Category Archives: Cytoreductive Surgery (HIPEC)
cytoreductive surgery and intraoperative hyperthermic chemotherapy
We’ve talked a lot about HIPEC here – but we have not really talked about the risks of treatment. While we mentioned the arduous nature of the procedure itself, we’ve left more in-depth discussions to the oncologists.
Now researchers at the National Institute of Health have developed a tool to help clinicians and their patients determine the risks of HIPEC. In an article published over at Surviving Mesothelioma, the authors discuss their recent study and the results. Since the procedure itself carries significant mortality – the calculator offers an important tool for determining who the best candidates are for successful treatment with this procedure.
Schaub NP, Alimchandani M, Quezado M, Kalina P, Eberhardt JS, Hughes MS, Beresnev T, Hassan R, Bartlett DL, Libutti SK,Pingpank JF, Royal RE, Kammula US, Pandalai P, Phan GQ, Stojadinovic A, Rudloff U, Alexander HR, Avital I. (2012). A Novel Nomogram for Peritoneal Mesothelioma Predicts Survival. Ann Surg Oncol. 2012 Dec 12
Now that Case Western has decided to adopt HIPEC for treatment of gynecological cancers (uterine, ovarian, endometrial etc.) they have published an article patting themselves on the back..
But truthfully, not bad, case western, not bad at all.. It’s a good article with a nice explanation for people new to Hyperthermic Intraperitoneal Chemotherapy – (and I am always happy to see more state-of-the-art treatments offered to people with cancer.)
That’s one of the reasons we’ve championed HIPEC here at Bogota Surgery - state-of-the-art cancer treatment with an excellent track record according to medical literature and published research. Too often patients, particularly patients with cancer or other serious medical illnesses are preyed upon with junk or uncertain science, like super-vitamin supplement programs, Laetrile clinics and quasi-futuristic stem-cell therapies.
But HIPEC is different, and it’s been here for quite a while – with over ten years worth of scientific data to support continued experimentation (large-scale) and use.
We first encountered HIPEC in Bogotá at the hands of Dr. Fernando Arias at Fundacion Santa Fe de Bogotá. In our continued quest for information (see our series on HIPEC) – he continues to be at the forefront of HIPEC treatment with more experience than doctors like Dr. Trey Blazer at Duke, teams at Case Western, and the other scattered programs throughout the United States. With the exception of its creator, Dr. David Sugarbaker – Dr. Arias has as much experience, evidence and training as anyone I’ve encountered..
See our tab labelled Cytoreductive Surgery for more on HIPEC
More ongoing research trials to validate HIPEC as a potential treatment for ovarian cancer.
The University Hospitals of Cleveland, Ohio recently started several new clinical trials to test the effectiveness of hyperthermic intra-peritoneal chemotherapy in women with ovarian and endometrial cancer. Unfortunately, the trials are small (around 60 woman) which means that even positive results will be far from definitive for researchers involved in the HIPEC debate. It also offers only limited opportunities for patients with ovarian cancer to receive potentially life-saving treatment.
Medpage recently published a nice overview on ovarian cancer and the current treatment modalities – which can be seen here.
More on HIPEC: here at Bogota Surgery:
If you remember, previous New York Times articles questioned the efficacy of hyperthermic chemotherapy given during cytoreductive surgery. We promised to investigate, and return with more results to this question.
Recently several articles have been published on the topic, including this one – in the journal of Clinical Oncology. This narrative by Maurie Markman talks about the quick dismissal of HIPEC by many oncologists, particularly for larger tumors – and he questions the wisdom of this approach in light of recent research results.
In fact, several large new American studies – including one at Case Western are examining the use of HIPEC, particularly in gynecological cancers like ovarian and uterine cancers which carry a dismal prognosis.
American Hospitals are finally jumping on the HIPEC bandwagon…
This last link isn’t really news – it’s a press release, but since it’s on a surgical oncologist (Dr. Wilbur Bowne) who was an early American adopter of HIPEC, I thought readers might be interested.
Previous Bogota Surgery posts on HIPEC
HIPEC: The basics
Looks like it’s about time to check in with our favorite surgical oncologist, and HIPEC expert, Dr. Fernando Arias..
Check back soon for more..
Another story about bringing HIPEC to the masses – this time in Mumbai, India.. I have to wonder about the research for the article – everytime I see the phrase, “A ray of hope”.. sounds suspiciously like the original title of a certain article (in Colombia Reports.com) all of us are familiar with over here at Bogota Surgery.org.
HIPEC and peritoneal mesothelioma – more effective in women?
There’s a new article on the HIPEC procedure that’s a nice read for people interested in this procedure. The article is unrelated to medical tourism – it’s about the first application of hyperthermic intraperitoneal chemotherapy at a private facility in India. (As you can imagine – I wouldn’t recommend that anyone have a procedure at a facility where doctors have just started trialling the technique.) That being said – the article gives a nice overview of the procedure itself.
Raleigh – Durham Airport (RDU) – A more personal post today for readers -
The nice thing about traveling to Colombia is that even though the distances are pretty far geographically, flight times are pretty short. After a one hour flight to Miami, it’s just three short hours to Bogotá. Despite that – Bogotá is certainly a world away from my quiet life in Virginia.
- Now I am here in the airport, beginning my journey back to Colombia, starting with a week in Bogotá, my favorite of all Colombian cities (so far!) My adoration of Bogotá came as quite of a surprise to me – and still surprises me after all these months. I’d enjoyed Cartagena – that beautiful, historic but steamy coastal city, but I expected that. It has architecture, museums, monuments along with the ocean, and a latin-caribbean feeling that I like so much. Anyone can love Cartagena with its elegant fortresses, warm sunny weather and welcoming residents. No – Bogota is different. It’s high mountain elevation (8000 ft) gives it a unique climate (eternal fall) with distinct rainy seasons. The city sprawl extends the entire basin of the foot of the mountains – the city itself is surrounded by a haze mix of cloud, smog/ pollution from its inhabitants..
No, my enjoyment of Bogotá was a complete surprise. I had expected to tolerate the city, to endure the bustle, rush, the traffic and the very condensed humanity that is a city of ten million people. It was, in my mind, a necessary evil as part of my research for writing the book. I am many things, but a city girl? Not hardly. A more rustic/ rural / redneck gal could not be found, in northern Nevada, West Virginia and now, in the smallest of urban cities, a mere hamlet of southern Virgina. I expected to be intimidated by the sheer volume of people; after all, I hate crowds, and busy public places. But somehow, it was the complete opposite – it was invigorating, intoxicating.
The very sophistication, the people, the life of the city was addicting in a way I never expected. As three months turned to four, and then five – I kept expecting for my love affair with the city to fade or flame out. But it hasn’t, and I am already mourning my return to the USA.
In Bogota Surgery news:
The New York Times has recently published an article talking about the HIPEC procedure as “bringing hope to patients**”. In typical media fashion, they manage to interview the one surgeon who talks about the procedure in an exceedingly cavalier fashion – and the author of the article reinforces this with his terminology (which I find disturbing.) Did he really need to describe the surgery thusly:
“After slicing the man’s belly wide open, he thrust his gloved hands deep inside, and examined various organs, looking for tumors. He then lifted the small intestine out of the body to sift it through his fingers.
As he found tumors, he snipped them out. “You can see how this is coming off like wallpaper,” Dr. Lowy said as he stripped out part of the lining of the man’s abdominal cavity.
After about two hours of poking and cutting, Dr. Lowy began the so-called shake and bake. The machine pumped heated chemotherapy directly into the abdominal cavity for 90 minutes while nurses gently jiggled the man’s bloated belly to disperse the drug to every nook and cranny. ”
Blatent sensationalism in my opinion - certainly guaranteed to sell papers. If they terrorize a few patients in the process, I guess they don’t care.. Using patient friendly terminology doesn’t mean writing an article like a Stephen King novel.. But then – I am guessing that Andrew Pollack has never had a close family member or friend facing this sort of illness.
The author also does a poor job researching his sources or the actual clinical indications for the procedure, but Bogota Surgery readers will be interested to note the cost of the procedure in the USA ranges from 20,000 to 100,000 – which certainly provides plenty of incentive for medical tourism.
However, despite this fantastic language – the authors voice serious concerns about the effectiveness and appropriateness of this procedure. As you know, I have been following the available research and will continue to do so – to bring readers more information about this procedure; it’s feasibility and effectiveness.
** Since publishing my initial article on HIPEC with hope in the title, there have been a spate of articles using that terminology, as well as several blatent rip-offs of my original article. The success of this article has been surprising, as well as the level of plagerism with on-line media, including large, well-known media outlets.
Thanks to the eagle-eyed reader who notified me that portions of one of my articles “Bogotá hospital offers hope to abdominal cancer patients” (originally published on Colombia Reports.com) was featured in the article, “Agencies promote Central and Southern American medical tourism.”
I’ve asked them to provide a link to the original article so readers can get more information on the topic.
Update: 29 June 2011: Here’s a link to the new article on Treatment Abroad (which is an International Medical Travel Journal sister site) that gives their readers the information they really need. (The name of the doctor, of course!) It’s a summary of the original Colombia Reports.com article. They still haven’t cited the ‘borrowed’ content on the original article, or provided the name of the physician doing the treatment (Dr. Fernando Arias) but I guess it’s an improvement.
Another article on the effectiveness of HIPEC (cytoreductive surgery with intraoperative hyperthermic chemotherapy) in the news. This story comes out of India and highlights doctors there and the HIPEC procedure for treatment of abdominal cancers (intestinal and ovarian cancers.)
The Future is Now.. in an article on Medscape, dated December of 2010 and originally published in Future Oncology, Dr. Ze Lu et. al discusses the future of cancer treatment. (The article is several pages in length – so I haven’t re-posted but reference information is provided below). Dr. Ze Lu and his colleagues believe the future of oncology treatment is…. Intraperitoneal Hyperthermic Chemotherapy (HIPEC)..
In August, we’ll check back in with Bogotá’s resident expert on HIPEC, Dr. Fernando Arias.
Lu, Z., Wang, J., Wientjes, G., & Au, J. (2010). Intraperitoneal therapy for peritoneal cancer. Future Oncology. 2010 (6) 10; 1625 -1641
As we’ve seen several times before, Bogotá surgeons stay ahead of the curve on cutting edge treatments. In the last several weeks, HIPEC or Hyperthermic intraperitoneal chemotherapy (Sugarbaker procedure) has been dotting the news headlines in the United States, and across the globe.
But as my readers here at Bogotá Surgery know, not only have we talked about HIPEC in the past - Dr. Arias has been performing this procedure at Fundacion Santa Fe de Bogota since 2009. He reports he did eight cases in May alone. (This is considered fairly high volume if you review the amount of cases being done at other centers.)
Planning to catch up with Dr. Arias and check in later this summer..