Normothermic catheter-based intraperitoneal chemotherapy: Systematic review using the IDEAL framework

Peritoneal metastasis from (PM) remains a significant therapeutic challenge due to poor response to systemic chemotherapy, largely attributable to limited peritoneal drug penetration. Normothermic catheter-based intraperitoneal chemotherapy (IPC) offers a promising alternative, enabling high local drug concentrations with reduced systemic toxicity. This review applies the IDEAL Framework to assess the evolution of normothermic catheter-based IPC for PM treatment. A systematic review identified 205 original studies and 47 trial protocols or registrations. Normothermic catheter-based IPC has advanced through IDEAL Stages 0 to 3, with preclinical data establishing feasibility, early-phase trials demonstrating safety and efficacy, and recent randomised controlled trials, mainly in Asia, suggesting survival benefit. However, uptake remains limited, and IDEAL Stage 4 data, including long-term follow-up and registry outcomes are lacking. These findings underscore normothermic catheter-based IPC's potential as part of multimodal PM treatment. Further prospective, globally representative trials and long-term data collection are needed to guide broader clinical adoption.