Stunned by a diagnosis of stage-four ovarian cancer, Tracy Gosson, an otherwise healthy 52-year-old marketing executive, began Googling. The results were grim: Cancer recurs in nearly everyone with this disease after standard treatment, and only about 30% of ovarian patients survive five years.
“How do I get in that 30% lane?” Gosson thought.
She decided to try a nontraditional treatment that meant pouring hot liquid chemotherapy into her belly.
Hyperthermic intraperitoneal chemotherapy, or HIPEC, was decades old but slow to catch on. There wasn’t much evidence showing it helped.
There was so much doubt that when Gosson’s surgeon at Mercy Medical Center in Baltimore, Dr. Armando Sardi, adopted the little-known procedure first used in Japan more than 30 years ago, he had to develop his own standards and jerry-rig a heart bypass machine to get the chemo to 109 degrees.
But HIPEC now has dedicated equipment and mounting evidence that certain types of patients with advanced gastrointestinal and gynecological cancers can gain precious months and years cancer free.
Some of that research comes from Sardi’s team at Mercy based on patients like Gosson. But there’s more from others across the country and world. A Dutch study published earlier this year in the journal Lancet Oncology found late-stage ovarian cancer patients given HIPEC could still benefit after 10 years.
Johns Hopkins Hospital, the University of Maryland Medical Center and the National Cancer Institute in Bethesda are among the 115 hospitals now offering HIPEC, according to HIPECtreatment.com, an information repository. Insurance coverage also is catching up with the the $150,000 price tag.
“The field has branched out quite a bit from 10 or 15 years ago when surgical oncologists performed this complex surgery for a mishmash of patients with terminal disease,” said Dr. Vadim Gushchin, a surgical oncologist and director of Mercy’s HIPEC program.
“We have a much clearer understanding of what we can expect from this treatment for separate groups of patients,” he said. “Every category is treated differently, from using different drugs to being more or less aggressive in the operating room depending on the tumors we’re dealing with.”
Mercy doctors have performed more than 1,000 HIPEC procedures, and the hospital now averages up to 100 a year of that procedure on patients with advanced cancers in their midsections from their ovaries, colon, stomach, liver or other organs. It’s also used to treat mesothelioma, cancer of the membrane covering the lungs and abdomen that is caused by asbestos exposure.
Gushchin and Sardi said surgeons don’t often know how extensive an operation will be until they open up patients for surgeries that can last 12 to 14 hours. They generally cut out all visible tumors, diseased organs in whole or part, and organs that could later become diseased.
Sardi sliced a 16-inch opening in Gosson’s belly and removed her gallbladder, spleen, appendix and the flap of membrane connecting her stomach to other organs. She also had a hysterectomy, with removal of her womb, cervix, fallopian tubes and ovaries.
Then comes the hot chemotherapy bath. The cocktails, mixed from different drugs, are piped in through tubes, and the patient’s body is shaken to ensure every nook of the belly is soaked for at least 90 minutes before being sucked out.
Recovery is long, and the doctors said patients do better when the procedure is performed soon after diagnosis rather than after many rounds of debilitating chemotherapy and surgeries. There can also be side effects like pain and bloating and life adjustments from cutting out all or part of organs, some more severe (liver and intestines) versus others (gallbladders and appendixes).
“I tell them I’m going to run a truck over them and then back up and run over them again,” Sardi said of recovery, often exceeding two months.
Mercy tracks each patient so findings can inform the next surgeries, said Gushchin, who expressed gratitude to patients and families for participating in research. The doctors also spend time presenting findings and are now helping draft guidelines for national and international medical bodies that will dictate everything from who should get HIPEC to the temperature and length of the bath.
“We collaborate and teach,” Gushchin said. “The work is ongoing.”
Next, he and others say, is refining who will benefit by looking for specific genes and other factors influencing disease progression. Artificial intelligence may help with that, Gushchin said. Researchers are also looking at the best ways to respond when cancers reemerge, including other rounds of HIPEC.
While growing in acceptance, doctors need to temper patient expectations since not everyone will benefit or stay symptom-free for long, said Dr. Christina Annunziata, senior vice president of extramural discovery science at the American Cancer Society.
She has recommended the procedure at her practice at the Inova Schar Cancer Institute in Northern Virginia, where she still sees a limited number of patients. Given the gravity of advanced cancer diagnoses, she’d like more research and diagnostic tests. She’s also like to see agreement on how to apply the procedure.
For example, she said research suggests traditional IV chemotherapy before and even after HIPEC appears to benefit ovarian cancer patients.
“HIPEC is still not really considered standard, but it’s definitely an option to be discussed. A couple of recent studies have shown benefit,” Annunziata said.
“There still is a lot of hope for it,” she said. “The key thing that needs to be discussed on an individual basis are the characteristics that make people more amenable.”
Gosson believes HIPEC may be why she’s alive and healthy and wants people with terminal cancers to learn about the option. In addition to her day job as president of the Sagesse marketing firm, she’s now helping Sardi with a nonprofit organization he created called Partners for Cancer Care and Prevention to spread awareness. Several events are planned.
That group is also launching a network called Abdominal Cancers Alliance to connect people with HIPEC patients. Sardi said their stories are critical, as some have outlived the odds by years.
The Institute for Cancer Care at Mercy also is hosting a series of events to raise awareness and research funds, including a Sept. 24 walk called Heat It to Beat It, and a lot of patients like Gosson will attend.
“There are so few treatment options for people with advanced cancers; we’re told to pack up our things and go home and die,” said Gosson, who had her four-year checkup this week that found she remains cancer free.
“Maybe there is hope.”
