Treatment of peritoneal carcinomatosis by continuous hyperthermic peritoneal perfusion with cisplatin

Abstract

Over a decade ago Speyer et al. wrote that ‘extensive peritoneal involvement with metastatic tumor is a problem in the management of a variety of human tumors’ [1]. Yet, despite considerable clinical research over the past decade, this remains true for a variety of tumor histologies, including stomach, other gastrointestinal, and ovarian cancers, as well as for other rare histologies, such as intraabdominal mesothelioma and sarcoma. In a significant proportion of patients with peritoneal carcinomatosis, the disease remains confined to the peritoneal cavity and is the sole or major contributing cause of death. Different and innovative strategies that direct treatment to the peritoneal cavity have been tried and attest to the acknowledged importance and difficulty in treating this condition. In general, the major theoretical advantages of intraperitoneal treatment are that it allows the opportunity to directly apply high local concentrations of potentially effective treatment to the area of tumor while limiting systemic exposure and thereby decreasing toxicity. The limitations of this approach include the possibility of insufficient or incomplete distribution of the therapeutic agent to all the peritoneal surfaces at risk, variable penetration of the therapeutic agent into tumor, or dose-limiting local toxicity (Table 1).