Open AccessTreatment of Peritoneal Surface Malignancies with Hyperthermic Intraperitoneal Chemotherapy—Current Perspectives
Author(s) -
John Spiliotis,
Evgenia Halkia,
Eelco de Bree
Publication year - 2016
Publication title -
current oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.053
H-Index - 51
eISSN - 1718-7729
pISSN - 1198-0052
DOI - 10.3747/co.23.2831
Subject(s) - medicine , pseudomyxoma peritonei , hyperthermic intraperitoneal chemotherapy , peritoneal mesothelioma , cytoreductive surgery , peritoneal carcinomatosis , disease , ovarian cancer , intraperitoneal chemotherapy , cancer , oncology , perioperative , colorectal cancer , mesothelioma , malignancy , general surgery , intensive care medicine , appendix , surgery , pathology , paleontology , biology
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.