Advertisement

Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC): Initial Experience from Indian Centers and a Review of Literature

  • Ninad Katdare
  • Robin Prabhu
  • Suniti Mishra
  • Sanket Mehta
  • Aditi Bhatt
Original Article
  • 13 Downloads

Abstract

Cytoreductive surgery and HIPEC is a therapeutic option that benefits only selected patients with peritoneal metastases (PM). New treatments like pressurized intraperitoneal aerosol chemotherapy (PIPAC) have been developed to overcome some limitations of intraperitoneal chemotherapy and treat patients who are not eligible for a curative approach. The safety and feasibility of the procedure in the first few Indian patients treated with PIPAC, and the technique and the set-up required for PIPAC are described here. From May 2017 to August 2017, data was collected prospectively for all patients undergoing PIPAC at three Indian centers. The patients’ characteristic, operative findings, and perioperative outcomes were recorded. Seventeen procedures were performed in 16 patients with peritoneal metastases from various primary sites using standard drug regimens developed for the procedure. The median hospital stay was 1 day, minor and major complications were seen in two patients each (11.7%), and there was one post-operative death. Of the six patients who completed at least 6 weeks of follow-up, there was disease progression in two, unrelated problems in two patients, and a second procedure was performed in one patient. One patient underwent subsequent CRS and HIPEC. Our results show the feasibility and safety of PIPAC in Indian patients with a low morbidity and mortality and short hospital stay. While clinical trials will determine its role in addition to systemic chemotherapy, it can be used in patients who have progressed on one or more lines of systemic chemotherapy and those who have chemotherapy-resistant ascites.

Keywords

PIPAC Indian experience PIPAC review Peritoneal metastases 

References

  1. 1.
    Glehen O, Elias D, Gilly F-N (2008) Carcinoses Péritonéales D’Origine Digestive et Primitive: Rapport du 110ème Congrès de L’Association Française de Chirurgie—Monographie de L’Association française de Chirurgie. Rueil-Malmaison, France, Arnette, pp 101–151Google Scholar
  2. 2.
    Franko J, Shi Q, Meyers JP, et al. (2016) 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; published online Oct 12.  https://doi.org/10.1016/S1470-2045(16)30500-9
  3. 3.
    Grass F1, Vuagniaux A1, Teixeira-Farinha H1, Lehmann K2, Demartines N1, Hübner M1 (2017) Systematic review of pressurized intraperitoneal aerosol chemotherapy for the treatment of advanced peritoneal carcinomatosis. Br J Surg 104(6):669–678.  https://doi.org/10.1002/bjs.10521
  4. 4.
    Solass W, Kerb R, Mürdter T, Giger-Pabst U, Strumberg D, Tempfer C, Zieren J, Schwab M, Reymond MA (2014) Intraperitoneal chemotherapy of peritoneal carcinomatosis using pressurized aerosol as an alternative to liquid solution: first evidence for efficacy. Ann Surg Oncol 21(2):553–559.  https://doi.org/10.1245/s10434-013-3213-1 CrossRefPubMedGoogle Scholar
  5. 5.
    https://evs.nci.nih.gov/.../CTCAE/CTCAE_4.03_2010-06-14_QuickReference_8.5x11.p...CTCAE 4.03. Common Terminology Criteria for. Adverse Events (CTCAE). Version 4.0. Published: May 28, 2009 (v4.03: June 14, 2010)
  6. 6.
    Solass W, Sempoux C, Detlefsen S, Norman JC, Bibeau F (2016) Peritoneal sampling and histological assessment of therapeutic response in peritoneal metastasis: proposal of the peritoneal regression grading score (PRGS). Pleura Peritoneum 1:99–107Google Scholar
  7. 7.
    Solass W, Hetzel A, Nadiradze G, Sagynaliev E, Reymond MA (2012) Description of a novel approach for intraperitoneal drug delivery and the related device. Surg Endosc 26:1849–1855CrossRefPubMedGoogle Scholar
  8. 8.
    Blanco A, Giger-Pabst U, Solass W, Zieren J, Reymond MA (2013) Renal and hepatic toxicities after pressurized intraperitoneal aerosol chemotherapy (PIPAC). Ann Surg Oncol 20(7):2311–2316.  https://doi.org/10.1245/s10434-012-2840-2 CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Nadiradze G, Giger-Pabst U, Zieren J, Strumberg D, Solass W, Reymond MA (2015) Pressurized intraperitoneal aerosol chemotherapy (PIPAC) with low-dose cisplatin and doxorubicin in gastric peritoneal metastasis. J Gastrointest Surg 20(2):367–373.  https://doi.org/10.1007/s11605-015-2995-9 CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Hübner M, Teixeira Farinha H, Grass F, Wolfer A, Mathevet P, Hahnloser D, Demartines N (2017) Feasibility and safety of pressurized intraperitoneal aerosol chemotherapy for peritoneal carcinomatosis: a retrospective cohort study. Gastroenterol Res Pract 2017:6852749.  https://doi.org/10.1155/2017/6852749 CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Demtroder C, Solass W, Zieren J, Strumberg D, Giger-Pabst U, Reymond MA (2015) Pressurized intraperitoneal aerosol chemotherapy (PIPAC) with oxaliplatin in colorectal peritoneal metastasis. Color Dis 18(4):364–371.  https://doi.org/10.1111/codi.13130 CrossRefGoogle Scholar
  12. 12.
    Tempfer CB, Winnekendonk G, Solass W, Horvat R, Giger-Pabst U, Zieren J, Rezniczek GA, Reymond MA (2015) Pressurized intraperitoneal aerosol chemotherapy in women with recurrent ovarian cancer: a phase 2 study. Gynecol Oncol 137(2):223–228.  https://doi.org/10.1016/j.ygyno.2015.02.009 CrossRefPubMedGoogle Scholar
  13. 13.
    Graversen M, Detlefsen S, Bjerregaard JK, Pfeiffer P, Mortensen MB (2017 May 17) Peritoneal metastasis from pancreatic cancer treated with pressurized intraperitoneal aerosol chemotherapy (PIPAC). Clin Exp Metastasis 34:309–314CrossRefPubMedGoogle Scholar
  14. 14.
    Giger-Pabst U, Solass W, Buerkle B, Reymond MA, Tempfer CB (2015 Apr) Low-dose pressurized intraperitoneal aerosol chemotherapy (PIPAC) as an alternative therapy for ovarian cancer in an octogenarian patient. Anticancer Res 35(4):2309–2314PubMedGoogle Scholar
  15. 15.
    Solass W, Giger-Pabst U, Zieren J, Reymond MA (2013) Pressurized intraperitoneal aerosol chemotherapy (PIPAC): occupational health and safety aspects. Ann Surg Oncol 20(11):3504–3511.  https://doi.org/10.1245/s10434-013-3039-x CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Girshally R, Demtröder C, Albayrak N, Zieren J, Tempfer C, Reymond MA (2016) Pressurized intraperitoneal aerosol chemotherapy (PIPAC) as a neoadjuvant therapy before cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. World J Surg Oncol 14:253.  https://doi.org/10.1186/s12957-016-1008-0 CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Robella M, Vaira M, De Simone M (2016) Safety and feasibility of pressurized intraperitoneal aerosol chemotherapy (PIPAC) associated with systemic chemotherapy: an innovative approach to treat peritoneal carcinomatosis. World J Surg Oncol 14:128.  https://doi.org/10.1186/s12957-016-0892-7 CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Indian Association of Surgical Oncology 2018

Authors and Affiliations

  1. 1.Department of Surgical OncologyFortis SL Raheja HospitalMumbaiIndia
  2. 2.Department of Surgical OncologyFortis HospitalBangaloreIndia
  3. 3.Department of PathologyFortis HospitalBangaloreIndia
  4. 4.Department of Peritoneal Surface OncologySaifee HospitalMumbaiIndia

Personalised recommendations