information and questions about HIPEC

[Julie YW]

Hello All,

I'm investigating HIPEC as it seems like an appropriate procedure for me. Here's a link to my most recent post which contains a lot of information I gathered from Dr. Labow at Mt.Sinai in case anyone else finds the information useful. I wanted to ask though for those who have done the research before me what are the arguments against HIPEC. It seems to me after reading a few studies (and hearing summaries from my husband who has seemingly read everything on the topic) the arguments against are (1) there hasn't been any broad study of its effectiveness (the existing studies contained a limited number of cases from multiple countries in the range of 15 to 100) so there isn't anything really definitive to speak to its effectiveness so there's risk in that regard, (2) as a corollary to (1), there are arguments about selection biases for the existing studies meaning that the people who do well would have done well in the studies would have done well anyway under more traditional chemotherapy treatment and (3) given that uncertainty, the surgery can be quite serious with serious complications.

It seems to me that while HIPEC seems more effective for other types of cancer (such as appendicital or ovarian cancer), it is nonetheless a life extender if not necessarily a life saver in most cases. It also seems to me purely based on anectodal information that no one ever seems to "regret" doing HIPEC. I'm interested in hearing from naysayers and proponents of HIPEC. Thanks.

Julie

http://julieyipwilliams.wordpress.com/2 ... ews-maybe/

[jdepp]

Julie,

There have been discussions of prophylactic HIPECs on this forum. Skifletch had one and his situation was similar to yours in some ways. You might search those terms for more details -- here's one of the related threads.

viewtopic.php?f=1&t=12837&p=97371&hilit=prophylactic+hipec#p97371

[Julie YW]

Thanks jdepp. I wouldn't have thought to search for that term. I tried just HIPEC and just got a lot of stuff that wasn't responsive to my questions.

Julie

[jdepp]

It's a term that comes up in google scholar & other databases, e.g. this article.

"Prevention and early treatment of peritoneal metastases from colorectal cancer: Second-look laparotomy or prophylactic HIPEC?"

Good luck with this. My own 2-cent advice would be to have the laparoscopy and give the surgeon very clear indications for the hipec go-ahead.

[juliekei]

Hi Julie,
Just wanted to say that I am sending you strength and prayers. I have had two "successful" HIPECs with Dr. Labow. I was home after 4 nights in the hospital each time and I'm still fighting. Recently had VATS and am doing well on Xeloda. I am happy to speak with you any time...
Don't give up.

Julie

[Indefatigable]

Julie

You may find this useful, or not. I don't know. But you seem to have a pretty good handle on it already.

http://meetinglibrary.asco.org/presentationBySession/3991

For what it's worth, my wife has had a HIPEC. In short: PCI 15, CC-0. Gallbladder, spleen, colon, ovaries/uterus all gone. Small bowel resection with temporary illeostomy. 8 weeks in hospital (3 laparotomies; 1 thoractomy). What now looks to be a permanent ureteric stent (which has been swapped out twice already due to blockage/infection). Lost about 14 kgs. Not meaning to be discouraging, but I think it's worth having a counter perspective to Julie's 'in and out in a few days' experience. (I'm certainly happy you were Julie!, but I always shake my head in disbelief when I read comments like that . My wife didn't even wake up for four days!).

Having said all of that, Wifey is now 6 months post surgery and is NED (two clear scans). So in spite or Dr Ryan's reservations, for the meantime it appears to have all been worth it. Time will tell.

Best wishes.

I.

[debb]

Hi...I'm sorry you're going through this. I just wanted to share my story with you. I was also a HIPEC patient of Dr. L., whom I love.

I was diagnosed at 3C with tumor just above rectum. I had surgery before chemo, no radiation. Chemo was 12x FOLFOX, but oxi was discontinued after round 8, due to an allergic reaction. In 2010, a scan picked up cancer in my right ovary. I had surgery to remove both ovaries, but before the surgery date, the cancerous ovary had ruptured. The fluid in my abdominal cavity was tested, and the pathology for the fluid was negative for CRC, and the ovary was positive for CRC.

Of course, I was worried that the rupture release fluid that was cancerous, so I pursued HIPEC. The other option given to me was IP FUDR, which is a treatment of chemo administered through a port in your abdomen. Direct chemo is the best option for peritoneal mets. I decided to go with HIPEC, even though there was no evidence of cancer in my ab. I wanted to kill any possible microscopic cells, so prophylactic, I guess.

As such, my HIPEC was less invasive. No organs, other than my omentum, was removed (Tested Negative). Dr. L. had a good look around inside of me, saw no other cancer to be removed. And then he did chemo shake and bake on me. With no other cytoreduction, and just the chemo bath, recovery is easier, I guess, than when they have to cut out and remove a lot of stuff. I was out of the hospital in less than 5 days.

Dr. L. said I was a "boring" patient. I'll take that as a compliment! I guess I was one of those surgical candidates who may have done well otherwise (being young, healthy and fit), but I guess we'll never truly know. I have never regreted for one minute having had this done.

In 2012, I had VATS for a lung nodule. However, this nodule was on the scan that found the ovarian mass, but the lung nodule as not noted at that time. On subsequent scans, the lung nodule was noted and compared. It was so slowly growing..never got above 1mm. They weren't sure it was even cancer, but I took no chances, and scheduled VATS. It was CRC, and there was a second even smaller nodule nearby that was also removed. So this lung nodule was already present, but not noted when I had HIPEC. I have been clear ever since. I did not have chemo after either VATS or HIPEC.

If you have any questions that I can help you with, please PM me. Good Luck!

[Rheaeliza]

I also had my HIPEC by Dr. Labow. While I am happy with my decision, and absolutely cannon say enough good things about him, this is a major surgery, and while mortality from the actual surgery and during the surgery is low, complications can arise.

I am young, otherwise healthy, and in good shape, and I still had complications, infection, and a 3.5 week hospital stay. When I got home, I was physically and emotionally a wreck. I had lost over 30 lbs, I got winded walking to the corner, I needed a step stool to get into bed. I fell into a depression and questioned the surgery all the time. This is of course not typical, but it can happen. Also take note that I had 5 organs removed plus colon resection during the HIPEC, so...that's tough.

Again, feel free to reach out.

Best,
Rhea

[Julie YW]

I've decided to move forward with HIPEC with Dr. Labow. Here's my latest post with more information about HIPEC for others who may be now or in future trying to decide whether to do it.

http://julieyipwilliams.wordpress.com/2 ... -and-more/

[Rheaeliza]

I think that's wonderful, and good luck to you. I have posted to you more than once that I know you are in good hands with dr. Labow.

Ps, I went off of avastin 6 weeks before hipec but stayed on xeloda and irrinotecan I believe until 10 days or so prior to hipec.

[Julie YW]

Rhea, that's really interesting. He told me 3 weeks off chemo before and after surgery.

[Rheaeliza]

I just looked it up and I'm totally wrong. I had my regular chemo, and would have had been due up the Wednesday before surgery but skipped that one and had surgery 5 days later. So it was a little less than 3 weeks but times well, so I only felt like I was "off chemo" for those 5 days. Sorry for the mis info! I know him and my oncologist weren't too concerned, also I was on a lower dose of xeloda and irrinotecan at that point too!

Good luck with the today show tomorrow! I'm going to try to tune in if I can get my butt out of bed!

[scottg]

I am one of only a few who has done 2 HIPEC surgries,,, diagnosed 4/06 cancer free today,,,To sum it up,,what other choices do you have? chemo alone cures very few people and if you qualify for hipec it has 2-3x the success rate for long term survival..It is a big surgery especialy between chemos and the positive outcome stats are slightly scewed due to the selection process,,a combination of chemo and surgery seems to be the best chance for long term survival. always willing to talk 516 6505623,,,scott

[Nester]

Hi scott sounds very interesting news to me i had one hipec but still had a recurrance 1'5 years after, i still have a little hope to get cured, your words are encouraging.

M.