Skip to main content

Advertisement

SpringerLink
Log in

Oncological Outcomes After Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC) in the Treatment of Peritoneal Carcinomatosis

  • Original Research
  • Published:
Journal of Gastrointestinal Cancer Aims and scope Submit manuscript

Abstract

Background

Pressurized intraperitoneal aerosol chemotherapy (PIPAC) is a new surgical technique for the treatment of initially unresectable peritoneal carcinomatosis (PC). Our objective was to assess its oncological outcomes.

Methods

Between July 2016 and September 2020, data from 100 PIPAC procedures with oxaliplatin or doxorubicin-cisplatin in 49 patients with PC (all etiologies) were analyzed. We studied the evolution of the peritoneal cancer index (PCI), the need for radical surgery (R0), and overall survival (OS).

Results

The patients’ median age was 65 (59; 71) years, and 55.1% were women. Median PIPAC procedures per patient were 2 (1–3), and 28 (57.1%) underwent more than one PIPAC procedure. Median PCI at the first PIPAC was 19 (15–22). PCI decreased for 37%, remained stable for 29.6%, and increased for 33.4% patients. Four (8.3%) underwent radical R0 surgery after PIPAC. After a median follow-up of 16.1 months (1.5–90.1), the median overall survival from PC diagnosis was 29.1 months (14.8–34.3), with a median gastric and colorectal PC survival of 11.3 (7.2–34.3) and 29.1 months (16.1–31) respectively. Overall survival after the first PIPAC session was 11.6 months (6–17.3), with median survival after gastric and colorectal PCs being 6 (2.9–15.5) and 13.3 months (5–17.6), respectively. Stratification of patients according to the number of lines of systemic chemotherapy, PIPAC procedures, and the chronology of PC onset did not result in a significant difference in survival.

Conclusion

The OS was in line with the literature. PIPAC could delay oncological progression and improve survival. These encouraging results justify the ongoing and future evaluations of PIPAC by prospective randomized trials.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Dehal A, Smith JJ, Nash GM. Cytoreductive surgery and intraperitoneal chemotherapy: an evidence-based review-past, present and future. J Gastrointest Oncol. 2016;7(1):143–57. https://doi.org/10.3978/j.issn.2078-6891.2015.112.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Franko J, Shi Q, Meyers JP, et al. Prognosis of patients with peritoneal metastatic colorectal cancer given systemic therapy: an analysis of individual patient data from prospective randomised trials from the Analysis and Research in Cancers of the Digestive System (ARCAD) database. Lancet Oncol. 2016;17(12):1709–19. https://doi.org/10.1016/S1470-2045(16)30500-9.

    Article  PubMed  Google Scholar 

  3. Bonnot PE, Piessen G, Kepenekian V, et al. Cytoreductive surgery with or without hyperthermic intraperitoneal chemotherapy for gastric cancer with peritoneal metastases (CYTO-CHIP study): a propensity score analysis. J Clin Oncol. 2019;37(23):2028–40. https://doi.org/10.1200/JCO.18.01688.

    Article  CAS  PubMed  Google Scholar 

  4. van Driel WJ, Koole SN, Sikorska K, et al. Hyperthermic intraperitoneal chemotherapy in ovarian cancer. N Engl J Med. 2018;378(3):230–40. https://doi.org/10.1056/NEJMoa1708618.

    Article  PubMed  Google Scholar 

  5. Solaß W, Hetzel A, Nadiradze G, Sagynaliev E, Reymond MA. Description of a novel approach for intraperitoneal drug delivery and the related device. Surg Endosc. 2012;26(7):1849–55. https://doi.org/10.1007/s00464-012-2148-0.

    Article  PubMed  Google Scholar 

  6. Khomyakov V, Ryabov A, Ivanov A, et al. Bidirectional chemotherapy in gastric cancer with peritoneal metastasis combining intravenous XELOX with intraperitoneal chemotherapy with low-dose cisplatin and Doxorubicin administered as a pressurized aerosol: an open-label, Phase-2 study (PIPAC-GA2). Pleura Peritoneum. 2016;1(3):159–66. https://doi.org/10.1515/pp-2016-0017.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Nadiradze G, Giger-Pabst U, Zieren J, Strumberg D, Solass W, Reymond MA. Pressurized intraperitoneal aerosol chemotherapy (PIPAC) with low-dose cisplatin and doxorubicin in gastric peritoneal metastasis. J Gastrointest Surg. 2016;20(2):367–73. https://doi.org/10.1007/s11605-015-2995-9.

    Article  PubMed  Google Scholar 

  8. Tempfer CB, Celik I, Solass W, et al. Activity of pressurized intraperitoneal aerosol chemotherapy (PIPAC) with cisplatin and doxorubicin in women with recurrent, platinum-resistant ovarian cancer: preliminary clinical experience. Gynecol Oncol. 2014;132(2):307–11. https://doi.org/10.1016/j.ygyno.2013.11.022.

    Article  CAS  PubMed  Google Scholar 

  9. Tempfer CB, Winnekendonk G, Solass W, et al. Pressurized intraperitoneal aerosol chemotherapy in women with recurrent ovarian cancer: a phase 2 study. Gynecol Oncol. 2015;137(2):223–8. https://doi.org/10.1016/j.ygyno.2015.02.009.

    Article  CAS  PubMed  Google Scholar 

  10. Demtröder C, Solass W, Zieren J, Strumberg D, Giger-Pabst U, Reymond MA. Pressurized intraperitoneal aerosol chemotherapy with oxaliplatin in colorectal peritoneal metastasis. Colorectal Dis. 2016;18(4):364–71. https://doi.org/10.1111/codi.13130.

    Article  PubMed  Google Scholar 

  11. Graversen M, Detlefsen S, Bjerregaard JK, Pfeiffer P, Mortensen MB. Peritoneal metastasis from pancreatic cancer treated with pressurized intraperitoneal aerosol chemotherapy (PIPAC). Clin Exp Metastasis. 2017;34(5):309–14. https://doi.org/10.1007/s10585-017-9849-7.

    Article  CAS  PubMed  Google Scholar 

  12. Khosrawipour T, Khosrawipour V, Giger-Pabst U. Pressurized intra peritoneal aerosol chemotherapy in patients suffering from peritoneal carcinomatosis of pancreatic adenocarcinoma. PLoS ONE. 2017;12(10): e0186709. https://doi.org/10.1371/journal.pone.0186709.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Falkenstein TA, Götze TO, Ouaissi M, Tempfer CB, Giger-Pabst U, Demtröder C. First clinical data of pressurized intraperitoneal aerosol chemotherapy (PIPAC) as salvage therapy for peritoneal metastatic biliary tract cancer. Anticancer Res. 2018;38(1):373–8. https://doi.org/10.21873/anticanres.12232.

    Article  CAS  PubMed  Google Scholar 

  14. Tidadini F, Abba J, Quesada JL, et al. Effect of pressurized intraperitoneal aerosol chemotherapy on the survival rate of patients with peritoneal carcinomatosis of gastric origin. J Gastrointest Canc. 2021. https://doi.org/10.1007/s12029-021-00698-8.

    Article  Google Scholar 

  15. Alyami M, Bonnot PE, Mercier F, et al. Pressurized intraperitoneal aerosol chemotherapy (PIPAC) for unresectable peritoneal metastasis from gastric cancer. Eur J Surg Oncol. 2021;47(1):123–7. https://doi.org/10.1016/j.ejso.2020.05.021.

    Article  PubMed  Google Scholar 

  16. Alyami M, Hübner M, Grass F, et al. Pressurised intraperitoneal aerosol chemotherapy: rationale, evidence, and potential indications. Lancet Oncol. 2019;20(7):e368–77. https://doi.org/10.1016/S1470-2045(19)30318-3.

    Article  PubMed  Google Scholar 

  17. Jacquet P, Sugarbaker PH. Clinical research methodologies in diagnosis and staging of patients with peritoneal carcinomatosis. Cancer Treat Res. 1996;82:359–74. https://doi.org/10.1007/978-1-4613-1247-5_23.

    Article  CAS  PubMed  Google Scholar 

  18. Alyami M, Sgarbura O, Khomyakov V, et al. Standardizing training for pressurized intraperitoneal aerosol chemotherapy. Eur J Surg Oncol. 2020;46(12):2270–5. https://doi.org/10.1016/j.ejso.2020.05.007.

    Article  PubMed  Google Scholar 

  19. Solass W, Kerb R, Mürdter T, et al. Intraperitoneal chemotherapy of peritoneal carcinomatosis using pressurized aerosol as an alternative to liquid solution: first evidence for efficacy. Ann Surg Oncol. 2014;21(2):553–9. https://doi.org/10.1245/s10434-013-3213-1.

    Article  PubMed  Google Scholar 

  20. Gockel I, Jansen-Winkeln B, Haase L, et al. Pressurized intraperitoneal aerosol chemotherapy (PIPAC) in gastric cancer patients with peritoneal metastasis (PM): results of a single-center experience and register study. J Gastric Cancer. 2018;18(4):379–91. https://doi.org/10.5230/jgc.2018.18.e37.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Ellebæk SB, Graversen M, Detlefsen S, et al. Pressurized intraperitoneal aerosol chemotherapy (PIPAC)-directed treatment of peritoneal metastasis in end-stage colo-rectal cancer patients. Pleura Peritoneum. 2020;5(2):20200109. https://doi.org/10.1515/pp-2020-0109.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Thomassen I, van Gestel YR, van Ramshorst B, et al. Peritoneal carcinomatosis of gastric origin: a population-based study on incidence, survival and risk factors. Int J Cancer. 2014;134(3):622–8. https://doi.org/10.1002/ijc.28373.

    Article  CAS  PubMed  Google Scholar 

  23. Jayne DG, Fook S, Loi C, Seow-Choen F. Peritoneal carcinomatosis from colorectal cancer. Br J Surg. 2002;89(12):1545–50. https://doi.org/10.1046/j.1365-2168.2002.02274.x.

    Article  CAS  PubMed  Google Scholar 

  24. Elias D, Lefevre JH, Chevalier J, et al. Complete cytoreductive surgery plus intraperitoneal chemohyperthermia with oxaliplatin for peritoneal carcinomatosis of colorectal origin. J Clin Oncol. 2009;27(5):681–5. https://doi.org/10.1200/JCO.2008.19.7160.

    Article  PubMed  Google Scholar 

  25. Hanker LC, Loibl S, Burchardi N, et al. The impact of second to sixth line therapy on survival of relapsed ovarian cancer after primary taxane/platinum-based therapy. Ann Oncol. 2012;23(10):2605–12.

    Article  CAS  PubMed  Google Scholar 

  26. Eveno C, Jouvin I, Pocard M. PIPAC EstoK 01: pressurized intraperitoneal aerosol chemotherapy with cisplatin and doxorubicin (PIPAC C/D) in gastric peritoneal metastasis: a randomized and multicenter phase II study. Pleura Peritoneum. 2018;3(2):20180116. https://doi.org/10.1515/pp-2018-0116.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Oliver Goetze T, Al-Batran SE, Pabst U, et al. Pressurized intraperitoneal aerosol chemotherapy (PIPAC) in combination with standard of care chemotherapy in primarily untreated chemo naïve upper gi-adenocarcinomas with peritoneal seeding - a phase II/III trial of the AIO/CAOGI/ACO. Pleura Peritoneum. 2018;3(2):20180113. https://doi.org/10.1515/pp-2018-0113.

    Article  PubMed  PubMed Central  Google Scholar 

  28. History of Changes for Study: NCT04811703. https://www.clinicaltrials.gov/ct2/history/NCT04811703?V_1=View. Accessed 10 May 2022.

Download references

Author information

Authors and Affiliations

  1. Department of Digestive and Emergency Surgery, Grenoble Alpes University Hospital, CS 10232, 38043, 38043, CEDEX 09, Grenoble, France

    Fatah Tidadini, Julio Abba, Bertrand Trilling, Aline Bonne, Alison Foote, Jean-Luc Faucheron & Catherine Arvieux

  2. Lyon Center for Innovation in Cancer, EA 3738, Lyon 1 University, Lyon, France

    Fatah Tidadini & Catherine Arvieux

  3. Clinical Pharmacology Unit, INSERM CIC1406, Grenoble Alpes University Hospital, Grenoble, France

    Jean-Louis Quesada

  4. UMR 5525, CNRS, TIMC-IMAG, University Grenoble Alps, Grenoble, France

    Bertrand Trilling & Jean-Luc Faucheron

Authors
  1. Fatah Tidadini
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Julio Abba
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jean-Louis Quesada
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Bertrand Trilling
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Aline Bonne
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Alison Foote
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jean-Luc Faucheron
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Catherine Arvieux
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Study concept and design: Tidadini, Arvieux. Data acquisition: Tidadini, Abba, Trilling, Bonne, Arvieux. Quality control of data and algorithms: Tidadini, Abba, Arvieux. Data analysis and interpretation: Tidadini, Quesada, Faucheron, Arvieux. Statistical analysis: Quesada. Manuscript preparation: Tidadini, Faucheron, Foote, Arvieux. Manuscript editing: Tidadini, Foote. Manuscript review: all authors.

Corresponding author

Correspondence to Catherine Arvieux.

Ethics declarations

Ethics Approval

All procedures performed in this study were in accordance with the ethical standards research committee and with the Helsinki declaration. The study was registered in the internal register of the Grenoble Alpes University Hospital of studies respecting the reference methodology MR004 of the French National Commission for Informatics and Freedoms (CNIL).

Consent to Participate

Patients were informed that their anonymized data might in the future be the subject of clinical research and could oppose this by informing the doctor.

Competing Interests

The authors declare no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tidadini, F., Abba, J., Quesada, JL. et al. Oncological Outcomes After Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC) in the Treatment of Peritoneal Carcinomatosis. J Gastrointest Canc 54, 632–641 (2023). https://doi.org/10.1007/s12029-022-00843-x

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12029-022-00843-x

Keywords

Search

Navigation