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Clinical Outcome for Patients Managed with Low-Dose Cisplatin and Doxorubicin Delivered as Pressurized Intraperitoneal Aerosol Chemotherapy for Unresectable Peritoneal Metastases of Gastric Cancer

  • Peritoneal Surface Malignancy
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Pressurized intraperitoneal aerosol chemotherapy (PIPAC) is increasingly used to manage gastric cancer peritoneal metastasis (GCPM).

Methods

This study analyzed a prospective database of GCPM patients treated with cisplatin and doxorubicin PIPAC (PIPAC-C/D). The outcome criteria were adverse events, pathologic response [peritoneal regression grading score (PRGS)], and overall survival (OS).

Results

The PIPAC-C/D procedure was scheduled for 144 patients with a median age of 57 years (range 22–88 years). Access to the abdominal cavity for the first PIPAC failed in 11 patients (7.7 %). A total of 296 procedures were performed for 131 patients. Of the 144 patients, 52 (36.1%) underwent one PIPAC, 32 (22.2%) underwent two PIPACs, 24 (16.7%) underwent three PIPACs, and 21 (14.6%) underwent four or more PIPACs. The overall morbidity/mortality was grade 1 for 22 patients (15.3%), grade 2 for 32 patients (22.2%), grade 3 for 7 patients (4.9%), grade 4 for no patients (0%), and grade 5 for 2 patients (1.4%). Of the 37 patients who had three or more PIPACs eligible for histopathologic response analysis, 27 (73%) had major or complete regression (PRGS 1/2). A median OS of 11 months (range 0–61 months) for the total study population and 16 months (range 2–61 months) for the patients with three or more PIPACs was observed. For 10 patients (7%) who underwent cytoreductive surgery and hyperthermic intraperitoneal chemotherapy, the median OS was 15 months (minimum, 4 months; maximum, 27 months). Multivariate analysis showed three or more PIPACs to be an independent prognostic factor for improved OS (hazard ratio, 0.36; p < 0.0001).

Conclusions

Repetitive PIPAC-C/D ± systemic chemotherapy is associated with low morbidity and mortality rates. Prospective randomized trials are needed to confirm whether three or more PIPAC-C/Ds improve clinical outcome.

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Authors and Affiliations

  1. Department of Digestive, Oncological, Endocrine, Hepato-Biliary, Pancreatic and Liver Transplant Surgery, Trousseau Hospital, Chambray les Tours, France

    Rémy Sindayigaya MD, Elias Karam MD & Mehdi Ouaissi MD, PhD

  2. Department of Surgery and Therapy Center for Peritonealcarcinomatosis, Marien Hospital Herne, Ruhr University Bochum, Herne, Germany

    Can Dogan MD, Cédric Remy Demtröder MD, Britta Fischer MD & Urs Giger-Pabst MD

  3. Department of General and Visceral Surgery, Therapy Center for Metabolic and Bariatric Surgery, St. Martinus Hospital Düsseldorf, Düsseldorf, Germany

    Cédric Remy Demtröder MD

  4. University of Münster, Münster, Germany

    Jonathan Robin Buggisch MD

  5. Department of Obstetrics and Gynecology and Therapy Center for Peritoneal Carcinomatosis, Marien Hospital Herne, Ruhr-Universität Bochum, Herne, Germany

    Clemens B. Tempfer MD

  6. Department of Hepatogastroenterology and Digestive Oncology, Trousseau Hospital, Chambray les Tours, France

    Thierry Lecomte MD, PhD

  7. Department of General, Visceral, and Transplant Surgery, University Hospital of Münster, Münster, Germany

    Urs Giger-Pabst MD

  8. University of Applied Science Düsseldorf, Düsseldorf, Germany

    Urs Giger-Pabst MD

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  1. Rémy Sindayigaya MD
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Correspondence to Mehdi Ouaissi MD, PhD.

Ethics declarations

Thierry Lecomte has received payments for clinical research/scientific work from Sanofi Genzyme and Merck; he is a consultant and expert for Sanofi Genzyme; he has conducted courses and training for Merck, Amgen and Lilly. He has received invitations to national and international congresses from Amgen and Servier. All other authors have no conflicts of interest or financial ties to disclose.

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Sindayigaya, R., Dogan, C., Demtröder, C.R. et al. Clinical Outcome for Patients Managed with Low-Dose Cisplatin and Doxorubicin Delivered as Pressurized Intraperitoneal Aerosol Chemotherapy for Unresectable Peritoneal Metastases of Gastric Cancer. Ann Surg Oncol 29, 112–123 (2022). https://doi.org/10.1245/s10434-021-10860-y

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