Selection Criteria for Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC) Treatment in Patients with Peritoneal Metastases

Aurélie Balmer (1) , Daniel Clerc (1) , Laura Toussaint (2, 1) , Olivia Sgarbura (3, 4) , Abdelkader Taïbi (5, 6, 1) , Martin Hübner (1) , Hugo Teixeira Farinha (1)

1 CHUV - Centre Hospitalier Universitaire Vaudois = Lausanne University Hospital [Lausanne]
2 Aarhus University [Aarhus]
3 ICM - Institut régional de Cancérologie de Montpellier
4 IRCM - U1194 Inserm - UM - Institut de Recherche en Cancérologie de Montpellier
5 CHU Limoges
6 XLIM-BIO-SANTÉ - BIO-SANTÉ

Background: The standard treatment protocol for PIPAC consists of three procedures. Completion of treatment has been shown to be prognostic of improved survival. The aim of this study was to identify predictors for completion of treatment. Methods: Retrospective multicentric cohort study of patients with peritoneal metastases undergoing PIPAC in three PIPAC expert centers. Per protocol (PP) treatment was defined as patients receiving ≥3 PIPACs and was compared to patients receiving <3. Results: Overall, 183 patients had 517 PIPACs. The main reasons for stopping PIPAC were disease progression in 50% patients, bowel obstruction in 15%, patient’s refusal to pursue in 10%, conversion to cytoreductive surgery in 7%, and medical reasons in 8%. Overall, 95 patients (52%) had PP treatment. The PP median OS was 17 vs. 7 months, p = 0.001. PP patients had r ascites (410 ± 100 mL vs. 960 ± 188 mL, p = 0.001), no prior history of bowel obstruction (12% vs. 24%, p = 0.028), and more bimodal treatment (39% vs. 13%, p < 0.001). After multiple regression, bimodal treatment was found as an independent predictive factor for completing PP (OR = 4.202, 95%CI [1.813, 10.630], p < 0.001), along with prior bowel obstruction (OR = 0.389, 95%CI [0.153, 0.920], p = 0.037). Conclusion: The absence of ascites and prior bowel obstruction can help to select patients suitable for PIPAC. Best results seem to be achieved when PIPAC is combined with systemic chemotherapy.

Mots clés: PIPAC; peritoneal cancer; carcinomatosis; peritoneal surface malignancies; peritoneal metastases

Domaines: Cancer; Hépatologie et Gastroentérologie; Pharmacologie

Aurélie Balmer, Daniel Clerc, Laura Toussaint, Olivia Sgarbura, Abdelkader Taïbi, et al.. Selection Criteria for Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC) Treatment in Patients with Peritoneal Metastases. Cancers, 2022, 14 (10), pp.2557. ⟨10.3390/cancers14102557⟩. ⟨hal-04523177⟩