have led to promising outcomes compared to a treatment method using surgical procedure alone.

“Few randomized trials have shown that the survival rate of patients with stage 3c ovarian cancer who were treated with surgery and HIPEC has improved by more than a year as compared to surgery alone. HIPEC offers hope of cure to certain patients with an otherwise incurable disease. This is especially true to individuals with pseudomyxoma who, apart from surgery and HIPEC, have hardly any option in terms of treatment. If the impact of the disease is still limited, then chances of cure are always high,” Dr. Kamath said.

Despite promising results in ovarian cancer, Dr. Kamath, however, pointed out that, as per the trials, using HIPEC in colorectal cancer has failed to show positive results. “There are many phase 2& 3 trials going on and the future of HIPEC will depend on the results of these trials.”

He added: “HIPEC has been used in many different conditions with varying degrees of success. The main benefit of HIPEC is that it ensures good drug delivery into the peritoneum, which is important to destroy the cancer cells there. Like any surgical procedure, however, there are risks involved.”

During his over 17 years of experience, Dr. Kamath has become adept in all types of cancer surgeries, including head and neck, breast, thoracic, gastrointestinal, and gynecologic cancers. He has performed a high number of major cancer surgeries with exceptional clinical outcomes and an extremely low complication rate.

Across various Apollo Hospitals, almost 800 to 1,000 patients have undergone HIPEC procedure. The safety of the procedure has been positive, with less than 5 per cent post-operative mortality. The clinical outcomes, meantime, have been mixed depending on the condition for which it has been performed.