CHENNAI: Ovarian cancer is the third most common cancer among women of India. About 50 per cent of the total cases occur between 45-65 years of age. The most preferred type of treatment is surgery plus chemotherapy. Early detection and treatment may go a long way to reduce the number of cases in India.
Treatment with Hyperthermic Intraperitoneal chemotherapy (HIPEC) along with cytoreductive surgery resulted in better survival outcomes than surgery alone in patients with advanced and recurrent ovarian cancer. Such radical surgery combined with HIPEC offers the last glimpse of hope for improved disease free and overall survival.
What is cytoreductive surgery?
It is a highly radical surgery which involves multiorgan resection such as total hysterectomy and salphingoophorectomy, pelvic and para aortic lymphadenectomy, supracolic omentectomy, complete peritonectomy, debulking of all visible tumour deposits and bowel resection if indicated.
What is HIPEC Therapy?
It is a highly sophisticated technique by which chemotherapeutic agents are circulated within the abdominal cavity at 420 Celsius for about 90 minutes using a specialised machine.
Advantages of HIPEC Therapy
Better penetration of the drug into the tumour tissue.
Targets microscopic tumour deposits in peritoneal cavity invisible to naked eye.
Higher doses of chemo agents can be used.
Various studies have shown confirming evidence of improved disease free and overall survival.
What are the challenges in HIPEC Therapy?
Long surgical procedure involving 10-12 hours of operating time.
Skilled anaesthetic team for intra operative monitoring of electrolytes and body temperature.
Good surgical expertise.
Good postoperative ICU care.
Role of HIPEC Therapy
Newly emerging evidence has substantiated the usage of HIPEC in peritoneal malignancies arising from ovary, colon, rectum, appendix, stomach and peritoneum.
When done at specialised centres by specialist oncologists, the morbidity of this procedure can be very minimal.
Around 70 to 80 per cent of the ovarian cancers are diagnosed at advanced stage (Stage 3). Multimodality treatment is usually required for such advanced tumours which include surgery and chemotherapy. Pre-operative chemotherapy is very beneficial in downstaging the tumour and it also dramatically increases the possibility of complete surgical removal later.
The surgery is usually performed after three or four cycles of chemotherapy. During surgery, the abdominal cavity is thoroughly assessed for residual tumour load using a scoring system called Peritoneal Carcinomatosis Index (PCI). The surgery involves complete removal of all tumour deposits that are visible to naked eye. It is usually combined with radical hysterectomy, pelvic and para aortic lymphadenectomy, total omentectomy and total peritonectomy.
If required, resection of other involved organs is combined along i.e, sleeve/distal gastrectomy, bowel resection, anterior resection of rectum and splenectomy. The completeness of cytoreduction is calculated using a scoring system called as CC score. This is followed by intra abdominal instillation of chemotherapeutic agents as described above which is targeted at microscopic tumour cells. It requires strict multidisciplinary approach and teamwork between surgical oncologists, medical oncologists, anaesthetists and intensivists.
The writer is the director of Institute of Oncology, Gleneagles Global Health City, Chennai