It seems that the latest trend in treating cancer is a combination of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (Hipec) or, as it is more familiarly called, hot chemotherapy. The massively invasive procedure was originally performed only on patients with a rare type of appendix cancer, but many of the nation s leading medical centers, such as Massachusetts General and Montefiore Medical Center in New York, have begun using the technique to treat colorectal and ovarian cancers.
Lasting up to eight hours, Hipec surgery begins when a surgeon cuts open a patient s abdomen and sifts through each individual organ by hand looking for tumors to excise. Then, a machine pumps heated chemotherapy (nearly 108 degrees Fahrenheit) into the abdominal cavity for about 90 minutes, a technique that is supposed to be more effective than intravenous chemotherapy because cancerous cells are unable to withstand the higher temperatures that healthy cells can.
Approximately 1,500 people undergo the procedure annually, but this number is expected to grow to 10,000, which Dr. David P. Ryan, clinical director of the Massachusetts General Hospital Cancer Center, says is the just the latest example of a therapy that catches on with little evidence that it really works. We re practicing this technique that has almost no basis in science, he says, while suggesting that the only reason it has been extended to colorectal cancer patients is because you can t make a living doing this procedure in appendix cancer patients.
The only study examining the efficacy of Hipec was conducted in the Netherlands over a decade ago and included 105 patients. Those who received Hipec and intravenous chemotherapy had a median survival time of 22.3 months, compared to 12.6 months among those receiving only intravenous therapy. However, 8 percent of the patients in the Hipec group died from the treatment itself.
This technique employs wishful thinking at best, says ACSH's Dr. Gilbert Ross. He adds, Resorting to this surgery is both unprofessional and possibly unethical, since doctors are exploiting patients desperation in hopes of an actual benefit though there is minimal evidence of such.
Hot chemotherapy costs between $20,000 and $100,000, and Dr. Ross finds it unbelievable to learn that in this era of high ethical standards and full disclosure, hospitals are profiting greatly from a procedure that has not undergone extensive studies to confirm its efficacy (if any). Since the FDA cannot regulate medical practices, this sounds like an abdication of responsibility by state and hospital boards, he says.
Since there are effective treatment options out there such as Avastin for colorectal cancer patients, adds ACSH's Dr. Josh Bloom, it would be insane not to try one of those first. Yet once known therapies fail, some people will try anything. I hope there really is something to Hipec, because this is a brutal treatment to endure, and it would be tragic to put a dying patient through it for no reason.
