Abstract
Peritoneal metastasis (PM) originating from gastrointestinal and gynecological malignancies are associated with a poor prognosis and rapid disease progression. Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is an effective treatment option with curative intent. Hyperthermia enhances the cytotoxicity of chemotherapeutic drugs, thereby killing microscopic tumors and reducing the risk of tumor recurrence. Eight parameters potentially have an impact on the efficacy of HIPEC: the type of drug, drug concentrations, carrier solution, volume of the perfusate, temperature of the perfusate, duration of the treatment, the technique of delivery, and patient selection. In this review, a literature search was performed on PubMed, and a total of 564 articles were screened of which 168 articles were included. Although HIPEC is a successful treatment, there is no standardized method for delivering HIPEC: the choice of parameters is presently largely determined by institutional preferences. We discuss the current choice of the parameters and hypothesize about improvements toward uniform standardization. Quantifying the effect of each parameter separately is necessary to determine the optimal way to perform HIPEC procedures. In vivo, in vitro, in silico, and other experimental studies should shed light on the role of each of the eight parameters.
Highlights
Peritoneal surface malignancies are generally associated with poor prognosis and rapid disease progression
We present an overview of the recent hyperthermic intraperitoneal chemotherapy (HIPEC) literature and discuss these between institutes worldwide
We present an overview of the recent literature influencing the efficacy of HIPEC—ʺpatient parameters of HIPEC, and argue thatselection”
Summary
Peritoneal surface malignancies are generally associated with poor prognosis and rapid disease progression. In current practice, the treatment used for peritoneal metastasis from various origins is, increasingly, CRS, in combination with intraperitoneal chemotherapy (IPC). The recently presented results of the multicenter randomized French Prodige-7 trial restarted the discussion of the additive effect of HIPEC to CRS in patients with PM from a CRC origin, especially following induction systemic therapy and using the 30 min high-dose oxaliplatin schedule for HIPEC [24]. Number of studies published and PubMed. Pie chart showing the distribution of each cancer origin of all included papers in this review. [26] distinguishes number of treatment parameters determine the efficacy of HIPEC. We present an overview of the recent literature influencing the efficacy of HIPEC—ʺpatient (seven) parameters of HIPEC, and argue thatselection”.
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