UAE: ‘Hot chemotherapy’ gives new hope to cancer patients

Nandini Sircar/Dubai
Filed on April 4, 2021

Though advanced, morbidity, mortality and complications remained high in this procedure.

Just when his cancer was getting worse, Sudanese doctor Mohammad Abdel Rahman took a risk and agreed to an emerging procedure called ‘hot chemotherapy’. Thanks to the complex operation, he is now feeling much better — with up to ‘99 per cent of his tumour’ gone.

“I am glad the UAE has surgeons who are trained to do these complex procedures and where one can expect to have the level of care to support such complexity. This country is truly passionate about innovation in healthcare,” said 36-year-old Mohammad, a Ras Al Khaimah resident battling middle rectal cancer.

“My condition started worsening and that’s when I began having extensive discussions with my doctors about this high-risk procedure. I was always confident about their level of skill and I decided to go ahead with it. I am glad I did so because I am feeling much better now. I will remain indebted not only to the team of doctors who operated on me but also to all the nurses who took great care of me.”

His surgery, also known as hyperthermia (heated) intraperitoneal chemotherapy (Hipec), was carried out a few weeks ago. It was the first time the critical operation was performed in the Northern Emirates.

Dr Sadir Alrawi — the surgical oncologist who led the procedure conducted at Burjeel Specialty Hospital Sharjah — said the operation combined abdominal surgery and peritoneal chemotherapy to attack one’s cancer in multiple ways at once.

Though advanced, morbidity, mortality and complications remained high in this procedure. “There have been multiple trials and only a very experienced hand can be successful with it. Though morbidity or mortality is lower than any cardiac surgery and even pancreatic surgery, the fear of extra cost and extra time and further complications makes it a high-risk procedure,” Dr Alrawi said.

“In the UAE, more than 40 cases of Hipec have been done and these cases have been successful. There is a multi-disciplinary acceptance approach that is followed here in the country before going ahead with a surgery of this nature. It has been approved for mesothelioma for appendiceal cancer but it is still considered controversial for colorectal cancer as some say it may or may not be beneficial for the patient. So, patient selection is important and is done on a case-by-case basis.”

Dr Alrawi said the Hipec therapy was developed in the UAE’s government hospitals and later brought to private healthcare facilities like Al Zahra and VPS.

“We did three cases in the VPS within the last month, two in Burjeel Medical City in Abu Dhabi and the first one in Sharjah which was done two weeks ago on this patient — who was a young doctor with extensive peritoneal tumor carcinomas. Despite difficulties and with many approvals of our multidisciplinary tumour board and after the consent of the patient, we went ahead with this procedure,” he explained.

After an eight-hour surgery, the doctors claim to have removed at least 99 per cent of Mohammad’s tumour.

Dr Mehdi Afrit, medical oncology specialist at Burjeel Specialty Hospital, Sharjah, said “the most important risk involved in the procedure was allergic reaction to the chemotherapy medicine used, infection, and neutropenia and post-operative complications”.

This is why the decision to proceed with it should be taken up in the multidisciplinary board meeting. “If successful, this procedure can change and improve the quality of life, decrease the symptoms and reduce the rate of recurrence in a patient,” Dr Afrit said.

Difference between chemo and Hipec

Explaining the difference between the usual chemotherapy and Hipec, Dr Prasanta Kumar Dash, oncologist at Canadian Specialist Hospital, said: “It’s a cancer treatment that pumps warm chemotherapy drugs into one’s abdomen. The patient gets one very large dose of chemotherapy, but it’s not as toxic. That’s because the drugs aren’t injected into one’s bloodstream, so they don’t move around one’s body as much as chemotherapy given through an IV.

“The chemotherapy drugs are heated to about 106-109 degrees Fahrenheit. Cancer cells can’t handle heat. The heat also helps the drugs enter one’s cells more easily and works better.”

First, the surgeon cuts out any visible tumours in a step called cytoreductive surgeries or CRS. Then, to target any remaining cancer, one’s abdomen is filled with heated liquid that has chemotherapy drugs in it.

Hipec is so far used for hard-to-treat abdominal cancers. It has also shown promise against ovarian and gastric cancer.

Dr Arun Karanwal, oncologist at Prime Hospital, pointed out: “This combination of surgery and heated chemotherapy is now becoming an important option of treatment for some recurrent cancers.

“It can give significant improvements in cancer control when given to properly selected patients. It is not a solo therapy and most of the time requires good surgery to remove small cancer spots in the abdomen. It is often followed by additional chemotherapy cycles given through vein or by oral forms. Its treatment requires good multidisciplinary team support and care as it can cause severe reactions or side-effects in a small percentage of patients.”

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