Tracy Gosson was shocked when she learned in 2019 that she had stage 4 ovarian cancer.
With the cancer growing “at a lightning pace,” she underwent her first round of chemotherapy within three weeks of the diagnosis. Gosson, the founder and president of Baltimore-based marketing firm Sagesse, received chemotherapy every week for nine weeks at Mercy Medical Center in Baltimore.
During the chemotherapy, conversations took place on having to undergo surgery, she said. And while looking into her treatment options, she came across one that would eventually help save her life: Hyperthermic Intraperitoneal Chemotherapy (HIPEC).
Two months after receiving the treatment, she was swinging a golf club again.
HIPEC is a two-part treatment option for cancers that result in peritoneal spread in coating the abdominal cavity. The first aspect is a cytoreductive surgery in which doctors inspect organs in the abdominal cavity to remove any visible forms of cancer. Then, the surgeon injects chemotherapy that is heated at more than 105 degrees into a patient’s abdomen to try to kill any cancer not removed during the cytoreductive surgery.
“Running chemotherapy through your entire body is toxic as hell. I mean, I always equate it to ‘I’m going to burn down the entire forest to kill five trees’,” Gosson said. “So the idea is, if we know that the cancer is primarily in the abdomen, let’s put that chemo there and really, really let it get in there.”
The cancers for which HIPEC can be used as a treatment option include appendix cancer, colon cancer, gastric cancer, mesothelioma and ovarian cancer.
The HIPEC treatment has grown exponentially in recognition over the past 20 years. Medical systems in Baltimore — Mercy Medical Center, the University of Maryland Medical Center and Johns Hopkins — are among the facilities across the United States that offer the treatment.
“People are starting to see that there’s a benefit of it,” said Dr. Teresa Diaz-Montes, a gynecologic oncologist at Mercy.
At Mercy, Dr. Armando Sardi is considered a leading surgical oncologist for HIPEC treatment. When Sardi began performing the treatment in the early 1990s, he was one of a handful of people worldwide doing so, he said.
Sardi has treated more than 1,000 patients with the treatment, including Gosson. Two years ago, he received a letter from a man who underwent three HIPEC treatments who is now married with two children and runs a foundation for appendix cancer.
“It is a big misunderstanding from medical oncologists and some surgeons and other primary physicians that they feel that people are going to have a miserable disease, and they’re going to have a miserable quality of life if we do this,” Sardi said. “Not everybody does very well, but most do. And they have an amazing quality of life.”
But there has also been resistance to the treatment, with some doctors and medical systems objecting to using the treatment at all. Reasons for this resistance could be because of its intensive nature and a belief that typical chemotherapy treatment remains the best way to treat cancer, Diaz-Montes said.
The treatment has been known to be more effective in certain cancers than others, said Dr. Julia Terhune, a surgical oncologist at the University of Maryland Medical Center. Peritoneal mesothelioma, for example, has responded very well to HIPEC treatment, while data is more split on cancers such as colon and gastric cancer.
As of August 2019, out of more than 800 successful HIPEC procedures at Mercy Medical Center — most of which involved a stage 4 cancer diagnosis — 63% of the patients are alive and 46% are disease-free. Those survival rates are considerably lower for gastric and colorectal cancers.
“I think that’s where the patient selection becomes of utmost importance in finding the right patients who are going to benefit without significant morbidity,” said Terhune, who is also an assistant professor of surgery at the University of Maryland School of Medicine.
Sardi and Diaz-Montes say they anticipate more people will seek HIPEC treatment in the future. But there’s work that needs to be done to get to that point, Sardi said.
“This is something that we need to train more physicians to do,” Sardi said. “We need to publish a lot, but we need to raise more awareness.”
That awareness is something Helen Szablya has pushed for since recovering from stage 4 ovarian cancer.
Szablya received her diagnosis in 2009 when she was living in Baltimore. She ended up becoming Sardi’s patient; he said the HIPEC treatment offered her an 85% chance of recovering.
Now, nearly 12 years later, Szablya is “capable of doing everything that a 68-year-old person would be able to do,” she said.
To Szablya, doctors’ reluctance and lack of knowledge about HIPEC is preventing the treatment from becoming more widespread. She has shared her story at a couple of medical symposiums, and now living in Los Angeles, she has told her doctors about the benefits of HIPEC.
“The majority (of doctors in L.A.) have not even heard of it,” Szablya said. “And because it is such an incredibly major breakthrough in how to deal with these difficult cancers, they should know about it.”
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