A systematic review on quality of life (QoL) of patients with peritoneal metastasis (PM) who underwent pressurized intraperitoneal aerosol chemotherapy (PIPAC)

Abstract

Objectives Pressurized intraperitoneal aerosol chemotherapy (PIPAC) has recently emerged as a palliative alternative for patients with unresectable peritoneal metastasis (PM). Quality of life (QoL) has increasingly been used as an endpoint to evaluate treatment outcomes. This review aims to identify evidence on how PIPAC would impact the QoL of PM patients. Content A systematic review was performed on articles identified from Medline, EMBASE, PsycInfo, and Web of Sciences. A meta-analysis was conducted on further selected studies. ACROBAT-NRSI was attempted to assess the risk of bias (RoB). Summary Nine studies using the EORTC QLQ-C30 questionnaire to assess QoL after repeated PIPAC cycles were identified. Majority was found to be moderately biased and a great extent of heterogeneity was observed. Four studies on PM from either gastric cancer (GC) or epithelial ovarian cancer (EOC) were included for meta-analysis. In 31 GC patients and 104 EOC patients, QoL remained stable in 13/14 and 11/14 EORTC QLQ-C30 scales. PIPAC was inferior to cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) in global QoL and functioning but superior in symptom reduction. Outlook PIPAC is a well-tolerated option for most GC and EOC patients with irresectable PM. Future trials are warranted to confirm the findings.

Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC) in the Treatment of Gastric Cancer: Feasibility, Efficacy and Safety—A Systematic Review and Meta-Analysis

“…Regarding the topic of PIPAC in the treatment of PM, a total of eleven systematic reviews [53,[56][57][58][59][60][61][62][63][64][65] and six narrative reviews [55,[66][67][68][69][70]…”

“…Regarding the topic of PIPAC in the treatment of PM, a total of eleven systematic reviews [ 53 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 ] and six narrative reviews [ 55 , 66 , 67 , 68 , 69 , 70 ] have been published. The most recent systematic review, by Di Giorgio et al, was published in 2023 [ 53 ].…”

Application and progress of palliative therapy in advanced gastric carcinomas

“…The results indicated that the overall complication rate and major complication rate (CTCAE-III, IV) was 6.1% and 3.1%, and 14.3% of the patients could receive tumor resection during the treatment, which shows that PIPAC is a safe and effective drug delivery system for the treatment of PM in gastric carcinomas. Based on the retrospective analysis, it was found that for the majority of GC patients with unresectable PM, PIPAC was a well-tolerated option providing good quality of life stability in terms of symptom relief ( 88 ). These studies provide new ideas for the chemotherapy of gastric carcinoma peritoneal metastasis.…”

Aplicación de la quimioterapia por aerosolización intraperitoneal presurizada (PIPAC) en la carcinomatosis peritoneal de origen colorrectal

“…En caso de una recuperación postoperatoria sin complicaciones, el procedimiento puede ser realizado en ambulatorio. [37][38][39] Luego de una PIPAC, es indispensable proceder con los cuidados postoperatorios clásicos, incluyendo analgesia y antieméticos para el manejo del dolor y las náuseas causados por las microgotas de quimioterápico sobre la membrana peritoneal, en particular el oxaliplatino, que es muy irritante a nivel peritoneal. 40 Algunos autores han reportado situaciones poco frecuentes vinculadas al acto quirúrgico propiamente dicho, 41 como ciertos problemas anafilácticos durante la inducción anestésica y al quimioterápico, sangrado de diferente índole, lesiones viscerales al ingreso de los trocares, lesiones viscerales al intentar una adhesiólisis, neumotórax al realizar las biopsias sobre el diafragma.…”

“…Escala de calificación de regresión peritoneal Peritoneal Regression Grading Score (PRGS) Cáncer de los Estados Unidos (National Cancer Institute) y así estandarizar todo evento adverso. Pocos autores han reportado reacciones menores y transitorias en muestras de sangre, como elevación de la proteína C reactiva, la urea y la creatinina, las transaminasas y bilirrubinas.Paralelamente, la calidad de vida (del inglés Quality of Life -QoL) de los pacientes con carcinomatosis localizada en el peritoneo, puede monitorearse con los cuestionarios mencionados de la EORTC-QLQC 30 y de la Organización Europea de Investigación y Tratamiento del Cáncer (del inglés European Organization for Research and Treatment of Cancer Quality of Life Questionnaire) los días 1, 60, 120 y 180 posteriores al procedimiento 38,42. …”