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Drug therapy of cancer spreading in the peritoneum

Systemic chemotherapy has little effect on mucinous masses in the abdomen. Patients who cannot undergo cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC), or those with inoperable recurrence may still be candidates for systemic chemotherapy.

Intraoperative chemotherapy

If maximal cytoreduction (CC 0-1) is achieved, hyperthermic intraoperative intraperitoneal chemotherapy (HIPEC) may be given as direct continuation of the operation. This extends the time of surgery with three hours. By administering chemotherapy intraperitoneally, the concentration of the rinse fluid can be increased as opposed to intravenous administration. To enhance the effect of chemotherapy, the solution in the peritoneum maintained at 41,5–42.0°C.

Pseudomyxoma peritonei from appendix and carcinomatosis from colon and rectum 

  • At Oslo University Hospital, mitomycin C is currently used and is dosed based on body surface:35 mg/m², max 70 mg.
  • 50% of the dose is added to the lavage fluid when the correct intraabdominal temperature is reached, thereafter 25% after 30 minutes, and the remaining 25% after 60 minutes.
  • The perfusion is stopped after 90 minutes. The abdominal cavity is rinsed, the abdomen is closed and the patient is awakened.

Carcinomatosis from abdominal mesothelioma

  • At the Oslo University Hospital, cisplatin is used currently and is dosed based on body surface, 50 mg/m², max 100 mg and doxorubicin 15 mg/m², max 30 mg.
  • 50% of the dose is added to the perfusion circuit when the correct intraabdominal temperature is reached, thereafter 25% after 30 minutes, and the remaining 25% after 60 minutes.
  • The perfusion is stopped after 90 minutes.The abdominal cavity is rinsed, the abdomen is closed and the patient is awakened.

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