Current Approaches and Emerging Strategies in the Treatment of Peritoneal Carcinomatosis

Peritoneal carcinomatosis (PC) is a common, prognostically unfavorable manifestation of advanced gastrointestinal and gynecological malignancies whose treatment is constrained by the blood-peritoneal barrier, which limits drug penetration even when cytoreductive surgery is combined with systemic chemotherapy. This review evaluates current intraperitoneal treatment modalities and emerging technologies for overcoming this limitation, based on recent clinical trials and meta-analyses identified through Scopus and PubMed. We sequentially examine conventional intraperitoneal chemotherapy (IPC); hyperthermic intraperitoneal chemotherapy (HIPEC) in ovarian, gastric, and colorectal cancers, with attention to patient selection and the peritoneal cancer index as determinants of survival benefit; pressurized intraperitoneal aerosol chemotherapy (PIPAC) and its electrostatic precipitation variant (ePIPAC); and photodynamic and photothermal therapy for tumor treatment. Novel strategies are also discussed, including IPC combined with immune checkpoint inhibitors, optical dosimetry, and nanomedicine-based drug delivery as tools for improving treatment precision. Overall, management of PC is transitioning toward a personalized, multimodal approach: HIPEC and PIPAC provide standardized platforms for regional therapy, but future progress depends on integrating advanced drug delivery systems, immunotherapy, and real-time intraoperative monitoring, with standardization of protocols through large multicenter trials remaining a priority for translating these modalities into clinical practice.