Systemic chemotherapy and pressurized intraperitoneal aerosol chemotherapy (PIPAC): A bidirectional approach for gastric cancer peritoneal metastasis

A Phase I Dose Escalation Study of Oxaliplatin, Cisplatin and Doxorubicin Applied as PIPAC in Patients with Peritoneal Carcinomatosis

“…In fact, the therapeutic aerosol administered under pressure reported a more homogeneous distribution compared to liquid chemotherapy [6,7], a deeper tissue penetration [8,9] and a higher drug tissue concentration [10]. Promising results have been published in peritoneal metastasis of gastric [11][12][13], ovarian [14,15], colorectal [16], pancreatic [17,18] and hepatobiliary [19] origins, demonstrating that PIPAC is feasible, safe, and well-tolerated, with a good clinical response rate [20,21].…”

The emergence of pressurized intraperitoneal aerosol chemotherapy as a palliative treatment option for patients with diffuse peritoneal metastases: a narrative review

“…The latter reported on an overall histopathological regression rate (intention to treat) of 12-71% (35,52,56,(63)(64)(65). Four other studies reported on gastric cancer patients, and histopathological regression (intention to treat) varied from 25-50% (39,60,66,74). In ovarian cancer patients, histopathological regression (intention to treat) varied from 6-17% (38,53,58).…”

“…Thus, both primary and secondary non-access should be prevented as much as possible to prevent unnecessary interruptions of treatment. Both primary (34,35,38,39,42,(48)(49)(50)(51)(52)(53)(54)(56)(57)(58)(59)(62)(63)(64)(65)(66) and secondary (34,35,(39)(40)(41)(42)47,(49)(50)(51)(54)(55)(56)(57)(59)(60)(61)(62)(63)66) nonaccess rates widely varied among studies. Primary nonaccess was observed in 0-17% of patients, although two studies reported a primary non-access rate of 24% and 28%.…”

“…Reported complications during the PIPAC-procedure were scarce. The most common intraoperative complication was an iatrogenic bowel injury (0-3% of total PIPAC procedures, except for one study reporting an iatrogenic bowel injury in 6% of total PIPAC procedures) (34,35,(38)(39)(40)(41)(42)47,48,54,(63)(64)(65)(66)(67)(68)(69). Post-operatively, most adverse events consisted of grade 1 and 2 abdominal pain, nausea, vomiting, and fatigue, according to the Common Terminology Criteria for Adverse Events (CTCAE).…”

“…Median overall survival (OS), as calculated from first PIPAC, varied widely based on primary tumour. In patients with gastric cancer, an OS of 5 to 7 months was reported (42,63,66,74). However, one study reported an OS of 19 months for gastric cancer patients treated with PIPAC, although the interval was not mentioned (75).…”