Researchers have known for some time that cancer cells respond differently to heat than normal tissue cells. Heat delivered at a certain temperature kills tumor cells without harming normal tissue, and heat greatly increases cancer cells' absorption of chemotherapy agents. Thermal ablation exploits this difference by inserting probes into tumors and heating them to destroy tumor tissue without harming normal cells.

Another approach to heat treatment was developed in the 1980s by Paul Sugarbaker, M.D. at the Washington Cancer Center in Washington, D.C. Dr. Sugarbaker pioneered a method of heating the body cavity and applying highly concentrated chemotherapy agents directly to cancer tissue. Called Cyto-reductive Surgery with Heated Intraperitoneal Therapy (HIPC) and also referred to as the Sugarbaker Procedure, the novel therapy is designed to treat patients with pseudomyxoma peritonei (PMP) or cancer from another site that has spread throughout the organ-filled peritoneal cavity, but not into the liver or sites outside the peritoneal cavity.

The cyto-reductive surgery with heated intraperitoneal therapy is a two-part treatment that begins with surgical removal of much tumorous tissue as possible. Directly following the cyto-reductive surgery, a circulation solution is dispersed throughout the peritonea until it reaches at least 105 degrees. At this time a tumor specific chemotherapy solution is added and allowed to circulate for 90 minutes. The high temperature improves absorption into the peritoneal tissue. The solution is then drained and the cavity is thoroughly washed with saline solution, which is then drained away.

Indications:

• Pseudomyxoma peritonei.
• Peritoneal mesothelioma.
• Peritoneal sarcoma.
• Recurrent intraperitoneal cancer including, colorectal cancer, gastric cancer or ovarian cancer.
• Palliation of patients with malignant ascites.

Benefits:

• Heat increases the drug penetration into the tissue.
• Heat increases the cytotoxicity (ability to kill cells) of selected chemotherapy agents.
• Heat has anti-tumor effects by itself
• Intraoperative chemotherapy allows manual distribution of both the drug and heat uniformly to all surfaces of the abdomen and pelvis.
• Renal (kidney) toxicities (side effects) of chemotherapy can be avoided

Team Approach

Utilizing experts in surgical and medical oncology, surgery, pathology, anesthesia and critical care, the Peritoneal Carcinoma Program takes a team approach to ensure each patient gets comprehensive and effective treatment. The Peritoneal Carcinoma Program is directed by Gregory Graves, M.D., surgical oncologist, and recently welcomed Stacey D’Andre, M.D., medical oncologist, as co-medical director.

The Cyto-Reductive Surgery is currently available at Sutter Medical Center, Sacramento for patients who meet required criteria.

For more information, email capsurg@sutterhealth.org or call (916) 454-6913.