Hyperthermic intraperitoneal chemoperfusion in the treatment of locally advanced intra-abdominal cancer

Background: Surgical treatment of intra-abdominal cancer is often followed by local recurrence. In a subgroup of patients, local recurrence is the sol e site of disease, reflecting biologically low-grade malignancy. These pati ents might, therefore, benefit from local treatment. Recently, debulking su rgery followed by hyperthermic chemoperfusion has been proposed in the trea tment of locally advanced or recurrent intra-abdominal cancer. This paper r eviews the rationale and assesses the currently accepted indications for an d results of this novel treatment. Methods: A systematic web-based literature review was performed. Informatio n was also retrieved from handbooks, congress abstracts and ongoing clinica l trials. Results: A growing body of experimental evidence supports the use of hypert hermia combined with chemotherapy as an adjunct to cytoreductive surgery. R andomized clinical trials are available to support its use in the treatment and prevention of peritoneal carcinomatosis following resection of patholo gical tumour stage pT(3) or pT(4) gastric cancer; several other phase III t rials are ongoing. Numerous phase I and II trials have reported good result s for various other indications, with acceptable morbidity and mortality ra tes. Case mix, limited patient numbers and absence of a standardized techni que are, however, a drawback in many of these series. Conclusion: For a subgroup of patients with peritoneal cancer without dista nt disease, debulking surgery followed by hyperthermic chemoperfusion may o ffer a chance of cure or palliation in this otherwise untreatable condition . This novel therapy should, however, be considered experimental until furt her results from ongoing phase In trials become available.