Cytoreduction with HIPEC is the best chance for a higher quality of life for people with peritoneal mesothelioma. Through a two-step process of surgery and heated chemotherapy, patients have seen a dramatic increase in survival time.
What is Cytoreduction with HIPEC?
Cytoreduction with HIPEC is a combination of surgery and chemotherapy used in patients with peritoneal mesothelioma. This aggressive surgery is improving survival rates in patients who receive it all over the world.
First, doctors use cytoreduction surgery (commonly called “debulking”) to remove the peritoneal lining, which removes all visible tumors from the abdomen. Then, heated chemotherapy drugs are applied to the surgery site. This kills any microscopic mesothelioma cancer cells that may have been left behind.
While this does not cure mesothelioma, it does wipe out all the cancer in your body at the time of surgery.
This groundbreaking surgery is administered by top mesothelioma doctors. It was invented by mesothelioma specialist Dr. Paul Sugarbaker in the 1980s, and is commonly referred to as the “Sugarbaker procedure.”
This surgery is being performed by specialists at cancer centers throughout the United States. Dr. Sugarbaker practices at the Washington Cancer Institute in Washington D.C. There are also doctors at Mayo Clinic campuses in Arizona, Florida, and Minnesota who perform this surgery.
How Can Cytoreduction with HIPEC Help Me?
Cytoreduction with HIPEC is arguably the most effective surgery for mesothelioma.
Because the heated chemotherapy is applied directly after surgery, all of the cancer cells that remain behind after the removal of visible tumors are killed. This helps to not only kill remaining cells but also manage the growth of new tumors and reduce symptoms caused by them.
Most doctors think HIPEC is more effective than traditional chemotherapy. “HIPEC allows for a higher concentration of chemotherapy to be delivered into the abdomen more effectively and safely than standard chemotherapy,” said Dr. Sricharan Chalikonda of the Cleveland Clinic.
Peritoneal mesothelioma has the best prognosis of all types of mesothelioma due to this procedure. Some patients who received this procedure have lived 5 years or longer, even if they were diagnosed after the cancer has spread.
Who is Eligible for Cytoreduction with HIPEC?
Patients who are in relatively good health — and whose cancer has not spread — may qualify for cytoreduction with HIPEC. Patients need to work with a mesothelioma doctor (like Dr. Paul Sugarbaker) to undergo this surgery.
People who are good candidates for cytoreduction with HIPEC have:
- Good overall health (ability to go about daily life without help)
- No signs of other major diseases
- Normal heart function
- No major metastasis (spread to other areas of the body)
The most important factor is how advanced your disease is. Surgery isn’t as helpful in advanced peritoneal mesothelioma. For this reason, not everyone is a candidate for cytoreduction and HIPEC. Only patients with a low chance of complications are accepted for surgery.
To determine if you can receive this treatment, doctors will examine your overall health and note how the cancer has spread. They will normally do this through a series of tests.
Some pre-surgery tests you may expect include:
CT and PET Scans: These scans can locate instances of metastasis. If the cancer has spread to distant areas, surgery is more likely to hurt than help you.
Echocardiogram: This test uses sound waves to measure heart function. It’s critical for surgical candidates to have a healthy heart to endure the long operation.
Performance Tests: Doctors may measure how long you can exercise while measuring your heart rate and blood pressure. They may also consider your body mass index.
Blood Tests: These tests ensure you have an appropriate red blood cell count. This is important for any surgical patient.
Laparoscopy: This procedure uses a camera placed through a small incision to locate tumors. Surgeons may want to examine the extent of tumors before opening the abdomen.
Patients under the age of 65 are usually operable, but older patients may not be candidates in some cancer centers. However, most specialists consider overall health more important than a patient’s age.
Cytoreduction with HIPEC Procedure
This treatment consists of two parts:
- Cytoreduction Surgery (Debulking): First, the surgeon makes an incision in the abdomen and removes the peritoneum – the lining of the uterus. During this surgery, all visible tumors are removed and it is sometimes necessary to remove other organs like the gallbladder, spleen or the peritoneum – the lining of the abdomen.
- HIPEC: HIPEC stands for “heated intraperitoneal chemotherapy.” Liquid chemotherapy (heated to nearly 108 degrees) is applied to the abdominal cavity after surgery. The surgeon and oncologist let the chemotherapy sit in the abdomen for up to 90 minutes. By applying the chemotherapy directly to where the tumors previously were, any remaining cells are killed.
Heated chemotherapy used to be controversial, but doctors have perfected the procedure over the years. Over time, the medical community recognized its importance for peritoneal mesothelioma patients as survival times climbed.
“[Cytoreduction] and HIPEC then quickly became the treatment of choice, with an improvement in median overall survival of 30 to 92 months,” said doctors in a clinical review of the surgery.
Because only a small amount of chemotherapy is absorbed, a higher dose can be used without the traditional side effects of chemotherapy. Some studies suggest that chemotherapy agents are more powerful when heated.
Cytoreduction with HIPEC Recovery Times
Patients usually spend between 7-15 days in the hospital to recover from this treatment. Once the doctors have determined that there is no risk of complications, patients can return home to continue the healing process.
It is not uncommon for patients to feel fatigued for 2-3 months after the operation.
This can happen for a number of reasons, including:
- Pre-operation complications (like breathing trouble) that continue after surgery
- Your body could still be adjusting to living without the abdominal lining
- Side effects of chemotherapy
- Loss of protein due to your body healing the surgery site
Your doctor will schedule several follow-up appointments to monitor your recovery. During these appointments, your doctor will note any changes to your eating or exercise routines to improve your overall health.
Both healthy eating habits and exercise can have a positive effect on recovery, but it is important to introduce them slowly so your body has time to heal.
Cytoreduction with HIPEC Life Expectancy
Cytoreduction with HIPEC offers the best chance for peritoneal patients to reach remission and extend their life expectancies.
Today, many patients live long past the 5-year mark even if the cancer had begun to spread. In one study, the survival time in patients increased by 50 percent compared to those who didn’t get HIPEC.
Patients who receive multiple cancer treatments (surgery, chemotherapy, and radiation therapy) usually live longer. They may also have a better quality of life when compared to people who have only one or two different types of cancer treatment.
The survival time for peritoneal mesothelioma also used to be between 6 and 12 months before HIPEC was added. Those who don’t have surgery are unlikely to have long-term survival.
Getting Cytoreduction with HIPEC
Cytoreduction with HIPEC is the best choice of treatment for patients with peritoneal mesothelioma. This surgery gives patients the best chances of exceeding their initial prognosis because of its use of both surgery and chemotherapy to treat patients.
While there are mesothelioma specialists in cancer centers all over the U.S., it is important to find a doctor who is skilled in treating peritoneal mesothelioma with this surgery.
If you are receiving health care through the VA, ask your doctors about cytoreduction with HIPEC. While most VA mesothelioma doctors typically treat pleural mesothelioma, there are treatment options available through non-VA doctors.