Health Problem: Cancer within the abdominal cavity sometimes occurs as sarcoma (cancer affecting mesodermal tissue, e.g., connective tissue). Sarcomas within the abdominal cavity might be secondary tumors that have spread from the site of origin or they might represent primary tumor in the form of retroperitoneal sarcoma. Abdominal sarcomas are rare and have a very poor prognosis. Peritoneal carcinomatosis (i.e., sarcomatosis) occurs when sarcomas spread to the peritoneal surface. In the United States, approximately 12,750 new soft tissue sarcomas are diagnosed annually and of these cases, approximately 36% arise in the abdominal viscera or the retroperitoneum.
Technology Description: Hyperthermic intraperitoneal chemotherapy (HIPC) is used as an adjunct to surgery for the treatment of sarcomas with peritoneal involvement. HIPC occurs immediately following optimal cytoreductive surgery (CRS). During HIPC, chemotherapeutic drugs are introduced directly into the peritoneal space to eliminate microscopic tumors on the peritoneal lining and outer surfaces of affected organs and to kill tumor cells that have disseminated throughout the cavity. Heating enhances the cytotoxic effect of the drugs.
Controversy: Cytoreductive surgery plus HIPC is associated with substantial perioperative morbidity. Definitive patient selection criteria are needed to identify patients that are most likely to benefit from this procedure.
Key Questions:
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Is CRS plus HIPC effective for improving outcomes in patients with sarcoma and peritoneal involvement?
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What harms are associated with CRS plus HIPC?
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Have definitive patient selection criteria been established for CRS plus HIPC for sarcoma with peritoneal involvement?
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