Andrea Di Giorgio1, Carlo Abatini1, Miriam Attalla El Halabieh1, Emanuele Vita2, Giuseppe Vizzielli3, Valerio Gallotta3, Fabio Pacelli1, Stefano Rotolo4,5. 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. Division of General Surgery, A. Gemelli University Hospital and Institute for Research and Care, Rome, Italy - stefanorotolo@gmail.com. 5. Department of Surgery, Oncology, and Stomatology, University of Palermo, Palermo, Italy.
Abstract
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.
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.
Authors: Stefano Rotolo; Andrea Di Giorgio; Marco Cintoni; Emanuele Rinninella; Marta Palombaro; Gabriele Pulcini; Carlo Alberto Schena; Vito Chiantera; Giuseppe Vizzielli; Antonio Gasbarrini; Fabio Pacelli; Maria Cristina Mele Journal: Pleura Peritoneum Date: 2022-03-01