Hyperthermic intraperitoneal chemotherapy (HIPEC) Program

Hyperthermic (or heated) intraperitoneal chemotherapy, called HIPEC for short, is a treatment for cancers that begin in or have spread to the thin layer of tissue that lines the abdomen and abdominal organs known as the peritoneum. After a surgeon removes all visible tumors from the abdominal (peritoneal) cavity in a procedure called cytoreductive surgery (CRS), heated chemotherapy drugs are pumped into the abdomen where they bathe abdominal tissues for about 90 minutes before being drained and rinsed from the abdominal cavity. In many cases, the goal of the treatment is to cure patients of cancer by killing any cancer cells that remain after cytoreductive surgery.

HIPEC is used to treat cancers in the peritoneum, including those that have spread—or metastasized—from the gastrointestinal tract, colon, appendix, and ovaries, among other organs, as well as cancerous tumors that started in the peritoneum.

Cancer that originates in the peritoneum is very rare. However, each year, around 60,000 people in the United States are diagnosed with metastatic cancer that has spread to the peritoneum from elsewhere in the body. People with these cancers often experience debilitating symptoms, including abdominal and back pain, nausea, constipation, and fatigue, and can have a poor prognosis.

However, HIPEC, combined with cytoreductive surgery, can improve the outlook for many people with these types of cancers, helping them live longer and with an improved quality of life. For some people, HIPEC can result in a long-term cure. In other cases, with HIPEC, doctors can manage incurable cancers as chronic illnesses rather than as terminal diseases.

The benefits of HIPEC include: 

• HIPEC delivers a concentrated and targeted dose of chemotherapy. In HIPEC, highly concentrated chemotherapy is delivered directly to the inner lining of the abdomen, where it comes into contact with and kills cancer cells. By contrast, traditional chemotherapy is a “systemic” treatment: It is infused into the blood and reaches cancer cells by traveling through blood vessels. Unfortunately, traditional systemic chemotherapy is often ineffective in treating cancers in the peritoneum. This is due, in part, to the peritoneal-blood barrier, which obstructs the delivery of chemotherapy.
• Fewer side effects. Conventional systemic chemotherapy is delivered to cells throughout the body. It kills cancer cells but can also kill healthy cells, resulting in a range of side effects. Although this is also true of the chemotherapy drugs used in HIPEC, the side effects are minimized because the peritoneal-blood barrier lowers the amount of chemotherapy that gets absorbed into the bloodstream and transported to cells around the body.
• Improved effectiveness of chemotherapy. HIPEC uses chemotherapy drugs heated to 108° F (42° C). Heating chemotherapy drugs improves their ability to penetrate tissue because the high temperatures expand blood vessels and can increase their effectiveness in killing cancer cells. The heat itself can also kill cancer cells and may make them more susceptible to the chemotherapy.

Despite its benefits, HIPEC may not be suitable for all patients. Patient selection is crucial, and our multidisciplinary team of medical oncologists, surgical oncologists, and interventional radiologists collaborate to determine the most appropriate candidates for this treatment.