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Study Supports CRS/HIPEC for Peritoneal Mesothelioma

ByAlex Strauss

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Another study supports the safety of a new treatment approach for peritoneal mesothelioma that combines cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemoperfusion (HIPEC). The study finds the procedure safe, even when it is performed by surgeons who are new to the technique.

HIPEC is a secondary treatment for mesothelioma and other cancers used in combination with open surgery. It involves bathing the open body cavity with a mixture of heated chemotherapy medicines. The drugs are designed to attack mesothelioma and other cancer cells left behind after cytoreductive surgery and to prevent new cancer cells from forming. The heat is believed to help the drugs more easily penetrate into tissue.

Cancer researchers at the University of Arizona, which has recently begun using CRS/HIPEC, conducted a small study on a group of patients with various abdominal cancers, including peritoneal mesothelioma, a virulent cancer involving the lining of the abdominal cavity. The aim of the study was to compare the outcomes of cancer patients who underwent CRS/HIPEC with those who did not, to determine the safety and feasibility of the new program.

Fourteen percent of patients in the study had mesothelioma. Some of the patients studied underwent CRS/HIPEC as a curative measure, while others received it for palliation of their cancer symptoms. The peritoneal cancer index (PCI) is a measure of the severity of the cancer. The majority of patients who underwent curative CRS/HIPEC had an average PCI of 10, compared with a PCI of 25 among those who were not recommended for CRS/HIPEC.

The good news for peritoneal mesothelioma patients considering this approach is that the University of Arizona had no post operative deaths among the CRS/HIPEC patients studied. Thirty-six percent of patients did experience postoperative complications, the most serious of which was abdominal obstruction. The report supports the findings of other recent HIPEC studies which suggest that the procedure is a relatively safe way to help prevent the spread of mesothelioma within the abdomen.

Based on their findings, the University of Arizona team concluded that, when it is performed at a tertiary care institution, CRS/HIPEC is safe and feasible for mesothelioma and other cancers, even when the program itself is new.

Sources:

Konstantinidis, IT, “Cytoreductive surgery and hyperthermic intraperitoneal chemoperfusion: The University of Arizona early experience”, June 27, 2012, World Journal of Gastrointestinal Surgery, pp. 135-40.
Sugarbaker, PH, “Hyperthermic intraoperative thoracoabdominal chemotherapy”, May 10, 2012, Gastroenterology Research and Practice, Epub ahead of print.

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