HIPEC Primary Cancers Description
Down turn arrow for descriptions from Dr. Jesus Esquivel.
First HIPEC ever was in 1979. A 47 year old Japanese patient with PMP reached out to Dr. Spratt from University of Louisville, Kentucky. Today, almost every patient with PMP is seen by a HIPEC surgeon.
Encompasses a wide range of biological aggressiveness with many behaving like PMP and some like colorectal cancer. Cytoreductive surgery remains the key component of treatment and will be coupled with HIPEC in the vast majority of cases.
Numerous studies continue to demonstrate the benefit of Cytoreductive surgery and HIPEC in patients with Non-Gynecological, Non-Gastrointestinal tumors with peritoneal dissemination; especially those with low PCI and low proliferation indexes like Ki67.
Data from recently conducted and/or published prospective randomized trials has failed to demonstrate any benefit of HIPEC with Oxaliplatin for 30 minutes both as part of Cytoreductive surgery or in the adjuvant setting. Numerous retrospective studies support the addition of HIPEC for 90 minutes with Mitomycin C in patients with low PSDSS (Peritoneal Surface Disease Severity Score). Prospective, RCT with Mitomycin C are needed.
Excluding the sarcomatoid variants, there is universal agreement, that Cytoreductive surgery and HIPEC are standard of care for this group of patients.
Described as the ideal biological model to study the role of HIPEC after Cytoreductive surgery. Increasing number of randomized controlled trials continue to validate the positive effect of HIPEC, making advanced EOC (Epithelial Ovarian Cancer), the fastest growing indication for Cytoreductive surgery and HIPEC.
A selected number of patients with limited peritoneal disease and adequate response to systemic therapies will benefit from a complete Cytoreductive surgery. Several studies, including prospective randomized data, demonstrate that adding HIPEC to these patients, translates into improved survival.