01. What Is HIPEC?
What Is Hyperthermic Intraperitoneal Chemotherapy (HIPEC)?
Heated intraperitoneal chemotherapy (HIPEC) washes the abdominal cavity with heated chemo drugs. This is usually done after surgery to remove tumors and lesions. HIPEC is also referred to as hyperthermic chemotherapy. It is a form of chemoperfusion.
HIPEC is a common treatment for peritoneal mesothelioma. In 2016, HIPEC plus cytoreductive surgery (CRS) was presented as a standard of care for peritoneal mesothelioma. It may also be used to treat ovarian cancer, colon cancer, gastric cancer and appendiceal cancer.
Researchers continue studying ways to improve the effectiveness of HIPEC and surgery for cancer treatment.
02. HIPEC and Mesothelioma
How Does HIPEC Treat Peritoneal Mesothelioma?
HIPEC treats peritoneal mesothelioma with heated chemo drugs circulated right in the abdomen. The goal of HIPEC is to kill cancer cells left behind after surgery.
Peritoneal mesothelioma’s location makes it difficult for traditional chemo to reach the tumors. HIPEC gets around this issue by directly putting chemo drugs in the same place as the cancer. The procedure washes the abdominal cavity with heated chemo fluid, which is why it may be called a chemo bath.
Cancer tissue absorbs heated chemo drugs better than unheated. The high temperature of the chemo fluid can also kill mesothelioma cells. So HIPEC aggressively targets tumors with heat and direct contact with chemo.
HIPEC offers a variety of benefits, such as extended life expectancy and symptomatic relief.
HIPEC surgery is a two-step procedure to treat peritoneal mesothelioma tumors. Tumors are removed surgically. Then heated chemo drugs are applied directly into the abdominal cavity.
What Is HIPEC Surgery?
- HIPEC surgery is a two-step treatment to remove peritoneal tumors.
- First, visible tumors are removed surgically (CRS). Heated chemo drugs are then put directly into the abdominal cavity (HIPEC).
- CRS may also be referred to as debulking.
How Does a Heated Chemotherapy Wash Work?
With HIPEC, a perfusion machine heats and gently pumps chemotherapy drugs into the abdomen. Tubes (catheters) circulate the hot chemo fluid between the patient and the machine for 1 to 2 hours.
When complete, the surgeon drains the chemo fluid, rinses the abdomen, then closes any incisions. Because HIPEC delivers the drugs directly to the site of the cancer, it helps kill cells left behind after CRS.
HIPEC is not administered intravenously like traditional chemo. Instead, doctors insert two tubes into the patient’s abdomen. These are often referred to as in-flow and out-flow tubes:
- One tube pumps the heated chemo solution into the body.
- The other tube circulates the fluid back to the perfusion machine, which heats the fluid.
This chemo solution may include a variety of different chemo drugs, such as cisplatin, mitomycin and doxorubicin. The surgeon can consider multiple patient factors to decide which drug or combination is best.
Administering HIPEC targets cancerous cells because:
- Healthy cells die at 111.2° F.
- Cancer cells die at 104° F.
- The chemo solution will be heated to a temperature between 104°F and 109°F.
- HIPEC chemo fluid is hot enough to kill cancer cells but cool enough to leave healthy cells largely unharmed.
The hot chemo fluid circulates within the abdomen for 1 to 2 hours. Once the HIPEC wash is finished, physicians will drain and rinse the chemo from the abdominal cavity. They will then close the incisions.
Combined with surgery, the entire process takes about 6 – 14 hours.
How Long Is Recovery After CRS + HIPEC?
Patient recovery time following CRS and HIPEC can vary. This is because HIPEC procedure timing and details may differ slightly between treatment centers. Patients generally spend 7 – 12 days in the hospital for monitoring after the procedure. HIPEC patients may experience fatigue for 2 – 3 months after their procedure.
As noted, recovery time and processes may vary. One patient’s recovery may not look the same as another’s. Patients should talk to their care team to better understand what to expect from HIPEC treatment and recovery.
A patient’s recovery from HIPEC and surgery commonly involves:
- Attending follow-up appointments
- Getting plenty of rest
- Maintaining a healthy diet
- Monitoring for any abnormal side effects
- Remaining active when possible
- Taking any prescribed medication
Follow-up appointments may consist of blood tests and imaging scans. These appointments can continue for as long as the patient’s doctor deems necessary.
Did You Know?
03. Benefits of HIPEC
How Does HIPEC Benefit Mesothelioma Patients?
HIPEC treatment can benefit mesothelioma patients in many ways. Studies suggest heated chemo may kill mesothelioma cancer cells more effectively than unheated chemo. Peritoneal mesothelioma patients who receive HIPEC plus CRS have life expectancies ranging from about 4 to 8 years. Some patients have lived much longer. HIPEC treatment can also relieve mesothelioma symptoms.
Benefits of HIPEC for Treating Mesothelioma
- Allows for highly concentrated chemo application
- Can extend life expectancy, when combined with surgery
- Can help prevent recurrence after surgery to remove mesothelioma tumors
- Can result in less side effects than intravenous chemo
- May reduce cancer-related symptoms
- Reaches cancer cells on the organ surfaces that systemic chemo may not
Many HIPEC benefits are due to how the medication is administered. The heated chemo is confined to the abdominal cavity. This allows patients to receive higher concentrations of chemo drugs.
With systemic chemo, the drugs enter the bloodstream directly. This method requires patients to receive a lower concentration of medication. A higher concentration could harm too many healthy cells. Patients may also experience worse side effects with systemic chemo.
How Successful Is HIPEC for Treating Mesothelioma?
HIPEC after CRS has improved survival for peritoneal mesothelioma. Median survival in a group of peritoneal mesothelioma patients who did and did not undergo treatment was 31 months. However, median survival reached 50 months in a group of peritoneal patients who had CRS and HIPEC.
Additional studies have found similar success with HIPEC and surgery for mesothelioma. Dr. Paul Sugarbaker and Dr. Edward Levine have contributed to this success. Along with other peritoneal mesothelioma experts, they treated hundreds of patients with CRS and HIPEC. Results from this study included:
- Median overall survival of 67 months
- 1-year survival rate of 83%
- 3-year survival rate of 62%
- 5-year survival rate of 52%
A small study treated patients with CRS and HIPEC. Then, patients underwent another form of abdominal chemo treatment. Researchers found:
- 50% of patients lived 13 years or longer without signs of the cancer progressing
- 100% of patients lived 8 years or longer
CRS and HIPEC can extend patient lifespan and improve quality of life. Patients can speak with a mesothelioma specialist to understand how HIPEC may impact them.
04. HIPEC Side Effects
Side Effects and Risks of HIPEC for Mesothelioma
HIPEC surgery has its own risks and side effects. These may include bleeding, blood clots and other concerns associated with surgery. Other potential side effects associated with HIPEC and surgery for mesothelioma include:
- Blood clots
- Digestive issues
- Fistula formation (abnormal connection between two body parts or tissues)
- Severe bleeding
- Tissue perforation (a hole)
- Wounds that will not heal (dehiscence)
Not all patients will experience all of these side effects. Every patient’s treatment and experience may be different. A recent study noted that CRS with HIPEC has a lower complication rate than other surgical procedures. This means the long list of side effects need not cause more alarm than many other surgeries.
Patients should discuss potential complications with their mesothelioma specialist. The doctor can talk with them about which treatment side effects may be most likely.
05. HIPEC Eligibility
Who Is Eligible for HIPEC Treatment?
Doctors weigh various factors when considering if HIPEC fits a patient’s treatment plan. Patients should discuss HIPEC eligibility with a specialist.
Chemo combined with surgery is considered a multimodal treatment. Multimodal treatments may be more aggressive, which can impact eligibility.
One of the main requirements for patients to be eligible for HIPEC and surgery is good overall health. However, physicians may take other individual factors into consideration.
Patients should consult with a specialist to understand their eligibility. Exceptions or additional conditions may apply to a patient’s case. If ineligible, patients may be able to undergo other mesothelioma treatments to improve their prognosis.
Resources for Mesothelioma Patients
06. Related Therapies
Other Related Therapies
Other local therapies are similar to HIPEC. Some studies have looked at adding local chemo treatments after HIPEC for treating mesothelioma.
- EPIC: Early postoperative intracavitary chemotherapy
- NIPEC: Normothermic intraperitoneal chemotherapy
- PIPAC: Pressurized intraperitoneal aerosol chemotherapy
- HITHOC: Hyperthermic intrathoracic chemotherapy
These therapies differ by temperature of the chemo solution, length of application and types of cancer they can treat.
- EPIC stands for early postoperative intracavitary chemotherapy.
- EPIC is administered while a patient is recovering from surgery.
- Chemo medication stays in the abdomen for several hours, exposing cancer cells to the drug longer.
- NIPEC stands for normothermic intraperitoneal chemotherapy.
- NIPEC is administered after surgery. Specialists circulate room-temperature chemo medication throughout the abdominal cavity.
- This can be done in a long-term treatment course.
- HITHOC stands for hyperthermic intrathoracic chemotherapy.
- HITHOC is administered to patients during a cancer surgery. Specialists circulate heated chemo through the thoracic cavity.
- HITHOC is a treatment option for pleural mesothelioma.
Mesothelioma clinical trials continue investigating HIPEC combined with other types of chemo. One study found the 5-year mesothelioma survival rates in patients treated with surgery and different chemo combinations. This included HIPEC, EPIC and NIPEC.
Published results of this study show a 5-year survival rate of:
- 44% for CRS combined with HIPEC
- 52% for CRS combined with HIPEC and EPIC
- 75% for CRS combined with HIPEC, EPIC and NIPEC
EPIC and NIPEC may be available at leading cancer centers. More research may help find new ways of using EPIC and NIPEC to treat mesothelioma and other cancers.
07. Where to Find HIPEC
Where Can I Find HIPEC Treatment for Mesothelioma?
Washington Cancer Institute at MedStar Washington Hospital Center is considered one of the best medical centers for HIPEC treatment. Below is a list of other treatment centers that offer HIPEC.
Brigham and Women’s Hospital
Moffitt Cancer Center
Mount Sinai Medical Center
University of Washington Medical Center
Note: This list is not exhaustive. Look for a treatment center near you to determine if HIPEC is offered.
Some doctors specialize in peritoneal mesothelioma treatment. Various peritoneal mesothelioma specialists have researched HIPEC and have experience performing the procedure.
Below is a list of HIPEC doctors.
Brian W. Loggie, M.D.
David Bartlett, M.D.
James Pingpank, M.D.
Umut Sarpel, M.D.
Note: This list is not exhaustive. Look for a doctor near you to determine if HIPEC is offered.
As studies continue to show success with HIPEC, it may become more widely available to patients.
08. Common Questions
Common Questions About HIPEC
Can HIPEC cure mesothelioma cancer?
- HIPEC and cytoreductive surgery cannot cure peritoneal mesothelioma. However, the treatment combination may improve patient survival. HIPEC surgery may be the most effective method of improving survival for some patients.
Can HIPEC be used palliatively?
- HIPEC may be used palliatively. Doctors may recommend palliative HIPEC for patients who do not qualify for surgery. This approach can help relieve some mesothelioma symptoms. HIPEC can also be helpful for patients with malignant ascites, or fluid buildup in the abdomen.
How much does HIPEC and surgery cost?
- If eligible, patients may pay anywhere from $20,000 to $100,000 for HIPEC and cytoreductive surgery treatment. One recent study indicated an average HIPEC procedure cost of around $80,000 per patient.
Is HIPEC covered by insurance?
- Some insurance policies cover HIPEC with surgery. However, costs can vary depending on plan and insurance provider. Patients should discuss coverage with their insurance company.
What is cytoreductive surgery?
- Cytoreductive surgery (CRS) removes cancer tissue from the abdomen. It is often followed by heated chemo (HIPEC). The goal of this combination is to get rid of as much cancer as possible. The surgery removes large, visible tumor masses. HIPEC targets cancer cells left behind after surgery. CRS plus HIPEC is a standard treatment for peritoneal mesothelioma.
How is HIPEC different from traditional chemotherapy?
- HIPEC is not administered intravenously like traditional chemo. Instead, HIPEC drugs go right into the patient’s abdomen. As such, HIPEC can use a higher dose of chemo to kill cancer cells than traditional chemo can. HIPEC drugs stay in the belly, causing fewer side effects than traditional chemo.