A doctor at Weill Cornell Medicine – Qatar (WCM-Q) wants to bring an innovative form of surgery for ovarian cancer to Qatar in the hope of improving survival rates among women.
Dr Arash Rafii Tabrizi, Professor of Genetic Medicine in Obstetrics and Gynaecology at WCM-Q, recently took part in a new surgical protocol in France that has only been in use for a few months. Doctors believe that it may improve the survival rate of patients with ovarian cancer and Dr Rafii Tabrizi would like to work with local stakeholders to set up an innovative programme for advanced ovarian cancer management and introduce the new personalised medicine approach in Qatar.
Dr Rafii Tabrizi explained that ovarian cancer is the deadliest form of gynecological cancer, with patients diagnosed at an advanced stage only likely to live for three or four years. Breast cancer has a survival rate of 80-90%. Prognosis for ovarian cancer is considerably poor as it develops in the abdomen and symptoms often go unrecognised until the cancer is at an advanced stage and has spread throughout the body.
Currently, the standard treatment is surgery to remove all tumors, followed by intravenous chemotherapy, but recurrence is common and Dr Rafii Tabrizi believes this is because microscopic cancer cells are able to hide in the peritoneum.
Most patients will experience a recurrence of the disease within three years following the operation and will then require additional chemotherapy and sometimes, surgery. Because of the high prevalence of relapse, it adds credence to the theory that the peritoneum – the membrane that lines the abdominal cavity and surrounds the internal organs – provides cancer cells with a refuge in which they are protected from the chemotherapy drugs.’
Dr Rafii Tabrizi said that for the last ten years, his laboratory, supported by Qatar Foundation and the Qatar National Research Fund, has examined the relationship between the peritoneum and cancer cells.
We have identified that the peritoneum cells become activated during surgery and this reaction is hijacked by the cancer cells to evade the chemotherapy drugs. So, we have to disrupt this relationship to improve the chances of destroying the disease.’
In 2004, Dr Rafii Tabrizi became involved with the concept of HIPEC – hyperthermic intraperitoneal chemotherapy – in advanced ovarian cancer. This involves heating the chemotherapy drugs and then applying them directly to the abdominal cavity rather than giving them intravenously. The heat provides a shock to cancer cells which leads to cell death, and applying the chemotherapy directly to the abdomen allows it to be delivered in a higher concentration than delivering it intravenously. Unfortunately, the technique was not effective.
However, doctors still believed the peritoneum to be the key so the process has been changed: to reduce the shock to the patient’s body, the temperature of the chemotherapy drugs has been reduced by two degrees to 40 degrees. This new protocol has now been in use for a few months, and Dr Tabrizi took part in his first operation at the University Hospital Foch.
The operation involved meticulous teamwork with surgeons and anesthesiologists, and lasted nine hours. The patient, who is in her 60s, had an advanced form of ovarian cancer and was carefully selected for her suitability for the procedure. She was also placed on a strict exercise regime before the operation to ensure she was physically fit. Dr Rafii Tabrizi said the woman is now out of intensive care. They are now waiting to see if the cancer will return. But he is, however, optimistic.
The theory is that there are microscopic cancer cells left in the peritoneum after surgery to remove the visible tumors, so we literally saturate the abdominal cavity and organs with the chemotherapy drugs.
Dr Rafii Tabrizi hopes to work with local stakeholders and bring the procedure to Qatar. So far, the procedure has only been carried out in a few countries, but given the severity of ovarian cancer Dr Rafii Tabrizi said they need to offer patients every possible chance of increasing their lifespan or even beating the cancer altogether.
Visit qatar-weill.cornell.edu for more information on Dr Rafii Tabrizi.