A Technically Feasible Treatment for Peritoneal Carcinomatosis

Peritoneal and pleural carcinomatosis are late complications of a primary tumour mainly developed in abdominal organs. Peritonectomy followed by hyperthermic intraperitoneal chemotherapy (HIPEC) represents a feasible and effective intervention, which however has considerable risks and cannot guarantee the cure. It appears reasonable to propose and discuss an alternative treatment based on intraperitoneal application of ozone either as a gas or dissolved in physiological solution. Light and flexible silastic catheters have been implanted into the peritoneal cavities. Two distinct protocols have been used. Protocol a) has been based on five daily successive sessions. For each session the ozone concentration was of 50 μg/ mL with a gas volume of 2000-2500 mL, hence a total ozone dose of 100-125 mg has been used. Protocol b) used at the morning the insufflations of gaseous oxygen-ozone mixture at low ozone concentrations and in the afternoon the intraperitoneal infusion of a sterile lipid emulsion in ozonated NaCl 0.9% solution (42 °C). All the four patients presenting peritoneal carcinomatosis, ascite and multiple metastasis from colon, ovary and pancreas tumors, showed a prolonged survival after treatment based on protocol a). The single case treated with protocol b), even if it is clinically irrelevant, it has been significant only for improving technical details. Ozone, not only possesses direct cytotoxic activity on peritoneal neoplastic cells, but via its messengers stimulates a number of important biological activities among which immune-stimulation as well as both activation and up-regulation of antioxidant enzymes. In comparison to chemotherapeutic drugs, ozone displays only a local oxidant activity without multi-organ toxicity. Moreover, it is an inexpensive drug and it is easy to use in precisely defined dosages. Based on these technical data, it is hoped that this paper may interest a group of oncologists for both optimizing the methodology and exploring the most effective scheme of ozone delivery.