board write 게시판
Title Treatment of Peritoneal Metastasis of Cancer by HIPEC
Date 2017.08.28 Link

Severe peritoneal metastasis of cancer is treated by HIPEC for the first time in Incheon…2-year survival rate is improved by 2.5 times.

<Peritoneal Surface Malignancy & Recurrent Cancer Clinic opened in Gil Medical Center. Killing Cancer Cells with high temperature.>

A businessman Mr. Kim (age 72) was diagnosed with 3rd stage colon cancer 3 years ago. Cancer cells were already invading large part of his colon. Surgery was not possible at that time, so chemotherapy was started. After several cycles of the chemotherapy, cancer cells were reduced in size, and surgery was finally performed. Cancer cells in large intestine and some part of the colon was removed. The surgery itself was successful, but cancer cells were found near the peritoneal area after two years. He visited Peritoneal Surface Malignancy & Recurrent Cancer Clinic of Gil Medical Center.

“Metastatic peritoneal cancer is a very complicated type of cancer with short survival time and poor prognosis compared to metastatic cancer to liver or lungs” said professor Lee, Won Seok, department of Surgery. “Recently, treatment for peritoneal metastasis has been studied a lot. First, remove the visible cancer cells, and you can use hyperthermic intraperitoneal chemotherapy (HIPEC) during the surgery, which increases survival rate of patient” said professor Lee.

Like Mr. Kim, peritoneal metastasis occurs fairly frequently; it occurs in 10-15% of colon cancer diagnosis and in 25% to 35% of cases after resection. The next most common case is hepatic metastasis. Whereas the 5-year survival rate with hepatic or lung metastasis is between 30% and 35%, peritoneal metastasis survival rate is much worse, about 5 to 7 months. Therefore, the peritoneal metastasis is considered to be the end-stage cancer with no treatment. Nowadays, injecting chemo drugs with newly developed ones was tried, but its effect was not so therapeutic.

◆ HIPEC, increases life expectancy of peritoneal metastasis

Recently, Peritoneal Surface Malignancy & Recurrent Cancer Clinic was opened for the first time in Gil Medical Center.

This clinic is located on the 2nd floor of Main Building, and consists of more than 10 medical specialists as multidisciplinary team, including chemotherapy, radiology, surgery, nuclear medicine, anesthesiology as well as oncology nurse coordinators. With their teamwork and infrastructure, they are doing their best to treat peritoneal metastasis by tumor resection and HIPEC (hyperthermic intraperitoneal chemotherapy) procedure.

Peritoneal metastasis is complicated to treat because curative resection of cancer cells is not possible. Instead, other methods are being used, such as steroids, puncture of ascites or surgical bypass.

Recently, different kinds of chemo drugs have been developed and used, but the therapeutic effect is minimal. Since there is little vascularization in peritoneal metastasis, chemo drugs cannot reach cancer cells via blood vessel. For this reason, chemo drugs are rather used to remove metastatic cancer cells in whole body.

Peritoneal Surface Malignancy & Recurrent Cancer Clinic of Gil Medical Center introduced the latest HIPEC procedure to maximize prognosis. Professor Lee said ”Many specialists regard peritoneal metastasis as end-stage cancer with no further intervention. Using HIPEC for peritoneal metastasis could definitely increase the patient’s life expectancy”.

Median survival time of those who received HIPEC treatment has been increased from 12.6 months to 22.3 months, and 2-year survival rate was reported to be increased from 16% to 43%.

◆ HIPEC, Improving the transmittance of chemo drugs for peritoneal metastasis.

Using common chemo drugs for peritoneal metastasis is not effective due to lack of blood vessels in cancer cells.

Yet, HIPEC procedure can maximize therapeutic effects of chemo drugs. It is known that concentration of chemo drugs is increased up to 25 times more with HIPEC procedure after injecting chemo drugs into cancer areas.

Using HIPEC increases temperature of lesion area up to 40 ~ 43 Celsius. During this time, cell membrane change occurs, and transmittance of blood vessels rises, raising the concentration of chemo drugs. This procedure is done by inserting heated chemo drugs to inside abdominal cavity for about 90 minutes to destroy cancer cells before closing the surgical incision.

Special equipment is needed for applying HIPEC under general anesthesia. So Gil Medical Center introduced HIPEC equipment.

Professor Lee said “HIPEC uses the characteristic of cancer cells that they are vulnerable to high temperature. After surgical resection, we can destroy more cancer cells. Recent multiple research shows HIPEC increases the survival rate and life quality of patients with peritoneal metastasis”.

◆ Frequent occurrence of peritoneal metastasis in colon cancer patients

Colon cancer often leads to peritoneal metastasis.

After colon cancer treatment, peritoneal metastasis occurs in 25-35 % of all cancer recurrence cases. Reason is unknown, but it is assumed that colon cancer cells penetrate intestinal walls and sown on peritoneum. Other possible cause is that colon cancer cells circulate in blood vessels and stick to peritoneum.

Frequency of this disease is 3 times higher in men than women. It mainly occurs after age of 40.

Major symptoms are abdominal bloating and occasional abdominal pain. Moreover, other unknown gastrointestinal symptoms and weight loss lasting over a few months can also occur.

“It is not easy to detect peritoneal metastasis early. After colon cancer treatment, regular and constant monitoring and tests should be done for prompt treatment in case peritoneal metastasis is suspected.” said professor Lee.