SIDEBAR: From Small Centers to Academic Centers
The use of cytoreduction plus hyperthermic intraperitoneal chemotherapy (HIPEC) to treat carcinomatosis “came from the smaller centers,” noted Nita Ahuja, MD, Director of the Peritoneal Surface Malignancies Program at Johns Hopkins Medicine. “A lot of things in medicine come from academia and move outward, but here, the technique came from smaller centers into academic centers.” Now that cytoreduction and HIPEC has arrived as a field, Dr. Ahuja advocates establishing uniform consensus guidelines for patient selection.
“Patients are seeking it. They are desperate,” she said. “I think that some patients do benefit, and we don’t need to deny them that. But we need to have clear-cut guidelines and say, these are the people who will truly benefit from this aggressive therapy. That conversation needs to happen.” So far, she said, it has only been happening “in bits and pieces.”
Along with the program she directs at Johns Hopkins, Dr. Ahuja mentioned several other cytoreduction and HIPEC programs with experienced surgeons in the United States. “Certainly Paul Sugarbaker, MD, has been doing it the longest,” she said. Dr. Sugarbaker is at Washington Hospital Center in Washington, DC. “The University of Maryland has Richard Alexander, MD. And Jesus Esquivel, MD, who was trained by Paul Sugarbaker, is at St. Agnes Health Care.” Both of these centers are in Baltimore. “The University of Pittsburgh Medical Center has David L. Bartlett, and University of California, San Diego, has Andrew M. Lowy, just to name a few,” Dr. Ahuja added. “Certainly those are the centers that have been doing it for a while.”
Dr. Ahuja noted that there are also websites where physicians can list themselves as providers of cytoreduction and HIPEC, but it is not always possible to find out their level of experience. ■
Disclosure: Dr. Ahuja reported no potential conflicts of interest.
Successful Use of Cytoreduction and Hyperthermic Intraperitoneal Chemotherapy May Hinge on Prior Experience
A review of 60 consecutive patients with peritoneal carcinomatosis who underwent cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy (HIPEC)—sometimes called “hot chemotherapy”—found 0% mortality and 33% morbidity, with “a significant reduction of grade III/IV morbidity,...