Gastric cancer treated with pressurized intraperitoneal aerosol chemotherapy: revising an option for peritoneal carcinomatosis

Abstract

Aim: Gastric cancer is the cancer with the highest rate of peritoneal metastization and this type of spread is associated with a higher death rate compared to distant organ metastasis. The systemic chemotherapy has a minimal effect in peritoneal metastasis so new types of treatment have emerged. The authors revised the main studies done in pressurized intraperitoneal aerosol chemotherapy (PIPAC) and presented the main conclusions.

Methods: A PubMed search was conducted focusing on PIPAC in gastric cancer. The MeSH database was searched with the terms: “Gastric cancer [MeSH] and intraperitoneal aerosol chemotherapy”.

Results: Seven studies were analyzed. All the studies performed the technique with aerosol of doxorubicin and cisplatin. All cases were well tolerated, with minor adverse effects. Patients presented resolution of their abdominal symptoms and regression of macroscopic carcinomatosis. Cytoreductive surgery or hypertermic intraperitoneal chemotherapy could be performed in some patients with good response to PIPAC. The peritonitis caused by the chemotherapy was well tolerated.

Conclusion: PIPAC can induce remission in end-stage and resistant disease with acceptable side effects, good safety levels for patients and health professionals, and quality of life improvement.

Keywords

Pressurized intraperitoneal aerosol chemotherapy / gastric cancer / peritoneal carcinomatosis

References

[1] Ferlay J,Dikshit R,Mathers C,Parkin DM,Bray F.Cancer incidence and mortality worldwide: Sources, methods and major patterns in GLOBOCAN 2012..Int J Cancer2015;136:E359-86

[2] Okines A,Allum W,Cervantes A.Gastric cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up..Ann Oncol2010;21:v50-4

[3] Yonemura Y,Sasaki T,Mizumoto A,Takao N,Miura M.Surgical treatment for peritoneal carcinomatosis from gastric cancer..Eur J Surg Oncol2010;36:1131-8

[4] Yonemura Y,Endou Y,Mizumoto A,Li Y,Takeshita K,Takao N,Sako S.Peritoneal cancer treatment..Expert Opin Pharmacother2014;15:623-36

[5] Gill RS,Nagendran J,Shi X,Schiller D.Treatment of gastric cancer with peritoneal carcinomatosis by cytoreductive surgery and HIPEC: a systematic review of survival, mortality, and morbidity..J Surg Oncol2011;104:692-8

[6] Nadiradze G,Zieren J,Solass W.Pressurized intraperitoneal aerosol chemotherapy (PIPAC) with low-dose cisplatin and doxorubicin in gastric peritoneal metastasis..J Gastrointest Surg2016;20:367-73 PMCID:PMC4722080

[7] Hübner M,Teixeira-Farinha H,Mathevet P.Pressurized intraperitoneal aerosol chemotherapy - practical aspects..Eur J Surg Oncol2017;43:1102-9

[8] Tempfer C.Pressurized intraperitoneal aerosol chemotherapy as an innovative approach to treat peritoneal carcinomatosis..Med Hypotheses2015;85:480-4

[9] Solass W,Mürdter T,Strumberg D,Zieren J,Reymond MA.Intraperitoneal chemotherapy of peritoneal carcinomatosis using pressurized aerosol as an alternative to liquid solution: first evidence for efficacy..Ann Surg Oncol2014;21:553-9 PMCID:PMC3929768

[10] Teixeira Farinha H,Kefleyesus A,Romain B,Demartines N.Impact of pressurized intraperitoneal aerosol chemotherapy on quality of life and symptoms in patients with peritoneal carcinomatosis: a retrospective cohort study..Gastroenterol Res Pract2017;2017:4596176 PMCID:PMC5339484

[11] Girshally R,Albayrak N,Tempfer C.Pressurized intraperitoneal aerosol chemotherapy (PIPAC) as a neoadjuvant therapy before cytoreductive surgery and hyperthermic intraperitoneal chemotherapy..World J Surg Oncol2016;14:253 PMCID:PMC5039790

[12] Alyami M,Sgarbura O,Villeneuve L,Quenet F,Bakrin N.Multicentric initial experience with the use of the pressurized intraperitoneal aerosol chemotherapy (PIPAC) in the management of unresectable peritoneal carcinomatosis..Eur J Surg Oncol2017;43:2178-83