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hipec

vinaykumar
Posts: 66
Joined: Dec 2012

i am posting this on behalf of my father who has recently been diagnosed with colorectal cancer

he underwent the surgery today in delhi ( India) )( 13-12-2012) ( Right hemocolectomy,removal of mesentry and omentum)

the surgeon said that they saw subcentimeter 2 seeds in peritonium also and removed those also along with the lymph nodes. There were no ascites seen

There was no visible spread detected in liver or kidneys. The pre surgery PET CT scan also did not show any spread

while we post operative biopsy report. I was wondering if anyone can provide an opinion if he is a good candidate for HIPEC once he recovers from this surgery.

thanks

A

Chelsea71
Posts: 1170
Joined: Sep 2012

Yes, it sounds like he would be a good candidate, providing he is in good physical condition. The cut off age is 70. It is a tough surgery. My husband had it in April 2012. It sounds like your Dad has already had a considerable amount of debulking completed. If you have specific questions, I would be happy to try and answer them. I've done a lot of research surrounding Hipec.

Chelsea

vinaykumar
Posts: 66
Joined: Dec 2012

thanks for your response.
yes,my father is quite healthy ( vegetarian,no smoking drinking or previous surgery)

i talked to a surgeon who suggested that we do 3 months of folfox then wait 3 weeks ,follow it up with hipec and then 3 more months of chemo.

wondering if thats the standard regime followed? also,there seems to be confusion on the sucess rate the hipec...

Chelsea71
Posts: 1170
Joined: Sep 2012

Success depends on several factors. Very important that the surgeon is able to achieve a complete cytoreduction and also the overall lymph node status. Those with no (or little) retro-peritoneal lymph node involvement and no metastasis to the liver seem to be more successful. Success will also depend on the volume of disease (Regardless of a complete cytoreduction. Those with low volume fare out better). Many surgeons will not do HIPEC if there is liver or lung involvement. There are several regimes re chemo. My husbands surgeon wanted 13 sessions of Folfiri and then Hipec. Others do surgery and then 6 mos. Chemo. What your fathers surgeon suggested sounds quite reasonable. Different aspects of the surgery seem to vary from centre to centre. There seems to be no standard way of doing it. Each team has their own way of doing things. They may tailor the procedure depending on the patient's situation. Going into the surgery strong and relatively healthy will be a big asset for him.

Chelsea

vinaykumar
Posts: 66
Joined: Dec 2012

is there any diet plan you follow pre and post hipec ?

Chelsea71
Posts: 1170
Joined: Sep 2012

Nothing formal going into it. Just a healthy balanced diet. Post Hipec was difficult. The "hot chemo" really puts the whole digestive system in to shock. Steve (my husband) has always loved to eat. After hipec eating was very difficult. No appetite. For the first few days (maybe weeks) the stomach doesn't know what to do with the food. Eating was not enjoyable. It was more of a chore. Steve lost about 25 lbs. It took him about 8 months to put it back on. Exercise might be difficult for your Dad as he is recovering from surgery. Steve went into it quite physically fit. Walking for an hour a day and some weight lifting. He ate a lot of green leafy vegetables, fruit smoothies etc... It's a big operation. Most of all, I think you have to go into it very strong mentally.

Take care,

Chelsea

vinaykumar
Posts: 66
Joined: Dec 2012

did your husband use monoclonal drugs?

Erbitux and Vectibix

Chelsea71
Posts: 1170
Joined: Sep 2012

Yes. Avastin with the Folfiri.

vinaykumar
Posts: 66
Joined: Dec 2012

so the post op biopsy reports just came in , not sure if we should still consider hipec or only chemo will help

omentum - tumor deposit ( metastatic adenocarcinoma - present)

{ as i stated earlier, there was a total omentectomy done during the surgery)

lymph nodes -

pericolonic lymph nodes - retrieved - 11 , lymph node with metastatic tumour - 07

para aortic lymph nodes retrived - 06 , lymph node with metastatic tumour - 0

extent of local spread

veseral peritoneum - free
deepest layer of invasion - perimuscular adipose tissue
large vessel invasion - present
small/ vessel / lymphatic invasion - present
peri neural invasion - present

Chelsea71
Posts: 1170
Joined: Sep 2012

Is the oncologist recommending no HIPEC or is your father having second thoughts?

Chelsea

vinaykumar
Posts: 66
Joined: Dec 2012

no , i havent seen the onco yet....just trying to understsnd this further....since there is nothing omentum i was thinkign if i shoudl consider hipec. i shall start meeting oncologists in the next 2 days.

i havnt told my father about hipec....he needs some time to mentally get out of the surgery which just happened.

Chelsea71
Posts: 1170
Joined: Sep 2012

Even though the omentum is gone, there is likely residual tumor cells floating around the abdominal cavity. The idea is that the heated chemotherapy will destroy these cells before they are able to form a new tumor and latch on to an organ. Heated chemo is much more effective (I've hear 70 - 100%). The fact that they are applying it directly is important, as well. Systemic chemo is less effective for cancer in the abdominal cavity. The blood/peritoneal barrier makes it harder for system chemo to reach this area. My husbands surgeon told us that the application of the "hot chemo" is not the dangerous part of the surgery. The risk is with the removal of the cancer and resecting of the organs. In your fathers case that has already been done. The recovery would be easier than compared to my husband who required a lot of resecting prior to the heated chemo application.

Having said that, you're right. I would think your Dad would need significant time to recover physically and mentally from the last surgery. HIPEC is a biggie. He would want to go into it feeling very strong and motivated to fight. In some cases, there seems to be no big hurry to do HIPEC. I'm sure it varies with each patient. This surgery would likely be available to him down the road. I would see what the onc has to say about doing the systemic chemo first, taking a break and then revisiting the idea of HIPEC.

Chelsea

vinaykumar
Posts: 66
Joined: Dec 2012

Whats d diffence betwn palliative chemo and curative chemo? Is the dosage diffrent but medicines the same?

 

the oncologist i met said he is considering my fathers case as palliative and will do 6 cycles of folfox 6

(5fu , leucovorin, ocaliplatin)

pete43lost_at_sea's picture
pete43lost_at_sea
Posts: 3915
Joined: Nov 2010

sorry to hear about your fathers illness.
I too have peritoneal seedlings, with liver and lung.
I am trying some interesting alternative therapies in german clinics.
HIPEC is a big operation with complications, I may well do it one day, but it depends on getting the tumours under control.

I did the folfox post op, it did not buy me a cure. that said I hope it works for your father. You are a really good son. google peritonecomy and start reading. great surgical teams are in USA, JAPAN, GERMANY and even AUSTRALIA.

goodluck

hugs,
Pete

vinaykumar
Posts: 66
Joined: Dec 2012

hi pete.... whats the criterion for deciding hipec in your case? as i mentioned my father has peritonial seeding but no seeding on the liver . The parts which has depostis (omentum, colon, mesentry,LNs) have already been resected.There were no ascites seen

also , can you guide me to the alternative therapies you are trying?

vinaykumar
Posts: 66
Joined: Dec 2012

hi pete.... whats the criterion for deciding hipec in your case? as i mentioned my father has peritonial seeding but no seeding on the liver or ascites . The parts which has depostis (omentum, colon, mesentry,LNs) have already been resected.

also , can you guide me to the alternative therapies you are trying?

pete43lost_at_sea's picture
pete43lost_at_sea
Posts: 3915
Joined: Nov 2010

Still focusing dendritic vaccines, removab, infusions and chemo embolisation.
I need lung and liver clear for 6 months before hipec.

I am still trying brute force approach, I went with the best clinic I could find and afford.

See other posts for German experiences.

Hugs,
Pete

Ps make this Xmas extra special

AVIAN
Posts: 2
Joined: Dec 2012

Said to know all about. I hope HIPEC by now available in Gurgaon also. Only patient should be healthy to receive it.

vinaykumar
Posts: 66
Joined: Dec 2012

not sure about gurgoan...bu **** avalible in a few places in mumbai

AVIAN
Posts: 2
Joined: Dec 2012

In mumbai i know about the Saifee hospital who perform that.

vinaykumar
Posts: 66
Joined: Dec 2012

yes, i am already in touch with them.

adan1
Posts: 2
Joined: Dec 2012

If you need any lit , can send email to us at infoaahealthcare@gmail.com

adan1
Posts: 2
Joined: Dec 2012

It is available in Rajiv Gandhi cancer center in delhi. My company installed it and the Drs have been able to increase median survival rates in colorecatal and Gyne cancers with dissemination into peritoneum.

hipecindia
Posts: 1
Joined: Nov 2013

Hipec treatment is available at Bangalore for the last 3 years. It is available at Sakra World Hospital. You can get in touch with me at info@sakraworldhospital.com for more information

mehta
Posts: 1
Joined: May 2014

HIPEC is being regularly done at Saifee Hospital in Mumbai. The surgeons name is Dr. Sanket Mehta. He also operates at some other hospitals as well. He was one of the pioneers of HIPEC in India. 

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