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Treatment of Peritoneal Metastasis with Pressurized Intraperitoneal Aerosol Chemotherapy: Results from the Prospective PIPAC-OPC2 Study

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

Abstract

Background

Pressurized Intraperitoneal Aerosol chemotherapy (PIPAC) is a local treatment for peritoneal metastasis (PM). Prospective data are scarce and evaluation of treatment response remains difficult. This study evaluated the use of the Peritoneal Regression Grading score (PRGS) and its prognostic value.

Patients and Methods

This was a prospective, controlled phase II trial in patients with PM from gastrointestinal, gynaecological, hepatopancreatobiliary, primary peritoneal, or unknown primary cancer. Patients in performance status 0–1, with a non-obstructed gastrointestinal tract, and a maximum of one extraperitoneal metastasis were eligible. Colorectal or appendiceal PM had PIPAC with oxaliplatin, other primaries had PIPAC with cisplatin and doxorubicin. Biopsies were taken at each PIPAC and evaluated using the PRGS. Quality-of-life questionnaires were reported at baseline and after three PIPACs.

Results

One hundred ten patients were treated with 336 PIPACs (median 3, range 1–12). One hundred patients had prior palliative chemotherapy and 45 patients received bidirectional treatment. Complete or major histological response to treatment (PRGS 1–2) was observed in 38 patients (61%) who had three PIPACs, which was the only independent prognostic factor in a multivariate analysis. The median overall survival (mOS) from PIPAC 1 was 10 months, while patients with PM from gastric, colorectal, and pancreatic cancer had a mOS of 7.4, 16.7, and 8.2 months, respectively. Global health scores were significantly reduced, but patients were less fatigued, nauseated, constipated, and had better appetite after three PIPACs.

Conclusions

PIPAC with oxaliplatin or cisplatin and doxorubicin was able to induce a major or complete histological response during three PIPACs, which may provide significant prognostic information, both at baseline and after treatment.

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Author information

Authors and Affiliations

  1. Odense PIPAC Center, Odense University Hospital, Odense, Denmark

    Martin Graversen MD, PhD, S. Detlefsen MD, PhD, A. P. Ainsworth MD, PhD, C. W. Fristrup MD, PhD, A. O. Knudsen MD, P. Pfeiffer MD, PhD, L. S. Tarpgaard MD, PhD & M. B. Mortensen MD, PhD, DMSci

  2. Department of Surgery, Odense University Hospital, Odense, Denmark

    Martin Graversen MD, PhD, A. P. Ainsworth MD, PhD, C. W. Fristrup MD, PhD & M. B. Mortensen MD, PhD, DMSci

  3. OPEN—Open Patient data Explorative Network, Odense University Hospital, Odense, Region of Southern Denmark, Denmark

    Martin Graversen MD, PhD

  4. OPAC—Odense Pancreas Center, Odense University Hospital, Odense, Denmark

    Martin Graversen MD, PhD, S. Detlefsen MD, PhD, A. P. Ainsworth MD, PhD, C. W. Fristrup MD, PhD, P. Pfeiffer MD, PhD & M. B. Mortensen MD, PhD, DMSci

  5. Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark

    Martin Graversen MD, PhD, S. Detlefsen MD, PhD, P. Pfeiffer MD, PhD, L. S. Tarpgaard MD, PhD & M. B. Mortensen MD, PhD, DMSci

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

    S. Detlefsen MD, PhD

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

    A. O. Knudsen MD, P. Pfeiffer MD, PhD & L. S. Tarpgaard MD, PhD

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  1. Martin Graversen MD, PhD
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Correspondence to Martin Graversen MD, PhD.

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Graversen, M., Detlefsen, S., Ainsworth, A.P. et al. Treatment of Peritoneal Metastasis with Pressurized Intraperitoneal Aerosol Chemotherapy: Results from the Prospective PIPAC-OPC2 Study. Ann Surg Oncol 30, 2634–2644 (2023). https://doi.org/10.1245/s10434-022-13010-0

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