Article information
Abstract
Peritoneal carcinomatosis, without special treatment, is a fatal sign of gastrointestinal and gynaecological malignancy. Cytoreductive surgery to remove gross disease is combined with perioperative intraperitoneal and intravenous chemotherapy to eradicate the residual microscopic disease. Knowledge of the effect of the peritoneal barrier on the pharmacokinetics of the chemotherapy agents, and the factors that affect this, enables a good combination of drugs, dosage and solution volume to be selected, in order to predict peritoneal and systemic exposure to the treatment and its toxicity. Timing of the chemotherapy as a planned part of the surgical procedure to maximise exposure of all peritoneal surfaces is crucial to success. In this article we update the pharmacokinetic basis for perioperative chemotherapy treatment of peritoneal carcinomatosis of gastrointestinal or gynaecological origin.
Keywords:
Intraperitoneal chemotherapy
Peritoneal-plasma barrier
Appendiceal cancer
Colorectal cancer
Peritoneal mesothelioma
Ovarian cancer
Resumen
En los tumores digestivos y ginecológicos, la carcinomatosis peritoneal, sin tratamientos especiales, es una manifestación fatal de estas enfermedades. La cirugía citorreductora, que extirpa la enfermedad microscópica, se combina con quimioterapia perioperatoria intraperitoneal e intravenosa para eliminar la enfermedad microscópica residual. Entender bien el efecto de la membrana peritoneal en la farmacocinética de los quimioterápicos y los factores que la modifican permite elegir la combinación de fármacos, calcular su dosis y el volumen de disolución, lo que facilita predecir la exposición peritoneal y sistémica al tratamiento y su toxicidad. Coordinar la quimioterapia como una parte programada del tratamiento quirúrgico para obtener la máxima exposición en toda la superficie peritoneal es crucial para el éxito del tratamiento. En este artículo actualizamos las bases farmacocinéticas de la quimioterapia perioperatoria de la carcinomatosis peritoneal.
Palabras clave:
Quimioterapia intraperitoneal
Barrera peritoneoplasmática
Cáncer de apéndice
Cáncer colorrectal
Mesotelioma peritoneal
Cáncer de ovario
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