From palliation to cure: PIPAC for peritoneal malignancies

Area of Science:

• Oncology
• Surgical Oncology
• Gastroenterology

Background:

• Systemic chemotherapy has limited efficacy for peritoneal disease due to poor drug penetration.
• Locoregional chemotherapy offers better drug delivery but is restricted to limited peritoneal spread.
• Pressurized intraperitoneal aerosol chemotherapy (PIPAC) is a novel method for intraperitoneal drug administration.

Purpose of the Study:

• To conduct a meta-analysis on the safety and pathological anti-tumoral efficacy of PIPAC for peritoneal carcinomatosis (PC).
• To provide evidence supporting further research into PIPAC.
• To assess PIPAC's role in managing peritoneal disease.

Main Methods:

• Systematic review and meta-analysis of published studies on PIPAC.
• Data collected and analyzed according to the PRISMA statement.
• Inclusion of studies reporting safety and pathological efficacy of PIPAC in various tumor entities.

Main Results:

• A pathological response rate of 43.7% was observed across 20 studies involving 668 patients and 1480 PIPAC cycles.
• The pooled rate of severe adverse events (CTCAE grade 3-4) was 10%.
• Seven deaths were reported, with four attributed to PIPAC.

Conclusions:

• PIPAC is a safe procedure with relevant anti-tumoral activity against peritoneal carcinomatosis.
• Further studies are needed to evaluate the clinical benefit of PIPAC, including in early-stage disease.
• This review provides a foundation for future PIPAC research.