Abstract
Background: Cytoreductive surgery (CRS), followed by hyperthermic intraperitoneal chemotherapy (HIPEC), combines radical surgery with abdominal heated chemotherapy, constituting a multimodal treatment approach. Since clear standards for HIPEC conduct in colorectal carcinoma (CRC) are lacking, we aimed to provide a comprehensive structured survey. Data sources and study eligibility criteria: A systematic literature search was performed in PubMed, with keywords “HIPEC” and “colorectal cancer”, according to established guidelines. Articles were systematically screened, selecting 87 publications complemented by 48 publications identified through extended search for subsequent synthesis and evaluation, extracting inter alia details on used drugs, dosage, temperature, exposure times, and carrier solutions. Results: Compiled publications contained 171 reports on HIPEC conduct foremost with mitomycin C and oxaliplatin, but also other drugs and drug combinations, comprising at least 60 different procedures. We hence provide an overview of interconnections between HIPEC protocols, used drugs and carrier solutions as well as their volumes. In addition, HIPEC temperatures and dosing benchmarks, as well as an estimate of in vivo resulting drug concentrations are demonstrated. Conclusions and implications: Owing to recent developments, HIPEC conduct and practices need to be reassessed. Unfortunately, imprecise and lacking reporting is frequent, which is why minimal information requirements should be established for HIPEC and the introduction of final drug concentrations for comparability reasons seems sensible.
Highlights
Peritoneal metastasis (PM) can originate from a heterogeneous group of malignant tumors and frequently remains restricted to the peritoneal cavity
135 publications, comprising articles identified by systematic as well as manual search were compiled from the scientific literature, adding up to 171 reports on hyperthermic intraperitoneal chemotherapy (HIPEC) conduct performed for PM of CRC origin (Figure 1; Tables S1–S9)
This protocol administered 35 mg/m2 MMC fractionated over 90 min and was featured in the first ever randomized controlled trial (RCT) testing Cytoreductive surgery (CRS) and HIPEC versus systemic chemotherapy [2]
Summary
Peritoneal metastasis (PM) can originate from a heterogeneous group of malignant tumors and frequently remains restricted to the peritoneal cavity. Depending on the extent of intra-abdominal tumor load, considerable survival benefits have been reported when compared to systemic chemotherapy alone, including a randomized controlled trial (RCT) [1,2]. This multimodal approach includes an ancillary treatment added to surgery, where a heated solution containing cytotoxic drugs is applied directly to the peritoneal cavity. This procedure called HIPEC is intended to destroy any remaining tumor cells after tumor removal. Imprecise and lacking reporting is frequent, which is why minimal information requirements should be established for HIPEC and the introduction of final drug concentrations for comparability reasons seems sensible
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