Standardization of Patient Selection and Hyperthermic Intraperitoneal Chemotherapy Protocol for Peritoneal Surface Malignancy in Indian Patients

Abstract

Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) combined have been recognized as standard of care for treatment of patients with peritoneal carcinomatosis (PC). Different drug regimens have been employed over the years for HIPEC. Drug choice primarily depends on its known activity against the disease being treated and its suitability for intraoperative administration with hyperthermia. There is no standardized HIPEC dosimetry and methodology for intraperitoneal chemotherapy administration and varies amongst institutions in India. The quality of the HIPEC treatment should be constant and comparable between the different institutions, so that patients can receive high-quality treatment anywhere in India. The aim was to standardize the process of HIPEC by creating and implementing a protocol for Indian patients with PC. We have performed CRS + HIPEC on 186 patients since February 2011 for various etiologies. This review will discuss the pharmacological principles of the various intraperitoneal chemotherapy techniques and the protocol being practised at our institution. The treatment protocol was determined and implemented in 2011. Experience resulted in refining the patient selection and Manipal HIPEC protocol that has become the standard for our patients. It is a complex procedure that requires a high level of expertise of the institute and technical skills of the surgeons. The procedure comes with substantial morbidity and mortality risks when compared to other major procedures. The implementation of a standardized protocol could result in safe procedures and reduced complication rates.