1
|
Kefleyesus A, Bhatt A, Escayola C, Khomyakov V, Hübner M, Reymond MA, Thieme R, Sgarbura O, Willaert W, Ceelen W, Di Giorgio A, Vizzielli G, Glehen O, Robella M, Bakrin N. Descriptive review of current practices and prognostic factors in patients with ovarian cancer treated by pressurized intraperitoneal aerosol chemotherapy (PIPAC): a multicentric, retrospective, cohort of 234 patients. Front Oncol 2023; 13:1204886. [PMID: 37692848 PMCID: PMC10484798 DOI: 10.3389/fonc.2023.1204886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 06/26/2023] [Indexed: 09/12/2023] Open
Abstract
Introduction Ovarian cancer (OC) is the primary cause of mortality in women diagnosed with gynecological cancer. Our study assessed pressurized intraperitoneal aerosol chemotherapy (PIPAC) as treatment for peritoneal surface metastases (PSM) from recurrent or progressive OC and conducted survival analyses to identify prognostic factors. Material and methods This retrospective cohort study, conducted across 18 international centers, analyzed the clinical practices of patients receiving palliative treatment for PSM from OC who underwent PIPAC. All patients were initially treated appropriately outside any clinical trial setting. Feasibility, safety, and morbidity were evaluated along with objective endpoints of oncological response. Multivariate analysis identified prognostic factors for OS and PFS. Results From 2015-2020, 234 consecutive patients were studied, from which 192 patients were included and stratified by platinum sensitivity for analysis. Patients with early recurrence, within one postoperative month, were excluded. Baseline characteristics were similar between the groups regarding platinum sensitivity (platinum sensitive (PS) and resistant (PR)), but chemotherapy frequency differed, as did PCI before PIPAC. Median PCI decreased in both groups after three cycles of PIPAC (PS 16 vs. 12, p < 0.001; PR 24 vs. 20, p = 0.009). Overall morbidity was 22%, with few severe complications (4-8%) or mortality (0-3%). Higher pathological response and longer OS (22 vs. 11m, p = 0.012) and PFS (12 vs. 7m, p = 0.033) were observed in the PS group. Multivariate analysis (OS/PFS) identified ascites (HR 4.02, p < 0.001/5.22, p < 0.001), positive cytology at first PIPAC (HR 3.91, p = 0.002/1.96, p = 0.035), and ≥ 3 PIPACs (HR 0.30, p = 0.002/0.48, p = 0.017) as independent prognostic factors of overall survival/progression-free survival. Conclusions With low morbidity and mortality rates, PIPAC is a safe option for palliative treatment of advanced ovarian cancer. Promising results were observed after 3 PIPAC, which did improve the peritoneal burden. However, further research is needed to evaluate the potential role of PIPAC as an independent prognostic factor.
Collapse
Affiliation(s)
- Amaniel Kefleyesus
- Department of Surgical Oncology, Lyon University Hospital, Centre Hospitalier Lyon-Sud, Lyon, France
- Department of Visceral Surgery, Lausanne University Hospital CHUV, University of Lausanne (UNIL), Lausanne, Switzerland
| | - Aditi Bhatt
- Department of Surgical Oncology, Zydus Hospital, Ahmedabad, India
| | - Cecilia Escayola
- Division of Gynaecologic Surgery, Clinica del Pilar, Barcelona, Spain
| | - Vladimir Khomyakov
- Moscow Research Oncological Institute named after (n. a.) Pyotr Alexanderovich (P. A.) Herzen, Thoracoabdominal, Moscow, Russia
| | - Martin Hübner
- Department of Visceral Surgery, Lausanne University Hospital CHUV, University of Lausanne (UNIL), Lausanne, Switzerland
| | - Marc A. Reymond
- Department of General and Transplant Surgery , University Hospital Tübingen, Tübingen, Germany
| | - René Thieme
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - Olivia Sgarbura
- Department of Surgical Oncology, Cancer Institute Montpellier (ICM), University of Montpellier, Montpellier, France
| | - Wouter Willaert
- Department of GI Surgery, Ghent University Hospital, Ghent, Belgium
| | - Wim Ceelen
- Department of GI Surgery, Ghent University Hospital, Ghent, Belgium
- Cancer Research Institute Ghent (CRIG), Ghent University Hospital, Ghent, Belgium
| | - Andrea Di Giorgio
- Surgical Unit of Peritoneum and Retroperitoneum, Fondazione Policlinico, Universitario A. Gemelli Scientific Institute for Research, Hospitalization and Healthcare (IRCCS), Rome, Italy
| | - Giuseppe Vizzielli
- Department of Obstetrics and Gynecology, Fondazione Policlinico, Universitario A. Gemelli Scientific Institute for Research, Hospitalization and Healthcare (IRCCS), Rome, Italy
| | - Olivier Glehen
- Department of Surgical Oncology, Lyon University Hospital, Centre Hospitalier Lyon-Sud, Lyon, France
| | - Manuela Robella
- Unit of Surgical Oncology, Candiolo Cancer Institute, Fondazione Policlinico (FPO)-Scientific Institute for Research, Hospitalization and Healthcare (IRCCS), Candiolo, Italy
| | - Naoual Bakrin
- Department of Surgical Oncology, Lyon University Hospital, Centre Hospitalier Lyon-Sud, Lyon, France
| |
Collapse
|
2
|
Ezanno AC, Malgras B, Pocard M. Pressurized intraperitoneal aerosol chemotherapy, reasons for interrupting treatment: a systematic review of the literature. Pleura Peritoneum 2023; 8:45-53. [PMID: 37304159 PMCID: PMC10249753 DOI: 10.1515/pp-2023-0004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 03/23/2023] [Indexed: 06/13/2023] Open
Abstract
Objectives Pressurized intraperitoneal aerosol chemotherapy (PIPAC) gives encouraging results in the treatment of peritoneal metastasis (PM). The current recommendations require at least 3 sessions of PIPAC. However, some patients do not complete the full treatment course and stop after only 1 or 2 procedures, hence the limited benefit. A literature review was performed, with search terms including "PIPAC" and "pressurised intraperitoneal aerosol chemotherapy." Content Only articles describing the causes for premature termination of the PIPAC treatment were analysed. The systematic search identified 26 published clinical articles related to PIPAC and reporting causes for stopping PIPAC. Summary The series range from 11 to 144 patients, with a total of 1352 patients treated with PIPAC for various tumours. A total of 3088 PIPAC treatments were performed. The median number of PIPAC treatments per patient was 2.1, the median PCI score at the time of the first PIPAC was 19 and the number of patients who did not complete the recommended 3 sessions of PIPAC was 714 (52.8%). Disease progression was the main reason for early termination of the PIPAC treatment (49.1%). The other causes were death, patients' wishes, adverse events, conversion to curative cytoreductive surgery and other medical reasons (embolism, pulmonary infection, etc…). Outlook Further investigations are necessary to better understand the causes for interrupting PIPAC treatment and also improving the selection of patients who are most likely to benefit from PIPAC.
Collapse
Affiliation(s)
- Anne-Cecile Ezanno
- Department of digestive surgery, Begin Military Teaching Hospital, Saint Mandé, France
| | - Brice Malgras
- Department of digestive surgery, Begin Military Teaching Hospital, Saint Mandé, France
- French Military health Service Academy, Ecole du Val de Grâce, Paris, France
| | - Marc Pocard
- Department of digestive surgery, La Pitié Salpétrière Hospital, Paris, France
- INSERM, U965 Cart unit, Paris, France
| |
Collapse
|
3
|
Deban M, Châtelain J, Fasquelle F, Clerc D, Toussaint L, Hübner M, Teixeira Farinha H. The role of cytology in patients undergoing pressurized intraperitoneal aerosol chemotherapy (PIPAC) treatment for peritoneal carcinomatosis. Pleura Peritoneum 2023; 8:75-81. [PMID: 37304163 PMCID: PMC10249751 DOI: 10.1515/pp-2022-0197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 04/20/2023] [Indexed: 06/13/2023] Open
Abstract
Objectives Cytology of ascites or peritoneal washing is a routine part of staging of peritoneal metastases (PM). We aim to determine value of cytology in patients undergoing pressurized intraperitoneal aerosol chemotherapy (PIPAC). Methods Single-center retrospective cohort study included consecutive patients having PIPAC for PM of different primary between January 2015 and January 2020. Results A total of 75 patients (median 63 years (IQR 51-70), 67 % female) underwent a total of 144 PIPAC. At PIPAC 1 59 % patients had positive and 41 % patients had negative cytology. Patients with negative and positive cytology only differed in terms of symptoms of ascites (16% vs. 39 % respectively, p=0.04), median ascites volume (100 vs. 0 mL, p=0.01) and median PCI (9 vs. 19, p<0.01). Among 20 patients who completed 3 PIPACs (per protocol), cytology changed in one from positive to negative, and in two from negative to positive. Median overall survival was 30.9 months in the per protocol group and 12.9 months in patients having <3 PIPACs (=0.519). Conclusions Positive cytology under PIPAC treatment is more frequently encountered in patients with higher PCI and symptomatic ascites. Cytoversion was rarely observed and cytology status had no impact on treatment decisions in this cohort.
Collapse
Affiliation(s)
- Mélina Deban
- Department of Visceral Surgery, Faculty of Biology and Medicine UNIL, Lausanne University Hospital (CHUV), Lausanne, Switzerland
- Section of Surgical Oncology, Department of Surgery, University of Calgary, Calgary, Canada
| | - Julien Châtelain
- Department of Visceral Surgery, Faculty of Biology and Medicine UNIL, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - François Fasquelle
- Faculty of Biology and Medicine UNIL, Institute of pathology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Daniel Clerc
- Department of Visceral Surgery, Faculty of Biology and Medicine UNIL, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Laura Toussaint
- Department of Visceral Surgery, Faculty of Biology and Medicine UNIL, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Martin Hübner
- Department of Visceral Surgery, Faculty of Biology and Medicine UNIL, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Hugo Teixeira Farinha
- Department of Visceral Surgery, Faculty of Biology and Medicine UNIL, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| |
Collapse
|
4
|
Pressurized intraperitoneal aerosol chemotherapy (PIPAC) in patients with peritoneal surface malignancies (PSM): a prospective single-center registry study. J Cancer Res Clin Oncol 2023; 149:1331-1341. [PMID: 36513815 PMCID: PMC9984350 DOI: 10.1007/s00432-022-04517-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 12/03/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE Pressurized intraperitoneal aerosol chemotherapy (PIPAC) is a new, palliative approach for patients with peritoneal surface malignancies (PSMs). Its main goals are to control symptoms and ascites. For this experimental procedure, treatment efficacy and patient safety need to be closely monitored. METHODS We performed a prospective registry study for patients with PSMs. Cisplatin (C) (7.5 mg/m2 body surface) and doxorubicin (D) (1.5 mg/m2) were administered laparoscopically via PIPAC. RESULTS Between November 2015 and June 2020, we recorded data from 108 patients and 230 scheduled procedures. Tumor burden, patient fitness, quality of life, operating time and in-hospital stay remained stable over consecutive procedures. We recorded 21 non-access situations and 14 intraoperative complications (11 intestinal injuries, and three aspirations while inducing anesthesia). Three or more previous abdominal surgeries or cytoreductive surgery (CRS) with intraperitoneal hyperthermic chemoperfusion (HIPEC) were risk factors for non-access and intestinal injuries (χ2, p ≤ 0.01). Five Grade IV and three Grade V postoperative complications according to the Clavien-Dindo Classification (CDC) occurred. Median overall survival was 264 days (interquartile range 108-586). Therapies were primarily discontinued because of death (34%), progressive (26%), or regressive (16%) disease. CONCLUSION PIPAC is effective in stabilizing PSMs and retaining quality of life in selected patients. Earlier abdominal surgeries and CRS with HIPEC should be considered when determining the indication for PIPAC. Randomized controlled studies are needed to evaluate PIPAC's therapeutic benefits compared to systemic chemotherapy (sCHT) alone. TRIAL REGISTRATION NCT03100708 (April 2017).
Collapse
|
5
|
Lang N, Diciola A, Labidi-Galy I, Ris F, Di Marco M, Mach N, Petignat P, Toso C, Undurraga M, Hubner M. Nab-PIPAC: a phase IB study protocol of intraperitoneal cisplatin and nab-paclitaxel administered by pressurised intraperitoneal aerosol chemotherapy (PIPAC) in the treatment of advanced malignancies confined to the peritoneal cavity. BMJ Open 2023; 13:e067691. [PMID: 36604127 PMCID: PMC9827272 DOI: 10.1136/bmjopen-2022-067691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Intraperitoneal dissemination is a major problem resulting in very poor prognosis and a rapid marked deterioration in the quality of life of patients. Pressurised intraperitoneal aerosol chemotherapy (PIPAC) is an emergent laparoscopic procedure aiming to maximise local efficacy and to reduce systemic side effects. METHODS AND ANALYSIS Nab-PIPAC, a bicentre open-label phase IB, aims to evaluate safety of nab-paclitaxel and cisplatin association using in patients with peritoneal carcinomatosis (PC) of gastric, pancreatic or ovarian origin as ≥1 prior line of systemic therapy. Using a 3+3 design, sequential intraperitoneal laparoscopic application of nab-paclitaxel (7.5, 15, 25, 37.5, 52.5 and 70 mg/m2) and cisplatin (10.5 mg/m2) through a nebuliser to a high-pressure injector at ambient temperature with a maximal upstream pressure of 300 psi. Treatment maintained for 30 min at a pressure of 12 mm Hg and repeated4-6 weeks intervals for three courses total.A total of 6-36 patients are expected, accrual is ongoing. Results are expected in 2024.The primary objective of Nab-PIPAC trial is to assess tolerability and safety of nab-paclitaxel and cisplatin combination administered intraperitoneally by PIPAC in patients with PC of gastric, pancreatic or ovarian origin. This study will determine maximum tolerated dose and provide pharmacokinetic data. ETHIC AND DISSEMINATION Ethical approval was obtained from the ethical committees of Geneva and Vaud (CCER-2018-01327). The study findings will be published in an open-access, peer-reviewed journal and presented at relevant conferences and research meetings. TRIAL REGISTRATION NUMBER NCT04000906.
Collapse
Affiliation(s)
- Noemie Lang
- Service d'oncologie, Département d'Oncologie, Hôpitaux Universitaires de Genève, Genève, Switzerland
| | - Antonella Diciola
- Service d'oncologie, Département d'Oncologie, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Intidhar Labidi-Galy
- Service d'oncologie, Département d'Oncologie, Hôpitaux Universitaires de Genève, Genève, Switzerland
| | - Frédéric Ris
- Département de Chirurgie, Hôpitaux Universitaires Genève, Genève, Switzerland
| | - Mariagrazia Di Marco
- Service d'oncologie, Département d'Oncologie, Hôpitaux Universitaires de Genève, Genève, Switzerland
| | - Nicolas Mach
- Service d'oncologie, Département d'Oncologie, Hôpitaux Universitaires de Genève, Genève, Switzerland
| | - Patrick Petignat
- Département Gynécologie et Obstétrique, Hôpitaux Universitaires Genève, Genève, Switzerland
| | - Christian Toso
- Département de Chirurgie, Hôpitaux Universitaires Genève, Genève, Switzerland
| | - Manuela Undurraga
- Département Gynécologie et Obstétrique, Hôpitaux Universitaires Genève, Genève, Switzerland
| | - Martin Hubner
- Département de chirurgie, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| |
Collapse
|
6
|
Baggaley AE, Lafaurie GBRC, Tate SJ, Boshier PR, Case A, Prosser S, Torkington J, Jones SEF, Gwynne SH, Peters CJ. Pressurized intraperitoneal aerosol chemotherapy (PIPAC): updated systematic review using the IDEAL framework. Br J Surg 2022; 110:10-18. [PMID: 36056893 PMCID: PMC10364525 DOI: 10.1093/bjs/znac284] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 06/28/2022] [Accepted: 07/19/2022] [Indexed: 12/31/2022]
Affiliation(s)
- Alice E Baggaley
- Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, London, UK
| | | | - Sophia J Tate
- Department of Anaesthesia, Swansea Bay University Health Board, Swansea, UK
| | - Piers R Boshier
- Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, London, UK
| | - Amy Case
- Department of Cancer Services, Swansea Bay University Health Board, Swansea, UK
| | - Susan Prosser
- Department of Library Services, Swansea Bay University Health Board, Swansea, UK
| | - Jared Torkington
- Department of Surgery, University Hospital of Wales, Cardiff, UK
| | - Sadie E F Jones
- Department of Obstetrics and Gynaecology, University Hospital of Wales, Cardiff, UK
| | - Sarah H Gwynne
- Department of Cancer Services, Swansea Bay University Health Board, Swansea, UK
| | - Christopher J Peters
- Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, London, UK
| |
Collapse
|
7
|
Hübner M, Somashekhar SP, Teixeira Farinha H, Abba J, Rao RG, Alyami M, Willaert W. Treatment Response After Pressurized IntraPeritoneal Aerosol Chemotherapy (PIPAC) for Peritoneal Metastases of Colorectal Originf. ANNALS OF SURGERY OPEN 2022; 3:e203. [PMID: 37600288 PMCID: PMC10406066 DOI: 10.1097/as9.0000000000000203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 07/27/2022] [Indexed: 03/05/2023] Open
Abstract
The objective of this study is to analyze oncological outcomes of patients with peritoneal metastases (PM) of colorectal origin treated with Pressurized IntraPeritoneal Aerosol Chemotherapy (PIPAC). Background PIPAC has been demonstrated to be a feasible and safe novel treatment for patients with PM of various origins. Only small series reports on survival after PIPAC by disease entity. Methods International retrospective cohort study of consecutive patients with PM of colorectal origin. Outcome measures were overall survival (OS), radiological response according to Response Evaluation Criteria in Solid Tumors (RECIST), histological response (peritoneal regression grading score [PRGS]: complete response: 1-4: no response), change of peritoneal cancer index (PCI), and symptom control. Results Seventeen eligible centers compiled 256 non-selected patients (mean age 61 [50.6-69.2], 43% female) and 606 procedures. Sixty-three percent were treated after 2 lines of chemotherapy, median PCI at PIPAC1 was 18 (interquartile range [IQR] = 10-27). Median OS was 19.00 months (IQR = 12.9-29.8) from diagnosis and 9.4 months (IQR = 4.5-16.8) from PIPAC1. One hundred and four of 256 patients (40.6%) had ≥3 procedures (per protocol [pp]) with the following outcomes at PIPAC3: RECIST: 59.3% partial response/stable, 40.7% progression; mean PRGS: 2.1 ± 0.9. Median PCI was 21 (IQR = 15-29) at baseline and 20 (IQR = 12-27) at PIPAC3 (P = 0.02). Fifty-six (54%) and 48 (46%) patients were symptomatic at baseline and PIPAC3, respectively (P = 0.267). Median OS for the pp cohort was 11.9 months (IQR = 10.7-15.0) from PIPAC1. Independent predictors for survival were radiological response (HR = 3.0; 95% CI = 1.6-5.7) and no symptoms (HR = 4.5, 95% CI = 2.2-9.1) at PIPAC3. Conclusions Objective treatment response and encouraging survival were demonstrated after PIPAC for colorectal PM. Prospective registry data and comparative studies are now needed in to confirm these data.
Collapse
Affiliation(s)
- Martin Hübner
- From the Department of Visceral Surgery, University Hospital CHUV and University of Lausanne (UNIL), Lausanne, Switzerland
| | - S. P. Somashekhar
- Department of Surgical Oncology, Manipal Comprehensive Cancer Centre, Manipal Hospital, Bengaluru, India
| | - Hugo Teixeira Farinha
- From the Department of Visceral Surgery, University Hospital CHUV and University of Lausanne (UNIL), Lausanne, Switzerland
| | | | - Ramya G. Rao
- Department of Surgical Oncology, Manipal Comprehensive Cancer Centre, Manipal Hospital, Bengaluru, India
| | - Mohammad Alyami
- Department of General Surgery and Surgical Oncology, Oncology Center, King Khalid Hospital, Najran, Saudi Arabia
| | - Wouter Willaert
- Department of human structure and repair, Ghent University, Ghent, Belgium
| |
Collapse
|
8
|
Somashekhar SP, Abba J, Sgarbura O, Alyami M, Teixeira Farinha H, Rao RG, Willaert W, Hübner M. Assessment of Treatment Response after Pressurized Intra-Peritoneal Aerosol Chemotherapy (PIPAC) for Appendiceal Peritoneal Metastases. Cancers (Basel) 2022; 14:4998. [PMID: 36291781 PMCID: PMC9599491 DOI: 10.3390/cancers14204998] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 10/06/2022] [Accepted: 10/07/2022] [Indexed: 08/30/2023] Open
Abstract
Background The aim of this study was to analyse survival and surrogates for oncological response after PIPAC for appendiceal tumours. Methods This retrospective cohort study included consecutive patients with appendiceal peritoneal metastases (PM) treated in experienced PIPAC centers. Primary outcome measure was overall survival (OS) from the date of diagnosis of PM and from the start of PIPAC. Predefined secondary outcome included radiological response (RECIST criteria), repeat laparoscopy and peritoneal cancer index (PCI), histological response assessed by the Peritoneal regression grading system (PRGS) and clinical response. Results Final analysis included 77 consecutive patients (208 PIPAC procedures) from 15 centres. Median OS was 30 months (23.00-46.00) from time of diagnosis and 19 months (13.00-28.00) from start of PIPAC. 35/77 patients (45%) had ≥3 procedures (pp: per protocol). Objective response at PIPAC3 was as follows: RECIST: complete response 4 (11.4%), 11 (31.4%) partial/stable; mean PRGS at PIPAC3: 1.8 ± 0.9. Median PCI: 21 (IQR 18-27) vs. 22 (IQR 17-28) at baseline (p = 0.59); 21 (60%) and 18 (51%) patients were symptomatic at baseline and PIPAC3, respectively (p = 0.873). Median OS in the pp cohort was 22.00 months (19.00-NA) from 1st PIPAC. Conclusion Patients with PM of appendiceal origin had objective treatment response after PIPAC and encouraging survival curves call for further prospective evaluation.
Collapse
Affiliation(s)
- SP Somashekhar
- Manipal Comprehensive Cancer Center, Manipal Hospital, HAL Old Airport Rd, Kodihalli, Bengaluru 560017, India
| | - Julio Abba
- Department of Digestive and Emergency Surgery, Grenoble Alpes University Hospital, CEDEX 09, F-38043 Grenoble, France
| | - Olivia Sgarbura
- Surgical Oncology Department, Montpellier Cancer Institute (ICM), University of Montpellier, F-34298 Montpellier, France
- Institut de Recherche en Cancérologie de Montpellier (IRCM), INSERM U1194, Université de Montpellier, F-34298 Montpellier, France
| | - Mohammad Alyami
- Department of General Surgery and Surgical Oncology, Oncology Center, King Khalid Hospital, Najran 66262, Saudi Arabia
| | - Hugo Teixeira Farinha
- Department of Visceral Surgery, Faculty of Biology and Medicine UNIL, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011 Lausanne, Switzerland
| | - Ramya G. Rao
- Manipal Comprehensive Cancer Center, Manipal Hospital, HAL Old Airport Rd, Kodihalli, Bengaluru 560017, India
| | - Wouter Willaert
- Department of GI Surgery, Ghent University Hospital, 9000 Ghent, Belgium
| | - Martin Hübner
- Department of Visceral Surgery, Faculty of Biology and Medicine UNIL, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011 Lausanne, Switzerland
| |
Collapse
|
9
|
Kepenekian V, Bhatt A, Péron J, Alyami M, Benzerdjeb N, Bakrin N, Falandry C, Passot G, Rousset P, Glehen O. Advances in the management of peritoneal malignancies. Nat Rev Clin Oncol 2022; 19:698-718. [PMID: 36071285 DOI: 10.1038/s41571-022-00675-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2022] [Indexed: 11/09/2022]
Abstract
Peritoneal surface malignancies (PSMs) are usually associated with a poor prognosis. Nonetheless, in line with advances in the management of most abdominopelvic metastatic diseases, considerable progress has been made over the past decade. An improved understanding of disease biology has led to the more accurate prediction of neoplasia aggressiveness and the treatment response and has been reflected in the proposal of new classification systems. Achieving complete cytoreductive surgery remains the cornerstone of curative-intent treatment of PSMs. Alongside centralization in expert centres, enabling the delivery of multimodal and multidisciplinary strategies, preoperative management is a crucial step in order to select patients who are most likely to benefit from surgery. Depending on the specific PSM, the role of intraperitoneal chemotherapy and of perioperative systemic chemotherapy, in particular, in the neoadjuvant setting, is established in certain scenarios but questioned in several others, although more prospective data are required. In this Review, we describe advances in all aspects of the management of PSMs including disease biology, assessment and improvement of disease resectability, perioperative management, systemic therapy and pre-emptive management, and we speculate on future research directions.
Collapse
Affiliation(s)
- Vahan Kepenekian
- Surgical Oncology Department, Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France.,CICLY - EA3738, Université Claude Bernard Lyon I (UCBL1), Lyon, France
| | - Aditi Bhatt
- Department of Surgical Oncology, Zydus hospital, Ahmedabad, Gujarat, India
| | - Julien Péron
- Medical Oncology Department, Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France.,Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, UCBL1, Lyon, France
| | - Mohammad Alyami
- Department of General Surgery and Surgical Oncology, Oncology Center, King Khalid Hospital, Najran, Saudi Arabia
| | - Nazim Benzerdjeb
- CICLY - EA3738, Université Claude Bernard Lyon I (UCBL1), Lyon, France.,Department of Pathology, Institut de Pathologie Multisite, Hospices Civils de Lyon, UCBL1, Lyon, France
| | - Naoual Bakrin
- Surgical Oncology Department, Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France.,CICLY - EA3738, Université Claude Bernard Lyon I (UCBL1), Lyon, France
| | - Claire Falandry
- Department of Onco-Geriatry, Hôpital Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Guillaume Passot
- Surgical Oncology Department, Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France.,CICLY - EA3738, Université Claude Bernard Lyon I (UCBL1), Lyon, France
| | - Pascal Rousset
- CICLY - EA3738, Université Claude Bernard Lyon I (UCBL1), Lyon, France.,Department of Radiology, Hôpital Lyon Sud, Hospices Civils de Lyon, UCBL1, Lyon, France
| | - Olivier Glehen
- Surgical Oncology Department, Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France. .,CICLY - EA3738, Université Claude Bernard Lyon I (UCBL1), Lyon, France.
| |
Collapse
|
10
|
Balmer A, Clerc D, Toussaint L, Sgarbura O, Taïbi A, Hübner M, Teixeira Farinha H. Selection Criteria for Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC) Treatment in Patients with Peritoneal Metastases. Cancers (Basel) 2022; 14:cancers14102557. [PMID: 35626160 PMCID: PMC9139612 DOI: 10.3390/cancers14102557] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 05/13/2022] [Accepted: 05/15/2022] [Indexed: 02/04/2023] Open
Abstract
Background: The standard treatment protocol for PIPAC consists of three procedures. Completion of treatment has been shown to be prognostic of improved survival. The aim of this study was to identify predictors for completion of treatment. Methods: Retrospective multicentric cohort study of patients with peritoneal metastases undergoing PIPAC in three PIPAC expert centers. Per protocol (PP) treatment was defined as patients receiving ≥3 PIPACs and was compared to patients receiving <3. Results: Overall, 183 patients had 517 PIPACs. The main reasons for stopping PIPAC were disease progression in 50% patients, bowel obstruction in 15%, patient’s refusal to pursue in 10%, conversion to cytoreductive surgery in 7%, and medical reasons in 8%. Overall, 95 patients (52%) had PP treatment. The PP median OS was 17 vs. 7 months, p = 0.001. PP patients had r ascites (410 ± 100 mL vs. 960 ± 188 mL, p = 0.001), no prior history of bowel obstruction (12% vs. 24%, p = 0.028), and more bimodal treatment (39% vs. 13%, p < 0.001). After multiple regression, bimodal treatment was found as an independent predictive factor for completing PP (OR = 4.202, 95%CI [1.813, 10.630], p < 0.001), along with prior bowel obstruction (OR = 0.389, 95%CI [0.153, 0.920], p = 0.037). Conclusion: The absence of ascites and prior bowel obstruction can help to select patients suitable for PIPAC. Best results seem to be achieved when PIPAC is combined with systemic chemotherapy.
Collapse
Affiliation(s)
- Aurélie Balmer
- Department of Visceral Surgery, Faculty of Biology and Medicine UNIL, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011 Lausanne, Switzerland; (A.B.); (D.C.); (L.T.); (M.H.)
| | - Daniel Clerc
- Department of Visceral Surgery, Faculty of Biology and Medicine UNIL, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011 Lausanne, Switzerland; (A.B.); (D.C.); (L.T.); (M.H.)
| | - Laura Toussaint
- Department of Visceral Surgery, Faculty of Biology and Medicine UNIL, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011 Lausanne, Switzerland; (A.B.); (D.C.); (L.T.); (M.H.)
| | - Olivia Sgarbura
- Surgical Oncology Department, Montpellier Cancer Institute (ICM), University of Montpellier, F-34298 Montpellier, France;
- Institut de Recherche en Cancérologie de Montpellier (IRCM), INSERM U1194, Université de Montpellier, F-34298 Montpellier, France
| | - Abdelkader Taïbi
- Digestive Surgery Department, Dupuytren Limoges University Hospital, CNRS, XLIM, UMR 7252, F-87000 Limoges, France;
| | - Martin Hübner
- Department of Visceral Surgery, Faculty of Biology and Medicine UNIL, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011 Lausanne, Switzerland; (A.B.); (D.C.); (L.T.); (M.H.)
| | - Hugo Teixeira Farinha
- Department of Visceral Surgery, Faculty of Biology and Medicine UNIL, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011 Lausanne, Switzerland; (A.B.); (D.C.); (L.T.); (M.H.)
- Correspondence:
| |
Collapse
|
11
|
Robella M, Hubner M, Sgarbura O, Reymond M, Khomiakov V, di Giorgio A, Bhatt A, Bakrin N, Willaert W, Alyami M, Teixeira H, Kaprin A, Ferracci F, De Meeus G, Berchialla P, Vaira M, Villeneuve L, Cortés-Guiral D, Nowacki M, So J, Abba J, Afifi A, Mortensen MB, Brandl A, Ceelen W, Coget J, Courvoiser T, de Hingh IH, Delhorme JB, Dumont F, Escayola C, Eveno C, Ezanno AC, Gagnière J, Galindo J, Glatz T, Glehen O, Jäger T, Kepenekian V, Kothonidis K, Lehmann K, Lynch C, Mehta S, Moldovan B, Nissan A, Orry D, Pérez GO, Paquette B, Paskonis M, Piso P, Pocard M, Rau B, Singh S, Somashekhar S, Soravia C, Taibi A, Torkington J, Vizzielli G. Feasibility and safety of PIPAC combined with additional surgical procedures: PLUS study. Eur J Surg Oncol 2022; 48:2212-2217. [DOI: 10.1016/j.ejso.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 04/04/2022] [Accepted: 05/02/2022] [Indexed: 11/29/2022] Open
|
12
|
Teixeira Farinha H, Mattille D, Mantziari S, Demartines N, Hübner M. Early postoperative outcomes of staging laparoscopy for peritoneal metastases with or without pressurized intra-peritoneal aerosol chemotherapy (PIPAC). BMC Surg 2022; 22:122. [PMID: 35354404 PMCID: PMC8969273 DOI: 10.1186/s12893-022-01572-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 03/24/2022] [Indexed: 11/12/2022] Open
Abstract
Background Pressurized intraperitoneal aerosol chemotherapy (PIPAC) has been introduced for palliative treatment of peritoneal surface malignancies (PSM) and is currently tested also in the neoadjuvant and prophylactic setting. The aim was therefore to compare safety and tolerance of staging laparoscopy with or without PIPAC. Methods This retrospective analysis compared consecutive patients undergoing staging laparoscopy alone for oesogastric cancer with patients having PIPAC for suspected PSM of various origins from January 2015 until January 2020. Safety was assessed by use of the Clavien classification for complications and CTCAE for capturing of adverse events. Pain and nausea were documented by use of a visual analogue scale (VAS: 0–10: maximal intensity). Results Overall, 25 PIPAC procedures were compared to 24 staging laparoscopies. PIPAC procedures took a median of 35 min (IQR: 25–67) longer. Four patients experienced at least one complication in either group (p = 0.741). No differences were noted for postoperative nausea (p = 0.961) and pain levels (p = 0.156). Median hospital stay was 2 (IQR: 1–3) for PIPAC and 1 (IQR: 1–2) for the laparoscopy group (p = 0.104). Conclusions The addition of PIPAC did not jeopardize safety and postoperative outcomes of staging laparoscopy alone. Further studies need to clarify its oncological benefits.
Collapse
Affiliation(s)
- Hugo Teixeira Farinha
- Department of Visceral Surgery, Lausanne University Hospital (CHUV), University of Lausanne (UNIL), Rue du Bugnon, 46, 1005, Lausanne, Switzerland
| | - Daphné Mattille
- Department of Visceral Surgery, Lausanne University Hospital (CHUV), University of Lausanne (UNIL), Rue du Bugnon, 46, 1005, Lausanne, Switzerland
| | - Styliani Mantziari
- Department of Visceral Surgery, Lausanne University Hospital (CHUV), University of Lausanne (UNIL), Rue du Bugnon, 46, 1005, Lausanne, Switzerland
| | - Nicolas Demartines
- Department of Visceral Surgery, Lausanne University Hospital (CHUV), University of Lausanne (UNIL), Rue du Bugnon, 46, 1005, Lausanne, Switzerland
| | - Martin Hübner
- Department of Visceral Surgery, Lausanne University Hospital (CHUV), University of Lausanne (UNIL), Rue du Bugnon, 46, 1005, Lausanne, Switzerland.
| |
Collapse
|
13
|
Taibi A, Sgarbura O, Hübner M, Bardet SM, Alyami M, Bakrin N, Durand Fontanier S, Eveno C, Gagniere J, Pache B, Pocard M, Quenet F, Teixeira Farinha H, Thibaudeau E, Dumont F, Glehen O. Feasibility and Safety of Oxaliplatin-Based Pressurized Intraperitoneal Aerosol Chemotherapy With or Without Intraoperative Intravenous 5-Fluorouracil and Leucovorin for Colorectal Peritoneal Metastases: A Multicenter Comparative Cohort Study. Ann Surg Oncol 2022; 29:5243-5251. [PMID: 35318519 DOI: 10.1245/s10434-022-11577-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 02/22/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND This retrospective multicenter cohort study compared the feasibility and safety of oxaliplatin-based pressurized intraperitoneal aerosol chemotherapy (PIPAC-Ox) with or without intraoperative intravenous 5-fluorouracil (5-FU) and leucovorin (L). METHODS Our study included consecutive patients with histologically proven unresectable and isolated colorectal peritoneal metastases (cPM) treated with PIPAC-Ox in seven tertiary referral centers between January 2015 and April 2020. Toxicity events and oncological outcomes (histological response, progression-free survival, and overall survival) were compared between patients who received intraoperative intravenous 5-FU/L (PIPAC-Ox + 5-FU/L group) and patients who did not (PIPAC-Ox group). RESULTS In total, 101 patients (263 procedures) were included in the PIPAC-Ox group and 30 patients (80 procedures) were included in the PIPAC-Ox + 5-FU/L group. Common Terminology Criteria for Adverse Events v4.0 grade 2 or higher adverse events occurred in 48 of 101 (47.5%) patients in the PIPAC-Ox group and in 13 of 30 (43.3%) patients in the PIPAC-Ox + 5-FU/L group (p = 0.73). The complete histological response rates according to the peritoneal regression grading score were 27% for the PIPAC-Ox + 5-FU/L group and 18% for the PIPAC-Ox group (p = 0.74). No statistically significant differences were observed in overall or progression-free survival between the two groups. CONCLUSIONS The safety and feasibility of PIPAC-Ox + 5-FU/L appears to be similar to the safety and feasibility of PIPAC-Ox alone in patients with unresectable cPM. Oncological outcomes must be evaluated in larger studies.
Collapse
Affiliation(s)
- Abdelkader Taibi
- Digestive Surgery Department, Dupuytren Limoges University Hospital, Limoges, France. .,CNRS, XLIM, UMR 7252, University Limoges, Limoges, France.
| | - Olivia Sgarbura
- Department of Surgical Oncology, Cancer Institute Montpellier (ICM), University of Montpellier, Montpellier, France.,IRCM, Institut de Recherche en Cancérologie de Montpellier, INSERM U1194, Université de Montpellier, Institut régional du Cancer de Montpellier, Montpellier, France
| | - Martin Hübner
- Department of Visceral Surgery, Lausanne University Hospital (CHUV), University of Lausanne (UNIL), Lausanne, Switzerland
| | | | - Mohammed Alyami
- Department of General Surgery and Surgical Oncology, Lyon Sud University Hospital, Pierre Benite, France.,Department of General Surgery and Surgical Oncology, King Khalid Hospital, Najran, Saudi Arabia
| | - Naoual Bakrin
- Department of General Surgery and Surgical Oncology, Lyon Sud University Hospital, Pierre Benite, France
| | - Sylvaine Durand Fontanier
- Digestive Surgery Department, Dupuytren Limoges University Hospital, Limoges, France.,CNRS, XLIM, UMR 7252, University Limoges, Limoges, France
| | - Clarisse Eveno
- Department of General Surgery, University Hospital Lille, Lille, France
| | - Johan Gagniere
- Department of General Surgery, University Hospital Clermont-Ferrand, Clermont-Ferrand, France
| | - Basile Pache
- Department of Visceral Surgery, Lausanne University Hospital (CHUV), University of Lausanne (UNIL), Lausanne, Switzerland
| | - Marc Pocard
- INSERM U1275, CAP Paris-Tech, Carcinomatosis Peritoneum Paris Technology, Lariboisière Hospital, AP-HP, Paris 7 -Diderot University, Sorbonne Paris Cité, Paris, France.,Hepato-Biliary-Pancreatic Gastrointestinal Surgery and Liver Transplantation Pitié-Salpêtrière Hospital Assistance Publique/Hôpitaux de Paris, 75013, Paris, France
| | - François Quenet
- Department of Surgical Oncology, Cancer Institute Montpellier (ICM), University of Montpellier, Montpellier, France
| | - Hugo Teixeira Farinha
- Department of Visceral Surgery, Lausanne University Hospital (CHUV), University of Lausanne (UNIL), Lausanne, Switzerland
| | - Emilie Thibaudeau
- Department of Surgical Oncology, Institut de Cancérologie de l'Ouest, Saint Herblain, France
| | - Frederic Dumont
- Department of Surgical Oncology, Institut de Cancérologie de l'Ouest, Saint Herblain, France
| | - Olivier Glehen
- Department of General Surgery and Surgical Oncology, Lyon Sud University Hospital, Pierre Benite, France
| |
Collapse
|
14
|
Sgarbura O, Eveno C, Alyami M, Bakrin N, Guiral DC, Ceelen W, Delgadillo X, Dellinger T, Di Giorgio A, Kefleyesus A, Khomiakov V, Mortensen MB, Murphy J, Pocard M, Reymond M, Robella M, Rovers KP, So J, Somashekhar SP, Tempfer C, Van der Speeten K, Villeneuve L, Yong WP, Hübner M. Consensus statement for treatment protocols in pressurized intraperitoneal aerosol chemotherapy (PIPAC). Pleura Peritoneum 2022; 7:1-7. [PMID: 35602919 PMCID: PMC9069497 DOI: 10.1515/pp-2022-0102] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 02/02/2022] [Indexed: 12/11/2022] Open
Abstract
Objectives Safe implementation and thorough evaluation of new treatments require prospective data monitoring and standardization of treatments. Pressurized intraperitoneal aerosol chemotherapy (PIPAC) is a promising alternative for the treatment of patients with peritoneal disease with an increasing number of suggested drug regimens. The aim was to reach expert consensus on current PIPAC treatment protocols and to define the most important research topics. Methods The expert panel included the most active PIPAC centers, organizers of PIPAC courses and principal investigators of prospective studies on PIPAC. A comprehensive literature review served as base for a two-day hybrid consensus meeting which was accompanied by a modified three-round Delphi process. Consensus bar was set at 70% for combined (strong and weak) positive or negative votes according to GRADE. Research questions were prioritized from 0 to 10 (highest importance). Results Twenty-two out of 26 invited experts completed the entire consensus process. Consensus was reached for 10/10 final questions. The combination of doxorubicin (2.1 mg/m2) and cisplatin (10.5 mg/m2) was endorsed by 20/22 experts (90.9%). 16/22 (72.7%) supported oxaliplatin at 120 with potential reduction to 90 mg/m2 (frail patients), and 77.2% suggested PIPAC-Ox in combination with 5-FU. Mitomycin-C and Nab-paclitaxel were favoured as alternative regimens. The most important research questions concerned PIPAC conditions (n=3), standard (n=4) and alternative regimens (n=5) and efficacy of PIPAC treatment (n=2); 8/14 were given a priority of ≥8/10. Conclusions The current consensus should help to limit heterogeneity of treatment protocols but underlines the utmost importance of further research.
Collapse
Affiliation(s)
- Olivia Sgarbura
- Department of Surgical Oncology , Cancer Institute of Montpellier, University of Montpellier , Montpellier , France
- IRCM, Institut de Recherche en Cancérologie de Montpellier, INSERM U1194 , Université de Montpellier, Institut régional du Cancer de Montpellier , Montpellier , France
| | - Clarisse Eveno
- Department of Digestive and Oncological Surgery , University of Lille, Claude Huriez University Hospital , Lille , France
| | - Mohammad Alyami
- Department of General Surgery and Surgical Oncology , Oncology Center, King Khalid Hospital , Najran , Saudi Arabia
| | - Naoual Bakrin
- Department of General Surgery & Surgical Oncology , Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon , Pierre-Bénite , France
- Lyon University 1, EA 3738 CICLY , Lyon , France
| | - Delia Cortes Guiral
- Department of General Surgery and Surgical Oncology , Oncology Center, King Khalid Hospital , Najran , Saudi Arabia
| | - Wim Ceelen
- Department of GI Surgery , Ghent University Hospital , Ghent , Belgium
| | - Xavier Delgadillo
- Centre Médico Chirurgical Volta , Unité Spécialisée de Chirurgie , La Chaux-de-Fonds , Switzerland
| | - Thanh Dellinger
- Department of Gynecologic Oncology , City of Hope National Medical Center , Duarte , CA , USA
| | - Andrea Di Giorgio
- Peritoneal and Retroperitoneal Surgical Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS , Rome , Italy
| | - Amaniel Kefleyesus
- Department of General Surgery & Surgical Oncology , Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon , Pierre-Bénite , France
- Department of Visceral Surgery , Lausanne University Hospital CHUV, University of Lausanne (UNIL) , Lausanne , Switzerland
| | - Vladimir Khomiakov
- P.A. Hertsen Moscow Research Oncological Institute – Branch of the National Medical Research Center of Radiology , Moscow , Russia
| | - Michael Bau Mortensen
- Department of Surgery , Odense Pancreas Center (OPAC) & Odense PIPAC Center (OPC), Odense University Hospital , Odense , Denmark
| | - Jamie Murphy
- Academic Surgical Unit , Imperial College Healthcare NHS Trust , London , UK
| | - Marc Pocard
- Université de Paris, INSERM, U1275 CAP Paris-Tech , Paris , France
- Hepato-Biliary-Pancreatic Gastrointestinal Surgery and Liver Transplantation , Pitié Salpêtrière Hospital, AP-HP , Paris , France
| | - Marc Reymond
- Department of Surgery , University of Tübingen , Tübingen , Germany
| | - Manuela Robella
- Unit of Surgical Oncology , Candiolo Cancer Institute-FPO, IRCCS , Turin , Italy
| | - Koen P. Rovers
- Department of Surgery , Catharina Cancer Institute , Eindhoven , The Netherlands
| | - Jimmy So
- Division of Surgical Oncology , National University Cancer Institute , Singapore , Singapore
| | - S. P. Somashekhar
- Department of Surgical Oncology , Manipal Comprehensive Cancer Center, Manipal Hospital , Bangalore , India
| | - Clemens Tempfer
- Department of Obstetrics and Gynecology and Therapy Center for Peritoneal Carcinomatosis , Marien Hospital Herne, Ruhr-Universität Bochum , Herne , Germany
| | | | - Laurent Villeneuve
- Lyon University 1, EA 3738 CICLY , Lyon , France
- Department of Public Health , Clinical Research and Epidemiology, Hospices Civils de Lyon , Lyon , France
| | - Wei Peng Yong
- Cancer Science Institute of Singapore , National University of Singapore , Singapore , Singapore
| | - Martin Hübner
- Department of Visceral Surgery , Lausanne University Hospital CHUV, University of Lausanne (UNIL) , Lausanne , Switzerland
| |
Collapse
|
15
|
Sun BJ, Lee B. Review of Regional Therapies for Gastric Cancer with Peritoneal Metastases. Cancers (Basel) 2022; 14:cancers14030570. [PMID: 35158837 PMCID: PMC8833629 DOI: 10.3390/cancers14030570] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 01/15/2022] [Accepted: 01/19/2022] [Indexed: 12/20/2022] Open
Abstract
Simple Summary Gastric cancer is usually diagnosed at late stages and is associated with poor five-year survival rates. Metastasis to the peritoneal cavity is common and leads to even worse outcomes. Currently, the mainstay of treatment for metastatic gastric cancer is systemic chemotherapy or supportive care. These recommendations remain despite evidence that suggests systemic therapy has poor penetration into the abdominal cavity, limiting efficacy against peritoneal disease. Newer treatments have been developed to address this problem, specifically regional therapies aimed at delivering chemotherapy directly into the peritoneal cavity to eradicate tumor cells. These novel therapies include hyperthermic intraperitoneal chemotherapy, normothermic intraperitoneal chemotherapy, and pressurized intraperitoneal aerosolized chemotherapy. Regional therapies may also be combined with surgery to remove both macroscopic and microscopic disease. Although more clinical trials are needed to evaluate its efficacy, early studies have shown promising outcomes with intraperitoneal chemotherapy. Abstract Gastric cancer carries a poor prognosis and is a leading cause of cancer-related mortality worldwide. Patients with gastric cancer who develop peritoneal metastases have an even more dismal prognosis, with median survival time measured in months. Since studies have demonstrated that systemic chemotherapy has poor penetration into the peritoneum, multimodal treatment with intraperitoneal chemotherapy has been proposed for the treatment of peritoneal metastases and has become the foundation for newer therapeutic techniques and clinical trials. These include heated intraperitoneal chemotherapy (HIPEC) with cytoreductive surgery (CRS), which involves the application of heated chemotherapy into the abdomen with or without tumor debulking surgery; normothermic intraperitoneal chemotherapy (NIPEC), in which non-heated chemotherapy can be delivered into the abdomen via a peritoneal port allowing for repeat dosing; and pressurized intraperitoneal aerosolized chemotherapy (PIPAC), a newer technique of pressurized and aerosolized chemotherapy delivered into the abdomen during laparoscopy. Early results with intraperitoneal chemotherapy have shown promise in increasing disease-free and overall survival in select patients. Additionally, there may be a palliative effect of these regional therapies. In this review, we explore and summarize these different intraperitoneal chemotherapy treatment regimens for gastric cancer with peritoneal metastases.
Collapse
|
16
|
Pache B, Teixeira Farinha H, Toussaint L, Demartines N, Hastir D, Mathevet P, Sempoux C, Hübner M. Histological regression of peritoneal metastases of recurrent tubo-ovarian cancer after systemic chemotherapy. Front Surg 2022; 9:936613. [PMID: 36338656 PMCID: PMC9632969 DOI: 10.3389/fsurg.2022.936613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 09/08/2022] [Indexed: 11/28/2022] Open
Abstract
Introduction Post-treatment histological regression of peritoneal metastases (PM) is a new and potentially important predictor of oncological outcomes. Histology of PM from adnexal origin is usually evaluated by the Chemotherapy Response Score (CRS). The aim of this preliminary study was to quantify the response of PM of recurrent tubo-ovarian cancer (TOVC) after systemic chemotherapy by using the recently validated Peritoneal Regression Grading System (PRGS) and compare it with CRS. Correlation with per operative evaluation through Peritoneal Cancer Index (PCI) was performed. Material and methods Retrospective cohort study of all consecutive patients with recurrent PM from TOVC undergoing surgery after prior systemic chemotherapy from January 2015 to March 2019. Biopsies were assessed with the four-scale PRGS. Results Thirty-eight patients were included. Patients had a median of 2 (range 1-2) lines and 12 (range 3-18) cycles of prior systemic chemotherapy. Overall mean (SD) PRGS was 2.3 (±1.1). Of the patients, 26% (10) had complete response (PRGS 1), 40% (15) had major response (PRGS 2), 26% (10) minor response (PRGS 3), and 8% (3) had no response (PRGS 4). Mean PRGS was positively correlated with the Peritoneal Cancer Index (ρ = 0.5302, p = 0.0003) and inversely correlated with CRS (ρ = -0.8403, p < 0.0001). No correlation was highlighted between mean PRGS and overall survival (ρ = -0.0195, p = 0.9073). Conclusion CRS and mean PRGS correlated with each other. Histological response of PM after systemic chemotherapy was quantifiable and variable. The role of PRGS for the evaluation of treatment response and as potential surrogate marker for oncological outcomes is part of ongoing and planned research.
Collapse
Affiliation(s)
- Basile Pache
- Department of Visceral Surgery,Lausanne University Hospital (CHUV), University of Lausanne (UNIL), Lausanne, Switzerland
- Gynecology Unit, Department Women-Mother-Child,Lausanne University Hospital (CHUV), University of Lausanne (UNIL), Lausanne, Switzerland
- Faculté de Biologie et Médecine, University of Lausanne, Lausanne (UNIL), Switzerland
- Correspondence: Basile Pache
| | - Hugo Teixeira Farinha
- Department of Visceral Surgery,Lausanne University Hospital (CHUV), University of Lausanne (UNIL), Lausanne, Switzerland
- Faculté de Biologie et Médecine, University of Lausanne, Lausanne (UNIL), Switzerland
| | - Laura Toussaint
- Department of Visceral Surgery,Lausanne University Hospital (CHUV), University of Lausanne (UNIL), Lausanne, Switzerland
- Faculté de Biologie et Médecine, University of Lausanne, Lausanne (UNIL), Switzerland
| | - Nicolas Demartines
- Department of Visceral Surgery,Lausanne University Hospital (CHUV), University of Lausanne (UNIL), Lausanne, Switzerland
- Faculté de Biologie et Médecine, University of Lausanne, Lausanne (UNIL), Switzerland
| | - Delfyne Hastir
- Faculté de Biologie et Médecine, University of Lausanne, Lausanne (UNIL), Switzerland
- Department of Pathology,Lausanne University Hospital (CHUV), University of Lausanne (UNIL), Lausanne, Switzerland
| | - Patrice Mathevet
- Gynecology Unit, Department Women-Mother-Child,Lausanne University Hospital (CHUV), University of Lausanne (UNIL), Lausanne, Switzerland
- Faculté de Biologie et Médecine, University of Lausanne, Lausanne (UNIL), Switzerland
| | - Christine Sempoux
- Faculté de Biologie et Médecine, University of Lausanne, Lausanne (UNIL), Switzerland
- Department of Pathology,Lausanne University Hospital (CHUV), University of Lausanne (UNIL), Lausanne, Switzerland
| | - Martin Hübner
- Department of Visceral Surgery,Lausanne University Hospital (CHUV), University of Lausanne (UNIL), Lausanne, Switzerland
- Faculté de Biologie et Médecine, University of Lausanne, Lausanne (UNIL), Switzerland
| |
Collapse
|
17
|
Matuszak M, Ochowiak M, Włodarczak S, Krupińska A, Doligalski M. State-of-the-Art Review of The Application and Development of Various Methods of Aerosol Therapy. Int J Pharm 2021; 614:121432. [PMID: 34971755 DOI: 10.1016/j.ijpharm.2021.121432] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 12/09/2021] [Accepted: 12/23/2021] [Indexed: 12/23/2022]
Abstract
Aerosol therapy is a rapidly developing field of science. Due to a number of advantages, the administration of drugs to the body with the use of aerosol therapy is becoming more and more popular. Spraying drugs into the patient's lungs has a significant advantage over other methods of administering drugs to the body, including injection and oral methods. In order to conduct proper and effective aerosol therapy, it is necessary to become familiar with the basic principles and applications of aerosol therapy under various conditions. The effectiveness of inhalation depends on many factors, but most of all on: the physicochemical properties of the sprayed system, the design of the medical inhaler and its correct application, the dynamics of inhalation (i.e. the frequency of breathing and the volume of inhaled air). It is worth emphasizing that respiratory system diseases are one of the most frequently occurring and fastest growing diseases in the world. Accordingly, in recent years, a significant increase in the number of new spraying devices and pharmaceutical drugs for spraying has appeared on the market. It should also be remembered that the process of spraying a liquid is a complicated and complex process, and its efficiency is very often characterized by the use of micro- and macro parameters (including average droplet diameters or the spectrum of droplet diameter distribution). In order to determine the effectiveness of the atomization process and in the delivery of drugs to the patient's respiratory tract, the analysis of the size of the generated aerosol droplets is most often performed. Based on the proposed literature review, it has been shown that many papers dealt with the issues related to aerosol therapy, the selection of an appropriate spraying device, the possibility of modifying the spraying devices in order to increase the effectiveness of inhalation, and the possibility of occurrence of certain discrepancies resulting from the use of various measurement methods to determine the characteristics of the generated aerosol. The literature review presented in the paper was prepared in order to better understand the spraying process. Moreover, it can be helpful in choosing the right medical inhaler for a given liquid with specific rheological properties. The experimental data contained in this study are of great cognitive importance and may be of interest to entities involved in pharmaceutical product engineering (in particular in the case of the production of drugs containing liquids with complex rheological properties).
Collapse
Affiliation(s)
- M Matuszak
- Faculty of Chemical Technology, Poznan University of Technology, Institute of Chemical Technology and Engineering, 4 Berdychowo Street, 60-965 Poznan, Poland.
| | - M Ochowiak
- Faculty of Chemical Technology, Poznan University of Technology, Institute of Chemical Technology and Engineering, 4 Berdychowo Street, 60-965 Poznan, Poland
| | - S Włodarczak
- Faculty of Chemical Technology, Poznan University of Technology, Institute of Chemical Technology and Engineering, 4 Berdychowo Street, 60-965 Poznan, Poland
| | - A Krupińska
- Faculty of Chemical Technology, Poznan University of Technology, Institute of Chemical Technology and Engineering, 4 Berdychowo Street, 60-965 Poznan, Poland
| | - M Doligalski
- Faculty of Computer, Electrical and Control Engineering, University of Zielona Góra, 4a Szafrana Street, 65-516 Zielona Góra, Poland
| |
Collapse
|
18
|
Girardot-Miglierina A, Clerc D, Alyami M, Villeneuve L, Sgarbura O, Reymond MA, Hübner M. Consensus statement on safety measures for pressurized intraperitoneal aerosol chemotherapy. Pleura Peritoneum 2021; 6:139-149. [PMID: 35071734 PMCID: PMC8719448 DOI: 10.1515/pp-2021-0125] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 09/02/2021] [Indexed: 12/18/2022] Open
Abstract
Objectives Pressurized intraperitoneal aerosol chemotherapy (PIPAC) is a promising treatment for peritoneal cancer that entails, however, potential risks for the caregivers in the operating room (OR). This study aimed to reach a consensus within the PIPAC community on a comprehensive safety protocol. Methods Active PIPAC centers were invited to participate in a two-round Delphi process on 43 predefined items: concise summaries of the existing evidence were presented together with questions formulated using the population, intervention, comparator, and outcome framework. According to the Grading of Recommendations Assessment, Development, and Evaluation, the strength of recommendation was voted by panelists, accepting a consensus threshold of ≥50% of the agreement for any of the four grading options, or ≥70% in either direction. Results Forty-seven out of 66 invited panelists answered both rounds (response rate 76%). The consensus was reached for 41 out of 43 items (95.3%). Strong and weak recommendations were issued for 30 and 10 items, respectively. A positive consensual recommendation was issued to activate laminar airflow without specific strength, neither strong nor weak. No consensus was reached for systematic glove change for caregivers with a high risk of exposure and filtering facepiece mask class 3 for caregivers with low risk of exposure. Conclusions A high degree of consensus was reached for a comprehensive safety protocol for PIPAC, adapted to the risk of exposure for the different caregivers in the OR. This consensus can serve as a basis for education and help reach a high degree of adherence in daily practice.
Collapse
Affiliation(s)
- Arnaud Girardot-Miglierina
- Department of Visceral Surgery , Lausanne University Hospital CHUV, University of Lausanne (UNIL) , Lausanne , Switzerland
| | - Daniel Clerc
- Department of Visceral Surgery , Lausanne University Hospital CHUV, University of Lausanne (UNIL) , Lausanne , Switzerland
| | - Mohammad Alyami
- Department of General Surgery and Surgical Oncology , Oncology Center, King Khalid Hospital , Najran , Saudi Arabia
| | - Laurent Villeneuve
- Department of Public Health , Clinical Research and Epidemiological Unit, Lyon University Hospital , Lyon , France
- University of Lyon , Lyon , France
| | - Olivia Sgarbura
- Department of Surgical Oncology , Cancer Institute Montpellier (ICM) , Montpellier , France
- University of Montpellier , Montpellier , France
- IRCM, Institut de Recherche en Cancérologie de Montpellier, INSERM U1194, Université de Montpellier , Montpellier , France
| | - Marc-André Reymond
- Department of General and Transplant Surgery , University Hospital Tübingen and National Center for Pleura and Peritoneum , Tübingen , Germany
| | - Martin Hübner
- Department of Visceral Surgery , Lausanne University Hospital CHUV, University of Lausanne (UNIL) , Lausanne , Switzerland
| |
Collapse
|
19
|
Akaishi EH, Vaz da Silva DG, Lima HVG, Grapperon-Mathis RLM, Arakaki MDS, Galindo IVA, Daia LA, Araruna GF, Oliveira ALT, Mancini CN, Hoff PMG. Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC): The First Reported Case in Brazil Using Standardized Technique with the Capnopen® Nebulizer Device. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e933906. [PMID: 34725317 PMCID: PMC8574167 DOI: 10.12659/ajcr.933906] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Peritoneal metastasis is a common progression of abdominal-pelvic cancers, and it is associated with poorer oncological prognosis when compared to other metastasis sites. Its treatment has limited results, mainly because of poor bioavailability of chemotherapy within the abdominal cavity after systemic administration. Pressurized intraperitoneal aerosol chemotherapy (PIPAC) has been proposed as a novel method to deliver chemotherapy directly into the peritoneal surface; it combines the effectiveness and response of an intraperitoneal therapy with benefits of a minimally invasive approach. The laparoscopic capnoperitoneum is used to instill chemotherapy particles in a more efficient way for distribution and penetration when compared to peritoneal lavage. In the present study, we describe the first PIPAC performed in Brazil, according to the standard technique previously described with the Capnopen® nebulizer device, as well as technique details based on our literature review. CASE REPORT A 67-year-old man with pancreatic adenocarcinoma metastatic to the liver at first diagnosis underwent systemic treatment with the FOLFIRINOX protocol. After a major clinical response due to systemic treatment, pancreaticoduodenectomy was performed with resection and radiofrequency ablation of hepatic nodules. After 7 months of follow-up, the patient's condition evolved with symptomatic relapse in the peritoneum. Aiming at better control of this site, multiple PIPAC procedures were performed, showing excellent control of the peritoneal cavity disease. The patient had a sustained response in the peritoneal cavity and showed systemic disease progression 6 months after the first PIPAC procedure, which deceased at 20 months after the first PIPAC procedure and 42 months after the primary diagnosis. CONCLUSIONS This report shows that the PIPAC procedure is reproducible elsewhere, with safety and good functional results.
Collapse
Affiliation(s)
| | - Diego Greatti Vaz da Silva
- Department of Surgical Oncology, Oncologia D'Or, D'Or Institute for Research and Education (IDOR), São Paulo, SP, Brazil.,Department of Surgical Oncology, Mário Covas State Hospital, Faculdade de Medicina do ABC (FMABC), Santo André, SP, Brazil
| | - Helber Vidal Gadelha Lima
- Department of Surgery, University of São Paulo Hospital das Clínicas, São Paulo, SP, Brazil.,Department of Surgical Oncology, Oncologia D'Or, D'Or Institute for Research and Education (IDOR), São Paulo, SP, Brazil
| | | | - Mariana de Souza Arakaki
- Department of Surgical Oncology, Oncologia D'Or, D'Or Institute for Research and Education (IDOR), São Paulo, SP, Brazil
| | - Ivan Vinicius Andrade Galindo
- Department of Surgical Oncology, Oncologia D'Or, D'Or Institute for Research and Education (IDOR), São Paulo, SP, Brazil
| | - Lucas Afonso Daia
- Department of Surgical Oncology, Oncologia D'Or, D'Or Institute for Research and Education (IDOR), São Paulo, SP, Brazil
| | - Gustavo Ferreira Araruna
- Department of Surgical Oncology, Oncologia D'Or, D'Or Institute for Research and Education (IDOR), São Paulo, SP, Brazil
| | - André Luiz Torres Oliveira
- Department of Surgical Oncology, Oncologia D'Or, D'Or Institute for Research and Education (IDOR), São Paulo, SP, Brazil
| | - Caio Nasser Mancini
- Department of Surgical Oncology, Oncologia D'Or, D'Or Institute for Research and Education (IDOR), São Paulo, SP, Brazil
| | - Paulo Marcelo Gehm Hoff
- Department of Oncology, D'Or Institute for Research and Education (IDOR), São Paulo, SP, Brazil.,Department of Radiology and Medical Oncology, Cancer Institute of The State of São Paulo (ICESP), University of São Paulo Hospital das Clínicas, São Paulo, SP, Brazil
| |
Collapse
|
20
|
Toussaint L, Teixeira Farinha H, Barras JL, Demartines N, Sempoux C, Hübner M. Histological regression of gastrointestinal peritoneal metastases after systemic chemotherapy. Pleura Peritoneum 2021; 6:113-119. [PMID: 34676284 PMCID: PMC8482450 DOI: 10.1515/pp-2021-0118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 05/12/2021] [Indexed: 11/15/2022] Open
Abstract
Objectives Peritoneal metastases (PM) are relatively resistant to systemic chemotherapy, and data on histological response to therapy is rare. The aim of this study was to quantify the treatment response of PM after systemic chemotherapy. Methods Retrospective monocentric cohort study of 47 consecutive patients with PM from gastrointestinal origin undergoing surgery (cytoreduction: CRS + Hyperthermic IntraPEritoneal Chemotherapy [HIPEC] or Pressurized IntraPeritoneal Aerosol Chemotherapy [PIPAC]) after prior systemic chemotherapy from 1.2015 to 3.2019. Tumor response was assessed using the 4-scale Peritoneal Regression Grading System (PRGS) (4: vital tumor to 1: complete response). Results Patients had a median of 2 (range: 1-7) lines and 10 (3-39) cycles of prior systemic chemotherapy. A median of four biopsies (range: 3-8) was taken with a total of 196 analyzed specimens. Twenty-four biopsies (12%) showed no histological regression (PRGS4), while PRGS 3, two and one were diagnosed in 37 (19%), 39 (20%), and 69 (49%) specimens, respectively. A significant heterogeneity was found between peritoneal biopsies in 51% patients. PRGS correlated strongly with peritoneal spread (PCI, p<0.0001), and was improved in patients with more than nine cycles of systemic chemotherapy (p=0.04). Median survival was higher in patients with PRGS < 1.8 (Quartiles one and 2) than higher (Q3 and Q4), but the difference did not reach significance in this small cohort. Conclusions PRGS is an objective too to describe histological response of PM of GI origin after systemic chemotherapy. This response differs significantly between patients, allowing to distinguish between chemosensitive and chemoresistant tumors.
Collapse
Affiliation(s)
- Laura Toussaint
- Department of Visceral Surgery, Lausanne University Hospital (CHUV), University of Lausanne (UNIL), Lausanne, Switzerland
| | - Hugo Teixeira Farinha
- Department of Visceral Surgery, Lausanne University Hospital (CHUV), University of Lausanne (UNIL), Lausanne, Switzerland
| | - Jean-Luc Barras
- Institute of Pathology, Lausanne University Hospital (CHUV), University of Lausanne (UNIL), Lausanne, Switzerland
| | - Nicolas Demartines
- Department of Visceral Surgery, Lausanne University Hospital (CHUV), University of Lausanne (UNIL), Lausanne, Switzerland
| | - Christine Sempoux
- Institute of Pathology, Lausanne University Hospital (CHUV), University of Lausanne (UNIL), Lausanne, Switzerland
| | - Martin Hübner
- Department of Visceral Surgery, Lausanne University Hospital (CHUV), University of Lausanne (UNIL), Lausanne, Switzerland
| |
Collapse
|
21
|
Evaluation of the environmental contamination and exposure risk in medical/non-medical staff after oxaliplatin-based pressurized intraperitoneal aerosol chemotherapy. Toxicol Appl Pharmacol 2021; 429:115694. [PMID: 34428445 DOI: 10.1016/j.taap.2021.115694] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 08/11/2021] [Accepted: 08/16/2021] [Indexed: 11/17/2022]
Abstract
Pressurized intraperitoneal aerosol chemotherapy (PIPAC) is a technique to directly deliver chemotherapeutic drugs in the abdomen for the treatment of peritoneal metastases. Pressurization improves the treatment efficacy but increases the risk of exposure for the medical/non-medical staff who can be exposed by dermal or ocular contact, or inhalation of aerosols containing the cytotoxic drugs. The aim of this study was to evaluate the risk of exposure for the medical/non-medical staff (nurses, surgeons, anaesthesiologists and cleaning personnel; n = 13) during PIPAC with oxaliplatin performed according to the protocol recommended in France. Blood samples were collected 1 h before and immediately after PIPAC, and urine samples 1 h before, and then 3 h and the morning after PIPAC. In the control, non-exposed group (n = 7), only one urine and blood sample were collected. Surface contamination in the operating room was assessed in water- and Surfanios-impregnated wipe samples. The total elemental platinum in each sample was quantified by inductively coupled plasma mass spectrometry, using a method adapted to quantify trace amounts (ng.L-1) in very low volumes (100 μl). No surface contamination was detected. Although 25% of urine samples in the exposed group contained platinum, no statistical difference was observed in urine and plasma samples collected before and after PIPAC and with the control group samples. These findings suggest that the French PIPAC protocol does not increase the risk of exposure to platinum in all staff categories involved. This protocol could be considered in future occupational policies and consensus statements. Trial registration: NCT04014426.
Collapse
|
22
|
Mimouni M, Richard C, Adenot P, Letheule M, Tarrade A, Sandra O, Dahirel M, Lilin T, Lecuelle B, Gélin V, Cohen J, Fauconnier A, Vialard F, Huchon C, Chavatte-Palmer P. Pressurized intra-peritoneal aerosol chemotherapy (PIPAC): increased intraperitoneal pressure does not affect distribution patterns but leads to deeper penetration depth of doxorubicin in a sheep model. BMC Cancer 2021; 21:461. [PMID: 33902518 PMCID: PMC8073905 DOI: 10.1186/s12885-021-07955-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 02/23/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Pressurized Intra-Peritoneal Aerosol Chemotherapy (PIPAC) is an innovative treatment against peritoneal carcinomatosis. Doxorubicin is a common intra-venous chemotherapy used for peritoneal carcinomatosis and for PIPAC. This study evaluated the impact of increased PIPAC intraperitoneal pressure on the distribution and cell penetration of doxorubicin in a sheep model. METHODS Doxorubicin was aerosolized using PIPAC into the peritoneal cavity of 6 ewes (pre-alpes breed): N = 3 with 12 mmHg intraperitoneal pressure ("group 12") and N = 3 with 20 mmHg ("group 20"). Samples from peritoneum (N = 6), ovarian (N = 1), omentum (N = 1) and caecum (N = 1) were collected for each ewe. The number of doxorubicin positive cells was determined using the ratio between doxorubicine fluorescence-positive cell nuclei (DOXO+) over total number of DAPI positive cell nuclei (DAPI+). Penetration depth (μm) was defined as the distance between the luminal surface and the location of the deepest DOXO+ nuclei over the total number of cell nuclei that were stained with DAPI. Penetration depth (μm) was defined as the distance between the luminal surface and the location of the deepest DOXO+ nuclei. RESULTS DOXO+ nuclei were identified in 87% of samples. All omental samples, directly localized in front of the nebulizer head, had 100% DOXO+ nuclei whereas very few nuclei were DOXO+ for caecum. Distribution patterns were not different between the two groups but penetration depth in ovary and caecum samples was significantly deeper in group 20. CONCLUSIONS This study showed that applying a higher intra-peritoneal pressure during PIPAC treatment leads to a deeper penetration of doxorubicin in ovarian and caecum but does not affect distribution patterns.
Collapse
Affiliation(s)
- Myriam Mimouni
- Université Paris-Saclay, UVSQ, INRAE, BREED, 78350, Jouy-en-Josas, France.
- Ecole Nationale Vétérinaire d'Alfort, BREED, 94700, Maisons-Alfort, France.
- Department of Gynecology and Obstetrics, 10 rue du Champ Gaillard, CHI Poissy-Saint-Germain, 78300, Poissy, France.
| | - Christophe Richard
- Université Paris-Saclay, UVSQ, INRAE, BREED, 78350, Jouy-en-Josas, France
- Ecole Nationale Vétérinaire d'Alfort, BREED, 94700, Maisons-Alfort, France
| | - Pierre Adenot
- Université Paris-Saclay, UVSQ, INRAE, BREED, 78350, Jouy-en-Josas, France
- Ecole Nationale Vétérinaire d'Alfort, BREED, 94700, Maisons-Alfort, France
| | - Martine Letheule
- Université Paris-Saclay, UVSQ, INRAE, BREED, 78350, Jouy-en-Josas, France
- Ecole Nationale Vétérinaire d'Alfort, BREED, 94700, Maisons-Alfort, France
| | - Anne Tarrade
- Université Paris-Saclay, UVSQ, INRAE, BREED, 78350, Jouy-en-Josas, France
- Ecole Nationale Vétérinaire d'Alfort, BREED, 94700, Maisons-Alfort, France
| | - Olivier Sandra
- Université Paris-Saclay, UVSQ, INRAE, BREED, 78350, Jouy-en-Josas, France
- Ecole Nationale Vétérinaire d'Alfort, BREED, 94700, Maisons-Alfort, France
| | - Michèle Dahirel
- Université Paris-Saclay, UVSQ, INRAE, BREED, 78350, Jouy-en-Josas, France
- Ecole Nationale Vétérinaire d'Alfort, BREED, 94700, Maisons-Alfort, France
| | - Thomas Lilin
- Centre de Recherche BioMédicale (CRBM), ENVA, UPE, Maisons-Alfort, France
| | - Benoit Lecuelle
- Centre de Recherche BioMédicale (CRBM), ENVA, UPE, Maisons-Alfort, France
| | - Valérie Gélin
- Université Paris-Saclay, UVSQ, INRAE, BREED, 78350, Jouy-en-Josas, France
- Ecole Nationale Vétérinaire d'Alfort, BREED, 94700, Maisons-Alfort, France
| | - Julien Cohen
- Medistat, Biostatistics, 10-12 rue de la Conception, 13004, Marseille, France
| | - Arnaud Fauconnier
- Department of Gynecology and Obstetrics, 10 rue du Champ Gaillard, CHI Poissy-Saint-Germain, 78300, Poissy, France
- Department of Pharmacy, 10 rue du Champ Gaillard, CHI Poissy-Saint-Germain, Poissy, France
| | - François Vialard
- Université Paris-Saclay, UVSQ, INRAE, BREED, 78350, Jouy-en-Josas, France
- Ecole Nationale Vétérinaire d'Alfort, BREED, 94700, Maisons-Alfort, France
- Department of Gynecology and Obstetrics, 10 rue du Champ Gaillard, CHI Poissy-Saint-Germain, 78300, Poissy, France
| | - Cyrille Huchon
- Department of Gynecology and Obstetrics, 10 rue du Champ Gaillard, CHI Poissy-Saint-Germain, 78300, Poissy, France
- EA 7285 Clinical Risks and Safety on Women's Health, University Versailles-Saint-Quentin en Yvelines, 2 avenue de la Bièvre, 78180, Montigny le Bretonneux, France
- APHP. Department of Gynecology and Obstetrics, Hôpital Lariboisière, University of Paris, 2, rue Ambroise Paré, 75010, Paris, France
| | - Pascale Chavatte-Palmer
- Université Paris-Saclay, UVSQ, INRAE, BREED, 78350, Jouy-en-Josas, France
- Ecole Nationale Vétérinaire d'Alfort, BREED, 94700, Maisons-Alfort, France
| |
Collapse
|
23
|
Feldbrügge L, Gronau F, Brandl A, Auer TA, Oeff A, Thuss-Patience P, Pratschke J, Rau B. Systemic Chemotherapy Including Ramucirumab in Combination With Pressurized Intra-Peritoneal Aerosol Chemotherapy Is a Safe Treatment Option for Peritoneal Metastasis of Gastric Cancer. Front Oncol 2021; 10:610572. [PMID: 33912438 PMCID: PMC8074678 DOI: 10.3389/fonc.2020.610572] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 12/08/2020] [Indexed: 01/10/2023] Open
Abstract
Background Pressurized intraperitoneal aerosol chemotherapy (PIPAC) is a laparoscopic technique for local chemotherapy. It has been used for treatment of peritoneal metastasis of gastric cancer (PM GC) in combination with systemic therapy. VEGFR2 antagonist ramucirumab is a second-line therapy for GC, and has been suspected to cause wound healing disorders. Methods This is a retrospective single center cohort study of patients with PM GC, who received PIPAC treatment in combination with systemic chemotherapy with and without ramucirumab. Data on patients’ characteristics and their perioperative courses were collected and complication rates were compared with regard to preoperative use of ramucirumab and time between last dose of systemic therapy and PIPAC treatment. Results Fifty patients underwent 90 PIPAC treatments for PM GC in 3 years. Overall postoperative morbidity was 11% with 6% severe complications. The mean interval between systemic therapy and PIPAC was 20 days. Neither the length of interval nor the use of ramucirumab had an effect on complication rates. Conclusion Our study suggests that addition of ramucirumab to pre-PIPAC systemic therapy, irrespective of the length of the treatment-free interval before PIPAC, does not increase the risk of postoperative complications and is therefore a safe option for treatment of PM GC.
Collapse
Affiliation(s)
- Linda Feldbrügge
- Department of Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Felix Gronau
- Department of Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Andreas Brandl
- Department of Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,Digestive Unit, Champalimaud Foundation, Lisbon, Portugal
| | - Timo Alexander Auer
- Department of Radiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Alan Oeff
- Department of Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Peter Thuss-Patience
- Department of Hematology, Oncology, and Tumor Immunology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Johann Pratschke
- Department of Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Beate Rau
- Department of Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| |
Collapse
|
24
|
Lurvink RJ, Van der Speeten K, Rovers KP, de Hingh IHJT. The emergence of pressurized intraperitoneal aerosol chemotherapy as a palliative treatment option for patients with diffuse peritoneal metastases: a narrative review. J Gastrointest Oncol 2021; 12:S259-S270. [PMID: 33968442 DOI: 10.21037/jgo-20-497] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Pressurized intraperitoneal aerosol chemotherapy (PIPAC) is an emerging palliative treatment for patients with unresectable peritoneal metastases. Potential advantages of PIPAC over current treatment options are a homogeneous intraperitoneal distribution, low local and systemic toxicity, and enhanced tumour penetration. Given these possible benefits, PIPAC is increasingly implemented in many centres worldwide. Scientific research into PIPAC is currently available from in vitro/in vivo/in animal studies, retrospective cohorts in humans, and phase I and II studies in humans. There are no results from randomised trials comparing PIPAC with conventional treatment, such as palliative systemic therapy. This narrative review aimed to provide an overview of the currently available literature on PIPAC. In general, repetitive PIPAC was feasible and safe for patients and operating room personnel. Primary and secondary non-access rates varied from 0-17% and 0-15%, respectively. Iatrogenic bowel injury was observed in 0-3% of PIPAC procedures. CTCAE grade 1-2 complications were common, mostly consisting of abdominal pain, nausea, vomiting, and fatigue. CTCAE grade 3-4 complications were uncommon, occurring on 0-15% of PIPAC procedures. Post-operative mortality rates of 0-2% were reported. The risk of occupational exposure to cytotoxic drugs was very low when strict safety guidelines were followed. Clinical heterogeneity was high in most studies, since, in general, patients with unresectable peritoneal metastases from a variety of primary tumours were included. Also, patients received either PIPAC monotherapy or PIPAC combined with concomitant systemic therapy, and were able to receive PIPAC in any line of palliative treatment. Since the results were generally not stratified for these three important factors, this severely complicates the interpretation of results. Based on the current literature, PIPAC may be regarded as a promising palliative treatment option in patients with diffuse peritoneal metastases. Initial results show that it is feasible and safe. However, well designed and (ideally) randomized controlled trials are urgently needed to determine the additional value of PIPAC in this setting. Until then, PIPAC should preferably be performed in the setting of clinical trials.
Collapse
Affiliation(s)
- Robin J Lurvink
- Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands
| | | | - Koen P Rovers
- Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands
| | - Ignace H J T de Hingh
- Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands.,GROW - School for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands
| |
Collapse
|
25
|
Oh S, Paik H, Park SJ, Lee EJ, Kim HS. Pressurized intraperitoneal aerosol chemotherapy for recurrent ovarian, fallopian or primary peritoneal cancer with peritoneal carcinomatosis: a narrative review. Gland Surg 2021; 10:1244-1251. [PMID: 33842271 DOI: 10.21037/gs-2019-ursoc-12] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
For recurrent ovarian, fallopian or primary peritoneal cancer with peritoneal carcinomatosis (PC), it is challenging to resect tumors completely or to get complete remission by intravenous (IV) chemotherapy, and many patients show the resistance to various chemotherapeutic agents for IV chemotherapy ultimately. As an alternative, pressurized intraperitoneal aerosol chemotherapy (PIPAC) has been introduced for treating the disease, which delivers chemotherapeutic agents as an aerosol form while maintaining high intraperitoneal (IP) pressure. Based on preclinical studies, PIPAC showed better penetration depth and distribution of drugs into the peritoneum in comparison to conventional IP chemotherapy. Tumor regression on histology and peritoneal carcinomatosis index (PCI) has also been shown in relevant studies. In addition, most of the PIPAC procedures were completed successfully with acceptable toxicity due to the use of a low dose of chemotherapeutic agents. For considering these advantages of PIPAC, we review the current status of PIPAC for treating recurrent ovarian, fallopian or primary peritoneal cancer through literature review.
Collapse
Affiliation(s)
- Soohyun Oh
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Haerin Paik
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Soo Jin Park
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Eun Ji Lee
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Hee Seung Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| |
Collapse
|
26
|
Rovers KP, Wassenaar ECE, Lurvink RJ, Creemers GJM, Burger JWA, Los M, Huysentruyt CJR, van Lijnschoten G, Nederend J, Lahaye MJ, Deenen MJ, Wiezer MJ, Nienhuijs SW, Boerma D, de Hingh IHJT. Pressurized Intraperitoneal Aerosol Chemotherapy (Oxaliplatin) for Unresectable Colorectal Peritoneal Metastases: A Multicenter, Single-Arm, Phase II Trial (CRC-PIPAC). Ann Surg Oncol 2021; 28:5311-5326. [PMID: 33544279 DOI: 10.1245/s10434-020-09558-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 12/23/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Despite its increasing use, pressurized intraperitoneal aerosol chemotherapy with oxaliplatin (PIPAC-OX) has never been prospectively investigated as a palliative monotherapy for colorectal peritoneal metastases in clinical trials. This trial aimed to assess the safety (primary aim) and antitumor activity (key secondary aim) of PIPAC-OX monotherapy in patients with unresectable colorectal peritoneal metastases. METHODS In this two-center, single-arm, phase II trial, patients with isolated unresectable colorectal peritoneal metastases in any line of palliative treatment underwent 6-weekly PIPAC-OX (92 mg/m2). Key outcomes were major treatment-related adverse events (primary outcome), minor treatment-related adverse events, hospital stay, tumor response (radiological, biochemical, pathological, ascites), progression-free survival, and overall survival. RESULTS Twenty enrolled patients underwent 59 (median 3, range 1-6) PIPAC-OX procedures. Major treatment-related adverse events occurred in 3 of 20 (15%) patients after 5 of 59 (8%) procedures (abdominal pain, intraperitoneal hemorrhage, iatrogenic pneumothorax, transient liver toxicity), including one possibly treatment-related death (sepsis of unknown origin). Minor treatment-related adverse events occurred in all patients after 57 of 59 (97%) procedures, the most common being abdominal pain (all patients after 88% of procedures) and nausea (65% of patients after 39% of procedures). Median hospital stay was 1 day (range 0-3). Response rates were 0% (radiological), 50% (biochemical), 56% (pathological), and 56% (ascites). Median progression-free and overall survival were 3.5 months (interquartile range [IQR] 2.5-5.7) and 8.0 months (IQR 6.3-12.6), respectively. CONCLUSIONS In patients with unresectable colorectal peritoneal metastases undergoing PIPAC-OX monotherapy, some major adverse events occurred and minor adverse events were common. The clinical relevance of observed biochemical, pathological, and ascites responses remains to be determined, especially since radiological response was absent.
Collapse
Affiliation(s)
- Koen P Rovers
- Department of Surgery, Catharina Cancer Institute, Eindhoven, The Netherlands
| | - Emma C E Wassenaar
- Department of Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Robin J Lurvink
- Department of Surgery, Catharina Cancer Institute, Eindhoven, The Netherlands
| | - Geert-Jan M Creemers
- Department of Medical Oncology, Catharina Cancer Institute, Eindhoven, The Netherlands
| | - Jacobus W A Burger
- Department of Surgery, Catharina Cancer Institute, Eindhoven, The Netherlands
| | - Maartje Los
- Department of Medical Oncology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | | | | | - Joost Nederend
- Department of Radiology, Catharina Cancer Institute, Eindhoven, The Netherlands
| | - Max J Lahaye
- Department of Radiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Maarten J Deenen
- Department of Clinical Pharmacy, Catharina Cancer Institute, Eindhoven, The Netherlands
| | - Marinus J Wiezer
- Department of Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Simon W Nienhuijs
- Department of Surgery, Catharina Cancer Institute, Eindhoven, The Netherlands
| | - Djamila Boerma
- Department of Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Ignace H J T de Hingh
- Department of Surgery, Catharina Cancer Institute, Eindhoven, The Netherlands. .,GROW-School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands.
| |
Collapse
|
27
|
Castagna A, Zander AJ, Sautkin I, Schneider M, Shegokar R, Königsrainer A, Reymond MA. Enhanced intraperitoneal delivery of charged, aerosolized curcumin nanoparticles by electrostatic precipitation. Nanomedicine (Lond) 2021; 16:109-120. [PMID: 33448879 DOI: 10.2217/nnm-2020-0373] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Aims: To investigate the potential of curcumin-loaded polylactic-co-glycolic acid nanoparticles (CUR-PLGA-NPs), alone and with electrostatic precipitation, for improving tissue uptake during pressurized intraperitoneal aerosol chemotherapy (PIPAC). Methods: Positively and negatively charged CUR-PLGA-NPs were delivered as PIPAC into inverted bovine urinary bladders ex vivo. The experiment was repeated with the additional use of electrostatic precipitation pressurized intraperitoneal aerosol chemotherapy (electrostatic PIPAC). Results: Positively charged CUR-PLGA-NPs increased depth of tissue penetration by 81.5% and tissue concentration by 80%. Electrostatic precipitation further improved the uptake of positively charged CUR-PLGA-NPs by 41.8%. Conclusion: The combination of positive charge and electrostatic precipitation have significant potential to improve tissue uptake of nanoparticles during intraperitoneal chemotherapy.
Collapse
Affiliation(s)
- Arianna Castagna
- Department of General, Visceral & Transplant Surgery, Comprehensive Cancer Center, University of Tübingen, Hoppe-Seyler-Strasse 3, Tübingen 72076, Germany
| | - Alexandra J Zander
- Department of Pharmacy, Biopharmaceutics & Pharmaceutical Technology, Saarland University, Saarbrücken 66123, Germany
| | - Iaroslaw Sautkin
- Department of General, Visceral & Transplant Surgery, Comprehensive Cancer Center, University of Tübingen, Hoppe-Seyler-Strasse 3, Tübingen 72076, Germany
| | - Marc Schneider
- Department of Pharmacy, Biopharmaceutics & Pharmaceutical Technology, Saarland University, Saarbrücken 66123, Germany
| | | | - Alfred Königsrainer
- Department of General, Visceral & Transplant Surgery, Comprehensive Cancer Center, University of Tübingen, Hoppe-Seyler-Strasse 3, Tübingen 72076, Germany
| | - Marc André Reymond
- Department of General, Visceral & Transplant Surgery, Comprehensive Cancer Center, University of Tübingen, Hoppe-Seyler-Strasse 3, Tübingen 72076, Germany
| |
Collapse
|
28
|
Drevet G, Maury JM, Bakrin N, Tronc F. Technique of pressurized intrathoracic aerosol chemotherapy (PITAC) for malignant pleural effusion. Pleura Peritoneum 2020; 5:20200129. [PMID: 33575461 PMCID: PMC7823156 DOI: 10.1515/pp-2020-0129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 10/21/2020] [Indexed: 11/17/2022] Open
Abstract
Objectives Malignant pleural effusion (MPE) is a devastating evolution of several malignancies. Pressurized intrathoracic aerosol chemotherapy (PITAC) might be a novel therapy option in MPE. Methods PITAC is considered for patients with MPE with a performance status <2 and without other metastatic sites. General anesthesia is administered and a double-lumen bronchial tube is inserted. The patient is placed in a lateral decubitus position, and the operation is performed after ipsilateral lung exclusion. Two 12-mm balloon trocars are inserted—one in the seventh intercostal space in the mid-axillary line and one in the fifth intercostal space in the anterior axillary line. Extent of pleural disease and volume of MPE are documented. MPE is removed and parietal pleural biopsy are performed. An intrathoracic pressure of 12 mmHg CO2 is established, and a combination of Cisplatin (10.5 mg/m2 in a total volume of 150 cc NaCl 0.9%) and Doxorubicin (2.1 mg/m2 in a total volume of 50 cc NaCl 0.9%) are aerosolized via nebulizer in the pleural cavity. Vital signs and nebulization are remote-controlled. After 30 min, the remaining toxic aerosol is exhausted using a closed surgical smoke evacuation system. A 24Fr chest tube is inserted in postero-apical position with continuous negative pressure of 20 cm H2O. When needed, PITAC may be repeated every six weeks in alternate with systemic chemotherapy. Results In our hands, the technique above has shown to be feasible and safe. Conclusions Further studies are needed to assess the potential symptomatic and oncological benefits of PITAC in MPE.
Collapse
Affiliation(s)
- Gabrielle Drevet
- Department of Thoracic Surgery, Lung and Heart-Lung Transplantation, Louis Pradel Hospital, Hospices Civils de Lyon, Lyon, France
| | - Jean-Michel Maury
- Department of Thoracic Surgery, Lung and Heart-Lung Transplantation, Louis Pradel Hospital, Hospices Civils de Lyon, Lyon, France.,Viral Infection and Comparative Pathology (IVPC), UMR 754, Claude Bernard Lyon 1 University, Lyon, France
| | - Naoual Bakrin
- Department of General Surgery and Surgical Oncology, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France.,EMR 3738 Lyon Sud Charles Mérieux Faculty, Claude Bernard University Lyon 1, Oullins, France
| | - François Tronc
- Department of Thoracic Surgery, Lung and Heart-Lung Transplantation, Louis Pradel Hospital, Hospices Civils de Lyon, Lyon, France
| |
Collapse
|
29
|
Somashekhar SP, Rohit KC, Deo SVS, Ashwin KR. Practice patterns, attitudes, and knowledge among clinicians regarding hyperthermic intraperitoneal chemotherapy and pressurized intraperitoneal aerosol chemotherapy: a national survey by Indian society of peritoneal surface malignancies (ISPSM). Pleura Peritoneum 2020; 5:20200120. [PMID: 33364340 PMCID: PMC7746887 DOI: 10.1515/pp-2020-0120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 07/29/2020] [Indexed: 11/15/2022] Open
Abstract
Objectives Perception of cytoreductive surgery (CRS), hyperthermic intraperitoneal chemotherapy (HIPEC), and pressurized intraperitoneal aerosol chemotherapy (PIPAC) for treating peritoneal surface malignancies (PSM) differ widely among physicians. Methods This on-site survey performed during a major oncology congress in 2019 evaluated the current opinion, perceptions, knowledge and practice of HIPEC and PIPAC among oncologists in India. Results There were 147 respondents (gynecologists (30%), surgical oncologists and gastrointestinal surgeons (64%), and medical oncologists (6%)). Whereas most respondents considered CRS and HIPEC an appropriate therapeutic option, 25% would not recommend CRS and HIPEC. The main barriers to referral to an expert center were inaccessibility to such a center (37.8%), non-inclusion of CRS and HIPEC in clinical practice guidelines (32.4%), and a high morbidity/mortality (21.6%). Variations were found in the various practice patterns of CRS/HIPEC like eligibility criteria, HIPEC protocols and safety measures. Although PIPAC awareness as a novel therapeutic option was high, only a limited number of centers offered PIPAC, mainly because of non-access to technology and missing training opportunities (76.2%). Conclusions Lack of widespread acceptance, poor accessibility and low utilization presents a significant challenge for HIPEC and PIPAC in India. There is a need to raise the awareness of curative and palliative therapeutic options for PSM. This might be achieved by the creation of expert centers, specialized training curricula and of a new sub-speciality in oncology.
Collapse
Affiliation(s)
| | - Kumar C Rohit
- Department of Surgical Oncology, Manipal Comprehensive Cancer Center, Manipal Hospital, Bangalore, India
| | - S V S Deo
- All India Institute of Medical Sciences, New Delhi, India
| | | |
Collapse
|
30
|
Current practice of pressurized intraperitoneal aerosol chemotherapy (PIPAC): Still standardized or on the verge of diversification? Eur J Surg Oncol 2020; 47:149-156. [PMID: 32900609 DOI: 10.1016/j.ejso.2020.08.020] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 07/20/2020] [Accepted: 08/20/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND PIPAC is a new treatment modality for peritoneal cancer which has been practiced and evaluated until very recently by few academic centers in a highly standardized manner. Encouraging oncological outcomes and the safety profile have led to widespread adoption. The aim of this study was to assess current PIPAC practice in terms of technique, treatment and safety protocol, and indications. METHODS A standardized survey with 82 closed-ended questions was sent online to active PIPAC centers which were identified by help of PIPAC training centers and the regional distributors of the PIPAC-specific nebulizer. The survey inquired about center demographics (n = 8), technique (n = 34), treatment and safety protocol (n = 34), and indications (n = 6). RESULTS Overall, 62 out of 66 contacted PIPAC centers answered the survey (response rate 93%). 27 centers had performed >60 PIPAC procedures. A consensus higher than 70% was reached for 37 items (50%), and higher than 80% for 28 items (37.8%). The topics with the highest degree of consensus were safety and installation issues (93.5% and 80.65%) while chemotherapy and response evaluation were the least consensual topics (63.7 and 59.6%). The attitudes were not influenced by volume, PIPAC starting year, type of activity, or presence of peritoneal metastases program. CONCLUSION Homogeneous treatment standards of new techniques are important to guarantee safe implementation and practice but also to allow comparison between cohorts and multi-center analysis of merged data including registries. Efforts to avoid diversification of PIPAC practice include regular update of the PIPAC training curriculum, targeted research and a consensus statement.
Collapse
|
31
|
Martellotto S, Maillot C, Villeneuve L, Eveno C, Sgarbura O, Pocard M. Restricted access to innovative surgical technique related to a specific training, is it ethical? Example of the PIPAC procedure. A systematic review and an experts survey. Int J Surg 2020; 83:235-245. [PMID: 32738543 DOI: 10.1016/j.ijsu.2020.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 06/26/2020] [Accepted: 07/06/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Using the example of Pressurized Intra Peritoneal Aerosol Chemotherapy (PIPAC), we analyse the development model of this procedure and provide an ethical analysis of the involvement of the industry in a new development. SUMMARY BACKGROUND DATA In the case of breakthrough innovation, medical training is essential for safe use of the new procedure. In some cases, pharmaceutical companies decide to organise this training. But when it becomes the only training opportunity to use the device, scientists and clinicians could be exposed to a conflict of interest? METHODS We performed a literature review of PIPAC publications using the STROBE criteria. Then, we conducted interviews with an expert panel to analyse the ethical impact of involvement of the industry in the development of the PIPAC procedure. RESULTS The number of publications has increased every year since the first publication in Germany, where the technology was developed in 2013. The scientific production was of good quality, with a mean STROBE score of 18.2 ± 2.4 out of 22 points. Ten of the 33 included studies declared a conflict of interest. From the interviews, the main axe concerning the implication of the industry was the training model. The company had decided that only trained and approval surgeon could perform the PIPAC procedure. All four interviewed practitioners agreed that it was initially a good way to implement the procedure safely, but later they felt uncomfortable about the control and validation by the industry. CONCLUSION Based on the growing number of published papers from a growing number of international centres, the controlled training model is not limiting. However, the different levels of conflict of interest complicate transparency, and we postulated that this development model is limited to the beginning of the procedure diffusion. CLINICALTRIAL. GOV REGISTRATION NCT04341337.
Collapse
Affiliation(s)
- S Martellotto
- Sorbonne Université, Department of Endocrine and Digestive Surgery, Hospital Pitié Salpêtrière, Assistance Publique, Hôpitaux de Paris, Paris, France.
| | - C Maillot
- Department of Orthopedic and Traumatologic Surgery, Hospital Paris Nord Val de Seine, Bichat/Beaujon, Assistance Publique, Hôpitaux de Paris, Paris, France.
| | - L Villeneuve
- Department of Public Health, Clinical and Epidemiological Research, Hospices Civils de Lyon, EMR 3738, Lyon 1 University, Lyon, France.
| | - C Eveno
- Department of Digestive and Oncologic Surgery, Claude Huriez University Hospital, Centre Hospitalier Universitaire (CHU) Lille, Université de Lille, INSERM Unité Mixte de Recherche 1172-JPARC Jean-Pierre Aubert Research Center, Team "Mucins, Epithelial Differentiation, and Carcinogenesis", Lille, France.
| | - O Sgarbura
- Department, Montpellier Cancer Institute (ICM), University of Montpellier, Montpellier, France.
| | - M Pocard
- Université de Paris, UMR 1275 CAP Paris-Tech, F-75010, Paris, France; Department of Digestive and Oncologic Surgery, Hôpital Lariboisière, 2 Rue Ambroise Paré, 75010, Paris, France.
| |
Collapse
|
32
|
Di Giorgio A, Sgarbura O, Rotolo S, Schena CA, Bagalà C, Inzani F, Russo A, Chiantera V, Pacelli F. Pressurized intraperitoneal aerosol chemotherapy with cisplatin and doxorubicin or oxaliplatin for peritoneal metastasis from pancreatic adenocarcinoma and cholangiocarcinoma. Ther Adv Med Oncol 2020; 12:1758835920940887. [PMID: 32782488 PMCID: PMC7383654 DOI: 10.1177/1758835920940887] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 06/15/2020] [Indexed: 02/06/2023] Open
Abstract
Background Systemic chemotherapy for pancreatic adenocarcinoma (PDAC) and cholangiocarcinoma (CC) with peritoneal metastases (PM) is affected by several pharmacological shortcomings and low clinical efficacy. Pressurized intraperitoneal aerosol chemotherapy (PIPAC) is expected to maximize exposure of peritoneal nodules to antiblastic agents. This study aims to evaluate safety and efficacy of PIPAC for PM of PDAC and CC origin. Methods This is a retrospective analysis of consecutive PDAC and CC cases with PM treated with PIPAC at two European referral centers for peritoneal disease. We prospectively recorded from August 2016 to May 2019 demographic, clinical, surgical, and oncological data. We performed a feasibility and safety assessment and an efficacy analysis based on clinical and pathological regression. Results Twenty patients with PM from PDAC (14) and CC (six) underwent 45 PIPAC administrations. Cisplatin-doxorubicin or oxaliplatin were administered to eight and 12 patients, respectively. We experienced one intraoperative complication (small bowel perforation) and 18 grade 1-2 postoperative adverse events according to Common Terminology Criteria for Adverse Events version 4.0. A pathological regression was recorded in 50% of patients (62% in the cisplatin-doxorubicin cohort and 42% in the oxaliplatin one). Median survival from the first PIPAC was 9.7 and 10.9 months for PDAC and CC, respectively. Conclusion PIPAC resulted feasible and safe without relevant toxicity issues, with both cisplatin-doxorubicin and oxaliplatin. The pathological response observed supports the evidence of antitumoral activity. Despite the study limitations, these outcomes are encouraging, recommending PIPAC in prospective, controlled trials in the palliative setting or the first line chemotherapy for PM from PDAC and CC.
Collapse
Affiliation(s)
- Andrea Di Giorgio
- Foundation Policlinico Universitario A. Gemelli - IRCCS, Peritoneum and Retroperitoneum Surgery, Roma, Lazio, Italy
| | - Olivia Sgarbura
- Department of Surgical Oncology, Montpellier Cancer Institute, Montpellier, Languedoc-Roussillon, France
| | - Stefano Rotolo
- Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.), University of Palermo, Via del Vespro, 129, Palermo, 90127, Sicilia, Italy
| | - Carlo Alberto Schena
- Foundation Policlinico Universitario A. Gemelli - IRCCS, General Surgery Unit, Roma, Lazio, Italy
| | - Cinzia Bagalà
- Foundation Policlinico Universitario A. Gemelli - IRCCS, Division of Medical Oncology, Roma, Lazio, Italy
| | - Frediano Inzani
- Foundation Policlinico Universitario A. Gemelli - IRCCS, Anatomic Pathology Unit, Roma, Lazio, Italy
| | - Andrea Russo
- Foundation Policlinico Universitario A. Gemelli - IRCCS, Institute of Intensive Care Medicine and Anesthesiology, Roma, Lazio, Italy
| | - Vito Chiantera
- Division of Gynecologic Oncology, University of Palermo, Palermo, Sicilia, Italy
| | - Fabio Pacelli
- Foundation Policlinico Universitario A. Gemelli - IRCCS, Peritoneum and Retroperitoneum Surgery, Roma, Lazio, Italy
| |
Collapse
|
33
|
Alyami M, Hübner M, Grass F, Bakrin N, Villeneuve L, Laplace N, Passot G, Glehen O, Kepenekian V. Pressurised intraperitoneal aerosol chemotherapy: rationale, evidence, and potential indications. Lancet Oncol 2020; 20:e368-e377. [PMID: 31267971 DOI: 10.1016/s1470-2045(19)30318-3] [Citation(s) in RCA: 179] [Impact Index Per Article: 44.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 04/18/2019] [Accepted: 04/23/2019] [Indexed: 02/06/2023]
Abstract
Pressurised intraperitoneal aerosol chemotherapy (PIPAC) was introduced as a new treatment for patients with peritoneal metastases in November, 2011. Reports of its feasibility, tolerance, and efficacy have encouraged centres worldwide to adopt PIPAC as a novel drug delivery technique. In this Review, we detail the technique and rationale of PIPAC and critically assess its evidence and potential indications. A systematic search was done to identify all relevant literature on PIPAC published between Jan 1, 2011, and Jan 31, 2019. A total of 106 articles or reports on PIPAC were identified, and 45 clinical studies on 1810 PIPAC procedures in 838 patients were included for analysis. Repeated PIPAC delivery was feasible in 64% of patients with few intraoperative and postoperative surgical complications (3% for each in prospective studies). Adverse events (Common Terminology Criteria for Adverse Events greater than grade 2) occurred after 12-15% of procedures, and commonly included bowel obstruction, bleeding, and abdominal pain. Repeated PIPAC did not have a negative effect on quality of life. Using PIPAC, an objective clinical response of 62-88% was reported for patients with ovarian cancer (median survival of 11-14 months), 50-91% for gastric cancer (median survival of 8-15 months), 71-86% for colorectal cancer (median survival of 16 months), and 67-75% (median survival of 27 months) for peritoneal mesothelioma. From our findings, PIPAC has been shown to be feasible and safe. Data on objective response and quality of life were encouraging. Therefore, PIPAC can be considered as a treatment option for refractory, isolated peritoneal metastasis of various origins. However, its use in further indications needs to be validated by prospective studies.
Collapse
Affiliation(s)
- Mohammad Alyami
- Department of General Surgery and Surgical Oncology, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France; Department of General Surgery and Surgical Oncology, Oncology Center, King Khalid Hospital, Najran, Saudi Arabia.
| | - Martin Hübner
- Department of Visceral Surgery, Lausanne University Hospital, University of Lausanne, Switzerland
| | - Fabian Grass
- Department of Visceral Surgery, Lausanne University Hospital, University of Lausanne, Switzerland; Department of Surgery, Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN, USA
| | - Naoual Bakrin
- Department of General Surgery and Surgical Oncology, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France; EMR 3738 Lyon Sud Charles Mérieux Faculty, Claude Bernard University Lyon 1, Oullins, France
| | - Laurent Villeneuve
- Department of Public Health, Clinical Research and Epidemiology, Hospices Civils de Lyon, Lyon, France
| | - Nathalie Laplace
- Department of General Surgery and Surgical Oncology, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France; EMR 3738 Lyon Sud Charles Mérieux Faculty, Claude Bernard University Lyon 1, Oullins, France
| | - Guillaume Passot
- Department of General Surgery and Surgical Oncology, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France; EMR 3738 Lyon Sud Charles Mérieux Faculty, Claude Bernard University Lyon 1, Oullins, France
| | - Olivier Glehen
- Department of General Surgery and Surgical Oncology, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France; EMR 3738 Lyon Sud Charles Mérieux Faculty, Claude Bernard University Lyon 1, Oullins, France
| | - Vahan Kepenekian
- Department of General Surgery and Surgical Oncology, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France; EMR 3738 Lyon Sud Charles Mérieux Faculty, Claude Bernard University Lyon 1, Oullins, France
| |
Collapse
|
34
|
Alyami M, Bonnot PE, Mercier F, Laplace N, Villeneuve L, Passot G, Bakrin N, Kepenekian V, Glehen O. Pressurized intraperitoneal aerosol chemotherapy (PIPAC) for unresectable peritoneal metastasis from gastric cancer. Eur J Surg Oncol 2020; 47:123-127. [PMID: 32561204 DOI: 10.1016/j.ejso.2020.05.021] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 05/09/2020] [Accepted: 05/25/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND PIPAC is a recent approach with promising results for patients with peritoneal metastasis (PM). We aimed to evaluate survival and postoperative outcome of patients with unresectable PM from gastric origin treated with chemotherapy and PIPAC. METHODS A retrospective analysis of a prospective maintained PIPAC database was queried for all patients diagnosed with unresectable PM from gastric cancer who underwent PIPAC before 2018. PIPAC with Cisplatin 7.5 mg/m2 and doxorubicin 1.5 mg/m2 were given for 30 min at 6-week intervals. Outcome criteria were overall survival and adverse events according to (CTCAE) version4.0. RESULTS One hundred Sixty-three PIPAC were done in 42 consecutive patients. Twenty-two (52%) of the patients were female. Signet-ring cells were observed in 33/42 patients (78.6%). At the first PIPAC, median age was 51.5 years (32-74). Median PCI was 17 (1-39). Twenty (47.6%) patients underwent more than 2 lines of pre-PIPAC chemotherapy. All patients had systemic chemotherapy alternating with PIPAC. Median consecutive PIPAC procedures were 3 (1-12). Overall and major complications (CTCAE - III, IV) occurred in 10 (6.1%) and 5 procedures (3.1%), respectively. Two patients (4.7%) died within 30 days of a PIPAC procedure, one related to small bowel obstruction and a pulmonary embolism for the other. Overall Survival was 19.1 months. Six (14.3%) patients became resectable during treatment and underwent curative intent CRS and HIPEC. CONCLUSIONS PIPAC with low-dose cisplatin and doxorubicin is safe and feasible in association with systemic chemotherapy for gastric PM. Survival data are encouraging and justify further clinical studies in this indication.
Collapse
Affiliation(s)
- Mohammad Alyami
- Department of General Surgery & Surgical Oncology, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre, Bénite, France; EMR 3738, Lyon 1 University, Lyon, France; Department of General Surgery and Surgical Oncology, Oncology Center, King Khalid Hospital, Najran, Saudi Arabia.
| | - Pierre-Emmanuel Bonnot
- Department of General Surgery & Surgical Oncology, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre, Bénite, France; EMR 3738, Lyon 1 University, Lyon, France
| | - Frederic Mercier
- Department of General Surgery & Surgical Oncology, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre, Bénite, France; Department of Surgical Oncology, Centre Hospitalo-Universitaire de Montreal, Montreal, Canada
| | - Nathalie Laplace
- Department of General Surgery & Surgical Oncology, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre, Bénite, France; EMR 3738, Lyon 1 University, Lyon, France
| | - Laurent Villeneuve
- Department of General Surgery & Surgical Oncology, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre, Bénite, France; EMR 3738, Lyon 1 University, Lyon, France
| | - Guillaume Passot
- Department of General Surgery & Surgical Oncology, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre, Bénite, France; EMR 3738, Lyon 1 University, Lyon, France
| | - Naoual Bakrin
- Department of General Surgery & Surgical Oncology, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre, Bénite, France; EMR 3738, Lyon 1 University, Lyon, France
| | - Vahan Kepenekian
- Department of General Surgery & Surgical Oncology, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre, Bénite, France; EMR 3738, Lyon 1 University, Lyon, France
| | - Olivier Glehen
- Department of General Surgery & Surgical Oncology, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre, Bénite, France; EMR 3738, Lyon 1 University, Lyon, France
| |
Collapse
|
35
|
Tate SJ, Torkington J. Pressurized intraperitoneal aerosol chemotherapy: a review of the introduction of a new surgical technology using the IDEAL framework. BJS Open 2020; 4:206-215. [PMID: 31957257 PMCID: PMC7093779 DOI: 10.1002/bjs5.50257] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 12/06/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The IDEAL (Idea, Development, Evaluation, Assessment, Long-term study) framework is a scheme of investigation for innovative surgical therapeutic interventions. Pressurized intraperitoneal aerosol chemotherapy (PIPAC) is a procedure based on laparoscopy to deliver intraperitoneal chemotherapy for peritoneal metastases, introduced in 2011. The aim of this article was to review literature on PIPAC and assess whether development of the technique has followed the IDEAL framework. METHODS A search of MEDLINE and Embase was carried out to identify scientific reports on PIPAC published between January 2000 and February 2019. The studies were categorized according to the IDEAL stages. RESULTS Eighty-six original research papers on PIPAC were identified. There were 23 stage 0, 18 stage 1, 25 stage 2a and six stage 2b studies. Protocol papers for stage 1, 2b and 3 studies, and trial registrations for stage 2a studies, were also identified. The number of centres publishing reports and the number of publications has increased each year. Overall, there has been progression through the IDEAL stages; however, about 60 per cent of clinical reports published in 2018 were stage 1 Idea-type studies. CONCLUSION Since its introduction, studies investigating PIPAC have progressed in line with the IDEAL framework. However, the majority of studies reported recently were stage 0 and 1 studies.
Collapse
Affiliation(s)
- S. J. Tate
- Department of General SurgeryUniversity Hospital of WalesCardiffUK
- Division of Cancer and GeneticsCardiff University School of MedicineCardiffUK
| | - J. Torkington
- Department of General SurgeryUniversity Hospital of WalesCardiffUK
| |
Collapse
|
36
|
Ploug M, Graversen M, Pfeiffer P, Mortensen MB. Bidirectional treatment of peritoneal metastasis with Pressurized IntraPeritoneal Aerosol Chemotherapy (PIPAC) and systemic chemotherapy: a systematic review. BMC Cancer 2020; 20:105. [PMID: 32041558 PMCID: PMC7011374 DOI: 10.1186/s12885-020-6572-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 01/23/2020] [Indexed: 02/08/2023] Open
Abstract
Background Pressurized intraperitoneal aerosol chemotherapy (PIPAC) is used in the palliative treatment of peritoneal metastasis. The combination of intraperitoneal and systemic chemotherapy seems rational, and the aim of this systematic review was to compare PIPAC directed monotherapy with a bidirectional treatment approach (PIPAC in combination with systemic chemotherapy). Main outcomes were survival and quality of life. Methods A systematic literature search in Medline, Embase, Cochrane and the “Pleura and Peritoneum” was conducted and analyzed according to PRISMA guidelines. Studies in English reporting on bidirectional treatment with PIPAC and systemic chemotherapy and published before April 2019 were included. Results Twelve studies with a total of 386 patients were included. None were specifically designed to compare mono- versus bidirectional treatment, but 44% of the patients received bidirectional treatment. This was more frequent in women (non-gynecological cancers) and one-third of the bidirectional treated patients had received no prior chemotherapy. Data from the included studies provided no conclusions regarding survival or quality of life. Conclusion Bidirectional treatment with PIPAC and systemic chemotherapy is practised and feasible, and some patients are enrolled having received no prior systemic chemotherapy for their PM. The difficulty in drawing any conclusions based on this systematic review has highlighted the urgent need to improve and standardize reports on PIPAC directed therapy. We have, therefore, constructed a list of items to be considered when reporting on clinical PIPAC research. Trial registration International Prospective Register of Systematic Reviews, PROSPERO. Registration number: 90352, March 5, 2018.
Collapse
Affiliation(s)
- Magnus Ploug
- Odense PIPAC Center (OPC) and Odense Pancreas Center (OPAC), Upper GI and HPB Section, Department of Surgery, Odense University Hospital, J.B.Winsløvs Vej 4, 5000, Odense C, Denmark.
| | - Martin Graversen
- Odense PIPAC Center (OPC) and Odense Pancreas Center (OPAC), Upper GI and HPB Section, Department of Surgery, Odense University Hospital, J.B.Winsløvs Vej 4, 5000, Odense C, Denmark
| | - Per Pfeiffer
- Odense PIPAC Center (OPC) and Odense Pancreas Center (OPAC), Upper GI and HPB Section, Department of Surgery, Odense University Hospital, J.B.Winsløvs Vej 4, 5000, Odense C, Denmark
| | - Michael Bau Mortensen
- Odense PIPAC Center (OPC) and Odense Pancreas Center (OPAC), Upper GI and HPB Section, Department of Surgery, Odense University Hospital, J.B.Winsløvs Vej 4, 5000, Odense C, Denmark
| |
Collapse
|
37
|
Overall clinical and trichoscopic analysis performed in patients who underwent pressurized intraperitoneal aerosol chemotherapy (PIPAC) treatment for peritoneal carcinomatosis - initial trial preliminary report. Postepy Dermatol Alergol 2019; 36:461-467. [PMID: 31616222 PMCID: PMC6791163 DOI: 10.5114/ada.2018.77096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 06/14/2018] [Indexed: 11/17/2022] Open
Abstract
Introduction Cutaneous adverse events are among the remaining problematic issues of current oncology. The term peritoneal carcinomatosis (PC) refers to the advanced cancer stage. The innovative treatment of PC includes the use of pressurized intraperitoneal aerosol chemotherapy (PIPAC). Aim To present a preliminary report from an initial trial aimed at an overall clinical and trichoscopic analysis performed in patients who underwent PIPAC treatment due to PC. Material and methods For all steps of this study we obtained the consent of the local bioethics commission #KB 196/2018. Three different hair assessment methods were used in our study: 1) general clinical and patient self-feeling assessment; 2) hair pull test; 3) and trichoscopic analysis. Results No hair or scalp disorders were noted in the observation period. In the self-feeling test assessment the vast majority recognized their hair as being of comparable quality or even better in quality compared to previous forms of chemotherapy they had undergone. In all patients we observed a reduction of hair loss in the pull test in the hospitalization period. In trichoscopic analysis we found all determinants and signs of hair disorders in the assessed group. Conclusions The PIPAC is safe and is not a burdensome or aggressive form of therapy, especially according to the very important factors influencing the potential quality of hair and hair loss. The authors, however, realize that to obtain comprehensive results and evaluate this novel and promising method we need to perform more research without any limitations like those in our study.
Collapse
|
38
|
Gockel I, Jansen-Winkeln B, Haase L, Niebisch S, Moulla Y, Lyros O, Lordick F, Schierle K, Wittekind C, Thieme R. Pressurized IntraPeritoneal Aerosol Chemotherapy (PIPAC) in patients with peritoneal metastasized colorectal, appendiceal and small bowel cancer. TUMORI JOURNAL 2019; 106:70-78. [PMID: 31469058 DOI: 10.1177/0300891619868013] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Patients with intestinal cancer (colorectal, appendiceal, and small bowel) with peritoneal metastases (PM) have a poor prognosis. We assessed whether pressurized intraperitoneal aerosol chemotherapy (PIPAC) together with systemic chemotherapy is an effective treatment option for these entities in palliative intent. METHODS Between November 2015 and February 2018, prospective data registry was performed (NCT03100708). Thirteen patients with intestinal cancer (median age 61 years [range 49-77]) underwent 26 PIPAC procedures with a median number of 2 interventions per patient (range 1-6). A chemoaerosol consisting of cisplatin/doxorubicin was administered during standard laparoscopy. RESULTS The median peritoneal carcinomatosis index according to Sugarbaker before the first PIPAC was 14 (range 2-27), and the median ascites volume was 10 mL (range 0-6300 mL). Six patients who received 2 or more PIPAC procedures had decreased and stable ascites volumes, while only 1 patient displayed increased ascites. The median overall survival was 303 days (range 30-490) after the first PIPAC procedure. CONCLUSIONS PIPAC offers a novel treatment option for patients with PM. Our data show that PIPAC is safe and well-tolerated. Ascites production can be controlled by PIPAC in patients with intestinal cancer. Further studies are required to document the significance of PIPAC within palliative therapy concepts. TRIAL REGISTRATION NCT03100708.
Collapse
Affiliation(s)
- Ines Gockel
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - Boris Jansen-Winkeln
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - Linda Haase
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - Stefan Niebisch
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - Yusef Moulla
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - Orestis Lyros
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - Florian Lordick
- University Cancer Center Leipzig, University Hospital of Leipzig, Leipzig, Germany
| | - Katrin Schierle
- Institute of Pathology, University Hospital of Leipzig, Leipzig, Germany
| | | | - René Thieme
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany
| |
Collapse
|
39
|
Graversen M, Detlefsen S, Ellebaek SB, Fristrup C, Pfeiffer P, Mortensen MB. Pressurized IntraPeritoneal Aerosol Chemotherapy with one minute of electrostatic precipitation (ePIPAC) is feasible, but the histological tumor response in peritoneal metastasis is insufficient. Eur J Surg Oncol 2019; 46:155-159. [PMID: 31493986 DOI: 10.1016/j.ejso.2019.08.024] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 08/14/2019] [Accepted: 08/28/2019] [Indexed: 01/20/2023] Open
Abstract
INTRODUCTION Electrostatic precipitation Pressurized IntraPeritoneal Aerosol Chemotherapy (ePIPAC) has shown superior penetration depth and tissue uptake compared to standard PIPAC. We investigated the feasibility and objective tumor response to ePIPAC with 1 min of precipitation in patients with peritoneal metastasis (PM). MATERIALS AND METHODS Patients with PM from various abdominal cancers were included in an amendment to the ongoing prospective PIPAC-OPC2 trial. Colorectal and appendiceal PM were treated with oxaliplatin, patients with PM from other primaries were treated with a combination of cisplatin and doxorubicin. Three ePIPAC procedures were planned in each patient including repeated peritoneal biopsies for response evaluation. After emission to the peritoneal cavity, the aerosolized chemotherapeutics were precipitated for 1 min followed by immediate exsufflation and abdominal closure. Histological regression from the first to the third ePIPAC was evaluated according to the Peritoneal Regression Grading Score (PRGS) and compared to data from the PIPAC-OPC1 trial. Complications and toxicities were recorded according to Dindo-Clavien and CTCAE. RESULTS Sixty-five ePIPAC procedures were performed in 33 patients (median 2, range 1-6). Ten patients were eligible for response evaluation based on biopsies from the first and third ePIPAC procedure. Four patients had disease progression, four patients had regressive disease, and two patients had stable disease according to PRGS. No life threatening adverse reactions and no mortality was observed following ePIPAC. CONCLUSION One minute ePIPAC was feasible and safe, but the histological tumor response was insufficient compared to standard PIPAC directed therapy with 30 min passive diffusion time.
Collapse
Affiliation(s)
- Martin Graversen
- Odense PIPAC Center & Odense Pancreas Center (OPAC), Odense University Hospital, J.B. Winsloews Vej 4, 5000, Odense, Denmark; Department of Surgery, Upper GI and HPB Section, Odense University Hospital, Denmark; Odense Patient Data Explorative Network, OPEN, University of Southern Denmark, Denmark.
| | - Sönke Detlefsen
- Odense PIPAC Center & Odense Pancreas Center (OPAC), Odense University Hospital, J.B. Winsloews Vej 4, 5000, Odense, Denmark; Department of Pathology, Odense University Hospital, Denmark
| | - Signe Bremholm Ellebaek
- Odense PIPAC Center & Odense Pancreas Center (OPAC), Odense University Hospital, J.B. Winsloews Vej 4, 5000, Odense, Denmark; Department of Surgery, Upper GI and HPB Section, Odense University Hospital, Denmark
| | - Claus Fristrup
- Odense PIPAC Center & Odense Pancreas Center (OPAC), Odense University Hospital, J.B. Winsloews Vej 4, 5000, Odense, Denmark; Department of Surgery, Upper GI and HPB Section, Odense University Hospital, Denmark
| | - Per Pfeiffer
- Odense PIPAC Center & Odense Pancreas Center (OPAC), Odense University Hospital, J.B. Winsloews Vej 4, 5000, Odense, Denmark; Department of Oncology, Odense University Hospital, Denmark
| | - Michael B Mortensen
- Odense PIPAC Center & Odense Pancreas Center (OPAC), Odense University Hospital, J.B. Winsloews Vej 4, 5000, Odense, Denmark; Department of Surgery, Upper GI and HPB Section, Odense University Hospital, Denmark
| |
Collapse
|
40
|
Rovers KP, Lurvink RJ, Wassenaar EC, Kootstra TJ, Scholten HJ, Tajzai R, Deenen MJ, Nederend J, Lahaye MJ, Huysentruyt CJ, van 't Erve I, Fijneman RJ, Constantinides A, Kranenburg O, Los M, Thijs AM, Creemers GJM, Burger JW, Wiezer MJ, Boerma D, Nienhuijs SW, de Hingh IH. Repetitive electrostatic pressurised intraperitoneal aerosol chemotherapy (ePIPAC) with oxaliplatin as a palliative monotherapy for isolated unresectable colorectal peritoneal metastases: protocol of a Dutch, multicentre, open-label, single-arm, phase II study (CRC-PIPAC). BMJ Open 2019; 9:e030408. [PMID: 31352425 PMCID: PMC6661551 DOI: 10.1136/bmjopen-2019-030408] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Repetitive electrostatic pressurised intraperitoneal aerosol chemotherapy with oxaliplatin (ePIPAC-OX) is offered as a palliative treatment option for patients with isolated unresectable colorectal peritoneal metastases (PM) in several centres worldwide. However, little is known about its feasibility, safety, tolerability, efficacy, costs and pharmacokinetics in this setting. This study aims to explore these parameters in patients with isolated unresectable colorectal PM who receive repetitive ePIPAC-OX as a palliative monotherapy. METHODS AND ANALYSIS This multicentre, open-label, single-arm, phase II study is performed in two Dutch tertiary referral hospitals for the surgical treatment of colorectal PM. Eligible patients are adults who have histologically or cytologically proven isolated unresectable PM of a colorectal or appendiceal carcinoma, a good performance status, adequate organ functions and no symptoms of gastrointestinal obstruction. Instead of standard palliative treatment, enrolled patients receive laparoscopy-controlled ePIPAC-OX (92 mg/m2 body surface area (BSA)) with intravenous leucovorin (20 mg/m2 BSA) and bolus 5-fluorouracil (400 mg/m2 BSA) every 6 weeks. Four weeks after each procedure, patients undergo clinical, radiological and biochemical evaluation. ePIPAC-OX is repeated until disease progression, after which standard palliative treatment is (re)considered. The primary outcome is the number of patients with major toxicity (grade ≥3 according to the Common Terminology Criteria for Adverse Events v4.0) up to 4 weeks after the last ePIPAC-OX. Secondary outcomes are the environmental safety of ePIPAC-OX, procedure-related characteristics, minor toxicity, postoperative complications, hospital stay, readmissions, quality of life, costs, pharmacokinetics of oxaliplatin, progression-free survival, overall survival, and the radiological, histopathological, cytological, biochemical and macroscopic tumour response. ETHICS AND DISSEMINATION This study is approved by an ethics committee, the Dutch competent authority and the institutional review boards of both study centres. Results are intended for publication in peer-reviewed medical journals and for presentation to patients, healthcare professionals and other stakeholders. TRIAL REGISTRATION NUMBER NCT03246321, Pre-results; ISRCTN89947480, Pre-results; NTR6603, Pre-results; EudraCT: 2017-000927-29, Pre-results.
Collapse
Affiliation(s)
- Koen P Rovers
- Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | - Robin J Lurvink
- Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | - Emma Ce Wassenaar
- Department of Surgery, Sint Antonius Hospital, Nieuwegein, The Netherlands
| | - Thomas Jm Kootstra
- Department of Surgery, Sint Antonius Hospital, Nieuwegein, The Netherlands
| | - Harm J Scholten
- Department of Anaesthesiology, Catharina Hospital, Eindhoven, The Netherlands
| | - Rudaba Tajzai
- Department of Clinical Pharmacy, Catharina Hospital, Eindhoven, The Netherlands
| | - Maarten J Deenen
- Department of Clinical Pharmacy, Catharina Hospital, Eindhoven, The Netherlands
| | - Joost Nederend
- Department of Radiology, Catharina Hospital, Eindhoven, The Netherlands
| | - Max J Lahaye
- Department of Radiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Iris van 't Erve
- Department of Pathology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Remond Ja Fijneman
- Department of Pathology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | | | - Maartje Los
- Department of Medical Oncology, Sint Antonius Hospital, Nieuwegein, The Netherlands
| | - Anna Mj Thijs
- Department of Medical Oncology, Catharina Hospital, Eindhoven, The Netherlands
| | | | - Jacobus Wa Burger
- Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | - Marinus J Wiezer
- Department of Surgery, Sint Antonius Hospital, Nieuwegein, The Netherlands
| | - Djamila Boerma
- Department of Surgery, Sint Antonius Hospital, Nieuwegein, The Netherlands
| | - Simon W Nienhuijs
- Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | - Ignace Hjt de Hingh
- Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands
- GROW - School for Oncology and Development Biology, Maastricht University, Maastricht, Netherlands
| |
Collapse
|
41
|
Alyami M, Mercier F, Siebert M, Bonnot PE, Laplace N, Villeneuve L, Passot G, Glehen O, Bakrin N, Kepenekian V. Unresectable peritoneal metastasis treated by pressurized intraperitoneal aerosol chemotherapy (PIPAC) leading to cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Eur J Surg Oncol 2019; 47:128-133. [PMID: 31253545 DOI: 10.1016/j.ejso.2019.06.028] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 06/13/2019] [Accepted: 06/19/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND PIPAC is a recent method of intraperitoneal chemotherapy. The aim of this study was to describe the clinical characteristics of the patients who became amenable to CRS & HIPEC after PIPAC treatment. METHODS All patients diagnosed with unresectable PM who became resectable throughout PIPAC treatment were included. Outcome criteria were adverse events following PIPAC procedure and rate of secondary CRS and HIPEC. RESULTS Four hundred thirty-seven PIPAC were done in 146 consecutive patients. Among them, 26 patients (17.8%) who underwent 76 PIPAC were scheduled for CRS and HIPEC after reduction of the peritoneal burden. PM were from gastric, peritoneal mesothelioma, ovarian, colorectal and small bowel in 13, 7, 4, 1 and 1 patients, respectively. At the time of the first PIPAC, median age was 58.6 years (32-76.3). Median PCI was 16 (1-39). All patients had systemic chemotherapy in between PIPAC session. Median consecutive PIPAC procedure was 3 (1-8). Complications occurred in 3 PIPAC session (4%) and there was no major complication (CTCAE III or higher). Complete CRS and HIPEC was achieved in 21 patients of the 26 scheduled (14.4%). The remaining 5 patients were considered unresectable at the exploratory laparotomy. Among patients who underwent CRS and HIPEC, with median follow-up of 7 (1-26) months, 14 patients (66.7%) were alive without recurrence, 2 patients (9.5%) were alive with recurrence and 5 patients (23.8%) died. CONCLUSIONS Complete CRS and HIPEC can be achieved in strictly selected patient with unresectable PM at diagnosis after repeated PIPAC session with palliative intent.
Collapse
Affiliation(s)
- Mohammad Alyami
- Department of General Surgery & Surgical Oncology, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France; EMR 3738, Lyon 1 University, Lyon, France; Department of General Surgery and Surgical Oncology, Oncology Center, King Khalid Hospital, Najran, Saudi Arabia.
| | - Frederic Mercier
- Department of General Surgery & Surgical Oncology, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France; Department of Surgical Oncology, Centre Hospitalo-Universitaire de Montreal, Montreal, Canada
| | - Matthieu Siebert
- Department of General Surgery & Surgical Oncology, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France; EMR 3738, Lyon 1 University, Lyon, France
| | - Pierre-Emmanuel Bonnot
- Department of General Surgery & Surgical Oncology, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France; EMR 3738, Lyon 1 University, Lyon, France
| | - Nathalie Laplace
- Department of General Surgery & Surgical Oncology, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France; EMR 3738, Lyon 1 University, Lyon, France
| | - Laurent Villeneuve
- Department of General Surgery & Surgical Oncology, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France; EMR 3738, Lyon 1 University, Lyon, France
| | - Guillaume Passot
- Department of General Surgery & Surgical Oncology, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France; EMR 3738, Lyon 1 University, Lyon, France
| | - Olivier Glehen
- Department of General Surgery & Surgical Oncology, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France; EMR 3738, Lyon 1 University, Lyon, France
| | - Naoual Bakrin
- Department of General Surgery & Surgical Oncology, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France; EMR 3738, Lyon 1 University, Lyon, France
| | - Vahan Kepenekian
- Department of General Surgery & Surgical Oncology, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France; EMR 3738, Lyon 1 University, Lyon, France
| |
Collapse
|
42
|
Willaert W, Van de Sande L, Van Daele E, Van De Putte D, Van Nieuwenhove Y, Pattyn P, Ceelen W. Safety and preliminary efficacy of electrostatic precipitation during pressurized intraperitoneal aerosol chemotherapy (PIPAC) for unresectable carcinomatosis. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2019; 45:2302-2309. [PMID: 31221459 DOI: 10.1016/j.ejso.2019.06.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 06/04/2019] [Accepted: 06/12/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Pressurized intraperitoneal aerosol chemotherapy (PIPAC) was recently introduced to treat unresectable peritoneal metastases. Adding an electrostatic field may enhance charged droplet precipitation and tissue penetration, resulting in improved anticancer efficacy. We report for the first time its safety and preliminary efficacy. MATERIALS AND METHODS Patients underwent PIPAC combined with an electrostatic field, using the Ultravision™ apparatus. Adverse events were scored with the Common Terminology Criteria. Treatment response was assessed after more than one PIPAC, using clinical symptoms, tumor markers, CT imaging and histological regression. RESULTS Forty-eight patients (median age, 61 y) with diverse primary tumors underwent 135 procedures (median per patient, 3). Most (65.2%) were treated as outpatient. Twenty-eight (58.3%) patients received concomitant chemotherapy. The most frequent treatment-related toxicities were anemia (grade 1 to 3, 13 [9.6%]), ileus (grade 1 to 3, 5 [3.7%]), anorexia (grade 1 to 3, 6 [4.4%]), nausea (grade 1 to 3, 5 [3.7%]) and vomiting (grade 1 to 3, 7 [5.2%]). There was no grade 4 or 5 morbidity. Twenty (41.7%) patients did not complete three treatments, mainly because of disease progression (n = 13). After two procedures, there were one responder and 8 non-responders. After three treatments, we observed 11 responders, two patients with stable disease, and 15 non-responders. All but one patient with therapy response received simultaneous chemotherapy. CONCLUSION Electrostatic precipitation during PIPAC is well tolerated and safe. After three procedures and concomitant chemotherapy, response or stable disease is achieved in approximately half of cases. These findings warrant prospective trials in homogeneous patient cohorts.
Collapse
Affiliation(s)
- W Willaert
- Department of Gastro-intestinal Surgery, Ghent University Hospital, Corneel Heymanslaan 10, B-9000, Ghent, Belgium; Laboratory of Experimental Surgery, Department of Human Structure and Repair, Ghent University, Corneel Heymanslaan 10, B-9000, Ghent, Belgium.
| | - L Van de Sande
- Laboratory of Experimental Surgery, Department of Human Structure and Repair, Ghent University, Corneel Heymanslaan 10, B-9000, Ghent, Belgium; Cancer Research Institute Ghent (CRIG), Ghent University, Belgium
| | - E Van Daele
- Department of Gastro-intestinal Surgery, Ghent University Hospital, Corneel Heymanslaan 10, B-9000, Ghent, Belgium
| | - D Van De Putte
- Department of Gastro-intestinal Surgery, Ghent University Hospital, Corneel Heymanslaan 10, B-9000, Ghent, Belgium
| | - Y Van Nieuwenhove
- Department of Gastro-intestinal Surgery, Ghent University Hospital, Corneel Heymanslaan 10, B-9000, Ghent, Belgium
| | - P Pattyn
- Department of Gastro-intestinal Surgery, Ghent University Hospital, Corneel Heymanslaan 10, B-9000, Ghent, Belgium
| | - W Ceelen
- Department of Gastro-intestinal Surgery, Ghent University Hospital, Corneel Heymanslaan 10, B-9000, Ghent, Belgium; Laboratory of Experimental Surgery, Department of Human Structure and Repair, Ghent University, Corneel Heymanslaan 10, B-9000, Ghent, Belgium; Cancer Research Institute Ghent (CRIG), Ghent University, Belgium
| |
Collapse
|
43
|
Struller F, Horvath P, Solass W, Weinreich FJ, Strumberg D, Kokkalis MK, Fischer I, Meisner C, Königsrainer A, Reymond MA. Pressurized intraperitoneal aerosol chemotherapy with low-dose cisplatin and doxorubicin (PIPAC C/D) in patients with gastric cancer and peritoneal metastasis: a phase II study. Ther Adv Med Oncol 2019; 11:1758835919846402. [PMID: 31205501 PMCID: PMC6535725 DOI: 10.1177/1758835919846402] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 04/04/2019] [Indexed: 01/11/2023] Open
Abstract
Background: Efficacy of second-line systemic chemotherapy in recurrent gastric cancer with peritoneal metastasis (RGCPM) is limited. We assessed the feasibility, safety and possible efficacy of pressurized intraperitoneal aerosol chemotherapy (PIPAC) in patients with RGCPM after ⩾1 line of palliative intravenous chemotherapy. Methods: In this open-label, single-arm, monocentric phase II ICH-GCP clinical trial, patients were scheduled for three courses of PIPAC with cisplatin 7.5 mg/m2 and doxorubicin 1.5 mg/m2 (PIPAC C/D) every 6 weeks. Patients with bowel obstruction or extraperitoneal metastasis were ineligible. The primary endpoint was clinical benefit rate (CBR) by Response Evaluation Criteria in Solid Tumors based on clinical records. Secondary endpoints included overall survival (OS), median time to progression (TTP), peritoneal carcinomatosis index (PCI), histological regression and ascites volume. Safety and tolerability were assessed by Common Terminology Criteria for Adverse Events (CTCAE) version 4, quality of life (QoL) by EORTC-QLQ30 questionnaire. Results: A total of 25 patients were enrolled and available for the analysis of the primary endpoint. Of those 25 patients, 10 (40%) had a radiological complete, partial response or stable disease. Median OS [intention to treat (ITT)] was 6.7 months, median TTP was 2.7 months. Complete or major regression on histology were observed in 9/25 patients (36%, ITT) or 6/6 [100%, per protocol (PP)] patients. There were no suspected unexpected serious adverse reactions, no treatment-related deaths, no CTCAE grade 4 toxicity and three (12%) grade 3 toxicities. Changes in the QLQ-C30 scores during PIPAC C/D therapy were small and not significant. Conclusions: PIPAC C/D was well tolerated and active in patients with RGCPM. Survival was encouraging. Randomized controlled trials should now be designed in this indication.
Collapse
Affiliation(s)
- Florian Struller
- Department of General and Transplant Surgery, Tübingen, University Hospital, Hoppe-Seyler-Strasse 3, 72076 Tübingen, Germany
| | - Philipp Horvath
- Department of General and Transplant Surgery, University Hospital Tübingen, Germany
| | - Wiebke Solass
- Department of Pathology, University Hospital Tübingen, Germany
| | | | - Dirk Strumberg
- Department of Medical Oncology, Marien Hospital, Ruhr University Bochum, Germany
| | - Marios K Kokkalis
- Department of General and Transplant Surgery, University Hospital Tübingen, Germany
| | - Imma Fischer
- Institute for Clinical Epidemiology and Applied Biometrics, University Hospital Tübingen, Germany
| | - Christoph Meisner
- Institute for Clinical Epidemiology and Applied Biometrics, University Hospital Tübingen, Germany
| | - Alfred Königsrainer
- Department of General and Transplant Surgery, University Hospital Tübingen, Germany
| | - Marc A Reymond
- Department of General and Transplant Surgery, University Hospital Tübingen, Germany National Center for Pleura and Peritoneum, University Hospital, Tübingen, Germany
| |
Collapse
|
44
|
Sgarbura O, Hübner M, Alyami M, Eveno C, Gagnière J, Pache B, Pocard M, Bakrin N, Quénet F. Oxaliplatin use in pressurized intraperitoneal aerosol chemotherapy (PIPAC) is safe and effective: A multicenter study. Eur J Surg Oncol 2019; 45:2386-2391. [PMID: 31092362 DOI: 10.1016/j.ejso.2019.05.007] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 04/26/2019] [Accepted: 05/08/2019] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION Pressurized intraperitoneal aerosol chemotherapy (PIPAC) is a new drug delivery method used in patients with peritoneal cancer (PC) of primary or secondary origin. Intraperitoneal use of oxaliplatin raises concerns about toxicity, especially abdominal pain. The objective of this study was to assess the tolerance of PIPAC with oxaliplatin (PIPAC-Ox) in a large cohort of patients and to identify the risk factors for high grade toxicity, discontinuation of treatment and impaired survival. MATERIAL AND METHODS This retrospective cohort study included all consecutive patients treated with PIPAC-Ox (92 mg/m2) in five centers specialized in the treatment of PC. The procedure was repeated every 6 weeks. Outcomes of interest were Common Terminology Criteria for Adverse Events (CTCAE), symptoms and survival (Kaplan-Meier). Univariate risk factors were included in a multinominal regression model to control for bias. RESULTS Overall, 251 PIPAC-Ox treatments were performed in 101 patients (45 female) having unresectable PC of various origins: 66 colorectal, 15 gastric, 5 ovarian, 3 mesothelioma, 2 pseudomyxoma, 10 other malignancies (biliary, pancreatic, endocrine) respectively. The median PCI was 19 (IQR: 10-28). Postoperative abdominal pain was present in 23 patients. Out of the 9 patients with grade 3 abdominal pain, only 3 needed a change of PIPAC drug. CTCAE 4.0 toxicity grade 4 or higher was encountered in 16(15.9%) patients. The patients had a mean of 2.5 procedures/patient (SD = 1.5). 50 subjects presented with symptom improvement. CONCLUSIONS Oxaliplatin-based PIPAC appears to be a safe treatment that offers good symptom control and promising survival for patients with advanced peritoneal disease.
Collapse
Affiliation(s)
- Olivia Sgarbura
- Department of Surgical Oncology, Cancer Institute Montpellier (ICM), Montpellier, France; University of Montpellier, France.
| | - Martin Hübner
- Department of Visceral Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Mohammad Alyami
- Department of General Surgery and Surgical Oncology, Lyon Sud University Hospital, Pierre Benite, France; Department of General Surgery and Surgical Oncology, King Khalid Hospital, Najran, Saudi Arabia
| | - Clarisse Eveno
- Department of General Surgery, University Hospital Lille, Lille, France
| | - Johan Gagnière
- Centre Hospitalier Universitaire Clermont-Ferrand, France
| | - Basile Pache
- Department of Visceral Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Marc Pocard
- INSERM U1275, CAP Paris-Tech, Carcinomatosis Peritoneum Paris Technology, Lariboisière Hospital, AP-HP, Paris 7- Diderot University, Sorbonne Paris Cité, France
| | - Naoual Bakrin
- Department of General Surgery and Surgical Oncology, Lyon Sud University Hospital, Pierre Benite, France
| | - François Quénet
- Department of Surgical Oncology, Cancer Institute Montpellier (ICM), Montpellier, France; University of Montpellier, France
| |
Collapse
|
45
|
Graversen M, Fristrup C, Kristensen TK, Larsen TR, Pfeiffer P, Mortensen MB, Detlefsen S. Detection of free intraperitoneal tumour cells in peritoneal lavage fluid from patients with peritoneal metastasis before and after treatment with pressurised intraperitoneal aerosol chemotherapy (PIPAC). J Clin Pathol 2019; 72:368-372. [PMID: 30755498 DOI: 10.1136/jclinpath-2018-205683] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 01/14/2019] [Accepted: 01/15/2019] [Indexed: 12/20/2022]
Abstract
AIMS In this study, we investigated whether free intraperitoneal tumour cells (FITC) were detectable in ascites or peritoneal lavage fluid (PLF) from patients with peritoneal metastasis (PM) before and after treatment with pressurised intraperitoneal aerosol chemotherapy (PIPAC). METHODS Ascites or PLF retrieved at the first and third PIPAC procedures was analysed by conventional cytology, carcinoembryonic antigen (CEA) and total protein concentration, and quantitative reverse transcriptase PCR (qRT-PCR) for mRNA expression of CEA, epithelial cell adhesion molecule (EpCAM) and cancer antigen 125 (CA-125). Conventional cytology and qRT-PCR were also performed in a negative control group (benign PLF specimens and inflammatory ascites). The treatment response was compared with the histological response based on repeated peritoneal biopsies evaluated by the Peritoneal Regression Grading Score (PRGS). RESULTS Thirty-five patients with PM of various origins were included from 2015 to 2016. At the first PIPAC procedure, FITC were detected by conventional cytology (sensitivity 0.58, specificity 1.00), CEA protein (cut-off 0.4 µg/L, sensitivity 0.71), CEA mRNA (sensitivity 0.75, specificity 1.00), EpCAM mRNA (sensitivity 0.71, specificity 1.00) and CA-125 mRNA (sensitivity 0.43, specificity 1.00). The combination of CEA/EpCAM mRNA had a sensitivity of 0.88 and a specificity of 1.00. The evaluation of ascites or PLF retrieved at the third PIPAC procedure failed to detect treatment response, when compared with the histological PRGS. CONCLUSIONS The evaluation of CEA and EpCAM mRNA detects FITC with a high sensitivity and an excellent specificity, but is not useful for response evaluation in patients treated with PIPAC. TRIAL REGISTRATION NUMBER NCT02320448.
Collapse
Affiliation(s)
- Martin Graversen
- Department of Surgery, Odense University Hospital, Odense, Denmark .,Odense Patient data Exploratory Network - OPEN, Odense University Hospital, Odense, Denmark.,Odense PIPAC Center, Odense University Hospital, Odense, Denmark
| | - Claus Fristrup
- Department of Surgery, Odense University Hospital, Odense, Denmark.,Odense PIPAC Center, Odense University Hospital, Odense, Denmark
| | | | | | - Per Pfeiffer
- Odense PIPAC Center, Odense University Hospital, Odense, Denmark.,Department of Oncology, Odense University Hospital, Odense, Denmark
| | - Michael Bau Mortensen
- Department of Surgery, Odense University Hospital, Odense, Denmark.,Odense PIPAC Center, Odense University Hospital, Odense, Denmark
| | - Sönke Detlefsen
- Odense PIPAC Center, Odense University Hospital, Odense, Denmark.,Department of Pathology, Odense University Hospital, Odense, Denmark
| |
Collapse
|
46
|
Horvath P, Yurttas C, Struller F, Bösmüller H, Lauer UM, Nadalin S, Königsrainer A, Reymond MA. Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC) for Peritoneal Metastases in Solid Organ Graft Recipients: First Experience. Ann Transplant 2019; 24:30-35. [PMID: 30643112 PMCID: PMC6346813 DOI: 10.12659/aot.911905] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 09/19/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Therapy of peritoneal metastases (PM) in solid organ transplant recipients is challenging. Pressurized intraperitoneal aerosol chemotherapy (PIPAC) might constitute a new therapeutic opportunity for these patients. MATERIAL AND METHODS This was a single-center, retrospective analysis of prospective registry data (NCT03210298) in a tertiary care center between 1.7.2016 and 31.12.2017. Intraperitoneal administration of oxaliplatin 92 mg/m² body surface or a combination of cisplatin 7.5 mg/m² and doxorubicin 1.5 mg/m², repeated every 6 weeks. Objective tumor response was documented via histology (Peritoneal Regression Grading Score, PRGS), adverse events according to Common Terminology Criteria for Adverse Events (CTCAE) 4.0. RESULTS Out of 71 consecutive patients treated with PIPAC, 2 patients (2.8%) were solid organ transplant recipients. The first patient had metachronous PM of colonic cancer origin after liver transplantation. The second patient had synchronous PM of pancreatic cancer origin after combined kidney-pancreas transplantation. After repeated combined systemic and PIPAC chemotherapy, objective histological response was documented in both patients. No adverse events >CTCAE 2 were recorded. There was no measurable liver or renal toxicity. PIPAC procedures could be repeated (2, resp. 3 cycles) without any interruption of immunosuppressive medication or impairment of respective plasmatic drug levels. The first patient passed away 7 months after the first PIPAC, the second patient was still alive after 8 months. CONCLUSIONS PIPAC can induce objective regression of PM in solid organ transplant recipients without inducing organ toxicity or interfering with immunosuppressive therapy.
Collapse
Affiliation(s)
- Philipp Horvath
- Department of General, Visceral and Transplant Surgery, University of Tübingen, Tübingen, Germany
| | - Can Yurttas
- Department of General, Visceral and Transplant Surgery, University of Tübingen, Tübingen, Germany
| | - Florian Struller
- Department of General, Visceral and Transplant Surgery, University of Tübingen, Tübingen, Germany
| | - Hans Bösmüller
- Institute of Pathology, University of Tübingen, Tübingen, Germany
| | - Ulrich M. Lauer
- Department of Internal Medicine VIII, University of Tübingen, Tübingen, Germany
| | - Silvio Nadalin
- Department of General, Visceral and Transplant Surgery, University of Tübingen, Tübingen, Germany
| | - Alfred Königsrainer
- Department of General, Visceral and Transplant Surgery, University of Tübingen, Tübingen, Germany
| | - Marc André Reymond
- Department of General, Visceral and Transplant Surgery, University of Tübingen, Tübingen, Germany
- National Center for Pleura and Peritoneum, Comprehensive Cancer Center South-Western Germany, Tübingen, Germany
| |
Collapse
|
47
|
Siebert M, Alyami M, Mercier F, Gallice C, Villeneuve L, Bérard F, Glehen O, Bakrin N, Kepenekian V. Severe hypersensitivity reactions to platinum compounds post-pressurized intraperitoneal aerosol chemotherapy (PIPAC): first literature report. Cancer Chemother Pharmacol 2018; 83:425-430. [PMID: 30511218 DOI: 10.1007/s00280-018-3740-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 11/26/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Pressurized intraperitoneal aerosol chemotherapy (PIPAC) shows encouraging results for patients with unresectable peritoneal metastasis. Several reports demonstrated the safety of the procedure combined with systemic chemotherapy, with a low rate of complication. The aim of this study is to report severe hypersensitivity reactions to platinum compounds (SHRPC) during PIPAC procedures. METHODS All patients who underwent PIPAC for non-resectable PC in Lyon Sud University hospital were included in a prospective institutional database. All patients who presented a SHRPC after PIPAC were included in our analysis. RESULTS One hundred and thirty-two patients underwent 383 PIPAC procedures between December 2015 and December 2017. oxaliplatin's and cisplatin-doxorubicin's protocols were used in 71 and 312 PIPAC, respectively. Four patients (3%) developed SHRPC; two patients (2.8%) after oxaliplatin and two patients (0.6%) after cisplatin-doxorubicin protocols. SHRPC occurred during the 6th PIPAC with cisplatin-doxorubicin protocol and during 2nd and 3rd PIPAC of the oxaliplatin protocol. Three events appeared within 15 min and one event occurred 50 min following nebulization. All the SHRPC have been managed successfully without any complication. CONCLUSIONS This is the first report of SHRPC after PIPAC. The physician must constantly keep this rare but life-threatening complication in mind, especially after repeated PIPAC administration or previous platinum-based systemic chemotherapy.
Collapse
Affiliation(s)
- Matthieu Siebert
- Department of Surgical Oncology, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France.,EMR 3738, Lyon 1 University, Lyon, France
| | - Mohammad Alyami
- Department of Surgical Oncology, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France. .,EMR 3738, Lyon 1 University, Lyon, France. .,Department of General Surgery and Surgical Oncology, King Faisal Specialist Hospital and research center, Riyadh, Saudi Arabia. .,Département de Chirurgie Générale, Digestive et Endocrinienne, CHU Lyon Sud, 165 Chemin du Grand Revoyet, 69495, Pierre-Bénite, France.
| | - Frederic Mercier
- Department of Surgical Oncology, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France.,EMR 3738, Lyon 1 University, Lyon, France
| | - Colin Gallice
- Department of Surgical Oncology, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France.,EMR 3738, Lyon 1 University, Lyon, France
| | - Laurent Villeneuve
- Department of Surgical Oncology, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France.,EMR 3738, Lyon 1 University, Lyon, France
| | - Frédéric Bérard
- Service d'Allergologie et Immunologie Clinique, INSERM U851, Dufourt-5F. CHU Lyon-Sud, Pierre-Bénite, France
| | - Olivier Glehen
- Department of Surgical Oncology, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France.,EMR 3738, Lyon 1 University, Lyon, France
| | - Naoual Bakrin
- Department of Surgical Oncology, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France.,EMR 3738, Lyon 1 University, Lyon, France
| | - Vahan Kepenekian
- Department of Surgical Oncology, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France.,EMR 3738, Lyon 1 University, Lyon, France
| |
Collapse
|
48
|
Gockel I, Jansen-Winkeln B, Haase L, Rhode P, Mehdorn M, Niebisch S, Moulla Y, Lyros O, Lordick F, Schierle K, Wittekind C, Thieme R. 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; 18:379-391. [PMID: 30607301 PMCID: PMC6310762 DOI: 10.5230/jgc.2018.18.e37] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 12/03/2018] [Accepted: 12/03/2018] [Indexed: 12/23/2022] Open
Abstract
PURPOSE Gastric cancer (GC) patients with peritoneal metastasis (PM) have poor prognosis. Pressurized intraperitoneal aerosol chemotherapy (PIPAC) in combination with systemic chemotherapy is a novel treatment option for patients in stage IV of the disease. MATERIALS AND METHODS Between November 2015 and June 2018, prospective data collection was performed in 24 patients with GC and PM (median age, 57; range, 44-75 years). These patients underwent 46 PIPAC procedures with a median number of 2 interventions per patient (range, 1-6). A laparoscopic access was used and a combined therapy of cisplatin and doxorubicin aerosol was administered. RESULTS The median peritoneal carcinomatosis index before the 1st PIPAC was 14 (range, 2-36), and the median ascites volume in patients before the 1st PIPAC was 100 mL (range, 0-6 mL, 300 mL). Eleven patients, who received 2 or more PIPAC procedures, had decreased and stable volumes of ascites, while only 3 patients displayed increasing volume of ascites. The median overall survival was 121 days (range, 66-625 days) after the 1st PIPAC procedure, while 8 patients who received more than 3 PIPAC procedures had a median survival of 450 days (range, 206-481 days) (P=0.0376). CONCLUSIONS Our data show that PIPAC is safe and well tolerated, and that the production of ascites can be controlled by PIPAC in GC patients. Patients, who received 2 or more PIPAC procedures, reported a stable overall quality of life. Further studies are required to document the significance of PIPAC as a palliative multimodal therapy. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03100708.
Collapse
Affiliation(s)
- Ines Gockel
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - Boris Jansen-Winkeln
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - Linda Haase
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - Philipp Rhode
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - Matthias Mehdorn
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - Stefan Niebisch
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - Yusef Moulla
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - Orestis Lyros
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - Florian Lordick
- University Cancer Center Leipzig, University Hospital of Leipzig, Leipzig, Germany
| | - Katrin Schierle
- Institute of Pathology, University Hospital of Leipzig, Leipzig, Germany
| | | | - René Thieme
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany
| |
Collapse
|
49
|
Nowacki M, Zegarski W. The scientific report from the first pressurized intraperitoneal aerosol chemotherapy (PIPAC) procedures performed in the eastern part of Central Europe. J Int Med Res 2018; 46:3748-3758. [PMID: 29916281 PMCID: PMC6135997 DOI: 10.1177/0300060518778637] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 05/02/2018] [Indexed: 12/15/2022] Open
Abstract
Objective To perform a single-centre, detailed analysis of the preparations for the introduction of the first pressurized intraperitoneal aerosol chemotherapy (PIPAC) programme in the eastern part of Central Europe. Methods The study analysed the 14-month preparation period prior to the performance of the first PIPAC procedure with respect to: (i) general preparations; (ii) patient referral and qualification; (iii) the first PIPAC procedure; (iv) the 2 weeks following PIPAC programme establishment; and (v) general problematic issues that arose. Results The length of time needed to prepare our institution for the first PIPAC procedure was extremely long compared with other European Union PIPAC centres: 14 months versus a standard 3-6 months of preparation. The longest amount of time (12 months) was required to prepare the required paperwork. Conclusions A new PIPAC programme was successfully established in the eastern part of Central Europe. The length of time to implement this method was significantly longer because of lengthy bureaucratic processes. These current findings should help new centres, especially in this part of Europe, to establish a PIPAC programme more quickly.
Collapse
Affiliation(s)
- Maciej Nowacki
- Department of Surgical Oncology, Ludwik Rydygier’s
Collegium Medicum, Nicolaus Copernicus University in Torun, Bydgoszcz,
Poland
| | - Wojciech Zegarski
- Department of Surgical Oncology, Ludwik Rydygier’s
Collegium Medicum, Nicolaus Copernicus University in Torun, Bydgoszcz,
Poland
| |
Collapse
|
50
|
Tempfer C, Giger-Pabst U, Hilal Z, Dogan A, Rezniczek GA. Pressurized intraperitoneal aerosol chemotherapy (PIPAC) for peritoneal carcinomatosis: systematic review of clinical and experimental evidence with special emphasis on ovarian cancer. Arch Gynecol Obstet 2018; 298:243-257. [PMID: 29869089 DOI: 10.1007/s00404-018-4784-7] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 05/09/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Systemic chemotherapy is not effective in patients with peritoneal carcinomatosis (PC) and only a minority of affected patients is eligible for cytoreductive surgery. Intraperitoneal chemotherapy may provide a therapy alternative for these patients. METHODS We performed a systematic review of clinical and experimental evidence on the safety and efficacy of pressurized intraperitoneal aerosol chemotherapy (PIPAC) in patients with PC and provide clinical recommendations based on the available evidence. RESULTS Fifty-eight reports were identified, categorized as experimental (18 reports), clinical (28 reports), and other articles (14 reports). Experimental studies demonstrated improved tissue penetration and peritoneal coverage. The 28 clinical studies reported on 3515 procedures in 1547 patients with PC of various primary tumors with 16 of these studies reporting on patients with ovarian cancer. Toxicity was manageable. Based on 1197 patients in 22 studies, adverse events CTCAE grades 1, 2, 3, 4, and 5 were observed in 537 (45%), 167 (14%), 83 (7%), 10 (0.8%), and 19 (1.6%) cases, respectively. In a pooled analysis, the objective tumor response rate was 69% and the mean overall survival duration was 13.7 months. No significant hepatic, renal, or hematologic toxicity was described. PIPAC maintained and/or improved quality of life, as reported in 10 studies with 396 patients. CONCLUSIONS Available evidence from controlled trials (phase I and phase II) and retrospective cohort studies in > 1500 patients unequivocally demonstrates that PIPAC is feasible, safe, and effective. PIPAC maintains quality of life in patients with recurrent cancer and PC. PIPAC is as evidence-based as any other treatment in women with ovarian cancer and PC beyond the third line of systemic chemotherapy and can be recommended in this indication.
Collapse
Affiliation(s)
- Clemens Tempfer
- Department of Obstetrics and Gynecology, Marien Hospital Herne, Ruhr-Universität Bochum, Hölkeskampring 40, 44625, Herne, Germany.
| | - Urs Giger-Pabst
- Department of Surgery, Marien Hospital Herne, Ruhr-Universität Bochum, Herne, Germany
| | - Ziad Hilal
- Department of Obstetrics and Gynecology, Marien Hospital Herne, Ruhr-Universität Bochum, Hölkeskampring 40, 44625, Herne, Germany
| | - Askin Dogan
- Department of Obstetrics and Gynecology, Marien Hospital Herne, Ruhr-Universität Bochum, Hölkeskampring 40, 44625, Herne, Germany
| | - Günther A Rezniczek
- Department of Obstetrics and Gynecology, Marien Hospital Herne, Ruhr-Universität Bochum, Hölkeskampring 40, 44625, Herne, Germany
| |
Collapse
|