HIPEC Trials and the US: A Review and Call to Action

Excerpt

One of the most controversial therapies in the field of oncology today is cytoreductive surgery (CRS) and heated intraperitoneal chemotherapy (HIPEC). Regional therapy for the peritoneum was described as early as the 1960s for gynecologic malignancies, with the first gastrointestinal cancer case described in 1980. Since then, a small number of surgeons in the US, Europe, and Japan have further refined this intervention, with enough success that additional surgeons have been trained in these techniques such that there are currently more than 100 institutions in the US that offer HIPEC. Demand for the procedure is driven by patients with advanced tumors and few treatment options, and by the treating physicians who have observed increased survival in their patients. Surgical resection of metastatic disease is not novel and resection of colorectal liver metastases has evolved to standard care¹ (without a randomized trial of liver resection versus systemic therapy). Resection of isolated or limited metastatic melanoma has long been accepted, particularly in the absence of effective systemic therapies until the last decade.² The argument against CRS/HIPEC rests on the lack of level 1 evidence, coupled with the potential for significant morbidity from CRS and HIPEC. Today, the chasm between HIPEC and non-HIPEC institutions seems fixed, yet now more than ever we need multi-institutional clinical trials. This will require both ‘sides’ to compromise, and, in an effort to promote collaboration, the following review presents the highest quality available data regarding CRS, HIPEC and colorectal cancer, with a discussion of remaining clinical questions and the barriers that lie ahead. …..HIPEC Trials and the US. …