Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is a treatment option for certain types of advanced abdominal cancers, such as peritoneal mesothelioma, pseudomyxoma peritonei, and advanced ovarian cancer. The selection of patients for CRS with HIPEC requires a thorough evaluation by a multidisciplinary team of specialists, including surgeons, medical oncologists, radiologists, and pathologists.
The selection criteria for CRS with HIPEC include various factors related to the patient’s general health status, tumor characteristics, and disease stage. The following are some of the key factors that are considered in the selection process:
Tumor Type: The type of cancer is one of the most important factors in determining whether a patient is a candidate for CRS with HIPEC. This treatment is most commonly used for peritoneal surface malignancies, such as peritoneal mesothelioma, pseudomyxoma peritonei, and advanced ovarian cancer. Other types of cancer, such as colorectal cancer, may also be considered for CRS with HIPEC in certain cases.
Disease Stage: The stage of the cancer is another important factor in determining whether a patient is a candidate for CRS with HIPEC. This treatment is typically reserved for patients with advanced or metastatic disease, where the cancer has spread to the peritoneal cavity or other organs within the abdomen.
Performance Status: The patient’s overall health and performance status are important considerations in the selection process. Patients who are in good general health and have a good performance status are more likely to tolerate the surgery and chemotherapy involved in CRS with HIPEC. Patients with significant comorbidities or poor performance status may not be suitable candidates for this treatment.
Age: Age is another factor that may be considered in the selection process. While age alone should not be a determining factor, older patients may be more susceptible to complications from surgery and chemotherapy.
Tumor Burden: The extent of the disease and tumor burden are also important factors. Patients with a large tumor burden or extensive disease throughout the abdomen may not be suitable candidates for CRS with HIPEC.
Prior Treatment: The type and extent of prior treatment also need to be considered. Patients who have already undergone extensive surgery or radiation therapy may not be suitable candidates for CRS with HIPEC.
Tumor Biology: The biology of the tumor is also an important consideration. Certain tumors may be more responsive to chemotherapy than others, and the presence of certain genetic mutations may also affect the selection of patients for CRS with HIPEC.
Patient Preferences: Finally, the patient’s preferences and goals of care should be taken into consideration. CRS with HIPEC is a complex and intensive treatment that requires a significant commitment from the patient. Patients should be fully informed about the risks and benefits of the treatment and have a realistic understanding of what to expect.
In summary, the selection of patients for CRS with HIPEC requires a comprehensive evaluation by a multidisciplinary team of specialists. The treatment is most commonly used for peritoneal surface malignancies, such as peritoneal mesothelioma, pseudomyxoma peritonei, and advanced ovarian cancer. Other factors that are considered in the selection process include disease stage, performance status, age, tumor burden, prior treatment, tumor biology, and patient preferences.
