01. What Is HIPEC?
What Is HIPEC?
Heated intraperitoneal chemotherapy (HIPEC) is a heated chemotherapy wash administered to the abdominal cavity after surgery to remove tumors and lesions. HIPEC is also referred to as chemoperfusion and hyperthermic chemotherapy.
HIPEC is a common treatment for peritoneal mesothelioma. It may also be used to treat ovarian cancer, colon cancer, gastric cancer and appendiceal cancer. Researchers continue to study the effectiveness of HIPEC and surgery for cancer treatment.
02. HIPEC and Mesothelioma
How Does HIPEC Treat Mesothelioma?
HIPEC is typically used after cytoreductive surgery to treat peritoneal mesothelioma.
HIPEC involves circulating a heated chemotherapy wash throughout the intraperitoneal cavity. The goal of HIPEC is to kill any remaining cancer cells after surgery.
HIPEC may offer patients a variety of benefits, such as extended life expectancy and symptomatic relief.
HIPEC surgery is a procedure to remove peritoneal mesothelioma tumors. HIPEC surgery is also referred to as cytoreductive surgery and debulking.
Surgeons aim to remove all visible tumors during mesothelioma surgery. However, it’s common for some cancer cells to remain. HIPEC helps target and kill those remaining cells, also helping to prevent recurrence.
HIPEC surgery has its own risks and side effects. Patients may experience bleeding, blood clots and other concerns. It is also common for patients to feel fatigued for months after the surgical procedure.
How Does Heated Chemotherapy Wash Work?
After the tumors are removed, doctors will administer the heated chemotherapy wash to target remaining cancer cells.
To administer HIPEC, doctors will insert two catheters (small tubes) into the patient’s abdomen. The catheters are often referred to as in-flow and out-flow tubes. One tube will pump the heated chemotherapy solution into the body. The other tube will circulate the fluid back to the HIPEC machine (perfusion system), which heats the fluid.
Administering HIPEC only targets cancerous cells because:
- Healthy cells die at 111.2° F.
- The chemotherapy will be heated to a temperature between 104°F and 109°F.
- Optimal temperature is high enough to kill cancer cells but low enough to protect healthy cells.
Doctors may change the patient’s position or massage the abdomen during the procedure. This is to ensure the chemotherapy drugs reach all areas within the abdominal cavity. Once the HIPEC wash is finished, physicians will rinse the abdominal cavity with a saline solution. They will then close the incisions.
The chemotherapy wash is typically circulated in the abdomen for at least 90 minutes. Combined with surgery, the entire process takes 8 – 14 hours, on average.
How Long Is Recovery After HIPEC?
The HIPEC procedure is not yet standardized, so timing may vary. Patients will typically spend 10 – 12 days in the hospital after the procedure for monitoring. HIPEC patients may experience fatigue for 2 – 3 months after their procedure. During this time, patients are advised to rest but also remain as active as possible to avoid blood clots and other complications.
A patient’s recovery from HIPEC and surgery typically involves:
- Getting plenty of rest
- Remaining active when possible
- Monitoring for any abnormal side effects
- Taking any prescribed medication
- Maintaining a healthy diet
- Attending follow-up appointments
Follow-up appointments will likely consist of blood tests and imaging scans. These appointments will continue for as long as the patient’s doctor deems necessary.
Resources for Mesothelioma Patients
03. Benefits of HIPEC
How Does HIPEC Benefit Mesothelioma Patients?
Studies suggest heated chemotherapy may be more effective in killing mesothelioma cancer cells than traditional chemotherapy. HIPEC has been able to extend the life expectancies of many peritoneal mesothelioma patients. HIPEC treatment can also relieve a patient’s symptoms.
Benefits of HIPEC for Treating Mesothelioma
- Allows for highly concentrated chemotherapy application
- Reaches cancer cells on the organ surfaces that systemic chemotherapy may not
- Often results in less side effects than intravenous chemotherapy
- Can extend life expectancy, when combined with surgery
- May reduce cancer-related symptoms
- Helps prevent recurrence after surgery to remove mesothelioma tumors
Many HIPEC benefits are due to how the medication is administered. The heated chemotherapy is confined to the abdominal cavity (peritoneum). This allows patients to receive higher concentrations of chemotherapy drugs.
With systemic chemotherapy (intravenous), the drugs enter the bloodstream. As a result, patients receive a lower concentration of medication. This prevents the chemotherapy drug from harming too many healthy cells throughout the body. Patients may also experience worse side effects with systemic chemotherapy.
04. HIPEC Side Effects
Side Effects of HIPEC for Mesothelioma
There are several potential side effects associated with HIPEC and surgery for mesothelioma, including:
- Blood clots
- Digestive issues
- Severe bleeding
- Wound will not heal (dehiscence)
- Fistula formation (abnormal connection between two body parts or tissues)
- Tissue perforation (a hole)
Most of these side effects are associated with HIPEC surgery. These are also potential side effects and not applicable to all patients. A recent study noted that HIPEC surgery has a lower complication rate than other procedures.
Patients should discuss potential complications with their mesothelioma specialist. Some individuals, such as elderly patients and those in poor overall health, may be more susceptible to treatment side effects.
05. HIPEC Success Rates
How Successful Is HIPEC for Treating Mesothelioma?
The average life expectancy for peritoneal mesothelioma is 31 months. However, life expectancies have greatly improved with HIPEC treatment. Some studies show 45% of patients survive 10 years or longer when treated with HIPEC and cytoreductive surgery.
Additional studies have found similar success with HIPEC and surgery for mesothelioma. Dr. Paul Sugarbaker, Dr. Edward Levine and other renowned peritoneal mesothelioma doctors studied HIPEC and mesothelioma.
They analyzed 294 patients diagnosed with diffuse malignant peritoneal mesothelioma. Each patient underwent HIPEC and surgery. The HIPEC regimen used was a combination of cisplatin and doxorubicin, common chemotherapy drugs. HIPEC survival rates 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 study from the Washington Cancer Institute looked at 161 peritoneal mesothelioma patients. All 161 patients underwent the first round of HIPEC and surgery. Only 44 patients underwent a second round of HIPEC and surgery. Researchers found:
- A median survival of 77 months after the first round of surgery for all 161 patients
- A median survival of 54 months after the second surgery for the 44 patients that underwent an additional round
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.
06. HIPEC Eligibility
Who Is Eligible for HIPEC Treatment?
Patients should discuss HIPEC eligibility with a specialist. Chemotherapy combined with surgery is considered a multimodal treatment. Multimodal treatment is considered more aggressive, which can impact eligibility.
One of the main requirements for patients to be eligible for HIPEC and surgery is good overall health and physical strength. However, physicians may take other individual factors into consideration.
Patients should always consult with a specialist to determine eligibility. There may be exceptions or additional conditions that apply to a patient’s case. If ineligible, patients may be able to undergo other mesothelioma treatments to improve their prognosis.
If eligible, patients may pay anywhere from $20,000 – $100,000 for HIPEC and cytoreductive surgery treatment. One recent study indicated an average HIPEC procedure cost of around $80,000 per patient.
HIPEC with surgery is commonly covered by insurance. However, patients should discuss coverage with their insurance company.
07. Related Therapies
Other Related Therapies
There are other therapies similar to HIPEC. Some studies have looked at the combination of HIPEC with such alternatives.
- EPIC: Early postoperative intracavitary chemotherapy
- NIPEC: Normothermic intraperitoneal chemotherapy
- HITHOC: Hyperthermic intrathoracic chemotherapy
These therapies differ by chemotherapy temperature, length of application and types of cancer they can treat.
- Specialists circulate chemotherapy throughout the body cavity affected by cancer.
- Doctors administer EPIC while the patient is recovering from surgery.
- Chemotherapy medication stays within the patient’s body for several days. This exposes the cancer cells to the drug for longer.
- Specialists circulate a room-temperature chemotherapy drug(s) throughout the abdominal cavity.
- Doctors administer NIPEC after surgery for peritoneal mesothelioma.
- NIPEC is typically done in a long-term course of treatment (NIPEC-LT).
- Specialists circulate heated chemotherapy throughout the thoracic cavity.
- Doctors administer HITHOC as soon as possible after surgery.
- HITHOC is a palliative option for pleural mesothelioma.
- Researchers are also testing HITHOC for lung cancer and breast cancer.
Mesothelioma clinical trials continue to test HIPEC combined with other types of chemotherapy. One study by Dr. Paul Sugarbaker and other researchers studied 5-year survival rates in patients treated with surgery and different chemotherapy combinations. This includes HIPEC, EPIC and NIPEC.
Published results of this study include:
- A 5-year survival rate of 44% for CRS combined with HIPEC
- A 5-year survival rate of 52% for CRS combined with HIPEC and EPIC
- A 5-year survival rate of 75% for CRS combined with HIPEC, EPIC and NIPEC
EPIC and NIPEC are newer chemotherapy treatment options. More research is needed to study their effectiveness in treating mesothelioma and other cancers.
08. Where to Find HIPEC
Where Can I Find HIPEC Treatment for Mesothelioma?
Washington Cancer Institute at 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.
Banner MD Anderson Cancer Center
Banner – University Medical Center Phoenix
Cedars-Sinai Medical Center
City of Hope
Moffitt Cancer Center
Cancer Treatment Centers of America, Chicago
Edward Cancer Center – Naperville
Brigham and Women’s Hospital
Barbara Ann Karmanos Cancer Institute
Billings Clinic Cancer Center
Mount Sinai Medical Center
NY-Presbyterian/Columbia University Medical Center
Fox Chase Cancer Center
UPMC Hillman Cancer Center
The University of Texas MD Anderson Cancer Center
University of Washington Medical Center
Washington Cancer Institute
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.
Some of the best HIPEC surgeons have published hundreds of articles on HIPEC and mesothelioma patients. For example, Dr. Paul Sugarbaker has published more than 600 related articles. Below is a list of other HIPEC doctors.
Nabil Wasif, M.D.
Joel M. Baumgartner, M.D.
W. Charles Conway, II, M.D.
Steven Ahrendt, M.D.
Ali Ahmad, M.D.
Jason M. Foster, M.D.
Brian W. Loggie, M.D.
Umut Sarpel, M.D.
Edward A. Levine, M.D.
David Bartlett, M.D.
Dr. Giorgos C. Karakousis, M.D.
Evan S. Ong, M.D.
Paul H. Sugarbaker, 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.