Pressurized Intraperitoneal Aerosol Chemotherapy Enhanced by Electrostatic Precipitation (ePIPAC) for Patients with Peritoneal Metastases

Abstract

Background. Pressurized intraperitoneal aerosol chemotherapy (PIPAC) is a new mode of intraperitoneal chemotherapy administration that can potentially be improved by the addition of electrostatic precipitation (ePIPAC). This study aimed to describe the procedural details of ePIPAC and to analyze its safety for patients with nonresectable peritoneal metastasis as well as their tolerance and response to this treatment. Methods. This retrospective cohort study included consecutive patients treated with ePIPAC in three centers from April 2019 to April 2020. The toxicities of each patient were assessed using the Common Terminology Criteria for Adverse Events (CTCAE). Complications were documented according to the Clavien classification. Quality of life (QoL) was assessed using EORTC-QLQ-C30, and the peritoneal regression grading score (PRGS) was used to grade histologic responses. Further surrogates for responses were the Peritoneal Cancer Index (PCI), ascites, and symptoms. Results. Overall, 69 patients received 147 ePIPACs with oxaliplatin (n = 34) or cisplatin/doxorubicin (n = 35) mainly for colorectal (n = 25), ovarian (n = 14), and gastric (n = 13) primary cancers. Systemic chemotherapy was

Evaluation of the environmental contamination and exposure risk in medical/non-medical staff after oxaliplatin-based pressurized intraperitoneal aerosol chemotherapy

“…Moreover, the number of samples collected from each participant was limited in time (before, after and the morning after PIPAC). The current findings cannot be extended to ePIPAC that has administration times shorter than 30 minutes (Taibi et al, 2020) because in this case the operating room staff return in the room earlier after the remote administration, and this might modify the risk of exposure.…”

Technology development of hyperthermic pressurized intraperitoneal aerosol chemotherapy (hPIPAC)

“…hPIPAC is not the only research road to optimize the target tissue effect of intraperitoneal drug delivery. Other options are, for example, longer duration of exposition, increasing intraperitoneal pressure, ádvanced drug formulations, and electrostatic precipitation PIPAC (ePIPAC) [23][24][25][26][27].…”

Histological regression of gastrointestinal peritoneal metastases after systemic chemotherapy

“…A generic, unique score for assessing histological tumor response to chemotherapy in PM makes sense because of the clinical impact of histological response to therapy and because the organ of metastasis (peritoneum) is the same [ 3 ]. The PRGS has been the object of a multi-institutional validation study [ 4 ] and is now diffusing into clinical practice [ 8 , 14 ], [ 15 ], [ 16 ], [ 17 ], [ 18 ], [ 19 ], [ 20 ]. The PRGS is increasingly used as secondary [ 21 ], [ 22 ], [ 23 ], [ 24 ], or even as primary outcome criteria [ 25 ] in clinical studies on PM.…”