Hot chemotherapy may not withstand the scientific heat
Baku, August 22 (AZERTAC). HIPEC stands for Heated Intraperitoneal Chemotherapy, a procedure used to treat advanced abdominal cancers. You may have heard of HIPEC under a previous name: IPHC, chemo-bath, HIIC (Heated Intraoperative Intraperitoneal Chemotherapy), Intraperitoneal Chemohyperthermia or Continuous Hyperthermic Peritoneal Perfusion. HIPEC is performed during a surgery to remove an abdominal tumor. Once the tumor has been removed (“cytoreduction”), the surgeon continuously circulates a heated, sterile chemotherapy solution throughout the peritoneal cavity for up to two hours. The HIPEC procedure is designed to attempt to kill any remaining cancer cells. The solution is then removed and the incision closed. Giving the chemotherapy in the abdomen at the time of surgery allows for greater concentrations of the drug where it is needed. Adding heat has a threefold advantage: Heat at 42 degrees celsius kills cancer cells while not affecting normal cells, heat makes the killing effect of the chemotherapy more powerful, heat softens the tumor nodules so the penetration of the chemotherapy into the tumor is enhanced. It seems that the latest trend in treating cancer is a combination of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (Hipec) — or, as it is more familiarly called, “hot chemotherapy.” The massively invasive procedure was originally performed only on patients with a rare type of appendix cancer, but many of the nation`s leading medical centers, such as Massachusetts General and Montefiore Medical Center in New York, have begun using the technique to treat colorectal and ovarian cancers.
Lasting up to eight hours, Hipec surgery begins when a surgeon cuts open a patient`s abdomen and sifts through each individual organ by hand looking for tumors to excise. Then, a machine pumps heated chemotherapy (nearly 108 degrees Fahrenheit) into the abdominal cavity for about 90 minutes, a technique that is supposed to be more effective than intravenous chemotherapy because cancerous cells are unable to withstand the higher temperatures that healthy cells can. Approximately 1,500 people undergo the procedure annually, but this number is expected to grow to 10,000, which Dr. David P. Ryan, clinical director of the Massachusetts General Hospital Cancer Center, says is the just the latest example of a therapy that catches on with little evidence that it really works. “We`re practicing this technique that has almost no basis in science,” he says, while suggesting that the only reason it has been extended to colorectal cancer patients is because “you can`t make a living doing this procedure in appendix cancer patients.”
The only study examining the efficacy of Hipec was conducted in the Netherlands over a decade ago and included 105 patients. Those who received Hipec and intravenous chemotherapy had a median survival time of 22.3 months, compared to 12.6 months among those receiving only intravenous therapy. However, 8 percent of the patients in the Hipec group died from the treatment itself. “This technique employs wishful thinking at best,” says ACSH`s Dr. Gilbert Ross. He adds, “Resorting to this surgery is both unprofessional and possibly unethical, since doctors are exploiting patients` desperation in hopes of an actual benefit — though there is minimal evidence of such.” Hot chemotherapy costs between $20,000 and $100,000, and Dr. Ross finds it unbelievable to learn that in this era of high ethical standards and full disclosure, hospitals are profiting greatly from a procedure that has not undergone extensive studies to confirm its efficacy (if any). “Since the FDA cannot regulate medical practices, this sounds like an abdication of responsibility by state and hospital boards,” he says.
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