Renowned Harvard-trained American cancer surgeon discusses heated chemotherapy or “hot chemo bath” cancer treatment. Hot chemo bath is part of The Sugarbaker Procedure, this consists of cytoreductive surgery and Hyperthermic Intraperitoneal Chemotherapy (HIPEC). What makes hyperthermic heated chemotherapy particularly effective in metastatic peritoneal cancers? How to select chemotherapy medications that are used in heated chemotherapy? "Hot chemo bath" heated chemotherapy efficacy explained. Dr. Anton Titov, MD. Hyperthermic Intraperitoneal Chemotherapy (HIPEC), hot chemo bath, heated chemotherapy is treatment for Colon cancer, gastric cancer, ovarian cancer. Dr. Paul Sugarbaker, MD. They spread in the abdomen and peritoneal cavity. Peritoneal metastases in advanced stage 4 colon cancer treatment by cytoreductive surgery and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) [hot chemo bath, heated chemotherapy]. Medical second opinion clarifies colon cancer or ovarian cancer diagnosis. Dr. Paul Sugarbaker, MD. Medical second opinion confirms that cure is possible in metastatic colon cancer. Intraperitoneal chemotherapy treatment for advanced stage 4 cancer with metastatic lesions in the abdomen. Medical second opinion helps to select a precision medicine treatment for stage 4 ovarian cancer or stage 4 colon cancer or metastatic stage 4 gastric cancer. Get medical second opinion on advanced cancer with peritoneal metastases. Dr. Paul Sugarbaker, MD. Best peritoneal metastatic advanced cancer treatment by surgical operation and regional chemotherapy. Video interview with Dr. Paul Sugarbaker. Leading expert in peritoneal metastatic cancer treatment (cytoreductive surgery and Hyperthermic Intraperitoneal Chemotherapy (HIPEC), hot chemo bath, heated chemotherapy. Peritoneal metastases from colon cancer, ovarian cancer, and other gastrointestinal cancers are treated by Sugarbaker Procedure. Dr. Anton Titov, MD. One part of procedure is resection of peritoneal metastases. Another part of the Sugarbaker Procedure involves Hyperthermic Intraperitoneal Chemotherapy (HIPEC). It is hot chemo bath, heated chemotherapy. Dr. Anton Titov, MD. Please talk more about hyperthermia part of Hyperthermic Intraperitoneal Chemotherapy (HIPEC). Dr. Anton Titov, MD. Why increasing the temperature of chemotherapy is important for peritoneal metastases cancer therapy? Dr. Paul Sugarbaker, MD. Renowned Gastrointestinal Cancer Surgeon. Hyperthermia has been shown in animal laboratory and in humans to increase the penetration of the chemotherapy into normal tissues. The chemotherapy gets deeper into the tissues when it is applied with heat. We know that. Secondly the chemotherapy medications that we use have increased cytotoxicity when applied as part of Hyperthermic Intraperitoneal Chemotherapy (HIPEC). In other words, hyperthermic chemotherapy solutions have increased killing of the cancer cells when they are used with heat. Dr. Paul Sugarbaker, MD. Hyperthermic chemotherapy medications work better than they are used at normal body temperature. that is been very well demonstrated. the third aspect of it is this. Dr. Anton Titov, MD. Heat in and of itself is an effective treatment of some cancers. Hot chemo bath, heated chemotherapy. There are other reasons for using the Hyperthermic Intraperitoneal Chemotherapy (HIPEC). For example, it took six hours for surgery to resect peritoneal cancer metastases and finish a cytoreductive procedure. The patient's abdomen has been open to the air for a long time. Dr. Paul Sugarbaker, MD. Renowned Gastrointestinal Cancer Surgeon. Patients tend to become cold during the surgical operation. Patient's body temperature decreases to 35 or even 34 degrees Celsius. Dr. Paul Sugarbaker, MD. The anesthesiologists are managing all the vital signs and the blood coagulation. They are very happy that now the patient is going to come back up to normal body temperature. applying Hyperthermic Intraperitoneal Chemotherapy (HIPEC) is actually a very physiologic thing to do. Dr. Anton Titov, MD. What kind of a temperatures of chemotherapy solution are we talking about? [hot chemo bath, heated chemotherapy.] Dr. Paul Sugarbaker, MD. Renowned Gastrointestinal Cancer Surgeon. For Hyperthermic Intraperitoneal Chemotherapy (HIPEC) procedure we like to have 42-43 degrees centigrade within the whole abdomen. Dr. Anton Titov, MD. how is the solutions of chemotherapy heated? Is chemotherapy solution preheated. Then applied as a hot solution? Dr. Paul Sugarbaker, MD. Renowned Gastrointestinal Cancer Surgeon. Most of the modern HIPEC machines involve a recirculation. there is a pump this pumps the chemotherapy into the patient's peritoneal space in the abdomen. then the chemotherapy is drawn out. Chemotherapy solution goes through a heating apparatus, usually a coil,. Then chemotherapy is pumped back into the patient. It is a continuous flow of chemotherapy solution. It goes in warm at 44 - 45 degrees. It is distributed around the patient's abdomen. Dr. Paul Sugarbaker, MD. Heated chemotherapy solution can be distributed around the peritoneal space by moving the patient's abdomen or by the surgeon's double-gloved hand. Sometimes we are moving the chemotherapy solution around the abdomen, it almost immediately cools down to the 42 - 43 degrees. [hot chemo bath, heated chemotherapy]. Then intraperitoneal chemotherapy solution comes out at the other side through the drains at about 39 degrees. Sometimes chemotherapy to treat peritoneal cancer metastases comes around, it just recirculates again into the patient's abdomen. Dr. Anton Titov, MD. selection of the chemotherapeutic medication for Hyperthermic Intraperitoneal Chemotherapy (HIPEC) depends on the type of cancer? Is there a preferred chemotherapeutic medications that you use in the Sugarbaker procedure? Dr. Paul Sugarbaker, MD. Renowned Gastrointestinal Cancer Surgeon. I would say that choosing the correct chemotherapy medication requires the most work at this point in time. We need to work more on the selection of the optimal chemotherapy agent for a particular patient. as you know at this point in time we tend to choose cancer treatment medications based on the anatomic location of the cancer. For colorectal cancer we usually mitomycin C or mitomycin C and doxorubicin. But is that the best chemotherapy medication for a particular patient? It probably is not. Dr. Anton Titov, MD. This is a continuous topic of discussion that I had with a lot of oncologists. The goal is to move from anatomical classification of tumors and into the molecular markers in the tumor and in the patient. Dr. Paul Sugarbaker, MD. We have to use for personalized medicine for the patient to select chemotherapy. Not just the anatomical classification of cancers. That seems to be what you are talking about. Dr. Paul Sugarbaker, MD. Renowned Gastrointestinal Cancer Surgeon. Absolutely. it is distressing that we know that using mitomycin C maybe helps 50% of the patients. Only half of cancer patients are going to respond to that chemotherapy medication. Even though it is heated during Hyperthermic Intraperitoneal Chemotherapy (HIPEC) treatment. a lot of peritoneal metastatic cancer patients will not benefit from this chemotherapy medication. all patients are getting is 90 minute washing of their abdomen. Dr. Anton Titov, MD. Only 50% of patients benefit from this chemotherapy medication during Hyperthermic Intraperitoneal Chemotherapy (HIPEC)? That is a toss of a coin? Dr. Paul Sugarbaker, MD. Renowned Gastrointestinal Cancer Surgeon. That's correct! That's correct! we now need to begin using multiple chemotherapy agents for Hyperthermic Intraperitoneal Chemotherapy (HIPEC) to treat abdominal cancer metastases. Dr. Paul Sugarbaker, MD. Medications given into the peritoneal space that are augmented by heat. we have to use chemotherapy medications that are given in the bloodstream, this are augmented by heat. Because these chemotherapy medications will circulate to the abdominal organs. chemotherapy to treat peritoneal metastatic cancer will be augmented by the heat within the peritoneal space during Hyperthermic Intraperitoneal Chemotherapy (HIPEC). we need now to be thinking about a combination of intravenous and intraperitoneal chemotherapy agents to get a maximal response from peritoneal cancer tumor. Dr. Paul Sugarbaker, MD. Because we have 90 minutes to treat peritoneal metastatic cancer during Hyperthermic Intraperitoneal Chemotherapy (HIPEC). We have to be very accurate in what we're doing. Sometimes we do not select chemotherapy medications correctly. A lot of patients are going to be treated with chemotherapy and not benefit from cancer treatment. Luckily probably the most meaningful treatment method of all aspects of Hyperthermic Intraperitoneal Chemotherapy (HIPEC) is surgery. It is the peritonectomy and the visceral resection that is the most important part of Hyperthermic Intraperitoneal Chemotherapy (HIPEC). I would say 90% of it is in the surgical part of peritoneal cancer treatment. 10% of benefit for patients is in the Hyperthermic Intraperitoneal Chemotherapy (HIPEC) [hot chemo bath, heated chemotherapy] Dr. Anton Titov, MD. It is a combination of precision medicine and precision surgery [to treat peritoneal metastases from colorectal cancer, ovarian cancer or gastric cancer?] Dr. Paul Sugarbaker, MD. Renowned Gastrointestinal Cancer Surgeon. Absolutely, Yes. [hot chemo bath, heated chemotherapy]. ”Hot chemo bath" heated chemotherapy efficacy explained by leading peritoneal cancer surgeon. Dr. Anton Titov, MD. Hyperthermic Intraperitoneal Chemotherapy HIPEC for stage 4 cancer.