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Chimiothérapie hyperthermique intrapéritonéale (HIPEK et PIPAK) : ce qu'il faut savoir
À notre époque, les maladies cancéreuses sont de plus en plus répandues dans le monde entier ; mais, fort heureusement, les traitements se développent également d’une manière fulgurante.
Parmi les techniques qui ont vu le jour récemment, il y a la chimiothérapie chaude (ou chauffée) – techniquement : chimiothérapie hyperthermique intrapéritonéale (CHIP) –. Celle-ci est appliquée avec succès dans le traitement des patients atteints de tumeurs dans l’abdomen.
La chimiothérapie hyperthermique intrapéritonéale (CHIP) est une technique chirurgicale utilisée pour traiter certains cancers de l’abdomen. Elle consiste à administrer une chimiothérapie chauffée directement dans la cavité péritonéale qui entoure les organes abdominaux.
Le professeur Süleyman Yedibela , spécialiste en chirurgie générale au Centre médical Anadolu , partage avec nous des informations importantes sur les méthodes de chimiothérapie à chaud…
À quels patients HIPEK et PIPAK s’adressent-ils ? La CHIP se déroule en deux étapes : (1) Cytoréduction : le chirurgien enlève autant de tumeur visible que possible. (2) Chimiothérapie hyperthermique : une solution de chimiothérapie est chauffée à environ 42 °C puis perfusée dans la cavité péritonéale. La solution circule dans l’abdomen pendant 30 à 90 minutes, elle est ensuite retirée.
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En outre, la technique de la chimiothérapie hyperthermique intrapéritonéale s’applique aux patients atteints des types de tumeurs suivantes :
Pseudomyxoma peritonei (type de cancer originaire du péritoine) ;
Mésothéliome péritonéal (type de cancer provenant de la paroi de l’abdomen) ;
Atteinte du péritoine en cas de carcinome du gros intestin et du rectum (colorectal) ;
Atteinte du péritoine en cas de cancer gastrique ;
Propagation du cancer de l’appendice au péritoine ;
Atteinte du péritoine en cas de cancer de l’ovaire et de l’utérus. Qu’est-ce que la chimiothérapie chaude HIPEK ? La chimiothérapie chaude (HIPEK) est un traitement destiné à des patients strictement sélectionnés. Il consiste souvent en une intervention chirurgicale sur plusieurs organes (ablation de toutes les tumeurs visibles) et en une ablation (partielle) du péritoine, qui ne peut généralement être réalisée qu’une seule fois.
Chez les patients dont le cancer est localisé au péritoine et qui n’ont pas (ou peu) de métastases dans d’autres organes (systémiques), l’ablation de toutes les tumeurs visibles associée à une chimiothérapie intrapéritonéale hyperthermique (HIPEK) peut entraîner une amélioration de la survie.
Lors d’une opération ouverte, outre la tumeur primaire et les éventuelles métastases hépatiques, le péritoine est en grande partie retiré et les organes ou parties d’organes atteints sont enlevés. En présence de métastases à distance, d’un état général dégradé et d’une atteinte étendue du péritoine, l’HIPEK ne peut pas être pratiquée.
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L’atteinte du péritoine est habituellement évaluée avant la chirurgie cytoréductive proprement dite avec HIPEK dans le cadre d’une laparoscopie diagnostique et quantifiée à l’aide du PCI (= Peritoneal Carcinomatosis Index) selon Sugarbaker. Un PCI faible signifie que le péritoine n’est que légèrement affecté par les nodules tumoraux, tandis qu’un score plus élevé signifie que les métastases péritonéales sont plus étendues.
Une fois que le patient a été débarrassé de toutes les tumeurs visibles, une chimiothérapie hyperthermique est administrée par voie intrapéritonéale dans l’abdomen fermé pendant 60 minutes. Les patients doivent être soigneusement sélectionnés pour cette opération, car ils présentent souvent des comorbidités et le risque de l’opération doit être soigneusement évalué.
En outre, la durée de l’hospitalisation est généralement estimée entre 10 et 14 jours.
Le traitement du carcinome de la paroi abdominale par HIPEK et PIPAK Le traitement du carcinome de la paroi abdominale (péritoine) ou du carcinome métastasé provenant d’un cancer situé ailleurs dans le corps est un défi que doit relever une équipe médicale pluridisciplinaire.
L’invasion du péritoine par les cellules tumorales est un signe de maladie tumorale avancée. Le patient est souvent décrit comme « incurable » et « inopérable ». Le traitement systémique palliatif (= chimiothérapie) représente actuellement le traitement standard. Cependant, grâce à de nouvelles méthodes , au traitement chirurgical ou à la chimiothérapie locale, la maladie peut être contrôlée chez certains patients.
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Dans certains cas, une guérison peut être obtenue. Il est important que la prolongation de la vie puisse se faire avec une bonne qualité de vie. La chimiothérapie locale appliquée à la cavité abdominale peut être réalisée en cas d’échec ou d’intolérance du traitement systémique ou en complément de celui-ci.
Il est important de sélectionner les patients qui bénéficieront d’une intervention chirurgicale. Le Centre Anadolu propose deux méthodes pour cela : HIPEK et PIPAK.
Quand le PIPAK est-il pratiqué ? Le PIPAK (chimiothérapie intrapéritonéale en aérosol sous pression) est réalisé par laparoscopie (méthode mini-invasive) en pulvérisant des médicaments chimiothérapeutiques dans le péritoine et implique un traitement local répété (généralement trois traitements à environ six semaines d’intervalle).
Elle peut être réalisée parallèlement à une chimiothérapie systémique en cours, à condition que la numération sanguine (en particulier les leucocytes et les plaquettes) ne chute pas brutalement sous l’effet de la chimiothérapie. Partant, le Centre Médical Anadolu propose pour les patients qui ne conviennent pas à l’HIPEK, la procédure PIPAK.
Tout d’abord, la cavité abdominale est examinée et l’implication péritonéale est assurée par une opération peu invasive. L’agent chimiothérapeutique (cisplatine et doxorubicine) est ensuite administré sous forme d’aérosol à haute pression dans la cavité abdominale à l’aide d’un pulvérisateur.
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La procédure PIPEK est très douce et peut être réalisée parallèlement à une chimiothérapie systémique en cours. Le jour de l’intervention, les patients peuvent se lever et se déplacer dans le service. Le séjour à l’hôpital dure généralement 4 à 5 jours. Les effets secondaires systémiques sont très rares. Le traitement n’est pas administré une seule fois, mais au moins trois fois à des intervalles de six semaines.
Bien que la procédure PIPAK soit relativement récente, des séries de cas et de rapportsdonnent des résultats très prometteurs. Dans certains cas, l’utilisation du PIPAK peut conduire à une élimination complète de la tumeur , c’est-à-dire à une régression complète de l’atteinte péritonéale.
Enfin, il faut noter que le principal avantage de ce traitement est son faible taux de complications et sa très bonne tolérance. La qualité de vie ne se détériore pas avec ce traitement.