Hyperthermic chemotherapy or hyperthermic intraperitoneal chemotherapy (HIPEC) is a technique used to treat gastrointestinal cancers and sarcomas that have spread to the abdominal lining. It is also known as intra-abdominal hyperthermic chemoperfusion or Intraperitoneal Hyperthermic Chemotherapy (IPHC).

Technique of Hyperthermic Chemotherapy

HIPEC is done in combination with surgery wherein a heated drug solution is used and this procedure is done in an operating room under anesthesia.

This technique involves the use of catheters and a pumping device that bathes the entire abdominal cavity with the chemotherapy drugs for about two hours. This chemotherapy solution is a liquid chemical solution that kills the cancer cells. Higher concentrations of this solution can be used when it is given directly into the abdomen compared to the concentration of drugs given in the conventional IV chemotherapy. This way, there are fewer side effects compared to the conventional chemotherapy. This is also because of the peritoneal-plasma barrier that prevents these strong drugs from entering the bloodstream.

Hyperthermic Intra operative Peritoneal Chemotherapy (HIPEC) is a recent technique. Intra operative means the chemotherapy solution is poured into the abdomen during the cytoreduction or debulking surgery. This drug solution is heated to a temperature higher than normal body temperature that is why it is called hyperthermic. The high temperature of the solution enhances the therapeutic effect of the drug. The fluid goes throughout the abdomen in a constant flow and kills the small tumors remaining after surgery. Both heat and direct contact help the drugs to kill the cancer cells effectively.

Cytoreduction Surgery

Cytoreduction is a surgery by which a bulk of tumor is removed surgically thereby reducing the cancer cells. This is called debulking the tumor.

Cytoreduction (debulking) surgery is a very long and complicated procedure and has risk of post surgery complications. Parts of the large and small bowel along with cancerous parts in the abdomen are removed during this surgery. Complete cytoreduction or debulking means that all the visible tumors are removed surgically. However, most of the times,  incomplete cytoreduction can happen if small tumors are left behind. If they are not removed then they spread thereby reducing the survival. These small tumors, which cannot be seen, are usually less than 2.5 mm.

To destroy these small tumors and prevent them from growing, this surgery is followed by HIPEC or hyperthermic chemotherapy. This technique is intra operative.

Debulking surgeries can take as long as 12 hours or more and require huge incisions. Cytoreduction surgeries are also used as a method of treatment for ovarian cancer, colon cancer and gastric cancer that has spread to the abdomen. It is also used as a method of treatment for pancreatic cancer, if it has metastasized to the abdomen.

Clinical studies have shown that HIPEC is significantly effective than just surgery for these mentioned cancers. HIPEC along with cytoreduction improves the survival and the quality of life for patients. This also reduces pain.

During the procedure, all visible tumors from the patient’s abdomen are removed by inserting plastic tubes in the abdominal wall and the incisions are closed. These tubes are then attached to a pump, which puts a heated anti-cancer drug into the abdominal cavity.

Hyperthermic chemotherapy has been proved effective compared to conventional chemotherapy, surgery or radiation especially in case of abdominal cancers. The logic behind this is that, if these anti cancer drugs are directly administered into the cancer cells then they are more effective. In addition, the heat enhances the effectiveness of the drug and improves the quality of life with prolonged survival of the patients.