Clinical Outcome for Patients Managed with Low-Dose Cisplatin and Doxorubicin Delivered as Pressurized Intraperitoneal Aerosol Chemotherapy for Unresectable Peritoneal Metastases of Gastric Cancer.

Abstract

BACKGROUND:

Pressurized intraperitoneal aerosol chemotherapy (PIPAC) is increasingly used to manage gastric cancer peritoneal metastasis (GCPM).

METHODS:

This study analyzed a prospective database of GCPM patients treated with cisplatin and doxorubicin PIPAC (PIPAC-C/D). The outcome criteria were adverse events, pathologic response [peritoneal regression grading score (PRGS)], and overall survival (OS).

RESULTS:

The PIPAC-C/D procedure was scheduled for 144 patients with a median age of 57 years (range 22-88 years). Access to the abdominal cavity for the first PIPAC failed in 11 patients (7.7 %). A total of 296 procedures were performed for 131 patients. Of the 144 patients, 52 (36.1%) underwent one PIPAC, 32 (22.2%) underwent two PIPACs, 24 (16.7%) underwent three PIPACs, and 21 (14.6%) underwent four or more PIPACs. The overall morbidity/mortality was grade 1 for 22 patients (15.3%), grade 2 for 32 patients (22.2%), grade 3 for 7 patients (4.9%), grade 4 for no patients (0%), and grade 5 for 2 patients (1.4%). Of the 37 patients who had three or more PIPACs eligible for histopathologic response analysis, 27 (73%) had major or complete regression (PRGS 1/2). A median OS of 11 months (range 0-61 months) for the total study population and 16 months (range 2-61 months) for the patients with three or more PIPACs was observed. For 10 patients (7%) who underwent cytoreductive surgery and hyperthermic intraperitoneal chemotherapy, the median OS was 15 months (minimum, 4 months; maximum, 27 months). Multivariate analysis showed three or more PIPACs to be an independent prognostic factor for improved OS (hazard ratio, 0.36; p < 0.0001).

CONCLUSIONS:

Repetitive PIPAC-C/D ± systemic chemotherapy is associated with low morbidity and mortality rates. Prospective randomized trials are needed to confirm whether three or more PIPAC-C/Ds improve clinical outcome.

• Authors: Rémy Sindayigaya, Can Dogan, Cédric Remy Demtröder, Britta Fischer, Elias Karam, Jonathan Robin Buggisch, Clemens B Tempfer, Thierry Lecomte, Mehdi Ouaissi, Urs Giger-Pabst
• Journal: Annals of surgical oncology (Ann Surg Oncol) Vol. 29 Issue 1 Pg. 112-123 (Jan 2022) ISSN: 1534-4681 [Electronic] United States
• PMID: 34611790 (Publication Type: Journal Article)
• Copyright: © 2021. Society of Surgical Oncology.

Chemical References

• Aerosols
• Doxorubicin
• Cisplatin

Topics

• Adult
• Aerosols
• Aged
• Aged, 80 and over
• Cisplatin
• Doxorubicin
• Humans
• Middle Aged
• Peritoneal Neoplasms (drug therapy)
• Stomach Neoplasms (drug therapy)
• Young Adult