Is your patient a candidate?

The most common tumor types for which patients receive HIPEC are colorectal cancer, appendiceal cancer, pseudomyxoma peritonei, as well as peritoneal mesothelioma, gastric cancer and select other non-GI cancers. The key to success with HIPEC is proper patient selection. Patient appropriate for HIPEC should have limited peritoneal disease amenable to complete resection. One commonly used staging system for staging of peritoneal disease is the Peritoneal Cancer Index (PCI) (References:4).

for_physicians_1

Patient with extensive disease PCI score greater than 20 are unlikely to benefit from HIPEC. Evidence of bulky tumor at the hepatoduodenal ligament, root of the mesentery, and retroperitoneal region suggest non-resectable disease. In addition, patients with poor performance status (ECOG performance score <2) or evidence of extra-abdominal disease are not considered candidates for HIPEC.

HIPEC surgery is a treatment that requires multi-modality approach and involves participation of multiple specialists. Because of its magnitude and technical complexity HIPEC surgery is associated with significant blood loss and post-operative complications and should only be performed in center with a specific expertise.

* Illustration reprinted with permission from Elsevier, from Gilly FN et al. Quantitative prognostic indices in peritoneal carcinomatosis. Eur J Surg Oncol. 2006;32(6):597-601.