Peritoneal carcinomatosis dominates the clinical picture of many patients with gastrointestinal, gynecological and urological cancers. For many of them its dev­ astating effects contribute directly to their death. Most clinicians consider peritoneal carcinomatosis an incurable metastatic disease and give palliative treatment, re­ stricted to limited surgery and systemic chemotherapy. Contrary to this view, Paul Sugarbaker and his collegues base their approach on the concept that peritoneal carcinomatosis represents regional tumor spread, similar in its impact on treatment and prognosis to that of lymph node metastases in other malignancies. This concept emphasises the value of regional tumor control, as a potentially curative measure. In this book the combination of aggressive cytoreduction and intraperitoneal chemotherapy to control peritoneal carcinomatosis is extensively explored. Basic to this approach is the observation that most cancer cells show only relative resistence against commonly available drugs, which can be overcome by a sufficient increase of drug concentrations in tumor tissue. After intraperitoneal delivery, drugs will reach high tissue concentrations in the superficial few cell layers, while plasma concentrations will remain below toxic levels. Patients with only limited residual tumor at the peritoneal surface after cytoreduction may therefore benefit from intraperitoneal chemotherapy.

Inhalt

Foreword; A. Cohen. Preface; P.H. Sugarbaker. Section I: Pharmacology. 1. Intraperitoneal taxol; M. Markman. 2. Early postoperative intraperitoneal adriamycin as an adjuvant treatment for visceral and retroperitoneal sarcoma; P.H. Sugarbaker. 3. Intraoperative hyperthermic lavage with cisplatin for peritoneal carcinomatosis and sarcomatosis; A. Stephens, et al. 4. Intraperitoneal regional chemotherapy with mitoxantrone; K. Link, et al. 5. Treatment of peritoneal carcinomatosis by continuous hyperthermic peritoneal perfusion with cisplatin; H.R. Alexander, D.L. Fraker. 6. Surgically directed chemotherapy: heated intraperitoneal lavage with mitomycin C; V. Fernandez-Trigo, et al. Section II: Disease states. 7. Pathobiology of peritoneal carcinomatosis from ovarian malignancy; T.A. Sugarbaker, et al. 8. Complete parietal and visceral peritonectomy of the pelvis for advanced primary and recurrent rectosigmoid cancer; P.H. Sugarbaker. 9. Prognostic features for peritoneal carcinomatosis in colorectal and appendiceal cancer patients when treated by cytoreductive surgery and intraperitoneal chemotherapy; P.H. Sugarbaker. 10. Pseudomyxoma peritonei; P.H. Sugarbaker. 11. Clinical determinants of treatment failures after cytoreductive surgery and intraperitoneal chemotherapy in patients with pseudomyxoma peritonei; V. Fernandez-Trigo, et al. 12. Recurrent intraabdominal cancer causing intestinal obstruction: Washington Hospital Center experience with 42 patients managed by surgery and intraperitoneal chemotherapy; A.M. Averbach, P.H. Sugarbaker. 13. Peritoneal carcinomatosis: Natural history and rational therapeutic interventions using intraperitoneal chemotherapy; P.H. Sugarbaker. 14. Survival time and prevention of side effects of intraperitoneal hyperthermic perfusion with mitomycin c combined with surgery for patients with advanced gastric cancer; S. Fujimoto, et al. 15. Intraperitoneal 5-fluoracil and mitomycin c as an adjuvant to resectable gastric cancer: a status report; W. Yu. 16. Mechanism and treatment of peritoneal carcinomatosis: Intraperitoneal chemotherapy with mitomycin c bound to carbon particles; T. Takahashi, et al. 17. Peritoneal mesothelioma: treatment approach based on natural history; A.M. Averbach, P.H. Sugarbaker. Pathology of peritoneal mesothelioma; M.E. Kass. Rationale for intraperitoneal chemotherapy in the treatment of adenocarcinoma of the pancreas; S.E. Ettinghausen. Heated intraperitoneal mitomycin c infusion treatment for patients with gastric cancer and peritoneal metastasis; S. Fujimoto, et al. Peritoneal carcinomatosis from adenocarcinoma of the colon; M.E.T. Schellinx, et al.