Chemotherapy for Peritoneal Mets
Your medical oncologist is usually the quarterback of your treatment team. He/she will treat your cancer systemically with the appropriate chemotherapy for your specific cancer. If cancer spreads to the peritoneum, you will likely continue with a systemic chemotherapy regimen. Cancer that has spread to the peritoneum is called peritoneal metastases (PM).
Chemotherapy is the main method of treatment for peritoneal mets, Chemotherapy drugs are spread throughout the body and can kill cancer cells in the peritoneum, though not highly effective. As chemotherapy protocols improve, patient survival and drug side effects decrease and treatment regimens directly targeting the peritoneum are now used.
Intraperitoneal Chemotherapy for Peritoneal Mets
Intraperitoneal (IP) chemotherapy is a way to put some of your chemotherapy into your abdomen (also called the peritoneal cavity) rather than into a vein. By putting the chemotherapy into your abdomen, the drugs can treat cancer cells directly. The drugs are also absorbed from the tissues of the abdomen into your blood. This way the drugs also reach cancer cells that may have spread to other parts of the body. IP chemotherapy affects any cancer cells in your abdomen at a higher concentration and works on them for a longer time than chemotherapy given by vein.
Prior to IP chemotherapy being administered, a port must be placed to allow the medicine to be infused into the abdominal cavity. The port is placed in the abdomen during a surgical procedure, either in the operating room during surgery to debulk a tumor, or by an interventional radiology team if no surgery is being done or there are complications during surgery. The port is placed underneath the skin and then sutured to the ribs. You can feel the port under the skin. There is a tube that extends from the port, into the peritoneal cavity. Typically a port can be used just 24 hours after it is placed, as long as there are no complications and the port is functioning prop
Two main types of IPC have been used in the United States:hyperthermic intraperitoneal chemotherapy (HIPEC) and early post-operative intraperitoneal chemotherapy (EPIC). Both are delivered directly into the abdomen to treat cancer where it is most likely to recur. HIPEC treatment consists of heated delivery of mitomycin into the abdomen through a catheter for 100 minutes after tumor removal surgery is completed. EPIC treatment involves delivery of floxuridine and leucovorin through an abdominal catheter for three days post-operatively, while the patient recovers in the hospital.
Non-randomized comparisons of patients undergoing HIPEC and EPIC have shown similar survival rates.
Pressurized intraperitoneal aerosol chemotherapy,
Pressurized intraperitoneal aerosol chemotherapy, or PIPAC, is a new treatment technique that gives chemotherapy in the form of a pressurized aerosol, or spray.
PIPAC is safe, and most people handle it well. It has fewer side effects than regular chemotherapy. Complications are rare. So far, results look promising.
PIPAC is new, so doctors are still learning who it may work best for. It’s most often used for end-stage peritoneal carcinomatosis, or cancer in the thin layer of tissue that lines your abdomen (belly) and covers most of the organs in it. You usually get it when cancer in your digestive system or female reproductive organs spreads.
It may be an option if you have stomach cancer ; platinum-resistant, recurrent ovarian cancer (a type that comes back 6 months after treatment with platinum-based chemotherapy); or colorectal cancer, and surgery isn’t an option for you.
It may also help if tumors in your stomach, pancreas, liver, or appendiceal cancer spreads to your abdomen.
Targeted therapy is the use of personalized drugs that target tumor cells. With their help, it is possible to find and destroy cancer cells in the bone tissue.
Immunotherapy for Metastatic Cancer
It is one of the newer cancer treatments. New immuno-oncology treatments are being actively tested to evaluate their safety and effectiveness in patients with metastatic cancer. This is the most promising way to save people with bone metastases so far.
Your medical oncologist should meet with your complete treatment team to see if other treatment options are available and if one might be right for you.