Complications of extensive adhesion formation after intraperitoneal chemotherapy

The results of modeling studies have suggested and clinical investigations have confirmed a major pharmacokinetic advantage for exposure of the peritoneal cavity to certain chemotherapeutic agents compared with exposure of the systemic circulation when these drugs are delivered through the intraperitoneal route. Objective antitumor responses and significant palliation of symptoms have been demonstrated. One major concern with the use of intraperitoneal therapy is the risk of inducing peritoneal sclerosis and extensive adhesion formation. At the University of California at San Diego (UCSD) Cancer Center, 115 patients with advanced intra-abdominal malignant conditions have been treated with several intraperitoneal chemotherapy programs. To date, with a total of 1,103 patient-months of follow-up study, seven episodes of small intestinal obstruction have developed of which two were definitely and five possibly related to chemotherapy induced adhesion formation. The development of methods to prevent or decrease peritoneal sclerosis will allow for greater application of this innovative therapeutic approach.