|
Intraoperative
Hyperthermic Peritoneal Perfusion, IHPP, a unique method
of delivering chemotherapy is extending the lifespan
and improving the quality of life of some patients with
advanced abdominal and gynecological cancers.
Cancer is a formidable
foe—one that sometimes triumphs despite the best
of efforts with surgery, chemotherapy, or radiation.
As researchers explore new ways to combat an old enemy,
a unique method of delivering chemotherapy is extending
the lifespan and improving the quality of life of some
patients with advanced abdominal and gynecological cancers.
These patients have undergone
Intraoperative Hyperthermic Peritoneal Perfusion, or
IHPP—in essence, a warmed chemotherapy bath that
immediately follows tumor-removing surgery.
“Not all cancers
are receptive to chemotherapy taken by mouth or intravenously,”
says Dr.
Lawrence Harrison, associate professor of surgery
at New Jersey Medical School and chief of the division
of surgical oncology at University Hospital. “At
the same time, the peritoneal cavity—the belly—can
be a complex area from which to remove tumors. In the
process of removing a tumor, the surgeon can inadvertently
dislodge some tiny cancer cells that then reattach themselves
to the peritoneal surface. With IHPP, chemotherapy has
a better opportunity of accessing hard-to-reach areas.”
A patient who has IHPP
first undergoes cytoreductive surgery, or debulking,
to remove as much of the tumor as possible. One very
aggressive approach used for certain cancers is a peritonectomy,
in which the surgeon “strips” the peritoneum,
the membranous lining of the abdominal cavity, of cancer
cells. Immediately after the surgery, with the patient
remaining on the operating room table, a high dose of
warmed chemotherapy (up to about 100º Fahrenheit)
is directed to the open abdominal area. The chemotherapy
“bath” lasts about 90 minutes, after which
it is drained away. The surgeon closes the incision,
and the patient is taken to a recovery area, then a
hospital room.
 |
 |
| |
Chemotherapy
being added to the perfusion fluid. |
| |
|
IHPP isn’t a brand-new
technique—it’s been around for about 15
years—but as more studies are conducted, its benefits
are confirmed. In one study of patients with gastric
cancer and peritoneal metastasis (where cancer has spread
to the peritoneum) those who had only surgery were all
dead within 15 months, with a median survival of 8 months.
Of the patients who had surgery and IHPP, 54 percent
were alive one year later; 47 percent survived for three
years; and 31 percent reached the five-year survival
milestone. IHPP has other benefits. It is not uncommon
for patients with advanced abdominal cancers to have
ascites, a build-up of fluid in the peritoneal area,
which can be quite painful. IHPP has relieved the severity
of ascites for some patients or caused the fluid build-up
to completely disappear. And because of the body’s
anatomy, IHPP can provide direct portal vein perfusion
of chemotherapy to the liver, an organ to which these
cancers often spread. Additionally, IHPP produces none
of the side effects associated with systemic chemotherapy,
such as nausea and fatigue.
 |
|
CT scan of patient with pseudomyxoma peritonei (as
indicated by the yellow arrow). |
|
| |
|
“Nearly all IHPP
patients are people that have no other hope. They have
advanced, recurrent cancers that have not responded
to other treatments; many are expected to live only
another six to 12 months. Other than IHPP, the best
we can do for them is to provide palliative care,”
says Dr. Harrison, who has performed about 20 IHPP procedures
at University Hospital.
IHPP can be effective because heated
chemotherapy permeates tissues better and makes cancer
cells more reactive to its toxic properties. Also, the
surgical oncologist can direct high doses of the drug
directly to where it’s needed.
The cancers that respond most favorably
to IHPP include gastric (stomach) cancer; colorectal
cancer; ovarian cancer (which can spread to the abdominal
area); pseudomyxoma peritonei (PMP); peritoneal mesothelioma;
and peritoneal carcinomatosis. PMP begins as a polyp
in the appendix or ovary and then bursts through the
organ; a jelly-like mucous spreads through the peritoneum.
Peritoneal mesothelioma, associated with exposure to
asbestos, affects about only 1 in 1 million people.
Tumors known as peritoneal carcinomatosis can develop
from cancers of the digestive tract or from the peritoneum.
|
 |
| |
Dr. Harrison
with IHPP set-up ready to perfuse. |
| |
|
While IHPP may offer
many benefits, not every person with advanced abdominal
or gynecological cancer is a good candidate for the
procedure. “Patient selection is very important,”
says Dr. Harrison. “The tumor has to be confined
to the belly. Additionally, the patient must be strong
enough physically to withstand a lengthy operation.”
Together, the surgery and the IHPP can take between
four to 12 hours, depending on the extent of the cytoreduction.
Wound infection and healing difficulties are two possible
complications of IHPP, but the surgery itself (rather
than the chemotherapy) is the major risk. Still, he
says, for most people, IHPP is a safe procedure. The
length of hospitalization after IHPP varies depending
on the type of surgery, but a typical stay is between
5 to 10 days.
“For some patients
with advanced abdominal cancer, IHPP has the potential
to help them live longer or be in more comfort,”
says Dr. Harrison. “It can offer hope when there
wasn’t much to be hopeful about before.”
For more
information, visit our IHPP website at www.TheUniversityHospital.com/ihpp.
To arrange for a consultation with Dr. Lawrence Harrison,
call (973) 972-5583.
|
|
