Review of Options to Traditional HIPEC for Prevention and Treatment of Peritoneal Metastases

Area of Science:

• Oncology
• Surgical Oncology
• Peritoneal Metastases Management

Background:

• Cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) is a treatment modality for peritoneal metastases.
• Complete cytoreduction is crucial for patient benefit from CRS and HIPEC.
• Limited efficacy of HIPEC in high-grade tumors like colorectal, gastric, and ovarian cancers has been observed.

Purpose of the Study:

• To evaluate the application and limitations of CRS with HIPEC in managing peritoneal metastases.
• To highlight the importance of complete cytoreduction for successful outcomes.
• To explore alternative treatment options for invasive intra-abdominal malignancies with peritoneal metastases, particularly for high-grade tumors.

Main Methods:

• Review of current clinical applications of CRS and HIPEC.
• Analysis of factors influencing patient outcomes, focusing on the degree of cytoreduction.
• Identification of limitations of HIPEC in specific tumor types and stages.

Main Results:

• CRS with HIPEC is effective for selected patients with peritoneal metastases, with outcomes strongly correlated with complete cytoreduction.
• Higher-grade tumors (colorectal, gastric, ovarian) show limited benefit from CRS and HIPEC.
• HIPEC's effectiveness is compromised by tumor invasion into subperitoneal lymphatics, common in high-grade malignancies.

Conclusions:

• CRS with HIPEC is a valuable tool for specific patient groups with peritoneal metastases, emphasizing the necessity of achieving complete tumor removal.
• The effectiveness of HIPEC is restricted in high-grade tumors due to their invasive nature and lymphatic involvement.
• Further investigation into alternative therapeutic strategies is warranted for invasive intra-abdominal cancers with peritoneal spread.