Cancer Fighters Thrive is a quarterly print and online magazine bringing readers practical, innovative and inspirational information about cancer treatment and survivorship.
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INNOVATION "IORT and HIPEC can be effective therapies in achieving long-term tumor control." —Michael Haddock, MD, Mayo Clinic cancer cells that remain on the surface of organs or intestines. Because HIPEC delivers high-dose chemotherapy to targeted areas and minimizes exposure to healthy tissues, the treatment attempts to maximize ef- ficacy while reducing side effects. "After learning about HIPEC and dis- cussing the treatment with my doctor, I was willing to try it," Karen says. "I want- ed to try anything to live one more day." Charles Komen Brown, MD, PhD, medical director of surgery for CTCA and national director of hyperthermic intraperitoneal chemotherapy, performed HIPEC on Karen in April 2009. "Before the advent of HIPEC in the late eighties, patients received chemotherapy intravenously after surgery," Dr. Brown says. "But that isn't always the most ef- ficient way to target residual microscopic cancer cells. HIPEC delivers a targeted, heated chemotherapy bath directly to the abdomen immediately following sur- gery. Because the remaining cancer cells are unable to endure the higher tem- peratures [about 107 degrees F], they are more susceptible to being destroyed by chemotherapy." Dr. Brown says that candidates for HIPEC are patients with carcinomatosis, where the cancer has spread throughout the abdominal lining and the surfaces of the abdominal organs. It is usually of- fered to patients with recurrent ovarian, colon, appendiceal, and other gastroin- testinal cancers confined to the abdo- cfthrive.com men. "Clinical studies have shown that colon cancer patients who have had cy- toreductive surgery [to reduce the intra- abdominal tumor] along with HIPEC have doubled their median survival rate," Dr. Brown says. "HIPEC is becom- ing the new standard of care for patients with carcinomatosis."1 After undergoing surgery and re- ceiving HIPEC in April 2009, Karen re- mained cancer-free for nine months. Doctors treated two local recurrences with chemotherapy and surgery. Now, five years after receiving a dire prognosis, she is cancer-free. "I felt like I took the path less chosen by electing to have the HIPEC treatment, but I never lost hope," she says. HIGH-DOSE RADIATION Another surgical advance offering hope to patients with locally recurrent can- cers—in this case pelvic, rectal, breast, and other soft-tissue cancers—is intra- operative radiation therapy (IORT), which can effectively destroy microscopic tumors that surgeons cannot remove. During IORT a patient receives a sin- gle dose of radiation immediately after a tumor is surgically removed. A machine called a linear accelerator delivers a con- centrated beam of radiation to the tu- mor area. Healthy organs and tissues are shifted or shielded to protect them from radiation exposure. "IORT allows us to deliver a high dose of radiation in a small, tightly focused area," says Michael Haddock, MD, pro- fessor of radiation oncology at the Mayo Clinic College of Medicine. Dr. Haddock has performed about 600 IORT treat- ments since 1994. "Because healthy or- gans aren't exposed to radiation, it's safer than traditional radiation treatments." A single dose of intraoperative ra- diation may be as effective as 10 to 20 daily radiation treatments. Patients who receive IORT are less likely to need ad- ditional radiation after surgery, thereby shortening their treatment time and al- lowing them to return to daily activities. "IORT is considered standard care at institutions that have the equipment and the expertise," Dr. Haddock says. "IORT and HIPEC can be effective therapies in achieving long-term tumor control." Cancer researchers are continuing to develop advanced surgical treatments that combine multiple therapies. For pa- tients that means fewer treatment side effects, faster recoveries, and possibly better outcomes. As Karen's case shows, researchers are creating better ways to deliver cancer a knockout punch. http://www.cancercenter.com/conventional-cancer- treatment/radiation-therapy/iort.cfm http://www.cancercenter.com/cancer-center-news/ news/HIPEC-treatment-gives-cancer-patients-new- hope.cfm Reference 1. Verwaal VH, van Ruth S, de Bree E, et al. Randomized trial of cytoreduction and hyperthermic intraperitoneal chemotherapy versus systemic chemotherapy and pal- liative surgery in patients with peritoneal carcinoma- tosis of colorectal cancer. Journal of Clinical Oncology. 2003;21(20):3737-43. summer 2012 | cancer fighters thrive 35