Diseases with peritoneal dissemination and their treatment:
The diseases with peritoneal dissemination that require cytoreductive surgery και hyperthermic intraperitoneal intraoperative chemotherapy (HIPEC) are:
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pseudomyxoma peritonei
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colorectal cancer with peritoneal spread
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gastric cancer with peritoneal spread
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appendiceal cancer with peritoneal spread
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small bowel cancer with peritoneal spread
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peritoneal mesothelioma
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advanced ovarian cancer (FIGO stage III)
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peritoneal sarcomatosis
For these diseases cytoreductive surgery combined with intraperitoneal chemotherapy is considered the standard treatment.
Intraperitoneal hyperthermic chemotherapy is performed after tumor resection and before the reconstruction of the continuity of the alimentary tract.
It has been shown that high molecular weight substances (as are most of the cytostatic drugs) have the property to remain on the peritoneal surfaces for long and act intensively while they are slowly absorbed in the systemic circulation. This is followed by the eradication of the peritoneal spread provided the residual tumor is less than 2-3mm because intraperitoneal chemotherapy can not by absorbed by larger tumors. As a consequence, surgical resection is of the utmost importance.
Mitomycin-C is used for the diseases of the gastrointestinal tract (pseudomyxoma peritonei, colorectal cancer, gastric cancer, appendiceal cancer, and cancer of the small bowel), for 90 minutes at 42-430C. Cis-platin combined with Mit-C may be used instead of Mit-C alone for gastric cancer. The combination of cis-platin and doxorubicin may be used in peritoneal mesothelioma, ovarian cancer, and peritoneal sarcomatosis. For colorectal and appendiceal cancer oxaliplatin may be alternatively used.
Sometimes it is necessary to be used early postoperative intraperitoneal chemotherapy under normothermia for the first 5 postoperative days. 5-FU or taxanes are usually used as cytostatics in early postoperative intraperitoneal chemotherapy.
