HIPEC Treatment for Appendix Cancer, Pseudomyxoma Peritonei and other Peritoneal Surface Malignancies
CRS and HIPEC in the Treatment of PSMs
Multidimensional Analysis of the Learning Curve for Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy in Peritoneal Surface Malignancies
Kusamura, Shigeki MD, PhD; Baratti, Dario MD; Deraco, Marcello MD
Objective: To evaluate the learning curve of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in treating peritoneal surface malignancies (PSM).
Summary and Background: CRS and HIPEC to treat PSM is a complex procedure with a significant morbidity. A long-lasting training program is required to acquire expertise in this type of operation.
Methods: We performed CRS using peritonectomy procedures. HIPEC through the closed abdomen technique employed cisplatin and mitomycin-C or cisplatin and doxorubicin. Risk-adjusted sequential probability ratio test was used to assess the learning curve on a series of 420 cases of PSM on the basis of rates of incomplete cytoreduction and G3-5 morbidity (NCI-CTCAE v3). We determined control limits setting the type I/II error rates and unacceptable odds ratios (ORs) for the outcomes being studied. We performed the risk adjustment using logistic regression model.
Results: Rates of incomplete cytoreduction, G3-5 morbidity, and postoperative mortality rates were 10.2%, 28.5%, and 2.1%, respectively. The risk-adjusted sequential probability ratio test curve crossed the lower control limit at the 137th and 149th case, respectively, for incomplete cytoreduction and G3-5 morbidity. At those points, the actual ORs are lower than the prespecified ORs for outcomes being studied. Therefore, we estimated that approximately 140 cases are necessary to ensure surgical proficiency in CRS and HIPEC.
Conclusions: CRS and HIPEC to treat PSM has a steep learning curve requiring 140 procedures to acquire expertise.
Source: Annals of Surgery February 2012 - Volume 255 - Issue 2 - p 348–356
doi: 10.1097/SLA.0b013e3182436c28 © 2012 Lippincott Williams & Wilkins, Inc.
Eight Year Old Patient Treated with HIPEC
Photo Courtesy of Edgar Estrada, Miami Children's Hospital
Left to right, 8 year old patient, Kelly, her mother, Miami Children's Hospital Interim Chief of Pediatric Surgery Dr. Cathy Burnweit, Chief Medical Officer Dr. Deise Granado-Villar, and Hematologist-Oncologist Dr. Guillermo De Angulo. Not shown, HIPEC treatment specialist, Dr Andrea Hayes-Jordan, MD Anderson Children's Cancer Hospital.
Eight Year Old
Patient Treated with HIPEC in USA
On September 30th, 2011, an eight year old patient in Florida was treated with HIPEC for the treatment of a rare cancer.
The young patient, named Kelly, is a resident of Miami and has been treated for a rhabdomyosarcoma abdominal cancer at Miami Children's Hospital since 2006.
It became apparent that another, more effective treatment was required, when the youngster continued to experience recurrences after being treated with chemotherapy and radiation.
Initially, Kelly's specialists in Miami planned to send her to the MD Anderson Children’s Cancer Hospital in Houston, TX, for pediatric HIPEC treatment. However, when Kelly's health insurance medical plan would not approve the out-of-state treatment, her physicians in Miami initiated a plan to bring pediatric HIPEC specialist Dr Hayes-Jordan to Florida for the procedure.
Kelly's physicians at Miami Children's Hospital, chief surgeon Dr. Cathy Anne Burnweit, oncologist Dr. Guillermo De Angulo, and chief medical officer, Dr. Deise Granado-Villar, collaborated with Dr. Andrea Hayes-Jordan of MDACC to provide the 8 year old with state of the art treatment. Dr Hayes-Jordan has previous experience in administering pediatric HIPEC treatment at MD Anderson's Children's Cancer Hospital in Houston.
Following the youngster's successful recuperation and release from Miami Children's Hospital, she returned, with her family, several weeks later to celebrate a very special birthday!
View the video below to learn more about this inspirational young patient, her loving family, and her amazing medical team.
Our thanks to filmmaker Dan Perez and to photographer Edgar Estrada for helping to make this article possible.
Copyright © by Gabriella Graham/PMP Pals' Network January 31, 2012
On September 30th, 2011, an eight year old patient in Florida was treated with HIPEC for the treatment of a rare cancer.
The young patient, named Kelly, is a resident of Miami and has been treated for a rhabdomyosarcoma abdominal cancer at Miami Children's Hospital since 2006.
It became apparent that another, more effective treatment was required, when the youngster continued to experience recurrences after being treated with chemotherapy and radiation.
Initially, Kelly's specialists in Miami planned to send her to the MD Anderson Children’s Cancer Hospital in Houston, TX, for pediatric HIPEC treatment. However, when Kelly's health insurance medical plan would not approve the out-of-state treatment, her physicians in Miami initiated a plan to bring pediatric HIPEC specialist Dr Hayes-Jordan to Florida for the procedure.
Kelly's physicians at Miami Children's Hospital, chief surgeon Dr. Cathy Anne Burnweit, oncologist Dr. Guillermo De Angulo, and chief medical officer, Dr. Deise Granado-Villar, collaborated with Dr. Andrea Hayes-Jordan of MDACC to provide the 8 year old with state of the art treatment. Dr Hayes-Jordan has previous experience in administering pediatric HIPEC treatment at MD Anderson's Children's Cancer Hospital in Houston.
Following the youngster's successful recuperation and release from Miami Children's Hospital, she returned, with her family, several weeks later to celebrate a very special birthday!
View the video below to learn more about this inspirational young patient, her loving family, and her amazing medical team.
Our thanks to filmmaker Dan Perez and to photographer Edgar Estrada for helping to make this article possible.
Copyright © by Gabriella Graham/PMP Pals' Network January 31, 2012
View the video of Kelly's inspirational story!
HIPEC Consensus Statement
HIPEC Consensus Statement Agreement
Cytoreductive Surgery and Hyperthermic Intraperitoneal
Chemotherapy in the Management of Peritoneal Surface
Malignancies of Colonic Origin: A Consensus Statement
Source: Springerlink 2006
Presented at ASCO, January 2012...
International Study of 2300 PMP Patients: CRS and HIPEC
An international array of surgical oncology researchers, including Terence C. Chua, Brendan J. Moran, Paul H. Sugarbaker, Edward Allen Levine, Olivier Glehen, Francois N. Gilly, Dominique Elias, Dario Baratti, Marcello Deraco, Armando Sardi, David L. Morris, established a multi institutional registry in affiliation with the Peritoneal Surface Oncology Group International (PSOGI) to study the effects of CRS and HIPEC on nearly 2,300 Pseudomyxoma Peritonei patients.
Early and long-term outcome data on 2,298 patients with Pseudomyxoma Peritonei of appendiceal origin treated by a strategy of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC.)
This poster was presented by Terence C. Chua, BSc Med (Hons) MB BS at the 2012 Gastrointestinal Cancers Symposium on January 20.2012 Session Type and Session Title: General Poster Session C: Cancers of the Colon and Rectum Abstract No:532 Citation:J Clin Oncol 30, 2012 (suppl 4; abstr 532)
Author(s): Terence C. Chua, Brendan J. Moran, Paul H. Sugarbaker, Edward Allen Levine, Olivier Glehen, Francois N. Gilly, Dominique Elias, Dario Baratti, Marcello Deraco, Armando Sardi, David L. Morris, Peritoneal Surface Oncology Group International; University of New South Wales, Sydney, Australia; NCG Pseudomyxoma Peritonei Centre, The North Hampshire Hospital, Basingstoke, United Kingdom; Washington Hospital Center, Washington, DC; Wake Forest School of Medicine, Winston-Salem, NC; Centre Hospitalo-Universitaire Lyon Sud, Lyon, France; Institut Gustave Roussy, Villejuif, France; Istituto Nazionale per la Cura e lo Studio dei Tumori , Milan, Italy; Mercy Medical Center, Baltimore, MD
Background: Pseudomyxoma peritonei (PMP) originating from an appendiceal mucinous neoplasm remains a biologically heterogeneous disease. The purpose of this study was to evaluate the outcome and long-term survival after cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) consolidated through an International Registry study.
Methods: A retrospective multi-institutional registry was established through collaborative efforts of participating units affiliated with the Peritoneal Surface Oncology Group International (PSOGI).
Results: 2298 patients from 16 specialized units underwent CRS for PMP. Treatment related mortality was 2% and major operative complication was 24%.
The median survival was 196 months (16.3 years) and the median progression-free survival was 98 months (8.2 years) with a 10- and 15-year survival rate of 63% and 59% respectively.
Multivariate analysis identified prior chemotherapy treatment (P<0.001), PMCA histopathological subtype (P<0.001), major postoperative complication (P=0.008), high PCI (P=0.013), debulking surgery (CCR2/3) (P<0.001), not using HIPEC (P=0.030) as independent predictors for a poorer progression-free survival.
Older age (P=0.006), major postoperative complication (P<0.001), debulking surgery (CCR2/3) (P<0.001), prior chemotherapy treatment (P=0.001) and PMCA histopathological subtype (P<0.001) were independent predictors of a poorer overall survival.
Conclusions: The combined modality strategy for PMP may be performed safely with acceptable morbidity and mortality in a specialized unit setting with 63% of patients surviving beyond 10-years. Minimizing non-definitive operative and systemic chemotherapy treatments prior to definitive cytoreduction may facilitate the feasibility and outcome of this therapy to achieve long-term survival. Optimal cytoreduction achieves the best outcomes.
Early and long-term outcome data on 2,298 patients with Pseudomyxoma Peritonei of appendiceal origin treated by a strategy of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC.)
This poster was presented by Terence C. Chua, BSc Med (Hons) MB BS at the 2012 Gastrointestinal Cancers Symposium on January 20.2012 Session Type and Session Title: General Poster Session C: Cancers of the Colon and Rectum Abstract No:532 Citation:J Clin Oncol 30, 2012 (suppl 4; abstr 532)
Author(s): Terence C. Chua, Brendan J. Moran, Paul H. Sugarbaker, Edward Allen Levine, Olivier Glehen, Francois N. Gilly, Dominique Elias, Dario Baratti, Marcello Deraco, Armando Sardi, David L. Morris, Peritoneal Surface Oncology Group International; University of New South Wales, Sydney, Australia; NCG Pseudomyxoma Peritonei Centre, The North Hampshire Hospital, Basingstoke, United Kingdom; Washington Hospital Center, Washington, DC; Wake Forest School of Medicine, Winston-Salem, NC; Centre Hospitalo-Universitaire Lyon Sud, Lyon, France; Institut Gustave Roussy, Villejuif, France; Istituto Nazionale per la Cura e lo Studio dei Tumori , Milan, Italy; Mercy Medical Center, Baltimore, MD
Background: Pseudomyxoma peritonei (PMP) originating from an appendiceal mucinous neoplasm remains a biologically heterogeneous disease. The purpose of this study was to evaluate the outcome and long-term survival after cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) consolidated through an International Registry study.
Methods: A retrospective multi-institutional registry was established through collaborative efforts of participating units affiliated with the Peritoneal Surface Oncology Group International (PSOGI).
Results: 2298 patients from 16 specialized units underwent CRS for PMP. Treatment related mortality was 2% and major operative complication was 24%.
The median survival was 196 months (16.3 years) and the median progression-free survival was 98 months (8.2 years) with a 10- and 15-year survival rate of 63% and 59% respectively.
Multivariate analysis identified prior chemotherapy treatment (P<0.001), PMCA histopathological subtype (P<0.001), major postoperative complication (P=0.008), high PCI (P=0.013), debulking surgery (CCR2/3) (P<0.001), not using HIPEC (P=0.030) as independent predictors for a poorer progression-free survival.
Older age (P=0.006), major postoperative complication (P<0.001), debulking surgery (CCR2/3) (P<0.001), prior chemotherapy treatment (P=0.001) and PMCA histopathological subtype (P<0.001) were independent predictors of a poorer overall survival.
Conclusions: The combined modality strategy for PMP may be performed safely with acceptable morbidity and mortality in a specialized unit setting with 63% of patients surviving beyond 10-years. Minimizing non-definitive operative and systemic chemotherapy treatments prior to definitive cytoreduction may facilitate the feasibility and outcome of this therapy to achieve long-term survival. Optimal cytoreduction achieves the best outcomes.
HIPEC: Clinical Trials
Dr David L Bartlett
HIPEC is Effective for the Treatment of Colorectal Cancer
Dr Paul Sugarbaker
Systematic Review on the Efficacy of Cytoreductive Surgery Combined With Perioperative Intraperitoneal Chemotherapy for Peritoneal Carcinomatosis From Colorectal Carcinoma
by Tristan D. Yan, Deborah Black, Renaldo Savady, Paul H. Sugarbaker
Sources: the Peritoneal Surface Malignancy Program, Washington Cancer Institute, Washington, DC; and the School of Public Health and Community Medicine, The University of New South Wales, Sydney, Australia
Address reprint requests to Paul H. Sugarbaker, MD, 106 Irving St, NW, Suite 3900N, Washington, DC, 20010
by Tristan D. Yan, Deborah Black, Renaldo Savady, Paul H. Sugarbaker
Sources: the Peritoneal Surface Malignancy Program, Washington Cancer Institute, Washington, DC; and the School of Public Health and Community Medicine, The University of New South Wales, Sydney, Australia
Address reprint requests to Paul H. Sugarbaker, MD, 106 Irving St, NW, Suite 3900N, Washington, DC, 20010
Is HIPEC Effective for the Treatment of Colorectal Cancer?
Dr David P Ryan
Cytoreductive Surgery and Hyperthermic Intraperitonal Chemotherapy: History Repeating Itself or a New Standard? By David P. Ryan, MD
Harvard Medical School, Boston, MA and Massachusetts General Hospital Cancer Center, Boston, MA.
© 2011 by American Society of Clinical Oncology. 1092-9118/10/1-10
Harvard Medical School, Boston, MA and Massachusetts General Hospital Cancer Center, Boston, MA.
© 2011 by American Society of Clinical Oncology. 1092-9118/10/1-10
Consult with a HIPEC Treatment Specialist
View HIPEC Treatment Videos
HIPEC Patient Profiles!
What is HIPEC?
HIPEC, or Hyperthermic intraperitoneal chemotherapy, provides specially trained surgeonswith the ability to apply heated chemotherapy directly within and throughout the peritoneal cavity, for the purpose of killing any hidden tumor cells that may not have been removed during CRS (cytoreductive surgery.) Regionally applied chemotherapy, or HIPEC, may increase the efficacy of cancer treatment, without causing significant toxicity to the remainder of the body. HIPEC has become a standard course of care for many appendiceal, colorectal and ovarian cancer cases, as well as for the treatment of Pseudomyxoma Peritonei and other Peritoneal Surface Malignancies (PSMs.) HIPEC includes the use of a heated sterile solution with chemotherapy continuously circulated throughout the abdominal cavity for approximately 90 minutes.
The chemotherapy(ies) (most commonly Mitomycin C or Mitomycin C plus Oxaliplatin) are heated to 40-42°C or 107.6°F for circulation within the abdominal cavity. Clinical studies have shown that these temperatures may increase the chemotherapy's therapeutic effect.The chemotherapy solution is circulated throughout the abdomen to kill any tumor cells that may remain after surgery.
HIPEC treatment provides surgeons with the ability to apply high doses of chemotherapy directly into the peritoneal cavity without significant toxicity to the remainder of the body. The effects of heat with regionally applied chemotherapy, may increase the efficacy of the treatment, with the goal of achieving a cure.The HIPEC treatment is applied directly following peritonectomy or CRS (cytoreductive surgery.)
HIPEC is also referred to as perfusion as it includes perfusion of the peritoneal cavity.
HIPEC may be included at the conclusion of the cytoreductive surgery for the treatment of appendix cancer, ovarian cancer pseudomyxoma peritonei and other peritoneal surface malignancies, if substantial tumor debulking is accomplished through CRS.
HIPEC may be administered when complete removal of visible tumor (or debulking) is achieved through cytoreductive surgery; it involves perfusion of the peritoneal cavity with chemotherapy heated to approximately 40 degrees Celsius.
HIPEC is administered with the infusion of heated chemotherapy during the last 90 minutes of the CRS procedure. Through HIPEC the surgeon(s) intend to destroy any residual tumor cells that may not have been surgically removed during the actual CRS surgery process.
HIPEC is a detailed medical process and should only be administered by qualified surgical oncologists. HIPEC is not a "hot chemo bath."
Each patient's case is unique. Most patients live productive and healthy lives following HIPEC.
How can I learn more about preparing for and recuperating from HIPEC?
Join the PMP Pals' Network HIPEC Pals' Resource Group today!
What is "regional perfusion?"
Regional perfusion refers to the localized perfusion of chemotherapy, ie when heated chemotherapy is infused directly into the abdomen, or peritoneal cavity, as it is for appendix cancer "PMP" patients, as opposed to systemic chemo, which circulates throughout the body.
Click on any of the following links to learn more about the HIPEC Treatment:
Pros and Cons of HIPEC: Need for Phase III Trials
Source: Oncology Times, January 2007
International Consensus of PSMG for CRS and HIPEC
Source: Springerlink, Oct 2006
AUSTRALIA
St George's Hospital, Sydney
Morbidity and Mortality: Study of HIPEC and CRS for Treatment of Peritoneal Carcinomatosis
Source: Annals of Surgery, Feb 2009, Dr David Morris, Dr Tristan Yan
BELGIUM
Dr Stefaan Mulier provides HIPEC treatment for Pseudomyxoma Peritonei and Peritoneal Carcinomatosis
Source: Leopold Park Clinic in Brussels
Dr Wim P Ceelen, MD, PhD, FACS treats Pseudomyxoma Peritonei with HIPEC www.surgery.ugent.be
CANADA
Treatment of Peritoneal Carcinomatosis
Source: Universite de Montreal, Canada, 2009
FRANCE
Treatment for Pseudomyxoma Peritonei
Source: Institut Gustave Roussy, Cedex 2008
GERMANY
Safety of Gastric Resection During Cytoreductive Surgery
Source: Annals of Surgical Oncology, 2009, Prof P Piso
Quality of life following surgery for Peritoneal Carcinomatosis
Source: Dr Pompiliu Piso, 2009
CRS and HIPEC for the Treatment of Peritoneal Carcinomatosis
Source: Prof Pompiliu Piso, 3rd Annual Symposium, 2008
CRS for Senior Patients
Source: Dr Herwart Mueller, Germany
Peritoneal Carcinomatosis
Source: University of Erlangen Nuremberg 2006
Improved Prognosis for Pseudomyxoma Peritonei and Appendix Cancer
Source: German Medical Science, 2006
Study with laboratory rats
Source: Deutscher Krebskongress, 2004
PHASE II STUDY FOR PERITONEAL CARCINOMATOSIS
Professor P Piso, in Regensburg, Germany provides a prospective, multicenter Phase II study evaluating multimodality treatment with pre- and postoperative systemic chemotherapy with FOLFOX/Cetuximab or FOLFIRI/ Cetuximab, complete cytoreductive surgery (CRS), and HIPEC in patients with diagnosed with Peritoneal Carcinomatosis.
For more information and to contribute to Prof Piso's research, contact him via:
Leitender Oberarzt
Klinik und Poliklinik für Chirurgie
der Universität Regensburg
Franz Josef Strauß Allee 11
D-93053 Regensburg
Tel.:0941-944-6809
Fax:0941-944-6860
Source: Dr Piso provided this information to the PMP Pals' Network.
GREECE
Antonios-Apostolos K Tentes, M.D. Director of the Surgical Department at the Didimotichon General Hospital in Didmotichon Greece is conducting several clinical trials including one focused on colorectal cancer and one focused on gastric cancer.
Colorectal Cancer: This study focuses on patients with colorectal cancer who have T3 and T4 tumors. The patients are randomly selected to undergo either surgery alone, or surgery combined with HIPEC, provided that R0 resection has been performed. The final goal of the study is compare the survival rates between these two groups of patients.
Gastric Cancer: This study includes patients with T3 and T4 tumors. The patients undergo D2 gastrectomies and receive HIPEC.
No further treatment is required. The goal of this study is to identify the survival and recurrence rates.
For more information, contact:
Dr Atonios-Apostolos K Tentes
Didimotichon General Hospital
Didimotichon, 68300, Greece
ITALY
Twelve year study of Pseudomyxoma Peritonei Treatment with CRS and HIPEC
Source: San Giuseppe Hospital, June 2009
Prognosis for Pseudomyxoma Peritonei following surgery
Source: NCI, Milan, Italy 2009
Prognosis for Pseudomyxoma Peritonei evaluating tumor markers following surgery
HIPEC Treatment: Dott. Marcello Deraco: Pseudomyxoma Peritonei and Appendix Cancer
Source: Dott. Marcello Deraco
JAPAN
Treatment of Appendix Cancer and Pseudomyxoma Peritonei
Source: Pub Med 2009
NEDERLAND/HOLLAND
Peritoneal Carcinomatosis, Peritoneal Carcinomatosis and Appendix Cancer in Holland
Cytoreduction and HIPEC Treatment for Appendix Cancer and Pseudomyxoma Peritonei (pdf)
Source: Netherlands Cancer Institute, Prof VJ Verwaal, 2006
USA
HIPEC: UPMC Koch Cancer Treatment Center Pgh PA
Source: UPMC Koch Cancer Treatment Center
HIPEC: The Complexity of Clinical Trials
Source: Dr David L Bartlett, UPMC, Society of Surgical Oncology 2008
CRS and HIPEC for Treatment of Colorectal Carcinomatosis
Source: Annals of Surgial Oncology, Nov 2008
CRS and HIPEC for Treatment of Peritoneal Carcinomatosis
Source: Annuals of Surgical Oncology, 2008
Treatment and Definition for the Treatment of Pseudomyxoma Peritonei and Appendix Cancer
Source: University of Maryland
Dr Martin Goodman provides HIPEC
Source: Tufts, Boston
Dr Perry Shen: Pseudomyxoma Peritonei and Appendix Cancer Treatment
Source: Dr Perry Shen, WFU
DPAM and and HIPEC Treatment
Source: Wake Forest University
Dr David L Bartlett; HIPEC Complexity
Source: Society of Surgical Oncology
Koch Cancer Center (Drs David L Bartlett, James Pingpank, Matthew Holtzman, S. Ahrendt)
Source: UPMC Koch Cancer Center
Dr Martin Goodman:Pseudomyxoma Peritonei and Appendix Cancer Treatment
Source: Tufts 2009
Dr Andrew Lowy: Pseudomyxoma Peritonei and Appendix Cancer
http://health.ucsd.edu/cancer/patcare/gastro/appendiceal/
Dr Jesus Esquivel: HIPEC Treatment
HIPEC Treatment with Graphic Description
Source:Dr Jesus Esquivel HIPEC.org
Dr Jesus Esquivel: Pseudomyxoma Peritonei and Appendix Cancer Treatment
Source: Dr Jesus Esquivel, St Agnes
Pros and Cons of HIPEC: Dr Jesus Esquivel
Source: Oncology Times, Jan 2007
Laparoscopic Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy in Patients with Limited Peritoneal Surface Malignancies: Feasibility, Morbidity and Outcome in an Early Experience.
Laparoscopic CRS and HIPEC in Patients with Limited PSMs
Source: Esquivel J, Averbach A, Chua TC St. Agnes Hospital, Baltimore, Maryland.
Ann Surg. 2011 Jan 6.
Dr Armando Sardi:CRS and HIPEC offer longterm survival for Peritoneal Carcinomatosis of disseminated Appendiceal tumor origin
Source: Dr Armando Sardi, Mercy Med Center, Journal of American College of Surgeons, Sept 2009
Dr Paul Sugarbaker evaluates perioperative chemotherapy agents for treatment of Pseudomyxoma Peritonei
Source: The Oncolgist, Feb 2005
ASCO Summaries for post op prognosis of Pseudomyxoma Peritonei
Source: ASCO
Phase I Study for Appendix Cancer
Source: NIC and WFU, 2009
HIPEC for Pseudomyxoma Peritonei and Peritoneal Carcinomatosis Treatment
Surgery with HIPEC (pdf)
HIPEC, General Interest for Appendix Cancer, Peritoneal Carcinomatosis and Pseudomyxoma Peritonei Patients
Terumo Medical Corporation
Manufacturerer of HIPEC perfusion equipment
INTERNATIONAL PANEL for HIPEC TREATMENT
Pros and Cons of HIPEC: Need for Phase III Trials
Source: Oncology Times, January 2007
International Consensus of PSMG for CRS and HIPEC
Source: Springerlink, Oct 2006
Articles and Abstracts by HIPEC Treatment Specialists
AUSTRALIA
St George's Hospital, Sydney
Morbidity and Mortality: Study of HIPEC and CRS for Treatment of Peritoneal Carcinomatosis
Source: Annals of Surgery, Feb 2009, Dr David Morris, Dr Tristan Yan
BELGIUM
Dr Stefaan Mulier provides HIPEC treatment for Pseudomyxoma Peritonei and Peritoneal Carcinomatosis
Source: Leopold Park Clinic in Brussels
Dr Wim P Ceelen, MD, PhD, FACS treats Pseudomyxoma Peritonei with HIPEC www.surgery.ugent.be
CANADA
Treatment of Peritoneal Carcinomatosis
Source: Universite de Montreal, Canada, 2009
FRANCE
Treatment for Pseudomyxoma Peritonei
Source: Institut Gustave Roussy, Cedex 2008
GERMANY
Safety of Gastric Resection During Cytoreductive Surgery
Source: Annals of Surgical Oncology, 2009, Prof P Piso
Quality of life following surgery for Peritoneal Carcinomatosis
Source: Dr Pompiliu Piso, 2009
CRS and HIPEC for the Treatment of Peritoneal Carcinomatosis
Source: Prof Pompiliu Piso, 3rd Annual Symposium, 2008
CRS for Senior Patients
Source: Dr Herwart Mueller, Germany
Peritoneal Carcinomatosis
Source: University of Erlangen Nuremberg 2006
Improved Prognosis for Pseudomyxoma Peritonei and Appendix Cancer
Source: German Medical Science, 2006
Study with laboratory rats
Source: Deutscher Krebskongress, 2004
PHASE II STUDY FOR PERITONEAL CARCINOMATOSIS
Professor P Piso, in Regensburg, Germany provides a prospective, multicenter Phase II study evaluating multimodality treatment with pre- and postoperative systemic chemotherapy with FOLFOX/Cetuximab or FOLFIRI/ Cetuximab, complete cytoreductive surgery (CRS), and HIPEC in patients with diagnosed with Peritoneal Carcinomatosis.
For more information and to contribute to Prof Piso's research, contact him via:
Leitender Oberarzt
Klinik und Poliklinik für Chirurgie
der Universität Regensburg
Franz Josef Strauß Allee 11
D-93053 Regensburg
Tel.:0941-944-6809
Fax:0941-944-6860
Source: Dr Piso provided this information to the PMP Pals' Network
GREECE
Antonios-Apostolos K Tentes, M.D. Director of the Surgical Department at the Didimotichon General Hospital in Didmotichon Greece is conducting several clinical trials including one focused on colorectal cancer and one focused on gastric cancer.
Colorectal Cancer: This study focuses on patients with colorectal cancer who have T3 and T4 tumors. The patients are randomly selected to undergo either surgery alone, or surgery combined with HIPEC, provided that R0 resection has been performed. The final goal of the study is compare the survival rates between these two groups of patients.
Gastric Cancer: This study includes patients with T3 and T4 tumors. The patients undergo D2 gastrectomies and receive HIPEC. No further treatment is required. The goal of this study is to identify the survival and recurrence rates.
For more information, contact:
Dr Atonios-Apostolos K Tentes
Didimotichon General Hospital
Didimotichon, 68300, Greece
ITALY
Twelve year study of Pseudomyxoma Peritonei Treatment with CRS and HIPEC
Source: San Giuseppe Hospital, June 2009
Prognosis for Pseudomyxoma Peritonei following surgery
Source: NCI, Milan, Italy 2009
Prognosis for Pseudomyxoma Peritonei evaluating tumor markers following surgery
HIPEC Treatment: Dott. Marcello Deraco: Pseudomyxoma Peritonei and Appendix Cancer
Source: Dott. Marcello Deraco
JAPAN
Treatment of Appendix Cancer and Pseudomyxoma Peritonei
Source: Pub Med 2009
NEDERLAND/HOLLAND
Peritoneal Carcinomatosis, Peritoneal Carcinomatosis and Appendix Cancer in Holland
Cytoreduction and HIPEC Treatment for Appendix Cancer and Pseudomyxoma Peritonei (pdf)
Source: Netherlands Cancer Institute, Prof VJ Verwaal, 2006
USA
HIPEC: UPMC Koch Cancer Treatment Center Pgh PA
Source: UPMC Koch Cancer Treatment Center
HIPEC: The Complexity of Clinical Trials
Source: Dr David L Bartlett, UPMC, Society of Surgical Oncology 2008
CRS and HIPEC for Treatment of Colorectal Carcinomatosis
Source: Annals of Surgial Oncology, Nov 2008
CRS and HIPEC for Treatment of Peritoneal Carcinomatosis
Source: Annuals of Surgical Oncology, 2008
Treatment and Definition for the Treatment of Pseudomyxoma Peritonei and Appendix Cancer
Source: University of Maryland
Dr Martin Goodman provides HIPEC
Source: Tufts, Boston
Dr Perry Shen: Pseudomyxoma Peritonei and Appendix Cancer Treatment
Source: Dr Perry Shen, WFU
DPAM and and HIPEC Treatment
Source: Wake Forest University
Dr David L Bartlett; HIPEC Complexity
Source: Society of Surgical Oncology
Koch Cancer Center (Drs David L Bartlett, James Pingpank, Matthew Holtzman, S. Ahrendt)
Source: UPMC Koch Cancer Center
Dr Martin Goodman:Pseudomyxoma Peritonei and Appendix Cancer Treatment
Source: Tufts 2009
Dr Andrew Lowy: Pseudomyxoma Peritonei andAppendix Cancer
http://health.ucsd.edu/cancer/patcare/gastro/appendiceal/
Dr Jesus Esquivel: HIPEC Treatment
HIPEC Treatment with Graph Description
Source:Dr Jesus Esquivel HIPEC.org
Dr Jesus Esquivel:Pseudomyxoma Peritonei and Appendix Cancer Treatment
Source: Dr Jesus Esquivel, St Agnes
Pros and Cons of HIPEC: Dr Jesus Esquivel
Source: Oncology Times, Jan 2007
Dr Armando Sardi:CRS and HIPEC offer longterm survival for Peritoneal Carcinomatosis of disseminated Appendiceal tumor origin
Source: Dr Armando Sardi, Mercy Med Center, Journal of American College of Surgeons, Sept 2009
Dr Paul Sugarbaker evaluates perioperative chemotherapy agents for treatment of Pseudomyxoma Peritonei
Source: The Oncolgist, Feb 2005
ASCO Summaries for post op prognosis of Pseudomyxoma Peritonei
Source: ASCO
Phase I Study for Appendix Cancer
Source: NIC and WFU, 2009
HIPEC for Pseudomyxoma Peritonei and Peritoneal Carcinomatosis Treatment
Surgery with HIPEC (pdf)
HIPEC Treatment for Pediatric Patients
Source: MD Anderson, February 2011
Laparoscopic CRS and HIPEC
Laparoscopic Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy in Patients with Limited Peritoneal Surface Malignancies: Feasibility, Morbidity and Outcome in an Early Experience.
Laparoscopic CRS and HIPEC in Patients with Limited PSMs
Source: Esquivel J, Averbach A, Chua TC St. Agnes Hospital, Baltimore, Maryland.
Ann Surg. 2011 Jan 6. [Epub ahead of print]
Abstract
INTRODUCTION: Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) are being widely used in the treatment of patients with peritoneal surface malignancies. The open procedure has been associated with high grade III and IV morbidity and prolonged hospitalization.
METHODS: Patients with peritoneal surface malignancies and no gross evidence of carcinomatosis on the computed tomographic scan were enrolled to undergo laparoscopic CRS and HIPEC. We aimed to assess the feasibility, safety, and outcome of this procedure. Postoperative complications were reported according to the National Cancer Institute Common Toxicity Criteria.
RESULTS: From October 2008 to January 2010, 14 patients were enrolled into the protocol. Amongst these 14 patients, one patient was found with extensive carcinomatosis at the time of laparoscopy and had no surgical procedure. Thirteen patients had a complete cytoreduction and HIPEC, 10 (77%) laparoscopically and 3 (23%) were converted to an open procedure. There was one grade 3 morbidity (10%) and one patient (10%) in the laparoscopy group experienced a grade 4 complication, needing a reoperation for an internal hernia. Mean length of hospital stay was 6 days for those completed laparoscopically, 8 days for those converted to an open procedure and 8 days for a matched cohort of patients with an upfront open procedure.
CONCLUSIONS: This initial investigative stage demonstrates the feasibility and safety of cytoreductive surgery and HIPEC via the laparoscopic route in selected patients with low-tumor volume and no small bowel involvement mainly from appendiceal malignancies. Longer follow-up and additional studies are required to evaluate its long-term efficacy.
PMID: 21217512 [PubMed - as supplied by publisher]
Learning Curve for CRS and HIPEC in Treating PSMs
Multidimensional Analysis of Learning Curve for Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy in Peritoneal Surface Malignancies
Kusamura, Shigeki MD, PhD; Baratti, Dario MD; Deraco, Marcello MD
Abstract
Objective: To evaluate the learning curve of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in treating peritoneal surface malignancies (PSM).
Summary and Background: CRS and HIPEC to treat PSM is a complex procedure with a significant morbidity. A long-lasting training program is required to acquire expertise in this type of operation.
Methods: We performed CRS using peritonectomy procedures. HIPEC through the closed abdomen technique employed cisplatin and mitomycin-C or cisplatin and doxorubicin. Risk-adjusted sequential probability ratio test was used to assess the learning curve on a series of 420 cases of PSM on the basis of rates of incomplete cytoreduction and G3-5 morbidity (NCI-CTCAE v3). We determined control limits setting the type I/II error rates and unacceptable odds ratios (ORs) for the outcomes being studied. We performed the risk adjustment using logistic regression model.
Results: Rates of incomplete cytoreduction, G3-5 morbidity, and postoperative mortality rates were 10.2%, 28.5%, and 2.1%, respectively. The risk-adjusted sequential probability ratio test curve crossed the lower control limit at the 137th and 149th case, respectively, for incomplete cytoreduction and G3-5 morbidity. At those points, the actual ORs are lower than the prespecified ORs for outcomes being studied. Therefore, we estimated that approximately 140 cases are necessary to ensure surgical proficiency in CRS and HIPEC.
Conclusions: CRS and HIPEC to treat PSM has a steep learning curve requiring 140 procedures to acquire expertise.
Annals of Surgery:
POST AUTHOR CORRECTIONS, 26 December 2011
doi: 10.1097/SLA.0b013e3182436c28
Original Article: PDF Only (C) 2011 Lippincott Williams & Wilkins, Inc.
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Health Insurance and HIPEC
Health Insurance Coverage for HIPEC
Appeals for Insurance Denials
Insurance and Appeals assistance for HIPEC coverage of payment
Source: ThermaSolutions, Inc.
Medicare "code" for HIPEC treatment: 96445
How to Appeal a Denial from your Health Insurance Provider (including denials for HIPEC treatment)
HIPEC for OB/GYN
HIPEC: Intraoperative HIPEC Treatment w/Cisplatin for Peritoneal Carcinomatosis of Ovarian Origin
HIPEC: Ovarian Cancer
The Role of Hyperthermic Intraperitoneal Chemotherapy (HIPEC) in Ovarian Cancer
Source: The Oncologist C. William Helm MD
HIPEC: Ovarian Cancer
The Role of Hyperthermic Intraperitoneal Chemotherapy (HIPEC) in Ovarian Cancer
Source: The Oncologist C. William Helm MD
Successful Pregnancies post CRS with HIPEC!
Childbearing After Hyperthermic Intraperitoneal Chemotherapy:
Results From an International Survey.
Ortega-Deballon P, Glehen O, Levine E, Piso P, Sugarbaker PH, Hayes-Jordan A, Facy A, Bakrin N, Rat P.
Abstract
BACKGROUND: Cytoreductive surgery (CRS) and heated intraperitoneal chemotherapy (HIPEC) can improve survival in selected patients with primary or secondary peritoneal malignancies. With the opportunity for long-term survival, questions about the impact of those procedures in fertility in women of childbearing age can be raised.
MATERIALS AND METHODS: An international survey was performed among all teams participating in the International Peritoneal Surface Malignancy Group in order to collect data about pregnancies and their outcome in women having undergone previous CRS with adjuvant HIPEC.
RESULTS: There were 7 pregnancies reported after CRS and HIPEC in women treated for peritoneal malignancies. All these women conceived spontaneously, most of them within 2 years after the procedure. They delivered most often by vaginal way after an uneventful pregnancy. Their newborns were healthy, except 1 case of congenital diaphragmatic hernia requiring emergent surgery. There were 2 additional uneventful pregnancies reported after the diagnosis of pseudomyxoma peritonei and before CRS and HIPEC, with the support of the medical team. Another woman having undergone oocytes retrieval and embryo cryopreservation prior to the surgery was mother of twins after the procedure via a surrogate mother.
CONCLUSION: Childbearing after cytoreductive surgery and heated intraperitoneal chemotherapy is possible in women conserving their genital organs after the procedure. The question of fertility should be considered and discussed in women in reproductive age prior to cytoreductive surgery and heated intraperitoneal chemotherapy. Different options could be offered in this setting. Multidisciplinary decision making involving surgical oncologists and fertility specialists is important.
Annals of Surgical Oncology 2011 Feb 11
HIPEC: Ovarian and Abdominal Cancers
Source: St Lukes/Roosevelt Courtesy of ABC 7
HIPEC: Intraperitoneal Hyperthermic Perfusion
Source: National Cancer Institute of Milan, Italy
HIPEC en Espanol
Quimoioterapia Intraperitoneal Hipertermica (HIPEC en Espanol)
Los pacientes susceptibles de ser tratados con HIPEC incluyen :
• Cáncer del Apéndice
• Cáncer de Colon
• Cáncer Gástrico.
• Cáncer de Ovario
• Mesotelioma Peritoneal y
• Pseudomyxoma Peritoneal
2011 HIPEC Symposium, Toluca Mexico
"Ultraradical" Surgery and HIPEC for Colorectal Cancer
Ultraradical Surgery and heated chemotherapy HIPEC as multimodal treatment for advanced colorectal cancer
Author(s): S. Nikolic, M. Zegarac, M. Buta, A. Martinovic, I. Djurisic; Institute for Oncology and Radiology of Serbia, Belgrade, Serbia and Montenegro; Institute for Oncology and Radiology of Serbia, Belgrade, Serbia
Source: ASCO, 2011
Conclusions: Ultraradical surgery combined with HIPEC prolongs patient's survival and is considered to be a safe procedure if performed by the experience team of oncological surgeons.
Legal and Safety Considerations for HIPEC Administration
Legal and Safety Considerations of Administering HIPEC, Risk/Benefit Analysis for HIPEC, Morbidity-Mortality, Protection of Medical Personell During Administration of HIPEC, Biohazard Management of HIPEC, OSHA, NOSH, Certification
Source: Centre Hospitalier Lyon Sud, Pierre Benite, France, 2008
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