Intraperitoneal Chemotherapy, is a perfusion technique in which heated chemotherapy is administered directly into the abdomen during surgery. There are a few terms that apply to this technique of delivering chemotherapy, continuous hyperthermia peritoneal perfusion, heated intraoperative peritoneal chemotherapy, and HIPEC. Another term that is used is EPIC, this refers to extending the period of intraperitoneal chemotherapy beyond the operating room, Early Postoperative Inraperitoneal Chemotherapy. The way the technique works is that direct administration of heated chemotherapy in the peritoneal space provides an increase in the drug concentration in the peritoneum as opposed to receiving the chemotherapy through your veins or by mouth.
This technique has been developed over the years, in coordination with cytoreductive surgery. Cytoreductive surgery is removing all of the tumor evident to the eye. In 1934, Dr. Meigs of New York theorized that in locally advanced abdominal cancers, like ovarian cancer, that by resecting all he could see would reduce complications such as intestinal obstructions, perforation, ascites. Further treatment would then include post op radiation. This technique did not take hold until the late 1960’s and 1970’s. The evolvement of Cytoreductive surgery is important to the development of HIPEC as both procedures are used together.
The reports from the centers undergoing this procedure have been very encouraging. Survival for selected patients, with certain types of peritoneal mesothelioma has been encouraging.
Peritoneal mesothelioma is a very rare cancer and progress has been made with various techniques including HIPEC. The need for patients with peritoneal mesothelioma to go to one of the leading centers for peritoneal mesothelioma cannot be emphasized enough.
Dr. Brian Loggie is an expert in this technique having been one of the pioneer researchers in this since 1991 publishing his findings in an article – The American Surgeon, October 2001, Prospective Trial for the Treatment of Malignant Peritoneal Mesothelioma, by Brian W. Loggie, MD, Ronald A. Fleming, Pharm. D., Richard P. McQuellon, PhD, Gregory B. Russell, M.S., Kim R. Geisinger, M.D., Edward A. Levine, M.D. from the Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina.
The February 2016 edition of Journal of Gastrointestinal Oncology, “Then and now, cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC), a historical perspective” by Madalyn G. Neuwirth, H Richard Alexander, and Giorgos C. Karakousis is an excellent resource to review these techniques.
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