Treatment of Peritoneal Surface Malignancies with Hyperthermic Intraperitoneal Chemotherapy—Current Perspectives

Abstract

Peritoneal carcinomatosis (ptc) represents advanced malignant disease and has generally been associated with a grim prognosis. Peritoneal surface malignancy is often the major source of morbidity and mortality; it is of major concern in cancer management. Although ptc is categorized as metastatic disease, it represents a special disease pattern considered to be a locoregional disease limited to the abdominal cavity. The combination of cytoreductive surgery (crs) and intraoperative hyperthermic intraperitoneal chemotherapy (hipec) has successfully been used as locoregional treatment for selected patients with ptc from gastric, colorectal, and ovarian cancer; with mesothelioma; and with pseudomyxoma peritonei. In the prophylactic setting, hipec can also be used to prevent ptc in high-risk patients, and the first results of the "second-look" approach are promising. Patient selection-in which the risks of perioperative morbidity and mortality, which are analogous to those for any other major gastrointestinal surgery, are assessed-is of utmost importance. Those risks have to be weighed against the anticipated survival benefit, which depends mainly on tumour biology, extent of disease, and probability of achieving complete crs. The present review discusses the principles of crs and hipec, the most significant recent clinical data, and current perspectives concerning the application of this treatment modality in various malignancies. Ongoing trials and future directions are noted. It appears that the combination of crs and hipec is an indispensable tool in the oncologist's armamentarium.

Overall and disease-free survival in patients treated with CRS + HIPEC with cisplatin and paclitaxel for gastric cancer with peritoneal carcinomatosis

“…J Gastrointest Oncol 2017;8(3):572-582 jgo.amegroups.com CRS + HIPEC for treating advanced GC with or without PC, it is still not accepted as standard treatment, likely because GC is still associated with a poor prognosis, even without peritoneal disease (7)(8)(9)(10). In analyzing data about CRS + HIPEC in advanced GC it is important to discriminate whether it is used as a prophylactic treatment, or for the management of primary gastric cancer with SPC or for the management of MPC.…”

Preclinical Evaluation of Cetuximab and Benzoporphyrin Derivative‐Mediated Intraperitoneal Photodynamic Therapy in a Canine Model

“…Radiation therapy to doses adequate to successfully treat PC can result in significant toxicity to the adjacent normal tissues, especially the small bowel (8). Systemic therapy alone lacks the ability to deliver adequate drug levels and, therefore, results in decreased efficacy (9). However, as described in a randomized study of 105 patients, investigators showed improved survival when combining cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) as compared to palliative surgery and systemic chemotherapy (10).…”

Pharmacological principles of intraperitoneal and bidirectional chemotherapy

“…While there is scientific data to advocate the combination of cytoreductive surgery and perioperative intraperitoneal chemotherapy as treatment modality for peritoneal surface malignancies [33][34][35][36][37][38][39], the second component is still far from standardized. Significant variations in intraperitoneal chemotherapy remain and may influence the pharmacokinetics and pharmacodynamics of intraperitoneally delivered drugs, including their dose, the volume and the kind of carrier solution, the technique (open or closed abdomen), the intra-abdominal pressure and temperature, the duration of the intraperitoneal chemotherapy and the extent of (peritoneal) resections (Table 1) [3,18,40].…”