Hyperthermic Intraperitoneal Chemotherapy: A Critical Review

Wim Ceelen*, Jesse Demuytere, Ignace de Hingh

*Corresponding author for this work

Research output: Contribution to journal(Systematic) Review article peer-review

6 Citations (Web of Science)

Abstract

Simple Summary Patients with cancer of the digestive system or ovarian cancer are at risk of developing peritoneal metastases (PM). In some patients with PM, surgery followed by intraperitoneal (IP) chemotherapy has emerged as a valid treatment option. The addition of hyperthermia is thought to further enhance the efficacy of IP chemotherapy. However, the results of recent clinical trials in large bowel cancer have put into question the use of hyperthermic intraperitoneal chemotherapy (HIPEC). Here, we review the rationale and current results of HIPEC for PM and propose a roadmap to further progress. With increasing awareness amongst physicians and improved radiological imaging techniques, the peritoneal cavity is increasingly recognized as an important metastatic site in various malignancies. Prognosis of these patients is usually poor as traditional treatment including surgical resection or systemic treatment is relatively ineffective. Intraperitoneal delivery of chemotherapeutic agents is thought to be an attractive alternative as this results in high tumor tissue concentrations with limited systemic exposure. The addition of hyperthermia aims to potentiate the anti-tumor effects of chemotherapy, resulting in the concept of heated intraperitoneal chemotherapy (HIPEC) for the treatment of peritoneal metastases as it was developed about 3 decades ago. With increasing experience, HIPEC has become a safe and accepted treatment offered in many centers around the world. However, standardization of the technique has been poor and results from clinical trials have been equivocal. As a result, the true value of HIPEC in the treatment of peritoneal metastases remains a matter of debate. The current review aims to provide a critical overview of the theoretical concept and preclinical and clinical study results, to outline areas of persisting uncertainty, and to propose a framework to better define the role of HIPEC in the treatment of peritoneal malignancies.

Original languageEnglish
Article number3114
Number of pages16
JournalCancers
Volume13
Issue number13
DOIs
Publication statusPublished - Jul 2021

Keywords

  • peritoneal
  • HIPEC
  • intraperitoneal
  • drug transport
  • COLORECTAL PERITONEAL METASTASES
  • PERIOPERATIVE SYSTEMIC THERAPY
  • COMPLETE CYTOREDUCTIVE SURGERY
  • PSEUDOMYXOMA PERITONEI
  • GASTRIC-CANCER
  • OVARIAN-CANCER
  • RANDOMIZED-TRIAL
  • OPEN-LABEL
  • CARCINOMATOSIS
  • TRANSPORT

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