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Hyperthermic Intraperitoneal Chemotherapy (HIPEC) Methodology, Drugs and Bidirectional Chemotherapy.

S J Valle1, N A Alzahrani2, W Liauw3

  • 1Department of Surgery, University of New South Wales & St George Hospital, Kogarah, Australia.

Indian Journal of Surgical Oncology
|April 12, 2016
PubMed
Summary

Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy are standard treatments for peritoneal carcinomatosis. This review explores the pharmacology of intraperitoneal chemotherapy techniques for better treatment outcomes.

Keywords:
Bidirectional chemotherapyCytoreductive surgery (CRS)Hyperthermic intraperitoneal chemotherapy (HIPEC)MethodologyPeritoneal carcinomatosis (PC)

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Area of Science:

  • Oncology
  • Surgical Oncology
  • Pharmacology

Background:

  • Peritoneal carcinomatosis (PC) necessitates advanced treatment strategies.
  • Cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) is a standard of care for select PC patients.
  • CRS aims to remove visible tumors, while HIPEC targets microscopic disease in the peritoneum.

Purpose of the Study:

  • To review the pharmacological principles underlying various intraperitoneal chemotherapy (IPEC) techniques.
  • To discuss factors influencing the efficacy of IPEC, including drug choice and pharmacokinetics.
  • To highlight the lack of standardized IPEC administration protocols.

Main Methods:

  • Review of existing literature on CRS and IPEC for peritoneal carcinomatosis.
  • Discussion of different IPEC regimens: HIPEC, early postoperative intraperitoneal chemotherapy (EPIC), and bidirectional chemotherapy.
  • Analysis of pharmacokinetic and pharmacodynamic considerations for cytotoxic agents used in IPEC.

Main Results:

  • CRS and HIPEC offer a standard treatment approach for a subset of PC patients.
  • IPEC delivers high local chemotherapy concentrations, potentially reducing systemic toxicity.
  • Treatment efficacy depends on the specific cytotoxic agent and its properties.

Conclusions:

  • Understanding the pharmacology of IPEC is crucial for optimizing treatment for peritoneal carcinomatosis.
  • Further research may lead to standardized IPEC methodologies.
  • CRS and HIPEC represent a significant advancement in managing advanced peritoneal disease.