Hyperthermic Chemotherapy
Principle
Complementing the surgical cytoreduction treatment with intraoperative hyperthermic chemotherapy, by regulating the temperature and flow rate in the abdominal or thoracic cavity.
HIPEC or HITHOC?
Hyperthermic chemotherapy can be performed in the abdominal cavity: HIPEC or in the thoracic cavity: HITHOC.
Hyperthermic Intraperitoneal Chemotherapy HIPEC
Clinical indications
What are the clinical indications?
Curative treatment of peritoneal carcinosis *:
- Primary origin: rare diseases of the peritoneum
- Pseudomyxoma: 1-2 cases/year/million
- Mesothelioma: 2-3 cases/year/million
- Of secondary origin: approximately 100,000 cases/year
- Colorectal (15%)
- Ovarian (60%)
- Gastric (50%)
*Peritoneal carcinoma: A tumour that spreads from its primary site in the peritoneum and can invade the entire peritoneal cavity and all the organs it contains.
The peritoneum: further consideration?
The peritoneum has recently been recognised as an organ in its own right. This is a very thin, solid membrane made up of two layers that can move over each other.
- The parietal layer covers the entire internal wall of the abdominal cavity
- The visceral layer covers the external surface of all the organs contained in the abdominal cavity.
What is the procedure?
- CRS (Cytoreduction surgery): macroscopic reduction in tumour volume and removal of the various nodules visible to the naked eye and scattered throughout the peritoneum. The operation varies in duration. It can vary from one or two hours for very localised disease to more than nine or ten hours for more advanced disease.
- Calculation of the Sugarbaker Peritoneal Cancer Index (PCI). If the PCI is greater than 20, HIPEC is contraindicated.
- HIPEC (Intraperitoneal Chemotherapy): filling the abdominal cavity with a heated chemotherapy liquid to eliminate free, microscopic cancer cells (a “hyperthermic bath” lasting 60 to 90 minutes).
HIPEC
Things to remember
Two HIPEC techniques are currently used: open-abdomen (coliseum technique) or closed-abdomen.
The important points for full HIPEC treatment are to obtain a uniform temperature throughout the abdominal cavity and uniform diffusion of the peritoneal dialysate. The temperature of the bath should be at least 41 C and no more than 43 C (risk of digestive perforation above this temperature). The duration of the hyperthermic bath (30 to 90 minutes), the technique used (open-abdomen vs. closed), the temperature of the bath and the concentration of chemotherapy vary between teams.
Open HIPEC: coliseum technique
Closed HIPEC: Monitoring intra-abdominal pressure
What are the clinical benefits of HIPEC?
The advantage of HIPEC is that it has a local action; only a very small amount of chemotherapy liquid passes into the bloodstream (unlike conventional chemotherapy), which avoids the usual side effects of chemotherapy. It has also been shown that this method of treatment increases the quality of disease control in the peritoneum, reduces the rate of relapse and increases the long-term survival rate of patients, without increasing the risk of morbidity.
HITHOC
Hyperthermic Intrathoracic Chemotherapy
The same procedure can be performed in the thoracic cavity.
Gamida Tech
SunChip 2 equipment manufacturer
Gamida Tech, 18 years of experience in the manufacture of medical devices.
In 2005, Gamida Tech designed its first piece of SunChip equipment, in collaboration with Dr Dominique Elias and the biomedical team at the Institut Gustave Roussy, Villejuif. The SunChip system is a medical device specially designed for intraperitoneal chemotherapy. Building on its experience, Gamida Tech launched the SunChip 2 in 2017, which combines the performance, safety and precision of the SunChip with new features in terms of design and simplicity for greater versatility.
GAMIDA, French expertise in anaesthesia / intensive care, oncology surgery and biomedical engineering
Expertises
About us
Contact
+33 (0)1 39 59 86 00
contact@gamida.fr
31 rue des Alouettes, Eaubonne