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Updated: Jun 25, 2026
09:02
Percutaneous Hepatic Perfusion (PHP) with Melphalan as a Treatment for Unresectable Metastases Confined to the Liver
Published on: July 31, 2016
Using pharmacologic data to plan clinical treatments for patients with peritoneal surface malignancy
Kurt Van der Speeten1, Oswald Anthony Stuart, Paul H Sugarbaker
1Washington Cancer Institute, Washington Hospital Center, Washington, DC 20010, USA.
Current Drug Discovery Technologies
|March 12, 2009
Summary
Peritoneal carcinomatosis, a fatal cancer spread, is treated with surgery and chemotherapy. This approach combines cytoreductive surgery with perioperative chemotherapy to effectively manage abdominal and pelvic malignancies.
Area of Science:
- Oncology
- Surgical Oncology
- Pharmacology
Background:
- The abdomen and pelvis are common sites for gastrointestinal and gynecologic cancer spread.
- Transcoelomic dissemination leads to peritoneal carcinomatosis, a fatal condition without intervention.
- Effective treatment requires addressing both gross disease and microscopic residual cancer cells.
Purpose of the Study:
- To outline the multimodal treatment strategy for peritoneal carcinomatosis.
- To explain the rationale behind combining cytoreductive surgery with perioperative chemotherapy.
- To highlight the importance of chemotherapy route selection and administration techniques.
Main Methods:
- Cytoreductive surgery to remove visible cancerous tissue.
- Perioperative intraperitoneal chemotherapy (IP chemo) and intravenous chemotherapy (IV chemo).
- Selection of chemotherapy agents based on pharmacologic properties and administration route.
- Use of moderate hyperthermia (41-42°C) to enhance intraperitoneal chemotherapy penetration.
- Dosing based on body surface area to predict systemic exposure and toxicity.
Main Results:
- Peritoneal carcinomatosis is a fatal manifestation of advanced cancers.
- Combining cytoreductive surgery with perioperative chemotherapy improves outcomes.
- The peritoneal-plasma barrier influences chemotherapy clearance, necessitating specific administration strategies.
- Hyperthermia enhances drug penetration into small cancer nodules.
- Predictable systemic drug exposure and toxicity are achievable with standardized dosing.
Conclusions:
- Cytoreductive surgery combined with perioperative chemotherapy is essential for managing peritoneal carcinomatosis.
- Intraperitoneal chemotherapy, particularly with hyperthermia, effectively targets cancer cells on peritoneal surfaces.
- Careful selection and administration of chemotherapy agents are critical for maximizing efficacy and minimizing toxicity.
- Optimizing the timing and delivery of chemotherapy within the surgical procedure is key to successful treatment.
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