HIPEC: Revolutionizing Cancer Treatment with Advanced Chemotherapy

28 August,2024

Cancer, a word that carries fear and uncertainty, is rising exponentially and affecting millions worldwide. In India, abdominal cancers, including colorectal, gastric, liver, and ovarian cancers, account for over 100,000 new cases annually. Colorectal cancer alone has an incidence of approximately 25,000-30,000 cases each year. Treatments available in India include surgery, chemotherapy, and radiotherapy.

However, increased cases have prompted medical science to explore and develop numerous treatment modalities. Among these, hyperthermic intraperitoneal chemotherapy (HIPEC) stands out as a groundbreaking approach, particularly for cancers within the abdominal cavity.

In this blog, we will explore the complexities of HIPEC, what it is, how it works, its benefits, and its future in cancer treatment.

What is HIPEC?

HIPEC is an advanced line of cancer treatment, which stands for hyperthermic intraperitoneal chemotherapy. This treatment is used for the treatment of various types of abdominal cancer. The procedure involves heated solutions of chemotherapy drugs administered directly into the abdominal cavity.

The treatment is usually performed after the surgical removal of visible tumors, a procedure known as cytoreductive surgery (CRS). The combination of CRS and HIPEC is particularly effective against cancers that have spread to the peritoneal surfaces, including:

• Peritoneal carcinomatosis: Secondary cancer within the peritoneum, often originating from primary cancers like colorectal, ovarian, or gastric cancers.
• Appendiceal cancer: A rare form of cancer originating from the appendix, sometimes leading to peritoneal dissemination.
• Mesothelioma: It is a type of cancer that affects the lining of the abdomen or lungs, often associated with asbestos exposure.

How Does HIPEC Work?

HIPEC (hyperthermic intraperitoneal chemotherapy) is a specialized cancer treatment that combines surgical tumor removal with a heated chemotherapy bath to target and eliminate residual cancer cells in the abdominal cavity. The process involves two critical steps, CRS and HIPEC.

Cytoreductive Surgery (CRS)

The first phase of HIPEC treatment is cytoreductive surgery (CRS), an extensive surgical procedure in which the surgeon carefully removes all visible tumors from the abdominal cavity, aiming to achieve what is known as "complete cytoreduction." This process may require the removal of parts of affected organs, such as sections of the colon, small intestine, spleen, gallbladder, or the peritoneum. The primary objective of CRS is to eliminate all visible tumors, as HIPEC is most effective in targeting and eradicating microscopic residual cancer cells that are left behind. The process involves:

Hyperthermic Intraperitoneal Chemotherapy (HIPEC)

Following the successful removal of visible tumors, the HIPEC procedure begins. 

During this step, a heated chemotherapy solution typically warmed to 41-43°C (105.8-109.4°F), is circulated throughout the abdominal cavity. The chemotherapy bath is delivered directly to the area where cancer cells remain, maximizing its impact while minimizing systemic exposure. It is a better form of chemotherapy for abdominal cancers due to: 

• Increased Drug Penetration: The heat enhances the absorption of chemotherapy drugs into cancer cells, allowing for deeper penetration into tissues.
• Localized Chemotherapy: By targeting the abdominal cavity directly, HIPEC delivers a high concentration of chemotherapy precisely where needed, reducing the risk of systemic side effects.
• Thermal Sensitivity of Cancer Cells: Cancer cells are more sensitive to heat than normal cells, making them more susceptible to destruction when exposed to heated chemotherapy.

The chemotherapy solution circulates in the abdominal cavity for 60-90 minutes, ensuring thorough exposure to all potentially affected areas. After the chemotherapy bath, the solution is drained from the abdomen, and the area is rinsed to remove any residual chemicals. The surgical incisions are then closed, completing the HIPEC procedure.

What are the Benefits of HIPEC?

The introduction of this advanced treatment comes with many advantages over traditional chemotherapy, especially for certain types of cancers:

• Targeted Treatment: HIPEC delivers chemotherapy directly to the abdominal cavity, focusing on the cancer-affected area.
• Increased Drug Penetration: The heat used in HIPEC enhances the absorption of chemotherapy drugs by cancer cells.
• Minimal Systemic Side Effects: By localizing the chemotherapy, HIPEC reduces exposure to the rest of the body, lowering side effects.
• Effective Against Microscopic Cells: HIPEC is particularly effective in targeting and killing microscopic cancer cells left after surgery.
• Improved Survival Rates: Studies have shown that this line of cancer treatment can significantly extend survival rates for patients with peritoneal surface malignancies.
• Reduced Cancer Recurrence: HIPEC therapy helps lower cancer recurrence chances by targeting residual cells.
• Enhanced Quality of Life: Patients often experience a better quality of life post-HIPEC due to reduced tumor burden and delayed recurrence.
• Customizable Chemotherapy Doses: The chemotherapy dosage can be adjusted to maximize effectiveness and minimize toxicity.

The Process of Receiving HIPEC

While HIPEC offers significant benefits, it is a complex and intensive procedure that requires careful patient selection and preparation. Some of the overview of what patients can expect from this particular line of treatment:

• Patient Selection: Only some people are suitable for HIPEC. The choice depends on the cancer type, stage, and overall health. Oncologists and surgeons assess if HIPEC will be beneficial.
• Preoperative Preparation: Patients undergo many tests before surgery, such as imaging, blood tests, and sometimes diagnostic laparoscopy. These help oncologists assess the disease's extent and plan the surgery. Patients must be in good health and able to handle a long surgery.
• The Surgical Procedure: CRS and HIPEC can take 6 to 12 hours. Patients are under general anesthesia. The surgical team removes visible tumors and then administers heated chemotherapy.
• Postoperative Care: Recovery is intensive. Patients usually spend several days in the ICU and may stay in the hospital for up to two weeks. They are monitored for complications like infections or bowel obstructions.
• Long-Term Follow-Up: After leaving the hospital, patients need regular check-ups, imaging studies, and possibly more treatments based on their cancer type and response to HIPEC.

Risks and Complications

As with any major surgical procedure, HIPEC has risks and potential complications. These can include:

• Infection: Given the extensive nature of the surgery, there is a risk of infection, particularly within the abdominal cavity.
• Bowel Obstruction: The surgery and chemotherapy can lead to scar tissue formation, which might cause bowel obstructions.
• Organ Dysfunction: The intensity of the procedure can sometimes lead to temporary or permanent dysfunction of organs within the abdominal cavity.
• Blood Clots: Another risk factor of this treatment is blood clotting, which arises because of the extended surgery time and recovery period.
• Symptomatic effects: This line of treatment can cause other complications, such as nausea, weight loss, vomiting, pain, and diarrhea. 

Despite these risks, for many patients, the potential benefits of HIPEC outweigh the possible complications, especially in cases where traditional treatments offer limited success.

The Future of HIPEC in India

As research and clinical experience with HIPEC continue to grow, there is increasing interest in expanding its use beyond peritoneal surface malignancies. Studies are exploring its potential benefits in other cancers, such as those involving the thoracic cavity (thoracic HIPEC) and certain liver and pancreatic cancers.

Likewise, India is racing to improve healthcare services for patients by continuously adopting the latest technologies to treat complex diseases. Various cancer hospitals in India have adopted HIPEC treatment, which has proven effective in treating multiple cancers, such as peritoneal carcinomatosis.

HIPEC vs. Traditional Chemotherapy

HIPEC differs from traditional chemotherapy mainly in how the drug is delivered.

• Traditional chemotherapy is systemic, spreading throughout the entire body, which can cause widespread side effects and may not reach high enough drug levels in the abdominal cavity. 
• HIPEC, on the other hand, targets the chemotherapy directly to the affected area, improving its effectiveness and reducing overall exposure. 
• Additionally, HIPEC uses heat to boost the effects of chemotherapy. 
• While traditional chemotherapy is given at normal body temperature, HIPEC involves heating the drug to enhance its cancer-fighting properties and damage cancer cells further, making them more susceptible to treatment.

Takeaway

HIPEC is a significant advancement for treating abdominal cancers, offering new hope for patients with limited options. It combines surgery with heated chemotherapy to target cancer cells in the abdominal cavity while reducing overall side effects. Though it's a complex procedure, HIPEC can extend or even save lives for suitable patients. As research continues, HIPEC's role in cancer treatment is expected to grow, providing new opportunities for those with challenging cancers.