Journal of Gastric Cancer

The Korean Gastric Cancer Association (대한위암학회)
권호 표지
DOI QR코드

DOI QR Code

Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC) in Gastric Cancer Patients with Peritoneal Metastasis (PM): Results of a Single-Center Experience and Register Study

  • Gockel, Ines (Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig) ;
  • Jansen-Winkeln, Boris (Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig) ;
  • Haase, Linda (Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig) ;
  • Rhode, Philipp (Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig) ;
  • Mehdorn, Matthias (Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig) ;
  • Niebisch, Stefan (Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig) ;
  • Moulla, Yusef (Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig) ;
  • Lyros, Orestis (Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig) ;
  • Lordick, Florian (University Cancer Center Leipzig, University Hospital of Leipzig) ;
  • Schierle, Katrin (Institute of Pathology, University Hospital of Leipzig) ;
  • Wittekind, Christian (Institute of Pathology, University Hospital of Leipzig) ;
  • Thieme, Rene (Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig)
  • Received : 2018.08.03
  • Accepted : 2018.12.03
  • Published : 2018.12.31
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: Gastric cancer (GC) patients with peritoneal metastasis (PM) have poor prognosis. Pressurized intraperitoneal aerosol chemotherapy (PIPAC) in combination with systemic chemotherapy is a novel treatment option for patients in stage IV of the disease. Materials and Methods: Between November 2015 and June 2018, prospective data collection was performed in 24 patients with GC and PM (median age, 57; range, 44-75 years). These patients underwent 46 PIPAC procedures with a median number of 2 interventions per patient (range, 1-6). A laparoscopic access was used and a combined therapy of cisplatin and doxorubicin aerosol was administered. Results: The median peritoneal carcinomatosis index before the 1st PIPAC was 14 (range, 2-36), and the median ascites volume in patients before the 1st PIPAC was 100 mL (range, 0-6 mL, 300 mL). Eleven patients, who received 2 or more PIPAC procedures, had decreased and stable volumes of ascites, while only 3 patients displayed increasing volume of ascites. The median overall survival was 121 days (range, 66-625 days) after the 1st PIPAC procedure, while 8 patients who received more than 3 PIPAC procedures had a median survival of 450 days (range, 206-481 days) (P=0.0376). Conclusions: Our data show that PIPAC is safe and well tolerated, and that the production of ascites can be controlled by PIPAC in GC patients. Patients, who received 2 or more PIPAC procedures, reported a stable overall quality of life. Further studies are required to document the significance of PIPAC as a palliative multimodal therapy.

Keywords

References

  1. Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM. Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer 2010;127:2893-2917. https://doi.org/10.1002/ijc.25516
  2. Ferlay J, Steliarova-Foucher E, Lortet-Tieulent J, Rosso S, Coebergh JW, Comber H, et al. Cancer incidence and mortality patterns in Europe: estimates for 40 countries in 2012. Eur J Cancer 2013;49:1374-1403. https://doi.org/10.1016/j.ejca.2012.12.027
  3. Geng X, Liu H, Lin T, Hu Y, Chen H, Zhao L, et al. Survival benefit of gastrectomy for gastric cancer with peritoneal carcinomatosis: a propensity score-matched analysis. Cancer Med 2016;5:2781-2791. https://doi.org/10.1002/cam4.877
  4. Roviello F, Caruso S, Marrelli D, Pedrazzani C, Neri A, De Stefano A, et al. Treatment of peritoneal carcinomatosis with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: state of the art and future developments. Surg Oncol 2011;20:e38-e54. https://doi.org/10.1016/j.suronc.2010.09.002
  5. Brandl A, Pachmayr E, Gul-Klein S, Alberto M, Thuss-Patience P, Rau B. Surgical treatment of peritoneal metastases of gastric cancer. Chirurg 2018;89:669-677. https://doi.org/10.1007/s00104-018-0625-2
  6. Yonemura Y, Endou Y, Shinbo M, Sasaki T, Hirano M, Mizumoto A, et al. Safety and efficacy of bidirectional chemotherapy for treatment of patients with peritoneal dissemination from gastric cancer: selection for cytoreductive surgery. J Surg Oncol 2009;100:311-316. https://doi.org/10.1002/jso.21324
  7. Wagner AD, Unverzagt S, Grothe W, Kleber G, Grothey A, Haerting J, et al. Chemotherapy for advanced gastric cancer. Cochrane Database Syst Rev 2010:CD004064.
  8. Koizumi W, Narahara H, Hara T, Takagane A, Akiya T, Takagi M, et al. S-1 plus cisplatin versus S-1 alone for first-line treatment of advanced gastric cancer (SPIRITS trial): a phase III trial. Lancet Oncol 2008;9:215-221. https://doi.org/10.1016/S1470-2045(08)70035-4
  9. Minchinton AI, Tannock IF. Drug penetration in solid tumours. Nat Rev Cancer 2006;6:583-592. https://doi.org/10.1038/nrc1893
  10. Jansen-Winkeln B, Thieme R, Haase L, Niebisch S, Pommer C, Lyros O, et al. Perioperative safety of intraperitoneal aerosol chemotherapy: analysis of our first 111 pressurized intraperitoneal aerosol chemotherapy (PIPAC) procedures. Chirurg 2018. doi: 10.1007/s00104-018-0667-5 [In press].
  11. Nowacki M, Alyami M, Villeneuve L, Mercier F, Hubner M, Willaert W, et al. 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. Eur J Surg Oncol 2018;44:991-996. https://doi.org/10.1016/j.ejso.2018.02.014
  12. Hubner M, Grass F, Teixeira-Farinha H, Pache B, Mathevet P, Demartines N. Pressurized intraperitoneal aerosol chemotherapy - practical aspects. Eur J Surg Oncol 2017;43:1102-1109. https://doi.org/10.1016/j.ejso.2017.03.019
  13. Coccolini F, Ansaloni L, Manfredi R, Campanati L, Poiasina E, Bertoli P, et al. Peritoneal adhesion index (PAI): proposal of a score for the “ignored iceberg” of medicine and surgery. World J Emerg Surg 2013;8:6. https://doi.org/10.1186/1749-7922-8-6
  14. Jacquet P, Sugarbaker PH. Clinical research methodologies in diagnosis and staging of patients with peritoneal carcinomatosis. Cancer Treat Res 1996;82:359-374.
  15. Harmon RL, Sugarbaker PH. Prognostic indicators in peritoneal carcinomatosis from gastrointestinal cancer. Int Semin Surg Oncol 2005;2:3. https://doi.org/10.1186/1477-7800-2-3
  16. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004;240:205-213. https://doi.org/10.1097/01.sla.0000133083.54934.ae
  17. Fayers P, Aaronson NK, Bjordal K, Groenvold M, Curran D, Bottomley A, eds. EORTC QLQ-C30 Scoring Manual. 3rd ed. Brussels: European Organisation for Research and Treatment of Cancer, 2001.
  18. Lordick F, Lorenzen S, Yamada Y, Ilson D. Optimal chemotherapy for advanced gastric cancer: is there a global consensus? Gastric Cancer 2014;17:213-225. https://doi.org/10.1007/s10120-013-0297-z
  19. Matsumoto H, Kawazoe A, Shimada K, Fukuoka S, Kuboki Y, Bando H, et al. A retrospective study of the safety and efficacy of paclitaxel plus ramucirumab in patients with advanced or recurrent gastric cancer with ascites. BMC Cancer 2018;18:120. https://doi.org/10.1186/s12885-018-4057-7
  20. Lordick F, Shitara K, Janjigian YY. New agents on the horizon in gastric cancer. Ann Oncol 2017;28:1767-1775. https://doi.org/10.1093/annonc/mdx051
  21. Grass F, Vuagniaux A, Teixeira-Farinha H, Lehmann K, Demartines N, Hubner M. Systematic review of pressurized intraperitoneal aerosol chemotherapy for the treatment of advanced peritoneal carcinomatosis. Br J Surg 2017;104:669-678. https://doi.org/10.1002/bjs.10521
  22. Odendahl K, Solass W, Demtroder C, Giger-Pabst U, Zieren J, Tempfer C, et al. Quality of life of patients with end-stage peritoneal metastasis treated with pressurized intraperitoneal aerosol chemotherapy (PIPAC). Eur J Surg Oncol 2015;41:1379-1385. https://doi.org/10.1016/j.ejso.2015.06.001
  23. Alyami M, Gagniere J, Sgarbura O, Cabelguenne D, Villeneuve L, Pezet D, et al. Multicentric initial experience with the use of the pressurized intraperitoneal aerosol chemotherapy (PIPAC) in the management of unresectable peritoneal carcinomatosis. Eur J Surg Oncol 2017;43:2178-2183. https://doi.org/10.1016/j.ejso.2017.09.010
  24. Robella M, Vaira M, De Simone M. Safety and feasibility of pressurized intraperitoneal aerosol chemotherapy (PIPAC) associated with systemic chemotherapy: an innovative approach to treat peritoneal carcinomatosis. World J Surg Oncol 2016;14:128. https://doi.org/10.1186/s12957-016-0892-7
  25. Nadiradze G, Giger-Pabst U, Zieren J, Strumberg D, Solass W, Reymond MA. Pressurized intraperitoneal aerosol chemotherapy (PIPAC) with low-dose cisplatin and doxorubicin in gastric peritoneal metastasis. J Gastrointest Surg 2016;20:367-373. https://doi.org/10.1007/s11605-015-2995-9
  26. Giger-Pabst U, Solass W, Strumberg D, Zieren J, Reymond M. Erste klinische ergebnisse der "pressurized intraperitoneal aerosol chemotherapy" (PIPAC) bei patienten mit magenkarzinom und fortgeschrittener peritonealkarzinose. Z Gastroenterol 2013;51:K364.
  27. Higaki E, Yanagi S, Gotohda N, Kinoshita T, Kuwata T, Nagino M, et al. Intraoperative peritoneal lavage cytology offers prognostic significance for gastric cancer patients with curative resection. Cancer Sci 2017;108:978-986. https://doi.org/10.1111/cas.13219
  28. Goetze TO, Al-Batran SE, Pabst U, Reymond M, Tempfer C, Bechstein WO, et al. Pressurized intraperitoneal aerosol chemotherapy (PIPAC) in combination with standard of care chemotherapy in primarily untreated chemo naive upper GI-adenocarcinomas with peritoneal seeding - a phase II/III trial of the AIO/CAOGI/ACO. Pleura Peritoneum 2018;3.

Cited by

  1. Celastrus Orbiculatus Extracts Inhibit the Metastasis through Attenuating PI3K/Akt/mTOR Signaling Pathway in Human Gastric Cancer vol.19, pp.14, 2018, https://doi.org/10.2174/1871520619666190731162722
  2. From palliation to cure: PIPAC for peritoneal malignancies vol.110, pp.4, 2018, https://doi.org/10.23736/s0026-4806.19.06081-6
  3. Systemic chemotherapy and pressurized intraperitoneal aerosol chemotherapy (PIPAC): A bidirectional approach for gastric cancer peritoneal metastasis vol.34, pp.None, 2020, https://doi.org/10.1016/j.suronc.2020.05.006
  4. Enhancing Delivery of Small‐Molecule‐ and Cell‐Based Therapies for Ovarian Cancer Using Advanced Delivery Strategies vol.3, pp.11, 2018, https://doi.org/10.1002/adtp.202000144
  5. Restricted access to innovative surgical technique related to a specific training, is it ethical? Example of the PIPAC procedure. A systematic review and an experts survey vol.83, pp.None, 2020, https://doi.org/10.1016/j.ijsu.2020.07.004
  6. Pressurized intraperitoneal aerosol chemotherapy (PIPAC) for rare gynecologic indications: peritoneal metastases from breast and endometrial cancer vol.20, pp.1, 2018, https://doi.org/10.1186/s12885-020-07627-1
  7. Pressurized intraperitoneal aerosol chemotherapy (PIPAC) for unresectable peritoneal metastasis from gastric cancer vol.47, pp.1, 2018, https://doi.org/10.1016/j.ejso.2020.05.021
  8. Synchronous peritoneal metastases of gastric cancer origin: incidence, treatment and survival of a nationwide Dutch cohort vol.24, pp.4, 2018, https://doi.org/10.1007/s10120-021-01160-1
  9. Laparoscopic Heated Intraperitoneal Chemotherapy in the Treatment of Carcinomatosis of Gastric Adenocarcinoma Origin vol.10, pp.20, 2018, https://doi.org/10.3390/jcm10204757
  10. Exploring high pressure nebulization of Pluronic F127 hydrogels for intraperitoneal drug delivery vol.169, pp.None, 2021, https://doi.org/10.1016/j.ejpb.2021.10.001
  11. PIPAC for the Treatment of Gynecologic and Gastrointestinal Peritoneal Metastases: Technical and Logistic Considerations of a Phase 1 Trial vol.29, pp.1, 2018, https://doi.org/10.1245/s10434-021-10505-0
  12. Clinical Outcome for Patients Managed with Low-Dose Cisplatin and Doxorubicin Delivered as Pressurized Intraperitoneal Aerosol Chemotherapy for Unresectable Peritoneal Metastases of Gastric Cancer vol.29, pp.1, 2018, https://doi.org/10.1245/s10434-021-10860-y