Hyperthermic Intraperitoneal Chemotherapy and Cytoreductive Surgery in the Management of Peritoneal Carcinomatosis

Rahul Rajeev, MBBS; Kiran K. Turaga, MD

Disclosures

Cancer Control. 2016;23(1):36-46. 

In This Article

Perfusion Techniques

Drug delivery to the peritoneum is controlled by flow rate, temperature, dose, and duration of HIPEC. Experiments by Facy et al[59,60] on animal models suggest that increasing the intraperitoneal pressure enhances the penetration of the chemotherapeutic drug into the peritoneum but not the depth of penetration. The effect is maximal when using an open technique at 25 cm H2O more in the parietal peritoneum than visceral, and it is feasible and well tolerated. In animal and in vitro models, higher flow rates were seen to shorten the time to attain and maintain target temperatures during HIPEC, thus resulting in higher temperature gradients that may potentially enhance the rate of cytotoxicity.[61] Ceelen et al[62] reported that higher perfusion temperatures worsen the metabolic changes associated with oxaliplatin HIPEC but they do not affect surgical outcomes.

Despite the evolution of HIPEC as standard therapy in peritoneal carcinomatosis, standardized protocols are not yet followed in the United States.[63] After a Dutch cancer institute implemented an HIPEC protocol in peritoneal surface malignancy centers in the Netherlands, outcomes were improved compared with the preimplementation phase.[64] A standard protocol decreased the length of procedures, rate of blood loss, complications, and duration of hospital stay.[64] It should be noted that, with experience, the corresponding improvement in patient selection led to fewer numbers of patients with extensive disease after the protocol was enforced.[64] Attempts at standardizing the delivery of HIPEC in US centers specializing in peritoneal surface malignancy have resulted in a recommendation of a closed technique using a standardized dual dose of mitomycin in a 90-minute cycle in patients with CRC-PC.[63]

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