Peritoneal surface malignancies (PSM) are cancers that originate from the lining of the abdominal cavity, also known as the peritoneum. These cancers can include colorectal, ovarian, gastric, and other types of cancer, and they can be challenging to treat. One treatment option for PSM is cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC), but there are also alternative treatments available.
Systemic Chemotherapy
Systemic chemotherapy is a treatment that involves the use of drugs that are delivered through the bloodstream to kill cancer cells. This type of chemotherapy is often used as a first-line treatment for many types of cancer, including PSM. In some cases, systemic chemotherapy may be used in combination with other treatments, such as surgery or radiation therapy.
While systemic chemotherapy can be effective in treating PSM, it has some limitations. The drugs used in systemic chemotherapy can cause side effects such as nausea, vomiting, fatigue, and hair loss. Additionally, systemic chemotherapy may not be able to penetrate the peritoneal cavity at a high enough concentration to effectively kill cancer cells.
Intraperitoneal Chemotherapy
Intraperitoneal chemotherapy is a type of chemotherapy that is delivered directly into the peritoneal cavity. This type of chemotherapy can be delivered through a catheter that is inserted into the abdomen or through a surgically implanted port. Intraperitoneal chemotherapy can be used alone or in combination with other treatments, such as surgery.
One advantage of intraperitoneal chemotherapy is that it can deliver high concentrations of chemotherapy drugs directly to the cancer cells in the peritoneal cavity. This can increase the effectiveness of the chemotherapy and reduce the risk of side effects that are associated with systemic chemotherapy. However, intraperitoneal chemotherapy can also have side effects, such as abdominal pain and infection.
Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC)
Pressurized intraperitoneal aerosol chemotherapy (PIPAC) is a relatively new treatment option for PSM. PIPAC involves the use of a laparoscope to create a small hole in the abdomen, through which a nebulizer is inserted. The nebulizer delivers a mist of chemotherapy drugs into the peritoneal cavity under pressure.
One advantage of PIPAC is that it can deliver chemotherapy drugs directly to the cancer cells in the peritoneal cavity without the need for extensive surgery. PIPAC is also associated with fewer side effects than other forms of chemotherapy. However, PIPAC is still a relatively new treatment, and more research is needed to determine its long-term effectiveness.
Immunotherapy
Immunotherapy is a type of cancer treatment that works by boosting the body’s immune system to fight cancer cells. There are several different types of immunotherapy, including monoclonal antibodies, checkpoint inhibitors, and cancer vaccines.
Immunotherapy has shown promise in treating a variety of different types of cancer, including PSM. In fact, some studies have shown that immunotherapy may be more effective in treating PSM than traditional chemotherapy. However, not all patients are candidates for immunotherapy, and more research is needed to determine which patients are most likely to benefit from this treatment.
Radiation Therapy
Radiation therapy is a type of cancer treatment that uses high-energy radiation to kill cancer cells. This type of therapy can be delivered externally or internally. External radiation therapy involves the use of a machine that delivers radiation to the cancer cells from outside the body, while internal radiation therapy involves the use of a radioactive implant that is placed directly into the peritoneal cavity.
Radiation therapy can be effective in treating PSM, but it does have some limitations. For example, radiation therapy can damage healthy cells as well as cancer cells, leading to side effects such as fatigue, nausea, and skin irritation. Additionally, radiation therapy may not be able to penetrate the peritoneal cavity at a high enough concentration to effectively kill cancer cells.
In conclusion, there are several alternative treatments available for peritoneal surface malignancies besides CRS/HIPEC. These treatments include systemic chemotherapy, intraperitoneal chemotherapy, pressurized intraperitoneal aerosol chemotherapy (PIPAC), immunotherapy, and radiation therapy. The choice of treatment will depend on several factors, including the type and stage of cancer, as well as the patient’s overall health and preferences. Patients should work with their healthcare providers to determine the best treatment plan for their individual needs.
