Intraperitoneal (IP) chemotherapy

Intraperitoneal cisplatin and paclitaxel after optimal debulking improved survival in ovarian cancer in GOG-172 (2006) but toxicity and catheter problems limited uptake, and GOG-252 (with bevacizumab) showed no advantage, so HIPEC given once at surgery has largely replaced repeated IP cycles. In gastric cancer with peritoneal metastases, intraperitoneal paclitaxel with systemic chemotherapy (PHOENIX-GC, Japanese phase 3) showed borderline benefit and is used in Japan; PIPAC is the laparoscopic aerosol version. Regional chemotherapy in general (hepatic arterial infusion, isolated limb perfusion, intravesical, intrathecal) shares the same rationale of concentrating dose where the cancer is.