ASO Author Reflections: Standardizing HIPEC Methodology and Regimens: a Prelude to the PSOGI Expert Consensus

Excerpt

Hyperthermic intraperitoneal chemotherapy (HIPEC) was developed in combination with cytoreductive surgery (CRS) for the treatment of peritoneal metastases (PMs) from different primary tumors in an era when hyperthermia was being used extensively in the treatment of different malignancies. Systemic chemotherapy (SC) produced dismal results for most tumors. The understanding of the biology of PMs has grown, along with the experience with HIPEC, which has moved rapidly from the bench to the bedside.1 The initial decades were spent in developing centers of expertise to reduce the proportion of incomplete resections and the morbidity and mortality from the procedure. Due to gaps in the preclinical data and clinical experience, parameters for evaluating efficacy were poorly defined and efficacy was evaluated for the combination of CRS and HIPEC. During this period, surgeons developed a multitude of HIPEC regimens using different drug combinations with multiple variations in the methodology and elements vital to the procedure.2 Some recent randomized trials have not shown a benefit of HIPEC over CRS alone and the question has been raised as to whether a different regimen would produce a favorable outcome. …