Heated chemo is the key as Tampa General doctor tackles ovarian cancer

Over the span of three weeks, Brenda Gotlen watched as her abdomen got bigger. Her lower stomach felt bloated.

"It got to the point that I looked nine months pregnant," said Gotlen, a 62-year-old Seffner resident.

She made an appointment to see her primary care physician, but the doctor was stumped. She advised Gotlen to go to an emergency room in nearby Plant City, and to tell the doctors there to do a CT scan.

That's when she first got the bad news.

"They told me I had ovarian cancer. I had a tumor, 10 inches wide, on my ovary. I was devastated," Gotlen said, recalling the day, last July. She later learned that her tumor's advanced state made her an excellent candidate for a newer, but risky, medical procedure that requires heating chemotherapy medicine with saline solution and running it through her abdomen.

It's believed that only one physician in Florida performs the procedure, which is similar to dialysis. And he's based in Tampa.

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Ovarian cancer is known as "the silent killer" because it is rarely diagnosed until it's already in advanced stages, when prognosis is not great.

Gotlen's condition was so severe that physicians at the Plant City emergency room gave her just two referrals: Go to Moffitt Cancer Center or to Tampa General, two institutions with long histories of taking the most difficult cases.

Moffitt didn't accept Gotlen's insurance, so she opted to see Dr. Thomas Rutherford, a professor and director of gyecologic oncology at USF Health who works at Tampa General Hospital.

He was quick to take action after meeting Gotlen and assessing her case. Just three days later, he had her in surgery, only to find another problem: Gotlen had a mucinous tumor, which is "more like jelly you spread on toast than the regular hard tumors," she explained. The doctor was able to remove only some of it.

But Gotlen's case was unique and serious enough for Rutherford to consider her for the procedure involving heated chemotherapy medicine. Known as hyperthermic intraperitoneal chemotherapy, or HIPEC, it had shown positive results with other ovarian cancer patients.

The chemotherapy solution is heated to 107.6 degrees, about the temperature of a warm bath. Physicians open the patient's abdomen and feed the liquid directly into that area of the body through tubes and a catheter. Then it is drained from the abdomen and the incision is closed.

The procedure, which takes about 90 minutes, allows for higher concentrated doses of chemotherapy while minimizing the exposure to the rest of the body. The heat aids in the absorption of the dose.

The result is an inflammatory response that helps destroy cancer cells, Rutherford said. Research indicates that the procedure also induces an anti-cancer response from the immune system.

Doctors have shown renewed interest in exploring immnotherapies in cancer treatment. Late last year, the U.S. Food and Drug Administration approved two kinds of Chimeric Antigen Receptor Therapy, where specialists "re-program" a patient's cells to attack blood and bone marrow-type cancer cells.

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"When what you're doing doesn't work, go back and read, look at what's been done before," said Rutherford, who came to Tampa through USF Health a little more than a year ago.

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He originally began using HIPEC while working at the Western Connecticut Health Network to treat cancers in the abdomen, such as stomach, colon and appendix. Of the 22 ovarian cancer patients he had treated with the HIPEC method there, only one developed cancer again, Rutherford said. So far, he's treated eight women in Florida and has three more patients scheduled this month.

In January, the method was highlighted in the New England Journal of Medicine.

"This procedure can be very tough on the patient," Rutherford cautioned. "It's a rocky six to seven months to recover."

Gotlen remembers Rutherford describing how it would feel: Like "a sunburn, but on the inside."

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It takes a complex team of physicians, anesthesiologists and nurses to perform the procedure. Patients are wrapped in cooling blankets and sometimes their feet and forehead are iced to keep them from overheating.

Side effects include some gastrointestinal issues, and there are risks of fluid in the lung and kidney damage, Rutherford said. But he told Gotlen that he'd never had a patient with severe complications.

"He was honest and didn't sugarcoat anything," she said. "He told me he had performed 138 surgeries on women with ovarian cancer, and I was going to be 139. I thought, 'Whoa, that's really a big deal,'" she said.

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She searched the term "HIPEC" on YouTube, and said the videos she watched scared her at first. But she didn't have much choice. She previously had gone through six weeks of regular chemotherapy after the removal of her tumor and ovary, but it had no effect on the cancer.

"He said it's this, or in six to eight months, my cancer will start to attack other organs and that would be it," Gotlen said, recalling a conversation with Rutherford.

After the Dec. 12 procedure, she went home, hoping for the best. She immediately started to improve and felt few side effects. She sees Rutherford every month for check-ups, and she's cancer-free for now.

"I don't know if the cancer will come back," Gotlen said. "My mother and my grandmother had cancer. It could come back. But I feel better. I have a lot of energy. HIPEC is what cured me."

Contact Justine Griffin at jgriffin@tampabay.com or (727) 893-8467. Follow @SunBizGriffin.