[Importance and problems of intraperitoneal chemotherapy]

Intraperitoneal chemotherapy for prophylaxis and treatment of peritoneal carcinosis is a new treatment modality. Due to a very difficult definition of remission for peritoneal carcinosis, results of this treatment modality are difficult to state. The total remission rates are currently between 30 and 50% in minimal residual disease. The major advantage of intraperitoneal chemotherapy is the augmentation of the local concentration of the cytotoxic agent which exceeds the serum level in some cases by a factor of 1000. Due to totally implantable systems the high risk of infection in patients with Tenckhoff catheters could be reduced to nearly zero. After perfusion of the peritoneal cavity with a cytotoxic agent the concentration in the portal vein can exceed that in the peripheral blood by a factor of 10. Results of two adjuvant trials could not show a survival benefit of treated patients, however the incidence of peritoneal carcinosis was significantly decreased. New treatment options are a perfusion of the peritoneal cavity with effective cytotoxic drugs in the very early postoperative time period. The combined treatment of cytostatics and "biological response modifiers" could further increase the effectiveness of this treatment modality.