Clinical Perspectives

Second Cytoreductive Surgery/HIPEC Found to Provide Significant Benefit

November 23, 2013

hipec-web.jpg Hyperthermic intraperitoneal chemotherapy

Mesothelioma patients could benefit significantly from a second round of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC). According to a study conducted at Moffitt Cancer Center and reported in the Annals of Surgical Oncology, those mesothelioma patients who have undergone a second combination cytoreductive surgery and hyperthermic intraperitoneal chemotherapy procedure show a significantly better survival rate than those who only undergo the procedure one time.

The study has revealed that for those mesothelioma patients who have the procedure twice, the survival advantage can be as much as three times that of those who did not undergo the second procedure.

One of the researchers involved in the study is enthusiastic but still cautious. Surgical oncologist Sophie Dessureault, MD said, “I don’t think you can definitively say it’s the way to go for everyone. The sample was small, and there are many variables, but the study suggests this might be a patient’s best option. It’s definitely something to look at.”

The procedure involves a debulking surgery that removes as many of the mesothelioma cancer cells as possible throughout the abdominal area. The subsequent HIPEC involves the rinsing or bathing of the entire internal area with a heated, chemotherapy-based solution designed to kill any remaining cancer cells. The solution circulates in the abdomen for almost two hours before it is drained, and the patient leaves the operating room.

The surgery/HIPEC combination has become popular with a handful of specialists treating peritoneal mesothelioma, a rare but aggressive cancer that is diagnosed in an estimated 1,000 Americans annually. Moffitt is one of a select group of cancer centers equipped to perform the HIPEC.

The study involved 29 peritoneal patients who were at Moffitt from June 2004 to March 2012. All but three patients underwent the HIPEC and cytoreductive surgery. Eight of the patients who had both procedures returned for a second, very similar treatment after new growth of the tumors emerged.

The median survival rate for all 29 patients was 41 months. Those who stopped after one debulking/HIPEC procedure had a median survival of 27.2 months. While the median survival rate for the eight who returned for at least a second procedure was 80 months.

“This was a little surprising,” Dessureault said. “What we found was the further out from the first procedure, the more likely it would work with a second. If you’re 3, 4, or 5 years down the road from the first, you’ll very likely benefit from a repeat.”

Patients typically do not get a second round of debulking/HIPEC if the mesothelioma recurrence comes within 18 months after the first surgery. They usually are offered standard systemic chemotherapy. If the recurrence comes after 18 months, the option of a second debulking and HIPEC is considered. It is thought that this direct application of chemotherapy not only is more effective but also eliminates many of the negative side effects that accompany systemic administration of the medication.

The survival numbers could be misleading because only the healthiest patients are eligible for surgery, especially with a second round of surgery.

“This was not a final-answer study,” Dessureault said. “But there is something to it that warrants further research. It tells us that maybe we’re onto something here. It’s something you talk to the patient about, that maybe it might be a good option.”