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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 5/2023

05-01-2023 | Metastasis | Peritoneal Surface Malignancy

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

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

Published in: Annals of Surgical Oncology | Issue 5/2023

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Abstract

Background

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

Patients and Methods

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

Results

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

Conclusions

PIPAC with oxaliplatin or cisplatin and doxorubicin was able to induce a major or complete histological response during three PIPACs, which may provide significant prognostic information, both at baseline and after treatment.
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Metadata
Title
Treatment of Peritoneal Metastasis with Pressurized Intraperitoneal Aerosol Chemotherapy: Results from the Prospective PIPAC-OPC2 Study
Authors
Martin Graversen, MD, PhD
S. Detlefsen, MD, PhD
A. P. Ainsworth, MD, PhD
C. W. Fristrup, MD, PhD
A. O. Knudsen, MD
P. Pfeiffer, MD, PhD
L. S. Tarpgaard, MD, PhD
M. B. Mortensen, MD, PhD, DMSci
Publication date
05-01-2023
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 5/2023
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-022-13010-0

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