Original China Anti-Cancer Association China Anti-Cancer Association Science Communication Platform April 14, 2026

To implement the spirit of the “Healthy China Action—Cancer Prevention and Control Implementation Plan (2023–2030)” and help achieve the goal of attaining an awareness rate of over 80% for core cancer prevention and control knowledge, the Chinese Anti-Cancer Association, drawing on the “Chinese Guidelines for Integrated Oncology Diagnosis and Treatment” (CACA Guidelines), has organized experts to compile two specialized popular science publications: “Core Popular Science Knowledge for Cancer Patient Management in China (2026)” and “Core Popular Science Knowledge for Cancer Prevention and Screening among Chinese Residents (2026).” Grounded in standardized, high-quality content, these resources provide systematic support for public education on cancer prevention and control aimed at the entire population. Content is now being released sequentially for reference and use.

Core point one: HIPEC is a local treatment technique that involves continuously perfusing the abdominal cavity with heated chemotherapy solution, primarily used to directly eliminate free cancer cells and microscopic lesions within the abdominal cavity.

How is HIPEC performed?

HIPEC is typically performed during or after surgery. During the procedure, a peritoneal perfusion catheter is placed to allow a chemotherapy-containing perfusate to circulate continuously within the abdominal cavity and be maintained at an optimal therapeutic temperature for a specified duration. The primary goal is to harness the synergistic effects of hyperthermia and chemotherapy to eradicate residual free cancer cells and microscopic lesions that are undetectable to the naked eye.

What role does “hyperthermia” play in treatment?

“Hyperthermia” is not merely the heating of a medicinal solution; it is an essential component of the therapeutic effect. An environment of 42–43°C can directly damage tumor cells on one hand, and on the other hand increase the permeability of tumor cell membranes, facilitating drug entry into tissues. Meanwhile, elevated temperatures may also impair the ability of tumor cells to repair drug-induced damage, thereby enhancing the cytotoxic effects of chemotherapeutic agents.

How does this technique differ from conventional intraperitoneal chemotherapy?

The key difference between the two lies in HIPEC’s inclusion of precisely temperature-controlled hyperthermia. Conventional intraperitoneal chemotherapy relies solely on the advantage of high drug concentrations within the abdominal cavity. In contrast, HIPEC achieves a synergistic effect by combining hyperthermia with chemotherapy through precise temperature control (41–43°C), theoretically resulting in superior cytotoxicity against cancer cells compared to standard normothermic perfusion alone. Temperature regulation is critical; excessively high temperatures can damage normal tissues, while insufficient heat fails to produce the desired synergistic effect.

Core point two: HIPEC is not suitable for all patients with peritoneal metastases; rather, it serves as a complementary or adjunctive component of multimodal therapy in carefully selected patients with malignant intra-abdominal tumors.

Which cancer patients are suitable for considering HIPEC?

HIPEC is primarily considered for intra-abdominal malignancies prone to peritoneal metastasis, such as pseudomyxoma peritonei, certain colorectal cancers, gastric cancer, and some epithelial ovarian cancers. However, it is important to emphasize that not all patients with these tumors are suitable candidates for HIPEC. The decision to consider this technique depends on the tumor type, the extent of peritoneal disease, the feasibility of achieving satisfactory cytoreduction, the presence or absence of extra‑abdominal metastases, the patient’s performance status, and the experience of the treating center. Currently, the indications for pseudomyxoma peritonei are relatively well defined, whereas for colorectal, gastric, and ovarian cancers, rigorous patient selection and individualized decision‑making are emphasized.

Is HIPEC used to treat existing metastases, or is it used for prevention?

Both approaches are used, but their therapeutic goals differ. For patients with confirmed, localized peritoneal metastases, HIPEC is an important treatment modality (therapeutic use). For patients whose primary tumor has been resected but who, during surgery or based on postoperative pathology, are at very high risk of peritoneal recurrence—such as those with serosal invasion or positive cytology in peritoneal lavage fluid—HIPEC can be employed to prevent peritoneal recurrence (prophylactic use).

If distant metastases to the liver, lungs, or other sites have already occurred, can HIPEC still be performed?

In general, if patients have significant distant extra‑peritoneal metastases, the therapeutic value of HIPEC is markedly reduced. This technique is essentially a local treatment targeting intra‑abdominal lesions and cannot replace systemic therapy for controlling widely metastatic disease. At this stage, the focus of treatment should typically shift to systemic therapies, such as chemotherapy, targeted therapy, or immunotherapy. Whether local therapy still offers clinical benefit requires careful multidisciplinary assessment, taking into account the extent of metastases, the tumor’s biological behavior, and the overall treatment objectives.

Core point three: The core mechanism of HIPEC lies in the synergistic sensitization effect of hyperthermia and chemotherapy, with treatment temperatures commonly set at 43°C.

Why does heating enhance the effectiveness of chemotherapy?

Hyperthermia has a well-established experimental and clinical basis for enhancing the efficacy of chemotherapy. Its possible mechanisms include increasing tumor cell membrane permeability, thereby facilitating drug entry into cells; modulating tumor cells’ repair of DNA damage; and directly inducing apoptosis in certain tumor cells.

Is a higher temperature always better?

Higher temperatures are not always better. HIPEC emphasizes a relatively optimal therapeutic window. Temperatures that are too low may result in insufficient synergistic sensitization, while excessively high temperatures can increase thermal injury to normal tissues and perioperative risks. A commonly used clinical temperature is 43°C, aimed at enhancing drug efficacy while ensuring safety.

Are all chemotherapy drugs suitable for use with heat?

Not all chemotherapeutic agents are suitable for use in hyperthermic intraperitoneal chemotherapy (HIPEC). The drugs selected for HIPEC typically must meet certain criteria, such as retaining activity at elevated temperatures, achieving high local concentrations within the peritoneal cavity, and having manageable toxicity. The specific choice of drug and regimen should be determined based on the tumor type, prior treatment history, and institutional experience, rather than being chosen arbitrarily.

Core point four: HIPEC is usually not used in isolation but is performed in combination with cytoreductive surgery to address microscopic residual disease that is invisible to the naked eye.

Why must HIPEC be performed in conjunction with cytoreductive surgery? Can it not be performed alone?

Because the two procedures complement each other. The goal of cytoreductive surgery is to remove as much visible tumor tissue as possible, while HIPEC aims to eliminate microscopic residual disease and free cancer cells that are invisible to the naked eye after surgery. If only cytoreductive surgery is performed, these residual cells will be the source of future recurrence; if only HIPEC is used, the drug cannot penetrate large tumor masses. Therefore, performing cytoreductive surgery first, followed by hyperthermic intraperitoneal perfusion, is the key combination for achieving curative intent or long-term control.

What exactly does “cytoreductive surgery” refer to?

This is a type of radical surgery designed to achieve maximal resection of all intraperitoneal tumor metastases. It may involve combined resection of multiple organs (such as part of the stomach, intestine, spleen, gallbladder, uterus, and adnexa) and extensive stripping of the peritoneal surface. The surgical goal is to achieve no macroscopic residual disease or only minimal residual disease, which is the most critical factor influencing the efficacy of subsequent HIPEC and patient prognosis.

If the surgery cannot achieve complete resection, is HIPEC still necessary?

It remains valuable, but the prognosis is directly related to the size of residual disease. According to the International Collaborative Group on Peritoneal Surface Tumors consensus, postoperative residual status is classified as: C0 (no residual disease) and C1 (residual disease <2.5 mm). Studies have shown that HIPEC provides the greatest benefit to patients with C0/C1 status. If the residual disease is too large (C2/3), drug penetration is limited, significantly reducing efficacy. Therefore, the completeness of surgery is a prerequisite for determining whether to proceed with HIPEC and for predicting its therapeutic outcome.

Core point five: HIPEC is not suitable for all patients; rigorous selection of candidates who are likely to benefit is key to maximizing benefits and managing risks.

Which patients are not suitable for HIPEC treatment?

Patients with any of the following conditions are generally considered to have contraindications or to be at high risk: 1. Extensive, unresectable metastases outside the abdominal cavity, such as liver, lung, or brain metastases. 2. Widespread intraperitoneal tumor dissemination that precludes achieving satisfactory cytoreduction. 3. Poor general condition, unable to tolerate treatment. 4. Uncontrolled intestinal obstruction, severe intra-abdominal infection, or extensive intestinal adhesions. 5. Severe dysfunction of vital organs (heart, lungs, liver, kidneys). The physician will conduct a comprehensive evaluation.

What is the “Peritoneal Cancer Index”? Why is it important?

The Peritoneal Cancer Index (PCI) is an internationally recognized scoring system that quantitatively assesses the severity of peritoneal metastases. During surgery, 13 regions of the abdominal cavity are examined, and each region is scored (0–3 points) based on the size of tumor lesions; the total score ranges up to 39. Generally, patients with lower PCI scores (e.g., <20 for colorectal cancer, <15 for gastric cancer) derive clearer clinical benefits from HIPEC.

Is age an absolute contraindication to HIPEC?

Age alone is not an absolute contraindication. More important than age are the patient’s overall condition, performance status, nutritional status, and organ reserve. Some very elderly patients, despite their advanced age, are in good general health and may still tolerate treatment after thorough evaluation; conversely, some younger patients with multiple comorbidities may face higher risks.

Key Point Six: High-quality cytoreduction is a crucial prerequisite for HIPEC to be more effective; the lower the residual tumor burden, the greater the benefit in local control.

Why might HIPEC be more effective when the residual disease burden is lower?

Because hyperthermic intraperitoneal chemotherapy (HIPEC) has limited penetration depth into tumor tissue, it is more suitable for managing minimal residual disease rather than large tumor nodules. If substantial residual lesions remain after surgery, the drug struggles to adequately penetrate deep into the tumor, naturally reducing treatment efficacy. Therefore, the value of HIPEC largely hinges on the principle of “debulking as much as possible” beforehand.

How can we determine whether the surgery has achieved “satisfactory debulking”?

The CC grading system is commonly used in clinical practice for assessment. Generally, C0 indicates no gross residual disease after surgery, while C1 indicates only minimal residual disease; these two categories are typically considered “satisfactory debulking.” For HIPEC, achieving C0 or C1 usually implies greater potential benefit.

What if the tumor involves major blood vessels or organs, making complete resection impossible?

In such cases, treatment decisions must balance efficacy and safety. Striving for complete tumor removal at too great a cost may instead increase the risk of severe complications or even endanger life. Therefore, when satisfactory cytoreduction is unlikely, the team may first consider systemic therapy, reassess the opportunity for surgery, or shift the treatment goal to disease control and symptom relief, rather than blindly pursuing aggressive resection.

Key Point Seven: Compared with systemic intravenous chemotherapy, HIPEC achieves high local concentrations of the drug within the abdominal cavity while significantly reducing systemic toxic side effects.

What are the advantages of HIPEC compared to systemic chemotherapy?

The main advantage lies in achieving high local concentrations with low systemic toxicity. HIPEC can elevate intraperitoneal chemotherapy drug concentrations to tens or even hundreds of times those attained with intravenous administration, thereby aggressively targeting intra-abdominal lesions. Meanwhile, due to the peritoneal barrier, the drug is absorbed into the bloodstream slowly, resulting in very low systemic plasma levels; this avoids the severe hematologic suppression, intense nausea and vomiting, alopecia, and other systemic toxicities commonly seen with intravenous chemotherapy, leading to generally better patient tolerance.

After completing HIPEC, is systemic intravenous chemotherapy still necessary?

It remains necessary in most cases. HIPEC is an effective local therapy, but its efficacy is limited against potential microscopic metastases that may have already spread via the bloodstream. Therefore, depending on the primary tumor type and guideline recommendations, systemic adjuvant chemotherapy should typically be initiated or continued after recovery from HIPEC—usually 4 to 6 weeks later—to control systemic disease.

Can HIPEC replace systemic chemotherapy?

No. HIPEC and systemic therapy address the problem from different angles: the former is a local treatment, while the latter is systemic. For many patients with peritoneal metastases, a more effective approach is not to choose one over the other, but to integrate local and systemic therapies in appropriately selected patients.

Key point eight: Its major complications include bone marrow suppression, hepatic and renal dysfunction, intestinal obstruction, and anastomotic leakage; the incidence is related to drug selection, perfusion duration, and the patient’s underlying condition.

What is the most common complication after HIPEC treatment?

Postoperative complications can be classified into several categories: 1. Surgery-related complications, such as bleeding, infection, enterocutaneous fistula, anastomotic leakage, and intestinal obstruction, which are directly related to the complexity of cytoreductive surgery. 2. Chemotherapy-related complications, such as bone marrow suppression (leukopenia and thrombocytopenia) and transient hepatic or renal dysfunction. 3. Hyperthermic intraperitoneal chemotherapy (HIPEC)-related complications, such as transient fever and intra-abdominal thermal injury.

Under what circumstances is intestinal fistula or anastomotic leakage more likely to occur?

Intestinal fistulas or anastomotic leaks are typically associated with multiple factors, including poor patient nutritional status, inadequate local blood supply, excessive tension at the anastomosis, extensive surgical resection, and the adverse effects of hyperthermic perfusion and medications on tissue healing. Prevention hinges on strictly adhering to surgical indications, optimizing nutrition and infection control, performing meticulous surgery and anastomotic techniques, and appropriately managing perfusion temperature, duration, and pharmacologic regimens. Postoperatively, close monitoring is essential, with prompt intervention for any abnormalities.

What should be done if white blood cell and platelet counts decrease after surgery?

This suggests that varying degrees of bone marrow suppression may have occurred, usually related to drug absorption into the bloodstream. In most patients, these changes are mild and can be detected promptly through regular follow-up complete blood counts. Physicians will manage the findings according to the severity of the decline, employing measures such as observation, administration of medications to stimulate white blood cell production, transfusion of red blood cells or platelets when necessary, and enhanced infection prophylaxis. With standard supportive care, most patients recover gradually, but close ongoing monitoring remains essential.

Key Point Nine: In some patients, HIPEC combined with cytoreductive surgery may improve local control and long-term outcomes.

Is there definitive evidence that HIPEC can prolong survival?

For certain specific tumors and carefully selected patients, some studies suggest that HIPEC combined with cytoreductive surgery may confer survival benefits; however, results vary across cancer types, drug regimens, and studies. Currently, it is relatively clear that HIPEC prolongs survival in patients with peritoneal pseudomyxoma. Therefore, it is not appropriate to generalize that all patients with peritoneal metastases will derive significant benefit.

Can HIPEC cure peritoneal metastatic cancer?

For a very small subset of patients with low tumor burden who achieve satisfactory cytoreduction, longer disease-free survival may indeed be attainable; however, for most patients, the realistic goals are primarily to prolong survival, improve local control within the peritoneal cavity, and alleviate symptoms. Therefore, HIPEC is better regarded as an important component of a comprehensive treatment strategy, rather than a universally “curative” approach for all patients with peritoneal metastases.

How long does the therapeutic effect last? What should be done in case of relapse?

The duration of treatment efficacy varies considerably and is closely related to the primary tumor type, extent of peritoneal metastasis, quality of debulking surgery, and whether subsequent systemic therapy is administered appropriately. Even with a favorable initial response, the peritoneum remains a high-risk site for recurrence. If recurrence occurs, subsequent strategies include reassessing suitability for repeat surgery and locoregional therapies, initiating systemic treatment, or transitioning to supportive care based on the patient’s condition. The key is for a multidisciplinary team to tailor a new plan according to the recurrence site, time to recurrence, and the patient’s current status.

This article is excerpted from “Core Science-Based Knowledge for Managing Cancer Patients in China (2026)”