Is pressurized intraperitoneal aerosol chemotherapy safe and effective in the treatment of peritoneal metastases from pancreatic adenocarcinoma?

Abstract

Introduction and purpose: Pancreatic adenocarcinoma (PAC) is the third most common cancer of the gastrointestinal tract in the Western population. Peritoneal metastases (PM) affect 5-10% patients with PAC at the moment of diagnosis and 50% of patients who experience a recurrence after a successful resection. This review aims to evaluate the efficacy of pressurized intraperitoneal aerosol chemotherapy (PIPAC) in the treatment of PM from PAC based on the literature available on PubMed websiteBrief description of the state of knowledge: PIPAC is a relatively new method of treatment and the number of studies investigating its application in the treatment of PM from PAC is scarce. Nevertheless, initial findings suggest that PIPAC is linked to 15,6 months of the median overall survival, while standard intravenous chemotherapy reaches only 7,6 months . Furthermore, PIPAC seems to be a fairly safe method, as no grade 3 or grade 4 complications (according to CTCAE v4.0) occurred. However, all of the studies involved an unrepresentative number of patients and they were not free from a selection bias. Moreover, due to the novelty of the PIPAC procedure, it still needs to be properly standardised. Conclusions: Available data concerning the application of PIPAC in the treatment of PM from PDAC is limited. Large prospective studies consisting of control groups are still lacking. Nevertheless, the results of accessible studies displaying a median OS of participants reaching 14-16,8 months, with no G3 and G4 complications, are encouraging and justify further research.

Keywords

• aerosol chemotherapy
• pancreatic adenocarcinoma
• peritoneal metastases
• pipac