Colorectal surgeon Garrett Nash and gynecologic oncology surgeon Oliver Zivanovic describe clinical research that evaluates heated intraperitoneal chemotherapy (HIPEC) for the treatment of cancers of the appendix, colon, and rectum that have spread to the abdominal lining. Very few centers in the country offer this new approach.
Intraperitoneal chemotherapy, which involves the administration of anticancer drugs directly into the abdomen, has been used for two decades to treat these cancers. The approach enables surgeons to administer heated chemotherapy in the controlled environment of the operating room at higher doses than when the treatment is given intravenously, thereby exposing cancer cells directly to the anticancer drugs. It is believed that heating the chemotherapy may make it better able to penetrate and kill cancer cells.
To prepare for HIPEC, patients undergo cytoreductive surgery for removal of cancerous tissue, and the incision is partially closed. At this point, intraperitoneal tubes connected to the HIPEC machine are inserted. The heated chemotherapy is perfused into the abdomen for approximately 100 minutes; the tubes are removed, the abdomen irrigated, and the incision closed.
Now Dr. Nash and his colleagues are assessing HIPEC using the drug mitomycin C in comparison with conventional postoperative intraperitoneal chemotherapy through the phase II ICARuS trial (Intraperitoneal Chemotherapy After cytoReductive Surgery).