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Peritoneal carcinosis and hyperthermia

stetoscopioCarcinomatosis of the peritoneum (peritoneal carcinomatosis) is a very frightening occurrence on the path of a patient suffering from cancer.

The peritoneum is a serous membrane that covers and contains the abdominal viscera, keeping them anchored to the abdomen wall.

It can be invaded by tumor cells and significant problems may stem from the spread of neoplastic disease in this area. Moreover, the lack of vascularization that is to say a low presence of blood vessels in the tissue, makes sure that chemotherapic drugs cannot properly reach their target.

Another important prognostic factor is the localization of the organ where the tumor originated and hence its sensitivity to treatment. In fact, we must never forget that the metastatic cells will always have the same cellular tissue type of the organ where the tumor originated, even if the metastasis is located in a completely different area of the body.

How can capacitive hyperthermia (external hyperthermia) be useful? Hyperthermia may enhance the local effect of cytotoxic drugs (chemotherapy) improving their diffusion through the vasodilation that is locally caused by the heat.

Hyperthermia can be used in all solid tumors including those within the peritoneal cavity. The only instance where hyperthermia can't be used while treating tumors in this area, is the presence of a major effusion of ascitic fluid (often the patient says he has "water in the belly").

Why can't hyperthermia be used if there is such an effusion? Simply because the excessive heating of the water can damage healthy tissue and also because the heat is dispersed in a large volume of liquids which brings to an imbalance in the heat distribution.

Hyperthermia also causes a local activation of the immune response. Even subjects in conditions of precarious balance can benefit from capacitive hyperthermia (i.e. with external probes that emit radio frequency), because it is a non-invasive procedure that does not even need the use of a needle.

Hyperthermia only? In selected cases we can also proceed with hyperthermia alone, although more effective results can be reached by the combination of chemotherapy and hyperthermia, from the same perspective of a multimodal approach to the treatment of tumors, which I will always continue to endorse.

Dr. Carlo Pastore