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Percutaneous Hepatic Perfusion PHP with Melphalan as a Treatment for Unresectable Metastases Confined to the Liver
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Higher flow rates improve heating during hyperthermic intraperitoneal chemoperfusion.

Matthew J Furman1, Robert J Picotte, Mark J Wante

  • 1Division of Surgical Oncology, University of Massachusetts Medical Center, Worcester, Massachusetts.

Journal of Surgical Oncology
|August 30, 2014
PubMed
Summary

Higher flow rates during heated intraperitoneal chemotherapy (HIPEC) improve peritoneal heating and efficacy. Achieving goal temperatures requires a minimum HIPEC flow rate, crucial for effective cancer treatment.

Keywords:
chemosensitivityflow ratesheat sinkheated intraperitoneal chemotherapy

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Area of Science:

  • Oncology
  • Surgical Oncology
  • Medical Physics

Background:

  • Heated intraperitoneal chemotherapy (HIPEC) utilizes thermal injury and enhanced drug delivery to eliminate cancer cells.
  • The efficacy of HIPEC is influenced by the temperature achieved within the peritoneal cavity.

Purpose of the Study:

  • To investigate the relationship between HIPEC flow rates and peritoneal heating efficiency.
  • To determine the minimum flow rate necessary to achieve therapeutic temperatures during HIPEC.

Main Methods:

  • A laboratory model simulating HIPEC conditions was used to assess temperature changes at varying flow rates.
  • HIPEC procedures were conducted in a swine model to monitor inflow, outflow, and peritoneal temperatures.
  • Retrospective analysis of temperature and flow rate data from 20 clinical HIPEC procedures.

Main Results:

  • Increased HIPEC flow rates significantly reduced the time to reach target temperatures (43°C) in both the water bath and saline bag models.
  • Higher flow rates created greater temperature gradients between the water bath and the heat sink.
  • In the swine model, higher flow rates led to faster peritoneal heating and increased temperature differentials.
  • Clinical HIPEC data indicated that higher flows correlated with improved peritoneal heating and lower average visceral temperatures.

Conclusions:

  • A minimum flow rate is essential for achieving and maintaining the target temperatures required for effective HIPEC.
  • Flow rate is a critical, modifiable parameter influencing the thermal efficacy of heated intraperitoneal chemotherapy.