New treatment
CLINICAL | ONCOLOGY
provides hope for advanced ovarian cancer patients Breakthrough HIPEC procedure can improve quantity and quality of life.
T
HE SOUTH AFRICAN medical community has made important strides in treating ovarian cancer in the country, after three breakthrough procedures were recently performed at the Life Entabeni Hospital in Durban. Hyperthermic intraperitoneal chemotherapy (HIPEC) is a highly sophisticated procedure for the treatment of abdominal cancers and when it is performed with cytoreductive surgery, it results in longer recurrence-free survival and overall survival than surgery or chemotherapy alone. This is according to a landmark study conducted in the Netherlands and Belgium and published in the New England Journal of Medicine in 2018. The nine-year randomised control trial included 245 patients with newly diagnosed stage III epithelial ovarian, fallopian tube, or peritoneal cancer. What the study results revealed was that the combination of HIPEC and surgery could improve the survival rate in patients by 12 months. Peritoneal cancers include ovarian cancer, fallopian tube cancer, primary peritoneal cancer, pseudomyxoma peritonei, appendix cancer, colorectal cancer and mesothelioma. “The prognosis for ovarian cancer is poor, with the majority of patients only being diagnosed in stage 3 or 4. So when the study came out, we identified many of our patients who would benefit from the technology but, at the same time, there were no centres in the country performing HIPEC,” says Dr Naseem Bhorat, the surgeon at Life Entabeni Hospital who performed all three HIPEC procedures. “The study gave me hope that the treatment could give our patients a better chance of beating the disease.” Understanding the need in South Africa for a new treatment breakthrough like HIPEC, Dr Bhorat, together with gynaecology oncologist Dr Kamendran Govender, travelled to Vienna, Paris and Mumbai to learn the specific techniques and bring this knowledge back to the country. The team also spent time in the
Netherlands, where they were trained by the experienced surgeon, Dr Ignace HJT de Hingh. In a process that took over two years of planning and preparation, hospital staff were specifically trained and a multidisciplinary team of specialists, including an anaesthetist and a perfusionist, was assembled to ensure the safety and recovery of each patient.
Dr Naseem Bhorat.
According to Dr Bhorat, “The HIPEC technology and equipment is expensive, which is partly why the procedure isn’t widely performed in South Africa. Fortunately, we could partner with Tau Medical Supplies who sponsored the machines and disposables, enabling us to perform the procedure on two patients with pseudomyxoma and one with primary peritoneal cancer.” Tau Medical Supplies is the exclusive South African distributor of the Performer HT HIPEC system, which is manufactured in Italy by RanD. “With all three surgeries taking place at Life Entabeni Hospital, we are incredibly proud to affiliate ourselves with this groundbreaking procedure. There’s a dire need
for it in this country and with HIPEC having such a positive impact on patients’ lives, we hope there’ll be many more of these lifesaving procedures done at our hospital,” says Bhaviksha Maharaj, Hospital Manager at Life Entabeni Hospital. THE BENEFITS OF HIPEC Before the HIPEC procedure, all visible tumours or cancerous lesions are removed throughout the peritoneal cavity using cytoreductive surgery. A highly concentrated dose of chemotherapy is then heated to 43° Celsius and delivered into the peritoneal cavity. A surgeon continuously circulates this solution for 60-90 minutes, ensuring that all abdominal organs come into contact with the chemical, helping to destroy any remaining microscopic cancer cells. Combining surgery and chemotherapy achieves several important goals. As the solution is delivered directly to the abdomen, the patient receives a higher and more concentrated dose, while heating improves effectiveness. Being largely isolated in the peritoneal cavity and then subsequently removed, there is minimal exposure to the rest of the body, which reduces the normal side effects of chemotherapy. “While HIPEC is routine in leading cancer centres in Europe, India and the US, it’s a breakthrough procedure in South Africa,” explains Evette Le Roux, Country Manager at Tau Medical Supplies. “We fully understand the burden on hospitals and theatres, but with the large number of ovarian, pseudomyxoma peritonei and gastric cancer patients in the country who can benefit from HIPEC, we’re delighted that we can sponsor the machines that are helping these doctors change lives. Of course we would like this treatment to be accessible to many more people, and so we
have submitted an application for medical aid approval, and we are currently waiting for the outcome on that decision.” MULTIDISCIPLINARY APPROACH Tau Medical Supplies is also supplying machines to the recently opened Peritoneal Centre at Capital Hospital in Durban, a centre specifically for patients with peritoneal cancer. The centre is important in the fight against cancer as it helps doctors, patients and their families plan the treatment in a multidisciplinary way. Pathologists, radiologists, general surgeons and gynaecology oncologists are available, together with support affiliates including dieticians, psychologists, psychiatrists, physiotherapists, anaesthetists and physicians. “Working together, all the specialists and affiliates guarantee that treatment won’t be fragmented,” says Dr Govender. “We’ve taken this approach as it ensures that the treatment offered to the patient is as safe as possible, and that the patient gets the best outcome physically and psychologically.” The centre is also important as a source of knowledge. Many peritoneal cancer patients in the country are unaware that HIPEC is an alternative, innovative method of delivering chemotherapy, and that the procedure, when combined with cytoreductive surgery, is successful in improving the length and quality of a patient’s life. By educating and informing people that HIPEC is available, more patients will be identified who fit the criteria for successful treatment.
MEDICAL CHRONICLE | APRIL 2020
23
