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. 2021 Sep;28(9):5275-5286.
doi: 10.1245/s10434-020-09508-0. Epub 2021 Jan 20.

Pressurized Intraperitoneal Aerosol Chemotherapy for Colorectal Peritoneal Metastases

Nicolas Tabchouri #  1 , Jonathan Buggisch #  2 , Cédric Rémy Demtröder  3   4 , Julien Thiery  1 , Günther Rezniczek  5 , Clemens B Tempfer  5 , Britta Fischer  3 , Can Dogan  5 , Thierry Lecomte  6 , Mehdi Ouaissi  7   8 , Urs Giger-Pabst  2   3
Affiliations

Pressurized Intraperitoneal Aerosol Chemotherapy for Colorectal Peritoneal Metastases

Nicolas Tabchouri et al. Ann Surg Oncol. 2021 Sep.

Abstract

Background: The benefit of repetitive PIPAC specifically in CPM patients has yet to be demonstrated in terms of oncological and functional outcomes.

Objective: The aim of this study was to evaluate the outcome of patients with non-resectable colorectal peritoneal metastases (CPM) treated with pressurized intraperitoneal aerosol chemotherapy (PIPAC).

Methods: We conducted an analysis of a prospective single-center database of all CPM patients who underwent PIPAC with oxaliplatin 92 mg/m2 body surface (PIPAC-Ox). The outcome criteria were adverse events (Common Terminology Criteria for Adverse Events version 4.0), Peritoneal Regression Grading Score (PRGS), and survival.

Results: Overall, 102 patients with a median age of 64 years (33-88) were scheduled for PIPAC-Ox. Access to the abdominal cavity for the first application failed in 22/102 (21.6%) patients. A total of 185 PIPACs were performed, with 26/102 (25.5%), 20/102 (19.6%), 17/102 (16.7%), and 17/102 (16.7%) patients undergoing one, two, three, and four or more PIPACs, respectively. Perioperative overall morbidity/mortality Grade I-V occurred in 14 (7.6%), 29 (15.8%), 6 (3.2%), 1 (0.5%), and 1 (0.5%) patient without significant differences between each cycle. Of 27 patients who underwent three or more PIPACs, 20/102 (19.6%) had major/complete CPM regression (PRGS 1-2). In a multivariate analysis, independent predictive factors for > 12 months' survival following the first PIPAC-Ox administration were three or more PIPACs (odds ratio [OR] 4.5, 95% confidence interval [CI] 1.35-15.2; p = 0.014) and younger patient age (OR 1.058, 95% CI 1.00-1.12; p = 0.039).

Conclusions: Repetitive PIPAC-Ox for CPM patients, alone or combined with perioperative systemic chemotherapy, is feasible. Our data suggest that three or more consecutive PIPAC-Ox cycles for advanced CPM can improve survival.

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References

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