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Severe peritoneal sclerosis after repeated pressurized intraperitoneal aerosol chemotherapy with oxaliplatin (PIPAC OX): report of two cases and literature survey

Clinical & Experimental Metastasis volume 35, pages 103–108 (2018)Cite this article

Abstract

Pressurized intraperitoneal aerosol chemotherapy (PIPAC) is a new laparoscopic administration of chemotherapy for peritoneal metastasis (PM). PIPAC is repeated every 5th week, and seems to stabilize or improve quality of life, and might improve survival. So far, PIPAC has been well tolerated. With this paper, we aim to highlight a potential severe adverse reaction, as we describe the first cases of severe peritoneal sclerosis (SPS) caused by PIPAC. Patients with isolated PM were included in a prospective PIPAC protocol. Following insufflation of normothermic CO2, laparoscopy was performed at an intraabdominal pressure of 12 mmHg. After peritoneal lavage and quadrant biopsies of the PM, the patients were treated with oxaliplatin 92 mg/m2 (flowrate 0.5 ml/s, maximum pressure of 200 per square inch). Treatment related toxicity was evaluated after 2 weeks. Response was evaluated histologically by the Peritoneal Regression Grading Score (PRGS) and cytologically by analysis of the lavage fluid. In a series of 24 PIPAC patients treated with oxaliplatin, two patients developed SPS. Patient one had a mucinous adenocarcinoma of the appendix with PM, the mean PRGS was reduced from 2.75 to 1.75 during the course of therapy. Patient two had an appendiceal goblet cell carcinoid with a dominating mucinous adenocarcinoma component with PM, the mean PRGS was reduced from 2.00 to 1.67. Repeated applications of PIPAC with oxaliplatin can lead to SPS.

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Fig. 1
Fig. 2

Abbreviations

EPS:

Encapsulating peritoneal sclerosis

IPC:

Intraperitoneal chemotherapy

PIPAC:

Pressurized intraperitoneal aerosol chemotherapy

PM:

Peritoneal metastasis

SPS:

Severe peritoneal sclerosis

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Author information

Affiliations

  1. Upper GI and HPB Section, Department of Surgery, Odense University Hospital, J.B. Winsloews Vej 4, Indgang 20, Penthouse 2., 5000, Odense C, Denmark

    M. Graversen, L. Lundell & M. B. Mortensen

  2. Odense PIPAC Center (OPC), Odense University Hospital, Odense, Denmark

    M. Graversen, S. Detlefsen, P. Pfeiffer & M. B. Mortensen

  3. Department of Pathology, Odense University Hospital, Odense, Denmark

    S. Detlefsen

  4. Department of Oncology, Odense University Hospital, Odense, Denmark

    P. Pfeiffer

  5. Division of Surgery, CLINTEC, Karolinska Institutet, Stockholm, Sweden

    L. Lundell

Authors
  1. M. Graversen
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  2. S. Detlefsen
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  3. P. Pfeiffer
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  4. L. Lundell
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  5. M. B. Mortensen
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Corresponding author

Correspondence to M. Graversen.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study complies with the Helsinki Declaration and was approved by The Regional Committees on Health Research Ethics for Southern Denmark (Project-ID: S-20140211, http://www.clinicaltrials.gov Identifier NCT02320448), and all participants gave oral and written informed consent.

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Graversen, M., Detlefsen, S., Pfeiffer, P. et al. Severe peritoneal sclerosis after repeated pressurized intraperitoneal aerosol chemotherapy with oxaliplatin (PIPAC OX): report of two cases and literature survey. Clin Exp Metastasis 35, 103–108 (2018). https://doi.org/10.1007/s10585-018-9895-9

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  • DOI: https://doi.org/10.1007/s10585-018-9895-9

Keywords

  • PIPAC
  • Peritoneal metastasis
  • Complications
  • Peritoneal sclerosis
  • Encapsulated peritoneal sclerosis
  • Intraperitoneal chemotherapy