hipec : stopgap chemo

Systemic chemo does not easily reach peritoneal mets, as they have no direct blood supply.  I had no systemic chemo pre-debulking and intraperitoneal chemo.  Had systemic (Folfox) after.

Steve did 13 Folfiri (9 with avastin).  Four week break prior to Hipec.  The cancer did not spiral out of control during the break.  The systemic chemo was surprising effective against his peritoneal cancer.  After Hipec the surgeon said that he could tell by the way the cancer looked that the Folfiri had done quite a number on it.

Chelsea

Chelsea71 said:

Steve did 13 Folfiri (9 with

Steve did 13 Folfiri (9 with avastin).  Four week break prior to Hipec.  The cancer did not spiral out of control during the break.  The systemic chemo was surprising effective against his peritoneal cancer.  After Hipec the surgeon said that he could tell by the way the cancer looked that the Folfiri had done quite a number on it.

 

Chelsea

Hey Chels,

I know that you were obviously simply replying to his question about systemic chemo before HIPEC, but since your post seemed more postive than you may have intended (at least to me), I just want him to be aware that like Rick, HIPEC did not help your husband either.  So, I've decided to quote from your csn bio:  "...HIPEC surgery April 13, 2012 at Hospital Maisonneuve Rosemont in Montreal, Quebec. Big operation. Treated very aggressively. Surgeon was hopeful. First Scan following surgery (Aug. 2012) showed numerous liver metastasis". 

And sorry folks, but I have never seen where HIPEC has been successful, although I'll exclude Alice in this statement because I believe her mets were from appendix cancer, which has an overall better success rate according to Dr. Sugarbaker (the inventor of HIPEC).  He actually denied performing Rick's surgery since he stated that colon cancer patients don't express well with HIPEC treatment so he will not perform any more surgeries on colon cancer patients.  If I had a "do-over" in life, I would have now preferred Rick to have had those four months that he spent recovering from surgery to instead have had them spent with his family.  Quality over quantity I suppose would have been the better choice; but as they say, hindsight is 20/20.

Take care all.

LivinginNH said:

 
Hey Chels,
I know that you

 

Hey Chels,

I know that you were obviously simply replying to his question about systemic chemo before HIPEC, but since your post seemed more postive than you may have intended (at least to me), I just want him to be aware that like Rick, HIPEC did not help your husband either.  So, I've decided to quote from your csn bio:  "...HIPEC surgery April 13, 2012 at Hospital Maisonneuve Rosemont in Montreal, Quebec. Big operation. Treated very aggressively. Surgeon was hopeful. First Scan following surgery (Aug. 2012) showed numerous liver metastasis". 

And sorry folks, but I have never seen where HIPEC has been successful, although I'll exclude Alice in this statement because I believe her mets were from appendix cancer, which has an overall better success rate according to Dr. Sugarbaker (the inventor of HIPEC).  He actually denied performing Rick's surgery since he stated that colon cancer patients don't express well with HIPEC treatment so he will not perform any more surgeries on colon cancer patients.  If I had a "do-over" in life, I would have now preferred Rick to have had those four months that he spent recovering from surgery to instead have had them spent with his family.  Quality over quantity I suppose would have been the better choice; but as they say, hindsight is 20/20.

Take care all.

Hi Cynthia,

When Steve had Hipec his cancer at that time was contained to his abdominal cavity.  Surface cancer, with the exception of two retro-peritoneal lymph nodes discovered during his first surgery (colectomy-removal of the primary tumor).  I can remember the surgeon saying that this surgery was ideally done when there is only surface cancer.  The surgeon was very aggressive.  He targeted the affected lymph nodes and removed many others as a precaution.  Steve lost the tail of his pancreas, spleen, some small intestine, some abdominal wall, his rectal stump.....big, big surgery.  Clear margins.  Four months later there were tumors in the liver.  Prior to hipec the liver appeared fine.  So, we don't know if it spread there during surgery or if there were seedlings present prior to hipec that were too small to be detected.  Shortly before he died there were small spots on his lungs, as well.  I don't have huge regrets about hipec.  We knew going into it that it was risky and that it would involve a long recovery.  We knew the chances of him being cured were a longshot but we had hoped that such a big surgery would have bought him more time. His cancer did not return to the peritoneal cavity and for this I am grateful.  As we all know, the peritoneal cavity is not the best place to have tumors.  As the tumors grow they cause blockages and really affect ones QOL.  Basically, I am glad that at the end he was suffering from liver metastasis vs. peritoneal spread.  I do regret not having him use cimetidine before and after surgery.  I have really never heard of hipec curing anyone with MCRC.  Appendix cancer is more successfully treated by hipec.  In hindsight would we have done the hipec?  Likely not.  I actually spend a lot of time thinking about what we would have done differently.  Steve's cancer was very very aggressive.  A lot went wrong along the way.  He developed a lot of unusual complications.  I suspect that huge clot that developed by his port that completely blocked his superior vena cava played a big role in his downward spiral.  I think it prevented the chemo from being as effective as it should have been.  It seems like it all went downhill after the clot formed.  Anyways, Steve's anesthesiologist told him that hipec is the roughest surgery a person can have.  (It's nick name is MOAS for mother of all surgeries). It certainly shouldn't be entered into lightly.  As I stated earlier, I have not heard of any cc cures from hipec.  I think it's been proven to extend people's lives by six months to a year.  It takes some people close to a year to fully recover.  Is it worth the risk and brutal recovery?  In my opinion, probably not.

Chelsea

abrub said:

A side note - I didn't have HIPEC

I had EPIC, which is IP chemo administered after surgery via a belly port.  It uses a different chemo agent than is used in HIPEC.  I had a version of 5FU directly administered into my belly at about 300x the strength you can get with 5FU by IV.  HIPEC is usually mitomycin C or oxaliplatin.

And yes, my cancer was appendiceal in origin.  We'll see how I'm doing in a few days, as I have my next follow-up scan on Thursday (first MRI for this.)  So far, so good at 6 years out from surgery/IP chemo.

Alice

Ah, yes, EPIC, I had asked about that, but the doctor said that it wouldn't help him for some reason.  I still don't understand why since it helped you so much.  It seems to make perfect sense to administer it directly into your belly, but what do I know...   Best wishes for a great scan this week, I'm sure it will be fine.     I'll keep you in my thoughts, and as Roger used to say, "Will be sending sparks your way." 

Hugs,

Cyn

LivinginNH said:

 
Hi,
Yes, I too am very glad

 

Hi,

Yes, I too am very glad that Steve didn't pass from peritoneal spread as Rick did.  And, like you, I have never heard of anyone having success with HIPEC, so I'd really hate for this poster to have his Dad go through it.  I still hold some anger at the surgeon for leading Rick on at how HIPEC would give him an extra five years at least.  Rick had surface cancer only, so the surgeon said that he too was "shocked" when it came back four months later.  If only I knew then what I know now...it's true, hindsight is 20/20.   I so hate this friggin disease. 

(Ok, I'll get off my soapbox now, sometimes I just need to vent - especially when I seen the word HIPEC mentioned.)

Take care

who had HIPEC and has been NED for a while now, I think 2-3 years.  But he was in his late 20s when he had it done, and in exceptionally good health.  One person out of the many I've seen on the forums who have had this done is a pretty sad "success" rate.

We're just so desperate to live, and the doctors truly do want to save us...it's not surprising that we all try just about anything to survive.  The instinct and will to fight for life is just so strong.

My sister had surgery two months before she died (not HIPEC just tumor debulking).  She spent two weeks of those two months in the hospital instead of at home with her husband and kid.  It wasn't the right decision, but when you're in the heat of the moment, it seems impossible to make the right decision.

I'm so sad for all of us who lost people we loved to this beast.  Although I shouldn't call it that, I guess...that's an insult to beasts everywhere.

LivinginNH said:

 
Hey Chels,
I know that you

 

Hey Chels,

I know that you were obviously simply replying to his question about systemic chemo before HIPEC, but since your post seemed more postive than you may have intended (at least to me), I just want him to be aware that like Rick, HIPEC did not help your husband either.  So, I've decided to quote from your csn bio:  "...HIPEC surgery April 13, 2012 at Hospital Maisonneuve Rosemont in Montreal, Quebec. Big operation. Treated very aggressively. Surgeon was hopeful. First Scan following surgery (Aug. 2012) showed numerous liver metastasis". 

And sorry folks, but I have never seen where HIPEC has been successful, although I'll exclude Alice in this statement because I believe her mets were from appendix cancer, which has an overall better success rate according to Dr. Sugarbaker (the inventor of HIPEC).  He actually denied performing Rick's surgery since he stated that colon cancer patients don't express well with HIPEC treatment so he will not perform any more surgeries on colon cancer patients.  If I had a "do-over" in life, I would have now preferred Rick to have had those four months that he spent recovering from surgery to instead have had them spent with his family.  Quality over quantity I suppose would have been the better choice; but as they say, hindsight is 20/20.

Take care all.

I was diagnosed with Stage IV colon cancer in April 2013. I had the Hipec right after surgery to remove all cancer that could find. It was successful at this point in my opinion because even though I have had an allergic reaction to the oxiliplatin for chemotherapy, I am now only on Xeloda with Avastin introduced into it 2 weeks ago and my Oncologist says everything is going well. I have a scan scheduled for Wednesday to see if he is correct. The only problem I am experiencing right now is soreness in the back of my neck. 

I had at least 4 weeks between chemo and HIPEC surgery.  At least 8 weeks off Avastin.  Then my surgeon made me wait 3 months before starting chemo again.  Wish I had started right away.  Definitely do the cimietidine and PSK after surgery. 

I know of one woman, she's not on this discussion board that had stage IV colon cancer had HIPEC as her first surgery and is NED 5 years later.  That's the only "cured" person I know of that had HIPEC.  I have had recurrances, but so far all in the peritoneum, although they were originally in the upper left quadrant, now down near the rectum and I've wondered if the HIPEC wash helped that.  Since, it's been over 4 years since I had HIPEC and I'm doing well, even with the recurrances.  Good luck to your dad, Traci

vinaykumar said:

thanks for the inputs

thanks for the inputs evryone. this really helps me breath easy and focus on getting other things in order for the surgery.

 

In India ( thats where we stay ) , HIPEC is a new modality and the surgeon i have zeroed in on has done about 30 HIPEC , altough he has done abt 700 cytoreductions without HIPEC.

 

i am wondering  taking my dad to europe for HIPEC would be better ( the surgeons i contacted there have > 400 HIPEC experience)  , but i dont want get stuck in europe if his recovery is longer than the usual 4 weeks !!

The tricky part is the cytoreduction.  This is where you want a lot of talent and experience.  700 is a nice number.