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Current Status of Hyperthermic Intraperitoneal Chemotherapy (HIPEC) in Colorectal Cancer (CRC)
S P Somashekhar1, Adwaith Krishna Surendran2, Deep Goyal3
1Department of Surgical Oncology, Aster DM Healthcare, Bengaluru, Karnataka, India.
South Asian Journal of Cancer
|March 10, 2025
Summary
Cytoreduction surgery with hyperthermic intraperitoneal chemotherapy (HIPEC) is a debated treatment for colorectal cancer. While not showing significant survival benefits over surgery alone in all trials, it may benefit selected patients when used with specific protocols.
Area of Science:
- Oncology
- Surgical Oncology
- Gastroenterology
Background:
- Colorectal cancer (CRC) accounts for 8.7% of global cancer deaths, highlighting the need for effective treatments.
- Cytoreduction surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) is a multimodal strategy for managing CRC, particularly for peritoneal metastases.
- HIPEC aims to eliminate microscopic disease by delivering heated chemotherapy directly into the peritoneal cavity post-CRS.
Purpose of the Study:
- To examine early trials, procedural variations, and recent clinical research on the efficacy of CRS combined with HIPEC for colorectal cancer.
Main Methods:
- Review of existing literature on HIPEC techniques (coliseum, closed abdomen, laparoscopic) and chemotherapy regimens (Sugarbaker, triple dosing, low dose mitomycin C).
- Analysis of clinical research assessing the efficacy of HIPEC, including its advantages, disadvantages, and comparison with other intraperitoneal treatments.
- Evaluation of factors influencing HIPEC outcomes, such as chemotherapy drug selection and patient selection criteria.
Main Results:
- HIPEC techniques vary, with the coliseum method offering superior heat uniformity and the laparoscopic method providing optimal distribution.
- Mixed results have been reported for different HIPEC regimens and chemotherapy agents (oxaliplatin, mitomycin C).
- Recent trials like PRODIGE 7 question the benefits of HIPEC, citing chemoresistance and increased postoperative morbidity, although some support its use in carefully selected patients.
Conclusions:
- HIPEC for colorectal cancer with peritoneal metastases remains a debated topic, with current evidence suggesting no statistically significant overall survival improvement compared to CRS alone.
- HIPEC may still be beneficial in specific clinical settings or with well-designed protocols, necessitating further research and standardized approaches.
- Further trials are required to determine HIPEC's definitive role, optimize patient selection, and compare it with alternative intraperitoneal therapies.
