Multicenter comprehensive methodological and technical analysis of 832 pressurized intraperitoneal aerosol chemotherapy (PIPAC) interventions performed in 349 patients for peritoneal carcinomatosis treatment: An international survey study

Our plain-English summary of Multicenter comprehensive methodological and technical analysis of 832 pressurized intraperitoneal aerosol chemotherapy (PIPAC) interventions performed in 349 patients for peritoneal carcinomatosis treatment: An international survey study, by M. Nowacki, M. Alyami, L. Villeneuve, et al (European Journal of Surgical Oncology, 2018).

The study

• Authors: M. Nowacki, M. Alyami, L. Villeneuve, F. Mercier, M. Hubner, W. Willaert, W. Ceelen, M. Reymond, D. Pezet, C. Arvieux, V. Khomyakov, L. Lay, S. Gianni, W. Zegarski, N. Bakrin, O. Glehen
• Journal: European Journal of Surgical Oncology
• Published: 2018;44(7):991-996
• Cited by: 79 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: Pressurized intraperitoneal aerosol chemotherapy (PIPAC) is a new drug delivery method offered in selected patients suffering from non-resectable peritoneal carcinomatosis (PC). As reported experience is still limited, we conducted a survey among active PIPAC centers aiming to report their technical approach and clinical findings.

Methods: An online survey was sent to active PIPAC centers worldwide. The questionnaire consisted of 34 closed questions and was conducted over a period of 3 months beginning in March 2017.

Results: Nine out of 15 contacted centers completed the questionnaire totaling 832 PIPAC procedures in 349 patients. Most common indications for PIPAC were PC from gastric, ovarian and colorectal origin. The mean time between each PIPAC procedure was 6-8 weeks. Seven of nine (77.8%) centers evaluate the PCI at every PIPAC procedure. At least four tissue samples for histopathology analysis were retrieved in 5 (55.6%). All centers (100%) use the same chemotherapy protocol: oxaliplatin at a dosage of 92mg/m2 for PC of colorectal origin and a combination of cisplatin and doxorubicin at a dosage of 7.5mg/m2 and 1.5mg/m2, respectively, for other types of PC. Eight centers (88.9%) perform routine radiological evaluation before first PIPAC and after third PIPAC.

Conclusion: These data confirm that PIPAC procedures are homogeneously performed in established centers. Standardization of the procedure will facilitate future international multicenter prospective clinical trials.

Copyright © 2018 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.

In plain English

This survey asked centers that perform PIPAC (pressurized intraperitoneal aerosol chemotherapy) how they do it. PIPAC sprays chemotherapy into the abdomen to treat peritoneal carcinomatosis, which is cancer spread across the abdominal lining. Of 15 centers contacted in 2017, nine in six countries completed a 34-question online survey, reporting 832 procedures in 349 patients. Gastric, ovarian and colorectal cancers were the most common reasons for treatment. Of 680 procedures broken down by cancer type, 34 were for peritoneal mesothelioma, treated at 7 centers. The study did not look at asbestos exposure. Seven centers reported a mean 6-week interval between procedures, and two reported 8 weeks. Seven of nine centers scored disease spread at every procedure. The text says all centers followed one protocol: oxaliplatin for colorectal-origin disease and cisplatin with doxorubicin for other types, with one center also using mitomycin C. A table lists 6 centers for oxaliplatin and 8 for cisplatin with doxorubicin. The authors concluded that PIPAC is standardized and performed in a small number of expert centers. They noted that only 60% of contacted centers responded and that intended protocols may differ from practice.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: International online survey of PIPAC treatment centers (34 closed questions), analyzed descriptively
• Who was studied: 9 of 15 contacted PIPAC centers (60%) in Argentina, Belgium, France, Germany, Russia and Switzerland, reporting on 349 patients and 832 procedures; survey run for 3 months from March 2017
• Exposure: No asbestos exposure was studied. The subject was the PIPAC procedure itself: technique, safety measures and chemotherapy regimens (oxaliplatin 92mg/m2 for colorectal-origin disease; cisplatin 7.5mg/m2 plus doxorubicin 1.5mg/m2 for other types)
• Main results:
  • The responding centers reported 832 PIPAC procedures in 349 patients in total
  • Most procedures were for gastric cancer (41.1%), ovarian cancer (22.7%) and colorectal cancer (20.1%)
  • Table 1 lists peritoneal mesothelioma as treated by 7 centers, accounting for 34 PIPAC procedures (5%) among the 680 procedures broken down by cancer type
  • The reported mean interval between procedures was 6 weeks in 7 centers (77.8%) and 8 weeks in 2 centers (22.2%). The highest number of procedures in one patient was 9
  • 7 of 9 centers (77.8%) always evaluated the peritoneal cancer index at each procedure
  • 4 or 5 biopsies were taken in 5 centers (55.6%); the remaining centers took 1 to 3
  • The text reports that all centers used the same cancer-specific protocol (oxaliplatin for colorectal-origin disease, cisplatin plus doxorubicin for other types); Table 3 lists 6 centers for oxaliplatin and 8 for cisplatin plus doxorubicin
  • One center (11.2%) also used a mitomycin C protocol at 1.5mg/m2 when the other protocols were formally contraindicated
  • 4 centers (44.4%) measured tumor markers at each cycle; 8 centers (88.9%) did imaging before the first and after the third procedure
  • 6 centers (66.7%) had operating rooms equipped with laminar airflow
• The authors' conclusion: The authors concluded that PIPAC procedures are performed homogeneously in established centers and that standardization will facilitate future international multicenter trials
• Limitations the authors state:
  • Only a limited number of centers existed and only 60% of contacted experts responded, so true practice might differ
  • The survey reports intended protocols, which might differ from actual practice
  • Medical equipment differed between hospitals

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma, Ovarian cancer, Peritoneal mesothelioma.

Medical terms in this study, explained in our Lexicon: Chemotherapy, Histopathology, Cisplatin, Doxorubicin, Clinical Trial.

Related studies

• Quality of life of patients with end-stage peritoneal metastasis treated with Pressurized IntraPeritoneal Aerosol Chemotherapy (PIPAC) — K. Odendahl, W. Solass, et al. (2015)
• Multicentric initial experience with the use of the pressurized intraperitoneal aerosol chemotherapy (PIPAC) in the management of unresectable peritoneal carcinomatosis — M. Alyami, J. Gagniere, et al. (2017)
• Unresectable peritoneal metastasis treated by pressurized intraperitoneal aerosol chemotherapy (PIPAC) leading to cytoreductive surgery and hyperthermic intraperitoneal chemotherapy — M. Alyami, F. Mercier, et al. (2021)
• Oxaliplatin use in pressurized intraperitoneal aerosol chemotherapy (PIPAC) is safe and effective: A multicenter study — O. Sgarbura, M. Hübner, et al. (2019)
• Quality of life after cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy: a prospective study of 216 patients — G. Passot, N. Bakrin, et al. (2014)
• Current practice in cytoreductive surgery and HIPEC for metastatic peritoneal disease: Spanish multicentric survey — R. Morales-Soriano, N. Esteve-Pérez, et al. (2018)

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