Good Doctor·Hyperthermic Perfusion | Commentary on Literature | (1) "Clinical Application of Isothermal Circulating Hyperthermic Perfusion Chemotherapy in the Prevention and Treatment of Cavity Metastatic Cancer"

Introduction: Guidelines for hyperthermic intraperitoneal chemotherapy (HIPEC) were first published in Europe in 2008 by the European Society of Surgical Oncology (ESSO) and the European Society of Gynaecological Oncology (ESGO), and in the United States in 2014 by the American Society for Peritoneal Surface Malignancy (ASPSM). In China, the CACA guidelines for HIPEC were released in 2023. To date, no guidelines for hyperthermic intrathoracic chemotherapy (HITHOC) have been issued either domestically or internationally. The authors of this article and their team began clinically applying body-cavity hyperthermic perfusion machines to treat 290 patients as early as 2006, successfully completing a total of 1,075 HIPEC or HITHOC procedures. They can thus be regarded as pioneers and trailblazers in this field.

“Clinical Application of Isothermal Circulating Hyperthermic Perfusion Chemotherapy in the Prevention and Treatment of Malignant Pleural and Peritoneal Metastases” – Modern Oncology, June 2009, Vol. 17, No. 6 (by Zhu Yanguang, Liu Wenchao, Liu Duhu, Fan Li, Cheng Jie, Sun Juanhua, and Shao Jie)

[Indicative Abstract] Over the past two years, constant-temperature cyclic hyperthermic intraperitoneal perfusion has been employed as a dual-route thermal chemotherapy approach—administered both intraperitoneally and intravenously—to prevent and treat malignant peritoneal metastases, achieving satisfactory outcomes that are unattainable with non-circulating intraperitoneal hyperthermic perfusion alone. This article, drawing on clinical observations and relevant literature, analyzes and compares the mechanisms, feasibility, therapeutic protocols, and efficacy of circulating versus non-circulating hyperthermic intraperitoneal perfusion.

[Keywords] Intracavitary hyperthermic perfusion chemotherapy; Intracavitary metastatic cancer; Intracavitary constant-temperature circulating hyperthermic perfusion chemotherapy

[Article Number] 1672-4992-(2009)06-1165-03

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Since 1980, when American general surgeon John S. Spratt reported the first case of hyperthermic intraperitoneal chemotherapy for pseudomyxoma peritonei (PMP) in the journal Cancer Research (1980;40(2):256–60), the development, maturation, and standardization of the hyperthermic intraperitoneal chemotherapy (HIPEC) technique—culminating in the publication of guidelines and expert consensus—has spanned 45 years. HIPEC is now a standard therapeutic modality for preventing peritoneal implantation metastases from malignant tumors, for combined cytoreductive surgery (CRS) in the treatment of primary and metastatic tumors of the peritoneal surface, and for palliative management of malignant ascites. Drawing on the principles and technological advances of HIPEC, hyperthermic intrathoracic chemotherapy (HITHOC) was introduced in the 1990s for the treatment of malignant pleural mesothelioma (MPM) and metastatic pleural tumors, including pleural metastases from lung cancer, thymoma, and other malignancies. Although clinical application of HITHOC has achieved a fluid control rate of 90% in patients with malignant pleural effusion, there currently remains no unified standard or consensus among experts, either domestically or internationally, regarding its clinical use.

Since 2006, the teams led by Professors Zhu Yanguang and Liu Wenchao from the Department of Oncology at Xijing Hospital, affiliated with the Air Force Medical University (formerly the Fourth Military Medical University), have been using the GD intracavitary hyperthermic perfusion system to treat 290 patients with thoracic and abdominal metastatic cancers, performing a total of 1,075 sessions of intracavitary hyperthermic perfusion chemotherapy or treatment. The clinical efficacy and research findings were published in the journal Modern Oncology in 2009.

This study represented a pioneering clinical investigation in the domestic application of hyperthermic intraperitoneal chemotherapy (HIPEC) for the treatment of pleural and peritoneal metastatic cancer at the time. Its salient features include a detailed description of the techniques for hyperthermic perfusion of the abdominal and thoracic cavities, covering such parameters as perfusate temperature, total volume, flow rate, and selection of chemotherapeutic agents. It also reported for the first time a method for establishing an effective circulating HIPEC system via “acupuncture or percutaneous catheter placement” (i.e., a minimally invasive approach). Unlike the intraoperative use of HIPEC in CRS procedures abroad, all patients in this study received thoracic or abdominal HIPEC under the care of the Department of Medical Oncology. The 155 cases treated involved pleural and peritoneal effusions of diverse types, including hemorrhagic, chylous, gelatinous, and purulent (infectious) fluid. Regardless of the nature of the effusion, the unique “unidirectional perfusion” function of the GD HIPEC machine—first flushing the thoracic or abdominal cavity followed by circulating hyperthermic perfusion—consistently yielded excellent therapeutic outcomes. The total volume of perfusate could be adjusted according to the capacity of the body cavity: for loculated effusions, 200–500 mL was used for perfusion and irrigation; for the thoracic cavity, 500–1,500 mL; and for the abdominal cavity, 2,500–3,500 mL. Irrespective of the size of the body cavity, the GD HIPEC machine was capable of meeting the required perfusion demands. The overall response rate for abdominal HIPEC reached 91.2%, while that for thoracic HIPEC was 94%; meanwhile, the incidence of complications was only 0.6%, with adverse reactions such as nausea and vomiting occurring in 6% of cases, thereby markedly improving patients’ quality of life.