hipec

[chrisin]

First of all, I want to say a warm hello to all the Colonclub Members. On the message board I have already found a ton of very useful information of how to deal with the disease of my mother. In August she was diagnosed with a 5 cm tumor in the sigmoid colon which metastasized to the peritoneal cavity as well as to the liver (13 mm). She was treated for one year because of anxiety&depression which was supposed to be the major factor for her sleepiness, cahexia and fatigue. Thus things went really far. The most brutal fact is that she was doing her 6 moth check-up since 2002 when beast cancer showed up. Unfortunately the breast oncologist was unable to diagnose colon cancer stage 4 (usg, bone scan clear). Then she went to the primary care physician and asked for colonoscopy that was ordered.

Because of almost complete blockage, an exploratory laparotomy has been done and her primary was not operable. Fortunately she has remarkable response to folfiri. After 4 cycles all the symptoms have gone and her weight increased.

I am wondering if she should push for hipec. Her oncologist said it might be unnecessary but I recon that a chance for cure is really slim with ordinary chemo. Minding only 13 mm liver tumor she would be a good candidate for the procedure. Also thinking - what would be the best time window for hipec? Any thoughts?

[nervousnelly26]

Hi Chrisin,

I am in a very similar position as I am also the caregiver to a mother in her 60s with peri mets.

My mother is considering HIPEC. Even though she does not have mets anywhere else (at least not yet), her primary oncologist said that she would not advise HIPEC as she does not believe it works. They also said that it would be difficult because my mother has already had abdominal surgeries and there is a lot of scar tissue and any additional surgeries would be high risk of complications. Your mother may be in a better position there if they have not done a resection on her primary tumor. Are they planning to do one now since she has responded so well to folfiri?

We are going to get second opinions from HIPEC surgeons and different oncologists. I have been doing a lot of research, and my understanding is that even with HIPEC, there is little chance of a cure, but it can lead to longer survival times. I believe the survival times with just systemic chemo are very poor (1-2 years). I would love it if anyone could tell me differently, or if anyone has experienced luck with peri mets and systemic chemo, as that is probably the route we will have to go.

If you are pushing for HIPEC, it's probably better to start looking sooner rather than later. I would suggest trying to find surgeons in your area and going from there.

Good luck and please keep me posted!

[chrisin]

Your mother may be in a better position there if they have not done a resection on her primary tumor. Are they planning to do one now since she has responded so well to folfiri?

We don't want to do a chemo break just for now. If it works, the plan is to do 12-15 cycles and then decide. When it stops working we will probably push for the surgery with hipec. Hipec surgeon wants to see her after 3-4 months of chemo. If complete cytoreduction is obtainable then a chance of 45% 5y OS is possible with the procedure. I don't know if the data is reliable (no randomized trials). I tried to search for successful Colonclub Members but so far I recall only 2-3.

[SMR]

I know of at least one CC member who has passed 5 years NED after HIPEC. A lot depends on how extensive the peritoneal malignancy is. It is common to "sandwich" the surgery in between chemo - meaning 3-4 months chemo, then HIPEC, then return to chemo. There are others here who've obtained periods of NED after HIPEC, or just prolonged life with decent quality.

[tigerpaw]

I had HIPEC 8 months ago. My peritoneal spread was limited, the path report showed only two mets. My last PET scan in August showed no peritoneal disease, and all tumor markers (CEA, ca 19-9, CA125) were normal.My surgeon told me results after HIPEC are comparable to results after liver and lung resection. But correct patient selection is critical, results are much better with limited disease. I did not have chemo before or after.

[norwegianwood]

I am thankfully in the position to post a "success story" involving peritoneal spread. My mother (also in her 60s) was diagnosed stage IV with peritoneal carcinomatosis and likely distant lymph node spread in nov-11. She was denied HIPEC, so her only option was chemo (Fliri and Avastin). She had an remarkable response to chemo, and she hasn't had any treatment since june-12. She just had a NED CT-scan this week, and has no symptoms from the disease. We've had a "scare" with regards to a slow CEA rising trend (from 2 to 10 over the course of a year), but CEA has dropped 2 points to 8 from the last check-up, and the scan is clear.

We realise that this is a highly unusual scenario, and we would have gone for HIPEC if given the option, but the choice was really out of our hands. But so far, so good. If you are interested in looking in to supplements etc, I would would suggest IP6 with inositol (which my mother has used since diagnosis) and PSK, and our last "experiment" was adding DCA since last scan - don't know if that has contributed to the CEA drop or not. Beware of potential neuropathy issues with DCA, they really urge patients not to self medicate with it, but I have always been a bit of a "rebel" and felt that we didn't have much to lose. Don't know whether these supplements has tipped the scale in our favor or not, but I am so so thankful to still have my mother with me in excellent health.

Best of luck to your loved ones!

[chrisin]

I am thankfully in the position to post a "success story" involving peritoneal spread.

Thank you for the "success story" post. I read it when my mother was pronounced "dying" by a local surgeon. You gave me hope and she is still with us in a very good shape

[Dolce17]

Hi norwegianwood,
Your success story is amazing and so so incredibly great to hear!!!

My father is stage IV, had 2 peritoneal mets. He had surgery End of March 15 they removed his primary tumor and 80% of his omentum, one month of recovery and then, started chemo May 15 (12 rounds). He just finished his last round this week. Scan on 10/20, CEA is normal and last scan at 3 months was clear. We are not sure what to do now, he wants to take a break and feel better before considering Hipec. My question is, do you think it is better to go right into Hipec now even though no visible cancer is showing on the scan? I fear that his cancer will come back as soon as he stops the systemic chemo, oncologist said it can come back as early as 3 months.

Father
Stage IV
2 peritoneal mets
surgery 3/15 removal of primary tumor and 80% omentum
may 15 ( start 12 cycles of chemo)
Aug 15 ( clear scan normal CEA)

[chrisin]

Maybe dense screening with MRI ever 2 months would be feasible. You should ask the surgeon if he removed all visible tumors (cc0). In case he did not, I think surgery with hipec is worth considering. Otherwise I am not sure, as randomized trials - cs with hipec vs cs with systemic chemo are ongoing.