Hot Chemotherapy / HIPEC

gastrointestinal tract ( Stomach, colon and peritoneum) and gynecological ( over ) cancers can recur in the abdomen at the time of diagnosis or in the postoperative follow-up period. We refer to the widespread intra-abdominal spread as peritoneal carcinomatosis. Recurrence of cancer in the same organ, lymph node or intra-abdominal (peritoneum) reduces the expected life expectancy.

We encounter a common disease called advanced stage-stage 4 in 15% of patients at the time of diagnosis in colon cancer and in 5-30% of patients in gastric cancer. The average life expectancy of these patients is 6 months (1,2). After a successful cytoreductive surgery and HIPEC, this period may exceed 11 months. In ovarian cancers, there is a life expectancy of 12-25 months with only chemotherapy in diffuse disease; Life expectancy can increase up to 22-64 months after cytoreductive surgery and HIPEC.

Today, after removing cancerous tissues (cytoreductive surgery) in cases of intra-abdominal relapsed cancer, we apply intra-abdominal hot chemotherapy (hyperthermic intraperitoneal chemotherapy -HIPEC). In cytoreductive surgery, tissues with cancer spread and peritoneal surfaces are removed. The aim is to clean the visible tumor areas. After the tumor foci are cleared, it is planned to treat cancerous areas at the microscopic-cellular level with chemotherapy drugs that have less side effects on the body.

The effectiveness of intra-abdominal chemotherapy drugs has been shown to be more effective than standard chemotherapy given intravenously (3). Intra-abdominal administration of chemotherapy drugs with increased temperature (hyperthermia) increases blood flow in the peritoneum and can directly kill cancerous cells (cytotoxicity) (4). Cisplatin, mitomycin C, paclitaxel, liposomal doxorubicin, oxaliplatin, carboplatin, docetaxel and irinotecan can be used as chemotherapy drugs. Hyperthermia-temperature is applied at 40-450. After treatment, the life expectancy of patients increases, and some patients can be completely cured (5).

The operation time is long, more tissue needs to be removed, and we can see more problems in the postoperative period. The most common problems are intra-abdominal bleeding, anastomotic leaks, respiratory system problems and a higher risk of death. In general, general morbidity after cytoreductive surgery and HIPEC has been reported as 12-56%, and perioperative mortality between 0-12% (6). In addition, toxicity may develop in kidney and blood cells due to hot chemotherapy.

Determination of patients suitable for HIPEC and cytoreductive surgery is done with a multidisciplinary approach. Patients with good performance should be evaluated by general surgery, medical and radiation oncology, and patients who would benefit from this treatment should be determined. It should be known that not every patient is suitable for this treatment. The more widespread the cancerous cells are (tumor grade, lymph node involvement, lymphatic/venous invasion, signet ring cell histology), the success of treatment is negatively affected.

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