Siteman Cancer Center Expands Peritoneal Surface Malignancy Program and HIPEC Treatment Options

Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine in St. Louis announces a significant expansion to its Peritoneal Surface Malignancy Program to include a broader multidisciplinary team dedicated to the advanced treatment of peritoneal malignancies and the use of heated intraperitoneal chemotherapy (HIPEC).

Developed over the past three decades, HIPEC is used to treat cancers involving the peritoneum, the inner lining of the abdomen. The surgical procedure involves two phases – cytoreductive surgery (CRS) to remove all visible tumor followed by direct application of heated chemotherapy to the abdomen to eradicate residual cancer cells. The two-pronged approach has demonstrated a notable increase in survival rates for patients with advanced-stage cancers.

“All of us involved in the Peritoneal Surface Malignancy Program at Washington University have experience and advanced fellowship training with HIPEC,” said Washington University surgical oncologist Trang Nguyen, MD, of Siteman, who was recruited to lead the program. “We also have been involved in research and clinical trials that continue to improve overall survival rates and we plan to bring more clinical trials to Siteman to better understand the use of HIPEC in the multimodal management of cancer patients.”

Good outcomes require a multidisciplinary approach and detail-oriented peri-operative care by dedicated inpatient and outpatient teams. Nguyen, along with Washington University medical oncologist and gastrointestinal cancer specialist Olivia Aranha, MD, PhD, and Washington University gynecologic oncologist Brooke Sanders, MD, also of Siteman, form the core of the Peritoneal Surface Malignancy team.

Cancers that can be treated with CRS + HIPEC include those that have spread beyond the origin point into the peritoneum, including:

• Appendiceal neoplasm and cancers
• Colorectal cancers
• Gastric cancers
• Peritoneal mesothelioma
• Ovarian/Fallopian tube/Primary peritoneal cancers

Sanders said the procedure should be considered as an option upon initial diagnosis. “HIPEC is not a treatment option for cancers that have spread beyond the peritoneal cavity and into the lungs or bones,” she said. “That’s why it’s critical for cases to be reviewed as soon as possible so that all treatment options can be evaluated.”

Toward that goal, a dedicated multidisciplinary Peritoneal Tumor Board meets regularly to rapidly review cases and recommend treatment options, including the use of CRS + HIPEC.

CRS + HIPEC can the sole treatment for certain cancers such as low-grade appendiceal neoplasms. However, there are many cases, particularly with gynecologic and higher-grade cancers, when neoadjuvant and adjuvant systemic chemotherapy is added to the treatment regimen. “In patients with high-grade epithelial, ovarian, fallopian tube and peritoneal cancers, for example, they receive three systemic chemotherapy treatments prior to the CRS + HIPEC,” Sanders said. “They then get three more cycles of chemotherapy afterward.”

In colorectal cancers, an estimated 10% of patients will have peritoneal involvement upon initial diagnosis. In those that develop a recurrence, up to 25% of patients will have peritoneal involvement. “Peritoneal involvement is the most common factor in the death of patients with advanced colorectal cancers,” Aranha said. “In the past, these were thought to be metastatic cancer, so we treated it differently. The paradigm has shifted, and peritoneal involvement now is considered to be more regional than metastatic, and we have been treating it with HIPEC in eligible patients. CRS + HIPEC is really a trimodal therapy, of which an adequate cytoreduction is the most important component.”

For patients undergoing CRS + HIPEC, the use of heated chemotherapy increases blood flow and oxygenation as well as enhances drug penetration directly into any residual tumors. The drug remains in the abdomen for about 90 minutes before being removed. “Some of my patients call it a ‘power-washing,’” Nguyen said. “We maneuver the patient and the drug so that we can bathe the entire abdominal cavity and let the drug penetrate the peritoneum.”

Patients from multiple states are regularly evaluated for and treated with CRS + HIPEC at Siteman Cancer Center. For more information about the Peritoneal Surface Malignancy Program, call 800-600-3606, or visit the HIPEC treatment webpage