The Role of Hyperthermic Intraperitoneal Chemotherapy for Non-colorectal Peritoneal Surface Malignancies.
BACKGROUND
Peritoneal carcinomatosis, from a variety of gastrointestinal and gynecological malignancies, has been historically challenging to treat and there remains a wide range of biologic aggressiveness in these patients. Malignancies commonly associated with PC include those of colorectal, appendiceal, gastric, ovarian, sarcoma, small intestinal, and primary peritoneal origin among others. Advances in our understanding of this unique disease process have led to significant interest in cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) as an emerging treatment option. The goal of CRS-HIPEC is to remove all visible macroscopic disease while preserving organ function, and then treat microscopic disease through perfusion of the peritoneal cavity with heated chemotherapy.


PURPOSE
Although recent reviews have focused on the management of peritoneal carcinomatosis secondary to colorectal cancer given the publication of several recent randomized controlled trials, the purpose of the current review is to summarize the evidence on CRS-HIPEC for non-colorectal peritoneal surface malignancies, including appendiceal neoplasms, malignant peritoneal mesothelioma, gastric cancer, and ovarian cancer.


RESULTS
While retrospective studies have clarified the importance of prognostic factors such as the peritoneal carcinomatosis index, completeness of cytoreduction, histopathological characteristics, and lymph node positivity, the lack of convincing level 1 evidence for the use of CRS-HIPEC has led to it remaining a highly controversial topic.


CONCLUSION
The decision to utilize CRS-HIPEC should involve a multidisciplinary team approach and evaluation of prognostic factors to balance the short-term morbidity of the operation with maximum long-term benefits. Large, multi-institutional groups and ongoing trials hold promise for clarifying the role of CRS-HIPEC in peritoneal surface malignancies.
['Morris|Mackenzie C|MC|', 'Cloyd|Jordan M|JM|', 'Hays|John|J|', 'Patel|Sameer H|SH|0000-0001-6442-1857']
D000971:Antineoplastic Combined Chemotherapy Protocols D015179:Colorectal Neoplasms D003131:Combined Modality Therapy D065426:Cytoreduction Surgical Procedures D006801:Humans D006979:Hyperthermia, Induced D000084262:Hyperthermic Intraperitoneal Chemotherapy D010534:Peritoneal Neoplasms D012189:Retrospective Studies D015996:Survival Rate
Cytoreductive surgery Mesothelioma Gastric cancer Ovarian cancer Appendiceal cancer HIPEC Hyperthermia