Multimodal treatment of peritoneal carcinomatosis and sarcomatosis

Peritoneal carcinomatosis and sarcomatosis (PCS) are short-term fatal condi tions amenable only to palliative treatment. They are generally considered as a systemic disease at clinical presentation, and are resistant to standa rd treatments. However, there may be in the natural history a phase of loco -regional tumour spread during which the tumour may still be curable. Surgical treatment alone, or in combination with systemic chemotherapy, has yielded poor results in terms of survival and quality of life. One approac h is cytoreductive surgery (CS) combined with the intraperitoneal administr ation of antiblastic agents. This may diminish any residual tumour followin g macroscopic excision and may overcome the pharmacokinetic limits of syste mic chemotherapy. A further improvement in this multimodal approach may be achieved by the use of hyperthermic intraperitoneal intraoperative chemothe rapy (HIIC). Results so far have been encouraging. However, series reported in the liter ature are relatively small and heterogeneous, and clinical and technical fa ctors which include the selection of patients, optimal drugs dosage and tem perature, evaluation of outcome and costs are still under discussion. (C) 2 001 Harcourt Publishers Ltd.