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Heat plus chemo equals weapon to fight ovarian cancer

September 30, 2015 | Robert Bristow, MD, MBA
Hyperthermic intraperitoneal chemotherapy (HIPEC)

“Shake ’n’ bake.”

We seldom hear that term used in reference to a potentially lifesaving procedure.

However, it accurately describes a treatment we’re using for some patients with ovarian cancer called hyperthermic intraoperative peritoneal chemotherapy (HIPEC). In this process, a heated chemotherapy solution is pumped into a patient’s abdomen after surgery and swished around to reach cancer cells left behind. 

We know that delivering chemotherapy drugs directly into the abdomen — known as intraperitoneal chemotherapy — is more effective in killing rogue cancer cells on the spot. Using this kind of chemotherapy increases your chances of survival. We also know that heat kills cancer cells.

With HIPEC, we combine heat with intraperitoneal chemotherapy to further increase our ability to kill cancer cells.

Twenty-two thousand women in the U.S. are diagnosed with ovarian cancer every year — including 2,200 in California. The five-year survival rate in California is 48 percent. We can do better, and HIPEC, when combined with surgery by an experienced gynecologic oncologist, may be one way to save more lives.

How HIPEC works to fight ovarian cancer

When a woman has ovarian cancer, the sooner she can start chemotherapy after surgery, the better. If a woman has to wait more than three or four weeks to begin traditional chemotherapy, her chance of survival decreases.

With HIPEC, the patient only has to wait 15 or 20 minutes after surgery to begin chemotherapy. Immediately after “debulking” surgery — a search-and-destroy mission to remove all visible cancer cells, along with the reproductive organs — a woman will receive chemotherapy while still under anesthesia.

While debulking removes all visible cancer cells, it’s possible that there are hidden or rogue cancer cells that have migrated away from the tumor and spread elsewhere in the abdomen, where they can then take root and grow. These are the cells that HIPEC aims to destroy.

Before her incision is closed, we pump a heated solution of chemotherapy — 42 degrees Celsius, or the temperature of a hot bath – into the patient’s abdomen. The abdomen is then massaged — this is the “shake” part — to circulate the warm fluid so it covers any remaining microscopic cancer cells.

This “chemo bath” lasts 60 to 90 minutes and, when completed and the fluid removed, the incision is closed.

HIPEC benefits

Some of the benefits of HIPEC include:

  • Higher concentrations of chemotherapy can be delivered directly to the cancer cells, minimizing exposure to the rest of the body.
  • Patients experience fewer side effects because less of the chemo is absorbed by the body.
  • Heated chemotherapy drugs are more effective at killing cancer cells that have spread within the abdomen.

Who benefits from HIPEC?

HIPEC has been used to treat multiple cancers in the ovaries, the appendix, the colon and the abdomen.

The treatment typically has been used on patients with late-stage or recurrent cancer. However, Bristow's team is leading a research study to determine whether HIPEC treatment is effective for women with newly diagnosed ovarian cancer.

HIPEC treatment is not for everyone. Before a patient can be considered, she must be healthy enough to tolerate the five- to six-hour surgery and the 60- to 90-minute chemotherapy at the end of it. It’s a long procedure and may not be appropriate for someone who is frail or who has multiple medical conditions and for whom the chemo’s toxicity would be too high.

While HIPEC is not new, not all medical centers have the resources to perform the procedure and many patients do not know to ask about it.

While HIPEC’s full impact remains to be seen, we are optimistic that it will prove to be another positive step in the march toward more effective ovarian cancer treatment and, ultimately, survival.

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