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Watering Dandelions with Chemo Bath

UC San Diego Health milestone: 500 patients undergo HIPEC while ovarian cancer meets new foe

By Yadira Galindo   |   March 02, 2018

​A scar that runs across Steve Belkin’s abdomen is the only physical reminder of a rare form of appendiceal cancer or of the aggressive treatment, known as heated intraperitoneal chemoperfusion (HIPEC), that he underwent to rid his body of the disease.

Belkin is among the 500 people who have undergone this specialized treatment at UC San Diego Health. He was referred by his Los Angeles-based doctors to Moores Cancer Center at UC Diego Health, known as one of the most experienced in treatments for advanced abdominal cancers, when surgeons discovered mucin in his abdomen during an emergency appendectomy in 2010.

Belkini and son

“When a doctor says they don’t know what something is, it’s pretty concerning,” said Belkin. “When the diagnosis was made, they referred me to a specialist at UC San Diego, where I found out that the tumor had opened up. They described it like a dandelion, if you blow on it spreads everywhere.”

Belkin had no previous symptoms, which is common for this and many other types of cancers. He was diagnosed with stage IV disease because it had spread, or metastasized, throughout his abdomen to his liver, gall bladder, pelvis and the lining of the abdomen, called the peritoneum.

Because it was contained to his abdominal cavity and had not spread through the blood or lymphatic system, Belkin was referred to Andrew Lowy, MD, a UC San Diego Health surgical oncologist known worldwide for his expertise in HIPEC, also known as chemo bath.

Belkin’s cancer was slow spreading, making him an ideal candidate for treatment with HIPEC in conjunction with cytoreductive surgery, an operation to remove all visible cancer cells.

“Even when all signs of cancer are gone, we know there are still cancer cells present in the abdominal cavity that are either floating around or attached to the surfaces of organs that we cannot see,” said Lowy. “At this point, we deliver HIPEC therapy to kill microscopic cells that are invisible to the eye.”

When all tumors are removed, chemotherapy is administered in a salt solution through catheters that continuously pump the drug in and out of the patient’s sealed abdomen. The chemotherapy is heated to a high temperature while circulated around the abdominal cavity for approximately 90 minutes to reach all surfaces that might contain cancer cells.

“The great thing about HIPEC is that, unlike intravenous chemotherapy, the amount of chemotherapy that gets in the bloodstream, and thereby affects other organs and tissues, is reduced. So the side effects of HIPEC are much fewer,” said Lowy.

For Belkin, the first three months were difficult. Recovery is mostly from the surgery but heating the abdominal organs with HIPEC can result in a slower return of normal gastrointestinal functions, like eating and bowel movements. Within six months, Belkin was feeling better, and within one year, his quality of life had returned to normal.

“Initially, it sounded pretty crazy to me, but once it was clearly defined that this was the best course of action and I knew that Dr. Lowy was the specialist, I didn’t hesitate,” said Belkin. “If there is a decent chance that it would cure you or extend your life I would say: Do it.”

Today, Belkin is healthy with no signs of cancer. He is married, a father of an 18-month-old boy and he and his wife are expecting a girl in May.

In 2017, UC San Diego Health treated 75 patients with HIPEC, making it one of a dozen or so hospitals that treats more than 50 patients with HIPEC each year.

Andrew Lowy

“Studies show that in most complex surgeries, no matter what organ or disease, the more procedures a surgeon or institution performs the better the results and the lower rates of complications,” said Lowy. “If you are being treated for a rare disease, seek out an institution that performs a high volume of that therapy.”

Up to 70 percent of malignancies treated with HIPEC at UC San Diego Health are appendiceal cancer followed by colorectal cancer. HIPEC is intense and is reserved for patients with these advanced cancers, as well as peritoneal mesothelioma and highly selected patients with stomach cancer.

More recently, a study published in the New England Journal of Medicine by researchers from the Netherlands, showed that women who underwent cytoreductive surgery with HIPEC had a longer recurrence-free survival and overall survival than that with surgery alone. In fact, the median overall survival increased by one year.

“Ovarian cancer is the prototype disease that HIPEC should be designed for because this cancer typically spreads inside the abdominal cavity,” said Jula Veerapong, MD, who along with Lowy, Joel Baumgartner, MD, and Kaitlyn Kelly, MD, make up the UC San Diego Health HIPEC team. “Adding another modality to fight cancer would be beneficial for patients with cancer of the ovary.”

In fact, Veerapong recently administered HIPEC to a patient with ovarian cancer alongside Ramez Eskander, MD, UC San Diego Health gynecologic oncologist. The team will continue to evaluate each patient with this disease to determine which therapy is best for the individual, including the possibility of HIPEC therapy.

“This is exciting news for patients with ovarian cancer because if we are able to provide heated chemotherapy at the time of surgery it may be our best shot because with any type of cancer your first shot is your best shot,” said Veerapong.

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