Thermic homogeneity and standardization of intraperitoneal chemohyperthermia for peritoneal carcinomatosis

Background: Numerous approaches, proposed for the technical realisation of intraperitoneal chemohyperthermia (IPCH) to treat peritoneal carcinomatosis, reflect the difficulties encountered in attempts to obtain a reproducible and standardized procedure. One of the main difficulties is achieving uniform hyperthermia. This phase I study reports three technical procedures which were successively tested to treat twenty one patients with macroscopic peritoneal carcinomatosis during the last three years. Methods and results: Temperature homogeneity was assessed with six thermic probes placed at different points inside the abdominal cavity. The first procedure (n=5) was performed with the entire closure of the abdominal wound, a closed circuit with one pump and one heat exchanger and Y connections between drains but was discontinued due to considerable temperature inhomogeneity. The second procedure (n=7) was performed without closure of the: abdominal cavity, using a peritoneal cavity expander. It permitted a perfect thermic homogeneity, but was abandoned because volumetric standardization was unattainable: and because parietal wound recurrences occurred. The third procedure (n=9) was performed with closure of the skin alone and suppression of the Y connection between the drains (two pumps and two heat exchangers were required). Relatively good thermic homogeneity was obtainable (abdominal temperatures were between 42°and 44°C), and drug concentration and the infusate volume calculated according to the body surface area could be standardized. Conclusion: Standardized and reproducible IPCH was possible and thermic homogeneity was satisfactory with the third procedure. The standardization of this complex treatment technique is the only way to draw reliable therapeutic conclusions from a clinical study and to export the method.