Chemo-Hyperthermia-Intra-Peritoneal (CHIP)

Concept:

The goal is to treat the microscopic disease present on the peritoneum as effectively as possible.
The principle is based on the combination of complete tumor reduction surgery, chemotherapy delivered with a large dose directly to the peritoneum and local hyperthermia. The goal being to sterilize a microscopic cancerous disease, with the aim of improving survival.

Technical principles

Resection:
Performing HIPEC first requires complete surgical excision of macroscopically detectable peritoneal carcinomatosis (visible to the naked eye) by the surgeon. This meticulous surgical cytoreduction associated with HIPEC, lasts several hours.

Chemotherapy:
When all tumor lesions have been removed, the patient's abdomen is filled with a liquid which is heated to 42°C. The liquid containing the chemotherapy circulates in the patient's abdomen for 1 hour 30 minutes. This chemotherapy delivered intraperitoneally has the advantage of bathing all the surfaces of the organs and walls of the abdomen; it thus exposes the intra-abdominal tumor sites to high concentrations of cytotoxic agents that it would be impossible to reach by the systemic route for toxicity reasons.

Indications:

HIPEC is an option during initial treatment, in patients entering a neoadjuvant chemotherapy regimen – interval surgery.
This care is offered to patients whose disease is not resectable during an initial intervention (most often due to digestive involvement requiring multiple digestive resections).
Chemotherapy treatment is started with the aim of making an intervention feasible after 3 or 4 chemotherapy sessions.
“Interval surgery” is then performed, with the objective of complete resection of the visible lesions.
It will then be necessary to complete the chemotherapy up to a total of 6 to 8 sessions.
A therapeutic trial has shown a benefit in terms of progression-free survival and overall survival in the event of association of HIPEC at the time of interval surgery (in the event of complete or almost complete resection of the carcinomatosis).

HIPEC can also be offered in the event of a so-called “platinum sensitive” recurrence of ovarian cancer. This treatment is then integrated into a multicenter research protocol (CHIPOR) and is offered to the patient by the surgeon if she meets the conditions required to be included in the protocol.

The postoperative course:

After this type of intervention, a stay in resuscitation or intensive care unit is systematic, in order to detect and treat the toxic effects of chemotherapy on certain organs, the kidneys in particular.