HIPEC Therapy – What it means and how it helps in the fight against cancer

HIPEC is basically an abbreviation of a broader term, i.e. hyperthermic intraperitoneal chemotherapy. It is not an actual therapy, but a procedure that is part of a more complex treatment of advanced, metastatic intra-abdominal cancers.

In this idea, it is very important to emphasize that it does not come to treat those tumors, but it tries to prevent the recurrence of the disease after the oncological surgeon removes those tumors completely and here we have to associate that term tumor cytoreduction plus this hyperthermic intraperitoneal chemo-therapy. Basically this is the role, to prevent the disease from recurring.

The HIPEC procedure is by no means exclusive but complementary to other oncological procedures. Basically systemic chemotherapy, as it is known, is part of the arsenal, and is well established in oncology protocols.

This HIPEC therapy, which will follow at the same time as the operation, after removal of tumours from the abdomen, is a component of the surgical act, not separate from the surgical act. Patients receive neoadjuvant therapy, which prepares the operation, after which oncological surgeons intervene and at the end of the operation, when indicated, in certain patients, we apply intraperitoneal chemotherapy, i.e. HIPEC.

At present, clearly, for many years, medicine has been evidence-based, here we are talking about studies that have been carried out and have shown benefits or less benefits, related to some procedures. The same is true for HIPEC, which has now been shown to improve survival in patients diagnosed with peritoneal metastases after colorectal cancer, gastric cancer, ovarian cancer, including after primary cancers such as mesothelioma, a rarer but unfortunately existing disease.

In these cancers, HIPEC therapy has been shown to improve survival in carefully selected cases.

The history is quite far back, we could say, somewhere in the 90s, in the United States this procedure was started, at first experimentally. It turned out that these patients with peritoneal metastases, with peritoneal carcinomatosis, as many people know it, really were in stage IV disease, who had only a very small, paleo chance of survival with conventional therapies.

The HIPEC technique was able to prevent the onset of the disease, by acting on microscopic disease, which was proven to be the primary cause of relapse, basically this was the plus of the HIPEC technique.

A lot of research is still being done on this subject, in order to improve the protocols, the agents used, in order to remove the macroscopic disease, which we can see with our eyes, and to act on the microscopic disease, which cannot be seen, and which can spoil the patient’s prognosis.

How long can you live with peritoneal carcinomatosis after the HIPEC procedure?

A patient treated with conventional palliative techniques, i.e. systemic chemotherapy, has a survival rate of no more than one and a half to two years, and here the discussion is more complex, depending on the disease, the type of cancer, gastric cancer being more aggressive than, for example, colorectal or ovarian cancer, which are less aggressive.

Once HIPEC therapy was also combined, on selected cases, which is very important, five-year survivals were also achieved. In the case of ovarian cancer, 80% of patients selected for HIPEC therapy are alive at 5 years, on some trials, and progress in this therapy is impressive.

HIPEC - Dr. Bartoș team