Regional Perfusion Therapy for Peritoneal Mesothelioma

Peritoneal mesothelioma is a cancer of the tissue that lines your abdominal cavity (i.e., peritoneum). Doctors diagnose about 500 new cases of peritoneal mesothelioma each year.

Peritoneal Mesothelioma Causes and Risks

Mesothelioma is a slow-growing but aggressive cancer. It forms years or even decades after regular asbestos exposure.

Asbestos is a naturally occurring, sand-like mineral. Its needle-like fibers harm human tissue when inhaled or swallowed.

Most asbestos exposure happens in the workplace.

The following types of workers may be at risk:

• Construction workers
• Electricians
• Firefighters
• Mechanics
• Plumbers

Those who work around flame retardants are also at risk.

Hyperthermic Intraperitoneal Chemoperfusion (HIPEC) for Peritoneal Mesothelioma

Hyperthermic intraperitoneal chemoperfusion (HIPEC) is a type of advanced regional perfusion cancer therapy. Doctors deliver very high doses of heated chemotherapy directly into the abdominal cavity to treat peritoneal mesothelioma.

Traditional chemotherapy, which circulates throughout the entire body, has limited effectiveness against mesothelioma. Regional perfusion therapies, like HIPEC, are cutting-edge surgical techniques offered by UPMC, that have proven more successful.

The benefit of regional perfusion therapy is that it effectively kills cancer while limiting harm to the rest of the body.

UPMC offers many types of regional perfusion cancer therapies.

UPMC typically uses HIPEC to treat peritoneal mesothelioma. HIPEC is an advanced surgical technique by which very high doses of heated chemotherapy are given directly into the abdomen to treat peritoneal metastases. It is generally used in combination with and immediately after a specialized surgical procedure called cytoreductive surgery (CRS).

• CRS aims to surgically remove all visible cancer nodules.
• HIPEC aims to treat small cancer nodules or invisible (microscopic) cancer cells that may be left behind after CRS.

Depending on your type and stage of cancer and your overall health, your doctor may suggest CRS-HIPEC.

What to Expect During Treatment for Peritoneal Mesothelioma

A surgeon generally combines HIPEC with CRS.

First, your doctor performs CRS to remove all visible cancer nodules (or as much of the tumor as possible). HIPEC immediately follows to treat any leftover small or invisible (microscopic) tumor nodules. The surgery itself can last a long time, depending on how many tumors are present.

You will sleep through the treatment under general anesthesia.

During HIPEC, the surgeon inserts small tubes and temperature probes into the abdomen:

• One tube delivers the heated chemotherapy solution into your abdomen.
• The other tube circulates the fluid back to a heating element to maintain a temperature between 105 and 107.6 F (40.6 C to 42 C) in the abdomen.

The surgeon will rock you back and forth for about two hours to ensure the chemotherapeutic drug washes over all the cancer cells. This process aims to kill any remaining cancer within the abdomen.

At the end of CRS-HIPEC, the surgeon turns off the pump and allows your body to return to a normal temperature, flushes the abdomen with a saline solution to clear out the medicine, removes the tubes and temperature probes, and closes the incisions.

Peritoneal Mesothelioma Prognosis

While people with peritoneal mesothelioma often have a poor outlook, early diagnosis and aggressive treatment can help.

In the past, people with mesothelioma lived for less than a year on average. Only one in ten Americans survived five years after diagnosis.

However, cutting-edge treatments have increased the average time people live.

For example, studies show that people treated with CRS-HIPEC survive between 34 and 92 months on average. Up to six in 10 Americans survive five years.

HIPEC is a complex treatment that requires a highly skilled and experienced team of experts. According to a 2002 study in the New England Journal of Medicine, patients undergoing complex surgical procedures can significantly reduce their risk of postoperative death by selecting a high-volume hospital.Since 2001, our program at UPMC Hillman Cancer Center has performed more than 1,900 CRS-HIPEC procedures. Learn more about other treatment options for mesothelioma at UPMC Hillman Cancer Center.