Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for breast cancer-related peritoneal carcinomatosis: rationale, evidence, and future directions

Peritoneal carcinomatosis (PC) from breast cancer is a rare but clinically significant manifestation of stage IV disease, most commonly associated with invasive lobular carcinoma and specific molecular subtypes. Systemic chemotherapy has limited efficacy in this setting due to poor peritoneal drug penetration and the physiological peritoneal-plasma barrier. Cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) has emerged as a promising locoregional strategy, delivering heated chemotherapy directly into the peritoneal cavity following maximal cytoreduction. While evidence from retrospective series suggests meaningful survival benefit in selected patients — with overall survival reaching 49 months in some cohorts — no prospective randomized data specific to breast cancer currently exist. This review evaluates the biological rationale, available clinical evidence, prognostic factors including the peritoneal cancer index and completeness of cytoreduction score, procedural risks, and future directions for CRS-HIPEC in breast cancer-related PC. The potential role of emerging systemic agents, precision medicine tools, and minimally invasive intraperitoneal strategies is also discussed.