A surgical oncologist with Cancer Care Northwest PS, of Spokane, is finding broader uses for an internal abdominal wash with heated chemotherapy drugs following cancer surgery, a procedure that once was considered a last resort only for some cancer patients.


The procedure, called hyperthermic intraperitoneal chemoperfusion, or HIPEC, originally was developed to treat a rare condition in which malignant tumors produce mucous that builds up in the abdominal cavity.


The surgical oncologist, Dr. Ryan Holbrook, began using it about seven years ago to help buy time for some terminally ill cancer patients.


Since then, however, Holbrook increasingly has been using HIPEC following the surgeries he performs to treat a broader range of cancers that have spread to the abdomen in the form of peritoneal tumors on the lining of the abdominal cavity and the surface of abdominal organs and tissues. He says the procedure slows and sometimes prevents recurrence of peritoneal tumors.


Holbrook says the use of HIPEC for that purpose is gaining acceptance nationally, although he doesnt know of any other surgeons here who perform it. He says its performed at about 35 centers across the country, and more than half of those just started using the procedure in the last two years.


HIPEC involves washing the abdominal cavity for 90 minutes using a heated chemotherapy solution. The treatment is used after invasive surgery during which as much of the peritoneal tumors are removed as possible.


The surgical procedure that precedes HIPEC can take up to 14 hours, Holbrook says.


You have to look in every nook and cranny in the abdominal cavity to get all of the tumors possible, he says. Its some of the most challenging surgery I do, and I do a lot of complex surgery.


The chemotherapy drugs used in the HIPEC bath, which vary depending on the type of cancer involved, are heated to about 107 degrees Fahrenheit, Holbrook says.


The drugs are heated for two reasons, he says. First, heat kills cancer cells, while leaving most normal cells unaffected. Second, heat also softens tumors, allowing the chemotherapy drugs to penetrate more deeply.


Holbrook now is using the procedure to treat patients whose cancers originated in the colorectal, ovarian, stomach, and appendix regions and have spread to the abdominal cavity.


For some patients, the surgery and HIPEC treatment are followed for several days by daily abdominal chemotherapy treatments administered through catheters, he says.


For many patients, the tumors are slow-growing enough in the abdominal cavity that the procedure has a good outcome, Holbrook says. For some, its a cure.


For instance, 70 percent to 80 percent of patients with cancer of the appendix who undergo the procedure remain symptom free five years later, he says.


Other cancers that sometimes produce tumors in the abdominal cavity, such as those of colorectal origin, are more difficult to remove completely from the abdominal cavity, although the surgery combined with HIPEC usually extends life expectancy in those patients, he says.


Although he performs the procedure on many patients who previously have undergone other surgical procedures and chemotherapy, the prognosis for patients considering abdominal surgery with HIPEC often is better for those who havent undergone other invasive cancer treatments.


Its optimal to use it as a first resort, he says. Thats the best opportunity to get the cancer cleaned out.


The procedure often requires a large incision from the bottom of the sternum to the pubic bone, he says.


Because the chemotherapy drugs are administered on a topical basis rather than injected into the bloodstream, and because the surgery involves a large incision, the patients quality of life following the procedure is affected more by the surgery than the toxic effects of the chemotherapy, he says.


After the first three to six months, the quality of life is good. Most patients get back to normal or near normal, Holbrook says.


In the early days of the procedure, he swished the chemotherapy solution manually with his hands inside the open incision. Now, the incision is closed following the surgery and the solution is circulated and drained through catheters.


Were finding its more important to keep the heat up, than to agitate the chemo solution, he says.


He says he first heard about the wash procedure more than 10 years ago through research conducted by HIPEC pioneer Dr. Paul H. Sugarbaker, of the Washington Cancer Institute, in Washington, D.C.


It made sense to me. If its a surface malignancy, you should be able to clean it up and treat it with topical chemo, he says. Its an opportunity to help unique cancer patients.


Holbrook says he expects to do more than 20 surgeries followed by HIPEC this year, up from about 10 a few years ago.


Contact Mike McLean at (509) 344-1266 or via e-mail at mikem@spokanejournal.com.