Surgical treatment of peritoneal carcinomatosis with reduction surgery and perioperative chemotherapy
Tuesday, August 5th, 2008.
La Revue du Praticien. 2008 May 15;58(9):940-3. [Link]
Zinzindohoué F, Glehen O, Ferraz JM, Gilly F, Cuqnenc PH.
Service de chirurgie digestive, générale et oncologique, Hôpital Européen Georges-Pompidou, 75908 Paris. franck.zinzindohoue@egp.aphp.fr
Abstract
So far, peritoneal carcinomatosis had been considered as the last progression stage of intra-abdominal cancers, and thus without any therapeutic recourse. During the last ten years, the association of tumour surgical resection and perioperative intraperitoneal chemotherapy (with or without hyperthermia) has proven to produce long term survival and even cure. This aggressive therapeutic strategy is associated with mortality and morbidity, which add to the mortality and morbidity of surgery and chemotherapy. It thus requires a careful patient selection conducted by specialized multidisciplinary teams. The main indications are peritoneal carcinomatosis on colorectal cancer, stomach cancer, ovarian cancer, pseudomyxoma and mesothelioma. The treatment can also be initiated secondarily, if carcinomatosis is detected during a procedure performed in a center where this type of treatment is not provided. An organ resection should thus be performed. The patient is then referred to a specialized center, either within the ten days following the procedure, or after three months, most of the time after an adjuvant therapy.
Glossary
- adjuvant therapy
- (add-joo-vunt) treatment used in addition to the main treatment. It usually refers to hormonal therapy, chemotherapy, or radiation added after surgery to increase the chances of curing the disease or keeping it in check.
- therapy
- any of the measures taken to treat a disease. Unproven therapy is any therapy that has not been scientifically tested and approved. Use of an unproven therapy instead of standard (proven) therapy is called alternative therapy. Some alternative therapies have dangerous or even life-threatening side effects. For others, the main danger is that a patient may lose the opportunity to benefit from standard therapy. Complementary therapy, on the other hand, refers to therapies used in addition to standard therapy. Some complementary therapies may help relieve certain symptoms of cancer, relieve side effects of standard cancer therapy, or improve a patient's sense of well-being. The ACS recommends that patients considering use of any alternative or complementary therapy discuss this with their health care team.
- resection
- surgery to remove part or all of an organ or other structure.
- morbidity
- a measure of the new cases of a disease in a population; the number of people who have a disease.
- mortality
- a measure of the rate of death from a disease within a given population.
- chemotherapy
- (key-mo-THER-uh-pee) treatment with drugs to destroy cancer cells. Chemotherapy is often used with surgery or radiation to treat cancer when the cancer has spread, when it has come back (recurred), or when there is a strong chance that it could recur.
- cancer
- malignancy; a group of diseases typified by abnormal, generally out-of-control, cell growth.
- mesothelioma
- a tumor derived from mesothelial tissue, such as the peritoneum (lining the abdomen) or pleura (lining the lungs). More on mesothelioma.
- peritoneal
- (pair-uh-tuh-nee-al) the serous membrane that lines the cavity of the abdomen. (More on Peritoneal Mesothelioma.)
- intraperitoneal chemotherapy
- (IPC) a form of regional chemotherapy; the flooding of the abdominal cavity with chemotheraputic drugs to target the cancer cells directly. It is sometimes heated to improve absorption of the anticancer drugs by the cancerous cells and because heat itself can kill cancer cells.
