Perioperative Care of Intraoperative Chemotherapy and Radiation: Limb and Peritoneal Perfusion Procedures

One limitation of systemic chemotherapy is that toxicity of a nontargeted organ restricts the amount of drug that can be administered to a patient, often to a dose lower than is necessary for killing the treated malignancy. This limitation may be overcome in diseases that are regionally confined by delivering the chemotherapy in an isolated perfusion system where systemic absorption and exposure of distant organs are minimized. These systems allow for high doses of chemotherapy to be delivered to an isolated region or organ within the patient. Not infrequently, such a high dose can be used in this fashion that it would be lethal if delivered systemically, but when sequestered in the region of the malignancy, may have a high enough dose to be tumoricidal and tolerable.