Axel Davigo1,2, Guillaume Passot1,2, Olivia Vassal3, Muriel Bost4, Clément Tavernier1,2, Evelyne Decullier5, Naoual Bakrin1,2, Mohammad Alyami1,2,6, Jeanne-Marie Bonnet7, Vanessa Louzier7, Christian Paquet7, Bernard Allaouchiche3,7, Olivier Glehen1,2, Vahan Kepenekian1,2. 1. Department of Digestive Surgery, Hospices Civils de Lyon, Lyon-Sud University Hospital, Lyon, France. 2. EMR 3738, Lyon 1 University, Lyon, France. 3. Department of Intensive Care, Hospices Civils de Lyon, Lyon-Sud University Hospital, Lyon, France. 4. Department of Biology and Anatomopathology, Laboratory of Trace Element and Toxic Metal Analysis, Hospices Civils de Lyon, Lyon, France. 5. Hospices Civils de Lyon, Pole de Santé Publique, Lyon, France. 6. King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia. 7. Université de Lyon, VetAgro Sup, APCSe, Marcy l'Étoile, France.
Abstract
Purpose: Pressurized intraperitoneal aerosol chemotherapy (PIPAC) is a novel approach for delivering intraperitoneal chemotherapy and offers perspective in the treatment of peritoneal carcinomatosis. Concept is based on a 12 mmHg capnoperitoneum loaded with drug changed in microdoplets. It was postulated to guarantee a more homogeneous drug distribution and tissular uptake than hyperthermic intraperitoneal chemotherapy (HIPEC). The aim of this study was to compare cisplatin peritoneal distribution and pharmacokinetic between HIPEC and PIPAC procedures in a healthy swine model. Methods: Two groups of eight pigs underwent either HIPEC with cisplatin (70 mg/m2) at 43 °C for 60 min, or PIPAC with cisplatin (7.5 mg/m2) for 30 min. Postoperatively, peritoneal areas were biopsied allowing peritoneal cavity cartography. Tissular and plasmatic cisplatin concentrations were analyzed. Results: Cisplatin distribution was heterogeneous in both the groups with higher concentrations obtained closed to the delivery sites. Median total platinum peritoneal concentration by pig was higher in the HIPEC group than in the PIPAC group (18.0 μg/g versus 4.3 μg/g, p < .001) but the yield was 2.2 times better with PIPAC. Platinum concentrations were higher in the HIPEC group in all stations. At each time-point, cisplatin plasmatic concentrations were higher in the HIPEC group (p < .001) but beneath the toxicity threshold.Conclusions: With doses used in clinical practice, HIPEC guaranteed a higher cisplatin peritoneal uptake than PIPAC in this swine model. Spatial drug distribution was heterogeneous with both technics, with hotspots closed to the drug delivery sites. Nevertheless, considering the dose ratio, IP drug uptake yield was better with PIPAC.
Purpose: Pressurized intraperitoneal aerosol chemotherapy (PIPAC) is a novel approach for delivering intraperitoneal chemotherapy and offers perspective in the treatment of peritoneal carcinomatosis. Concept is based on a 12 mmHg capnoperitoneum loaded with drug changed in microdoplets. It was postulated to guarantee a more homogeneous drug distribution and tissular uptake than hyperthermic intraperitoneal chemotherapy (HIPEC). The aim of this study was to compare cisplatin peritoneal distribution and pharmacokinetic between HIPEC and PIPAC procedures in a healthy swine model. Methods: Two groups of eight pigs underwent either HIPEC with cisplatin (70 mg/m2) at 43 °C for 60 min, or PIPAC with cisplatin (7.5 mg/m2) for 30 min. Postoperatively, peritoneal areas were biopsied allowing peritoneal cavity cartography. Tissular and plasmatic cisplatin concentrations were analyzed. Results:Cisplatin distribution was heterogeneous in both the groups with higher concentrations obtained closed to the delivery sites. Median total platinum peritoneal concentration by pig was higher in the HIPEC group than in the PIPAC group (18.0 μg/g versus 4.3 μg/g, p < .001) but the yield was 2.2 times better with PIPAC. Platinum concentrations were higher in the HIPEC group in all stations. At each time-point, cisplatin plasmatic concentrations were higher in the HIPEC group (p < .001) but beneath the toxicity threshold.Conclusions: With doses used in clinical practice, HIPEC guaranteed a higher cisplatin peritoneal uptake than PIPAC in this swine model. Spatial drug distribution was heterogeneous with both technics, with hotspots closed to the drug delivery sites. Nevertheless, considering the dose ratio, IP drug uptake yield was better with PIPAC.
Authors: Soo Jin Park; Eun Ji Lee; Aeran Seol; Sunwoo Park; Jiyeon Ham; Ga Won Yim; Seung-Hyuk Shim; Whasun Lim; Suk-Joon Chang; Gwonhwa Song; Ji Won Park; Hee Seung Kim Journal: J Gynecol Oncol Date: 2022-05-24 Impact factor: 4.756
Authors: Phil Höltzcke; Iaroslav Sautkin; Samuel Clere; Arianna Castagna; Alfred Königsrainer; Peter P Pott; Marc A Reymond Journal: Surg Endosc Date: 2022-08-29 Impact factor: 3.453