Rationale and techniques of intra-operative hyperthermic intraperitoneal chemotherapy.
BACKGROUND
In recent years surgical cytoreduction followed by intra-operative hyperthermic intraperitoneal chemotherapy (HIPEC) was introduced as treatment modality in patients with peritoneal surface malignancy. In the current review the rational for this approach, the prerequisites and the different techniques used are discussed.


METHODS
A literature search through PubMed was performed.


RESULTS
Pharmacokinetic studies have shown an important dose advantage for intraperitoneal versus intravenous application. Hyperthermia enhances the penetration of cytostatic drugs into tumour tissue and also shows synergism with various cytostatic drugs. The penetration depth of drugs into tissue is limited, therefore HIPEC can only be effective in patients with minimal residual disease after (aggressive) surgery. HIPEC can be conducted in various ways, without clear proven advantage of one method over the others. Local complications after this combined treatment approach are mainly surgery related. Intraperitoneal chemotherapy may cause systemic toxicity, dependent on the drug used. In randomised studies cytoreductive surgery followed by HIPEC has proven its value in the prevention of peritoneal dissemination in gastric cancer. Phase II data on HIPEC in peritoneal carcinomatosis of colorectal origin and pseudomyxoma peritonei are promising, but randomised studies are still not available.


CONCLUSIONS
Aggressive surgical cytoreduction and HIPEC in patients with peritoneal surface malignancy has a clear rational and seems to have clinical value.
Witkamp
A J
AJ
Department of Surgical Oncology, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, CX 1066 Amsterdam, the Netherlands.
de Bree
E
E
Van Goethem
R
R
Zoetmulder
F A
FA
D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001682:Biological Availability; D006801:Humans; D006979:Hyperthermia, Induced / Q000379:methods*; D007263:Infusions, Parenteral / Q000379:methods; D007430:Intraoperative Care / Q000379:methods; D009369:Neoplasms / Q000188:drug therapy*; D010529:Peritoneal Cavity; D010539:Permeability
D000970:Antineoplastic Agents