Significance and management of local recurrences and limited metastatic disease in the abdomen

INTRAPERITONEAL THERAPY OF GASTROINTESTINAL CARCINOMA Implantation of tumor cells on peritoneal surfaces from a gastrointestinal or gynecologic primary carcinoma or from soft-tissue sarcoma negatively impacts survival duration and quality of life. The most common cancers that spread to the peritoneum are shown in Table 1. For most patients with peritoneal metastases, death occurs within 1 ~ear.4~ Death usually results from complications directly related to peritoneal disease, most commonly intestinal obstruction and inaniti0n.4~ Patients with carcinomatosis may experience intestinal perforation or fistula, intra-abdominal abscess, malnutrition, bleeding, or massive as cite^.^ Symptoms include pain, nausea, anorexia, and discomfort related to ascites. These patients traditionally have not been considered for curative therapy, with treatment efforts focused primarily on palliation. Response to systemic chemotherapy is uncommon in patients with peritoneal metastases from all histologies except ovarian adenocarcinoma. Cytotoxic chemotherapy given systemically is not believed to enter the peritoneal cavity in concentrations adequate to treat macroscopic peritoneal disease. The treatment of patients with peritoneal metastases remains a formidable challenge for clinicians. Frequently, patients with peritoneal metastases have disease confined to the