Consensus guidelines for pressurized intraperitoneal aerosol chemotherapy: Technical aspects and treatment protocols

Alyami, Mohammad; Villeneuve, Laurent; Nowacki, Maciej; So, Jimmy Bok Yan; Sgarbură, Olivia; Abba, J.; Afifi, Adnane; Mortensen, Michael Bau; Bhatt, Aditi; Brandl, Andreas; Ceelen, Wim; Coget, J; Courvoiser, Thomas; Hingh, Ignace H. J. T. de; Delhorme, Jean-Baptiste; Giorgio, Andrea Di; Dumont, Frédéric; Escayola, Cecilia; Eveno, Clarisse; Ezanno, Anne-Cécile; Gagnière, Johan; Galindo, Julio; Glatz, Torben; Gléhen, Olivier; Jäger, Tarkan; Képénékian, Vahan; Khomyakov, V. M.; Kothonidis, Konstantinos; Lehmann, Kuno; Lynch, Craig; Mehta, Sanket; Moldovan, Bogdan; Nissan, Aviram; Orry, David; Pérez, Gloria Ortega; Paquette, Brice; Paškonis, Marius; Piso, Pompiliu; Pocard, Marc; Rau, Beat; Robella, Manuela; Singh, Sapna; Somashekhar, S.P.; Soravia, Claudio; Taibi, Abelkader; Torkington, Jared; Vizzielli, Giuseppe; Willaert, Wouter

doi:10.1016/j.ejso.2021.10.028

Cited by 23 publications

(14 citation statements)

References 31 publications

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“…The presence of malignant ascites has already been reported to be associated with poorer prognosis [26]. Intraperitoneal and extraperitoneal progression underlined in our series supports the rigorous monitoring of the disease progression during the exploration phase of the PIPAC procedure, along with current recommendations [9,27]. In line with our results, the use of bimodal treatment, combining PIPAC with systemic chemotherapy might be a good option to limit tumoral progression.…”

Section: Discussionsupporting

confidence: 88%

Selection Criteria for Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC) Treatment in Patients with Peritoneal Metastases

Balmer

Clerc

Toussaint

et al. 2022

Cancers

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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.

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Section: Discussionsupporting

confidence: 88%

Selection Criteria for Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC) Treatment in Patients with Peritoneal Metastases

Balmer

Clerc

Toussaint

et al. 2022

Cancers

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“…There is a high interest in ePIPAC that showed impressive distribution and penetration potential in translational studies [ 35 , 36 ]. While associated morbidity was explored and remains similar to that of traditional PIPAC [ 14 ], some of the associated variables (time of exposure, activation of the generator) have still not gained consensus and need further research [ 23 ]. This prerogative was confirmed among the research priorities.…”

Section: Discussionmentioning

confidence: 99%

“…The current consensus emerged from a clinical need of PIPAC centers worldwide [ 8 , 23 ]. In order to deliver recommendations, the expert panel was forced to take into account only current and, thus, limited evidence and to apply a modified Delphi methodology.…”

Section: Discussionmentioning

confidence: 99%

“…The consensus process followed current recommendations and was previously applied to standardize safety and technical aspects of PIPAC treatment [ 20 ], [ 21 ], [ 22 ], [ 23 ], [ 24 ]: Expert panel: eligible were members of the ISSPP education committee with large personal experience with PIPAC treatment and the principal investigators of prospective studies on PIPAC. The core group (OS, CE, and MH) contacted all eligible persons three times at least and no colleague was deliberately excluded.…”

Section: Methodsmentioning

confidence: 99%

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Consensus statement for treatment protocols in pressurized intraperitoneal aerosol chemotherapy (PIPAC)

Sgarbură

Eveno

Alyami

et al. 2022

Pleura and Peritoneum

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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.

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“…A potential explanation of this heterogeneity would be the lack of any other treatment options for this patient's setting in combination with the need to make the most of a treatment that is generally well tolerated. This flourishing of studies testifies to the rapid evolution of the method, but further diversification of protocols in the absence of new evidence should be prevent: to this end, recent consensus guidelines has been published to facilitate benchmarking and analysis of outcomes [29].…”

Section: Discussionmentioning

confidence: 99%

Feasibility and safety of PIPAC combined with additional surgical procedures: PLUS study

Robella

Sgarbură

Reymond

et al. 2022

European Journal of Surgical Oncology

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Consensus guidelines for pressurized intraperitoneal aerosol chemotherapy: Technical aspects and treatment protocols

Cited by 23 publications

References 31 publications

Selection Criteria for Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC) Treatment in Patients with Peritoneal Metastases

Selection Criteria for Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC) Treatment in Patients with Peritoneal Metastases

Consensus statement for treatment protocols in pressurized intraperitoneal aerosol chemotherapy (PIPAC)

Feasibility and safety of PIPAC combined with additional surgical procedures: PLUS study

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