Hyperthermic intraperitoneal chemotherapy
Abstract
In the past, patients with peritoneal metastases have been treated only with palliative therapy. Their state was deemed to be incurable. The median survival time was approximately two months. The therapeutic approach started to change in the nineties. Some researchers were of the opinion that peritoneal metastases were, in certain cases, only a locoregional disease and consequently, the patient could not only be treated, but cured. One of the main supporters of this theory and new treatment approach was Paul Sugarbaker. The proposed treatment consisted of cytoreductive surgery in combination with intraperitoneal chemotherapy. The purpose of the surgical procedure is macroscopic elimination of the tumour and removal of its microscopic remains via intraperitoneal chemotherapy. The procedure in which we apply a heated chemotherapeutic agent is known as hyperthermic intraperitoneal chemotherapy. Heat on its own has some direct anti-tumour effects. It causes protein denaturation, lysosomal activation and increased apoptotic cell death. If the chemotherapeutic agent is heated, complex chemical reactions take place, which promote its effectiveness and increase the depth of penetration. The best results achieved by this method have been reported in colorectal carcinoma, appendiceal malignancies, ovarian carcinoma and peritoneal mesothelioma. In the paper, the authors present this complex procedure, indications, criteria of patient selection and contemporary knowledge on the effectiveness of this method of treatment for certain types of cancer.
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