Chapter category: Oncology
Cytoreduction, Peritonectomy and Hyperthermic Antiblastic Peritoneal Perfusion for the Treatment of Peritoneal Carcinomatosis
Hyperthermia in Cancer Treatment:
A Primer
Edited by: Gian Franco Baronzio and Erich Dieter HagerISBN: 0-387-33440-8
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Chapter authors:
Michele De Simone* and Marco Vaira
Peritoneal carcinomatosis may present as synchronous disease or like evolution of gastrointestinal or female genital tumors (including pseudomyxoma peritonei, a variable malignancy myxoid tumor, arising from the appendix). It is also the common way of presentation of primitive peritoneal tumors (like peritoneal mesothelioma). Peritoneal carcinomatosis has been considered nearly impossible to treat with surgery till few years ago. Moreover, the results obtained with systemic chemotherapy were poor. In the ‘80s, some authors developed and improved a new combined technique to manage peritoneal carcinomatosis, consisting in cytoreduction of neoplastic lesions, peritonectomy (removal of peritoneum macroscopically affected from tumor) and hyperthermic antiblastic peritoneal perfusion (H.A.P.P.). Carcinomatosis nodes usually affects peritoneum in preferential sites as the pelvis, the ileum-caecal angle, the right diaphragm and retrohaepatic space, the lesser omentum, the left diaphragm and paracolic spaces. In fact, in these regions the peristalsis is less effective, there are the points of peritoneal fluid absorbtion and, finally, these areas are particularly anfractuous, with virtual spaces, so the circulation of fluids is slow and neoplastic cells may easily lodge. At least, cells may deposit under action of the force of gravity. For these reasons, peritonectomy is particularly indicated in these regions. The rationale of combining hyperthermia and chemotherapy has been described in previous chapters. The peritoneal cavity can be considered a “pharmacological sanctuary” for the presence of the peritoneal-plasmatic barrier, that is independent from mesothelial layer, and preserves the leakage to systemic circulation of high molecular weight drugs as Cisplatinum, C-Mytomicin, Doxorubicin, Oxaliplatinum. So it’s possible the use of an high concentration of cytostatic drugs into the tumor area, with mild side-effects. The H.A.P.P. has maximal efficacy when all the macroscopic disease has been removed with cytoreduction and peritonectomy. There is loss of efficacy on nodules bigger than 3 mm, because this is the maximal depth that the drugs can reach, even in hyperthermic condition.
Additional chapters from this book:
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Cytoreduction, Peritonectomy and Hyperthermic Antiblastic Peritoneal Perfusion for the Treatment of Peritoneal Carcinomatosis
Michele De Simone* and Marco Vaira
Peritoneal carcinomatosis may present as synchronous disease or like evolution of gastrointestinal or female genital tumors (including pseudomyxoma peritonei, a variable malignancy myxoid tumor, a...
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Whole Body Hyperthermia at 43.5-44?C: Dreams or Reality?
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A high level of body temperature (43?C) is needed for effective use of whole body hyperthermia. Such high level hyperthermia can only be safely used, taking into account a theory of developing post-...
Thermo-Chemo- Radiotherapy Association: Biological Rationale, Preliminary Observations on Its Use on Malignant Brain Tumors
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Future Perspectives of Interstitial and Perfusional Hyperthermia
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A Step Deep on Hyperthermia, Hypoxia and Chemotherapy Interactions
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Heating methodologies of restricted and specific body volumes as means to treat cancer are critically examined from the physical point of view. Difficulties in the application of heating methodologi...
Hyperthermia and Radiotherapy in the Management of Prostate Cancer
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Carcinoma of the prostate has been included in the top five big killer neoplasms at today. The management of advanced disease is still a problem in oncology. Starting from the begging of eighties, h...
Hyperthermia and Angiogenesis: Results and Perspectives
Cristina Roca and Luca Primo
Hyperthermia (HT) is a promising method for cancer treatment when combined with radiotherapy or chemotherapy. The molecular mechanisms of anti-tumoral efficacy of HT are not well understood. Besides...
Thermometry: Clinical Aspects and Perspectives
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Inadequate thermal dose received by the tumor can cause failures in hyperthermic treatments. In order to compare different treatments and to correlate the treatment data with the clinical results, i...
Results of Hyperthermia Alone with Radiation Therapy and/or Chemotherapy
Pietro Gabriele and Cristina Roca
The interest in Clinical Hyperthermia (HT) was maximum in eighties and decreases during nineties of the last century but now, thank to possibility of heat deeply and to measure the temperature not i...
On the Biochemical Basis of Tumour Damage by Hyperthermia
P. Pietrangeli and B. Mondovi
Tumour cells are selectively inhibited by hyperthermia (41-42.5¡C) in the same conditions where normal cells are not damaged. At higher temperature, also normal cells are injured. In spite of the lar...
