From the Guidelines
The treatment plan for peritoneal cancer should involve a multimodal approach combining cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for eligible patients, as this approach has been shown to improve progression-free survival (PFS) and overall survival (OS) in selected patients with peritoneal carcinomatosis 1.
Key Considerations
- The cornerstone of treatment is cytoreductive surgery (CRS) to remove visible tumors, often combined with HIPEC, where heated chemotherapy drugs are circulated directly in the abdominal cavity to kill remaining cancer cells.
- Following surgery, systemic chemotherapy regimens such as FOLFOX or carboplatin with paclitaxel are typically administered for 4-6 cycles.
- For certain types of peritoneal cancer, targeted therapies like bevacizumab or PARP inhibitors may be added.
- Treatment effectiveness depends on factors including the primary cancer type, extent of disease, and the patient's overall health.
- Patients should expect regular follow-up with CT scans every 3-6 months and tumor marker tests to monitor for recurrence.
Recent Evidence
- A recent study published in the Journal of Clinical Oncology in 2022 highlighted the importance of integrating genomic biology into therapeutic strategies for gastric cancer peritoneal metastasis, suggesting that a combination of peritoneal-directed treatment strategies and systemic therapy may be required for the treatment of GCPM 1.
- Another study published in 2022 demonstrated that combined systemic and intraperitoneal chemotherapy can lead to successful downstaging of peritoneal metastasis, allowing for conversion gastrectomy in selected patients and resulting in improved overall survival 1.
Patient Selection
- Preoperative patient selection is crucial for the success of the combined treatment concept, with main selection criteria including good general health status, limited intraperitoneal tumor dissemination, limited small bowel disease, and no extra-abdominal metastasis 1.
- The Peritoneal Cancer Index (PCI) should be used to assess the extent of peritoneal disease, with a PCI score of less than 20 being a favorable prognostic factor for CRS and HIPEC.
From the Research
Treatment Plan for Peritoneal Cancer
The treatment plan for peritoneal cancer typically involves a combination of surgical and chemotherapeutic approaches.
- Complete cytoreductive surgery (CRS) is often performed to remove all visible tumor tissue 2, 3, 4, 5, 6.
- Hyperthermic intraperitoneal chemotherapy (HIPEC) is a type of intraperitoneal chemotherapy that involves heating the chemotherapy drugs to a high temperature before administering them directly into the abdominal cavity 2, 3, 4, 5, 6.
- Pressurized intraperitoneal aerosol chemotherapy (PIPAC) is another type of intraperitoneal chemotherapy that involves administering chemotherapy drugs in the form of an aerosol directly into the abdominal cavity 2, 3.
- Neoadjuvant intraperitoneal and systemic chemotherapy (NIPS) may be used as a neoadjuvant treatment to reduce the burden of peritoneal disease before surgery 3.
- Palliative care, including palliative intraperitoneal chemotherapy, may be used to control symptoms and improve quality of life in patients with advanced disease 2, 3.
Surgical Approaches
Surgical approaches for peritoneal cancer include:
- Complete cytoreductive surgery (CRS) to remove all visible tumor tissue 2, 3, 4, 5, 6.
- Debulking surgery to remove as much of the tumor as possible 6.
- Bowel resection may be necessary in some cases 6.
Chemotherapeutic Approaches
Chemotherapeutic approaches for peritoneal cancer include:
- Hyperthermic intraperitoneal chemotherapy (HIPEC) with mitomycin C or cisplatin 2, 3, 4, 5, 6.
- Pressurized intraperitoneal aerosol chemotherapy (PIPAC) 2, 3.
- Neoadjuvant intraperitoneal and systemic chemotherapy (NIPS) 3.
- Palliative intraperitoneal chemotherapy to control symptoms and improve quality of life in patients with advanced disease 2, 3.