Disease Definition
Hot chemotherapy is the application of heated chemotherapy solution to the abdominal cavity of a patient with cancer that has spread to the peritoneal cavity. The heated chemotherapy solution is administered into the patient's abdominal cavity after cytoreductive surgery. Successful results are obtained in certain types of cancer with hot chemotherapy. Hot chemotherapy (HIPEC) is applied together with cytoreductive surgery.
Some of the cancer types with successful results with cytoreductive surgery and hot chemotherapy are:
Appendix Cancers (Appendix mucinous adenocarcinoma)
Peritoneal Mesothelioma (inner membrane tumor)
Colorectal Cancers (Large intestine/small intestine cancers) )
Ovarian Cancer
Neuroendocrine tumors
Gastric cancer
Other cancers related to the digestive system
These types of cancer sometimes spread to the peritoneum and other organs. In these cases, neither surgery nor chemotherapy alone can be effective. Hot chemotherapy combined with cytoreductive surgery is a new and effective treatment approach against such difficult-to-treat cancers. The first step in cytoreductive surgery/hot chemotherapy surgery is to remove all visible cancer from the body. (Cytoreductive surgery aims to reduce the number of cancer cells in the body.)
Cytoreductive Surgery
Surgery for advanced ovarian, primary peritoneal cancer, colon cancer, and stomach cancer The intervention approach has evolved from tumor removal surgeries to more extensive surgical procedures. The aim of this surgery is to remove all visible tumors affecting the protective membrane of the abdomen. Cytoreductive surgery is a complex procedure, can take quite a long time, and only an experienced specialist can perform this procedure effectively. In cytoreductive surgery, the surgeon removes tumors using an electrosurgical instrument called a handpiece. This tool burns diseased tissue with the intense heat it generates using high-voltage electricity. These complex procedures, which require parts from many organs, are often They take a long time and require a surgeon with advanced knowledge of abdominal anatomy.
Hot Chemotherapy
After all visible cancer is removed, the surrounding organs are heated and It is washed with a high-concentration chemotherapy drug applied during the surgery as a one-time application. Studies show that this particular type of chemotherapy is effective against microscopic cancer that cannot be removed by cytoreductive surgery. In some patients, this approach may eliminate the need for a lengthy and arduous process of conventional chemotherapy.
Are You an Appropriate Candidate for Hot Chemotherapy?
The best candidates for hot chemotherapy are the following diagnoses: are people who have someone who has:
Appendix cancer
Cancer of the large intestine
Desmoplastic small round cell tumors (usually seen in adolescents and young adults)
Malignant ascites
Mesothelioma (inner membrane) uru)
Ovarian cancer
Carcinoma of the peritoneum
Stomach cancer
Other cancers in the advanced stage of the abdomen
Hot chemotherapy is a long-term treatment for abdominal cancers in some patients. In other cases, hot chemotherapy allows doctors to treat incurable cancers as if they were chronic rather than terminal diseases. Hot chemotherapy is not suitable in the following cases:
Conditions where treatment is not strictly appropriate
ECOG performance status greater than 2
Cancers that cannot be surgically removed by imaging
Cancers that have spread beyond the abdomen
Comprehensive concomitant diseases that prevent surgeries (kidney failure, heart disease, COPD and others)
PCI Index (Too high intra-abdominal spread scoring)
INCREASE EXPECTED LIFE!
Hot Chemotherapy Procedure
Although it differs to a certain extent depending on the doctor and treatment centre, the general concept of the operation may be time is the same. The procedure has two phases: Surgical intervention and hot chemotherapy bath.
• Phase: Surgery
First of all, the tumor is removed from the body as much as possible by cytoreductive surgery. The procedure may involve a wide variety of surgical techniques aimed at clearing the abdominal cavity of all visible elements of cancer. Hot chemotherapy is not effective when applied without surgery because chemotherapy drugs cannot reach deep into tumors. Cytoreductive surgery is a very challenging operation for the surgeon because the cancer can combine to form thousands of small tumors that cover the entire peritoneum. In some cases, it may not be possible to completely clear the tumors and so you may need to consider other treatment options. These cells pose a serious risk of the cancer returning. For this reason, these cells are targeted with heated chemotherapy drugs immediately after surgery. The aim is to destroy as many cancer cells as possible that cannot be removed by surgery, to prolong life expectancy and to prevent the cancer from returning. As soon as the surgical procedure is finished, plastic tubes called catheters are placed in the abdominal cavity. The tubes are then connected to the perfusion system (an advanced machine that heats the chemotherapy solution, pumps it into the body, and collects it back). In addition, special probes are placed to monitor the temperature of the solution inside the body. After all tubes and probes are in place, the incision is closed with sutures or skin staples. Then the perfusion system is started. The perfusion system continuously delivers the salt solution into the abdominal cavity and begins to collect it back. As the solution passes through the machine, it is raised to the desired temperature (between 40.5 degrees and 43 degrees Celsius). Cancer cells begin to die at 40 degrees, while normal cells can withstand up to 44 degrees. When the solution reaches the correct temperature, 1 or more chemotherapy drugs are added to the solution. While the medicine mixes with the solution and fills the abdominal cavity, the doctor massages the patient's abdomen with his hand. This ensures that the solution is fully mixed and that the cancer-killing drugs can be treated microscopically. It helps the cells to reach every tissue surface where they can be accommodated. Chemotherapy drugs are circulated between the patient's abdominal cavity and the machine for a certain period of time. Although some studies have seen 2-hour applications, doctors usually do not do this application for more than 1 hour. When the chemotherapy bath is complete, the medicated solution is withdrawn from the body. The abdominal cavity is then washed with a drug-free saline solution. Finally, the surgeon reopens the incision, removes the tubes and probes, then closes the incision one last time. The entire procedure, including cytoreductive surgery and hot chemotherapy, can take between 6 and 18 hours (as the duration of the surgical procedure varies from case to case). The longer the cancer has spread in the abdomen, the longer the operation takes.
After the ProcedureThe average length of stay in the hospital following the hot chemotherapy operation is 10-12 days. Fatigue is common after surgery, but it is important to stay active to prevent complications such as clot formation. Recovery after surgery takes several months. Your surgeon will brief you on all aspects of the healing process, including how to take care of incision wounds. The most challenging aspect of the healing process will be the feeling of fatigue. It will probably take 2-3 months before you start to feel normal. Until this time, it's important to stay active (within your own limits) and eat well. You should try to stand up and move around throughout the healing process. Aim for a little more each day.
Treatment after Hot Chemotherapy
Although the hot chemotherapy procedure is used to treat the patient, peritoneal cancer is an aggressive disease and successful it often returns even after a hot chemotherapy procedure. The course of the disease after hot chemotherapy depends on many factors such as the source of the disease and the level at the time of diagnosis, the possibility of removing all visible cancer during the surgical intervention and the condition of the patient. Not all patients recover from cancer after hot chemotherapy, but in general, the patient's life expectancy is expressed in years, not months, after this procedure. Some patients may recover from the disease after the procedure. The success of hot chemotherapy To move forward, the doctor may recommend continuing with systemic chemotherapy after the operation. Systemic chemotherapy, which is started 4-6 weeks after the hot chemotherapy procedure, can be done with pills and/or intravenously. The purpose of this additional chemotherapy is to prevent or delay the return of peritoneal cancer and the spread of cancer to organs such as the liver and lungs. This is called supportive chemotherapy. Supportive chemotherapy application after hot chemotherapy is not beneficial for every patient. Many factors related to the particular situation of the patient are taken into account when deciding on the application of supportive chemotherapy. Patients may encounter certain problems years after the application of hot chemotherapy. Patients may have questions they want to ask. For this reason, it is beneficial for a doctor who is knowledgeable about peritoneal cancer and hot chemotherapy to follow the patient closely during this period. The results of hot chemotherapy can vary significantly between patients. Results will vary, for example, depending on the source of the peritoneal cancer and how advanced it is at the time of diagnosis. Generally, good results are obtained after hot chemotherapy in patients with pseudomyxoma peritonei who have successfully removed the tumors. In the majority of such patients, there is even complete disappearance of the disease. Remission of the disease is less common in patients with colon cancer or malignant peritoneum. However, in general, the life expectancy of these patients is expressed in years, not months, after hot chemotherapy.
Side Effects
Most of the side effects are caused by surgery rather than direct chemotherapy. originates. The operation has serious complications, which are reported in the international literature and are seen at a rate of 30%. It is very important to choose the right surgeon for the operation, as an experienced surgeon working with a qualified medical team will reduce the risk of complications. Possible side effects related to the operation:
• Inflammation of the pancreas (6-7%)
• Leakage from the intestine due to post-operative bleeding or tissue damage (4-5%)
• Low white blood cell count in the blood risk of infection and bleeding (10%)
Depending on chemotherapy drugs
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