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Chemo Bath

June 15, 2015

In the Spring of 2013, Ronald Duncan went to the doctor seeking help for what he thought was an abdominal hernia. Not long afterward he received the devastating news that he had Stage IV appendiceal cancer. Told it was terminal, he was given a 30 percent chance of survival.

Fast forward to today—Duncan is celebrating two years being cancer-free thanks to the advances in the administration of chemotherapy led by Kamran Idrees, M.D., assistant professor of Surgery at Vanderbilt University Medical Center.

“The procedure he performed saved my life,” said an emotional Duncan. “The diagnosis was tragic. I was terminal. And here was a doctor who asked if I wanted to try this new approach.”

“It was a game time decision,” Duncan recalls Idrees saying. “He wouldn’t know for sure if he could use the new approach until he cut me open. I call it an internal, 90-minute chemotherapy cavity flush and it’s a pure miracle.”

The official name of the new treatment is Hyperthermic Intraperitoneal Chemotherapy (HIPEC) and is performed at a handful of centers across the country.

Idrees and his team established the Peritoneal Surface Malignancy/ HIPEC Therapy program at Vanderbilt-Ingram Cancer Center, targeting cancers that impact the abdominal lining (peritoneum) that are usually deemed untreatable, including colorectal, appendiceal, certain ovarian tumors and mesothelioma.

First, an 8-to-12-hour surgery reduces the tumor burden. This is followed by chemoperfusion where the belly is rinsed with a heated chemotherapy solution for up to 90 minutes.

“We are able to use a higher dose of chemotherapy in the peritoneal cavity than we would be able to administer through the bloodstream because of the toxicity,” said Idrees. “The solution is heated to 42 degrees centigrade (107.6 F) in an attempt to kill any remaining cancer cells.

“Our patients’ quality of life is vastly improved and survival rates are increased. That gives us all such motivation to continue building and expanding this route of treatment.”

Idrees and his team are hopeful that there are other indications for the application. He would like to initiate isolated limb and liver chemoperfusion in the near future to treat patients with melanoma, sarcoma and metastatic liver tumors.

“We have performed more than 50 HIPEC cases, expanding the referral base to neighboring states including Kentucky, Alabama, Arkansas, Indiana, Missouri and Mississippi with good operative outcomes,” said Idrees.

The prospect of the new treatment gave Duncan hope.

“I understand what it feels like to be diagnosed with a terminal cancer. I remember like it was yesterday, when I got the calls. I literally had to tell myself to breathe,” he said.

“I believe in this procedure. I know it can save lives. I took a chance. I am alive and doing well and it’s a privilege to serve as a guide for others with questions.”

– Jessica Pasley