Purpose: Pressurized intraperitoneal
aerosol chemotherapy (PIPAC) is a novel approach for delivering intraperitoneal
chemotherapy and offers perspective in the treatment of
peritoneal carcinomatosis. Concept is based on a 12 mmHg capnoperitoneum loaded with drug changed in microdoplets. It was postulated to guarantee a more homogeneous drug distribution and tissular uptake than
hyperthermic intraperitoneal chemotherapy (
HIPEC). The aim of this study was to compare
cisplatin peritoneal distribution and pharmacokinetic between
HIPEC and PIPAC procedures in a healthy swine model.Methods: Two groups of eight pigs underwent either
HIPEC with
cisplatin (70 mg/m2) at 43 °C for 60 min, or PIPAC with
cisplatin (7.5 mg/m2) for 30 min. Postoperatively, peritoneal areas were biopsied allowing peritoneal cavity cartography. Tissular and plasmatic
cisplatin concentrations were analyzed.Results:
Cisplatin distribution was heterogeneous in both the groups with higher concentrations obtained closed to the delivery sites. Median total
platinum peritoneal concentration by pig was higher in the
HIPEC group than in the PIPAC group (18.0 μg/g versus 4.3 μg/g, p < .001) but the yield was 2.2 times better with PIPAC.
Platinum concentrations were higher in the
HIPEC group in all stations. At each time-point,
cisplatin plasmatic concentrations were higher in the
HIPEC group (p < .001) but beneath the toxicity threshold.Conclusions: With doses used in clinical practice,
HIPEC guaranteed a higher
cisplatin peritoneal uptake than PIPAC in this swine model. Spatial drug distribution was heterogeneous with both technics, with hotspots closed to the drug delivery sites. Nevertheless, considering the dose ratio, IP drug uptake yield was better with PIPAC.