PRESSURIZED INTRA-PERITONEAL AEROSOL CHEMOTHERAPY


ABOUT PIPAC

Pressurized Intra-Peritoneal Aerosol Chemotherapy (PIPAC) is a laparoscopic procedure of administration of aerosolized chemotherapy within the abdominal cavity, where the laws of physics allow a high tissue concentration of chemotherapy in the cancer cells, but without the usual side effects and toxicity of injected chemotherapy.

Pressurized Intra-Thoracic Aerosol Chemotherapy (PITAC) is the same procedure when used for chest for cancers that have spread to pleura.

PIPAC and PITAC are likely to improve their quality of life with very few side effects.This procedure is repeated at least 3 times at a gap of 4-6 weeks with least side effects.Though PIPAC represents a new treatment modality, it is not an experimental treatment.

More than thousand applications have been performed in few specialized centers in Europe with promising results. A good response to treatment, as well as slowing-down of tumor progression has been repeatedly demonstrated, which in consequence might improve survival. Fortunately, only few side effects have been seen, thanks to the minimally-invasive (laparoscopic) surgical approach, and the risks of the surgical intervention are altogether marginal.

WHEN IS PIPAC AND PITAC PERFORMED?

Peritoneal carcinomatosis represents end stage disease in many types of cancer when the cancer has spread in the peritoneum and no curative treatment (like HIPEC) is possible for various reasons. Majority of patients with this will die from their disease within six months.

Chemotherapy may prolong survival in selected patients, but poor performance status, low response rates, and toxic side effects of chemotherapy have led to conservative treatment strategies in these patients. The same happens when cancer is spread (metastasis) to chest cavity (pleura) as well. Thanks to recent research efforts, we dispose nowadays of an efficient alternative therapy with less surgical risks and only little impact on quality of life.

Patients with Peritoneal or pleural carcinomatosis, who are in good condition and with a remaining life expectancy of more than a few months, may still have an unmet need for additional treatment in order to be able to perform with a high quality of life for as long as possible. These are the patients who may benefit from PIPAC or PITAC. PIPAC and PITAC are likely to improve their quality of life with very few side effects.

DESCRIPTION OF THE PROCEDURE:

PIPAC can only be applied by laparoscopy. The fumigation as a gas allows a homogeneous dispersion of chemotherapy within the peritoneal cavity or pleural cavity. The administration of chemotherapy under pressure increases the local tissue penetration of the chemotherapy allowing high concentrations in cancer cells.

The procedure is performed under general anesthesia. Two trocars or tubes are inserted via two small incisions (5-12 mm) into the peritoneal cavity. Carbon dioxide insufflation grants the necessary workspace. First, small tissue samples of the tumor knots are retrieved (biopsy). Then, the chemotherapy is dispersed as pressurized aerosol inside the abdominal or chest cavity for 30 minutes. At the end of the procedure, the pressure is released and the gas aspirated, and the skin incisions are closed.

The whole procedure lasts about 90 minutes. The length of hospital stay is usually 3-4 days. Three applications of PIPAC or PITAC are recommended within 3 months with a delay between the applications: 4-6 weeks. Alternatively, this can be interspersed with chemotherapy between every second cycle. All patients are observed closely during the therapeutic cycle.

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