Peritoneal Carcinomatosis
Is HIPEC : the new standard
Dr. Randeep singh
Consultant Medical Oncologist
Max Cancer Centre ,Delhi
INDIA
o 55 year old female
o Comorbidities: Nil
ECOG (PS) = 1
o Chief Complaints: pain abdomen, vomiting
constipation for 3 days since two month Dec 2014
o O/E Abdomen distended & reduced bowel sounds
o USG Abdomen: Mass in the caecal region
o Colonoscopy : Eccentric large growth in caecum
o CEA: 13.21 ng/mL
o Biopsy: Moderately diff. adenocarcinoma
CECT Abdomen
Circumferential
bowel
involving
thickening
caecum,
asc. colon & hepatic
flexure along with
peritoneal
nodules
and
omental
thickening
,
no
enlarged nodes or
liver mets
SURGERY
Rt. Radical
hemicolectomy with
total peritonectomy
hysterectomy
splenectomy
cholecyctectomy
omentectomy
HIPEC WITH
OXALIPLATIN 130
mg/m2 FOR 1
HOUR
HPR
• 8 × 7 cm tumor involving ascending colon
• Multiple peritoneal deposits , largest 2.5 cm
• P.D. Signet ring adenocarcinoma
• Tumor inv. Full thickness with serosal inv.
• LVI + : PNI +
• 12/17 Lymph nodes show metastasis
• All cut margins free with closes CRM 0.1 cms
• Multiple mesentric and omental nodules show metastasis
POINTS TO PONDER
 Is cytoreductive surgery & HIPEC the new standard
for all peritoneal limited disease where CC0 & CC1 :
R0 resection can be achieved
 Which is best drug and its dose for HIPEC in 2015
 Does EPIC has any advantage in this patient
 Does anyone or everyone need adjuvant systemic
chemotherapy post surgery +HIPEC
 Any role of targeted therapy in this patient