New Cancer Debate: Are 'Shake & Bake' Chemotherapy Baths Effective?

A controversial, aggressive and rarely-performed cancer treatment, commonly called hot chemotherapy, was recently up for debate at the 2011 American Society of Clinical Oncology annual meeting.

Hot chemotherapy (or hot chemo baths) is a procedure that involves cutting open the abdominal cavity and surgically removing all visible cancers from organs (cytoreductive surgery). The incision is then stitched back up and 3 liters saline and chemotherapeutic liquid is pumped into the abdomen at 42 degrees Celsius (about 108 degrees Fahrenheit). Some doctors are reported as saying the heat makes the chemotherapy more effective.

For 90 minutes to two hours, nurses jiggle the abdomen gently to ensure it reaches all abdominal crevices. The liquid is then pumped out. This "chemo bath" part of the procedure is called hyperthermic intraperitoneal chemotherapy (Hipec).

As the New York Times reports, this therapy was initially reserved for rare forms of appendix cancers, but is now also being offered for some ovarian and colorectal cancers. However, it is only offered at a few hospitals in North America.

This video explains it all:

This video has the real-life procedure but with graphic images (WARNING):

Though very little data exists on the effectiveness of Hipec, some say it helps increase the lives of those with certain types of abdominal cancers while others say traditional intravenous chemotherapy would be just as effective and less invasive.

The New York Times has more on the debate:

[David P. Ryan, clinical director of the Massachusetts General Hospital Cancer Center] debated the procedure publicly at the recent annual meeting of the American Society of Clinical Oncology. While some patients did seem to live much longer than expected, he said that they had been carefully selected and might have fared well even without the therapy.

Proponents say that if cancer has spread into the abdominal cavity but not elsewhere, then lives can be prolonged by removing all the visible tumor and killing what’s missed with Hipec.

By contrast, said Paul Sugarbaker, a surgeon at Washington Hospital Center and the leading proponent of Hipec, “there are no long-term survivors with systemic chemotherapy — zero.”

Here's more detail on how the procedure went in one San Fransico resident who let the New York Times reporter sit in on his procedure on the condition they not use his full name:

Mr. S. had abdominal pain eventually diagnosed as appendicitis. But the appendix was found to be cancerous. Such cancers typically spew mucus containing tumor cells into the abdominal cavity. So he signed up for surgery and Hipec with [surgeon Andrew Lowy from the University of California, San Diego].

“I’ve had to say my goodbyes to everybody,” Mr. S. said the day before the operation. “I had to talk to my priest. I had to do all these things I never thought I’d have to do at 41. I wouldn’t wish it on my worst enemy, but I have to go through with it.”

Dr. Lowy explored the entire cavity from the diaphragm to the pelvis. He found mucus in several spots that he sopped up with a cloth and also tiny tumors the size of a pencil eraser that had implanted in several spots. He snipped those out and sewed up the wounds. He removed the right side of the man’s colon and the omentum, a fatty structure.

Then two Y-shaped tubes hooked to the Hipec machine were inserted into the abdominal cavity, one to deliver the chemotherapy and the other to bring the drug back to the machine to be reheated. The incision was sewn up around the tubes so the chemotherapy would not leak.

The man’s belly was filled with three liters of saline fluid and the chemotherapy, a generic drug called mitomycin C, heated to 42 degrees Celsius, or nearly 108 degrees Fahrenheit. Any hotter could have caused injuries. Bloated with liquid, the man’s torso resembled a water bed.

After 90 minutes, the fluid was drained and the incision reopened for a final check before the patient was stitched up. The procedure took six hours.

This Canadian News Station reported in late July that a recent University of Calgary study using this procedure resulted in a 30 percent increase of survival for patients with colon cancer and 50 percent increase in patients with appendix cancer.

The New York Times also includes that a trial on this procedure in the United States was suspended due to lack of patient volunteers.