Pressurized Intraperitoneal Aerosol Chemotherapy for Colorectal Peritoneal Metastases

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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Affiliations

Authors

Contributions

NT, JB, CRD, JT, GR, CBT, BF, CD, TL, MO and UGP made substantial contributions to the study conception and design, acquisition of data, and/or analysis and interpretation of data; participated in drafting or critically revising the manuscript for important intellectual content; and gave approval for the final version to be published.

Corresponding author

Correspondence to Mehdi Ouaissi MD, PhD.

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Disclosure

The authors received no specific funding for this work. Nicolas Tabchouri, Jonathan Buggisch, Cédric Rémy Demtröder, Julien Thierry, Günther Rezniczek, Clemens B. Tempfer, Britta Fischer, Can Dogan, Mehdi Ouaissi, and Urs Giger-Pabst have no conflict of interest. Thierry Lecomte receives personal fees from Amgen, Merk Serono, Servier, Sanofi Genzyme and non-financial support from Amgen and Servier.

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Tabchouri, N., Buggisch, J., Demtröder, C.R. et al. Pressurized Intraperitoneal Aerosol Chemotherapy for Colorectal Peritoneal Metastases. Ann Surg Oncol (2021). https://doi.org/10.1245/s10434-020-09508-0

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