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HIPEC Methodology, Comparison of Techniques, and Drug Regimens: Is There a Need for Standardization?

  • K. Van der Speeten
  • L. Lemoine
Chapter

Abstract

The introduction of cytoreductive surgery and hyperthermic intraperitoneal peroperative chemotherapy has greatly improved the prognosis of patients with peritoneal carcinomatosis in both phase II and III trials. A clear pharmacologic and clinical rationale for this treatment strategy has been demonstrated. Whereas the cytoreductive surgery has been highly standardized, reproducible, and predictable, the same cannot be said of the intraperitoneal chemotherapy modalities. A staggering variety of chemotherapy application techniques and regimens has been reported. Most of these regimens have been based on extrapolation of systemic chemotherapy data. An urgent need for more standardization of the intraperitoneal chemotherapy modalities is needed. The aim of this manuscript is to review the rationale, variables, and modalities of intraperitoneal chemotherapy. At the same time, it seeks to offer guidance on the current intraperitoneal chemotherapy regimens and potential directions toward more standardization.

Keywords

HIPEC methodology HIPEC drug regimens HIPEC protocols Bidirectional chemotherapy HIPEC EPIC NIPS BIC Pharmacology Dosimetry Peritoneal carcinomatosis 

Abbreviations

5-FU

5-Fluorouracil

AUC

  Area under the curve

BIC

Bidirectional intraoperative chemotherapy

BSA

Body surface area

CRS

Cytoreductive surgery

EPIC

Early postoperative intraperitoneal chemotherapy

HIPEC

Hyperthermic intraperitoneal peroperative chemotherapy

IP

Intraperitoneal

IV

Intravenous

MTC

Mass transfer coefficient

NIPS

Neoadjuvant intraperitoneal and systemic chemotherapy

PIPAC

Pressurized intraperitoneal aerosol chemotherapy

PM

Peritoneal metastases

SPIC

Sequenced postoperative intraperitoneal chemotherapy

Notes

Acknowledgements

Lemoine L is supported by the Agency for Innovation by Science and Technology (IWT) in Brussels, Belgium. Lemoine L is a researcher for the Limburg Clinical Research Program (LCRP) UHasselt-ZOL-Jessa, supported by the foundation Limburg Sterk Merk (LSM), Hasselt University, Ziekenhuis Oost-Limburg, and Jessa Hospital, Belgium.

Conflict of Interest Statement

No potential conflicts of interest.

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© Springer Nature Singapore Pte Ltd. 2018

Authors and Affiliations

  1. 1.Department of Surgical OncologyZiekenhuis Oost-LimburgGenkBelgium
  2. 2.Department of Biochemistry, Faculty of MedicineUniversity HasseltDiepenbeekBelgium
  3. 3.Washington Cancer Institute, Washington Hospital CenterWashington, DCUSA

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