Prakash Pandalai, MD, an ​assistant professor of surgery and surgical oncologist at the University of Kentucky Markey Cancer Center, discusses outcomes with adjuvant hyperthermic intraperitoneal chemotherapy (HIPEC) in patients with colorectal cancer (CRC).

The phase 3 COLOPEC trial examined the use of adjuvant HIPEC as a way to prevent peritoneal recurrence in patients who have a high risk of carcinomatosis development, according to Pandalai. This was a European, multi-institutional trial that included high-risk patients who were found to have peritoneal carcinomatosis or high-risk features. 

However, investigators found no significant advantages in terms of disease-free survival or recurrence in the patients who received adjuvant HIPEC, concludes Pandalai.

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Prakash Pandalai, MD, discusses outcomes with adjuvant hyperthermic intraperitoneal chemotherapy in patients with colorectal cancer.



Dr. Pandalai on Outcomes With Adjuvant HIPEC in CRC

Prakash Pandalai, MD, ​assistant professor of surgery, surgical oncologist, University of Kentucky, Markey Cancer Center, discusses the development of peritoneal carcinomatosis in colorectal cancer (CRC).

Peritoneal carcinomatosis is a disease that affects many patients with CRC. Notably, this occurs when the primary tumor ​perforates or spreads outside of the colon and sheds tumor cells into the abdominal cavity​. These cells often stick to the peritoneum or other organs​, such as the small intestine or omentum, Pandalai says. 

Peritoneal carcinomatosis is a complicated condition. As such, it’s critical for patients to understand the natural history ​of the disease. Different analogies could be used, such as the grilled cheese analogy. In this example, the melted cheese could represent the cancer cells and the toasted bread could represented the peritoneum. When the 2 pieces of bread are stuck together with melted cheese, they become difficult to separate. In this analogy, cancer cells ​that stick to the peritoneum could cause ​highly morbid complications, such as abdominal pain and bowel blockages.

Systemic chemotherapy is rarely effective in terms of penetrating the peritoneal cavity. Therefore, surgery with heated intraperitoneal chemotherapy is often implemented, Pandalai concludes.

Prakash Pandalai, MD, discusses the development of peritoneal carcinomatosis in colorectal cancer. 

Dr. Pandalai on the Development of Peritoneal Carcinomatosis in CRC

Prakash Pandalai, MD, ​assistant professor of surgery, surgical oncologist, University of Kentucky, Markey Cancer Center, discusses the use of cytoreductive surgery plus heated intraperitoneal chemotherapy (HIPEC) in the treatment of patients with colorectal peritoneal carcinomatosis.

Cytoreductive surgery and HIPEC are often thought of as a combination operation, but it's actually 2 separate procedures, according to Pandalai. The goal of cytoreductive surgery is to remove all the gross visible tumors, resulting in a multi-visceral resection during which a small piece of the intestine, colon, or appendix can be removed if they are found to have tumor deposits.

After surgery is complete, it's important to understand that the abdominal cavity can contain additional cancer cells following cytoreductive surgery, Pandalai explains. As such, catheters can be placed inside the abdominal cavity, allowing it to be profused for a period of time with chemotherapy that is infused in a heated solution.

Investigators set out to determine the value of each component of this regimen through the PRODIGE 7 study, during which patients were randomized to receive cytoreductive surgery with or without HIPEC. Through this approach, investigators were able to assess the efficacy of HIPEC, Pandalai concludes.

Prakash Pandalai, MD, ​discusses the use of cytoreductive surgery plus heated intraperitoneal chemotherapy in the treatment of patients with colorectal peritoneal carcinomatosis.


Dr. Pandalai on the Use of Cytoreductive Surgery Plus HIPEC in Colorectal Peritoneal Carcinomatosis

Prakash Pandalai, MD, ​assistant professor of surgery, surgical oncologist, University of Kentucky, Markey Cancer Center, discusses the efficacy of aggressive cytoreductive surgery plus heated intraperitoneal chemotherapy (HIPEC) in colorectal peritoneal carcinomatosis.

Historically, patients with colorectal peritoneal carcinomatosis who are treated with chemotherapy alone ​typically have a median overall survival of less than 1 year, Pandalai says. Add​ing aggressive cytoreductive surgery and HIPEC ​to traditional chemotherapy ​can improve outcomes for these patients.

Single​- and multi-institutional series have demonstrated an improved median OS with this regimen ​in the range of 40​to 45 months, which is quite profound for these patients, Pandalai concludes.

Prakash Pandalai, MD, discusses the efficacy of aggressive cytoreductive surgery plus heated intraperitoneal chemotherapy in colorectal peritoneal carcinomatosis.



Prakash Pandalai, MD

Articles

Dr. Pandalai on Outcomes With Adjuvant HIPEC in CRC

Dr. Pandalai on the Development of Peritoneal Carcinomatosis in CRC

Dr. Pandalai on the Use of Cytoreductive Surgery Plus HIPEC in Colorectal Peritoneal Carcinomatosis

Dr. Pandalai on the Efficacy of Cytoreductive Surgery Plus HIPEC in Colorectal Peritoneal Carcinomatosis