Thermal Therapies in The Multidisciplinary Management of Peritoneal Metastases

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Background: Peritoneal metastases arise from biologically distinct tumors and require treatment to be matched to disease distribution. Radiofrequency ablation, microwave ablation, and high-intensity focused ultrasound are focal procedures, whereas cytoreductive surgery with hyperthermic intraperitoneal chemotherapy is directed at the peritoneal cavity. Methods: PubMed/MEDLINE was searched from inception to 10 July 2026. Randomized trials, prospective studies, major cohorts, technical consensus documents, and disease-specific guidance were prioritized. Evidence from non-peritoneal abdominal tumors was included only to define the established role and limitations of focal ablation. Results: Focal ablation may be useful for a targetable visceral metastasis, isolated implant, oligoprogression, or symptom palliation in a patient who also has peritoneal disease; it is not intended to control diffuse peritoneal spread. Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy remains the principal cavity-directed thermal strategy, but its value is tumor- and protocol-specific. Thirty-minute oxaliplatin hyperthermic intraperitoneal chemotherapy did not improve survival after complete cytoreduction in colorectal peritoneal metastases. Randomized gastric-cancer studies, including PERISCOPE II, do not support routine gastrectomy plus cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. The strongest randomized evidence supports cisplatin hyperthermic intraperitoneal chemotherapy during interval cytoreductive surgery for selected stage III epithelial ovarian cancer. Practice in pseudomyxoma peritonei and diffuse malignant peritoneal mesothelioma relies mainly on specialized-center data and consensus. Conclusions: Thermal modalities should be judged against the clinical task they are designed to perform. Focal ablation is a selective local-control tool; cytoreductive surgery with hyperthermic intraperitoneal chemotherapy is a configurable locoregional platform whose benefit depends on primary tumor, burden, completeness of cytoreduction, regimen, and center expertise. Abbreviations: CRS, cytoreductive surgery; DMPM, diffuse malignant peritoneal mesothelioma; HIFU, high-intensity focused ultrasound; HIPEC, hyperthermic intraperitoneal chemotherapy; MDT, multidisciplinary team; MWA, microwave ablation; OS, overall survival; PCI, Peritoneal Cancer Index; PFS, progression-free survival; PM, peritoneal metastases; PMP, pseudomyxoma peritonei; RFA, radiofrequency ablation.

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