[Rationale for perioperative chemotherapy treatment in peritoneal carcinomatosis]

Peritoneal carcinomatosis, without special treatment, is a fatal sign of gastrointestinal and gynaecological malignancy. Cytoreductive surgery to remove gross disease is combined with perioperative intraperitoneal and intravenous chemotherapy to eradicate the residual microscopic disease. Knowledge of the effect of the peritoneal barrier on the pharmacokinetics of the chemotherapy agents, and the factors that affect this, enables a good combination of drugs, dosage and solution volume to be selected, in order to predict peritoneal and systemic exposure to the treatment and its toxicity. Timing of the chemotherapy as a planned part of the surgical procedure to maximise exposure of all peritoneal surfaces is crucial to success. In this article we update the pharmacokinetic basis for perioperative chemotherapy treatment of peritoneal carcinomatosis of gastrointestinal or gynaecological origin.