Peritoneal carcinomatosis. Twelve years of experimental and clinical research.

Peritoneal carcinomatosis (PC) has been the main subject of researchin our department for 12 years. This metastatic disease hasbeen considered for a long time as a fatal clinical entity and as theterminal stage of the disease: patients with PC were given onlysymptomatic or palliative treatments.In 1988, we evaluated a new device: the intraperitoneal chemohyperthermia(IPCH). Techniques, biological and tissular tolerancewere evaluated experimentally on dogs.Between 1989 and 1997, 160 patients (100 digestive PC and 60ovarian PC) were included in phase II and phase III trials. The mortalityrate was 3% and the morbidity rate 15%. The overall 3-yearsurvival rate was 20% ; at 1 year no patient with stage 3 or 4 PC(malignant granulations more than 5 mm) was alive and 3-year survivalrate of patients with stage 1 or 2 PC (malignant granulationsless than 5 mm) was 40%. These survival results (interesting forstage 1 or 2, disappointing for stage 3 or 4) led us to evaluate since1998, a new therapeutic approach combining peritonectomy procedures(described by P Sugarbaker in 1995) and IPCH for the treat -ment of PC.Today, digestive PC are not systematically considered as a surgicalcontra-indication : other specialized teams in France and in Europedevelop these approaches and phase II or phase III trials have justbeen confirmed by the randomized Dutch trial of Franck Zoetmulder: as the liver and the liver metastasis 30 years ago, the peritoneumis not an inaccessible metastatic site.