REVIEW  UPDATES IN OVARIAN CANCER AND SECONDARY PERITONEAL TUMORS 

Minerva Medica 2019 August;110(4):385-98

DOI: 10.23736/S0026-4806.19.06081-6

Copyright © 2019 EDIZIONI MINERVA MEDICA

language: English

From palliation to cure: PIPAC for peritoneal malignancies

Andrea DI GIORGIO ¹, Carlo ABATINI ¹, Miriam ATTALLA EL HALABIEH ¹, Emanuele VITA ², Giuseppe VIZZIELLI ³, Valerio GALLOTTA ³, Fabio PACELLI ¹, Stefano ROTOLO ^{1, 4} ✉

¹ Division of General Surgery, A. Gemelli University Hospital and Institute for Research and Care, Rome, Italy; ² Division of Medical Oncology, A. Gemelli University Hospital and Institute for Research and Care, Rome, Italy; ³ Unit of Gynecologic Oncology, A. Gemelli University Hospital and Institute for Research and Care, Rome, Italy; ⁴ Department of Surgery, Oncology, and Stomatology, University of Palermo, Palermo, Italy

INTRODUCTION: Systemic chemotherapy offers poor control over peritoneal disease, maybe as a consequence of restricted drug availability within the abdominal cavity. Locoregional chemotherapy may overcome these shortcomings but its administration is limited to a few patients with confined peritoneal spread. Pressurized intraperitoneal aerosol chemotherapy (PIPAC) emerged in the last years as a novel method of intraperitoneal drug administration.
EVIDENCE ACQUISITION: We report a meta-analysis of published studies on PIPAC safety and pathological anti-tumoral efficacy on PC from various tumor entities, with the aim of providing more evidence to support further research. This systematic review and meta-analysis were designed, conducted and reported according to the PRISMA statement.
EVIDENCE SYNTHESIS: An overall pathological response rate of 43.7% was calculated on a total of 668 patients who underwent 1480 PIPAC cycles across the 20 studies. Pooled severe adverse events rate (CTCAE grade 3-4) was 10% and seven deaths across all studies were reported, of which only four were related to PIPAC.
CONCLUSIONS: PIPAC is a safe procedure which has a relevant anti-tumoral activity on peritoneal carcinomatosis. Further studies, even in the early stage of disease, are awaited to assess the clinical benefit of PIPAC. This review may serve as a reliable basis for future research.

KEY WORDS: Palliative care; Peritoneal neoplasms; Drug therapy